bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 057: Outcomes in Patients with Aspiration vs Stent Retriever Thrombectomy
Authors: Kaur G. , Rodriguez W. , Scott J. , Esechie A. , Christopher K. , Edgell R. , Linares G. 
Published: January 2025

Introduction
There are currently multiple devices cleared by the FDA for endovascular therapy in acute ischemic stroke. While data on the superior efficacy of dual stent retriever and aspiration catheter techniques for mechanical thrombectomy (MT) is mixed, our study compares outcomes between the stent retriever and aspiration techniques.

Method
We reviewed 257 patients with large vessel occlusion (LVO) who underwent mechanical thrombectomy (MT) between 2018 and June 2023. From this cohort, we identified 48 patients: 22 who underwent MT exclusively with a stent retriever and 26 who underwent MT using an aspiration catheter. Patients who received dual‐device MT were excluded from the study. Our primary outcomes included successful recanalization, defined as a modified Thrombolysis in Cerebral Ischemia (TICI) score of greater than or equal to 2b, the duration of intensive care unit (ICU) stay, and a 90‐day modified Rankin Scale (mRS) score of 0‐3. Secondary outcomes included the number of passes and complications, such as intracranial hemorrhage (ICH).

Results
Baseline characteristics, including age and BMI, were comparable between the two groups. The proportion of patients achieving a good outcome (TICI score greater than or equal to 2b) was 90.9% in the stent retriever group compared to 84.6% in the aspiration catheter group. The average ICU stay was 5.6 days for the stent retriever group and 3 days for the aspiration catheter group. The proportion of patients with a favorable 90‐day mRS score (0‐3) was 69.2% in the stent retriever group and 85.7% in the aspiration catheter group. First‐pass effect occurred in 72.7% of patients in the stent retriever group, compared to 57.7% in the aspiration catheter group. Intracranial hemorrhage (ICH) was observed in 28.6% of patients in the stent retriever group and 19.2% in the aspiration catheter group (p=0.45).

Conclusion
Our study found that the stent retriever technique resulted in better recanalization and fewer passes compared to the aspiration catheter. However, the aspiration catheter group had shorter ICU stays, better functional outcomes, and fewer complications. With newer devices, further research with standardized techniques is needed to provide more clarity on these findings.
Abstract 063: A Scoping Review of Drug‐Induced Hypertension in the Endovascular Thrombectomy Era
Authors: Rodriguez-Calienes A. , Chavez-Ecos F. A. , Huynh J. K. , Flores-Boggiano E. A. , Vilca-Salas M. I. , Espíritu-Vilcapoma X. , Aliaga-Cavalcanti C. , Morán-Mariños C. , Ortega-Gutierrez S. 
Published: January 2025

Introduction
Since 2015, endovascular thrombectomy (EVT) has become the gold standard for treating large vessel occlusion acute ischemic stroke (LVO‐AIS). Drug‐induced hypertension (DIH) shows promise in enhancing collateral blood flow to the ischemic penumbra, particularly in LVO‐AIS patients with larger penumbral tissue volumes compared to other stroke subtypes. Despite its potential, current AIS guidelines lack specific recommendations regarding the use of DIH in patients undergoing recanalization therapy. This review aims to provide a comprehensive analysis of the existing evidence on DIH in AIS within the context of the EVT era.

Methods
We conducted a comprehensive search of five electronic databases, supplemented by gray literature, to identify studies on DIH in AIS between 2015 and 2024. Data extraction focused on key variables including study design, patient population, target blood pressure (BP), pharmacological agents used, dosage, timing and duration of intervention, recanalization strategies (intravenous thrombolysis, EVT), DIH's impact on outcomes, and associated adverse effects.

