bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 322: Localized Injection Of Lidocaine And Glucocorticoid For Headache Treatment (LIGHT): Interim Phase 1 Study Safety Analysis
Authors: Koneru M. , Shaikh H. A. , Khalife J. , Patel P. D. , Syrow L. , Thomas A. J. , Jovin T. G. , Tonetti D. A. 
Published: January 2025

Introduction/Purpose
Treatment‐refractory migraine is a challenging clinical condition. Failure to adequately control symptoms under standard therapy causes significant pain burden, migraine‐related disability, and impaired quality of life. New approaches to refractory migraine treatment may have potential to improve patient outcomes. The objective is to characterize the safety of a new endovascular approach to refractory migraine treatment.

Materials/Methods
A non‐randomized, open‐label phase 1 clinical trial for the injection of lidocaine (40mg) and methylprednisolone (20mg) into the middle meningeal arteries bilaterally is in progress. Patients receive the study treatment, and are evaluated at 1 week, 6 week, and 3 month follow‐up visits. Incidence of adverse events were ascertained and classified per severity and relatedness to the study treatment. An interim descriptive analysis was conducted on patients enrolled to date on the incidence of safety events.

Results
Of the 8 patients enrolled thus far, 62.5% (5/8) completed 3‐month follow‐up. Most patients were able to be discharged within less than 1 day of treatment. During the study duration, a total of 8 potential adverse events were ascertained; 3 (37.5%) events were unrelated to the study treatment or migraines, and 3 (3.75%) events were recurrence of migraine symptoms. Of the two adverse events possibly related to the study intervention; one patient had self‐resolving mild dizziness and blurry vision after the procedure, and one patient had temporary facial paralysis, presenting as a facial droop, lasting less than 1 hour after the procedure. The temporary facial droop was hypothesized to have occurred due to injection of lidocaine very proximally in this patient, which may have caused reflux and migration of lidocaine to branches supplying the trigeminal ganglion, resulting in a transient trigeminal nerve palsy. There were no strokes, access site issues, or mortalities in any enrolled patients.

Conclusion
Our interim safety analysis demonstrates favorable tolerability and safety of this investigational treatment. Endovascular injection of lidocaine and methylprednisolone demonstrates potential to be a safe approach to refractory migraine treatments. Additional data following completion of enrollment is necessary to ascertain the full safety profile of this treatment.
Abstract 330: Morphologic Analysis of Ruptured Aneurysms: A Retrospective Study
Authors: Gong A. , Dang D. , Awan O. , Mugge L. , Meister M. , Fortes M. , Greenberg E. , Chandela S. , Vyas N. , Chitale A. 
Published: January 2025

Background/Purpose:
Aneurysm size and morphology have been previously correlated with risk of spontaneous rupture. However, there is a lack of consensus regarding which morphological parameters are useful for this prediction. The purpose of this study is to assess the size and morphology of ruptured aneurysms in our retrospective cohort and compare these findings to previously cited parameters within the literature.

Materials and Methods:
Between 2021‐2023, 150 patients with subarachnoid hemorrhage secondary to ruptured aneurysms were admitted to our hospital. Two investigators reviewed 3‐dimensional angiograms of all aneurysms to evaluate for morphological parameters which have been previously shown to correlate with rupture in previous studies.

Results
The average diameter of aneurysm rupture was 6.4 ± 4.4mm. 71% of these aneurysms were less than 7mm. The most common location of rupture was the anterior communicating artery (32.6%) followed by the posterior communicating artery (21.7%). The most common morphology of ruptured aneurysms were single sac aneurysms with irregular margins (39.1%) and multilobulated aneurysms (39.1%). The average aspect ratio was 1.23 ± 0.47. Only 28.2% of our patients demonstrated an aspect ratio >1.5. The average size ratio was 3.2 ± 2.0. 63% of these patients demonstrated a size ratio >2. The average area ratio was 6.5 ± 6.5 with 93% of these patients having an area ratio >1.5. The average bottleneck ratio, neck to parent artery ratio and height to width ratio are 1.9 ± 0.93, 1.4 ± 0.7 and 1.23 ± 0.47 respectively.

