bluuebunny/crossref_metadata_2025 huggingface dataset:
Data from Integrative pan-cancer genomic and transcriptomic analyses of refractory metastatic cancer
Authors: Pradat Yoann , Viot Julien , Yurchenko Andrey A. , Gunbin Konstantin , Cerbone Luigi , Deloger Marc , Grisay Guillaume , Verlingue Loic , Scott Veronique , Padioleau Ismael , Panunzi Leonardo , Michiels Stefan , Hollebecque Antoine , Jules-Clement Gerome , Mezquita Laura , Laine Antoine , Loriot Yohann , Besse Benjamin , Friboulet Luc , Andre Fabrice , Cournede Paul-Henry , Gautheret Daniel , Nikolaev Sergey I.
Published: April 2023

Abstract
Metastatic relapse after treatment is the leading cause of cancer mortality, and known resistance mechanisms are missing for most treatments administered to patients. To bridge this gap, we analyze a pan-cancer cohort (META-PRISM) of 1,031 refractory metastatic tumors profiled via whole-exome and transcriptome sequencing. META-PRISM tumors, particularly prostate, bladder, and pancreatic types, displayed the most transformed genomes compared to primary untreated tumors. Standard-of-care resistance biomarkers were identified only in lung and colon cancers - 9.6% of META-PRISM tumors, indicating that too few resistance mechanisms have received clinical validation. In contrast, we verified the enrichment of multiple investigational and hypothetical resistance mechanisms in treated compared to non-treated patients, thereby confirming their putative role in treatment resistance. Additionally, we demonstrated that molecular markers improve six-month survival prediction, particularly in patients with advanced breast cancer. Our analysis establishes the utility of META-PRISM cohort for investigating resistance mechanisms and performing predictive analyses in cancer.
Supplementary Table S4 from CD142 Identifies Neoplastic Desmoid Tumor Cells, Uncovering Interactions Between Neoplastic and Stromal Cells That Drive Proliferation
Authors: Al-Jazrawe Mushriq , Xu Steven , Poon Raymond , Wei Qingxia , Przybyl Joanna , Varma Sushama , van de Rijn Matt , Alman Benjamin A.
Published: April 2023

Summary of double-color cell sorting experiments.
Abstract Number ‐ 15: Morphological Characteristics of Ruptured and Unruptured Intracranial Aneurysms: A Systematic Literature Review and Meta‐Analysis
Authors: Sanchez Sebastian , Hickerson Meredith , Patel Rishi R , Ghazaleh Dana , Tarchand Ranita , Pederson John , Samaniego Edgar A
Published: April 2023

Introduction

It is unclear what morphological features of brain aneurysms are better at predicting risk of rupture.We have performed a meta‐analysis to analyze the best morphological determinants of risk of rupture.

Methods

The Nested Knowledge platformwas used to search thePubMed database for studiesreporting aneurysmal size, aspect ratio (AR), size ratio (SR), ellipticity index (EI), nonsphericity index (NSI) and undulation index (UI).Effect sizes were computed as logarithmically transformed mean differences (MD) between ruptured and unruptured aneurysm. Finally, effect sizes were pooled using random‐effects and inverse‐variance weighting via restricted effects maximum likelihood estimation.

Results

We included 63 studies with 13,025 aneurysms: ruptured 6966 and unruptured 6059. Ruptured aneurysms were larger compared to unruptured (µ 6.1 mm, 95% CI 5.7‐6.6 vs 4.9 mm, 95% CI 4.5‐5.3 respectively, p < 0.001). There was no significant difference in size between ruptured and unruptured aneurysms in the anterior cerebral artery (ACA, p = 0.28), anterior communicating artery (ACom, p = 0.31) and basilar artety (BA, p = 0.51). AR was significantly higher in ruptured compared to unruptured aneurysms(µ 1.5,95% CI: 1.4‐1.6 vs.1.1, 95% CI: 1.1‐1.2 respectively,p < 0.001).SR was significantly higher in ruptured compared to unruptured aneurysms (µ 2.3,95% CI: 2.1‐2.5 vs. 1.6, 95% CI: 1.4‐1.8 respectively,p < 0.001).Ruptured aneurysms in the ACA and Acom had the largest mean SRs (2.5, 95% CI: 1.0‐ 6.4 and 2.6,95% CI: 2.2‐ 3.0 respectively).NSI and EI were higher in ruptured compared to unruptured aneurysms (p = 0.049 and p = 0.049, respectively). UI was similar in ruptured and unruptured aneurysms (p = 0.22).

Conclusions

Small aneurysms in the ACA and ACom can rupture regardless of size. SR is the best predictor of rupture status for aneurysms in these locations.SR and AR are predictors of rupture status independently of size.
Abstract Number ‐ 26: Results from Flat‐Panel CT as a predictor following Mechanical Thrombectomy
Authors: Rueda‐Carrillo Luis G , Giurgiutiu Dan‐Victor
Published: April 2023

Introduction

Flat‐panel CT provides quick and effective parenchymal cross‐sectional imaging. Pre‐thrombectomy, flat‐panel can be obtained to evaluate ischemic stroke patients for thrombectomy candidacy in cases where the traditional CT scanner is bypassed. Post‐thrombectomy images obtained from flat‐panel CT are also effective in evaluating complications such as contrast extravasation, hemorrhage, or increased core size. Findings on flat‐panel CT may provide information to guide decisions such as blood pressure goals, antiplatelet or anticoagulation regimen, thrombolytic reversal, and the need for emergent neurosurgical intervention in rare cases.

