bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract Number ‐ 118: Compressive Vertebrobasilar Dolichoectasia: A Rare Etiology of Acute Pontine Ischemic Stroke Undeterred by Anticoagulation
Authors: Asif Ahmer , Singh Raman , Shoaib Maria , Al‐Awwad Ahmad
Published: April 2023

Introduction

Dolichoectasia is a term used to describe dilated, elongated and tortuous arteries due to defects within the medial layer of their walls secondary to loss of elasticity. Multiple pathophysiological processes might lead to the development of dolichoectatic vessels, and activation of metalloproteinases and irregular turbulent blood flow seem to cause irreversible disruption of the internal elastic lamina. Consequences often include mass effects and ischemic and hemorrhagic stroke. Blood flow within dolichoectatic arteries is turbulent predisposing to thrombus formation with resultant ischemic strokes. Ideally, with optimal anticoagulation therapy, such strokes can be prevented. However, in rare instances, they can still occur despite anticoagulation, likely due to direct compression of pontine perforators from dolichoectasias or persistent turbulent flow.

Methods

Case report

Results

A 66‐year‐old woman with hypertension, diabetes mellitus, atrial fibrillation (taking warfarin at home), and left‐sided trigeminal neuralgia due to compressive left vertebrobasilar dolichoectasia with a focal fusiform aneurysm, presented with transient dysarthria and lightheadedness lasting for less than an hour. MRI brain did not show any acute pathology. CTA head showed worsening left vertebrobasilar dolichoectasia with transitional fusiform aneurysm (24 mm in diameter) with mass effect on the anterior part of the pons and lower midbrain. Next day, the patient developed dysarthria and right‐sided weakness, and a repeat MRI brain showed a left acute paramedian pontine infarct. Warfarin was discontinued, and the patient was started on a heparin drip and later transitioned to Apixaban. Eventually, a diagnostic cerebral angiogram and surpass stent placement within the aneurysm were attempted which went uneventful and the flow through the aneurysm regularized. The patient was eventually discharged home on Apixaban and Prasugrel with interval follow‐up.

Conclusions

Compression of perforating vessels supplying brainstem structures, branching off the pathologic vertebrobasilar dolichoectasia is a rare etiology of acute pontine ischemic stroke, not with standing the anticoagulation. It warrants immediate neurosurgical intervention to optimize blood flow and prevent a recurrence.
Abstract Number ‐ 121: Flow Diversion Jet: A Dangerous Mechanism in the Flow Diversion Treatment of Giant Intracranial Aneurysms
Authors: Brake Aaron , Fry Lane , Chatley Kevin , Heskett Cody , De Stefano Frank , Lei Catherine , Peterson Jeremy , Ebersole Koji
Published: April 2023

Introduction

We present a patient with a giant vertebrobasilar system aneurysm. This case provides an in‐depth analysis of the pathologic mechanism resulting in catastrophic distal hemorrhage following stent deployment due to the shared effects of normal perfusion pressure breakthrough (NPPB) and the Windkessel phenomenon. The Windkessel phenomenon and NPPB occur before and after treatment of various vascular malformations, respectively. These phenomena are hypothesized to contribute to the loss of cerebrovascular autoregulation. High flow lesions and giant aneurysms reduce blood flow in downstream vessels, causing chronic distal vasodilation to protect against ischemia. Sudden restoration of normal pulsatile flow, following treatment, compromises the integrity of distal vessels leading to potential catastrophic intracerebral hemorrhage.

Methods

A retrospective review of the patient’s medical record was performed.

Results

A 60‐year‐old female initially presenting with pulsatile neck mass was found to have dolichoectasia of the right cervical internal carotid artery and two large, irregular, vertebrobasilar aneurysms. Managed conservatively for 10 years before developing gait ataxia, new imaging revealed growth of the now giant, more distal aneurysm. Flow diversion with partial coiling of the aneurysms was pursued. Following deployment, DynaCT demonstrated catastrophic thalamic and midbrain hemorrhage with intraventricular extension. A review of intra‐aneurysmal pressure measurements, angiography, MRI, and neuromonitoring data strongly suggests rupture of multiple deep perforators following the conversion to laminar flow when the flow diverting chain was finalized. This suggests giant aneurysms chronically depress the distal pulse pressure by acting as a Windkessel reservoir. Flow diversion bypasses the reservoir increasing pulse pressure distal to the aneurysm, exceeding autoregulatory capacity, leading to hemorrhage.

Conclusions

This is the first case in the literature to describe NPPB and the Windkessel phenomenon in the attempt to treat giant aneurysms with flow diversion. Flow diversion bypasses the reservoir, suddenly changing turbulent flow to laminar flow. The resultant dramatic rise in pulse pressure distal to the aneurysm can exceed the autoregulatory mechanisms of small distal vessels such as perforating branches. While demonstrating a poor outcome, awareness of these mechanisms and meticulous intra‐operative blood pressure management may reduce or prevent complications. Further modeling of flow dynamics both before and following treatment of these aneurysms may lead to altered guidelines in the temporality of treatment due to potential catastrophic sequelae.
Abstract Number ‐ 158: Balloon Guide Catheter Effect on First Pass and Revascularization Success.
Authors: Modzelewski Michael D , Liang Conrad W , Perlman Sabrina M , Duggan Mark , Toor Harjyot , Sheth Sunil A , Martinez Evelin Duran , Chao Kuo , Feng Lei , Noufal Mazen , Nguyen Binh V , Mowji Pankaj J , Sangha Navdeep
Published: April 2023

Introduction

The use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) has been suggested to lower the risk of distal embolization and improve first pass revascularization rates in patients with acute ischemic stroke. However, a recent large randomized controlled trial suggests there is no significant difference in initial and final revascularization scores among EVT performed with a BGC versus without. We assessed the influence of BGC use during EVT on first pass (FP) and revascularization (RV) success in a historical database from a multi‐hospital health system.

