bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 308: Inpatient Optimization of Endovascular Therapy for Acute Ischemic Stroke in Patients with Active Malignancy
Authors: Dawod G. , Desai H. , Ehidom C. , Díaz P. , Lin N. , Boddu S. , Knopman J. , Navi B. B. , Schaff L. , Ramos A. 
Published: January 2025

Introduction
Landmark trials studying the efficacy of endovascular therapy for patients with large vessel occlusions generally excluded patients with active cancer. Of those with malignancy undergoing mechanical thrombectomy, they tend to have worse clinical outcomes despite technical success. Thus, implications of mechanical thrombectomy in this cohort remains debated. Our objective is to elucidate post thrombectomy outcomes in patients with active cancer to further optimize inpatient management.

Methods
We conducted a retrospective cohort study of stroke thrombectomy cases performed at our institution from January 2010 to March 2024. Pearson Chi‐square test and Fisher's exact test were used to analyze categorical variables, and Mann‐Whitney U tests were used for continuous variables. Multivariable logistic regression analyses were performed to evaluate for independent associations between baseline characteristics and study outcomes of interest, specifically, successful endovascular reperfusion (≥TICI 2b) and poor clinical outcome, defined as death or disposition to hospice.

Results
We identified 50 patients with active cancer who underwent mechanical thrombectomy (MT) for stroke. Mean age was 63.8 years (SD, 11.4), 48% were men, and 68% had stage IV cancer. Successful reperfusion was achieved in 78% of patients, and 50% ultimately had a poor clinical outcome, including 40% inpatient deaths. Of those that died inpatient, 46% of deaths were due to non‐neurological causes. 78% of patients undergoing MT were treated with optimal medical management post stroke with either anticoagulation or antiplatelet therapy. In total, 16% of patients went on to complete cancer treatment. While there were no pre‐EVT variables that were significantly associated with outcome change, the decision to initiate anticoagulation post‐EVT while inpatient was associated with more favorable outcomes (p=0.006). Only 6% of patients were found to have sICH, and the use of IV thrombolysis prior was not found to impact this rate.

Conclusion
In our study, we found that despite a high successful reperfusion rate, nearly half of cancer patients undergoing mechanical thrombectomy for large vessel occlusion strokes had a poor clinical outcome. We found that anticoagulation post thrombectomy independently correlated with a more favorable outcome. Future studies must further elucidate other factors that may influence outcomes to guide in optimal patient selection and maximize overall success of EVT in patients with cancer.
Abstract 315: Intraventricular hemorrhage due to bilateral vertebral artery dissection during treatment in drug intoxication patient: a case report
Authors: Cho B. , Jang D. , Kim D. 
Published: January 2025

Introduction
A vertebral artery dissection is a possible cause of stroke in young and middle‐aged adults without risk factors for cerebrovascular disease. It often occurs spontaneously for no particular reason, but it can also occur due to trauma or other causes. This study aims to report the treatment experience of bilateral vertebral artery dissection and intraventricular hemorrhage in a patient hospitalized for drug intoxication in our hospital.

Methods
A fifty‐six‐year‐old woman was found collapsed on the street and visited the emergency department of our hospital, complaining of comatose mentality and hypothermia. The Glasgow Coma Scale score measured at the visit was 3 points, and bradycardia and hypotension were present. A bag of medications prescribed by a psychiatrist was found in the patient's bag, and a drug screen test performed showed benzodiazepines positive. Brain CT performed in the emergency room did not reveal an acute lesion, so the patient was admitted to the intensive care unit at the department of emergency medicine under a drug intoxication impression. After four days of hospitalization, the patient's response started to improve, and on the 7th day, she showed a drowsy mentality. IVH was found in the bilateral lateral ventricles on diffusion MR performed on day 7, and dissection was confirmed in the bilateral distal V4 segment on additional CT angiography.

