bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 049: Predictors of Hemorrhagic Transformation Following Mechanical Thrombectomy with Emergent Carotid Artery Angioplasty and Stenting for Tandem Occlusions of the Anterior Circulation
Authors: Jaikumar V. , Raygor K. P. , Shah S. , Stockman I. , Kruk M. , Scullen T. A. , Bouslama M. , Davies J. , Snyder K. V. , Levy E. I. , Siddiqui A. H. 
Published: January 2025

Introduction
Hemorrhagic transformation of the ischemic core following mechanical thrombectomy (MT) for acute ischemic strokes can negate the benefits of the procedure. Previous regressions have identified variables suggesting larger strokes and longer procedural times as significant predictors of hemorrhagic transformation. Tandem occlusions add another layer of complexity, as the proximal carotid occlusion and the emergent carotid artery angioplasty and stenting (eCAS) introduces additional factors that can influence hemorrhagic transformation by altering the dynamics of reperfusion. We investigated predictors of hemorrhagic transformations following MT+eCAS performed for anterior circulation tandem occlusion in patients with baseline mRS 0‐2.;

Methods
Retrospective analysis of institutional thrombectomy database for patient characteristics, thrombectomy details, in‐hospital course, and follow‐up outcomes to shortlist significant univariate predictors to conduct multivariate binomial logistic regression and assess for significant predictors of hemorrhagic transformations following MT+eCAS during in‐hospital stay.;

Results
Multivariate binomial backwards logistic regression identified hypertension (p=0.042) and use of balloon guide catheters as opposed to conventional guide catheters (p=0.035) to significantly increase the risk of hemorrhagic transformation. Middle cerebral artery occlusions as opposed to internal carotid terminus occlusions (p=0.025), conscious sedation as opposed to general anesthesia (p=0.002), primary aspiration passes as opposed to primary stent retriever passes (p=0.007), retrograde as opposed to anterograde eCAS (p=0.004), intracranial slow flow following MT+eCAS (p=0.049) and oral aspirin/ticagrelor as opposed to intravenous eptifibatide load prior to eCAS (p=0.021) suggested reduced risk of hemorrhagic transformation, symptomatic or not.;

Conclusion
The study identified procedural predictors of hemorrhagic transformation specific to tandem occlusions. Patients undergoing mechanical thrombectomy with carotid artery stenting (MT+eCAS) under general anesthesia, using primary stent retriever passes, anterograde eCAS, and receiving an intravenous eptifibatide load before eCAS were particularly vulnerable to hemorrhagic transformation. Gradual reperfusion, shown to be protective against hemorrhagic transformation, was supported by the significance of intracranial slow flow.
Abstract 058: Outcomes in Patients with Spontaneous Intracranial Hemorrhage Who Underwent Thromboelastography Testing
Authors: Kaur G. , Rodriguez W. , Tseng S. , Wu N. , Guagliardo E. , Rheder J. , Christopher K. M. , Greene‐Chandos D. , Wang F. 
Published: January 2025

Introduction
In the U.S., intracerebral hemorrhage (ICH) accounts for 10‐15% of all strokes, yet it carries a significantly higher risk of death or long‐term disability. While the Thromboelastography Platelet (TEG PM) mapping tool is well‐established for managing coagulopathy in trauma, organ transplantation, massive transfusions, and ECMO patients, its use in spontaneous ICH is not well understood. This study aims to evaluate patient outcomes in spontaneous ICH cases that received TEG testing compared to those that did not.

Method
Following IRB approval, we conducted a retrospective review of 215 patients with intracerebral hemorrhage (ICH) from June 2020 to June 2023. Out of these, 160 had spontaneous ICH, with 98 undergoing TEG‐PM testing and 62 not. The primary outcome was to evaluate the frequency of platelet transfusions and complications related to external ventricular drains (EVD). The secondary outcome was to compare discharge outcomes, using discharge status as a proxy for functional recovery, with discharge to home or acute rehab considered a good outcome. Chi‐square tests were performed to analyze differences between the TEG and non‐TEG groups, with all analyses conducted using IBM SPSS Statistics.

