bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 5: Interim Results of PRE‐SEAL IT Saccular Endovascular Aneurysm Lattice System First in Human Interventional Trial
Authors: Pabon Boris , Torres Victor , Patiño Manuel , Peláez Felipe , Mútis Jorge , Cardozo Margarita , Pereira Edgard , Badruddin Aamir , Woodward Keith , Wolfe Thomas , Zaidat Osama 
Published: April 2023

Introduction
Preliminary in vivo animal intracranial aneurysm (IA) studies have demonstrated promising immediate and follow‐up aneurysm occlusion rates using the novel Saccular Endovascular Aneurysm Lattice (SEAL) system. The PRE‐SEALTM IT trial was designed to assess the feasibility, safety, and effectiveness of the SEAL system in patients with previously untreated ruptured and unruptured wide‐neck IA.

Methods
PRE‐SEAL IT is an on‐going, prospective, interventional, core‐lab adjudicated, single‐arm study performed in Medellin, Columbia. Key inclusion criteria included: 1. Age 20–80 years, 2. Saccular shape, bifurcation, or terminus IA, 3. Wide neck aneurysm with neck size ≥4 mm or dome‐to‐neck ratio <2, and 4. IA diameter 2mm to 25mm. Consented and enrolled patients were treated with the SEALTM device. A follow‐up DSA was performed at 24‐hours, 6 months, and 12 months and a MRA at 3 months. Final clinical follow‐up was at 24‐months. Primary efficacy outcome was achieving complete occlusion (WOS grade A or B) at 6 months angiographic follow up. Primary safety outcome was any stroke with an increase in NIHSS of 4 up to discharge.

Results
From December 2021 through June 2022, 15 patients have been enrolled into the PRE‐SEAL IT trial. Ten women and 5 men were treated with the SEAL device, with a mean age of 56.8±9.5 years. Of the 15 IA, 12 were anterior circulation (ICA‐T (1), MCA (7), AcomA (3), A2‐A3 (1)) and 3 posterior circulations (Basilar, VBJ‐fenestration, SCA), and 14 were unruptured (93.3%). Mean aneurysm width was 6.1±2.5mm. Immediate post‐procedure complete occlusion (Grade A, B) was achieved in 9 patients (60%) and adequate occlusion (Grade A, B, C) in 13 (86.6%). At 24‐hours follow‐up, 12 patients (80%) had complete occlusion and 15 (100%) achieved adequate occlusion. Six‐month complete occlusion rate (Grade A and B) was 100% (8/8). Interim results were site adjudicated. No cases of intraoperative rupture, or bleeding or re‐bleeding, or clinical stroke were observed.

Conclusions
The interim results of the PRE SEAL‐IT trial demonstrated promising complete occlusion rates at 24‐hour and 6 month follow‐up with no safety concerns. Trial enrollment will be completed in October, and final 24‐hour results will be presented at the 2022 SVIN Annual Meeting.
Abstract Number ‐ 18: Potential impact in low and middle‐income countries stroke networks of a deep learning triage tool
Authors: Lagos‐Servellon Javier , Bonifacio‐Delgadillo Dulce , Ribo Marc , Santamaria Cristina Granés , Punsoda Victor Salvia , Urtasun Agustina , Díaz Facundo Nahuel , Pou Cristian Martí 
Published: April 2023

Introduction
Early and accurate identification of large vessel occlusion (LVO) and intracranial hemorrhage (ICH) on initial neuroimaging is essential in a stroke network. A machine learning algorithm (MLA) able to predict LVO or ICH on non‐contrast computed tomography (NCCT) may accelerate workflows.We performed a validation analysis to measure the MLA accuracy among suspected stroke patients transferred to a Comprehensive Stroke Centre (CSC) in Mexico and the possible impact on the workflow in low and middle income countries (LMIC) .

Methods
From February 2021 to March 2022 consecutive patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. MLA prediction of LVO and ICH was tested against expert physicians readings and clinical follow‐up. We calculated sensitivity, specificity, positive predictive value and negative predictive value. Receiver operating curves were generated for MLA‐LVO, MLA‐ICH and; areas under the curve were calculated. Potential time savings and impact on workflow times were calculated for a scenario in which MLA could analyse initial NCCT at PSC avoiding imaging repetition at CSC.