Results
Conservative treatment was performed in the intensive care unit, and a follow‐up CT showed that the hemorrhage was resolved. Still, dissecting aneurysms with an increased size was confirmed in both V4 segments. Emergency stent‐assisted coil embolization was performed for left V4 dissecting aneurysm with bleb. There were no complications during the procedure, and the right V4 dissecting aneurysm was decided to do embolization after a follow‐up examination. After the procedure, the patient showed an alert mentality, and there were no acute abnormal findings in the follow‐up examination.
In the MRA performed one year after the procedure, the treated area on the left V4 dissecting aneurysm was well maintained. The right V4 dissecting aneurysm showed normal findings due to spontaneous healing.

Conclusion
In the case of vertebral artery dissection, which rapidly changes shape, careful observation is required, and appropriate treatment is required before new neurological symptoms develop. For treatment, stent‐assisted coil embolization can be a good option, and since spontaneous healing can occur in some cases, it is essential to determine an appropriate treatment method. In addition, appropriate follow‐up tests and identification of the cause are necessary for patients with decreased consciousness for which the cause is unclear.
Abstract 326: Mechanical Thrombectomy in Low NIHSS: Preventing High mRS
Authors: Bajrami A. , Senadim S. , Aksoy S. , Bas D. F. , Geyik S. 
Published: January 2025

Introduction
Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is very effective treatment in patients with high National Institutes of Health Stroke Scale (NIHSS) scores. However, disability can also be seen in patients with NIHSS scores of 0‐5. Besides, clinical deterioration as a result of stroke progression is quite common in patients with large vessel occlusion (LVO). Although there are studies investigating the effectivity of EVT in patients with low NIHSS scores, more comprehensive data are needed on patient selection and safety. In this study we aimed to determine the clinical outcome of patients with low NIHSS scores who underwent mechanical thrombectomy in our center.

Methods
We conducted a single‐center, retrospective study of a prospectively maintained database of stroke patients presenting with NIHSS scores of 0‐5. Patients who applied within 24 hours from the onset of symptoms were included in the study. Detailed clinical information of the patients such as age, sex and the presence of comorbidities, localization of occlusion, procedural measures were recorded. Clinical outcomes were evaluated with NIHSS scores at 24 hours and mRS 3 months.

Results
A total of 147 patients were enrolled in this study. Patient presenting with NIHSS<5 within 24 hours of onset and imaging modalities showing large or medium vessel occlusion and diffusion‐perfusion mismatch were evaluated for MT. The mean age was 62.75 ± 14.63 and 85 (57.8%) of the patients were male. A total of 8 (5.4%) patients had occlusion in extracranial ICA, 16 (10.9%) in ICA terminal, 49 (33.3%) in MCA M1, 52 (35.4%) in MCA M2 and 8 (5.4%) in M3, 3 (2.1%) in ACA, whereas 5 (3.4%) patients in basilar artery and 6 (4.1%) patients in PCA. The mean NIHSS on admission was 3.28 ± 1.37 and 3.29 ± 3.95 at 24 hours. The patients with mRS scores of 0‐2 were evaluated as functionally independent. The number of functionally independent patients at 90 days was 108 (79.4%), whereas 15 (10.2%) patients died.

Conclusions:
In this study low NIHSS patients with underlying vessel occlusion benefit from MT in terms of 3.month mRS. Still large cohort, randomized studies are warranted to show superiority to medical treatment.
Abstract 331: MR Steal Phenomenon Corresponds to Cerebral Angiogram Circulation Time
Authors: Ismail R. , Manganero M. , Szekeres D. , Bender M. , Wang H. 
Published: January 2025

Background
Cerebrovascular reserve (CVR) is crucial for assessing hemodynamic impairment in patients with cerebrovascular steno‐occlusive disease. While catheter cerebral angiography is the gold‐standard for evaluating CVR and collateral circulation, acetazolamide‐challenged arterial spin labeling perfusion MRI (AC‐ASL) has emerged as a non‐invasive alternative, but its effectiveness in reflecting neuroangiographic parameters is not fully understood.

Methods
A retrospective study was conducted on patients who underwent AC‐ASL from 2014‐2022. Patients were excluded if concurrent angiographic analysis was not performed, or image quality was compromised. The study involved correlating cerebral angiographic metrics like arteriocapillary circulation time (ACCT) and superior sagittal sinus entry (SSSE) with AC‐ASL flow parameters in patients with steno‐occlusive disease. MR acquisitions were obtained prior to acetazolamide administration and after 1 g of acetazolamide administered‐ at 5 and 10 minutes intervals. Cerebral angiography was typically performed via transfemoral approach utilizing a dual plane digital subtraction (DSA) radiographic angiographic system. CT angiograms were utilized if DSA was not available.