Results
We performed a Mann‐Whitney U test to compare ICH volume and initial National Institutes of Health Stroke Scale (NIHSS) scores between the two groups. The results showed that ICH volume was significantly lower in the non‐TEG‐PM group, with a p‐value of 0.002. The median ICH volume of TEG‐PM group was 13 (IQR 4.0‐36.0), while in non‐TEG‐PM group was 4.35 (IQR 1.0‐19.6). There was no significant difference in the initial NIHSS scores between the groups (p=0.063). In patients who underwent TEG‐PM, 10.2% received platelet transfusion as compared to non‐TEG‐PM group where 0% patients received platelet transfusion with p‐value of 0.009. In TEG‐PM group, 26.8 % patients had EVD placement vs 9.7 % in non‐TEG‐PM group with Odds Ratio 0.29 (0.11‐0.76). There was 1% EVD associated hemorrhage seen in patients of TEG‐PM group as compared to 0% in non‐TEG‐PM. 44.9% of the patients in the TEG‐PM had good discharge outcome as compared to 64.5% in non‐TEG‐PM group with p‐value of 0.1

Conclusion
The data indicates that TEG‐PM testing is not a reliable predictor of patient outcomes in spontaneous ICH. Interestingly, patients who underwent TEG‐PM testing received more platelet transfusions compared to those who did not, but this did not impact the discharge outcomes. The ICH volume in both groups were not clinically significant.
Abstract 061: A Multi Center Clinical Experience in Medellin, Colombia Using The Pipeline Vantage Device for the Treatment of Intracranial Aneurysms. Initial Results and One Year Follow‐Up
Authors: Mutis J. , Pabon B. , Torres V. , Brunet F. , Vergara J. , Pelaez F. , Patino M. , Arteaga J. , Cardozo M. , Vargas G. 
Published: January 2025

Background and Purpose
Flow diverter technology has evolves trying to provide safe, stability and a good long‐term result. We report a local / regional experience with the fourth generation Pipeline Vantage Embolization Device in the treatment of intracranial aneurysms.

Methods
We present here a multi‐center, prospective, interventional, single‐arm trial of the Pipeline Vantage Embolization Device for the treatment of intracranial aneurysms. The primary end points were the effectiveness (the complete occlusion rate at 6‐ and 12‐month) and the safety (the presence or absence of serious adverse events during procedure and follow‐up) Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow‐up.

Results
Between October 2022 and January 2024, 73 patients harboring 91 intracranial aneurysms were treated in 76 interventions at 6 centers in Medellin, Colombia. Pipeline Vantage Embolization Device placement was technically successful in all patients. Most aneurysms (85.7%) were located at the anterior circulation, and the mean diameter was 6.7 mm. At 6 months, 56 of 70 (80%) aneurysms showed a complete occlusion and one year follow up revealed a complete occlusion in 56/63 (89.2%) Bifurcation aneurysms (odds ratio, 5.66; 95% CI, 1.01‐31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11‐22.36) predicted persistence. A mild Neointimal hyperplasia (i.e < 25%) was evidenced in 10/63 (15.8%) and significant (i.e >50%)in 3/63. Of the 73 enrolled patients, 69 (94.5%) were treated without serious adverse events during the procedure or during the follow‐up. No mortality procedural related.

Conclusions
The treatment of intracranial aneurysms using the novel Pipeline Vantage Embolization Device was safe and effective. Our findings in terms of complete occlusion rates were similar to those seen in previously published studies with flow diverter devices and earlier generation Pipeline devices.
Abstract 077: Bilateral medial medullary infarction mimicking Guillain‐Barré Syndrome (GBS): Case report and qualitative systematic review
Authors: Chirinos J. M. Sequeiros , Alva-Diaz C. , Quispe-Vicuña C. , Salvador-Oscco E. , Capcha-Jimenez U. , Javier-Murillo N. , Guerrero-Yrene M. , Padilla-Santos M. , Saiki S. , Uribe-León A. , Terry F. , Geldres-Aranibar R. , Mori N. 
Published: January 2025

Purpose
To summarize the medical literature related to the diagnosis of bilateral medial medullary infarction (MMI) mimicking GBS.

Methods
We identified all published case studies in five databases until February 2024. We performed a narrative synthesis to develop differential criteria on the included cases. A case report is also presented.

Results
We present the case of a patient with asymmetric and progressive motor weakness, bulbar dysfunction, albuminocytologic dissociation in cerebrospinal fluid (CSF), and negative brain CT scan in the acute stage. He was initially diagnosed with Guillain‐Barré Syndrome (GBS), treated with immunoglobulin without a favorable response, finally the diagnosis of MMI was made with re‐evaluation during the evolution and confirmed by brain magnetic resonance imaging. A systematic review of the literature of MMI case reports was carried out, focusing on an initial diagnosis of Guillain‐Barré Syndrome. We selected 8 studies (9 patients) of bilateral MMI with problems in the timely diagnosis and initial diagnosis of GBS. The most frequent clinical onset was respiratory problems (44.4%). The finding in CSF and nerve conduction studies were normal or negative in 60% of the cases. The delay occurred in the early stages of diagnosis in all cases. The use of immunosuppressive therapy was given in only one case. A discussion of the case report and the diagnostic challenges reported in the literature was made.

