bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 133: Safe Guiding Catheter Navigation in Carotid Artery Stenting for Low‐positioned Common Carotid Lesions: “No‐touching” Technique
Authors: Takenobu Yohei , Nomura Noriko , Sugita Yoshito , Okada Akihiro , Kawauchi Takeshi , Yang Tao , Hashimoto Kenji 
Published: March 2024

Introduction
In carotid artery stenting (CAS), a guiding catheter (GC) placement to the appropriate position is the first step of the successful procedure. In normal settings, GC is navigated along with stable support of guidewire and inner‐catheter which are sent distally to external carotid artery. In cases of low‐positioned common carotid artery (CCA) lesions, however, safe GC placement without touching lesions is often difficult. Herein, we report the technique of safe GC navigation of “no‐touching” to the low‐position CCA plaque using Newton‐shaped stiff inner‐catheter.

Methods
We reviewed CAS procedures with low‐positioned CCA lesions using “no‐touching” technique: a balloon guiding catheter (BGC) was coaxially advanced in combination with 4‐French Newton‐shaped stiff inner‐catheter (Newton‐T®, Medikit, Tokyo, Japan). With its advantage of shape and stiffness buffering the kickback force with support of lesser curvature of aortic arch, BGCs were navigated to the appropriate position without touching to the plaques.

Results
The technique were applied in 5 cases (age: 73‐85 years old, 4 males, 4 left‐sided lesions) among the 37 consequent CAS cases. GC fixation by GooseNeck snare was used concurrently in 2 cases. BGCs were successfully navigated without touching plaques in all cases. CAS procedures were subsequently undergone and no complication was observed.

Conclusion
GC navigation using “no‐touching” technique with Newton‐T catheter was safe and useful in CAS procedures for low‐positioned CCA lesions.
Abstract 154: Training Independent Artificial Intelligence Models for the Detection of Intracranial Pathology
Authors: Eskian Mahsa , Sharashidze Vera , Heit Jeremy , Masoud Hesham , Gould Grahame 
Published: March 2024

Introduction
Intracranial hemorrhage (ICH) and brain parenchymal midline shift (MLS) are medical emergencies and require timely diagnosis for early triage to lifesaving care. Artificial intelligence (AI) has shown potential in shortening the time to diagnosis. Although most of models have been compromised with the need of training sample resulting in overfitting as an obstacle to generalizability of models. In this study we introduce independent training models for the early detection of intracranial pathologies in imaging.

Methods
The software was developed using Python version 3.11.3. Software packages NumPy, scipy, skimage, stardist, and matpotlib were used for imaging intensity, color, and a shape‐based auto segmentation of intracranial objects.

Results
The current AI model is able to auto segment the Pineal gland for measurement of MLS (Figure‐1), and can detect imaging evidence of the hyperdense vessel sign (Figure‐2), and demonstrative large intracranial vessel (Figure‐3).

Conclusion
Our auto segmentation model is based on objects features instead of training models, thus providing a fast, generalizable, and feasible AI model. This tool has adjacent utility for detection and segmentation of intracranial vessels, hemorrhage, and midline shift.
Abstract 168: Platelet function testing and risk of periprocedural complications with flow diversion: An international multicenter study
Authors: Vranic Justin E. , Dmytriw Adam A. , Berglar Inka K. , Alotaibi Naif M. , Cancelliere Nicole M. , Stapleton Christopher J. , Rabinov James D. , Harker Pablo , Gupta Rajiv , Koch Matthew J. , Raymond Scott B. , Mascitelli Justin R. , Patterson T. Masoud , Namaani Kareem El , Kühn Anna L. , Pukenas Bryan , Jankowitz Brian , Burkhardt Jan M. , Siddiqui Adnan H. , Jabbour Pascal , Singh Jasmeet , Puri Ajit S. , Regenhardt Robert , Pereira Vitor M. , Patel Aman 
Published: March 2024

Introduction
Dual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using Pipeline embolization device (PED). We sought to assess the impact of platelet function testing (PFT) on reducing periprocedural thromboembolic complications associated with PED flow diversion in patients receiving aspirin and clopidogrel.

Methods
Patients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation. Clinical variables including the results of PFT prior to treatment, periprocedural DAPT regimen, and intracranial complications occurring within 72‐hours of embolization were identified from the medical record. Complication rates were compared between PFT and non‐PFT groups. Differences between groups were tested for statistical significance using the Wilcoxon rank sum, Fisher exact, or Chi‐square tests. A p‐value <0.05 was statistically significant.

