bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 221: Challenging the Norm: Large Stent Retrievers Show No Disadvantage in Medium Vessel Occlusions
Authors: Miller S. , Sy S. , Saei H. , Georgiadis A. , Tekle W. , Hassan A.
Published: January 2025

Background

Mechanical thrombectomy has become widely used in order to treat patients with ischemic stroke. While studies have examined the effect of stent retriever size in various cerebral vessels, the efficacy of differently sized stent retrievers for mechanical thrombectomy in M2 segment middle cerebral artery (MCA) occlusions is as of yet unknown. Understanding the efficacy of differently sized stent retrievers could lead to better outcomes for affected patients, therefore this retrospective study examines 3mm, 4mm, and 6mm stent retrievers in order to determine how size affects patient outcomes.

Methods

Data collected from M2 MCA strokes in a comprehensive stroke center was retrospectively analyzed and multivariable analysis performed. Patient outcomes were quantified using NIHSS 24 hours post procedure and modified Rankin score (mRS) at discharge and after 90 days. Successful outcomes were defined as an NIHSS score of less than 10 and an mRS score less than 3. First pass success rate and final TICI scores of 3 were used to quantify successful recanalization while noting the incidence of complications such as symptomatic intracranial hemorrhage. Time from puncture to recanalization was also collected to give an idea of the difficulty of the procedure. Variables were compared using Chi Square, ANOVA and Kruskal Wallis tests, with subgroup analysis performed to further investigate between group differences as needed.

Results

A total of 139 patients were included who underwent thrombectomy with stent retrievers sized 3mm (n=23), 4mm, (n=56), and 6mm (n=60). No significant between group difference was noted in baseline demographics, clinical characteristics, 24h NIHSS (p=0.83), 24h NIHSS <10 (0.2), mRS at discharge (p=0.14), mRS at 90 days (p=0.07), time from puncture to recanalization (p=0.12), first pass success rate (p=0.98) and rate of final TICI 3 (p=0.21). All three sizes had similar rates of complication, with no significant difference in rates of death (p=0.46) or symptomatic intracranial hemorrhage (p=0.32). These findings were further supported by a multivariable regression model adjusting for baseline NIHSS and other relevant factors.

Discussion

This retrospective study failed to show a significant difference between differently sized stent retrievers in treating isolated M2 occlusion. This study was limited by its sample size andpotential unmeasured confounders such as variation in M2 occlusion severity. Further clinical trials are needed to determine whether the location or extent of the occlusion are important factors that might affect the efficacy of differently sized stent retrievers.
Abstract 293: Identifying risk factors for post‐operative seizure after chronic subdural hematoma treatment with craniotomy, burr hole evacuation or middle meningeal artery embolization.
Authors: Ranawaka K.
Published: January 2025

Objective

Post‐operative seizures can occur in 2.6% to 23% of patients with chronic subdural hematomas (cSDH). Hematoma size, midline shift, worse clinical status at admission, and craniotomy with membranectomy have been described as risk factors for its development; however, the impact of middle meningeal artery embolization (MMAe) remains unexplored. This retrospective study aims to determine post‐operative seizure rates in cSDH patients treated with MMAe and compare them with those undergoing craniotomy and burr hole evacuation.

Methods

A bi‐institutional retrospective review of 592 cSDH treated surgically and endovascularly from 2017 to 2021 was conducted. Patient, hematoma, and procedural characteristics were compared among interventions using Fisher exact tests, t‐tests, and ANOVA. Multivariate logistic regression was employed to compare the relationship of post‐operative seizures with the type of treatment, adjusting for sex, age, subdural SDH thickness, midline shift, pre‐operative GCS score, and prophylactic AED use. Secondary outcomes evaluated included complications, additional drainage, and length of hospitalization.

Results

Post‐operative seizure rates were 3.1% for burr hole evacuation, 2.6% for burr hole evacuation with MMAe, 15.3% for craniotomy, 11.1% for craniotomy with MMAe, and 6.7% for MMAe alone. Multivariate logistic regression revealed lower seizure rates in patients undergoing burr hole evacuation with or without MMAe compared to those with MMAe alone (p=0.007, OR 0.18, 95% CI 0.05‐0.62). Craniotomy with or without subsequent MMAe had a higher risk of post‐operative seizure compared to burr hole drainage with or without MMAe (p=0.0002, OR 5.66, 95% CI 2.28‐14.04). Overall post‐operative complications were lower in MMAe alone compared to burr hole drainage alone (P=0.01, OR 0.35, 95% CI 0.15‐0.79).

Conclusion

Burr hole evacuation demonstrated the lowest post‐operative seizure rates in cSDH patients, followed by MMAe alone and then craniotomy, and this association was significant after controlling for confounders.
Abstract 322: Localized Injection Of Lidocaine And Glucocorticoid For Headache Treatment (LIGHT): Interim Phase 1 Study Safety Analysis
Authors: Koneru M. , Shaikh H. A. , Khalife J. , Patel P. D. , Syrow L. , Thomas A. J. , Jovin T. G. , Tonetti D. A.
Published: January 2025

Introduction/Purpose

Treatment‐refractory migraine is a challenging clinical condition. Failure to adequately control symptoms under standard therapy causes significant pain burden, migraine‐related disability, and impaired quality of life. New approaches to refractory migraine treatment may have potential to improve patient outcomes. The objective is to characterize the safety of a new endovascular approach to refractory migraine treatment.

