bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract Number ‐ 163: Underlying ICAD is associated with worse outcomes in acute large vessel occlusion undergoing endovascular thrombectomy
Authors: Morsi Rami Z. , Thind Sonam , Karrison Theodore , Lee Harrison , Nahab Fadi , Gupta Rishi , Carrión‐Penagos Julián , Awad Issam A , Coleman Elisheva , Brorson James R , McKoy Cedric , Morales Jacqueline , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass‐Hout Tareq
Published: April 2023

Introduction

Acute large vessel occlusion (LVO) can be secondary to thromboembolism or intracranial atherosclerotic disease (ICAD). Data on LVO management due to underlying ICAD are scarce. We hypothesized that patients with ICAD have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD.

Methods

We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between January 14, 2018 and October 24, 2021. Presence of ICAD at LVO site was determined by the interventionalist. We compared in‐hospital mortality, 90‐day mortality, and 90‐day modified Rankin Scale (mRS) scores between those with and without ICAD, in unadjusted and adjusting logistic regression models.

Results

Among 215 patients (mean age 67.1±16.0 years; 60.5% female; 80.5% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥ 2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.054). In‐hospital and 90‐day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0–2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in‐hospital mortality (OR = 4.1, 95% CI 1.7‐9.7), 90‐day mortality (OR = 3.7, 95% CI 1.6‐8.6), and poor functional outcome at 90 days (OR = 5.5, 95% CI 1.6‐19.4).

Conclusions

Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT. Further research is warranted to understand factors associated with worse outcomes and investigate alternative interventional approaches and medical management in this high‐risk population.
Abstract Number ‐ 167: Predictors of Incomplete Recanalization in Mechanical Thrombectomy
Authors: Schrodt Clare E , Rodriguez Wilson , Christopher Kara , Linares Guillermo , Gordon Weston
Published: April 2023

Introduction

Endovascular mechanical thrombectomy (MT) is a highly effective treatment for acute ischemic stroke (AIS) patients due to large vessel occlusion. Although many of these patients achieve successful recanalization, there remains a proportion of patients who fail to recanalize. Incomplete recanalization (defined as TICI 0–2a) has been associated with poor functional outcome; however, risk factors that may predispose these patients to incomplete recanalization remain unclear. We aimed to evaluate various demographic and procedural variables as predictors of incomplete recanalization.

Methods

AIS patients from 2019–2022 at our institution were reviewed. All patients who received MT for treatment were identified. Demographic characteristics including comorbidities, medications, thrombolytic use, ASPECTS, hematologic markers as well as procedural data including TICI score, time to clot, technique, occlusion location, and number of passes was assessed.

Results

One‐hundred eighty‐two patients received MT. Forty‐one patients had incomplete recanalization. History of tobacco use (aOR = 57.8, 95% CI = 5.75—581.2) and no history of HMG‐CoA reductase inhibitor use prior to hospital admission (aOR = 20.9, 95% CI = 1.58—277.1) were found to be predictors of incomplete recanalization. Baseline ASPECTS score, multiple passes with stent retriever, sex, LDL, and hematocrit count were also included in the multivariate analysis due to univariate association (p< 0.10) with the primary outcome.

Conclusions

A history of tobacco use may indicate a predisposition to difficulty in recanalizing a large‐vessel occlusion with MT. These results may also indicate a protective mechanism of HMG‐CoA reductase inhibitor use in these patients that increases the likelihood of recanalization. While successful recanalization in AIS patients due to large‐vessel occlusion has been well established in recent years to predict improved functional outcome, further investigations evaluating the characteristics of those AIS patients who are unable to be recanalized with MT are warranted.
Abstract Number ‐ 173: Mechanical Thrombectomy in Combination with Intra‐Arterial Thrombolysis for Acute Ischemic Stroke
Authors: Elfil Mohamed , Ghozy Sherief , Abbas Alzhraa S , Ghaith Hazem S , Morsi Rami , Aladawi Mohammad , Elmashad Ahmed , Villafuerte‐Trisolini Brian J , Gonzalez‐Castellon Marco , Thorell William E , Al‐Mufti Fawaz
Published: April 2023

Introduction

Mechanical thrombectomy (MT) is the gold standard for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Although >70% of patients in the randomized clinical trials (RCTs) assessing the efficacy of MT for AIS‐LVO had successful recanalization, only up to 27% were free of disability according to the 90‐day modified Rankin scale (mRS) score. It is suggested that microcirculation disruption distal to the LVO might contribute to futile recanalization. Hence, combining intra‐arterial (IA) tissue plasminogen activator (tPA) with MT was investigated in a few studies in an attempt to reduce the burden of distal microthrombi and microcirculation disruption. We conducted this meta‐analysis to provide collective evidence in this regard.

Methods

We performed this meta‐analysis following the Preferred Reporting Items for Systematic Review and Meta‐Analyses statement recommendations. We aimed to include all original studies investigating the benefits of IA tPA in AIS patients undergoing MT.All screening and extraction stages were conducted by two authors, with a third author resolving any conflicts. Using R software, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI). A fixed‐effect model was adopted to pool all data due to the absence of significant heterogeneity among the included studies. Heterogeneity was assessed using Q statistics and the I2test, where I2> 50% or P‐value < 0.05 were considered significant.

