bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 100: Endovascular treatment of a traumatic near‐miss vessel injury
Authors: Varon Alberto , Mehta Tapan 
Published: March 2024

Introduction
Traumatic injuries are a common cause of death, representing nearly 8% of all deaths worldwide(1). Vascular injury can occur in about 3% to 20% of the patients that suffer from a blunt or penetrating craniocervical injury (2). The most commonly injured arteries from penetrating trauma include CCA, ICA, and ECA (73%,22%, and 5% respectively)(3). Embolization is now a well‐established endovascular technique to treat traumatic hemorrhagic injuries(4). We present a case of a patient with a near‐miss injury treated endovascularly.

Methods
We present the case of a 29‐year‐old male who was found unconscious with a knife embedded in his left face. On arrival at the hospital, the patient was hemodynamically stable with no ongoing hemorrhage or respiratory distress. CTA did not reveal any vascular injury; however, due to the knife's location, the neurointerventional radiology team was consulted and performed an embolization of the proximal third of the internal maxillary artery. The patient was later taken to the operating room for the removal of the knife.

Results
The non‐serrated end of the knife had resulted in impingement of the distal left ECA just proximal to the bifurcation of the superficial temporal artery and internal maxillary artery and resulting in approximately 80% narrowing of the vessel. Given the extent of impingement of the foreign object on the distal portion of the left ECA, after discussing with the otolaryngology team, a decision was made to proceed with coil embolization of the vessel due to concerns for vessel injury which can result in life‐threatening hemorrhage or pseudoaneurysm during removal of the foreign object in the OR. A total of 4 HydroFrame coils were deployed from the proximal one‐third of the internal maxillary artery into the ECA covering the superficial temporal artery to the origin of the occipital artery. 2 MicroPlex 5mm x 22cm Cosmos 10 bare platinum coils were placed intact to the left ECA extending proximally just distal to the occipital artery. Final AP projection of the left ECA post coil embolization was performed showing complete occlusion of the vessel across the area of impingement at the distal ECA proper. Retrograde filling of the internal maxillary artery was noted. The left middle meningeal artery is occluded and no longer visualized as its origin is being covered by coils. Patient underwent foreign object removal by ENT and had a good functional outcome.

Conclusion
Endovascular intervention prior to foreign object removal can improve outcomes and decrease the risk of severe vascular injury.
Abstract 125: Amyloid Beta‐Related Angiitis: A Case Presentation
Authors: Suryadevara Tejeswi , Izadyar Sharam 
Published: March 2024

Introduction
We detail the presentation and diagnostic workup of a woman who was ultimately diagnosed with Amyloid Beta‐Related Angiitis (ABRA), which can be a challenging condition to diagnose.

Methods
This is a case report which describes the presentation and workup that led to the diagnosis of ABRA.

Results
64‐year‐old woman with history of hypertension, hypothyroidism, hyperlipidemia and diabetes mellitus presented to outside hospital with progressive encephalopathy and worsening expressive aphasia for three months who was transferred to our center for a left frontal lobe mass with vasogenic edema. MRI brain with and without gadolinium showed multiple small enhancing cerebral regions, diffuse swelling, and leptomeningeal enhancement. Lumbar puncture was within normal limits. Cytology and CA 19‐9, CEA, and alpha‐fetoprotein were all normal. CT thorax, abdomen, and pelvis with contrast did not reveal findings suspect for malignancy. Given diagnostic uncertainty, brain biopsy of the left frontal lesion was completed. Findings were consistent with amyloid beta deposition in the walls and concerning for an inflammatory angiitis, without features to suggest infectious or malignancy related process. Vasculitic labs were notable for positive ANA (1:160), speckled pattern, but were otherwise negative. She completed a five day course of methylprednisolone 1g IV with some improvement in encephalopathy and aphasia. She was started on a prednisone taper and cyclophosphamide and discharged to a skilled nursing facility with follow up with vascular neurology and neuroimmunology planned.

Conclusion
ABRA is a complication seen in cerebral amyloid angiopathy and is a rare cause of CNS vasculitis. This condition should be suspected in the appropriate clinical scenario, particularly given the improvement often noted with immunosuppression (1).
Abstract 137: Management of cSDH with the Use of 10:1 Glue Hyper‐Dilution in MMA Embolization: Radiographic Follow‐up
Authors: Khan Muhammad W. , Meyer Benjamen M. , Campos Jessica K. , Laghari Fahad A. , Zarrin David , de Beaufort Jonathan C. Collard , Amin Gizal , Golshani Kiarash , Beaty Narlin B. , Bender Matthew , Colby Geoffrey P. , Lin Li‐Mei , Coon Alexander L. 
Published: March 2024

Introduction
Middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH) is becoming an alternative to surgical intervention. Recent literature suggests distal embolic penetration beyond visible MMA branches achieves optimal cSDH devascularization. Here, we report the mid‐term radiographic follow‐up of a hyper‐dilution glue technique for enhanced embolization of non‐visible dural vasculature.