Materials/Methods

A non‐randomized, open‐label phase 1 clinical trial for the injection of lidocaine (40mg) and methylprednisolone (20mg) into the middle meningeal arteries bilaterally is in progress. Patients receive the study treatment, and are evaluated at 1 week, 6 week, and 3 month follow‐up visits. Incidence of adverse events were ascertained and classified per severity and relatedness to the study treatment. An interim descriptive analysis was conducted on patients enrolled to date on the incidence of safety events.

Results

Of the 8 patients enrolled thus far, 62.5% (5/8) completed 3‐month follow‐up. Most patients were able to be discharged within less than 1 day of treatment. During the study duration, a total of 8 potential adverse events were ascertained; 3 (37.5%) events were unrelated to the study treatment or migraines, and 3 (3.75%) events were recurrence of migraine symptoms. Of the two adverse events possibly related to the study intervention; one patient had self‐resolving mild dizziness and blurry vision after the procedure, and one patient had temporary facial paralysis, presenting as a facial droop, lasting less than 1 hour after the procedure. The temporary facial droop was hypothesized to have occurred due to injection of lidocaine very proximally in this patient, which may have caused reflux and migration of lidocaine to branches supplying the trigeminal ganglion, resulting in a transient trigeminal nerve palsy. There were no strokes, access site issues, or mortalities in any enrolled patients.

Conclusion

Our interim safety analysis demonstrates favorable tolerability and safety of this investigational treatment. Endovascular injection of lidocaine and methylprednisolone demonstrates potential to be a safe approach to refractory migraine treatments. Additional data following completion of enrollment is necessary to ascertain the full safety profile of this treatment.
Abstract 330: Morphologic Analysis of Ruptured Aneurysms: A Retrospective Study
Authors: Gong A. , Dang D. , Awan O. , Mugge L. , Meister M. , Fortes M. , Greenberg E. , Chandela S. , Vyas N. , Chitale A.
Published: January 2025

Background/Purpose:

Aneurysm size and morphology have been previously correlated with risk of spontaneous rupture. However, there is a lack of consensus regarding which morphological parameters are useful for this prediction. The purpose of this study is to assess the size and morphology of ruptured aneurysms in our retrospective cohort and compare these findings to previously cited parameters within the literature.

Materials and Methods:

Between 2021‐2023, 150 patients with subarachnoid hemorrhage secondary to ruptured aneurysms were admitted to our hospital. Two investigators reviewed 3‐dimensional angiograms of all aneurysms to evaluate for morphological parameters which have been previously shown to correlate with rupture in previous studies.

Results

The average diameter of aneurysm rupture was 6.4 ± 4.4mm. 71% of these aneurysms were less than 7mm. The most common location of rupture was the anterior communicating artery (32.6%) followed by the posterior communicating artery (21.7%). The most common morphology of ruptured aneurysms were single sac aneurysms with irregular margins (39.1%) and multilobulated aneurysms (39.1%). The average aspect ratio was 1.23 ± 0.47. Only 28.2% of our patients demonstrated an aspect ratio >1.5. The average size ratio was 3.2 ± 2.0. 63% of these patients demonstrated a size ratio >2. The average area ratio was 6.5 ± 6.5 with 93% of these patients having an area ratio >1.5. The average bottleneck ratio, neck to parent artery ratio and height to width ratio are 1.9 ± 0.93, 1.4 ± 0.7 and 1.23 ± 0.47 respectively.

Conclusions:

Aneurysm size may not be a good predictor of rupture as aneurysms less than 7mm commonly rupture. However, morphology may be a better predictor as aneurysms with irregular margins and multilobulated aneurysms were commonly seen in our cohort. Additionally, previously cited parameters such as size ratio > 2 and an area ratio > 1.5 may be better predictors of rupture compared to the commonly cited aspect ratio > 1.5.
Abstract 337: National Trends in Intervention Modality for Hospitalizations with Infectious Intracranial Aneurysms and Associated Outcomes
Authors: Dawod G. , Zhang C. , Kamel H. , Murthy S. , Parikh N. S. , Merkler A. E.
Published: January 2025

Introduction

Data regarding how to treat infectious intracranial aneurysms most effectively remains sparse. With growing utilization of endovascular therapy for cerebrovascular disease, we examined trends in endovascular versus neurosurgical treatment of infectious aneurysms and investigated the impact of treatment modality on patient outcomes.

Methods

Using data from the National Inpatient Sample from 2000 to 2019, we conducted a trends analysis on rates of treatment modalities among all hospitalizations with infective endocarditis with ruptured or unruptured cerebral aneurysms. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD‐9 and ICD‐10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in‐hospital mortality and discharge disposition.

Results

We identified 24,461 hospitalizations with an infectious intracranial aneurysm in the setting of infective endocarditis. The mean age was 56.0 years (SD, 17.8) and 61.8% were male. The overall rate of intervention was 5.8% (95% CI, 5.0‐6.5%), and this did not change over time (p=0.669). There was a significant increase in the rate of endovascular repair (APC=3.6%; 95% CI, 1.2%‐8.1%) and a significant decrease in the rate of open neurosurgical repair (APC= ‐5.4%; 95% CI, ‐8.1% to ‐3.5%). Treatment modality was not associated with in‐hospital mortality (p=0.698) or non‐home discharge disposition (p=0.897).

