bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 189: An Expedited Transfer Protocol Improves Door In Door Out Times
Authors: Cort M. , Owens K. , Stein L. , Blum C. , Novello P. , McPartland E. , Hoey C. , Sellers M. , Rothstein A. 
Published: January 2025

Background
Rapid reperfusion with mechanical thrombectomy for ischemic stroke secondary to large vessel occlusion leads to significant reduction in morbidity and mortality. DIDO time is an important metric for stroke centers without on‐site mechanical thrombectomy. Delays in treatment can occur when patients present at a Primary Stroke Center (PSC) then require transfer to the CSC for MT. Our system Comprehensive Stroke Center (CSC) receives patients from 2 of our systems PSC's. In order to expedite care an expedited transfer protocol was implemented.Purpose: The goal of this work is to decrease the time at the PSC, known as door‐in‐door‐out (DIDO) and decrease overall time from patient presentation to treatment with thrombectomy, known as door to groin time (DTG).Methods: Patients are screened at triage by a PSC emergency department provider for the following: aphasia, gaze preference, or neglect with unilateral weakness within 24 hours of last known normal. If these criteria are present, the emergency department provider contacts the CSC transfer center to initiate the expedited transfer process, which begins moving transfer resources to the PSC while clinical work‐up continues. This expedited early transfer process was implemented in January 2021. Transfers for MT during the 12‐month period before and after the implementation of the expedited transfer process were analyzed.Results: Mean DIDO was lower when expedited protocol was utilized (99 min vs. 137 min respectively, (p=.017)). Mean DTG was unchanged (27 min vs. 37 min respectively, (p = 0.067)).Conclusions: Use of the expedited transfer process allows transfer resources to begin moving to the patient with a suspected LVO in parallel with ongoing evaluation, resulting in faster DIDO and times leading to faster treatment aimed at reducing stroke morbidity and mortality.
Abstract 192: Angioedema Following Lifesaving Thrombolysis In Acute Ischemic Stroke
Authors: Huhulea E. , Uddin A. , Syed S. , Jain A. , Sasan C. , Nguyen T. , Lui A. K. , Paul D. , Al‐Mufti F. 
Published: January 2025

Introduction
Orolingual angioedema is a recognized adverse effect of tissue plasminogen activator (tPA) treatment in the setting of acute ischemic stroke (AIS). Although its incidence is relatively low (0.1‐0.7%), the reaction is generally mild but may trigger life‐threatening airway occlusion and necessitate rapid intubation. This is the first study to examine the differences in complications, management, and outcomes of AIS patients with and without tPA‐induced angioedema.

Methods
The National Inpatient Sample (NIS) was queried by ICD‐9‐CM/ICD‐10‐CM codes to identify AIS patients treated with tPA who experienced subsequent angioedema. Baseline characteristics, treatment, complications, and functional outcomes were analyzed through multivariate regression and compared through a propensity score matching (PSM) analysis.

Results
This study examined 99,935 patients diagnosed with AIS and administered tPA between 2010 and 2019. AIS patients with tPA‐induced angioedema were younger (67.44 years vs 69.32 years, p < 0.01), less likely to be white (53.83% vs 66.48%, p < 0.01), and presented with higher acute stroke severity scores (0.69 vs 0.63, p < 0.01) than non‐angioedema AIS patients. Following PSM analysis, patients with angioedema had higher rates of tracheostomy (5.7% vs 0.49%, p < 0.01) and lower rates of endovascular mechanical thrombectomy (4.72% vs 9.63%, p < 0.01). Angioedema patients were observed to have similar rates of decompressive hemicraniectomy (p = 0.16), pneumonia (p = 0.06), sepsis (p = 0.82), acute kidney injury (p = 0.05), acute myocardial infarction (p = 0.43), cardiac arrest (p = 0.56), poor functional outcome (p = 0.25), and in‐hospital mortality (p = 0.32). Patients who developed angioedema were also observed to have longer LOS (7.34 days vs 5.41 days, p < 0.01).

Conclusion
There appears to be no difference in complication risk, functional outcome, and in‐hospital mortality between AIS patients with and without tPA‐induced angioedema. The observed increase in LOS may be attributed to the increased rates of tracheostomy following oropharyngeal swelling. Airway instability may also preclude AIS patients with angioedema from mechanical thrombectomy, offering one explanation for the observed difference in intervention rates. Further research is needed to better understand the impact of tPA‐induced angioedema on interventions and outcomes of patients with acute ischemic stroke.

