bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 146: Re‐stenting Following Recurrence after Venous Sinus Stenosis Stenting for Idiopathic Intracranial Hypertension
Authors: D'Amato Salvatore A , Martinez‐Gutierrez Juan Carlos , Kole Matthew J , Engstrom Allison C , Nguyen Tien , Inam Mehmat E , Tang Rosa , Al‐Zubidi Nagham , Adesina Ore‐Ofeoluwatomi O , Sheth Sunil A , Chen Peng Roc 
Published: April 2023

Introduction
Venous sinus stenosis (VSS) stenting in medically refractory Idiopathic Intracranial Hypertension (IIH) patients has emerged as an effective treatment with low rates of failure and recurrence. However, the best treatment strategy following recurrence of symptoms in previously stented patients with initial response is unclear and frequently leads to shunt placement. We investigated the role of re‐stenting in patients with recurrence after prior successful stenting.

Methods
This is a retrospective review of a prospectively maintained IIH registry. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012–2022. Patients were divided into those who underwent a single stenting procedure (Group S) and those who underwent placement of an additional stent due to recurrence of clinical symptoms and angiographic stenosis (Group R). All re‐stenting was performed in adjacent or remote regions of stenosis. Bivariate analyses were utilized to compare clinical outcomes.

Results
86 patients were included with a median age of 33 [IQR 26‐39] and 94% were females. Group S (79/86) and Group R (7/86) had similar baseline characteristics. There was similar improvement in post‐stenting opening pressure (22.4±6.7 vs. 25.2±4.6 cm H2O, p = 0.35, Group S vs. Group R), change in opening pressure (11.6±10.4 vs. 5.3±12.2 cm H2O, p = 0.20, Group S vs. Group R) and resolution of tinnitus (91.8 vs. 80%, p = 0.28, Group S vs. Group R). Headache improvement was higher in Group S at 6 weeks, but similar at 6 months (92.8 vs. 60%, p = 0.02 and 88.2 vs. 80%, p = 0.59, Group S vs. Group R). Group S also had higher improvement in visual disturbances at 6 months (93.8 vs. 60%, p = 0.01, Group S vs. Group R), but similar improvement in papilledema (92.2 vs 100%, p = 0.68, Group S vs. Group R). None of the re‐stented patients required VPS rescue.

Conclusions
VSS re‐stenting in IIH patients with recurrence after initial stenting is feasible with similar efficacy in reducing intracranial pressure and symptoms.
Abstract Number ‐ 153: Mobile stroke units in acute ischemic stroke: A comprehensive meta‐analysis of nineteen controlled trials
Authors: Doheim Mohamed F , Hagrass Abdulrahman Ibrahim , Al‐kafarna Mohammed , Mostafa Mohamed Abdelhady , Elfil Mohamed , Elsayed Sarah Makram , Fayoud Aya Mamdouh , Hamdallah Aboalmagd , Hasan Mohammed Tarek , Almaghary Bashar Khaled , Ragab Khaled Mohamed , Kamal Abdallah , Al‐Mufti Fawaz 
Published: April 2023

Introduction
In certain circumstances, mobile stroke units (MSU) with on‐site treatment teams and a computed tomography scanner may offer faster therapy with tissue plasminogen activator (tPA) for stroke patients who need immediate treatment. We conducted a systematic review and meta‐analysis to compare clinical outcomes in MSU patients to those in conventional care.

Methods
We searched key electronic databases from inception till September 2021. The primary outcomes were mortality at 7 days and 90 days. The secondary outcomes included modified Rankin scale (mRS) at 90 days, alarm to intravenous thrombolysis (IVT) or intra‐arterial recanalization, and time from symptom onset or last known well (LKW) to thrombolysis.

Results
We included nineteen controlled trials and cohort studies to conduct our final analysis. Our comparison revealed that 90‐day mortality rate significantly declined in MSU group as compared to conventional care group (OR = 0.81, 95%CI [0.69,0.95]), while there was no significant difference at 7 days (OR = 0.88, 95%CI [0.68,1.15]). As regard achieving functional independence at 90 days (mRS = 0–2), MSU showed better results (OR = 1.24, 95%CI [1.03,1.49]). MSU was associated with shorter time from symptoms onset or LKW to thrombolysis (MD = ‐36.79, 95%CI [‐47.48, ‐26.10]) and alarm to IV thrombolysis or intra‐arterial recanalization (MD = ‐29.69, 95%CI [‐34.46, ‐24.92]).

