bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 175: Impact of COVID‐19 on Intracranial Aneurysm Treatment and Outcomes: A Nationwide Propensity Score Matched Study.
Authors: Zermeno Jorge R. Rios , Ghaith Abdul Karim A. , El‐Hajj Victor G. , Michaelides Loizos , Tawk Rabih G. 
Published: March 2024

Introduction
The coronavirus disease 2019 (COVID‐19) pandemic has had a global impact on healthcare systems. There is limited data on the influence of COVID‐19 on treatment and outcomes in patients with intracranial aneurysms. We aimed to investigate the impact of COVID‐19 on the overall complications, including ischemic stroke and subarachnoid hemorrhage (SAH) rates in patients treated for intracranial aneurysms (IAs).

Methods
This national, multicenter, retrospective cohort study included patients diagnosed and treated for IAs from January 2016 to December 2020 in the National Inpatient Sample (NIS). A total of 57,715 admissions were identified. Of these, 45,979 occurred pre‐COVID and 11,736 during the COVID pandemic period. The outcome data points included the occurrence of postprocedural ischemic strokes or SAHs, death, non‐routine discharge, total charges (US dollars), and length of stay (days). A 1:1 propensity score matching protocol was applied using a K‐nearest neighbor approach to evaluate differences in the outcome data points between the pre‐COVID and during COVID periods. The trends during the study period were assessed using piecewise joinpoint regression with the Mann‐Kendall test.

Results
Overall, the mean age was 65 years, with most of the patients (69.9%) being females. Endovascular interventions were performed in 82.9% of pre‐COVID IAs admissions compared to 82.4% during the COVID period, while open surgical treatment was performed in 17.1% of pre‐COVID and 17.6% of the patients during COVID (p=0.625). After matching, there were no differences in length of stay (p=0.266), non‐home discharge (p=0.475), and in‐hospital mortality rates (p=0.305) between the two periods; however, the overall complication rate was significantly higher during the pandemic (31.1% vs. 28.3%; p<0.001). From 2016 to 2020, an upward trend in hospitalizations for ischemic stroke was seen among patients treated for IAs (6.1% to 7.9%; p=0.04). No trends were observed with respect to the occurrence of SAH or death (p=0.31). Patients hospitalized after treatment of IAs during the COVID pandemic had significantly higher odds of ischemic strokes (OR 1.13; 95% CI 1.05 to 1.22; p=0.03) but not SAH (OR 0.97; 95% CI 0.88 to 1.06; p=0.89).

Conclusion
The COVID‐19 pandemic has significantly impacted the healthcare system. In patients receiving treatment for IAs, this analysis noted a correlation between the COVID‐19 pandemic and postoperative complications, notably ischemic strokes. Unraveling the pandemic’s “black box” leads to awareness of plausible breaches within the system, which acts as a crucial component in improving situational readiness and preparedness in the event of similar large‐scale crises.
Abstract 179: Tackling Intracranial Aneurysm in Africa: Bridging the Gap in Medical Infrastructure
Authors: Uwishema Olivier 
Published: March 2024

Introduction
Intracranial Aneurysm results from enlargement in the wall of a blood vessel in the brain, especially in the circle of Willis. It represents a high mortality and morbidity rate due to its risk of rupture causing Sub Arachnoid Hemorrhage which is a dangerous and life‐threatening condition. Therefore, early treatment before rupture prevents major neurological debilitating and fatal effects. The aim of this study is to assess the burden of Intracranial Aneurysm in Africa regarding its epidemiology, risk factors, and clinical outcomes.

Methods
A review of the literature was done for studies published between 2019 and 2023 to obtain a better and updated review of Intracranial Aneurysm and its clinical presentations and outcomes in Africa.

Results
Variations of Sub Arachnoid Hemorrhage have been reported across different countries. Africa presents a fatality rate higher than developed countries. Based on limited reports, the 30‐day mortality rate from aneurysmal Sub Arachnoid Hemorrhage was 26.6% in Kenya and 44.4% in Nigeria. Additionally, a Sudanese in‐hospital cohort reported 40% mortality within 3 weeks and 87.5% in the first week. The bad clinical outcomes of Intracranial Aneurysm in Africa are due to a lack of detection tools, misdiagnosis, delayed management, and sub‐optimal treatment.

