bluuebunny/crossref_metadata_2025 huggingface dataset:
O ser-mulher na narrativa seriada mexicana Juana Inés: entre a lógica do empoderamento individual e a construção de identificações latinas
Authors: Scabin Nara Lya Cabral , Budag Fernanda Elouise
Published: January 2025

Based on the precept of the dialogical constitution of discourse, we turn to the television miniseries Juana Inés, which portrays the life of the 17th-century Mexican nun and writer to understand which meanings of feminism the production articulates or, better yet, examine the dialogues the miniseries established regarding meanings of feminism. Throughout the seven chapters that make up the miniseries, being a woman plays a central role in the construction of the narrative and the representation of its protagonist. In this context, we note the crossing of an affirmative perspective and the incorporation of the logic of individual empowerment in what is known as “media feminisms” without, however, emptying a political potential and another for Latin identification.
Abstract 083: Comparison of Antiplatelets and Anticoagulants for Secondary Stroke Prevention in Ischemic Stroke Patients with Cancer: A Systematic Review and Meta Analysis
Authors: Shakir M. , Ahmed M. , Khan S. , Irshad H. Atif , Salman R. , Ali E. Abid , Qureshi A. I.
Published: January 2025

Background

Ischemic stroke patients with underlying cancer remain at high risk for subsequent stroke but the appropriate choice for secondary stroke prevention is not known.

Objective

To compare the efficacy and safety of antiplatelets and anticoagulants for secondary stroke prevention ischemic stroke patients with underlying cancer.

Methods

We conducted a systematic review of the literature using MEDLINE (via PubMed), the Cochrane Library, and Scopus, and included all relevant studies published from inception to June 2024. Articles were screened according to predefined eligibility criteria, and relevant studies were assessed for quality using the validated Newcastle‐Ottawa Scale. The odds ratio (OR) with 95% confidence intervals (CI) were calculated using random effect model (meta package in R (version 4.1.2, R Foundation for Statistical Computing).

Results

A total of 8 studies were included in the final analysis with cumulative sample size of 4,588 participants: 2,203 (48%) in the antiplatelet group and 2,128 (46%) in the anticoagulant group. The mean age of the patients was 69.44 ± 10.02 years, with 59.7% were male and 93.6% had solid tumors. A pool analysis of three studies showed a 13 % of overall complication rate for anti‐platelet therapy (95% CI: 5‐35%, P<0.01). Anti‐coagulant therapy had a 8% of overall complication rate across three studies (95% CI: 2‐22%, P<0.01). No significant difference in overall complication odds was found between the therapies (OR 0.83, 95% CI 0.34‐2.01, p = 0.26). Anti‐platelet therapy showed a trend towards lower recurrent stroke odds (OR = 0.6441, p = 0.2203). Gastrointestinal bleeding odds were higher with anti‐platelets (OR = 1.7425, p = 0.6367), and ICH odds were lower (OR = 0.7238, p = 0.2367). Major bleeding odds showed no significant difference (OR = 0.66, 95% CI 0.36‐1.22, p = 0.35), but anti‐platelets significantly reduced death odds (OR = 0.7203, 95% CI 0.54‐0.95, p = 0.022).

Conclusion

There were no differences in the rates of recurrent ischemic stroke or hemorrhagic events in ischemic stroke patients with underlying cancer treated with antiplatelets or anticoagulants. There was lower mortality observed in patients treated with antiplatelets.
Abstract 092: Efficacy and Safety of Transcarotid Approach for Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Study with Systematic Review and Meta‐Analysis
Authors: Ezzeldin M. , Soliman Y. , Hukamdad M. , Ezzeldin R. , Tatapudi S. V. , Bushnaq S. , Hassaballa H. , Zwein M. , Jaikumar V. , Lim J. , Dolia J. N. , Martins P. N. , Haussen D. C. , Grossberg J. A. , Pabaney A. A. , Jumaa M. A. , Alhajala H. , Siddiqui A. H.
Published: January 2025

Background

Anatomical or technical challenges in certain patients during mechanical thrombectomy (MT) can render recanalization through distal access sites impossible. The transcarotid approach is a valuable rescue technique. Despite its potential, this approach is infrequently employed in clinical practice due to concerns about serious complications or operator unfamiliarity. As a result, the safety and efficacy of the transcarotid approach in MT remain insufficiently characterized.

Methods

We conducted a multicenter two‐arm case series comparing cases of acute ischemic stroke (AIS) with large vessel occlusion (LVO) that were managed with MT via the transcarotid approach to medical management alone after failed MT. We included our results in a systematic review and single‐arm meta‐analysis of the literature investigating the transcarotid approach for MT by pooling our cases with data from existing literature. The pooled data were reported as proportions or means with 95% confidence intervals (CI). Subsequently, we performed logistic and linear regressions using individual patient data from all studies to identify predictors of outcomes such as mortality and complications.

Results

Nine studies were included in this systematic review and meta‐analysis. MT with the transcarotid approach had a 31% complication rate (95% CI 0.23; 0.40), 37% mortality rate at 90 days (95% CI 0.27; 0.49), and 86% reperfusion rate (95% CI 0.79; 0.91). 38% of cases had mRS 0‐3 at 90 days (95% CI 0.23; 0.56). Factors predicting complications were tPA use (OR 3.35, 95% CI 1.37; 8.24). Factors predicting mortality at 90 days were higher age (OR 1.04, 95% CI 1.01; 1.09), higher NIHSS at presentation (OR 1.10, 95% CI 1.01; 1.19) lower ASPECTS score (OR 0.70, 95% CI 0.47; 0.98), and higher mRS at discharge (OR 28, 95% CI 3.72; 211.3). Recanalization was associated with lower odds of mortality at 90 days (OR 0.30, 95% CI 0.08; 0.95).