Results
140 consecutive patients admitted from march 2021 to February 2022 were included in the study, final physicians diagnostics were: 22 ICH (15.7%) and 53 LVO (37.8%) MLA detected 22 ICH (15.7%) and 58 LVO (41.4%).The area under the curve for the identification of ICH with MLA was 0.97 (sensitivity: 94%, specificity: 91%, positive predictive value: 83.3%[MR1][JL2], negative predictive value: 100%). The area under the curve for the identification of LVO with MLA was 0.91 (sensitivity: 100%, specificity: 95.8%, positive predictive value: 85.7%, negative predictive value: 96.4%). Implementation of MLA‐LVO in the network could save CTA acquisition times of 40 (IQR 26) minutes by taking patients directly to the angiosuite for endovascular treatment.

Conclusions
In patients with suspected acute stroke, a MLA can quickly and reliably predict ICH and LVO. Such a tool could accelerate the diagnosis, mitigate the contrast imaging dependency and improve the workflow efficiency in stroke networks in LMIC where access to contrast imaging is often limited.
Abstract Number ‐ 22: Hemorrhagic Outcomes in Patients Demonstrating Early Venous Filling After Mechanical Thrombectomy For Acute Ischemic Stroke
Authors: Al‐Shaibi Faisal , Pujara Deep , Hassan Ameer , Abraham Michael , Sitton Clark , Shaker Faris , Duncan Kelsey , Chugh Arunit , Haussen Diogo , Ortega‐Gutierrez Santiago , Sundararajan Sophia , Hu Yin , Ray Abhishek , Sila Cathy , Bambakidis Nicholas , Sarraj Amrou 
Published: April 2023

Introduction
Endovascular thrombectomy (EVT) for acute ischemic infarcts with large vessel occlusion have been shown to improve functional outcomes. However, there is still the risk of hemorrhagic transformation (HT). Early identification of patients at risk of HT is paramount to enhance EVT outcomes. EVF can be an indicator of the hyperemia that occurs following an infarct. We evaluated if early venous filling (EVF) defined as contrast filling of any cerebral vein within the arterial phase on angiogram can predict individuals at a higher risk of HT after EVT.

Methods
From the SELECT cohort,EVT patients with evaluable digital subtraction angiography were included in the study. Baseline clinical and imaging characteristics as well as clinical and hemorrhagic outcomes were compared between patients demonstrating EVF and no EVF. Association between EVF with symptomatic ICH and parenchymal hemorrhage was examined using multivariable logistic regression models.

Results
46/254 (18%) patients had EVF at the end of the procedure. Age and NIHSS were similar between the patients with and without EVF, although patients with EVF presented earlier (1.39 (0.88‐2.75) hours vs 2.62 (1.10‐4.28) hours, p = 0.024), and demonstrated lower CT ASPECTS (7 (6‐9) vs 8 (7‐9), p = 0.022). The presence of EVF was associated with significantly higher odds of sICH (EVF: 8.7% vs no EVF: 5.6%, aOR: 4.72, 95% CI: 1.05‐21.28, p = 0.043) and demonstrated a trend towards higher odds of parenchymal hemorrhage type 1 or 2 (EVF: 10.9% vs no EVF: 6.3%, aOR: 3.64, 95% CI: 0.96‐13.73, p = 0.057) and mortality (EVF: 17% vs no EVF: 12%, aOR: 3.22, 95% CI: 0.93‐11.13, p = 0.064). Functional outcomes did not differ at 90 days between the two groups

Conclusions
Early identification of EVF may help to identify patients with increased risk of hemorrhagic transformation after EVT. This finding was independent from time last known well. While EVF is suggestive of hyperemia it is also a biomarker of infarct volume and may help to implement early therapeutic measurements to reduce hemorrhagic transformation risk such as strict blood pressure control. Further studies to evaluate EVF as a potential marker for hemorrhagic transformation are required.
Abstract Number ‐ 24: Endovascular thrombectomy with or without bridging thrombolysis in patients with ischemic stroke: A cost‐utility analysis
Authors: Morsi Rami Z. , Zhang Yuan , Zhu Meng , Xie Shitong , Carrión‐Penagos Julián , Desai Harsh , Tannous Elie , Kothari Sachin , Khamis Assem , Tarabichi Ammar , Bastin Reena , Hneiny Layal , Thind Sonam , Coleman Elisheva , Brorson James R , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass‐Hout Tareq 
Published: April 2023

Introduction
There is clinical equipoise behind bridging intravenous thrombolysis (BT) with endovascular thrombectomy (EVT). We performed a cost‐effectiveness analysis comparing EVT and BT versus EVT alone.