Abbreviations
Nationwide Inpatient Sample (NIS), acute ischemic stroke (AIS), tissue plasminogen activator (tPA), mechanical thrombectomy (MT), propensity score matching (PSM), deep vein thrombosis (DVT), pulmonary embolism (PE), urinary tract infection (UTI), length of stay (LOS)
Abstract 200: Associations Between Atrial Fibrillation and Cognitive Decline Following Minor, Moderate, and Major Ischemic Stroke: A Post Hoc Analysis
Authors: Elsayed M. M. , Hegazy Z. , Fakhry M. , Sherif A. , Hafez O. 
Published: January 2025

Introduction
Atrial fibrillation (AF) is a well‐established risk factor for stroke, but its role in cognitive decline following ischemic stroke remains underexplored. This study investigates the impact of AF on cognitive outcomes across different severities of ischemic stroke, aiming to better understand the interplay between AF and post‐stroke cognitive function.

Methods
We conducted a post hoc analysis using data from the ELAN randomized clinical trial, involving 600 patients who experienced ischemic strokes of varying severity. Stroke severity was categorized as minor, moderate, or major. Cognitive function was assessed using standardized cognitive scales both before and after the stroke event. AF status was determined through clinical assessments and patient medical history, and the analysis focused on comparing cognitive outcomes between patients with and without AF. Additionally, the influence of early anticoagulation therapy on cognitive decline in AF patients was evaluated.

Results
The analysis revealed that patients with AF exhibited a significantly higher risk of cognitive decline following ischemic strokes of all severities. Specifically, the odds ratios for cognitive decline were 1.45 (95% CI: 1.10‐1.93) for minor strokes, 1.68 (95% CI: 1.25‐2.24) for moderate strokes, and 2.03 (95% CI: 1.54‐2.66) for major strokes in patients with AF compared to those without AF. Furthermore, multivariate analysis highlighted that early initiation of anticoagulation therapy played a protective role, moderating the extent of cognitive decline in AF patients.

Conclusion
This study underscores the significant association between AF and an increased risk of cognitive decline following ischemic strokes of varying severity. The findings emphasize the importance of timely and effective management of AF, particularly through early anticoagulation therapy, to mitigate cognitive impairment in stroke survivors. Given the strong link between AF and adverse cognitive outcomes post‐stroke, these results suggest that routine cognitive assessment and proactive AF management should be integral components of post‐stroke care. Addressing AF in stroke patients may offer a pathway to reducing the burden of cognitive decline and improving overall recovery outcomes.
Abstract 214: Carotid dissection and occlusion leading to acute ischemic stroke, hypotension and bradycardia
Authors: Iqbal Z. , Mohammedalkhair A. , Albana A. , Reardon T. , Miller D. 
Published: January 2025

Introduction
The carotid sinus regulates blood pressure and heart rate. Damage to the carotid sinus, whether from a surgical procedure or compression by a mass, can lead to hypotension and bradycardia. We report a case of carotid artery dissection resulting in symptomatic hypotension and bradycardia which has been uncommonly reported.

Presentation
A 65‐year‐old female presented with speech changes and altered mental status. On examination, the heart rate was in the 30s, fluctuating between the 40s and 50s. A CT scan revealed a subacute hypodensity in the territory of the left middle cerebral artery. CT angiography showed luminal irregularity in the distal common carotid artery and carotid bifurcation, occlusion of the internal carotid artery with reconstitution at the supraclinoid segment, suggesting a possible dissection. MRI identified an acute ischemic infarct in the anterior left insular cortex and adjacent left frontal lobe. MRA of the neck confirmed the occlusion of the left internal carotid artery, with no evidence of calcified or low‐density fatty plaque at the bifurcation. During her stay, the patient also developed hypotension with systolic blood pressure in the 80s and 90s requiring fluids. EKG showed sinus bradycardia. Patients did not have a history of bradycardia or hypotension. She was not on any medication at home or in hospital which could contribute to bradycardia. Cardiology was consulted who attribute this to carotid artery dissection.

