bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 162: Hydration Status and Functional Outcomes in Patients with Large Vessel Occlusion Stroke Undergoing Endovascular Therapy
Authors: Baldwin‐LeClair Abigail , Patel Avish , Patel Karan N , Siegler James E , Kamen Scott , Thau Lauren , Wolfe Jared , Zhang Linda , Thomas Kavya , Vigilante Nicholas , Thon Jesse M 
Published: April 2023

Introduction
Large vessel occlusion (LVO) and dehydration are both independently associated with poor functional outcomes and increased odds of mortality in acute ischemic stroke. Dehydration has previously been shown to affect collateral blood flow in LVO stroke, but it is unclear if this leads to worsened clinical outcomes.

Methods
A stroke center registry (10/2019‐12/2021) of consecutive adults who had undergone successful endovascular therapy (EVT, with thrombolysis in cerebral infarction score 2b/3) for anterior circulation LVO (ICA, M1, or M2) was queried. Dehydration on presentation was defined using laboratory surrogates: blood urea nitrogen/creatinine ratio >15 or serum osmolality >296 mOsm/kg. The primary outcome was a favorable shift in 90‐day modified Rankin Scale (mRS) using a proportional odds model, adjusting for age, pre‐stroke mRS, National Institutes of Health Stroke Scale (NIHSS), and Alberta Stroke Program Early Computed Tomography Scale (ASPECTS). Secondary outcomes included early improvement in 24h NIHSS.

Results
Of the 318 patients with anterior LVO who underwent EVT, 206 (65%) met criteria for dehydration, and 181 (87.9%) had both mRS and ASPECTS data available. Younger age, lower NIHSS, lower mRS, and higher ASPECTS were all strongly and independently associated with a favorable shift in 90d mRS. Dehydrated patients had similar changes in 24‐hr NIHSS scores (‐5 [interquartile range, IQR ‐10 to 0] vs. ‐5 [IQR ‐8 to 0], p = 0.37). Dehydration was not associated with a less favorable shift in 90‐day mRS (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.41‐1.33), which remained non‐significant after multivariable adjustment (OR 1.46, 95%CI 0.74‐2.86). With serum osmolality assessed continuously, higher serum osm was associated with a less favorable shift in mRS at 90d (OR 0.95, 95%CI 0.92‐0.99, p = 0.009), but this did not persist after multivariable adjustment (p = 0.92) and was driven by the association between higher osmolality and age (r = 0.24, p(bonferroni)< 0.01) and pre‐stroke mRS (r = 0.20, p(bonferroni) = 0.04).

Conclusions
There was no association between dehydration and lower odds of early clinical improvement or long‐term functional recovery following successful endovascular thrombectomy.
Abstract Number ‐ 172: First‐in‐Human Experience: Route 92 Medical 132 cm FreeClimb 88 Catheter for Anterior Circulation LVOs
Authors: English Joey D , Puri Ajit S , Caldwell James , Singh Jasmeet 
Published: April 2023

Introduction
Direct aspiration thrombectomy of proximal anterior circulation large vessel occlusions (LVOs) with super‐bore catheters (SBCs, 0.088” ID) may result in improved first pass success, though their consistent delivery to the target occlusion remains challenging. We report the first‐in‐human experience with a novel full‐length 132 cm 0.088” ID FreeClimb ® 88 catheter (Route 92 Medical, San Mateo, CA, currently approved for neurovascular access), and its customized Tenzing ® 8 delivery catheter, for anterior circulation LVO acute stroke patients.

Methods
We performed a retrospective review of thrombectomy cases for proximal anterior circulation large vessel occlusions performed at three stroke centers from May 2022 through August 2022. All patients were treated using the Route 92 Medical 8F Base Camp® guide catheter, FreeClimb ® 88 catheter and Tenzing ® 8 delivery catheter in an off‐label fashion.