Conclusion

Although rates of infectious intracranial aneurysm intervention for infective endocarditis did not change, utilization of endovascular treatment increased while the use of open neurosurgical treatment decreased. Further directions include elucidating predictors of favorable outcomes for those undergoing intervention as well as the most beneficial timing for the procedure during hospitalization.
Abstract 352: Oral Cilostazol and High‐Dose Intravenous Albumin in Aneurysmal Subarachnoid Hemorrhage Patients with Refractory Cerebral Ischemia
Authors: Bhatti I. , Bains N. K. , Ngo M. , Gomez F. , Arora N. , Nattanmai P. , Siddiq F. , Gomez C. R. , Suarez J. I. , Qureshi A. I.
Published: January 2025

Background and Purpose

Cerebral ischemia associated with vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) requires a multifaceted approach. We report the use of the combination of enteral cilostazol and intravenous (IV) high‐dose albumin in aSAH patients with cerebral ischemia refractory to other accepted pharmacologic and endovascular treatments.

Materials and Methods

Three aSAH patients who developed cerebral ischemic symptoms despite treatment with oral nimodipine and endovascular measures (i.e., intraarterial vasodilators and balloon angioplasty) were treated with enteral cilostazol (200 mg/day) and one or more doses of IV (25%) albumin (1.25 g per kg over 8 hours). The patients were monitored by serial neurological examinations, transcranial Doppler imaging (TCDI) ultrasound, and computed tomographic angiography (CTA) and perfusion (CTP) scans.

Results

Three patients (ages 58, 67 and 56 years) developed symptomatic cerebral ischemia and vasospasm following an aSAH. Due to limited angiographic response to endovascular treatment, including intraarterial vasodilators with or without balloon angioplasty, IV (25%) albumin and enteral cilostazol were administered. CT angiogram and perfusion 2‐3 days post‐treatment demonstrated resolution of the perfusion deficits and angiographic vasospasm. Concurrently, TCDI demonstrated improved vasospasm and resolution of neurological deficits. None of the patients required any additional treatments for cerebral ischemia.

Conclusions

A combination of oral cilostazol and IV high dose (25%) albumin was associated with amelioration of angiographic vasospasm, reduction of tissue perfusion deficits, and clinical improvement of aSAH patients with severe refractory cerebral ischemia.
Abstract 371: Posterior Spinal Artery Territory Infarct Following Endovascular Basilar Artery Stenting For Basilar Artery Aneurysm: A Case Report
Authors: Ali A. , Ramachandran R. , Machinetc O. , Vulkanov V.
Published: January 2025

Introduction/Purpose

Posterior spinal artery infarcts are exceedingly rare due to high level of collateral circulation inthe spinal cord. Additionally thromboembolic phenomenon is a potential complication duringendovascular aneurysm repair via digital subtraction angiography (DSA). Hereby, we report acase of posterior spinal artery infarct following cerebral angiography and endovascular basilarartery pipeline embolization for basilar artery aneurysm. Our goal is to outline successfuldiagnosis and management of this rare event.

Materials and Methods

A single case report and literature review via PubMed

Results

Our patient is a 59‐year‐old female with a basilar artery aneurysm. Following treatment of anewly diagnosed unruptured 2.48mm x 2.22 mm proximal basilar artery aneurysm, adjacent toorigin of the right anterior inferior cerebellar artery (AICA) with a Pipeline Embolization Device(PED), she presented as bilateral dorsal cord syndrome. On exam, she had isolated findings ofloss of vibration and joint position sense in her feet and ankles and sensory ataxia, MRI of thecervical spine without contrast showed a small focus of increased T2/STIR signal intensity in thedorsal midline at the level of C2‐3, involving bilateral nuclei gracilis. There was no evidence ofdisc herniation or central canal stenosis. MRI brain without contrast was obtained to rule outbasilar artery perforator stroke given procedure's proximity to basilar perforators, which did notshow a stroke.According to literature, 28 cases with PSAS were identified in 22 articles, 12 cases due toatherosclerosis, 7 cases due to artery dissection and 3 cases of iatrogenic etiology. To ourknowledge, Vertebral artery dissection (VAD) and atherosclerosis were by far the most commonetiology identified in reported cases of Posterior Spinal Artery Syndrome (PSAS). We proposethat in our patient, the constellation of acute onset of symptoms, exam and MRI findings areconsistent with arterial thromboembolism following the PED procedure.

Conclusion

Although infrequently reported in literature, spinal cord infarct should be recognized as apotential complication of endovascular interventions for lesions of posterior circulation
Abstract 382: Racial and ethnic differences in risk factors, etiologies and outcomes in young patients with intracerebral hemorrhage
Authors: Vyas V. , Kherani D. , Dongarwar D. , Kondapalli S. , Shah E. , Seol H. , House K. , Norris D. , Sharrief A.
Published: January 2025

To evaluate racial and ethnic differences in risk factors, etiologies and outcomes in young patients with intracerebral hemorrhage (ICH).

Racial and ethnic disparities in risk factors, etiologies and outcomes for young patients with ischemic stroke (AIS) are well described. Less is known about racial and ethnic disparities for young patients presenting with ICH. As ICH is associated with higher short‐term and long‐term mortality than AIS and has a rising incidence, it is important to review disparities in its evaluation and management.

We identified patient aged 18‐50 from our stroke registry with non‐traumatic ICH from 10/2016 to 11/2019. Baseline characteristics were abstracted, and ICH risk factors, etiologies and outcomes were compared between racial and ethnic groups. Independent samples t‐test and chi‐squared test were utilized for continuous and categorical outcomes, respectively. All tests were two‐tailed and the error rate was set at 5%.