Methods

Patients with anterior circulation large vessel occlusion undergoing EVT with stent‐retriever or aspiration between 2012 and 2018 at three Kaiser Permanente Southern California (KPSC) region hospitals were identified from the database. BGC use was determined through manual chart review. A chi‐squared test compared the relationship of BGC use with the primary outcomes. The primary outcomes were FP and RV success using a dichotomized TICI score of 2b or greater.

Results

218 patients were included in the study. BGC was used in 35/218 (16%) of patients. There was no significant difference in age (p = 0.65), gender (p = 0.92), presenting NIHSS (p = 0.45), hypertension (p = 0.66), diabetes (p = 0.85), atrial fibrillation (p = 0.36), serum glucose (p = 0.43), or pre‐EVT TPA administration (p = 0.36). Among EVT with BGC, FP success was 13/35 (37%) and EVT without BGC had a FP success of 76/183 (42%); p = 0.71. Successful final RV with BGC occurred in 30/35 (86%) while EVT without BGC had a successful final RV of 162/183 (89%); p = 0.78. Because BGC use occurred only with stent‐retriever treatment, subgroup analysis was performed comparing the BGC group (N = 35) with the non‐BGC stent‐retriever (N = 88) and aspiration thrombectomy (N = 95) groups. There was no significant difference in FP (p = 0.88) or RV success (p = 0.42) between the BGC (37% FP and 86% RV), non‐BGC stent‐retriever (42% FP and 92% RV), and aspiration thrombectomy groups (41% FP and 86% RV).

Conclusions

Among our population, BGC use was not associated with higher first pass or final revascularization success.
Abstract Number ‐ 159: Intubation for Patients Undergoing Mechanical Thrombectomy of DiVOs is Associated with Increased Symptomatic ICH
Authors: Zainab Anika , Desai Sohum , Saei Hamzah , Tekle Wondwossen G
Published: April 2023

Introduction

Distal vessel occlusions (DiVO) represent the next frontier of interventional stroke care. Some practitioners advocate for intubatingDiVOpatients to facilitate roadmapping techniques and vessel selection to assure procedural success. However, prior work studying thrombectomy in large vessel occlusion (LVO) suggests intubation is associated with worse outcomes. We sought to examine whether this relation also exists inDiVOpatients.

Methods

A prospectively maintained neuro‐endovascular database was queried for patients between January 2013 to August 2022. Patients included in the analysis had undergone mechanical thrombectomy of distal circulation defined as M2, M3, P2, P3, A2 and A3 segments of the MCA, PCA, and ACA respectively.Primary outcomes measured were NIHSS at 24 hours and at discharge. Secondary outcomes measured was the occurrence of symptomatic ICH post procedure.

Results

A total of 33 patients fit inclusion criteria among our database containing 826 mechanical thrombectomies. While there were more males in the endotracheal intubation group (p = 0.03), there were no other differences in baseline characteristics such as hypertension, diabetes, or prior antiplatelet medication use. Amongst the intubated cohort, we found increased rate of symptomatic intracerebral hemorrhage (ICH) (p = 0.03), worse NIHSS at 24 hours (p = 0.01), and worse NIHSS at hospital discharge (p = 0.002).

Conclusions

Endotracheal intubation for mechanical thrombectomy inDiVOpatients also appears to be associated with increased rates of symptomatic ICH which drives worse outcomes at 24 hours and discharge.
Abstract Number ‐ 175: First Pass Results of Mechanical Thrombectomy with two‐drop zone NeVaTM Device
Authors: Geyik Serdar , Bajrami Arsida , Ertugrul Ozgur , Senadim Songul , Erdem Eren , Baltacioglu Feyyaz , Nogueira Raul G
Published: April 2023

Introduction

Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy.The NeVaTM(Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTMdevice for mechanical thrombectomy.

Methods

Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria.The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post‐intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded.

Results

There was female pre‐dominance (54.5%). Median presenting NIHSS was 16 (IQR, 3–32). 88 MCA‐m1 (60,6%), 43 ICA‐tip (29,6%), 11 MCA‐m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7–136). First‐pass reperfusion scores were mTICI 0–2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% andmTICI 3 35.9%.Mean number of pass was1,84±1,14.Final mTICI 2b‐3 score was 97.9% and TICI2c‐3 score was 87.6%. No device related adverse event occurred. The mean 24‐hour NIHS score was 6 (IQR 0–33).

