bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1122‐000021: Delayed Vasospasm and Cerebral Ischemia Following Mild Traumatic Brain Injury
Authors: Chen Alex K , Giurgiutiu Dan‐Victor
Published: December 2021

Introduction
: Post‐traumatic vasospasm (PTV) is a significant cause of morbidity and mortality following traumatic brain injury (TBI).
1
Delayed PTV is thought to occur due to inflammation from SAH.
1
The risk of symptomatic PTV is associated with the severity of TBI.
1,2,3
Treatment of PTV traditionally involves agents used in aneurysmal vasospasm such as Nimodipine. Intra‐arterial and intravenous verapamil and milrinone have been utilized to treat PTV.
4
We present a rare case of delayed cerebral ischemia caused by PTV without SAH treated with intra‐arterial milrinone and oral verapamil.

Methods
: This is a case report of a case of a 16‐day delay of cerebral ischemia secondary to PTV.

Results
: A 19‐year‐old female without significant medical history presented to the emergency room as the restrained driver in a motor vehicle collision involving a car versus a tree. The patient’s Glasgow Coma Scale score was 13 and the initial head CT did not demonstrate SAH with a Rotterdam score of 0. There were multiple fractures and soft tissue contusions noted on imaging which required surgical correction and splinting. The patient’s hospital stay was complicated by a large retroperitoneal hematoma requiring blood transfusions and surgical evacuation. 16 days after admission, the patient experienced sudden‐onset right upper extremity paralysis and weakness of the right leg. CT head demonstrated loss of gray‐white differentiation in the left middle cerebral artery (MCA) territory and CT angiography demonstrated 70% stenosis of the left supra‐clinoid internal carotid artery (ICA) and proximal left MCA. Cerebral angiography demonstrated 60% stenosis left supra‐clinoid ICA and 60% stenosis at the origin of the left MCA consistent with PTV. Left MCA stenosis improved to 20% post 10 mg intra‐arterial milrinone in the left ICA (Figure 1). The patient also received verapamil orally. Transcranial doppler demonstrated elevated peak systolic velocities at 298 cm/s in the left MCA and 276 cm/s in the left ICA. Six days later this improved to 150 cm/s in the left MCA and 151 cm/s in the left ICA. The patient continued to be unable to move her right side against gravity with dense expressive aphasia and dysarthria at discharge to inpatient rehabilitation. At follow‐up 4 weeks later, her right hemiparesis had improved significantly to being able to stand with assistance and her expressive aphasia had improved from one word to occasionally forming several word sentences.

Conclusions
: PTV is a potentially devastating complication of TBI. As our case demonstrates, the presence of mild TBI and absence of SAH may be falsely reassuring.
2
Additionally, our case report demonstrates that intra‐arterial milrinone causes radiographic improvement in PTV. Further studies are needed for the best screening and diagnostic exams for PTV and therapeutic interventions.
Abstract 1122‐000022: Delays in Care for Patients with Acute Stroke During Hospitalization for Other Reasons
Authors: Vigilante Nicholas , Patel Parth , Romiyo Prasanth , Thau Lauren , Heslin Mark , Chen Austin , Thon Jesse M , Siegler James E
Published: December 2021

Introduction
: In‐hospital stroke (IHS) is defined as stroke that occurs during hospitalization for non‐stroke conditions. We aimed to understand the timing of symptom recognition for patients who experienced IHS and its impact on the care they receive.

Methods
: A prospective, single center registry of adult patients (9/20/19‐2/28/21) was queried for acute anterior circulation IHS. Indications for hospitalization, delays from last known well (LKW) to symptom recognition, imaging, and treatment were explored.

Results
: Of 928 consecutively evaluated adults with acute stroke, 85 (9%) developed an anterior circulation IHS, 39 (46%) of whom were female, with a median age of 67 years (IQR 60–76) and median NIHSS of 15 (IQR 4–22). Sixty‐eight (80%) had a >1 hour delay from last known well to symptom recognition. Two patients (2%) received IV thrombolysis, although another 38 (45%) would have been eligible if not for a delay in symptom recognition. An ICA, M1, or M2 occlusion was observed in 18 patients (21%), 7 of whom were treated at a median of 174 minutes after LKW (IQR 65–219). Compared to the 11 patients who did not undergo thrombectomy with large vessel occlusion, those who underwent thrombectomy had non‐significantly shorter delays from LKW until neuroimaging (median 85 [IQR 65‐162] vs. 216 [IQR 133‐507], p = 0.12).

Conclusions
: While uncommon, patients with IHS experience delays in symptom recognition and treatment, which lead to exclusion from acute care treatment such as thrombolysis and thrombectomy. Earlier detection with more frequent nursing assessments or advanced neuromonitoring devices in at‐risk patients may reduce delays in care.
Abstract 1122‐000026: Factors Associated with Gender Differences in Patients with Lewy Body Dementia
Authors: Onuoha Chika P , Agbomi Lidadi , Madubuike Nneoma , Coker Oreoluwa , Nathaniel Samuel I , Poupore Nicolas , Bailey Melissa , Roley Laurie , Goodwin Richard , Russ‐Sellers Rebecca , Nathaniel Thomas I
Published: December 2021

Introduction
: Several studies have investigated gender differences in patients with Lewy Body Dementia (LBD), however, whether the observed differences are associated with demographic and pharmacological factors is not fully understood. The current study tested the hypothesis that specific demographic or pharmacological factors may contribute to the observed gender difference.

