bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 148: Balloon‐assisted retrograde Cerebral Venography in Cerebral Venous Interventions: A novel avenue for diagnostic venous imaging
Authors: Choudhri Omar
Published: March 2024

Introduction

Angiographic imaging of cerebral venous system is derived from the delayed phase of a cerebral arteriogram. The venous phase of arteriogram provides washed out images, quality of which is determined by the direction of dominant venous outflow, iodinated contrast ratio and flat panel imaging resolution*. Direct venous injections are limited in visualization due to injections against the direction of blood flow. We identified a method of cerebral phlebography under temporary venous balloon occlusion of jugular vein or venous sinus to obtain high resolution 2D and 3D images for diagnosis and treatment of cerebral venous pathology. We propose the addition and use of large diameter compliant balloon guide catheters in the workflow of cerebral venous imaging to optimize filling of cerebral venous system and significantly improve venous imaging.

Methods

A case series of 15 patients who underwent Intracranial Venous Interventions were collected from the Hospital of the University of Pennsylvania. All patients underwent 2 and 3‐dimensional retrograde phlebography assisted by temporary inflation of balloon guide catheter.

Results

9 females and 6 males received venous access predominantly located in right cubital fossa in the cephalic or basilic vein using an 8 and 9 french sheaths. The balloon guide catheters employed included Walrus Balloon Guide 8F (Q’apel medical) 8 cases, Dr Banner Balloon Guide ( EO solutions corp) 5 cases, Bobby Balloon guide (microvention)1 case, Emboguard Balloon Guide ( Cerenovus) 1 case. Utilization of balloon catheters resulted in minimal increase in average procedure time with improved filling and depiction of venous vessels, and no complications.

Conclusion

Balloon assisted retrograde phlebography using compliant balloon guide catheters is an effective way to image cerebral veins while decreasing the difficulty associated with working against the flow of venous blood.
Abstract 161: Repeated administration of thrombolytic therapy in the setting of stuttering lacunar infarct
Authors: Kaur Gunjanpreet , Rodriguez Wilson , Khasiyev Farid , Gao Xiaoyi , Abeer Aysha , Narayanan Karthik , Braun James , Esechie Aimalohi , Knecht Jordan Scott
Published: March 2024

Introduction

Tissue plasminogen activator (tPA) is the standard of care for the treatment of acute ischemic stroke with symptom onset within 4.5 hours. One exclusion criterion for tPA administration is stroke within 3 months due to the presumed increased risk of hemorrhage. While the rate of early recurrent stroke (ERS) within 3 months is as high as 14.5‐18.3%, the safety and effectiveness of repeated tPA administration remain unclear. An increasing number of studies pose a challenge to this recommendation. One study identified 19 patients who received tPA for ERS and found no symptomatic intracranial hemorrhage. Fifteen other studies with a cohort of 57 patients (including one patient receiving repeated tPA within 90 minutes) reached the same conclusion that repeated tPA is safe in ERS. We present a patient with stuttering motor weakness who received intravenous (IV) tPA twice, 3 days apart with discharged modified Rankin scale (mRS) of 3.

Methods

The patient was identified in routine clinical practice.

Results

Our patient is a 61‐year‐old right‐handed Caucasian woman with a medical history of untreated hypertension presented with sudden onset of left arm and leg weakness. IV tPA was given at the local emergency department (ED) and she was then transferred to our comprehensive stroke center. Upon arrival, her National Institutes of Health Stroke Scale (NIHSS) was 0. Her symptoms were completely resolved. Computed tomography (CT) head was unremarkable and CT angiography (CTA) did not show significant stenosis or occlusion. Magnetic resonance imaging (MRI) of the brain was negative for an acute infarct. She was diagnosed with a transient ischemic attack and was discharged home with aspirin and a high‐intensity statin for secondary stroke prevention. She presented to the ED the next day with identical left‐sided weakness again. Her NIHSS was 5 this time and IV tPA was given again. MRI showed an acute infarct in the right posterior limb of the internal capsule. Transthoracic echo did not reveal an intracardiac shunting or thrombus. The stroke mechanism was small vessel disease, and anti‐hypertensive medications were added to the treatment. She was discharged to an acute rehabilitation center with an mRS of 3 and her 90‐day mRS was 1 on follow up.

Conclusion

Management of ERS is a challenging issue in stroke care. Our case adds value to the current limited literature demonstrating the safety and effectiveness of repeated tPA in ERS, especially in patients with MR negative stuttering lacunar infarct and subsequent improvement following tPA. Further research with larger registries is needed to identify appropriate selection criteria for repeated tPA use in this patient population.
Abstract 166: Comparative Outcome of Intracranial Dissecting Aneurysms Treated by Endovascular and Surgical Treatment following intracranial hemorrhage
Authors: Jha Vikas Chandra
Published: March 2024

Introduction

intracranial dissecting aneurysm in pediatric age group is uncommon and very few studies are available comparing outcome following endovascular and surgery. The primary objective of this study was to evaluate the clinico‐radiological characteristics of intracranial dissecting aneurysms (IDAs) in childhood and assess the treatment outcomes associated with this condition.

Methods

A retrospective analysis was performed on pediatric patients who received treatment for spontaneous IDAs at our institution between January 2019 and December 2023. Detailed examinations of clinical presentation, aneurysm features, treatment modalities, and patient outcomes were conducted.

