bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 118: Compressive Vertebrobasilar Dolichoectasia: A Rare Etiology of Acute Pontine Ischemic Stroke Undeterred by Anticoagulation
Authors: Asif Ahmer , Singh Raman , Shoaib Maria , Al‐Awwad Ahmad 
Published: April 2023

Introduction
Dolichoectasia is a term used to describe dilated, elongated and tortuous arteries due to defects within the medial layer of their walls secondary to loss of elasticity. Multiple pathophysiological processes might lead to the development of dolichoectatic vessels, and activation of metalloproteinases and irregular turbulent blood flow seem to cause irreversible disruption of the internal elastic lamina. Consequences often include mass effects and ischemic and hemorrhagic stroke. Blood flow within dolichoectatic arteries is turbulent predisposing to thrombus formation with resultant ischemic strokes. Ideally, with optimal anticoagulation therapy, such strokes can be prevented. However, in rare instances, they can still occur despite anticoagulation, likely due to direct compression of pontine perforators from dolichoectasias or persistent turbulent flow.

Methods
Case report

Results
A 66‐year‐old woman with hypertension, diabetes mellitus, atrial fibrillation (taking warfarin at home), and left‐sided trigeminal neuralgia due to compressive left vertebrobasilar dolichoectasia with a focal fusiform aneurysm, presented with transient dysarthria and lightheadedness lasting for less than an hour. MRI brain did not show any acute pathology. CTA head showed worsening left vertebrobasilar dolichoectasia with transitional fusiform aneurysm (24 mm in diameter) with mass effect on the anterior part of the pons and lower midbrain. Next day, the patient developed dysarthria and right‐sided weakness, and a repeat MRI brain showed a left acute paramedian pontine infarct. Warfarin was discontinued, and the patient was started on a heparin drip and later transitioned to Apixaban. Eventually, a diagnostic cerebral angiogram and surpass stent placement within the aneurysm were attempted which went uneventful and the flow through the aneurysm regularized. The patient was eventually discharged home on Apixaban and Prasugrel with interval follow‐up.

Conclusions
Compression of perforating vessels supplying brainstem structures, branching off the pathologic vertebrobasilar dolichoectasia is a rare etiology of acute pontine ischemic stroke, not with standing the anticoagulation. It warrants immediate neurosurgical intervention to optimize blood flow and prevent a recurrence.
Abstract Number ‐ 121: Flow Diversion Jet: A Dangerous Mechanism in the Flow Diversion Treatment of Giant Intracranial Aneurysms
Authors: Brake Aaron , Fry Lane , Chatley Kevin , Heskett Cody , De Stefano Frank , Lei Catherine , Peterson Jeremy , Ebersole Koji 
Published: April 2023

Introduction
We present a patient with a giant vertebrobasilar system aneurysm. This case provides an in‐depth analysis of the pathologic mechanism resulting in catastrophic distal hemorrhage following stent deployment due to the shared effects of normal perfusion pressure breakthrough (NPPB) and the Windkessel phenomenon. The Windkessel phenomenon and NPPB occur before and after treatment of various vascular malformations, respectively. These phenomena are hypothesized to contribute to the loss of cerebrovascular autoregulation. High flow lesions and giant aneurysms reduce blood flow in downstream vessels, causing chronic distal vasodilation to protect against ischemia. Sudden restoration of normal pulsatile flow, following treatment, compromises the integrity of distal vessels leading to potential catastrophic intracerebral hemorrhage.

Methods
A retrospective review of the patient’s medical record was performed.

Results
A 60‐year‐old female initially presenting with pulsatile neck mass was found to have dolichoectasia of the right cervical internal carotid artery and two large, irregular, vertebrobasilar aneurysms. Managed conservatively for 10 years before developing gait ataxia, new imaging revealed growth of the now giant, more distal aneurysm. Flow diversion with partial coiling of the aneurysms was pursued. Following deployment, DynaCT demonstrated catastrophic thalamic and midbrain hemorrhage with intraventricular extension. A review of intra‐aneurysmal pressure measurements, angiography, MRI, and neuromonitoring data strongly suggests rupture of multiple deep perforators following the conversion to laminar flow when the flow diverting chain was finalized. This suggests giant aneurysms chronically depress the distal pulse pressure by acting as a Windkessel reservoir. Flow diversion bypasses the reservoir increasing pulse pressure distal to the aneurysm, exceeding autoregulatory capacity, leading to hemorrhage.

