bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 159: Computed Tomography Angiography Negative Spinal Artery Dissection
Authors: Ghani Mohammad R. , Roddy Eric , Liu Wei 
Published: March 2024

Introduction
Vertebral artery dissection (VAD) is a relatively common cause of ischemic stroke, especially after chiropractic neck manipulation. VAD usually can be diagnosed by noninvasive imaging studies such as CT angiography (CTA) of the head and neck with suggestive findings of an arterial string sign, arterial stenosis, a double lumen sign, a pseudoaneurysm, or an occlusion. However, in rare situations, CTA may display normal arterial caliber except for very subtle signs such as abnormal dorsal thickening of the arterial wall against adjacent fat at the V3 segment of the vertebral artery. This is referred to as the "suboccipital rind sign." Here we wish to report such a case as identified at our institution.

Methods
Electronic charts of a patient with acute spinal shock and strokes were reviewed.

Results
The patient is a 36‐year‐old female with chronic neck pain, status‐post C5‐T1 spinal fusion who presented emergently with quadriparesis that following chiropractic neck manipulation. She felt a “pop” at the neck during the neck manipulation. She shortly thereafter began experiencing persistent neck pain associated with tingling sensations of both upper extremities on her drive home. She then noted transient right‐hand weakness as she was attempting to open a package. Her symptoms then temporarily resolved with rest, but after some time the paresthesia and neck pain reoccurred, worsened, and quickly progressed to quadriplegia. Brain MRI was negative for acute stroke. However, MRI of the cervical spine demonstrated acute cervical spinal cord ischemia in addition to post‐surgical changes. CTA head and neck reported normal arterial caliber. A diagnostic angiogram was performed that showed no evidence of arterial dissection but did demonstrate absence of the anterior spinal artery. Subsequently, CTA was further reviewed on thin slice revealing a “suboccipital rind sign" of the left V3 segment, suggesting left vertebral artery V3 segment dissection. Hypercoagulable workup was negative, and the patient was treated with anticoagulation.

Conclusion
Arterial dissection is usually readily diagnosable by CTA with high sensitivity. However, a study with normal caliber vessels in the reconstituted images does not always exclude an arterial dissection. To our knowledge there have been six reported vertebral dissection cases with a normal appearing lumen on CTA or conventional angiography. However, similar to our case, they displayed “suboccipital rind” signs on CTA thin cross‐section due to the thickening of the dissected artery on the V3 segment. The V3 segment has a horizontal course which runs parallel to the axially acquired imaging plane, which makes it difficult to appreciate the classic crescentic wall hematoma associated with arterial dissection. We hope that increased awareness of the typical location and appearance of the “suboccipital rind” sign on CTA may increase the detection rates of subtle arterial dissections in the setting normal‐appearing arterial lumens.
Abstract 170: Flow Diversion for Distal Aneurysms of the Posterior Circulation: A Multicenter Retrospective Study
Authors: Dibas Mahmoud , Vivanco‐Suarez Juan , Rodriguez‐Calienes Aaron , Hanel Ricardo A. , Toth Gabor , Galecio‐Castillo Milagros , Pereira Vitor M. , Altschul David , Alva Cristian , Fifi Johanna T. , Kan Peter T. , Puri Ajit S. , Wakhloo Ajay K. , Khandelwal Priyank , Farooqui Mudassir , Ortega‐Gutierrez Santiago 
Published: March 2024

Introduction
Flow diversion (FD) has emerged as an effective treatment option for intracranial aneurysms (IAs). However, there is limited evidence regarding its safety and efficacy specifically for distal aneurysms of the posterior circulation including posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), superior cerebellar artery (SCA), and the P2 and P3 segment of the posterior cerebral artery (PCA). This study aimed to investigate the outcomes of FD for these aneurysms.