Results

The study involved 25 pediatric patients with IDAs, with a mean age of 12.4 ± 4.9 years (range, 3–15 years), comprising 25% of all treated intracranial aneurysms in pediatric cases during the specified period. Among them, 15 (60%) were male and 10 (40%) were female. The incidence of large (≥10 mm) or giant (≥25 mm) aneurysms was 40%. Endovascular treatment was administered to 11 (44%) patients, surgical treatment to 9 (36%) patients, and 5 (20%) patients received conservative treatment. Perioperative complications occurred in 2 patients treated with endovascular and 3 patients treated surgically (p = 0.21). Out of those treated with endovascular intervention, two patients achieved full recovery with a Glasgow Outcome Scale (GOS) score of 5, and one patient treated surgically recovered with a GOS score of 4. Overall, 22 (88%) patients experienced a favorable outcome, while three (12%) had an unfavorable outcome during a mean follow‐up of 22.32 ± 7.43 months (range, 6–55 months).

Conclusion

Pediatric IDAs are infrequent occurrences. In this specific series, endovascular management emerged as a relatively safe and effective treatment approach for pediatric IDAs. However, continued follow‐up is essential due to the potential risk of aneurysm recurrence and de novo aneurysm formation following treatment.
Abstract 167: Surgical treatment for unruptured Anterior communicating artery aneurysm
Authors: Hirohata Masaur
Published: March 2024

Introduction

We report the results of endovascular surgery as the first‐line treatment for unruptured anterior communicating artery aneurysms.

Methods

Fifty‐seven patients (F:M, 30:27; mean age, 65.5 years) underwent surgery for unruptured anterior communicating artery aneurysms in our hospital between January 2018 and January 2023.

Results

The mean aneurysm dome size was 5.29 mm (2–22 mm), and the mean aneurysm neck size was 3.2 mm (1.5–7 mm). Coil embolization was performed for fifty‐four patients using various adjunctive techniques (simple, 7; double catheter, 15; balloon neck remodeling, 7; stent‐assisted, 26 (LVIS Jr., 12; ATLAS, 14). Neck clipping was performed in 3 cases. The surgical results revealed complete coil embolization in 27, neck remnant in 26, and dome filling in 1 patient(s). The reason for 3 patients treated with neck clipping are patient's preference in one, associated with severe Middle cerebral artery stenosis needed TSA MCA anastomosis on one, and difficulty of embolization in one patient. Postoperative thrombotic complications were observed in 1 patient. The modified Rankin scale scores were 0 in 32 (96.5%) patients, 3 in 1 (1.7%) patients, and 6 in 1 (1.7%) patient. Follow‐up was performed in 55 patients, averaging 29.5 months (3–45 months). However, one patient underwent re‐aneurysm embolization for major recanalization of the aneurysm dome, and none of them suffered from rupture of the treated aneurysm.

Conclusion

Endovascular surgery may be the first choice of treatment for unruptured anterior communicating artery aneurysms.
Abstract 175: Impact of COVID‐19 on Intracranial Aneurysm Treatment and Outcomes: A Nationwide Propensity Score Matched Study.
Authors: Zermeno Jorge R. Rios , Ghaith Abdul Karim A. , El‐Hajj Victor G. , Michaelides Loizos , Tawk Rabih G.
Published: March 2024

Introduction

The coronavirus disease 2019 (COVID‐19) pandemic has had a global impact on healthcare systems. There is limited data on the influence of COVID‐19 on treatment and outcomes in patients with intracranial aneurysms. We aimed to investigate the impact of COVID‐19 on the overall complications, including ischemic stroke and subarachnoid hemorrhage (SAH) rates in patients treated for intracranial aneurysms (IAs).

Methods

This national, multicenter, retrospective cohort study included patients diagnosed and treated for IAs from January 2016 to December 2020 in the National Inpatient Sample (NIS). A total of 57,715 admissions were identified. Of these, 45,979 occurred pre‐COVID and 11,736 during the COVID pandemic period. The outcome data points included the occurrence of postprocedural ischemic strokes or SAHs, death, non‐routine discharge, total charges (US dollars), and length of stay (days). A 1:1 propensity score matching protocol was applied using a K‐nearest neighbor approach to evaluate differences in the outcome data points between the pre‐COVID and during COVID periods. The trends during the study period were assessed using piecewise joinpoint regression with the Mann‐Kendall test.

Results

Overall, the mean age was 65 years, with most of the patients (69.9%) being females. Endovascular interventions were performed in 82.9% of pre‐COVID IAs admissions compared to 82.4% during the COVID period, while open surgical treatment was performed in 17.1% of pre‐COVID and 17.6% of the patients during COVID (p=0.625). After matching, there were no differences in length of stay (p=0.266), non‐home discharge (p=0.475), and in‐hospital mortality rates (p=0.305) between the two periods; however, the overall complication rate was significantly higher during the pandemic (31.1% vs. 28.3%; p<0.001). From 2016 to 2020, an upward trend in hospitalizations for ischemic stroke was seen among patients treated for IAs (6.1% to 7.9%; p=0.04). No trends were observed with respect to the occurrence of SAH or death (p=0.31). Patients hospitalized after treatment of IAs during the COVID pandemic had significantly higher odds of ischemic strokes (OR 1.13; 95% CI 1.05 to 1.22; p=0.03) but not SAH (OR 0.97; 95% CI 0.88 to 1.06; p=0.89).

Conclusion

The COVID‐19 pandemic has significantly impacted the healthcare system. In patients receiving treatment for IAs, this analysis noted a correlation between the COVID‐19 pandemic and postoperative complications, notably ischemic strokes. Unraveling the pandemic’s “black box” leads to awareness of plausible breaches within the system, which acts as a crucial component in improving situational readiness and preparedness in the event of similar large‐scale crises.
Abstract 179: Tackling Intracranial Aneurysm in Africa: Bridging the Gap in Medical Infrastructure
Authors: Uwishema Olivier
Published: March 2024

Introduction

Intracranial Aneurysm results from enlargement in the wall of a blood vessel in the brain, especially in the circle of Willis. It represents a high mortality and morbidity rate due to its risk of rupture causing Sub Arachnoid Hemorrhage which is a dangerous and life‐threatening condition. Therefore, early treatment before rupture prevents major neurological debilitating and fatal effects. The aim of this study is to assess the burden of Intracranial Aneurysm in Africa regarding its epidemiology, risk factors, and clinical outcomes.

