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Are school-based management reforms improving education? This book analyzes the theory and evidence behind decentralized decision-making in schools worldwide. Decentralized Decision-Making in Schools explores the impact of school-based management (SBM) reforms across diverse countries. It examines how empowering principals and teachers, and strengthening parental involvement, affects educational outcomes. The authors review over 20 country experiences, providing insights into the effectiveness of SBM in various contexts. * Discover the key factors for successful SBM implementation. * Understand the impact of SBM on student achievement and attendance. * Learn how to design effective education projects with decentralized authority. This insightful analysis is for education officials, policymakers, and researchers seeking evidence-based strategies for improving school governance and student outcomes.

There is in Botswana a single government owned museum, the National Museum and Art Gallery, recently re-named, the Botswana Museum, and seven government assisted NGO museums. The NGO museums are members of the Botswana Museums Association (MBA)

Concerns about systemic racism at academic and research institutions have increased over the past decade. Here, we investigate data from the National Science Foundation (NSF), a major funder of research in the United States, and find evidence for pervasive racial disparities. In particular, white principal investigators (PIs) are consistently funded at higher rates than most non-white PIs. Funding rates for white PIs have also been increasing relative to annual overall rates with time. Moreover, disparities occur across all disciplinary directorates within the NSF and are greater for research proposals. The distributions of average external review scores also exhibit systematic offsets based on PI race. Similar patterns have been described in other research funding bodies, suggesting that racial disparities are widespread. The prevalence and persistence of these racial disparities in funding have cascading impacts that perpetuate a cumulative advantage to white PIs across all of science, technology, engineering, and mathematics.

Evaluating the effects of some or all academic research funding is difficult because of the many different and overlapping sources, types, and scopes. It is therefore important to identify the key aspects of research funding so that funders and others assessing its value do not overlook them. This article outlines 18 dimensions through which funding varies substantially, as well as three funding records facets. For each dimension, a list of common or possible variations is suggested. The main dimensions include the type of funder of time and equipment, any funding sharing, the proportion of costs funded, the nature of the funding, any collaborative contributions, and the amount and duration of the grant. In addition, funding can influence what is researched, how and by whom. The funding can also be recorded in different places and has different levels of connection to outputs. The many variations and the lack of a clear divide between “unfunded” and funded research, because internal funding can be implicit or unrecorded, greatly complicate assessing the value of funding quantitatively at scale. The dimensions listed here should nevertheless help funding evaluators to consider as many differences as possible and list the remainder as limitations. They also serve as suggested information to collect for those compiling funding datasets.

IntroductionMechanical thrombectomy (MT) for acute ischemic stroke (AIS) combining intravenous (IV) or intra-arterial (IA) thrombolysis has been studied recently. However, no study has explored the outcomes of combining both IV and IA thrombolysis with MT.MethodsData from Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to 2023 was utilized. We compared AIS patients with LVO who underwent MT and combined IVT and IAT with those who underwent MT with IVT only. We performed propensity score (PS) matching between the two groups using age, sex, premorbid mRS, admission NIHSS, occluded vessel, ASPECTS score, time from symptoms onset to arterial puncture, and frontline technique. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) 0–2. Secondary outcomes included successful recanalization (mTICI ≥2C), early neurological improvement, any ICH, mRS 0–1, and 90-day mortality.ResultsA total of 2495 LVO-related AIS patients were included, consisting of the IA+IV group (n = 266) and the IV group (n = 2228). Propensity matching yielded 192 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.61–1.52, p = 0.60; OR: 0.92, 95% CI:0.42–2.03, p > 0.90, respectively). The IA+IV group had a significantly lower proportion of successful recanalization (OR:0.41, 95% CI: 0.27–0.62, p < 0.001), and early neurological improvement (OR: 0.55, 95% CI: 0.30–1.00). However, 90-daymRS 0–2, mRS 0–1, and mortality rates showed no significant differences between the two groups.ConclusionThis study suggests that the combined use of IAT and IVT in AIS patients undergoing MT is safe. Although the MT+IVT+IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes and mortality rates were comparable to the MT+IVT group, indicating a potential delayed benefit of additional IAT therapy.Disclosures R. Abo Kasem: None. S. Elawady: None. B. Mulpur: None. H. Matsukawa: None. C. Cunningham: None. M. Sowlat: None. A. Orscelik: None. N. Nawabi: None. J. Isidor: None. I. Maier: 3; C; speakers’ honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. S. Yoshimura: 6; C; received lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. A. Alawieh: None. A. Alaraj: 2; C; Consultant for Cerenovus. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. Investments in Galaxy Therapeutics. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. O. Tanweer: 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention Inc, Medtronic Inc. Educational/Research Grants: Q’apel Inc, Steinberg Foundation. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Consultant for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. Speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. M. Park: 2; C; Consultant for Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereota. W. Brinjikji: 1; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology. He rec. M. Moss: None. E. Daglioglu: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. Minor equity interest Vastrax, Borvo medical, Syn. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. Altschul: 2; C; Consultant for MicroVention, Stryker, and Cerenovus. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus. N. Goyal: None.

