bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 255: Effect of Oral Glibenclamide on Delaying Peak Onset of Malignant Cerebral Edema in Large Hemispheric Infarctions
Authors: Oei M. , Hollar M. , Giurgiutiu D. , Shah M. , Garcia K. 
Published: January 2025

Title
Delayed Peak of Malignant Cerebral Edema in Large Hemispheric Infarction with Oral Glyburide Treatment: A Case Study

Introduction
Malignant cerebral edema (MCE) is a severe complication of large hemispheric infarction, often leading to poor outcomes and high mortality rates. Invasive measures, such as decompressive craniotomy, are both reactive in nature and have limited applicability. Other medical therapies are also used, but are reactive and have mixed results with limited evidence of efficacy. A growing body of evidence has indicated that glyburide, a sulfonylurea receptor 1 (SUR1) inhibitor, may prevent or delay the onset of MCE. This case study explores the effects of oral glyburide on the timing and severity of MCE in a patient with a large hemispheric infarction.

Methods
A 53‐year‐old woman with a large left middle cerebral artery territory infarction was treated prophylactically with oral glyburide (2.5 mg daily) for five days. Standard care, including hyperosmolar therapy, was administered. The patient's neurological status and midline shift were monitored using serial CT imaging from post‐stroke day (PSD) 0 to PSD 18.

Results
Initial imaging showed large hemispheric infarction without midline shift. However, a gradual increase in midline shift was observed, peaking at 13 mm on PSD 14, which is later than the typical 3‐5‐day peak in similar cases. Despite this delayed peak swelling, the patient's clinical status remained stable, and no further escalation of care was needed. The patient tolerated glyburide without adverse effects, such as symptomatic hypoglycemia.

Discussion
The delay in the peak of MCE observed in this case suggests that glyburide may extend the window for effective management of edema. While the exact mechanism remains unclear, the early stabilization of neurological status with delayed significant edema warrants further investigation into glyburide as a potential prophylactic therapeutic option. This case aligns with earlier research indicating that glyburide can mitigate ischemia‐induced edema, potentially improving outcomes in stroke patients.

Conclusion
This case suggests that glyburide may delay the peak of malignant cerebral edema in large hemispheric infarctions, offering a new avenue for proactive management of this condition. Further studies are needed to confirm these findings and establish glyburide's role in acute stroke management.
Abstract 270: Endovascular Versus Medical Management of Acute Ischemic Strokes Due to Distal Medium Vessel Occlusions
Authors: Rehman M. Aemaz ur , Javairia F. , Shaikh M. , Ejaz R. , Abid M. , Fatmi W. , Malik A. A. , Imran A. , Ali R. , Aladawi M. 
Published: January 2025

Introduction
Although endovascular treatment (EVT) is highly effective for acute ischemic strokes due to proximal large vessel occlusions (LVOs), its efficacy and safety in distal medium vessel occlusions (DMVOs) has shown conflicting results. EVT in distal medium vessel occlusions is considered high‐risk due to reduced vessel size and tortuosity, but newer techniques and recent efforts to explore the EVT potential have encouraged us to revisit thrombectomy indications. We thus performed a systematic review and meta‐analysis to compare its efficacy and safety with the best medical treatment (BMT) in treating primary DMVOs.

Methods
A comprehensive search was performed on Embase, PubMed, and Cochrane from inception to April 2024. Efficacy outcomes of interest included functional independence (90‐day modified Rankin scale (mRS) 0‐2) and excellent functional outcomes (90‐day mRS 0‐1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and 90‐day mortality. Statistical analysis was performed on Review Manager (RevMan) version 5.3.

Results
Two randomized controlled trials and twenty observational studies were included in this meta‐analysis with a total sample size of 4081; 1858 (46%) patients were included in the EVT arm and 2223 (54%) belonged to the BMT arm. In the overall cohort, EVT was comparable to BMT in terms of functional independence (OR 0.97, 95% CI 0.74 to 1.28, p=0.86), symptomatic ICH (OR 1.38, 95% CI 0.75 to 2.53), and mortality (OR 1.23, 95% CI: 0.88 to 1.70). A trend towards the superiority of EVT for excellent functional outcomes in strokes with NIHSS score >6 was observed but this finding missed statistical significance by a narrow margin (OR 1.22, 95% CI 0.96 to 1.56, p=0.10). An analysis of studies with mild strokes (NIHSS <6) showed that EVT leads to significantly lower rates of functional independence (OR 0.57, 95% CI 0.33 to 0.99, p=0.05) and also leads to significantly higher rates of sICH in these patients (OR 6.35, 95% CI 1.56 to 25.83, p=0.010).