Methods

A review of the literature was done for studies published between 2019 and 2023 to obtain a better and updated review of Intracranial Aneurysm and its clinical presentations and outcomes in Africa.

Results

Variations of Sub Arachnoid Hemorrhage have been reported across different countries. Africa presents a fatality rate higher than developed countries. Based on limited reports, the 30‐day mortality rate from aneurysmal Sub Arachnoid Hemorrhage was 26.6% in Kenya and 44.4% in Nigeria. Additionally, a Sudanese in‐hospital cohort reported 40% mortality within 3 weeks and 87.5% in the first week. The bad clinical outcomes of Intracranial Aneurysm in Africa are due to a lack of detection tools, misdiagnosis, delayed management, and sub‐optimal treatment.

Conclusion

African countries present a lack of proper medical interventions rendering Intracranial Aneurysm a life‐threatening condition. Further investigations are needed to improve the medical infrastructure and knowledge in order to have better clinical outcomes and reduce the mortality rates of Intracranial Aneurysm in Africa.
Abstract 183: Characteristics and Outcomes of Treated and Untreated Mycotic Aneurysms: A Single Center Study
Authors: Patel Smit A. , Balabhadra Anvesh , Miller Ethan , Tunguturi Ajay , Bruno Charles , Sussman Eric , Ollenschleger Martin , Mehta Tapan
Published: March 2024

Introduction

Infectious intracranial aneurysms (IIAs), commonly referred to as mycotic aneurysms, are a common sequela of infective endocarditis (IE). The morbidity rate is known to be about 80% in ruptured IIAs. Over the last decade, we have seen a rise in the utilization of endovascular therapies over conservative management for the treatment of IIAs with promising results. We present a single‐center experience describing the characteristics and outcomes of treated and untreated IIAs.

Methods

This is a single‐center retrospective observational study of patients admitted with IE who developed IIAs and were admitted at our institute from 2016 to 2022. Descriptive statistics were performed using SAS statistical software and Microsoft Excel.

Results

Out of a total of 862 patients with IE, 25 patients (3.0%) were identified to have 41 IIAs (single aneurysm in 18 patients and multiple aneurysms in 7 patients). The median (IQR) age of our population was 45 (27‐65) years, with 28/41 (68.3%) male patients.

The overall mean (minimum‐maximum) size of all IIAs was 2.8 (0.2‐11) mm. The number of treated IIAs was 14/41 (34.1%) while 27/41 (65.9%) of IIAs were not intervened on. Among those IIAs treated, 92.8% were treated with an endovascular approach; 50% underwent onyx embolization, 28.6% underwent n‐BCA embolization, 14.2% underwent coil embolization, and 7.2% (n=1) underwent surgical intervention. The average (minimum‐maximum; mm) size of ruptured IIAs was 4.4 (1‐11) whereas the size of untreated IIAs was 2.0 (0.2‐9); (P=0.002). Among the treated group of IIAs, the majority were discharged home (21.4%) or discharged to facilities (78.6%). There was no in‐hospital mortality observed among the treated group. No IIAs were found to re‐rupture following embolization, and there was no change in any patient’s baseline neurologic examination following the embolization procedure.

Conclusion

Endovascular therapy is overall safe and effective in the management of IIAs and may be considered among patients with ruptured IIAs while accounting for their underlying comorbidities. Patients with secured IIAs are less likely to have in‐hospital mortality and are more likely to have better outcomes upon discharge. However, this may be influenced by case selection bias. Additional large center observational studies are warranted to confirm our findings.
Abstract 211: Comparing Early and Late Window 3mm Trevo Stent Retriever Performance in Medium Vessel Occlusion Thrombectomy
Authors: Koneru Manisha , Zhao Christopher , Siegler James E , Vigilante Nicholas , Khalife Jane , Tonetti Daniel , Shaikh Hamza
Published: March 2024

Introduction

Endovascular thrombectomy has been shown to be beneficial for select patients with medium vessel occlusion ischemic strokes. Newer mechanical thrombectomy devices have designs to facilitate navigation of the medium and distal cerebrovasculature. In this single‐center study, we aim to compare the performance of 3mm Trevo NXT stent retrievers (Stryker, Kalamazoo, MI) for medium vessel occlusion mechanical thrombectomy for patients treated within either the early (<6 hour) or late (>6 hour) treatment window.

Methods

A retrospective review was conducted of acute ischemic stroke patients with medium vessel occlusions (i.e., M2‐M4, ACA, and PCA) who underwent thrombectomy over 5 years (2018‐2022) at a single comprehensive stroke center. Classification into early or late window was defined as time from last known well to groin puncture less than 6 hours or greater than 6 hours, respectively. Primary efficacy outcome included successful recanalization (modified thrombolysis in cerebral infarction [mTICI]>=2B) using 3mm Trevo NXT on either first pass or rescue pass (i.e., after initial pass failure with another device). Primary safety outcome is rate of complications associated with the stent retriever. Primary clinical outcome was National Institutes of Health Stroke Scale (NIHSS) shift between admission and discharge.