Methods

We analyzed 93 thrombectomy cases from 2021 to 2022, where flat‐panel CT was obtained, with follow‐up CT and MRI. Demographics were reviewed for this series of cases. Cases where stratified and compared depending on results on flat‐panel CT. Medical records were reviewed for changes in management. The local IRB approved the project, and consent was waived according to institutional guidelines.

Results

For our patient population, the median age was 70; race was 59% Caucasian, 40% African American, and 1% Hispanic; and gender was 46% female and 54% male. From the flat‐panel CT, we had the following results: Flat‐panel CT was normal in 68% of cases, 20% had contrast extravasation, 9% showed evidence of contrast extravasation vs. hemorrhage, 2% had hemorrhage during the procedure, and 1% had contrast retained in the vessels. On follow‐up CT, 35% had no change, 16% had contrast extravasation, 8% had SAH, 4% had contrast extravasation vs. hemorrhage, 3% had hemorrhagic transformation, 1% had IVH, 1% had petechial hemorrhages, and 31% had no follow‐up CT. On MRI, 20% had hemorrhagic transformation, 41% had no hemorrhage, 6% had microhemorrhages, 10% had petechial hemorrhages, 2% had ICH, 1% had 1 IVH, 1% had SAH, 1% had contrast extravasation, 17% of the cases had no follow‐up MRI. Based on flat‐panel CT, results for normal and contrast extravasation were as follows (Table 1.). Therapy was altered by the flat‐panel CT results in 10 cases. The main change in therapy was a delay in restarting antiplatelet and anticoagulation therapy, which took place in 9 cases.

Conclusions

Post thrombectomy flat‐panel CT is a useful screen post thrombectomy for high‐risk findings such as contrast extravasation and hemorrhagic transformation. Further studies are needed to determine ideal management in cases of contrast extravasation or hemorrhage on flat‐panel CT.
Abstract Number ‐ 36: Acute Angioplasty And/or Stenting Posterior Circulation Intracranial Atherosclerotic Disease Related Large Vessel Occlusion
Authors: Mekonnen Ermias A , Nejad Layla , Desai Sohum , Saei Hamzah , Hassan Ameer E
Published: April 2023

Introduction

With prior studies showing the value of percutaneous transluminal angioplasty and stenting (PTAS) for rescue of acute large vessel occlusions (LVO) of anterior circulation in patients with underlying intracranial atherosclerotic disease (ICAD), we investigated the safety and efficacy of PTAS in posterior circulation intracranial atherosclerosis‐related occlusions (ICAS‐O).

Methods

By utilizing a prospectively collected endovascular database at a comprehensive stroke center from January 2016‐May 2022, variables such as demographics, co‐morbid conditions, symptomatic intracerebral hemorrhage (ICH), mortality rate at discharge, recanalization rate, modified thrombolysis in cerebral infarction score (mTICI) and favorable clinical outcome via modified Rankin Scale (mRS) were examined. The outcomes between acute PTAS + MT in the anterior and posterior circulation groups were then compared and analyzed.

Results

Within a group of 75 acute ischemic stroke (AIS) patients who underwent rescue PTAS, 15 (20.0 %) belonged to the posterior circulation ICAS‐O group. Baseline characteristics between the posterior and anterior groups were similar, except for gender (6.7% vs 45.0%) and atrial fibrillation (21.7% vs 0.0%). While there was no statistical difference in discharge NIH Stroke Scale(18% vs 23%, P = 0.860) or favorable outcome (modified Rankin Scale ≤ 2) at 90 days (46.7% vs 38.7 %, P = 0.477) between the posterior and anterior ICAS‐O groups respectively, symptomatic ICH rate was higher in the anterior group (11.7 vs 6.7%, P = 0.495).

Conclusions

Rescue angioplasty and stenting seems to be a safe and efficacious treatment option for ICAS‐related LVO of posterior circulation. Future larger, multicenter prospective studies would provide further analysis and allow for corroboration of the results of our study.
Abstract Number ‐ 38: Outcome Predictors in Posterior Circulation Stroke After Mechanical Thrombectomy: Pooled Analysis from NASA and TRACK
Authors: Ashouri Yazan K , Castonguay Alicia C , Prologo‐richardson Paige , Massad Abdallah , Jelani Ali Al , Armouti Ahmad , Nguyen Thanh N , Nogueira Raul G , English Joey D , Farid Hamed , Gupta Rishi , Martin Coleman , Haussen Diogo C , Mueller‐Kronast Nils , Zaidat Osama O
Published: April 2023

Introduction

Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and effective. However, many people still have poor outcomes despite treatment. The aim of this study was to identify the predictors of good functional outcome in posterior circulation strokes after mechanical thrombectomy from the Trevo Stent‐Retriever Acute Stroke TRACK and the North American Solitaire Stent Retriever Acute Stroke (NASA) registries.

Methods

Patient‐level data from the TRACK and NASA registries were pooled and patients with posterior circulation stroke were included in the analysis. Patients were dichotomized into those with 90‐day good functional outcome (mRS≤2) and poor functional outcome (mRS>2). Baseline and procedural data were compared between the two cohorts. Multivariate logistic regression was then performed to identify predictors of functional outcome. P‐value < 0.05 was considered significant.