Conclusion

MT using the transcarotid approach is an effective rescue strategy for recanalization in the setting of failed femoral and radial access, with promising complication and mortality rates and excellent reperfusion rate. The proportion of transcarotid cases achieving mRS 0‐3 at 90 days is comparable to the outcomes reported for traditional femoral access.
Abstract 109: Impact of Hospital Readmission Site on Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy: A Nationwide Analysis
Authors: Wu M. , Shu L. , Mawad M. , Nguyen T. , Siegler J. , Luo A. , Guo X. , Strelecky L. , Yaghi S.
Published: January 2025

Introduction

Mechanical thrombectomy (MT) significantly improves outcomes in patients with acute ischemic stroke due to large vessel occlusion. While MT has been widely adopted, there is limited understanding of how the site of hospital readmission after MT influences patient outcomes. Specifically, it remains unclear whether readmission to the original hospital where MT was performed (the “index hospital”) offers advantages over readmission to a different hospital (“non‐index hospital”). Addressing this gap is crucial for optimizing post‐MT care and improving long‐term outcomes for stroke patients.

Method

We conducted a retrospective cohort analysis using data from the Nationwide Readmissions Database, focusing on acute ischemic stroke patients who underwent MT between 2016 and 2019. Multivariable Cox regression and Fine and Gray competing risks models were used to assess the impact of readmission site on patient outcomes, including mortality and the likelihood of discharge to home. Interaction and subgroup analyses were performed to explore the influence of previous discharge status, readmission hospital size and MT volume, and readmission diagnosis on these outcomes.

Result

The analysis included 18,330 patients readmitted within 90 days post‐MT, with 63.7% readmitted to index hospitals and 36.3% to non‐index hospitals. Readmission to the index hospital was not significantly associated with reduced mortality (HR = 1.05, 95% CI 0.86‐1.29, p = 0.619) but was linked to a higher likelihood of discharge to home (Subdistributed HR = 1.26, 95% CI 1.16‐1.36, p < 0.001). The effect of index hospital readmission on home discharge was significantly influenced by the MT volume of the readmission hospital (p = 0.023 for interaction). Subgroup analysis indicated that patients readmitted with cerebrovascular disease diagnoses had a non‐significant likelihood of home discharge when readmitted to the index hospital (SHR = 1.24, 95% CI 0.98‐1.58, p = 0.774), and those with infectious disease diagnoses also did not experience a significantly improved likelihood of home discharge (SHR = 0.95, 95% CI 0.66‐1.37, p = 0.130).

Conclusion

This nationwide analysis suggests that for acute ischemic stroke patients treated with MT, readmission to non‐index hospitals within 90 days is associated with less favorable outcomes, particularly for those readmitted with non‐cerebrovascular and non‐infectious conditions. These findings highlight the need for targeted strategies to address the disparities in outcomes related to readmission site, potentially informing future improvements in post‐MT care pathways. Further research is warranted to better understand the underlying causes of these disparities and to enhance continuity of care for this vulnerable patient population.
Abstract 143: Social cognition impairments in patients with isolated cerebellar stroke
Authors: Pertiwi D. Mengku , Bajrami A. , Adamis C. , Akbas Y. , Gumus I. , Senadim S. , Demirtas‐Tatlidede A.
Published: January 2025

Introduction/Purpose

Recent studies point to an important role for the cerebellum in nonmotor functions, primarily including higher cognitive functions and affect. However, the available evidence on the cerebellar contribution to social cognitive faculties are currently sparse and the exact role of the cerebellum in social cognition is yet to be elucidated. The present study aimed to investigate the impairments in social cognition in a group of patients who suffered from isolated cerebellar stroke. We hypothesized that patients in earlier stages of their stroke and patients with posterior cerebellar lesions would be more affected in the social cognition domain than the rest of the group.

Materials/Methods

We tested 30 patients with isolated ischemic cerebellar stroke and 30 age, sex‐ and education‐matched healthy controls. Patients were classified according to the duration after stroke (acute, subacute and chronic) as well as the location of the cerebellar lesion. A cognitive battery primarily focusing on social cognition was performed and included Montreal Cognitive Assessment (MoCA), Reading the Mind in the Eyes Test, Penn CNB Emotion Recognition Test, Faux Pas test, Tromso Social Intelligent Scale, The Social‐Emotional Expertise Scale and Geriatric Depression Scale. A thorough neurological examination was performed and Brief Ataxia Rating Scale was administered to assess ataxia symptoms specifically. The results were analyzed according to the timeline of ischemic insult and location of the lesions (e.g. anterior cerebellum, posterior cerebellum, right and left cerebellar hemispheres).

Results

Our results revealed a significant difference for the Penn Emotion Recognition Test pointing to significantly reduced anger recognition in the cerebellar stroke group compared to the healthy controls (p<0.05). The Faux‐Pas test revealed a significant impairment confined to the affective theory of mind section of the test (p<0.05). Data from the Reading the mind in the Eyes test did not reveal statistical significance between the cerebellar stroke and control groups (p>0.05). However, when analyzed for subgroups, the performance score was significantly lower in patients with left posterior cerebellar stroke (p=0.015). The scales and the MOCA test did not show significant differences among the patients and the healthy controls (p>0.05).