Results

Following the database search, a manual search of references, and different screening phases, we included 5 studies (2,686 patients) satisfying the predefined inclusion criteria. Successful recanalization rates were comparable between both groups. The 90‐day functional independence was reported in 4 studies (2,474 patients), with comparable rates between both groups (OR = 1.25; 95%CI = 0.92‐1.70; P‐value = 0.154). Mortality was reported in 3 studies (368 patients), with comparable rates between both groups (OR = 0.73; 95%CI = 0.44‐1.23; P‐value = 0.240). Symptomatic intracranial hemorrhage (sICH) was reported in 5 studies (2,678 patients) with no significant difference between the two groups (OR = 0.66; 95%CI = 0.34‐1.26; P‐value = 0.304).

Conclusions

The current evidence does not show any significant differences between MT alone versus MT plus IA tPA in terms of 90‐day functional independence, mortality, and sICH. With the limited number of studies and included patients, more studies are needed to investigate the benefits and safety of the combined MT and IA tPA.
Abstract Number ‐ 200: Aneurysmal versus “Benign” Perimesencephalic Subarachnoid Hemorrhage
Authors: Alrohimi Anas , Pandhi Abhi , Abdulrazzak Mohammad A , Bain Mark , Moore Nina , Hussain Shazam , Wadden Daniel , Toth Gabor
Published: April 2023

Introduction

Perimesencephalic subarachnoid hemorrhage (PMSAH) is characterized by bleeding centered in the basal cisterns anterior to the midbrain and pons without intraparenchymal or overt intraventricular extension. The term “benign” is often attached, because typically no source of bleeding is identified on high‐resolution vascular imaging, and recovery if often uncomplicated. Rarely, however, PMSAH can be secondary to ruptured vertebrobasilar aneurysms, and outcomes of these patients is underreported.

Methods

Retrospective analysis of patients with PMSAH to determine the rate of underlying ruptured aneurysm or vascular abnormality, associated complications, and outcomes. Age, sex, vascular risk factors, presenting symptoms, Hunt and Hess grade, modified Fisher grade, rate of underlying ruptured aneurysm, vasospasm, re‐bleed, hydrocephalus, and modified Rankin scale (mRS) were collected. Primary outcome was good functional status at discharge (mRS 0–2), reported as odds ratio (OR) with 95% confidence interval (CI).

Results

A total of 74 patients with PMSAH between 2007 and 2022 were identified. Mean age was 55.5± 10 years, and 60% were male. Hypertension and smoking were reported in 57% and 35% of patients, respectively. The most common presenting symptom was thunderclap headache in 89% of patients. Median (IQR) ofHunt and Hess grade was 2 (1‐2), and modified Fisher grade was 3 (1‐3). An underlying ruptured aneurysm was found in 3 patients (4%); two of which were in the vertebrobasilar system and one in the posterior communicating artery. Most common complications in this cohort was vasospasm in 28%, followed by hydrocephalus in 11%. Among patients with aneurysmal bleed, vasospasm and hydrocephalus occurred in 66% of patients each, compared to 8.5% and 27%, respectively in patients with non‐aneurysmal PMSAH. Re‐bleeding occurred only in one patient (1.3%); which occurred in a patient with non‐aneurysmal source of hemorrhage. A total of 88% of patients in our cohort had a favorable functional outcome (mRS 0–2) at discharge. An underlying ruptured aneurysm and acute hydrocephalus were associated with poor functional status(OR = 18.3, [1.5–228], P < 0.024), and OR = 25.8, [4.5–149], P < 0.001), respectively. However, vasospasm was noted to be asymptomatic in most cases (90%) and was not associated with unfavorable outcomes (OR = 0.75, [0.14–3.9], P < 0.73).

Conclusions

“Benign” PMSAH pattern was associated with a ruptured aneurysm in 4% of patients in our cohort.An underlying aneurysm and acute hydrocephalus were associated with poor outcomes. However, vasospasm was incidental and was not associated with unfavorable outcomes in patients with PMSAH.
Abstract Number ‐ 201: Increased Utilization of Neuro‐Endovascular Procedures: 2013–2019
Authors: Brown Nolan , Steiger Kyle , Singh Rohin , Koester Stefan , Shahrestani Shane , Stonnington Henry , Catapano Joshua , Srinivasan Visish , Gendreau Julian , Patel Naresh , Erben Young
Published: April 2023

Introduction

Endovascular procedures have become increasingly popular in recent years due to preference of minimally invasive approaches and technological advancement.This study aims to characterize the trends in procedural rates of common neuro‐endovascular procedures performed by neurologists, neurosurgeons, and radiologists.

Methods

The Medicare Provider Utilization Database was queried from 2013 to 2019 for all primary Current Procedural Terminology codes identified by the American Medical Association as pertaining to endovascular procedures of the nervous system (61623, 61624, 61630, 61635, 61626, 61645, and 61650). Statistical analyses, including data aggregation, exploratory analysis, and propensity adjustment, were performed using R, version 4.0.1 (The R Foundation, Vienna, Austria). The two‐sided Mann‐Kendall trend test, a non‐parametric statistical test that assesses for monotonic trends in either an upward or downward trend, was utilized to assess for trends over time. A significance level of 0.05 was used.