Methods
: A 5‐year data collected from a regional registry from 608 LBD patients including 332 men and 276 women were analyzed. Factors associated with men and women patients with LBD were determined using the logistic regression model. Multicollinearity was evaluated using variance inflation factors (VIFs), with values greater than five suggestive of multicollinearity

Results
: The results indicate that Caucasian men (94.3% vs 83.3%) were more likely to present with LBD. In the adjusted analysis, increasing age (OR = 1.042, 95% CI, 1.025‐ 1.058, P ˂ 0.001) was more likely to be associated with women with LBD, while olanzapine (OR = 2.871, 95% CI, 1.902‐4.334, P˂ 0.001), buspirone (OR = 2.388, 95% CI, 1.527‐3.735, P˂ 0.001), escitalopram (OR = 1.444, 95% CI, 1.079‐1.932, P = 0.014) and tobacco use (OR = 1.424, 95% CI, 1.075‐1.887, P = 0.014) were associated with men with LBD

Conclusions
: More men presented with LBD compared to women. Our findings reveal specific demographic and pharmacological factors that contribute to gender differences among LBD patients.
Abstract 1122‐000029: Pharmacological and Clinical Factors Associated with Gender Difference in Alzheimer Dementia Patients
Authors: Imeh‐Nathaniel Samuel I , Coker‐Ayo Oreoluwa O , Agbomi Liddy , Madubike Nneoma , Pamela Chika , Poupore Nicolas , Bailey‐Taylor Melissa J , Roley Laurie Theriot , Goodwin Richard L , McPhail Brooks , Russ‐Sellers Rebecca , Nathaniel Thomas I
Published: December 2021

Introduction
: Alzheimer dementia (AD) has been reported in both men and women. However, factors contributing to gender differences are not fully understood. We tested the hypothesis that specific pharmacological, demographic, and risk factors contribute to gender difference in AD.

Methods
: A retrospective analytical approach was used to analyze data from 12,632 AD patients, comprising 4,584 men and 8,048 women. Univariate and multivariate analyses determined the factors contributing to the gender difference in AD patients.

Results
: About 36% of AD patients were men, and 64% were women. Citalopram (OR = 1.187, 95% CI, 1.044 – 1.350, P = 0.009) was associated with men, while escitalopram (OR = 1.213, 95% CI, 1.119 – 1.315, P<0.001) was associated with women. In both men and women, increasing age (OR = 1.075, 95% CI, 1.071 – 1.079, P<0.001/OR = 1.096, 95% CI, 1.093 – 1.100, P<0.001), tobacco use (OR = 1.150, 95% CI, 1.054 – 1.254, P = 0.002/OR = 1.150, 95% CI, 1.073 – 1.233, P<0.001), and black patients (OR = 2.380, 95% CI, 2.120 – 2.674, P<0.001/OR = 1.395, 95% CI, 1.268 – 1.535, P<0.001) were associated with AD.

Conclusions
: Our findings reveal similarities and differences in factors associated with both men and women AD patients, suggesting the development of management strategies for the care of AD.
Abstract 1122‐000030: Satellite Model for the Management of Aneurysms to Desaturate the Third Level Health System
Authors: Lagos‐Servellon Javier , Bonifacio‐Delgadillo Dulce , Castellanos‐Pedroza Enrique , Venegas Gustavo , Escalante‐Lanza Gretel
Published: December 2021

Introduction
: The Centro Medico Nacional 20 de Noviembre is the most complex centre of the Mexican public health system. The SARS COV‐2 pandemic has progressively saturated health services at all levels, impacting chronic non‐communicable diseases 1. Aneurysmal subarachnoid haemorrhage has a mortality rate of up to 35% if not treated 2. Endovascular management of aneurysms provides a therapeutic possibility that shortens the time and reduces complications if implemented in an outpatient system with high standards of patient choice and reduces the chances of complications 3. We present a case series of patients with ruptured and unruptured brain aneurysms treated in a satellite system to reduce in‐hospital days and complications.

Methods
: A retrospective analysis was carried out of 66 patients admitted on an outpatient basis at the Centro Medico Nacional “20 de noviembre” between May 2020 to June 2021. The patients were entered into a “satellite” system for coils’ endovascular management or flow diverter, previously diagnosed with digital subtracter angiography and computed tomography angiogram. The analysis of variables was done using the Shapiro‐Wilk test to determine the normality of the sample distribution. The correlation of variables was done using Chi‐square.

Results
: The mean age of the patients was 53.8 years SD 14.31 years. 71.2% of the patients were female, and 28.2% were male. There was a 59.1% left predominance regarding the aneurysm side, 37.9% on the right side, and 3.0% was a single vessel. The arterial predominance was 77.3% anterior circulation. 95.5% of the patients underwent embolization with the placement of coils, and 4.5% had a flow diverter. The mean time of admission was 23.3 hours SD 12.4 hours. Complications occurred in 13.6% of the population studied, the most frequent being vasospasm, arterial occlusion, hydrocephalus, and death from aspiration pneumonia. The modified Rankin scale at 90 days was 0.38 SD 1.13. There was a significant relationship (p = 0.05) between the left side and complications.

