bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 163: Underlying ICAD is associated with worse outcomes in acute large vessel occlusion undergoing endovascular thrombectomy
Authors: Morsi Rami Z. , Thind Sonam , Karrison Theodore , Lee Harrison , Nahab Fadi , Gupta Rishi , Carrión‐Penagos Julián , Awad Issam A , Coleman Elisheva , Brorson James R , McKoy Cedric , Morales Jacqueline , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass‐Hout Tareq 
Published: April 2023

Introduction
Acute large vessel occlusion (LVO) can be secondary to thromboembolism or intracranial atherosclerotic disease (ICAD). Data on LVO management due to underlying ICAD are scarce. We hypothesized that patients with ICAD have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD.

Methods
We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between January 14, 2018 and October 24, 2021. Presence of ICAD at LVO site was determined by the interventionalist. We compared in‐hospital mortality, 90‐day mortality, and 90‐day modified Rankin Scale (mRS) scores between those with and without ICAD, in unadjusted and adjusting logistic regression models.

Results
Among 215 patients (mean age 67.1±16.0 years; 60.5% female; 80.5% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥ 2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.054). In‐hospital and 90‐day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0–2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in‐hospital mortality (OR = 4.1, 95% CI 1.7‐9.7), 90‐day mortality (OR = 3.7, 95% CI 1.6‐8.6), and poor functional outcome at 90 days (OR = 5.5, 95% CI 1.6‐19.4).

Conclusions
Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT. Further research is warranted to understand factors associated with worse outcomes and investigate alternative interventional approaches and medical management in this high‐risk population.
Abstract Number ‐ 167: Predictors of Incomplete Recanalization in Mechanical Thrombectomy
Authors: Schrodt Clare E , Rodriguez Wilson , Christopher Kara , Linares Guillermo , Gordon Weston 
Published: April 2023

Introduction
Endovascular mechanical thrombectomy (MT) is a highly effective treatment for acute ischemic stroke (AIS) patients due to large vessel occlusion. Although many of these patients achieve successful recanalization, there remains a proportion of patients who fail to recanalize. Incomplete recanalization (defined as TICI 0–2a) has been associated with poor functional outcome; however, risk factors that may predispose these patients to incomplete recanalization remain unclear. We aimed to evaluate various demographic and procedural variables as predictors of incomplete recanalization.

Methods
AIS patients from 2019–2022 at our institution were reviewed. All patients who received MT for treatment were identified. Demographic characteristics including comorbidities, medications, thrombolytic use, ASPECTS, hematologic markers as well as procedural data including TICI score, time to clot, technique, occlusion location, and number of passes was assessed.

Results
One‐hundred eighty‐two patients received MT. Forty‐one patients had incomplete recanalization. History of tobacco use (aOR = 57.8, 95% CI = 5.75—581.2) and no history of HMG‐CoA reductase inhibitor use prior to hospital admission (aOR = 20.9, 95% CI = 1.58—277.1) were found to be predictors of incomplete recanalization. Baseline ASPECTS score, multiple passes with stent retriever, sex, LDL, and hematocrit count were also included in the multivariate analysis due to univariate association (p< 0.10) with the primary outcome.

Conclusions
A history of tobacco use may indicate a predisposition to difficulty in recanalizing a large‐vessel occlusion with MT. These results may also indicate a protective mechanism of HMG‐CoA reductase inhibitor use in these patients that increases the likelihood of recanalization. While successful recanalization in AIS patients due to large‐vessel occlusion has been well established in recent years to predict improved functional outcome, further investigations evaluating the characteristics of those AIS patients who are unable to be recanalized with MT are warranted.
Abstract Number ‐ 173: Mechanical Thrombectomy in Combination with Intra‐Arterial Thrombolysis for Acute Ischemic Stroke
Authors: Elfil Mohamed , Ghozy Sherief , Abbas Alzhraa S , Ghaith Hazem S , Morsi Rami , Aladawi Mohammad , Elmashad Ahmed , Villafuerte‐Trisolini Brian J , Gonzalez‐Castellon Marco , Thorell William E , Al‐Mufti Fawaz 
Published: April 2023

Introduction
Mechanical thrombectomy (MT) is the gold standard for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Although >70% of patients in the randomized clinical trials (RCTs) assessing the efficacy of MT for AIS‐LVO had successful recanalization, only up to 27% were free of disability according to the 90‐day modified Rankin scale (mRS) score. It is suggested that microcirculation disruption distal to the LVO might contribute to futile recanalization. Hence, combining intra‐arterial (IA) tissue plasminogen activator (tPA) with MT was investigated in a few studies in an attempt to reduce the burden of distal microthrombi and microcirculation disruption. We conducted this meta‐analysis to provide collective evidence in this regard.