Discussion
The carotid sinus is a neurovascular structure located at the bifurcation of the common carotid artery and extending into the proximal internal carotid artery. Hypotension and bradycardia are commonly observed in patients who undergo carotid artery stenting due to stretching of these baroreceptors. Patients with carotid body tumor or neck mass with compression of the carotid bifurcation and internal carotid artery. Similarly, there are case reports in literature with dissection of internal carotid artery presenting with syncope, bradycardia and hypotension. While dissection of the internal carotid artery has been documented to cause these symptoms, dissection involving the carotid bifurcation and associated occlusion is less commonly reported. Prior to associating dissection as etiology, complete workup to rule carotid body dysfunction, sinus node dysfunction, or carotid sinus hypersensitivity should be carried out.

Conclusion
Dissection of the carotid bifurcation and internal carotid artery has been associated with hypotension, bradycardia, and syncope. However, not all cases of carotid dissection result in these symptoms. Therefore, further investigation is needed to assess the dissection's characteristics, location, and the impact of any associated stenosis or atherosclerosis on symptom development.
Abstract 262: Endovascular coiling of very small unruptured aneurysms: Subgroup analysis from the ECOSA registry
Authors: Ashouri Y. K. , Almajali M. , Levy E. , Nogueira R. , Xavier A. , Linfante I. , Narayanan S. , Chaudhari A. , Gupta R. , Anwar M. , Hsu D. , Mueller‐Kronast N. , Lin E. , Edgell R. , Nguyen T. , Zaidat O. 
Published: January 2025

Introduction and aim
Endovascular treatment of ruptured and unruptured Intracranial aneurysm (IA) treatment has evolved over the recent years since the publication of the ISAT and BRAT trials. However, very small (≤3 mm) unruptured aneurysm treatment remains unclear. The aim of this study was to describe outcomes in patients with (≤3 mm aneurysms who were treated with endovascular coiling.

Methods
The Endovascular Coil Embolization of Small Unruptured Cerebral Aneurysm (ECOSA) registry was utilized and patients with aneurysms ≤3 mm were identified. Baseline characteristics, treatment modalities, periprocedural outcomes and long‐term clinical and angiographic outcomes were reported.

Results
Out of 903 aneurysms within the ECOSA study, 116(12.4%) were very small aneurysms. Mean (standard deviation [SD]) age of patients was 52.3(12.1). Most patients were females (76.3%) and white (61.7%). More than half of patients were hypertensive (61.2%) while 6.9% were diabetic. Active smoking was prevalent in 31.9% of the cohort. Most common aneurysms were incidental in (78.4%). Mean(SD) max diameter of aneurysms was 2.66 (0.87) mm. Most common location of aneurysm was the ICA (36.2%) followed by ACA/acomm (21.7%). Stent‐assisted coiling was utilized in 23.3% of patients and balloon‐assisted coiling in 15.2%. In terms of outcomes, thromboembolic events occurred in 1.7% of patients, and all were asymptomatic. No periprocedural mortality occurrence was reported. Clinical follow‐up was available for 84.5% of patients with mean 7.15 months and angiographic in 52.7% of patients with median of 7.75 months. Good functional outcome (mRS0‐2)was achieved in 93.9% of patients. Most patients (73.8%) had complete occlusion(RROCI) and adequate occlusion(RROC I‐II) was achieved in 86.3%. Modality of follow‐up imaging was DSA in 28.4%, MRA in 26.7% and CTA in 5.2%.

Conclusion
Endovascular coiling can be performed safely and effectively in patients with unruptured ≤3 mm aneurysms.
Abstract 266: Endovascular Thrombectomy in Patients on Long‐Term Anticoagulation
Authors: Naghani I. Moeini , Vazquez S. , Jain A. , Wang R. , Vieira K. , Sacknovitz A. , Dominguez J. , Al‐Mufti F. 
Published: January 2025

Introduction
Endovascular thrombectomy (EVT) has become a popular treatment of acute ischemic stroke (AIS) due to its favorable clinical endpoints in comparison to intravenous thrombolysis (IvT). Many patients who present with conditions necessitating thrombectomy are on long‐term oral anticoagulation therapy (AC) due to comorbidities and/or prophylactic prevention. ACs are a risk factor for intracerebral hemorrhage (ICH) in AIS patients treated with IvT, but evidence on the risk for patients treated with EVT is scarce. ACs may also alter clot composition to allow for easier recanalization and improved clinical outcomes following EVT, but clinical evidence is uncertain. We sought to compare the risk of ICH and clinical outcomes of patients on anticoagulant therapy treated with EVT vs. non‐anticoagulated (non‐AC) patients treated with EVT for AIS.