Results

Out of 119 posterior stroke patients (99 BA, 16 VA, and 4 PCA), a total of 110 patients had mRS data available on follow‐up. Good functional outcome was observed in 44 patients (37%). Patients with mRS≤2 were less likely to have hypertension (61.4% versus 83.3%, p = 0.01), dyslipidemia (38.6% versus 62.1%, p = 0.016), and diabetes (18.2% versus 36.4%, p = 0.040). Patients with mRS≤2 had a lower mean baseline NIHSS (15.2±9.95 versus 22.6±9.50, p< .001). Time to puncture, utilization of BGC, general anesthesia use, number of passes, and successful recanalization (TICI≥ 2B) were not significantly different between the two cohorts. On multivariate analysis, higher baseline NIHSS was associated with worse functional outcome (OR:0.91, CI:0.87‐0.96, P< .001). Use of IV tPA was associated with higher odds of achieving good functional outcomes (OR:2.82, CI:1.06‐7.51, P:0.038).

Conclusions

In this pooled analysis of the NASA and TRACK Registries, posterior circulation patients achieving good outcome were more likely to have a lower baseline NIHSS and less comorbidities. Use of IV‐tPA and lower baseline NIHSS were independent predictors of functional outcome.
Abstract Number ‐ 39: Comparison of Clinical and Radiographic Efficacy of Particles versus nBCA/Onyx in MMA Embolization for cSDH
Authors: Khalife Jane , Salem Mohamed , Wong Victoria , Karimov Allen , Badger Clint , Gordon Jared , Jovin Tudor , Jankowitz Brian , Burkhardt Jan‐Karl , Shaikh Hamza , Thomas Ajith
Published: April 2023

Introduction

Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative to open surgery for treatment of chronic subdural hematoma (cSDH). Different embolic materials are utilized in this procedure per operators’ discretion; however, limited data currently exists regarding the clinical and radiographic efficacy of these embolic materials, with available studies lumping Onyx and N‐Butyl cyanoacrylate (n‐BCA) into a single group of liquid embolic material.

Methods

Series of consecutive patients undergoing MMA embolization (MMAE) for cSDH at 2 North American centers (2019‐2021) were included. The primary outcomes included cSDH radiographic resolution of cSDH with at least 50% reduction of hematoma thickness to be considered treatment success. Clinical outcomes were defined as the proportion of patients requiring additional unplanned surgical intervention. These outcomes compared between the particles group, the liquid group which were further subdivided into the n‐BCA and Onyx groups.

Results

Overall, 185 patients undergoing 198 MMAE procedures (median age 72 years, 27.5% women) were included in this analysis. In this cohort, 42.6% of the procedures were performed utilizing particles embolic material, while n‐BCA and Onyx were utilized in 29.5% and 26.8% of procedures, respectively. On last follow‐up imaging (median 3.5 months), ≥ 50% reduction in hematoma thickness was achieved in 67.7%, 71.1%, and 72.3% in the particles, Onyx and the n‐BCA group, respectively (p = 0.2). There were no differences in the proportion of patients requiring additional unplanned surgery between the groups (p = 0.6). Similarly, there was no difference in procedural complications between the 3 embolic materials groups.

Conclusions

MMAE for cSDH utilizing particles and liquid embolic materials (including Onyx and n‐BCA) appears to have an overall equivalent safety and efficacy profiles in cSDH treatment. Further studies with larger sample sizes and longer follow‐up are warranted.
Abstract Number ‐ 40: Unique presentation of Dural AV fistula with brainstem stroke and extensive edema
Authors: Patel Priyadarshee , Suryadevara Neil , Ruiz Aldo Mendez
Published: April 2023

Introduction

Intracranial dural arteriovenous fistulae (dAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. DAVFs can mimic other neurologic disorders and produce a broad spectrum of signs and symptoms, including headache, tinnitus, vertigo, Parkinsonism, and visual field and gait disturbances. We present a case report of extensive dural AV Fistula which lead to brainstem ischemic stroke from compression of brainstem flow void.

Methods

Case Report

Results

64 year old man with past medical History of Rheumatoid arthritis, presented with sudden onset of right facial weakness. On arrival patient was noted to be hypertensive to 200/105 and on exam noted to have right complete facial nerve palsy. Patient also revealed a significant history of severe, throbbing, posterior headaches in the last 1–2 months. Patient had CT head which was negative for bleed. CT angiography showed Abnormal hyperattenuating tubular vessel extending along the right cerebellar hemisphere and posterolateral pons extending towards the venous confluence at Galen. Over the course of 5 hours, the patient reported difficulty swallowing and intense headaches. MRI brain showed acute to early subacute infarct involving the right dorsolateral medulla and abnormal T2 prolongation involving essentially the entire cross‐section of the upper medulla and inferior pons representing edema. The patient was taken for Diagnostic catheter angiogram which showed dural AV fistula extending along the right cerebellar hemisphere. Onyx embolization was performed on the Right Middle meningeal artery and right Superior cerebellar artery with complete obliteration of dAVF.

Conclusions

The spectrum of signs and symptoms associated with DAVFs has been attributed to any one or combination of 6 pathophysiologic factors: the arteriovenous shunt, cerebral hypoxia and ischemia, increased venous pressure, retrograde drainage and secondary engorgement of basal sinuses, sinus obstruction, and subarachnoid hemorrhage secondary to involvement of the pial venous system. Prompt evaluation and management is necessary for patients presenting with neurological symptoms with headache.
Abstract Number ‐ 74: Venous Thrombectomy as Treatment for Central Venous Sinus Thrombosis presenting as symptomatic Idiopathic Intracranial Hypertension
Authors: Detaram Harshil Dharamdasani , Ma Alice
Published: April 2023

Introduction

Thrombosis of the cerebral venous sinus (CVST) is an uncommon form of stroke which primarily affects young adults, usually females. Patients with CVST present with either symptoms related to increased intracranial pressure secondary to venous congestion or focal brain injury from infarction or haemorrhage. Treatment of CVST currently involves anticoagulation with venous thrombectomy (VT) used as salvage therapy in refractory CVST. However, the clinical outcomes of patients with symptoms of idiopathic intracranial hypertension (IIH), secondary to CVST, pre‐ and post‐ VT has not been documented. In this case study we present two cases where patients presented with symptoms of IIH secondary to CVST who subsequently underwent VT salvage therapy.

