bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 037: Aneurysm Occlusion Rates with WEB Treatment: Single‐Institution Study and Review
Authors: Tokov Michael , Garton Andrew , Carnevale Jospeh , Kocharian Gary , Boddu Srikanth , Knopman Jared 
Published: March 2024

Introduction
To provide our single‐institution experience and outcome data with the WEB device in 51 patients treated for ruptured and unruptured intracranial aneurysms.

Methods
Occlusion rates in a cohort of 51 patients treated with WEB were collected at time of procedure and at last follow‐up between the years 2019 and 2021. Angiographic outcomes were assessed on the WEB occlusion scale (WOS) and occlusion status scale (OSC). Compaction was assessed on imaging. Functional outcomes were assessed using the modified Rankin Scale. Thromboembolic complications and retreatments were recorded. Statistical analysis was performed to identify predictors of inadequate occlusion.

Results
A total of 51 patients underwent endovascular embolization using the WEB device with a mean follow‐up of 14.9 months. Ruptured aneurysmal subarachnoid hemorrhage accounted for 15.7% (8/51) of all patients. Most of the patients (92.1%) were functionally independent at presentation. The most common aneurysm location in the present study was MCA bifurcation (52.9%). The median maximal aneurysm diameter was 6.9mm, while the median neck size was 4.4mm. Last follow‐up consisted of 49 patients and imaging was obtained in 45 patients. Adequate occlusion was documented at 97.8% (WOS) and 93.3% (OSC). Retreatment was required in 1 aneurysm. Minor compaction was noted in 11.1% with no cases of major compaction. The majority of patients had the same presenting and post‐procedure mRS. Thromboembolic complications were encountered in 7.8% (4/51) of procedures; 3 of which were symptomatic and none were permanent. There were no hemorrhagic complications. An analysis of the data shows that larger aneurysm dimensions, necessity for adjunctive stent, and minor compaction were significantly associated with inadequate occlusion. Aneurysm height and dome width remained independent predictors of inadequate occlusion

Conclusion
This study confirms the safety and efficacy profile of the WEB device for the embolization of intracranial aneurysms at our institution. A high rate of adequate occlusion at a midterm follow‐up demonstrates high efficacy of the WEB device in our experience. Predictors of inadequate occlusion, which we explored, proved consistent with the literature on known variables associated with residual aneurysms.
Abstract 045: A Radiomics Based Pipeline for Paired Risk‐Stratification of Intracranial Atherosclerotic Plaques
Authors: Sese Elena S. Sagues , Sanchez Sebastian , Veeturi Sricharan , Patel Tatsat , Tutino Vicent M. , Ojeda Diego J. , Miller Jacob M. , Saleem Arshaq , Gudino Andres , Wang Bincheng , Samaniego Edgar A. 
Published: March 2024

Introduction
High resolution vessel wall imaging (HR‐VWI) enables accurate visualization of intracranial atherosclerotic plaques. Radiomics can be utilized as an objective quantification method of plaque appearance and shape. We aimed to analyze the radiomics features (RFs) obtained from 7T‐HR‐VWI to differentiate between culprit and non‐culprit plaques in patients with intracranial atherosclerotic disease (ICAD).

Methods
Patients with ICAD as stroke etiology undergoing HR‐VWI were included in the study. Culprit plaques in the vascular territory of the stroke were identified. The degree of stenosis, area degree of stenosis and plaque burden were calculated. Three‐dimensional segmentation of the plaque was performed, and RFs were extracted. We then evaluated multiple machine learning models to predict and identify culprit plaques using significantly different RFs. The dataset was then randomly divided into training and testing datasets, and the trained model was evaluated on the independent testing dataset.

Results
The study included 33 patients with ICAD as the cause of stroke. Univariate analysis revealed 38 significantly different RFs between culprit and non‐culprit plaques in pre‐contrast MRI, 39 in post‐contrast MRI and 25 RFs that were different between pre and post contrast MRIs. Additionally, seven shape‐based RFs exhibited significant distinctions between the two plaque types. The random forest model achieved an accuracy rate of 81% (88% sensitivity and 75% specificity) in identifying culprit plaques in the independent testing dataset. This model successfully identified the culprit plaque in 7 out of 8 cases during the testing phase.