BackgroundFour recent randomized controlled trials demonstrated the efficacy and safety of mechanical thrombectomy (MT) for large vessel occlusion acute ischemic strokes (LVO-AIS) patients presenting with low Alberta Stroke Program Early CT Score (ASPECTS). However, these trials included very few patients aged over 80 years. In this study we aim to investigate whether elderly ischemic LVO-AIS patients with low ASPECTS benefit from MT.MethodsThis study used the data from the Stroke Thrombectomy and Aneurysm Registry (STAR), a prospectively maintained database of 49 thrombectomy-capable stroke centers in the US, Europe, and Asia between 2013 and 2023. LVO-AIS patients ≥ 80-year-old presenting with ASPECTS ≤ 5, who underwent MT for internal carotid artery (ICA), M1, or M2 segments of middle cerebral artery (MCA) occlusion. The primary outcome was 90-day favorable outcomes, defined as modified Rankin Scale [mRS] score of 0–3. Secondary outcomes included modified Thrombolysis in Cerebral Ischemia (mTICI) score, 90-day mortality and symptomatic intracranial hemorrhage (sICH).ResultsAmong the 10,229 patients who underwent mechanical thrombectomy, 101 met the inclusion criteria. Successful recanalization was achieved in 81 (80.2%) of patients. 19 (18.8%) patients experienced 90-day favorable outcomes, with 8 (7.9%) achieving an mRS score of 0–2. sICH occurred in 14 (13.9%) patients, and the 90-day mortality rate was 49.5%. Only 1 patient (5.6%) ≥ 90 years achieved a favorable outcome at 90 days, while 11 patients (21.2%) aged 80–84 years and 7 patients (22.5%) aged 85–89 did. Among all patients aged ≥ 80 years, multivariate analysis identified higher ASPECTS (aOR, 1.21; 95% CI, 1.09 - 1.35; p < 0.001) as a predictor of 90-day favorable outcome, but it is not associated with 90-day mortality (aOR, 1.02; 95% CI, 0.93 - 1.12; p = 0.70).ConclusionOur study highlights the efficacy and safety of mechanical thrombectomy for elderly patients aged ≥ 80 years presenting with low ASPECTS. However, for individuals aged ≥ 90 years, the decision to proceed with thrombectomy should be carefully considered on a case-by-case basis.Abstract E-077 Figure 1Percentages of sICH, good outcomes, and successful recanalization among different age groups of elderly patients with lows ASPECTS who underwent trombectomyDisclosures Z. Hubbard: None. C. Cunningham: None. S. Elawady: None. R. Abo Kasem: None. J. Isidor: None. H. Matsukawa: None. I. Maier: 3; C; speakers honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 3; C; lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. J. Grossberg: 1; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst,. 2; C; Consultant: Cognition, Imperative Care. A. Alawieh: None. A. Alaraj: 2; C; Consultant for Cerenovus. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. 4; C; Investments in Galaxy Therapeutics. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Consultant for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 1; C; Contact PI for NIH Grant R21NS128641. 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Speaker for Penumbra and Silk Road Medical. M. Park: 2; C; Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative. 4; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. W. Brinjikji: 2; C; Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 4; C; Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. M. Moss: None. E. Daglioglu: None. R. Williamson Jr.: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. 4; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. Altschul: 1; C; Research Support The Bee Foundation. 2; C; Consultant for MicroVention, Stryker, Q’apel, Synchron, and Cerenovus. 4; C; Investor Von Vascular,. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus.