Conclusions
: The management of aneurysms with a short in‐hospital time is a feasible solution in reducing the decongestion of tertiary health systems. Endovascular management with coils results in a low rate of complications, which is why this therapeutic route can be followed to desaturate third‐level health systems and a flow diversion in high well‐selected patients. The relationship between complication rates related to the left side of aneurysms is likely due to the more significant number of aneurysms on this side, not due to anatomical vessel idiosyncrasy.
Abstract 1122‐000035: Is Age Critical in Determining Stroke Severity Within the Telestroke Network?
Authors: Simmons Cassie A , Poupore Nicolas , Gonzalez Fernando , Nathaniel Thomas I
Published: December 2021

Introduction
: Age is the single most important risk factor for stroke and an estimated 75% of all strokes occur in people >65 years of age. In addition, adults >75 years’ experience more hospitalization stays and higher mortality rates with an estimated 50% in the occurrence of all strokes. Several comorbidities have been linked to an increased risk and severity of acute ischemic stroke (AIS). How these factors differentially contribute to the severity of stroke in patients ages >65 and <75 as well as those ≥75 is not known. In this study, we aim to investigate how age, coupled with various clinical risk factors, affects AIS severity within these two age categories.

Methods
: This retrospective data analysis study was conducted using the data collected from the PRISMA Health Stroke Registry between 2010 and 2016. Baseline clinical and demographic data for patients ages >65 and <75 as well as those ≥75 was analyzed using univariate analysis. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to examine the association of specific baseline risk factors or comorbidities associated with worsening or improving neurologic functions. The primary functions were risk factors associated with improving or worsening neurologic outcome in each age category.

Results
: Adjusted multivariate analysis showed that AIS population of patients >65 and <75 experiencing heart failure (OR = 4.398, 95% CI, 3.912 – 494.613, P = 0.002) and elevated HDL levels (OR = 1.066, 95% CI, 1.009 – 1.126, P = 0.024) trended towards worsening neurologic functions while patients experiencing obesity (OR = 0.177, 95% CI, 0.041 – 0.760, P = 0.020) exhibited improving neurologic functions. For the patients ≥75 years of age, direct admission (OR = 0.270, 95% CI, 0.085 – 0.856, P = 0.026) was associated with improvement of patients treated in the telestroke.

Conclusions
: Age is a strong risk factor for AIS, and aged stroke patients have higher morbidity and worsening functional recovery than younger patients. In this study, we observed differences in stroke risk factor profiles for >65 and <75 and ≥75 age categories. Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions among AIS for patients aged >65 and <75. Obese patients and individuals ≥75 years who were directly admitted were most likely to exhibit improving neurologic functions. Most importantly, findings from this study reveal specific risk factors that can be managed to improve the care in older stroke patients treated in the telestroke network.
Abstract 1122‐000036: Demographic and Pharmacological Characteristics of Alzheimer Dementia Patients with Mild Cognitive Impairment stratified by Gender
Authors: Coker‐Ayo Oreoluwa O , Nathaniel Samuel , Onuoha Chika , Madubuike Nneoma , Agbomi Lidadi , Poupore Nicolas , Bailey‐Taylor Melissa , Theriot‐Roley Laurie , Goodwin Richard , Russ‐Sellars Rebecca , McPhail Brooks , Nathaniel Thomas
Published: December 2021

Introduction
: The role that specific clinical factors play in contributing to gender differences in Alzheimer’s patients with mild cognitive impairment (MCI) is not yet fully understood. In this study, we tested the hypothesis that pharmacological, demographic, and risk factors may contribute to gender difference in Alzheimer’s patients with MCI.

Methods
: Methods Data collected for 5 years was analyzed using a retrospective data analytical approach on 33,064 Alzheimer patients, including 13,569 men and 19,495 women that presented with MCI. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to identify specific factors that contribute to gender differences in MCI patients.

Results
: Results Our records indicate that women that presented with MCI were more likely to be taking Buspirone (OR = 0.767, 95% CI, 0.683‐0.861, P<0.001) while men within this population were more likely to be taking Galantamine (OR = 0.559, 95% CI, 0.382‐0.818, P<0.001). ETOH use was associated with MCI in both men (OR = 0.696, 95% CI, 0.638‐0.760, P<0.001) and women with Alzheimer’s Dementia (OR = 0.484, 95% CI, 0.442‐0.529, P<0.001).

Conclusions
: Conclusion Our findings reveal gender differences in men and women that presented with MCI. Management strategies should consider identified factors to provide better care for Alzheimer patients with MCI.
Abstract 1122‐000046: A Latin American Model of the PHASES Score
Authors: Calienes Aaron Rodriguez , Rodriguez‐Calienes Aaron , Saal‐Zapata Giancarlo , Malaga Marco , Rodriguez Rodolfo
Published: December 2021

Introduction
: The PHASES score was developed to predict the 5‐year risk of rupture for intracranial aneurysms (IAs). However, only populations from North America, Europe, and Japan were included in the original study. As the population of origin is an item in the score, it has yet to be applied in a Latin American population. We aimed to determine the best approximation to employ this model in this previously unstudied population.

Methods
: We extracted the data of 848 Peruvian patients with ruptured (n = 486) and unruptured (n = 362) IAs from 2010 to 2020. According to the PHASES score, the North American and European (other than Finish), Japanese, and Finnish populations are rated with 0, 3 and 5 points, respectively. Therefore, we developed three PHASES‐derived models in which our Peruvian population is rated with 0 (Model A), 3 (Model B), and 5 (Model C) points. We compared the observed probability of each model to the expected probability reported by the original PHASES score using a scatter plot. We then compared the goodness‐of‐fit of each model using the Hosmer‐Lemeshow test in STATA version 14.

