bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 97: Middle meningeal artery embolization to treat chronic subdural hematomas – Retrospective study of morphological parameters
Authors: Syed Shoaib , Syed Shoaib , John Kevin , Dashti Reza , Fiorella David , Sadasivan Chander 
Published: April 2023

Introduction
Chronic subdural hematomas are a common neurovascular condition that involve the gradual and continual exudation of fluid from a compromised cell layer lining the dura [1]. Embolization of the middle meningeal artery (MMAE) results in lower recurrence rates as compared to traditional surgical burr hole evacuation [2‐4]. Liquid embolic agents such as cyanoacrylates or ethylene vinyl alcohol copolymers can potentially provide a distinct advantage with greater distal penetration resulting in faster hematoma resolution [5]. Their inherent radiopacity (after pre‐mixing) also allows for accurate visualization and control over embolization. The hypothesis of this study is that liquid embolic surface area would correlate with more effective cSDH volume resolution in patients.

Methods
Under IRB approval, we retrospectively analyzed non‐contrast head CTs and immediate post‐embolization flat‐detector CTs from 45 patients who underwent first‐line MMAE with a liquid embolic. Patients who received any neurosurgical intervention were excluded. 3D‐Slicer was used to segment and calculate hematoma volumes pre‐embolization, as well as at 1‐month, 3‐months, and 6‐months post‐embolization. The flat‐detector CT scans were also segmented to calculate the surface area of the liquid embolic.

Results
There was significant reduction in hematoma volume at 1‐, 3‐ and 6‐months with respect to the preoperative cSDH volume (Figure A, Pre: pre‐treatment, mo: month). The liquid embolic surface area significantly correlated with (a) pre‐embolization hematoma volume (R2 = 0.27, p = 0.0002, n = 45), (b) the reduction in volume at 1‐month post‐embolization (R2 = 0.16, p = 0.007, n = 41), (c) volume reduction at 3‐months post‐embolization (R2 = 0.29, p = 0.0015, n = 32), (d) hematoma volume resorption rate (cc/day) calculated at 1‐month post‐embolization (R2 = 0.16, p = 0.011, n = 39), and (e) hematoma volume resorption rate calculated at 3‐months post‐embolization (R2 = 0.34, p = 0.0003, n = 34, Figure B). The liquid embolic surface area was not correlated to the volume reduction at 6‐months (p = 0.3, n = 26).

Conclusions
The luminal surface area of MMA vasculature embolized with liquid embolics may be correlated to the reduction in cSDH volumes. The liquid embolic segmentation method used here needs further refinement to improve accuracy. Additional data sets are required to confirm the correlations reported here.
Abstract Number ‐ 102: Middle Meningeal Artery Embolization Failure Profile: A Single Institution Retrospective Study
Authors: Mahmoud Noor A , Coulibaly Nangorgo J , Ernst Griffin , Raney Brasen C , Shakir Hakeem J 
Published: April 2023

Introduction
Middle Meningeal Artery (MMA) embolization has emerged as a qualitative treatment option for subdural hematomas (SDH). Multiple studies have compared MMA embolization to other alternatives, namely surgery, and conservative treatment, with some indicating that MMA embolization was as effective and safe as the other two options. This study aimed to identify predictors of failures in SDH patients undergoing an MMA embolization.

Methods
We retrospectively reviewed 52 patients receiving MMA embolization for subdural hematoma management at our institution from 2020 until July 5, 2022 either as primary or adjunctive management. Patients who were under the age of 18 were excluded. Our definition of failure was any MMA embolization requiring an additional surgical procedure to evacuate the hematoma or relieve persistent symptoms.

Results
52 patients with mean age of 71±14 and male gender 36 (69.2%) were reviewed. Most common presenting symptom was headache27 (51.9%) followed by gait instability22 (42.3%).35 out of 52 patients underwent MMA embolization as primary management of chronic subdural hematoma without prior surgical treatment. Six out of the 35 patients (17.1%) required a rescue surgical treatment due to increased hematoma size or recurrence of symptoms. Our early trend shows that half of the patients whose MMA embolization failed had a possible onset of SDH between 2 to 4 weeks prior the embolization. This trend is similar to Khorasanizadeh et al. description in which they concluded that late‐stage SDH was more predicated to have a failure of MMA embolization compared to early‐stage SDH (1). Of the remaining three patients, one was diagnosed with metastatic prostate cancer to the bones and kidney. This patient passed away 12 days after the procedure despite a craniotomy post‐embolization.