Conclusion

Our findings provide critical information regarding the cerebellar contributions on the social cognition network and expands the available evidence regarding the impairment in the social cognition following cerebellar stroke. Further research comprising more patients and detailed neuroimaging data will be able to illuminate the details of social cognition after cerebellar insult.
Abstract 146: Symptomatic Basilar Stenosis Presenting as Focal Tonic Posturing and Wrong Way Eyes
Authors: Eldeiry A. , Taylor A.
Published: January 2025

Introduction

A common encounter for the Vascular Neurologist assessing emergent neurological complaints is recognition of stroke mimics and stroke chameleons. Unlike mimics, stroke chameleons are presentations that masquerade as an alternative neurological entity when they are truly ischemic in nature. We present a rare case of bilateral pontine infarcts masquerading as a presumptive focal tonic seizure with gaze deviation in a patient with transient decorticate posturing and wrong way eyes secondary to symptomatic basilar stenosis.

Materials/Methods

Case Report

Results

We report a case of a 77‐year‐old gentleman with a medical history of coronary artery disease, atrial fibrillation, prior liver transplant, and B‐cell lymphoma in remission who was recently discharged from an outside facility after an episode of right‐sided hemiparesis in the context of several months of kaleidoscopic‐like vision changes where electroencephalogram (EEG) showed left temporal sharp waves. Patient subsequently presented to our emergency department (ED) with fluctuating onset of alternating laterality of facial paralysis over several days and eventually left‐sided hemiparesis. On admission, magnetic resonance imaging (MRI) of the brain showed no evidence of ischemic stroke. While in the ED, the patient had a two‐minute episode of tonic flexion contraction of the left upper extremity, leftward gaze, and intact awareness, with cessation after 2 milligrams of intravenous (IV) lorazepam. He was subsequently loaded with IV lacosamide with suspicion for focal motor seizure resulting in a post‐ictal Todd's paralysis. Follow‐up vessel imaging subsequently showed a severely stenotic basilar artery with intraluminal thrombus, raising concern of brainstem hypoperfusion. EEG the following morning was normal. On day 3, given clinical concern persisted, repeat MRI Brain revealed bilateral pontine infarcts. The patient was treated with IV heparin and blood pressure support. He was ultimately discharged ambulatory with a walker with mild facial palsy.

Conclusion

With much attention placed on stroke mimics in clinical practice, stroke chameleons require a high index of suspicion for the prompt identification of patients presenting with acute ischemic stroke. Brainstem ischemia warrants close attention, with decorticate posturing presenting similarly to a focal tonic motor seizure and a paramedian pontine reticular formation lesion presenting with wrong way eyes (i.e. gaze deviation towards the affected limb), exhibiting high potential for misdiagnosis. This case highlights the complexities of brainstem anatomy, places focus on the variability of the presenting features of stroke and underscores the caliber clinical suspicion carries in patients with MRI‐negative strokes.
Abstract 183: Acute Ischemic Stroke Treatment in India: Barriers to Access
Authors: Yavagal R.
Published: January 2025

Introduction

Acute ischemic stroke (AIS) is one of the leading causes of disability and mortality in India. Mechanical thrombectomy (MT) is a highly effective new standard of care for large vesselocclusion AIS. However, less than 1.4% of all stroke patients in India are able to receive this treatment inthe appropriate treatment window because of multiple barriers according to the MT GLASS study (Asif etal.,2023) conducted by SVIN_Mission Thrombectomy. In this study, we aim to analyze the barriers toacute stroke treatment, including MT, in India.

Methodology

From April 2024 to July 2024, we conducted an electronic survey of Indian neurologistsin 9/28 states of India, representing all 5 India Mission Thrombectomy Regional committees, regardingthe most common barriers to local access to acute stroke therapies including MT. Following the survey,we also interviewed 3 of the neurologists with a scripted questionnaire inquiring about access to acutestroke therapies in their regions. We did a statistical analysis of the survey responses using descriptivestatistics.

Results

We received 14/32 (43.8%) survey responses which included representation from all nine states.The top barriers to stroke treatment per the respondents included a lack of patient awareness of strokesymptoms, financial barriers, and patients’ inability to reach the hospital in time. 9/14 (64.9%) of therespondents had under 20 stroke centers in their state with 8/14 (57.14%) reporting 100‐500 averageannual stroke cases per center. Though MT is available in 85.47% of stakeholders’ regions, 92.86%record that patients do not arrive in time for treatment. Overall, 50% of stakeholders reported that patientsare not able to identify BE FAST. According to neurologists from Madhya Pradesh and Rajasthan, 100%of patients are not able to recognize basic stroke symptoms (BE FAST). Additionally, the cost oftreatment leads many patients to forgo care. According to the survey results, the average cost of stroketreatment is 488,636 rupees ($5823.40), with the average monthly salary being less than 20,000 rupees($238.15) in Rajasthan, West Bengal, and Karnataka ($238.31) (Forbes, 2024). While health insurance inIndia may cover the cost and care of treatment depending on the policy, 92.9% of stakeholders recordedthat patients refuse treatment because of the cost. 100% of respondents reported extremely poorinfrastructure and access to acute stroke care in rural areas as compared to urban areas.