Conclusion
In this study symptomatic culprit plaques had a different signature RFs compared to other plaque within the same subject. A machine learning model built with RFs successfully identified the symptomatic atherosclerotic plaques in most cases. Radiomics is a promising tool for stratification of plaques in patients with ICAD.
Abstract 064: The Pushability of Commonly Used Microwires in Neuroendovascular Procedures
Authors: Molaie Amir , Fukuda Keiko A , Sakuta Kenichi , Suzuki Kentaro , Ghovvati Mahsa , Kaneko Naoki , Selim Omar , Tateshima Satoshi , Imahori Taichiro , Hanaoka Yoshiki 
Published: March 2024

Introduction
In distal and medium‐vessel occlusions (DMVOs), there are increasing opportunities to deliver devices through tortuous and medium sized arteries. However, this comes at the risk of microwire perforation during distal microcatheter advancement for navigation in these curved, slender vessels, leading to hemorrhagic complications. Currently, microwires with a range of stiffness levels are available. However, it is unclear how the variations in stiffness and the relative positioning of the microwire and microcatheter may affect the force applied to the vessel wall. Few studies have compared objective metrics across different commonly used devices. We sought to compare the pushability of various Synchro Select and Chikai microwires using both proximal and distal support.

Methods
In a moderate tortuosity, silicone flow model of the middle cerebral artery (MCA) branches, we tested 0.014” nitinol microwires (Synchro Select Soft, Standard, or Support), or 0.014” stainless steel microwires (Chikai, Black, and Black Soft) in a TrevoTrak 21 microcatheter docked either in the proximal M1 segment or distal M2 segment. Applied force was measured using an Imada force gauge DST‐1A at the M2 ten times for each experiment. The slope, measured in mN per mm, of the applied distal force during the maximal pushing period was calculated.

Results
The average slope of the pushing force within a distal microcatheter was 10.64 mN/mm with a Synchro Soft, 10.85 mN/mm with a Standard, and 15.28 mN/mm with a Support microwire (p < 0.0001). The average slope of the pushing force in a proximal microcatheter was 1.61 mN/mm with a Synchro Soft, 3.15 mN with a Synchro Standard, and 3.87 mN with a Synchro Support microwire (p <0.001). With the Chikai microwires, the average slope of the pushing force within a distal microcatheter was 12.48 mN/mm with a Chikai Black Soft wire, 12.82 mN/mm with a Chikai Black microwire, and 14.11 mN/mm using a Chikai microwire (p=0.801). Within a proximal microcatheter, the average maximal force was 2.42 mN/mm using a Chikai Black Soft wire, 3.16 mN/mm using Chikai Black, and 3.91 mN/mm using the Chikai wire (p < 0.001).

Conclusion
This study demonstrated that stiffer microwires push the arterial wall with significantly greater force within a microcatheter close to the wall. Pushability of the microwire significantly dropped across all microwires when the microcatheter was positioned more proximally. This is the first known report of the pushability of commonly used microsystems in neuroendovascular procedures.
Abstract 075: Treatment Trends and Clinical Outcomes of Endovascular Therapy for Pediatric Unruptured Intracranial Aneurysms
Authors: Dicpinigaitis Alis J. , Syed Shoaib , Sillari Catherine , Gandhi Chirag D. , Al‐Mufti Fawaz 
Published: March 2024

Introduction
Due to the relative rarity of unruptured intracranial aneurysms (UIA) in the pediatric population, evidence regarding treatment modalities and clinical outcomes remains limited. This study aims to characterize the utilization and clinical outcomes of endovascular therapy (EVT) and microsurgical clipping (MSC) for pediatric UIAs over a two‐decade interval using a large national registry.

Methods
Pediatric (< 18 years of age) UIA hospitalizations were identified in the National Inpatient Sample from 2002 to 2019. Temporal utilization and clinical outcomes were compared for treatment with EVT and MSC.

Results
Among 734 UIAs identified during the study period, 64.9% (n = 476) were treated with EVT. Utilization of EVT significantly increased during the study period from 54.3% (2002‐2004) to 78.6% (2017‐2019) (p = 0.002 by Cochrane‐Armitage test). Treatment with EVT did not differ as a function of increasing age, but was mostly highly utilized in the youngest age grouping [70.4% (0‐2 years), 64.0% (3‐12 years), 64.3% (13‐17 years); p = 0.578]. In comparison with those treated with MSC, pediatric patients treated with EVT demonstrated higher rates of favorable outcomes (discharge to home without services) (96.0% vs. 91.1%, p = 0.006), shorter durations of hospital stay (4.6 vs. 10.0 days, p < 0.001), and lower rates of ischemic or hemorrhagic procedural‐related complications (1% vs. 4%, p = 0.010).

