bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 217: Influence of CT Perfusion on Decision‐Making for Endovascular Thrombectomy in Distal Occlusions: A Multi‐center Analysis
Authors: Mehta Amol , Ballekere Anjan N. , Iyyangar Ananya S. , Abdelkhaleq Rania , Azeem Hussain , Le Ngoc M. , Sheth Sunil A. 
Published: March 2024

Introduction
There is increasing interest in performing endovascular thrombectomy (EVT) for distal occlusions. Decision making for distal and medium vessel occlusions (DMVO) is variable and factors associated with undergoing the treatment at present remain incompletely characterized.

Methods
From our prospectively maintained multi‐center registry encompassing four comprehensive stroke centers in the greater Houston area, we identified patients with DMVO acute ischemic stroke (AIS). Patients with occlusions in and beyond the M2 segment, A2 segment, and P2 segment were included. The primary outcome was the likelihood of undergoing EVT, which was analyzed using multivariable logistic regression. We adjusted for time of day of presentation, NIHSS score, ASPECTS, and TPA administration, with the primary independent variable being whether CTP was used in the patient’s evaluation. Secondary outcomes included discharge modified Rankin Scale (mRS), dichotomized 0‐3 vs. 4‐6

Results
Among 269 patients with distal occlusions, the median age was 68 (IQR 18), median NIHSS score was 12 (IQR 11), 47.2% were female, and 39.4% received TPA. The most common occlusion locations were M2 (77.7%) followed by P2 (9.7%), and 12.6% comprised the remainder of the occlusions. 166 (61.7%) underwent CTP and 37.9% underwent EVT. Median infarct core on CTP was 18.8 cc and penumbra was 83.1 cc. In multivariable analysis, patients evaluated with CTP were less likely to undergo EVT (OR 0.56 [95% CI ‐1.11;‐0.02]). CTP usage was also associated with a non‐significant reduced likelihood of good discharge outcome (OR 0.59, [95% CI 0.33;1.02]).

Conclusion
In our multi‐center cohort, patients with DMVO screened with CTP were nearly 50% less likely to undergo EVT. While the modality may assist with occlusion detection, it may also influence whether treatment is offered.
Abstract 227: Combined Technique Versus Stent‐Retriever Alone: Angioarchitectural and Technical Analysis
Authors: Tarek Mohamed A. , Martins Pedro N. , Mohammaden Mahmoud H. , Monteiro Mateus Damiani , Grossberg Jonathan A. , Dolia Jay C. , Pabaney Aqueel , Nogueira Raul G. , Haussen Diogo C. 
Published: March 2024

Introduction
Combined technique mechanical thrombectomy with contact aspiration with stent‐retriever has been shown to lead to comparable final reperfusion rates compared with stent retriever alone. We aimed to explore if anatomical and technical features could have interaction with the chances of reperfusion by each technique.

Methods
Retrospective analysis of a prospective mechanical thrombectomy (MT) database. Inclusion criteria: anterior circulation large vessel occlusion(LVO) due to carotid terminus or proximal MCA(M1) occlusion, first‐line stent‐retriever (SR) alone or combined technique (SR plus aspiration), and angiographic run with stent in place. The primary analysis was the interaction between clinical and angiographic characteristics and first‐line MT modality on first‐pass effect (FPE; first‐pass eTICI2c‐3). Secondary analyses aimed to evaluate predictors of FPE.

Results
A total of 150 patients were included in the analysis (SR alone,n=62 vs. combined technique, n=88). Demographics, vascular risk factors and NIHSS were comparable between groups. The SR group had higher IV‐tPA use (41.9%vs.26.1%,P=0.04), higher rates of FPE(64.5%vs.47.7%,P=0.04) but similar baseline ASPECTS, CTA collateral score, clot burden, as compared to the combined technique. Anatomical and technical variables (reperfusion channel, SR position in dominant MCA division, angle of interaction, diameter of stent proximal to clot, diameter of stent distal to clot, type of extracranial carotid or cavernous carotid tortuosity, clot length were comparable between both groups. None of the anatomical and technical factors were found to have an interaction with the modality (SR alone vs combined technique) on the chances of FPE (Pinteraction >0.05)(Figure). FPE was observed in 54.6% of the entire cohort. Multivariable analysis showed that use of IV‐tPA(OR 156.5,95%CI 4.59‐5334.8,P=0.005), lower angle of interaction (OR 0.94,95%CI 0.89‐0.99,P=0.03), presence of reperfusion channel (OR 145.8,95%CI 1.96‐108277.4),P=0.02), higher clot burden score (OR 8.17,95%CI 1.38 ‐48.21,P=0.02), type‐3 cavernous ICA tortuosity (OR 0.001,95%CI 0‐0.23,P=0.01) were independently associated FPE.

