Frequency of ICU Specific Interventions After Middle Meningeal Artery

Background: Middle meningeal artery embolization (MMAE) is increasingly performed for the treatment of chronic subdural hematomas. Some authors have described managing minimally symptomatic patients with MMAE in the outpatient setting. Our practice, however, has been to routinely admit patients after MMAE to the neuro-intensive care setting. Objective of this research is to analyze the frequency of ICU level interventions after MMAE in the neuro-intensive care unit. Methods: A consecutive series of MMA embolizations for cSDH were retrospectively reviewed from 2020 to 2022 at Valley Baptist Medical Center in Harlingen, TX, USA. Frequency of ICU specific interventions such as need for post procedural mechanical ventilation, need for intravenous vasopressor or antihypertensive medications was recorded. Results: A total of 50 MMA embolizations were performed during the study period. The average age of patients included in the study was 63 years old +/- 16 years with 30% being female. 34% patients did not receive any sort of ICU level intervention at all. Among the remaining who did, 32% required mechanical ventilation post procedurally. 14% needed a vasopressor and 48% required intravenous antihypertensives to maintain systolic blood pressure within goal parameters. Conclusions: 34% of patients who underwent MMAE did not require any ICU level interventions afterwards. The most common reason for an ICU intervention after MMAE was for correction of blood pressure to maintain within specified goal. Further investigation is warranted but it suggests that liberalizing blood pressure parameters could reduce the need for ICU utilization after MMAE

Medical Students Preventing Medical Errors: A Student-Led Approach to Patient Safety in Preclinical Curriculum

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer (1). Early exposure to patient safety knowledge may lead to students to deliver safer care in their clerkship and residency years. This study was designed to assess the change in knowledge from earlier exposure and education during pre-clinical years and its impact on interest and knowledge about patient safety. Methods: For the past four years, a patient safety training has been conducted for interested first and second-year medical students and responses are assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assesses student knowledge on various aspects of patient safety, identifying the correct course of action in different scenarios concerning patient safety. Results:The average percentage of correct answers on patient safety knowledge-based questions was 71.4% on the pre-test training and decreased to 68.4% in the 6-month post-test . The percent of students who considered themselves to be well-versed in different aspects of patient safety was 15.2% in the pre-test training and increased to 75% in the 6-month post-test. The percent of students that plan to incorporate patient safety techniques into their future practice was 97% in the pre-test training and 100% in the 6-month post-test. The percent of students who believed that patient safety can have a large impact on health outcomes was initially 97% in the pre-test training and 98.3% in the 6-month post-test. Conclusion:Improvement in patient safety knowledge amongst students immediately after training is promising. Although the percentage of correct answers decreased over time, students exhibited more knowledge on patient safety topics immediately after training than they had prior to any patient safety training. The lack of statistically significant findings can most likely be attributed to small sample size and will likely improve with further data collection.Continued training sessions will solidify knowledge about patient safety in preclinical years and potentially in clerkship years, and will allow for students to gain confidence in their knowledge of patient safety and medical errors

Abstract Number ‐ 101: Blood Pressure Interventions Are Most Common Reason for ICU Admission After MMA Embolization

Introduction Middle meningeal artery embolization (MMAE) is a minimally invasive technique that is increasingly performed for the treatment of chronic subdural hematomas. In comparison to prior surgical interventions, which often resulted in complications such as insufficient drainage or recurrence of rebleeding, MMAE has greatly reduced the need for multiple inpatient hospitalizations. Some authors have described managing minimally symptomatic patients with MMAE in the outpatient setting. Our practice, however, has been routinely admitting patients to the neuro‐intensive care setting after MMAE. The objective of this research is to analyze the frequency of ICU level interventions that were administered to patients after MMAE in the neuro‐intensive care unit in order to gain a better understanding of postoperative management and assess the potential for future management in the outpatient setting. Methods A consecutive series of MMA embolizations for cSDH were retrospectively reviewed from 2020 to 2022 at Valley Baptist Medical Center in Harlingen, TX, USA. Frequency of ICU specific interventions such as need for post procedural mechanical ventilation, need for intravenous vasopressor or antihypertensive medications was recorded. Additional data collected included patient clinical presentations, indications for treatment, additional neurosurgical intervention, length of ICU stay, and blood pressure parameters. Results A total of 50 MMA embolizations were performed during the study period. The average age of patients included in the study was 63 years old +/‐ 16 years with 30% being female. 34% patients did not receive any sort of ICU level intervention at all. Among the remaining who did, 32% required mechanical ventilation post procedurally. 14% needed a vasopressor and 48% required intravenous antihypertensives to maintain systolic blood pressure within goal parameters. Conclusions The most common reason for an ICU intervention after MMAE was for correction of blood pressure to maintain within specified goal. 34% of patients who underwent MMAE did not require any ICU level interventions afterwards. Further investigation is warranted, but current data suggests that liberalizing blood pressure parameters could potentially reduce the need for ICU utilization after MMAE. Assessment of various components of ICU level interventions administered to patients post‐MMAE allows for a better understanding on preventive measures that can be taken in the future to reduce length of inpatient stay post procedurally, which would reduce risk of iatrogenic complications, minimize spread of nosocomial infections, andoverall increase patient comfort

