bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 7: Final Angiographic, Clinical and Thrombus Composition Results of 1000 Patients in the EXCELLENT Registry
Authors: Nogueira Raul G , Andersson Tommy , Yoo Albert J , Hanel Ricardo A , Zaidat Osama O , Hacke Werner , Jovin Tudor , Fiehler Jens , De Meyer Simon F , Brinjikji Waleed , Doyle Karen , Liebeskind David S , Haussen Diogo , Inoa Violiza , Humphries William , Woodward Keith B , Jabbour Pascal M , Francois Olivier , Bozorgchami Hormozd , Levy Elad I , Boor Stephan , Cohen Jose , Dashti Shervin R , Taqi Muhammad A , Budzik Ronald F , Schirmer Clemens M , Hussain Shazam , Estrade Laurent , De Leacy Reade A , Puri Ajit S , Chitale Rohan V , Brekenfeld Caspar , Siddiqui Adnan H 
Published: April 2023

Introduction
EXCELLENT (NCT03685578; Cerenovus) is a large, prospective, international, real‐world registry of endovascular clot removal in acute ischemic stroke (AIS) with EmboTrap as the first line mechanical thrombectomy (MT) device, which included collection and analysis of the retrieved thrombus material.

Methods
Between September 2018 and March 2021, 1000 “all‐comer” patients were enrolled at 34 global sites (27 US, 5 EU, 1 UK, 1 Israel) and treated according to standard of care at each center (with Embrotrap as first line). The study employed blind endpoint evaluation, including a core imaging lab and an independent 90‐day mRS assessment. Retrieved clot was collected per each MT maneuver from 538 subjects across 26 sites and clot analysis was performed by independent central labs blinded to clinical data.

Results
mITT population included 998 subjects. Mean age was 69.9±14.18 years (range 18–102), 51.8% (517/998) subjects were female and 9.9% (97/997) had a pre‐stroke mRS 3–5. Baseline NIHSS was 15.6±6.87 (range 0–36); 10.1% (82/815) subjects had a large core (ASPECTS 0–5); 5.8% (57/990) had posterior stroke; 56.3% (523/929) underwent MT ≤ 6hrs of onset and 38.1% (380/998) received IV‐tPA prior to MT. First pass eTICI 2c‐3 was achieved in 38.3% (377/984) and final 2b‐3 in 94.5 % (930/984; median number of passes = 1) of subjects. 90‐day mRS≤2 or ≤pre‐stroke was 46.9% (429/915) and 90‐day all‐cause mortality was 19.0% (175/921). The univariate analysis of clot components showed high red blood cell and low platelet content were significant predictors of good mRS outcome (p < 0.001 and 0.009) and negative predictors of 90‐day mortality (p < 0.001 and 0.017, respectively).

Conclusions
This large multi‐center, all‐comer cohort reflects the population undergoing thrombectomy today in a real world‐setting. Final angiographic, clinical and thrombus composition results, along with multivariate analysis of predictors of clinical outcomes, will be presented at the time of the conference.
Abstract Number ‐ 20: Predictors of Outcomes for Patients with Malignancy and Acute Ischemic Stroke Undergoing Endovascular Therapy
Authors: Dawod Giana , Desai Harsh , Lin Ning , Boddu Srikanth , Knopman Jared , Navi Babak B , Ramos Alexander 
Published: April 2023

Introduction
Patients with active cancer face an increased risk for stroke. Randomized trials studying the efficacy of endovascular therapy for patients with large vessel occlusions generally excluded patients with cancer. Herein, we sought to better understand predictors of outcome for active cancer patients undergoing mechanical thrombectomy for acute ischemic stroke.

Methods
We conducted a retrospective cohort study of stroke thrombectomy cases performed at our institution from January 2010 to November 2021. Baseline clinical characteristics (age, gender, cancer type, use of anticoagulation, NIHSS, use of tPA, time to reperfusion) were recorded. Study outcomes were successful endovascular reperfusion (≥ TICI 2b) and poor clinical outcome, defined as inpatient death or disposition to hospice. Pearson Chi‐square test and Fisher’s exact test were used to analyze categorical variables, and Mann‐Whitney U tests were used for continuous variables. Multivariable logistic regression analyses were performed to evaluate for independent associations between baseline characteristics and study outcomes.