Methods
The National Inpatient Sample, an approximation of a 20% stratified sample of discharges from US community hospitals, was queried for all patients seen from 2016 to 2020 that underwent EVT for AIS. That sample was divided into patients on preexisting anticoagulation therapy and those that were not. Patients on long‐term AC therapy were identified using appropriate ICD10 codes and compared to those who were not on long‐term AC therapy.

Results
Of the 2,946,195 patients presenting with AIS, 287,405 (9.8%) were on long‐term AC therapy. Patients on long‐term AC therapy were less likely to have aphasia, hemiplegia, brain herniation, coma, and mechanical ventilation (all p's <0.001) when compared to those who were not on long‐term AC therapy. Despite AIS patients on long‐term AC therapy having less rates of serious features on presentation than nonAC patients, AIS patients on AC that underwent EVT were more likely to experience ICH (14.1% vs 12%; OR 1.206, 95% CI 1.058‐1.375, p=0.006) and less likely to be discharged home (35% vs 39.4%; OR 0.831, 95% CI 0.758‐0.91, p<0.001) as compared to their propensity score matched non‐AC counterparts undergoing EVT. Patients undergoing EVT experienced similar inpatient mortality (8.8% vs 9.6%; OR 0.913, 95% CI 0.784‐1.064, p = 0.260) and length of stay (LOS) (54.7% vs 55.7%; OR 0.958, 95% CI 0.877‐1.047, p=0.355) irrespective of AC therapy.

Conclusion
Long‐term AC may provide a protective effect in the setting of AIS. Although EVT is associated with increased risk of ICH in patients on long‐term AC, in‐hospital mortality and length of stay are similar to those not on long‐term AC. These findings support EVT as an option for treatment in AC patients, but research identifying optimal patient selection for EVT in the setting of long‐term AC is necessary.
Abstract 273: Evaluating Clinical Outcomes and Cost‐Effectiveness of Robotic Carotid Artery Stenting: A Multi‐Center, Propensity Score Matched Study
Authors: Patel S. , Roy J. , Musmar B. , Sarikonda A. , Scott K. , Abbas R. , Fuleihan A. , Sivaganesan A. , Tjoumakaris S. , Gooch M. R. , Rossenwasser R. , Srinivasan V. , Burkhardt J. , Jabbour P. M. 
Published: January 2025

Objective
Preclinical studies suggest that robotic carotid artery stenting (CAS) could be superior to manual CAS. However, very limited comparative data exists comparing robotic and manual CAS patients. In addition, no data exists comparing the costs of manual and robotic CAS.

Methods
All robotic CAS cases at 2 academic neurosurgery centers were retrospectively reviewed and 1:1 propensity matched with manual CAS cases. Personnel costs, supply costs, and total procedure costs were collected in collaboration with hospital administration using time‐driven activity‐based cost‐analysis (TDABC).

Results
24 robotic CAS cases were performed between 2019 and 2023. Co‐morbidities and baseline procedural characteristics were well‐matched between robotic and manual cases. Unplanned manual conversion was observed in only one robotic case (4.2%). Robotic CAS complications and outcomes were comparable to manual. Robotic CAS was associated with a significantly increased fluoroscopy time (29.0 vs. 19.2 min.; p<0.001). Robotic procedure time (88.9±18.2 min.) was significantly (p=0.003) higher than manual (68.72±22.4 min.). Health professional costs ($1,589.71±176.92, $1,375.99±233.39, p<0.005), supply cost ($3,918.25±421.20, $2,152.74±1,030.26, p<0.001) and total procedure costs ($5,306.11±608.95, $3,437.56±1,165.67, p<0.001) were greater for robotic CAS.

Conclusions
With a low rate of technical failure and post‐operative complications, we show robotic carotid artery stenting is safe and feasible in the first multi‐center and largest sample to date. In addition, robotic CAS achieves comparable clinical outcomes. Robotic CAS was associated with increased fluoroscopy time, but fluoroscopy time decreased as operators gained familiarity with the CorPath GRX. Robotic CAS was associated with a greater procedural cost, which was driven by greater personnel and supply costs. Our findings highlight the need for further studies to optimize robotic CAS and reduce its associated costs.
Abstract 299: Implications of Age on Post Stroke Depression in Intracerebral Hemorrhage Patients
Authors: Couture L. , Baskin L. , Petway A. , Eagen P. , Cahuiche A. E. , Colpo G. Delevati , McCullough L. D. 
Published: January 2025

Introduction
Risk Factors for stroke consistently have been researched regarding ischemic strokes, but unfortunately are overlooked in respect to hemorrhagic strokes. Intracerebral Hemorrhages (ICH) are a critical disease consistently associated with high mortality rates and poor functional outcomes among survivors. Research on non‐traumatic, spontaneous ICHs have progressed in acute treatment strategies, such as surgical interventions and evacuations, however insight into possible associations with risk factors have elucidated researchers. In this study we aim to investigate social factors including sex, age, and race to understand if non‐modifiable factors may affect functional outcomes after ICH.