Conclusion
A retrospective evaluation of nearly twenty years of population‐level data from the United States demonstrates increasing utilization of EVT for the treatment of pediatric UIAs with high rates of favorable outcomes and shorter hospital stays in comparison to those treated with microsurgery. However, limitations of available registry data (such as absence of radiographic parameters and aneurysm morphological characteristics) temper any definitive claims regarding treatment efficacy.
Abstract 083: Initial Angiogenesis in Vein of Galen Malformations Is Associated with Increased Symptomatic Burden
Authors: Devarajan Alex , Shigematsu Tomoyoshi , Bonet Jessica M. , Bazil Maximilian J. , Morgenstern Peter F. , Ghatan Saadi , Molofsky Walter J. , Berenstein Alejandro , Fifi Johanna T. 
Published: March 2024

Introduction
Vein of Galen Malformations (VOGM) are congenital brain arteriovenous malformations which often present during the neonatal or infantile periods. While endovascular embolization is the recommended management for this pathology, a subset of VOGM patients present with pathologic angiogenesis which complicates endovascular therapy. Previous studies have shown that these patients require a greater number of embolizations to achieve cure, but it is unclear whether this radiographic finding is associated with differences in clinical presentation.

Methods
A single‐center retrospective review identified all patients with a Vein of Galen Malformation from January 2004 to May 2023. Patients were stratified into three groups based on the development and timing of angiogenesis during their treatment course: pre‐intervention angiogenesis, post‐intervention angiogenesis, and no angiogenesis. Clinical presentations, relevant imaging, radiographic data, and procedural details were reviewed.

Results
178 patients with VOGM were identified. 38 patients were in the pre‐intervention angiogenesis group, 51 patients were in the post‐intervention angiogenesis group, and 89 patients were in the no angiogenesis group. Pre‐intervention angiogenesis patients were significantly older on presentation for initial angiogram than post‐intervention angiogenesis or no angiogenesis patients (p<0.05). At initial clinical presentation, patients with pre‐intervention angiogenesis demonstrated significantly greater developmental delay (p<0.05). This difference persisted after controlling for age at initial presentation. Patients presenting with angiogenesis either pre‐intervention or post‐intervention required more embolizations to achieve cure compared to patients who did not develop angiogenesis during their treatment course (p<0.05).

Conclusion
Patients with VOGM who present with pre‐intervention angiogenesis demonstrate significantly more serious neurologic symptoms on initial presentation, even after controlling for age at presentation. Given that patients with angiogenesis are often older on initial presentation and require more embolizations to be cured, early and timely treatment is likely necessary to mitigate the further progression of both the angiogenic network and any associated neurological symptoms.
Abstract 091: Intraventricular milrinone for management of vasospasm following aneurysmal subarachnoid hemorrhage
Authors: Razavi Seyed Mostafa , Khurana Mahika , Mau Cynthia Zevallos , Sandhu Divyajot 
Published: March 2024

Introduction
Aneurysmal subarachnoid hemorrhage (aSAH) accounts for about 10% of hemorrhagic strokes [1] and holds a high mortality and morbidity rate. [2, 3] Vasospasm is one of the more devastating complications of aSAH. Novel imaging modalities have drastically improved our ability in prompt detection of vasospasm in these patients. However, clinical management of this complication is still debated among experts. [4] Systemic cerebral vasodilators are widely used in aSAH patients, but guidelines for interventional and rescue procedures are not well developed. [5]

Methods
Here, we report a case of severe vasospasm following aSAH that was successfully treated with intraventricular injection of milrinone through external ventricular drain (EVD) in conjunction to standard therapy.