Among 619 patients in the study, 29% were non‐Hispanic White (NHW), 32% non‐Hispanic Black (NHB), 31% Hispanic (HIS), 5% Asian, and 4% other. HIS were least likely to be insured (51.9%) compared to NHB (66.7%) and NHW (71.2%). NHB were most likely to be single (54.4%) and living alone (20.5%). HIS were more likely not to not have a primary care provider (60.8%; p<0.01). NHB had a greater arrival systolic blood pressure (180.2 vs. 163.2, p<0.01) and diastolic blood pressure (103.9 vs 94.8, p<0.01), compared to NHW. Prior history of hypertension (69.7%) and diastolic dysfunction on ECHO (24.6%) was more prevalent in NHB, compared to NHW and HIS. NHB had the greatest incidence of moderate (17.4%) to severe (15.4%) left ventricle (LV) hypertrophy, and three times greater odds than NHW to have at least moderate LV hypertrophy. Hypertensive etiology for ICH was most prevalent in NHB (65.1%, p<0.01) compared to NHW (46.9%) and HIS (52.9%).

Although we did not find significant differences in measured outcomes, our study demonstrates underlying sociodemographic and clinical risk factors which may underlie racial and ethnic disparities for young patients with ICH.
Abstract 388: Real World Experience Using the Balt Carrier Delivery Catheter for Intracranial Access During Mechanical Thrombectomy
Authors: Snyder T. , Jankowitz B. , Scarpiello S. , Haimi J. , Zacharatos H. , Sussman E.
Published: January 2025

Introduction

Delivery catheters that reduce the ledge effect of aspiration catheters while maintaining a tapered atraumatic tip have recently become a focus for intracranial access during treatment of acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Most companies package their proprietary insert catheter with their own aspiration catheter. The Balt Carrier (The Balt Group, Montmorency, France) is the only separately packaged delivery catheter which comes in three sizes and is designed to safely and efficiently deliver the operator's aspiration catheter of choice to the face of the thrombus with or without the use of a wire. In this study, we share our experience using the Balt Carrier delivery catheter for patients undergoing MT for AIS.

Methods

We conducted a retrospective case series study of prospectively collected AIS patients undergoing MT at two comprehensive stroke centers. Patients were included in the study if Carrier was utilized to advance an aspiration catheter to the face of an intracranial thrombus. First pass was defined as the time at which the aspiration catheter engaged the clot. We defined successful recanalization as a reperfusion score of TICI 2b or greater. Carrier complications were defined as any vessel injury detected on angiogram during intervention or symptomatic hemorrhage detected on head CT with a change in NIHSS greater than 3 points.

Results

In nineteen patients, 4 ICA, 12 M1, 2 M2, and 1 basilar artery occlusion were targeted for MT. Four different 6F aspiration catheters were utilized ranging in ID from 0.070” to 0.071.” All three sizes of Carrier were utilized: 4 small, 13 medium, 2 large. The aspiration catheter successfully reached the target lesion in all cases (19/19) on first attempt. A wire was used in nine cases. Of those nine cases, 6 were physician preference and 3 required a wire because the Carrier tip atraumatically entered two fetal Pcomms and one posterior meningeal artery. The median puncture time to first pass and puncture time to successful reperfusion was 16 minutes and 25 minutes respectively. There were no complications.

Conclusion

The Balt Carrier delivery catheter was successful in delivering various aspiration catheters for intracranial access to the target occlusion with no complications. Reducing the ledge effect of various aspiration catheters during MT while maintaining an atraumatic tip may help safely expedite intracranial access with even larger catheters. More studies are needed to confirm the results of this small two center retrospective study.
Abstract 395: Retinal artery/arteriole occlusion risks after endovascular treatment for unruptured intracranial aneurysm
Authors: kim M.
Published: January 2025

Purpose

To evaluate the association between retinal artery/arteriole occlusion (RAO) and unruptured intracranial aneurysm (UIA).

Methods

Incident UIA patients from a nationwide cohort (n=253 240) were categorised into three groups based on subsequent treatment: observation (n=208 993), microsurgical clipping (n=14 168) and endovascular treatment (EVT) groups (n=30 079). The incidence and the incident time of RAO were analysed. HRs of RAO and associated risk factors were evaluated. Additionally, a hospital cohort comprising 2569 consecutive UIA patients treated at a tertiary hospital was analysed with detailed clinical information of UIAs.

Result

In the nationwide cohort analysis, the incidence of RAO was significantly higher in EVT group than in observation and clipping groups, especially within 60 days (early RAO (within 60 days): HR=4.00, 95%CI: 2.44 to 6.56); delayed RAO (after 60 days): HR=1.74, 95%CI: 1.13 to 2.68). Multivariable analysis showed that the presence of chronic kidney disease (p=0.009) and use of a balloon microcatheter during the procedure (p=0.013) were associated with a higher risk of RAO. In hospital cohort analysis, 11 (0.8%) cases of RAO occurred after EVT, whereas none occurred after microsurgical clipping (p<0.001). Patients with RAO were younger and received balloon microcatheters more frequently than their counterparts. Ten cases of RAO (90.9%) occurred in paraclinoid aneurysms, where EVT was preferred over microsurgical clipping.