Methods
A retrospective analysis of a multicentric observational registry was performed between 2014 and 2022. Patients harboring distal aneurysms of the posterior circulation including the PICA, AICA, SCA, and PCA P2‐3 treated with FD were included. Aneurysms characteristics and outcomes were calculated for the total series and a comparison was performed between fusiform/dissecting versus saccular aneurysms. The primary outcome was complete occlusion at last imaging follow up which was defined as per the Raymond Roy occlusion scale. Additional outcomes included the retreatment rate, and thromboembolic and hemorrhagic complications

Results
Overall, 36 patients with 36 aneurysms were treated with FD with a median age in years of 60.0 (interquartile range [IQR]: 52.8‐65.3 years). Of those, 13 were fusiform/dissecting while 23 were saccular IAs. Complete occlusion was achieved in 78.1% for all IAs at a median follow‐up of 14.0 months (IQR: 9.3‐48.6 months). There was no significant difference in rates of complete occlusion between fusiform/dissecting (91.7%) and saccular aneurysms (70%, p=0.151). Thromboembolic and hemorrhagic complications were observed in four cases (11.1%), and retreatment was required for four IAs (11.4%). There was no significant difference in rates of thromboembolic and hemorrhagic complications, or retreatment between fusiform/dissecting and saccular IAs

Conclusion
This study suggests the safety and efficacy of FD for distal aneurysms of the posterior circulation. Further larger‐scale studies are warranted to confirm these findings and to explore the long‐term safety and efficacy of FD in this specific aneurysm population.
Abstract 177: Clinical and Imaging Outcomes of Ophthalmic Aneurysm Flow Diversion with or without Adjunctive Coiling
Authors: Abdulrazzak Mohammad Ammar 
Published: March 2024

Introduction
Flow diversion (FD) is commonly used for the treatment of aneurysms involving the ophthalmic segment of the carotid artery (COA). The origin of the ophthalmic artery (OA) in relation to the aneurysm sac can affect recurrence and complications. We studied the effects of COA treatment with FD alone or in combination with coil embolization, based on the origin of the ophthalmic artery in‐relation to the aneurysm sac.

Methods
Retrospective analysis of a prospectively collected tertiary center database. Based on the ophthalmic artery origin, four types of carotid ophthalmic aneurysms were previously described and implemented in this study: OA originates from Type A. directly from the aneurysm fundus, B. aneurysm neck, C. inner curve of the carotid siphon, and D. OA separate from the aneurysm. Imaging outcomes were aneurysm occlusion and OA patency at 1‐year, determined by Digital Subtraction Angiography (DSA) or MRA. Clinical outcome was treatment‐related visual complications.

Results
A total of 60 patients treated at our tertiary center between January 2017 and November 2019 were reviewed. 4 patients were lost to follow up. Clinical and angiographic data of 59 COAs treated with FD +/‐ coil embolization were available. FD alone was used in 44 (75%) aneurysms, the rest had adjunct coiling. Median age was 55. Ten (17%) patients were men. Thirty two aneurysms (55%) were Type D, 22 (37%) Type B, 5 (8%) Type A. No Type C aneurysms were identified. Overall complete occlusion rate was 82%; 94% vs 71% for adjunct coiling vs FD only, respectively. Residual filling was seen in 4 (12%) Type D aneurysms, 8 (35%) Type B aneurysms, and 1 (20%) Type A aneurysm. The ophthalmic artery was occluded at follow up in all but one patient in Type A aneurysm group (80%), 2 (7.1%) in Type D, and 6 (27%) in Type B. 6/15 (40%) of patients in the adjunct coiling group had transient and short‐lasting disturbing visual symptoms, vs 7/44 (16%) in the FD only group. No patient had long‐term visual complications. A total of 10 patients showed OA occlusion at follow up, 4 of them in the adjunct coiling group (26%). There was 1 patient (2%) with a non‐disabling stroke due to antiplatelet therapy interruption and in‐stent thrombosis.

Conclusion
Flow diversion appears safe and effective for COA treatment. Adjunct coil embolization increased COA occlusion 1 year after FD treatment without significant increase in long‐term visual complications. Adjunct coiling and ophthalmic artery origin location appear to have a significant effect on treatment result, and should be considered at treatment planning.
Abstract 191: Simulating Intracranial Stenosis: A Methodological Approach In An In‐Vitro Neurovascular Model
Authors: Tiberi Riccardo Daniel , Li Jiahui , Vargas Joan , Jablonska Magda , Cendrero Judith , Canals Pere , Molina Marc , Tomasello Alejandro , Ribo Marc 
Published: March 2024

Introduction
Intracranial atherosclerotic disease (ICAD) induces the luminal narrowing of an intracranial vessel and represents one of the major causes of ischemic strokes [1, 2, 3, 4]. In vitro 3D printed models have gained popularity in the stroke research field as they are morphologically accurate and offer the possibility to simulate clinical scenarios for training purposes or device testing. Despite being a challenge for interventionalists, to date, clinically accurate ICAD in vitro models have not been developed. We aimed to develop a 3D printed ICAD model including realistic features to provide an optimal simulation phantom for research and training purposes.