Conclusions

In conclusion, the NeVa thrombectomy device offers a high rate of first‐pass success along with favorable safety profile. Larger series and multi‐center studies are needed for further investigation
Abstract Number ‐ 186: Keep it simple: MAC (Manual Aspiration with Contrast) Technique Endovascular Management of Acute ischemic Stroke
Authors: Torres Victor , Pabon Boris , Patiño Manuel , Pelaez Juan , Mutis Jorge , Cardozo Margarita , Zapata Andres
Published: April 2023

Introduction

The availability of advanced large‐bore diameter aspiration catheters has improved recanalization rates and time. We report a prospectively collected clinical experience with a simple technique: MAC (Manual Aspiration Contrast Enhancement) as the primary method for vessel recanalization. Gently contrast injection while the aspiration catheter is advanced to the thrombus and subsequently creating a closed‐loop system with the contrast column within the catheter can result in better visualization during the aspiration, thus improving the FPE avoiding clot fragmentation, multiple passes and blind movements of catheter by a single operator.

Methods

47 prospectively patients with ELVO and 3 cases of middle vessel occlusion (MVO) at four institutions were included in the study. The MAC technique was utilized in all patients. Procedural and clinical data were analyzed.

Results

MAC technique using SOFIA 6 Plus Catheter was successful in achieving first pass effect (FPE) and Thrombolysis in Cerebral Infarction (TICI) 2b‐ 3 revascularizations in 77% of cases. The average time from groin puncture to at least TICI 2b recanalization was 16 min. National Institutes of Health Stroke Scale (NIHSS) score average at onset of 16, and improved to a median NIHSS score at discharge of 5.5. One ICA rupture and two symptomatic intracerebral hemorrhages were recorded peri operatively.

Conclusions

MAC technique is a simple, fast, safe, and effective method that has reduced the requirements to multiple passes and also avoiding the use of expensive materials to reach the occlusion site. MAC is a replicable approach without additional training requirements.
Abstract Number ‐ 189: Comparative Device Analysis for First Pass Stent Retriever Mechanical Thrombectomy
Authors: Baker David , Hussain M. Shazam , Toth Gabor
Published: April 2023

Introduction

Limited data is available regarding comparative outcomes amongst FDA‐approved devices for mechanical thrombectomy (MT). The objective of this study is to assess procedural efficacy, clinical outcomes, and safety of currently available stent retriever devices when used during first pass thrombectomy for acute ischemic stroke.

Methods

A retrospective analysis was performed on all patients who underwent MT for large vessel occlusion (LVO) at a single comprehensive stroke center between January 2016 and January 2022. All patients who underwent MT with a stent retriever (Solitaire, Embotrap, Trevo) during first pass were included in the analysis. Primary efficacy and safety outcomes included time to recanalization, attainment of first‐pass effect (FPE), recanalization TICI score, 90‐day modified Rankin scale (mRS), and incidence of hemorrhagic transformation. One‐way ANOVA was used to compare median time to recanalization amongst cohorts. Chi‐squared test was used to compare frequencies of outcome measures amongst cohorts.

Results

During the study period, 234 patients underwent MT for LVO with use of stent retriever device during the first pass. In these cases, the type of stent retriever utilized was Solitaire (n = 163), Embotrap (n = 45), or Trevo (n = 26). There were no significant differences between cohorts in terms of age, gender, ethnicity, initial NIH stroke scale, or level of occlusion, or comorbidities. No significant differences were observed between cohorts for any primary outcome measures. The median time to recanalization was 53 min [Solitaire], 49 min [Embotrap], 63 min [Trevo] (p = 0.17). First‐pass effect was attained in 28.6% [Solitaire], 38.4% [Embotrap], 26.9% [Trevo] (p = 0.41). TICI 2b or greater recanalization was attained in 80.3% [Solitaire], 88.9% [Embotrap], 84.6% [Trevo] (p = 0.38). 90‐day mRS of 0–2 was observed in 36.6% [Solitaire], 38.9% [Embotrap], 34.8% [Trevo] (p = 0.95). Hemorrhagic transformation was observed in 45.9% [Solitaire], 36.8% [Embotrap], 34.6% [Trevo] (p = 0.40).

Conclusions

The type of stent retriever chosen for first pass thrombectomy did not predict procedural efficacy, clinical outcomes, or safety in our single center analysis.
Abstract Number ‐ 230: Mobile Stroke Unit Experience With Anticoagulant Related Intracranial Hemorrhage
Authors: Kareem Samer Abdul , Chaubal Varun , Kareem Mustafa Abdul , Subu Rand Al , Lin Eugene , Zaidat Osama
Published: April 2023

Introduction

The advent of mobile stroke units (MSU) provide a golden opportunity to rapidly reverse anticoagulant related intracranial hemorrhage (AC‐ICH) in the pre‐hospital setting. The timely reversal of anticoagulants is crucial in halting hematoma expansion and achieving good clinical outcomes. It is known that AC‐ICH is associated with higher mortality rate and higher hematoma expansion than spontaneous ICH. Multiple studies showed that rapid reversal of AC‐ICH is associated with better outcomes and more stability of the hematoma size. Studies showed there is delay in initiation of therapy and revere the anticoagulants in ICH cases, [1,2}. Here, we report 3 cases of AC‐ICH diagnosed on the MSU with pre‐hospital use of reversal agents. To our knowledge, this is the first case series of Non vitamin K antagonist oral anticoagulants (NOACS) on the MSU.

Methods

We reviewed the MSU data from May 2016 to December 2020 and those with AC‐ICH were selected. Baseline demographics and clinical presentation were obtained including clinical outcome.