Methods
We performed this meta‐analysis following the Preferred Reporting Items for Systematic Review and Meta‐Analyses statement recommendations. We aimed to include all original studies investigating the benefits of IA tPA in AIS patients undergoing MT.All screening and extraction stages were conducted by two authors, with a third author resolving any conflicts. Using R software, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI). A fixed‐effect model was adopted to pool all data due to the absence of significant heterogeneity among the included studies. Heterogeneity was assessed using Q statistics and the I2test, where I2> 50% or P‐value < 0.05 were considered significant.

Results
Following the database search, a manual search of references, and different screening phases, we included 5 studies (2,686 patients) satisfying the predefined inclusion criteria. Successful recanalization rates were comparable between both groups. The 90‐day functional independence was reported in 4 studies (2,474 patients), with comparable rates between both groups (OR = 1.25; 95%CI = 0.92‐1.70; P‐value = 0.154). Mortality was reported in 3 studies (368 patients), with comparable rates between both groups (OR = 0.73; 95%CI = 0.44‐1.23; P‐value = 0.240). Symptomatic intracranial hemorrhage (sICH) was reported in 5 studies (2,678 patients) with no significant difference between the two groups (OR = 0.66; 95%CI = 0.34‐1.26; P‐value = 0.304).

Conclusions
The current evidence does not show any significant differences between MT alone versus MT plus IA tPA in terms of 90‐day functional independence, mortality, and sICH. With the limited number of studies and included patients, more studies are needed to investigate the benefits and safety of the combined MT and IA tPA.
Abstract Number ‐ 200: Aneurysmal versus “Benign” Perimesencephalic Subarachnoid Hemorrhage
Authors: Alrohimi Anas , Pandhi Abhi , Abdulrazzak Mohammad A , Bain Mark , Moore Nina , Hussain Shazam , Wadden Daniel , Toth Gabor 
Published: April 2023

Introduction
Perimesencephalic subarachnoid hemorrhage (PMSAH) is characterized by bleeding centered in the basal cisterns anterior to the midbrain and pons without intraparenchymal or overt intraventricular extension. The term “benign” is often attached, because typically no source of bleeding is identified on high‐resolution vascular imaging, and recovery if often uncomplicated. Rarely, however, PMSAH can be secondary to ruptured vertebrobasilar aneurysms, and outcomes of these patients is underreported.

Methods
Retrospective analysis of patients with PMSAH to determine the rate of underlying ruptured aneurysm or vascular abnormality, associated complications, and outcomes. Age, sex, vascular risk factors, presenting symptoms, Hunt and Hess grade, modified Fisher grade, rate of underlying ruptured aneurysm, vasospasm, re‐bleed, hydrocephalus, and modified Rankin scale (mRS) were collected. Primary outcome was good functional status at discharge (mRS 0–2), reported as odds ratio (OR) with 95% confidence interval (CI).

Results
A total of 74 patients with PMSAH between 2007 and 2022 were identified. Mean age was 55.5± 10 years, and 60% were male. Hypertension and smoking were reported in 57% and 35% of patients, respectively. The most common presenting symptom was thunderclap headache in 89% of patients. Median (IQR) ofHunt and Hess grade was 2 (1‐2), and modified Fisher grade was 3 (1‐3). An underlying ruptured aneurysm was found in 3 patients (4%); two of which were in the vertebrobasilar system and one in the posterior communicating artery. Most common complications in this cohort was vasospasm in 28%, followed by hydrocephalus in 11%. Among patients with aneurysmal bleed, vasospasm and hydrocephalus occurred in 66% of patients each, compared to 8.5% and 27%, respectively in patients with non‐aneurysmal PMSAH. Re‐bleeding occurred only in one patient (1.3%); which occurred in a patient with non‐aneurysmal source of hemorrhage. A total of 88% of patients in our cohort had a favorable functional outcome (mRS 0–2) at discharge. An underlying ruptured aneurysm and acute hydrocephalus were associated with poor functional status(OR = 18.3, [1.5–228], P < 0.024), and OR = 25.8, [4.5–149], P < 0.001), respectively. However, vasospasm was noted to be asymptomatic in most cases (90%) and was not associated with unfavorable outcomes (OR = 0.75, [0.14–3.9], P < 0.73).