Results
Ten consecutive acute stroke patients with anterior circulation LVOs were treated. The median age was 71 (45‐91) and 6 were female (60%). The median presenting NIHSS score and ASPECT score were 17 (8‐24) and 9 (6‐10), respectively. LVO locations were as follows: two right carotid termini, three right M1 middle cerebral arteries, and five left M1 middle cerebral arteries. Three patients also had tandem occlusion/near‐occlusion of the respective cervical internal carotid artery. The FC88 catheter was delivered to the target occlusion with 100% success. The median time from groin puncture to catheter delivery to the target occlusion was 14 minutes (7‐35). First pass complete reperfusion (modified Thrombolysis in Cerebral Infarction score, mTICI, of 3) was achieved in 9/10 (90%) patients (self‐adjudicated). Adjunctive therapy for a residual M2 occlusion was utilized in 1/10 patients. There were no adverse events or post‐procedural symptomatic hemorrhages.

Conclusions
Our first‐in‐human experience with a novel 132 cm full‐length super‐bore catheter (Route 92 FreeClimb ® 88 catheter) and its customized catheter delivery device (Tenzing ® 8) for aspiration thrombectomy of proximal anterior circulation large vessel occlusions demonstrated 100% successful delivery to the target occlusion, with TICI 3 first pass reperfusion achieved in 90% of patients.
Abstract Number ‐ 174: Direct carotid puncture for mechanical thrombectomy in acute ischaemic stroke
Authors: Mutis Jorge , Pabon Boris , Torres Victor , Patiño Manuel , Pelaez Juan , Cardozo Margarita 
Published: April 2023

Introduction
While the benefit of mechanical thrombectomy (MT) for patients with acute ischemic stroke with large‐vessel occlusion (AIS‐LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonge. In the following cases, functional and safety outcomes of mechanical thrombectomy via direct carotid puncture were evaluated in patients with acute ischemic stroke with limited vascular access.

Methods
We evaluated seven patients with AIS‐LVO who underwent attempted MT in last year with limmited vascular access for aborted MT after failed transfemoral access or attempted MT via DCP.

Results
Of 11 patients with AIS‐LVO who underwent attempted MT, Direct carotid access was successfully obtained in all patients, mean age [± SD] 63 ±15 years. Successful reperfusion (thrombolysis in cerebral infarction score 2b or 3) was achieved in 11 patients (100%). Carotid access complications included disection vascular in 1 pacient, with second vascular Access (carotid puncture) required. In 3 patients (42.8%) thrombolysis therapy with IV r‐TPA were administered during thrombectomy by direct carotid puncture. 3 patients presented neck hematomas but they did not require any subsequent interventions. All patients required angio‐seal vascular closure device for direct carotid Access 6F. We found that the final functional outcome was based on modified Rankin Scale score between 1 and 3 achieve in 8 of 11 patients (71.4%).

Conclusions
DCP for emergency MT in patients with AIS‐LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates.
Abstract Number ‐ 181: Anterograde versus Retrograde approaches in the Endovascular Management of Tandem Lesions
Authors: Zevallos Cynthia B , Galecio‐Castillo Milagros , Farooqui Mudassir , Abraham Michael , Divani Afshin , Ribo Marc , Petersen Nils , Fifi Johanna , Guerrero Waldo , Malik Amer , Siegler James , Nguyen Thanh N , Sheth Sunil A , Yoo Albert J , Linares Guillermo , Janjua Nazli , Quispe‐Orozco Darko , Tekle Wondewossen , Oliver Marion , Zaidi Syed , Castonguay Alicia , Kobsa Jessica , Prasad Ayush , Ikram Asad , Answer Hamza , Patterson Mary , Requena Manuel , Olive Marta , Qureshi Abid , Barkley Tiffany , Matsoukas Stavros , Rana Ameena , Abdalkader Mohamad , Salazar‐Marioni Sergio , Soomro Jazba , Vivanco‐Suarez Juan , Rodriguez‐Calientes Aaron , Turabova Charoskhon , Edgell Randall , Mokin Maxim , Yavagal Dileep , Zaidat Osama , Jumaa Mouhammad , Hassan Ameer , Ortega‐Gutierrez Santiago 
Published: April 2023

Introduction
There are two approaches for treating stroke patients with tandem occlusions: the anterograde approach (AA, extracranial lesions first) and the retrograde approach (RA, intracranial lesion first). Both techniques are associated with favorable functional outcomes. We aimed to compare both techniques for efficacy and safety outcomes in a multicenter study.