Results

Of 81 patients with medium vessel occlusion ischemic strokes, 38 patients (44.7% female, median age of 73.5 years [IQR 66‐82], median initial NIHSS 13 [IQR 8‐23]) underwent thrombectomy with 3mm Trevo NXT. Stent retriever‐assisted aspiration (versus stent retriever only) was performed in 31/38 (81.6%) patients. Successful recanalization with stent retriever was achieved in 28/38 (73.7%) of patients. There was no significant difference in rate of recanalization between early and late window thrombectomy (16/22 [72.7%] early window vs. 12/16 [75%] late window, p=0.8752). The lack of significant difference in recanalization rate was consistent with stent retriever use during first pass (11/14 [78.6%] early window vs. 9/10 [90%] late window, p=0.6146) and as rescue (5/8 [62.5%] early window vs. 3/6 [50%] late window, p=0.6400). There was no significant difference in the rate of stent retriever complications between early and late windows (1/16 [6.3%] early vs. 0/22 [0%] late, p=0.4211). There was no significant difference in median NIHSS shift from admission to discharge ( ‐6 [IQR ‐16 ‐ 9] early window vs. ‐3 [IQR ‐5 ‐ 4] late window, p=0.3666).

Conclusion

In both early and late window medium vessel occlusion thrombectomy, the 3mm Trevo NXT as first line and rescue intervention performs comparably and adequately. Future multicenter studies will further characterize novel stent retriever performance in medium vessel occlusion thrombectomies.
Abstract 220: Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta‐analysis
Authors: Rodriguez‐Calienes Aaron , Chavez‐Ecos Fabian A. , Espinosa‐Martinez David , Bustamante‐Paytan Diego , Borjas‐Calderón Nagheli Fernanda , Galecio‐Castillo Milagros , Vivanco‐Suarez Juan R. , R Waldo Guerrero , Ortega‐Gutierrez Santiago
Published: March 2024

Introduction

Carotid artery stenting (CAS) has emerged as a viable alternative to carotid endarterectomy for managing carotid artery stenosis in high‐risk patients (1). While the transfemoral arterial approach (TF) remains the preferred method, it is associated with inherent limitations and potential complications (2‐4). Consequently, exploring the transradial artery access (TR) as a potential option becomes crucial in optimizing patient outcomes and procedural success rates. Limited data exists comparing the outcomes of TR approach in CAS to TF approach. This study aims to systematically review and meta‐analyze the outcomes and complication rates between TR and TF access for CAS.

Methods

A systematic electronic search was conducted in four databases up to May 10th, 2023. Studies with randomized or non‐randomized designs, involving CAS through TR or TF approach, were included. Outcomes of interest were stroke, transient ischemic attack (TIA), death, myocardial infarction (MI), and access site complications. A meta‐analysis was performed, analyzing pooled odds ratios (ORs) and 95% confidence intervals (CI) to assess the effect size of the vascular access approaches.

Results

Six studies with a total of 6,917 patients were included, out of which 602 (8.7%) underwent the TR approach, and 6,315 (91.3%) underwent the TF approach. Meta‐analysis results showed no significant difference in stroke occurrence between TR and TF groups (TR: 1.7% vs. TF: 1.9%; OR = 0.98; 95% CI 0.49 – 1.96; I2 = 0%). Similarly, no significant difference was found in death (TR: 1% vs. TF: 0.9%; OR = 0.95; 95% CI 0.38 – 2.37; I2 = 0%), MI (TR: 0.2% vs. TF: 0.3%; OR = 1.53; 95% CI 0.20 – 11.61; I2 = 0%), TIA (TR: 0.4% vs. TF: 1%; OR = 0.46; 95% CI 0.11 – 1.95; I2 = 0%), and access site complications (TR: 2.2% vs. TF: 1%; OR = 0.97; 95% CI 0.48 – 1.98; I2 = 0%).

Conclusion

In the comparison of TR and TF approaches for CAS, no significant differences were observed in stroke, death, MI, TIA, or access site complications. TR approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications. However, further studies are needed to confirm these findings and establish guidelines for optimal access site selection.
Abstract 224: Morphological characteristics of carotid webs associated with stroke risk and clot burden
Authors: Martins Pedro N. , Monteiro Mateus D. , Tarek Mohamed A. , Nahab Fadi , Dolia Jaydevsinh , Allen Jason , Frankel Michael , Nogueira Raul , Haussen Diogo
Published: March 2024

Introduction

Carotid webs (CaWs) have been established as an ischemic stroke etiology although lesion characteristics that may lead to increased stroke risk are still uncertain (1). We aim to evaluate the associations between CaW morphological features evaluated via computed tomography angiography (CTA) with clinical and radiological variables.

Methods

This is a retrospective analysis of a prospectively collected mechanical thrombectomy database. Individuals that presented with a suspected symptomatic CaW since July 2014 were selected after appropriate workup. The database included symptomatic CaW, asymptomatic CaW contralateral to the symptomatic side in case of bilateral lesions, and incidentally identified CaW (asymptomatic patients). We recorded the following CaW variables (Figure 1): length, base, thickness, caudal/middle/cranial angles in relationship to the vessel axis, area as well as perimeter of the pocket.