Conclusion
It is recommended to consider MMI for differential diagnosis in patients with symptoms of acute progressive quadriparesis and bulbar dysfunction, therefore a thorough assessment of the clinical presentation is necessary.
Abstract 078: Caresto heal: First multicenter experiences with a new 3rdgeneration carotid stent
Authors: Jansen O. , Nordmeyer H. , Schild D. , Wodarg F. 
Published: January 2025

Introduction
The CARESTO heal is a coated carotid stent aiming to support atherosclerotic plaques by using a dense single‐layer mesh. Due to its great flexibility, it easily navigates through tortuous anatomies. Additionally, the CARESTO features the anti‐thrombogenic HEAL coating.

Aim of Study
The objective of this study is to examine the technical specifics, advantages, and possible obstacles associated with the innovative stent design of the CARESTO heal.

Method
The first CARESTO implantations including data on procedural safety and efficacy have been retrospectively analyzed. Pre‐treatment carotid plaque characterization was performed. For elective cases double antiplatelet medication was administered while acute cases were treated under Aspirin only.

Results
66 patients from ten European neurovascular centers have been treated, including Carotid Webs and ICA dissections. The mean age was 68 years with a median degree of pre‐treatment stenosis of 63%. Mean post‐treatment stenosis was 10% with a technical success rate of 100%. One peri‐procedural retinal ischemia occurred, but no other severe complications have been observed. Already available six weeks and six months ultra sound follow up showing no recurrence of stenosis nor new neurological events.

Conclusion
This multicenter study shows that the CARESTO heal Stent is both safe and effective in treating carotid stenosis. Additional analysis with full follow‐up data will offer thorough insights into the stent's long‐term safety and efficacy. The carotid stenting technique using the CARESTO heal differs technically from other carotid stents but is particularly advantageous in challenging, tortuous vessel anatomies and in the treatment of highly vulnerable plaques.
Abstract 123: Microcatheter Guided Blood Patch for Treatment of Cervical Cerebrospinal Fluid Leak
Authors: Tolba H. , Fakih R. , Khan M. , Qureshi A. I. 
Published: January 2025

Introduction
Epidural blood patch (EBP) remains the therapy of choice in treating refractory headaches due to low cerebrospinal fluid (CSF) pressure. If a CSF leakage source is detected, targeted fluoroscopy‐guided EBP should be considered over non‐targeted (blind) technique. Cervical CSF leakage can be challenging to treat with targeted EBP given the high‐risk site.

Methods
We present a case of microcatheter‐guided targeted cervical EBP. A 44‐year‐old male with no significant past medical history presented with 4 weeks history of refractory headaches upon sitting and standing up. MRI brain showed bilateral subdural hygromas alongside diffuse pachymeningeal enhancement. A spinal myelogram showed evidence of a CSF leak at C4‐C5 level.

Results
The patient was placed in prone position to access the space between the spinous processes of L2 and L3 vertebrae. A 14‐gauge 6‐inch needle was then inserted at the interlaminar space, and CSF was observed. The needle was then exchanged over a microwire with a 4F introducer sheath under fluoroscopic guidance. Once the sheath was confirmed to be in the epidural space, a 0.014‐inch microwire was introduced and advanced into the cervical region. A 0.021‐inch ID microcatheter was advanced over the wire and parked at the C5‐C6 level. Then, 10cc of autologous blood mixed with Omni opaque contrast was injected through the microcatheter into the epidural space at the C5‐C6 level. Dyna CT demonstrated blood layering in the epidural space both anteriorly and posteriorly to the Dural sac, covering the entirety of the cervical region. Patient reported an instant relief of headache during the EBP and continued to be headache‐free by the time he was discharged.

Conclusion
We illustrated fluoroscopy‐guided microcatheter‐assisted EBP as an effective treatment of intracranial hypotension due to cervical CSF leak.
Abstract 138: Robotics in Mechanical Thrombectomy. Colombian Feasibility Experience Using the New Adaptive Tiger Device. First in Human Study (FIM)
Authors: Pabon B. , Torres V. M. , Vergara J. , Mutis J. , Brunet F. , Cardozo M. , Arteaga J. , Vargas G. , Pelaez F. , Patino M. 
Published: January 2025

Purpose
The Adaptive Tiger is a novel radially adjustable stent retriever technology for Large Vessel Occlusion (LVO), The unique controllability of adaptive Tiger allows for employing a robotic controller to expand and relax the mesh automatically, using real‐time force measures to react accordingly for maximal encapsulation of the clot, and optimal radial forces during retrieval.The objective of this Registry Study is to evaluate the performance of the new Adaptive Tiger in restoring blood flow in patients with LVO who are ineligible for intravenous tissue plasminogen activator (IV t‐PA) or who fail IV t‐PA therapy.

