bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 057: Recent Trends and Outcomes of Hospital Transfer for Endovascular Stroke Treatment in U.S.
Authors: Abbasi Mohammad H. , Warach Steven , Saber Hamidreza 
Published: March 2024

Introduction
Optimal triage strategies for patients suspected of acute ischemic stroke due to large vessel occlusion remains debated. Whereas secondary analyses from randomized trials have demonstrated no differences in thrombectomy outcomes in transferred vs direct presentation strokes (1‐2), several registry based cohorts reported worse functional outcomes in those with transferred presentation mode (3‐4). We explored the US national claims database to explore trends in presentation (transferred vs direct presentation) and their outcomes for EVT hospitalizations using a nationally representative sample.

Methods
National Inpatient Sample database was retrospectively explored from 2016 to 2020 for stroke hospitalizations with EVT. Outcomes were compared for EVT hospitalizations with direct vs transferred presentation at discharge. Outcomes included favorable discharge disposition (home without assistance); in‐hospital mortality; and radiographic intracranial hemorrhage (ICH).

Results
Among 100,865 admissions with EVT, 32,685 (32.4%) presented following hospital transfer for thrombectomy. The utilization of EVT in US nearly doubled during between 2017 to 2020, and the proportion of in‐hospital transfer for EVT remained unchanged during this period. White race, higher baseline NIHSS, hospital size and status (urban teaching vs rural), and hospital location were independent predictors of transferred status for EVT. Transferred status was significantly associated with a lower likelihood of achieving favorable outcome (OR: 0.80, CI: [0.72, 0.89], P<0.001) and a higher likelihood of ICH (1.18 [1.07, 1.31], P=0.001), whereas no differences were observed in early mortality following transferred vs direct presentation mode (1.07 [0.93, 1.23], P=0.33).

Conclusion
Nearly one in 3 EVTs in US is performed in patients presenting following transfer from another acute care hospital. Transferred presentation status was associated with worse clinical outcomes following EVT in a real‐world setting. Future studies are needed to determine the optimal triage strategies for patients suspected of harboring large vessel occlusion strokes.
Abstract 061: Identification of Proteins Predictive of Post‐Thrombectomy Outcome Based on an Appalachian vs. Non‐Appalachian Cohort
Authors: Maglinger Benton 
Published: March 2024

Introduction
The Appalachia region of North America is known to have significant health disparities, specifically, worse risk factors and outcomes for stroke. Appalachians are more likely to have comorbidities related to stroke, such as diabetes, obesity, and tobacco use, and are often less likely to have stroke interventions such as mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO). As our Comprehensive Stroke Center directly serves stroke subjects from both Appalachian and non‐Appalachian areas, we set out to identify proteomic biomarkers predictive of stroke outcomes specific to subjects residing in Appalachia.

Methods
Eighty‐one subjects met inclusion criteria for this study. These subjects underwent MT for ELVO, and during the procedure, carotid arterial blood samples were acquired and subsequently sent for proteomic analysis. Samples were processed in accordance with the Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC; clinicaltrials.gov; NCT 03153683). Statistical analyses were utilized to examine whether relationships between protein expression and outcomes differed by Appalachian status for functional outcomes (NIH Stroke Scale; NIHSS and Modified Rankin Score; mRS), cognitive outcomes (Montreal Cognitive Assessment; MoCA), and mortality.

Results
No significant differences were found in demographic data nor co‐morbidities when comparing Appalachia to non‐Appalachia subjects. However, time from stroke onset to treatment (last known normal) was significantly longer in patients from Appalachia, so this datapoint was entered as a co‐variate in all predictive models. A comprehensive analysis of 184 cardiometabolic and inflammatory proteins revealed seven Appalachia‐specific proteins predictive of NIHSS, fourteen predictive of MoCA, six predictive of mRS, and seven proteins related to mortality. Specifically, within the Appalachian group, the protein multiple epidermal growth factor‐like domains protein 9 (MEGF9) was positively correlated to discharge NIHSS, elevated levels of the proteins coagulation factor XI (F11) and mannose binding protein (MBL2) were found to have an increased likelihood of worse mRS, but there were no proteins identified from the Appalachian cohort that were predictive of worse MoCA score, nor worse mortality.