Methods

We retrospectively analysed institutional data of patients who underwent VT for CVST from 2017–2022. Patients who presented with well documented symptoms of IIH without cerebral infarction or haemorrhage were included. Clinical outcomes including neuroimaging, retinal nerve fibre layer (RNFL) thickness from optical coherence tomography (OCT), visual acuity and use of medications including acetazolamide and anticoagulation were recorded. The technical aspects of the VT procedure are also described.

Results

Two patients were identified (2 women) that fit the study criteria. Both patients were taking the oral contraceptive pill. They both presented similarly with papilledema and symptoms of IIH including; headache, diplopia and nausea. There was symptomatic progress in both patients despite medical management with anticoagulation and acetazolamide. Patient A, a 39‐year‐old lady, was found to have a severe sagittal sinus thrombosis involving the entire sinus. Her lumbar puncture revealed an opening pressure of 31 cmH2O. She underwent urgent VT which revealed a highly organised thrombus and as such minimal change was achieved with repeated passes, however, her post‐op imaging showed partial recanalization of the right transverse sinus. Patient B, a 26‐year‐old lady, had a partially occlusive right transverse sinus thrombosis extending into the jugular vein. Manometry revealed elevated venous pressures. She underwent VT with alteplase injection to the site of thrombosis. After multiple passes, recanalization of the right transverse sinus was achieved. Post‐operative OCTs demonstrated a significant reduction in RNFLs bilaterally in both patients. Both patients also experienced resolution of symptoms over a few days and remained asymptomatic with gradually decreasing doses of acetazolamide.

Conclusions

VT may be a safe and effective treatment option in patients with medically refractory CVST who present with symptoms of IIH. In both patients there was marked improvement in symptoms and RNFL thickness after the procedure.
Abstract Number ‐ 81: Safety and Efficacy of Trans‐carotid Intervention in Multiple Scenarios: Medellin Experience Direct Carotid access.
Authors: Pabon Boris , Torres Victor M , Patiño Manuel , Pelaez Juan F , Mutis Jorge , Cardozo Margarita , Zapata Andres
Published: April 2023

Introduction

Direct carotid puncture has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR. A believe of higher risk for neurovascular procedures or major accesssite related complications restrict its use. This study was conducted to investigate the feasibility and safety of trans carotid Neurointervention for a variety of pathologies.

Methods

Since 2018 we implemented a direct carotid access under special considerations to perform a therapeutic approach. A total of 14 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 2), Mechanical Thrombectomy MT (n = 5), AVM´s treatment (n = 2), intracranial Aneurysms treatment (n = 5). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered.

Results

Mean age was 64.3 ± 10.3 years. all cases but two we treated the patients under General Anesthesia GA. Major indication to this approach was : anatomical and access limitations. (in 12 cases wasn’t possible to reach the ICA through femoral or radial access due to extreme aortic arc tortuosity. Two patients with Leriche Syndrome) All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%). Two patients presented mild vasospasm and resolved using IA vasodilators. Both CAS were performed without any complications and none embolic protection device used. For MT(n = 5): a SOFIA 6Fr for ADAPT was used in 3 cases with TICI 2b‐3 in all cases. Combined approach ¨Solumbra¨ solitaire and aspiration catheter was used in two cases, one TICI 2a and one TICI 3. For the AVM´s treatment we use a 6Fr guiding catheter and non‐detachable microcatheters to inject Onix with a high grade of obliteration. Five aneurysms were treated with this approach (2 ICA – ophthalmic; 2 MCA and one AcomA) Mean average time of the procedure was 34.5 min. (ranged 9–59 min) just one bleeding complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site.

Conclusions

Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.
Abstract Number ‐ 83: First WEB case. Direct vertebral artery access for basilar tip artery aneurysm
Authors: Torres Victor , Pabon Boris , Patiño Manuel , Pelaez Juan , Mutis Jorge , Cardozo Margarita
Published: April 2023

Introduction

being able to think of different accesses does not change the possibilities with each patient

Methods

case report

Results

Patient with subarachnoid hemorrhage in the posterior fossa. A tomography is performed that confirms the hemorrhage and a vascular lesion that is visualized at the top of the basilar artery. For the procedure, radial and femoral access was performed without achieving stable access to the basilar artery. Therefore, after multiple attempts, we consider that the best option is direct V2 left vertebral puncture. Access was achieved by vertebral puncture to the aneurysm and occlusion was performed on the top of the basilar artery. Tomographic controls were performed without complications. Patient then presented severe pulmonary compromise that required intubation and prolonged stay in the ICU. Control is performed after a month with adequate occlusion of the aneurysmal lesion.

Conclusions

it’s nothing new just follow what nelson hopkins says: If You Want to Learn New Things, Read Old Books: Cutdown Techniques Are Well Described in the Old Literature
Abstract Number ‐ 86: Intracranial Angioplasty via Type II Proatlantal Intersegmental Artery
Authors: Babici Denis , Johansen Phillip Phillip , Sial Nadia , Snelling Brian
Published: April 2023

Introduction

A proatlantal intersegmental artery (PIA) is an exceedingly rare primitive anastomosis between the carotid and vertebrobasilar circulations. PIA’s may be accompanied by ipsilateral or bilateral vertebral artery (VA) agenesis and can originate from the cervical internal carotid artery (ICA, type I) or external carotid artery (ECA, type II) before eventually joining the vertebrobasilar system. Several authors have described this anomaly in different clinical scenarios, but to our knowledge, there are no studies documenting intracranial vertebral artery angioplasty through a type II PIA in the setting of a vertebrobasilar stroke.