Results

Between 2013 to 2019 a total of 40,730 endovascular procedures were performed by neurosurgeons, neurologists and radiologists treating Medicare patients. When all codes were combined, there was a significant increase in the number of procedures done by all specialists: Radiology (2013:1080; 2019:4938; p:0.02), Neurosurgery (2013:1230; 2019:4508; p< 0.01), and Neurology (2013:205; 2019:2397; p:0.04). Significant increases in mechanical thrombectomy (CPT61645) were observed in all fields: Radiology (2016:1287, 2019:3542; p< 0.01), Neurosurgery (2016:610; 2019:2326; p< 0.01), Neurology (2016:569; 2019:1951; p< 0.01). Increases in transcatheter permanent occlusion (CPT61624) were observed in neurosurgery (2013:1230; 2019:2049; p:0.04). Increases in temporary balloon artery occlusion (CPT61623) were noted in neurology (2013:21; 2019:27; p:0.04).

Conclusions

Endovascular procedures have seen a dramatic rise in utilization over a short amount of time, particularly mechanical thrombectomy. Future investigation should include more inclusive datasets beyond the Medicare population.
Abstract Number ‐ 209: Short‐ and long‐term outcomes of mechanical thrombectomy in acute ischemic stroke patients with active cancer
Authors: Yoshimoto Takeshi , Koge Junpei , Tanaka Kanta , Shiozawa Masayuki , Kamogawa Naruhiko , Kataoka Hiroharu , Koga Masatoshi , Toyoda Kazunori , Ihara Masafumi
Published: April 2023

Introduction

We aim to investigate the difference in mechanical thrombectomy (MT) outcome for cancer‐related stroke (CRS) with active and inactive cancer.

Methods

Of the consecutive acute ischemic stroke (AIS) patients admitted to our institute from 2010 to 2021, patients with cancer who received MT within 24 hours of onset and were enrolled.Outcomes including the favorable outcome (modified Rankin Scale score of 0 to 2) at3 months, 1‐year,and death within 3 months or 1‐yearwere assessed between patients with active and inactive cancer among patients with cancer. The rate offirst pass effect (FPE, extendedThrombolysis in Cerebral Infarction[eTICI] 2c/3 after first pass) and final eTICI 2c/3 achievement were also assessed. Active cancer was defined as a cancer that was diagnosed within 6 months; required chemotherapy or surgical treatment within 6 months; or was recurrent, metastatic, or inoperable.

Results

Of 59 patients (26 women; median age, 80 years; median NIH Stroke Scale score[NIHSS] 17), 19 (32.2%) patients had an active cancer. Patients with active cancer has less atrial fibrillation (47% vs. 78%,P< 0.01) and higher medianD‐dimer(4.60μg/mLvs. 2.00μg/mL,P< 0.01). There were no significant differences in the favorable outcome at 3 months (26% vs. 45%,P = 0.26) and at 1 year (26% vs. 45%,P = 0.26) between both groups, but death within 3 months (32% vs. 5%,P< 0.01) and within 1 year (42% vs. 8%,P< 0.01) were more frequent in patients with active cancer than those with inactive cancer.

Conclusions

Long‐term clinical outcomes of patients with active cancer were worse than those with inactive cancer.
Abstract Number ‐ 239: Subcortical Infarcts in Patients with Nonstenotic Cervical Atherosclerotic Disease
Authors: Siegler James E , Kamen Scott , Vigilante Nicholas , Rana Ankit , Penckofer Mary , Hester Taryn , Oak Solomon , Patel Karan , Koneru Manisha , Thau Lauren , Sprankle Kenyon , Kim Kelly , Thomas Kavya , Zhang Linda , Wolfe Jared
Published: April 2023

Introduction

Prior studies have elucidated a relationship between nonstenotic plaque in patients with cryptogenic embolic (cortical) infarcts, however it is unclear if nonstenotic carotid plaque is relevant in subcortical infarct patterns.

Methods

A nested cohort of consecutive patients with anterior, unilateral, subcortical infarcts without an identifiable embolic source were identified from a prospective stroke registry (September 2019 ‐ June 2021). Patients with extracranial stenosis >50% were excluded. Patients with computed tomography angiography were included and comparisons made according to infarct pattern being lacunar (single lesion < 1.5cm on computed tomography [CT] or < 2.0cm on diffusion weighted imaging [DWI]) versus cryptogenic (≥ 1.5cm on CT or ≥ 2.0cm on DWI, or scattered subcortical lesions). Prevalence estimates for cervical internal carotid artery (ICA) plaque presence were estimated with 95% confidence intervals (CI), and differences in plaque thickness and features were compared between sides.

Results

Of the 1684 who were screened, 141 met inclusion criteria (n = 80 due to small vessel disease, n = 61 cryptogenic). The median age was 66y (interquartile range, IQR 58–73) and National Institutes of Health Stroke Scale score was 3 (IQR 1–5). There was a higher probability of finding excess plaque ipsilateral to the stroke (41.1%, 95%CI 33.3‐49.3%) than finding excess contralateral plaque (29.1%, 95%CI 22.2‐37.1%; p = 0.03), but this was driven by patients with cryptogenic infarcts (excess ipsilateral vs. contralateral plaque frequency of 49.2% vs. 14.8%, p< 0.001) and not lacunar disease (35.0% vs. 40.0%, p = 0.51).