Conclusions
More clinical trials are needed to further establish MMA embolization as standard of care in the management of cSDH in a subset profile of patients with higher success rates.
Abstract Number ‐ 106: Particle Versus Liquid Embolic Materials in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma
Authors: Krothapalli Neeharika , Patel Smit , Fayad Mohamad , Elmashad Ahmed , Patel Raj , Sussman Eric , Bruno Charles , Ollenschleger Martin , Mehta Tapan 
Published: April 2023

Introduction
Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses with a high recurrence rate in the aging population. The primary pathologic process is repeated micro bleeding from fragile neo‐vessels supplied by peripheral branches of the middle meningeal artery (MMA). MMA embolization is an efficacious minimally invasive neuroendovascular technique for the management of chronic subdural hematoma. It has demonstrated reduced incidence of re‐bleeding and recurrence of cSDH in elderly patients. Particle and liquid embolic materials are commonly used to devascularize the MMA however studies comparing the safety and outcomes between these two materials are limited. Our objective was to perform a descriptive analysis to investigate differences and outcomes among two most frequently employed materials for MMA embolization.

Methods
We performed a single center retrospective review of patients ≥ 18 years who had MMA embolization for cSDH between July 2020 and May 2022. The primary safety, radiation dosage, fluoroscopy time, radiographic and clinical outcomes were compared between particle and liquid embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version.

Results
In a cohort of 116, 48 (41.38%) were treated with liquid embolic material and 68 (58.62%) were treated with particle. The median age of the cohort was 73 years in particle group and 73.5 years in liquid embolic group. There was no significant difference in radiation dose or duration among both groups. There was no reported mortality associated to procedure. One patient experienced non‐disabling ischemic stroke in the particle group. Based on imaging follow‐up, three patients in particle group and one in liquid embolic group had asymptomatic recurrence. One patient in each group had symptomatic recurrence requiring hematoma evacuation. Index median size of hematoma was 12 mm in particle group and 11 mm in liquid embolic group. At approximately one month follow up, the median size of hematoma reduced to 6 mm in both groups.

Conclusions
Our series demonstrates that liquid embolic and particle embolization are equally safe and effective among patients undergoing MMA embolization for management of cSDH.
Abstract Number ‐ 123: Retained microvascular wire during acute stroke thrombectomy and stenting.
Authors: Giurgiutiu Dan‐Victor , Tong Brian 
Published: April 2023

Introduction
There is limited information on retained wires during neuro interventional ischemic cases, although there is a wealth of information on cardiac cases. Retained wires can present with thrombosis, perforation, or may be followed for longer period of time, with no complications. Changes in outcome vary on the ability of the wire to migrate, the size of the vessel adjacent to the wire, and the difficulty in retrieving the retained item.

Methods
We present a case report on a 56‐year‐old man who presented in 2018 with a left internal carotid occlusion horizontal petrous level, with no early signs of stroke on CT, and 106 mL penumbra on CT perfusion (CTP), with dense expressive and receptive aphasia.

Results
Patient developed hemiparesis while sitting sitting up, and drops in blood pressure, below the presenting blood pressure of 200 over 100 mmHg. The patient was taken for emergent thrombectomy. Patient underwent petrous thrombectomy with a residual high grade stenosis. This was followed by cavernous angioplasty, and Wingspan stenting. We attempted to cross the stenosis with a Gateway balloon and Synchro2 microwire. The wire tip was trapped and separated after extensive rotation, with a retained 5 mm tip. After inspecting the wire, there is no clear evidence of any a retained product. The tip was secured with a Wingspan stent. After thrombectomy and stenting aphasia improved. Four days later the patient developed worsening aphasia, and was found to have stent reocclusion. During CT angiography (CTA) it became apparent that a small wire extended from the left internal carotid petrous segment at the level of the wingspan stent down to the descending aorta. CT angiography of the chest and abdomen after reperfusion found that the wire was anchored in the left internal carotid, and extended down to the renal artery. Thrombus was aspirated, and ICA reconstructed with coronary stents in the petrous, and self‐expanding stents in the cervical segments, with TICI 3 reperfusion. Follow‐up imaging with CT chest and abdomen at six months, one year, and four years found the wire to be still anchored to the left internal carotid stent, and stable in the superior mesenteric artery. There is no evidence of thrombus formation, or distal embolization. We examined a Synchro2 microwire ex vivo were able to detach the tip, and have the inner core unravel up to a meter in length. Given that the wire shaft did not appear to be altered, the retained product was likely an unraveled inner core.