Conclusions
“Benign” PMSAH pattern was associated with a ruptured aneurysm in 4% of patients in our cohort.An underlying aneurysm and acute hydrocephalus were associated with poor outcomes. However, vasospasm was incidental and was not associated with unfavorable outcomes in patients with PMSAH.
Abstract Number ‐ 201: Increased Utilization of Neuro‐Endovascular Procedures: 2013–2019
Authors: Brown Nolan , Steiger Kyle , Singh Rohin , Koester Stefan , Shahrestani Shane , Stonnington Henry , Catapano Joshua , Srinivasan Visish , Gendreau Julian , Patel Naresh , Erben Young 
Published: April 2023

Introduction
Endovascular procedures have become increasingly popular in recent years due to preference of minimally invasive approaches and technological advancement.This study aims to characterize the trends in procedural rates of common neuro‐endovascular procedures performed by neurologists, neurosurgeons, and radiologists.

Methods
The Medicare Provider Utilization Database was queried from 2013 to 2019 for all primary Current Procedural Terminology codes identified by the American Medical Association as pertaining to endovascular procedures of the nervous system (61623, 61624, 61630, 61635, 61626, 61645, and 61650). Statistical analyses, including data aggregation, exploratory analysis, and propensity adjustment, were performed using R, version 4.0.1 (The R Foundation, Vienna, Austria). The two‐sided Mann‐Kendall trend test, a non‐parametric statistical test that assesses for monotonic trends in either an upward or downward trend, was utilized to assess for trends over time. A significance level of 0.05 was used.

Results
Between 2013 to 2019 a total of 40,730 endovascular procedures were performed by neurosurgeons, neurologists and radiologists treating Medicare patients. When all codes were combined, there was a significant increase in the number of procedures done by all specialists: Radiology (2013:1080; 2019:4938; p:0.02), Neurosurgery (2013:1230; 2019:4508; p< 0.01), and Neurology (2013:205; 2019:2397; p:0.04). Significant increases in mechanical thrombectomy (CPT61645) were observed in all fields: Radiology (2016:1287, 2019:3542; p< 0.01), Neurosurgery (2016:610; 2019:2326; p< 0.01), Neurology (2016:569; 2019:1951; p< 0.01). Increases in transcatheter permanent occlusion (CPT61624) were observed in neurosurgery (2013:1230; 2019:2049; p:0.04). Increases in temporary balloon artery occlusion (CPT61623) were noted in neurology (2013:21; 2019:27; p:0.04).

Conclusions
Endovascular procedures have seen a dramatic rise in utilization over a short amount of time, particularly mechanical thrombectomy. Future investigation should include more inclusive datasets beyond the Medicare population.
Abstract Number ‐ 209: Short‐ and long‐term outcomes of mechanical thrombectomy in acute ischemic stroke patients with active cancer
Authors: Yoshimoto Takeshi , Koge Junpei , Tanaka Kanta , Shiozawa Masayuki , Kamogawa Naruhiko , Kataoka Hiroharu , Koga Masatoshi , Toyoda Kazunori , Ihara Masafumi 
Published: April 2023

Introduction
We aim to investigate the difference in mechanical thrombectomy (MT) outcome for cancer‐related stroke (CRS) with active and inactive cancer.

Methods
Of the consecutive acute ischemic stroke (AIS) patients admitted to our institute from 2010 to 2021, patients with cancer who received MT within 24 hours of onset and were enrolled.Outcomes including the favorable outcome (modified Rankin Scale score of 0 to 2) at3 months, 1‐year,and death within 3 months or 1‐yearwere assessed between patients with active and inactive cancer among patients with cancer. The rate offirst pass effect (FPE, extendedThrombolysis in Cerebral Infarction[eTICI] 2c/3 after first pass) and final eTICI 2c/3 achievement were also assessed. Active cancer was defined as a cancer that was diagnosed within 6 months; required chemotherapy or surgical treatment within 6 months; or was recurrent, metastatic, or inoperable.