Results
Seven studies were identified, with sample sizes ranging from 50 to 218 participants (median: 136). Of these, four were retrospective, and three were randomized controlled trials. Two studies focused on patients with lacunar stroke, two on patients with early neurological deterioration, and three on a broader AIS subpopulation. Three studies specifically targeted patients ineligible for recanalization therapy, three included a mixed population of both recanalization and non‐recanalization patients, and only one exclusively studied patients eligible for EVT. Notably, none of the studies involving recanalization therapy detailed the timing of DIH initiation relative to the therapy. The most common target BP was a 20% increase from baseline systolic BP (observed in 4/7 studies). Phenylephrine infusion was the most frequently used agent (4/7 studies), followed by norepinephrine (2/7 studies). Four studies reported achieving primary efficacy outcomes of DIH, including improved functional status and early neurological improvement. Safety outcomes and adverse effects were not associated with DIH in three of the four studies that evaluated these factors.

Conclusion
The current evidence on DIH for AIS in the EVT era remains inconclusive, particularly concerning its benefit in patients undergoing revascularization therapy. Although achieving a 20% increase in baseline systolic BP with phenylephrine infusion is a commonly utilized approach, the variability in protocols and lack of standardized guidelines underscore the need for further research. To establish a definitive role for DIH, well‐designed, prospective studies, with specific focus on timing, AIS subtypes, and standardization of intervention protocols are required.
Abstract 073: ASPECTS decay during interfacility transfers in patients with large vessel occlusion
Authors: Alrohimi A. , Ishaque N. , Wagner A. , Jeerakathil T. , Buck B. , Shuaib A. , Hill M. D. , Almekhlafi M. , Mishra S. 
Published: January 2025

Background
Some patients with large vessel occlusion (LVO) are first evaluated at primary stroke centers (PSCs) before transfer to a comprehensive stroke center (CSC) for Endovascular thrombectomy (EVT). A subgroup of those patients experiences rapid infarction growth during transfer limiting the benefit from intervention. We evaluated the incidence, predictors, and outcomes of imaging decay of patients with LVO transferred for EVT.

Methods
A retrospective analysis of all patients with anterior circulation LVO transferred for EVT. ASPECTS decay was defined as 2 ASPECTS points decrement at CSC compared to PSC. Primary outcome was 90 day home time.

Results

182 (44.5% female) patients met the inclusion criteria. Median (IQR) time between baseline and follow up CTs was 250.5 (163‐324.25) minutes. Out of the 182 patients, 66 patients (36%) had ASPECTS decay, and 32/66 patients (48%) underwent EVT. Collateral score was strongly associated with the ASPECTS decay (OR= 0.29, [0.19‐0.46], p<0.001) in multivariate logistic regression. Patients with ASEPCTS decay have a significant lower rate of 90‐day home‐time (P<0.001) and higher risk of 90‐day mortality (P<0.001), and in hospital death (P=0.03). In patients with ASPECTS decay, performing EVT was not associated with improved 90‐day home time (
β
= 0.19, [‐3.2 ‐27.8], p=0.12).

Conclusions
For patients with LVO transferred for thrombectomy, a third of our patients developed ASPECTS decay. Collateral blood flow was the main determinant of ASPECTS decay during inter‐facility transfers. Decay is strongly associated with poor functional outcomes.
Abstract 075: Associations between Glucocorticoid Treatment with Clinical Outcomes and Medical Complications in Patients with Subarachnoid Hemorrhage
Authors: YANG X. , Gallagher A. , Fong C. T. , Walters A. M. , Leslie‐Mazwi T. , Souter M. J. , Levitt M. , Wahlster S. , Lele A. V. 
Published: January 2025

Introduction and Purpose
The impact of glucocorticoids (GCs) on outcomes in aneurysmal subarachnoid hemorrhage (aSAH) is insufficiently explored. This study examined associations between GC treatment within one week from aSAH and clinical outcomes.

Methods
Retrospective, observational cohort study of adult patients with aSAH admitted to a comprehensive stroke center between 01/2014‐01/2019. Patients were stratified into two groups: GCs exposure within the first 7‐days from admission versus no GCs during the hospitalization. Propensity matched cohorts adjusted for age, gender, and Hunt‐&‐Hess grade on admission were compared using multivariable regressions to determine associations between GCs treatment and clinical outcomes of: discharge‐to‐home rates, severe vasospasm (defined as Lindegaard ratio > 6.0 on transcranial doppler), delayed cerebral ischemia (DCI, defined as cerebral infarction on magnetic resonance imaging), in‐hospital mortality and medical complications (ventriculostomy‐related infection, ventilator‐associated pneumonia, catheter‐associated urinary tract infection, delirium).