Conclusions
Retained neurovascular products can predispose to reocclusion, and should be secured. Once secured the course can be benign. When a wire with a wound core is fractured, unwound core can remain behind with the wire appearing as if it has been fully retrieved.
Abstract Number ‐ 126: Use of Woven EndoBridge device for Aneurysms in Off‐Labeled Locations: Systematic Review and Meta‐Analysis
Authors: Rodriguez‐Calienes Aaron , Vivanco‐Suarez Juan , Galecio‐Castillo Milagros , Malaga Marco , Zevallos Cynthia , Farooqui Mudassir , Moran‐Mariños Cristian , Fanning Noel F. , Algin Oktay , Pabon Boris , Mouchtouris Nikolaos , Jabbour Pascal , Ortega‐Gutierrez Santiago 
Published: April 2023

Introduction
The Woven EndoBridge (WEB) device was originally approved to treat intracranial wide‐necked saccular bifurcation aneurysms. Recent studies have suggested its use for the treatment of intracranial aneurysms (IA) in alternative locations with variable success. We aimed to evaluate the safety and efficacy of the WEB for IAs in off‐labeled locations using a meta‐analysis (MA) of the literature.

Methods
We performed a systematic review of all studies including patients treated with WEB for IAs in locations different than what is currently on‐label FDA until May 2022. Our primary efficacy and safety outcomes were adequate occlusion at last follow up and a composite of intraprocedural and postprocedural complications, respectively. The Raymond‐Roy (RR) scale and the Bicêtre Occlusion Scale Score (BOSS) were used to define complete (RR: 1; BOSS: 0‐0’) and adequate (RR:1‐2; BOSS: 0–2) occlusion. Additional safety outcomes included intraprocedural (thromboembolic, hemorrhagic, device deployment, or air embolism) and postprocedural (ischemic or hemorrhagic) complications, and mortality. We performed a random‐effects MA of proportions and assessed the certainty of the evidence using the GRADE approach. Statistical heterogeneity across studies was assessed with I2 statistics. Logistic regression of the patient level data was used to study the predictors of complete occlusion.

Results
Ten studies were selected, and 285 patients (79% female; mean age 58 years) with 288 aneurysms (35% ruptured) were included. Adequate and complete occlusion rates were 89% (95% CI 81–94%; I2 = 0%; moderate‐certainty evidence) and 64% (95% CI 57–70%; I2 = 13%; moderate‐certainty evidence), respectively. The composite safety outcome rate was 8% (95% CI 3–17%; I2 = 34%; very low‐certainty evidence). The intraprocedural and postprocedural complication rates were 6% (95% CI 4–10%; I2 = 0%; very low‐certainty evidence) and 1% (95% CI 0–1%; I2 = 33%; very low‐certainty evidence), respectively. The mortality rate was 2% (95% CI 1–7%; I2 = 0%; very low‐certainty evidence). Aneurysm width (OR = 0.5; p = 0.03) was the only significant predictor of complete occlusion.

Conclusions
The preliminary studies evaluating the use of WEB for the treatment of IAs in off‐labeled locations has demonstrated rates of adequate occlusion and procedural complications comparable to the landmark studies that evaluated the use of the WEB for on‐label bifurcation aneurysms. Given the level of evidence, we consider the interpretation of our results should be done cautiously until confirmation from larger prospective studies are obtained.
Abstract Number ‐ 134: How far can we go? WEB technology for the treatment of sidewall IA. Single Institution.
Authors: Pabon Boris , Torres Victor , Patiño Manuel , Pelaez Juan , Mutis Jorge , Cardozo Margarita 
Published: April 2023

Introduction
Few years after introduction, Flow disruption technology using WEB device has been used safely for the treatment of wide‐neck bifurcation aneurysms, but the use of this endosaccular approach to treat side‐wall lesions in terms of feasibility, safety, stability and aneurysm occlusion rate after this treatment is unknown.

