bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 157: Three‐Month Functional Outcomes in Poor Grade Aneurysmal Subarachnoid Hemorrhage Patients Undergoing Endovascular Treatment of Cerebral Vasospasm
Authors: Fakih R. , Ahmed R. , Ma X. , Bhatti I. , Gillani S. , Siddiq F. , Gomez C. , Qureshi A.
Published: January 2025

Objective

To determine the effect of endovascular treatment (EVT) of cerebral vasospasm on functional outcomes among poor‐grade subarachnoid hemorrhage (SAH) patients.

Background

EVT of cerebral vasospasm in poor‐grade SAH patients poses unique challenges due to difficulty in differentiating symptomatic and asymptomatic cerebral vasospasm and severe neurological injury prior to occurrence of vasospasm.

Methods

We analyzed data from two tertiary stroke centers, focusing on poor grade SAH patients who required EVT for cerebral vasospasm. Poor‐grade SAH patients were defined as those presenting with a Hunt and Hess/WFNS scale score of 4 or higher. EVT of vasospasm consisted of angioplasty and/or intraarterial vasodilators. Functional outcome was assessed at 90 days using the modified Rankin scale (mRS) score, categorized as 0‐3 (favorable outcome) and 4‐6 (unfavorable outcome), and 90‐day mortality rate.

Results

The sample consisted of 80 patients (mean age 52.7 ± 10.1 years, 61% women) with poor‐grade SAH and cerebral vasospasm. EVT consisted of intra‐arterial vasodilator infusion in 62 patients, among which 24 had additional angioplasty. At 90 days, 39% (n=24) of those who received EVT achieved a favorable functional outcome, with 32% mortality rate. Among patients who received angioplasty, 54.2% achieved favorable outcomes versus 45.8% with unfavorable (p=0.167); Of those who underwent IA vasodilator therapy for vasospasm, 38.7% achieved favorable outcomes, and 61.2% had unfavorable outcomes (p=0.372). The outcomes were comparable to poor grade SAH patients who did not require EVT for cerebral vasospasm (n=18), in whom favorable functional outcome and mortality rate were 33% and 22%, respectively.

Conclusions

Favorable functional outcomes can be seen in over one‐third of poor‐grade SAH patients who are treated with EVT for cerebral vasospasm, which was comparable to those who do not require treatment for cerebral vasospasm. Our results support use of EVT for cerebral vasospasm in poor grade SAH patients.
Abstract 167: A Case of Consequential Stroke and Heart Failure in Ebstein's Anomaly
Authors: Baumann E. G. , Cheon B. , Shaffer S. , Kenniff S. , Abdelhamid N. , Ajiboye N. , Kamal H. , Mehta B.
Published: January 2025

Introduction

Ebstein's anomaly (EA) is a rare congenital heart condition, accounting for less than 1% of congenital heart defects. Though uncommon, individuals with EA have a significantly increased risk of stroke, through poorly understood mechanisms. We present a case of a large vessel stroke in a patient with EA, coexisting patent foramen ovale (PFO), and conduction abnormalities, which ultimately required a heart transplant.

Materials/Methods

N/A

Case

A 22‐year‐old male with a history of Ebstein's anomaly and Wolff‐Parkinson‐White Syndrome presented with left middle cerebral artery (MCA) syndrome and atrial fibrillation with rapid ventricular response (AFib‐RVR). CT angiography confirmed a left MCA M1 occlusion. He received intravenous tissue plasminogen activator (tPA) followed by emergent mechanical thrombectomy, achieving modified treatment in cerebral ischemia (mTICI) grade 2B (67‐89%). MRI showed a left MCA stroke with hemorrhagic conversion, along with distal embolic strokes in the left MCA M3/M4 segments. Cardioembolic workup revealed a PFO, EA with extreme apical displacement of the tricuspid valve, and severe tricuspid regurgitation. The patient was discharged on full‐dose aspirin with plans for anticoagulation after three weeks. Despite ablation of his AFib during hospitalization, he returned with severe right heart failure, necessitating heart transplant. He currently has no neurological deficits and is followed at our institution.

Discussion

Ebstein's anomaly (EA) is a rare congenital heart condition occurring in 1 to 5 per 100,000 births. Characterized by tricuspid valve abnormalities, EA often presents with tricuspid regurgitation, atrialization of the right ventricle, and reduced right ventricular ejection fraction. Up to 50% of patients have associated cardiac defects, such as PFO or secundum atrial septal defect (ASD), leading to an increased risk of paradoxical embolic stroke. The risk of stroke in EA increases with age, with an incidence of 1.4% at 10 years, 15.9% at 50 years, and 23.5% at 70 years. This risk is further compounded by comorbid arrhythmias, such as AFib (20%) and accessory pathways, including Wolff‐Parkinson‐White Syndrome (10‐20%). This case highlights the importance of early identification and comprehensive management of cardiac risk factors in EA, including consideration for heart transplantation, to prevent stroke and other complications.
Abstract 182: Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes with the United States General Population
Authors: Dicpinigaitis A. J. , Al‐Mufti F.
Published: January 2025

Introduction

Incarcerated individuals in state and federal prisons demonstrate disproportionately high rates of cardiovascular disease, especially hypertension and tobacco use. As a result, in comparison with the United States general population, inmates are faced with a more than three‐fold risk of acute ischemic stroke (AIS). Unfortunately, some evidence suggests that incarcerated individuals receive suboptimal medical care due structural barriers in healthcare delivery as well as discrimination based on incarcerated status. To our best knowledge, no studies to date have evaluated treatment rates and clinical outcomes of AIS in this specialized population.