Conclusion
Appalachia is an underserved population with significantly worse health disparities, specifically related to ischemic stroke. Our study found that patients who presented from Appalachian regions have a different proteomic response at time of MT when compared to otherwise similar subjects presenting from non‐Appalachian communities. These differentially expressed proteins could be used as prognostic biomarkers as well as novel therapies targeted at an underserved population. Lastly, expression differences may be in part related to environmental exposures, such as coal pollution, which will require additional studies moving forward.
Abstract 063: Emergent versus delayed carotid artery stenting in tandem occlusion strokes treated with thrombectomy
Authors: Seblani Nader El , Kalra Saurabh , Ortega‐Gutierrez Santiago , Kalra Deepak , Nagaraja Nandakumar 
Published: March 2024

Introduction
It is controversial when to pursue carotid artery stenting (CAS) after acute tandem occlusion (TO) strokes treated with endovascular thrombectomy (EVT). We conducted a retrospective observational study to evaluate the clinical and safety outcomes of emergent versus delayed CAS in the first week of EVT.

Methods
In this retrospective cohort study, using 2016‐19 Nationwide Readmissions Database, we identified patients with acute ischemic stroke who had EVT for anterior circulation large vessel occlusions (LVOs) and CAS up to 7 days of EVT. CAS performed on day ‐1, 0 or 1 day after admission was considered as emergent CAS. CAS performed 2‐7 days after EVT was defined as delayed CAS. The primary clinical outcomes were all‐cause mortality during same admission. Secondary safety outcomes included intracranial hemorrhage (ICH), seizures, gastric tube (G‐tube) insertion, > 24‐hours mechanical ventilation, tracheostomy, length of stay (LOS), and discharge location (home vs. others). Multivariate logistic regression analysis was used to compare outcomes in emergent CAS group in comparison to delayed CAS group. Age, sex, hypertension, diabetes mellitus, hyperlipidemia, and use of thromobolytics were considered as covariates.

Results
We identified total of 1990 hospitalizations meeting the study inclusion criteria (mean age: 67 years ± standard deviation:12 years, female 612 (31%). Of these, 1745 (87%) had undergone emergent CAS with EVT and 245 (13%) had delayed CAS (2‐7 days) pos‐EVT. Baseline characteristics were similar between the two cohorts. Delayed CAS cohort had significantly less mortality rates [6 vs 13%; OR 0.43, 95% CI 0.24‐0.78], less ICH [20 vs 30%; OR 0.6, 95% CI 0.43‐0.82¬¬], less cerebral edema [16 vs 23%; OR 0.65, 95% CI 0.44‐0.96], and less mechanical ventilation for >24‐hours [11 vs 18%; OR 0.54, 95% CI 0.34‐0.85]. There was no significant difference between the two treatment groups for tracheostomy, G‐tube placements, new‐onset seizure, and mean LOS.

Conclusion
Delaying CAS for 2‐7 days after EVT might be a safer approach for endovascular revascularization in anterior circulation LVO strokes secondary to tandem lesions.
Abstract 068: Basilar artery bifurcation anatomy as a determinant of recanalization and stroke outcome
Authors: Abbasi Mohammad Hossein , Eltatawy Ali , Messé Steven R. , Mowla Ashkan , Prestigiacomo Charles J. , Smith Matthew S. , Rosso Michela , Kasner Scott E. , Shirani Peyman 
Published: March 2024

Introduction
Background: Thrombectomy improves outcomes in patients with basilar artery (BA) occlusion [1,2]. We hypothesized that the anatomic configuration of the BA bifurcation, classified as T‐ or Y‐shaped, may impact the outcome. Specifically, we expected that a T‐shaped BA would involve more deep penetrating arteries of the midbrain and thalamus, leading to greater disability or death [3,4].

Methods
In this 2‐center retrospective cohort study over seven years, we included patients with stroke due to distal BA occlusion and performed blinded classification of their BA anatomy as either T‐ or Y‐shaped [Figure 1]. The primary outcomes were favorable functional status at 90 days (modified Rankin Scale 0 – 2) and successful reperfusion (TICI scores 2B or 3).

