outcomes. However, without complete ingestion of the clot, much of it remains outside of the catheter and can be a source of distal emboli. Super Large Bore Aspiration (SLBA) has shown high rates of complete clot ingestion. We report the initial clinical feasibility, safety, and efficacy of this novel SLBA-insert combination-Super Large-bore Ingestion of Clot (SLIC technique) for stroke. SLIC entails a triaxial assembly of an 8 Fr 0.106' Base Camp catheter, 0.088' catheter extender (HiPoint) and an insert catheter (Tenzing 8), that completely consumes the inner diameter of the 0.088' SLBA catheter. The HiPoint catheter is delivered over the Tenzing 8 to the face of the embolus, which is withdrawn, while aspirating through the Base Camp and HiPoint catheters as a single assembly. Materials and Methods Retrospective review of three comprehensive stroke center databases between February 2021 and January 2022 and identification of patients treated using the SLIC technique. Data collection and analysis was performed under an Institutional Review Board approved protocol. Patient selection for endovascular treatment was based on advanced imaging with non-contrast head CT, CT angiography and/or CT perfusion. Patients included in this series were found to have a large cerebral vessel occlusion with viable ischemic penumbra (6-24 hours) in the vascular territory supplied by the occluded target artery. Clinical and procedural data of the group of patients undergoing SLIC thrombectomy were extracted. Results Thirty-three patients with large vessel occlusion were treated with SLIC. Mean patient age was 70 years (range 30-91 years) and 17 patients were male (51.5%). The median presenting NIHSS was 21 (range 1-34) and median ASPECTS score was 8 (range 5-10). Successful delivery of the 0.088' catheter to the site of the occlusion was achieved in all cases. Successful revascularization defined as mTICI2B was seen in 100% using a single pass in most of the cases (82%). Final mTICI2C was achieved in 94.1% of patients, with 73.5% mTICI3 recanalization. The rate of first-pass effect in achieving excellent reperfusion defined as mTICI2C was seen in 70.5% of cases. There were no adverse events or post-procedural symptomatic intracranial hemorrhages. Conclusion Our initial experience with the SLIC technique resulted in achieving first-pass effect (mTICI2C) in 70.5%. Navigation of the SLBA catheter extender over the Tenzing insert was successful and safe in this early experience.

Introduction Idiopathic intracranial hypertension (IIH) is a neurological disorder of unknown etiology characterized by increased intracranial pressure, resulting in headaches, pulsatile tinnitus, and papilledema. A major risk factor for IIH is obesity, and weight management can help improve symptoms of IIH. Venous sinus stenting is a surgical intervention aimed at resolving IIH. This study aims to evaluate the effect of venous sinus stenting on post-operative body mass index (BMI) changes in IIH patients. Secondary objective is to determine post-operative BMI changes by papilledema resolution. Methods Consecutive patients undergoing venous sinus stenting for IIH who have been diagnosed with papilledema were retrospectively reviewed from two comprehensive North American cerebrovascular centers. Patient demographics, surgical course, and post-operative outcomes and weight were calculated. A systematic review and meta analysis of post-operative weight in stented IIH patients with papilledema was conducted to determine BMI changes. Results Thirty patients with a diagnosis of idiopathic intracranial hypertension (IIH) and papilledema who underwent venous sinus stenting were identified across two institutions. All subjects were female, with a mean age of 32.8 ± 2.8. At 3-month follow up, the mean BMI decreased by 1.57%, increasing to 1.80% at 6 months; at the last follow up, there was a mean decrease of 2.19% in BMI. Average follow up was 6.02 ± 1.50 months. Systematic review revealed one study that met all inclusion criteria for the meta-analysis, containing 13 patients, yielding a total of 35 patients. The mean age was 31.23 ± 1.88 years and BMI decreased by 0.15% at 3-month follow up, and further decreased by 1.80% at 6 months. Last follow up displayed a mean decrease of 2.19% in BMI. Average follow up was 6.02 ± 1.50 months. Statistical analysis showed no significant difference in percent change regardless of whether or not papilledema resolved. Conclusions In conclusion, this study demonstrated that venous sinus stenting may result in modest decreases in BMI in IIH patients. The evidence suggests that with the intervention of venous sinus stenting, patients experienced a decrease in their BMI regardless of papilledema resolution. Further research such as larger prospective trials are needed to further understand the effect of transverse sinus stenting on weight loss.

correlations were used to describe associations between the abundance of individual proteins and tLKW. Gene ontology analysis and KEGG pathway analysis was further performed on all proteins with abundances associated with increased tLKW. Results A total of 2,790 proteins were reliably (present in >80%) identified across all samples, and thus included for analysis. Clots collected > 6hr and < 6hr tLKW were strongly enriched in 13 and 5 proteins, respectively (|log 2 fold-change| > 0.5, p < 0.05). Numerous proteins were negatively and positively associated with tLKW (Spearman's; 0.25 < || < 0.46). GO tags associated with RNA and protein metabolism were over-represented in the set of proteins associated with increased tLKW (p adj < 0.05). The most significantly represented KEGG pathways involve tRNA synthesis and amino acid metabolism (p adj < 0.05).. Conclusions This study points, for the first time, to differences in the proteomic landscapes between thrombi from AIS patients that are related to time since symptom onset. Taken together, the present data support a view of the stroke thrombus as a living, dynamic microenvironment with increasing intracellular protein and RNA processing with increased tLKW. More work is required to further characterize early and late stroke thrombi, as a changing clot landscape may directly underlie responsiveness to treatment.

feature variables as inputs. Numerous machine learning studies and competitions have demonstrated that XGBoost is a highperformance prediction model, so the predictions of the PNN were compared to those predicted by XGBoost. Furthermore, both PNN and XGBoost were trained using bagging ensemble learning, a technique for training an ensemble of multiple member models based on bootstrapping to improve prediction robustness.Results For both regression and classification, there were almost no differences in the prediction performance between the PNN and XGBoost ensembles. Prediction accuracy was improved when more correlated feature variables were available (from Group Preop to Group DC). For example, the best performance was achieved using Group Postop in regression of NIHSS changes (RMSE: 4.34 for PNN vs. 4.30 for XGBoost) and using Group DC in classification of mRS severity (accuracy: 0.78 for PNN vs. 0.77 for XGBoost; the same trend using different feature groups can be found in other measures, such as precision, recall, F1-scoure, and AUC-ROC). Furthermore, PNN accurately described the distributions of NIHSS changes represented by predicted means and SDs. Notably, in Group Preop, even patients with the worst predicted outcomes had an approximately 50% chance of improvement. Feature importance analysis showed that both the predictions of the NIHSS changes and mRS severity primarily relied on earlier NIHSS, Pre mRS, and patient age. Conclusions This study demonstrates the utility of probabilistic ensemble learning in clinical decision-making and prognosis. It can provide robust predictions as well as quantify data uncertainty. Our results regarding NIHSS changes reinforce the substantial benefits of MT, that can improve outcomes in nearly half of patients. The degree of disability relevant to the 90day follow-up mRS can be determined by probabilistic learning available as early as discharge.

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