Conclusions
This is the first case in the literature to describe NPPB and the Windkessel phenomenon in the attempt to treat giant aneurysms with flow diversion. Flow diversion bypasses the reservoir, suddenly changing turbulent flow to laminar flow. The resultant dramatic rise in pulse pressure distal to the aneurysm can exceed the autoregulatory mechanisms of small distal vessels such as perforating branches. While demonstrating a poor outcome, awareness of these mechanisms and meticulous intra‐operative blood pressure management may reduce or prevent complications. Further modeling of flow dynamics both before and following treatment of these aneurysms may lead to altered guidelines in the temporality of treatment due to potential catastrophic sequelae.
Abstract Number ‐ 158: Balloon Guide Catheter Effect on First Pass and Revascularization Success.
Authors: Modzelewski Michael D , Liang Conrad W , Perlman Sabrina M , Duggan Mark , Toor Harjyot , Sheth Sunil A , Martinez Evelin Duran , Chao Kuo , Feng Lei , Noufal Mazen , Nguyen Binh V , Mowji Pankaj J , Sangha Navdeep 
Published: April 2023

Introduction
The use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) has been suggested to lower the risk of distal embolization and improve first pass revascularization rates in patients with acute ischemic stroke. However, a recent large randomized controlled trial suggests there is no significant difference in initial and final revascularization scores among EVT performed with a BGC versus without. We assessed the influence of BGC use during EVT on first pass (FP) and revascularization (RV) success in a historical database from a multi‐hospital health system.

Methods
Patients with anterior circulation large vessel occlusion undergoing EVT with stent‐retriever or aspiration between 2012 and 2018 at three Kaiser Permanente Southern California (KPSC) region hospitals were identified from the database. BGC use was determined through manual chart review. A chi‐squared test compared the relationship of BGC use with the primary outcomes. The primary outcomes were FP and RV success using a dichotomized TICI score of 2b or greater.

Results
218 patients were included in the study. BGC was used in 35/218 (16%) of patients. There was no significant difference in age (p = 0.65), gender (p = 0.92), presenting NIHSS (p = 0.45), hypertension (p = 0.66), diabetes (p = 0.85), atrial fibrillation (p = 0.36), serum glucose (p = 0.43), or pre‐EVT TPA administration (p = 0.36). Among EVT with BGC, FP success was 13/35 (37%) and EVT without BGC had a FP success of 76/183 (42%); p = 0.71. Successful final RV with BGC occurred in 30/35 (86%) while EVT without BGC had a successful final RV of 162/183 (89%); p = 0.78. Because BGC use occurred only with stent‐retriever treatment, subgroup analysis was performed comparing the BGC group (N = 35) with the non‐BGC stent‐retriever (N = 88) and aspiration thrombectomy (N = 95) groups. There was no significant difference in FP (p = 0.88) or RV success (p = 0.42) between the BGC (37% FP and 86% RV), non‐BGC stent‐retriever (42% FP and 92% RV), and aspiration thrombectomy groups (41% FP and 86% RV).

Conclusions
Among our population, BGC use was not associated with higher first pass or final revascularization success.
Abstract Number ‐ 159: Intubation for Patients Undergoing Mechanical Thrombectomy of DiVOs is Associated with Increased Symptomatic ICH
Authors: Zainab Anika , Desai Sohum , Saei Hamzah , Tekle Wondwossen G 
Published: April 2023

Introduction
Distal vessel occlusions (DiVO) represent the next frontier of interventional stroke care. Some practitioners advocate for intubatingDiVOpatients to facilitate roadmapping techniques and vessel selection to assure procedural success. However, prior work studying thrombectomy in large vessel occlusion (LVO) suggests intubation is associated with worse outcomes. We sought to examine whether this relation also exists inDiVOpatients.

Methods
A prospectively maintained neuro‐endovascular database was queried for patients between January 2013 to August 2022. Patients included in the analysis had undergone mechanical thrombectomy of distal circulation defined as M2, M3, P2, P3, A2 and A3 segments of the MCA, PCA, and ACA respectively.Primary outcomes measured were NIHSS at 24 hours and at discharge. Secondary outcomes measured was the occurrence of symptomatic ICH post procedure.