Conclusions

The probability of finding ipsilateral, nonstenotic carotid plaque in patients with subcortical cryptogenic strokes exceeds the probability of contralateral plaque and is driven by larger subcortical infarcts, classically defined as being cryptogenic. Approximately 1 in 3 unilateral anterior subcortical infarcts may be due to nonstenotic ICA plaque.
Abstract Number ‐ 251: The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm
Authors: Kim Hongbum , Park Wonhyoung
Published: April 2023

Introduction

Pterional craniotomy is the most commonly used craniotomy for cerebral aneurysm. Surgical closed suction drains are widely used to reduce complications caused by postoperative fluid collection. However, scarce literature is available on the efficacy of surgical closed suction drains in pterional craniotomy.This study aims to investigate the influence of closed suction drains on postoperative epidural hematoma (EDH) that requires evacuation and surgical site infections (SSIs).

Methods

We performed a retrospective review of patients who underwent pterional craniotomies for cerebral aneurysm between January 2006 and December 2020 at our center. Patients were divided into subarachnoid hemorrhage (SAH) and non‐SAH groups. The differences in the incidence of EDH and SSI between patients with and without drain insertion were compared in each group. Univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with EDH and SSI, including the use of drains.

Results

Among 5,280 patients, 4,767 non‐SAH and 513 SAH patients were included. The occurrences of EDH and SSIs were not associated with drain in both non‐SAH (p = 0.549, p = 0.693, respectively) and SAH patients (p = 0.153, p = 0.093, respectively). However, longer operation time was associated with occurrence of EDH in non‐SAH patients by univariate logistic regression analysis (odds ratio = 1.01, p < 0.001).

Conclusions

There was no significant difference in the incidence of EDH requiring evacuation and SSI in the group with and without drain. Therefore, it was considered unnecessary to use drain routinely after the pterional craniotomy.
Abstract Number ‐ 255: Laser Speckle Flowgraphy As A Surrogate Marker For Symptomatic Carotid Stenosis
Authors: Jones Matthew T , Sanchez Sebastian , Patel Rishi R , Miller Jacob M , Raghuram Ashrita , Kardon Randy , Samaniego Edgar
Published: April 2023

Introduction

The severity of internal carotid artery (ICA) atherosclerosis is assessed through measurements of degree of stenosis. This approach does not factor in mechanisms compensating for reduced distal perfusion, such as collateral circulation. An alternative approach is evaluating severity of carotid stenosis based on downstream changes in ocular perfusion. Laser speckle flowgraphy (LSFG) is a non‐invasive tool that quantifies intraocular blood flow. This pilot study investigated whether LSFG metrics could be surrogates for degree of stenosis. Additionally, we quantified changes in flow through the stenosed vessel before and after stenting usingsyngoiFlow (iFlow).

Methods

Fourteen patients had stents placed to treat symptomatic carotid stenosis. LSFG metrics were obtained before and after stenting. Mean blur rate (MBR), an index of ocular blood velocity, and associated waveform parameters were extracted from the optic nerve head (ONH) region of the eye. iFlow quantified time to peak (TTP), an index of peak cerebral contrast flow, by transforming digital subtraction angiography (DSA) images into perfusion heat maps.TTPswere extracted for seven regions of interest (ROIs) by two raters.

Results

Two LSFG waveform parameters were significantly negatively correlated with degree of stenosis. These parameters, flow acceleration index (FAI) and rising rate (RR), also increased significantly after stenting. Intraclass correlation coefficients calculated for TTPs showed substantial agreement across all ROIs. Significant decreases in TTP after stenting were observed in ROIs placed in the high cervical ICA, cavernous segment of the ICA, and brain parenchyma.

Conclusions

LSFG provides biometrics that can accurately measure the impact of ICA stenosis by quantifying distal perfusion. Indices of ocular blood flow acceleration may serve as surrogate metrics for degree of stenosis. iFlow is a sensitive tool to quantify changes in flow after stenting. Non‐invasive flow‐dependent methods are promising in the assessment of patients with ICA stenosis.
Abstract Number ‐ 259: Recanalization Before Completion of Alteplase Infusion Leads to Improved Outcomes: A Retrospective Analysis
Authors: Bach Ivo , Czap Alexandra L , Dongarwar Deepa , Sheth Sunil A
Published: April 2023

Introduction

The recently published CHOICE trial found that intra‐arterial infusion of alteplase improved clinical outcomes in patients undergoing EVT for LVO AIS, an effect that was possibly due to a reduction in reperfusion‐related injury. Here, we examine whether intravenous alteplase, administered after successful endovascular reperfusion, results in improved clinical outcomes.

Methods

From our prospectively collected multicenter institutional registry drawn from four comprehensive stroke centers in the greater Houston area, we identified cases who underwent EVT with substantial reperfusion (TICI 2b/3) prior to termination of the intravenous alteplase continuous drip. Control patients were then identified as patients who underwent EVT with TICI 2b/3 after completion of intravenous alteplase, matching on age, baseline Modified Rankin Scale (mRS), initial NIH Stroke Scale (NIHSS), and comorbidities. The primary outcome was 90 day disability and was determined by mRS shift analysis, comparing the case and control populations.

Results

Among 21 cases and 24 matched controls, there were no significant difference between the mean age, gender, race, initial NIHSS, baseline mRS, or ASPECT score. Time from last known well to recanalization was longer in controls (48 min vs 151 min, p< 0.01). Patients who achieved reperfusion prior to termination of the alteplase continuous drip had better 90 day clinical outcomes relative to their presentation mRS when compared to patients who achieved reperfusion after termination of the alteplase. A change in mRS of 1 or less was seen in 71% vs 33% in the continued infusion group vs controls respectively.

