bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 15: Morphological Characteristics of Ruptured and Unruptured Intracranial Aneurysms: A Systematic Literature Review and Meta‐Analysis
Authors: Sanchez Sebastian , Hickerson Meredith , Patel Rishi R , Ghazaleh Dana , Tarchand Ranita , Pederson John , Samaniego Edgar A 
Published: April 2023

Introduction
It is unclear what morphological features of brain aneurysms are better at predicting risk of rupture.We have performed a meta‐analysis to analyze the best morphological determinants of risk of rupture.

Methods
The Nested Knowledge platformwas used to search thePubMed database for studiesreporting aneurysmal size, aspect ratio (AR), size ratio (SR), ellipticity index (EI), nonsphericity index (NSI) and undulation index (UI).Effect sizes were computed as logarithmically transformed mean differences (MD) between ruptured and unruptured aneurysm. Finally, effect sizes were pooled using random‐effects and inverse‐variance weighting via restricted effects maximum likelihood estimation.

Results
We included 63 studies with 13,025 aneurysms: ruptured 6966 and unruptured 6059. Ruptured aneurysms were larger compared to unruptured (µ 6.1 mm, 95% CI 5.7‐6.6 vs 4.9 mm, 95% CI 4.5‐5.3 respectively, p < 0.001). There was no significant difference in size between ruptured and unruptured aneurysms in the anterior cerebral artery (ACA, p = 0.28), anterior communicating artery (ACom, p = 0.31) and basilar artety (BA, p = 0.51). AR was significantly higher in ruptured compared to unruptured aneurysms(µ 1.5,95% CI: 1.4‐1.6 vs.1.1, 95% CI: 1.1‐1.2 respectively,p < 0.001).SR was significantly higher in ruptured compared to unruptured aneurysms (µ 2.3,95% CI: 2.1‐2.5 vs. 1.6, 95% CI: 1.4‐1.8 respectively,p < 0.001).Ruptured aneurysms in the ACA and Acom had the largest mean SRs (2.5, 95% CI: 1.0‐ 6.4 and 2.6,95% CI: 2.2‐ 3.0 respectively).NSI and EI were higher in ruptured compared to unruptured aneurysms (p = 0.049 and p = 0.049, respectively). UI was similar in ruptured and unruptured aneurysms (p = 0.22).

Conclusions
Small aneurysms in the ACA and ACom can rupture regardless of size. SR is the best predictor of rupture status for aneurysms in these locations.SR and AR are predictors of rupture status independently of size.
Abstract Number ‐ 26: Results from Flat‐Panel CT as a predictor following Mechanical Thrombectomy
Authors: Rueda‐Carrillo Luis G , Giurgiutiu Dan‐Victor 
Published: April 2023

Introduction
Flat‐panel CT provides quick and effective parenchymal cross‐sectional imaging. Pre‐thrombectomy, flat‐panel can be obtained to evaluate ischemic stroke patients for thrombectomy candidacy in cases where the traditional CT scanner is bypassed. Post‐thrombectomy images obtained from flat‐panel CT are also effective in evaluating complications such as contrast extravasation, hemorrhage, or increased core size. Findings on flat‐panel CT may provide information to guide decisions such as blood pressure goals, antiplatelet or anticoagulation regimen, thrombolytic reversal, and the need for emergent neurosurgical intervention in rare cases.

Methods
We analyzed 93 thrombectomy cases from 2021 to 2022, where flat‐panel CT was obtained, with follow‐up CT and MRI. Demographics were reviewed for this series of cases. Cases where stratified and compared depending on results on flat‐panel CT. Medical records were reviewed for changes in management. The local IRB approved the project, and consent was waived according to institutional guidelines.

