bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 127: Poly(vinyl alcohol) grafts of brain aneurysms with patient‐specific morphologies
Authors: Gopal Megha , Gopal Megha , Wong Robert , Sloutski Aaron , Dashti Reza , Rafailovich Miriam , Sadasivan Chander 
Published: April 2023

Introduction
Current animal models of brain aneurysms used for testing neuro‐interventional devices have highly simplistic vascular anatomy in comparison with human aneurysm‐parent vessel complexes. Poly(vinyl alcohol) (PVA) is a leading biomaterial for manufacture of artificial vascular grafts because of its biocompatibility, hemocompatibility, availability, low cost, moldability/castability, and tunable mechanical properties to match arterial compliance [1,2]. However, PVA is non‐cell adhesive and requires modification with additives to promote endothelialization of the luminal surface to maintain long‐term graft patency [1,3]. We have previously studied the biocompatibility of resorcinol bis(diphenyl phosphate) (RDP) coated clays blended with polymers and have found excellent cell adhesion and proliferation with human dermal fibroblasts as well as dental pulp stem cells [4]. Our overall goal is to develop a new in vivo model of brain aneurysms by manufacturing patient‐specific aneurysm anatomies with a blend of PVA and RDP clay and grafting them into animals. Here, we evaluate the casting of PVA in the shape of patient‐specific aneurysms.

Methods
10% PVA (w/w) (99% hydrolyzed, 85–124K molecular weight, Sigma Aldrich) was dissolved in deionized water, to which 1% RDP clay (ICL Industrial Products, Be’er Sheva, Israel) was added. The PVA was crosslinked using 15% (w/w) of sodium trimetaphosphate and 30% (w/w) of sodium hydroxide, after which rheological studies (stress sweeps using a Bohlin Gemini rheometer) were conducted. In the casting procedure, negative molds of both simple tubes and complex aneurysm geometries were designed using Rhinoceros 3D software (Robert McNeel & Associates, Seattle, WA) and 3D printed in ABS plastic. The negative mold was then filled with beeswax, resulting in a positive wax mold that was dip‐coated 8 times in PVA solution, and spun on a two‐axis spinner in between each dip to ensure even coverage. After overnight drying in a fume hood, the model was placed in heated water, allowing the wax to melt out and leaving behind the luminal PVA cast.

Results
Rheology on the crosslinked polymers showed that the PVA/RDP blend exhibited over twice the elastic modulus of unblended PVA (Figure A). Such enhanced mechanical properties are consistent with previous studies [5]. Both simple tubular geometries and patient‐specific anatomies were able to be successfully cast using the methodology developed here (Figure B).

Conclusions
This proposed casting methodology demonstrates a realistic, efficient way to replicate complex aneurysm geometries with comparatively inexpensive materials and short time frame. Future endeavors will include further exploration of the PVA/RDP biocompatibility as well as completing the casting procedure with a PVA/RDP blend.
Abstract Number ‐ 131: Microsurgical Clipping and Endovascular Treatment of Paraclinoid Aneurysms: A Systematic Review and Meta‐Analysis
Authors: Borjas‐Calderón Nagheli Fernanda , Rodriguez‐Calienes Aaron , Zila‐Velasque J. Pierre , Grados‐Espinoza Pamela , Terry‐Escalante Fernando , Malaga Marco , Vivanco‐Suarez Juan , Chavez‐Malpartida Sandra , Moran‐Mariños Cristian , Ortega‐Gutierrez Santiago 
Published: April 2023

Introduction
Paraclinoid aneurysms (PAs) have traditionally been treated with clipping. However, with the emergence of new techniques, endovascular treatment (EVT) has supplanted surgical treatment in recent years. We aimed to determine the safety and efficacy of EVT and microsurgical clipping for PAs.

Methods
A systematic review was performed in Scopus, Embase, Medline, Web of Science, and Cochrane from inception to March 2022 for all studies that tested the safety and efficacy of EVT or microsurgical clipping of PAs. Efficacy outcomes included complete aneurysm occlusion at last follow‐up, immediate complete occlusion, and an mRS 0–2 at last follow‐up. Safety outcomes included mortality, intraoperative and postoperative complications. We performed a random‐effects meta‐analysis of proportions and assessed the statistical heterogeneity across studies with I2 statistics.