Results
The study included 32 patients, predominantly with unilateral disease. A significant correlation was found between AC‐ASL adjusted steal percent and angiographic ACCT (r = ‐0.345, p=0.049), which was stronger when comparing the ratio of ACCT between occlusive and nonocclusive hemispheres (r = ‐0.40, p=0.020). No significant correlation was found with SSSE nor angiographic collateralization patterns.

Conclusion
AC‐ASL can non‐invasively evaluate arteriocapillary circulation time, comparable to catheter angiography in patients with steno‐occlusive disease. This suggests AC‐ASL is useful for assessment of CVR in patients, providing a safe and non‐invasive methodology.
Abstract 344: Novel technique for endovascular biopsy of carotid endothelial cells in carotid artery stenosis: Proof of Concept & Follow Up of SVIN 2023 Pilot Grant
Authors: Bounajem M. T. , Dabb S. , Richter K. , Budohoski K. , Grandhi R. 
Published: January 2025

Introduction
Acute ischemic stroke remains to be one of the top causes for morbidity and mortality among the general population, with approximately 800,000 strokes occurring per year nationwide. While the potential etiologies of stroke are numerous, 15‐20% of all strokes are attributed to carotid artery stenosis. While isolated studies have been conducted sampling carotid plaques after CEA, there is a dearth of literature examining the characteristics of the endoluminal cells and their molecular characteristics (such as transcriptomes) in carotid artery disease. We therefore employed a novel method for endovascular biopsy of carotid endothelial cells in the setting of carotid artery stenosis.

Methods
A prospective registry of adult patients undergoing endovascular treatment for carotid artery stenosis was maintained from January 2024 to August 2024. Informed consent was obtained, and at the conclusion of the case, critical devices were collected and placed in dissociation buffer including the access wire/sheath tip, the distal embolic protection device, and any balloons utilized for balloon angioplasty. Cells were then washed from the samples using a series of centrifugation, wash, and pelleting steps. Once completed, the pellet was then resuspended in a solution containing Hibernate A, and a standard antibody staining and sorting protocol was performed utilizing fluorescence activated cell sorting (FACS) to identify endothelial cells (via CD31 antibodies) and to exclude white blood cells (negative sorting via CD45 antibodies).

Results
Six patients met inclusion criteria and gave consent for endothelial carotid biopsy. After sorting for endothelial cells via FACS, the mean number of endothelial cells collected from the access sheath/wire was 1506 cells per patient. Similarly, the mean number of endothelial cells collected from the balloons utilized for angioplasty was 1124 cells. Finally, the mean number of endothelial cells collected from the distal embolic protection device was 5021 cells per patient.

Discussion
The preliminary findings herein suggest that this method of endovascular biopsy may very well be a reliable method for collecting endothelial cells from the carotid artery in the setting of treatment for carotid artery stenosis. Sample collection is still ongoing to further support the viability of this technique. Collected endothelial cells will then undergo RNA sequencing in order to describe the transcriptomic profile present in endothelial cells of diseased carotid arteries.
Abstract 345: Occult Antiphospholipid Syndrome Presenting as Subdural Hematoma: A Rare Manifestation of Arterial Hypercoagulability
Authors: Welsh C. , Gagi K. , Solemani S. 
Published: January 2025

Objective
To describe a case of antiphospholipid syndrome (APS) which presented with subdural hemorrhage, a rarely described manifestation of a commonly hypercoagulable disorder.