We used mixed‐effects models to compare measurements between symptomatic and asymptomatic webs in the complete sample and paired Wilcoxon tests to compare webs of individuals with contralateral, symptom‐discordant CaW. Measurements were evaluated against clot burden via Poisson regression.a

Results

118 webs (85 symptomatic and 33 asymptomatic) from 98 stroke patients were included. Median [IQR] for age was 52[42‐58] years old, 69.0% were female, 68.4% presented with a single symptomatic web, 18.4% had both a symptomatic and an asymptomatic web, 11.2% had only an asymptomatic web, whereas 2.0% had bilaterally asymptomatic webs. Symptomatic CaW were significantly larger in length (2.5mm[2.1‐3.5] vs. 2.2mm[1.7‐2.7];p=0.004) and pocket area (1.5mm²[0.9‐2.6] vs. 0.9 mm²[0.2‐1.3];p=0.007) compared to the asymptomatic lesions. The cranial angle was more acute for symptomatic CaW (66.9°[57.1°‐78.4°] vs. 76.2°[66.9°‐88.7°];p=0.046). No other significant associations were noted. Among the 18 patients who were analyzed for contralateral/symptom‐discordant webs, symptomatic CaW also showed more extensive lengths (2.9mm[2.3‐4.0] vs. 2.2mm[1.6‐3.1];p=0.009) but less acute rostral angles (33.1°[25.3°‐43.5°] vs. 27.9°[16.8°‐35.9°]) than their asymptomatic counterparts. Among symptomatic webs, clot burden was not significantly associated with base, length, thickness, perimeter or pocket area. Nevertheless, each 15° increase in the angle within the pocket was associated with a 1.1‐fold increase in clot burden (exp(β) = 1.1(95%CI1.0‐1.2), p = 0.044) for each 15° increase), with more obtuse angles indicating a higher intracranial vessel occlusion thrombus load.

Conclusion

Symptomatic carotid webs displayed larger lengths and pocket areas as compared to asymptomatic lesions. The angles that determine pocket area and degree of stenosis differed between symptomatic and asymptomatic webs.
Abstract 248: Structural Analysis of Aspiration Catheters and Procedural Outcomes: An Analysis of the SVIN Registry
Authors: Dolia Jaydevsinh N. , Mohammaden Mahmoud H. , Tarek Mohamed A. , Monteiro Mateus D. , Grossberg Jonathan A. , Pabaney Aqueel H. , Frankel Michael V. , Jillella Dinesh E. , Hassan Ameer V. , Tekle Wondwossen E. G. , Georgiadis Alexandros G. , Saei Hamzah , Gutierrez Santiago Ortega , Vivanco‐Suarez Juan , Galecio‐Castillo Milagros , Rodriguez‐Calienes Aaron , Majidi Shahram , Fifi Johanna , Matsoukas Stavros , Siegler James , Penckofer Mary , Rana Ankit , Sheth Sunil , Maroni Sergio Salazar , Nguyen Thanh , Abdalkader Mohamad , Linfante Italo , Dabus Guilherme , Mehta Brijesh , Sessa Joy , Jumaa Mouhammad , Sugg Rebecca , Linares Guillermo , Al‐Bayati Alhamza , Libeskind David , Noguiera Raul , Haussen Diogo
Published: March 2024

Introduction

Rapid expansion of mechanical thrombectomy and swift manufacturing development has translated into significant evolution of large bore catheter technology. The objective of this study was to evaluate the association among diverse structural components of large bore aspiration catheters on procedural performance.

Methods

Retrospective analysis of a prospectively maintained mechanical thrombectomy consortium (SVIN Registry) treated with stand‐alone contact aspiration for the first pass in the MCA M1 or intracranial ICA occlusions from 2012‐2021. Catheters were stratified based on construction materials, tip technology, catheter sizing, and catheter lining. Factors associated with first pass effect (FPE ‐ first‐pass eTICI2c‐3 reperfusion) as well as speed of clot engagement were analyzed.

Results

We identified 983 patients with proximal occlusion and aspiration as the first pass technique. FPE was observed in 34% and associated with age (OR:1.016;95%CI:1.006‐1.027), cardioembolic stroke etiology (OR:1.685;95%CI:1.77 ‐2.41), MCA M1(OR:2.737;95%CI:1.091 ‐1.867), non‐general anesthesia (OR:0.546;95%CI:0.389 ‐0.767), as well as with 0.070” (OR:2.038;95%CI:1.099 ‐3.779) and 0.088” (OR:3.899;95%CI:1.582 ‐9.606) distal catheter inner diameter in the adjusted analysis. Median time from arterial access to clot contact was 17 minutes with faster times observed in younger patients (OR:0.986;95%CI:0.975 ‐0.996) as well as with the use of aspiration catheters with shorter length of distal outer hydrophilic coating (18‐30cm) on multivariable regression (OR:0.303; 95%CI:0.113‐0.816).

Conclusion

Larger aspiration catheter distal inner diameter was associated with higher rates of FPE. Aspiration catheters with reduced distal tip hydrophilic coating were associated with faster arterial access to clot contact time.
Abstract 256: Proposal of multimodal CT‐based scoring system in prediction of hemorrhagic transformation in acute ischemic stroke
Authors: Elsaid Nada
Published: March 2024

Introduction

The routinely used computed tomography (CT)‐based workup in the setting of acute ischemic stroke (AIS) includes non‐contrast brain CT, CT angiography (CTA), and CT perfusion. Several CT, CTA, CTP‐based radiological biomarkers of hemorrhagic transformation (HT) were reported.

To assess the predictive value of the combined multimodal CT parameters for HT after AIS and proposal of predictive scoring scale.

Methods

The source images of the NCCT, CTA and CTP of 282 AIS patients involving the anterior circulation (HT = 91, non‐HT = 191) were retrospectively reviewed and the following biomarkers were recorded and analyzed: Early subtle ischemic signs, hyperdense middle cerebral artery sign (HMCAS) and Alberta Stroke Program Early CT Score (ASPECTS) < 7 in NCCT, large‐vessel occlusion (LVO), clot burden score (CBS) < 6, large‐vessel occlusion, poor collateral score (CS) and Tmax > 6 s ≥ 56.5 ml. A scoring system to predict HT based on these biomarkers was developed. Each biomarker counts for a single point with the total score ranging from 0 to 7.