Methods

Adult hospitalizations for AIS were identified in the 2015‐2020 National Inpatient Sample. Clinical variables, including incarcerated status, were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Rates of endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) in addition to clinical outcomes (routine discharge back to institution/to home and in‐hospital mortality) were compared between incarcerated and non‐incarcerated individuals. Multivariable logistic regression (MVLRG) analysis controlling for age, race/ethnicity, baseline NIHSS score, stroke location, cardiovascular risk factors, and treatment modality was performed to determine the adjusted association of incarcerated status with the above clinical outcomes.

Results

Among 1,037,020 AIS hospitalizations, 460 (44.4/100,000) documented incarcerated status. Rates of EVT (6.5% vs. 6.7%, p=0.907) and IVT (19.6% vs. 18.1%, p=0.401) did not differ between incarcerated and non‐incarcerated individuals, respectively. Incarcerated individuals experienced higher rates of routine discharge disposition in comparison with non‐incarcerated individuals (75.0% vs. 36.6%, p<0.001), but mortality rates did not differ (2.2% vs. 3.5%, p=0.115). Following MVLRG analysis, incarcerated status was independently associated with routine discharge disposition (aOR 4.63, 95% CI 3.62, 5.92; p<0.001), but not with mortality (aOR 1.04, 95% CI 0.55, 1.97; p=0.906). Sensitivity testing in three separate sub‐group analyses of patients receiving acute reperfusion therapies (IVT and/or EVT), in strokes of the posterior circulation, and in high severity strokes (NIHSS>15) confirmed the findings of the primary analysis.

Conclusion

Incarcerated individuals with AIS are offered EVT and IVT at comparable rates to the general population and experience favorable clinical outcomes after accounting for age, stroke severity, and cardiovascular risk factors. Although these findings are encouraging, incarcerated individuals included in this study may represent a biased sample of those from particularly conscientious institutions and may not necessarily reflect the broader landscape of stroke care for this vulnerable population in the United States.
Abstract 189: An Expedited Transfer Protocol Improves Door In Door Out Times
Authors: Cort M. , Owens K. , Stein L. , Blum C. , Novello P. , McPartland E. , Hoey C. , Sellers M. , Rothstein A.
Published: January 2025

Background

Rapid reperfusion with mechanical thrombectomy for ischemic stroke secondary to large vessel occlusion leads to significant reduction in morbidity and mortality. DIDO time is an important metric for stroke centers without on‐site mechanical thrombectomy. Delays in treatment can occur when patients present at a Primary Stroke Center (PSC) then require transfer to the CSC for MT. Our system Comprehensive Stroke Center (CSC) receives patients from 2 of our systems PSC's. In order to expedite care an expedited transfer protocol was implemented.Purpose: The goal of this work is to decrease the time at the PSC, known as door‐in‐door‐out (DIDO) and decrease overall time from patient presentation to treatment with thrombectomy, known as door to groin time (DTG).Methods: Patients are screened at triage by a PSC emergency department provider for the following: aphasia, gaze preference, or neglect with unilateral weakness within 24 hours of last known normal. If these criteria are present, the emergency department provider contacts the CSC transfer center to initiate the expedited transfer process, which begins moving transfer resources to the PSC while clinical work‐up continues. This expedited early transfer process was implemented in January 2021. Transfers for MT during the 12‐month period before and after the implementation of the expedited transfer process were analyzed.Results: Mean DIDO was lower when expedited protocol was utilized (99 min vs. 137 min respectively, (p=.017)). Mean DTG was unchanged (27 min vs. 37 min respectively, (p = 0.067)).Conclusions: Use of the expedited transfer process allows transfer resources to begin moving to the patient with a suspected LVO in parallel with ongoing evaluation, resulting in faster DIDO and times leading to faster treatment aimed at reducing stroke morbidity and mortality.
Abstract 192: Angioedema Following Lifesaving Thrombolysis In Acute Ischemic Stroke
Authors: Huhulea E. , Uddin A. , Syed S. , Jain A. , Sasan C. , Nguyen T. , Lui A. K. , Paul D. , Al‐Mufti F.
Published: January 2025

Introduction

Orolingual angioedema is a recognized adverse effect of tissue plasminogen activator (tPA) treatment in the setting of acute ischemic stroke (AIS). Although its incidence is relatively low (0.1‐0.7%), the reaction is generally mild but may trigger life‐threatening airway occlusion and necessitate rapid intubation. This is the first study to examine the differences in complications, management, and outcomes of AIS patients with and without tPA‐induced angioedema.

Methods

The National Inpatient Sample (NIS) was queried by ICD‐9‐CM/ICD‐10‐CM codes to identify AIS patients treated with tPA who experienced subsequent angioedema. Baseline characteristics, treatment, complications, and functional outcomes were analyzed through multivariate regression and compared through a propensity score matching (PSM) analysis.