Results
Eighty‐nine studies included 6496 patients, 3682 treated with EVT and 2814 with microsurgical clipping. Immediate complete occlusion rates were 92% (95% CI 88 – 96%; I2 = 60%) and 46% (95% CI 34 – 59%; I2 = 93%) for clipping and EVT, respectively. The rate of complete occlusion at last follow‐up was 94% (95% CI 91 – 96%; I2 = 0%) and 69% (95% CI 63 – 74%; I2 = 79%) for microsurgical clipping and EVT, respectively. Among EVT studies, the rate of complete occlusion was 54% (95% CI 48 – 59%; I2 = 50%), 52% (95% CI 39 – 64%; I2 = 73%), and 77% (95% CI 54 – 91%; I2 = 91%) for primary coiling, stent‐assisted coiling, and flow diversion, respectively. Among clipping studies, the rate of last follow‐up mRS 0–2 was 86% (95% CI 76 – 92%; I2 = 72%). Among EVT studies, the rate of last follow‐up mRS 0–2 was 94% (95% CI 86 – 98%; I2 = 93%). Mortality rate was 4% (95% CI 3 – 7%; I2 = 57%) and 1% (95% CI 0 – 3%; I2 = 0%) for clipping and EVT, respectively. Among EVT studies, the mortality rate was 3% (95% CI 1 – 6%; I2 = 0%) and 3% (95% CI 1 – 9%; I2 = 39%) for primary coiling and flow diversion, respectively. Intraoperative and postoperative complications were present in 9% (95% CI 6 – 14%; I2 = 68%) and 21% (95% CI 17 – 26%; I2 = 87%) among clipping studies, respectively. Intraoperative and postoperative complications were present in 6% (95% CI 4 – 9%; I2 = 64%) and 9% (95% CI 6 – 13%; I2 = 72%) among EVT studies, respectively.

Conclusions
In conclusion, microsurgical clipping and EVT for PAs are both safe and effective treatment modalities. Treatment via either approach should be determined on a case‐by‐case basis and according to institutional experience and resources.
Abstract Number ‐ 136: Aspirin Desensitization in Cerebral Aneurysms and Management for the Neurointerventionalist
Authors: Saund Amardeep , Lehnerer Parisa , Fatteh Shahnaz , Ajiboye Norman 
Published: April 2023

Introduction
Aspirin (ASA) is the pillar of cerebrovascular and systemic vascular disease management. ASA allergy/hypersensitivity presents a challenge to the NeuroInterventionalist due to difficulties achieving optimum medical management prior to and after neurointerventional treatment. Currently there is vast cardiovascular literature describing successful ASA desensitization protocols, however the same cannot be said for neurointervention.The purpose of our study was to describe our experience with ASA hypersensitivity management in cerebrovascular disease and review of the relevant literature in patients with aneurysms. We present two cases of patients with cerebrovascular aneurysms requiring neurointervention with a pipeline embolization device who were successfully desensitized to their ASA hypersensitivity prior to treatment and the different variables encountered/approach for each patient.

Methods
N/A

Results
37 yo F with history of pre‐eclampsia while pregnant with twins presented with complaints of a severe headache 22 days after delivery and on MRA head and neck had unruptured bilateral paraclinoid para‐ophthalmic internal carotid artery aneurysms. She was placed on Brilinta instead of Plavix due to subtherapeutic PruTest. She underwent successful endovascular coil embolization of the unruptured RIGHT paraclinoid para‐ophthalmic internal carotid artery aneurysm. Post coil embolization she underwent desensitization in the ICU for ASA under the care of the ICU physician and the allergist; 1mg, 5mg, 10mg, 20mg, 45mg ‐ each given 30 min apart. The protocol was followed by ASA 81mg the next morning and had successful endovascular flow diversion with Pipeline Flex Embolization Device for LEFT paraclinoid para‐ophthalmic internal carotid artery aneurysm. 71 yo F with history of uncontrolled HTN. During her hypertensive work‐up was found to have an approximately 6 mm unruptured right internal carotid artery aneurysm on CTA. She was successfully desensitized to ASA and optimized with Aspirin and Brilinta. She underwent successful endovascular flow diversion with Microvention FRED X Flow Diverter of the unruptured medially directed right paraclinoid ophthalmic segment internal carotid artery aneurysm.

Conclusions
There are few reports of ASA desensitization in patients with cerebral aneurysms ‐ due to this there are few established set protocols. We describe our protocol for high risk patients and post‐op management of patients undergoing neurointerventional procedures.We report these 2 case reports to help add to the current literature of ASA desensitization utilization in patients with CNS aneurysms and may help create more standardized protocols.
Abstract Number ‐ 137: Delayed aneurysmal rupture of a giant fusiform vertebrobasilar aneurysm after flow‐diversion embolization with adjunctive coiling
Authors: Granstein Justin H , Campos Jessica K , Himstead Alexander S , Wang Alice S , Zhang Angie , Granstein Justin H , Yuki Ichiro , Suzuki Shuichi 
Published: April 2023

Introduction
Vertebrobasilar aneurysms carry a high risk of operative morbidity and high mortality risk with rupture. Treatment with flow diversion embolization has gained popularity. While adjunctive coiling may lower the risk of delayed aneurysm rupture (DAR), DAR can occur during stent endothelialization. describe a case of DAR following flow diversion with adjunctive coil embolization of a giant vertebrobasilar aneurysm and review the literature to further characterize this phenomenon.