Conclusions

Patients undergoing EVT who continued to be treated with intravenous alteplase following reperfusion had better 90d clinical outcomes relative to those with reperfusion after infusion termination. These findings further support the possible efficacy of thrombolytics following endovascular reperfusion.
Abstract Number ‐ 267: The Role of Non‐stenosing Carotid Artery Plaques in ESUS, is it a Silent Offender?
Authors: Jumah Ammar , Nour Hassan Aboul , Choudhury Omar , Eltous Lara , Zoghoul Sohaib , Walsh Megan , Chebl Alex , Marin Horia , Miller Daniel
Published: April 2023

Introduction

The secondary prevention of Acute ischemic stroke (AIS)varies based on the root cause of the initial event; thus, determining the cause of an individual AIS is critical for implementing effective care. The well‐described TOAST classification is used to classify stroke etiology, and according to this paradigm, the presence of large vessel disease is considered a high risk for subsequent stroke only if >50% carotid artery stenosis is present. Cryptogenic strokes represent around 30% of all AIS and Embolic stroke of unknown source (ESUS) is a subcategory of the cryptogenic strokes and is characterized as a non‐lacunar ischemic stroke presumed to be of an embolic origin with no evidence of an obvious source of emboli. Here we discuss the most important and latest evidence on the relationship between ESUS and high‐risk plaque features not causing significant stenosis per NASCET criteria.

Methods

N/A

Results

The Relationship Between ESUS and Non‐stenosing Carotid Artery Plaques is mainly illustrated in the following points: Plaque vulnerability Researchers have described the following high‐risk features of plaques that may lead to stroke (Table). Plaque vulnerability is a plaque’s susceptibility to rupture and is a proposed determinant of high risk for superimposed thrombosis. According to a meta‐analysis conducted by Kamtchum‐Tatuene et al, high‐risk plaque features were three times more prevalent in patients with symptomatic versus asymptomatic carotid stenosis.3 Laterality of cartid plaques and stroke A meta‐analysis of 8 studies that assessed 323 patients with ESUS showed that mild carotid stenosis with high‐risk plaque features was more commonly located ipsilateral to the stroke side (32.5%) versus being contralaterally located (4.6%).4 Knight‐Greenfield et al evaluated plaque features by CTA in patients with AIS who did not have hemodynamic stenosis. It was also found that ESUS patients had a higher total plaque thickness ipsilateral to the stroke side when compared to the contralateral stroke‐free hemisphere.5 Clot composition and stroke etiology Fibrin/platelet component was dominant in cardioembolic thrombi and cryptogenic stroke, while red blood cells were seen more frequently in non‐cardioembolic thrombi. This supports the hypothesis that plaque histological features play a major role in causing large vessel occlusion despite the absence of significant stenosis.8

Conclusions

Despite the evidence that high‐risk plaque features can predict a recurrent stroke, adoption of this principle and its integration into the medical guidelines have not yet been established. This reflects a lack of clinical trials that have utilized detailed plaque characterization for assessing risk of stroke.
Abstract Number ‐ 279: Clinical Factors of Vascular Dementia, Alzheimer’s Disease, and Mixed Vascular Dementia Stratified by Gender
Authors: Stanley Madison C , Stanley Madison C , Poupore Nicolas , Bailey‐Taylor Melissa J , Roley Laurie Theriot , Nathaniel Thomas
Published: April 2023

Introduction

The different factors that contribute to gender differences among patients with vascular dementia (VaD), Alzheimer’s disease (AD), and mixed vascular dementia and Alzheimer’s disease (VDAD) are not fully understood. This study examined gender differences among patients with VaD, AD, and VDAD using demographic and pharmacologic factors.

Methods

Data was collected from Prisma Health‐Upstate Alzheimer registry from 2016 to 2021 for 6,039 VaD patients, 9,290 AD patients, and 412 VDAD patients. A logistic regression model was used to determine demographic and pharmacological factors that are associated with gender differences in patients with VaD, AD, and VDAD.

Results

In the adjusted analysis for patients with VaD, increasing age (OR = 1.023, 95% CI, 1.017‐1.029, p< 0.001) and use of aripiprazole (OR = 4.395, 95% CI, 2.880‐6.707, p< 0.001) were more associated with women, whereas use of tobacco (OR = 0.312, 95% CI, 0.278‐0.349, p< 0.001) and galantamine (OR = 0.228, 95% CI, 0.116‐0.449, p< 0.001) were more associated with men. In patients with AD, Black race (OR = 1.747, 95% CI, 1.486‐2.053, p< 0.001) and use of buspirone (OR = 1.541, 95% CI, 1.265‐1.878, p< 0.001) were more associated with women, whereas use of ETOH (OR = 0.627, 95% CI, 0.547‐0.718, p< 0.001) and memantine (OR = 0.882, 95% CI, 0.799‐0.974, p = 0.013) were more associated with men. In patients with VDAD, use of rivastigmine (OR = 3.293, 95% CI, 1.131‐9.585, p = 0.029) was more associated with women, whereas increased length of hospital stay (OR = 0.910, 95% CI, 0.828‐1.000, p = 0.049) was more associated with men.