Methods
Patients were carefully selected. IRB approved. Clinical, anatomical, angiographical and technical considerations were analyzed. Procedure related complications, procedural time, antiplatelet therapy requirements. Web Occlusion Scale (WOS) was used for the Follow‐up.

Results
From August 2017 and March 2021 a total of 14 wide‐necked, sidewall, IA were selected for WEB treatment. Aneurysm mean size 5.3mm in width and 5.8 in height. Aneurysm Location: ICA 8 cases (five PComA, two Carotid‐ophtalmic segment, one AChoA segment), Superior Cerebellar Artery SCA in 5 patients (35%), and one impressive case in posterior circulation associated with a basilar fenestration next to VBJ. Eight cases were unruptured (57%), and six cases with history of SAH‐ acute setting. DAPT used pre operatively in all elective cases but none patient remain under antiplatelets after procedure. Technical success of 100%. Mean procedure time: 24 min. None related procedure complications recorded. Immediately angiographic occlusion was evidenced in 9 cases. Radiological Follow up (ranging 1‐ 26 months) available in 9/14 showed a WOS adequate occlusion in all cases.

Conclusions
In our early experience using WEB device to treat different conditions than bifurcation IA´s, the results showed that endossacular approach was feasible in highly selected patients, safety profile in agreement with previous bifurcation experiences and very effective to treat challenge cases with a high probability of recurrence or therapeutic failure. Larger series and controlled studies are required to expand its indications in a near future.
Abstract Number ‐ 138: Complex symptomatic dissecting pseudoaneurysm with inflow zone stenosis required angioplasty before flow‐diversion‐a technical report.
Authors: Lodi Yahia M , Campos Jessica K 
Published: April 2023

Introduction
16.4 percent of patients diagnosed with fibromuscular dysplasia (FMD) are found to have internal carotid artery (ICA) dissection [1] which may lead to life threatening ICA dissecting pseudoaneurysm (ICADPA). Endovascular repair of ICADPA may be urgent when ICADPA is symptomatic, potential for rupture with no good alternatives. Tortuous anatomy with FMD and ICADS can represent a significant endovascular challenge, especially if there is an aneurysmal inflow‐zone stenosis.Objective: We present a unique case of right ICADPA with an inflow‐zone parent artery stenosis underwent angioplasty and repair with surpass evolve flow diverter (SEFD).

Methods
Case report and chart review.

Results
49‐year‐old man history of hypertension, hyperlipidemia, and left ICADPA status post stenting/stent‐assisted coiling in 2017, who presented with right‐sided pulsatile tinnitus after a facial injury. Cerebral angiography revealed a tortuous right ICA with FMD, and presence of a right ICADPA at the skull base measuring 16×8 mm with inflow zone stenosis and a post‐stenotic dilatation. An emergency repair was performed with an informed consent under general anesthesia. In order for the SEFD to deploy properly, an angioplasty of inflow‐zone parent artery stenosis was performed with a 3×20mm Maverick balloon. Subsequently, a SEFD measuring 5×40 mm was deployed to cover the dissecting pseudoaneurysm, and a second SEFD measuring 5×20 mm was deployed covering the ICADS resulting in good apposition of SEFD and securement of ICADS.Use of a metal self‐deployable stent prior to flow diversion was not an option due to the presence of extreme tortuosity and acute angulations on the parent artery.patient was discharged home after 24 hours with 325 mg of aspirin and 75 mg of clopidogrel and good blood pressure control. 90‐days follow‐up, demonstrated good recovery with modified Rankin score of 0 with no symptoms.

Conclusions
ICADPA with aneurysmal inflow zone parent artery stenosis and the presence of extream tortuosity and acute angulations, may require angioplasty prior to the flow diversion for successful repair. Further studies are required.
Abstract Number ‐ 140: Transcranial Doppler Emboli Monitoring for Stroke Prevention after Flow Diversion: A Single Center Experience
Authors: Costa Matias , Allawi Aws , Vivanco‐Suarez Juan , Jaleel Naser , Douville Colleen , Loh Yince , Patel Akshal , Monteith Stephen J 
Published: April 2023

Introduction
Following the favorable clinical and radiographical results of flow diversion, its use has continually expanded for the treatment of complex intracranial aneurysms. The high metal surface of flow diverters (FD) increases the risk of thromboembolic complications. Current emboli monitoring data after FD placement is limited. Transcranial doppler (TCD) offers a non‐invasive evaluation of microembolic signals and might be a valuable tool to prevent ischemic complications. We evaluated the rate of embolic signals and their management after FD implantation.