Materials and Methods
A novel programmable electro‐mechanical sensor/controller is coupled with a Tigertriever. The sensor/controller automatically executes the operational phases and the optimal opening and closing of mesh throughout each phase. Five patients with AIS and LVO were consented and treated with Robotic Tiger.

Results
A total of 5 Adaptive Tiger devices were used. All cases with LVO secondary to MCA occlusion. The Adaptive Tiger console operated as intended in all passes. Using force measurements in real‐time and advanced control algorithms, the console expanded the mesh automatically up to wall opposition, executed the active integration technique, and relaxed the mesh for optimal clot retrieval. A final revascularization TICI > 2b‐c, 3 was obtained in all the cases at the end of the procedure. Non‐Major adverse events procedural related were registered in this small series.

Conclusion
This First ever experience with Robotic Tigertriever demonstrates the feasibility of utilizing robotically‐controlled Tigertriever technology for automatic thrombectomy easily and safely.
Abstract 157: Three‐Month Functional Outcomes in Poor Grade Aneurysmal Subarachnoid Hemorrhage Patients Undergoing Endovascular Treatment of Cerebral Vasospasm
Authors: Fakih R. , Ahmed R. , Ma X. , Bhatti I. , Gillani S. , Siddiq F. , Gomez C. , Qureshi A. 
Published: January 2025

Objective
To determine the effect of endovascular treatment (EVT) of cerebral vasospasm on functional outcomes among poor‐grade subarachnoid hemorrhage (SAH) patients.

Background
EVT of cerebral vasospasm in poor‐grade SAH patients poses unique challenges due to difficulty in differentiating symptomatic and asymptomatic cerebral vasospasm and severe neurological injury prior to occurrence of vasospasm.

Methods
We analyzed data from two tertiary stroke centers, focusing on poor grade SAH patients who required EVT for cerebral vasospasm. Poor‐grade SAH patients were defined as those presenting with a Hunt and Hess/WFNS scale score of 4 or higher. EVT of vasospasm consisted of angioplasty and/or intraarterial vasodilators. Functional outcome was assessed at 90 days using the modified Rankin scale (mRS) score, categorized as 0‐3 (favorable outcome) and 4‐6 (unfavorable outcome), and 90‐day mortality rate.

Results
The sample consisted of 80 patients (mean age 52.7 ± 10.1 years, 61% women) with poor‐grade SAH and cerebral vasospasm. EVT consisted of intra‐arterial vasodilator infusion in 62 patients, among which 24 had additional angioplasty. At 90 days, 39% (n=24) of those who received EVT achieved a favorable functional outcome, with 32% mortality rate. Among patients who received angioplasty, 54.2% achieved favorable outcomes versus 45.8% with unfavorable (p=0.167); Of those who underwent IA vasodilator therapy for vasospasm, 38.7% achieved favorable outcomes, and 61.2% had unfavorable outcomes (p=0.372). The outcomes were comparable to poor grade SAH patients who did not require EVT for cerebral vasospasm (n=18), in whom favorable functional outcome and mortality rate were 33% and 22%, respectively.

Conclusions
Favorable functional outcomes can be seen in over one‐third of poor‐grade SAH patients who are treated with EVT for cerebral vasospasm, which was comparable to those who do not require treatment for cerebral vasospasm. Our results support use of EVT for cerebral vasospasm in poor grade SAH patients.
Abstract 167: A Case of Consequential Stroke and Heart Failure in Ebstein's Anomaly
Authors: Baumann E. G. , Cheon B. , Shaffer S. , Kenniff S. , Abdelhamid N. , Ajiboye N. , Kamal H. , Mehta B. 
Published: January 2025

Introduction
Ebstein's anomaly (EA) is a rare congenital heart condition, accounting for less than 1% of congenital heart defects. Though uncommon, individuals with EA have a significantly increased risk of stroke, through poorly understood mechanisms. We present a case of a large vessel stroke in a patient with EA, coexisting patent foramen ovale (PFO), and conduction abnormalities, which ultimately required a heart transplant.