Conclusions
Stroke patients treated in MSU had a lower incidence of the 90‐day mortality. They also had better functional independence at 90 days and time from symptom onset or LKW to thrombolysis than those treated with conventional care.
Abstract Number ‐ 156: Transradial versus Transfemoral Access for Mechanical Thrombectomy: A Meta‐Analysis of Nine Studies (2,161 Patients)
Authors: Elfil Mohamed , Doheim Mohamed F , Ghaith Hazem S , Salem Mohamed M , Aboutaleb Pakinam E , Aladawi Mohammad , Al‐Mufti Fawaz , Nogueira Raul G 
Published: April 2023

Introduction
Previous studies have compared the transradial access (TRA) with the transfemoral access (TFA) in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We conducted this meta‐analysis to provide comprehensive evidence regarding the comparison of procedural and clinical outcomes of the TRA versus the TFA in AIS patients undergoing MT.

Methods
We performed a comprehensive literature search of four electronic databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL) from inception until 1 May 2022. All duplicates were removed, and all references of the included studies were screened manually for any eligible studies. The full‐text articles of eligible abstracts were retrieved and screened for continued eligibility. Relevant data were extracted and then analyzed. For outcomes that constitute continuous data, the mean difference (MD) between the two groups and its standard deviation (SD) were pooled. For outcomes that constitute dichotomous data, the frequency of events and the total number of patients in each group were pooled as odds ratio (OR) between the two groups.

Results
Nine studies were included in this meta‐analysis, all of which were observational studies. The population of the studies was homogenous comprising a total of 2,161 patients who underwent MT, including 446 in the TRA group and 1,715 in the TFA group. There were no significant differences across the two groups in terms of successful recanalization (Thrombolysis in cerebral Infarction [TICI] score of 2b‐3: OR 0.83, 95% CI [0.55 to 1.25], P = 0.36) (Figure 1, A), complete recanalization (TICI 3: OR 1.16, 95% CI [0.50 to 2.68], P = 0.73), favorable functional outcome (90‐day modified Rankin scale [mRS] score of 0–2 (OR 0.86, 95% CI [0.53 to 1.41], P = 0.56), first‐pass reperfusion (OR 0.88, 95% CI [0.64 to 1.19], P = 0.41), number of passes (MD 0.12, 95% CI [‐0.18 to 0.42], P = 0.43) (Figure 1, B), access‐to‐reperfusion time (MD ‐3.92 minutes, 95% CI [‐9.49 to 1.65], P = 0.17), the amount of contrast used (MD 5.03 mL, 95% CI [‐20.27 to 30.33], P = 0.70), or symptomatic intracranial hemorrhage (OR 0.86, 95% CI [0.47 to 1.57], P = 0.62). However, access‐site complications were significantly less frequent in the TRA group as compared to the TFA group (OR 0.18, 95% CI [0.06 to 0.51], P = 0.001) (Finger 1, C).

Conclusions
In patients undergoing MT for AIS, the collective evidence suggests that the TRA seems to result in lower rates of access‐site complications than the TFA without any significant compromise in other clinical or procedural metrics. Large prospective studies are warranted.
Abstract Number ‐ 160: Insurance Status as a Predictor of Outcome in Mechanical Thrombectomy
Authors: Fedorova Margarita , Rodriguez Wilson , Christopher Kara , Linares Guillermo 
Published: April 2023

Introduction
Multiple studies have shown socioeconomic disparities in accessing treatment for acute ischemic stroke. Recent studies revealed that mechanical thrombectomy (MT) is more likely to be performed in patients with commercial insurance compared to other insurance types (Medicare, Medicaid, and uninsured). Insurance status can be used as a proxy for the patient’s socioeconomic status (SES), however, limited published data is not indicative of significant influence of SES on outcomes. We aimed to compare outcomes of MT in association with patients’ primary insurance.