Conclusion
BMT is comparable to EVT for distal medium vessel ischemic strokes (AIS‐DMVO). There may be a trend towards EVT achieving higher rates of excellent functional outcomes (mRS 0‐1) in patients with NIHSS score >6 but BMT is superior to EVT in patients with NIHSS score <6.
Abstract 296: Impact of Statin Initiation and Resumption on Mortality Following Intracranial Hemorrhage: A Meta‐Analysis
Authors: Baskaran A. B. , Atlaw S. , Morsi R. , Kozel O. A. , Smith M. , Nugent J. , Aldaher B. , Agwu C. , Chahine A. , Karar L. , Jhaveri A. , Penagos J. C. , Kothari S. , Siddiqui O. , Najam N. , Desai H. , Metman O. V. , Rana R. , Thind S. , Sehgal N. , Lawrence M. , Iourinets J. , Patel S. , Amin A. , Jafary H. , Lis P. , Prabhakaran S. , Kass‐Hout T. 
Published: January 2025

Background
The use of statins following intracranial hemorrhage (ICH) is disputed. Prior studies have found inconsistent effects of statins on the risk of subsequent ICH and other outcome measures. Moreover, many previous studies do not distinguish between post‐ICH statin treatment in patients resuming previous statin therapy versus initiation in statin‐naïve patients. This meta‐analysis consolidates the evidence surrounding the use of therapies following ICH, with a focus on mortality in these two subgroups.

Methods
A comprehensive search of MEDLINE, EMBASE, and The Cochrane Library was conducted up to 2024 to identify studies on statin initiation or resumption versus no statin use in intracerebral/intraparenchymal hemorrhage patients, yielding 8 studies meeting inclusion/exclusion criteria. The protocol was registered with PROSPERO, and data were analyzed using a Pairwise Meta Analysis on R, applying common and random effects models with heterogeneity assessed via I² statistics. Mortality outcomes were categorized into “short‐term” (≤90 days) and “long‐term” (>90 days to 1 year) mortality.

Results
Mortality events occurred in 2946 out of 9501 patients (31.0%) in the control group, 123 out of 2248 patients (5.5%) in the statin initiation group, and 787 out of 3944 patients (20.0%) in the statin resumption group. For the ≤90 days timeframe, the random effects model showed a significant reduction in mortality with statin initiation, with a relative risk (RR) of 0.15 (95% CI [0.081; 0.26], p < 0.0001), and with statin resumption, the RR was 0.32 (95% CI [0.18; 0.55], p < 0.0001). Heterogeneity was high, with an I² of 84.3%. For the >90 days up to 1 year timeframe, statin initiation was associated with a reduction in mortality, with an RR of 0.39 (95% CI [0.29; 0.53], p < 0.0001). Statin resumption also showed a reduction in mortality, with an RR of 0.65 (95% CI [0.46; 0.92], p = 0.0145). Heterogeneity was moderate, with an I² of 41.7%.

Conclusion
Statin therapy following ICH, whether through initiation or resumption, is associated with a significant reduction in mortality both within 90 days and beyond 90 days up to one year. Interestingly, statin initiation showed a stronger effect compared to resumption. These findings support the continuation or initiation of statins in the acute phases of ICH management regardless of previous statin use.
Abstract 314: Intracisterna Magna (ICM) Injection
Authors: Kim V. , Roychowdhury S. 
Published: January 2025

Introduction/Purpose
Intracisterna magna (ICM) injection is used as a route to deliver intrathecal gene therapy to treat neuropathies and lysosomal storage disorders. This allows requiring smaller doses than if therapy was delivered through other routes of vector delivery in the brain and spinal cord. This procedure had never been performed in humans before, only animals, at the time of procedure.