Results
Overall, 339 patients (mean age 54.7 ± 12.9) were included. Propensity matched cohort analysis was performed in 298 patients (mean age 54.4 ± 13.2). Most aneurysms (239, 80.2%) were located in the anterior circulation and 59 (19.8%) were in the posterior circulation; 152 (51%) underwent surgical clipping, 150 (50.3%) underwent endovascular coiling, and 4 underwent both procedures. Patients in the GCs group received a calculated median dose of dexamethasone of 114.7mg (IQR = 38‐295.6). Treatment with GCs was associated with higher discharge‐to‐home rates (z = 2.21, 95% confidence interval (CI) 0.28‐0.76), but also a higher frequency of severe vasospasm (z = 3.01, 95% CI 0.78‐1.56). A non‐significant trend towards lower frequency of DCI was noted in the GCs group (z = ‐1.8, 95% CI (‐0.68) ‐ (‐0.2)). No difference was found in all‐cause in‐hospital mortality or any of the medical complications between groups.

Conclusion
GCs treatment within the first 7‐days was associated with higher discharge‐to‐home rates, but mixed results were observed regarding the incidence of vasospasm and DCI. From a safety side‐effect profile, GCs appeared to be well tolerated. Our findings highlight the need for further studies to determine the utility of GCs in aSAH.
Abstract 097: Endovascular Treatment of Refractory Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Single Center 16‐year Experience
Authors: Behzadi F. , Tsiang J. , Jani R. , Payman A. , Bond B. , Kam A. , Pasquale D. , Serrone J. 
Published: January 2025

Introduction
Refractory post‐hemorrhagic cerebral vasospasm (PHCV) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is a morbid and possibly fatal condition that often requires endovascular treatment with either intra‐arterial (IA) vasodilator therapy or percutaneous transluminal balloon angioplasty (PTA). This study aims to evaluate the efficacy of these treatments and explore the risk factors of poor clinical outcomes amongst patients with refractory PHCV receiving endovascular therapy.

Methods
All adult patients who received IA vasodilators or PTA for PHCV due to aSAH from 2007 to 2023 at our institution were included. Patients were divided into Good and Poor outcome cohorts based on 6‐month modified Rankin of > 2 cutoff and were compared for all identifiable risk factors using multivariate analysis. Radiographic changes in vessel diameter and cerebral circulation time (CCT) were measured and compared between individual PTA and IA sessions using various metrics.

Results
A total of 83 refractory vasospasm patients with an average age of 52.0 years old, 66% of whom were female. Poor outcomes were seen in 65% of patients. Female sex (p=0.045) and initial vasospasm symptom of only headaches (p=0.044) were protective factors against poor outcomes. History of hypertension (p=0.010), earlier onset of vasospasm (p=0.008), requiring systemic hypertensive therapy (p=0.012), and longer initial pre‐treatment CCT (p=0.042) were risk factors of poor outcomes. PTA was superior to IA vasodilators pre‐ to post‐treatment vessel diameter (0.44 mm in PTA compared to 0.23 mm in IA; p=0.017) but CCT was similarly improved with both modalities.

Conclusions
In this single‐center retrospective review, most patients (65%) treated with endovascular therapy for PHCV experienced poor outcomes. A history of hypertension, earlier onset of vasospasm, and longer initial pre‐treatment CCT were predictive of poor outcome. Female sex and headache presentation were predictive of good outcomes. PTA had a statistically superior intra‐treatment improvement in vessel diameter compared to IA vasodilators. All other radiographic parameters were similar between PTA and IA therapy.
Abstract 172: A Machine Learning Model for Prediction of Short‐Term Functional Outcomes in Cerebral Venous Thrombosis
Authors: Govind A. , Meghana B. , Byadarhaly K. , Kenchaiah R. 
Published: January 2025

Background
Dural Sinus and Cerebral Vein Thrombosis (CVT) represents a rare yet significant cause of stroke, with distinct pathophysiological mechanisms compared to arterial strokes. Despite the progress in machine learning‐based predictive models for arterial stroke, which have significantly advanced prognostication and treatment strategies, there remains a notable absence of similar models for CVT.