Results

All the aforementioned multimodal CT biomarkers and the selected cut offs were significantly associated with higher HT risk. The calculated scores were statistically significant different between the HT and the non‐HT groups with AUC 0.761 (95% CI 0.703–0.819, P < 0.0000001). Rates of HT were approximately five times higher in patients with score ≥ 3.

Conclusion

Multimodal CT‐based scoring system may provide highly reliable predictive model of hemorrhagic transformation in acute ischemic stroke.
Abstract 261: Mechanical thrombectomy in patients with large‐territory acute ischemic stroke requiring a decompressive hemicraniectomy
Authors: Ansari Junaid , Simoncini Pedro , Fakhre Waddih , Sheikh Mohammad , Bocklud Brooke , Moore Sydney , Abubakar Muhammad , Caskey Joshua , Bridges James , Juneau Patrick , Abushehab Nimer , Cuellar Hugo , Guthikonda Bharat
Published: March 2024

Introduction

Mechanical thrombectomy (MT) has demonstrated a significant improvement in functional outcomes for patients with anterior circulation strokes and large‐vessel occlusion (LVO). However, despite successful recanalization, certain patients still experience large hemispheric ischemia (LHI), necessitating decompressive hemicraniectomy (DHC). This study aims to investigate the characteristics and predictive factors associated with LHI requiring DHC in patients with successfully recanalized anterior circulation LVO, shedding light on potential factors influencing patient outcomes in this context.

Methods

We retrospectively analyzed 117 patients with LHI admitted to OLSU from November 2015 to March 2023. These individuals were then matched into two groups: a study group who had undergone decompressive hemicraniectomy (38) and a control group of individuals who had not (79). Additionally, within the DHC recipients, these individuals were further subgrouped into those who had undergone MT. Information was collected on demographic variables, medical history and clinical parameters. Functional outcomes were assessed via binarization of the following variables: the modified Rankin scale score on discharge (0‐4: good outcome vs. 5‐6: poor outcome).

Results

Among the 38 patients with LHI who underwent DHC (mean age 52.47 + 12.27 years, 63.1% males), 16 (42.1%) patients received intravenous tPA administration, and 13 (34%) underwent mechanical thrombectomy (MT) with successful reperfusion (TICI ≥ 2b) achieved in 8 (61.5%) of these patients. The assessment of the modified Rankin Scale (mRS) at discharge (0‐4: good outcome, 5‐6: poor outcome) revealed that both intravenous tPA (p‐value ‐ 0.206) and MT (p‐value 0.50) were not significantly associated with a good clinical outcome at discharge.

Conclusion

In the overall analysis of all individuals with complete outcome data, none of the variables (DHC receipt, MT receipt, tPA receipt) were significantly associated with mRS at discharge. The study did not find significant associations between the examined variables and the outcome (mRS on discharge) in patients with LHI who underwent DHC, regardless of whether they underwent reperfusion therapy or not. Advancements in acute ischemic stroke therapies such as thrombolytics and thrombectomy may reduce the need for DHC.
Abstract 275: Hypothesizing After Results are Known (HARKing) in Neurovascular Research Induced by Meeting Abstract Preparation Guidelines
Authors: Vaddi Venya , Hou Jesse W. , Rao Neal M. , Saver Jeffrey L.
Published: March 2024

Introduction

A “reproducibility crisis” has afflicted the recent medical literature, affecting 75‐89% of major reported findings. An important cause of the inability to replicate results is hypothesizing after the results are known (HARKing): presenting a post hoc hypothesis according with findings as if it were a confirmed a priori hypothesis. Meeting abstract instructions may affect the frequency of HARKing.

Methods

We tested the hypothesis that, compared with abstract instructions NOT indicating a "hypothesis" should be stated, instructions indicating THAT a "hypothesis" should be stated would increase the proportion of abstracts judged by field content experts to exhibit HARKing. [Hypothesis pre‐registered at AsPredicted.org (#5019)]. We analyzed randomly sampled abstracts from 4 International Stroke Conference (ISC) meeting years with highly forceful (2015), moderately forceful (2017), and non‐forceful (2013 and 2022) requirements for statement of a “hypothesis” in abstract preparation instructions, regardless of whether a hypothesis statement was appropriate (confirmatory science) or inappropriate (exploratory science).

Results

The 163 abstracts (39 to 43 in each meeting year) equally sampled the 14‐17 ISC topic categories. Explicit “hypothesis” statements were more common in the highly and moderately forceful instruction years (30% and 27%) than in the non‐forceful instruction years (9% and 13%) (p = 0.006). Among the total 32 hypothesis statements, 81% were deemed falsifiable, and 19% non‐falsifiable. None (0%) of hypotheses were stated as pre‐registered prior to study conduct. Overall, 59% (19/32) of the hypothesis statements were adjudicated by two independent content experts as likely to be hypothesizing after the results were known (HARKing). HARKing was more common in the highly and moderately forceful instruction years (20% and 15%) than the non‐forceful instruction years (9% and 3%) (p = 0.03).