Conclusion
African countries present a lack of proper medical interventions rendering Intracranial Aneurysm a life‐threatening condition. Further investigations are needed to improve the medical infrastructure and knowledge in order to have better clinical outcomes and reduce the mortality rates of Intracranial Aneurysm in Africa.
Abstract 183: Characteristics and Outcomes of Treated and Untreated Mycotic Aneurysms: A Single Center Study
Authors: Patel Smit A. , Balabhadra Anvesh , Miller Ethan , 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). The morbidity rate is known to be about 80% in ruptured IIAs. Over the last decade, we have seen a rise in the utilization of endovascular therapies over conservative management for the treatment of IIAs with promising results. We present a single‐center experience describing the characteristics and outcomes of treated and untreated IIAs.

Methods
This is a single‐center retrospective observational study of patients admitted with IE who developed IIAs and were admitted 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 overall mean (minimum‐maximum) size of all IIAs was 2.8 (0.2‐11) mm. The number of treated IIAs was 14/41 (34.1%) while 27/41 (65.9%) of IIAs were not intervened on. Among those IIAs treated, 92.8% were treated with an endovascular approach; 50% underwent onyx embolization, 28.6% underwent n‐BCA embolization, 14.2% underwent coil embolization, and 7.2% (n=1) underwent surgical intervention. The average (minimum‐maximum; mm) size of ruptured IIAs was 4.4 (1‐11) whereas the size of untreated IIAs was 2.0 (0.2‐9); (P=0.002). Among the treated group of IIAs, the majority were discharged home (21.4%) or discharged to facilities (78.6%). There was no in‐hospital mortality observed among the treated group. No IIAs were found to re‐rupture following embolization, and there was no change in any patient’s baseline neurologic examination following the embolization procedure.

Conclusion
Endovascular therapy is overall safe and effective in the management of IIAs and may be considered among patients with ruptured IIAs while accounting for their underlying comorbidities. Patients with secured IIAs are less likely to have in‐hospital mortality and are more likely to have better outcomes upon discharge. However, this may be influenced by case selection bias. Additional large center observational studies are warranted to confirm our findings.
Abstract 211: Comparing Early and Late Window 3mm Trevo Stent Retriever Performance in Medium Vessel Occlusion Thrombectomy
Authors: Koneru Manisha , Zhao Christopher , Siegler James E , Vigilante Nicholas , Khalife Jane , Tonetti Daniel , Shaikh Hamza 
Published: March 2024

Introduction
Endovascular thrombectomy has been shown to be beneficial for select patients with medium vessel occlusion ischemic strokes. Newer mechanical thrombectomy devices have designs to facilitate navigation of the medium and distal cerebrovasculature. In this single‐center study, we aim to compare the performance of 3mm Trevo NXT stent retrievers (Stryker, Kalamazoo, MI) for medium vessel occlusion mechanical thrombectomy for patients treated within either the early (<6 hour) or late (>6 hour) treatment window.

Methods
A retrospective review was conducted of acute ischemic stroke patients with medium vessel occlusions (i.e., M2‐M4, ACA, and PCA) who underwent thrombectomy over 5 years (2018‐2022) at a single comprehensive stroke center. Classification into early or late window was defined as time from last known well to groin puncture less than 6 hours or greater than 6 hours, respectively. Primary efficacy outcome included successful recanalization (modified thrombolysis in cerebral infarction [mTICI]>=2B) using 3mm Trevo NXT on either first pass or rescue pass (i.e., after initial pass failure with another device). Primary safety outcome is rate of complications associated with the stent retriever. Primary clinical outcome was National Institutes of Health Stroke Scale (NIHSS) shift between admission and discharge.

Results
Of 81 patients with medium vessel occlusion ischemic strokes, 38 patients (44.7% female, median age of 73.5 years [IQR 66‐82], median initial NIHSS 13 [IQR 8‐23]) underwent thrombectomy with 3mm Trevo NXT. Stent retriever‐assisted aspiration (versus stent retriever only) was performed in 31/38 (81.6%) patients. Successful recanalization with stent retriever was achieved in 28/38 (73.7%) of patients. There was no significant difference in rate of recanalization between early and late window thrombectomy (16/22 [72.7%] early window vs. 12/16 [75%] late window, p=0.8752). The lack of significant difference in recanalization rate was consistent with stent retriever use during first pass (11/14 [78.6%] early window vs. 9/10 [90%] late window, p=0.6146) and as rescue (5/8 [62.5%] early window vs. 3/6 [50%] late window, p=0.6400). There was no significant difference in the rate of stent retriever complications between early and late windows (1/16 [6.3%] early vs. 0/22 [0%] late, p=0.4211). There was no significant difference in median NIHSS shift from admission to discharge ( ‐6 [IQR ‐16 ‐ 9] early window vs. ‐3 [IQR ‐5 ‐ 4] late window, p=0.3666).