Case description and technique
The procedure was performed under general anesthesia. It was vital that the patient did not move during the entirety of the procedure. This is generally a high risk procedure due to the surrounding vasculature and risk of stroke. Contraindications include anatomic variability where the posterior inferior cerebellar artery (PICA) or vertebral artery would be obstructing the area for access. Other contraindications include the presence of an occipital sinus, Chiari I malformation or low lying tonsils. Potential complications include soft tissue injury, vascular injury, bleeding, and CSF leak. The pediatric patient's head was flexed to open the pathway to the cisterna magna. Cross sectional imaging with CT with contrast was used to identify the vertebral artery, PICA, and veins. The patient was positioned lateral decubitus with the right side down. The posterior craniocervical junction was sterilely prepped and draped. Xylocaine was used for local anesthesia. 25G 3 inch spinal needle was advanced into posterior neck, progressing into the cisterna magna using 2mm cuts until CSF was seen draining through needle. 0.5cc Isovue‐180 contrast was injected showing uptake in the cisterna magna. 5cc CSF removed was removed followed by introduction of 5cc of the experimental drug per protocol followed by a saline chaser. There was no immediate complication and the patient was admitted to the pediatric intensive care unit (PICU) for ongoing cardiorespiratory and neurologic monitoring.

Outcome
This was the first patient with GM1 gangliosidosis to be treated via ICM injection of a viral vector at the time of procedure.
Abstract 319: IV Thrombolysis Administration for Acute Ischemic Stroke After Cervical Epidural Injection: A Case Report
Authors: Phan C. , Tar M. I. , LaBarte T. 
Published: January 2025

Introduction
Intravenous (IV) thrombolysis with recent lumbar puncture is a relative contraindication due to the potential for development of epidural hematoma. While there have been case reports of uncomplicated IV thrombolysis after lumbar puncture or epidural anesthesia, there is limited data overall regarding the safety of IV thrombolysis for acute ischemic stroke (AIS) in patients who have undergone a neuraxial procedure. To our knowledge, there are no reported cases of successful IV thrombolysis after cervical epidural injection (CEI).

Methods
This is a case report.

Results
An 83‐year‐old male with past medical history of hyperlipidemia and prior stroke with residual right arm weakness presented for worsening right arm weakness and new symptoms of right leg weakness. Neurological exam also revealed aphasia and right facial droop. Patient presented within the time window for IV thrombolysis. However, the patient received a CEI earlier that day, which was confirmed to be around C7 level and considered uncomplicated with additional clinical observation that the dura was not punctured. Non‐contrast CT head showed no evidence of intracranial hemorrhage. CT angiogram of the head and neck showed an occlusion of the proximal aspect of the left internal carotid artery. Neurointerventional radiology was consulted to discuss the safety of IV thrombolysis given the recent epidural steroid injection. After extensive discussion regarding indication, risks, and benefits of IV thrombolysis with the patient and his son, informed consent was obtained, and IV Tenecteplase (TNK) was administered. The patient was then transferred to a thrombectomy capable center, where he received a balloon angioplasty and stenting to the left ICA with TICI 2b revascularization. MRI confirmed acute left frontal infarct. The patient remained stable without complications from the TNK and was discharged home on optimal medical management with antiplatelet therapy.

Conclusion
We present a case report of safe and successful administration of IV thrombolysis for AIS after recent CEI with resulting favorable recovery. The decision for IV thrombolysis was made after confirmation that the dura was not punctured. Further studies are necessary to establish the safety for IV thrombolysis after neuraxial procedures, such as epidural injections or epidural anesthesia.
Abstract 375: Predictors of Good Clinical Outcomes After First Pass Effect in Anterior Circulation Tandem Occlusions
Authors: Jaikumar V. , Lim J. , Monteiro A. , Stockman I. , Kruk M. , Shah S. , Scullen T. , Bouslama M. , Raygor K. P. , Davies J. M. , Snyder K. V. , Levy E. I. , Siddiqui A. H. 
Published: January 2025

Introduction
First pass effect (FPE) is an independent predictor of good clinical outcomes following mechanical thrombectomy (MT) in non‐tandem occlusions. A proximal tandem carotid steno‐occlusion introduces additional times and technical complexities which can influence recanalization and reperfusion dynamics and potentially, clinical outcomes in the long run. We evaluated the predictors of good clinical outcomes, specifically mRS0‐1 and mRS0‐2 at 90 days, in patients with anterior circulation tandem occlusions where recanalization was achieved through FPE from MT with emergent carotid artery angioplasty and stenting (eCAS), and had a baseline mRS0‐2.;

Methods
We perform a retrospective analysis of institutional thrombectomy database to identify univariate predictors. Significant predictors will be included in a multivariate logistic regression to determine significant predictors of mRS0‐1 and mRS0‐2 at 90 days post‐MT and eCAS.;