Results
: Nineteen percent of the patients were female. Hypertension was found in 34% of patients and 15% were >70 years. Fifty‐four percent of the aneurysms were smaller than 7mm, 25% ranged between 7 and 9.9mm, 18% were between 10 and 19.9mm, and 3% were larger than 20mm. Previous subarachnoid hemorrhage was found in 4%. The location of the aneurysms was the internal carotid artery in 4%, the middle cerebral artery in 4%, and arteries of the anterior and posterior circulation (including the anterior and posterior communicating artery) in 92%. When Model A was applied, 63% of the patients among the ruptured subgroup have an estimated 5‐year risk of rupture of <3% while 77% of the patients have an estimated risk of <3% in the unruptured subgroup. When Model B was applied, 30% of the patients among the ruptured subgroup have an estimated 5‐year risk of rupture of <3% and 42% of patients among the unruptured subgroup have an estimated risk of <3%. When Model C was applied, 96% of the patients among the ruptured subgroup have an estimated 5‐year risk of rupture of >3% while in the unruptured subgroup an estimated risk of <3% was observed only in 4% of the patients. When comparing observed to expected frequencies, model B presented a better calibration to the values reported by the original PHASES score. Additionally, the Hosmer‐Lemeshow showed Model B to have improved goodness‐of‐fit, compared to other models, although all presented adequate fit.

Conclusions
: We found that rating the Peruvian population with 3 points was the best approximation to the estimated risk calculated by the PHASES score to predict the 5‐year risk of rupture for IAs.
Abstract 1122‐000047: Machine Learning to Predict Stroke Outcomes after Mechanical Thrombectomy
Authors: Bouslama Mehdi , Pisani Leonardo , Haussen Diogo , Nogueira Raul
Published: December 2021

Introduction
: Prognostication is an integral part of clinical decision‐making in stroke care. Machine learning (ML) methods have gained increasing popularity in the medical field due to their flexibility and high performance. Using a large comprehensive stroke center registry, we sought to apply various ML techniques for 90‐day stroke outcome predictions after thrombectomy.

Methods
: We used individual patient data from our prospectively collected thrombectomy database between 09/2010 and 03/2020. Patients with anterior circulation strokes (Internal Carotid Artery, Middle Cerebral Artery M1, M2, or M3 segments and Anterior Cerebral Artery) and complete records were included. Our primary outcome was 90‐day functional independence (defined as modified Rankin Scale score 0–2). Pre‐ and post‐procedure models were developed. Four known ML algorithms (support vector machine, random forest, gradient boosting, and artificial neural network) were implemented using a 70/30 training‐test data split and 10‐fold cross‐validation on the training data for model calibration. Discriminative performance was evaluated using the area under the receiver operator characteristics curve (AUC) metric.

Results
: Among 1248 patients with anterior circulation large vessel occlusion stroke undergoing thrombectomy during the study period, 1020 had complete records and were included in the analysis. In the training data (n = 714), 49.3% of the patients achieved independence at 90‐days. Fifteen baseline clinical, laboratory and neuroimaging features were used to develop the pre‐procedural models, with four additional parameters included in the post‐procedure models. For the preprocedural models, the highest AUC was 0.797 (95%CI [0.75‐ 0.85]) for the gradient boosting model. Similarly, the same ML technique performed best on post‐procedural data and had an improved discriminative performance compared to the pre‐procedure model with an AUC of 0.82 (95%CI [0.77‐ 0.87]).

Conclusions
: Our pre‐and post‐procedural models reliably estimated outcomes in stroke patients undergoing thrombectomy. They represent a step forward in creating simple and efficient prognostication tools to aid treatment decision‐making. A web‐based platform and related mobile app are underway.
Abstract 1122‐000051: Isolated Diplacusis Due to Ipsilateral Temporal Lobe Infarction: A Case Report
Authors: Kerro Ali , Shahripour Reza Bavarsad
Published: December 2021

Introduction
: Double hearing or Diplacusis is a synchronous double perception of a sound and can have Binauralis or Monauralis pattern, with inner ear disorders being the main culprit
[1]
. Other forms of Auditory illusions have been reported as a co‐manifestation of stroke syndromes, but none as an isolated presentation
[1][2]
. This is a case of a 77‐year‐old male with acute onset isolated Diplacusis in a patient due to a right temporal lobe ischemic infarct. To our knowledge, this is the first case report of an isolated diplacusis due to cortical infarct.

Methods
: A case presentation with Pubmed search of review articles and case reports.

Results
: The patient had a past medical history of sensorineural deafness in his left ear. He described any sound heard as the same quality but occurring with an echo heard a fraction of a second later in his right ear. There was no decreased hearing quality or tinnitus reported in his right ear. His drug screen test was negative. His examination was only remarkable for a sensorineural hearing loss pattern on his left ear. His (NIHSS) was zero, and no other cranial nerve abnormalities were detected. His MRI was significant for a punctate restricted diffusion on the right temporal lobe, resembling an ischemic infarct (Figure).

Conclusions
: Isolated diplacusis can present as acute ischemic stroke in the temporal lobe. Further studies are needed to understand its pathophysiology.
Abstract 1122‐000052: Endovascular Management of Infectious PICA Aneurysm in the Setting of Recent Dental Work
Authors: Krothapalli Neeharika , Gershon Abner
Published: December 2021

Introduction
: Infectious intracranial aneurysms (IIA) of the posterior inferior cerebellar artery (PICA) are exceedingly rare and have been infrequently reported. IIAs are typically distal and located in the anterior circulation, particularly the middle cerebral artery and its distal branches. Etiology is secondary to hematogenous spread of septic emboli from a proximal source such as infective endocarditis. Few cases have documented an association between IIA and dental disease or procedures. We describe a rare case of an infectious PICA aneurysm in the setting of recent dental work and successfully treated with endovascular intervention.