Results
A total of 33 patients fit inclusion criteria among our database containing 826 mechanical thrombectomies. While there were more males in the endotracheal intubation group (p = 0.03), there were no other differences in baseline characteristics such as hypertension, diabetes, or prior antiplatelet medication use. Amongst the intubated cohort, we found increased rate of symptomatic intracerebral hemorrhage (ICH) (p = 0.03), worse NIHSS at 24 hours (p = 0.01), and worse NIHSS at hospital discharge (p = 0.002).

Conclusions
Endotracheal intubation for mechanical thrombectomy inDiVOpatients also appears to be associated with increased rates of symptomatic ICH which drives worse outcomes at 24 hours and discharge.
Abstract Number ‐ 175: First Pass Results of Mechanical Thrombectomy with two‐drop zone NeVaTM Device
Authors: Geyik Serdar , Bajrami Arsida , Ertugrul Ozgur , Senadim Songul , Erdem Eren , Baltacioglu Feyyaz , Nogueira Raul G 
Published: April 2023

Introduction
Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy.The NeVaTM(Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTMdevice for mechanical thrombectomy.

Methods
Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria.The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post‐intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded.

Results
There was female pre‐dominance (54.5%). Median presenting NIHSS was 16 (IQR, 3–32). 88 MCA‐m1 (60,6%), 43 ICA‐tip (29,6%), 11 MCA‐m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7–136). First‐pass reperfusion scores were mTICI 0–2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% andmTICI 3 35.9%.Mean number of pass was1,84±1,14.Final mTICI 2b‐3 score was 97.9% and TICI2c‐3 score was 87.6%. No device related adverse event occurred. The mean 24‐hour NIHS score was 6 (IQR 0–33).

Conclusions
In conclusion, the NeVa thrombectomy device offers a high rate of first‐pass success along with favorable safety profile. Larger series and multi‐center studies are needed for further investigation
Abstract Number ‐ 186: Keep it simple: MAC (Manual Aspiration with Contrast) Technique Endovascular Management of Acute ischemic Stroke
Authors: Torres Victor , Pabon Boris , Patiño Manuel , Pelaez Juan , Mutis Jorge , Cardozo Margarita , Zapata Andres 
Published: April 2023

Introduction
The availability of advanced large‐bore diameter aspiration catheters has improved recanalization rates and time. We report a prospectively collected clinical experience with a simple technique: MAC (Manual Aspiration Contrast Enhancement) as the primary method for vessel recanalization. Gently contrast injection while the aspiration catheter is advanced to the thrombus and subsequently creating a closed‐loop system with the contrast column within the catheter can result in better visualization during the aspiration, thus improving the FPE avoiding clot fragmentation, multiple passes and blind movements of catheter by a single operator.

Methods
47 prospectively patients with ELVO and 3 cases of middle vessel occlusion (MVO) at four institutions were included in the study. The MAC technique was utilized in all patients. Procedural and clinical data were analyzed.

Results
MAC technique using SOFIA 6 Plus Catheter was successful in achieving first pass effect (FPE) and Thrombolysis in Cerebral Infarction (TICI) 2b‐ 3 revascularizations in 77% of cases. The average time from groin puncture to at least TICI 2b recanalization was 16 min. National Institutes of Health Stroke Scale (NIHSS) score average at onset of 16, and improved to a median NIHSS score at discharge of 5.5. One ICA rupture and two symptomatic intracerebral hemorrhages were recorded peri operatively.

Conclusions
MAC technique is a simple, fast, safe, and effective method that has reduced the requirements to multiple passes and also avoiding the use of expensive materials to reach the occlusion site. MAC is a replicable approach without additional training requirements.
Abstract Number ‐ 189: Comparative Device Analysis for First Pass Stent Retriever Mechanical Thrombectomy
Authors: Baker David , Hussain M. Shazam , Toth Gabor 
Published: April 2023

Introduction
Limited data is available regarding comparative outcomes amongst FDA‐approved devices for mechanical thrombectomy (MT). The objective of this study is to assess procedural efficacy, clinical outcomes, and safety of currently available stent retriever devices when used during first pass thrombectomy for acute ischemic stroke.