Results
For our patient population, the median age was 70; race was 59% Caucasian, 40% African American, and 1% Hispanic; and gender was 46% female and 54% male. From the flat‐panel CT, we had the following results: Flat‐panel CT was normal in 68% of cases, 20% had contrast extravasation, 9% showed evidence of contrast extravasation vs. hemorrhage, 2% had hemorrhage during the procedure, and 1% had contrast retained in the vessels. On follow‐up CT, 35% had no change, 16% had contrast extravasation, 8% had SAH, 4% had contrast extravasation vs. hemorrhage, 3% had hemorrhagic transformation, 1% had IVH, 1% had petechial hemorrhages, and 31% had no follow‐up CT. On MRI, 20% had hemorrhagic transformation, 41% had no hemorrhage, 6% had microhemorrhages, 10% had petechial hemorrhages, 2% had ICH, 1% had 1 IVH, 1% had SAH, 1% had contrast extravasation, 17% of the cases had no follow‐up MRI. Based on flat‐panel CT, results for normal and contrast extravasation were as follows (Table 1.). Therapy was altered by the flat‐panel CT results in 10 cases. The main change in therapy was a delay in restarting antiplatelet and anticoagulation therapy, which took place in 9 cases.

Conclusions
Post thrombectomy flat‐panel CT is a useful screen post thrombectomy for high‐risk findings such as contrast extravasation and hemorrhagic transformation. Further studies are needed to determine ideal management in cases of contrast extravasation or hemorrhage on flat‐panel CT.
Abstract Number ‐ 36: Acute Angioplasty And/or Stenting Posterior Circulation Intracranial Atherosclerotic Disease Related Large Vessel Occlusion
Authors: Mekonnen Ermias A , Nejad Layla , Desai Sohum , Saei Hamzah , Hassan Ameer E 
Published: April 2023

Introduction
With prior studies showing the value of percutaneous transluminal angioplasty and stenting (PTAS) for rescue of acute large vessel occlusions (LVO) of anterior circulation in patients with underlying intracranial atherosclerotic disease (ICAD), we investigated the safety and efficacy of PTAS in posterior circulation intracranial atherosclerosis‐related occlusions (ICAS‐O).

Methods
By utilizing a prospectively collected endovascular database at a comprehensive stroke center from January 2016‐May 2022, variables such as demographics, co‐morbid conditions, symptomatic intracerebral hemorrhage (ICH), mortality rate at discharge, recanalization rate, modified thrombolysis in cerebral infarction score (mTICI) and favorable clinical outcome via modified Rankin Scale (mRS) were examined. The outcomes between acute PTAS + MT in the anterior and posterior circulation groups were then compared and analyzed.

Results
Within a group of 75 acute ischemic stroke (AIS) patients who underwent rescue PTAS, 15 (20.0 %) belonged to the posterior circulation ICAS‐O group. Baseline characteristics between the posterior and anterior groups were similar, except for gender (6.7% vs 45.0%) and atrial fibrillation (21.7% vs 0.0%). While there was no statistical difference in discharge NIH Stroke Scale(18% vs 23%, P = 0.860) or favorable outcome (modified Rankin Scale ≤ 2) at 90 days (46.7% vs 38.7 %, P = 0.477) between the posterior and anterior ICAS‐O groups respectively, symptomatic ICH rate was higher in the anterior group (11.7 vs 6.7%, P = 0.495).

Conclusions
Rescue angioplasty and stenting seems to be a safe and efficacious treatment option for ICAS‐related LVO of posterior circulation. Future larger, multicenter prospective studies would provide further analysis and allow for corroboration of the results of our study.
Abstract Number ‐ 38: Outcome Predictors in Posterior Circulation Stroke After Mechanical Thrombectomy: Pooled Analysis from NASA and TRACK
Authors: Ashouri Yazan K , Castonguay Alicia C , Prologo‐richardson Paige , Massad Abdallah , Jelani Ali Al , Armouti Ahmad , Nguyen Thanh N , Nogueira Raul G , English Joey D , Farid Hamed , Gupta Rishi , Martin Coleman , Haussen Diogo C , Mueller‐Kronast Nils , Zaidat Osama O 
Published: April 2023

Introduction
Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and effective. However, many people still have poor outcomes despite treatment. The aim of this study was to identify the predictors of good functional outcome in posterior circulation strokes after mechanical thrombectomy from the Trevo Stent‐Retriever Acute Stroke TRACK and the North American Solitaire Stent Retriever Acute Stroke (NASA) registries.

