bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 153: Pre‐procedural 3D visualization of deep‐learning vascular segmentation enhances identification of difficult femoral access in thrombectomy
Authors: Canals Pere , Requena Manuel , García‐Tornel Álvaro , Molina Marc , Tomasello Alejandro , Li Jiahui , Balocco Simone , Díaz Oliver , Ribó Marc 
Published: March 2024

Introduction
Difficult or impossible femoral access remains a significant burden for mechanical thrombectomy (MT) in stroke, affecting between 4.4% (impossible) to ∼10% of cases (time to first angiography [T1A] > 30 min) [1]. Visualization of CT angiography (CTA) or MR angiography are the only available diagnostic tools for neurointerventionalists (NIs) to qualitatively assess catheterization difficulty ahead of intervention. Visualization of 3D segmentation of the head‐and‐neck arteries from CTA may provide enhanced spatial information for catheter access difficulty assessment to the occlusion site, as well as large vessel occlusion (LVO) localization or carotid stenosis detection.

Methods
Three observers (2 expert NIs and 1 medical image engineer) assessed a sample of patients with anterior circulation stroke rating LVO location, femoral access difficulty according to a Likert scale (0 to 5) and assessment of radial access compared to femoral (easier or not). Raters were asked to answer the same form for each case twice, once after visualizing only the CTA and again after visualizing a deep‐learning, automated 3D segmentation of the head‐and‐neck arteries from CTA [2]. Cases were randomly sampled and blind to raters for both assessments. Likert scale values were normalized and averaged across observers, and correlation to T1A was studied. LVO localization accuracy and time needed for the analysis was also assessed.

Results
The final sample included N = 117 cases, where 22.98% presented difficult or impossible access. LVO location prevalence was 13/15/45/27% for extracranial ICA (eICA)/TICA/M1/M2, and 49/51% for right/left. Averaged Likert values presented significant linear correlation for both segmentation and CTA visualization, but this was much stronger in the former (R: 0.58 vs 0.30, p<0.001). Three‐dimensional visualization of segmented vessels allowed for an enhanced detection of difficult or impossible femoral access (ROC‐AUC: 0.85 vs 0.66). LVO detection was also superior after segmentation visualization (mean accuracy across observers: 0.81 vs 0.72) and time needed for assessment was on average 2.3 times shorter (44 s vs 100 s). In difficult or impossible patients, radial access was considered easier in 74% (63‐89%) of cases when visualizing the segmentation compared to 42% (35‐48%) when inspecting the CTA.

Conclusion
Visualization of deep‐learning 3D arterial segmentation resulted in enhanced difficult or impossible femoral access for MT, LVO detection and faster analysis over traditional pre‐procedural CTA inspection. Adding this visualization to the current workflow could enhance difficult access detection ahead of intervention.
Abstract 162: Indirect Carotid Cavernous Fistula with Oculomotor Nerve Palsy Secondary to Trauma
Authors: Iqbal Zahid 
Published: March 2024

Introduction
Intriguing and uncommon, we present a fascinating case of carotid‐cavernous fistula (CCF) following ocular trauma. Delving into medical nuances and outcomes, this reported case offers valuable insights for clinicians and researchers in the field of ophthalmology and interventional Neurology.

Methods
An elderly patient presented to the emergency department with diplopia and left eyelid ptosis two weeks after left ocular trauma. The patient had exotropia and hypotropia with restricted movement in all directions but mostly during adduction and infraduction which led to the diagnosis of oculomotor nerve palsy. Computer Tomography (CT) head was obtained which showed mild left proptosis with the prominence of the optic nerve sheath complex, CT angiography revealed asymmetric prominence of the left ophthalmic veins and enlarged left cavernous sinus with outward convex borders. CT face and mandible with IV contrast did not show any bony deformity. The patient underwent cerebral angiography that showed an indirect type 4 cavernous‐carotid fistula.