Results
580 patients underwent PED embolization with 262 patients dichotomized to the PFT group and 318 patients to the non‐PFT group. 13.7% of PFT group patients were clopidogrel non‐responders requiring changes in their pre‐embolization DAPT regimen. 5% of PFT group patients experienced thromboembolic complications versus 1.6% of patients in the non‐PFT group (p=0.019). Two (15.4%) PFT group patients with thromboembolic complications experienced permanent neurological disability versus 4 (80%) non‐PFT group patients. 2.2% of PFT group patients and 3.5% of non‐PFT group patients experienced hemorrhagic intracranial complications (p>0.9).

Conclusion
Pre‐procedural PFT prior to PED treatment of intracranial aneurysms in patients pre‐medicated with an aspirin and clopidogrel DAPT regimen may not be necessary to significantly reduce the risk of procedure‐related intracranial complications.
Abstract 169: Antiplatelet regimens after pseudoaneurysm embolization with phosphorylcholine coated flow diverters: a series of 180 cases
Authors: Bounajem Michael T. , Kuhn Anna , Abdelsalam Ahmed , Cortez Gustavo , Abbas Rawad , Pervez Mubashir , Saei Hamzah , Burke Shane , Hassan Ameer , Malek Adel , Naragum Varun , Dabus Guilherme C. , Tjoumakaris Stavropoula , Jabbour Pascal , Hanel Ricardo A. , Starke Robert M. , Suarez Juan Vivanco , Gutierrez Santiago Ortega , Farooqui Mudassir , Salem Mohamed , Jankowitz Brian , Taussky Philipp , Kilburg Craig , Puri Ajit S. , Grandhi Ramesh 
Published: March 2024

Introduction
Indications for flow diversion for the treatment of cerebral aneurysms have increased remarkably in recent years.1 This has been particularly useful for aneurysms that are difficult to treat via endosaccular or open approaches, such as pseudoaneurysms.2 Flow diversion, however, typically requires dual antiplatelet therapy (DAPT), which can contribute to greater morbidity particularly in patients with ruptured aneurysms or other comorbidities.3 The third‐generation iteration of the Pipeline Embolization Device (PED) incorporates Shield technology, a phosphorylcholine coating designed to reduce thrombogenicity via mimicry of native cell membranes.4 In light of this reduced thrombogenicity, there have been reports of early transition to single antiplatelet therapy (SAPT), or other variations on DAPT, in patients treated with PED Shield. We therefore aim to characterize the antiplatelet regimens, and associated thromboembolic/hemorrhagic outcomes, utilized in patients with aneurysms treated with PED Shield.

Methods
Factors including demographics, comorbidities, rupture status, devices placed, and antiplatelet regimen, among others, were collected. Follow‐up data including aneurysm thromboembolic complication, hemorrhagic complication, new neurological deficit, aneurysm occlusion, and in‐stent thrombosis were also recorded.

Results
One‐hundred and eighty patients were included in analysis, 18 of which were acutely ruptured. One hundred and sixty‐two patients had a single device placed, while the remaining had two devices placed. Three patients were maintained on SAPT post‐procedurally (aspirin or clopidogrel), with two additional patients treated with SAPT plus an anticoagulant for other purposes. One hundred and seventy‐two patients were maintained on DAPT, most commonly aspirin/clopidogrel (115), followed by aspirin/ticagrelor (40), and aspirin/prasugrel (16). Seven patients had strokes of any kind, three of which were unrelated to the treatment territory, and two of the remaining 4 were non‐compliant with antiplatelet therapy. One patient had a new intraparenchymal hemorrhage, but no appreciable deficit. Of the 135 patients with 6‐month follow‐up, 77 had complete aneurysm occlusion, and 116 demonstrated no in‐stent thrombosis.

Conclusion
We demonstrate herein the similar safety profile and efficacy of PED Shield with varying antiplatelet regimens, including SAPT in isolated cases.
Abstract 171: Embolization of non‐ruptured intracranial aneurysms with flow diverter devices in Mexico: Quick responses
Authors: Mena Diego López , López Mario Messina , Saldaña Charles Huamani , Martínez Pablo , Carrillo Mauricio Anibal Salazar , Mata Isaac Enrique Tello , Amaya Arturo Miguel Rosales , Velázquez Gerardo Cano , Santamaría Ivan Camilo Baracaldo , Cabrera Claudia Cecilia Cedeño , Canales Marvin Daniel Baltodano , Tello Humberto Montaño , Mawcinitt Isaac Sanchez , Murrieta Yolanda Aburto , Bañares Jorge Luis Balderrama , Romero Alonso Gutiérrez , Rosales Héctor Alfredo Montenegro 
Published: March 2024

Introduction
Flow diverters (FD) are stent‐type devices that enable the exclusion of intracranial aneurysms in clinical scenarios where coil‐type devices exhibit high failure rates. However, its effectiveness hasn't been examined in countries with low and middle incomes, like Mexico.