Conclusion
In both early and late window medium vessel occlusion thrombectomy, the 3mm Trevo NXT as first line and rescue intervention performs comparably and adequately. Future multicenter studies will further characterize novel stent retriever performance in medium vessel occlusion thrombectomies.
Abstract 220: Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta‐analysis
Authors: Rodriguez‐Calienes Aaron , Chavez‐Ecos Fabian A. , Espinosa‐Martinez David , Bustamante‐Paytan Diego , Borjas‐Calderón Nagheli Fernanda , Galecio‐Castillo Milagros , Vivanco‐Suarez Juan R. , R Waldo Guerrero , Ortega‐Gutierrez Santiago 
Published: March 2024

Introduction
Carotid artery stenting (CAS) has emerged as a viable alternative to carotid endarterectomy for managing carotid artery stenosis in high‐risk patients (1). While the transfemoral arterial approach (TF) remains the preferred method, it is associated with inherent limitations and potential complications (2‐4). Consequently, exploring the transradial artery access (TR) as a potential option becomes crucial in optimizing patient outcomes and procedural success rates. Limited data exists comparing the outcomes of TR approach in CAS to TF approach. This study aims to systematically review and meta‐analyze the outcomes and complication rates between TR and TF access for CAS.

Methods
A systematic electronic search was conducted in four databases up to May 10th, 2023. Studies with randomized or non‐randomized designs, involving CAS through TR or TF approach, were included. Outcomes of interest were stroke, transient ischemic attack (TIA), death, myocardial infarction (MI), and access site complications. A meta‐analysis was performed, analyzing pooled odds ratios (ORs) and 95% confidence intervals (CI) to assess the effect size of the vascular access approaches.

Results
Six studies with a total of 6,917 patients were included, out of which 602 (8.7%) underwent the TR approach, and 6,315 (91.3%) underwent the TF approach. Meta‐analysis results showed no significant difference in stroke occurrence between TR and TF groups (TR: 1.7% vs. TF: 1.9%; OR = 0.98; 95% CI 0.49 – 1.96; I2 = 0%). Similarly, no significant difference was found in death (TR: 1% vs. TF: 0.9%; OR = 0.95; 95% CI 0.38 – 2.37; I2 = 0%), MI (TR: 0.2% vs. TF: 0.3%; OR = 1.53; 95% CI 0.20 – 11.61; I2 = 0%), TIA (TR: 0.4% vs. TF: 1%; OR = 0.46; 95% CI 0.11 – 1.95; I2 = 0%), and access site complications (TR: 2.2% vs. TF: 1%; OR = 0.97; 95% CI 0.48 – 1.98; I2 = 0%).

Conclusion
In the comparison of TR and TF approaches for CAS, no significant differences were observed in stroke, death, MI, TIA, or access site complications. TR approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications. However, further studies are needed to confirm these findings and establish guidelines for optimal access site selection.
Abstract 224: Morphological characteristics of carotid webs associated with stroke risk and clot burden
Authors: Martins Pedro N. , Monteiro Mateus D. , Tarek Mohamed A. , Nahab Fadi , Dolia Jaydevsinh , Allen Jason , Frankel Michael , Nogueira Raul , Haussen Diogo 
Published: March 2024

Introduction
Carotid webs (CaWs) have been established as an ischemic stroke etiology although lesion characteristics that may lead to increased stroke risk are still uncertain (1). We aim to evaluate the associations between CaW morphological features evaluated via computed tomography angiography (CTA) with clinical and radiological variables.

Methods
This is a retrospective analysis of a prospectively collected mechanical thrombectomy database. Individuals that presented with a suspected symptomatic CaW since July 2014 were selected after appropriate workup. The database included symptomatic CaW, asymptomatic CaW contralateral to the symptomatic side in case of bilateral lesions, and incidentally identified CaW (asymptomatic patients). We recorded the following CaW variables (Figure 1): length, base, thickness, caudal/middle/cranial angles in relationship to the vessel axis, area as well as perimeter of the pocket.
We used mixed‐effects models to compare measurements between symptomatic and asymptomatic webs in the complete sample and paired Wilcoxon tests to compare webs of individuals with contralateral, symptom‐discordant CaW. Measurements were evaluated against clot burden via Poisson regression.a