Results
A 70‐year‐old man with a history of diabetes, hypertension, and hyperlipidemia was brought to the emergency department after he was found down and unresponsive. He was intubated by EMS on route. Head CT on arrival showed a diffuse subarachnoid hemorrhage, more prominent in the posterior fossa, and grade IV on the modified Fisher scale. An initial DSA showed a ruptured aneurysm in the second segment of the right posterior inferior cerebellar artery, second segment. A right frontal EVD was placed on the second day. Hemodynamic augmentation was achieved with intravenous and intraventricular milrinone. Cerebral arterial patency was evaluated with daily transcranial doppler (TCD). The patient did not show any evidence of vasospasm until day 9 where TCD revealed severe vasospasm in the basilar and bilateral vertebral arteries, as well as mild vasospasm of anterior and middle cerebral arteries.
Intraventricular milrinone was injected into the EVD in from day 9 to day 12. Using sterile technique, 4 mL of CSF was removed followed by the injection of 0.87mg (2mL) of milrinone into the EVD via a three way stop cock. EVD was then flushed with 2mL of preservative‐free saline and clamped for 1 hour. This procedure effectively improved vasospasm on serial TCDs and also DSAs (Figure1).
The patient underwent several DSA’s on days 10, 14, 19, 20, and 21 with targeted intraarterial milrinone and verapamil injections. His final TCD showed only mild middle cerebral artery and moderate basilar artery vasospasm. At that point, no more intervention was deemed necessary. A ventriculoperitoneal shunt was also placed. CT scan before discharge showed mild improvement in ventricular size and stable SAH blood products.
The course of hospitalization was complicated by hyponatremia, atrial fibrillation, and respiratory failure with inability to wean off ventilator, resulting in tracheostomy and gastrostomy tube placement. The patient was discharged in stable condition on day 30 to a rehabilitation center.

Conclusion
Intraventricular milrinone in addition to standard therapy can be an effective method in treatment of severe vasospasm in aSAH patients.
Abstract 097: Un‐stumped by Carotid Stump Syndrome: Use of External Carotid Stenting in Preventing Ischemic Stroke
Authors: Ehidom Clinton , Dawod Giana , Díaz Paulina , Wechsler Paul , Parauda Sarah , Knopman Jared , Parikh Neal 
Published: March 2024

Introduction
Recurrent infarcts to the internal carotid artery territory in the setting of a corresponding occlusion raises concern for carotid stump syndrome. Over time, robust anastomoses may develop between the patent ipsilateral external carotid artery and the anterior circulation distal to the site of occlusion. A carotid stump’s disturbance of flow uncommonly can form emboli that travel via retrograde flow from the occluded internal carotid artery to the ipsilateral external carotid artery and its collaterals. Stenosis of the external carotid artery in such patients can be a source of atheroembolism or hypoperfusion. We describe a case of external carotid stenting with carotid stump coil occlusion.

Methods
We present a case report. Verbal consent to share this information was obtained directly from the patient.

Results
A 75‐year‐old man with aortic stenosis, atrial arrhythmia, multiple prior bi‐hemispheric strokes, on aspirin and clopidogrel, presented with left facial droop, arm weakness, and slurred speech. Magnetic resonance imaging revealed embolic appearing strokes in the right middle cerebral artery territory (Figure 1A). Cerebral angiography revealed complete occlusion of the right internal carotid artery with perfusion of the right middle cerebral artery by external carotid artery anastomoses, and the external carotid was found to be stenosed proximally. Digital subtraction angiography revealed right external carotid – middle cerebral artery anastomoses via the right sphenopalatine artery, middle meningeal artery, internal maxillary artery, and ophthalmic collaterals (Figure 1B). The patient underwent coiling of the right internal carotid artery stump (Figure 1C) followed by stenting of the right external carotid using a 9 mm x 40 mm Cordis precise Pro stent. Post‐stenting angiogram demonstrated good apposition of the stent to the parent vessel walls and improvement of flow into the right external carotid and intracranial circulation (Figure 1D). The patient was treated with aspirin and ticagrelor for 3 months. Repeat imaging at follow up did not show further embolic episodes, with improvement in the patient’s deficits. After three months, he was continued on aspirin alone.

Conclusion
In patients with an occluded internal carotid artery and recurrent embolic infarcts ipsilateral to the side of the occlusion, carotid stump syndrome may be considered. In this case, we believe the patient’s carotid occlusion served as a nidus for emboli formation, or that there was atheroembolism from the stenosed external carotid artery despite adherence to dual antiplatelet therapy. By coiling the stump, we addressed a possible source of emboli, and stenting of the proximal external carotid optimized anterograde flow and prevented further atheroembolism. Our case showcases an interventional neuroradiology approach to carotid stump emboli and external carotid artery stenosis.
Abstract 099: Reversible Cerebral Vasoconstriction Syndrome Secondary to Weight Loss Patch: A Case Report​
Authors: Narayanan Karthik K. , Miremadi Brian B. , preet Gunjan , George Tikku , Hendry Heer 
Published: March 2024

Introduction
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a clinico‐radiographical syndrome characterized by severe thunderclap headache and reversible multifocal arterial vasoconstriction1. RCVS can be spontaneous or related to a trigger such as vasoactive medication/supplements. There is no previous data on the association of weight loss patch formulation in the genesis of unexplained RCVS.