Conclusion

The prevalence of stroke cases in India underscores the urgency of addressing barriers totreatment. Lack of patient education, treatment cost, and geographical discrepancies act as obstacles totreatment, compromising patients’ health.
Abstract 186: Adverse events and failures with Cerenovus CEREGLIDE 71 Intermediate Catheter: An analytic review of the FDA MAUDE database
Authors: Aljabali A. , Alkhawaldeh I. M. , Abualhayjaa M. , El Din Moawad M. H.
Published: January 2025

Introduction/Purpose

Recent literature has suggested that direct aspiration catheters as a first‐pass approach are a viable alternative to stent retriever‐based methods in mechanical thrombectomy for acute ischemic stroke. The Cereglide 71 aspiration catheter, launched by Cerenovus with TruCourse Technology, is specifically designed to navigate challenging anatomical conditions with reliable trackability and durable delivery.This study aims to evaluate the safety of the Cereglide 71 aspiration catheter by analyzing reports and data from the Manufacturer and User Facility Device Experience (MAUDE) database.

Methods

All patient‐ and device‐related reports from November 2023 onwards were obtained, screened, and compiled from the MAUDE database using the codes NRY and QJP. The reports were filtered to distinguish between patient‐related (PR) and device‐related (DR) events. Data filtering, organization, and analysis were performed using Microsoft Excel 2021 and Jamovi. Descriptive statistics were used to assess reporting frequency.

Results

During the study period, a total of 36 medical device reports were collected, comprising 27 device‐related problems and 13 patient‐related adverse events.The patient's adverse events included multiple cases of intracranial hemorrhage 5 (38%), thromboembolism 3 (23%), vascular dissections 2 (15%), ischemic stroke 1 (7%), carotid‐cavernous fistula 2 (15%), and cerebral vasospasm (15%). The device problems involved issues such as material twisting, bending, and deformation, often leading to cracks or stretching. Difficulties in advancing or retracting the device were frequently reported, along with fluid or blood leaks, component detachment, and accessory incompatibility. The reports lacked demographic data, with only three reports including patient age and gender. Nineteen reports were submitted by physicians, and only 12 catheters were returned to the manufacturer for further analysis.

Conclusion

This study emphasizes the importance of improved post‐market surveillance to enhance patient outcomes. To the best of our knowledge, this is the first report detailing complications related to the Cereglide 71 aspiration catheter as documented in the FDA MAUDE database. By utilizing real‐world data, the study identifies key complications relevant to clinical practice, Surgeons should be mindful of the range of potential complications to better manage patient expectations and optimize surgical preparedness.
Abstract 190: Anatomical variants in the circle of Willis as a risk factor for intracranial aneurysms: a study in the Mexican Population using diagnostic angiography.
Authors: Arellano P. Martinez , Aburto Y. , Marquez‐Moreno J. , Serrano‐Arias F. , Montenegro‐Rosales H. , Lopez‐Mena D.
Published: January 2025

Introduction/Purpose

Hemorrhagic stroke due to ruptured intracranial aneurysms comprises one of the lead causes of overall disability in Mexico and Latin America. The relationship between anatomical variants in the Circle of Willis/Cerebral Arterial Circle (CAC) and Intracranial Aneurysms (IA) remains an ongoing research subject.

Materials/Methods

We performed a retrospective study of cerebral digital subtraction angiographies at the Interventional Neuroradiology Department of the National Institute of Neurology and Neurosurgery in México, between July 1, 2020, and January 1, 2022. Data regarding Circle of Willis conformation, Avs and IA incidence, and demographic characteristics was collected.

Results

A total of 150 Diagnostic angiographies were studied, 96 procedures(64 %) belonged to female patients. We registered 144 AVs in the CAC in 96 (64%) angiograms. 75 (50%) were positive for IA. 30 (20%) were reported as non‐pathological. Significant relationships were found between aneurysms in the anterior circulation and A1 segment hypoplasia/ agenesis and IA in the posterior circulation and Posterior Cerebral Artery fetal origin/ hypoplasia. The frequency of angiograms diagnosed without pathology was significantly higher in the category of CAC without variants (80%) than that of pathological angiograms (48.76%) (p=0.003). AVs were found to be more common in patients with aneurismatic pathology than in those without pathology (p=0.048).

Conclusions

We found a significant relationship between the presence of IA and Avs, especially between specific Avs and IA incidence in the anterior and posterior circulation. This study offers new insights into the understanding of AVs for diagnostic and therapeutic purposes in vascular pathology.
Abstract 210: Brain death ancillary testing after the 2023 AAN guidelines: The need for CTA & DSA to focus on the brainstem arteries and veins.
Authors: Kapinos G. , Anderson E. , Roberts M. , Kellner C. , Shoirah H. , Shigematsu T. , Lopez L. Salgado , Farraye J. , Hickman Z.
Published: January 2025

Purpose

We propose CTA as a stewarding screen and bridge to DSA, TCD or SPECT, for better resource‐utilization in establishing cerebral circulatory arrest (CCA) in scenarios of death by neurologic criteria (DNC) but incomplete clinical exam. French scoring systems focusing on brainstem perfusion are best‐suited to cases with apnea test unavailable, pediatric or trauma cases, or skull base fractures.

Methods

We critically appraised the current American Academy of Neurology (AAN) guidelines advocating for specific brain death ancillary testing (BDAT). Complementing with the World Brain Death Project (WBDP) Lewis A et al. JAMA 2020 and Srairi M et al. report in Eur J Radiol. 2020, our study establishes that a focus on arteries perfusing and veins draining the brainstem on CTA or DSA can yield accuracy with CCA gold standard. We substantiate this viewpoint with illustrations from clinical experience at a level 1 trauma center with clinical pearls and pitfalls in open skull cases, with pediatric and trauma challenges.