Conclusion
We could not identify any anatomical or technical features that predisposed to a benefit in adding catheter aspiration to SR thrombectomy. IV r‐TPA, clot burden score, presence of reperfusion channel, type of cavernous carotid tortuosity, and angle of interaction were found independently associated with FPE. Large sample studies are warranted.
Abstract 234: Antithrombotic use in Emergent Cervical Carotid Artery Stenting in Thrombectomy
Authors: Mahmoud Noor A. 
Published: March 2024

Introduction
Current literature suggests a benefit in functional outcomes and reperfusion rates when carotid artery stenting (CAS) and mechanical thrombectomy (MT) are performed emergently. However, rates of symptomatic intracranial hemorrhages have been inconclusive. Antithrombotic protocols used in CAS and MT tend to be heterogenous among physicians. There is no standardized data on antithrombotic therapy use during CAS and MT procedures with less associated rates of symptomatic hemorrhagic transformation. We aimed to compare the efficacy and safety of antithrombotic use in patients requiring CAS and MT. Additionally, we sought to analyze clinical and mortality outcomes in CAS and MT retrospectively at our institution.

Methods
We searched for patients who underwent emergency cervical ICA stent placement and intracranial thrombectomy with stent‐retriever and/or aspiration devices in our institution between 2019‐2023. Clinicoangiographic and antithrombotic data were analyzed. Good clinical outcomes were a < 4 points of NIHSS at 24 hours, mRS (0‐3) at 90 days, and disposition to home or inpatient rehabilitation. Characteristics of hemorrhagic transformation (HT) according to the European Cooperative Acute Stroke Study (ECASS). Clinical, radiographic, and mortality outcomes were described.

Results
Twenty‐seven patients were treated. The mean age was 64 years, nine females: mean occlusion time 400 minutes, mean fluoro time 32 minutes. Fourteen patients received IV tissue‐type plasminogen (tPA) activator. The admission NIHSS score mean was 16. Stent placement was feasible in all cases. Thrombolysis in Cerebral Infarction score of 2B was achieved in 18 patients (66.7%); the rest had a TICI 3 score. Twelve patients had improved 4 NIHSS points between admission and 24 hours. Dual antiplatelet therapy with aspirin and clopidogrel was used in 15 patients before stenting. While six patients received aspirin and ticagrelor, and the rest received eptifibatide drip. Seven (26%) patients had symptomatic intracranial hemorrhages. Antithrombotic type of treatment had no significant association with bad outcomes (p‐value: 0.872), neither did IV tPA use (p‐value: 0.853). Fourteen patients had good clinical outcomes (mRS 0‐3) at discharge, while eight died. At 90 days follow‐up, the median mRS was 3.

Conclusion
Our analysis suggests no significant association between symptomatic hemorrhagic transformation with IV tPA or heterogenous antithrombotic use. Our retrospective study has several limitations, including sample size and heterogeneous pathology. Larger studies are needed to stratify symptomatic hemorrhages' high‐risk profile in CAS and MT.
Abstract 236: Effects of intravenous thrombolysis on thrombectomy outcomes: a systematic review and meta‐analysis
Authors: Tolba Hatem , Bilgin Cem , Ghozy Sherief , Kobeissi Hassan , Hassankhani Amir , Senol Yigit , Arul Santhosh , Kadrivel Ramanathan , Kallmes David 
Published: March 2024

Introduction
Efficacy and safety of intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) is still debatable. However, IVT's efficacy on stent retriever (SR) and aspiration thrombectomy (ASP) outcomes specifically remain unclear. In our meta‐analysis, we aimed to explore the effects of IVT on SR and ASP thrombectomy outcomes.

Methods
A systematic literature review was steered using Medline, Embase, Scopus, Web of Science, and Cochrane Center of Clinical Trials databases, according to PRISMA guidelines. Outcomes of interest included successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b), functional independence (modified Rankin Scale (mRS) ≤2), modified first pass efficacy (mFPE), symptomatic intracranial hemorrhage (sICH), and embolization to new territories (ENT).