Methods
Longitudinal, retrospective study of the patients who received care at a tertiary center between November 2020 and April 2022. Adults older than 18 with non‐ruptured intracranial aneurysms were included. After treatment with FD, post‐procedure control angiograms were performed between three and six months later. The occlusion rate was evaluated using the O'Kelly‐Marotta scale.

Results
There were 23 patients —2 of whom had double aneurisms—, 20 women, with an average age of 51.4 years (±13.3). 19 saccular aneurysms, 4 fusiform aneurysms, and 2 dissecting aneurysms were treated. Neck measurements were in the range of 1.9 to 19 mm. Angioplasties were performed as part of the procedure on four patients, and successful liberation was achieved in all procedures. Between three and six months of follow up, total occlusion was observed in 14 aneurisms, and three had less than 5% residuals. Only three late procedural related complications were found.

Conclusion
The patients treated with FD at our reference center had complex aneurysms. Complete occlusion was achieved in 56% of the treated aneurysms during follow up. The use of the FD appears to be safe and to have a high level of effectiveness, similar to what has been described in international reports.
Abstract 182: Optimal Timeframe from Securing Mycotic Aneurysms to Cardiac Surgery: A Single Center Study
Authors: Miller Ethan A. , Balabhadra Anvesh , Patel Smit , Tunguturi Ajay , Bruno Charles , Sussman Eric , Ollenschleger Martin , Mehta Tapan 
Published: March 2024

Introduction
Infectious Intracranial Aneurysms (IIAs), commonly referred to as mycotic aneurysms, are a common sequela of infective endocarditis (IE). Approximately 65% of patients found to have IIAs also have IE, and IIAs occur in up to 10% of patients with IE. Currently, there are no guidelines for the management of IIAs due to the small sample size of observational studies and no randomized controlled studies. In addition to management techniques regarding IIAs, strategic cardiac valve surgery planning also remains imperative. Standard recommendations are to delay cardiac surgery by four weeks if patients are treated conservatively and if they remain stable. However, if one is able to embolize and secure IIAs, then that delay between endovascular therapy (EVT) and surgery may be shortened. We present a single‐center experience demonstrating the timing between securing mycotic aneurysms and cardiac surgery.

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

Results
Out of a total of 862 patients with IE, 25 patients (3.0%) were identified to have 41 IIAs (single aneurysm in 18 patients and multiple aneurysms in 7 patients). The median (IQR) age of our population was 45 (27‐65) years, with 28/41 (68.3%) male patients. The most common location of IIAs was the distal segments of the posterior and middle cerebral arteries in both groups. Of these 41 IIAs, 24/41 (58.5%) were ruptured and 17/41 (41.5%) were unruptured. A total of 14/24 (58.3%) ruptured IIAs were treated vs. none were treated in the unruptured IIAs group (P=0.001).
A total of 8/41 (19.5%) IIAs were secured before undergoing cardiac valve surgery. The median (minimum‐maximum) number of days between securing aneurysms to valvular surgery was 18 (10‐29). Only 2/41 (4.9%) IIAs were detected following valvular surgery. Those were treated on day 3 and day 15 following surgery. There were 4/41 (9.7%) secured IIAs that did not undergo valvular surgery as they did not meet surgical criteria or had surgery planned at another admission.

Conclusion
Our study demonstrates that a timeframe of 2‐3 weeks from securing IIAs to cardiac surgery is considered safe. However, one should note that our cohort consists of a small sample size. Therefore, additional large multicenter observational studies are warranted to confirm these findings.
Abstract 188: Rescue Left Middle Cerebral Artery Stenting With Xience Skypoint Everolimus‐Eluting Stent: Technical Report
Authors: Singh Raman , Shakir Hakeem , Jen Shyian , Verma Uttam 
Published: March 2024

Introduction
Drug‐eluting stent (DES) use in symptomatic intracranial atherosclerosis disease (ICAD) has been described in the literature using different guiding and distal access catheters. We describe a case of deployment of a Xience Skypoint everolimus‐eluting stent (EES) (Abbott Vascular, Abbott Park, Illinois) into a symptomatic stenosed left M1 segment using Armadillo catheter (Q'Apel, Fremont, CA) with a successful result.