Results

This study examined 99,935 patients diagnosed with AIS and administered tPA between 2010 and 2019. AIS patients with tPA‐induced angioedema were younger (67.44 years vs 69.32 years, p < 0.01), less likely to be white (53.83% vs 66.48%, p < 0.01), and presented with higher acute stroke severity scores (0.69 vs 0.63, p < 0.01) than non‐angioedema AIS patients. Following PSM analysis, patients with angioedema had higher rates of tracheostomy (5.7% vs 0.49%, p < 0.01) and lower rates of endovascular mechanical thrombectomy (4.72% vs 9.63%, p < 0.01). Angioedema patients were observed to have similar rates of decompressive hemicraniectomy (p = 0.16), pneumonia (p = 0.06), sepsis (p = 0.82), acute kidney injury (p = 0.05), acute myocardial infarction (p = 0.43), cardiac arrest (p = 0.56), poor functional outcome (p = 0.25), and in‐hospital mortality (p = 0.32). Patients who developed angioedema were also observed to have longer LOS (7.34 days vs 5.41 days, p < 0.01).

Conclusion

There appears to be no difference in complication risk, functional outcome, and in‐hospital mortality between AIS patients with and without tPA‐induced angioedema. The observed increase in LOS may be attributed to the increased rates of tracheostomy following oropharyngeal swelling. Airway instability may also preclude AIS patients with angioedema from mechanical thrombectomy, offering one explanation for the observed difference in intervention rates. Further research is needed to better understand the impact of tPA‐induced angioedema on interventions and outcomes of patients with acute ischemic stroke.

Abbreviations

Nationwide Inpatient Sample (NIS), acute ischemic stroke (AIS), tissue plasminogen activator (tPA), mechanical thrombectomy (MT), propensity score matching (PSM), deep vein thrombosis (DVT), pulmonary embolism (PE), urinary tract infection (UTI), length of stay (LOS)
Abstract 200: Associations Between Atrial Fibrillation and Cognitive Decline Following Minor, Moderate, and Major Ischemic Stroke: A Post Hoc Analysis
Authors: Elsayed M. M. , Hegazy Z. , Fakhry M. , Sherif A. , Hafez O.
Published: January 2025

Introduction

Atrial fibrillation (AF) is a well‐established risk factor for stroke, but its role in cognitive decline following ischemic stroke remains underexplored. This study investigates the impact of AF on cognitive outcomes across different severities of ischemic stroke, aiming to better understand the interplay between AF and post‐stroke cognitive function.

Methods

We conducted a post hoc analysis using data from the ELAN randomized clinical trial, involving 600 patients who experienced ischemic strokes of varying severity. Stroke severity was categorized as minor, moderate, or major. Cognitive function was assessed using standardized cognitive scales both before and after the stroke event. AF status was determined through clinical assessments and patient medical history, and the analysis focused on comparing cognitive outcomes between patients with and without AF. Additionally, the influence of early anticoagulation therapy on cognitive decline in AF patients was evaluated.

Results

The analysis revealed that patients with AF exhibited a significantly higher risk of cognitive decline following ischemic strokes of all severities. Specifically, the odds ratios for cognitive decline were 1.45 (95% CI: 1.10‐1.93) for minor strokes, 1.68 (95% CI: 1.25‐2.24) for moderate strokes, and 2.03 (95% CI: 1.54‐2.66) for major strokes in patients with AF compared to those without AF. Furthermore, multivariate analysis highlighted that early initiation of anticoagulation therapy played a protective role, moderating the extent of cognitive decline in AF patients.

Conclusion

This study underscores the significant association between AF and an increased risk of cognitive decline following ischemic strokes of varying severity. The findings emphasize the importance of timely and effective management of AF, particularly through early anticoagulation therapy, to mitigate cognitive impairment in stroke survivors. Given the strong link between AF and adverse cognitive outcomes post‐stroke, these results suggest that routine cognitive assessment and proactive AF management should be integral components of post‐stroke care. Addressing AF in stroke patients may offer a pathway to reducing the burden of cognitive decline and improving overall recovery outcomes.
Abstract 214: Carotid dissection and occlusion leading to acute ischemic stroke, hypotension and bradycardia
Authors: Iqbal Z. , Mohammedalkhair A. , Albana A. , Reardon T. , Miller D.
Published: January 2025

Introduction

The carotid sinus regulates blood pressure and heart rate. Damage to the carotid sinus, whether from a surgical procedure or compression by a mass, can lead to hypotension and bradycardia. We report a case of carotid artery dissection resulting in symptomatic hypotension and bradycardia which has been uncommonly reported.

Presentation

A 65‐year‐old female presented with speech changes and altered mental status. On examination, the heart rate was in the 30s, fluctuating between the 40s and 50s. A CT scan revealed a subacute hypodensity in the territory of the left middle cerebral artery. CT angiography showed luminal irregularity in the distal common carotid artery and carotid bifurcation, occlusion of the internal carotid artery with reconstitution at the supraclinoid segment, suggesting a possible dissection. MRI identified an acute ischemic infarct in the anterior left insular cortex and adjacent left frontal lobe. MRA of the neck confirmed the occlusion of the left internal carotid artery, with no evidence of calcified or low‐density fatty plaque at the bifurcation. During her stay, the patient also developed hypotension with systolic blood pressure in the 80s and 90s requiring fluids. EKG showed sinus bradycardia. Patients did not have a history of bradycardia or hypotension. She was not on any medication at home or in hospital which could contribute to bradycardia. Cardiology was consulted who attribute this to carotid artery dissection.