Methods
: An 88‐year‐old male with medical history of atrial fibrillation on anticoagulation presented with one month duration of recurrent falls and progressive generalized weakness. CT head demonstrated left cerebral hemorrhage with scattered subarachnoid hemorrhage. MRI brain noted a rounded enhancing intra‐axial lesion located at the left paramedian cerebellum measuring 7 mm in maximal dimension. Further investigation with cerebral angiography demonstrated an infectious intracranial aneurysm of the left PICA. He underwent workup with an echocardiogram that noted a mobile echo density on the aortic valve consistent with a vegetation. Blood cultures were positive for Streptococcus salivarius and viridans. Investigation revealed that he had recent dental work performed and missed taking his prophylactic amoxicillin. Infectious disease was consulted and etiology was determined to be seeding of aortic valve from recent dental procedure that ultimately led to IIA formation.

Results
: Patient was treated with 6‐week course of intravenous ceftriaxone and underwent glue embolization for his left PICA aneurysm. Post embolization angiogram did not reveal any evidence of contrast filling within the aneurysm. He tolerated the procedure well with no complications and was subsequently discharged to inpatient rehabilitation with a modified Rankin scale (mRS) score of 3.

Conclusions
: IIAs of PICA in the setting of recent dental procedures are exceptionally rare and challenging to diagnose. They may be clinically silent until rupture and are usually identified incidentally on imaging or during autopsy. Physicians should maintain vigilance for this unique entity as prompt recognition and timely intervention may prevent severe morbidity and mortality.
Abstract 1122‐000053: Trends in Intervention Modality for Patients with Mycotic Aneurysms: A Nationwide Analysis
Authors: Dawod Giana , Dawod Giana , Zhang Cenai , Shi Hang , Merkler Alexander E , Parikh Neal S
Published: December 2021

Introduction
: Mycotic aneurysms, also known as infectious intracranial aneurysms, are sometimes responsible for intracranial hemorrhage in patients with infective endocarditis. Data regarding when and how to treat mycotic aneurysms most effectively are sparse. Given the widespread adoption of endovascular treatments for non‐infectious intracranial aneurysms and acute stroke, we hypothesized that endovascular treatment is increasingly utilized for patients with mycotic aneurysms. We examined trends in endovascular versus open neurosurgical treatment of mycotic aneurysms in patients with infective endocarditis.

Methods
: We performed a trends analysis using data from 2000–2015 from the National Inpatient Sample. The National Inpatient Sample is an all‐payer database that includes data for a representative sample of hospitalizations to non‐federal hospitals in the United States. We included all hospitalizations for patients with ruptured (on the basis of subarachnoid hemorrhage) or unruptured cerebral aneurysms alongside a diagnosis of infective endocarditis; diagnoses were ascertained using ICD‐9‐CM codes. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD‐9‐CM procedure codes. National Inpatient Sample survey weights were used to calculate nationally representative estimates. Logistic regression was used to evaluate the association between calendar year and intervention rate, presented as an odds ratio for each additional year.

Results
: We identified 1,015 hospitalizations for patients with a ruptured or unruptured cerebral aneurysm in the setting of infective endocarditis. Their mean age was 54.6 years (SD, 16.6), and 60.1% were male. The overall rate of intervention was 11.9% (95% CI, 9.6‐14.2%), and this rate did not change appreciably over time (p = 0.772). In comparing intervention modalities over time, there was a decrease in open neurosurgical repair (OR, 0.89; 95% CI, 0.84‐0.95; p = 0.001), offset by an increase in endovascular repair (OR, 1.07; 95% CI, 1.01‐1.14; p = 0.023) (Figure).

Conclusions
: Rates of mycotic aneurysm intervention during hospitalizations for infective endocarditis have not changed. However, the use of endovascular treatment has become more commonplace while the use of open neurosurgical treatments has decreased. Further directions include understanding whether this shift has improved patients’ outcomes and ultimately enumerating best practices for patients with mycotic aneurysms.
Abstract 1122‐000060: Endovascular Treatment of Large Intracranial Aneurysms Using Large Volume Coils: Safety and Efficacy
Authors: Zapata Giancarlo Saal , Saal‐Zapata Giancarlo , Valer‐Gonzales Dante , Preguntegui‐Loayza Ivethe , Rodriguez‐Calienes Aaron , Rodriguez‐Varela Rodolfo
Published: December 2021

Introduction
: Large volume coils in the treatment of intracranial aneurysms have demonstrated better packing density, shorter operative times, less number of coils per aneurysm and better cost‐effectiveness. However, most of the studies evaluated these coils in small or medium sized aneurysms. Therefore, our study aimed to determine our experience using large volume coils in the treatment of large intracranial aneurysms and determine its safety and efficacy.

Methods
: We retrospectively reviewed consecutive cases of intracranial aneurysms treated with Penumbra Coils 400 (PC400) at our institution between May 2016 and September 2019. Aneurysms > 12 mm in maximal diameter were selected according to the ISUIA trial. Clinical and radiological variables were collected. The modified Rankin Scale (mRS) was used to determine the clinical outcome and was dichotomized (good clinical outcome: mRS £2; poor clinical outcome: mRS >2). The Raymond Roy occlusion classification (RROC) was used to determine obliterations rates. An adequate obliteration was defined as RROC 1 or 2. Categorical variables were expressed as percentages and continuous variables as mean ± standard deviation. Stata v14 software was used for the analysis.

