bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 10: Stroke Patients with Carotid Artery Web Have High RoPE Scores and Low Frequency of PFO
Authors: Alshaer Qasem N , Karunamuni Nilushi , Osehobo Ehizele M , Koneru Sitara , Landzberg David R , Al‐Bayati Alhamza R , Nahab Fadi , Nogueira Raul G , Haussen Diogo C 
Published: April 2023

Introduction
PFO‐associated stroke is more common in young patients (<60 years) with less vascular risk factors, and with an infarct pattern consistent with embolic phenomena. These features are included in the Risk of Paradoxical Embolization (RoPE) score in which a high score (≥ 7) indicates a high likelihood of a symptomatic PFO. However, carotid artery webs (CaW) have been reported in patients with the same profile in which a PFO might be detected. In this study, we calculated RoPE score for patients with symptomatic CaW related strokes to identify how many of these patients would have been potentially misclassified as having a PFO‐associated stroke.

Methods
Patients presenting with ESUS and ipsilateral symptomatic CaW were included. Stroke work up was completed including cervicocranial vascular imaging that was reviewed by a neuroradiologist and an interventional neurologist. Shunt study was done with a TTE, TEE, and/or TCD, all with a bubble study. RoPE score of ≥ 7 was considered high.

Results
A total of 75 patients fulfilled the inclusion criteria of having an ipsilateral symptomatic CaW as the etiology of ESUS with no competing etiologies aside from PFO. The baseline characteristics are described in the table. The rates of vascular risk factors were generally low which is reflected by a high median RoPE score of 7 [IQR 5‐8], with 52% (n = 39) of patients having a score of ≥ 7. Ten patients (13%) had a PFO, of which 3 had high‐risk features. There was no significant difference in median RoPE score between patients with and without PFO (8 [6‐8] vs 6 [5‐8], p = 0.238), nor in the rate of patients with high RoPE score (78% vs 44%, p = 0.06). Recurrence happened in 16% (n = 12) of the patients and was always ipsilateral to the symptomatic CaW. No significant difference was detected in the rates of recurrence between high vs low RoPE scores (20.5% vs 11.1%, p = 0.351). Patients with a PFO had higher rates of recurrence compared to those without a PFO (40%, n = 4 vs 12.3%, n = 8, p = 0.048); however, none of the PFO patients with a recurrent stroke had a high‐risk PFO. A superimposed thrombus was seen on the CaW in 12.2% (n = 9) and was more commonly seen in patients who had recurrence (36%, n = 4 vs 8%, n = 5, p = 0.024).

Conclusions
Patients with ESUS from a presumably symptomatic CaW‐related stroke have high RoPE scores. The recurrence rates were high in this population and were always ipsilateral to the side of the CaW including in the PFO population. The PFO is likely incidental in this population despite having a high RoPE score. Neurologists should carefully evaluate the cervical vasculature before concluding that a PFO is stroke‐related and committing patients to PFO treatment.
Abstract Number ‐ 16: Thrombectomy alone versus Bridging intravenous alteplase in the US population: a pseudo‐randomized controlled trial
Authors: Salazar‐Marioni Sergio A , Abdelkhaleq Rania , Niktabe Arash , Tariq Bilal , Martinez‐Gutierrez Juan C , Sheth Sunil A , Kim Youngran 
Published: April 2023

Introduction
Recent randomized controlled trials (RCT) failed to demonstrate non‐inferiority of skipping IV tPA in patients with planned endovascular therapy (EVT). None of these studies included patients from the US due to regulatory challenges. Given practice patterns vary relative to Asia and Europe, we sought to address this topic using a validated alternative to RCTs, fuzzy regression discontinuity design (RDD).

Methods
From our prospectively maintained multi‐center registry we identified patients with LVO AIS treated with EVT with and without IV tPA treatment from 1/2018 ‐ 9/2021. We used the time cutoff for IV tPA as our discontinuity and assumed subjects on either side of the cutoff have markedly different probabilities of receiving the treatment but are similar in other relevant characteristics. The primary outcome was good functional outcome defined as 90‐day mRS 0–2 and it was compared between these two populations immediately adjacent to the cutoff using local linear regressions.