Conclusions

Our study revealed that there are gender differences and similarities in the demographic and pharmacological factors of VaD, AD, and VDAD. Future studies can be conducted investigating each of these factors to improve treatment of VaD, AD, and VDADin all patients.
Abstract Number: LBA7 Outcomes of Endovascular Thrombectomy Versus Medical Treatment in Ischemic Strokes Secondary to Medium Vessel Occlusion
Authors: Fourcand Farah Y , Scarpiello Sean , Amireh Abdallah , Snyder Thomas , Vyas Shrinjay , Joshi Rudra , Dubinsky Ilya , Percival Brigitte , Zacharatos Haralabos , Mehta Siddhart , Kirmani Jawad F
Published: April 2023

Introduction

Acute ischemic stroke (AIS) from arterial occlusions are treated with emergent endovascular thrombectomy (EVT) when clinically appropriate. Clinical outcomes of EVT in medium vessel occlusion (MVO) compared to large vessel occlusion (LVO) have neither been well established nor compared to alternate medical management. Our aim was to evaluate outcomes of patients with AIS secondary to MVO undergoing EVT.

Methods

We conducted a retrospective chart review of patients presenting to our comprehensive stroke center with MVO‐associated AIS undergoing EVT or aggressive intra‐arterial thrombolytic treatment with concurrent administration of IV eptifibatide. We assessed occlusion site, NIHSS (presentation, 7 day or discharge, 3 months), modified Rankin Scale (baseline, 90‐day), and intracranial hemorrhage (ICH) rate. MVO was defined as occlusion of pure M2 middle cerebral artery without M1 segment involvement, anterior cerebral artery A1 segment or more distal, and posterior cerebral artery P1 segment or more distal. Mann‐Whitney U test, Fisher exact test statistic, and T‐test statistic were used for analysis. Social science statistics software was used for data analysis.

Results

From August 2020 to December 2021, out of 175 patients who underwent EVT, 50 had MVO (n = 33 M2 occlusion, n = 12 M3 occlusion, n = 1 for P1, P2, A1, A2, A3 each). Twelve subjects with MVO received aggressive medical management with concurrent IV eptifibatide. Subjects between arms were similar at baseline (median NIHSS 11 [95% CI 10.75, 14.32]; mean age 71.5 [95% CI 69.24, 73.77]; male 48.39% [n = 30]). The difference between initial NIHSS and discharge NIHSS was statistically significant in the EVT arm (Z‐Score = 4.03; p‐value < .00001) but not in the medical arm (Z‐score = 1.96; p‐value 0.05). Hemorrhagic transformation occurred in 28% (n = 14) of EVT arm and 16.67% (n = 2) of medical arm. This was not statistically significant (Fisher value: 0.71). Median 90 day mRS was 1 (95% CI [0.89, 2.11]). The difference between 90 day mRS was not significantly different (Z‐score = ‐1.20; p‐value 0.23).

Conclusions

In our patient cohort, endovascular therapy was safe in medium vessel occlusion and may have more favorable clinical outcomes as illustrated by higher delta NIHSS in the endovascular thrombectomy group. Larger, prospective studies are needed to validate our results.
Abstract Number: LBA8 Thin Cut Non‐Contrast Computed Tomography for Periprocedural Planning: Thrombus Burden Assessment Prior to Mechanical Thrombectomy
Authors: Fourcand Farah Y , Amireh Abdallah , Scarpiello Sean , Percival Brigitte , Tabibzadeh Navid , Kirmani Ayman , Mehta Siddhart , Kirmani Jawad F
Published: April 2023

Introduction

In patients presenting with acute ischemic stroke (AIS), non‐contrast CT (NCCT) and CT angiography (CTA) are used to determine large vessel occlusions (LVO). Using thin‐cut NCCT, hyperdense signs represent thrombus. NCCT provides information on thrombus characteristics such as length and morphology that is not evidenced by CTA. The aim of this study is to determine if hyperdense signs identified on thin‐cut NCCT are a valid tool in periprocedural planning for endovascular thrombectomy (EVT).

Methods

At our comprehensive stroke center, patients presenting with AIS who had thin‐cut NCCT defined as 0.625mm per slice followed by EVT and subsequent High Resolution Photographs (HRPs) of post‐EVT thrombus were identified. High‐resolution photographs were taken by operating physician with adjacent ruler for accurate measurement. Thin‐cut NCCT and associated fully extracted thrombus HRPs were reviewed by two board certified vascular neurologists to determine agreement. Cohen’s K was used to determine kappa inter‐rater agreement. Wilcoxon signed‐rank test was used to determine if significant difference existed between thrombus length and independently measured hyperdense sign. Social science statistics software was used for data analysis.

Results

From January 2019 to December 2021, out of 87 cases where thrombus was extracted after EVT, 57 met inclusion criteria and had associated initial CT head. Mean age was 68.22 (95% CI 64.26, 72.18), and 49% were female (n = 28). Mean thrombus length was 12.49mm (95% CI 10.19, 14.80). Mean hyperdense sign length measured by Interpreter 1 was 12.86mm (95% CI 10.54, 15.18). Mean hyperdense sign length measured by Interpreter 2 was 12.61mm (95% CI 10.40, 14.83). Kappa score was 1. There was no significant difference in thrombus length and Interpreter 1 hyperdense sign (z = 0.99; p‐value 0.317) or Interpreter 2 hyperdense sign (z = ‐0.92; p‐value = 0.36).

