bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 139: Safety and Efficacy of Tirofiban Use in Acute Ischemic Stroke Patients Undergoing Thrombectomy: A Meta‐Analysis
Authors: Naeem A. , Albaramony N. , Ewis A. , Ahmed M. , Kelani H. , Spiotta A. 
Published: January 2025

Introduction
Intravenous thrombolysis with tissue plasminogen activator (tPA) and endovascular therapy (ET) represent the cornerstone of modern stroke management. Despite advancements in these therapies, a subset of patients fails to achieve optimal recanalization (TICI 2b‐3), which is associated with poor functional outcomes and higher mortality rates. As a result, there has been growing interest in adjunctive pharmacologic interventions that could enhance the efficacy of ET. The efficacy and safety of tirofiban as an adjunct to ET have not been conclusively established, with existing studies yielding inconsistent results.

Methods
We conducted a systematic review and meta‐analysis to assess the efficacy and safety of tirofiban in patients undergoing thrombectomy. A comprehensive search was carried out across PubMed, Embase, and the Cochrane Library for studies published through August 2024. For each outcome, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was evaluated using the I² statistic. Statistical analyses were performed using R.

Results
The meta‐analysis included 21 studies evaluating the effect of tirofiban plus ET on successful recanalization (TICI 2b‐3), showing a significant benefit with an odds ratio (OR) of 1.41 (95% CI 1.21‐1.65, p < 0.01), with low heterogeneity (I² = 25%). For excellent functional recovery (mRS 0‐1), 14 studies were analyzed, demonstrating a significant improvement with an OR of 1.17 (95% CI 1.03‐1.34, p = 0.02), and moderate heterogeneity (I² = 37%). In assessing good functional recovery (mRS 0‐2), 25 studies were pooled, and showed a significant effect of tirofiban plus ET with an OR of 1.30 (95% CI 1.19‐1.44, p < 0.01), with low heterogeneity (I² = 24%). Mortality outcomes across multiple studies revealed a significant reduction in mortality (OR 0.70, 95% CI 0.59‐0.84, p < 0.01), with moderate heterogeneity (I² = 44%). Lastly, for symptomatic intracranial hemorrhage (sICH), no significant difference was observed (OR 0.88, 95% CI 0.75‐1.04, p = 0.14), and heterogeneity was low (I² = 12%).

Conclusion
In conclusion, the meta‐analysis demonstrates that the addition of tirofiban to Endovascular Therapy (ET) significantly improves successful recanalization and functional recovery (mRS 0‐1 and mRS 0‐2) while reducing mortality, with low to moderate heterogeneity across the included studies. However, no significant difference in the risk of symptomatic intracranial hemorrhage (sICH) was observed. These findings suggest that Tirofiban plus ET may enhance clinical outcomes in patients undergoing treatment for acute ischemic stroke.
Abstract 162: Vertebral Artery Stenting for Compression Stenosis Due to Cervical Facet Hypertrophy
Authors: Fakih R. , Khan M. , Tolba H. , Bhatti I. , Gillani S. , Qureshi A. I. 
Published: January 2025

Background
Vertebrobasilar insufficiency can be caused by various pathologic conditions including atherosclerosis, dissections, steal phenomenon, etc. While endovascular treatment of those conditions is well‐established, stenting of vertebral artery (VA) compression stenosis due to cervical facet hypertrophy is uncommon. We describe a case of VA stenting to address the symptomatic stenosis caused by mass effect from cervical facet hypertrophy.

Method
A 78‐year‐old male with a history of deep venous thrombosis and paroxysmal atrial fibrillation presented with several episodes of transient loss of awareness triggered by neck movement from side to side. This has restricted his neck mobility. Computed tomography angiography (CTA) revealed stenosis of the left VA at the C3‐C4 level secondary to cervical facet hypertrophy. Decision was made to treat this problem via endovascular means.

Results
Access was achieved via the right femoral artery, and a guide catheter was parked in the left subclavian artery just proximal to the left VA ostium. The left VA was selected with an intermediate catheter, and angiography revealed a moderate stenosis at the cervical V2 segment, with no evidence of atherosclerosis nor dissection. 3D rotational angiography confirmed the stenosis being caused by a C3‐C4 facet hypertrophy impinging on the artery. We proceeded with angioplasty and stenting at the point of stenosis, using a balloon‐mounted Papyrus stent. Follow‐up angiography showed improvement in the degree of stenosis. At 1‐month follow‐up, patient was symptom‐free, with no recurrence of his symptoms.

