bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 86: Intracranial Angioplasty via Type II Proatlantal Intersegmental Artery
Authors: Babici Denis , Johansen Phillip Phillip , Sial Nadia , Snelling Brian 
Published: April 2023

Introduction
A proatlantal intersegmental artery (PIA) is an exceedingly rare primitive anastomosis between the carotid and vertebrobasilar circulations. PIA’s may be accompanied by ipsilateral or bilateral vertebral artery (VA) agenesis and can originate from the cervical internal carotid artery (ICA, type I) or external carotid artery (ECA, type II) before eventually joining the vertebrobasilar system. Several authors have described this anomaly in different clinical scenarios, but to our knowledge, there are no studies documenting intracranial vertebral artery angioplasty through a type II PIA in the setting of a vertebrobasilar stroke.

Methods
Single case study

Results
A 62‐year‐old male presented to the ED with slurred speech that began one hour prior to arrival. Computer tomography (CT) of the head revealed a small right posterior acute parietal subdural hematoma, and CT perfusion scan revealed ischemia of the cerebellar hemispheres bilaterally with small areas of core infarction and a moderate‐to‐large surrounding penumbra. Magnetic resonance imaging (MRI) of the brain was positive for bilateral acute ischemic strokes of the cerebellar and pontine arteries. CT angiogram of the head and neck revealed high grade stenosis of the right intracranial VA and narrowing of the left V1, V2, and V3 segments. The proximal left V4 segment was occluded with distal reconstitution. Catheter angiogram of the ICAs and ECAs showed that the patient’s right VA did not originate from the right subclavian artery but instead from the right ECA. The patient was subsequently determined to have a type II PIA with critical stenosis. We proceeded with right VA submaximal angioplasty via the type II PIA. The procedure went without complications and resulted in restoration of vertebrobasilar blood flow, with only moderate stenosis following the submaximal angioplasty. On day 5 postoperatively, the patient reported resolution of his symptoms and was subsequently discharged.

Conclusions
We presented a case of vertebrobasilar stroke in which the right VA did not originate from the right subclavian artery but instead from the ECA, with a subsequent diagnosis of a type II PIA. The only option for management was to perform the right VA angioplasty via the PIA, which we believe to be the first documented case of intracranial vertebral angioplasty through a type II PIA. This case serves as a reminder of the very rare cases of persistent fetal circulation and the importance of performing a catheter angiogram of both the ICA and ECA. Evaluation of the ECA and subsequent observation of a PIA can completely change both the management and outcomes of the patient. This case underscores the complexity of the intracranial atherosclerotic disease, the beneficial role of endovascular intervention, and the necessity of future studies to identify the optimal treatment methods for vertebrobasilar stroke.
Abstract Number ‐ 98: Intravenous dose‐adjusted cangrelor use for neuroendovascular procedures: An institutional experience
Authors: Morsi Rami Z. , Desai Harsh , Kothari Sachin , Thind Sonam , Carrión‐Penagos Julián , Coleman Elisheva , Brorson James R , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass‐Hout Tareq 
Published: April 2023

Introduction
The optimal antiplatelet therapy regimen for certain neuroendovascular procedures remains unclear. This study investigates the safety and feasibility of intravenous dose‐adjusted cangrelor in patients undergoing neuroendovascular procedures.

Methods
We conducted a retrospective chart review of all consecutive patients who underwent neuroendovascular procedures and were placed on intravenous cangrelor between September 1, 2020 and March 13, 2022. Cangrelor was administered as a 15 mcg/kg bolus followed by 2 mcg/kg/min infusion titrated to goal P2Y12reaction unit (PRU) level of 50 to 150, and then transitioned to oral antiplatelet therapy. Demographic characteristics, interventional variables, and clinical outcomes were collected.