Results
We included 88 (66.2%) patients who achieved first pass effect among 133 anterior tandem occlusions undergoing MT with eCAS. Among patients with mRS0‐2 at 90 days, multivariate regression identified age (OR:0.857[0.772‐0.952],p=0.004), intravenous alteplase (OR:12.3[1.3‐114],p=0.027), use of a ballon guide catheter as opposed to conventional guides (OR:0.02[0.01‐0.63],p=0.027), time from arterial access to recanalization (OR:0.96[0.92‐0.999],p=0.043), pre‐eCAS oral aspirin/ticagrelor load as opposed to intravenous eptifibatide load (OR:0.017[0.001‐0.964],p=0.048) and symptomatic ICH (OR:0.025[0.001‐0.723],p=0.032) to be significant predictors. Significant predictors for mRS0‐1 at 90‐days were male sex (OR:41.33[1.45‐1179.31],p=0.03), hypertension (OR:0.03[0‐0.44],p=0.012), diabetes (OR:0.04[0‐0.63],p=0.023), use of a ballon guide catheter as opposed to conventional guides (OR:0.03[0‐0.66],p=0.027), distal embolization (OR:0.02[0‐1.71],p=0.082), time from arterial access to recanalization (OR:0.93[0.86‐0.99],p=0.026), residual carotid stenosis after eCAS (OR:0.003[0‐0.18],p=0.005), pre‐eCAS oral aspirin/ticagrelor load as opposed to intravenous eptifibatide load (OR:0.02[0‐0.25],p=0.016) and symptomatic ICH (OR:0.01[0‐0.38],p=0.012). Notably, heparin infusion post procedure predicted improved outcomes but was insignificant (OR: 55.54[0.59‐5226.65],p=0.083).;

Conclusion
The study highlights important considerations for eCAS, including the choice of antiplatelet loading agent, residual carotid stenosis and longer recanalization times which seem to impact good clinical outcomes.
Abstract 380: Proximal coiling versus Liquid Agents in Treatment for Middle Meningeal Artery Embolization: A single center study with 72 patients
Authors: Senol Y. , Cifci H. , Sayin B. , Ozbakir M. , Orscelik A. , Krishnan N. , Belen A. , Daglioglu E. 
Published: January 2025

Background
Various embolic materials, including n‐butyl cyanoacrylate (nBCA), Onyx, and coils, have been used in MMA embolization. The choice of embolic material may influence procedural outcomes, including the extent of MMA branch embolization and the risk of complications. To address this gap, we compared clinical and radiological outcomes for proximal coiling vs liquid agents in the treatment of subdural hematomas (SDHs).

Methods
A retrospective case‐control study assessed 72 patients with SDH who met inclusion criteria and underwent either proximal coiling (n=10) or liquid embolization (n=62) between 2022 and 2023. Demographic data, clinical presentation, radiological membrane thickness, procedure time, complications, and follow‐up outcomes were recorded. Clinical outcomes were assessed using the modified Rankin Scale (mRS) at admission and at the 90‐day follow‐up. Descriptive statistics for baseline characteristics and outcomes were calculated Univariate and multivariate correlations were investigated using binomial and multinomial logistic regressions with reporting of the odds ratios (ORs).

Results
Overall cohort had a mean age of 68.1 years, with no significant differences between the coil and liquid groups in age, gender distribution, or comorbidities. Significant differences were observed in preoperative SDH width (p<0.01) and membrane presence (p=0.04) between the two groups. Clinical outcomes at 90‐day follow‐up showed no statistically significant differences in mRS scores between the coil and liquid agent groups. Complications were reported in 4.2% of the total cohort, occurring only in the liquid embolic group, with no complications in the coil group. Retreatment was required in 5.6% of patients, with one case in the coil group and three cases in the liquid group, showing no significant difference (p>0.95). The overall mean mRS score improved significantly from 3.1 at admission to 1.0 at 90 days, with no significant difference in the degree of improvement between the two groups (p=0.50). The mean procedural duration was 40.2 minutes, with the coil group having a slightly longer mean duration (48.3 minutes) compared to the liquid group (39.0 minutes), though this difference was not statistically significant (p=0.07)