Conclusion

Performing EVT for UIA may increase the risk of subsequent RAO. Care should be taken when treating paraclinoid aneurysms with balloon microcatheters.
Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study
Authors: Elrefaei A. , Pujara D. , Kleinig T. J. , Hassan A. E. , Portela P. C. , Ortega-Gutierrez S. , Abraham M. G. , Manning N. W. , Siegler J. E. , Goyal N. , Blackburn S. , Sitton C. W. , Wu T. Y. , Blasco J. , Sangha N. S. , Arenillas J. F. , Opaskar A. , McCullough-Hicks M. E. , Wallace A. , Cordato D. , Arthur A. S. , Grotta J. , Parsons M. W. , Ribo M. , Albers G. W. , Campbell B. C. , Sarraj A.
Published: January 2025

Introduction

Endovascular thrombectomy (EVT) is shown to be associated with better clinical outcomes even after 24 hours of stroke onset. However, how stroke severity affect this association has not been well‐established.

Methods

From SELECT LATE, a retrospective cohort study from 17 high volume EVT centers across US, Spain, Australia and New Zealand, patients were stratified based on median stroke severity (NIHSS ≤15 vs >15). The association of treatment arm and functional and safety outcomes was examined using appropriate regression models adjusted for confounders, with sensitivity analyses repeated using Inverse Probability of Treatment Weights (IPTW).

Results

Of 301 eligible patients, median age was 69 (59‐81) y and 50% participants were females. 159 (107 EVT, 52 MM) had NIHSS ≤15, whereas 142 (78 EVT, 64 MM) patients had NIHSS >15 at the time of presentation. As stroke severity increased, outcomes worsened in both overall (acOR: 0.93, 95% CI: 0.89‐0.97, p<0.001 for each point) and among patients receiving EVT (acOR: 0.94, 95% CI: 0.90‐0.99, p=0.021 for each point) – figure 1. EVT was associated with higher odds of functional independence in patients with NIHSS ≤15 (EVT: 53% vs MM: 18%, aOR: 3.56, 95% CI: 1.35‐9.43, p=0.011) – fig 2. Estimates of association also favored EVT in those with NIHSS >15 (EVT: 18% vs MM: 5%, aOR: 2.29, 95% CI: 0.43‐12.16, p=0.33), without significant heterogeneity (p‐interaction: 0.61). Similar results were also observed for ordinal shift in mRS and excellent outcome (mRS 0‐1) – table 1, and in sensitivity analyses using IPTW. Symptomatic ICH was also higher with EVT across both strata (NIHSS ≤15: EVT: 11% vs MM: 2%, aOR: 8.09, 95% CI: 0.63‐103.85, p=0.11 and NIHSS>15 – EVT: 10% vs MM: 2%, p=0.07).

Conclusions

Among patients presenting beyond 24 hours of last known well, outcomes worsened with increased stroke severity. However, estimates of association favored EVT in both lower and higher stroke severity strata, without significant heterogeneity. Further exploration of stroke severity and its effect of EVT outcomes and treatment effect is warranted.

Figure 1. Predicted probability of functional independence by NIHSS across EVT vs MM. As stroke severity increased, outcomes worsened in both EVT and MM arms.

Figure 2. Distribution of mRS scores at 90‐day follow‐up across NIHSS and treatment strata. EVT was associated with better functional outcomes across both NIHSS strata.

Table 1. EVT association with functional and safety outcomes across NIHSS strata.
Abstract 418: Targeted tirofiban use for endovascular treatment of ischemic stroke
Authors: Kang J.
Published: January 2025

Purpose

For complex thrombus events of intracranial atherosclerotic occlusion, tirofiban, a glycoprotein IIb/IIIa antagonist, could increase the success of endovascular treatment (EVT). This study investigated the applicability of this targeted tirofiban use.

Methods

Stroke patients undergoing EVT were enrolled with the approval of the prospective use of tirofiban in ongoing thrombosis, re‐occlusion, and in‐stent thrombus formation. The presumptive mechanism of cerebral occlusions was divided into atherosclerotic and other etiologies. Then, the efficacy and safety outcomes of target tirofiban use were evaluated according to the location and mechanism of occlusion.

Results

Among those with symptomatic intracranial occlusion, 41.8% had atherosclerotic occlusion (ICAO), while 56.2% had atherosclerotic occlusions in the case of extracranial vessels. Tirofiban use rates were 24.5% of ICAO and 20.6% of extracranial atherosclerotic occlusions, while 6.8% of non‐atherosclerotic occlusions. In ICAO, tirofiban use presented a similar successful recanalization rate compared to those who did not use tirofiban (88.9% versus 86.1%), also in symptomatic intracerebral hemorrhage (2.4% versus 1.9%, P=0.81) and stroke recurrence (22.2% versus 13.3%, P=0.11). Multivariate analyses showed that ICAO, with the reference of non‐atherosclerotic occlusion, had no different effect on the successful recanalization (adjusted odds ratio, 0.70; 95% confidence interval, 0.40 ‐ 1.23), stroke recurrence (0.97; 0.55 ‐ 1.65), and SHT (0.51; 0.15 ‐ 1.36) when tirofiban use was taken into consideration.

Conclusion

Targeted tirofiban use may enhance the chance of recanalization in atherosclerotic occlusion without increasing the risk of safety concerns.
Abstract 445: Transradial Versus Transfemoral Access in Diagnostic Cerebral Angiography: A Comprehensive Systematic Review and Meta‐analysis of Clinical Outcomes and Complications
Authors: Hamouda A.
Published: January 2025

Background

Diagnostic Cerebral Angiography (CA) is a relatively common procedure that provides detailed evaluation of the brain's blood vessels. With the growing preference for Transradial artery (TRA) access over Transfemoral artery (TFA) access, our review aims to compare clinical outcomes and complications associated with these two approaches.