Results
A precise incidence of CCF fistula has not been reported so far in the literature but it is estimated to be present in 0.2 % of patients presenting with traumatic brain injury with an increased incidence of 4 % with basilar skull fractures. They can occur spontaneously or following closed skull injury, skull base fractures, or iatrogenically after craniotomies, endoscopic transsphenoidal or sinus surgery, and endovascular procedures. They can be classified based on angiographic arterial architecture (direct or indirect), hemodynamics (high flow or low flow), and etiology (spontaneous or traumatic). Type A are direct fistulas, whereas types B, C, and D are indirect fistulas.
Direct CCFs often present with pulsatile exophthalmos, orbital bruit, chemosis, diplopia, ocular redness, orbital pain, swelling, swishing or buzzing sounds, headache, or vision loss. Indirect low‐flow CCFs may be asymptomatic and insidious in onset and mostly present with chemosis and conjunctival injection.

Conclusion
Indirect carotid‐cavernous fistula rarely occurs secondary to a head trauma without any bony deformity and it's even rare to have an oculomotor nerve palsy on presentation, it should be considered as an etiology when evaluating patients for ocular nerve palsies.
Abstract 165: Subarachnoid Hemorrhage Related to Thoracic Spinal Cord Stimulator Placement
Authors: Arthur Melinda C. , Tandon Adesh , Lebovitz Jonathon , Wright Paul 
Published: March 2024

Introduction
Spinal cord stimulators (SCS) offer safe and effective pain relief. Precise lead placement is critical. Indications for lead placement include chronic pain, failed back surgery syndrome and complex regional pain syndrome (1). Hardware related complications include lead fracture and lead migration into the subdural space. Complications can also include spinal cord injury, nerve root damage or lack of desired pain control (2). We present a case of subarachnoid hemorrhage (SAH) due to SCS lead migration into the subdural space.

Methods
An 81‐year‐old female patient with a past medical history of heart failure, atrial fibrillation and a mechanical mitral valve, presents with a severe headache and right hemiparesis. The patient was anticoagulated with a warfarin to heparin bridge. One week prior to presentation, the patient underwent SCS placement for chronic lower back pain due to post herpetic neuralgia. She was also found to have 8/10 pain on palpation of the lumbar spine and loss of sensation in the right lower extremity. An urgent CT brain revealed a SAH in the bilateral occipital lobes, right sylvian fissure and right temporal lobe. CT angiogram was also performed and did not reveal any evidence of a cerebral aneurysm. CT of the thoracic spine revealed neurostimulator lead migration into the subdural space. Neurosurgery was consulted and subsequently removed the SCS. The patient’s hemiparesis resolved, and CT brain showed no progression of the hemorrhage. MRI brain showed no infarct.

Results
We propose that the combined risk of anticoagulation and lead migration into the subdural space led to the development of SAH.

Conclusion
In cases of a SAH, where a cerebral aneurysm or arteriovenous malformation have been excluded, other sources should be considered. We report a novel case of SAH following SCS placement.
Abstract 174: Treatment of Unruptured Saccular Aneurysms with PED: A Systematic Review and Meta‐Analysis of Long‐Term Outcomes
Authors: Zermeno Jorge A. Rios , Ghaith Abdel Karim , Greco Elena , Michaelides Loizos , Ruiz Omar R. Ortega , Faisal Umme H. , Tawk Rabih G. 
Published: March 2024

Introduction
The Pipeline Embolization Device (PED) is commonly used for intracranial aneurysm treatment. While its effectiveness for certain types of aneurysms is well‐established, its efficacy for saccular aneurysms remains debatable. This review and meta‐analysis aimed to assess the long‐term outcomes of PED treatment for unruptured intracranial aneurysms (UIA).

Methods
A systematic review and meta‐analysis were conducted following PRISMA guidelines. Studies with at least one year of follow‐up after PED treatment for saccular aneurysms were included. The primary endpoint was angiographic complete aneurysm occlusion at long‐term (≥ 12 mo.) follow‐up. Secondary outcomes included long‐term complications. We conducted a meta‐regression analysis to explore the potential sources of heterogeneity across studies.