Results
70 patients (mean age 66 years, 36% women) were included. 38 had T‐ and 32 had Y‐shaped bifurcations. Baseline characteristics were similar for both groups, including demographics, treatment time, baseline NIHSS, THRIVE score, posterior circulation collateral score, and presence of tandem occlusion. Comparing the T‐ to the Y‐ shape, there was no difference in the likelihood of successful reperfusion (1.09 [0.52–2.27], p=1.00) nor 90‐day favorable mRS (0‐2) score (RR: 0.68 [0.37–1.27]; p=0.18). Similarly, mortality at 30 and 90 days were not significantly affected by the type of bifurcation.

Conclusion
The configuration of the basilar artery does not significantly impact reperfusion success or stroke outcome.
Abstract 077: Readmission Rates and Etiologies among Patients with Subarachnoid Hemorrhage: A Nationwide United States Analysis
Authors: Laswi Ibrahim , Arabi Maryam , Al‐Najjar Yousef , Dargham Soha , Jerdi Salman Al , Khalil Charbel Abi 
Published: March 2024

Introduction
Subarachnoid Hemorrhage (SAH) is the leading cause of morbidity and mortality in stroke patients, associated with severe neurological, infectious, and thromboembolic complications. Identifying clinical predictors linked to hospital readmissions after a SAH allows for the determination of patients with higher risks of complications, opening an avenue for prevention and improved quality of care.

Methods
The Nationwide Readmission Database (NRD) was used to extract patients with SAH (ICD‐10 code: I60.x) from 2016‐2019. The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 30 and 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates.

Results
We identified 68,726 patients with SAH, with a mean age of 60.47 years, and 57.86% being female. Overall, 7.79% (n=5354) were readmitted within 30 days and 12.04% (n=8525) were readmitted within 90 days. The rate of 30‐day readmission was overall stable (7.34% in 2016 and 7.70% in 2019; p=0.42), but the 90‐day readmission rate slightly increased from 11.69% in 2016 to 12.47% in 2019 (p=0.04). Around 62% of 90‐day readmissions occurred within the first 30 days. Patients readmitted within 30 days were more likely to be older (mean age = 61.92 vs 60.99 years; p<0.001) and male (43.96% vs 41.74%; p=0.002) compared to those not requiring readmission. They had a higher prevalence of diabetes (23.38% vs 18.82%), hypertension (74.34% vs 70.12%), obesity (13.95% vs 12.25%), dyslipidemia (38.17% vs 33.02%), smoking (39.30% vs 37.43%), prior TIA/ischemic stroke (22.60% vs 20.39%), coronary artery disease (15.03%), DVT (6.06% vs 3.51%), peripheral vascular disease (14.24% vs 11.09%), chronic renal failure (13.34% vs 9.35%), and heart failure (10.57% vs 7.75%) (p<0.001 for all). The most common etiologies of 30‐ and 90‐day readmission were cardiovascular (42.53% and 40.79%), neurological (12.34% and 11.50%), and infectious (8.41% and 8.21%).

Conclusion
The annual rate of 90‐day readmission, but not 30‐day readmission, increased from 2016 to 2019. Readmitted patients both within 30 and 90 days were more likely to have a higher prevalence of vascular risk factors and related comorbidities.. The most common cause of 30‐ and 90‐day readmission is cardiovascular diseases followed by neurological and infectious conditions. Further studies are required to offer risk stratification and prevention strategies for readmission among patients with Subarachnoid Hemorrhage.
Abstract 078: Managing Clopidogrel Resistance in Neurointervention: Surveying Current Approaches
Authors: Kim Hyun Woo , Bach Ivo , Martinez‐Gutierrez Juan Carlos , Dmytriw Adam , Zeineddine Hussein , D'Amato Salvatore , Sheth Sunil 
Published: March 2024

Introduction
Due to the variability in patient responses to clopidogrel, adjusting antiplatelet regimen based on platelet function testing has become a widespread practice to reduce thromboembolic complications in neurointervention. In the absence of standardized guideline, we aimed to explore the practice patterns related to clopidogrel resistance.