Conclusion

Abstract preparation instructions requiring the use of a hypothesis statement promoted hypothesizing after the results are known, with HARKing present in 1 out of every 5 meeting abstracts. To improve reproducibility of neurovascular research studies, appropriate meeting abstract preparation instructions are desirable, recommending hypothesis statements only for the small proportion of stroke studies that are of confirmatory, rather than exploratory, design.
Abstract 283: Readmission Rates and Etiologies among Patients with Primary Angiitis of the Central Nervous System
Authors: Laswi Ibrahim , Al‐Najjar Yousef , Arabi Maryam , Dargham Soha , Jerdi Salman Al , Khalil Charbel Abi
Published: March 2024

Introduction

Primary Angiitis of the Central Nervous System (PACNS) is a rare, relapsing inflammatory disorder of blood vessels in the brain and spinal cord presenting clinically with a spectrum of manifestations including strokes, seizures, and neurologic deficits. Limited data are available on the modifiable and nonmodifiable predictors of readmissions for patients diagnosed with PACNS, which hinders the ability of healthcare systems to risk‐stratify patients based on their specific demographics, comorbidities, and hospital status.

Methods

We identified patients with PACNS (ICD‐10 code: I67.7) admitted from 2016‐2019 using the Nationwide Readmission Database (NRD). The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 30 and 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates.

Results

We identified 1,398 patients admitted with a primary diagnosis of PACNS between 2016 and 2019. The mean age was 52.81 years, with 59.20% (n=828) being female. The 30‐day readmission rate was 10.52% (n=147) and the 90‐day readmission rate was 19.60% (n=274). Nearly half of 90‐day readmissions occurred within the first 30 days. Annual variations in readmission rates were insignificant. Age and sex distribution were not statistically different between patients not requiring readmission, those readmitted within 30 days, and those readmitted within 90 days. Compared to those not requiring readmission, patients readmitted within 30 days had a higher prevalence of diabetes (38.07% vs 29.06%; p=0.023) and hypertension (65.66% vs 56.88%; p=0.035), while those readmitted within 90 days had a higher prevalence of diabetes (41.56% vs 27.19%, p<0.001), dyslipidemia (48.49% vs 39.77%, p=0.009), obstructive sleep apnea (10.79% vs 6.73%, p=0.028), and ischemic stroke (32.56% vs 25.18%, p=0.013). The most common etiologies of 30‐ and 90‐day readmissions were cardiovascular (47.05% and 47.81%), neurological (26.80% and 20.61%), and infectious (9.07% and 7.58%).

Conclusion

The rates of 30‐ and 90‐day readmissions among patients with PACNS have remained stable between 2016 and 2019. Patients with PACNS requiring readmission had a higher incidence of vascular risk factors. Cardiovascular, neurological, and infectious conditions were the most common etiologies for 30‐ and 90‐day readmissions. While our analysis suggests a role for vascular risk factor modification to prevent readmissions in patients diagnosed with PACNS, further research is required to validate this hypothesis and identify other modifiable risk factors.
Reaction of Brazilian genotypes of pulses (pea, chickpea and lentil) to the root-knot nematode Meloidogyne enterolobii
Authors: Pinto Thávio J.B. , Cunha Dwillian F. , Silva Giovani O. , Pinheiro Jadir B. , Correia Valdir R. , Ragassi Carlos F. , Cares Juvenil E.
Published: March 2024

The root-knot nematode, Meloidogyne enterolobii, is an important pathogen of numerous crops, including the so-called pulses. Hence, it is necessary to identify genetic resistance, as it is the most efficient, cost-effective, and environmentally sound way to manage nematodes in the field. The objective of this study was to screen a Brazilian germplasm collection of pulse crops (peas, chickpeas, and lentils) comprising accessions from the Embrapa Germplasm Bank and commercial cultivars against M. enterolobii under glasshouse conditions. The experiment was conducted with 23 treatments (genotypes), i.e., 14 pea, six chickpea and one lentil genotype, and two tomato cultivars, ‘Rutgers’ (susceptible) and ‘Nemadoro’ (resistant). Each plant (replication) was inoculated with 5000 eggs and second-stage juveniles (J2) of M. enterolobii and evaluated 65 days after inoculation, considering the following variables: gall index, egg mass index, number of eggs per g of roots, and reproduction factor. The experiments were conducted at two independent time points (summer and autumn/winter). Results showed that all 23 plant genotypes were susceptible to the nematode, with pea genotype ‘Itapuã’ being intolerant to infection. Cultivation of pulse crops has been steadily increasing both in Brazil and worldwide. Our research findings make a valuable contribution to the ongoing efforts to identify genetic resistance to nematode pathogens that can significantly affect the productivity of these crops. By identifying and developing resistant genotypes, pulse crop yields can be safeguarded, and sustainable agricultural practices can be supported.
Development and validation of four TaqMan real-time PCR diagnostics for the identification and quantification of Pratylenchus crenatus, Pratylenchus neglectus, Pratylenchus penetrans and Pratylenchus thornei
Authors: Orlando Valeria , Roberts David , Edwards Simon G. , Prior Thomas , Neilson Roy , Back Matthew A.
Published: March 2024

Pratylenchus crenatus, P. neglectus, P. penetrans and P. thornei are globally the most commonly occurring species of root-lesion nematodes (RLN). Correct identification and quantification of these nematodes is important for strategic management interventions such as rotation choice and nematicide use. A real-time quantitative PCR can provide a fast and reliable alternative to morphological identification, which requires significant taxonomic experience. A TaqMan hydrolysis probe method based on the 28S rDNA D2-D3 expansion region was developed and validated for the identification and quantification of these four root-lesion nematode species. Standard curves for each target RLN species were generated by plotting known gene copy number, obtained by a ten-fold serial dilution of purified plasmids, with corresponding Ct values. Each standard curve had a strong linear correlation () between Ct value and gene copy number. There was consistent amplification of samples with target species from different geographic locations within the UK, whereas a lack of amplification was noted for selected non-target species: P. coffeae, P. pseudocoffeae, P. vulnus, P. fallax, Globodera rostochiensis, Meloidogyne hapla, Trichodorus primitivus and Bitylenchus hispaniensis. Specificity and sensitivity of the methods were confirmed by three experiments that explored different life stages, increasing the number of target species, and had mixed Pratylenchus samples. Finally, estimates obtained by qPCR methods were compared with counting carried out by microscopy showing a good correlation (). The TaqMan real-time PCR developed in this study provides a specific, fast and accurate quantification of P. crenatus, P. neglectus, P. penetrans and P. thornei.
Eugène Viollet-le-Duc, an Amateur Orologist on the Cusp between Romanticism and Positivism
Authors: Baridon Laurent , Morfee Adrian
Published: March 2024

