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High speed craft has become prominent in maritime industry. Sophisticated electronic navigation equipment on bridge increases mental demands of high speed craft navigator. In the present study, mental workload of high speed craft navigators has been assessed in terms of bridge navigation operations. For this purpose, the pairwise comparison of the effects of Electronic Chart Display and Information System, Automatic Radar Plotting Aid, Automatic Identification System and autopilot on mental workload and Revised NASA Task Load Index questionnaires were carried out. High speed craft navigators sorted berthing, unberthing, navigation in coastal waters, navigation in restricted waters, and navigation on open sea operations according to their mental workload levels. In addition, they indicated the factors mostly affecting mental workload and the remarkable suggestions to keep the optimum level of mental workload. As result of these findings, considerations have been made for increasing the safety of high speed craft navigation.

Although professional identity development is an important concept in medical education, the process has not been well-investigated from a student perspective. This study examines the metaphorical images formulated by first grade medical students in Turkey to describe physicians in the context of establishing a professional identity, along with its limitations. Participants (N=148) completed the prompt: A physician is like _____ because _____ to indicate their conceptualizations of physician. The data were analyzed both qualitatively and quantitatively. Altogether, 71 well-articulated metaphorical images were identified - comprising six conceptual themes. While subject to some limitations, the use of metaphors to formulate and describe professional identities can be helpful in reflecting the personal beliefs and values of matriculants to medical school, as well as providing some guidance and feedback to curriculum development efforts.

BackgroundEndovascular device effectiveness and safe use rely on closely simulating real-world scenarios during preclinical testing. This study mainly focused on endoscopic evaluation of radial access catheter failure mechanisms tested on human cadaveric models.MethodsA human cadaveric model was created by catheterizing the ascending and descending aorta in a cadaver model consisting of the head, neck, bilateral arms, and torso. An endoscopic camera was inserted through the ascending aorta to evaluate radial access catheter performances. Blood-mimicking fluid was circulated in the cadaver model using an external pump. Bilateral radial access was obtained using 7F slender sheaths. All catheters were tested by a senior neurointerventionist, and during the procedures, all movements of catheters were recorded endoscopically. All recorded videos are evaluated by experienced neurointerventionists to find out possible failure mechanisms of radial access catheters.ResultsWe identified four possible failure mechanisms associated with current-market radial access catheters. These failure mechanisms were simultaneously demonstrated through endoscopic and fluoroscopic imaging. They include insufficient torque transmission, catheter whipping due to torque build-up, scratching atheroma plaques during catheter advancement, catheters getting stuck during advancement by the septum between the brachiocephalic trunk and the left common carotid, and catheters becoming lodged on the edge of the inner vascular layer. All failure mechanisms were documented through endoscopic and fluoroscopic recordings.ConclusionsThe development and optimization of radial access catheters are necessary. Visualizing possible failure mechanisms will contribute to a better understanding of these failure mechanisms and enable the development of more effective catheters.Abstract E-096 Figure 1Disclosures Y. Senol: 6; C; Microvention. M. Asghariahmadabad: 6; C; Microvention. N. Krishnan: None. A. Orscelik: None. L. Savastano: 4; C; Endovascular Horizons. 5; C; Endovascular Engineering, VerAvanti.