Results
118 webs (85 symptomatic and 33 asymptomatic) from 98 stroke patients were included. Median [IQR] for age was 52[42‐58] years old, 69.0% were female, 68.4% presented with a single symptomatic web, 18.4% had both a symptomatic and an asymptomatic web, 11.2% had only an asymptomatic web, whereas 2.0% had bilaterally asymptomatic webs. Symptomatic CaW were significantly larger in length (2.5mm[2.1‐3.5] vs. 2.2mm[1.7‐2.7];p=0.004) and pocket area (1.5mm²[0.9‐2.6] vs. 0.9 mm²[0.2‐1.3];p=0.007) compared to the asymptomatic lesions. The cranial angle was more acute for symptomatic CaW (66.9°[57.1°‐78.4°] vs. 76.2°[66.9°‐88.7°];p=0.046). No other significant associations were noted. Among the 18 patients who were analyzed for contralateral/symptom‐discordant webs, symptomatic CaW also showed more extensive lengths (2.9mm[2.3‐4.0] vs. 2.2mm[1.6‐3.1];p=0.009) but less acute rostral angles (33.1°[25.3°‐43.5°] vs. 27.9°[16.8°‐35.9°]) than their asymptomatic counterparts. Among symptomatic webs, clot burden was not significantly associated with base, length, thickness, perimeter or pocket area. Nevertheless, each 15° increase in the angle within the pocket was associated with a 1.1‐fold increase in clot burden (exp(β) = 1.1(95%CI1.0‐1.2), p = 0.044) for each 15° increase), with more obtuse angles indicating a higher intracranial vessel occlusion thrombus load.

Conclusion
Symptomatic carotid webs displayed larger lengths and pocket areas as compared to asymptomatic lesions. The angles that determine pocket area and degree of stenosis differed between symptomatic and asymptomatic webs.
Abstract 248: Structural Analysis of Aspiration Catheters and Procedural Outcomes: An Analysis of the SVIN Registry
Authors: Dolia Jaydevsinh N. , Mohammaden Mahmoud H. , Tarek Mohamed A. , Monteiro Mateus D. , Grossberg Jonathan A. , Pabaney Aqueel H. , Frankel Michael V. , Jillella Dinesh E. , Hassan Ameer V. , Tekle Wondwossen E. G. , Georgiadis Alexandros G. , Saei Hamzah , Gutierrez Santiago Ortega , Vivanco‐Suarez Juan , Galecio‐Castillo Milagros , Rodriguez‐Calienes Aaron , Majidi Shahram , Fifi Johanna , Matsoukas Stavros , Siegler James , Penckofer Mary , Rana Ankit , Sheth Sunil , Maroni Sergio Salazar , Nguyen Thanh , Abdalkader Mohamad , Linfante Italo , Dabus Guilherme , Mehta Brijesh , Sessa Joy , Jumaa Mouhammad , Sugg Rebecca , Linares Guillermo , Al‐Bayati Alhamza , Libeskind David , Noguiera Raul , Haussen Diogo 
Published: March 2024

Introduction
Rapid expansion of mechanical thrombectomy and swift manufacturing development has translated into significant evolution of large bore catheter technology. The objective of this study was to evaluate the association among diverse structural components of large bore aspiration catheters on procedural performance.

Methods
Retrospective analysis of a prospectively maintained mechanical thrombectomy consortium (SVIN Registry) treated with stand‐alone contact aspiration for the first pass in the MCA M1 or intracranial ICA occlusions from 2012‐2021. Catheters were stratified based on construction materials, tip technology, catheter sizing, and catheter lining. Factors associated with first pass effect (FPE ‐ first‐pass eTICI2c‐3 reperfusion) as well as speed of clot engagement were analyzed.

Results
We identified 983 patients with proximal occlusion and aspiration as the first pass technique. FPE was observed in 34% and associated with age (OR:1.016;95%CI:1.006‐1.027), cardioembolic stroke etiology (OR:1.685;95%CI:1.77 ‐2.41), MCA M1(OR:2.737;95%CI:1.091 ‐1.867), non‐general anesthesia (OR:0.546;95%CI:0.389 ‐0.767), as well as with 0.070” (OR:2.038;95%CI:1.099 ‐3.779) and 0.088” (OR:3.899;95%CI:1.582 ‐9.606) distal catheter inner diameter in the adjusted analysis. Median time from arterial access to clot contact was 17 minutes with faster times observed in younger patients (OR:0.986;95%CI:0.975 ‐0.996) as well as with the use of aspiration catheters with shorter length of distal outer hydrophilic coating (18‐30cm) on multivariable regression (OR:0.303; 95%CI:0.113‐0.816).