Methods
We conducted a survey targeting neurointerventionalists, comprising multiple‐choice questions and opportunities for free‐text responses when necessary. The survey was distributed via a professional society – the Society of Vascular and Interventional Neurology (SVIN) and two emailing lists – WovenEndoBridge and Neurointerventional Research Consortium. The data obtained from the responses were analyzed using descriptive statistics.

Results
A total of 133 neurointerventionalists representing 83 institutions within 24 countries responded to the survey. 62% of respondents tested for clopidogrel resistance prior to any neurovascular stent placements. 80% utilized VerifyNow point‐of‐care P2Y12 assay; other assays included multiplate analyzer, platelet function analyzer (PFA‐100), and CYP2C19 genotype assay. Respondents reported 25 different therapeutic thresholds, with the P2Y12 Reaction Units range between 60 and 180 most commonly used (16.4%). 61% reported they would switch to ticagrelor in the case of persistent resistance. On the other hand, when patients are supratherapeutic, 48% did not make any changes while 42% reduced clopidogrel dose. Finally, 93% felt that there was a lack of well‐established protocol for management of clopidogrel resistance.

Conclusion
Neurointerventional practice patterns around clopidogrel resistance remains heterogeneous. Our results underscore the need for evidence‐based guidance on anti‐thrombotic management during cerebrovascular stenting.
Abstract 080: Continuous Automated Stroke Screening Software for Early Detection of Neurological Impairment
Authors: Eskian Mahsa , Sharashidze Vera , Heit Jeremy J. , Taghdiri Foad , Masoud Hesham , Gould Grahame 
Published: March 2024

Introduction
Stroke is the second leading cause of death worldwide leaving up to 50 % of Survivor chronically disabled after their event. Early diagnosis and treatment can significantly lower mortality and morbidity, significantly reducing the economic burden of long‐term disability. Due to the painless nature of most stroke events, many lack the stimulus to seek emergency assistance, further compounded by a symptomatology of deficit resulting in being unaware of the symptoms or lacking the ability to call for help when needed. A continuous automated stroke screening software tool was developed to address these pitfalls in prehospital care, allowing for the early detection of neurological impairment and the release of a medical emergency alert to facilitate emergency medical care.

Methods
Python version 3.11.3, NumPy, OpenCV, and mediapipe were used for facial and hand land marking with mathematical models employed to detect eye gaze direction, facial symmetry, eyelid closure and left or right hand detection.

Results
We were able to demonstrate consistent performance of the final software to continuously detect the eye gaze deviation, or center in real time video capturing (Figure‐1). Software is also capable of detecting lower facial palsy through facial symmetry recognition of smiling to demonstrate a right or left sided palsy (Figure‐2). The ability to blink can be detected to differentiate motor neuron palsy and used as a measure of mental status demonstration of the ability to follow a simple midline command (Figure‐3). Detection of lateralizing hand presentation to the camera allows the software to be used in detecting hemi‐neglect, and antigravity muscle strength in upper extremity. (Figure 1‐3).

Conclusion
Our developed automated stroke screening software can be used for continuous, physician independent, monitoring of neurologic patients and the detection of acute deficits and emergency alert to facilitate early care. The software is designed for use in medical emergency alert systems, tele stroke assessments, and remote surveillance of the neurological examination in intensive care unit or patients in isolation. Here we present the initial software development and capability, we are currently studying our detection models on patients with neurological deficits in varied practice settings.
Abstract 081: Clinical Presentation and Treatment of 26 Spinal Epidural Arteriovenous Fistulas: A Single Center Experience
Authors: Beaman Charles , Molaie Amir , Ghochani Yasmin , Fukuda Keiko , Peterson Catherine , Kaneko Naoki , Nour May , Szeder Viktor , Colby Geoffrey , Tateshima Satoshi , Jahan Reza , Duckwiler Gary 
Published: March 2024

Introduction
Spinal epidural arteriovenous fistulas (SEAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy.

Methods
This is a single center, retrospective case series of patients with SEAVF who underwent observation or treatment at UCLA medical center from 1993 to 2023.