Discussion

The carotid sinus is a neurovascular structure located at the bifurcation of the common carotid artery and extending into the proximal internal carotid artery. Hypotension and bradycardia are commonly observed in patients who undergo carotid artery stenting due to stretching of these baroreceptors. Patients with carotid body tumor or neck mass with compression of the carotid bifurcation and internal carotid artery. Similarly, there are case reports in literature with dissection of internal carotid artery presenting with syncope, bradycardia and hypotension. While dissection of the internal carotid artery has been documented to cause these symptoms, dissection involving the carotid bifurcation and associated occlusion is less commonly reported. Prior to associating dissection as etiology, complete workup to rule carotid body dysfunction, sinus node dysfunction, or carotid sinus hypersensitivity should be carried out.

Conclusion

Dissection of the carotid bifurcation and internal carotid artery has been associated with hypotension, bradycardia, and syncope. However, not all cases of carotid dissection result in these symptoms. Therefore, further investigation is needed to assess the dissection's characteristics, location, and the impact of any associated stenosis or atherosclerosis on symptom development.
Abstract 262: Endovascular coiling of very small unruptured aneurysms: Subgroup analysis from the ECOSA registry
Authors: Ashouri Y. K. , Almajali M. , Levy E. , Nogueira R. , Xavier A. , Linfante I. , Narayanan S. , Chaudhari A. , Gupta R. , Anwar M. , Hsu D. , Mueller‐Kronast N. , Lin E. , Edgell R. , Nguyen T. , Zaidat O.
Published: January 2025

Introduction and aim

Endovascular treatment of ruptured and unruptured Intracranial aneurysm (IA) treatment has evolved over the recent years since the publication of the ISAT and BRAT trials. However, very small (≤3 mm) unruptured aneurysm treatment remains unclear. The aim of this study was to describe outcomes in patients with (≤3 mm aneurysms who were treated with endovascular coiling.

Methods

The Endovascular Coil Embolization of Small Unruptured Cerebral Aneurysm (ECOSA) registry was utilized and patients with aneurysms ≤3 mm were identified. Baseline characteristics, treatment modalities, periprocedural outcomes and long‐term clinical and angiographic outcomes were reported.

Results

Out of 903 aneurysms within the ECOSA study, 116(12.4%) were very small aneurysms. Mean (standard deviation [SD]) age of patients was 52.3(12.1). Most patients were females (76.3%) and white (61.7%). More than half of patients were hypertensive (61.2%) while 6.9% were diabetic. Active smoking was prevalent in 31.9% of the cohort. Most common aneurysms were incidental in (78.4%). Mean(SD) max diameter of aneurysms was 2.66 (0.87) mm. Most common location of aneurysm was the ICA (36.2%) followed by ACA/acomm (21.7%). Stent‐assisted coiling was utilized in 23.3% of patients and balloon‐assisted coiling in 15.2%. In terms of outcomes, thromboembolic events occurred in 1.7% of patients, and all were asymptomatic. No periprocedural mortality occurrence was reported. Clinical follow‐up was available for 84.5% of patients with mean 7.15 months and angiographic in 52.7% of patients with median of 7.75 months. Good functional outcome (mRS0‐2)was achieved in 93.9% of patients. Most patients (73.8%) had complete occlusion(RROCI) and adequate occlusion(RROC I‐II) was achieved in 86.3%. Modality of follow‐up imaging was DSA in 28.4%, MRA in 26.7% and CTA in 5.2%.

Conclusion

Endovascular coiling can be performed safely and effectively in patients with unruptured ≤3 mm aneurysms.
Abstract 266: Endovascular Thrombectomy in Patients on Long‐Term Anticoagulation
Authors: Naghani I. Moeini , Vazquez S. , Jain A. , Wang R. , Vieira K. , Sacknovitz A. , Dominguez J. , Al‐Mufti F.
Published: January 2025

Introduction

Endovascular thrombectomy (EVT) has become a popular treatment of acute ischemic stroke (AIS) due to its favorable clinical endpoints in comparison to intravenous thrombolysis (IvT). Many patients who present with conditions necessitating thrombectomy are on long‐term oral anticoagulation therapy (AC) due to comorbidities and/or prophylactic prevention. ACs are a risk factor for intracerebral hemorrhage (ICH) in AIS patients treated with IvT, but evidence on the risk for patients treated with EVT is scarce. ACs may also alter clot composition to allow for easier recanalization and improved clinical outcomes following EVT, but clinical evidence is uncertain. We sought to compare the risk of ICH and clinical outcomes of patients on anticoagulant therapy treated with EVT vs. non‐anticoagulated (non‐AC) patients treated with EVT for AIS.

Methods

The National Inpatient Sample, an approximation of a 20% stratified sample of discharges from US community hospitals, was queried for all patients seen from 2016 to 2020 that underwent EVT for AIS. That sample was divided into patients on preexisting anticoagulation therapy and those that were not. Patients on long‐term AC therapy were identified using appropriate ICD10 codes and compared to those who were not on long‐term AC therapy.

Results

Of the 2,946,195 patients presenting with AIS, 287,405 (9.8%) were on long‐term AC therapy. Patients on long‐term AC therapy were less likely to have aphasia, hemiplegia, brain herniation, coma, and mechanical ventilation (all p's <0.001) when compared to those who were not on long‐term AC therapy. Despite AIS patients on long‐term AC therapy having less rates of serious features on presentation than nonAC patients, AIS patients on AC that underwent EVT were more likely to experience ICH (14.1% vs 12%; OR 1.206, 95% CI 1.058‐1.375, p=0.006) and less likely to be discharged home (35% vs 39.4%; OR 0.831, 95% CI 0.758‐0.91, p<0.001) as compared to their propensity score matched non‐AC counterparts undergoing EVT. Patients undergoing EVT experienced similar inpatient mortality (8.8% vs 9.6%; OR 0.913, 95% CI 0.784‐1.064, p = 0.260) and length of stay (LOS) (54.7% vs 55.7%; OR 0.958, 95% CI 0.877‐1.047, p=0.355) irrespective of AC therapy.