Results
Of 59 patients (26 women; median age, 80 years; median NIH Stroke Scale score[NIHSS] 17), 19 (32.2%) patients had an active cancer. Patients with active cancer has less atrial fibrillation (47% vs. 78%,P< 0.01) and higher medianD‐dimer(4.60μg/mLvs. 2.00μg/mL,P< 0.01). There were no significant differences in the favorable outcome at 3 months (26% vs. 45%,P = 0.26) and at 1 year (26% vs. 45%,P = 0.26) between both groups, but death within 3 months (32% vs. 5%,P< 0.01) and within 1 year (42% vs. 8%,P< 0.01) were more frequent in patients with active cancer than those with inactive cancer.

Conclusions
Long‐term clinical outcomes of patients with active cancer were worse than those with inactive cancer.
Abstract Number ‐ 239: Subcortical Infarcts in Patients with Nonstenotic Cervical Atherosclerotic Disease
Authors: Siegler James E , Kamen Scott , Vigilante Nicholas , Rana Ankit , Penckofer Mary , Hester Taryn , Oak Solomon , Patel Karan , Koneru Manisha , Thau Lauren , Sprankle Kenyon , Kim Kelly , Thomas Kavya , Zhang Linda , Wolfe Jared 
Published: April 2023

Introduction
Prior studies have elucidated a relationship between nonstenotic plaque in patients with cryptogenic embolic (cortical) infarcts, however it is unclear if nonstenotic carotid plaque is relevant in subcortical infarct patterns.

Methods
A nested cohort of consecutive patients with anterior, unilateral, subcortical infarcts without an identifiable embolic source were identified from a prospective stroke registry (September 2019 ‐ June 2021). Patients with extracranial stenosis >50% were excluded. Patients with computed tomography angiography were included and comparisons made according to infarct pattern being lacunar (single lesion < 1.5cm on computed tomography [CT] or < 2.0cm on diffusion weighted imaging [DWI]) versus cryptogenic (≥ 1.5cm on CT or ≥ 2.0cm on DWI, or scattered subcortical lesions). Prevalence estimates for cervical internal carotid artery (ICA) plaque presence were estimated with 95% confidence intervals (CI), and differences in plaque thickness and features were compared between sides.

Results
Of the 1684 who were screened, 141 met inclusion criteria (n = 80 due to small vessel disease, n = 61 cryptogenic). The median age was 66y (interquartile range, IQR 58–73) and National Institutes of Health Stroke Scale score was 3 (IQR 1–5). There was a higher probability of finding excess plaque ipsilateral to the stroke (41.1%, 95%CI 33.3‐49.3%) than finding excess contralateral plaque (29.1%, 95%CI 22.2‐37.1%; p = 0.03), but this was driven by patients with cryptogenic infarcts (excess ipsilateral vs. contralateral plaque frequency of 49.2% vs. 14.8%, p< 0.001) and not lacunar disease (35.0% vs. 40.0%, p = 0.51).

Conclusions
The probability of finding ipsilateral, nonstenotic carotid plaque in patients with subcortical cryptogenic strokes exceeds the probability of contralateral plaque and is driven by larger subcortical infarcts, classically defined as being cryptogenic. Approximately 1 in 3 unilateral anterior subcortical infarcts may be due to nonstenotic ICA plaque.
Abstract Number ‐ 251: The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm
Authors: Kim Hongbum , Park Wonhyoung 
Published: April 2023

Introduction
Pterional craniotomy is the most commonly used craniotomy for cerebral aneurysm. Surgical closed suction drains are widely used to reduce complications caused by postoperative fluid collection. However, scarce literature is available on the efficacy of surgical closed suction drains in pterional craniotomy.This study aims to investigate the influence of closed suction drains on postoperative epidural hematoma (EDH) that requires evacuation and surgical site infections (SSIs).

Methods
We performed a retrospective review of patients who underwent pterional craniotomies for cerebral aneurysm between January 2006 and December 2020 at our center. Patients were divided into subarachnoid hemorrhage (SAH) and non‐SAH groups. The differences in the incidence of EDH and SSI between patients with and without drain insertion were compared in each group. Univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with EDH and SSI, including the use of drains.

Results
Among 5,280 patients, 4,767 non‐SAH and 513 SAH patients were included. The occurrences of EDH and SSIs were not associated with drain in both non‐SAH (p = 0.549, p = 0.693, respectively) and SAH patients (p = 0.153, p = 0.093, respectively). However, longer operation time was associated with occurrence of EDH in non‐SAH patients by univariate logistic regression analysis (odds ratio = 1.01, p < 0.001).