Methods
Patient data were pooled from 17 centers and divided into AA and RA groups. We performed multivariable logistic regressions to evaluate the association between each group with efficacy and safety outcomes.

Results
552 patients were included in the study, 270 (48.4%) were treated with the AA, and 288 (51.6%) with the RA. There were no differences between groups for functional outcome (mRS 0–2) at 90 days (aOR = 0.93, 95%CI: 0.58‐1.48, p = 0.75), and successful reperfusion [mTICI >2b] (aOR = 0.83, 95%CI: 0.44‐1.56, p = 0.57). Similarly, we did not observe any differences for safety outcomes related to sICH (OR = 0.57, 95%CI: 0.25‐1.29, p = 0.18), parenchymal hematoma type 2 (OR = 0.61, 95%CI: 0.3‐1.22, p = 0.16), and all‐cause mortality at 90 days (OR = 1.22, 95%CI: 0.66‐2.26, p = 0.52). However, the median puncture‐to‐reperfusion time was higher in AA compared with RA [59 minutes (IQR: 38–92) vs 53.5 minuntes (IQR: 37–87)].

Conclusions
The AA and RA approaches for the treatment of tandem occlusions seem to achieve similar efficacy and safety outcomes. These results are consistent with those of a previous multi‐center study. Additionally, and in line with previous research, there is a puncture‐to‐reperfusion time difference between both approaches, which suggests a potential benefit when using the RA. However, further prospective randomized studies are needed to elucidate its benefit in achieving better clinical outcomes.
Abstract Number ‐ 184: Prediction Model For Medical Rescue Treatment Strategies In Patients With Incomplete Reperfusion
Authors: Mujanovic Adnan , Kurmann Christoph , Dobrocky Tomas , Meinel Thomas , Grunder Lorenz , Beyeler Morin , Lang Matthias F , Jung Simon , Klail Tomas , Hoffmann Angelika , Seiffge David J , Heldner Mirjam , Pilgram‐Pastor Sara , Mordasini Pasquale , Arnold Marcel , Piechowiak Eike I , Gralla Jan , Fischer Urs , Kaesmacher Johannes 
Published: April 2023

Introduction
After successful reperfusion is achieved (extended Thrombolysis in Cerebral Infarction (eTICI) ≥ 2b50), decision on pursuing additional treatment strategies in order to achieve complete reperfusion (eTICI = 2c/3), is multifactorial and depends on patient’s clinical and imaging characteristics. We have developed and validated a clinical decision tool to provide individualized predictions on achieving delayed reperfusion based on individual patient data.

Methods
Single‐center registry analysis for all consecutive patients admitted between 02/2015 – 12/2020. Primary variable of interest was perfusion imaging outcome in patients with incomplete reperfusion (eTICI 2a‐2c), evaluated on the 24‐hour follow‐up imaging. This variable was dichotomized into delayed reperfusion, in case of non‐observable perfusion deficit, and persistent perfusion deficit, in case of perfusion deficit captured on the final angiography imaging. Final model variable selection was performed via bootstrapped (n = 200) stepwise backwards regression. Model was split into a training and testing set (80:20 ratio), with 10‐fold cross validation resampling.

Results
372 patients (50.8% female, mean age 74) were included, with 228 (61.2%) of them having delayed reperfusion. Final model identified seven variables of importance including: age, sex, atrial fibrillation, Intervention‐to‐Follow‐Up time, maneuver count, eTICI and collateral status. Model’s discriminative ability for predicting delayed reperfusion was adequate (AUC 0.83, 95% CI 0.74 –0.92), with an overall adjusted calibration (Brier score 0.17, 95% CI 0.15‐0.18).

Conclusions
Current model presents a tool that may aid clinical decision‐making process in selection of patients for pursuing additional treatment strategies after incomplete reperfusion has been achieved. This is an important next step towards personalized treatment of stroke patients undergoing mechanical thrombectomy.
Abstract Number ‐ 191: Barriers to Mechanical Thrombectomy in Africa
Authors: Morakinyo Oreoluwa E , Amuta Augustine C , Ajenaghughrure Godbless , Nriagu Bede N , Mejulu Eunice O 
Published: April 2023

Introduction
The emergence of mechanical thrombectomy (MT) as a standard of care has revolutionized the management of proximal large vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). Endovascular therapy has already been shown to provide better long‐term outcomes when compared to standard treatment alone. However, despite the significant advances and benefits associated with MT in the treatment of proximal LVOs in developed countries, Africa continues to lag in the use and adaptability of the “gold standard” for proximal LVO stroke treatment. With the prevalence of stroke in Africa approaching the highest rates in the world, this study seeks to highlight the problems threatening endovascular therapy in Africa. This is an important step in advocacy for more radical, effective, and evidence‐based management of patients with proximal LVOs in Africa.