Conclusions:
Aneurysm size may not be a good predictor of rupture as aneurysms less than 7mm commonly rupture. However, morphology may be a better predictor as aneurysms with irregular margins and multilobulated aneurysms were commonly seen in our cohort. Additionally, previously cited parameters such as size ratio > 2 and an area ratio > 1.5 may be better predictors of rupture compared to the commonly cited aspect ratio > 1.5.
Abstract 337: National Trends in Intervention Modality for Hospitalizations with Infectious Intracranial Aneurysms and Associated Outcomes
Authors: Dawod G. , Zhang C. , Kamel H. , Murthy S. , Parikh N. S. , Merkler A. E. 
Published: January 2025

Introduction
Data regarding how to treat infectious intracranial aneurysms most effectively remains sparse. With growing utilization of endovascular therapy for cerebrovascular disease, we examined trends in endovascular versus neurosurgical treatment of infectious aneurysms and investigated the impact of treatment modality on patient outcomes.

Methods
Using data from the National Inpatient Sample from 2000 to 2019, we conducted a trends analysis on rates of treatment modalities among all hospitalizations with infective endocarditis with ruptured or unruptured cerebral aneurysms. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD‐9 and ICD‐10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in‐hospital mortality and discharge disposition.

Results
We identified 24,461 hospitalizations with an infectious intracranial aneurysm in the setting of infective endocarditis. The mean age was 56.0 years (SD, 17.8) and 61.8% were male. The overall rate of intervention was 5.8% (95% CI, 5.0‐6.5%), and this did not change over time (p=0.669). There was a significant increase in the rate of endovascular repair (APC=3.6%; 95% CI, 1.2%‐8.1%) and a significant decrease in the rate of open neurosurgical repair (APC= ‐5.4%; 95% CI, ‐8.1% to ‐3.5%). Treatment modality was not associated with in‐hospital mortality (p=0.698) or non‐home discharge disposition (p=0.897).

Conclusion
Although rates of infectious intracranial aneurysm intervention for infective endocarditis did not change, utilization of endovascular treatment increased while the use of open neurosurgical treatment decreased. Further directions include elucidating predictors of favorable outcomes for those undergoing intervention as well as the most beneficial timing for the procedure during hospitalization.
Abstract 352: Oral Cilostazol and High‐Dose Intravenous Albumin in Aneurysmal Subarachnoid Hemorrhage Patients with Refractory Cerebral Ischemia
Authors: Bhatti I. , Bains N. K. , Ngo M. , Gomez F. , Arora N. , Nattanmai P. , Siddiq F. , Gomez C. R. , Suarez J. I. , Qureshi A. I. 
Published: January 2025

Background and Purpose
Cerebral ischemia associated with vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) requires a multifaceted approach. We report the use of the combination of enteral cilostazol and intravenous (IV) high‐dose albumin in aSAH patients with cerebral ischemia refractory to other accepted pharmacologic and endovascular treatments.

Materials and Methods
Three aSAH patients who developed cerebral ischemic symptoms despite treatment with oral nimodipine and endovascular measures (i.e., intraarterial vasodilators and balloon angioplasty) were treated with enteral cilostazol (200 mg/day) and one or more doses of IV (25%) albumin (1.25 g per kg over 8 hours). The patients were monitored by serial neurological examinations, transcranial Doppler imaging (TCDI) ultrasound, and computed tomographic angiography (CTA) and perfusion (CTP) scans.

Results
Three patients (ages 58, 67 and 56 years) developed symptomatic cerebral ischemia and vasospasm following an aSAH. Due to limited angiographic response to endovascular treatment, including intraarterial vasodilators with or without balloon angioplasty, IV (25%) albumin and enteral cilostazol were administered. CT angiogram and perfusion 2‐3 days post‐treatment demonstrated resolution of the perfusion deficits and angiographic vasospasm. Concurrently, TCDI demonstrated improved vasospasm and resolution of neurological deficits. None of the patients required any additional treatments for cerebral ischemia.

Conclusions
A combination of oral cilostazol and IV high dose (25%) albumin was associated with amelioration of angiographic vasospasm, reduction of tissue perfusion deficits, and clinical improvement of aSAH patients with severe refractory cerebral ischemia.
Abstract 371: Posterior Spinal Artery Territory Infarct Following Endovascular Basilar Artery Stenting For Basilar Artery Aneurysm: A Case Report
Authors: Ali A. , Ramachandran R. , Machinetc O. , Vulkanov V. 
Published: January 2025

Introduction/Purpose
Posterior spinal artery infarcts are exceedingly rare due to high level of collateral circulation inthe spinal cord. Additionally thromboembolic phenomenon is a potential complication duringendovascular aneurysm repair via digital subtraction angiography (DSA). Hereby, we report acase of posterior spinal artery infarct following cerebral angiography and endovascular basilarartery pipeline embolization for basilar artery aneurysm. Our goal is to outline successfuldiagnosis and management of this rare event.