Methods
A prospectively maintained IRB‐approved institutional database of the senior authors was retrospectively reviewed to identify and analyze cSDHs managed with 10:1 glue hyper‐dilution (TRUFILLTM n‐BCA liquid embolic) paradigm.

Results
Over a 5‐month study period (September 2022 to February 2023), 46 cases of 10:1 glue hyper‐dilution for MMA embolization were identified in 23 patients. 56% of the cases were female with an average age of 70±1.59 years. Average admission cSDH thickness was 9.3±0.8 mm with an average midline shift of 3.5±0.5 mm. Bilateral embolization was performed in 91% (n=21) of patients. Technical success was achieved in all cases without need for periprocedural rescue surgery. One postprocedural complication (2.2%), a unilateral partial facial nerve palsy (House‐Brackmann 2), was identified. All patients were discharged at their mRS baseline. Nine patients (40%) had radiographic follow‐up (mean 42±6.7 days; range 1 to 194 days). Complete resolution of the cSDH was achieved in 67% of those with follow‐up imaging (n=9) cases. In those with residual cSDH, average followup thickness was 7.2±0.8mm.

Conclusion
Mid‐term radiographic results of 10:1 glue hyper‐dilution for MMA embolization for enhanced non‐visible dural vasculature demonstrates a favorable safety profile compatible with the literature and encouraging resolution of cSDH. Further follow‐up and comparative studies are warranted.
Abstract 138: Use of a 046” Intermediate Guide Catheter for Mini‐Triaxial Access in Flow Diversion: Multi‐institution Experience
Authors: Khan Muhammad W. , Meyer Benjamen M. , Campos Jessica K. , Laghari Fahad A. , Zarrin David A. , de Beaufort Jonathan C. Collard , Amin Gizal , Golshani Kiarash , Beaty Narlin B. , Bender Matthew T. , Lin Li‐Mei P. , Colby Geoffrey P. , Coon Alexander L. 
Published: March 2024

Introduction
The latest FDA‐approved intermediate guide catheter, Vecta46, allows for a unique, mini‐triaxial access platform. The size of this catheter allows for 058” guide compatibility, intraluminal accommodation of an 027” microcatheter for flow diverter delivery, and angiographic procedural injections in an 070” guide catheter.

Methods
We retrospectively identified and analyzed patients who underwent Surpass Evolve flow diversion treatment utilizing the Vecta46 across the senior authors’ institutions.

Results
The use of the Vecta46 was identified for treatment of 9 aneurysms treated with the Surpass Evolve Flow Diverter (March to April 2023), in patient’s aged 61±3.5 years (range 40‐74 years) with 89% (n=8) female. Aneurysm average size of 4.3±0.47mm, aneurysms originating along the internal carotid artery (n=6) and MCA branches (n=4). Preoperative PRU measured 92 ± 21. Radial access was utilized in 2 cases. Mean Surpass Evolve utilized was 4.4±0.17mm (diameter) by 15.7±0.88mm (length). An 071” guide catheter (Armadillo, Q’Appel Medical) was used in 8 cases. Vecta46 was safely navigated to the supraclinoid ICA segment in all cases. Average fluoroscopy time was 24±3.1 minutes, radiation exposure was 756±259mGy, and verapamil was used in all cases. Technical success was achieved in all cases with adequate vessel wall apposition verified. There were no hemorrhagic complications nor parent vessel wall dissection or vasospasm in the region of the Vecta46 catheter on final control angiography in all 9 cases.

Conclusion
The new low‐profile Vecta46 intermediate catheter can be safely and effectively utilized in a 6‐French mini‐triaxial system for flow diverter delivery without compromising injection quality, support, or trackability.
Abstract 143: Tigertriever in the Treatment of Acute Ischemic Stroke with Underlying Intracranial Atherosclerotic Disease
Authors: Ojeda Diego , Ghannam Malik , Sanchez Sebastian , Almajali Mohammad , Koul Prateeka , Saver Jeffrey L. , Gupta Rishi , Sagues Elena , Gudino Andres , Saleem Arshaq , Wang Bincheng , Ortega Santiago , Samaniego Edgar 
Published: March 2024

Introduction
The Tigertriever stentretriever provides operators the ability to manually regulate the radial expansion of the device. In vitro testing of the Tigertriever has demonstrated that it exerts a radial force twice as powerful as that exerted by self‐expanding stentretrievers. The enhanced radial force of the Tigertriever may improve the recanalization of patients with acute large vessel occlusion (LVO) due to underlying intracranial atherosclerosis (ICAD). We analyzed the TIGER trial dataset to determine the safety and effectiveness of Tigertriever in the recanalization of patients with underlying ICAD and acute ischemic stroke.