Results

A total of 3 patients were identified. Patient 1 is a96 year‐oldfemale with history of Atrial fibrillation (AF) that presented with AC‐ICH related to Apixaban and was treated with Prothrombin complex concentrate (PCC). The time of MSU examination to treatment (MSUe‐T) was 41 minutes.The patient was neurologically intact and discharged home after 4 days, no further images were indicated as the patient was stable and back to baseline. Patient 2 is a68 year‐oldmale with history of deep vein thrombosis that presented with AC‐ICH related to Warfarin and was treated with PCC. TheMSUe‐T was 64 minutes. Repeated CT head in the ED was stable. Neurological exam improved and the patient discharged to a skilled nursing facility. Patient 3 is a79 year oldmale with history of AF that presented with AC‐ICH related to Rivaroxaban and was treated with PCC. TheMSUe‐T was 50 minutes. Repeated CT head after 3 days was stable. According to FASTEST trial, the average time from onset to treatment of AC‐ICH was 90–120 min.In this trial, the growth of the ICH during the first hours was associated with increase mortality rate,{3}

Conclusions

Our data demonstrated that management of AC‐ICH on the MSU is feasible and provides an ample opportunity to reverse AC in the hyper‐early stage of ICH. MSU might have an important role in reducing the mortality for AC‐ICH patients. Larger comparative studies between Emergency department and MSU are needed.
Abstract Number ‐ 236: Pure Arterial Malformations: A Case Report
Authors: Ahmed Rashid A , Regenhardt Robert W , Vranic Justin E , Dmytriw Adam A , Rabinov James D
Published: April 2023

Introduction

Pure arterial malformations are dilated, overlapping, and tortuous arteries forming a mass of arterial loops without a venous component. These malformations are rare, with limited cases reported in the literature. Affecting any of the intracranial arteries, they are usually found incidentally and often have a benign course.

Methods

We present a case of a pure arterial malformation in a young female with hyperprolactinemia. Furthermore, we review the literature and provide an updated summary of these malformations.

Results

A 28‐year‐old female with a history of infantile hemangiomas, polycystic ovary syndrome, and hyperprolactinemia presented with acne, mild hirsutism, and galactorrhea. Her neurological exam was normal. Magnetic Resonance Imaging (MRI) of the brain with and without contrast ruled out a prolactinoma but revealed a 3 cm vascular malformation at the margin of the left cavernous sinus extending posteriorly into the anterior left perimesencephalic cistern. Initial differentials included a pial arteriovenous malformation or less likely a dural arteriovenous fistula. She underwent a diagnostic cerebral angiogram which revealed a pure arterial malformation without arteriovenous shunting. This was composed of dysplasia of the left posterior communicating artery and anterior choroidal arteries. Stenosis of the left internal carotid artery distally with collateral support into the left anterior cerebral artery and middle cerebral artery was also noted. Lesser changes were noted in the right side with reconstitution of the right anterior cerebral artery from collaterals. Genetic testing for vascular malformation syndromes, including genes known to be associated with hereditary hemorrhagic telangiectasia, was negative. Repeat MRI/MRA done 8 months from the initial scan was stable with no abnormal large arterial venous shunting or definite saccular aneurysm formation noted.

Conclusions

Although rare, pure arterial malformations should be considered in the differential diagnosis for patients presenting with a cranial vascular malformation. Management of these lesions is usually conservative given their lack of arteriovenous shunting and low risk of rupture, with only a few cases undergoing surgery or endovascular treatment.
Abstract Number ‐ 242: Safety and Effectiveness of Intravenous Thrombolytic in Patients with Concurrent Migraine‐Headaches and Focal Neurological Deficits.
Authors: Asif Ahmer , Babar Sehar , Kherani Danish , Nagarajan Elanagan , Chandrasekaran Premkumar N , French Brandi R , Qureshi Adnan I
Published: April 2023

Introduction

It is relatively well recognized that migraine headaches can present with focal neurological deficits. Current guidelines do not exclude such patients from receiving intravenous recombinant tissue plasminogen activator (rt‐PA).

Methods

We reviewed the records of migraine patients with ischemic stroke using a combination of retrospective chart review and prospective identification. The migraine was classified based on the criteria proposed by the third International Classification of Headache Disorders (ICHD‐3) into migraine with aura, and hemiplegic migraine. We ascertained rates of early neurological improvement (defined by reduction in National Institutes of Health Stroke Scale (NIHSS) score of 4 points or greater or NIHSS score of 0 at24 hours), any intracerebral hemorrhage within 24 hours, and excellent functional outcome based on modified Rankin Scale (mRS 0–1) at one month.

Results

A total of 25 patients (mean age ± SD; 45.3 ± 10.6 years; 15 were women) who met the criteria of migraine headaches concurrently presented with focal neurological deficits and received intravenous rt‐PA. The migraine was classified as hemiplegic migraine and migraine with aura in 22 and 3 patients, respectively. Intravenous rt‐PA was administered at a mean period of 142 minutes(range 60–255 minutes). Computed tomographic angiography was performed in 24 patients and did not reveal any large vessel arterial occlusion. Early neurological improvement was seen in 13 of 25 patients. None of the patients developed post thrombolytic intracerebral hemorrhage. Excellent functional outcome was seen in all patients. Diffusion‐weighted magnetic resonance imaging (MRI) was performed in 25 patients within 72 hours of symptom onset and demonstrated a new infarction in 1 patient.