Methods

Single case study

Results

A 62‐year‐old male presented to the ED with slurred speech that began one hour prior to arrival. Computer tomography (CT) of the head revealed a small right posterior acute parietal subdural hematoma, and CT perfusion scan revealed ischemia of the cerebellar hemispheres bilaterally with small areas of core infarction and a moderate‐to‐large surrounding penumbra. Magnetic resonance imaging (MRI) of the brain was positive for bilateral acute ischemic strokes of the cerebellar and pontine arteries. CT angiogram of the head and neck revealed high grade stenosis of the right intracranial VA and narrowing of the left V1, V2, and V3 segments. The proximal left V4 segment was occluded with distal reconstitution. Catheter angiogram of the ICAs and ECAs showed that the patient’s right VA did not originate from the right subclavian artery but instead from the right ECA. The patient was subsequently determined to have a type II PIA with critical stenosis. We proceeded with right VA submaximal angioplasty via the type II PIA. The procedure went without complications and resulted in restoration of vertebrobasilar blood flow, with only moderate stenosis following the submaximal angioplasty. On day 5 postoperatively, the patient reported resolution of his symptoms and was subsequently discharged.

Conclusions

We presented a case of vertebrobasilar stroke in which the right VA did not originate from the right subclavian artery but instead from the ECA, with a subsequent diagnosis of a type II PIA. The only option for management was to perform the right VA angioplasty via the PIA, which we believe to be the first documented case of intracranial vertebral angioplasty through a type II PIA. This case serves as a reminder of the very rare cases of persistent fetal circulation and the importance of performing a catheter angiogram of both the ICA and ECA. Evaluation of the ECA and subsequent observation of a PIA can completely change both the management and outcomes of the patient. This case underscores the complexity of the intracranial atherosclerotic disease, the beneficial role of endovascular intervention, and the necessity of future studies to identify the optimal treatment methods for vertebrobasilar stroke.
Abstract Number ‐ 98: Intravenous dose‐adjusted cangrelor use for neuroendovascular procedures: An institutional experience
Authors: Morsi Rami Z. , Desai Harsh , Kothari Sachin , Thind Sonam , Carrión‐Penagos Julián , Coleman Elisheva , Brorson James R , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass‐Hout Tareq
Published: April 2023

Introduction

The optimal antiplatelet therapy regimen for certain neuroendovascular procedures remains unclear. This study investigates the safety and feasibility of intravenous dose‐adjusted cangrelor in patients undergoing neuroendovascular procedures.

Methods

We conducted a retrospective chart review of all consecutive patients who underwent neuroendovascular procedures and were placed on intravenous cangrelor between September 1, 2020 and March 13, 2022. Cangrelor was administered as a 15 mcg/kg bolus followed by 2 mcg/kg/min infusion titrated to goal P2Y12reaction unit (PRU) level of 50 to 150, and then transitioned to oral antiplatelet therapy. Demographic characteristics, interventional variables, and clinical outcomes were collected.

Results

A total of 50 patients were included. The mean age (years) was 56.0±18.6, and 26 (52.0%) were males. Most patients were African American (n = 39/48, 81.3%). The most common comorbidities were hypertension (n = 25/49, 51.0%), active smoking status (n = 14/40, 35.0%), and prior ischemic stroke (n = 13/49, 26.5%). Intravenous thrombolysis was used in 4 patients (8.0%). Cangrelor infusion was used for the following procedures: embolization (n = 10/50, 20.0%), embolization and stent placement (n = 9/50, 18.0%), thrombectomy alone (n = 5/50, 10.0%), thrombectomy and stent placement (n = 10/50, 20.0%), and stent placement only (n = 14/50, 28.0%). Stent placement occurred intracranially beyond petrous segment of the internal carotid artery in 18 patients, remainder of internal or common carotid artery in 12 patients, and both intracranial and carotid arteries in 3 patients. PRU levels were measured in 48 patients (96.0%), with 26 patients (54.2%) achieving a PRU level of 50–150 greater than or equal to 50% of the time. Approximately 51.5% of the patients had a favorable functional outcome with modified Rankin Scale (mRS) score of 0 to 2 at 90 days (n = 17/33).During 1‐year follow up, approximately 4 patients had recurrent or new strokes (9.5%), 1 patient had in‐stent thrombosis (2.9%) and 1 patient with symptomatic intracranial hemorrhage [sICH] (2.4%), both while not on antiplatelet therapy, 2 patients with asymptomatic intracranial hemorrhage [ICH] (4.8%), and no gastrointestinal bleeding events were recorded. When stratified by PRU level, there were no significant differences in sICH (p = 0.841) or asymptomatic ICH (p = 0.853).

Conclusions

To our knowledge, this is the first report to demonstrate the safety and effectiveness of intravenous cangrelor use titrated based on platelet function testing in the largest cohort of patients who underwent neuroendovascular procedures to date. Further studies, including comparative studies to standard dose maintenance cangrelor, are necessary.
Abstract Number ‐ 108: Effect of Percutaneous Inferior Sympathetic Ganglion Block on Intracranial Artery Diameters on Cerebral Angiography
Authors: Bains Navpreet K , Kumar Nitish , Siddiq Farhan , Gomez Camilo R , Qureshi Adnan I
Published: April 2023

Introduction

There is some data suggesting vasodilatory effect of sympathetic blockade in patients with aneurysmal subarachnoid hemorrhage but the effect on medium‐sized intracranial arteries remains unclear.