Methods
Patient‐level data from the TRACK and NASA registries were pooled and patients with posterior circulation stroke were included in the analysis. Patients were dichotomized into those with 90‐day good functional outcome (mRS≤2) and poor functional outcome (mRS>2). Baseline and procedural data were compared between the two cohorts. Multivariate logistic regression was then performed to identify predictors of functional outcome. P‐value < 0.05 was considered significant.

Results
Out of 119 posterior stroke patients (99 BA, 16 VA, and 4 PCA), a total of 110 patients had mRS data available on follow‐up. Good functional outcome was observed in 44 patients (37%). Patients with mRS≤2 were less likely to have hypertension (61.4% versus 83.3%, p = 0.01), dyslipidemia (38.6% versus 62.1%, p = 0.016), and diabetes (18.2% versus 36.4%, p = 0.040). Patients with mRS≤2 had a lower mean baseline NIHSS (15.2±9.95 versus 22.6±9.50, p< .001). Time to puncture, utilization of BGC, general anesthesia use, number of passes, and successful recanalization (TICI≥ 2B) were not significantly different between the two cohorts. On multivariate analysis, higher baseline NIHSS was associated with worse functional outcome (OR:0.91, CI:0.87‐0.96, P< .001). Use of IV tPA was associated with higher odds of achieving good functional outcomes (OR:2.82, CI:1.06‐7.51, P:0.038).

Conclusions
In this pooled analysis of the NASA and TRACK Registries, posterior circulation patients achieving good outcome were more likely to have a lower baseline NIHSS and less comorbidities. Use of IV‐tPA and lower baseline NIHSS were independent predictors of functional outcome.
Abstract Number ‐ 39: Comparison of Clinical and Radiographic Efficacy of Particles versus nBCA/Onyx in MMA Embolization for cSDH
Authors: Khalife Jane , Salem Mohamed , Wong Victoria , Karimov Allen , Badger Clint , Gordon Jared , Jovin Tudor , Jankowitz Brian , Burkhardt Jan‐Karl , Shaikh Hamza , Thomas Ajith 
Published: April 2023

Introduction
Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative to open surgery for treatment of chronic subdural hematoma (cSDH). Different embolic materials are utilized in this procedure per operators’ discretion; however, limited data currently exists regarding the clinical and radiographic efficacy of these embolic materials, with available studies lumping Onyx and N‐Butyl cyanoacrylate (n‐BCA) into a single group of liquid embolic material.

Methods
Series of consecutive patients undergoing MMA embolization (MMAE) for cSDH at 2 North American centers (2019‐2021) were included. The primary outcomes included cSDH radiographic resolution of cSDH with at least 50% reduction of hematoma thickness to be considered treatment success. Clinical outcomes were defined as the proportion of patients requiring additional unplanned surgical intervention. These outcomes compared between the particles group, the liquid group which were further subdivided into the n‐BCA and Onyx groups.

Results
Overall, 185 patients undergoing 198 MMAE procedures (median age 72 years, 27.5% women) were included in this analysis. In this cohort, 42.6% of the procedures were performed utilizing particles embolic material, while n‐BCA and Onyx were utilized in 29.5% and 26.8% of procedures, respectively. On last follow‐up imaging (median 3.5 months), ≥ 50% reduction in hematoma thickness was achieved in 67.7%, 71.1%, and 72.3% in the particles, Onyx and the n‐BCA group, respectively (p = 0.2). There were no differences in the proportion of patients requiring additional unplanned surgery between the groups (p = 0.6). Similarly, there was no difference in procedural complications between the 3 embolic materials groups.