Results
A total of 50 patients were included. The mean age (years) was 56.0±18.6, and 26 (52.0%) were males. Most patients were African American (n = 39/48, 81.3%). The most common comorbidities were hypertension (n = 25/49, 51.0%), active smoking status (n = 14/40, 35.0%), and prior ischemic stroke (n = 13/49, 26.5%). Intravenous thrombolysis was used in 4 patients (8.0%). Cangrelor infusion was used for the following procedures: embolization (n = 10/50, 20.0%), embolization and stent placement (n = 9/50, 18.0%), thrombectomy alone (n = 5/50, 10.0%), thrombectomy and stent placement (n = 10/50, 20.0%), and stent placement only (n = 14/50, 28.0%). Stent placement occurred intracranially beyond petrous segment of the internal carotid artery in 18 patients, remainder of internal or common carotid artery in 12 patients, and both intracranial and carotid arteries in 3 patients. PRU levels were measured in 48 patients (96.0%), with 26 patients (54.2%) achieving a PRU level of 50–150 greater than or equal to 50% of the time. Approximately 51.5% of the patients had a favorable functional outcome with modified Rankin Scale (mRS) score of 0 to 2 at 90 days (n = 17/33).During 1‐year follow up, approximately 4 patients had recurrent or new strokes (9.5%), 1 patient had in‐stent thrombosis (2.9%) and 1 patient with symptomatic intracranial hemorrhage [sICH] (2.4%), both while not on antiplatelet therapy, 2 patients with asymptomatic intracranial hemorrhage [ICH] (4.8%), and no gastrointestinal bleeding events were recorded. When stratified by PRU level, there were no significant differences in sICH (p = 0.841) or asymptomatic ICH (p = 0.853).

Conclusions
To our knowledge, this is the first report to demonstrate the safety and effectiveness of intravenous cangrelor use titrated based on platelet function testing in the largest cohort of patients who underwent neuroendovascular procedures to date. Further studies, including comparative studies to standard dose maintenance cangrelor, are necessary.
Abstract Number ‐ 108: Effect of Percutaneous Inferior Sympathetic Ganglion Block on Intracranial Artery Diameters on Cerebral Angiography
Authors: Bains Navpreet K , Kumar Nitish , Siddiq Farhan , Gomez Camilo R , Qureshi Adnan I 
Published: April 2023

Introduction
There is some data suggesting vasodilatory effect of sympathetic blockade in patients with aneurysmal subarachnoid hemorrhage but the effect on medium‐sized intracranial arteries remains unclear.

Methods
Serial ipsilateral intracranial angiograms were obtained before and after percutaneous inferior sympathetic ganglion block. The angiogram files were imported to a DICOM reader, Horos Open‐Source Medical Image Viewer (Version 3.3.6).The percent change of arterial diameter (compared with pre‐blockage image) was calculated in intracranial internal carotid (ICA), middle (MCA) and anterior cerebral (ACA) arteries. We also assessed the inter‐observer reliability of arterial diameter change using the Bland‐Altman method after two raters independently measured the arterial diameter in 2 images with a total of 12 arterial measurements.

Results
In Patient 1, there was an increase in diameter of intracranial ICA, MCA and ACA at 1 minute (9.62%, 10.34%, 8.64%), 5 minutes (11.38%, 12.22%, 14.42%) and 10 minutes (8.66%, 11.30%, 5.50%), respectively.In Patient 2, there was an increase in diameter at 1 minute (0.72%, 2.08%, ‐1.75%), 5 minutes (12.04%, 0.64%, 4.50%), 10 minutes (6.86%, 7.23%, 10.38%), 20 minutes (9.45%, ‐2.16%, 13.32%), and 30 minutes (7.31%, 12.02%, 6.50%), respectively. The Bland‐Altman coefficient of variation was 1.32 (range 0.01 ‐5.57) with majority (5 out of 6, 83%) of the data points within the upper and lower limits of acceptance.

Conclusions
We observed vasodilation in medium‐sized intracranial arteries ipsilateral to the percutaneous inferior sympathetic ganglion block as early as one minute post treatment and persisting for at least until 30 minutes post blockade.
Abstract Number ‐ 114: Deep Cerebral Venous Thrombosis requiring Venous Thrombectomy and Intra‐arterial Thrombolysis in Young Pregnant Female
Authors: Shah Aakashi , Ajiboye Norman 
Published: April 2023

Introduction
Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and mortality especially in young women and children (1). Even though, first‐line treatment remains anticoagulation, some patients deteriorate and endovascular treatment is needed. Currently there are no randomized controlled trials comparing the efficacy and safety of intracranial thrombolysis and mechanical thrombectomy to standard‐of‐care anticoagulation therapy (2). We present a case of a pregnant lady with CVST with successful clinical outcomes with venous thrombectomy and intraarterial thrombolysis.