Methods
We conducted a model‐based cost‐utility analysis comparing the cost‐effectiveness of EVT alone vs. EVT and BT for patients with acute ischemic stroke. We used a decision tree to examine the short‐term costs and outcomes at 90 days after the index stroke. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1‐year, 5‐year, and 20‐year time horizons. Treatment costs were based on administrative data. Clinical outcome inputs were derived from literature included in our systematic review. We considered the impact of disability and recurrent stroke on mortality risk, health‐related quality of life, and costs. We estimated total and incremental cost, quality‐adjusted life years (QALYs), and incremental cost‐effectiveness ratio (ICER), expressed as an incremental cost per QALY gained of EVT and BT compared with EVT alone.Probabilistic analysis was used to calculate the reference case estimates.

Results
The average costs per patient were estimated to be $55,503, $57,814, $68,183, and $84,946 for EVT only strategy, and $47,311, $49,556, $59,625, and $75,898 for EVT and BT over 90‐day, 1‐year, 5‐year, and 20‐year, respectively. The cost saving of EVT only strategy was driven by the avoided medication costs of IVT (ranging from $8,193 to $9,048). The additional thrombolytics led to slight decrease in QALY estimate during the 90‐day time horizon (loss of 0.0016 QALY), but a small gain over 1‐year, 5‐year, and 20‐year time horizons (0.0108, 0.0638, and 0.1481 QALY). With similar outcomes and less cost, the EVT only strategy was cost‐effective compared with EVT and BT. Analyses with longer time horizon show lower probabilities of EVT only strategy being cost‐effective. At a fixed willingness to pay threshold of $50,000, the probabilities of EVT only to be cost‐effective were 100%, 100%, 99.0%, and 65.9% over 90‐day, 1‐year, 5‐year, and 20‐year time horizons. At the willingness to pay thresholds of $100,000 per QALY, the probabilities of EVT only strategy being cost‐effective was 22.8% over the 20‐year time horizon.

Conclusions
Our cost‐effectiveness model suggested that bridging with thrombolytics may not be cost‐effective for patients with acute ischemic stroke secondary to large vessel occlusion.
Abstract Number ‐ 25: Acute Ischemic Stroke Intervention With Penumbra RED Reperfusion Catheters: Updated Subset Analysis From INSIGHT Registry
Authors: Teleb Mohamed S , Kellner Christopher P , Dabney Alan R , Baltan Selva , Sohrabji Farida , Pennypacker Keith R , Woodward Keith B , Nanda Ashish , Rivet Dennis J , Fraser Justin F 
Published: April 2023

Introduction
The prospective INSIGHT Registry is a multicenter ‘multi‐omic’ analysis of thrombi associated with acute hemorrhagic or ischemic stroke. This updated interim analysis evaluated the performance of Penumbra RED catheters used during aspiration thrombectomy for acute ischemic stroke (AIS).

Methods
All AIS cases in which Penumbra RED aspiration catheters (RED 62, 68, or 72) were utilized as a frontline treatment were included in the analysis. Retrieved clot fragments were classified based on their gross appearance. Key time metrics and procedural data were also collected, including first‐pass / post‐procedure modified Treatment in Cerebral Ischemia (mTICI) score.

Results
Of 400 patients enrolled across 25 US centers, 161 underwent thrombectomy with Penumbra RED catheters over ten months (Jul 2021 through Apr 2022). The mean patient age was 70.7 years, and 50.9% were female. The middle cerebral artery first segment (M1) was the most common primary occlusion site (60.4%; 96/159). IV t‐PA was administered before the procedure in 13.7% (22/161) of patients. The median time from stroke onset / last known well to mTICI≥ 2b was 5.0 hrs. [IQR 3‐11], and the median time from a puncture to mTICI≥ 2b was 23.0 mins [IQR 15‐31]. Firm‐red clots represented 45.3% (67/148), while soft‐red clots were found in 37.8% (56/148) of retrieved clots. In turn, firm‐white and soft‐white clots were seen in 11.5% (17/148) and 5.4% (8/148) of cases, respectively. Rates of the first pass and final mTICI≥ 2b scores by clot type are shown in Table 1.