Materials and Methods
A single case report and literature review via PubMed

Results
Our patient is a 59‐year‐old female with a basilar artery aneurysm. Following treatment of anewly diagnosed unruptured 2.48mm x 2.22 mm proximal basilar artery aneurysm, adjacent toorigin of the right anterior inferior cerebellar artery (AICA) with a Pipeline Embolization Device(PED), she presented as bilateral dorsal cord syndrome. On exam, she had isolated findings ofloss of vibration and joint position sense in her feet and ankles and sensory ataxia, MRI of thecervical spine without contrast showed a small focus of increased T2/STIR signal intensity in thedorsal midline at the level of C2‐3, involving bilateral nuclei gracilis. There was no evidence ofdisc herniation or central canal stenosis. MRI brain without contrast was obtained to rule outbasilar artery perforator stroke given procedure's proximity to basilar perforators, which did notshow a stroke.According to literature, 28 cases with PSAS were identified in 22 articles, 12 cases due toatherosclerosis, 7 cases due to artery dissection and 3 cases of iatrogenic etiology. To ourknowledge, Vertebral artery dissection (VAD) and atherosclerosis were by far the most commonetiology identified in reported cases of Posterior Spinal Artery Syndrome (PSAS). We proposethat in our patient, the constellation of acute onset of symptoms, exam and MRI findings areconsistent with arterial thromboembolism following the PED procedure.

Conclusion
Although infrequently reported in literature, spinal cord infarct should be recognized as apotential complication of endovascular interventions for lesions of posterior circulation
Abstract 382: Racial and ethnic differences in risk factors, etiologies and outcomes in young patients with intracerebral hemorrhage
Authors: Vyas V. , Kherani D. , Dongarwar D. , Kondapalli S. , Shah E. , Seol H. , House K. , Norris D. , Sharrief A. 
Published: January 2025

To evaluate racial and ethnic differences in risk factors, etiologies and outcomes in young patients with intracerebral hemorrhage (ICH).
Racial and ethnic disparities in risk factors, etiologies and outcomes for young patients with ischemic stroke (AIS) are well described. Less is known about racial and ethnic disparities for young patients presenting with ICH. As ICH is associated with higher short‐term and long‐term mortality than AIS and has a rising incidence, it is important to review disparities in its evaluation and management.
We identified patient aged 18‐50 from our stroke registry with non‐traumatic ICH from 10/2016 to 11/2019. Baseline characteristics were abstracted, and ICH risk factors, etiologies and outcomes were compared between racial and ethnic groups. Independent samples t‐test and chi‐squared test were utilized for continuous and categorical outcomes, respectively. All tests were two‐tailed and the error rate was set at 5%.
Among 619 patients in the study, 29% were non‐Hispanic White (NHW), 32% non‐Hispanic Black (NHB), 31% Hispanic (HIS), 5% Asian, and 4% other. HIS were least likely to be insured (51.9%) compared to NHB (66.7%) and NHW (71.2%). NHB were most likely to be single (54.4%) and living alone (20.5%). HIS were more likely not to not have a primary care provider (60.8%; p<0.01). NHB had a greater arrival systolic blood pressure (180.2 vs. 163.2, p<0.01) and diastolic blood pressure (103.9 vs 94.8, p<0.01), compared to NHW. Prior history of hypertension (69.7%) and diastolic dysfunction on ECHO (24.6%) was more prevalent in NHB, compared to NHW and HIS. NHB had the greatest incidence of moderate (17.4%) to severe (15.4%) left ventricle (LV) hypertrophy, and three times greater odds than NHW to have at least moderate LV hypertrophy. Hypertensive etiology for ICH was most prevalent in NHB (65.1%, p<0.01) compared to NHW (46.9%) and HIS (52.9%).
Although we did not find significant differences in measured outcomes, our study demonstrates underlying sociodemographic and clinical risk factors which may underlie racial and ethnic disparities for young patients with ICH.
Abstract 388: Real World Experience Using the Balt Carrier Delivery Catheter for Intracranial Access During Mechanical Thrombectomy
Authors: Snyder T. , Jankowitz B. , Scarpiello S. , Haimi J. , Zacharatos H. , Sussman E. 
Published: January 2025

Introduction
Delivery catheters that reduce the ledge effect of aspiration catheters while maintaining a tapered atraumatic tip have recently become a focus for intracranial access during treatment of acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Most companies package their proprietary insert catheter with their own aspiration catheter. The Balt Carrier (The Balt Group, Montmorency, France) is the only separately packaged delivery catheter which comes in three sizes and is designed to safely and efficiently deliver the operator's aspiration catheter of choice to the face of the thrombus with or without the use of a wire. In this study, we share our experience using the Balt Carrier delivery catheter for patients undergoing MT for AIS.