Results

The 2023 AAN DNC guidelines specify adult and pediatric metabolic abnormality ranges, but we posit in this scenario that neurophysiologic modalities may be preferred over DSA or SPECT. Trauma and pediatrics with open skull cases are left with DSA as sole accepted modality, with CTA deemed unacceptable by the guidelines, yet DSA is quite resource‐intensive. Preservation of cortical branches on CTA or DSA, SPECT islands of viable tissue under craniectomy sites, TCD not recommended in open skull situations, making angiographic nuclear and sonographic tests illogical choices in many cases in our experience. Skull base fractures and unsafe apnea tests represent the vast majority of scenarios requiring BDAT. In these cases, we used TCD of the VBJ, or CTA‐CTV focusing on the absence of brainstem venous drainage using the French scoring system, as more topographically pertinent and well‐suited.

Conclusions

BDATs have high false positive or negative rates due to particular clinical pitfalls. Our study proposes a new paradigm with topography‐based selection of the BDAT. This appraisal criticizes the guidelines for their blanket exclusion of EEG, N20, BAERs and CTA, especially in pediatric and trauma cases. Our experience applying French scores to CTA‐CTV focusing on the brainstem, when this is the cerebral region at play and clinically appropriate, allowed us to make DNC determinations more accurate and pertinent to each case. We call for a revalidation of CTA and comparison to DSA with same preconceived focus on brainstem arteriovenous flow. further, we look to subsequently prove that DSA is a superfluous tool in this redefined framework.
Abstract 223: Chronic pain prevalence and severity associated with stroke survivorship
Authors: Karim N. , Wang S. , Long‐Mills E. , Tumin D.
Published: January 2025

Introduction/Purpose

Stroke survivors experience multiple long‐term consequences that significantly impair their quality of life, including chronic pain in some patients. Excess prevalence, severity, and impact of chronic pain among stroke survivors is unknown, as prior studies have lacked comparator groups without a history of stroke. We used nationally representative data to compare the burden of chronic pain according to history of stroke survivorship in a nationally‐representative survey of US adults.

Materials/Methods

This study analyzed deidentified data from adult respondents in the 2019‐ 2021 and 2023 rounds of the National Health Interview Survey (NHIS), a cross‐sectional interview survey conducted by the CDC. The primary outcome was prevalence of chronic pain, defined as pain persisting or recurring over the 3 months before the interview. The primary exposure was lifetime experience of a stroke. Secondary outcomes evaluated among respondents with chronic pain included severity (1‐3 scale), impact on work (1‐4 scale), and impact on family life (1‐4 scale), with higher scale items indicating greater severity or impact.

Results

Based on an analytic sample included 105,329 adults, we estimated 3% had experienced a stroke and 22% were experiencing chronic pain (including 48% of stroke survivors). On adjusted binomial logistic regression, stroke survivorship was associated with higher odds of reporting chronic pain (odds ratio [OR]=1.63, p<0.001). On adjusted ordinal logistic regression, stroke survivorship was also associated with more severe pain, (OR=1.51, p<0.001), greater pain impact on life and work (OR=1.93, p<0.001), and greater pain impact on family life (OR=1.86, p<0.001).

Conclusion

Stroke survivorship is independently associated with a higher prevalence and greater severity of chronic pain compared to the general population. High prevalence of chronic pain among stroke survivors suggests the need for further research on how different types of strokes (not limited to lacunar or thalamic) may result in poststroke chronic pain. These findings emphasize the need for targeted intervention and increased attention to managing chronic pain among stroke survivors.
Abstract 238: Detachment of stent retriever device in mechanical thrombectomy for acute ischemic stroke
Authors: Kati S. Delibas , Hasoğlan M. Gürsoy
Published: January 2025

Introduction/Purpose

Mechanical thrombectomy in acute ischemic stroke brings out some undesired events during the procedure. Device related complications is one of the challenging problems. The detachment of trevo stent retriever is a rare situation and can be handled in different ways.

Materials/Methods

82 year old male patient was referred to ER with a sudden hemiparesis in the last 70 minutes. He was given apiksaban therapy for atrial fibrillation and known to use regularly. He was diagnosed with left MCA thrombosis which seemed to be the cause of this stroke. As he was under DOAC therapy the only way was to perform EVT. The procedure lasted in 18 minutes and we had a first pass effect. But the final screening showed that the cage of the trevo stent retriever was still in the MCA territory letting the blood flow properly. So instead of removing the remnant stent, we decided to give dual antiplatelet therapy because of the MCA stenosis. The patient covered from this period with mild neurologic defisits but after 2 months he passed away because of rectal bleeding which was suppposed to be the result of a underlying colorectal cancer.

Results

Stent retriever detachment is not common in the literature. Even trevo stent retriever detachments is much more rare. In this case the vascular curves and the ICAD of the arteries seem to cause this complication even the procedure was smooth.

Conclusion

It is important to evaluate the device complications properly. Mechanical removement can be applied if possible but it will be good to remember that sometimes medical approach can also stabilise the situation as well.
Abstract 267: Endovascular Thrombectomy in Patients with Anterior Circulation Stroke Presenting 6 Hours After Last Known Well: A Systematic Review and Meta‐analysis of 10 Randomized Clinical Trials
Authors: Essibayi M. , Mortezaei A. , Hajikarimloo B. , Taghlabi K. , Majidpoor J. , Hasan Z. , Abdalkader M. K. , Dmytriw A. , Rahmani R. , Nguyen T. , Kasab S. Al , Altschul D.
Published: January 2025

Background

Several randomized trials have evaluated the benefits of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion strokes presenting beyond 6 hours of the last known well (LKW). We aimed to synthesize the results from these trials to provide high‐level evidence regarding EVT treatment for patients presenting in the late window.