Methods

Serial ipsilateral intracranial angiograms were obtained before and after percutaneous inferior sympathetic ganglion block. The angiogram files were imported to a DICOM reader, Horos Open‐Source Medical Image Viewer (Version 3.3.6).The percent change of arterial diameter (compared with pre‐blockage image) was calculated in intracranial internal carotid (ICA), middle (MCA) and anterior cerebral (ACA) arteries. We also assessed the inter‐observer reliability of arterial diameter change using the Bland‐Altman method after two raters independently measured the arterial diameter in 2 images with a total of 12 arterial measurements.

Results

In Patient 1, there was an increase in diameter of intracranial ICA, MCA and ACA at 1 minute (9.62%, 10.34%, 8.64%), 5 minutes (11.38%, 12.22%, 14.42%) and 10 minutes (8.66%, 11.30%, 5.50%), respectively.In Patient 2, there was an increase in diameter at 1 minute (0.72%, 2.08%, ‐1.75%), 5 minutes (12.04%, 0.64%, 4.50%), 10 minutes (6.86%, 7.23%, 10.38%), 20 minutes (9.45%, ‐2.16%, 13.32%), and 30 minutes (7.31%, 12.02%, 6.50%), respectively. The Bland‐Altman coefficient of variation was 1.32 (range 0.01 ‐5.57) with majority (5 out of 6, 83%) of the data points within the upper and lower limits of acceptance.

Conclusions

We observed vasodilation in medium‐sized intracranial arteries ipsilateral to the percutaneous inferior sympathetic ganglion block as early as one minute post treatment and persisting for at least until 30 minutes post blockade.
Abstract Number ‐ 114: Deep Cerebral Venous Thrombosis requiring Venous Thrombectomy and Intra‐arterial Thrombolysis in Young Pregnant Female
Authors: Shah Aakashi , Ajiboye Norman
Published: April 2023

Introduction

Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and mortality especially in young women and children (1). Even though, first‐line treatment remains anticoagulation, some patients deteriorate and endovascular treatment is needed. Currently there are no randomized controlled trials comparing the efficacy and safety of intracranial thrombolysis and mechanical thrombectomy to standard‐of‐care anticoagulation therapy (2). We present a case of a pregnant lady with CVST with successful clinical outcomes with venous thrombectomy and intraarterial thrombolysis.

Methods

Case Report

Results

30 year old lady with no past medical history, 7 weeks and 4 days pregnant presented with acute progressive encephalopathy associated with nausea, vomiting and headaches. On admission, she was stuporous, had dysarthria, severe hemiparesis, and hemineglect on the right side. She had COVID‐19 infection and her fetus had subchorionic hematoma by ultrasound. Initial CT brain showed extensive cerebral venous sinus thrombosis (CVST). She was intubated and MRI showed venous infarcts. MR venography revealed acute extensive CVST of superior sagittal sinus, vein of galen, right transverse sinus, right sigmoid sinus, and right jugular vein. IV Heparin drip was initiated. Her follow‐up neurological exam deteriorated despite maximal medical therapy. The decision was made for endovascular recanalization. The cerebral angiogram confirmed the occlusion of deep venous system. Thrombectomy of bilateral internal jugular vein and sigmoid sinus was performed with retrieval of thrombi. Post‐thrombectomy runs demonstrated persistent extensive CVST and decision was made for intra‐arterial thrombolysis. A diagnostic catheter was secured in the right internal carotid artery catheter (ICA). Thombolysis was performed with 4 mg/hr recombinant tissue‐plasminogen activator (rt‐PA). Heparin drip IV was continued. Subsequently, the repeat CT brain showed significant improvement in the CVST and interval development of intraparenchymal hemorrhages and subarachnoid hemorrhages. Heparin and rt‐PA were held. The patient was found to have Factor V Leiden mutation and she was started on Enoxaparin 1mg/kg throughout her pregnancy and 6 weeks postpartum. Clinically she demonstrated significant neurologic improvement and was discharged to home from rehabilitation center. Currently, she is thirty‐ four weeks pregnant and neurologically intact without any deficits.

Conclusions

Pharmacological and mechanical endovascular interventions can have significantly successful clinical outcomes in deep cerebral venous thrombosis. Controlled studies are required to assess the safety and efficacy of these interventions when compared to standard systemic anticoagulation.
Abstract Number ‐ 119: Stent‐Coil Embolization Of A High Riding Jugular Bulb For Symptomatic Pulsatile Tinnitus
Authors: Abraham Michael G , Beattie Sean , Lingam Sivani , Genz Nick
Published: April 2023

Introduction

Tinnitus affects millions of people worldwide and in a significant number of people, tinnitus can be severe enough to impact day‐to‐day life. Various diseases can manifest with tinnitus, including atherosclerotic disease, AVMs, Meniere’s disease, IIH, medication toxicity, and neoplasms. Jugular bulb diverticula are a significant contributor to the incidence of persistent tinnitus. One study of 1579 temporal bone specimens, 8.2% were found to have high‐riding jugular bulbs. Other sources demonstrate a prevalence of 6% in the population. Another study demonstrated a high‐riding jugular bulb in 2.4‐7% of temporal bones, a 5 times higher prevalence of a high‐jugular bulb in patients with ear related symptoms, and tinnitus in 22% of patients in a 730 cohort who presented to otolaryngology. We present 3 cases of jugular bulb diverticula causing debilitating tinnitus and their subsequent treatment with stent‐assisted coiling.