Results
Eleven studies on 594 patients with 726 aneurysms were included, of which 5% were previously treated. The mean age was 55.7 years, and 78.3% were women. The mean aneurysm size was 7.72 mm, 8.95% were treated with more than one device, and 2.9% had adjunct coiling. The long‐term complete occlusion rate was 81% (CI 95%: 72% to 88%, p<0.01). Regarding long‐term complications, the rate of symptomatic ischemic stroke was 1% (CI 95%: 0% to 4%, p=0.07), the rate of delayed rupture was 1% (95%, CI 0% to 3%, p=0.02), and the rate of intracranial hemorrhage was 3% (CI 95%: 1% to 6%, p=0.81). The meta‐regression analysis revealed a decreasing trend per year for aneurysmal occlusion, ischemic stroke rate, and aneurysmal rupture rate over time and an increasing trend for ICH over time.

Conclusion
PED demonstrates high long‐term occlusion and low complication rates, suggesting it is a safe and effective treatment option for unruptured intracranial saccular aneurysms. However, studies with greater than 5‐10 years of follow‐up are needed to evaluate the clinical and radiographical outcomes of incompletely occluded aneurysms Additionally, as newer devices exhibit reduced thrombogenic profiles and ICH rates increase over time, reevaluation of antiplatelet therapy's role, including dosage and DAPT, is warranted.
Abstract 176: Management of Unruptured Intracranial Aneurysms in SubArachnoid Hemorrhage
Authors: Lingam Sivani , Samiee Tara , Galate Vince , Panchananam Vivek , Leconte Caitlin , Fry Lane , Paul Meirah , Abraham Michael G. 
Published: March 2024

Introduction
Subarachnoid hemorrhage (SAH) has an estimated prevalence of 7.9 per 100,000 person yearsi. It is primarily caused by the rupture of intracranial aneurysms, leading to severe consequences and a 60% 6‐month mortality rateii. The management of UIAs in SAH cases poses a unique dilemma due to the potential increased risk of rupture, especially when the exact source of SAH remains ambiguous in the presence of multiple UIAs. Although tools like the PHASES scoreiii and the Unruptured Intracranial Aneurysms Treatment Score (UIATS)iv help guide aneurysm management, they are not tailored specifically to the scenario of UIAs in SAH. Thus, there is a need to study and comprehend the management strategies and outcomes of these cases. We reviewed the management and outcomes of UIAs in SAH at our institution in the past 10 years.

Methods
A retrospective review of all patients presenting between July 2013 and July 2023 with SAH and one concomitant UIA at our institution were analyzed.

Results
A total of 79 patients with confirmed UIA on angiography met inclusion criteria. Of these, 20 patients (25.3%) with UIAs were intervened on, as opposed to 59 (74.7%) that were not. UIAs >7 mm in diameter were found in 6 patients, and of these, 5 patients received intervention. 45.6% of the patients had a Hunt Hess Score of ≥3, and of these, 27.8% were intervened on. 72.2% of the patients had a Modified Fisher score >2, and of these, only 22.8% of the UIAs were intervened on. 58.2% of patients had a PHASES score >3, and of these, 34.7% were intervened on. Of the patients that were intervened on, 80% had a PHASES score >3. There was no significant difference in the UIATS score between the two groups. 34.9% of patients were noted to have the UIA in the same vascular territory as the SAH and of these 36.3% were intervened on. Current use of blood thinning medication, personal history of SAH or UIA, hypertension history, age, nor gender significantly affected the rate of UIA intervention