Conclusions

Our study suggests that in acute ischemic stroke patients, hyperdense sign on thin‐cut NCCT may be a valid reliable marker of thrombus length and morphology that assists in peri‐procedural planning for mechanical thrombectomy. Larger, prospective studies are needed to validate our results.
Technologies of Decision Support and Proportionality in International Humanitarian Law
Authors: Gunneflo Markus , Noll Gregor
Published: April 2023

What does proportionality reasoning mean for decision support in international humanitarian law (ihl)? We first consider contemporary ihl commentaries on proportionality as an analogue form of decision support through a paradigmatic example. Over time, proportionality in ihl has changed from being a rule-specific space for discretionary decision making to a much broader compromise-seeking within boundaries marked by law. Today, proportionality is a master norm in ihl, remaking rules by stealth and enabling the accommodation of novel master technologies as lawful. Artificial Intelligence (ai) support for military decision making is one such master technology that resonates particularly well with the inner structure of proportionality thinking: both build on cost-benefit analysis and engender the quantification of the world through data collection. We analyse how cost-benefit analysis and digitalization and algorithmic processing intersect in the U.S. legal context, to then proliferate into U.S. warfare and decision support systems, and onwards into ihl.
Expressing the Evaluation of Socially Contested Issues through Metaphor: Higher Education Reform
Authors: Cibulskienė Jurga
Published: April 2023

Metaphor may express a positive or negative evaluation (Charteris-Black, 2014; Musolff, 2016). The paper aims to study how the predicative function of metaphor is manifested in the discourse of contemporary social concerns. The study was carried out within the framework of Critical Metaphor Analysis (cma), which was employed in order to determine how metaphors reflect attitudes towards higher education reform in Lithuania. The results show that the concept quality is understood as an object and evaluated through bipolar oppositions where the first element of the opposition is positively connoted while the second acquires a negative connotation. The evaluation of the concept reform is carried out through the source domains of movement, living being, object and conflict and is based on whether metaphors are used by the proponents of the reform or by the opposition.
A Radical Embodied Characterization of German Modal Constructions
Authors: Torres-Martínez Sergio
Published: April 2023

This paper starts out from a radical embodied analysis of German modals. The merit of this proposal is that it provides a framework for the conceptualization of these constructions as part of a broader continuity between perception, memory and consciousness. According to the interpretation and defense of this view offered here, I will argue that modal events in German are constructed as instances of the embodied information encoded by specific constructional attachment patterns. The results of the corpus study in the latter part of the paper reveal that syntactic content (rather than lexical information alone) is crucial for the reduction of both surprise and entropy, as it reflects cognitive processes associated with affordance mapping and the speakers’ need to increase epistemic capital. This shows that humans make use of stored perceptual maps, the combination of which allows us to construct and manipulate complex event representations.
A Cognitivist Approach to I promise and I guarantee Constructions
Authors: Kwon Iksoo , Jung Hanbeom , Kwon A Young , Kang Ji-in
Published: April 2023

This paper compares the constructional and functional properties of I promise (you) + X and I guarantee (you) + X constructions, whose construal revolves around the speaker’s commitment to making a situation happen and/or to vouching for the validity of the embedded clause X. Taking a usage-based perspective, it analyzes 563 spoken tokens of I promise constructions and 398 tokens of I guarantee constructions from the Corpus of Contemporary American English (coca). Three types of construals were identified: commissive, epistemic modal, or both. While the I promise construction can have any of the three, the I guarantee construction never has the commissive construal alone. Working within mental-spaces theory, this paper contends that the speaker’s commitment to the occurrence of the focal situation is necessarily involved in the default conceptualization of I promise constructions, but not of the other. The frequency data indicate that the distinctive conceptual structures motivate their functional distributions.
Relations across Cognitive Faculties: An Addition to the Taxonomy of Cognitive Semantics
Authors: Talmy Leonard
Published: April 2023

Language is often approached as a self-contained system, one with its own specifically linguistic elements of organization, generally independent of other systems in cognition. But by the analysis here, language shares parts of its organization with other systems in cognition and could not function without their participation. For this analysis, cognition is heuristically divided into a number of cognitive faculties, each judged to perform some integrated function. Some faculties, including language, are treated as “cognitive systems” and others as “cognitive organizers”. Language is examined both in its evolutionary relation to other faculties and as an interface among them.
Posthumous Selves
Authors: Binetti Roberto
Published: April 2023

The self-elegy is considered a hyper-literary genre which provides the readers with a self-portrait of the poets, while also discussing their own poetics and literary works. This article aims to re-map the genre of self-elegiac writing in contemporary Italy by focusing on two recently published collections: Patrizia Cavalli’s Vita meravigliosa (2020) and Biancamaria Frabotta’s Nessuno veda nessuno (2022). Both collections play with the genre of self-elegiac writing by trying to redefine its boundaries: first, both authors problematize the gender perspective intrinsic to the elegy; second, Cavalli and Frabotta delve into some of the canonical references and the structure of the elegiac genre; third, they insert their elegiac discourse within a global literary community.
Reinstatement of the Chinese species Rohdea yunnanensis (Asparagaceae)
Authors: FENG HUI ZHE , LI CUI HUA , LI XUE YU , LIU XIAO , LIN QIN WEN
Published: April 2023

Examination of living populations and herbarium specimens (including type material) of Rohdea yunnanensis and R. fargesii has revealed that the two species are morphologically very distinct from each other. We therefore reinstate the independent specific status of R. yunnanensis which has been placed in synonymy with R. fargesii var. fargesii. In former species, the blade margin denticulate; bract base branched or erose; perianth lobe also erose and denticulate; fruit conical and seed reniform, hilum oblique.
Gypsophila dumanii, Caryophyllaceae, a new species from Eastern Turkey
Authors: ARMAĞAN METİN , ÇAKIR-DİNDAR ECE GÖKÇE
Published: April 2023