Methods
A single‐center, retrospective cohort study of adult patients diagnosed with acute CVT confirmed on contrast‐enhanced CT/MR Imaging at admission was carried out at a specialized tertiary care center. Patients with a known history of recent or active infections or inflammatory conditions or missing data were excluded. Baseline clinical and demographic data, laboratory data including blood cell counts, Serum Homocysteine and Folate levels measured before the initiation of anticoagulation, and modified Rankin Scale (mRS) scores at discharge were collected. To study short‐term functional outcomes, patients were dichotomized into good (mRS 2 or less, encoded as output class 1) and poor (mRS >2 encoded as output class 0) functional outcome groups. Machine learning models were built in order to predict if patients belonged to good or poor function outcome groups (mRS2). The classifiers were validated using K‐fold cross validation to pick the best hyperparameters and were tested using a holdout data. The classifiers built include Support Vector Machine (SVM), Logistic Regression Regression (LR), Random Forests (RF) and Gradient Boosting. The performance of the classifiers are compared based on the Area Under the Receiver Operating Characteristic (AUROC) and Sensitivity.

Results
162 patients were included in the final dataset, 32 of whom had a significant disability (mRS>2) at discharge. The top variables for predicting the functional outcome groups were Platelet count, Serum Homocysteine, Neutrophil‐to‐Lymphocyte ratio, and Total Leucocyte Count at the time of admission. Support Vector Machine (SVM) was found to be the best‐performing algorithm with an accuracy of 0.86 and AUC of 0.643.

Conclusion
Using the SVM machine learning algorithm, a predictive model consisting of baseline platelet count, serum homocysteine, total leucocyte count, and the inflammatory marker Neutrophil‐to‐Lymphocyte Ratio was developed to predict short‐term functional outcomes in acute CVT. The high value of accuracy (0.86) indicates that the algorithm is able to reliably detect short‐term functional outcomes.
Abstract 181: Acute Ischemic Stroke And Endovascular Thrombectomy During COVID‐19 Pandemic: A Nationwide Analysis
Authors: Reddi P. , Mehta A. , Shafizadeh M. , Kellner C. , Dangayach N. , Fifi J. , Mocco J. , Majidi S. 
Published: January 2025

Introduction
COVID‐19 may be linked to higher rates of severe strokes and strokes in younger patients through distinct pathophysiological processes.

Objectives
To investigate characteristics and outcomes in COVID‐19 related acute ischemic stroke (AIS) and endovascular thrombectomy (EVT) in the 2020‐2021 National Inpatient Sample (NIS) database.MethodsNIS was queried for patients admitted in relation to AIS or who underwent EVT, stratifying patients based on COVID‐19 diagnosis. Demographics, co‐morbidities, and outcomes were compared between groups using univariate analyses. Propensity score matching was used for multivariable analyses. Primary outcomes were age difference and the difference in the prevalence of cardiovascular risk factors between the two groups. Secondary outcomes include rates of favorable hospital outcome, in‐hospital mortality, and the length of hospital stay.

Results
In the AIS cohort of 1,381,039 patients, 58,525 had COVID‐19. Mean age for COVID‐19 patients with AIS was lower (67.55 vs 69.40 years; SMD=0.134). There was a higher proportion of Black (21.1% vs 17.9%) and Hispanic patients (15.0% vs 8.5%) amongst COVID‐19 patients with AIS. In adjusted multivariable analyses, the presence of COVID‐19 in AIS patients was significantly associated with a higher rate of inpatient mortality (AOR:2.79; 95% CI[2.61‐2.98]; p<0.001) and a lower rate of favorable hospital outcome (AOR:0.66; 95% CI[0.62‐0.70]; p<0.001). 83,650 patients underwent EVT. 3,075 of these patients were diagnosed with COVID‐19. The COVID‐19 group in patients who underwent EVT presented with a younger average age (64.02 years vs 69.25 years; SMD=0.368) and a greater proportion of Black (19.0% vs 15.1%;SMD=0.277) and Hispanic patients (14.9% vs 8.4%; SMD=0.277). COVID‐19 in patients who underwent EVT was associated with higher in‐hospital mortality rate (AOR:2.21, 95% CI[1.65‐2.98], p<0.001).