Methods
Patients who received mechanical thrombectomy at our institution between 2019 and 2022 were reviewed and categorized according to their insurance status with the following parameters: commercial insurance, Medicare, Medicaid, and uninsured. Baseline and outcome data including demographic characteristics, past medical history, and unfavorable outcome (defined by 3–6 on the 90‐day modified Rankin Scale) were assessed.

Results
Insurance status was available for 172 patients, 55% of which had Medicare as their primary payer, 19% had commercial insurance, 17% had Medicaid, and 9% were uninsured. The mean age was 64.9 years; uninsured 55.4, Medicaid 52.2, commercial 55.3. Patients on Medicare were significantly older at 73.9 (F = 48.94, p< 0.001). Post‐hoc tests showed that those with Medicare were significantly older than those who had commercial insurance, Medicaid, or were uninsured (p< 0.001 for each post‐hoc comparison). Multivariate logistic regression revealed that, compared to those with commercial insurance, those with Medicare had lower odds of having an unfavorable mRS at 90 days (aOR = 0.28, 95% CI = 0.10‐0.80). There were no significant differences for those uninsured or on Medicaid.

Conclusions
Patients with Medicare as their primary payer were found to have 72% lower odds of poor functional outcome at 90 days compared to those with commercial insurance, however, patients undergoing MT at our site were primarily Medicare eligible. These results are promising because they highlight non‐inferior outcomes with Medicaid and superior outcomes with Medicare compared to commercial insurance despite previous studies reporting limited access to MT.
Abstract Number ‐ 164: Clot Density as a Predictor for Successful Mechanical Thrombectomy
Authors: Radaideh Yazan , Thind Sonam 
Published: April 2023

Introduction
Switching mechanical thrombectomy techniques (ADAPT, SR or combination) mid procedure has the potential to prolong time to recanalization as well as increase associated healthcare costs. The basis of selecting the frontline technique still relies heavily on the operators’ preference. Conflicting results indicating the varying performance of techniques relative to clot composition have been reported. Clot composition can be estimated based on clot density calculated in Hounsfield Units (HU) on pre‐intervention CT. Identifying how various clot composites behave can aid in the decision making for selecting a frontline technique.Our objective is to determine if clot density as measured by Hounsfield units can predict successful recanalization with ADAPT and the need for rescue stentriever when using ADAPT as the first line technique.

Methods
Retrospective review of all patients undergoing mechanical thrombectomy with first pass ADAPT at a single urban tertiary care academic stroke center. Clot HU values were calculated on pre‐intervention scans. We evaluated the number of passes, the use of rescue SR, the post intervention TICI grade and mRS on final follow up.

Results
There were 167 patients that underwent MT with ADAPT as the frontline approach. 122 were excluded for inability to calculate HU on pre‐ intervention scans, most often due to contamination with contrast media. 45 patients were included in the final analysis. 18/45 (40%) required SR rescue due to incomplete recanalization with first pass ADAPT. HU were dichotomized around the mean to “high” and “low”. Higher HU value was associated higher likelihood of SR use and higher final mRS scores, these however did not reach statistical significance. There was no difference in the total number of passes or the final TICI grade. AUC and ROC did not show a correlation between HU value and the use of SR or a higher number of passes need to achieve TICI ≥ 2b recanalization.

Conclusions
In our patient cohort, HU value was not able to predetermine the success rate of MT using ADAPT. There was no correlation between HU value and functional outcomes of patients. Reliability of clot HU value in determining MT success with ADAPT could not be established. Other factors should be considered when selecting frontline technique in mechanical thrombectomy.
Abstract Number ‐ 165: Are Smaller Stentrievers the Answer for Achieving Procedural Success in Distal Vessel Occlusions (DiVO)?
Authors: Zainab Anika , Dharwadkar Niti , Desai Sohum , Tekle Wondwossen G 
Published: April 2023

Introduction
Distal vessel occlusions (DiVO) represent the next frontier of interventional stroke care. Although many experts agree the current generation of stentrievers appear to be ill‐suited to address challenges presented by DiVO, some practitioners advocate utilizing smaller devices.We sought to examine whether smaller diameter devices (3,4 or 5 mm) had any edge over standard sized 6 mm device.