Conclusion
The majority of the UIAs in SAH were not intervened on, and the PHASES score and the UIATS score did not correlate with the decision on intervention. Of the ones that were intervened on, most of them were in the same vascular territory as the SAH. The decision to intervene appears to be on a case‐by‐case basis.
Abstract 181: Technical success of the WEB‐17 system for intracranial aneurysms: Summary of the early experience
Authors: Elrefaei Amro , Ghozy Sherief , Motawei Ahmed Sallam , Kobeissi Hassan , Moussalem Charbel , Kallmes David F. , Kadirvel Ramanathan 
Published: March 2024

Introduction
Background: The Woven Endo‐Bridge (WEB) device is an intrasaccular device being used to secure intracranial aneurysms through the endovascular approach. The WEB is commonly used for wide‐neck aneurysms. There are no comprehensive studies to assess the low‐profile device WEB 17 so far. Although, some single studies have reported their early experience using the device. We plan to provide a comprehensive assessment of the early center experience using the WEB 17 device to secure intracranial aneurysms.
Objective: To provide an overview of the early‐center experience of the 0.017‐inch endovascular Woven EndoBridge device (WEB‐17) device.

Methods
A systematic review and meta‐analysis were conducted following the PRISMA recommendations. On April 15, 2023, we searched for eligible papers in Pubmed, Web of Science (ISI), Scopus, and Embase databases. The meta‐analysis was done using R software version 4.3.0. and the "meta" package. Pooled prevalence (%) and their corresponding 95% confidence intervals (CI), random‐effects model based and the generalized linear mixed models (GLMMs) method. On the presence of multiple follow‐up points, we included the last available in the analysis. Complete occlusion was defined as Raymond–Roy occlusion classification (RROC) class I, and adequate occlusion was defined as RROC class I or II.

Results
Seven studies were finally included following the double‐reviewer screening of the retrieved literature. The patients' mean age ranged from 52.5±13.8 to 62.0±9.5 years, and 71.0% were females. The mean follow‐up duration ranged from 6±2.25 months to 11.6±4. Technical success was achieved in 98.34% (95% CI= 96.72‐99.17) of the cases, while adjunctive devices were used in 4.97% (95% CI= 1.60‐14.39) of them (Figure 1). The complete occlusion rate was 72.54% (95% CI= 63.44‐80.08) (Figure 2), while the adequate occlusion rate was 94.41 (95% CI= 88.17‐97.46) (Figure 3). There was no significant heterogeneity in all pooled outcomes.

Conclusion
The early experience of the device shows an efficacy profile comparable with the currently available devices in treating intracranial aneurysms.
Abstract 187: Nontraditional Lipid Indices and Intracranial Atherosclerotic Stenosis Burden
Authors: Park Jong‐Ho 
Published: March 2024

Introduction
Expert consensus guidelines recommend low‐density lipoprotein cholesterol (LDL‐C) as the primary serum lipid target for recurrent stroke risk reduction. Nontraditional lipid variables including triglycerides/high‐density lipoprotein cholesterol (HDL‐C) ratio and total cholesterol/HDL‐C ratio are linked to a vascular risk as a residual risk factor. Since intracranial atherosclerotic stenosis (ICAS)‐related stroke is prevalent in Asian population, we evaluated the relationship between lipid indices and ICAS burden.

Methods
We analyzed consecutively enrolled 1220 patients with acute ischemic stroke from March 2009 to May February 2013, who underwent brain MRI and MRA. ICAS was defined as >/=50% stenosis and quantified by presence, >/=2, and >/=3. Study patients were divided into four groups according to level of nontraditional lipid variables: triglycerides/HDL‐C, total cholesterol/HDL‐C ratio, and low‐density lipoprotein cholesterol (LDL‐C)/HDL‐C ratio, and non‐HDL‐C. Independent associations of 4 lipid variables with ICAS were assessed.