Methods

We carried out a systematic review using PubMed, Embase, Web of Science, Scopus databases, following the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. Inclusion was limited to studies that exclusively compared TRA versus TFA approaches for cerebral diagnostic purposes.

Results

Our study included 27 studies encompassing a total of 12,806 patients. The TRA arm comprised 6,284 patients with a median age of 57.9 years (range: 13.6‐78.2), and 46.4% were male (range: 27.8%‐82%). The TFA arm included 6,522 patients with a median age of 59.0 years (range: 13.0‐79.3), and 44.8% were male (range: 20.7%‐78.4%). Our analysis revealed that the TFA group had a higher successful Cerebral Angiography (CA) rate (OR= 0.62, CI [0.40; 0.95], p=0.03), and lower crossover rate (OR: 2.85, CI [1.39; 5.84], p<0.01) compared to the TRA group. However, the TRA group demonstrated a significantly lower rate of total complications (OR: 0.52, CI [0.33; 0.82], p<0.01, I
2
=59%, p< 0.001) and shorter hospital length of stay (LOS) in hours ([MD]: ‐33.25, CI [‐51.40; ‐15.11], p< 0.001) compared to the TFA group. There were no significant differences between groups in terms of puncture time, procedural time, mean contrast dose, radiation exposure, and radiation dose.

Conclusion

The choice of access site for cerebral angiography depends on various factors, including facility protocol, provider preference, vascular anatomy, and patient preferences. Our review highlighted the superiority of the transfemoral artery approach in terms of success rates and lower crossover rates. However, transradial artery access may be preferred due to its association with lower complication rates and shorter hospital stays, aligning with patient‐centered outcomes.
Abstract 454: Use of Intravenous Heparin For Patients With Acute Ischemic Stroke Due to Subocclusive Intracranial Thrombus
Authors: Rodriguez W. , Kaur G. , Ganev Y. , Karickal J. , Chennu N. , Christopher K. , Linares G. , Wang F.
Published: January 2025

Background

Sub‐occlusive thrombus in an intracranial artery is a rare cause of acute ischemic stroke, and there is limited data regards to its acute management. Historically, those patients had been treated with heparin drip and then transitioned to oral anticoagulation. We aim to analyze the effect of intravenous heparin in patients with acute ischemic stroke due to sub‐occlusive intracranial thrombus.

Method

We retrospectively reviewed patients with a diagnosis of acute ischemic stroke from 2019‐2023. We selected patients who met the inclusion criteria: 1) diagnosis of sub‐occlusive thrombus by neuroradiologist using Computed Tomography angiography (CTA), 2) acute treatment with heparin drip. We identified 18 patients with the diagnosis of sub‐occlusive thrombus. Good outcome at 90 days was defined as modified Rankin Score of ≤2, resolution of sub‐occlusive thrombus was evaluated with CTA at 6 months.

Results

Out of the 18 patients, 50% were females. The mean age was 62.7 years. The median duration of the heparin drip was 42.5 hours. The median NIHSS score on admission was 6. Of the 14 patients with a 90‐day mRS, 7 (50%) had a good outcome (mRS ≤2). In our study, 4 patients (22.2%) had recurrent ischemic stroke, one patient had a systemic hemorrhage, and two patients had an intracranial hemorrhage 10 days after the initial hospitalization. Thirteen patients (72.2%) were transitioned to apixaban, two patients (11.1%) to warfarin, one patient to rivaroxaban. Two were not able to transition secondary to mortality. Upon follow‐up, 39% (n=7) had resolution of thrombus on repeat imaging, 11 (61%) did not undergo repeat imaging.

Conclusion

The use of heparin drip in acute ischemic strokes associated with intracranial sub‐occlusive thrombus could be an effective and safe treatment. However, in our study, it was not a predictor of good outcome at 90 days. Further studies with bigger samples are needed to evaluate the effectiveness of intravenous heparin in those patients.
Larviculture of the freshwater prawn Macrobrachium spp. Spence Bate, 1868 (Decapoda, Palaemonidae): a comprehensive review
Authors: Taguemount Riyad
Published: January 2025

The freshwater prawns of the genus Macrobrachium Spence Bate, 1868, hold major potential for sustainable aquaculture intensification and diversification. Beyond the dominant giant river prawn M. rosenbergii (De Man, 1879), successful larviculture and domestication of additional species could boost production. However, inconsistent hatchery results have hampered the wider application and commercialization of cultivation protocols. This comprehensive review aims to analyse past larviculture research efforts to advance Macrobrachium farming practices. Several published studies documenting larviculture experiments on various Macrobrachium taxa are examined. Larval developmental patterns, optimal rearing salinity and temperature ranges, stocking densities, feeding regimes, and reported survival rates are compared within and among species. Significant inter- and intraspecific variability is apparent, highlighting the need for species-specific approaches. Past studies have applied generalized techniques derived from M. rosenbergii with varying success, further motivating the analytical review of findings. Key bottlenecks impeding consistent hatchery seed production are identified. In particular, knowledge gaps regarding larval nutritional needs, biofouling prevention, and weaning method optimization present ongoing challenges. By reconciling contradictory results and emphasizing biological nuances, this review distinguishes priorities for strengthening protocol development. Priorities include standardizing assessments, disseminating optimized techniques tailored to particular target species, and outlining future research directions. With reliable hatchery production, additional Macrobrachium species could be incorporated into polyculture or mono-crop systems, supporting livelihood diversification and sustainable intensification of aquaculture.
Women’s Leadership and Service in the Catholic Church in Africa: a Case Study of Women Catechists in the Tamale Ecclesiastical Province of Ghana
Authors: Dassah Emmanuel Zumabakuro , Nonterah Nora K.
Published: January 2025