Conclusions
This nationally representative analysis demonstrates patients with AIS and concomitant COVID‐19 infection were younger, with less cardiovascular risk factors, disproportionately Black and Hispanic, with worse neurological deficit and worse hospital outcome.
Abstract 229: Comparative Diagnostic Yield of Cardiac Computed Tomography Versus Echocardiography for Identifying Cardioembolic Sources in Ischemic Stroke: A Retrospective Single‐center Cohort Study
Authors: Liu M. , Ghozy S. , Osman K. , Nasr D. 
Published: January 2025

Background
Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Understanding stroke etiology is critical in future stroke prevention. A cardioembolic etiology of stroke makes up a significant proportion of all ischemic stroke. Part of the evaluation for a cardioembolic etiology requires a structural evaluation of the heart to evaluate for sources of thrombus. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCT) has emerged as a potential alternative, offering non‐invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi.
This study aimed to evaluate the diagnostic yield of CCT compared to TTE and TEE in detecting high‐risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular sources of thrombus, and ulcerated aortic plaques, in patients with ischemic stroke.

Methods
We conducted a retrospective, single‐center cohort study at Mayo Clinic, Rochester, MN, on patients who underwent CCT within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCT, TTE, and TEE in detecting structural cardiac sources of embolism.

Results
426 patients were included in our study. 87 patients underwent both CCT and TEE, 257 underwent CCT and TTE, and 82 only underwent CCT. The overall diagnostic yield of CCT for detecting high‐risk cardioaortic sources was 15.5%. Specifically, CCT identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCT demonstrated a higher yield than TTE (16.0% vs. 3.5%) and a comparable or higher yield than TEE (25.3% vs. 20.7%) in detecting these sources.

Conclusions
CCT proved to be a viable and potentially superior alternative to traditional echocardiography for identifying some high‐risk structural sources of cardioembolism in ischemic stroke patients. Its non‐invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCT in this context.
Abstract 235: Cyclic Aspiration in Mechanical Thrombectomy: Influencing Factors and Experimental Validation
Authors: Jablonska M. , Li J. , Tiberi R. , Tomasello A. , Ribo M. 
Published: January 2025

Introduction/Purpose
Mechanical thrombectomy is a fundamental intervention for acute ischemic stroke treatment. While conventional techniques are effective, cyclic aspiration (CyA) shows potential for better recanalization rates. We aim to investigate factors affecting CyA and compare them with static aspiration (StA).

Materials/Methods
StA setup consisted of an aspiration pump connected to pressure transducer. CyA was tested with five setups: single solenoid valve with air+saline (1) or saline alone (2) as aspiration medium; two solenoid valves with air+saline (3) as aspiration medium; complete air removal and saline feeding (4); pressurized saline feeding (5). To assess the efficacy of clot ingestion, the pressure transducer was replaced with a distal aspiration catheter. Moderately stiff clot analogs (15 mm) were used to investigate the ingestion quantified as clot relative weight loss. Additionally, the aspiration flow rate was assessed for each setup.

Results
With CyA setup 1, the amplitude of the achieved negative pressure waves declined with increasing frequencies but progressively increased with each subsequent iteration, achieving a maximum amplitude of 81 kPa for setup 5 at 1Hz. Relative clot weight loss was significantly higher with setup 5 at 5Hz than with StA (100% vs. 37,8%; p=0.05). Aspiration flow rate was lower with CyA than with StA (setup 5 at 5Hz: 199,8ml/min vs. StA: 311ml/min; p<0.01).

Conclusion
Cyclic aspiration with the appropriate setup may represent an encouraging innovation in mechanical thrombectomy, offering a promising pathway for improving efficacy in clot ingestion and recanalization. The observed benefits warrant confirmation in a clinical setting.