Methods
We conducted a retrospective case series study of prospectively collected AIS patients undergoing MT at two comprehensive stroke centers. Patients were included in the study if Carrier was utilized to advance an aspiration catheter to the face of an intracranial thrombus. First pass was defined as the time at which the aspiration catheter engaged the clot. We defined successful recanalization as a reperfusion score of TICI 2b or greater. Carrier complications were defined as any vessel injury detected on angiogram during intervention or symptomatic hemorrhage detected on head CT with a change in NIHSS greater than 3 points.

Results
In nineteen patients, 4 ICA, 12 M1, 2 M2, and 1 basilar artery occlusion were targeted for MT. Four different 6F aspiration catheters were utilized ranging in ID from 0.070” to 0.071.” All three sizes of Carrier were utilized: 4 small, 13 medium, 2 large. The aspiration catheter successfully reached the target lesion in all cases (19/19) on first attempt. A wire was used in nine cases. Of those nine cases, 6 were physician preference and 3 required a wire because the Carrier tip atraumatically entered two fetal Pcomms and one posterior meningeal artery. The median puncture time to first pass and puncture time to successful reperfusion was 16 minutes and 25 minutes respectively. There were no complications.

Conclusion
The Balt Carrier delivery catheter was successful in delivering various aspiration catheters for intracranial access to the target occlusion with no complications. Reducing the ledge effect of various aspiration catheters during MT while maintaining an atraumatic tip may help safely expedite intracranial access with even larger catheters. More studies are needed to confirm the results of this small two center retrospective study.
Abstract 395: Retinal artery/arteriole occlusion risks after endovascular treatment for unruptured intracranial aneurysm
Authors: kim M. 
Published: January 2025

Purpose
To evaluate the association between retinal artery/arteriole occlusion (RAO) and unruptured intracranial aneurysm (UIA).

Methods
Incident UIA patients from a nationwide cohort (n=253 240) were categorised into three groups based on subsequent treatment: observation (n=208 993), microsurgical clipping (n=14 168) and endovascular treatment (EVT) groups (n=30 079). The incidence and the incident time of RAO were analysed. HRs of RAO and associated risk factors were evaluated. Additionally, a hospital cohort comprising 2569 consecutive UIA patients treated at a tertiary hospital was analysed with detailed clinical information of UIAs.

Result
In the nationwide cohort analysis, the incidence of RAO was significantly higher in EVT group than in observation and clipping groups, especially within 60 days (early RAO (within 60 days): HR=4.00, 95%CI: 2.44 to 6.56); delayed RAO (after 60 days): HR=1.74, 95%CI: 1.13 to 2.68). Multivariable analysis showed that the presence of chronic kidney disease (p=0.009) and use of a balloon microcatheter during the procedure (p=0.013) were associated with a higher risk of RAO. In hospital cohort analysis, 11 (0.8%) cases of RAO occurred after EVT, whereas none occurred after microsurgical clipping (p<0.001). Patients with RAO were younger and received balloon microcatheters more frequently than their counterparts. Ten cases of RAO (90.9%) occurred in paraclinoid aneurysms, where EVT was preferred over microsurgical clipping.

Conclusion
Performing EVT for UIA may increase the risk of subsequent RAO. Care should be taken when treating paraclinoid aneurysms with balloon microcatheters.
Abstract 414: Stroke Severity in patients presenting beyond 24 hours of last known well ‐ a secondary analysis of SELECT LATE cohort study
Authors: Elrefaei A. , Pujara D. , Kleinig T. J. , Hassan A. E. , Portela P. C. , Ortega-Gutierrez S. , Abraham M. G. , Manning N. W. , Siegler J. E. , Goyal N. , Blackburn S. , Sitton C. W. , Wu T. Y. , Blasco J. , Sangha N. S. , Arenillas J. F. , Opaskar A. , McCullough-Hicks M. E. , Wallace A. , Cordato D. , Arthur A. S. , Grotta J. , Parsons M. W. , Ribo M. , Albers G. W. , Campbell B. C. , Sarraj A. 
Published: January 2025

Introduction
Endovascular thrombectomy (EVT) is shown to be associated with better clinical outcomes even after 24 hours of stroke onset. However, how stroke severity affect this association has not been well‐established.