Methods
Stereolithography 3D printing technique was used to create a resin neurovascular model based on vascular anatomies extracted from anonymized CTA images. The phantom includes the aortic arch, all supraoptic cervical arteries and a complete circle of Willis up to the M2‐MCA, A2‐ACA and P2‐PCA segments. 3% sodium alginate solution was cast into a stenosis mold and crosslinked in a 40% calcium chloride. The deformable gel constituted an 8mm long replaceable stenotic segment at the level of M1‐MCA simulating an atherosclerotic plaque with a 0.5mm internal diameter. A flow sensor (ME‐8PXL, Transonic) was used to measure the lesion flow rate before and after endovascular treatment was performed under fluoroscopy.

Results
The baseline angiographic run showed an irregular 80% stenosis at the level of M1‐MCA that generated a substantial delay of contrast arrival to the distal branches. After angioplasty (Gateway PTA Balloon Catheter 3.5x20mm, Boston Scientific) and stenting (Wingspan 2.5mmx15mm, Stryker) were performed the residual stenosis was <10% (Figure 1). An initial stenosis flow rate was registered with a value of 8.5 ± 5.33 mL/min. Following the completion of the endovascular procedure, the flow sensor detected a post‐procedural stenosis flow rate of 160 ± 3.45 mL/min.

Conclusion
The developed ICAD model is anatomically accurate and offers realistic physiological and procedural features. The phantom represents an ideal tool for training purposes and a platform to test different devices for the endovascular treatment of ICAD. The methodology and materials could be applied to simulate stenotic lesions at different levels in the cervical and intracranial arteries.
Abstract 194: Impact of Pre‐treatment Cerebral Microbleeds on the Outcomes of Endovascular Thrombectomy
Authors: Elfil Mohamed , Ghaith Hazem S. , Bayoumi Ahmed , Elmashad Ahmed , Aladawi Mohammad , Al‐Ani Mina , Najdawi Zaid , Al‐Mufti Fawaz 
Published: March 2024

Introduction
Endovascular thrombectomy (EVT) is the gold standard treatment for patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and there are several factors that can influence the outcomes of EVT in AIS‐LVO patients. We conducted this meta‐analysis to investigate the effect of cerebral microbleeds (CMBs) on the functional and safety outcomes of EVT in patients with AIS caused by LVO.

Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. We included observational studies that recruited AIS‐LVO patients, used susceptibility‐sensitive magnetic resonance imaging (MRI) to detect CMBs, and examined the association between them and predefined outcome events. The outcomes of interest included functional independence, revascularization success, and hemorrhagic adverse events. We conducted a meta‐analysis using the Mantel‐Haenszel method and calculated the risk ratios.

Results
Four studies involving 1,514 patients were included. A significant reduction in the likelihood of achieving a favorable functional outcome, as measured by the modified Rankin Scale (mRS), was observed in patients with CMBs (Risk Ratio (RR) 0.70, 95% Confidence Interval (CI): 0.53 ‐ 0.91, P=0.01). No significant differences were observed between the two groups in terms of successful revascularization (RR 0.93, 95% CI [0.74 to 1.17], P=0.51), mortality (RR 0.93, 95% CI [0.74 to 1.17], P=0.51), hemorrhagic transformation (RR 0.93, 95% CI [0.59 to 1.45], P=0.74), and parenchymal hematoma (RR 1.23, 95% CI [0.79 to 1.91], P=0.35).

Conclusion
The presence of CMBs significantly reduced the likelihood of achieving a favorable functional outcome after EVT in AIS‐LVO patients. However, CMBs did not impact the rates of successful revascularization, mortality, or the occurrence of various hemorrhagic complications. Future research should explore the mechanisms of this association and strategies to mitigate its impact.
Abstract 196: Navigation Orientation of the Angled Tip of the Zoom 71 catheter around the Carotid Siphon
Authors: Litao Miguel 
Published: March 2024

Introduction
Aspiration thrombectomy has been one of the mainstays of treatment in stroke interventions. The Zoom71 (Z71) aspiration catheter is unique with its angled tip. This study describes the orientation of the angled tip as its navigated around the carotid siphon and its association with trackability.