Results
Among 694 patients with LVO AIS who received EVT, median age was 69 [IQR 59‐79], 50%, were female, 44% White, 24% Black, and 14% Hispanic. 51% received IV tPA, with median onset to treatment time of 109 min [IQR 79‐160]. We observed a sharp drop (47%) in the probability of tPA around the cutoff time of 4 hours (allowing 30 minutes for in‐hospital evaluation), while there were no significant differences in other relevant features at the cutoff, validating the underlying RDD assumptions (Figure A). Overall, 33% of patients achieved good functional outcomes and there were no significant differences around the cutoff time (Figure B). In fuzzy RDD, there was no evidence of an association of receiving tPA with good functional outcome with regression discontinuity of only 1.0% (p = 0.98)There were no significant differences in rates of hemorrhage in patients treated with or without IV tPA (22% vs 21%, p = 0.68).

Conclusions
Our study provides the highest quality US‐based evidence supporting the findings of the outside US trials, demonstrating no benefit of skipping IV tPA in patients with planned EVT.
Abstract Number ‐ 23: In vitro evaluation of thrombectomy techniques: What is the most efficient combined technique?
Authors: Kaneko Naoki , Imahori Taichiro , Takayanagi Ariel , Liebeskind David , Tateshima Satoshi 
Published: April 2023

Introduction
A combined technique with contact aspiration and stent retriever is widely used for the treatment of patients with acute ischemic stroke due to the potential synergistic effect of the two technologies. However, there are no large studies that conclude the combined technique is more efficient compared to stent retriever only or contact aspiration. One of the issues in combined techniques may be the complexity, and multiple variations of combined techniques exist. We performed an in vitro study using three‐dimensional (3D) flow models and performed clot retrieval in order to explore effective and safe techniques for mechanical thrombectomy.

Methods
In a 3D silicone flow model with moderate tortuosity, we compared several techniques: 1. a pinching combination method (pull out stent retriever and aspiration catheter as a unit) with several variations of aspiration catheter locations; 2. an ingestion combination method (stent retriever removal through aspiration catheter); 3. stent retriever only; and 4. contact aspiration. We evaluated the success retrieval rates of a thrombus in the M2 branch. In addition, we measured pulling force during each technique to determine the amount of force exerted on the distal MCA vessel.

Results
The highest clot retrieval rate was achieved with a pinching combination technique with close contact with an aspiration catheter. The pulling force on the distal MCA vessel was high with the techniques that had high clot retrieval rates and low with the techniques that had low success rates. The pulling force was higher when the stent retriever was fully deployed compared with a pinching technique with a stent partially covered with an aspiration catheter.

Conclusions
In our in vitro model, the pinching combination method showed the highest clot retrieval rate when the aspiration catheter was advanced to the clot and the stent retriever. The pulling force experiments suggested the shorter stent retriever may decrease the rate of subarachnoid hemorrhage due to low pulling force.
Abstract Number ‐ 41: A Comparison of the Safety and Efficacy of Endovascular Techniques in Treating Basilar Tip Aneurysms
Authors: Ghochani Yasmin , Khurana Sukhdeep S , Kang Paul , Ducruet Andrew F 
Published: April 2023

Introduction
Basilar‐tip aneurysm (BTA) is the most common aneurysm found in the posterior fossa circulation, representing 5–8% of the total intracranial aneurysms. Endovascular techniques are first‐line for treatment of the vast majority of posterior circulation artery aneurysms because of their deep location and the high mortality and morbidity associated with open surgical clipping. Coil embolization (CE) is considered safer and more efficacious in the treatment of BTAs compared to open surgery but has increased rate of recanalization. Twoadjunctivemodifications of CE ‐balloon remodeling techniques(BRT) and stent‐assisted coiling (SAC) ‐ are availableto address the occlusion needs of BTAs of variable anatomies/morphologies, sizes, and rupture status.We aimed to compare the clinical utility, safety and efficacy of these adjuvant therapies for treating BTAs.

Methods
We conducted a retrospective review of the Barrow Neurological Institute (BNI) endovascular database from January 1996 through January 2019. Primary outcomes were obliteration as assessed by the modified Raymond Score (MRS), perioperative complications, recurrence, retreatment, and time to 1stretreatment. Secondary outcomes were stratification of the results based on rupture and wide‐neck status and the type of stent.