Methods
Case Report

Results
30 year old lady with no past medical history, 7 weeks and 4 days pregnant presented with acute progressive encephalopathy associated with nausea, vomiting and headaches. On admission, she was stuporous, had dysarthria, severe hemiparesis, and hemineglect on the right side. She had COVID‐19 infection and her fetus had subchorionic hematoma by ultrasound. Initial CT brain showed extensive cerebral venous sinus thrombosis (CVST). She was intubated and MRI showed venous infarcts. MR venography revealed acute extensive CVST of superior sagittal sinus, vein of galen, right transverse sinus, right sigmoid sinus, and right jugular vein. IV Heparin drip was initiated. Her follow‐up neurological exam deteriorated despite maximal medical therapy. The decision was made for endovascular recanalization. The cerebral angiogram confirmed the occlusion of deep venous system. Thrombectomy of bilateral internal jugular vein and sigmoid sinus was performed with retrieval of thrombi. Post‐thrombectomy runs demonstrated persistent extensive CVST and decision was made for intra‐arterial thrombolysis. A diagnostic catheter was secured in the right internal carotid artery catheter (ICA). Thombolysis was performed with 4 mg/hr recombinant tissue‐plasminogen activator (rt‐PA). Heparin drip IV was continued. Subsequently, the repeat CT brain showed significant improvement in the CVST and interval development of intraparenchymal hemorrhages and subarachnoid hemorrhages. Heparin and rt‐PA were held. The patient was found to have Factor V Leiden mutation and she was started on Enoxaparin 1mg/kg throughout her pregnancy and 6 weeks postpartum. Clinically she demonstrated significant neurologic improvement and was discharged to home from rehabilitation center. Currently, she is thirty‐ four weeks pregnant and neurologically intact without any deficits.

Conclusions
Pharmacological and mechanical endovascular interventions can have significantly successful clinical outcomes in deep cerebral venous thrombosis. Controlled studies are required to assess the safety and efficacy of these interventions when compared to standard systemic anticoagulation.
Abstract Number ‐ 119: Stent‐Coil Embolization Of A High Riding Jugular Bulb For Symptomatic Pulsatile Tinnitus
Authors: Abraham Michael G , Beattie Sean , Lingam Sivani , Genz Nick 
Published: April 2023

Introduction
Tinnitus affects millions of people worldwide and in a significant number of people, tinnitus can be severe enough to impact day‐to‐day life. Various diseases can manifest with tinnitus, including atherosclerotic disease, AVMs, Meniere’s disease, IIH, medication toxicity, and neoplasms. Jugular bulb diverticula are a significant contributor to the incidence of persistent tinnitus. One study of 1579 temporal bone specimens, 8.2% were found to have high‐riding jugular bulbs. Other sources demonstrate a prevalence of 6% in the population. Another study demonstrated a high‐riding jugular bulb in 2.4‐7% of temporal bones, a 5 times higher prevalence of a high‐jugular bulb in patients with ear related symptoms, and tinnitus in 22% of patients in a 730 cohort who presented to otolaryngology. We present 3 cases of jugular bulb diverticula causing debilitating tinnitus and their subsequent treatment with stent‐assisted coiling.

Methods
Retrospective chart review of patients who presented with symptoms of pulsatile tinnitus, noted to have a jugular bulb diverticulum on cerebral venogram, who underwent stent‐assisted coil embolization.

Results
A 71‐year‐old male with a history of migraines presented with nausea and right‐sided tinnitus that worsened on lying down. The persistence of symptoms prompted further investigation with a catheter venogram which demonstrated a high‐riding right jugular bulb measuring 10.37 mm x 8.61 mm. The patient underwent stent‐assisted coiling and embolization with improvement in his symptoms. A 57‐year‐old male with recent history of right ischemic infarct secondary to intracranial atherosclerosis had worsening left sided pulsatile tinnitus over one year to the point where it prevented sleep, waking him hourly. A CT‐Venogram revealed a left jugular bulb diverticulum measuring 5.33×5.02 mm. A cerebral angiogram and venogram confirmed this diagnosis and ruled out an AVM/dAVF. Stent‐assisted coiling resulted in immediate relief. The above patients were treated with a Zilver stent (Cook Medical, Bloomington, IN) and Target Coils (Stryker Neurovascular, Kalamazoo, MI). A 40‐year‐old woman presented with severe abrupt‐onset pulsatile right‐sided tinnitus and associated hearing loss, without any associated relieving factors. Due to the severity of her symptoms, she goes to counseling. A cerebral venogram revealed a right internal jugular diverticulum measuring 6.73 mm x 14.5 mm, without any associated dural sinus stenosis. She is scheduled for stent assisted coil embolization.