Methods
For this narrative review, PubMed and Google Scholar were used to search for literature on mechanical thrombectomy and endovascular treatment of LVOs in Africa. Selection criteria were manuscripts published in the last 10 years, written in English language, and addressed challenges with MT.

Results
42 papers from 21 African nations were found and reviewed. The major challenges and impediments to MT in Africa were, a lack of government policy on stroke care, a suboptimal health care financing model that makes endovascular treatment nearly impossible to afford, delay in presenting to the hospital after stroke onset coupled with very few emergency services with some countries having none, lack of specialized training, as well as, scarcity of neuroradiological infrastructure.

Conclusions
Despite these challenges, there is still hope for Africa. With its four domains (surveillance, prevention, acute treatment, and rehabilitation), the stroke quadrangle, adapted by many countries allows for focused initiatives aimed at successfully lowering the burden of stroke in Africa at the community level through prevention and education. There is still an urgent need for increased global support to address these challenges in Africa, even as programs like the MT2020+ by the Society of Vascular and Interventional Neurology (SVIN) have given Africa hope for the future of endovascular therapy by fostering collaboration, training, and policy development.
Abstract Number ‐ 193: Endovascular Thrombectomy for Basilar Artery Occlusion: Systematic Review and Meta‐analysis
Authors: Chiu Yu‐Ping , Lui Aiden K 
Published: April 2023

Introduction
Basilar artery occlusion (BAO), accounting for approximately 1% of all ischemic strokes and 5–10% of all proximal intracranial occlusions, usually causes devastating neurologic sequelae, poor prognosis and even death [1‐2]. Endovascular thrombectomy (EVT) has been recommended for anterior circulation stroke with large vessel occlusion (LVO) [3‐6]. During the past decade, there has been emerging interests in whether EVT could provide similar overwhelming benefits in posterior circulation stroke, especially BAO [7‐8]. The goal of our study is to compare EVT with conservative medical treatment (CMT) about the efficacy and the safety in patients with BAO.

Methods
All relevant literature comparing the outcomes of EVT versus CMT in patients with BAO were recruited via PubMed, Embase and the Cochrane Library until April 2022. Random‐effects model was adopted to pool estimates regrading favorable/good functional outcome, symptomatic intracranial hemorrhage (sICH) and the mortality. The heterogeneity of outcomes was assessed using the Cochran Q test (reported as a Cochran Q p value) and I2 statistics.

Results
Of the eight studies, a total of 3733 patients with pure BAO were enrolled. EVT was conducted in 2573 patients, and the others received CMT. Compared with CMT group, EVT group with or without intravenous thrombolytic therapy achieved more favorable functional outcome (OR 1.26, 95% CI 1.03 to 1.55, I2 = 54%, p = 0.05; Figure 1A) in patients with BAO. Similar trend was also noted in the good functional outcome (OR 1.23, 95% CI 0.97 to 1.57, I2 = 63%, p = 0.02; Figure 1B). Even though EVT group tended to provoke more sICH (OR 2.91, 95% CI 1.38 to 6.18, I2 = 22%, p = 0.27; Figure 1C), it reduced the mortality (OR 0.81, 95% CI 0.70 to 0.93, I2 = 31%, p = 0.19; Figure 1D) in patients with BAO, originally a devastating condition.