Methods

Retrospective chart review of patients who presented with symptoms of pulsatile tinnitus, noted to have a jugular bulb diverticulum on cerebral venogram, who underwent stent‐assisted coil embolization.

Results

A 71‐year‐old male with a history of migraines presented with nausea and right‐sided tinnitus that worsened on lying down. The persistence of symptoms prompted further investigation with a catheter venogram which demonstrated a high‐riding right jugular bulb measuring 10.37 mm x 8.61 mm. The patient underwent stent‐assisted coiling and embolization with improvement in his symptoms. A 57‐year‐old male with recent history of right ischemic infarct secondary to intracranial atherosclerosis had worsening left sided pulsatile tinnitus over one year to the point where it prevented sleep, waking him hourly. A CT‐Venogram revealed a left jugular bulb diverticulum measuring 5.33×5.02 mm. A cerebral angiogram and venogram confirmed this diagnosis and ruled out an AVM/dAVF. Stent‐assisted coiling resulted in immediate relief. The above patients were treated with a Zilver stent (Cook Medical, Bloomington, IN) and Target Coils (Stryker Neurovascular, Kalamazoo, MI). A 40‐year‐old woman presented with severe abrupt‐onset pulsatile right‐sided tinnitus and associated hearing loss, without any associated relieving factors. Due to the severity of her symptoms, she goes to counseling. A cerebral venogram revealed a right internal jugular diverticulum measuring 6.73 mm x 14.5 mm, without any associated dural sinus stenosis. She is scheduled for stent assisted coil embolization.

Conclusions

High‐riding jugular bulb or jugular diverticulum should be suspected as a potential and treatable cause of pulsatile tinnitus when other diagnoses have been ruled out. Our case series demonstrates that stent assisted coil embolization is safe and effective in relieving tinnitus and hearing loss, which can be debilitating in many cases.
Abstract Number ‐ 129: Intracranial Blister Aneurysm Management: An Australian Multi‐Centre Retrospective Analysis
Authors: Reidy Joseph D , Reidy Joseph D , Ma Alice , Faulder Kenneth , Harrington Timothy , Steinfort Brendan , Assaad Nazih
Published: April 2023

Introduction

Blister aneurysms (BA) are high risk neurovascular lesions that account for 1% of all intracranial aneurysms. The pathology of BAs, with defective vessel wall and broad‐based neck, make this clinical entity particularly difficult to treat. When these aneurysms present with acute subarachnoid haemorrhage there are associated with high rates of re‐rupture and mortality. These pose substantial challenges for both endovascular and microsurgical management. We report a multi‐centre retrospective analysis of BA management in Sydney, Australia, to describe the different surgical and endovascular approaches and the associated clinical outcomes.

Methods

A multicentre review of two large tertiary hospitals in Sydney with a search for imaging databases were screened for term of “blister” in all head and neck imaging modalities from January 2010 to June 2022. Operation reports were also screened for the 5‐year time period since cerebral angiogramreports transitioned from imaging database to surgical database. All identified reports were manually screened for confirmed diagnosis of blister aneurysm.

Results

21 cases with confirmed diagnosis of blister aneurysm that underwent management at respective facilities were included. 16 cases (76%) were managed endovascularly – one with stent‐assisted coiling and 15 with flow diversion stents. 4 cases (19%) were managed surgically – 3 of these were primary clipping, and one wrap and clipping technique. One surgical case was commenced as an endovascular case prior to conversion. One case was managed conservatively (5%). Clinical outcomes were discharge disposition, occlusion of aneurysm and post‐operative complications.

Conclusions

BAs have challenging therapeutic considerations with a high mortality and morbidity. Endovascular treatment offers a less invasive management option with a trend of lower rates of intraoperative rupture and lower mortality rates. Endovascular therapy had higher rates of retreatment and incomplete aneurysm occlusion on follow up imaging. Patients discharged directly home were comparable between groups. The decision making for blister aneurysms is complex, endovascular treatment shows promise for acute treatment but careful consideration of antithrombotic regime and requirement for EVD insertion or further surgery should be considered.
Abstract Number ‐ 142: Flow Diversion for Posterior Communicating Artery Aneurysms: Systematic Review and Meta‐Analysis
Authors: Vivanco‐Suarez Juan , Rodriguez‐Calienes Aaron , Farooqui Mudassir , Galecio‐Castillo Milagros , Malaga Marco , Ortega‐Gutierrez Satiago
Published: April 2023

Introduction

Posterior communicating artery (PComA) aneurysms are common and have a high risk of rupture. Flow diverters (FD) have demonstrated a safe and effective profile. However, the use of FD in PComA aneurysms has shown controversial results with high rates of recurrence and a high risk of potential ischemic complications. There, we aimed to evaluate the safety and efficacy of flow diversion for the treatment of PComA aneurysms with a meta‐analysis of the literature.

Methods

We performed a systematic search in Scopus, Embase, Medline, and Web of Science from inception until May 2022 for all the studies that reported the safety and effectiveness of FD for the treatment of intracranial aneurysms located in the posterior communicating artery. The primary effectiveness endpoint was a complete aneurysm occlusion rate at final follow‐up. The primary safety endpoint was a composite measure of cumulative events that occurred during and after the procedure. Events included death and ischemic/hemorrhagic complications. Random‐effects meta‐analysis was used to calculate proportions. Statistical heterogeneity across studies was assessed with I2 statistics.