Conclusion
MMA embolization using either coils or liquid embolic agents is an effective and safe treatment for cSDH, with both modalities showing comparable clinical outcomes and procedure times. While the liquid embolic group had a slightly higher rate of complications, this was not statistically significant. Both treatment options resulted in substantial improvements in mRS scores, suggesting their efficacy in reducing the recurrence and managing cSDH. Proximal coiling could be an alternative option, whereas the liquid agents or DMSO compatible are not available for MMA embolization
Abstract 394: Resolution of Bilateral Subdural Hematomas Following Pseudomeningocele‐Induced Intracranial Hypotension Treated with Fibrin Sealant
Authors: Iqbal Z. , Albana A. , Fu S. , Marin H. 
Published: January 2025

Introduction
CSF leaks lead to intracranial hypotension and is being increasingly diagnosed as a cause of headaches. These leaks may present simply as a headache but can also lead to severe neurological complications, such as brainstem herniation, bilateral subdural hematomas, and cranial nerve palsies. We present a case of a dural tear that resulted in a pseudomeningocele, which was treated successfully with fibrin sealant.

Presentation
A 67‐year‐old patient presented to the emergency department with a headache that had worsened acutely over the past 4 days, following several months of less severe symptoms. A CT scan of the head revealed isodense to hypodense components on the right and mixed attenuation components on the left, suggesting a subdural hematoma with mild mass effect. An MRI of the brain, both with and without contrast, showed subacute to chronic subdural hematomas with an acute component on the left side. The MRI also indicated diffuse smooth thickening and enhancement of the dura, drooping of the splenium, flattening of the ventral pons, and reduced ponto‐mamillary distance. A whole‐spine MRI, although motion‐degraded, did not reveal any CSF leak. The patient underwent an epidural blood patch placement to address the suspected CSF leak, but their headache did not improve. A repeat CT scan of the head showed mild worsening of the bilateral hematomas and midline shift. A dynamic myelogram revealed a ventral filling defect likely due to a T5‐T6 central and left paracentral disc extrusion, which was the origin of the dural tear and led to the development of a pseudomeningocele. The patient then received a CT‐guided transfemoral fibrin glue injection at T5/T6. Following this procedure, the patient experienced improvement in their headaches, and follow‐up images showed stable findings at 2 and 4 weeks. A repeat CT scan of the head at 10 weeks demonstrated significant improvement in the bilateral subdural hematomas.

Discussion
Treatment for CSF leaks ranges from simple observation to surgical repair in refractory and complicated cases. Typically, an epidural blood patch is the first‐line treatment and often resolves the headache. However, some cases remain refractory depending on the etiology of the CSF leak. Several endovascular treatments are under development, including embolization for CSF‐venous fistulas and fibrin sealant for other cases. Fibrin glue, a pharmaceutical product composed of human thrombin and fibrinogen, is introduced into the epidural space under image guidance. Fibrin sealant placement is a safe procedure and has emerged as a viable alternative for refractory cases.
Abstract 427: The Turkish National Thrombectomy Registry: Design and Initial Results
Authors: Gurkas E. , Onalan A. , Acar B. A. , Acar T. , Unal E. , Akpınar C. K. , Dogan H. , Memis Z. , Katı S. D. , Suri F. , Qureshi A. 
Published: January 2025

Background and Aims
Recent randomized controlled trials demonstrated the benefit of thrombectomy for large vessel occlusion in acute ischemic stroke patients. Real‐world data aid in assessing reproducibility of outcomes outside of clinical trials in various countries. We have designed and implemented a national registry in Turkiye. We present the design, progress, and initial data from the Turkish National Thrombectomy Registry.

Methods
Patients aged ≥18 years who underwent thrombectomy for acute ischemic stroke were registered. The key items on the data collection form were divided into general stroke demographics and thrombectomy related sections. The main outcomes of effectiveness are post procedure angiographic recanalization graded using modified Thrombolysis in Cerebral Infarction grade and functional independence (modified Rankin Scale score, 0‐2) at 3 months.

Results
As of August 2024, 6 hospitals (involving 9 interventional neurologists) from 4 cities have joined the registry. A total of 560 patients (mean age±standard deviation of 67±13 year; median baseline NIHSS score of 16, IQR 12‐18) treated with thrombectomy are entered in the registry. Occlusion sites were internal carotid artery (n=335), middle cerebral artery M1 or M2 segment (n=306), posterior circulation (n=11), and distal vascular locations (n=11). The mean time mean (minutes±standard deviation) from symptom onset to thrombectomy was 261+/‐148 minutes. Symptomatic intracerebral hemorrhage (≥4 points NIHSS score increase) within 24 hours was observed in 57 subjects. Overall, functional independence at 90 days was observed in 301 (53.7%) of 560 subjects.