IntroductionSubdural hematomas (SDH), especially when recurring, pose a significant challenge in treatment. Middle Meningeal Artery (MMA) embolization has emerged as a promising method for managing chronic cases. Studies suggest its effectiveness in refractory cases with repeated recurrences. However, recurrence may still occur after embolization, necessitating further interventions like craniotomy, re-do ipsilateral MMA embolization of contra-lateral embolization.Case PresentationAn 85-year-old male with a history of recent falls presented to the emergency room for rapidly progressive left-sided weakness. His medical history included remote burr hole for a left-sided subdural hematoma, coronary bypass graft surgery, chronic renal insufficiency, and he was taking ASA. A CT scan revealed a large right-sided subdural hematoma (SDH) with significant mass effect, prompting surgical evacuation followed by transradial MMA embolization with 150–250 microns PVA particles (Contour, Boston Scientific) and coiling of a large meningo-lacrimal artery. Following this procedure, the patient showed neurological improvement and was discharged, with ASA discontinued. Follow-up CT scan at four weeks showed significant recurrent right SDH. Angiography of the right internal maxillary artery revealed complete occlusion of previously embolized right MMA. Angiography of the left MMA revealed multiple distal branches of the frontal and parietal division crossing the midline to supply convexal branches of the contralateral MMA and right sided SDH membranes. This was likely facilitated by patchy, segmental, and predominantly proximal distribution of the embolysate. The left MMA was then embolized with 150–250 microns PVA particles (Contour, Boston Scientific). At two months follow up, the SDH was almost completely resolved in head CT.ConclusionRecurrent SDH after unilateral MMA embolization should prompt evaluation for contralateral MMA anastomosis. Contra-lateral MMA embolization should be considered as a viable treatment option.Disclosures M. Asghariahmadabad: None. Y. Senol: None. A. Orscelik: None. L. Savastano: None.

ObjectiveNeurointerventional surgery is witnessing a growth in trans-venous procedures by translating endovascular devices and techniques developed, optimized and used in the arterial system. However, major dural venous sinuses differ from cerebral arteries in their non-circular cross-sectional geometry and in the multiple structures that protrude or cross their lumens. This study employs the ‘live’ cadaver model previously developed and validated in our lab to study the anatomical phenotypes of intraluminal structures with angiography and high-resolution angioscopy.MethodsThe internal jugular veins of six (6) head and neck human cadaveric specimens were catheterized and physiologically pressurized with 0.9% saline and a venous flowrate of 6–9cc/sec was established. Cerebral Venograms were performed by injecting iodinated contrast at the confluence of the major dural sinuses. Then, an angioscope was used to study the anatomical structures in the lumen of transverse/sigmoid sinuses (n=12) and superior sagittal sinuses (n=6). Descriptive statistics were performed to evaluate anatomical structures.ResultsArachnoid granulations and septations were found in all specimens. The majority of arachnoid granulations (50%, n=12) were located in the mid and proximal segments of the transverse sinus (defining ‘proximal’ as towards the torcula), while 33.3% were found in the distal segment. Two specimens (33.3%) only had arachnoid granulations in the superior sagittal sinus. The anterior and middle third of the superior sagittal sinus contained at least two septations and multiple granulations. The average number of septations in the transverse sinus was 2.92 ± 0.79, with the right transverse sinus exhibiting a slightly higher number than the left (3.0 ± 0.89 vs 2.83 ± 0.75, p>0.05) And granulations are commonly found in the proximal transverse sinus, more frequently on the left side compared to the right (100% vs. 80%, p>0.05). Only granulations protruding >50% of the lumen were visible by angiography, while septations were not perceived in angiography.ConclusionThe lumen of major dural venous sinuses frequently harbor crossing septations and protruding granulation, which are typically invisible by angiography. These could interact with devices and impact endovascular procedures.Abstract O-040 Figure 1DisclosuresY. Senol: None. N. Krishnan: None. A. Liu: None. A. Haider: None. M. Amans: 1; C; Department of Defense, NIH, VS3 Medical. 2; C; Stryker, Microvention, VS3 Medical. 3; C; Weil Cornell Medical Center Department. 4; C; VS3 Medical. L. Savastano: None.