Conclusion

Long‐term AC may provide a protective effect in the setting of AIS. Although EVT is associated with increased risk of ICH in patients on long‐term AC, in‐hospital mortality and length of stay are similar to those not on long‐term AC. These findings support EVT as an option for treatment in AC patients, but research identifying optimal patient selection for EVT in the setting of long‐term AC is necessary.
Abstract 273: Evaluating Clinical Outcomes and Cost‐Effectiveness of Robotic Carotid Artery Stenting: A Multi‐Center, Propensity Score Matched Study
Authors: Patel S. , Roy J. , Musmar B. , Sarikonda A. , Scott K. , Abbas R. , Fuleihan A. , Sivaganesan A. , Tjoumakaris S. , Gooch M. R. , Rossenwasser R. , Srinivasan V. , Burkhardt J. , Jabbour P. M.
Published: January 2025

Objective

Preclinical studies suggest that robotic carotid artery stenting (CAS) could be superior to manual CAS. However, very limited comparative data exists comparing robotic and manual CAS patients. In addition, no data exists comparing the costs of manual and robotic CAS.

Methods

All robotic CAS cases at 2 academic neurosurgery centers were retrospectively reviewed and 1:1 propensity matched with manual CAS cases. Personnel costs, supply costs, and total procedure costs were collected in collaboration with hospital administration using time‐driven activity‐based cost‐analysis (TDABC).

Results

24 robotic CAS cases were performed between 2019 and 2023. Co‐morbidities and baseline procedural characteristics were well‐matched between robotic and manual cases. Unplanned manual conversion was observed in only one robotic case (4.2%). Robotic CAS complications and outcomes were comparable to manual. Robotic CAS was associated with a significantly increased fluoroscopy time (29.0 vs. 19.2 min.; p<0.001). Robotic procedure time (88.9±18.2 min.) was significantly (p=0.003) higher than manual (68.72±22.4 min.). Health professional costs ($1,589.71±176.92, $1,375.99±233.39, p<0.005), supply cost ($3,918.25±421.20, $2,152.74±1,030.26, p<0.001) and total procedure costs ($5,306.11±608.95, $3,437.56±1,165.67, p<0.001) were greater for robotic CAS.

Conclusions

With a low rate of technical failure and post‐operative complications, we show robotic carotid artery stenting is safe and feasible in the first multi‐center and largest sample to date. In addition, robotic CAS achieves comparable clinical outcomes. Robotic CAS was associated with increased fluoroscopy time, but fluoroscopy time decreased as operators gained familiarity with the CorPath GRX. Robotic CAS was associated with a greater procedural cost, which was driven by greater personnel and supply costs. Our findings highlight the need for further studies to optimize robotic CAS and reduce its associated costs.
Abstract 299: Implications of Age on Post Stroke Depression in Intracerebral Hemorrhage Patients
Authors: Couture L. , Baskin L. , Petway A. , Eagen P. , Cahuiche A. E. , Colpo G. Delevati , McCullough L. D.
Published: January 2025

Introduction

Risk Factors for stroke consistently have been researched regarding ischemic strokes, but unfortunately are overlooked in respect to hemorrhagic strokes. Intracerebral Hemorrhages (ICH) are a critical disease consistently associated with high mortality rates and poor functional outcomes among survivors. Research on non‐traumatic, spontaneous ICHs have progressed in acute treatment strategies, such as surgical interventions and evacuations, however insight into possible associations with risk factors have elucidated researchers. In this study we aim to investigate social factors including sex, age, and race to understand if non‐modifiable factors may affect functional outcomes after ICH.

Methods

A standard battery of questionnaires were given to patients with ICH during their hospitalization (N=51). Depression was measured via PHQ‐9, with scores above 5 denoting moderate to severe depressive symptoms. Social Isolation is measured utilizing UCLA Loneliness and Lubben Social Network Scale; these questionnaires measure patients’ self‐reported loneliness levels and social network respectively. To assess functional outcome of the patients, a Modified Rankin Scale (mRS) score is assigned prior to ICH (pre‐mRS), immediately after (post‐mRS), and 3 months after discharge (3‐month mRS), based on their functional abilities. An increase in mRS score denotes more functional disability, with a score of 6 denoting death.

Results

We found that ICH patients under 55 years of age had significantly higher levels of depression during their hospitalization than patients 55 and older (p<0.05). There were no significant differences in patients’ pre‐mRS scores, which was utilized to determine if these results were a ramification of younger patients having more disabling comorbidities and therefore less functional ability prior to stroke. There was no significant correlation with pre‐mRS or post‐mRS and depressive symptoms during hospitalization. There were also no significant differences between UCLA Loneliness and Lubben Social Network scores when stratified by age. We found no significant differences with depressive symptoms among sex, race, and ethnicity, or with 3‐month mRS.