Results
121 patients with an average follow‐up of 43.4 months were included. Ruptured aneurysms were more likely to be treated by CE vs. either adjuvant therapy (p< 0.001), and SAC was the preferred treatment for larger aneurysms (p = 0.004). SAC had significantly worse obliteration (MRS of 2.09±0.94) vs. BRT (MRS of 1.82±0.91; p = 0.038) but was less likely to be retreated as compared to BRT (35.3%; p = 0.047). However, SAC had a shorter time to first retreatment 13.4±13.8 months as compared to the BRT (25.3±26.7 months) and CE (50.3±68.5 months; p = 0.04 and 0.006, respectively). Lastly, SAC had significantly lower recurrence of 31.8% and near‐significantly lower retreatment rate of 27.3% (p = 0.045, 0.058, respectively) as compared to CE (recurrence of 46.2% and retreatment of 34.6%). There was no significant difference in peri‐operative complications among the three groups.

Conclusions
CE and its adjuvant therapies have similar safety profile but pose variable efficacy in terms of obliteration, recurrence, retreatment, and durability over time. This study represents one of the largest data sets on endovascular adjuvant therapy of BTAs and has the potential to inform clinical decision making when considering CE with BRT vs. SAC for BTA of specific size and morphology.As future directions, outcomes specifically in the old vs. new stent groups and according to further stratification of the largest dimension of the BTA will need to be analyzed, and we will further interrogate any association between the co‐morbidities, such as smoking status and hypertension, with aneurysm rupture, largest dimension, and wide‐neck status.
Abstract Number ‐ 45: Curative Embolization for Pediatric Low‐Grade Brain Arteriovenous Malformations
Authors: Galecio‐Castillo Milagros , Rodriguez‐Calienes Aaron , Vivanco‐Suarez Juan , Saal‐Zapata Giancarlo , Malaga Marco , Zevallos Cynthia , Ortega‐Gutierrez Santiago 
Published: April 2023

Introduction
Improvements in the safety and efficacy of curative embolization for brain arteriovenous malformations (bAVMs) have allowed to achieve comparable results to microsurgical resection and radiosurgery, especially for low‐grade bAVMs (Spetzler Martin [SM] grade I and II). However, whether this treatment modality is beneficial in the pediatric population remains unknown. Hence, we assessed the safety and efficacy of curative embolization for low‐grade bAVMs in children. In addition, we determined predictors of intraprocedural complications and predictors of complete occlusion in one embolization session.

Methods
Between 2010 and 2022, a retrospective analysis of all pediatric (≤18 years) patients who underwent curative embolization for low‐grade bAVMs was conducted at two institutions. Demographic data, clinical presentation, SM grade, and procedural characteristics were retrieved. The safety (intraprocedural complications and mortality) and efficacy (complete angiographic obliteration after the last embolization session) were evaluated. Multivariable logistic regression analysis was performed to identify potential predictive factors of intraprocedural complications and complete occlusion in one session. For selected variables, odds ratios (OR) with 95% confidence intervals (CI) and p value of the likelihood‐ratio test were presented.

Results
Sixty‐eight patients (41 females; mean age 12.9 ± 3.6 years) underwent a total of 102 embolization sessions. Fifty‐one bAVMs (75%) presented ruptured, and headache was the most common clinical presentation (50%). There were 24 (35%) SM grade I lesions and 44 (65%) grade II. Onyx was the most used embolic agent (33%) and the transarterial approach was the most common (93%). The mean volume of embolic agents in each patient was 2.4 ml (range 0.2 to 7.5 ml). Fourteen intraprocedural complications (14% of procedures) were observed and no deaths were reported. The most common complication was microcatheter‐related vessel perforation (6%). Single venous drainage decreased the risk of intraprocedural complications (OR = 0.19; 95% CI 0.04 – 0.78). Complete angiographic obliteration was achieved in 44 patients (65%). In 35 patients (52%) the bAVM was occluded with a single session. A small bAVM size was predictor of complete occlusion in one session (OR = 0.42; 95% CI 0.21 – 0.73).