Conclusion
This case illustrates vertebral stenting a potential therapeutic option for vertebral artery compression stenosis caused by cervical facet hypertrophy. Although residual stenosis remained, the intervention improved the patient's symptoms.
Abstract 187: Age impact on stroke risk and healing in patients treated with flow diverters for intracranial aneurysms: SCENT substudy
Authors: Wakhloo A. , Jenkins P. , Meyers P. M. , Coon A. L. , Kan P. T. , Puri A. , de Vries J. , Lanzino G. , Bain M. , Ebersole K. C. , Welch B. G. , Dogan A. , Jabbour P. , Mocco J. , Siddiqui A. H. , Turk Q. S. , Taussky P. , Hanel R. A. 
Published: January 2025

Introduction/Purpose
The multicenter, prospective, single‐arm, controlled, non‐randomized SCENT trial on flow diverter (FD) treatment for intracranial aneurysms (IA) was analyzed for patients’ age and IA characteristics impacting stroke and occlusion rates over 5 years.

Materials and Methods
Impact on major ipsilateral stroke and IA occlusion was studied by stratifying age as </= 65 years versus >65 years. Twice as many subjects treated were </= 65 years old (n=119/180). Product‐limit (Kaplan‐Meier) estimates of time to both endpoints, stratified by age group, were created. Univariate predictors of time to stroke were identified by including candidate variables in univariable proportional hazards regression models. Those variables found to be significant (p<0.10) at the univariate level were entered into a multivariable survival model to identify independent predictors. The stepwise selection produced a final reduced model with a significance level to both enter and stay set at 0.05.

Results
When parent artery stenosis and IA size were entered into a multiple‐stepwise survival model, only stenosis remained as an independently significant predictor of time to stroke. At 3‐year follow‐up, there were a total of 23 strokes (12.8%), with 11 (47.8%) occurring in subjects </= 65 years; there was a greater risk for seniors (HR1.96, 95% CI 0.83‐4.78, p=.122). Four patients (4/180; 2.2%) experienced aneurysm ruptured within the first week post‐treatment, with 3 being </= 65 and the fourth aged 66 years. No new strokes were reported between 3 and 5 years. Complete IA occlusion rates for seniors were 60.0% (33/55), 67.6% (25/37), and 85.7% (18/21) at 12, 36, and 60 months, respectively, as compared to 79.1% (87/110), 82.5% (66/80), and 91.8% (56/61) for younger subjects. The time to complete IA occlusion was shorter in younger patients (HR1.53, 95% CI 1.07‐2.19, p=.020). Five subjects (2.8%) underwent retreatment, 2 in 60‐year‐old patients, and one each aged 64, 70, and 75.

Conclusion
Stroke, early rupture risk, and aneurysm occlusion in patients treated with FD are related to age and pre‐existing parent artery stenosis, IA size, and location. With demographic shifts, future treatments need to focus on expedited and improved healing.
Abstract 195: Assessing the Safety and Efficacy of Heparin in Ruptured Intracranial Aneurysms
Authors: Kothari S. A. , Baskaran A. , Morsi R. , Desai H. , Smith M. , Kozel O. , Chahine A. , Patel S. , Iourinets J. , Jafary H. , Borghei A. , Lis P. , Prabhakaran S. , Siegler J. , Kass-Hout T. 
Published: January 2025

Introduction
Our study aims to retrospectively assess the safety of heparin during endovascular treatment of ruptured intracranial aneurysms.

Methods
A retrospective analysis of 56 patients who underwent endovascular aneurysmal repair for both ruptured and unruptured aneurysms was performed to examine outcomes.

Results
This series included 41 females (73.2%) and 15 males (26.8%) with a mean age of 55.9 ± 15.2 years treated with endovascular embolization of which there were 30 ruptured and 26 unruptured aneurysms. A total of 22 patients received an intraoperative heparin load before the procedure ranging from 3000‐7000 units. Therapeutic‐activated coagulation times were measured and maintained in all patients. Of the ruptured aneurysm cohort that received a heparin load (8/30, 26.7%), there was 1 thromboembolic complication intra‐procedurally, 1 thromboembolic complication post‐procedurally, and 1 hemorrhagic complication post‐procedurally. Of the unruptured aneurysm cohort (14/26, 31%) that received a heparin load, there was 1 thromboembolic intra‐procedurally and 0 hemorrhagic complications post‐procedurally.