Results
Table shows multivariable adjusted odds of ICAS by Increasing strata of each lipid indices. Compared with the lowest triglycerides/HDL‐C quartile, stepwise relationships were observed between increasing quartiles and the presence of ICAS (adjusted OR 1.04, 95% CI 0.68–1.58; 1.06, 0.69–1.62; and 1.80, 1.17–2.77), ICAS >/=2 (1.32, 0.83–2.09; 1.32, 0.82–2.11; and 1.72, 1.07–2.74), and ICAS >/=3 (2.49, 1.32–4.69; 2.98, 1.58–5.63; and 3.18, 1.67–6.04). Compared with the lowest total cholesterol/HDL‐C ratio, stepwise relationships were observed with ICAS >/=2 (1.51, 0.90–2.54; 1.56, 0.90–2.68; and 2.03, 1.00–3.74), and ICAS >/=3 (1.67, 0.84–3.33; 2.22, 1.10–4.51; and 2.63, 1.20–5.77). Relationships between LDL‐C/HDL‐C ratio and ICAS burden showed similar pattern to findings from total cholesterol/HDL‐C. Association between non‐HDL‐C and ICAS was not significant.

Conclusion
Among four lipid indices, elevated triglycerides/HDL‐C is more likely associated with ICAS burden. HDL‐C might exert as a crucial role for developing ICAS.
Abstract 202: Early Experience with the Aristotle Colossus 035” Micro‐Guidewire for Mechanical Thrombectomy: Experience in 6 Cases
Authors: Meyer Benjamen M. , Khan Muhammad W. , Campos Jessica K. , Laghari Fahad , Zarrin David A. , de Beaufort Jonathan C. Collard , Amin Gizal , Golshani Kiarash , Beaty Narlin , Bender Matthew T. , Colby Geoffrey P. , Lin Li‐Mei , Coon Alexander L. 
Published: March 2024

Introduction
Recent literature continues to demonstrate the successful role large‐bore aspiration catheters have in thrombus ingestion during mechanical thrombectomy. However, the ledge gap, or step off, between the catheter and the microwire can make navigating to distal vasculature difficult. A new 035” micro‐guidewire reduces the step off for 035” aspiration catheters (Aristotle 35 Colossus Guidewire, Scientia Vascular, West Vale City, UT) while maintaining torquability and softness. We report here our early experience in 6 mechanical thrombectomy cases.

Methods
We reviewed and analyzed a prospectively maintained database of the senior authors to identify cases utilizing a 035” micro‐guidewire with 035” aspiration catheters in mechanical thrombectomy.

Results
Six consecutive cases of 035” microwire use for mechanical thrombectomy were identified. Four (67%) patients were female with an average age of 77±5.3 years (range 56‐97). Average presenting NIHSS was 11±3. Thrombus locations included 50% (n=3) in the M2, 33% (n=2) in the M1, and 17% (n=1) in the P1. Radial access was performed in 1 case (17%), with remaining via femoral access (n=5, 83%). An 088” ID aspiration catheter was navigated to at least the M1 segment in all anterior circulation cases and the basilar in the posterior circulation case. The 035” wire was placed proximal to the occlusion in all cases allowing coaxial 035” and 071” catheter aspiration passes. The average number of passes was 2±0.3. TICI 2C/3 was achieved in 83% of cases (5/6) and 2b in the remaining case. There were no catheter‐related dissections, perforations, or hemorrhagic complications noted for the cases.
Figure 1. (A) AP angiography demonstrating a thrombus in the right M2 superior division (white). (B) 035” (yellow), 071” (orange), and 088” (red) aspiration catheters over the Colossus 35 micro‐guidewire (black) at the level of the thrombus without crossing it.

Conclusion
The Colossus 035” micro‐guidewire may offer advantages over its narrower counterparts by reducing ledge effect and the need to cross the thrombus. Further comparative studies against currently available microwires are needed in various anatomies to confirm this perceived performance advantage.
Abstract 204: On Old Dogs and New Tricks: Connecticut Perfusion Predicts Hemorrhagic Transformation After Thrombectomy
Authors: Abualnadi Yazan D. , Miller Samantha , Khalil Zorain M. , Desai Sohum K. , Sadiq Kaiser O. , Tekle Wondwossen G. , Hassan Ameer E. 
Published: March 2024

Introduction
Hemorrhagic transformation is a major complication of large vessel occlusion (LVO) recanalization after mechanical thrombectomy in acute ischemic stroke. We investigated whether computed tomography perfusion (CTP) derived hypoperfusion index ratio correlates with the rate of hemorrhagic transformation.