Results

A total of 13 studies with 397 patients harboring 403 aneurysms were included in our analysis. Mean age was 48 years and mean aneurysm size was 5.3 mm. Complete aneurysm occlusion at final follow‐up was 74% (95% CI 66–81%; I2 = 54%). The primary safety composite outcome was 5% (95% CI 3–9%; I2 = 0%). The mortality rate was 1% (95% CI 0–2%; I2 = 0%). Subgroup analysis showed that patients with a non‐fetal PComA had a higher rate (76%; 95% CI 62%‐86%; I2 = 53%) of complete aneurysm occlusion compared to those with a fetal PComA (36%; 95% CI 21%‐54%; I2 = 0%).

Conclusions

Our findings show that flow diversion for the treatment of aneurysms located in the PComA is effective and safe. However, the same treatment for aneurysms located in a fetal‐type PComA did not show the same efficacy profile suggesting that these cases might require an alternative treatment to achieve permanent occlusion rates.
Abstract Number ‐ 150: Association of 24‐hour Blood Pressure Parameters Post‐thrombectomy with Mortality in Anemic and Non‐anemic Patients
Authors: Nisar Taha , Nisar Taha , Tofade Toluwalase , Shaulov Shaul , Shapouran Sara , Abu‐hadid Osama , Khandelwal Priyank
Published: April 2023

Introduction

Higher blood pressure (BP) is considered to be harmful in patients who undergo mechanical thrombectomy (MT), however, the impact of BP post‐MT based on comorbidities like anemia has not been well studied. We aim to determine the association of 24‐h post‐MT BP parameters with mortality depending on the anemia status.

Methods

We conducted a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. Patients were dichotomized into anemic and non‐anemic groups based on the World Health Organization’s definition of anemia [hemoglobin < 12.0 g/dL in women and < 13.0 g/dL in men]. We performed a binary logistic regression analysis controlling for baseline parameters, with the 24‐h post‐MT BP parameters as predictors. The primary outcome was 3‐month mortality.

Results

220 patients met the inclusion criteria. The 3‐month mortality rate was 27.27%. In the multivariable analysis, the 24‐h parameters of a lower mean DBP (65.53±9.73 vs. 71.94±10.16; OR, 0.92; 95% CI, 0.86‐0.98; P 0.007), lower mean MAP (85.7±8.65 vs. 91.38±10; OR, 0.93; 95% CI, 0.86‐0.99; P 0.02), a lower minimum DBP (49.27±10.51 vs. 55.1±11.23; OR, 0.93; 95% CI, 0.88‐0.99; P 0.019), a lower minimum MAP (68.96±9.54 vs. 74.73±10.47; OR, 0.93; 95% CI, 0.87‐0.99; P 0.023) were significantly associated with mortality in patients with anemia. There was no association between 24‐hour BP Parameters post‐MT and mortality in non‐anemic patients.

Conclusions

In our study, lower BP parameters were associated with higher 3‐month mortality in anemic patients, however, this effect was not found in non‐anemic patients. Anemia induces a relative hypoxic state in target tissue in the event of an increase in metabolic demand such as stroke. Higher BP post‐MT can potentially promote perfusion and thus is not associated with worse outcomes in anemic patients post‐MT, whereas in non‐anemic patients it may potentially lead to reperfusion injury.
Abstract Number ‐ 154: Outcomes of Rescue Intracranial Stenting vs Failed Recanalization during Mechanical Thrombectomy
Authors: Santucci Joshua , Martucci Maria , Baker David , Hussain M Shazam , Toth Gabor
Published: April 2023

Introduction

Rescue stenting may be considered during mechanical thrombectomy (MT) if a newly recanalized intracranial vessel keeps re‐occluding, or recanalization is not achieved with conventional thrombectomy methods. There are multiple published case series with mixed results on safety and efficacy of this approach, and there are no available randomized trials. We aimed to compare the outcomes of rescue intracranial stenting with unsuccessful/poor reperfusion after MT.

Methods

Retrospective review of ischemic stroke patients who underwent MT from 2016–2021. Emergent intracranial stent patients were selected and compared with those who had poor/unsuccessful post‐procedural reperfusion (TICI 0–2a). Initial ASPECT score, NIHSS, number of passes, and MT method (aspiration vs stentriever) were recorded. Complications (intracranial hemorrhage, vessel perforation, groin or retroperitoneal hematoma, or distal embolization), final infarct size, 90‐day mRS, and mortality were analyzed.

Results

Sixteen patients underwent emergent intracranial stenting. Of the 89patients with failed MT, 34 had TICI 2a, 11 had TICI 1, and 44 had TICI 0 reperfusion. All 16 stenting patients achieved TICI 2B‐3 grade recanalization. Pre‐procedure ASPECT score was similar between both groups. Six patients had either intracranial vertebral or basilar artery stenting, and 10 had either intracranial ICA or MCA stenting. Patients with posterior compared to anterior circulation involvement were more likely to receive stenting (50% vs 11%, p = 0.003). There were no differences in the stenting versus non‐stenting group in 24‐hour post intervention NIHSS, post‐procedural complications, intracranial hemorrhage, infarct size, and mortality (75% vs 67%). The stenting group had better functional independence (mRS 0–2) at 90 days (33% vs 11%, p = 0.04). There were no outcome differences in anterior compared to posterior circulation stenting.

Conclusions

Rescue stenting was more often seen with posterior circulation strokes. In patients with failed or unsuccessful reperfusion after conventional MT, emergent stenting achieved better 90‐day functional independence without increasing rates of complications, intracranial hemorrhage, or mortality.