Methods
Prospectively collected cases involving large vessel occlusions of the anterior circulation which were intervened upon using the Zoom71 aspiration catheter were retrospectively analyzed. 71 passes, among 50 patients, among 7 operators, were analyzed with respect to Zoom71 catheter tip orientation with respect to the following corners: “Corner 1”‐ posterior vertical to horizontal portion of cavernous segment, “Corner 2”‐ ophthalmic turn, and “Corner 3”‐ ICA terminus to M1. The catheter tip orientation Was described as “UP” vs “DOWN” with respect to the inner curve of each corner. We also took note of whether the tip was “caught up” in the aforementioned corners during navigation.

Results
There was no preferential angled tip orientation of the Z71 as its navigated around the carotid siphon: Corner 1 (posterior vertical to horizontal cavernous), 51% (N=36) UP vs 44% (N=31) DOWN, p= 0.54; Corner 2 (ophthalmic), 46.5%(N=33) UP vs 53.5% (N=38) DOWN, p= 0.55; Corner 3 (terminus to M1) 43.7%
(N=31) UP vs 46.5% (N=33) DOWN, p=0.63. It was not caught up in Corner 1. It got caught up in Corner 2 in 15.5% (N=11) of passes. The UP orientation at Corner 2‐ with Z71 angled tip pointing towards the ophthalmic (away from the inner curve), was associated with getting caught in 21% (7/33) of passes vs 10.5% (4/38) for the DOWN orientation though this was not statistically significant, p= 0.22. It got caught up in Corner 3 in 4.7% (N=3/64) of passes. The UP orientation at Corner 3 was associated with getting caught in 6.5% (2/31) of passes vs 3% (1/33) for the DOWN orientation, p=0.52. Usage of Z88 as guide catheter may be associated with Z71 getting caught up less in Corner 2 compared to other guide Catheters, 9.3% (4/43) for Z88 vs 25% (7/28) for “Others”, p= 0.07. This also applied to corner 3, 0% for Z88 vs 11.1% (3/24) for “Others”, p=0.038.

Conclusion
There is no preferential orientation of the angled tip of the Z71 as it navigates around the carotid siphon. The DOWN orientation may allow for better trackability around the ophthalmic turn. Usage of Z88 as guide catheter may help with Z71 trackability around the siphon.
Abstract 205: Efficacy and Safety of Mechanical Thrombectomy for Primary MeVO with Disabling Deficit
Authors: Yoshimoto Takeshi , Tanaka Kanta , Koge Junpei , Abe Siichiro , Kamogawa Naruhiko , Yoshie Tomohide , Imamura Hirotoshi , Kataoka Hiroharu , Toyoda Kazunori , Koga Masatoshi , Ihara Masafumi 
Published: March 2024

Introduction
We aimed to evaluate the efficacy and safety of mechanical thrombectomy (MT) for medium vessel occlusion (MeVO) with the disabling deficit.

Methods
The study period was from January 2011 to December 2022. Inclusion criteria were 1) within 24 hours of stroke onset, 2) prestroke mRS score ≤1, 3) NIHSS score ≥4 or disabling deficit (complete hemianopia (≥2 on NIHSS), severe aphasia (≥2 on NIHSS), visual sensory extinction (≥1 on NIHSS), significant weakness with NIHSS subscore of paralysis ≥2), 4) MeVO (MCA distal M2, M3, ACA A1, A2, A3, PCA P1, P2, and P3). Outcomes were compared between the MT and standard medical treatment (SMT) groups. Outcome was defined as the favorable outcome (mRS score 0‐2 at 90 days), death within 90 days, and symptomatic intracranial hemorrhage (SICH).

Results
Of all, 192 patients (72 women, median age 78 years, median NIHSS score 11 points) were enrolled, and 76.6% (n=147) had distal M2 occlusion. Compared to the SMT group (n=153), the MT group (n=39) had a significantly larger median Tmax>10 sec volume (median 25 mL vs. 5 mL, P<0.01) and Tmax> 6‐sec volume (61 mL vs. 44 mL, P<0.01), while median NIHSS score (13 vs. 11, P=0.69) and intravenous thrombus (51.6％ vs. 55.3%, P=0.72) were significantly lower in the MT group. There were significantly more patients in the MT group with a favorable outcome (73.7% vs. 54.1%, adjusted odds ratio 2.59 95% confidence interval 1.07‐6.24), death within 90 days (7.9% vs. 3.1%), SICH (5.3% vs. 4.4%) were not significantly different. In subgroup analysis, MT was independently associated with age (<80 years; 1.33, 1.21‐15.57, P=0.222) and neurological severity (NIHSS ≥10 points; 2.79, 1.07‐7.24, P=0.870) for a favorable outcome.