Results
Between 2010–2021, we identified 49 patients with active cancer who underwent mechanical thrombectomy for stroke. Their mean age was 63 years (SD, 12), and 43% were men. The leading cancer types were lung (33%) and colorectal (14%). Successful reperfusion was achieved in 78% (95% CI, 66–90%) of patients, and 49% (95% CI, 34–63%) ultimately had a poor clinical outcome. Multivariable analyses yielded no significant predictors for successful reperfusion, while higher NIHSS (1.03, 95% CI, 1.01‐1.06, p = 0.011) and higher cancer stage (1.19, 95% CI, 1.04‐1.34, p = 0.014) were found to be predictors for poor clinical outcome.

Conclusions
The link between cancer and stroke has become increasingly appreciated. As tPA is often contraindicated in cancer patients with stroke because of recent bleeding or anticoagulant use, thrombectomy may be the only intervention to preserve one’s quality of life. However, we found that despite a high successful reperfusion rate, nearly half of these patients died or were made hospice during the index hospitalization. Future studies should investigate the reasons for poor clinical outcomes in these patients and whether different antithrombotic, blood pressure, or anti‐neoplastic strategies after thrombectomy could improve outcomes.
Abstract Number ‐ 21: Mechanical Thrombectomy versus Medical Management in Patients with acute LVO and Pre‐morbid Disability: Meta‐analysis
Authors: Galecio‐Castillo Milagros , Rodriguez‐Calienes Aaron , Vivanco‐Suarez Juan , Zevallos Cynthia B , Ortega‐Gutierrez Santiago , Farooqui Mudassir 
Published: April 2023

Introduction
Actual guidelines offer little guidance for endovascular treatment of patients with acute ischemic stroke (AIS) and pre‐morbid disability (PMD). Often, patients with a mRS >2 are not considered for mechanical thrombectomy (MT) and might not be given the best chance of achieving recovery. Three recent meta‐analysis have showed conflicting results regarding the benefit of MT, while persistently showing a significant increase in mortality.

Methods
We conducted a systematic search in Embase, Medline, and Web of Science for studies of patients with AIS and PMD who were treated with MT or MM. We included all definitions of PMD, main outcomes were favorable functionality at 90‐days (mRS 0–2 or return to baseline mRS), symptomatic ICH, and mortality. We performed meta‐analyses using a random‐effect model, and I2 to evaluate heterogeneity. Subgroup analyses were used when appropriate.

Results
2 studies contained data comparing PMD patients treated with MT versus MM, 14 studies contained data only of patients treated with MT, and 10 only of patients treated with MM; they provided data of 1071 patients in the MT group and 4547 in the MM group. Pooled rates in the MT group were 28% (95% CI 0.24‐0.32) for favorable functionality, 7% (95% CI 0.04‐0.12) for sICH, 43% (95% CI 0.36‐0.51) for 90‐days mortality, 18% (95% CI 0.14‐0.23) for intra‐hospital mortality, and pooled reperfusion rate (mTICI 0–2) of 80% (95% CI 0.72‐0.86). In a meta‐analysis of proportion with the treatments modalities as subgroups, including only studies with a similar definition of PMD, we obtained: for favorable functionality, MT = 26% (95% CI 0.23‐0.30) vs. MM = 35% (95% CI 0.22‐0.51); for sICH, MT = 6% (95% CI 0.05‐0.08) vs. MM = 6% (95% CI 0.05‐0.08); for 90‐days mortality, MT = 48% (95% CI 0.44‐0.52) vs. MM = 34% (95% CI 0.27‐0.41); and for in‐hospital mortality, MT = 18% (95% CI 0.14‐0.23) vs. MM = 22% (95% CI 0.17‐0.28). Additionally, meta‐analysis for 90‐days mortality in MT studies, showed a pooled rate of 49% (95% CI 0.45‐0.53) for the high tPA rate subgroup, and 30% (95% CI 0.19‐0.44) for the low tPA rate subgroup.