Conclusions
MMAE for cSDH utilizing particles and liquid embolic materials (including Onyx and n‐BCA) appears to have an overall equivalent safety and efficacy profiles in cSDH treatment. Further studies with larger sample sizes and longer follow‐up are warranted.
Abstract Number ‐ 40: Unique presentation of Dural AV fistula with brainstem stroke and extensive edema
Authors: Patel Priyadarshee , Suryadevara Neil , Ruiz Aldo Mendez 
Published: April 2023

Introduction
Intracranial dural arteriovenous fistulae (dAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. DAVFs can mimic other neurologic disorders and produce a broad spectrum of signs and symptoms, including headache, tinnitus, vertigo, Parkinsonism, and visual field and gait disturbances. We present a case report of extensive dural AV Fistula which lead to brainstem ischemic stroke from compression of brainstem flow void.

Methods
Case Report

Results
64 year old man with past medical History of Rheumatoid arthritis, presented with sudden onset of right facial weakness. On arrival patient was noted to be hypertensive to 200/105 and on exam noted to have right complete facial nerve palsy. Patient also revealed a significant history of severe, throbbing, posterior headaches in the last 1–2 months. Patient had CT head which was negative for bleed. CT angiography showed Abnormal hyperattenuating tubular vessel extending along the right cerebellar hemisphere and posterolateral pons extending towards the venous confluence at Galen. Over the course of 5 hours, the patient reported difficulty swallowing and intense headaches. MRI brain showed acute to early subacute infarct involving the right dorsolateral medulla and abnormal T2 prolongation involving essentially the entire cross‐section of the upper medulla and inferior pons representing edema. The patient was taken for Diagnostic catheter angiogram which showed dural AV fistula extending along the right cerebellar hemisphere. Onyx embolization was performed on the Right Middle meningeal artery and right Superior cerebellar artery with complete obliteration of dAVF.

Conclusions
The spectrum of signs and symptoms associated with DAVFs has been attributed to any one or combination of 6 pathophysiologic factors: the arteriovenous shunt, cerebral hypoxia and ischemia, increased venous pressure, retrograde drainage and secondary engorgement of basal sinuses, sinus obstruction, and subarachnoid hemorrhage secondary to involvement of the pial venous system. Prompt evaluation and management is necessary for patients presenting with neurological symptoms with headache.
Abstract Number ‐ 74: Venous Thrombectomy as Treatment for Central Venous Sinus Thrombosis presenting as symptomatic Idiopathic Intracranial Hypertension
Authors: Detaram Harshil Dharamdasani , Ma Alice 
Published: April 2023

Introduction
Thrombosis of the cerebral venous sinus (CVST) is an uncommon form of stroke which primarily affects young adults, usually females. Patients with CVST present with either symptoms related to increased intracranial pressure secondary to venous congestion or focal brain injury from infarction or haemorrhage. Treatment of CVST currently involves anticoagulation with venous thrombectomy (VT) used as salvage therapy in refractory CVST. However, the clinical outcomes of patients with symptoms of idiopathic intracranial hypertension (IIH), secondary to CVST, pre‐ and post‐ VT has not been documented. In this case study we present two cases where patients presented with symptoms of IIH secondary to CVST who subsequently underwent VT salvage therapy.

Methods
We retrospectively analysed institutional data of patients who underwent VT for CVST from 2017–2022. Patients who presented with well documented symptoms of IIH without cerebral infarction or haemorrhage were included. Clinical outcomes including neuroimaging, retinal nerve fibre layer (RNFL) thickness from optical coherence tomography (OCT), visual acuity and use of medications including acetazolamide and anticoagulation were recorded. The technical aspects of the VT procedure are also described.