Methods
An independent imaging laboratory assessed the presence of ICAD. ICAD was present if at least ≥ one of the following features were observed: (1) angiographic evidence of taper‐shape occlusion, (2) presence of arterial calcific lesions, and/or (3) remnant stenosis > 70% after mechanical thrombectomy (MT). Vessel diameter changes were studied by measuring the occlusion site and the proximal parent vessel using the best projection of pre‐ and post‐thrombectomy DSA images. additionally, a retrospective analysis of revascularization rates during the first attempt was conducted. The first‐pass effect (FPE) was defined as the achievement of successful recanalization (mTICI 2b‐3) using only one pass of the Tigertriever device.

Results
A total of 160 patients from the TIGER trial were included in our study, with 32 (20%) patients having ICAD. An increase in the mean diameter of the vessel at the site of the occlusion was observed post‐thrombectomy (1.5 ± 0.73 mm vs 1.88 ± 0.67 mm, p < 0.01). The diameter in the proximal parent vessel did not change after thrombectomy (2.22 ± 0.68 mm vs 2.32 ± 0.64 mm; p = 0.34). There were no symptomatic hemorrhages. The FPE was documented in of 15 out of 32 (46.8%) patients.

Conclusion
The Tigertriever device is safe and effective in the revascularization of patients with LVO and underlying ICAD. The diameter of the occluded arterial segment with underlying ICAD increased after mechanical thrombectomy with Tigertriever. The FPE with the Tigertriever in this subpopulation of the TIGER trial was 46.8%.
Abstract 145: Hyperacute Virtual Reality Augmented Rehabilitation (VRAR) in the Neurological ICU: A Safety and Feasibility Study
Authors: Subah Galadu , Lin Fangyi , Ming Tiffany , Clare Kevin , Oishi Akihiko , Thacker Akash , Bulbul Sarah , Uddin Anaz , Feldstein Eric , Nolan Bridget , Dominguez Jose , Zeller Sabrina , Hanft Simon , Gandhi Chirag , Al‐Mufti Fawaz 
Published: March 2024

Introduction
Virtual reality (VR) has shown great promise in stroke rehabilitation, providing interactive exercises that target motor and cognitive impairments with minimal adverse events and positive outcomes in improving motor function, balance, and patient motivation. However, most post‐stroke rehabilitation focuses on recovery after discharge, emphasizing the need for efficient interventions like VR to make the most of limited hospital rehab time for stroke survivors. This study aimed to evaluate the safety and feasibility of incorporating hyperacute virtual reality augmented rehabilitation (VRAR) as part of acute stroke care.

Methods
A prospective, proof‐of‐concept study was conducted with 13 eligible patients who experienced hemorrhagic or ischemic stroke between July 1st, 2021, and January 1st, 2022. Enrolled patients received VRAR in addition to the standard‐of‐care rehabilitation. Patients with dementia, expressive aphasia, delirium, or were unable to participate in physical therapy/ utilize the virtual reality hardware were excluded. Demographic data, functional scores, and complications were collected.

Results
Of the 13 patients who used the VRAR rehabilitation program, ten completed up to three visits. The cohort consisted of 50% male patients with a mean age of 73.6 years. Half of the patients had a primary diagnosis of ischemic stroke, while the rest were diagnosed with either hemorrhagic stroke (30%) or transient ischemic attack (20%). The mean length of hospital stay was 11.1 days, and the median time from admission to rehabilitation was 4 days. Most patients (80%) were discharged to outpatient rehabilitation, while 20% were discharged home. The median number of sessions was one, with four patients using the VRAR program multiple times. Despite the withdrawal of two patients (15.4%) who expressed mild discontent, there were no adverse events reported during the use of the VRAR rehabilitation program.

Conclusion
The findings of this study offer evidence backing the safety and feasibility of integrating VRAR as a supplementary tool in hyperacute stroke care. These results underscore the potential of VR therapy as a promising addition to conventional stroke rehabilitation methods.
Abstract 148: Balloon‐assisted retrograde Cerebral Venography in Cerebral Venous Interventions: A novel avenue for diagnostic venous imaging
Authors: Choudhri Omar 
Published: March 2024

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

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

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

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

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

Methods
The patient was identified in routine clinical practice.

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

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

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

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

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

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

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

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

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

Conclusion
Endovascular surgery may be the first choice of treatment for unruptured anterior communicating artery aneurysms.