Conclusion
This study suggests that heparin during endovascular treatment for ruptured intracranial aneurysms carries similar safety to those untreated with heparin pre‐procedurally warranting larger studies and further investigation.
Abstract 207: Beyond the Hospital: Evaluating the Durability of Outcomes for Stroke Survivors Receiving Principal Illness Navigation Services
Authors: Sheehan L. 
Published: January 2025

Introduction/Purpose
Post‐acute navigation services for stroke survivors have started to emerge over the last few years, spurred on by high readmission rates and subpar quality of life in the months after stroke discharge. While there is limited but promising evidence related to the outcomes of these navigation services post‐stroke, there have been few studies that have reviewed the durability of outcomes such as longitudinal readmission rates, quality of life metrics or functional status. This study aims to assess the 6‐months and 1‐year post‐discharge outcomes for stroke patients receiving post‐acute of Principal Illness Navigation (PIN) services. Measures will include inpatient readmission rates, quality of life via the PROMIS Global 10 and the modified Rankin Scale.

Materials/Methods
This is a mixed methods design including the retrospective analysis of readmissions data via historical HIE and ADT feeds along with the assessment of QoL and mRS based on patient report (PROMIS Global and 1 question mRS, respectively). In addition, patient and care partner surveys were conducted at 6‐months and 1‐year to assess ongoing recovery challenges as well as the longitudinal impacts of participation in PIN services after hospital discharge following stroke.

Results
Our abstract will review inpatient readmission rates for patients who reached at least 6 months post‐discharge, and those who reached at least 12 months post‐discharge. We will compare these results to published benchmarks, reporting 12‐month readmission rates ranging from 30% to nearly 50%. We will also report on patient self‐reported health challenges, SDOH concerns, and ability to live independently at 6 and 12 months post‐stroke.

Conclusion
The findings from this study will highlight the potential durability and long‐term benefits of Principal Illness Navigation (PIN) services for stroke survivors, particularly in reducing readmission rates compared to published data. Stroke patients historically experience very high and recurrent readmissions, and persistent challenges related to ambulation, fatigue, mental health, and socioeconomic stressors. Our preliminary results suggest that PIN improves key outcomes and that there is still a need for ongoing, comprehensive support beyond the first year of recovery. Addressing these long‐term needs, particularly mental health, will be critical to further enhancing stroke survivors’ quality of life and functional independence.
Abstract 240: Diagnostic Value of Catheter Angiography and Magnetic Resonance Imaging in Perimesencephalic and Non‐Perimesencephalic Subarachnoid Hemorrhage: A Retrospective Analysis
Authors: Gong A. , Khan H. , Dang D. , Sterner R. , Fortes M. , Greenberg E. , Chandela S. , Chitale A. , Chaudhry S. , Vyas N. 
Published: January 2025

Introduction/Purpose
Spontaneous subarachnoid hemorrhage (SAH) without a structural source can be seen in up to 15% of all spontaneous SAH, which includes diffuse non‐aneurysmal SAH, sulcal SAH and perimesencephalic (PM) SAH. Although catheter angiography is considered the gold standard to exclude a vascular etiology, multiple studies suggest that computed tomography angiography (CTA) is adequate in PMSAH and magnetic resonance imaging (MRI) does not produce additional benefit. Without clear recommendations, practice patterns regarding the diagnostic management of these patients remain variable throughout the country. The aim of this study was to evaluate the diagnostic value of MRI and catheter angiography in perimesencephalic (PM) and nonperimesencephalic (non‐PM) subarachnoid hemorrhage (SAH) of unknown origin.

Materials and Methods:
We conducted a retrospective study of all patients with spontaneous SAH between January 2021 and July 2023. Included in the study were cases of spontaneous SAH diagnosed with CT with an initial negative digital subtraction angiogram (DSA). Additionally, patients who had a positive finding for a vascular source of hemorrhage such as an aneurysm, arteriovenous malformation (AVM) or dural arteriovenous fistula (dAVF) on DSA with a negative CTA or a CT with a PMSAH bleeding pattern were included for comparison. The number and types of follow‐up imaging studies were recorded.