IntroductionDespite comparable outcomes for different frontline techniques in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), there are sparse data regarding if and when to switch techniques if the first-pass MT is unsuccessful. We investigated the converting from one MT technique to another on the second MT attempt for AIS among patients with anterior circulation large vessel occlusion (LVO).MethodsThis was a retrospective observational study using data from the large multicenter international ‘anonymous’. Data from 29 stroke centers for 10,229 patients between January 2010 and December 2022 was investigated. The primary outcome measure was successful recanalization defined as a modified Thrombolysis in Cerebral Ischemia score ≥2b. 90-day modified Rankin score (mRS) 0–2, mortality and symptomatic hemorrhage were used as secondary outcomes. Clinical and technical outcomes after the second MT attempt were compared between those with or without technique conversion.Results1,797 patients with unsuccessful first-pass MT were included in this analysis. Converting to alternative techniques following an unsuccessful first-pass MT was more likely to be associated with successful recanalization at the second attempt (adjusted odds ratio 2.30, 95% CI: 1.37–3.86, P = 0.002) and 90-day good clinical outcome (adjusted odds ratio 2.10, 95% CI: 1.15–3.85, P = 0.02) after multivariate adjustment.ConclusionsThis study demonstrates better clinical and technical outcomes with the conversion of the MT technique for the second attempt in AIS patients with anterior circulation LVO and an unsuccessful first-pass MT.Disclosures H. Matsukawa: 2; C; B. Braun. 3; C; Daiichi-Sankyo, Stryker. K. Uchida: 3; C; Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, Medtronic. A. Alawieh: None. C. Matouk: 1; C; Contact PI for NIH Grant R21NS128641. . 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Speaker for Penumbra and Silk Road Medical. S. Al Kasab: None. M. Sowlat: None. S. Elawady: None. R. Abo Kasem: None. J. Isidor: None. I. Maier: 3; C; speakers honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H, RMS has an unrestricted research grant from Medtronic and Balt and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medic. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. 3; C; Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. D. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Educational/Research Grants: Q’apel Inc, Steinberg Foundation. 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. J. Mascitelli: None. I. Fragata: None. J. Osbun: None. R. Crosa: None. M. S. Park: 2; C; Consultant for Medtronic. M. R. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker;. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative. 6; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Ar. W. Brinjikji: 2; C; He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 6; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology, He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. M. Moss: None. T. Dumont: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. 6; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. 4; C; Investments in Galaxy Therapeutics. S. Yoshimura: 6; C; lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus.