Methods
PubMed was queried using search terms: “delayed,” “aneurysm,” “rupture,” “flow diverter,” “flow diversion,” and “flow diverting stent” yielding 220 results. There were 47 studies describing 89 patients with DAR after flow diversion.

Results
A forty‐five‐year‐old male presented with posterior fossa compression symptoms secondary to a 30‐mm fusiform basilar artery aneurysm, which grew during short‐interval follow‐up to 35 mm. The patient consented to endovascular embolization. Tri‐axial catheter access system was used to deploy seven telescoping flow diverters from the basilar tip to the intradural left vertebral artery, and nine coils were subsequently deployed in the aneurysm dome. The right vertebral artery was coil embolized. The procedure was uncomplicated and the patient was continued on dual‐antiplatelet therapy. Four weeks later, the patient became unresponsive with absent brainstem reflexes, workup revealed diffuse subarachnoid hemorrhage with intraventricular hemorrhage. Digital subtraction angiography demonstrated contrast extravasation at the aneurysm neck. He succumbed to his neurological injury two days later. Out of 89 patients with DAR after flow diversion, only 3 occurred in fusiform basilar aneurysms treated with adjunctive coil embolization. Only one case, a 37.1‐mm aneurysm treated with 3 flow diverters with adjunctive embolization, occurred at greater than 30 days post‐intervention.

Conclusions
This case highlights the need to better characterize the role of adjunctive coiling with flow diversion for large or giant aneurysms, and to better understand risk factors related to delayed aneurysm rupture.
Abstract Number ‐ 149: Mechanical stent retriever thrombectomy of distal medium vessel occlusiono in acute ischemic stroke.
Authors: Lodi Yahia M , Reddy Varun V , Singh Amrinder , Khan Irfan 
Published: April 2023

Introduction
Randomized clinical trial (RTC) have demonstrated benefit of stent retriever mechanical thrombectomy (SRMT) of large vessel occlusion (LVO) in acute ischemic stroke (AIS) including with those present in 24 hours. However, trials have included predominately proximal middle cerebral artery (MCA, M1) and current recommendation is to perform SRMT in M1/M2. Therefore, AIS patients with distal medium vessel occlusion (DMVO)) with high NIHSS has no recommendation or options leading to disabilities. Objective of our study is to present the safety and feasibility of SRMT of DMVO who underwent SRMT. Additionally, we will describe technical aspect including their clinical and radiographic outcomes.

Methods
From a stroke‐endovascular databased, consecutive patient with SVO underwent SRMT from 2015–2022 were selected. Patient demographics including recanalization data with clinical and radiographic outcomes were collected.

Results
7 patients (4 female) with median age of 65.66 (range 41–86), median NIHSS of 13 (range 7–19) and median ASPECT 8 (7‐10) presented with SVO; right M3 in 2 and left M3/M4 in 5 patients. Of 7 DMVO patients, one presented in 4 hours and receives intravenous rTPA, 2 presented in 12 hours and 4 presented in unknown time of onset but last known normal was 24 hours. One of the left M3/4 patients was a singer who (41 years old) absolutely do not wanted to be alive if she didn’t regain her speech. Similarly, another 42‐year‐old woman with left M3/4 clot was teacher wanted her speech restored for teaching. Endovascular strategies: all but one received rectal 300 mg aspirin and 500 ml normal saline bolus. Under conscious sedation, 8 French balloon catheters were used in all cases and the guide was flushed with heparin and nitroglycerine mixed saline. Solitaire SRMT in 5 cases (4×20 in 1 and 4×40 in 6 cases) and trevo in one (3×20 mm). Patient with solitaire SRMT required single pass in which trap technique (suction through CAT6 and retriever of SRD as a unit without shaving of clots) was utilized using CAT6 132 mm catheter 6 cases and Trevo SRMT required 3 passes. All achieved TICI 3 recanalization without complications. Outcomes: immediate post STMT, median NIHSS 2 (0‐6), 24 hours median NIHSS 1 (1‐6) and 90 days NIHSS 0 for all. 90 days mRS0 in 4, mRS1 in 1 and mRS2 in 1. 24 hours CT scan demonstrated small stroke in 2 patients. One patient lost follow up. 41‐year‐old singer immediately regained her speech after SRMT discharged home in 36 hours. 42‐year‐old teacher improved her speech and continue to teach.