Conclusion
Larger aspiration catheter distal inner diameter was associated with higher rates of FPE. Aspiration catheters with reduced distal tip hydrophilic coating were associated with faster arterial access to clot contact time.
Abstract 256: Proposal of multimodal CT‐based scoring system in prediction of hemorrhagic transformation in acute ischemic stroke
Authors: Elsaid Nada 
Published: March 2024

Introduction
The routinely used computed tomography (CT)‐based workup in the setting of acute ischemic stroke (AIS) includes non‐contrast brain CT, CT angiography (CTA), and CT perfusion. Several CT, CTA, CTP‐based radiological biomarkers of hemorrhagic transformation (HT) were reported.
To assess the predictive value of the combined multimodal CT parameters for HT after AIS and proposal of predictive scoring scale.

Methods
The source images of the NCCT, CTA and CTP of 282 AIS patients involving the anterior circulation (HT = 91, non‐HT = 191) were retrospectively reviewed and the following biomarkers were recorded and analyzed: Early subtle ischemic signs, hyperdense middle cerebral artery sign (HMCAS) and Alberta Stroke Program Early CT Score (ASPECTS) < 7 in NCCT, large‐vessel occlusion (LVO), clot burden score (CBS) < 6, large‐vessel occlusion, poor collateral score (CS) and Tmax > 6 s ≥ 56.5 ml. A scoring system to predict HT based on these biomarkers was developed. Each biomarker counts for a single point with the total score ranging from 0 to 7.

Results
All the aforementioned multimodal CT biomarkers and the selected cut offs were significantly associated with higher HT risk. The calculated scores were statistically significant different between the HT and the non‐HT groups with AUC 0.761 (95% CI 0.703–0.819, P < 0.0000001). Rates of HT were approximately five times higher in patients with score ≥ 3.

Conclusion
Multimodal CT‐based scoring system may provide highly reliable predictive model of hemorrhagic transformation in acute ischemic stroke.
Abstract 261: Mechanical thrombectomy in patients with large‐territory acute ischemic stroke requiring a decompressive hemicraniectomy
Authors: Ansari Junaid , Simoncini Pedro , Fakhre Waddih , Sheikh Mohammad , Bocklud Brooke , Moore Sydney , Abubakar Muhammad , Caskey Joshua , Bridges James , Juneau Patrick , Abushehab Nimer , Cuellar Hugo , Guthikonda Bharat 
Published: March 2024

Introduction
Mechanical thrombectomy (MT) has demonstrated a significant improvement in functional outcomes for patients with anterior circulation strokes and large‐vessel occlusion (LVO). However, despite successful recanalization, certain patients still experience large hemispheric ischemia (LHI), necessitating decompressive hemicraniectomy (DHC). This study aims to investigate the characteristics and predictive factors associated with LHI requiring DHC in patients with successfully recanalized anterior circulation LVO, shedding light on potential factors influencing patient outcomes in this context.

Methods
We retrospectively analyzed 117 patients with LHI admitted to OLSU from November 2015 to March 2023. These individuals were then matched into two groups: a study group who had undergone decompressive hemicraniectomy (38) and a control group of individuals who had not (79). Additionally, within the DHC recipients, these individuals were further subgrouped into those who had undergone MT. Information was collected on demographic variables, medical history and clinical parameters. Functional outcomes were assessed via binarization of the following variables: the modified Rankin scale score on discharge (0‐4: good outcome vs. 5‐6: poor outcome).

Results
Among the 38 patients with LHI who underwent DHC (mean age 52.47 + 12.27 years, 63.1% males), 16 (42.1%) patients received intravenous tPA administration, and 13 (34%) underwent mechanical thrombectomy (MT) with successful reperfusion (TICI ≥ 2b) achieved in 8 (61.5%) of these patients. The assessment of the modified Rankin Scale (mRS) at discharge (0‐4: good outcome, 5‐6: poor outcome) revealed that both intravenous tPA (p‐value ‐ 0.206) and MT (p‐value 0.50) were not significantly associated with a good clinical outcome at discharge.

Conclusion
In the overall analysis of all individuals with complete outcome data, none of the variables (DHC receipt, MT receipt, tPA receipt) were significantly associated with mRS at discharge. The study did not find significant associations between the examined variables and the outcome (mRS on discharge) in patients with LHI who underwent DHC, regardless of whether they underwent reperfusion therapy or not. Advancements in acute ischemic stroke therapies such as thrombolytics and thrombectomy may reduce the need for DHC.