Conclusions
Up to one third of PMD patients who undergo MT might achieve favorable functionality, without increasing the risk of sICH and with rates similar to those obtained with MM. Furthermore, we observed a high 90‐day mortality rate, in both MT and MM groups. In subgroups exploration, there is trend of high tPA rates to be associated with the increased mortality. It is urgent to identify PMD patients who will benefit from MT and factors associated with poor outcomes.
Abstract Number ‐ 34: Basal ganglia infarct volume and risk of hemorrhagic transformation after endovascular thrombectomy
Authors: Regenhardt Robert W , Bonkhoff Anna K , Schirmer Markus D , Das Alvin S , Dmytriw Adam A , Vranic Justin E , Gupta Rajiv , Rabinov James D , Stapleton Christopher J , Patel Aman B , Rost Natalia S 
Published: April 2023

Introduction
As more large vessel occlusion stroke patients are treated with endovascular thrombectomy (EVT), understanding the pathophysiology of reperfusion injury and the risks of hemorrhagic transformation (HT) are increasingly important. Pre‐EVT infarct topography may have implications for acute interventional treatments such as stenting, and post thrombectomy care such as antithrombotic choice. We sought to quantify region‐specific volumes of infarcted tissue on pre‐EVT MRI, understand their importance for HT, and identify associations with clinical and imaging characteristics.

Methods
Patients with pre‐EVT MRI were identified retrospectively from a prospectively maintained database. Each patient’s diffusion weighted sequence underwent manual infarct delineation and was registered to a standard space for overlay with cortical, subcortical, and white matter atlases. Structure‐specific lesion volumes were determined. HT was defined as PH1 or PH2 hemorrhage by ECASS criteria. Variables with p< 0.10 in univariate analyses were included in multivariable models. Logistic regression was performed for associations with hemorrhagic transformation and linear regressions for infarct volumes.

Results
165 participants [median age 69 years (interquartile range, IQR 56–79), 56% women] were identified. Risk factors included hypertension (70%), diabetes (20%), atrial fibrillation (34%), and prior stroke/TIA (13%). 52% were treated with intravenous alteplase; 70% achieved TICI 2b‐3 reperfusion. HT occurred in 8%. Pre‐EVT infarct volumes [median (IQR)] were 22 cc (12‐43 cc) for total, 11 cc (6‐19 cc) for white matter, 5 cc (1‐19 cc) for cortex, and 3 cc (1‐6 cc) for basal ganglia. Pre‐EVT infarcts [median (IQR)] were made up of 48% (38‐60%) white matter, 23% (6‐47%) cortex, and 15% (4‐28%) basal ganglia. Paramagnetic sequences showed 3% had petechial hemorrhage and 40% had susceptibility vessel sign. Basal ganglia infarct volume was independently associated with HT (OR = 1.342, 95%CI = 1.002,1.797) in a model including white matter infarct volume, cortex infarct volume, smoking, and puncture‐recanalization time. Basal ganglia infarct volume was linked to susceptibility vessel sign (Beta = 0.233, p = 0.006) and NIHSS (Beta = 0.220, p = 0.012), when controlling for total infarct volume.

Conclusions
In this cohort, greater basal ganglia infarct volume was associated with a higher risk of hemorrhagic transformation, even when accounting for infarct volume in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery thrombus occlusion of perforators. These findings require further study in larger cohorts.
Abstract Number ‐ 66: Symptomatic Chronic Internal Carotid Artery Occlusion Managed With Bilateral Common Carotid Angioplasty: A Case Report
Authors: Frade Heitor Cabral , Banerjee Pankhuri , Abdullah Danny , Rane Schweta , Patel Anand , Chhabra Arun , Memon Muhammad Z , Shaltoni Hashem 
Published: April 2023

Introduction
Several guidelines have addressed symptomatic or asymptomatic carotid artery stenosis treatment with intensive medical management and surgical management based on the severity of stenosis [1]. In acute occlusions, endovascular treatment (EVT) and carotid endarterectomy (CEA) with or without prior thrombolytics provide the best recanalization and functional outcomes when compared to intravenous or intra‐arterial thrombolysis alone. There is, however, less robust evidence on management of symptomatic chronic internal carotid artery (ICA) occlusion occurring in tandem with significant contralateral ICA stenosis [2]. In chronic ICA occlusion (ICAO), EVT and carotid endarterectomy (CEA) are technically unfeasible, but indirect procedures have been arising as safe and effective alternatives, notably CEA or stenting of contralateral stenotic ICA [3] and CEA or stenting of ipsilateral external carotid artery (ECA) [4]. We hereby report a case of symptomatic chronic ICAO that was managed with staggered angioplasty and stenting of bilateral common carotid artery (CCA) bifurcations.

Methods
We hereby present a case report.