Conclusions
Curative embolization in pediatric low‐grade bAVMs can be performed with an acceptable complete occlusion rate but with a high rate of intraprocedural complications. The risk of intraprocedural complications was low in bAVMs with a single venous drainage. The odds of complete occlusion in one session are high in small bAVMs. Curative embolization should be selected on an individual basis in order to achieve optimal results.
Abstract Number ‐ 48: Cerebral Sinus Venous Thrombosis Secondary to Chronic Inflammatory Disorders in Children
Authors: Ravishankar Nidhi , Ahmed Anam , Karakas Cemal , Pehlivan Davut 
Published: April 2023

Introduction
Cerebral Sinus Venous Thrombosis (CSVT) is a rare form of venous thromboembolism that can lead to significant morbidity and mortality predominantly in young people. While previous literature has identified prothrombotic and infectious pathologies as significant risk factors for CSVT, chronic systemic conditions such as connective tissue diseases (CTD) are less studied. The purpose of the current study is to describe the clinical features, neuroimaging characteristics, treatment, and long‐term neurological outcomes in children with CSVT secondary to CTD.

Methods
We reviewed electronic medical records of patients under 18 years of age diagnosed with CSVT secondary to CTD between 2002–2018 in a single center. We analyzed data regarding demographics, comorbidities, neuroimaging and neurological examination findings during the initial encounter. Subsequent long‐term follow‐up neurological examinations, lab and imaging workup, and medical management was also analyzed.

Results
Eight patients (Male:Female: 6:2) met the criteria and were included in the analysis. The patient’s age ranged from 6 weeks to 17 years. CTDs include Behcet’s (n = 2), Kawasaki (n = 1), systemic lupus erythematosus (n = 1), Wegener granulomatosis (n = 1), sarcoidosis (n = 1), and inflammatory bowel disease (n = 1). Five patients had a normal neurological examination on initial presentation, two had papilledema, and one had hypotonia and poor suck reflex. On initial neuroimaging, the most common thrombosis locations were transverse sinuses (n = 7). All patients received anti‐thrombolytic therapy (heparin, warfarin, or Lovenox) between 2.5 to 6 months. Three patients had complete resolution and one had partial resolution of thrombosis on follow‐up neuroimaging (average = 4.3 months, range 3–8 months). On long‐term clinical follow‐up (average: 41.3 months, SD: 62.1), all patients had normal neurological examinations.

Conclusions
Our case series demonstrated that 50% of patients with CSVT secondary to CTD showed full/partial resolution of thrombosis on follow‐up neuroimaging. In addition, they also had good clinical outcomes on long‐term clinical follow‐up with anticoagulation or antithrombotic treatment. This study uncovers the favorable outcomes of CSVT associated with CTD in children, but more cohort studies are required in order to make accurate conclusions.
Abstract Number ‐ 49: Risk of HT with Early DOACs after Acute Ischemic Stroke: A Pooled Analysis
Authors: Alrohimi Anas , Rose David Z , Burgin Scott , Renati Swetha , Corbin Hilker , Deng Wei , Oliveira Guilherme H , Beckie Theresa M , Labovitz Arthur J , Fradley Michael G , Tran Nhi , Gioia Laura C , Kate Mahesh , Ng Kelvin , Dowlatshahi Dar , Field Thalia S , Coutts Shelagh B , Siddiqui Muzzafar , Hill Michael D , Miller Jodi , Jickling Glen , Shuaib Ashfaq , Buck Brian , Sharma Mike , Butcher Ken S 
Published: April 2023

Introduction
The risk of hemorrhagic transformation (HT) in the early phase of acute ischemic stroke (AIS) remains unknown, leading to potential unnecessary delays in initiation of anticoagulation for secondary stroke prevention. We sought to assess the rate of HT associated withdirect oral anticoagulant (DOAC) initiation within and beyond 48 hours after AIS, using a pooled analysis of available published data.