Conclusions
Our case series demonstrated that SRMT in DMVO with disabling NIHSS is feasible and safe if performed carefully. All patient achieved TICI 3 perfusion and first pass effect was better in trap technique using long solitaire STD. Good function outcomes were achieved in all cases irrespective of the types of SRD used and passes required to achieve TICI 3 perfusion. Further studies are required.
Abstract Number ‐ 161: Comparing Stroke Thrombectomy Outcomes In Younger V/S Older Population
Authors: Chandra Rahul , Pandhi Abhi , Kharal Abbas , Bain Mark , Moore Nina , Hussain M. Shazam , Toth Gabor 
Published: April 2023

Introduction
Large vessel occlusion (LVO) is estimated to account for up to 39% of all ischemic strokes with 62% of them resulting in post‐ischemic stroke dependency and 96% of all post‐ischemic stroke mortality. Advanced imaging modalities and efficient stroke systems of care have resulted in faster reperfusion times. There is however limited data on the outcomes of thrombectomy as a function of age. We present a retrospective analysis on thrombectomy in younger (age 18–49 years) versus older (age >50 years) patients.

Methods
Retrospective single center study with population being identified using our procedural database and “SlicerDicer” tool on EPIC from 2017–2021. Patients who underwent mechanical thrombectomy were divided into 2 groups based on age. Younger group consists of patients between the ages 18–49 while older group is 50 and over. Primary outcome of the study was to identify good clinical outcome as defined by mRS of 0–2 in both groups. Secondary outcomes included rate of favorable reperfusion defined by TICI 2b‐3, symptomatic ICH and mortality rate.

Results
> We have identified 48 patients between the age of 18–49 and 436 over the age of 50. > We found that median groin puncture to repercussion time was lower in younger population (32 v/s 69 mins; p = 0.0044) > The median groin puncture to first pass time was lower in younger population (22 v/s 43; p = 0.056), but it failed to show statistical significance. > Younger compared to older patients had better clinical outcomes (mRS 0–2) at 77.1% v/s 32.3% (p< 0.0001) and higher rates of favorable repercussion (TICI 2b‐3) at 93.7% v/s 72.9% (p = 0.0016) > The older group required more passes to achieve recanalization (4 or more passes: 4.3% v/s 16.2%; p = 0.035) > Mortality rate was significantly less in the younger population (8.3% v/s 22.1%; p = 0.026)

Conclusions
Younger patients had better clinical outcomes than their older counterparts after mechanical thrombectomy in our analysis. Other than younger age, higher rates of favorable repercussion, earlier recanalization, and less passes to recanalization were seen in association with better observed outcomes.
Abstract Number ‐ 168: Conventional angiography versus non‐invasive imaging in the assessment of symptomatic carotid disease
Authors: Khalife Jane , Padron Zachary , Oliveira Renato , Jovin Tudor 
Published: April 2023

Introduction
The indication for carotid endarterectomy in symptomatic carotid stenosis of 50% or more was established based on catheter angiography. Yet, in practice, operative referral is still largely based on non‐invasive imaging. We sought to determine the discrepancy between the two modalities in our retrospective cohort.

Methods
We retrospectively collected data from consecutive symptomatic patients between 2019 and 2021 at our institution who were referred for evaluation and possible stenting of carotid disease based on non‐invasive imaging showing moderate to severe stenosis or occlusion. All patients underwent digitally subtracted angiography (DSA) and were treated with stenting if there was stenosis of 50% or above or if there was presence of a string sign. Otherwise, they were continued on best medical therapy.

Results
98 total patients were referred for evaluation of carotid disease (Median age 60, 37% women). 21/98 were found to have a carotid occlusion on non‐invasive imaging, of those, 6 (28%) were found to have a string sign on CTA and were treated with stenting. 77/98 were found to have moderate to severe carotid artery stenosis based on non‐invasive imaging. Of those, 31 patients (40%), were not found to have significant carotid artery stenosis and were not treated with stenting. Out of total 99 patients who were referred for carotid intervention based on non‐invasive imaging, 38 (40%) patients had a change in the treatment plan.