Background/ObjectiveUnderstanding the prevalence and angioarchitecture of orbital branches of the middle meningeal artery (MMA), such as the meningolacrimal anastomosis (MLA), is critical to safely perform MMA embolizations. The diminutive size of these dural branches have limited the capacity to perform detailed dissection studies, and clinical angiographies likely underdiagnose the prevalence of these branches given the competing arterial flow from the orbit. We conducted a human cadaveric study to quantify the frequency and anatomical parameters of MLA by performing isolated high resolution angiography and DynaCTs of the MMA.MethodsAngiographies and Dyna CT were performed by navigating microcatheters and injecting iodinated contrast in the extracranial MMA in eight (8) human cadaveric specimens. Native and reconstructed images were analyzed for prevalence and morphometric variations.ResultsThe MLA was identified in 15 of 16(93.7%) specimens. Among these, 87.5% had a single ML branch per MMA, while 12.5% had more than one branch. The mean length of the dural segment of the MLA (from the origin at the MMA to the entry into the orbit) was 1.77 ± 0.70 cm. The mean diameter of the MLA was 0.93 ± 0.29 mm, and the MMA diameter at the origine of the MLA measured 2.15 ± 0.51 mm.ConclusionOrbital branches from the MMA are highly prevalent and must be accounted for at the time of selecting embolization agents and devices during MMA embolization.Abstract E-263 Figure 1DisclosuresY. Senol: None. M. Asghariahmadabad: None. A. Liu: None. N. Krishnan: None. P. Kumar: None. A. Orscelik: None. T. Jun: None. L. Savastano: None.

BackgroundIn acute ischemic stroke (AIS), intravenous thrombolysis (IVT) is standard, but some cases require surgical interventions after failed treatments. However, combining IVT or endovascular therapy with surgical embolectomy can increase hemorrhagic complications. Our meta-analysis assesses the use of surgical embolectomy post-unsuccessful thrombectomy in AIS patients.MethodsWe conducted a literature search using PRISMA guidelines using Pubmed, Embase, Scopus, and Web of Science up to April 26, 2023. Statistical analysis was performed using R software to combine prevalence rates and their respective 95% confidence intervals (CI) using a random-fixed model. We evaluated outcomes such as the modified Rankin Scale (mRS - 0–2), successful recanalization and modified treatment in cerebral infarction (mTICI) score ≥2, symptomatic intracranial hemorrhage (sICH), and 90-day mortality.ResultsOur analysis showed that the use of surgical intervention resulted in 48.15% (95% CI: 30.39–66.39) 90-day favorable outcome with (95% CI: 50.70–99.91) successful recanalization rate (mTICI >2) and sICH of 1.84% (95% CI: 0.03–57.30), and mortality rate of 12.31% (95% CI: 3.22–37.19) at 90 days.ConclusionOur analysis shows that surgical embolectomy may be considered a treatment option in stroke patients who failed thrombectomy.Disclosures M. Pakkam: None. A. Orscelik: None. B. Musmar: None. Y. Senol: None. S. Ghozy: None. C. Bilgin: None. R. Kadirvel: None. D. Kallmes: None.

BackgroundAnterior choroidal artery (AChoA) aneurysms are rare and pose a significant treatment challenge due to the artery’s small caliber and critical vascular territory. Endovascular treatment (EVT) has become a preferred approach, but optimal management strategies remain debated. This study compares the efficacy and safety of different EVT techniques, including primary coiling, stent-assisted coiling (SAC), and flow diversion (FD) in treating AChoA aneurysms.MethodsPatients were categorized by treatment modality, aneurysm morphology, and rupture status. Angiographic occlusion rates were assessed using the Raymond-Roy Occlusion Scale (RROS), and clinical outcomes were measured via the Modified Rankin Scale (mRS) at discharge and follow-ups. Statistical analyses compared occlusion rates, procedural complications, and functional outcomes among treatment groups.Results60 patients with 80 aneurysms, 44 (55%) were dependent(choroidal branch arises from aneurysm dome or neck) and 36 (45%) were independent(aneurysm arises adjacent to the choroidal branch) AChoA aneurysms. Primary coiling was performed in 29 cases, SAC in 21, and FD (with or without adjunctive coiling) in 30. Complete occlusion rates were significantly higher with SAC (83.3%) and FD (76.1%) compared to primary coiling (51.7%) (p = 0.007). Flow diversion had a higher rate of technical complications (25%), while ischemic complications were more frequent in dependent aneurysms (p < 0.05). No cases of symptomatic AChoA occlusion were observed after FD treatment. The overall mortality rate was 5%, with all cases occurring in the primary coiling group.ConclusionEVT of AChoA aneurysms is effective, with SAC and FD demonstrating superior occlusion rates compared to primary coiling. FD carries a higher risk of technical complications but maintains AChoA patency. Treatment choice should be guided by aneurysm morphology and patient risk factors to optimize outcomes.Abstract O-064 Figure 1DisclosuresY. Senol: None. H. Ciftci: None. Z. Oz: None. D. Duman: None. B. Sayin: None. M. Ozbakir: None. I. Akmangit: None. A. Belen: None. E. Daglioglu: None.