Conclusion
In MeVO with disabling deficits, MT was independently associated with more favorable outcomes than the SMT group.
Abstract 209: Incidence and outcome of perforations during medium‐vessel occlusion compared to large‐vessel occlusion thrombectomy
Authors: Psychogios Marios 
Published: March 2024

Introduction
Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during MeVO thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and LVO thrombectomy and to report on the procedural steps that led to perforation.

Methods
In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 01, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (i.e. modified Rankin Scale 0‐2) and all‐cause mortality at 90 days. Binomial test, chi‐squared test and t‐test for unpaired samples were used for statistical analysis.

Results
During 25,769 thrombectomies (5,124 MeVO, 20,645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p < 0.001). More MeVO than LVO patients with perforation achieved functional independence at three months (25.7% vs 10.9%; p=0.001). All‐cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent‐retriever/aspiration catheter were the two most common procedural steps that led to perforation.

Conclusion
In our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent‐retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.
Abstract 215: A Sweet Indicator: HbA1C and Thrombectomy Outcomes in Hispanics
Authors: Khalil Zorain M. , Miller Samantha D. , Abualnadi Yazan D. , Desai Sohum K. , Sadiq Kaiser O. , Tekle Wondwossen G. , Hassan Ameer E. 
Published: March 2024

Introduction
There is a higher prevalence of diabetes mellitus type 2 in Hispanics as compared to other ethnic groups in the United States. Diabetes is a risk factor for acute ischemic stroke and also a poor predictor of outcome for many interventional surgeries. We performed this retrospective cohort analysis to assess the impact of poorly controlled diabetes, defined as HbA1C of 9.0% or greater, on the functional and procedural outcomes of Hispanic patients with acute ischemic stroke undergoing mechanical thrombectomy.

Methods
We conducted a retrospective review of a prospectively maintained patient database at a large volume comprehensive stroke center. Patients included were of Hispanic origin presenting between 2012 and 2022 who underwent thrombectomy for acute ischemic stroke. Baseline patient demographics and clinical characteristics recorded include age, gender, HbA1C level, National Institutes of Health Stroke Scale (NIHSS) at admission, manual CT ASPECTS and stroke risk factors (hypertension, atrial fibrillation, coronary artery disease, congestive heart failure, LDL, smoking, history of stroke/TIAs). Patients were separated into two groups depending on the presence poorly controlled diabetes defined as an HbA1C of 9.0% or greater. Outcomes evaluated include modified Rankin scale at 3 months, symptomatic intracranial hemorrhage, mass effect, 90‐day mortality, and whether any stenting or angioplasty was required during mechanical thrombectomy.

Results
495 patients met the inclusion criteria out of which 69 had HbA1c of 9% or greater. Patients with poorly controlled diabetes were significantly younger (median age 63 vs 72, p <0.001), had a lower prevalence of atrial fibrillation (7.69% vs 29.8%, p <0.001) and a higher median LDL level (95.5 vs 72, p<0.001) compared to patients who did not have poorly controlled diabetes. Median NIHSS on admission was also lower in the poorly controlled diabetics group (13 vs 17, p = 0.02).
There was a statistically significant lower rate of functional independence (mRS 0‐2) at 90 days in patients with poorly controlled diabetes (30.6% vs 45.3%, p=0.05) after adjusting for age, NIHSS, and atrial fibrillation. Patients with poorly controlled diabetes also were more likely to require angioplasty (31.3% vs. 20.5%; p = 0.048) and stenting (28.4% vs. 18.1%; p = 0.049) during mechanical thrombectomy.

Conclusion
High HbA1c levels upon admission may be used to predict poor functional outcomes of thrombectomy and may also be associated with a greater chance of patients requiring angioplasty and/or stenting during thrombectomy. This can assist the physician in deciding if thrombectomy should be done on a patient with poorly controlled diabetes.