Results
: Eighteen patients harboring 18 intracranial aneurysms were treated. The mean age was 55 ± 12 years and 14 patients (78%) were women. A good preoperative clinical condition was found in 13 patients (72%). Ten aneurysms were unruptured (56%) and eight were dysplastic (44%). Paraclinoid aneurysms were the most frequently treated (61%). The mean number of coils were 6.2/aneurysm. The mean maximal diameter and neck were 18.9 ± 4.3 mm, and 5.7 ± 2.6 mm, respectively. The mean aspect ratio (AR) was 4 ± 1.9. Coiling was used in 10 cases (56%) followed by stent‐assisted coiling in 7 cases (39%) and balloon‐assisted coiling in 1 case. An immediate adequate obliteration rate was found in 8 cases (44%). Intraoperative complications occurred in two patients in which a coil loop migrated to the parent artery and a stent was placed without clinical consequences. In twelve patients (67%), angiographic follow‐up was performed. The mean follow‐up duration was 9.7 months. Nine patients (75%) showed a complete obliteration (RROC 1), whereas in three patients a residual aneurysm was still present. A good postoperative clinical outcome at discharge was found in 14 patients (78%). Procedure‐related morbidity and mortality were not reported.

Conclusions
: Embolization with large volume coils is a safe and effective alternative to conventional coils, with high obliteration rates at mid‐term follow‐up. Longer duration of angiographic follow‐up are needed in order to confirm the results presented here.
Abstract 1122‐000068: Basilar Artery Occlusion Thrombectomy Between Evidence Based Medicine and the Real‐World Practice, Single Centre Experience
Authors: Malky Islam El , Hendi Ali , Abdelkhalek Hazem
Published: December 2021

Introduction
: BAO (basilar artery occlusion) is well known by catastrophic outcomes whether death or disability in approximately 70 %.
1
Thrombectomy as an intervention in large vessel occlusion of anterior proximal circulation was approved after multiple RCTs and meta‐analyses.
2
In spite of two RCTs that appeared lately, there is still uncertainty about the effect of thrombectomy in BAO.
9, 10
Our study aims to report the outcome of BAO, as a further clue of MT effectiveness in BAO and variables affecting good outcome and mortality rate.

Methods
: We retrospectively collected the clinical and radiological data of 30 BAO patients treated in our center between 2016 and 2020. There is no limitation as regard age or presenting NIHHS. Twenty‐two patients who came to the emergency within 4.5 hours had I.V. thrombolytic therapy (73.3%). A favorable clinical outcome was considered if mRS ≤ 2. Angioplasty, stenting, or I.A thrombolysis were used as a rescue treatment. Symptomatic intracranial hemorrhage within two days after the initiation of treatment and mortality at 90 days were reported. The radiological outcome was assessed by modified Thrombolysis in Cerebral Infarction (mTICI) score where mTICI ≥ 2b or 3 at the end of the intervention was considered a favorable radiological result. Multiple variables were tested for their effect on favorable clinical outcomes and mortality (Table 1).

Results
: Among 30 patients, the mean age was 61.23 ± 16.81 years; 20/30 (66.7%) male. A favorable functional outcome was achieved in (40.7%). Successful revascularization was achieved in 26 patients (86.7 %). Four patients had procedural complications (13.3%). Symptomatic intracranial hemorrhage occurred in three cases (11%) and mortality at 90 days was 11 patients (36.7 %). The presenting NIHSS is the only predictor of mortality and the optimal cut‐off value for death was 15 with AUC = 0.758 (sensitivity 91 % and specificity 59%) and p‐value = 0.02. TOR (time of onset to recanalization) had no effect on the clinical outcome which is controversy with the paradigm of early reperfusion leading to a good outcome

Conclusions
: In spite of two RCSs approved no statistical difference between medical treatment and thrombectomy, thrombectomy is still an effective procedure in real‐world practice in selected cases. The presenting NIHSS is the only predictor of mortality in our studies. More studies are warranted to discover other predictors of BAO thrombectomy outcome to improve case selection and avoid futile recanalization.
Abstract 1122‐000075: Optimization of Transport Protocols to Increase the Odds of Thrombectomy
Authors: Killedar Amogh , Hill Michelle , Pema Peter , Budzik Ronald , Alhajeri Abdulnasser , Koss Adam , Dedhia Nikita , Loochtan Aaron , Rai Vivek , Katz Brian , Hicks William , Vora Nirav , Raetzke Brad
Published: December 2021

Introduction
: We sought to determine a distance threshold where mode of transportation impacted treatment options for potential thrombectomy patients.

Methods
: We retrospectively reviewed transferred stroke patients to our comprehensive stroke center within 8 hours of onset from January 2017 to December 2019. In our analysis, all patients had a CTA confirmed large vessel occlusion, NIHSS >10 and arrived within 8 hours of onset as a candidate for thrombectomy. Patients were not treated with thrombectomy if they presented with a completed infarct or hemorrhagic conversion. Patients were transferred by air or ground based on availability and safety. Transfers were grouped based on distance: 0–30 miles, 31–60 miles, 61–90 and > 90 miles. We performed a binomial logistic regression for each distance group to determine a threshold where the odds of receiving thrombectomy statistically decoupled based on mode of transportation.

Results
: Of the 243 patients reviewed, 52.1% (126) received thrombectomy. Transport for 50.8% (123) patients was by air. Hospitals transferring within 0–30 miles accounted for 26.6% (65); 31–60 miles accounted for 22.1% (54); 61–90 miles accounted for25.8% (63) and >90 miles accounted for 24.8% (60). The odds of receiving a thrombectomy were significantly higher with air transportation (OR 3.0, CI 1.04‐8.74, p = 0.043) at a distance threshold of >90 miles. At a distance threshold of 10 to 30 miles, the odds of receiving a thrombectomy were significantly higher with ground transportation (OR 5.5, CI 1.15‐26.14, p = 0.032). There was no difference between modes of transportation for 31 to 90 miles.