Conclusions
40% of the patients who were referred for revascularization based on non‐invasive imaging had a change in the treatment after conventional catheter angiography. Larger studies are warranted to confirm our findings.
Abstract Number ‐ 180: A Novel Internet Platform for Neurovascular Research Collaboration and Funding
Authors: McDonough Rosalie V , Mayank Arnuv , Saver Jeffrey L , Ganesh Aravind , Hill Michael D , Fladt Joachim C , Ospel Johanna M , Goyal Mayank 
Published: April 2023

Introduction
The current neurovascular research funding environment is highly competitive, stifling collaboration and hindering progress. Further, specific groups of researchers/research topics are disproportionately affected, resulting in inequity in the funding process. These include early‐career researchers, women, and researchers from low‐middle income countries. Certain conditions, e.g., rare, stroke‐related diseases are due to their low prevalence not suitable for clinical trials, and therefore even less likely to receive funding. Currently, there is no easy way for people working on such topics to come together and collaborate. To address this problem, a novel internet‐based platform, Collavidence (www.collavidence.com), was designed. The idea is to complement current systems of neurovascular research collaboration and funding for more inclusive, efficient, and impactful research results. The aim of this study is to present the initial performance of the platform in achieving this goal.

Methods
Analytics on pre‐defined user‐, project‐, and interaction‐based metrics will be performed to describe the level of platform engagement in the initial months following launch. These include the number of users and projects posted, the amount of funding accumulated, the proportion of successfully funded projects, and the iterative improvement of the proposals. Further, the relative engagement of early‐career, female researchers, and researchers from low‐middle‐income countries will be assessed.

Results
A qualitative assessment of the value of the overall platform, the process of iterative review, and possibilities for collaboration will be presented. Further, trends in platform engagement during the initial 3 months, including the relative distribution of specific user demographics to assess the platform’s success in encouraging equity, diversity, and inclusion, will be presented.

Conclusions
This study will assess the feasibility and initial success of Collavidence as a unique platform for neurovascular research collaboration and funding.
Abstract Number ‐ 183: pcASPECTS can help predict clinical outcome in basilar artery occlusion strokes who undergo endovascular thrombectomy
Authors: Ansari Junaid , Canadas David , Sheikh Mohammad Abdurrehman , Kandregula Sandeep , Abushehab Nimer , Degueure Arielle , Gaudet Alexandra , Rezayev Arthur , Caskey Joshua , Chappidi Maithreyi , Angellete Alexis , Sharma Pankaj , Cuellar‐Saenz Hugo 
Published: April 2023

Introduction
Basilar artery occlusion (BAO) is a life‐threatening condition associated with high morbidity and mortality. The clinical effectiveness of endovascular therapy (EVT) in patients with stroke due to BAO is not well established. The objective of our study is to investigate the role of Posterior circulation Acute Stroke Prognosis Early CT Score (pcASPECTS) in predicting clinical outcome in patients with BAO who undergo EVT.

Methods
We conducted a retrospective analysis on 45 patients with acute BAO who received EVT from November 2015 to June 2022. Information was collected on demographic variables, medical history, clinical parameters, and CT based pcASPECTS on admission. Functional outcomes were assessed via binarization of the following variables: the modified Rankin scale score on discharge, NIH stroke scale on discharge, and the modified Rankin scale score 90 days following discharge. A series of logistic regression models adjusted for age, gender, atrial fibrillation, systolic blood pressure at admission, tPA receipt, and NIH stroke scale on admission were run to assess the association of pcASPECTS score on admission with binarized outcome measures.

Results
Among 45 patients (mean age 63.6+11.4 years, 73.3% males), binarized pcASPECTS score on admission (< 7: greater severity, >7: lower severity) was not shown to be significantly associated with functional outcome across a series of logistic regression models. When assessing for binarized modified Rankin scale at discharge (0‐3: good outcome, 4–6: poor outcome), a lower severity of pcASPECTS showed 5.47 times the odds of a good outcome (OR: 5.47; 95% CI: 0.17, 173.25; p‐value: 0.34). When assessing for binarized NIH stroke scale on discharge (0‐15: mild/moderate; >15: severe), a lower severity pcASPECTS showed 6.05 times the odds of a mild/moderate outcome as opposed to a severe outcome (OR: 6.05; 95% CI: 0.32, 114.62; p‐value: 0.23). When assessing for a modified Rankin scale at 90 days post‐discharge, binarized as above, a lower severity pcASPECTS showed 4.36 times the odds of a good outcome (OR: 4.36; 95% CI: 0.27, 69.40; p‐value: 0.30).

Conclusions
Our study revealed that pcASPECTS on admission may help predict clinical outcomes in patients receiving EVT for BAO and therefore could be used as a guide for medical and endovascular management. These findings have far‐reaching applicability but will require larger studies to confirm significant clinical benefit.