Conclusions

In our analysis, intravenous rt‐PA was associated with high rates of early neurological improvement and excellent functional outcome at 1 month in patients with concurrent migraine headaches and focal neurological deficits.
Abstract Number ‐ 247: Multimodal imaging approach for the diagnosis of (ICAD): basic principles, current and future perspectives
Authors: Charles Jude H , Desai Sohum , Hassan Ameere
Published: April 2023

Introduction

Symptomatic intracranial atherosclerotic disease is among the most common causes of acute ischemic stroke. The imaging tools utilized for the diagnostic of ICAD have significantly evolved over the past few decades. This paper is a review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD.

Methods

A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included “imaging modalities in ICAD” “ICAD diagnostic” “Neuroimaging of ICAD” “Evaluation of ICAD”. A summary and comparison of each modality’s basic principles, advantages and disadvantages were included.

Results

A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD.

Conclusions

ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
Abstract Number ‐ 250: Case Series of Moyamoya Patients Diagnosed on Hyperacute Imaging
Authors: Xia Christina , Draytsel Dan , Gould Grahame
Published: April 2023

Introduction

Moyamoya disease is the idiopathic bilateral progressive stenosis of the anterior circulation arteries at the skull base, followed by the compensatory formation and proliferation of collateral small vessel arteries typically in the lenticulostriate region. The clinical diagnosis is made by neurovascular imaging with digital subtraction angiography being the gold standard of diagnosis. The term moyamoya syndrome is used when the formation of collateral arteries occur after unilateral vasculopathy or if the progressive stenosis occurs in the setting of known associated conditions such as sickle cell disease or prior cranial radiation treatment. For patients who have undiagnosed moyamoya syndrome, stroke symptoms may be the first presentation of the underlying disease.

Methods

We present a case series of 15 patients who arrived to our tertiary care hospital from December 2014 to July 2022.

Results

The majority of the patients were women with the average age of 43 years old. Patients were admitted with NIHSS ranging from 0 to 14, and two patients presented with signs suggestive of MCA syndrome. Including major ischemic stroke risk factors, five patients also had differentials of antiphospholipid antibody syndrome, connective tissue disorder, vasculitis, and congenital rubella as possible underlying conditions promoting the vasculopathy. Morbidity was high for moyamoya patients, with an average modified Rankin scale of 2 at discharge. Eleven patients had unknown moyamoya history at time of arrival and were identified based on hyperacute diagnostic CT angiography during stroke evaluation. Five patients were initially diagnosed as large vessel occlusion on CT angiography. Given the speed at which IV thrombolysis and mechanical thrombectomy decisions are made, patients with moyamoya vasculopathy require rapid and accurate interpretation of CT findings that distinguish them from standard large vessel occlusion patients and prevent the potentially catastrophic consequences of inappropriate treatment.

Conclusions

The pathophysiology leading to moyamoya disease is not well understood, but the stenosis process of major arteries is thought to be secondary to irregular hyperplasia of the tunica media, followed by compensatory growth of small collateral vessels. This collateralization leads to micro‐aneurysm formation in the small perforator branches. Moyamoya patients are at an increased risk of hemorrhage, representing a contraindication to IV thrombolysis, and, if mechanical thrombectomy is attempted, risk of possible large vessel rupture. In our case series, the 15 patients did not receive IV thrombolysis or mechanical thrombectomy based on appropriate diagnosis of moyamoya vasculopathy at time of emergency CT angiography, subsequently confirmed by elective, catheter cerebral angiography.
Abstract Number ‐ 261: Gender Specific Risk Factors for Recurrent Ischemic Stroke With Previous History of TIA
Authors: Djerdjour Leila , Nathaniel Thomas
Published: April 2023

Introduction

Gender differences in stroke outcomes have been investigated extensively, but whether this extends to recurrent strokes with a history of trans ischemic attack (TIA) is not fully understood. We examined gender differences in recurrent strokes patients with a history of TIA using a retrospective data analytical approach.

Methods

We assessed the risk factors of recurrent stroke patients with TIA in women compared to men using data collected between January 2010 through January 2016 from a Stroke Registry. We used logistic regression to determine risk factors associated with recurrent strokes with and without history of TIA. Our model was tested using the Hosmer‐Lemeshow test for the overall correct classification percentage, while interactions and multicollinearity between independent variables were examined using variance inflation factor.

Results

In the adjusted analysis, smoking history (OR = 2.763, 95% CI, 1.063‐7.185, P = 0.037), dyslipidemia (OR = 1.073, 95% CI, 1.039‐1.108, P< 0.001), and higher heart rate (OR = 1.049, 95% CI, 1.017‐1.082, P = 0.002) were associated with female patients with history of recurrent stroke and TIA. On the other hand, men were shown to have a higher incidence of coronary artery disease (CAD), elevateddiastolic blood pressuresand creatinine levels.

Conclusions

Our findings indicate risk factors in ischemic stroke patients with history of TIA that can be managed to improve the care of men and women with a recurrent stroke and a history of TIA.
Abstract Number ‐ 271: Comorbidities: Severe Stroke in Thrombolysis for Ischemic Stroke with Elevated Diastolic Blood Pressure
Authors: Knisely Krista M , Sanders Carolyn B , Edrissi Camron K , Poupore Nicholas S , Rathfoot Chase A , Nathaniel Thomas I
Published: April 2023

Introduction

Patients are at risk for different outcomes following stroke based on their diastolic blood pressure on admission. In this study, we determine differences in risk factors between patients with DBP < 80 and > = 80 mmHg and then determine which of these risk factors are associated with worsening neurologic outcomes after rtPA administration.