Methods
A prospectively maintained neuro‐endovascular database was queried for patients between January 2013 to August 2022. Patients included in the analysis had undergone mechanical thrombectomy of distal circulation defined as M2, M3, P2, P3, A2 and A3 segments of the MCA, PCA, and ACA respectively.Primary outcomes measured were TICI post procedure, mRS at discharge and mRS at 90 days.

Results
A total of 33 patients with DiVO were identified out of a database containing 826 mechanical thrombectomies. There were no other differences in baseline characteristics such as presentation NIHSS (p = 0.58) or comorbid medical conditions. We found no differences in post procedure recanalization TICI between large device and small devices cohorts (p = 1.00), symptomatic ICH (p = 0.52), mRS at discharge (p = 0.154) and mRS at 90 days (p = 0.22).

Conclusions
There do not appear to be any clinical or radiographic difference in utilizing smaller diameter stentrievers in setting of DiVO.
Abstract Number ‐ 170: Trends for Endovascular Mechanical Thrombectomy versus Intravenous Tissue Plasminogen Activator for Vertebrobasilar Stroke Treatment
Authors: Saha Ram , Solanki Shantanu , Bozkurt Subutay , Roy Anil 
Published: April 2023

Introduction
Acute vertebrobasilar artery occlusion (VBAO) represents approximately 20% of patients presenting with acute ischemic stroke. The occlusion is caused by an embolus or underlying atherosclerotic disease plaque rupture forming an acute thrombus. Without treatment, VBAO’s mortality nears 80–90%, thus, effective and timely treatment strategies become paramount in managing the patients. Herein, we analyzed the age difference and outcomes in patients that underwent either Endovascular Mechanical Thrombectomy (MT) or intravenous (IV) tissue plasminogen activator (tPA).

Methods
National Inpatient Sample (NIS) was queried from years 2016 to 2018 using ICD‐10 diagnosis and procedure codes for occlusion or thrombosis of vertebral artery or basilar artery (I63.21, I63.22, I63.01, and I63.02), IV tPA (3E03317), and MT (03CG3ZZ, 03CG3Z6, 03CG3Z7, 03CG4Z6, 03CG4ZZ). Chi‐square test and was used for statistical analysis.

Results
From 2016 to 2018, there were 37,310 patients admitted with vertebrobasilar stroke. Out of these, IV tPA was administered in 2,530 (6.8%) admissions, whereas MT was done in 2,330 (6.2%) admissions. IV tPA was used significantly more than MT in age groups 65–84 and > = 85 years. MT was used significantly more than IV tPA in age groups 18–44 and 45–64 (Figure 1). There was no significant difference in their use between men and women. In large hospitals, MT was more common than IV tPA (8.1% vs 7%, p < 0.0001), and in small hospitals, IV tPA usage was significantly higher (3.8% vs 2%, p < 0.0001). All‐cause mortality rate was significantly higher in MT than IV tPA admissions (16.8% vs 8.1%, p < 0.0001). There was no significant difference in mean length of stay (LOS) between the two modalities (Figure 1).

Conclusions
We saw a trend of higher rate of mechcnical thrombectomy in younger age group (18‐64 years) than older, however, no sex difference was noted. All‐cause mortality rate was higher in the mechanical thrombectomy group than intravenous tissue plasminogen activator group. In addition, there was no difference in length of hospital stay.
Abstract Number ‐ 176: Mechanical thrombectomy with or without bridging in stroke: A systematic review and meta‐analysis of RCTs
Authors: Morsi Rami Z. , Zhang Yuan , 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 , Mansour Ali , Prabhakaran Shyam , Kass‐Hout Tareq 
Published: April 2023

Introduction
Current published guidelines and meta‐analyses comparing direct mechanical thrombectomy (MT) alone versus MT with bridging intravenous thrombolysis (IVT) suggested that MT alone is non‐inferior to MT with bridging thrombolysis in achieving favorable functional outcome. Because of this controversy, we aimed to systematically update the evidence and meta‐analyze data from randomized trials comparing MT alone versus MT with bridging thrombolysis.