Methods
A pooled analysis of 6 studies (4 prospective observational blinded outcome studies and2 randomized trials) of DOAC initiation within 14 days of AIS or transient ischemic attack (TIA) was conducted. The primary endpoint was incident radiographic HT on follow‐up imaging. Secondary endpoints included symptomatic HT, new parenchymal hemorrhage, recurrent ischemic events, extracranial hemorrhage, mortality within the study period, and follow‐up modified Rankin Scale score.The results were reported as odds ratio (OR) andhazard ratio (HR)with 95% confidence interval (CI).

Results
We evaluated 509 patients; median infarct volume was1.5 (0.1‐7.8) ml, andmedian National Institutes of Health Stroke Scale was2 (0‐3).Incident radiographic HT was seen on follow‐up scan in 34 (6.8%) patients.DOAC initiation within 48 hours from index event was not associated with incident HT (adjusted OR 0.67, [0.30 – 1.50]P = 0.32).No patients developed symptomatic HT.Conversely, 31 (6.1%) patients developedrecurrent ischemic events, 64% of which occurred within 14 days.Initiating a DOAC within 48 hours of onset was associated with a trend towards lower rates of recurrent ischemic events, but this was not statistically significant (HR 0.42, [0.17 – 1.008]P = 0.052). In contrast to HT,recurrent ischemic events were associated with poor functional outcomes (OR = 6.8, [2.84 – 16.24], p< 0.001).

Conclusions
Initiation of DOAC within 48 hours after stroke was not associated with decreased risk of recurrent ischemic events, or increasedincident risk of HT. Both recurrent ischemic events and incident HT occurred at similar rates.Unlike HT, however, recurrent ischemic events were associated with poor outcomes.
Abstract Number ‐ 58: Effects of Neck Geometry on Reccurence in CFD Analysis for Aneurysms after Low VER Coiling
Authors: Uchikawa Hayato , Takao Hiroyuki , Fujimura Soichiro , Kasai Tomoki , Sunami Shota , Yuzawa Kazuya , Ishibashi Toshihiro , Fukudome Koji , Yamamoto Makoto , Murayama Yuichi 
Published: April 2023

Introduction
Although low volume embolization ratio is known as risk factor of aneurysmal recanalization, stable occlusion can be achieved in limited cases. Evaluation of hemodynamic parameters at the neck surface has usually been performed with a flat surface rather than a curved surface following the actual coil shape. In this study, we investigated the effect of the geometry of the neck surface on hemodynamics related to aneurysm recanalization after coil embolization in low volume embolization ratio.

Methods
We focused on aneurysms of 5–10 mm in size that were conducted coil embolization with 15–20% volume embolization ratio (low‐VER). Aneurysms that were recanalized after coil embolization and conducted additional coil deployment were defined as the recanalized case. We identified 25 aneurysms (7 recanalized and 18 stable). We randomly selected 3 recanalized cases and 6 stable cases. For each case, the three‐dimensional vascular geometry including aneurysm was reconstructed by preoperative angiographic images. To divide the aneurysm from the parent artery, two types of neck surfaces (flat neck surface and curved neck surface) were generated for each case. The embolized coil was modeled in the enclosed area with the neck plane and aneurysmal wall by our original virtual coiling simulation. CFD analyses were conducted with the flat neck surface and the curved neck surface. We estimated 6 morphological parameters and 35 hemodynamic parameters, and the mean values of hemodynamic parameters were compared between the flat neck surface and the curved neck surface. The change rate of each parameter in the curved neck was calculated based on that in the flat neck.

Results
Since the velocity and pressure were involved in recanalization factors by the previous studies, as illustrative hemodynamic parameters, the mean values and change rate of the spatially averaged velocity normal to the neck surface into the cerebral aneurysm (NVneck) and the pressure difference between the average pressure on the surface of control volume and the maximum pressure at the neck surface (PDneck) were summarized in Table 1. These parameters were higher with the curved neck surface geometry case than with the flat neck surface geometry case. Furthermore, the change rates were higher in the recanalized cases compared to those in the stable cases.

Conclusions
In the CFD analysis with the curved surface, the averaged inflow velocity and pressure difference at the neck surface were higher than those with the flat surface. In addition, the change rates of hemodynamic parameters in recanalized cases were higher than those of stable cases. Therefore, the hemodynamic parameters are changed depending on the geometry of the neck surface, which may affect the prediction accuracy for recanalization using CFD.