Conclusion

Social Isolation and pre‐hospitalization disability have minimal effects on functional outcomes, underscoring the need for providers to consider other modifiable risk factors in treating younger ICH patients. Understanding the physiological outcomes after stroke and the psychological changes post‐stroke must be studied more to try to lessen the burden among post‐stroke patients. Our finding of younger patients with higher levels of depressive symptoms compared to the older population must be considered by providers when treating younger ICH patients during their acute stage to prevent worse functional outcomes among this vulnerable population.
Abstract 304: Increased Stroke Severity and Mortality in Methamphetamine Users: A Propensity‐Matched Analysis
Authors: Wani R. , Salahuddin H.
Published: January 2025

Introduction

Methamphetamine (meth) is a highly addictive central nervous system stimulant that has been associated with an increased risk of cerebrovascular disease, particularly among younger individuals. Frequent methamphetamine use, defined as meth use exceeding 100 days annually in the United States, has increased by 66% from 2015 to 2019 and represents a growing concern among young patients. This study aims to compare the severity of stroke presentation between methamphetamine users and non‐users by employing propensity score analysis to account for confounding variables.

Methods

We conducted a retrospective review of consecutive stroke patients who presented to a Comprehensive Stroke Hospital between January 2023 and August 2024 with a definitive diagnosis of ischemic or hemorrhagic stroke. Baseline demographics, clinical presentation, and inpatient mortality were recorded. Patients in the methamphetamine stroke group were matched with non‐methamphetamine stroke patients based on age, gender, hypertension, diabetes mellitus, atrial fibrillation, and hyperlipidemia using propensity score analysis. Statistical analysis was performed using the T‐Test or Mann‐Whitney U‐Test where appropriate.

Results

Our study included 53 patients with a mean age of 56 (83% ischemic, 17% hemorrhagic) diagnosed with methamphetamine‐related stroke, who were matched to 200 non‐methamphetamine stroke patients with a mean age of 64 (88% ischemic, 12% hemorrhagic) during the study period. The average NIHSS score for meth‐positive patients was higher than that of the meth‐negative group (9.7 vs. 6.5; p=0.05). Meth‐positive patients also had higher white blood cell (WBC) (10 vs 9.3 p=0.03) and neutrophil (7.5 vs. 7.2 p=0.02) counts on presentation. The inpatient mortality rate for meth‐positive patients was significantly higher as well (13.2 vs. 9.5; p=0.02).

Conclusion

Methamphetamine use among stroke patients is associated with increased stroke severity, WBC count upon presentation, and a higher in‐hospital mortality rate. Future research should investigate the underlying mechanisms that contribute to this increased severity and the implications for treatment outcomes.
Abstract 308: Inpatient Optimization of Endovascular Therapy for Acute Ischemic Stroke in Patients with Active Malignancy
Authors: Dawod G. , Desai H. , Ehidom C. , Díaz P. , Lin N. , Boddu S. , Knopman J. , Navi B. B. , Schaff L. , Ramos A.
Published: January 2025

Introduction

Landmark trials studying the efficacy of endovascular therapy for patients with large vessel occlusions generally excluded patients with active cancer. Of those with malignancy undergoing mechanical thrombectomy, they tend to have worse clinical outcomes despite technical success. Thus, implications of mechanical thrombectomy in this cohort remains debated. Our objective is to elucidate post thrombectomy outcomes in patients with active cancer to further optimize inpatient management.

Methods

We conducted a retrospective cohort study of stroke thrombectomy cases performed at our institution from January 2010 to March 2024. Pearson Chi‐square test and Fisher's exact test were used to analyze categorical variables, and Mann‐Whitney U tests were used for continuous variables. Multivariable logistic regression analyses were performed to evaluate for independent associations between baseline characteristics and study outcomes of interest, specifically, successful endovascular reperfusion (≥TICI 2b) and poor clinical outcome, defined as death or disposition to hospice.

Results

We identified 50 patients with active cancer who underwent mechanical thrombectomy (MT) for stroke. Mean age was 63.8 years (SD, 11.4), 48% were men, and 68% had stage IV cancer. Successful reperfusion was achieved in 78% of patients, and 50% ultimately had a poor clinical outcome, including 40% inpatient deaths. Of those that died inpatient, 46% of deaths were due to non‐neurological causes. 78% of patients undergoing MT were treated with optimal medical management post stroke with either anticoagulation or antiplatelet therapy. In total, 16% of patients went on to complete cancer treatment. While there were no pre‐EVT variables that were significantly associated with outcome change, the decision to initiate anticoagulation post‐EVT while inpatient was associated with more favorable outcomes (p=0.006). Only 6% of patients were found to have sICH, and the use of IV thrombolysis prior was not found to impact this rate.

Conclusion

In our study, we found that despite a high successful reperfusion rate, nearly half of cancer patients undergoing mechanical thrombectomy for large vessel occlusion strokes had a poor clinical outcome. We found that anticoagulation post thrombectomy independently correlated with a more favorable outcome. Future studies must further elucidate other factors that may influence outcomes to guide in optimal patient selection and maximize overall success of EVT in patients with cancer.
Abstract 315: Intraventricular hemorrhage due to bilateral vertebral artery dissection during treatment in drug intoxication patient: a case report
Authors: Cho B. , Jang D. , Kim D.
Published: January 2025

Introduction

A vertebral artery dissection is a possible cause of stroke in young and middle‐aged adults without risk factors for cerebrovascular disease. It often occurs spontaneously for no particular reason, but it can also occur due to trauma or other causes. This study aims to report the treatment experience of bilateral vertebral artery dissection and intraventricular hemorrhage in a patient hospitalized for drug intoxication in our hospital.