Methods
Case report and review of literature

Results
67‐year‐old woman with type II diabetes mellitus, hypertension, hyperlipidemia, and recent admission for transient ischemic attack (resolving right hemiparesis and mild dysnomia in the setting of severe left M1 segment stenosis with discharge on Aspirin, Clopidogrel and Atorvastatin), presented with recurrence of symptoms, and MRI brain showing left basal ganglia acute infarction. No tPA was given low NIHSS and resolution of symptoms. Patient’s aphasia and hemiparesis worsened with segmental hypoperfusion which resolved by maintaining high blood pressures with norepinephrine drip. Decision was made to deploy a drug eluting stent into the stenosed M1 segment. Through femoral access, a 7F long destination sheath was inserted to the left common carotid origin. A 7F Armadillo catheter was then inserted into the left internal carotid artery (ICA) terminus. ASAHI Prowater coronary guidewire was inserted over which Xience Skypoint EES deployment was attempted but was unsuccessful given difficulty traversing the ICA ophthalmic segment. Ultimately, Armadillo catheter was advanced over a Phenom catheter (Medtronic) with good access into the distal M1 segment. The Phenom intermediate catheter was then removed, and the 2.25 mm x 12 mm stent was introduced through the Prowater guidewire into the segment and inflated to a pressure of 8 atm, with restoration of blood flow. Postoperatively, SBP was lowered to prevent reperfusion injury. Patient’s exam stabilized with mild dysnomia and right hemiparesis without any elevated blood pressure requirements. At 5‐months follow‐up, patient’s exam was non‐focal with NIHSS 0 and repeat DSA showed no evidence of stent occlusion and patent M1 segment.

Conclusion
Xience Skypoint EES can be successful in treating symptomatic MCA stenosis refractory to maximal medical therapy with good long term results.
Abstract 195: Changing Trends of Thrombolysis and Thrombectomy for Low Severity Stroke: National Inpatient Sample Analysis (2016‐2020)
Authors: Brake Aaron , Fry Lane , Chouhdry Hira , Lingam Sivani , Samiee Tara , Ebersole Koji , Abraham Michael 
Published: March 2024

Introduction
Over the past decade, stroke management has significantly improved with the widespread use of intravenous thrombolysis (IVT) and the establishment of endovascular thrombectomy (EVT) as the standard of care for increasing patients. However, a dilemma arises in cases of low‐severity stroke (NIHSS ≤ 5), as the EVT clinical trials do not include patients with such low NIHSS. There is debate surrounding the topic of EVT and IVT for low‐severity stroke, and often practice does not reflect the patient populations included in the initial clinical trials. Some recent studies suggest a trend toward decreasing pre‐thrombectomy IVT. (1) This study aims to examine the evolving trends of intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and their combination in low NIHSS acute ischemic stroke (AIS) management in the United States from 2016 to 2020.

Methods
We accessed the national inpatient sample database from 2016 through 2020. We included patients admitted with stroke and who had a recorded NIHSS ≤ 5. To determine if there were changes in the frequency of events over time, we compared the outcome measures utilizing logistic regression models with 2016 as the reference year.

Results
Compared to 2016 the rates of IVT have significantly decreased starting in 2018 through 2020. The rates of EVT have trended upward since 2016 and were significantly higher in the year 2020. The rates of thrombectomy plus thrombolysis have trended upward but have not significantly changed since 2016. These results can be visualized in the Figure below, * = p‐value < 0.05.

Conclusion
Our findings highlight a significant shift in stroke treatment, with the growing use of EVT while simultaneously decreasing rates of IVT for low‐NIHSS strokes. Current clinical trials protocol are submitted to examine EVT's efficacy for low NIHSS stroke (2), but it's also crucial to understand what is driving this change in real‐world practice. This understanding will inform treatment decisions and ensure they align with evidence‐based standards, guaranteeing optimal, standardized patient care.
Abstract 197: Mechanical Thrombectomy Of Basilar Artery Occlusion On A Hypoplastic Vertebrobasilar Circulation
Authors: Ghani Mohammad R. , Ali Syed Zahid , Shi Ping , Gentry Erik , Liu Wei 
Published: March 2024

Introduction
Basilar artery occlusion (BAO) is one of the most severe acute ischemic strokes which carries high mortality and morbidity risk. Mechanical thrombectomy (MT) has been used as a promising treatment for BAO. However, the vertebral‐basilar anatomy is more challenging for MT compared to the anterior circulation due to several congenital variants such as hypoplastic vertebral artery, fenestration on the vertebrobasilar junction, or chronic asymptomatic occlusions of vertebral arteries, and tortuous subclavian arteries and vertebral arteries (VAs). Here, we described a BAO case with hypoplastic vertebrobasilar arteries, which was successfully treated with thrombectomy using the direct aspiration technique.