Results
A 62‐year‐old male with atrial fibrillation and hypertension woke up with sudden dysarthria and right upper extremity and facial weakness. NIHSS at presentation was 4. Last seen normal 9 hours prior. Non‐contrast head computerized tomography (CT) did not show acute intracranial abnormality, CT angiogram of head and neck showed severe right ICA stenosis and complete occlusion of the left ICA at cervical, petrous and cavernous segments, with distal reconstitution at the supraclinoid segment with left proximal middle cerebral artery (MCA) thrombus. CT perfusion showed a core infarct volume of 8cc in left MCA territory, mismatch volume of 78cc and ratio of 10.8. Risks of acute neuro‐intervention were deemed to outweigh benefits. Given favorable perfusion imaging, and in concordance with the EXTEND trial [5], tPA was administered. The patient remained stable without hemorrhagic complications with residual deficits of mild right upper extremity weakness and mild expressive aphasia. MRI confirmed left ICA territory ischemic infarcts. Patient underwent stenting of the asymptomatic right ICA at the CCA bifurcation first, followed by left CCA stent after one month with impressive improvement in subsequent perfusion imaging.

Conclusions
Our case encourages consideration of well‐timed angioplasty and stenting in cases of chronic bilateral carotid artery disease especially when the asymptomatic side is also significantly stenotic
Abstract Number ‐ 68: Thrombectomy Through Persistent Trigeminal Artery In A Patient With P2 Occlusion: Case Report
Authors: Kashif Zain , Yashar Parham , Khatibi Kasra 
Published: April 2023

Introduction
Mechanical thrombectomy for distal medium vessel occlusions (DMVO) of the posterior circulation has been shown to be safe and technically feasible. Additionally, mechanical thrombectomy through a persistent trigeminal artery (PTA) for occlusions near the superior bifurcation of the basilar artery has been described before. However, the safety and efficacy of such procedures for DMVO remain unclear. We present a case of thrombectomy through a Saltzman type 1 PTA in an acute P2 occlusion.

Methods
A woman in her 80s with atrial fibrillation was admitted after undergoing a thrombectomy for a left M1 occlusion. Two days post‐procedure, she developed a right P2 occlusion with severe motor deficit secondary to thalamic hypoperfusion. She underwent mechanical thrombectomy through a right PTA. A balloon guide catheter (BGC) was placed in the right internal carotid artery (ICA). Initially, a 4F catheter over a 0.014 microwire was introduced but failed to navigate through the PTA. Afterward, the system was exchanged for a 5F aspiration catheter over a 0.021 microcatheter and 0.014 microwire which successfully tracked up through the PTA to the face of the clot. Aspiration alone was attempted initially, followed by the combined technique of aspiration with stent‐retriever.

Results
Our initial attempt to navigate the 4F catheter over the microwire through the PTA and up the basilar artery was unsuccessful as it continued to herniate into the cavernous ICA. Switching to the triaxial approach with the 5F catheter over the microsystem allowed navigation to the clot, however, aspiration alone was not sufficient to recanalize the occlusion and led to significant vasospasm which later self‐resolved. Instead, the combined technique resulted in successful thrombectomy with no untoward emboli into the right anterior circulation. The post‐procedural MRI showed multiple, scattered infarcts which were not evident on the MRI after the patient’s initial M1 thrombectomy. These infarcts involved the cerebellar and cerebral hemispheres bilaterally as well as the right thalamus. There was no evidence of subarachnoid hemorrhage on MRI. The patient continued to have significant left‐sided hemiparesis and could not be extubated, at which point the decision was made to transition to comfort measures until she passed.

Conclusions
Mechanical thrombectomy of a posterior circulation DMVO through a Saltzman type 1 PTA using the combined technique can be performed safely and effectively.
Abstract Number ‐ 76: Bow hunter’s syndrome‐ a rare case of hearing loss associated with co‐dominant vertebral artery compression
Authors: Miremadi Brian B , Alexopoulos Georgios , Coppens Jeroen 
Published: April 2023

Introduction
Bow hunter’s syndrome (BHS), also known as rotational vertebral artery syndrome, refers to symptomatic vertebrobasilar insufficiency (VBI) caused by mechanical compression and severe stenosis or occlusion of the vertebral artery (VA) during neck and head rotation. Etiologies include bony spurs and osteophytes, or hypertrophic muscles and ligaments compressing typically on the dominant vertebral artery. Upon turning their head, patients experience posterior circulation symptoms such as vertigo, dizziness, syncope, nausea, tinnitus, or headache. These patients are at risk of stroke due to repetitive mechanical damage to the vessel and thromboembolism. [1] We present a rare case of BHS associated with hearing loss that was caused by bony spurs compressing on a left co‐dominant vertebral artery seen on turning head to both sides.