Results
420 patients with spontaneous SAH were screened, in which 101 patients met study criteria. 86 patients were found to have a negative DSA, of which 51 (59.3%) were found to have a PMSAH bleeding pattern. Follow‐up MR performed within one week of presentation demonstrated no source of hemorrhage in any of the patients with PMSAH, however, within the subgroup of diffuse‐non‐aneurysmal SAH, two patients (5.7%) were found to have a cavernoma on MRI (p=0.039). Among the 226 patients (53.8%) who had a positive DSA in the same time period, nine patients (3.9%) had a negative CTA and 10 patients (4.4%) had a PMSAH hemorrhage pattern.

Conclusion
In spite of a well‐established hemorrhagic pattern for aneurysmal SAH, aneurysms may still present with a perimesencephalic SAH distribution. In light of our institutional experience, CTA is not deemed adequate alone for the exclusion of aneurysms in PMSAH, where catheter angiography should still be considered the gold standard in diagnostic evaluation. Finally, MRI of the brain and craniocervical region did not produce any benefit for the detection of a vascular etiology in PMSAH, however, the utilization of MRI should be considered for rare bleeding sources in non‐PM SAH, particularly when intraparenchymal hemorrhage is also present.
Abstract 243: Distal vs Non‐Distal Middle Meningeal Artery Embolization for Subacute‐Chronic Subdural Hematomas
Authors: Henkel N. , Mierzwa A. T. , Gharaibeh K. , Naz S. , Delcimmuto N. , Chang Y. , Zaidi S. , Jumaa M. 
Published: January 2025

Introduction
Subacute‐chronic subdural hematomas have a nearly 25‐30% recurrence rate following appropriate surgical evacuation of the primary hematoma. Recently, middle Meningeal artery (MMA) embolization techniques have demonstrated efficacy in preventing recurrence and has been increasingly adopted as part of mainstay therapy. However, technical considerations are still being established.

Methods
This is a single center retrospective study from January, 2022 through August, 2024 evaluating patients who received MMA embolization for subacute‐chronic SDH. Patients were excluded if they did not have follow up imaging. Patients were dichotomized into whether they received distal or non‐distal MMA embolization. All patients were treated with Onyx embolization. Embolization was considered distal when Onyx material reached membranous branches. Primary efficacy outcome was defined SDH improvement (reduction or completion resolution of SDH compared to discharge).

Results
There were 127 patients included in this study with 12 patients excluded for lacking final radiographic outcomes. Therefore, one‐hundred‐fifteen patients were included in the final analysis who were older (75 years) Caucasian (86%) males (78%). Fifty‐five (52%) and sixty (48%) patients received either a distal or non‐distal MMA embolization, respectively. The distally occluded cohort were more likely to be women (31% vs 13% p = 0.02) compared to the non‐distal cohort; otherwise, there were no significant baseline demographic differences between cohorts. Additionally, anticoagulation and antiplatelet usage were similar between cohorts. Patients had final imaging at a median 44 (IQR 26 ‐ 81) days following the procedure. There were equal rates of radiographic improvement between distally and non‐distally occluded MMA embolization techniques (85.5% vs 73.3% p = 0.11). On multivariate analysis controlling for potentially confounding factors, odds of improvement were similar (OR 1.96 95% CI 0.70 ‐ 5.52; p = 0.20).

Conclusion
Patients had similar rates of radiographic improvement despite choosing distally vs non‐distally occluding the middle meningeal artery. Further prospective research is required to validate our finding.
Abstract 245: Dose‐dependent relationship between periodontal disease and ischemic stroke
Authors: Dumitrascu C. , Grasu R. 
Published: January 2025

Introduction
The link between periodontal disease and cerebrovascular disease was reported in various studies, with several mechanistic underpinnings. To determine the predictive value of periodontal disease for cerebrovascular diseases, we aimed to investigate the quantitative association between various degrees of periodontal disease and subtypes of cerebrovascular disease.

Methods
Using Meta‐analyses Of Observational Studies in Epidemiology and PRISMA guidelines, we searched 6 databases through May 2024 for cohort and case‐control studies evaluating the relationship between periodontal disease and ischemic or hemorrhagic stroke. Studies were included if they reported risk ratios (RRs) and 95% confidence intervals or raw patient‐level data (that were computed into RRs). Unadjusted and vascular risk‐factor adjusted ORs were pooled into meta‐analysis using DerSimonian Laird random effects model. Study quality, publication and dissemination biases were assessed and integrated in the analyses (RevMan software).