Methods
From SELECT LATE, a retrospective cohort study from 17 high volume EVT centers across US, Spain, Australia and New Zealand, patients were stratified based on median stroke severity (NIHSS ≤15 vs >15). The association of treatment arm and functional and safety outcomes was examined using appropriate regression models adjusted for confounders, with sensitivity analyses repeated using Inverse Probability of Treatment Weights (IPTW).

Results
Of 301 eligible patients, median age was 69 (59‐81) y and 50% participants were females. 159 (107 EVT, 52 MM) had NIHSS ≤15, whereas 142 (78 EVT, 64 MM) patients had NIHSS >15 at the time of presentation. As stroke severity increased, outcomes worsened in both overall (acOR: 0.93, 95% CI: 0.89‐0.97, p<0.001 for each point) and among patients receiving EVT (acOR: 0.94, 95% CI: 0.90‐0.99, p=0.021 for each point) – figure 1. EVT was associated with higher odds of functional independence in patients with NIHSS ≤15 (EVT: 53% vs MM: 18%, aOR: 3.56, 95% CI: 1.35‐9.43, p=0.011) – fig 2. Estimates of association also favored EVT in those with NIHSS >15 (EVT: 18% vs MM: 5%, aOR: 2.29, 95% CI: 0.43‐12.16, p=0.33), without significant heterogeneity (p‐interaction: 0.61). Similar results were also observed for ordinal shift in mRS and excellent outcome (mRS 0‐1) – table 1, and in sensitivity analyses using IPTW. Symptomatic ICH was also higher with EVT across both strata (NIHSS ≤15: EVT: 11% vs MM: 2%, aOR: 8.09, 95% CI: 0.63‐103.85, p=0.11 and NIHSS>15 – EVT: 10% vs MM: 2%, p=0.07).

Conclusions
Among patients presenting beyond 24 hours of last known well, outcomes worsened with increased stroke severity. However, estimates of association favored EVT in both lower and higher stroke severity strata, without significant heterogeneity. Further exploration of stroke severity and its effect of EVT outcomes and treatment effect is warranted.

Figure 1. Predicted probability of functional independence by NIHSS across EVT vs MM. As stroke severity increased, outcomes worsened in both EVT and MM arms.

Figure 2. Distribution of mRS scores at 90‐day follow‐up across NIHSS and treatment strata. EVT was associated with better functional outcomes across both NIHSS strata.

Table 1. EVT association with functional and safety outcomes across NIHSS strata.
Abstract 418: Targeted tirofiban use for endovascular treatment of ischemic stroke
Authors: Kang J. 
Published: January 2025

Purpose
For complex thrombus events of intracranial atherosclerotic occlusion, tirofiban, a glycoprotein IIb/IIIa antagonist, could increase the success of endovascular treatment (EVT). This study investigated the applicability of this targeted tirofiban use.

Methods
Stroke patients undergoing EVT were enrolled with the approval of the prospective use of tirofiban in ongoing thrombosis, re‐occlusion, and in‐stent thrombus formation. The presumptive mechanism of cerebral occlusions was divided into atherosclerotic and other etiologies. Then, the efficacy and safety outcomes of target tirofiban use were evaluated according to the location and mechanism of occlusion.

Results
Among those with symptomatic intracranial occlusion, 41.8% had atherosclerotic occlusion (ICAO), while 56.2% had atherosclerotic occlusions in the case of extracranial vessels. Tirofiban use rates were 24.5% of ICAO and 20.6% of extracranial atherosclerotic occlusions, while 6.8% of non‐atherosclerotic occlusions. In ICAO, tirofiban use presented a similar successful recanalization rate compared to those who did not use tirofiban (88.9% versus 86.1%), also in symptomatic intracerebral hemorrhage (2.4% versus 1.9%, P=0.81) and stroke recurrence (22.2% versus 13.3%, P=0.11). Multivariate analyses showed that ICAO, with the reference of non‐atherosclerotic occlusion, had no different effect on the successful recanalization (adjusted odds ratio, 0.70; 95% confidence interval, 0.40 ‐ 1.23), stroke recurrence (0.97; 0.55 ‐ 1.65), and SHT (0.51; 0.15 ‐ 1.36) when tirofiban use was taken into consideration.

Conclusion
Targeted tirofiban use may enhance the chance of recanalization in atherosclerotic occlusion without increasing the risk of safety concerns.