Methods
A woman in her 50s presented with sporadic progressive episodes of dizziness which started about 4 years. In addition, she reported experiencing episodic tinnitus in her left ear, frequent headaches, neck pain, and syncopal episodes. She was diagnosed with severe left ear sensorineural hearing loss (SNHL). Vestibular therapy and multiple neuropathic medications (nortriptyline, gabapentin) only provided her with minimal relief.

Results
Examination showed left SNHL and neck tenderness. X‐ray of cervical spine showed bony hypertrophy adjacent to the dens and inferior to the anterior arch of C1, suggestive of large osteoarthritic bony spurs. CT angiogram showed narrowing of the left vertebral artery at C1 due to severe hypertrophic arthropathy of the lateral mass articulation. It also showed impingement of the left VA in the left transverse foramen. The intradural portion of the VA (V4) appeared to be co‐dominant with normal size. Dynamic cerebral angiogram revealed near occlusion of the left VA at the level of C1‐C2 with head to the right. Left VA remained patent in neutral position, and experienced reduction in flow with head rotation to the left. The dynamic stenosis of VA caused by mechanical compression upon head turn leading to VBI, and reversal of stenosis when rotating head to neutral position was consistent with diagnosis of Bow hunters syndrome.

Conclusions
This case report highlights a rare presentation of VBI caused by dynamic stenosis of VA as a sequela of mechanical compression of a co‐dominant VA upon head turn to both sides. Only about 2% of the BHS patients experience symptoms during head turn to both sides [2], which was the finding in our patient. Furthermore, this case illustrates an association between BHS and SNHL. Hearing loss is previously described in vertebral artery atresia [3]; however, we present a novel association between acquired BHS and SNHL. Although we could not prove the causality, the coexistence of the two conditions in this patient may help to elicit further clinical consideration and evaluation in patients with SNHL of unknown etiology.
Abstract Number ‐ 77: A Large Vessel Occlusion in Short Gut Syndrome‐ An Acquired Catastrophe of Hyper‐Homocysteinemia
Authors: Pervez Hira , Oostra Drew , Robbins Sarah , Rao Rahul 
Published: April 2023

Introduction
Strokes secondary to large vessel occlusions (LVO) are frequently caused by either atherosclerotic or thromboembolic sources (1). Both genetic and acquired etiologies can lead to elevated serum homocysteine levels causing LVO as recognized in our patient (2). Measuring homocysteine levels and vitamin B12, B6, and folate replacement can reduce the future risk of stroke by ∼25% (3).

Methods
A 42‐year‐old male with acute onset right‐sided facial droop, ataxia, gait instability, nausea, and vomiting. PMH: 11 weeks preterm with subtotal colectomy and short gut syndrome, and mild hypertension. No family h/o blood clots. LKW: >24 hours, initial NIHSS 6, required rapid sequence intubation with repeat NIHSS 28, decreased responsiveness, non‐reactive pupils, and ventilatory compromise. PE: decreased arousal and depressed mentation, facial asymmetry, flaccid right upper and lower extremity.

Results
Non‐contrast head CT: a hyperdense basilar artery (fig 1). CT angiogram of head and neck: Left vertebral artery stenosis with diminutive basilar artery. A diagnostic cerebral angiogram with mechanical thrombectomy was performed with TICI 2b recanalization (fig 2). A subsequent MRI brain further confirmed an acute bi‐cerebellar and left pontine ischemic infarct with diffusion restriction on DWI and ADC reversal (fig 1). Lab work: B12 < 50, homocysteine 50.08, methylmalonic acid 38,038, and folate wnl. A transthoracic, transesophageal ECHO with bubble study and a lower extremity doppler ruled out peripheral sources of stroke. He developed malignant cerebral edema requiring decompressive sub‐occipital craniectomy with external ventricular drain (EVD) placement and remained in the Neuro ICU until discharge.

Conclusions
•A build‐up of hcy (an intermediate product of methionine and cysteine metabolism) can occur de novo via or iatrogenically •This can cause arterial occlusion leading to ischemic strokes and venous thrombosis as seen in our patient. •Serial monitoring of Hcy, MMA, and replacing the deficient vitamins like B12, B6, and folate in these patients can help prevent the chance of ischemic CNS injuries