Results
We included four randomized controlled trials with 1176 patients. SR and ASP had similar mTICI ≥2b, mFPE, and mRS 0‐2 rates whether they received IVT or not. SR without IVT was associated with a lower rate of mFPE compared with the SR+IVT (RR 0.85, 95% CI 0.74 to 0.97). Additionally, ASP without IVT resulted in a lower rate of mRS 0‐2 than the ASP+IVT (RR 0.78, 95% CI 0.60 to 1.01). Finally, bridging therapy did not increase sICH and ENT rates after ASP or SR thrombectomy.

Conclusion
Our analysis suggests that SR and ASP thrombectomy have equivalent efficacy and safety outcomes regardless of prior IVT administration. Moreover, our results indicate that administration of IVT before MT may improve certain outcomes based on the used first‐line MT technique.
Abstract 258: Comorbidities Associated with Exclusion from rtPA in Obese Ischemic Stroke Patients with History of Smoking
Authors: Brewer Philip C , Ojo Dami T , Garg Sahil , Broughton Philip X , Nathaniel Thomas I 
Published: March 2024

Introduction
Recombinant tissue plasminogen activator (rtPA) is the only approved treatment for acute ischemic stroke (AIS) patients, however, only a minuscule percentage of patients receive rtPA [1, 2]. In some cases, the reason for patients' exclusion from rtPA is due to risk factors and comorbidities [1, 2]. Research has been conducted previously on rtPA exclusion in obese AIS patients as well as AIS patients with a history of smoking [3, 4, 5, 6]. However, little is known regarding the comorbidities associated with exclusion from rtPA in obese AIS patients with a history of smoking. ​
Therefore, a discussion surrounding these patients is warranted in order to better identify AIS patients who require special management in order to be eligible for rtPA. We hypothesize that the comorbidities associated with rtPA exclusion in obese AIS patients with a history of smoking will differ from comorbidities associated with rtPA exclusion in obese AIS patients or AIS patients with a history of smoking.

Methods
Retrospective data on demographic and clinical risk factors of obese AIS patients with a history of smoking was collected from a large stroke center from January 2010 to December 2016. Univariate analysis was used to differentiate between risk factors and demographics associated with exclusion and inclusion from rtPA. Variables in the univariate analysis were further analyzed using logistic regression. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each clinical risk factor were used to predict the increasing odds of an association of a specific clinical baseline risk factor with exclusion or inclusion from rtPA.

Results
In the adjusted analysis, Obese AIS patients with a history of smoking excluded from rtPA were more likely to present with CAS (OR = 0.069, 95% CI, 0.011‐0.442), diabetes (OR = 0.604, 95% CI, 0.366‐0.997), higher total cholesterol (OR = 0.975, 95% CI, 0.956‐0.995), history of drug and alcohol use (OR = 0.438, 95% CI, 0.232‐0.828). Higher NIHSS score (OR = 1.051, 95% CI, 1.017‐1.086), ambulation improvement (OR = 2.230, 95% CI, 1.423‐3.496), higher triglycerides (OR = 1.004, 95% CI, 1.001‐1.006), and higher HDL (OR = 1.028, 95% CI, 1.000‐1.057) were associated with Obese AIS patients that received rtPA.

Conclusion
Our findings reveal specific risk factors or comorbidities that contribute to the exclusion of Obese AIS patients with a history of smoking from rtPA. Specifically, a history of diabetes and higher total cholesterol were associated with rtPA exclusion in obese AIS patients with a history of smoking. These associations were not significantly correlated with rtPA exclusion in the populations of obese AIS patients or AIS patients with a history of smoking. These findings suggest the need to develop management strategies to improve the use of rtPA in obese AIS patients with a history of smoking.
Abstract 263: Cocaine Use and Acute Ischemic Stroke: Determining TOAST Etiology & Infarct Locations
Authors: Kothari Sachin , Desai Harsh , Behera Anit , Morsi Rami Z. , Carrion‐Penagos Julian , Smith Matthew , Coleman Elisheva , Kass‐Hout Tareq , Brorson James , Prabhakaran Shyam , Mendelson Scott J. 
Published: March 2024

Introduction
Cocaine‐induced vasospasm of small vessels has long been proposed as a mechanism for ischemic stroke (1). However, there are limited studies to date that have classified cocaine‐related ischemic strokes under a subtype of the Trial of ORG 10127 in Acute Stroke Treatment (TOAST) criteria. This study aims to describe cocaine‐related ischemic strokes by TOAST criteria, treatment, and clinical outcome.