Eugène Viollet-le-Duc is one of those architects who took an interest in science. His biography shows that, from a young age, he practiced arts and natural sciences. As a result, his love of landscape painting was related to geology. Throughout his career, he made analogies between architecture and living organisms. For instance, he compared his idea of architectural restoration to a paleontologist’s approach trying to piece back together an extinct animal. Looking at his library, however, shows that the scientific books he owned were rather general, except for the field of alpine geology, for which he took a particular interest. Yet this very interest was strongly defined by the objectives of the Club Alpin Français, which aimed at preserving and developing this natural heritage. Both romantic and positivist approaches were thus intertwined in Viollet-le-Duc’s scientific culture.
Retaining and Mobilising Geometric Knowledge
Authors: Luciano Erika
Published: March 2024

This paper is dedicated to the history of an extremely particular manuscript: Segre’s personal card index. Consisting of 515 handwritten cards on which he annotated bibliographic references, excerpts of readings that could be useful in his studies and teaching, comments and memoranda, Segre’s Schedario is the manuscript catalogue of a virtual library, a sort of reasoned bibliography that photographs the cultural heritage of Corrado Segre and, more generally, of an Italian geometer of the Belle Époque. In this paper, we will analyse how Segre constructed, organised and used the Schedario in order to structure his teaching and research activity.
A Medieval Islamic Astrolabe with Hebrew Inscriptions in Verona
Authors: Gigante Federica
Published: March 2024

This article presents a hitherto unknown remarkable astrolabe from Al-Andalus which likely belonged to the collection of Ludovico Moscardo (1611–1681) assembled in Verona in the seventeenth century. The astrolabe is datable to the eleventh century and features added Hebrew and Latin inscriptions. It underwent many modifications, additions, and adaptations as it changed hands and owners over time thus becoming a palimpsest object. With its added translations from Arabic into Hebrew, the astrolabe closely recalls the recommendations prescribed by the Spanish Jewish polymath Abraham Ibn Ezra (1089–1167) in the earliest surviving treatise on the astrolabe in the Hebrew language written in 1146 precisely in Verona. The astrolabe—today preserved in the Fondazione Museo Miniscalchi-Erizzo—stands out as a testimony to the contacts and exchanges among Arabs, Jews and Europeans in the medieval and early modern periods.
Evaluation of the antagonistic activity of black soldier fly frass extracts against plant pathogens using single- and double-layer agar bioassays
Authors: Arabzadeh G. , Delisle-Houde M. , Dorais M. , Deschamps M.-H. , Derome N. , Vandenberg G.W. , Tweddell R.J.
Published: March 2024

Larval frass from insects which consists of larval excrement, exoskeleton, and undigested diet, is a rich source of organic material and microorganisms. Despite its potential value, research on frass valorisation in agriculture is limited. In this study, single-layer agar (SLA) and double-layer agar (DLA) in vitro bioassays were conducted to evaluate the effect of water-based black soldier fly larvae (BSFL) frass extracts from two different diets on the growth of six plant pathogens: Alternaria solani, Botrytis cinerea, Fusarium oxysporum, Phytophthora capsici, Rhizoctonia solani and Sclerotinia sclerotiorum. The results showed that frass extract from Gainesville house fly diet strongly or completely inhibited the growth of all tested plant pathogens in both SLA and DLA bioassays, while frass extract from fruit/vegetable/bakery/brewery diet strongly inhibited the mycelial growth of A. solani, B. cinerea, and S. sclerotiorum, and moderately inhibited the mycelial growth of P. capsici in both bioassays. For both diets and bioassays, 0.22 μm microfiltered frass extracts which are free of microorganisms showed generally no effect on the growth of the pathogens indicating that growth inhibition is caused by frass-inhabiting microorganisms. Both SLA and DLA bioassays revealed strong antagonistic effect of microorganisms inhabiting BSFL frass against the plant pathogens B. cinerea, A. solani, R. solani, P. capsici, F. oxysporum and S. sclerotiorum. Moreover, the study showed the impact of the BSFL diet on the antagonistic effect of frass extract. In future work, the antagonistic effect of frass extracts against the above-mentioned pathogens will be tested in vivo. BSFL frass could eventually find applications for the control of plant diseases.
Evaluation of cryoprotein investigation using a digital external quality assurance scheme
Authors: Patel Dina , Sargur Ravishankar , Sheldon Joanna , Wheeler Rachel D , Stanley Carol
Published: March 2024

Background: Robust preanalytical and analytical processes are critical for the detection of cryoproteins. There is significant variation in practice in the detection, analysis and reporting.

Results: A survey in 2018 of 137 laboratories participating in the UK National External Quality Assessment Service (UK NEQAS) (6) quality control program showed significant variation in the laboratory processes which highlighted the need for standardisation of the detection, analysis and reporting of cryoglobulins.

Conclusion: The first available EQA scheme aiming to harmonise practice for cryoprotein testing has been developed by UK NEQAS and laboratories should participate in an appropriate EQA scheme to fulfil requirements for ISO accreditation.