Methods

A fifty‐six‐year‐old woman was found collapsed on the street and visited the emergency department of our hospital, complaining of comatose mentality and hypothermia. The Glasgow Coma Scale score measured at the visit was 3 points, and bradycardia and hypotension were present. A bag of medications prescribed by a psychiatrist was found in the patient's bag, and a drug screen test performed showed benzodiazepines positive. Brain CT performed in the emergency room did not reveal an acute lesion, so the patient was admitted to the intensive care unit at the department of emergency medicine under a drug intoxication impression. After four days of hospitalization, the patient's response started to improve, and on the 7th day, she showed a drowsy mentality. IVH was found in the bilateral lateral ventricles on diffusion MR performed on day 7, and dissection was confirmed in the bilateral distal V4 segment on additional CT angiography.

Results

Conservative treatment was performed in the intensive care unit, and a follow‐up CT showed that the hemorrhage was resolved. Still, dissecting aneurysms with an increased size was confirmed in both V4 segments. Emergency stent‐assisted coil embolization was performed for left V4 dissecting aneurysm with bleb. There were no complications during the procedure, and the right V4 dissecting aneurysm was decided to do embolization after a follow‐up examination. After the procedure, the patient showed an alert mentality, and there were no acute abnormal findings in the follow‐up examination.

In the MRA performed one year after the procedure, the treated area on the left V4 dissecting aneurysm was well maintained. The right V4 dissecting aneurysm showed normal findings due to spontaneous healing.

Conclusion

In the case of vertebral artery dissection, which rapidly changes shape, careful observation is required, and appropriate treatment is required before new neurological symptoms develop. For treatment, stent‐assisted coil embolization can be a good option, and since spontaneous healing can occur in some cases, it is essential to determine an appropriate treatment method. In addition, appropriate follow‐up tests and identification of the cause are necessary for patients with decreased consciousness for which the cause is unclear.
Abstract 326: Mechanical Thrombectomy in Low NIHSS: Preventing High mRS
Authors: Bajrami A. , Senadim S. , Aksoy S. , Bas D. F. , Geyik S.
Published: January 2025

Introduction

Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is very effective treatment in patients with high National Institutes of Health Stroke Scale (NIHSS) scores. However, disability can also be seen in patients with NIHSS scores of 0‐5. Besides, clinical deterioration as a result of stroke progression is quite common in patients with large vessel occlusion (LVO). Although there are studies investigating the effectivity of EVT in patients with low NIHSS scores, more comprehensive data are needed on patient selection and safety. In this study we aimed to determine the clinical outcome of patients with low NIHSS scores who underwent mechanical thrombectomy in our center.

Methods

We conducted a single‐center, retrospective study of a prospectively maintained database of stroke patients presenting with NIHSS scores of 0‐5. Patients who applied within 24 hours from the onset of symptoms were included in the study. Detailed clinical information of the patients such as age, sex and the presence of comorbidities, localization of occlusion, procedural measures were recorded. Clinical outcomes were evaluated with NIHSS scores at 24 hours and mRS 3 months.

Results

A total of 147 patients were enrolled in this study. Patient presenting with NIHSS<5 within 24 hours of onset and imaging modalities showing large or medium vessel occlusion and diffusion‐perfusion mismatch were evaluated for MT. The mean age was 62.75 ± 14.63 and 85 (57.8%) of the patients were male. A total of 8 (5.4%) patients had occlusion in extracranial ICA, 16 (10.9%) in ICA terminal, 49 (33.3%) in MCA M1, 52 (35.4%) in MCA M2 and 8 (5.4%) in M3, 3 (2.1%) in ACA, whereas 5 (3.4%) patients in basilar artery and 6 (4.1%) patients in PCA. The mean NIHSS on admission was 3.28 ± 1.37 and 3.29 ± 3.95 at 24 hours. The patients with mRS scores of 0‐2 were evaluated as functionally independent. The number of functionally independent patients at 90 days was 108 (79.4%), whereas 15 (10.2%) patients died.

Conclusions:

In this study low NIHSS patients with underlying vessel occlusion benefit from MT in terms of 3.month mRS. Still large cohort, randomized studies are warranted to show superiority to medical treatment.
Abstract 331: MR Steal Phenomenon Corresponds to Cerebral Angiogram Circulation Time
Authors: Ismail R. , Manganero M. , Szekeres D. , Bender M. , Wang H.
Published: January 2025

Background

Cerebrovascular reserve (CVR) is crucial for assessing hemodynamic impairment in patients with cerebrovascular steno‐occlusive disease. While catheter cerebral angiography is the gold‐standard for evaluating CVR and collateral circulation, acetazolamide‐challenged arterial spin labeling perfusion MRI (AC‐ASL) has emerged as a non‐invasive alternative, but its effectiveness in reflecting neuroangiographic parameters is not fully understood.

Methods

A retrospective study was conducted on patients who underwent AC‐ASL from 2014‐2022. Patients were excluded if concurrent angiographic analysis was not performed, or image quality was compromised. The study involved correlating cerebral angiographic metrics like arteriocapillary circulation time (ACCT) and superior sagittal sinus entry (SSSE) with AC‐ASL flow parameters in patients with steno‐occlusive disease. MR acquisitions were obtained prior to acetazolamide administration and after 1 g of acetazolamide administered‐ at 5 and 10 minutes intervals. Cerebral angiography was typically performed via transfemoral approach utilizing a dual plane digital subtraction (DSA) radiographic angiographic system. CT angiograms were utilized if DSA was not available.