Methods

A systematic search was conducted through four electronic databases, with no language restriction. Binary outcomes were analyzed using the risk ratio (RR) and 95% confidence interval (CI), while continuous outcomes were analyzed using the standardized mean difference (SMD) and 95% CI.

Results

Out of 2824 patients from 10 trials comparing EVT plus BMT and BMT alone among patients with AIS who presented beyond 6 hours of LKW, 1871 patients (n=981 EVT, n=890 BMT) were included in the analysis. The results showed benefits toward the EVT than BMT alone in Modified Rankin Scale (mRS) 0‐1 (RR= 1.84, p‐value < 0.0001), mRS 0‐2 (RR= 2.3, p‐value= 0.0064), and mRS 0‐3 (RR= 1.64, p‐value < 0.0001) at three months. No significant difference between EVT and BMT alone groups was found when analyzing either 90‐day mortality or symptomatic intracranial hemorrhage. Subgroup analysis showed that patients with large core stroke derived more benefits from thrombectomy than patients with non‐large core stroke in terms of 90‐day mRS 0‐2 (RR= 2.5, P‐value < 0.0001). However, we did not find significant difference between perfusion vs non‐perfusion imaging modalities in 90‐day mRS 0‐2 and mortality.

Conclusion

These findings strengthen the previous evidence for the benefits of thrombectomy over medical treatment in managing patients with stroke, even with large ischemic regions in the late time window.
Abstract 271: Enhancing Medical Student and Trainee Exposure to Neurointervention through Neuroendovascular Simulation: An Educational Interventional Study
Authors: Khalid F. , Lazzari Z. , Desai S. , Kenmuir C. , Anderson A. , Haussen D. , Dolia J.
Published: January 2025

Introduction

Mechanical thrombectomy (MT) represents a paradigm shift of treatment in modern medicine. However, a significant awareness gap persists amongst medical students and neurology trainees regarding MT and neurointervention, both domestically and globally. This study aimed to evaluate the impact of a targeted educational workshop combining didactic lectures and hands on neuroendovascular simulation to enhance awareness of this subspeciality and as well as global stroke disparities.

Materials/Methods

We conducted a pre and post intervention study involving 43 medical trainees spanning in training from first year of medical school to residents (24% M1, 24% M2, 12% M3, 5% M4, 12% resident) recruited through the Student Interest Group in Neurology (SIGN) at our hospitals’ affiliated medical schools. The intervention comprised of didactic sessions discussing neuroendovascular training pathways, global stroke care disparities and women in Neuro‐IR, followed by a hands on neuroendovascular workshop simulating MT and clot science. Participants completed pre and post intervention surveys assessing knowledge and interest in neuroendovascular procedures. Survey completion rates were 100% pre intervention and 77% post intervention.

Results

Pre‐intervention data revealed limited exposure to neuroendovascular procedures, with only 26% reporting prior exposure during medical training. 62% of participants self‐reported as “not at all knowledgeable” or “not very knowledgeable” about neurointerventional radiology. Only 59% were familiar with mechanical thrombectomy, and 40% were aware of its utilization rate for large vessel occlusions in the USA. Post‐intervention, 100% of participants reported increased awareness of specialties involved in neurointervention and conditions amenable to neuroendovascular treatment. 97% expressed confidence in explaining mechanical thrombectomy to peers. All participants reported enhanced understanding of local and global neurointerventional service needs. Interest in pursuing further training in neurointervention increased by 64%, with 96% indicating likelihood to explore a career in the field. 70% expressed inspiration to consider working in underserved areas. Participants suggested earlier exposure in training, expanding these workshops throughout medical schools, and structuring a medical student elective would impact their understanding and interest within neurointervention.

Conclusion

This study demonstrates the significant impact of a targeted educational intervention on medical trainees’ awareness and interest in neurointerventional radiology. The findings emphasize the importance of early exposure to this subspecialty, particularly given the variability in training center resources. Implementation of similar workshops could address the current knowledge gap and potentially influence career trajectories in this critical field.
Abstract 277: Examining the Impact of Area Deprivation on Endovascular Stroke Therapy Access
Authors: Ebirim E. , Le M. , Ballekere A. , Azeem H. , Iyyangar A. , Lee E. , Sheth S.
Published: January 2025

Intro & Background

Equitable access to healthcare is heavily impacted by socioeconomic factors, however, the effects of such disparities in accessing life‐saving stroke treatments remain incompletely characterized. Here we explore the impact of disparities on access to endovascular treatments for large vessel occlusion acute ischemic stroke (LVO AIS).

Methods & Materials

From our prospectively maintained multi‐hospital registry of four Comprehensive Stroke Centers, we identified patients 18 years or older with LVO AIS from January 2019‐ June 2020. Patient addresses and zip codes were matched to census‐tract level area deprivation index (ADI) scores obtained from Neighborhood Atlas (U. Of Wisconsin). ADI is a validated neighborhood‐level measure that utilizes variables such as income, education, and employment to quantify the level of deprivation in an area. The primary outcome was utilization of endovascular thrombectomy (EVT) by ADI quartile, adjusted for age, ASPECTS, and NIHSS, and was determined using multivariable logistic regression and expressed as OR [95% CI].