Results
A total of 26 patients were found to have a SEAVF at UCLA from 1993 to 2023. The median age at treatment was 59 years (range 4 months to 91 years). 16 of 26 patients (55.2%) were male. 12 were located in the cervical spine, 2 in the thoracic spine, 11 in the lumbar spine, and 1 in the sacral spine. Sacral, lumbar, and thoracic SEAVFs demonstrated a strong male predominance (12 of 14, 85.7%), while cervical SEAVFs were more common in women (8 of 12, 66.7%). The median duration of symptoms prior to treatment was 6.5 months (range 1 day to 8 years). Possible triggers included prior spinal surgery (n=3), turning neck (n=1), trauma to the neck (n=1), lifting a heavy box (n=1), prolonged period of bending over (n=1). The remaining patients did not have any particular trigger. All patients with lumbar and thoracic SEAVFs (except the 3‐month‐old) demonstrated flow voids and cord edema. Patients with cervical SEAVF did not demonstrate cord edema and only 5 of 12 explicitly mentioned flow voids. 22 patients were treated strictly endovascularly, 1 patient endovascularly and then surgically, 1 patient surgically, and 2 patients refused treatment. No patients treated endovascularly experienced complications. 19 of 23 patients (82.6%) treated endovascularly received complete cure after the first treatment. 1 patient had a successful subsequent embolization 2 days later. Of the 3 other incomplete treatments, one patient received subsequent successful surgery, one patient was a 3‐month‐old patient with Parkes‐Weber syndrome who subsequently died of other medical issues, and one was lost to follow‐up. One patient underwent surgical treatment alone due to the feeding arteries being too small to catheterize and unfortunately experienced a failed surgery on the first attempt and developed a surgical site infection after the second successful attempt at treatment. Onyx was used in 10 cases (9 of 10 successful). 2 cases treated with NBCA were unsuccessful. Cervical and Sacral SEAVFs were treated successfully (mostly prior to 2006) with coils and/or detachable balloons.

Conclusion
SEAVF is a rare disease that can be treated effectively and safely with endovascular embolization in most cases. Pre‐operative MRI demonstrated abnormalities in all cases. We found a strong male predominance in our cohort.
Abstract 092: Vasospasm as a Consequence of IVIg Usage for GBS.
Authors: Welsh Connor D 
Published: March 2024

Introduction
The relationship between Intravenous Immunoglobulin (IVIg) and cerebrovascular vasospasm is poorly and incompletely understood. Some case reports have identified IVIg as potential therapy for vasospasm, while others have implicated it as a causative agent in primarily coronary artery vasospasm and the development of atypical angina. This case illustrates a situation in which a patient with Guillain‐Barre Syndrome (GBS) was started on IVIg and developed subsequent vasospasm with cerebral infarcts requiring intra‐arterial therapy.

Methods
Case Report

Results
Our patient is a 62 year old female with a history of cervicothoracic subdural hematoma status postevacuation with left leg weakness, hypertension, known right ICA aneurysm, and chronic left ICA occlusion who presented as a transfer from an outside facility where she initially presented with progressive back pain, lower extremity weakness, areflexia and dysautonomia. MRI brain initially demonstrated posterior‐predominant T2 hyperintensities affecting subcortial white tracts suggestive of PRES. Lumbar puncture demonstrated cytoalbuminologic dissociation supporting a superimposed GBS. IVIg was initiated, however the patient's mentation and examination declined. Repeat MRI demonstrates bilateral, posterior‐predominant acute multifocal ischemic infarcts. Vessel imaging demonstrated vasospasm of the basilar and bilateral anterior Circle of Willis. Oral Verapamil was initiated. Digital Subtraction Angiography confirmed these findings; intra‐arterial verapamil was utilized with significant improvement in the patient's examination.

Conclusion
IVIg has only a weak association with coronary artery vasospasm, however is heavily implicated in the onset of this patient's diffuse vasospastic ischemic disease. Prompt identification and aggressive initiation of treatment is essential in minimizing the burden of ischemic stroke and optimizing outcomes for these complex patients.