Methods
We searched MEDLINE (through Ovid), EMBASE, and the Cochrane Library from inception to December 14, 2021 without any language restrictions to identify randomized controlled trials (RCTs) and post‐hoc analyses of RCTs comparing direct MT with or without bridging IVT in patients presenting with acute ischemic stroke secondary to a large vessel occlusion. We conducted meta‐analyses using random‐effects models to compare the rates for favorable functional outcome (defined as modified Rankin scale [mRS] score of 0 to 2) and mortality at 90 days, and symptomatic intracranial hemorrhage (sICH), between MT and MT with IVT. We also assessed the risk of bias using the Cochrane risk‐of‐bias tool (RoB) and the certainty of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results
Of 11,111 citations, we identified 53 eligible studies, and included 8 studies with a total of 3,008 participants. We found low‐certainty evidence suggesting that there is probably a small increase in the proportion of patients with favorable functional outcome with an mRS of 0 to 2 at 90 days for those who underwent MT with IVT compared to those with MT alone (risk ratio [RR] 1.08, 95% CI 0.99 to 1.19); moderate‐certainty evidence that there is probably a small decrease in mortality at 90 days for patients with MT plus IVT compared to MT alone (RR 0.86, 95% CI 0.71 to 1.03); and very low‐certainty evidence that there is possibly an increase in sICH for patients with MT plus IVT compared to MT alone (RR 1.17, 95% CI 0.85 to 1.61). When we restricted the analyses to RCTs only, we found no significant differences in favorable functional outcome (RR 2.05, 95% CI 0.97 to 1.13), mortality (RR 0.94, 95% CI 0.78 to 1.14), or sICH (RR 1.20, 95% CI 0.85 to 1.70).

Conclusions
Low‐certainty evidence shows that there is probably a small increase in the proportion of patients with favorable functional outcome, moderate‐certainty evidence shows that there is probably a small decrease in mortality, and very low‐certainty evidence that there is possibly an increase in sICH for patients with MT plus IVT compared to MT alone.
Abstract Number ‐ 188: Rescue Stenting for Intracranial Stenosis In ELVO patients Using Neuroform Atlas Stent Through Gateway Balloon
Authors: Memon Muhammad Z , Biswas Arundhati , Ezzeldin Mohamad , Nisar Taha , Singla Amit , Zaidat Osama O , Khandelwal Priyank 
Published: April 2023

Introduction
Management of acute large vessel occlusion due to intracranial stenosis remains challenging with high complication and poor recanalization rates. Morbidity is also related to the intracranial exchange that is required for stent placement after the rescue angioplasty. We aim to present our initial experience of deployment of Neuroform Atlas stent through the lumen of a Gateway angioplasty balloon to avoid microcatheter exchange.

Methods
Patients were identified from prospectively collected mechanical thrombectomy stroke database from Feb 2019 to July 2021. Demographic and clinical information was collected. Primary outcomes were favorable functional outcome at hospital discharge (modified Rankin Scale (mRS) score of 0–3), and the rate of intracranial hemorrhage (ICH). Good angiographic recanalization (TICI ≥ 2b), and mortality at 30 days were other outcomes.

Results
We identified 5 patients treated with this approach [mean age 54 ± 14 years, all were men] who presented with large vessel occlusion of middle cerebral artery. Initial median NIHSS was 8 (range 6–16) with one patient received IV t‐PA. Patient initially underwent mechanical thrombectomy using the Solumbra technique. Due to reocclusion or impending occlusion with evidence of atherosclerotic plaque, rescue angioplasty with stent placement was performed. Patients were loaded with 650 mg of aspirin and 180 mg of ticagrelor through nasogastric tube prior. Balloon angioplasty was performed using the gateway balloon size ranging from 1.5 to 3 mm which was inflated to subnominal pressures over 1 minutes. This was followed by placing Neuroform atlas stent through the gateway balloon with size ranging from 3 to 4 mm diameter and length ranges from 21–24 mm. TICI ≥ 2b was achieved in 4 patients. Mean time from symptoms onset to revascularization was (336 ± 90) minutes. One patient had asymptomatic ICH. 2 patients had mRs 0–3 at the time of discharge and one patient was dead at 1 month

Conclusions
Our preliminary experience showed lower risk of guidewire perforation as well as potentially decreased operative time and early reperfusion by deploying the Neuroform stent through a compatible gateway balloon microcatheter. This should be investigated further in a large multicenter study