Methods
A retrospective review was performed to identify patients with acute ischemic stroke and a positive cocaine urine toxicology screen at our stroke center from June 2020 – May 2022. Baseline demographics, urine toxicology, National Institute of Health Stroke Scale (NIHSS) scores, neuroimaging, TOAST criteria, location of stroke, home medications, comorbidities, medical management, and in‐patient outcomes were collected. Data analysis was conducted on IBM SPSS Version 28.

Results
A total of 74 patients were identified to have a positive cocaine status on admission with a diagnosis of new strokes. The mean age was found to be age 60.8 years old with a majority male population at 73.0% (54/74). Seventy‐eight percent (58/74) were found to be cocaine positive on admission with the remaining endorsing a history of cocaine use. The most common category under the TOAST criteria was large artery atherosclerosis 39.2% (29/74). Among the cocaine‐positive cohort, 10.8% (8/74) of patients received thrombolytics. Most patients had intracranial atherosclerotic disease (46/74, 62.2%) on imaging and in the area of the stroke (41/74, 55.4%). Overall mortality was low (72/74, 97.3%) and modified Rankin score (mRS) at discharge was less than 3 for 59.5% (44/74) of patients.

Conclusion
Our data suggests that although cocaine may contribute to small vessel disease, cocaine‐related ischemic strokes may have a higher association with large artery atherosclerosis. This study highlights the importance of future larger studies to investigate atherosclerosis as a contributor to cocaine‐induced ischemic strokes.
Abstract 267: A Bibliometric Analysis of Tenecteplase Research Utilizing a Commonly Used Citation Index
Authors: Huang Brendan 
Published: March 2024

Introduction
Tenecteplase is increasingly being used as a first‐line treatment for acute ischemic stroke after several randomized studies demonstrated its safety and efficacy, resulting in a massive increase in the number of published studies on this topic. Our aim was to investigate the most impactful authors and relevant journals that have been instrumental in validating this treatment, in hopes of identifying objective research trends that may assist scientists, health organizations, and funding agencies to collaborate and plan future avenues of research.

Methods
Using the search terms “Tenecteplase” and “Tenecteplase” AND “Stroke,” 2,683 and 1,150 references were queried, respectively, using the Abstract 20and citation database, Scopus. Scopus Citation Analysis was used to categorize the countries and authors who produced the most research. Metadata was retrieved and transferred to bibliographic visualization software, VOSviewer, for co‐authorship and co‐occurrence analyses to identify trends in tenecteplase research.

Results
Data visualization software identified three tenecteplase research clusters – myocardial infarction, pulmonary embolism, and acute ischemic stroke. Our bibliographic analysis graphically identified that ischemic stroke currently leads both myocardial infarction and pulmonary embolism in annual publications pertaining to tenecteplase therapy, and further pinpointed perfusion imaging and wake‐up strokes as the most relevant areas of study. The United States led all countries in tenecteplase publications, including exclusively stroke studies. The European Heart Journal led all journals in overall publications, while Stroke led all journals in stroke‐related studies.

Conclusion
Through the use of bibliographic analysis and data visualization, we identified major articles and journals that reflected and shaped the current landscape of tenecteplase; recognized authors who engaged in tenecteplase research as it progressed from cardiopulmonary disease to stroke; and postulated future avenues of research.
Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up
Authors: Chintaluru Yaswanth S , Atchaneeyasakul Kunakorn , Liaw Nicholas , Fukuda Keiko , Mendez Aldo , Kuybu Okkes , Desai Shasvat , Pinheiro Agostinho , Jadhav Ashutosh , Fitzgerald Kathryn C , Gross Bradley , Narayanan Sandra , Nogueira Raul , Lang Michael 
Published: March 2024

Introduction
The 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. A prior published analysis of national trends after one year in mechanical thrombectomy use and outcomes for stroke before and after publication of the 2015 US guideline update showed improved functional outcomes and lower peri‐procedural mortality. We analyze the national trends in mechanical thrombectomy use and outcomes for stroke five years after publication of the US guideline update.

Methods
We analyzed the National Inpatient Sample from 2012‐2019. ICD‐9 and ICD‐10 codes identified Ischemic stroke and mechanical thrombectomy patients. Similar to the previous study, discharge to home was the primary efficacy outcome measure in this study since it strongly correlates with mild degree of disability at discharge and 3 months post‐stroke. Safety outcomes include in‐hospital medical complications and mortality. We utilized multivariate logistic regression to assess outcomes.