Methods

A retrospective analysis was performed by looking at demographics, history, and clinical factors that are known risk factors for acute ischemic stroke. Data were obtained from a stroke registry that includes patient data from between 2010 and 2016. Univariate analysis was performed based on presenting diastolic blood pressure group. Patients who did not receive rtPA were excluded from further study and then patients were further divided by NIHSS > = 7 or > 7. Logistic regression was used to further evaluate variables. Odds Ratios with 95% Confidence Intervals (C.I.) were calculated and used to predict worsening neurologic outcomes for stroke patients based on their blood‐pressure group.

Results

In the population of stroke patients with diastolic blood pressure < 80 mmHg, increasing age (OR = 1.025, 95% C.I. = 1.011 – 1.039 . P‐value = < 0.001), and elevated blood glucose levels (OR = 1.003, 95% C.I. = 1 – 1.006, P‐value = 0.03) were associated with worsening neurologic outcomes. In the diastolic blood pressure group > = 80 mmHg, increasing age (OR = 1.026, 95% C.I. = 1.012 – 1.04. P‐value = < 0.001), history of drug or alcohol abuse (OR = 2.11, 95% C.I. = 1.116 – 3.988, P‐value = 0.022), hypertension (OR = 1.572, 95% C.I. = 1.01 – 2.449, P‐value = 0.035), and increasing heart rate (OR = 1.012, 95% C.I. = 1.012 – 1.022, P‐value = 0.024) were associated with worsening neurologic outcomes.

Conclusions

This study found that there are significant differences in the clinical factors between patients with a DBP < or > = 80 mmHg with acute ischemic stroke and these groups also had different risk factors for severe stroke after rtPA administration. In both groups, increasing age was associated with worsening neurologic outcomes, while direct admission was associated with improving outcomes. In the DBP < 80 mmHg group, elevated blood glucose levels were associated with worsening neurologic outcomes. In the DBP > = 80 mmHg group, a history of alcohol or drug use and increased heart rate were associated with worsening neurologic outcomes.
Abstract Number ‐ 275: Novel 3D Virtual Reality Simulator Use in Stroke Code Simulation
Authors: Reddy Aravind , Michael Mina , Zidan Awss , Masoud Hesham
Published: April 2023

Introduction

Stroke code simulations have gained popularity as an educational model for neurology resident and fellow training in the diagnosis and management of hyperacute stroke. Previous simulations have used live patients or standardized patients as surrogates for learners to interact with in the simulated codes. While these provide high fidelity, there can be significant costs associated with the training and deployment of standardized patients, as well as potential for inconsistencies from encounter to encounter. A novel 3D virtual reality based simulator (Dancing Eyes LLC, Skaneateles, NY) aims to reduce the costs of running stroke code simulations while maintaining high fidelity and encounter consistency. It can also have the additional benefit of being utilized at the convenience of the trainee’s schedule, reducing logistical hurdles for scheduling and organizing simulations.

Methods

Neurology residents (who have previously experienced live simulation stroke codes with standardized patients) will undergo simulation encounters using the 3D virtual reality‐based simulator. We will enroll 20–25 residents at post graduate year levels (PGY) 2–4. Following the simulated encounter, a debriefing session is conducted for learners to review the case, share their experience, and provide additional feedback. A post‐simulation survey will be comnducted that solicits trainee experience with the VR simulator in defined domains such as comfort, ease of use, fidelity, and overall educational experience and value.

Results

The VR simulator has been designed to be worn over the face and can be adjusted for trainee comfort. The simulator integrates imaging, labs, the ability to use a virtual NIH‐stroke‐scale booklet, and other neurologic examination tools by virtually grabbing them or selecting them from a panel user interface. The simulated VR patient registers the trainee’s voice and shows the speech that was detected. It then attempts to answer the question or perform the issued command based on variables that have been pre‐programmed for the specific encounter/simulation. Trainees are able to perform a full NIH stroke scale assessment on the simulated patient. We aim to report the results of our study in time for the SVIN Annual Meeting/update deadline prior to the meeting.

Conclusions

Figure 1 shows a trainee using the VR simulator in a simulated stroke code encounter, as well as a rendering of the simulated patient. The VR simulator aims to serve as a high‐fidelity, low‐cost, convenient and consistent training modality for stroke code simulation and enhance trainees ability and comfort with diagnosis and management of hyperacute stroke.
Abstract Number: LBA15 Transient Ischemic Attack Uncovering An Absent ICA
Authors: Dalal Siddharth , Kapoor Gaurav , Salamon Elliot
Published: April 2023

Introduction

Absence of the Internal Carotid Artery (ICA) is a rare cerebrovascular anomaly signified by agenesis, aplasia, or hypoplasia of the ICA and its’ bony canal. Agenesis refers to complete absence whereas aplasia refers to some partial remanent of the ICA or the carotid canal however, these terms are often used interchangeably. There are 6 types of ICA agenesis/aplasia of which type A consists of collateral flow supplied to the MCA via the P‐comm and ACA via the A‐comm. The prevalence of such a condition is reported at around .01% of the population. Patients are usually asymptomatic due to robust collaterals but, in some cases, can present with focal neurologic deficits. Here, we present a case of a patient who endured a transient ischemic attack and was subsequently found to have type A Right ICA aplasia on cerebrovascular imaging.