Methods
A retrospective analysis was performed on all patients who underwent MT for large vessel occlusion (LVO) at a single comprehensive stroke center between January 2016 and January 2022. All patients who underwent MT with a stent retriever (Solitaire, Embotrap, Trevo) during first pass were included in the analysis. Primary efficacy and safety outcomes included time to recanalization, attainment of first‐pass effect (FPE), recanalization TICI score, 90‐day modified Rankin scale (mRS), and incidence of hemorrhagic transformation. One‐way ANOVA was used to compare median time to recanalization amongst cohorts. Chi‐squared test was used to compare frequencies of outcome measures amongst cohorts.

Results
During the study period, 234 patients underwent MT for LVO with use of stent retriever device during the first pass. In these cases, the type of stent retriever utilized was Solitaire (n = 163), Embotrap (n = 45), or Trevo (n = 26). There were no significant differences between cohorts in terms of age, gender, ethnicity, initial NIH stroke scale, or level of occlusion, or comorbidities. No significant differences were observed between cohorts for any primary outcome measures. The median time to recanalization was 53 min [Solitaire], 49 min [Embotrap], 63 min [Trevo] (p = 0.17). First‐pass effect was attained in 28.6% [Solitaire], 38.4% [Embotrap], 26.9% [Trevo] (p = 0.41). TICI 2b or greater recanalization was attained in 80.3% [Solitaire], 88.9% [Embotrap], 84.6% [Trevo] (p = 0.38). 90‐day mRS of 0–2 was observed in 36.6% [Solitaire], 38.9% [Embotrap], 34.8% [Trevo] (p = 0.95). Hemorrhagic transformation was observed in 45.9% [Solitaire], 36.8% [Embotrap], 34.6% [Trevo] (p = 0.40).

Conclusions
The type of stent retriever chosen for first pass thrombectomy did not predict procedural efficacy, clinical outcomes, or safety in our single center analysis.
Abstract Number ‐ 230: Mobile Stroke Unit Experience With Anticoagulant Related Intracranial Hemorrhage
Authors: Kareem Samer Abdul , Chaubal Varun , Kareem Mustafa Abdul , Subu Rand Al , Lin Eugene , Zaidat Osama 
Published: April 2023

Introduction
The advent of mobile stroke units (MSU) provide a golden opportunity to rapidly reverse anticoagulant related intracranial hemorrhage (AC‐ICH) in the pre‐hospital setting. The timely reversal of anticoagulants is crucial in halting hematoma expansion and achieving good clinical outcomes. It is known that AC‐ICH is associated with higher mortality rate and higher hematoma expansion than spontaneous ICH. Multiple studies showed that rapid reversal of AC‐ICH is associated with better outcomes and more stability of the hematoma size. Studies showed there is delay in initiation of therapy and revere the anticoagulants in ICH cases, [1,2}. Here, we report 3 cases of AC‐ICH diagnosed on the MSU with pre‐hospital use of reversal agents. To our knowledge, this is the first case series of Non vitamin K antagonist oral anticoagulants (NOACS) on the MSU.

Methods
We reviewed the MSU data from May 2016 to December 2020 and those with AC‐ICH were selected. Baseline demographics and clinical presentation were obtained including clinical outcome.

Results
A total of 3 patients were identified. Patient 1 is a96 year‐oldfemale with history of Atrial fibrillation (AF) that presented with AC‐ICH related to Apixaban and was treated with Prothrombin complex concentrate (PCC). The time of MSU examination to treatment (MSUe‐T) was 41 minutes.The patient was neurologically intact and discharged home after 4 days, no further images were indicated as the patient was stable and back to baseline. Patient 2 is a68 year‐oldmale with history of deep vein thrombosis that presented with AC‐ICH related to Warfarin and was treated with PCC. TheMSUe‐T was 64 minutes. Repeated CT head in the ED was stable. Neurological exam improved and the patient discharged to a skilled nursing facility. Patient 3 is a79 year oldmale with history of AF that presented with AC‐ICH related to Rivaroxaban and was treated with PCC. TheMSUe‐T was 50 minutes. Repeated CT head after 3 days was stable. According to FASTEST trial, the average time from onset to treatment of AC‐ICH was 90–120 min.In this trial, the growth of the ICH during the first hours was associated with increase mortality rate,{3}

Conclusions
Our data demonstrated that management of AC‐ICH on the MSU is feasible and provides an ample opportunity to reverse AC in the hyper‐early stage of ICH. MSU might have an important role in reducing the mortality for AC‐ICH patients. Larger comparative studies between Emergency department and MSU are needed.
Abstract Number ‐ 236: Pure Arterial Malformations: A Case Report
Authors: Ahmed Rashid A , Regenhardt Robert W , Vranic Justin E , Dmytriw Adam A , Rabinov James D 
Published: April 2023

Introduction
Pure arterial malformations are dilated, overlapping, and tortuous arteries forming a mass of arterial loops without a venous component. These malformations are rare, with limited cases reported in the literature. Affecting any of the intracranial arteries, they are usually found incidentally and often have a benign course.