Methods
We conducted a retrospective cohort analysis of a prospectively maintained patient database. Included patients underwent mechanical thrombectomy for large vessel ischemic stroke from January 2019 to December 2022. Patients were separated into 2 groups depending on whether or not hemorrhagic transformation developed. Hypoperfusion index ratio on admission CTP was determined using VizAI software. Data were analyzed using Chi‐square and Mann‐Whitney U tests.

Results
Among the 289 patients included (median age, 72.5; 41.5% female), 55 (19%) had hemorrhagic transformation. Patients with hemorrhagic transformation had a significantly higher hypoperfusion index ratio (median, 0 vs 0.2; P= 0.004) compared with those with no hemorrhagic transformation. Multivariable analysis showed that for every 0.1 increase in the hypoperfusion index ratio, there was a significant 4.64‐fold increase in hemorrhagic transformation (OR 4.64; 95% CI 1.40 to 15.18; p=0.011).

Conclusion
In patients with LVO who underwent mechanical thrombectomy, a higher hypoperfusion index ratio on admission CTP was associated with an increased rate of hemorrhagic transformation. This suggests that the hypoperfusion index ratio could be used as a predictor for hemorrhagic transformation after mechanical thrombectomy.
Abstract 214: Predictors of Mechanical Thrombectomy Success and Failure: A Preliminary Analysis
Authors: Johnson‐Black Phoebe , Mukarram Faisal , Molaie Amir , Ghochani Yasmin , Saver Jeffrey , Szeder Viktor 
Published: March 2024

Introduction
Mechanical thrombectomy (MT) is now the standard of care in treatment of large vessel occlusion (LVO) in acute ischemic stroke (AIS). However, a significant minority of patients do not achieve successful recanalization. Previous case series’ have reported failed recanalization at a rate of approximately 12% (1). In the present study, we investigated clinical and procedural characteristics predictive of MT success and failure.

Methods
We conducted a retrospective analysis of MT patients with LVO presenting to our academic comprehensive stroke center from 2015‐2020. Recanalization failure was defined as TICI 0‐2a and success as TICI 2b‐3. We compared all 49 consecutive failure cases to a random selection of 85 successful MT cases. Demographic, clinical, procedural, and outcome data were compared between the two groups.

Results
In this cohort, there was no statistically significant difference in sex, pre‐stroke modified Rankin score (mRS), admission National Institutes of Health Stroke Scale (NIHSS), door‐to‐groin time, thrombolytic use, or site of occlusion between the two groups. In the success group, patients were older (76 vs 61, p=0.003), and had a higher average number of atherosclerotic risk factors (p=0.002). There was a higher proportion of embolic stroke of undetermined source (ESUS) in the success group compared with the failure group (8.5% vs 0%, p=0.039). A higher proportion of failure cases were due to large artery atherosclerosis (30.6% vs 19.5%, p=0.12) and cardioembolism (55.1% vs 67.1%, p=0.27), though neither of these differences were statistically significant. Stent‐retrieval alone (SR) was a more common first pass technique in failed than in successful MT (14.3% vs 0%, p=0.001).

Conclusion
This study investigated clinical and procedural factors associated with successful and failed recanalization in MT. In this cohort, stent‐retrieval alone as a first pass technique was more commonly associated with failed MT. Stroke etiology was associated with rates of failure, with a significantly higher proportion of ESUS in successful cases and a trend toward a higher proportion of large vessel atherosclerosis and cardioembolism in failed MT.