Conclusions
There was no significant difference in the incidence of EDH requiring evacuation and SSI in the group with and without drain. Therefore, it was considered unnecessary to use drain routinely after the pterional craniotomy.
Abstract Number ‐ 255: Laser Speckle Flowgraphy As A Surrogate Marker For Symptomatic Carotid Stenosis
Authors: Jones Matthew T , Sanchez Sebastian , Patel Rishi R , Miller Jacob M , Raghuram Ashrita , Kardon Randy , Samaniego Edgar 
Published: April 2023

Introduction
The severity of internal carotid artery (ICA) atherosclerosis is assessed through measurements of degree of stenosis. This approach does not factor in mechanisms compensating for reduced distal perfusion, such as collateral circulation. An alternative approach is evaluating severity of carotid stenosis based on downstream changes in ocular perfusion. Laser speckle flowgraphy (LSFG) is a non‐invasive tool that quantifies intraocular blood flow. This pilot study investigated whether LSFG metrics could be surrogates for degree of stenosis. Additionally, we quantified changes in flow through the stenosed vessel before and after stenting usingsyngoiFlow (iFlow).

Methods
Fourteen patients had stents placed to treat symptomatic carotid stenosis. LSFG metrics were obtained before and after stenting. Mean blur rate (MBR), an index of ocular blood velocity, and associated waveform parameters were extracted from the optic nerve head (ONH) region of the eye. iFlow quantified time to peak (TTP), an index of peak cerebral contrast flow, by transforming digital subtraction angiography (DSA) images into perfusion heat maps.TTPswere extracted for seven regions of interest (ROIs) by two raters.

Results
Two LSFG waveform parameters were significantly negatively correlated with degree of stenosis. These parameters, flow acceleration index (FAI) and rising rate (RR), also increased significantly after stenting. Intraclass correlation coefficients calculated for TTPs showed substantial agreement across all ROIs. Significant decreases in TTP after stenting were observed in ROIs placed in the high cervical ICA, cavernous segment of the ICA, and brain parenchyma.

Conclusions
LSFG provides biometrics that can accurately measure the impact of ICA stenosis by quantifying distal perfusion. Indices of ocular blood flow acceleration may serve as surrogate metrics for degree of stenosis. iFlow is a sensitive tool to quantify changes in flow after stenting. Non‐invasive flow‐dependent methods are promising in the assessment of patients with ICA stenosis.
Abstract Number ‐ 259: Recanalization Before Completion of Alteplase Infusion Leads to Improved Outcomes: A Retrospective Analysis
Authors: Bach Ivo , Czap Alexandra L , Dongarwar Deepa , Sheth Sunil A 
Published: April 2023

Introduction
The recently published CHOICE trial found that intra‐arterial infusion of alteplase improved clinical outcomes in patients undergoing EVT for LVO AIS, an effect that was possibly due to a reduction in reperfusion‐related injury. Here, we examine whether intravenous alteplase, administered after successful endovascular reperfusion, results in improved clinical outcomes.

Methods
From our prospectively collected multicenter institutional registry drawn from four comprehensive stroke centers in the greater Houston area, we identified cases who underwent EVT with substantial reperfusion (TICI 2b/3) prior to termination of the intravenous alteplase continuous drip. Control patients were then identified as patients who underwent EVT with TICI 2b/3 after completion of intravenous alteplase, matching on age, baseline Modified Rankin Scale (mRS), initial NIH Stroke Scale (NIHSS), and comorbidities. The primary outcome was 90 day disability and was determined by mRS shift analysis, comparing the case and control populations.

Results
Among 21 cases and 24 matched controls, there were no significant difference between the mean age, gender, race, initial NIHSS, baseline mRS, or ASPECT score. Time from last known well to recanalization was longer in controls (48 min vs 151 min, p< 0.01). Patients who achieved reperfusion prior to termination of the alteplase continuous drip had better 90 day clinical outcomes relative to their presentation mRS when compared to patients who achieved reperfusion after termination of the alteplase. A change in mRS of 1 or less was seen in 71% vs 33% in the continued infusion group vs controls respectively.

Conclusions
Patients undergoing EVT who continued to be treated with intravenous alteplase following reperfusion had better 90d clinical outcomes relative to those with reperfusion after infusion termination. These findings further support the possible efficacy of thrombolytics following endovascular reperfusion.