Methods

Case Report

Results

A 24‐year‐old Right‐handed Female with no past medical history except for tobacco use presented with transient left arm monoparesis. The patient had received chiropractic treatment involving hyperextension of her neck to the left just prior to symptom onset which transiently caused her left arm to become plegic and she resolved back to her neurologic baseline within 10 minutes. Neurologic exam was normal and non‐contrast head CT was negative however, demonstrated significant hypoplasia of the right carotid canal (Figure 1‐A). Contrast enhanced CT Angiogram of the head and neck demonstrated lack of contrast opacification of the Right Internal Carotid artery with absent Right carotid bulb and opacification of only the Right ECA (Figure 1‐B). MRI of the brain did not demonstrate any acute infarction. Gadolinium enhanced MRA of the Head and Neck confirmed absence of the Right internal carotid (Figure 2‐A) with prominent Right P‐comm and absent Right A1 segment (Figure 2‐B). Due to this variant anatomy, the postulated mechanism of patient’s TIA was thought to be related to transiently decreased cerebral perfusion caused by partial mechanical compression of her vertebral arteries asymmetrically affecting the Right MCA distribution due to sole supply from the Right posterior communicating artery.

Conclusions

This case illustrates a fascinating variation from normal embryologic angiogenesis and highlights the importance of collateral blood flow through the circle of Willis in patient’s with congenitally absent internal carotid arteries. Particularly, this patient’s presentation demonstrates the risk that vascular compromise of posterior circulation vessels may play in patients with Type A ICA agenesis/aplasia and their subsequent risk of incurring transient ischemic events.
Abstract Number: LBA16 Does Intracranial Hemorrhage Associated with Tenecteplase Occur Exclusively Within the Stroke Burden?
Authors: Fourcand Farah , Sahito Sindhu , Gadallah Nancy , Fourcand Farah , Aziz Kashif , Dubinsky Ilya , Peter Yong‐Bum , Tabibzadeh Navid , Mehta Siddhart , Panezai Spozhmy , Kirmani Jawad
Published: April 2023

Introduction

As IV tenecteplase (TNK) is becoming an alternative to IV alteplase in acute ischemic stroke (AIS), establishing the incidence of intracranial hemorrhage (ICH) complications is important. Given the higher fibrin specificity of TNK as compared to alteplase, our aim was to distinguish hemorrhage within the stroke burden versus spontaneous ICH in patients with AIS with TNK‐associated ICH.

Methods

Retrospective chart review of patients presenting from February 2020 to January 2022 with anterior circulation AIS to our comprehensive stroke center who received TNK was performed to evaluate for associated ICH. ECASS‐3 criteria was used to define hemorrhagic transformation and ICH score was used for primary, spontaneous ICH. Fisher exact test statistic was used to evaluate for significant differences in ASPECTS score, medium versus versus large vessel occlusion, angiographic recanalization, IV eptifibatide use, pre‐morbid antiplatelet use, and association with symptomatic versus asymptomatic hemorrhage. A benchmark less than 5% symptomatic ICH incidence was set based on historical alteplase rates within our network. Social science statistics software was used for data analysis.

Results

Out of 77 subjects who received TNK, 20.7% (n = 16) developed ICH, 9.1% (n = 7) of which were symptomatic ICH with a temporally‐related increase in NIHSS of at least 4 or greater. Seven subjects (43.75%) were male. Mean age was 73.38 (95% CI 65.92, 80.83). Median initial NIHSS was 16, 95% CI [11.74, 21.51]. Median ASPECTS was 9, 95% CI [8.74, 9.89]. Two subjects developed spontaneous, primary ICH (n = 1 symptomatic ICH, n = 1 non‐symptomatic ICH) in the absence of hemorrhagic transformation of ischemic stroke. No significant difference between subjects with asymptomatic hemorrhage versus symptomatic hemorrhage was found when comparing ASPECTS > = 7 versus < 7 (Fisher value = 1), angiographic recanalization (Fisher value = 1), use of IV eptifibatide (Fisher value = 1), pre‐morbid antiplatelet use (Fisher value = 0.13), or medium vessel occlusion (Fisher value = ‐0.63).

Conclusions

Expected rates of hemorrhagic transformation were higher in tenecteplase than our historical benchmark rate for alteplase. Spontaneous hemorrhage unrelated to ischemic stroke area were seen in 2 subjects without known hematological disorders. Larger, prospective studies are needed to validate safety of tenecteplase in real world settings.
Why Electoral Violence Persists in Africa? A Critical Review of Literature
Authors: Henry Rodrick
Published: April 2023

Electoral violence is a persistent phenomenon in Africa. Studies reveal that no single election has been held in Africa without incidents of violence. There is a surge of interest in electoral violence as an academic field, although still in its infancy. The existing literature on electoral violence primarily focuses on the concept, causes, impact and prevention mechanisms. Nevertheless, the question as to why electoral violence persists is inadequately addressed. This paper engages varied literature on electoral violence to uncover why electoral violence persists in Africa. I argue that although the literature provides diverse explanations on electoral violence in Africa, institutional account, particularly the consolidation of democratic institutions, is the most plausible explanation for why electoral violence persists.
The View through a Different Lens
Authors: Lush Emma
Published: April 2023