Conclusions
: Our analysis suggests that air transport beyond 90 miles increases the odds of receiving a thrombectomy for patients arriving within 8 hours of symptom onset. Ground transport, rather than air transport, between 10 and 30 miles may be more beneficial. Our results suggest that specific regional transport thresholds based on distance do exist and if recognized and altered can result in more favorable transfers.
Abstract 1122‐000078: C‐Guard Stent for the Treatment of Cervical Internal Carotid Artery Aneurysms: Report of 2 Cases
Authors: Urbina John Vargas , Saal‐Zapata Giancarlo , Valer‐Gonzales Dante , Preguntegui‐Loayza Ivethe , Vargas‐Urbina John , Rodriguez‐Calienes Aaron , Rodriguez‐Varela Rodolfo
Published: December 2021

Introduction
: C‐Guard carotid stent is a self‐expandable open cell stent covered with a double‐layer mesh which was developed for the treatment of internal carotid artery disease. Lower procedural and complications rates, as well as lower post‐operative infarctions are some advantages of this device. Nevertheless, the use of C‐Guard in the treatment of cervical internal carotid artery (ICA) aneurysms is scarce. Therefore, we present two cases in which the C‐Guard stent achieved complete angiographic occlusion at follow‐up.

Methods
: We identified two cases in which the C‐Guard carotid stent was used to treat symptomatic cervical ICA aneurysms. Angiographic follow‐up was performed.

Results
: Case 1: 47‐yo female presented left‐sided motor deficit. CT showed ischemic areas in the right hemisphere and CTA demonstrated an unruptured aneurysm in the C1 segment of the right ICA. The patient started dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. A 6mm x 40 mm C‐Guard carotid stent was deployed without complications. One‐year follow‐up CTA showed complete obliteration of the aneurysm with reconstruction of the ICA.

Case 2: 38‐yo male presented decreased left visual acuity. CTA and DSA showed an unruptured aneurysm in the C1 segment of the ICA. The patient started DAPT with aspirin and clopidogrel. A 7mm x 30 mm C‐Guard carotid stent was deployed without complications. Three‐month follow‐up DSA showed complete obliteration of the aneurysm with adequate filling of distal vessels.

Conclusions
: C‐Guard stent is a potential alternative to conventional carotid stents in the treatment of cervical ICA aneurysms with high obliteration rates at follow‐up.
Abstract 1122‐000081: Initial Experience Implementing the Transradial Approach for Diagnostic Cerebral Angiography
Authors: Urbina John Vargas , Saal‐Zapata Giancarlo , Preguntegui‐Loayza Ivethe , Vargas‐Urbina John , Rodriguez‐Calienes Aaron , Rodriguez‐Varela Rodolfo
Published: December 2021

Introduction
: The transradial approach (TRA) has gained acceptance among interventionists due to the lower operative complication rates, less operative time and better patient comfort. Our study aimed to analyze our experience in the implementation of the TRA for diagnostic cerebral angiographies.

Methods
: Between March 2020 and July 2021, consecutive patients who underwent TRA in two institutions were selected and data was retrospectively collected. Demographics, technical details of the procedure, duration of the procedure, fluoroscopy time and radiation exposure were analyzed.

Results
: A total of 76 angiographies using the TRA were done. The mean age was 47.5 ± 16.8 years (8 – 82 years). Women represented 57% of cases. Successful radial artery (RA) catheterization was done in 94% (85 patients/80 successful). A preoperative cocktail was used in all the cases. Subcutaneous lidocaine and a 5F sheath were used in 46% and 57% of cases, respectively. The Simmons 2 catheter was used in all the cases. Glidecath, followed by Merit were used in 40% and 32% of the cases, respectively. Right internal carotid artery (ICA), left ICA, right vertebral artery (VA), left VA, right external carotid artery (ECA) and left ECA were studied in 95%, 91%, 76%, 20%, 20% and 15% of the cases, respectively. Post‐operative vasospasm occurred in 29% of the cases, which resolved with intra‐arterial verapamil. Vasospasm was not associated with sheath diameter (p = 0.129) or local anesthesia (p = 0.065). The mean fluoroscopy time was 16 minutes. Conversion to TFA was done in 9 patients (10.6%), of which the RA was successfully catheterized in 4 patients: 1 patient had an atheroma in the brachial artery, 1 patient had a thrombus in the subclavian artery and 2 patients presented severe pain in the forearm. In the remaining 5 patients, there were 2 radial dissections and in 3 the RA could not be approached.

Conclusions
: The TRA is a safe and effective alternative to perform diagnostic cerebral angiographies with conversion rates according to the literature. The use of appropriate catheters is necessary in order to lower fluoroscopy times when this technique is chosen.
Abstract 1122‐000082: Outcomes of Chronic and Subacute Subdural Hemorrhages Treated with Middle Meningeal Artery Embolization
Authors: Elmashad Ahmed , Elmashad Ahmed , Fayad Mohamad , Patel Smit , Lima Jussie , Ollenschleger Martin , Bruno Charles , Kureshi Inam , Mehta Tapan
Published: December 2021

Introduction
: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate. Middle meningeal artery (MMA) embolization has been shown to reduce the incidence of re‐bleeding and prevent recurrence of cSDH by devascularizing the subdural membranes and shifting the balance from continued leakage and accumulation of blood and proteinaceous material to reabsorption. We report our single center experience of MMA embolization for treatment of chronic and subacute subdural hematoma.