Methods
We performed a retrospective, single‐center evaluation of adult patients who underwent a FD procedure with the Pipeline Embolization Device (PED) for unruptured intracranial aneurysms between 2012 and 2016. Covariates included patient demographics, comorbidities, aneurysm characteristics, procedure characteristics, and post‐procedure TCD emboli monitoring (immediate and >12 hours post‐operative). TCD emboli signals were classified as positive (< 15 microembolic signals) and strongly positive (>15 signals). The primary outcome was the rate of symptomatic stroke at 2 and 12 weeks in these patients.

Results
105 patients with 132 aneurysms were analyzed. Mean age was 59.7 years, and 78% were females. Mean aneurysm size was 7.8 ± 6.4 mm. Most of them were located in the paraclinoid region (40%). Two PEDs were implanted in 12 (11%) cases and adjunctive coiling was performed in 15 (14%) cases. Microemboli were detected in 11.4% of cases (12/105 patients) after PED deployment. In 5/12 patients, the emboli resolved upon repeat testing with no intervention. In 6/12 patients, further heparinization, additional clopidogrel administration, or change in antiplatelet agents were needed. These treatments reduced the microembolic events. In 1 patient who was clopidogrel‐resistant and a ticagrelor super‐responder, mechanical thrombectomy was necessary due to acute in‐stent thrombosis. There were no symptomatic strokes at 2 and 12 weeks.

Conclusions
TCD emboli monitoring can be a powerful non‐invasive tool for the early identification and prevention of thromboembolic events after FD implantation. Early detection of microembolic signals offers the possibility to modify postoperative management, avoid silent emboli, and potentially avoid symptomatic strokes.
Abstract Number ‐ 143: Middle Meningeal Artery Embolization of Septated Chronic Subdural Hematomas
Authors: Martinez‐Gutierrez Juan Carlos , D'Amato Salvatore A , Zeineddine Hussein A , Nahhas Michael I , Kole Matthew J , Kim Youngran , Kim Hyun Woo , Chen Peng Roc , Blackburn Spiros L , Spiegel Gary , Sheth Sunil A , Kitagawa Ryan S , Dannenbaum Mark J 
Published: April 2023

Introduction
Chronic Subdural Hematoma (cSDH) is projected to be the most common neurosurgical disease in the US by the end of the decade. MMA embolization is a promising new treatment; however, its efficacy in patients with complex, septated cSDH remains uncertain.

Methods
From our prospectively maintained registry of patients with cSDH treated with MMA embolization (with or without concurrent surgical drainage), we identified patients with and without septations. Septations were defined as hyperdense septa between the inner and outer membranes on a lower‐density background. The primary outcome was recurrence of cSDH, which was defined as any radiographic evidence of increase in thickness and/or new acute hemorrhage. Secondary outcomes included reduction in cSDH thickness, midline shift and rate of reoperation.

Results
Among 84 patients with 100 cSDHs, median age was 70 [IQR 59‐77] with 26.2% females. 35 CSDHs (35%) had membranes identified on imaging. Evacuation with burr holes was performed in 45.2% and craniotomy in 16.7% of the total cohort. Baseline characteristics between the patients with no septations (no SEP) and those with septatations (SEP) were similar except for median age (no SEP vs SEP, 66 vs 74, p = 0.006). Recurrence rate was lower in the SEP group (no SEP vs SEP, 21.5 vs 2.9%, p = 0.017) even when adjusting for clinically relevant factors (OR 0.07, p = 0.017). Despite larger baseline thickness in the SEP groups, the mean absolute reduction in thickness was more pronounced (no SEP vs SEP, ‐4.6 vs ‐8.0 mm, p = 0.016) with similar midline shift change. Rate of reoperation did not differ (6.2 vs 2.9%, p = 0.65). Recurrence free survival was significantly improved in patients with septations even after adjustment for age and evacuation strategy (Figure 1, p = 0.04).

Conclusions
MMAE in traditionally higher risk septated cSDHs appears to be highly effective with an even larger reduction in volume and lower risk of recurrence than non‐septated hematomas. These findings support the mechanistic theory of MMAE as a devascularization procedure of membrane neovasculature and may aid in improved patient selection.