Background and PurposeThe safety and efficacy profile of flow diverter treatment for intracranial aneurysms has been well-established. However, predictors of successful flow diversion remain poorly characterized. Failed flow diversion attempts burden the healthcare system and put patients at risk due to long-term antiplatelet treatment and potential periprocedural complications. Fibrinogen deposition represents an integral component of intraaneurysmal thrombus formation. Therefore, we aimed to develop a preclinical testing platform utilizing fibrinogen to predict the in vivo performance of flow diverters.MethodsA flow diverter (4.75 x 20 mm) was deployed in the glass model of a saccular paraophthalmic segment aneurysm (4x4x4 mm). A human fibrinogen solution (Fibryga, Octopharma, Paramus, NJ) was circulated through the glass model using a peristaltic pump in triplicates. Thrombin, heparin, and calcium chloride were added to the fibrinogen solution, and physiologic blood concentrations were mimicked for all ingredients except heparin. The test fluid temperature was stabilized at 37°C with a heating bath. Complete aneurysm neck coverage time was recorded for varying flow rates (3, 4, and 5 cc/sec) with or without heparin or calcium chloride addition.ResultsFibrinogen specifically aggregated at the flow diverter’s aneurysm neck portion (100%, 6/6), while other segments of the flow diverter remained patent. Fibrinogen aggregation occurred without platelet aggregation or activation of other coagulation factors. The time to complete neck coverage varied between 15 (figure 1) and 24 minutes for different flow rates, with a higher flow rate achieving faster neck coverage. The model was sensitive to thrombin, heparin, and calcium chloride concentrations (table 1). With physiological concentrations and flow rate, the flow diverter’s portion at the aneurysm neck was completely covered in 20 minutes.ConclusionsOur preliminary study supports the potential of fibrinogen-based benchtop flow model as an effective tool for predicting flow diverter’s in vivo performance. In our study, fibrinogen-based flow model successfully reflected the changes in flow rates and concentrations of main procoagulants. Further research is needed to validate the utility of fibrinogen-based models in predicting flow diverter’s performance in patients.Abstract E-210 Figure 1Abstract E-210 Table 1Fibrinogen aggregation times for different flow rates and test solutions Experiment Fibrinogen Flow Rate Thrombin Heparin Calcium Chloride Coverage time 1 330mg/dl 3cc/sec 0.1 U/ml - - 24 min 2 330mg/dl 4cc/sec 0.1 U/ml - - 20 min 3 330mg/dl 5cc/sec 0.1 U/ml - - 15 min 4 330mg/dl 4cc/sec - - - 80 min 5 330mg/dl 4cc/sec 0.1 U/ml 1 U/ml - 33 min 6 330mg/dl 4cc/sec 0.1 U/ml 1 U/ml 8 mg/dl 21 min Disclosures C. Bilgin: None. A. Oliver: None. S. Arul: None. Y. Senol: None. D. Ericson: None. J. Cebral: None. D. Kallmes: None. R. Kadirvel: None.