Conclusions
Our study worked in concert with the recent climate in the endovascular era [9] that EVT in BAO provides superior functional outcomes and less mortality compared with CMT. Despite the tendency of developing sICH after reperfusion, EVT still brought a dawn to posterior circulation stroke. We are no more at our wits’ end with BAO and its grave prognosis. Furthermore, we still need more future randomized control trials [10] or large‐scale cohorts for conclusive evidence.
Abstract Number ‐ 199: Acute Treatment of Aneurysmal Subarachnoid Patients with Flowdiversion: A Single Center Real World Experience
Authors: Ramakrishnan Pankajavalli , Harris Jatifha , Gibler Dana , Duck Nicole , Leesch Wofgang 
Published: April 2023

Introduction
Subarachnoid hemorrhage patients presenting with complex morphology, and those with dissecting /fusiform aneurysms, blister aneurysms have historically posed a challenge for acute endovascular treatment. Flow diversion as a treatment for ruptured intracranial aneurysms is a last resort given the need for dual antiplatelet therapy in the acute setting.

Methods
We present our single center experience, real world experience in the acute treatment of patients with subarachnoid hemorrhage with pipeline flow diversion device.

Results
6 patients presented acutely with a subarachnoid hemorrhage. Two of those had saccular intracranial aneurysms, 1 with a blister aneurysm, and 3 with dissecting aneurysms. 1 patient presented with a ruptured anterior choroidal artery location dissecting aneurysm, 1 with PCA blister aneurysm, 1 with intradural vertebral artery dissecting aneurysm, 1 saccular posterior communicating artery aneurysm, and another with a ruptured complex morphology anterior choroidal artery aneurysm, and 1 with dissecting PCA aneurysm. All patients were emergently loaded with dual antiplatelet therapy consisting of either aspirin and clopidogrel, or aspirin and ticagrelor or pletal and ticagrelor. 1 patient was treated with surface modified pipeline device with shield technology. Technical success was achieved in 100% of these patients. No acute in stent thrombosis was seen in this cohort. Four patients had no residual filling or recurrence at the 1st follow‐up at a median interval of 2–12 months. 1 patient died from fulminant vaso spasm. Follow‐up is pending in 1 patient.

Conclusions
In carefully selected patients, flow diversion in the acute setting is tolerated and can be an alternative treatment strategy with an acceptable safety profile.
Abstract Number ‐ 207: Modeling Optimal Patient Transport in a Stroke Network Capable of Remote Telerobotic Endovascular Therapy
Authors: Beaman Charles , Holodinsky Jessalyn K , Goyal Mayank , Tateshima Satoshi , Hill Michael D , Saver Jeffrey L , Kamal Noreen 
Published: April 2023

Introduction
Endovascular therapy (EVT) is the standard‐of‐care for large vessel occlusion stroke; however, timely access to treatment is still limited for a large proportion of the population. Telerobotic EVT has the potential to decrease time to treatment and expand existing networks of care to more rural populations. It is currently unclear how its implementation would impact existing stroke networks.

Methods
Conditional probability models were generated to predict the probability of excellent outcome (modified Rankin Scale 0–1 at 90 days post stroke) for patients with suspected large vessel occlusion (LVO). A baseline stroke network was created for California using existing intravenous thrombolysis (IVT) centers and comprehensive stroke centers (CSCs) capable of IVT and EVT. Optimal transport decisions and catchment areas were generated for the baseline model and three hypothetical scenarios through conversion of IVT centers at various distances from a CSC into centers capable of Telerobotic EVT [i.e. hospitals ≥ 15 and < 50 miles from a CSC were converted (Scenario 1), ≥ 50 and < 100 miles (Scenario 2), and ≥ 100 miles (Scenario 3)]. Catchment areas were calculated for each scenario using varied robotic procedural delay times and success rates.

Results
In the baseline model, 51 hospitals were designated as CSCs and 142 hospitals were designated IVT centers. Conversion of IVT centers into Telerobotic EVT centers decreased median travel time for LVO patients in all three scenarios. The estimated number of robotically treated LVOs per year in Scenarios 1, 2, and 3 were 2172, 740, and 212, respectively. Scenario 1 (15‐50 miles) was the most sensitive to robotic time delay and success rate, but all three scenarios were more sensitive to decreases in procedural success rate compared to time delay.

Conclusions
Telerobotic EVT has the potential to improve care for stroke patients outside of major urban centers. Compared to procedural time delays in robotic EVT, a decrease in procedural success rate would not be well tolerated. This modeling analysis can inform system planning for the potential advent of remote EVT care.