Methods
: We performed a retrospective chart review of all patients ≥18 years who underwent MMA embolization between 01/01/2020‐03/01/2021 for cSDH. We looked at the outcomes, rate of recurrence and possible complications after MMA embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version.

Results
: A total of 41 MMA embolizations were performed on 32 patients with a median age of 75 (Q1‐Q3 70–83). Median hematoma thickness was 12 mm. Among them, 52% patients underwent particle embolization while 48% underwent liquid embolization. One patient had recurrence on follow up imaging and required drainage with burr hole. Three patients underwent hematoma evacuation after MMA embolization without evidence of recurrence on imaging. Three cases were aborted due to high risk or difficult access. There were no procedure related complications in the whole study population. 65% patient achieved mRS 0–2 on 90 day follow up visit. There was no significant difference between particles and liquid embolizations.

Conclusions
: Middle meningeal artery embolization could be used as a safe and effective intervention for prevention of recurrence and improving outcomes of subacute or chronic subdural hematoma.
Abstract 1122‐000083: Endovascular Therapy Delay for Acute LVO is Associated with Worse Functional Outcome and Increased Mortality
Authors: Carrion‐Penagos Julian , Carrion‐Penagos Julian , Thind Sonam , Coleman Elisheva , Brorson James R , McKoy Cedric , Mendelson Scott J , Prabhakaran Shyam , Mansour Ali , Kass‐Hout Tareq
Published: December 2021

Introduction
: The importance of early mechanical thrombectomy (MT) has shown to improve functional outcomes for patients with acute large vessel occlusion (LVO). As well, prior studies have shown that earlier MT resulted in reduced hospital stay, more home‐time, and more desirable living situation in the 90 days after stroke. We hypothesized that delay in MT in patients with LVO would result in worse clinical outcome and increased mortality.

Methods
: We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between 01/2018 and 05/2021. We compared outcomes including in‐hospital mortality and 90‐day modified Rankin Scale (mRS) based on time from door‐to‐puncture and door‐to‐reperfusion, adjusting for relevant covariates using logistic regression.

Results
: Patients that had shorter door‐to‐puncture time were found to have higher probability of a lower modified Rankin Scale (mRS 0–2) at discharge (p = 0.03). Patients with door‐to‐puncture less than 60 minutes had a probability of 50% of achieving a good outcome. Longer door‐to‐puncture times were associated with lower probability of achieving mRS 0–2 at discharge. A similar finding was seen in patients that had shorter times to reperfusion (p = 0.05). Adjusting for age, baseline NIHSS score, and final TICI score, delayed door‐to‐reperfusion time in minutes was an independent predictor of increased mortality at 90 days of 9% for every 10 minutes delay (OR 1.009, 95% CI 1.003‐1.016, p = 0.006). Every 10 minutes delay in door‐to‐reperfusion time had 7% higher chance of poor functional outcome at 90 days (OR 1.007, 95% CI 1.004‐1.019, p = 0.015).

Conclusions
: Shorter times to MT and reperfusion impact functional outcome and mortality in LVO stroke patients. This indicates that an adequate hospital protocol and continuous education may lead to faster and more efficient stroke activations leading to a shorter time to MT and eventual reperfusion. Goals of door‐to‐puncture must be established in order to achieve better outcomes.
Abstract 1122‐000094: EVD Weaning Criteria Decreases VPS/ETV Placement and Hospital Stay in Subarachnoid Hemorrhage Patients
Authors: Kothari Sachin A , Siddiq Mevish S , Rahimi Scott , Shah Manan , Garcia Klepper A
Published: December 2021

Introduction
: The Neurocritical Care Society encourages an external ventricular drain (EVD) wean “as quickly as is clinically feasible” but guidelines on achieving it are limited (1). This study aims to improve quality of care by sharing a protocol to initiate EVD weaning. These criteria were developed over 7 years and showed a reduction in ventriculoperitoneal shunt/endoscopic third ventriculostomy (VPS/ETV) placement and length of stay (LOS) at our institute compared to national averages.

Methods
: 151 subarachnoid hemorrhage (SAH) patients from January 2016 to January 2019 were analyzed. 60 aneurysmal SAH (aSAH) and 18 non‐aneurysmal nontraumatic SAH (naSAH) patients required EVD placement. A gradual EVD weaning protocol was initiated if patients met the following criteria: the reason for EVD placement has resolved or is resolving, quantity of CSF output must be <250mL over 24 hours, quality of CSF must be nonbloody, ICP must be within normal limits, and the patient must be neurologically stable. It was acceptable to wean when the patient had mild cerebral vasospasm, but not moderate to severe cerebral vasospasm. EVD weaning was performed by increasing drain height by 5 millimeters of mercury every 24 hours if criteria were met. Charts were reviewed for LOS and rate of VPS/ETV. Gender, age, race, wean failure incidence, infection rates, and SIADH/CSW rates were obtained.

Results
: Average LOS for aSAH patients with EVD at our institute was 20.35 days. Incidence of VPS/ETV was 11%. Chi‐square analysis was performed, and aSAH patients were found to have higher rates of VPS/ETV placement (p<0.001) and EVD wean failures (p<0.001) than naSAH patients.

Conclusions
: Our criteria to initiate EVD weaning provided a reduction in VPS/ETV placement among aSAH patients compared to national averages and provides a standardized approach to EVD management. aSAH patients at our institute had a lower incidence of VPS/ETV placement of 11% compared to 21% nationally (2). aSAH patients at our institute also had a lower LOS at 20.35 days compared to 21.5 days nationally (3).