Abstract Number ‐ 165: Are Smaller Stentrievers the Answer for Achieving Procedural Success in Distal Vessel Occlusions (DiVO)?

Introduction Distal vessel occlusions (DiVO) represent the next frontier of interventional stroke care. Although many experts agree the current generation of stentrievers appear to be ill‐suited to address challenges presented by DiVO, some practitioners advocate utilizing smaller devices.We sought to examine whether smaller diameter devices (3,4 or 5 mm) had any edge over standard sized 6 mm device. Methods A prospectively maintained neuro‐endovascular database was queried for patients between January 2013 to August 2022. Patients included in the analysis had undergone mechanical thrombectomy of distal circulation defined as M2, M3, P2, P3, A2 and A3 segments of the MCA, PCA, and ACA respectively.Primary outcomes measured were TICI post procedure, mRS at discharge and mRS at 90 days. Results A total of 33 patients with DiVO were identified out of a database containing 826 mechanical thrombectomies. There were no other differences in baseline characteristics such as presentation NIHSS (p = 0.58) or comorbid medical conditions. We found no differences in post procedure recanalization TICI between large device and small devices cohorts (p = 1.00), symptomatic ICH (p = 0.52), mRS at discharge (p = 0.154) and mRS at 90 days (p = 0.22). Conclusions There do not appear to be any clinical or radiographic difference in utilizing smaller diameter stentrievers in setting of DiVO

Abstract Number ‐ 187: Short‐term Clinical Outcomes Amongst Patients On Anticoagulation and DAPT Who Underwent Stenting and Mechanical Thrombectomy

Introduction Dual antiplatelet therapy has long been established as the preferred treatment option for patients with intracranial or extracranial stenting. Anticoagulation is the preferred treatment option for patients at high risk of stroke with embolic risk factors. There is no data currently available analyzing patients presenting with acute ischemic stroke on anticoagulation who require an intracranial and or extracranial stent (IC/EC), requiring DAPT and anticoagulation with mechanical thrombectomy. Our objective is toinvestigate differences in recanalization and outcomes as well as safety of DAPT and AC in the setting of AIS post MT with stenting when compared to patients without AC. Methods A retrospective search at a large comprehensive stroke center was conducted and data was analyzed from 2013 to 2022. Patients presenting with AIS on AC who had MT and required IC/EC stent were selected and compared to patients not on AC. Outcomes were measured as symptomatic ICH and mortality. Patient demographics, stroke risk factors and stroke severity were abstracted amongst other variables. Results There were 301 patients out of 917 (42.9% Female) who presented with anticoagulation use prior to mechanical thrombectomy requiring ic/ec stent placement and DAPT therapy. See Table 1 for baseline demographics. Symptomatic ICH was seen in 24 (7.9%) compared to 50 (8.1%), Odds ratio 0.86/ p‐value = 0.573, Mortality was seen in 51 (16.9%) patients who received DAPT and a/c compared to 129 (20.9%) (OR 0.67) p = 0.028. Logistic regression model did not show any significant difference (See Table 2). Conclusions There was no statistical difference in symptomatic ICH in acute ischemic stroke patients treated with mechanical thrombectomy and acute stenting on anticoagulation when compared to those without anticoagulation. There was statistical difference in mortality and DAPT/AC actually had lower mortality rates. This data suggests that performing intracranial and extracranial stenting in the acute stroke setting while on anticoagulation and adding DAPT is safe. A larger multicenter study with longer follow up is needed to further confirm these findings