Results

Among 637 patients with LVO AIS, the median age was 68, 46% were female, 64% were white, 28% were black, and 19% identified as Hispanic. Median ADI was 57 IQR [32‐78]. Notably, non‐Hispanic Black (NH‐Black) patients had the largest proportion 48.9% (N=66) of those with the highest ADI scores ranging from 79‐100. Comparatively, non‐Hispanic White (NH‐White) patients represented the largest population 67.7% (N=84), of those with the lowest ADI scores of ≤31. Greater ADI scores were associated with a higher prevalence of stroke risk factors, including hypertension, type 2 diabetes, prior stroke, and hyperlipidemia. NIHSS, pMRS, ASPECTS, final TICI scores, 90‐day disability outcomes, and discharge disposition were comparable across the ADI quartiles. In the univariable analysis, patients with AIS LVO in greater ADI neighborhoods were less likely to undergo EVT (61% vs 67% vs 61% vs. 50%, ADI quartiles least to greatest respectively, p=0.01). In the multivariable analysis adjusted for age, ASPECTS, and NIHSS [1], higher ADI regions were less likely to receive EVT intervention (OR 0.73, 95% CI (0.59‐0.91), p<0.01).

Conclusion

Patients residing in disadvantaged neighborhoods (greater ADI regions) may have reduced access to EVT, despite comparable acute stroke presentation symptoms. These findings are consistent with prior studies demonstrating poorer health outcomes in these populations.
Abstract 279: Factors Affecting Oral Anticoagulation Use Amongst Patients With Atrial Fibrillation
Authors: Shaikh A. , Kandel A. , Ouf A.
Published: January 2025

Introduction/Purpose

Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke. Oral anticoagulants (OACs) are highly effective in reducing this risk. Despite the proven efficacy of OACs, non‐compliance remains a significant issue, often due to lack of health literacy amongst patients. Furthermore, a considerable number of eligible patients are not even prescribed OACs. Although various factors contribute to the underuse of OACs, limited research has explored the impact of patients’ attitudes and knowledge about OACs. Thus, the primary aim of this study is to identify the compliance rate of OACs among AF patients, and to explore the differences in attitude, education level, and knowledge that may influence OAC usage.

Methods

The research involved a prospective questionnaire‐based survey, conducted among patients with a known history of AF who presented at our institution. Descriptive statistics were used to describe patient characteristics, adherence to OACs, knowledge regarding OACs, and attitudes toward OACs. Values were expressed as medians for continuous data, and as counts and percentages for categorical data. Bivariate analyses, such as analysis of variance and t‐tests, were used to assess the relationships between these variables for both categorical and continuous data. Additionally, a binary logistic regression was employed to evaluate whether patients’ perceptions and socioeconomic status could predict non‐adherence to OAC therapy.

Results

In the OAC knowledge section, participants answered 65% of questions correctly on average, with a range of 45‐80%. Additionally, 71.4% reported missing more than one dose of their medication, with the most common reason being forgetfulness. Of these participants, 71.4% feared stroke more than severe bleeding, while 14% feared bleeding and another 14% were undecided. When asked about the level of stroke risk that would justify OAC use, responses varied: 14% said their risk of stroke would not influence OAC use, and 14% were uncertain. Of those who provided risk estimates, 28% chose a >2% risk threshold, 7% chose 5%, 28% selected 25%, and 7% opted for a 50% risk threshold.

Conclusion

Non‐adherence to OAC therapy is a persistent issue that requires further investigation. While the small sample size limited the ability to draw statistically significant conclusions, the preliminary data revealed trends in patient attitudes and compliance. Forgetfulness was the most frequently cited reason for non‐adherence. Interestingly, most non‐adherent patients feared stroke more than bleeding but did not fully understand the purpose of anticoagulation therapy. A larger sample size is necessary to better evaluate the correlation between OAC compliance, patient knowledge, and socioeconomic status.
Abstract 285: First‐Line Mechanical Thrombectomy Techniques and Clinical Outcomes In Basilar Artery Occlusions With Favorable Collaterals
Authors: Miao C. , Al‐Qudah A. , Katano T. , Doheim M. , Palegar T. , Pillai B. , Rocha M. , Starr M. , Bhatt N. R. , Lang M. , Gross B. , Nogueira R. G. , Al‐Bayati A. R.
Published: January 2025

Introduction

Mechanical thrombectomy (MT) has been demonstrated to be associated with improved clinical outcomes in patients with acute basilar artery occlusions (BAO) compared to medical management. The basilar artery on computed tomography angiography (BATMAN) score provides enhanced collateral prognostic accuracy in BAO patients. This study is aimed to determine if there is a correlation between first line mechanical thrombectomy techniques and subsequent clinical outcomes factoring their baseline BATMAN scoring.

Methods/Materials

We included patients who presented to our comprehensive stroke center between 2014 and 2023 and underwent MT for BAO. This cohort was subsequently divided into two groups based on the BATMAN score (≥7 vs. <7), and further subdivided within each group according to first‐line technique (Contact aspiration vs combined). We compared age, sex, posterior circulation ASPECT score (pc‐ASPECT), admission NIHSS, and mTICI (2b/2c‐3) between groups. Outcomes, including modified Rankin Scale (mRS) at 90 days, symptomatic intracranial hemorrhage, and mortality, were assessed for both groups.

Results

Of the 193 patients with BAO who received mechanical thrombectomy, 67 (34.7%) of them were found to have a favorable BATMAN score (>=7). We found that lower arrival NIHSS and higher pc‐ASPECT scores were significantly associated with favorable BATMAN score (p‐values 0.004 and 0.016, respectively). Aspiration only as the first line technique was associated with increased rates of TICI2B‐3 reperfusions compared to combined techniques (aOR 4.86, 95% CI 1.1‐26.3; P‐value 0.044) among patients with BATMAN (>=7). Despite absolute numerical differences in outcomes (mRS 0‐2; 31.7% vs 26.5%, Mortality; 41.3% vs 53.9) suggesting potential disparities between the two groups and their subgroups, these differences did not reach statistical significance.