Gypsophila dumanii, a new species belonging to the section Capituliformes, is here described and compared with the most similar G. olympica. A detailed description, original photographs, the current distribution area, and the conservation status of G. dumanii are given.
The first record of Trichotanypus Kieffer (Diptera, Chironomidae: Podonominae) in the Tibet Plateau of China, with description of a new species
Authors: LUO YIFAN , TANG HONGQU
Published: April 2023

Trichotanypus hani sp. nov. is described here based on the male, pupa and larva collected in the Tibet Plateau. The new species is characteristic by the elongated posterolateral heel of gonostylus in the male, bifid thoracic horn in the pupa and 8-10 mandible teeth in the larva. This is the first formal record of Trichotanypus from East Asia, indeed the first far-outside the circum-Arctic area.
A new species of planthopper in the genus Melanoliarus (Hemiptera: Auchenorrhyncha: Fulgoroidea: Cixiidae) from coconut palms (Cocos nucifera) in Trinidad
Authors: MYRIE WAYNE , BEEKHAM ALBADA , BAKSH AMEL , PARRIS JULIA , SHAH FAYAZ , BARTLETT CHARLES R. , HELMICK ERICKA E. , HENDRIX SOLOMON , BAHDER BRIAN W.
Published: April 2023

During a survey in Trinidad and Grenada for putative vectors of palm lethal decline phytoplasmas, three species of planthopper in the genus Melanoliarus (Hemiptera, Cixiidae) were collected. Melanoliarus maidis was collected from coconut palms in Grenada, M. kindli was collected from grasses in a coconut plot in Trinidad and a new species of Melanoliarus was collected from coconut palms in Trinidad. Herein the novel taxon is described with supplementary molecular data for the cytochrome c oxidase subunit I (COI) gene, 18S rRNA gene, and histone 3 (H3) gene to support placement in the genus Melanoliarus in the strict sense.
The ant subgenus Campomyrma of the genus Polyrhachis Smith, 1857 (Hymenoptera, Formicidae, Formicinae) in Thailand and Laos, with descriptions of two new species
Authors: JAITRONG WEEYAWAT , YAMANE SEIKI , SAMUNG YUDTHANA , NOON-ANANT NAWEE
Published: April 2023

The subgenus Campomyrma Wheeler, 1911 of the genus Polyrhachis Smith, 1758 in Thailand and Laos is reviewed. Four species are recognized, of which two are described and illustrated as new to science based on the worker and dealate queen under the names Polyrhachis quadrispinosa Jaitrong & Noon-anant, sp. nov. (found in a dead twig on a rubber tree) and P. lao Jaitrong & Yamane, sp. nov. (collected in dead wood). Polyrhachis sukarmani Kohout, 2007 is recorded for the first time from Thailand. A key to the Thai and Lao species of the subgenus based on the worker caste is given.
Indonesian Women’s Civil Service Leadership: Analysis of Career Progression Opportunity and Constraint
Authors: McLaren Helen , Patmisari Emi , Hamiduzzaman Mohammad , Star Cassandra , Widianingsih Ida
Published: April 2023

Women in Indonesia’s civil service ( n = 320) were surveyed about their career advancement. Analysis of variance identified differences in career progression, and post-hoc comparisons were tested using Fisher’s Least Significant Difference method. We found that family support and interpersonal relationships, paired with superior education to men, were critical to women’s successful leadership progression, especially through the echelon ranks. Qualitative results suggest that interpretations of hadith outweighed more contemporary textual readings, which required strategic maneuvering if women wanted to advance. This is because women’s own career aspirations required their ongoing loyalty to men and strategic maneuvering among filial, societal, and organizational constraints.
Discovery of the mechanism of n-propylparaben-promoting the proliferation of human breast adenocarcinoma cells by activating human estrogen receptors via metabolomics analysis
Authors: Chen Yunxia , Zhao Chan , Zheng Jun , Su Ning , Ji Hainan
Published: April 2023

Background

N-propylparaben (PP), a type of paraben, is commonly used as a preservative or antibacterial agent in daily chemicals, medicine, food, cosmetics, feed, and various industrial preservatives. Although PP promotes the growth of human breast adenocarcinoma (MCF-7) cells by activating the human estrogen receptor (ER), the mechanism responsible for this type of programmed cell proliferation is poorly understood.

Objective

To clarify the effect of PP on cell metabolic function and the potential molecular mechanism of PP induced MCF-7 cell proliferation from a new perspective.

Methods

To use high-resolution mass spectrometry-based metabolomics combined with bioinformatics analysis to analyze the molecular mechanism.

Results

The results illustrated that differential endogenous compounds related to the effects of PP on cell metabolic functions were detected. PP was found to promote glycolysis in MCF-7 cells and enhance the tricarboxylic acid cycle (TCA cycle) in mitochondria, thus improving the energy supply to these tumor cells for metabolic function and promotion of rapid proliferation. Moreover, we found that PP promoted cell proliferation by affecting the mitogen-activated protein kinase (MAPK) signaling pathway of MCF-7 cells.

Conclusion

Our results revealed the molecular mechanism of low concentration PP promoting MCF-7 cell proliferation by activating ER.