Materials/Methods
N/A

Case
A 22‐year‐old male with a history of Ebstein's anomaly and Wolff‐Parkinson‐White Syndrome presented with left middle cerebral artery (MCA) syndrome and atrial fibrillation with rapid ventricular response (AFib‐RVR). CT angiography confirmed a left MCA M1 occlusion. He received intravenous tissue plasminogen activator (tPA) followed by emergent mechanical thrombectomy, achieving modified treatment in cerebral ischemia (mTICI) grade 2B (67‐89%). MRI showed a left MCA stroke with hemorrhagic conversion, along with distal embolic strokes in the left MCA M3/M4 segments. Cardioembolic workup revealed a PFO, EA with extreme apical displacement of the tricuspid valve, and severe tricuspid regurgitation. The patient was discharged on full‐dose aspirin with plans for anticoagulation after three weeks. Despite ablation of his AFib during hospitalization, he returned with severe right heart failure, necessitating heart transplant. He currently has no neurological deficits and is followed at our institution.

Discussion
Ebstein's anomaly (EA) is a rare congenital heart condition occurring in 1 to 5 per 100,000 births. Characterized by tricuspid valve abnormalities, EA often presents with tricuspid regurgitation, atrialization of the right ventricle, and reduced right ventricular ejection fraction. Up to 50% of patients have associated cardiac defects, such as PFO or secundum atrial septal defect (ASD), leading to an increased risk of paradoxical embolic stroke. The risk of stroke in EA increases with age, with an incidence of 1.4% at 10 years, 15.9% at 50 years, and 23.5% at 70 years. This risk is further compounded by comorbid arrhythmias, such as AFib (20%) and accessory pathways, including Wolff‐Parkinson‐White Syndrome (10‐20%). This case highlights the importance of early identification and comprehensive management of cardiac risk factors in EA, including consideration for heart transplantation, to prevent stroke and other complications.
Abstract 182: Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes with the United States General Population
Authors: Dicpinigaitis A. J. , Al‐Mufti F. 
Published: January 2025

Introduction
Incarcerated individuals in state and federal prisons demonstrate disproportionately high rates of cardiovascular disease, especially hypertension and tobacco use. As a result, in comparison with the United States general population, inmates are faced with a more than three‐fold risk of acute ischemic stroke (AIS). Unfortunately, some evidence suggests that incarcerated individuals receive suboptimal medical care due structural barriers in healthcare delivery as well as discrimination based on incarcerated status. To our best knowledge, no studies to date have evaluated treatment rates and clinical outcomes of AIS in this specialized population.

Methods
Adult hospitalizations for AIS were identified in the 2015‐2020 National Inpatient Sample. Clinical variables, including incarcerated status, were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Rates of endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) in addition to clinical outcomes (routine discharge back to institution/to home and in‐hospital mortality) were compared between incarcerated and non‐incarcerated individuals. Multivariable logistic regression (MVLRG) analysis controlling for age, race/ethnicity, baseline NIHSS score, stroke location, cardiovascular risk factors, and treatment modality was performed to determine the adjusted association of incarcerated status with the above clinical outcomes.

Results
Among 1,037,020 AIS hospitalizations, 460 (44.4/100,000) documented incarcerated status. Rates of EVT (6.5% vs. 6.7%, p=0.907) and IVT (19.6% vs. 18.1%, p=0.401) did not differ between incarcerated and non‐incarcerated individuals, respectively. Incarcerated individuals experienced higher rates of routine discharge disposition in comparison with non‐incarcerated individuals (75.0% vs. 36.6%, p<0.001), but mortality rates did not differ (2.2% vs. 3.5%, p=0.115). Following MVLRG analysis, incarcerated status was independently associated with routine discharge disposition (aOR 4.63, 95% CI 3.62, 5.92; p<0.001), but not with mortality (aOR 1.04, 95% CI 0.55, 1.97; p=0.906). Sensitivity testing in three separate sub‐group analyses of patients receiving acute reperfusion therapies (IVT and/or EVT), in strokes of the posterior circulation, and in high severity strokes (NIHSS>15) confirmed the findings of the primary analysis.

Conclusion
Incarcerated individuals with AIS are offered EVT and IVT at comparable rates to the general population and experience favorable clinical outcomes after accounting for age, stroke severity, and cardiovascular risk factors. Although these findings are encouraging, incarcerated individuals included in this study may represent a biased sample of those from particularly conscientious institutions and may not necessarily reflect the broader landscape of stroke care for this vulnerable population in the United States.