This research investigates the experiences of female catechists within the Catholic Church in the Tamale Ecclesiastical Province of Ghana, highlighting the challenges encountered within a predominantly patriarchal and clerical institution. Unstructured, in-depth interviews were conducted with female catechists, women aspiring to engage in catechetical formation, and male catechists. This qualitative study shares light on the complexities inherent in their roles and the systemic barriers that impede participation. The findings indicate that patriarchal norms, limited access to education, and the pervasive impact of clericalism significantly hinders women’s participation in ministry. Clericalism, in particular, perpetuates gender biases by centralizing authority within a largely male clergy, thereby restricting women’s access to leadership positions. Despite these challenges, instances of resilience and optimism among female catechists were also identified, alongside recent initiatives by church leaders designed to promote greater inclusivity. This research emphasizes the need for collaborative strategies to eliminate clerical and patriarchal systems, promoting a more egalitarian church that fully recognizes and values the contributions of both men and women.
Antibacterial activity of fat from black soldier fly (Hermetia illucens) larvae against antibiotic resistant Campylobacter spp. strains
Authors: Silvan J.M. , Hurtado-Ribeira R. , Martin D. , Martinez-Rodriguez A.J.
Published: January 2025

In this study, the antibacterial effect of fats derived from black soldier fly larvae (BSFL) were evaluated against various antibiotic-resistant strains of Campylobacter jejuni and Campylobacter coli. BSFL fats with different free fatty acids (FFAs) contents were obtained based on the larvae’s processing conditions. Initially, antibiotic susceptibility testing revealed that all Campylobacter strains were resistant to at least one antibiotic, with two strains classified as multidrug-resistant. The antibacterial activity of the BSFL fats was directly correlated with their FFAs content. Fats obtained through freeze-drying and defatting via supercritical fluid extraction (SFE) exhibited the strongest antibacterial effects against Campylobacter spp., reducing bacterial growth by 4.1 to 5.6 log CFU/mL in C. jejuni and demonstrating bactericidal activity (reducing bacterial growth >6 log CFU/mL) against all C. coli strains. An analysis of the individual contributions of FFAs in BSFL fat revealed that lauric and linoleic acids were bactericidal (reducing bacterial growth >8 log CFU/mL), completely inhibiting the growth of C. jejuni and C. coli strains, while myristic, palmitic, and oleic acids showed no effect on Campylobacter growth. These findings suggest that BSFL fat, which has been shown to enhance broiler growth, could also serve as an effective strategy to combat Campylobacter spp. contamination in the food chain.
The green lacewing genus Kuwayamachrysa Tsukaguchi & Tago, 2018 from China, with description of two new species based on morphological and molecular evidence
Authors: WANG MAOZHI , LAI YAN , LIU XINGYUE
Published: January 2025

Previously, Kuwayamachrysa Tsukaguchi & Tago, 2018 (Neuroptera: Chrysopidae: Chrysopinae) was known as a monotypic green lacewing genus from the Palearctic region. Here we described two new species of Kuwayamachrysa from China: Kuwayamachrysa wujiaoensis sp. nov. and Kuwayamachrysa neptuna sp. nov. Also, Mallada qinlingensis Yang, 1989, currently named as Apertochrysa qinlingensis (Yang, 1989), is recognized as a junior synonym of Kuwayamachrysa kichijoi (Kuwayama, 1936). A key to the Kuwayamachrysa species is provided. The standard DNA barcoding region of cytochrome c oxidase subunit I (COI) of these species was sequenced for the verification of the new species.
Learning Statistics with jamovi
Authors: Navarro Danielle , Foxcroft David
Published: January 2025

Based on Danielle Navarro’s widely acclaimed and prize-winning book Learning Statistics with R, this elegantly designed textbook offers undergraduate students a thorough and accessible introduction to jamovi, as well as how to get to grips with statistics and data manipulation.

Lucid and easy to understand, Learning Statistics with jamovi covers the analysis of contingency tables, t-tests, correlation, regression, ANOVA and factor analysis, while also giving students a firm grounding in descriptive statistics and graphing. It includes learning aids for applying statistical principles using the jamovi interface, as well as embedded data files to accompany the book, and comprehensive chapters on probability theory, sampling and estimation, and null hypothesis testing.

Freely available in open access, Learning Statistics with jamovi is an ideal introduction for undergraduate and postgraduate students of psychology, as well as behavioural and health science students and anyone who needs to understand and use statistical analysis in their work.
4. Descriptive statistics
Authors: Navarro Danielle , Foxcroft David
Published: January 2025

In this chapter, we delve into the fundamentals of descriptive statistics, a crucial step in data analysis that involves summarising datasets into comprehensible and concise forms. The chapter begins by exploring the rationale behind descriptive statistics and introduces a real-world dataset, afl.margins, derived from the 2010 Australian Football League season. Through practical illustrations using jamovi, readers learn about various measures of central tendency, including the mean, median, and mode, and their respective applications. The chapter highlights how these measures offer insights into the "typical" values within data, while also explaining when and why each measure is appropriate depending on the data scale. Additionally, the text underscores the significance of visual aids like histograms to enhance the interpretability of numerical summaries.