Methods
Electronic Medical Records review of a patient with acute basilar artery occlusion stroke.

Results
55‐year‐old healthy gentleman presented to ER with acute onset with confusion, dysarthria, left‐sided weakness, and right facial droop. Initial NIHSS was 12. CT angiography (CTA) head and neck showed basilar artery was occluded in the distal one third segment. Because of the right fetal posterior cerebral artery and prominent left posterior communicating artery, his bilateral VAs and basilar artery were underdeveloped. The left VA appeared to be slightly bigger than the right one. After the patient received IV tPA, he was taken for mechanical thrombectomy. A Ballast catheter was placed in the left subclavian artery near the left VA origin. The conventional angiography showed the left VA was 2.8 mm and proximal basilar was about 2.1 mm. The Zoom 35 aspiration catheter was then used for mechanical thrombectomy. A complete basilar recanalization was achieved on the first pass. The patient improved after the MT. His NIHSS on discharge was 0.

Conclusion
The benefits of MT on BAO remain unknown despite several clinical trials. One of the reasons is due to more challenged vascular anatomy compared to anterior circulation. Underdevelopment of unilateral VA was commonly seen in posterior circulation ischemic strokes. But the underdevelopment of bilateral VAs with basilar arteries in BAO cases was rare and more difficult to treat. The Zoom 35 aspiration catheter provided a great advantage for this case with its smaller outer diameter, good navigation ability, and great aspiration efficacy. Our experience suggested a direct aspiration first pass technique (ADAPT) has an advantage on BAO, especially in the congenitally underdeveloped vertebrobasilar arteries.
Abstract 210: Mechanical Thrombectomy Outcomes for Tele‐Stroke Inter‐Hospital Transfers vs Direct Admit Patients
Authors: Ali Hamid , Amir Muhammad , Kasab Sami Al 
Published: March 2024

Introduction
Mechanical thrombectomy (MT) is the standard of care for patients with large vessel occlusion and salvageable tissue. Whether the benefit of thrombectomy is maintained for patients transferred to a thrombectomy‐capable center in a real‐world setting remains unknown. In this study, we sought to assess clinical outcomes of MT following inter‐hospital transfer.

Methods
We collected data for all patients who underwent MT at a single center between May 2016 and July 2021. Outcomes were compared between transferred and direct admit patients. Our outcomes measurements included National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at 90 days. We used Mann‐Whitney U and chi‐square tests for univariate analysis. Multivariate regression analysis was also carried out to assess the relationship between transfer status and long‐term functional independence (90 days mRS 0‐2) controlling for age, sex, symptom‐onset to groin time, IV thrombolysis, and baseline NIHSS.

Results
246/620 (40%) patients undergoing MT were transferred and 374/620 (60%) presented directly to our institution. There was no difference in age (68 vs. 70 years, P=0.58), baseline NIHSS (16 vs. 15, P=0.20), or ASPECTs score (7 vs. 8, P=0.06) in the transferred and direct admit groups, respectively. The duration from symptom‐onset to groin was longer (393 vs. 270 min, P<0.01) and rate of IV thrombolysis was more (48.4% vs. 37.4%, P=0.007) in the transferred patients. Functional independence (mRS 0‐2) at 90 days was observed in 44.6% of the patients in the transferred group compared to 49.2% in the direct thrombectomy group (P=0.928). On multivariate analysis, transfer status was not an independent predictor of long‐term functional independence (ARR 1.976, 95% CI 0.807‐4.838, P=0.136).

Conclusion
In the included cohort, no difference was found in long‐term functional independence between stroke patients who received mechanical thrombectomy following inter‐hospital transfer compared to patients who present directly to a thrombectomy‐capable center. These findings emphasize that optimizing telestroke workflow can mitigate the adverse effects of delay during transportation for patients that present to remote hospitals in rural areas.