In years past, much of the discussion around International Humanitarian Law and International Human Rights Law has been dedicated to considering the convergence of the two regimes; to discover a way to increase respect for the protection of the individual in armed conflict. Meanwhile, egregious violations of individual’s human rights continue to occur in armed conflicts – those in Ukraine, Yemen, Ethiopia, Afghanistan, and many others. This paper surveys the relationship between the two international disciplines, and considers that though ihl and ihrl are two regimes that have different aims, both contain norms that strive for the protection of the individual in armed conflict. Ultimately, this paper argues that protection of individuals in armed conflict can be strengthened by importing ihl norms into the ihrl framework. This cross-pollination allows treaty bodies to interpret, and make comments about, State Parties’ adherence to ihl that can increase respect for those norms, given ihrl’s associated enforcement mechanisms and communications machinery.
“A Global Web of Elegies”
Authors: Ramazani Jahan
Published: April 2023

Is the elegy global? To wrestle with this impossibly large question, can we approach it intrinsically by searching within elegy for traces of the genre’s worldwide reach? A contemporary elegy that can serve as a portal to the genre’s globality is Edward Hirsch’s book-length Gabriel (2014), a lament for the poet’s son that weaves a global web of elegies, citing more than a dozen mourning poets from classical and Edo Japan, medieval, Renaissance, and Romantic Britain, Renaissance Poland, nineteenth-century Germany and France, and twentieth-century Italy, Russia, and India. Though not comprehensive, Hirsch’s gathering makes visible the elegy’s global resonances, divergences, and scope.
The Elegiac Transnational
Authors: Admussen Nick
Published: April 2023

This essay is an elegy for the study of a Chinese elegy. Its putative archive is a book of poems printed in Shenzhen by the late Hei Guang, a collection I do not own by a poet who I never got to meet. My pursuit of the collection is hampered by my recent inability to travel to China, by changes in my ability to transculturate, and by the limits on global circulation in the age of climate change. Experimenting with tactics drawn from China’s tradition of lei elegy, I identify the loss of the collection as a disruption of the process of thick translation, of the ethical direction that animates world literature. By mourning the type of interactions that would have allowed me to translate Hei Guang well, I hope to reproduce the desire for heterogeneity and circulation into the post-pandemic, warming world.
Gautieria mianjin (Gomphales, Basidiomycota), a new species of false truffle from China
Authors: YANG KUN L. , YANG ZHU L. , ZHANG MING , WANG GENG-SHEN , LIU XIAO
Published: April 2023

A new species of false truffle, Gautieria mianjin, collected from northwestern China, is described based on morphological and phylogenetic evidence. It is characterized by its irregularly subglobose basidioma in the size of 2.5–5 cm in diameter with brain-like to honeycomb-like gleba and subglobose to broadly ellipsoid basidiospores measured 11–14×10–12 μm with 10–14 longitudinal ribs.
Jatropha chazaroi (Euphorbiaceae), an endangered new species from Apazapan, Veracruz, Mexico
Authors: SÁNCHEZ-SÁNCHEZ ODILÓN , JIMÉNEZ-RAMÍREZ JAIME , ARZABA-VILLALVA CARLOS , FRANCISCO-GUTIÉRREZ ANTONIO , ROSALES-LARA LUIS ÁNGEL
Published: April 2023

Jatropha chazaroi is described and illustrated as a new species from the state of Veracruz, Mexico. It is morphologically similar to J. podagrica but is distinguished by being a tree or shrub devoid of a caudex (vs. shrub with caudex) and lacking persistent and spinescent stipules (vs. having persistent and spinescent stipules). Its flowers possess connate staminate and pistillate calyces and corollas (vs. not connate). Jatropha chazaroi is only known from the municipality of Apazapan, Veracruz, and thrives in shady sites throughout intermittent waterways.
Revision of the subgenus Hemiglaphyrus Champenois, 1903 of Glaphyrus Latreille, 1807, with description of three new species and Atticoglaphyrus new subgenus (Coleoptera: Glaphyridae)
Authors: GHREJYAN TIGRAN , KALASHIAN MARK , SABATINELLI GUIDO
Published: April 2023

The subgenus Hemiglaphyrus Champenois, 1903 of Glaphyrus Latreille, 1807 is revised. It currently includes four species: G. (H.) caucasicus Kraatz, 1882 (type species), G. (H.) armeniacus Ghrejyan, Kalashian & Sabatinelli, new species from Armenia, G. (H.) urartu Sabatinelli, Ghrejyan & Kalashian, new species from East Turkey and Iran and G. (H.) schweigeri Ghrejyan, Kalashian & Sabatinelli, new species from Iran and Iraq, here described and illustrated. A key to Hemiglaphyrus species is provided. Atticoglaphyrus Ghrejyan, Kalashian & Sabatinelli, new subgenus is established for G. modestus Kiesenwetter, 1858 originally included in Hemiglaphyrus. Lectotypes of Glaphyrus caucasicus Kraatz, 1882 and Glaphyrus modestus Kiesenwetter, 1858 are designated.