Further, the chapter explores measures of variability, such as range, interquartile range, variance, and standard deviation, each serving to describe the spread or dispersion of data. Detailed explanations and examples clarify their computation, interpretation, and relevance, emphasising practical considerations like robustness to outliers. The discussion extends to skewness and kurtosis, offering insights into asymmetry and tail thickness in data distributions. Readers are also introduced to z-scores, enabling standardised comparisons across variables. The chapter concludes with guidance on calculating descriptive statistics for subgroups and summarises the key concepts. This foundational knowledge sets the stage for the subsequent chapter on data visualisation, equipping readers with essential tools for effective data analysis.
5. Drawing graphs
Authors: Navarro Danielle , Foxcroft David
Published: January 2025

This chapter explores the fundamental role of data visualisation in the analytical process, highlighting its dual purposes: as a tool for presenting information in an accessible and visually compelling manner, and as an aid to enhance understanding of the data during analysis. Beginning with an iconic example, the chapter revisits John Snow’s 1854 cholera map, illustrating the transformative power of effective visualisation in uncovering insights and driving impactful decisions. The discussion then transitions to practical guidance on creating graphs using the software jamovi, with an emphasis on simplicity and clarity. While jamovi offers robust default plotting capabilities, the chapter acknowledges its limitations for advanced customisation, directing readers towards tools like ggplot2 in R for more complex needs.

The chapter systematically introduces key visualisation types—histograms, boxplots, violin plots, and bar graphs—outlining their specific applications, strengths, and limitations. Detailed, step-by-step instructions are provided for generating each type of graph in jamovi, including tips for filtering data and refining visual outputs. The importance of interpreting these plots to detect patterns, distributions, or outliers is emphasised, alongside practical advice on exporting high-quality images for reports or presentations. Ultimately, the chapter underscores the centrality of visualisation in data analysis, offering readers both foundational knowledge and practical skills to effectively “show the data” and derive meaningful insights.
13. Comparing several means (one-way ANOVA)
Authors: Navarro Danielle , Foxcroft David
Published: January 2025

This chapter delves into the foundational principles and applications of one-way ANOVA (Analysis of Variance), a pivotal statistical tool introduced by Sir Ronald Fisher in the early 20th century. Despite its name suggesting a focus on variances, ANOVA primarily investigates differences in means across multiple groups. Through the use of a clinical trial example involving three drugs—placebo, Anxifree, and Joyzepam—the chapter illustrates the mechanics of one-way ANOVA, highlighting its ability to discern whether observed differences in outcomes, such as mood improvements, are statistically significant. Readers are guided through the calculations underpinning the F-statistic, including between-group and within-group variability, and how these components inform hypothesis testing. The chapter also explores the practicalities of conducting ANOVA using jamovi, ensuring accessibility for researchers and students.

Building on the core functionality of one-way ANOVA, the chapter addresses essential topics like effect size computation, post hoc testing for multiple comparisons, and adjustments for violations of assumptions. Key assumptions such as homogeneity of variance, normality, and independence are discussed alongside diagnostic methods and remedies, such as the Welch ANOVA and non-parametric alternatives like the Kruskal-Wallis test. For designs involving repeated measures, the chapter introduces the Friedman test. Emphasis is placed on the practical interpretation of results, including effect sizes and adjusted p-values, fostering a comprehensive understanding of ANOVA's capabilities and limitations in real-world research contexts.
Development of the next-generation air quality prediction system in the Unified Forecast System framework: Enhancing predictability of wildfire air quality impacts
Authors: Huang Jianping , Stajner Ivanka , Montuoro Raffaele , Yang Fanglin , Wang Kai , Huang Ho-Chun , Jeon Chan-Hoo , Curtis Brian , McQueen Jeff , Liu Haixia , Baker Barry , Tong Daniel , Tang Youhua , Campbell Patrick , Grell Georg , Frost Gregory , Schwantes Rebecca , Wang Siyuan , Kondragunta Shobha , Li Fangjun , Jung Youngsun
Published: January 2025

The National Oceanic and Atmospheric Administration (NOAA) has developed an advanced regional air quality prediction system (AQPS) within the Unified Forecast System (UFS) framework to improve representations of wildfire emissions and their impacts on air quality predictions. This innovative system integrates the Environmental Protection Agency’s (EPA) Community Multiscale Air Quality (CMAQ) model as a column chemistry model with the UFS-based atmospheric model, operating in an online mode. The calculation of wildfire gas and particulate emissions relies on satellite-derived fire products, high-resolution Regional Hourly Advanced Baseline Imager (ABI) and Visible Infrared Imaging Radiometer Suite (VIIRS) Emissions (RAVE).

A period in June and July 2023 with Quebec Canadian wildfires, which severely impacted air quality in the United States (US), was chosen as a case study to assess the predictive capability of the UFS-AQM system. The UFS-AQM predictions of fine particulate (PM2.5) and ozone (O3) were evaluated against AirNow observations from June 15 to July 14, 2023. The results indicate a substantial improvement in PM2.5 predictions when compared to the previous operational forecast. Meanwhile, the system demonstrates a strong ability of predicting O3 exceedance events during the dissipation phase of the wildfire. Furthermore, the online system shows more realistic predictions of aerosol optical depth (AOD) as compared to the previous operational forecast and satellite retrieval data. Finally, this study outlines a plan for further advancing a comprehensive regional AQPS at NOAA.