Conclusions

Aspiration as the first line technique was associated with increased rates of TICI 2b‐3 in patients with BATMAN score >=7. Further studies with larger populations might establish correlation with improved functional outcomes.
Abstract 301: Incidence And Predictors Of First Pass Effect Within 30 Minutes Of Groin Puncture
Authors: Tshimbombu T. N. , Desai S. , Cooper A. , Ducruet A. , Albuquerque F. , Jadhav A.
Published: January 2025

Title

Incidence And Predictors Of First Pass Effect Within 30 Minutes Of Groin Puncture

Introduction

First pass effect (FPE) is an established metric of success of mechanicalthrombectomy (MT). Recently, FPE within 30 minutes (FPE30) of groin puncture has been definedas a novel metric incorporating time as a dimension. We aim to determine the incidence andpredictors of FPE30 at a comprehensive stroke center (CSC).

Methods

We retrospectively analyzed MT data at a CSC. Demographic, clinical, procedural, andradiological data were collected and assessed by an independent interventional neurologist. FPEwas defined as mTICI 2C‐3 after one thrombectomy attempt and FPE30 was defined as FPE within30 minutes of groin puncture. We performed univariate and multivariate analyses to identifypredictors of FPE30.

Results

Of 274 MT patients, 24.8% had excellent reperfusion (mTICI 2C‐3), and 19.0%experienced FPE. Amongst FPE patients, 82.7% had FPE30 and 17.3% had FPE>30 (FPE but after30 minutes of groin puncture) (Figure). Mean time from puncture to reperfusion in FPE30 cohortwas 18 +/‐13 min and in FPE>30 cohort was 32 +/‐15 min. Age and gender were comparablebetween FPE30 versus FPE>30 groups. Internal carotid occlusions were less common (7% vs.33%, p=0.09) and radial access was more frequent (49% vs. 33%, p=0.4) in the FPE30 whencompared to FPE>30 cohort. Rate if mRS 0‐2 at 90 days was 34.9% in FPE30 and 33.3% inFPE>30 cohort.

Conclusion

First Pass Effect within 30 minutes is observed in a majority of patients experiencedFPE. Predictors of FPE>30 may include internal carotid occlusion and femoral route of access.Further analyses are needed to confirm our findings.
Abstract 387: Readmissions and retreatment among stent‐assisted endovascular coiling patients with unruptured intracranial aneurysm using ENTERPRISE®2 Stent versus LVIS™Stent
Authors: Rong Y. , Kottenmeier E. , Khanna R.
Published: January 2025

Introduction

Stent‐assisted endovascular coiling is a safe and effective method for treating wide‐necked unruptured intracranial aneurysm (UIA), which allows for increase in volumetric filling, prevents coil prolapse, and promotes aneurysm thrombosis. The objective of this study was to examine differences in 180‐day inpatient readmissions and retreatment among UIA patients treated with the laser cut nitinol ENTERPRISE® 2 stent versus the braided nitinol LVIS™ stent during endovascular stent assisted coiling procedure.

Methods

Using a U.S. nationwide hospital database, PINC AI Healthcare Database (PHD), UIA patients aged ≥18 years undergoing endovascular coiling procedures were identified and classified into ENTERPRISE® 2 and LVIS™ cohorts based on the stent used. Study outcomes, including 180‐day all‐cause and UIA‐related inpatient readmissions, and UIA‐related retreatment, were compared between the two groups. Inverse probability of treatment weighting of propensity score approach was used to balance covariates (i.e. patient demographic, comorbidity, and hospital characteristics) between the two cohorts. A weighted generalized estimating equation (GEE) model was used to assess outcomes among the weighted ENTERPRISE® 2 and LVIS™ cohorts.

Results

Based on study inclusion and exclusion criteria, 249 patients were identified, with 130 in the ENTERPRISE® 2 cohort and 119 in the LVIS™ cohort. Baseline patient characteristics were well balanced after weighting. Patients undergoing endovascular stent assisted coiling procedures using ENTERPRISE® 2 had significantly lower rates of 180‐day all‐cause inpatient readmissions compared to those treated with LVIS™ (9.1% vs 24.3%,
p
=0.016; odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.12‐0.82,
p
=0.018). Bivariate analysis revealed a significantly lower rate of 180‐day UIA‐specific inpatient readmission among the ENTERPRISE® 2 cohort versus the LVIS™ cohort (2.6% vs 12.4%,
p
=0.036); however, this difference was not significant in GEE analysis (OR: 0.19, 95% CI: 0.03‐1.04,
p
=0.056). No significant difference was observed for 180‐day UIA‐related retreatment among the study cohorts (ENTERPRISE® 2 vs LVIS™: 2.6% vs 11.6%,
p
=0.056; OR: 0.20, 95% CI: 0.03‐1.20,
p
=0.079).

Conclusions:

Patients who were treated with the laser cut ENTERPRISE®2 stent during endovascular coiling were observed to have significantly lower risk of all‐cause and UIA‐related inpatient readmissions compared to those treated with the braided LVIS™ stent. The laser cut form of the ENTERPRISE®2 stent may allow for high strut tension and compression strength making it less likely to be prone to deformation as compared to a braided stent like the LVIS™, which may be associated with the observed differences in readmission rates among the two stents.