Methods
A woman in her 40s presented with five days of recurrent acute onset severe right frontal headaches after starting Thrive weight loss patch supplementation. Head CT showed right frontal lobe hemorrhage with bilateral SAHs (Figure1). Brain MRI redemonstrated hemorrhages, numerous scattered foci of restricted diffusion, and a large area of restricted diffusion in the left insular cortex (Figure 2). Cerebral angiogram showed diffuse multifocal narrowing with a ‘beads‐on‐a‐string’ appearance of the cerebral vasculature and no aneurysms (Figure 3). Thrive patch contains undisclosed amounts of sympathomimetics and vasoactive compounds. Given the history, clinical symptoms of recurrent thunderclap headaches, and angiographic findings, the diagnosis of RCVS was made. Brain MRA 3 months after discharge showed no areas of cerebrovascular focal stenosis (Figure 4). At 4 month follow up, she reported 90% improvement of her symptoms.

Results
We report a temporal relationship between RCVS in a woman in her 40s and usage of a Thrive weight loss patch, which contains green tea extract, L‐arginine, 5‐hydroxytryptophan (5‐HTP), and Yerba Mate. We believe this report represents the first case of RCVS triggered by a weight loss patch. Multiple compounds within the Thrive patch have vasoactive properties that may contribute to RCVS genesis. Epigallocatechin (component of green tea extract) and 5‐HTP are metabolic compounds with potent vasoactive properties. They are components of weight loss and SSRI/SNRI medications respectively. Numerous studies have documented a temporal relationship between their use and subsequent development of RCVS2,3. Resolution of RCVS is reported after their discontinuation. Only one other case in our literature review investigated a patch modality in a temporal relationship with RCVS. It reported development and resolution of RCVS six days after nicotine patch use and discontinuation4. While Thrive patch does not contain nicotine, this case provides a further avenue for exploration as to whether pharmacokinetics of a patch modality influences a patient’s presentation with RCVS, as all prior reports document oral ingestion of substances.

Conclusion
Clinicians should be aware of the role of weight loss patches in RCVS, and their use should be assessed in large RCVS cohorts to clarify the association described in this report.
Abstract 118: Ophtalmic‐ethmoidal dural arteriovenous fistula
Authors: Tello Isaac E. , Montenegro Hector A. 
Published: March 2024

Introduction
Ophtalmic dural arteriovenous fistula is not a common diagnosis. They usually present as subarachnoid hemorrhage, or parenquimatous hemorrhage as in our patient. Male, 46 years old, electric worker, right‐handed. Family: Diabetes mellitus, gastric cancer, COVID. Tobacco, Marihuana and alcohol positive. Presents SAH on October 2022 posterior to physical activity. Intense cephalea, nausea and vomit, anxiety, with no neurological deficit, and went to sleep. Two days after, he presents somnolence, altered verbal speech, and disorientation, and next day he presents seizure, then he goes to emergency. Physical examination: Normal. Neurological examination: Disorientation, confused and non‐fluent language, altered mental status. No other signs of focalization. No visual affectation.

Methods
Patient was evaluated at emergency room. CT: SAH and parenquimatous left frontal basal hemorrhage of 2x3.4cm. AngioCT: a dilated orbito frontal vein, and a venous aneurysm at the anterior third of the superior sagittal sinus. Fronto basal fistula was suspected. Angiography was performed, and it was found right fronto‐basal arteriovenous fistula Borden III, Cognard IV. Comunication between righ ophthalmic artery to superior sagittal sinus. Patient was delivered home three days after the event. When patient had recovered clinically, we performed embolization.

Results
We performed doble access, femoral artery and braquial vein. It was not possible to achieve to the fistula through vein system. We catheterized ophthalmic artery, and did embolization through it, with a successful result, and with no ophthalmic symptoms after embolization.

Conclusion
Dural arteriovenous fistulas are shunts found from dural vessels. This type of fistulas ophthalmic‐ethmoidal are rare. We performed angiography which is the know gold standard for diagnosis, and we tried to do a combined access which was not possible, so we performed simple embolization through ophthalmic artery. This approach it is performed and it has been reported as an effective and safe treatment.