PurposeIn several studies, TransCarotid Artery Revascularization (TCAR) has been shown to have lower risks of major adverse outcomes, such as stroke, than transfemoral carotid artery stenting (CAS). These outcomes have raised questions about the competency of the catheters used in transfemoral CAS for flow reversal. This study evaluates a new balloon-sheath device, the Femoral Flow Reversal Carotid Artery Stenting (FFRACAS) device.Materials and MethodsThe FFRACAS prototype (ID = 0.117’; OD = 0.140’; L=80cm), TCAR-equivalent prototype (ID=0.104’; OD = 0.110’; L=30cm), and MoMa (Medtronic, Minneapolis; ID=0.083’; OD = 0.112’; L=90cm) were compared in a pulsatile flow model using a blood simulant at a flow rate of 800 mL/min. The venous system was simulated by an elevated saline reservoir set at a pressure of 10 mmHg. MoMa was tested under common carotid artery (CCA) balloon occlusion, both with and without external carotid artery (ECA) balloon occlusion. MoMa without ECA balloon occlusion was tested with the arteriovenous shunt system. The flow rates within the internal carotid artery (ICA), ECA, and shunt (if applicable) were monitored throughout the CAS stages (CCA flow arrest, shunt activation, and stent delivery). The study followed two different (ECA) inflow conditions after CCA occlusion: -10 mL/min and -20 mL/min. Statistical comparisons of the flow rates were performed using ANOVA and Tukey’s post-hoc tests.ResultsThroughout CAS, MoMa placement with ECA occlusion maintained retrograde ICA flow. A flow rate of -0.3 mL/min was observed during stent insertion. However, MoMa placement without ECA occlusion failed to reverse ICA flow under low (ICA=0.6 ± 0.5 mL/min) and high (12.8 ± 0.7 mL/min) ECA inflows. Under low ECA inflow, FFRACAS and TCAR prototypes reversed ICA flow similarly to each other after shunt activation (ICA= -4.8 ± 0.5 mL/min vs. -5.1 ± 1 mL/min, respectively, p=0.35). However, neither FFRACAS nor TCAR prototypes reversed ICA flow during stent delivery (ICA= 1.4 ± 0.5 mL/min vs. 3.1 ± 0.4 mL/min). Under high ECA inflow, FFRACAS (9.2 ± 0.8 mL/min) and TCAR (7.7 ± 0.7 mL/min) failed to reverse the ICA flow when the arteriovenous shunt was activated without a stent inserted.ConclusionFFRACAS offers an alternative to TCAR by achieving similar degrees of flow reversal from a transfemoral approach to that achieved with the transcarotid approach. The MoMa system with ECA balloon occlusion reliably maintains retrograde flow in ICA during CAS.Abstract E-126 Figure 1Indicates changes in flow direction upon CCA flow arrestDisclosures E. Bayraktar: None. J. Li: None. J. Cortese: 1; C; Medtronic, Phenox, Balt, French Society of Radiology (Bourse de Recherche Alain Rahmouni SFR-CERF), Philippe Foundation, French Society of Neuroradiology (Bourse de Mobilité Anne Bertrand SFNR). 3; C; Balt. C. Bilgin: None. Y. Senol: None. R. Kadirvel: 1; C; Cerenovus, Sensome, Neurogami Medical, Insera Therapeutics, Medtronic, Monarch Biosciences, MiVi Biosciences, Stryker, NIH, NSF, Piraeus Medical, Bionaut Labs. 4; C; Monarch Biosciences, Bionaut Labs. W. Brinjikji: 1; C; NIH. 2; C; Medtronic, Stryker, Imperative Care, MIVI Neurovascular, Cerenovus, Asahi, Balt, Microvention. 4; C; Nested Knowledge, Superior Medical Editors, Piraeus Medical, MIVI Neurovascular, Sonoris Medical. 5; C; MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, WFITN. 6; C; Medtronic, Balloon Guide Catheter Technology. D. Kallmes: 1; C; Cerenovus, Sensome, Neurogami Medical, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, Stryker, NIH. 2; C; NoNO Inc, Vesalio. 4; C; Medtronic, Nested Knowledge, LLC, Superior Medical Experts, LLC, Marblehead Medical, LLC, Conway Medical, LLC, Monarch Biosciences, Piraeus Medical, Balloon guide technology, Spine augmentation. 6; C; Brainomix.