Conclusions
Aspiration thrombectomy with Penumbra RED catheters resulted in good revascularization rates for all clot types.
Abstract Number ‐ 46: Automated Magnetic Resonance Perfusion Imaging in the Management of Delayed Cerebral Ischemia: A Pilot Study
Authors: Khatibi Kasra , Vespa Paul , Blanco Manuel Buitrago 
Published: April 2023

Introduction
Inadequate perfusion secondary to changes in vascular narrowing and breakdown of cerebral autoregulation is thought to be a major contributor to delayed cerebral ischemia (DCI). Subjective evaluation of narrowing of large and medium intracranial vessels on angiography detects vasospasm in up to 70% of patients, though only 30% become clinically symptomatic. There are no available tools for the quantification of tissue level perfusion to detect critical levels of ischemia in this setting. We aimed to evaluate focal perfusion changes using MR‐perfusion weighted imaging with automated thresholding of flow and timing parameters in the setting of DCI.

Methods
This is a prospective observational pilot study that includes seven patients with SAH. All patients underwent multimodality MRI including diffusion and perfusion imaging when there was concern for DCI. RAPID software was used to process diffusion and perfusion images and obtain threshold maps for diffusion restriction, Tmax prolongation and drops in cerebral blood volume (CBV), and cerebral blood flow (CBF). Correspondence of neuroanatomic location of focal perfusion alteration and pattern of perfusion alteration was evaluated.

Results
Neuroanatomical location of perfusion alteration corresponded to neurological symptoms in 86% (6/7) of patients. The prominent patterns were: prolongation of Tmax greater than four seconds (7/7), greater than 20% drop in CBF (3/7), and greater than 20% drop in CBV (3/7). Significant radiographic vasospasm on concurrently catheter angiogram and/or MR angiogram which corresponded to the supplying vessels to the neuroanatomic area with altered perfusion was seen in 71% (5/7) of the patients.

Conclusions
MRI‐perfusion imaging using RAPID software can help detect and quantify the presence of inadequate focal perfusion for DCI in real‐time. This tool could guide the timing and extent of endovascular vasodilatory and medical hyperdynamic treatment and larger studies of MRI‐perfusion imaging for DCI are warranted.
Abstract Number ‐ 69: Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome (RCVS): A Novel Case Report
Authors: Wakefield Colin , Ngo Brendon , Naydin Stanislav , Rahme Rudy , Binning Mandy 
Published: April 2023

Introduction
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a poorly understood but increasingly recognized entity, likely multifactorial in nature and characterized by diffuse cerebral vasospasm that present as sudden, intense, fluctuating headaches. A subset of RCVS patients can present with concomitant TIAs, cerebral infarctions, leukoencephalopathy, subarachnoid hemorrhages (SAH), and seizures. Due to insufficient evidence, there is currently no consensus on RCVS treatment guidelines. Calcium channel blockers such as nimodipine and verapamil have reportedly been employed with varying degrees of efficacy. Nicardipine, an L‐type calcium channel blocker, may prove effective in RCVS treatment because of its ability to penetrate the blood‐brain barrier. However, to date, only 5 case reports have discussed the use of intrathecal (IT) nicardipine for the treatment of severe RCVS, and there has been very limited exploration of continuous intraarterial (IA) administration. This case report examines the use of IT and continuous IA nicardipine in an RCVS patient refractory to traditional management.

Methods
We present the case of a 58‐year‐old female who was noted to have a non‐traumatic non‐aneurysmal SAH secondary to RCVS. The patient’s only risk factor for RCVS was alcoholic use. Initially managed with oral verapamil, she later developed refractory symptomatic vasoconstriction requiring multiple angiograms for spasmolysis via balloon angioplasty and IA nicardipine. Due to the refractory nature of her spasm despite the IA therapy, we decided to attempt intrathecal nicardipine, starting at 4 mg q12hours via an external ventricular drain (EVD). This dose was escalated to 4mg q6hours. The patient stabilized for 24 hours but again decompensated, requiring continuous IA spasmolysis via a microcatheter that was placed in the L MCA and left for continuous IA nicardipine infusion (5mg/hr). The patient showed slow incremental improvement clinically and a decrease in vasospasms on imaging, ultimately suffering minimal stroke burden.

Results
The patient subsequently showed improvement over time in neurological function and a decrease in vasospasms on CTA, MRA, and angiogram imaging, ultimately suffering minimal stroke burden (Fig. 1B).