Background
APS is a common arterial and venous hypercoagulable state—though rare in the general population with an incidence of 5 per 100,000 individuals. It most commonly presents with systemic ischemic insults, commonly to the brain in the form of ischemic stroke. This case highlights a known rare manifestation of APS: intracranial hemorrhage.
Design/Methods: N/A

Results
Patient is a 49 year old female with history of end‐stage renal disease who initially presented with altered mentation and hypertension. Her GCS was 7 upon arrival prompting intubation. CT head at that time revealed acute left parietal subdural hematoma. There was no clear history of trauma per the patient's family, and the patient was unable to provide any additional history of their own at that time. The etiology of her hemorrhage, in the acute setting, was not clearly discerned. She was managed in the ICU for several days, however she remained somnolent and unable to participate in examination despite removal of sedating agents. A repeat CT scan of the head was done at that time which revealed multifocal hypodensities consistent with late acute‐early subacute ischemic stroke. Subsequent CT angiography of the head and neck was negative for large vessel occlusive disease, extracranial atherosclerotic disease, vasospasm or other clear cerebrovascular constriction. Other embolic stroke workup including transthoracic and transesophageal echocardiogram was negative. At this point, a broader workup for embolic stroke of unclear source was launched. These studies included hypercoagulablity labs were sent and ultimately returned positive with elevated anticardiolipin and beta‐2 microglobulin consistent with an antiphospholipid antibody syndrome, prompting the initiation of anticoagulation. The patient has since improved clinically and is no longer mechanically ventilated, though does still require significant assistance with activities of daily living.

Conclusions
While rare, patients with otherwise unexplained hemorrhage should be investigated for possible immune‐mediated mechanisms for stroke—both ischemic and hemorrhagic.
Abstract 350: Optimizing Stroke Assessment of Dizziness: The Role and Impact of Video Head Impulse Testing
Authors: Vorobyev A. , Farrelly S. , Hartis A. , Monsch E. , Strange C. , Rizk H. , Holmstedt C. A. 
Published: January 2025

Introduction
Dizziness is a frequent and challenging symptom in patients with posterior ischemic stroke, often making it difficult to distinguish from peripheral vestibular disorders. The video head impulse test (vHIT) is a non‐invasive tool that measures the vestibulo‐ocular reflex (VOR) to assess semicircular canal function. This study evaluates the effectiveness of vHIT in the emergency department (ED) for differentiating between central (stroke‐related) and peripheral causes of dizziness. The primary objective is to confirm that vHIT is an effective tool for enhancing diagnostic confidence in ruling out stroke and avoiding unnecessary admissions, thereby optimizing resource allocation for other stroke patients.

Methods
In this prospective study, 30 patients who presented to the ED of the stroke center with dizziness and were subsequently admitted under standard stroke protocol were analyzed. Each patient underwent vHIT in addition to the standard stroke evaluation, which included MRI. The vHIT assessed the VOR in the lateral semicircular canal to detect vestibular hypofunction through measured gain reduction and saccadic eye movements. Two specialists independently analyzed the vHIT results, both blinded to the MRI findings.

Results
Of the 30 patients included in the study, MRI was performed on 27, serving as the gold standard for stroke detection. MRI confirmed the presence of a stroke in 10 cases (37%). Among these patients, the vHIT indicated a possible central etiology in 9 patients, with a sensitivity of 100% (95% CI: 66.37% to 100%). One patient's vHIT recordings were of poor quality, making the results uninterpretable. In the subgroup of 17 patients with negative MRI findings, vHIT suggested a peripheral cause of dizziness in 2 patients. The specificity of vHIT for central etiology was 15.38% (95% CI: 1.92% to 45.45%) with a negative predictive value of 100% (95% CI: 15.81% to 100.00%) and a positive predictive value of 40.97% (95% CI: 35.50% to 46.67%). One patient with a negative MRI but positive vHIT for peripheral etiology was unnecessarily admitted for 3 days.

Conclusion
Our findings suggest that incorporating vHIT into the ED workflow could be an effective strategy for ruling out stroke before proceeding with extensive stroke admissions and workups. vHIT appears to be a valuable tool in the initial assessment of patients with dizziness, facilitating the differentiation between central and peripheral causes. This approach has the potential to reduce unnecessary hospital admissions for patients without central pathology.
Abstract 354: Outcomes in Severity‐Stratified Subarachnoid Hemorrhages using Endovascular Coiling and Microsurgical Clipping
Authors: Sacknovitz A. , Jain A. , Thorman I. , Bienenstock R. , Schubert M. , Al‐Mufti F. 
Published: January 2025

Introduction/Purpose
Non‐traumatic subarachnoid hemorrhage (SAH) is an emergent medical condition characterized by acute onset bleeding into the subarachnoid space. Rupture of a saccular or berry aneurysm is the primary cause (85%), but other etiologies include other cerebral aneurysms, arteriovenous malformation, aortic dissection, and other vascular abnormalities. Historically, aneurysm clipping was the primary modality of treatment. The standard of care changed when the ISAT study established endovascular coiling as a better, less invasive alternative. The objective of this study was to describe mortality following intervention for aneurysm rupture using real‐world data with extensive control for severity of the resulting hemorrhage.