Methods
We present a case of a pure arterial malformation in a young female with hyperprolactinemia. Furthermore, we review the literature and provide an updated summary of these malformations.

Results
A 28‐year‐old female with a history of infantile hemangiomas, polycystic ovary syndrome, and hyperprolactinemia presented with acne, mild hirsutism, and galactorrhea. Her neurological exam was normal. Magnetic Resonance Imaging (MRI) of the brain with and without contrast ruled out a prolactinoma but revealed a 3 cm vascular malformation at the margin of the left cavernous sinus extending posteriorly into the anterior left perimesencephalic cistern. Initial differentials included a pial arteriovenous malformation or less likely a dural arteriovenous fistula. She underwent a diagnostic cerebral angiogram which revealed a pure arterial malformation without arteriovenous shunting. This was composed of dysplasia of the left posterior communicating artery and anterior choroidal arteries. Stenosis of the left internal carotid artery distally with collateral support into the left anterior cerebral artery and middle cerebral artery was also noted. Lesser changes were noted in the right side with reconstitution of the right anterior cerebral artery from collaterals. Genetic testing for vascular malformation syndromes, including genes known to be associated with hereditary hemorrhagic telangiectasia, was negative. Repeat MRI/MRA done 8 months from the initial scan was stable with no abnormal large arterial venous shunting or definite saccular aneurysm formation noted.

Conclusions
Although rare, pure arterial malformations should be considered in the differential diagnosis for patients presenting with a cranial vascular malformation. Management of these lesions is usually conservative given their lack of arteriovenous shunting and low risk of rupture, with only a few cases undergoing surgery or endovascular treatment.
Abstract Number ‐ 242: Safety and Effectiveness of Intravenous Thrombolytic in Patients with Concurrent Migraine‐Headaches and Focal Neurological Deficits.
Authors: Asif Ahmer , Babar Sehar , Kherani Danish , Nagarajan Elanagan , Chandrasekaran Premkumar N , French Brandi R , Qureshi Adnan I 
Published: April 2023

Introduction
It is relatively well recognized that migraine headaches can present with focal neurological deficits. Current guidelines do not exclude such patients from receiving intravenous recombinant tissue plasminogen activator (rt‐PA).

Methods
We reviewed the records of migraine patients with ischemic stroke using a combination of retrospective chart review and prospective identification. The migraine was classified based on the criteria proposed by the third International Classification of Headache Disorders (ICHD‐3) into migraine with aura, and hemiplegic migraine. We ascertained rates of early neurological improvement (defined by reduction in National Institutes of Health Stroke Scale (NIHSS) score of 4 points or greater or NIHSS score of 0 at24 hours), any intracerebral hemorrhage within 24 hours, and excellent functional outcome based on modified Rankin Scale (mRS 0–1) at one month.

Results
A total of 25 patients (mean age ± SD; 45.3 ± 10.6 years; 15 were women) who met the criteria of migraine headaches concurrently presented with focal neurological deficits and received intravenous rt‐PA. The migraine was classified as hemiplegic migraine and migraine with aura in 22 and 3 patients, respectively. Intravenous rt‐PA was administered at a mean period of 142 minutes(range 60–255 minutes). Computed tomographic angiography was performed in 24 patients and did not reveal any large vessel arterial occlusion. Early neurological improvement was seen in 13 of 25 patients. None of the patients developed post thrombolytic intracerebral hemorrhage. Excellent functional outcome was seen in all patients. Diffusion‐weighted magnetic resonance imaging (MRI) was performed in 25 patients within 72 hours of symptom onset and demonstrated a new infarction in 1 patient.

Conclusions
In our analysis, intravenous rt‐PA was associated with high rates of early neurological improvement and excellent functional outcome at 1 month in patients with concurrent migraine headaches and focal neurological deficits.