Results

The study included 32 patients, predominantly with unilateral disease. A significant correlation was found between AC‐ASL adjusted steal percent and angiographic ACCT (r = ‐0.345, p=0.049), which was stronger when comparing the ratio of ACCT between occlusive and nonocclusive hemispheres (r = ‐0.40, p=0.020). No significant correlation was found with SSSE nor angiographic collateralization patterns.

Conclusion

AC‐ASL can non‐invasively evaluate arteriocapillary circulation time, comparable to catheter angiography in patients with steno‐occlusive disease. This suggests AC‐ASL is useful for assessment of CVR in patients, providing a safe and non‐invasive methodology.
Abstract 344: Novel technique for endovascular biopsy of carotid endothelial cells in carotid artery stenosis: Proof of Concept & Follow Up of SVIN 2023 Pilot Grant
Authors: Bounajem M. T. , Dabb S. , Richter K. , Budohoski K. , Grandhi R.
Published: January 2025

Introduction

Acute ischemic stroke remains to be one of the top causes for morbidity and mortality among the general population, with approximately 800,000 strokes occurring per year nationwide. While the potential etiologies of stroke are numerous, 15‐20% of all strokes are attributed to carotid artery stenosis. While isolated studies have been conducted sampling carotid plaques after CEA, there is a dearth of literature examining the characteristics of the endoluminal cells and their molecular characteristics (such as transcriptomes) in carotid artery disease. We therefore employed a novel method for endovascular biopsy of carotid endothelial cells in the setting of carotid artery stenosis.

Methods

A prospective registry of adult patients undergoing endovascular treatment for carotid artery stenosis was maintained from January 2024 to August 2024. Informed consent was obtained, and at the conclusion of the case, critical devices were collected and placed in dissociation buffer including the access wire/sheath tip, the distal embolic protection device, and any balloons utilized for balloon angioplasty. Cells were then washed from the samples using a series of centrifugation, wash, and pelleting steps. Once completed, the pellet was then resuspended in a solution containing Hibernate A, and a standard antibody staining and sorting protocol was performed utilizing fluorescence activated cell sorting (FACS) to identify endothelial cells (via CD31 antibodies) and to exclude white blood cells (negative sorting via CD45 antibodies).

Results

Six patients met inclusion criteria and gave consent for endothelial carotid biopsy. After sorting for endothelial cells via FACS, the mean number of endothelial cells collected from the access sheath/wire was 1506 cells per patient. Similarly, the mean number of endothelial cells collected from the balloons utilized for angioplasty was 1124 cells. Finally, the mean number of endothelial cells collected from the distal embolic protection device was 5021 cells per patient.

Discussion

The preliminary findings herein suggest that this method of endovascular biopsy may very well be a reliable method for collecting endothelial cells from the carotid artery in the setting of treatment for carotid artery stenosis. Sample collection is still ongoing to further support the viability of this technique. Collected endothelial cells will then undergo RNA sequencing in order to describe the transcriptomic profile present in endothelial cells of diseased carotid arteries.
Abstract 345: Occult Antiphospholipid Syndrome Presenting as Subdural Hematoma: A Rare Manifestation of Arterial Hypercoagulability
Authors: Welsh C. , Gagi K. , Solemani S.
Published: January 2025

Objective

To describe a case of antiphospholipid syndrome (APS) which presented with subdural hemorrhage, a rarely described manifestation of a commonly hypercoagulable disorder.

Background

APS is a common arterial and venous hypercoagulable state—though rare in the general population with an incidence of 5 per 100,000 individuals. It most commonly presents with systemic ischemic insults, commonly to the brain in the form of ischemic stroke. This case highlights a known rare manifestation of APS: intracranial hemorrhage.

Design/Methods: N/A

Results

Patient is a 49 year old female with history of end‐stage renal disease who initially presented with altered mentation and hypertension. Her GCS was 7 upon arrival prompting intubation. CT head at that time revealed acute left parietal subdural hematoma. There was no clear history of trauma per the patient's family, and the patient was unable to provide any additional history of their own at that time. The etiology of her hemorrhage, in the acute setting, was not clearly discerned. She was managed in the ICU for several days, however she remained somnolent and unable to participate in examination despite removal of sedating agents. A repeat CT scan of the head was done at that time which revealed multifocal hypodensities consistent with late acute‐early subacute ischemic stroke. Subsequent CT angiography of the head and neck was negative for large vessel occlusive disease, extracranial atherosclerotic disease, vasospasm or other clear cerebrovascular constriction. Other embolic stroke workup including transthoracic and transesophageal echocardiogram was negative. At this point, a broader workup for embolic stroke of unclear source was launched. These studies included hypercoagulablity labs were sent and ultimately returned positive with elevated anticardiolipin and beta‐2 microglobulin consistent with an antiphospholipid antibody syndrome, prompting the initiation of anticoagulation. The patient has since improved clinically and is no longer mechanically ventilated, though does still require significant assistance with activities of daily living.

Conclusions

While rare, patients with otherwise unexplained hemorrhage should be investigated for possible immune‐mediated mechanisms for stroke—both ischemic and hemorrhagic.