Conclusions
Nicardipine, administered intrathecally utilizing an EVD or even intraarterial through a microcatheter, could potentially be beneficial in select patients with refractory RCVS to minimize repeat angiography/angioplasty. We suggest further studies to determine SAH incidence following RCVS and the efficacy of continuous intrathecal administration of the blood‐brain barrier penetrating calcium channel blocker, nicardipine, in RCVS patients.
Abstract Number ‐ 85: Distal Anterior Choroidal Artery Fusiform Aneurysm Successfully Treated with Flow Diversion
Authors: Mahmoud Noor A , Ernst Griffin , Grossen Audrey A , Bauer Andrew 
Published: April 2023

Introduction
Anterior choroidal artery (AChA) aneurysms account for 3–5% of intracranial aneurysms, and are often saccular, arising at or near the origin of the AChA, with distal lesions being exceedingly rare. Contrary to saccular aneurysms, fusiform aneurysms are associated with a higher risk of rebleeding and mortality due to their formidable anatomy requiring advanced techniques including bypass, stent‐assisted coiling, and, more recently, flow diversion. While flow diverters are becoming more popular, they are currently only approved forinternal carotid artery segment aneurysms. However, many institutions areexpanding their use to more distal and smaller caliber vessels. Herein we present a novel pathology of a dissecting distal AChA fusiform pseudoaneurysm with a small vessel caliber treated successfully with flow diversion.

Methods
Case presentation and surgical technique.

Results
We describe a 40‐year‐old woman with monoclonal gammopathy of unknown significance (MGUS), lichen sclerosis, and an unspecified connective tissue disease presenting with diffuse subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies 1; Hunt & Hess scale 2; Modified Fisher Scale 3). A digital subtraction cerebral angiogram revealed a dissecting (5×3 mm) left AChA pseudoaneurysm, 4mm distal to the origin (Figure 1). Flow Redirection Endoluminal Device (FRED Jr, Microvention, CA) (2.5mm 8/13 working/total length) was deployed within the vessel proximal to the aneurysm, preceded by an infusion of 5mg of verapamil to facilitate stent placement (Figure 2). Post procedure, she remained neurologically intact and was discharged on dual antiplatelet therapy (aspirin/ticagrelor). Repeat cerebral angiogram at six months showed patent flow diversion device and no pseudoaneurysm remnant (Figure 3) with a nonfocal physical examination.

Conclusions
Flow diversion may be a successful, and safe, therapeutic intervention for challenging distal intracranial aneurysms with smaller caliber vessels.
Abstract Number ‐ 88: Stroke Secondary to Free Floating Thrombus in a Post‐COVID Patient
Authors: Nagendra Shashank 
Published: April 2023

Introduction
In non COVID ‐19 patients, carotid intraluminal floating thrombi are rare, with a prevalence of 1.6% among patients with acute stroke/TIA In the COVID era, considerable number of cases with thrombus have been reported.

Methods
Here we report a case of a 47 year old female patient who presented with sudden onset left hemiparesis, dysarthria and facial deviation since 12 hours. She had h/o covid 1 month ago MRI Brain – DWI showed multiple embolic infarcts in right MCA territory MRI Angio – moderate to high grade stenosis at the origin of ICA

Results
Patient was taken up for DSA. Thromboaspiration done and Xact stent deployed across carotid bifurcation into right ICA Post op patient did well and her weakness had almost completely resolved

Conclusions
Highlighting points in this patient: lack of or only mild underlying atherosclerosis, no cardioembolic source. The highly prothrombotic state of some COVID 19 patients explains the presence of thrombus in medium and large vessels with or without mild atherosclerotic disease.
Abstract Number ‐ 117: Sandwich technique as rescue therapy. (Stent retriever)
Authors: Pabon Boris , Torres Victor , Patiño Manuel , Pelaez Juan , Mutis Jorge , Cardozo Margarita 
Published: April 2023

Introduction
system to extract foreign bodies in the cerebral circulation with 2 stent retrievers (solitare)

Methods
We present 2 cases in which we have had to withdraw devices. (Flow diverter due to poor opening and coil due to distal migration.)

Results
2 cases are presented, in which we used the technique developed by angioteam. In the first case we rescued a flow diverter stent that was exchanged for another stent. In the second case, we the rescued the coils that migrated from the internal carotid artery to the medium cerebral artery.

Conclusions
It is a rescue technique in which a distal stent retriever and a second proximal device are pulled between them to catch the device that is going to be removed Both cases were successfull in removing the flow diverter stent and coil.