Methods
A standard battery of questionnaires were given to patients with ICH during their hospitalization (N=51). Depression was measured via PHQ‐9, with scores above 5 denoting moderate to severe depressive symptoms. Social Isolation is measured utilizing UCLA Loneliness and Lubben Social Network Scale; these questionnaires measure patients’ self‐reported loneliness levels and social network respectively. To assess functional outcome of the patients, a Modified Rankin Scale (mRS) score is assigned prior to ICH (pre‐mRS), immediately after (post‐mRS), and 3 months after discharge (3‐month mRS), based on their functional abilities. An increase in mRS score denotes more functional disability, with a score of 6 denoting death.

Results
We found that ICH patients under 55 years of age had significantly higher levels of depression during their hospitalization than patients 55 and older (p<0.05). There were no significant differences in patients’ pre‐mRS scores, which was utilized to determine if these results were a ramification of younger patients having more disabling comorbidities and therefore less functional ability prior to stroke. There was no significant correlation with pre‐mRS or post‐mRS and depressive symptoms during hospitalization. There were also no significant differences between UCLA Loneliness and Lubben Social Network scores when stratified by age. We found no significant differences with depressive symptoms among sex, race, and ethnicity, or with 3‐month mRS.

Conclusion
Social Isolation and pre‐hospitalization disability have minimal effects on functional outcomes, underscoring the need for providers to consider other modifiable risk factors in treating younger ICH patients. Understanding the physiological outcomes after stroke and the psychological changes post‐stroke must be studied more to try to lessen the burden among post‐stroke patients. Our finding of younger patients with higher levels of depressive symptoms compared to the older population must be considered by providers when treating younger ICH patients during their acute stage to prevent worse functional outcomes among this vulnerable population.
Abstract 304: Increased Stroke Severity and Mortality in Methamphetamine Users: A Propensity‐Matched Analysis
Authors: Wani R. , Salahuddin H. 
Published: January 2025

Introduction
Methamphetamine (meth) is a highly addictive central nervous system stimulant that has been associated with an increased risk of cerebrovascular disease, particularly among younger individuals. Frequent methamphetamine use, defined as meth use exceeding 100 days annually in the United States, has increased by 66% from 2015 to 2019 and represents a growing concern among young patients. This study aims to compare the severity of stroke presentation between methamphetamine users and non‐users by employing propensity score analysis to account for confounding variables.

Methods
We conducted a retrospective review of consecutive stroke patients who presented to a Comprehensive Stroke Hospital between January 2023 and August 2024 with a definitive diagnosis of ischemic or hemorrhagic stroke. Baseline demographics, clinical presentation, and inpatient mortality were recorded. Patients in the methamphetamine stroke group were matched with non‐methamphetamine stroke patients based on age, gender, hypertension, diabetes mellitus, atrial fibrillation, and hyperlipidemia using propensity score analysis. Statistical analysis was performed using the T‐Test or Mann‐Whitney U‐Test where appropriate.

Results
Our study included 53 patients with a mean age of 56 (83% ischemic, 17% hemorrhagic) diagnosed with methamphetamine‐related stroke, who were matched to 200 non‐methamphetamine stroke patients with a mean age of 64 (88% ischemic, 12% hemorrhagic) during the study period. The average NIHSS score for meth‐positive patients was higher than that of the meth‐negative group (9.7 vs. 6.5; p=0.05). Meth‐positive patients also had higher white blood cell (WBC) (10 vs 9.3 p=0.03) and neutrophil (7.5 vs. 7.2 p=0.02) counts on presentation. The inpatient mortality rate for meth‐positive patients was significantly higher as well (13.2 vs. 9.5; p=0.02).

Conclusion
Methamphetamine use among stroke patients is associated with increased stroke severity, WBC count upon presentation, and a higher in‐hospital mortality rate. Future research should investigate the underlying mechanisms that contribute to this increased severity and the implications for treatment outcomes.