Materials/Methods
This retrospective cohort study analyzed survival data from a cohort of patients with ruptured intracranial aneurysms and recorded GCS who underwent endovascular coiling (n=634) and microsurgical clipping (n=223). Data were pulled from the TriNetX Research Network. One‐year mortality was assessed and compared using Cox proportional hazard models. Propensity score matching was used to control for demographics, comorbidities, the National Inpatient Sample‐SAH Severity Scale (NIS‐SSS) criteria, and GCS.

Results
When not controlled for severity, an analysis of 3,647 patients matched on all criteria except for GCS, the hazard of mortality was significantly elevated for coiling (HR=1.16; 1.02, 1.33). The cumulative one‐year survival was 86.6% in coiling and 88.3% in clipping. However, when the severity was controlled for using GCS (n=106 of each), patients with mild‐moderate hemorrhages (GCS 9‐15) had one‐year cumulative survival rates of 87.8% for coiling and 93.4% for clipping. Survival analysis showed that coiling was not associated with increased hazard of one‐year mortality (HR=1.74; 95% CI: 0.68, 4.41). Among patients with severe hemorrhages (GCS 3‐8), the cumulative survival rates were 41.3% for coiling and 51.8% for clipping, after matching (n=56 of each). The one‐year mortality hazard associated with coiling was also not significant in this population (HR=1.40; 0.83, 2.37).

Conclusions:
There were no significant differences in one‐year mortality between clipping and coiling in both mild‐moderate and severe SAH after ruptured intracranial aneurysms. Further research is needed to establish the differences in severity between the two groups and understanding the true hazards with larger cohorts.
Abstract 374: Predictors of early intracerebral hemorrhage in patients with cerebral sinus venous thrombosis: Systematic review and meta‐analysis
Authors: Gharaibeh K. , Alhajala H. , Pervez H. , Ali A. , Jumaa M. , Zaidi F. 
Published: January 2025

Objectives
Patients with cerebral venous thrombosis (CVT) may present with early intracerebral hemorrhage (EICH). The objective of this study was to identify predictors for EICH in CVT patients via a systematic review and meta‐analysis of observational studies.

Methods
Literature search on PubMed, EMBASE and Cochrane Library databases from inception up to 1 February 2024 was conducted. Five studies with predictors of EICH were included in qualitative synthesis and meta‐analysis.

Results
Pooled analysis demonstrated a statistically significant association between female gender and EICH (odd ratios (OR) = 1.51, 95% confidence interval (CI) = 1.23‐1.85, p < 0.01). The ICH patients had higher likelihood of seizures (OR = 3.07, 95% CI = 1.69‐5.58, p < 0.01), focal neurological deficits (OR = 4.07, 95% CI = 2.57‐6.44, p < 0.01), and decreased level of consciousness (OR=3.89, 95% CI = 2.53‐5.87, p < 0.01). Superior Sagittal Sinus thrombosis was associated with higher likelihood of EICH (OR: 1.49, 95% CI 1.05‐2.13, P = 0.03). No statistically significant association was demonstrated between presence of EICH and pregnancy, presence of hematological diseases or thrombophilia, or other site of venous thrombosis (deep venous system, or multiple sinuses involvement). Furthermore, patients who exhibited early EICH were notably less likely to attain a favorable functional outcome (mRS 0‐2) (OR: 0.28; 95% CI 0.16‐0.49; p < 0.001).

Conclusion
This meta‐analysis demonstrates that among CVT patients, female patients with new onset seizures, focal neurological deficits and decreased level of consciousness are more likely to present with EICH