Results
From 2012‐2019, 4,003,405 individuals with a diagnosis of ischemic stroke were recorded, 103,605 (2.6%) of which were treated with mechanical thrombectomy, proportionally increased from 4,910/452,905 (1.1%) in 2012 to 26,365/552,780 (4.8%) in 2019. The proportion of endovascular thrombectomy performing hospitals nearly doubled during the study period from 2012 (295/4,378; 6.7%) to 2019 (582/4,568; 12.7%). Odds of a mild disability outcome increased from 16% to 20%, OR 0.65 (0.57, 0.74), while mortality decreased from 15% to 12%, OR 0.69 (0.61, 0.78). Compared with 2012‐2014, the 2015‐2019 cohort showed increased odds of ICH and shock while the odds of DVT, pulmonary embolism, pneumonia, and UTI were significantly lower. The presence of septicemia, shock, and cardiac arrest were unchanged.

Conclusion
The number of large vessel occlusion stroke patients receiving mechanical thrombectomy treatment in the United States is increasing rapidly each year after the 2015 US guideline update. As the use of mechanical thrombectomy expands, included patients have more medical complications at baseline, but experience fewer complications, peri‐procedural mortality and overall improved outcomes.
Abstract 282: Understanding Current Organizational Strategies to Support Physician Well‐Being in Stroke, Neurocritical Care, and Neurointerventional Practice
Authors: Kothari Sachin A. , Castonguay Alicia , Guerrero Waldo , Asif Kaiz S. , El‐Ghanem Mohammad , Kumar Ashish , Abraham Michael , Dumitrascu Oana , Ramos Romario , Pandya Dhruvil J. 
Published: March 2024

Introduction
Burnout in medicine is an occupational hazard and has emerged as a pressing concern in recent years. Organizational changes can be impactful in countering burnout (1). The factors leading to burnout in medicine are multifaceted, encompassing organizational factors such as workload, inadequate support, and inefficient administrative systems. The purpose of this study is to investigate current organizational measures to support physician well‐being. This study was an initiative led by the SVIN wellness committee.

Methods
A 39‐question online survey investigating current organizational well‐being practices was distributed to physicians both nationally and internationally practicing stroke, neurocritical care, and interventional neurology. Data analysis was performed using Python, utilizing the libraries “pandas” and “sklearn”.

Results
This study analyzed burnout among 109 healthcare professionals, predominantly from the U.S. (93.6%) and Canada (6.4%). The majority were neurointerventional specialists (53.2%), aged 35‐44 years (52.3%), and male (62.4%). Burnout frequency was measured on a 0 (Never) to 4 (Every day) scale.
Using a Random Forest model, the study identified key burnout predictors from questions, which covered organizational leadership, wellness resources, compensation, and workload. The most influential predictors were: adequacy of compensation relative to specialty, workload, and stress (17.7% importance); leadership accountability for workforce wellbeing (9.1%); and establishment of wellness or burnout as a critical metric (7.5%). Other factors included provision of wellness screenings (7.1%), and dedication of resources toward professional well‐being (4.9%).

Conclusion
The study identifies compensation, leadership accountability, and wellness resources as key predictors of burnout among healthcare professionals. These findings highlight the need for targeted organizational strategies to enhance physician well‐being and mitigate burnout. Further research is warranted to validate and expand upon these findings.
The Status of Music in Islamic Law: Ibn Ḥajar al-Haytamī’s (d. 974/1567) Treatise Against Recreation in its Polemical Context
Authors: _ _ 
Published: March 2024

Abstract
Kaff al-raʿāʿ ʿan muḥarramāt al-lahw wa-l-samāʿ is an influential treatise on the legal status of music and other recreational activities written by the Shāfiʿī Ibn Ḥajar al-Haytamī (d. 974/1567) in 958/1551. This article offers the first analysis of this “treatise against recreation”. Ibn Ḥajar al-Haytamī argues for the impermissibility of most musical activities on the basis of the Qurʾan and Hadith, the consensus of the ʿulamāʾ (particularly from his Shāfiʿī school), and the incompatibility of recreation (lahw) and piety. These arguments are forged in response to claims found in more permissive texts by the Ẓāhirīs Ibn Ḥazm (d. 456/1064) and Ibn al-Qaysarānī (d. 507/1113) and the Mālikī Muḥammad al-Shādhilī al-Tūnisī (d. 882/1477). I suggest that it is Ibn Ḥajar’s negative attitude to lahw that underlies his restrictive views on music, highlight the gendered element in this attitude, and observe that attitudes to recreation are not interchangeable with affiliation to Sufism.