Conclusions
High‐riding jugular bulb or jugular diverticulum should be suspected as a potential and treatable cause of pulsatile tinnitus when other diagnoses have been ruled out. Our case series demonstrates that stent assisted coil embolization is safe and effective in relieving tinnitus and hearing loss, which can be debilitating in many cases.
Abstract Number ‐ 129: Intracranial Blister Aneurysm Management: An Australian Multi‐Centre Retrospective Analysis
Authors: Reidy Joseph D , Reidy Joseph D , Ma Alice , Faulder Kenneth , Harrington Timothy , Steinfort Brendan , Assaad Nazih 
Published: April 2023

Introduction
Blister aneurysms (BA) are high risk neurovascular lesions that account for 1% of all intracranial aneurysms. The pathology of BAs, with defective vessel wall and broad‐based neck, make this clinical entity particularly difficult to treat. When these aneurysms present with acute subarachnoid haemorrhage there are associated with high rates of re‐rupture and mortality. These pose substantial challenges for both endovascular and microsurgical management. We report a multi‐centre retrospective analysis of BA management in Sydney, Australia, to describe the different surgical and endovascular approaches and the associated clinical outcomes.

Methods
A multicentre review of two large tertiary hospitals in Sydney with a search for imaging databases were screened for term of “blister” in all head and neck imaging modalities from January 2010 to June 2022. Operation reports were also screened for the 5‐year time period since cerebral angiogramreports transitioned from imaging database to surgical database. All identified reports were manually screened for confirmed diagnosis of blister aneurysm.

Results
21 cases with confirmed diagnosis of blister aneurysm that underwent management at respective facilities were included. 16 cases (76%) were managed endovascularly – one with stent‐assisted coiling and 15 with flow diversion stents. 4 cases (19%) were managed surgically – 3 of these were primary clipping, and one wrap and clipping technique. One surgical case was commenced as an endovascular case prior to conversion. One case was managed conservatively (5%). Clinical outcomes were discharge disposition, occlusion of aneurysm and post‐operative complications.

Conclusions
BAs have challenging therapeutic considerations with a high mortality and morbidity. Endovascular treatment offers a less invasive management option with a trend of lower rates of intraoperative rupture and lower mortality rates. Endovascular therapy had higher rates of retreatment and incomplete aneurysm occlusion on follow up imaging. Patients discharged directly home were comparable between groups. The decision making for blister aneurysms is complex, endovascular treatment shows promise for acute treatment but careful consideration of antithrombotic regime and requirement for EVD insertion or further surgery should be considered.
Abstract Number ‐ 142: Flow Diversion for Posterior Communicating Artery Aneurysms: Systematic Review and Meta‐Analysis
Authors: Vivanco‐Suarez Juan , Rodriguez‐Calienes Aaron , Farooqui Mudassir , Galecio‐Castillo Milagros , Malaga Marco , Ortega‐Gutierrez Satiago 
Published: April 2023

Introduction
Posterior communicating artery (PComA) aneurysms are common and have a high risk of rupture. Flow diverters (FD) have demonstrated a safe and effective profile. However, the use of FD in PComA aneurysms has shown controversial results with high rates of recurrence and a high risk of potential ischemic complications. There, we aimed to evaluate the safety and efficacy of flow diversion for the treatment of PComA aneurysms with a meta‐analysis of the literature.

Methods
We performed a systematic search in Scopus, Embase, Medline, and Web of Science from inception until May 2022 for all the studies that reported the safety and effectiveness of FD for the treatment of intracranial aneurysms located in the posterior communicating artery. The primary effectiveness endpoint was a complete aneurysm occlusion rate at final follow‐up. The primary safety endpoint was a composite measure of cumulative events that occurred during and after the procedure. Events included death and ischemic/hemorrhagic complications. Random‐effects meta‐analysis was used to calculate proportions. Statistical heterogeneity across studies was assessed with I2 statistics.

Results
A total of 13 studies with 397 patients harboring 403 aneurysms were included in our analysis. Mean age was 48 years and mean aneurysm size was 5.3 mm. Complete aneurysm occlusion at final follow‐up was 74% (95% CI 66–81%; I2 = 54%). The primary safety composite outcome was 5% (95% CI 3–9%; I2 = 0%). The mortality rate was 1% (95% CI 0–2%; I2 = 0%). Subgroup analysis showed that patients with a non‐fetal PComA had a higher rate (76%; 95% CI 62%‐86%; I2 = 53%) of complete aneurysm occlusion compared to those with a fetal PComA (36%; 95% CI 21%‐54%; I2 = 0%).