Results
Two patients were identified (2 women) that fit the study criteria. Both patients were taking the oral contraceptive pill. They both presented similarly with papilledema and symptoms of IIH including; headache, diplopia and nausea. There was symptomatic progress in both patients despite medical management with anticoagulation and acetazolamide. Patient A, a 39‐year‐old lady, was found to have a severe sagittal sinus thrombosis involving the entire sinus. Her lumbar puncture revealed an opening pressure of 31 cmH2O. She underwent urgent VT which revealed a highly organised thrombus and as such minimal change was achieved with repeated passes, however, her post‐op imaging showed partial recanalization of the right transverse sinus. Patient B, a 26‐year‐old lady, had a partially occlusive right transverse sinus thrombosis extending into the jugular vein. Manometry revealed elevated venous pressures. She underwent VT with alteplase injection to the site of thrombosis. After multiple passes, recanalization of the right transverse sinus was achieved. Post‐operative OCTs demonstrated a significant reduction in RNFLs bilaterally in both patients. Both patients also experienced resolution of symptoms over a few days and remained asymptomatic with gradually decreasing doses of acetazolamide.

Conclusions
VT may be a safe and effective treatment option in patients with medically refractory CVST who present with symptoms of IIH. In both patients there was marked improvement in symptoms and RNFL thickness after the procedure.
Abstract Number ‐ 81: Safety and Efficacy of Trans‐carotid Intervention in Multiple Scenarios: Medellin Experience Direct Carotid access.
Authors: Pabon Boris , Torres Victor M , Patiño Manuel , Pelaez Juan F , Mutis Jorge , Cardozo Margarita , Zapata Andres 
Published: April 2023

Introduction
Direct carotid puncture has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR. A believe of higher risk for neurovascular procedures or major accesssite related complications restrict its use. This study was conducted to investigate the feasibility and safety of trans carotid Neurointervention for a variety of pathologies.

Methods
Since 2018 we implemented a direct carotid access under special considerations to perform a therapeutic approach. A total of 14 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 2), Mechanical Thrombectomy MT (n = 5), AVM´s treatment (n = 2), intracranial Aneurysms treatment (n = 5). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered.

Results
Mean age was 64.3 ± 10.3 years. all cases but two we treated the patients under General Anesthesia GA. Major indication to this approach was : anatomical and access limitations. (in 12 cases wasn’t possible to reach the ICA through femoral or radial access due to extreme aortic arc tortuosity. Two patients with Leriche Syndrome) All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%). Two patients presented mild vasospasm and resolved using IA vasodilators. Both CAS were performed without any complications and none embolic protection device used. For MT(n = 5): a SOFIA 6Fr for ADAPT was used in 3 cases with TICI 2b‐3 in all cases. Combined approach ¨Solumbra¨ solitaire and aspiration catheter was used in two cases, one TICI 2a and one TICI 3. For the AVM´s treatment we use a 6Fr guiding catheter and non‐detachable microcatheters to inject Onix with a high grade of obliteration. Five aneurysms were treated with this approach (2 ICA – ophthalmic; 2 MCA and one AcomA) Mean average time of the procedure was 34.5 min. (ranged 9–59 min) just one bleeding complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site.

Conclusions
Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.
Abstract Number ‐ 83: First WEB case. Direct vertebral artery access for basilar tip artery aneurysm
Authors: Torres Victor , Pabon Boris , Patiño Manuel , Pelaez Juan , Mutis Jorge , Cardozo Margarita 
Published: April 2023

Introduction
being able to think of different accesses does not change the possibilities with each patient

Methods
case report

Results
Patient with subarachnoid hemorrhage in the posterior fossa. A tomography is performed that confirms the hemorrhage and a vascular lesion that is visualized at the top of the basilar artery. For the procedure, radial and femoral access was performed without achieving stable access to the basilar artery. Therefore, after multiple attempts, we consider that the best option is direct V2 left vertebral puncture. Access was achieved by vertebral puncture to the aneurysm and occlusion was performed on the top of the basilar artery. Tomographic controls were performed without complications. Patient then presented severe pulmonary compromise that required intubation and prolonged stay in the ICU. Control is performed after a month with adequate occlusion of the aneurysmal lesion.

Conclusions
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