Results
12 prospective studies encompassing 31, 324 patients were eligible for the qualitative and quantitative syntheses. After vascular risk‐factor adjustment, any degree of periodontitis was associated with an increased risk of ischemic stroke (RR, 2.24, 95% CI [1.67‐2.98], p<0.001, I2=10). Subgroup analysis including subjects with moderate or severe periodontitis showed a higher risk of ischemic stroke (RR, 3.01, 95% CI [1.01‐4.05], p<0.001). Associations remained significant after adjustments for quality and publication biases. Heterogeneity was low (I2<20%) for all syntheses. The reported mechanisms were cardioembolism and thromboembolism. The risk of hemorrhagic stroke could not be synthesized due to limited data.

Conclusions
A dose‐dependent relationship exists between periodontal disease and ischemic stroke, even after adjustment for traditional cerebrovascular risk factors. It remains unknown if the risk of hemorrhagic stroke is increased in subjects with periodontal disease. Periodontal disease prevention and treatment may decrease the incidence of ischemic cerebrovascular disease.
Abstract 268: Endovascular Treatment for Non‐Resectable Meningiomas Encasing the Internal Carotid Artery: A Case Report
Authors: Albanna A. J. , Vismara T. , Idris A. , Reardon T. , Iqbal Z. , Kole M. 
Published: January 2025

Introduction
Carotid endovascular treatment with stenting is widely recognized as a safe and effective method for managing carotid stenosis due to underlying atherosclerotic disease. However, there is limited data on the efficacy of carotid stenting in cases where non‐resectable meningiomas encase the internal carotid artery.

Presentation
We report the case of a 50‐year‐old woman who initially presented with numbness in her right arm. Brain MRI revealed bilateral meningiomas encasing the cavernous segments of both internal carotid arteries, leading to mild narrowing. Follow‐up imaging showed that the left‐sided meningioma had enlarged, causing near occlusion of the left internal carotid artery and resulting in recurrent acute infarcts within the left ICA watershed territory. This led to the decision to proceed with a left STA‐MCA bypass. The patient later experienced right‐sided amaurosis fugax, with subsequent MRI showing further enlargement of the right‐sided meningioma encasing the right cavernous ICA. The patient underwent angioplasty and stenting of the right ICA, with no further neurological symptoms.

Discussion
Meningiomas are the most common tumors affecting the cavernous sinus and can invade the walls of the internal carotid artery, leading to significant stenosis. However, neurological deficits and cerebral ischemia due to reduced cerebral perfusion pressure from such stenosis are uncommon. Tumor resection in these scenarios poses risks, including carotid scarring and third nerve injury, emphasizing the need for alternative treatments. This case illustrates the safety and effectiveness of carotid artery stenting in such complex situations.

Conclusion
Carotid artery stenting is a viable and effective treatment option for patients with non‐resectable meningiomas causing symptomatic narrowing of the internal carotid artery.
Abstract 281: Factors Leading to ICU Stays After Endovascular Treatments for Unruptured Intracranial Aneurysms: A Review Study
Authors: Hamouda A. 
Published: January 2025

Background
For unruptured intracranial aneurysms (UIAs), conservative management is often possible. However, when direct treatment is warranted, endovascular treatments (EVTs) provide an effective minimally invasive approach. These procedures still necessitate careful patient monitoring, frequently in the Intensive Care Unit (ICU). The factors leading to ICU admission for these patients remains an area of debate.

Objective
This systematic review aims to highlight existing literature and identify gaps in understanding the factors contributing to ICU admission following EVTs for UIAs.

Methods
We utilized the Nested Knowledge Autolit semi‐automated software to gather studies published before April 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, and included studies that met predetermined population, intervention, control, and outcomes (PICO) criteria. Statistical analysis was performed using R software.

Results
We retrieved 181 studies and 9 met our inclusion criteria. There was significant variability across these studies on what factors they reported. Across included studies there were 8,098 patients, with 5,620 requiring ICU admission following EVTs for UIAs. Analysis revealed that anterior aneurysm location, aneurysm‐related symptoms, and procedure length were significant factors leading to ICU admission. The overall ICU admission rate was approximately 24.61 per 100 patients.

Conclusion
This review underscores the need for further research to understand what factors lead to ICU admission following EVTs for UIAs. Additional studies are needed that use a standardized approach to collect data on patient demographics, aneurysm characteristics, procedural details, and postoperative outcomes. Such studies will allow for concrete recommendations to be made on ICU needs and prognostic calculators to be developed in order to support clinical decisions and lower healthcare costs.