Conclusions
Our findings show that flow diversion for the treatment of aneurysms located in the PComA is effective and safe. However, the same treatment for aneurysms located in a fetal‐type PComA did not show the same efficacy profile suggesting that these cases might require an alternative treatment to achieve permanent occlusion rates.
Abstract Number ‐ 150: Association of 24‐hour Blood Pressure Parameters Post‐thrombectomy with Mortality in Anemic and Non‐anemic Patients
Authors: Nisar Taha , Nisar Taha , Tofade Toluwalase , Shaulov Shaul , Shapouran Sara , Abu‐hadid Osama , Khandelwal Priyank 
Published: April 2023

Introduction
Higher blood pressure (BP) is considered to be harmful in patients who undergo mechanical thrombectomy (MT), however, the impact of BP post‐MT based on comorbidities like anemia has not been well studied. We aim to determine the association of 24‐h post‐MT BP parameters with mortality depending on the anemia status.

Methods
We conducted a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. Patients were dichotomized into anemic and non‐anemic groups based on the World Health Organization’s definition of anemia [hemoglobin < 12.0 g/dL in women and < 13.0 g/dL in men]. We performed a binary logistic regression analysis controlling for baseline parameters, with the 24‐h post‐MT BP parameters as predictors. The primary outcome was 3‐month mortality.

Results
220 patients met the inclusion criteria. The 3‐month mortality rate was 27.27%. In the multivariable analysis, the 24‐h parameters of a lower mean DBP (65.53±9.73 vs. 71.94±10.16; OR, 0.92; 95% CI, 0.86‐0.98; P 0.007), lower mean MAP (85.7±8.65 vs. 91.38±10; OR, 0.93; 95% CI, 0.86‐0.99; P 0.02), a lower minimum DBP (49.27±10.51 vs. 55.1±11.23; OR, 0.93; 95% CI, 0.88‐0.99; P 0.019), a lower minimum MAP (68.96±9.54 vs. 74.73±10.47; OR, 0.93; 95% CI, 0.87‐0.99; P 0.023) were significantly associated with mortality in patients with anemia. There was no association between 24‐hour BP Parameters post‐MT and mortality in non‐anemic patients.

Conclusions
In our study, lower BP parameters were associated with higher 3‐month mortality in anemic patients, however, this effect was not found in non‐anemic patients. Anemia induces a relative hypoxic state in target tissue in the event of an increase in metabolic demand such as stroke. Higher BP post‐MT can potentially promote perfusion and thus is not associated with worse outcomes in anemic patients post‐MT, whereas in non‐anemic patients it may potentially lead to reperfusion injury.
Abstract Number ‐ 154: Outcomes of Rescue Intracranial Stenting vs Failed Recanalization during Mechanical Thrombectomy
Authors: Santucci Joshua , Martucci Maria , Baker David , Hussain M Shazam , Toth Gabor 
Published: April 2023

Introduction
Rescue stenting may be considered during mechanical thrombectomy (MT) if a newly recanalized intracranial vessel keeps re‐occluding, or recanalization is not achieved with conventional thrombectomy methods. There are multiple published case series with mixed results on safety and efficacy of this approach, and there are no available randomized trials. We aimed to compare the outcomes of rescue intracranial stenting with unsuccessful/poor reperfusion after MT.

Methods
Retrospective review of ischemic stroke patients who underwent MT from 2016–2021. Emergent intracranial stent patients were selected and compared with those who had poor/unsuccessful post‐procedural reperfusion (TICI 0–2a). Initial ASPECT score, NIHSS, number of passes, and MT method (aspiration vs stentriever) were recorded. Complications (intracranial hemorrhage, vessel perforation, groin or retroperitoneal hematoma, or distal embolization), final infarct size, 90‐day mRS, and mortality were analyzed.

Results
Sixteen patients underwent emergent intracranial stenting. Of the 89patients with failed MT, 34 had TICI 2a, 11 had TICI 1, and 44 had TICI 0 reperfusion. All 16 stenting patients achieved TICI 2B‐3 grade recanalization. Pre‐procedure ASPECT score was similar between both groups. Six patients had either intracranial vertebral or basilar artery stenting, and 10 had either intracranial ICA or MCA stenting. Patients with posterior compared to anterior circulation involvement were more likely to receive stenting (50% vs 11%, p = 0.003). There were no differences in the stenting versus non‐stenting group in 24‐hour post intervention NIHSS, post‐procedural complications, intracranial hemorrhage, infarct size, and mortality (75% vs 67%). The stenting group had better functional independence (mRS 0–2) at 90 days (33% vs 11%, p = 0.04). There were no outcome differences in anterior compared to posterior circulation stenting.

Conclusions
Rescue stenting was more often seen with posterior circulation strokes. In patients with failed or unsuccessful reperfusion after conventional MT, emergent stenting achieved better 90‐day functional independence without increasing rates of complications, intracranial hemorrhage, or mortality.