IntroductionThe growing solid evidence of the efficacy of Mechanical thrombectomy (MT) for large vessel occlusion has expanded the field for more distal circulation stroke such as the medium vessel occlusion (MeVO), with currently ongoing clinical trials. Consequently, the effectiveness and safety of using IV-tPA as a bridging therapy for MT in MeVO has not been thoroughly investigated.MethodsIn this retrospective cohort, patients with MT on MeVO were selected using stroke thrombectomy & aneurysm registry (STAR) that includes data from 31 centers internationally. MeVO was defined as the involvement of A2, A3, M2, M3, P2, P3 segments. They were categorized into two groups based on IV-tPA administration. Propensity score matching was performed with the adjustment for sex, age, onset to groin Time, Alberta stroke program early CT score (ASPECTS), admission National Institutes of Health Stroke Scale (NIHSS), Pre-Stroke modified ranking scale (mRS), prior Stroke, and atrial fibrillation. Primary outcome was defined as achieving a 90-day mRS of 0–2. Secondary outcomes were successful recanalization (modified Thrombolysis in Cerebral Infarction ≥ 2b), 90-day mRS of 0–1, symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage within 24 hours (asymptomatic and symptomatic ICH), and mortality.ResultsOf the 10,730 stroke patients, 1,419 patients were found to have an MeVO that underwent mechanical thrombectomy. After conduction of propensity matching analysis, 259 were matched in each arm. Among 518 patients, 276(53%) were female and the median age was 71 of which 326(67%) were white, 92 (18.8%) black, 22(4.5%) Hispanic and 50(10.2) others. The median admission NIHSS Score was 12 (7–18) and the ASPECTS was 9 (8–10). There was no statistically significant difference in the 90-day mRS 0–2 [aOR 1.03(0.80–1.60), P= 0.48], and 90-day mRS 0–1 [aOR 1.09(0.76–1.55), P= 0.65]. Successful recanalization was achieved in 49.8% of MeVO with IV-tPA versus 50.2% in those without IV-tPA (P=0.78). ICH within 24 hours and mortality showed no statistically significant difference between the two groups, [aOR 0.98(0.66–1.43), P=0.90; aOR 0.68(0.43–1.06), P=0.09]. SICH was more observed in patients with IV-tPA [OR 2.43(0.99–5.96), P=0.04].ConclusionOur results suggest no benefit of bridging therapy with IV-tPA for improvement of favorable clinical outcome among patients with MeVO who underwent mechanical thrombectomy, and it was associated with higher rates of SICH.Abstract O-022 Figure 1Disclosures M. Sowlat: None. J. Isidor: None. L. Maniakhina: None. H. Matsukawa: 2; C; B. Braun. . 3; C; Daiichi-Sankyo, Stryker. C. M. Cunningham: None. S. Samir Elawady: None. R. Abo Kasem: None. A. Orscelik: None. I. Maier: 3; C; Pfizer, Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health (R01NS111119–01A1) and (UL1, RMS has an unrestricted research grant from Medtronic and Balt. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial., Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. 3; C; Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. E. A Samaniego: 2; C; Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 3; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Medtronic and Microvention. J. A. Grossberg: 1; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst. 2; C; Cognition, Imperative Care. A. Alawieh: None. A. Alaraj: 2; C; Cerenovus. M. Ezzeldin: 2; C; Viz.ai and Imperative care. 4; C; Galaxy Therapeutics. D. G. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Q’apel Inc, Steinberg Foundation. 2; C; Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. 6; C; Proctor: Microvention Inc, Medtronic Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 1; C; Speaker for Penumbra and Silk Road Medical. 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. M. S. Park: 2; C; Medtronic. M. R. Levitt: 1; C; nrestricted educational grants from Medtronic and Stryker. 2; C; Medtronic, Aeaean Advisers and Metis Innovative. 6; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Ar. W. Brinjikji: 2; C; He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 6; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular, He receives royalties from Medtronic and Balloon Guide Catheter Technology, He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. M. Moss: None. E. Daglioglu: None. R. Williamson Jr: 2; C; Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. 6; C; PI for Imperative Trial;. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. J Altschul,: 2; C; MicroVention, Stryker, and Cerenovus. A. M Spiotta: 2; C; Penumbra, Terumo, RapidAI, Cerenovus.

IntroductionThe optimal treatment for tandem large vessel occlusions (TOs) is unclear. This study compared balloon angioplasty plus carotid artery stenting (CAS) versus balloon angioplasty (BA) alone for managing TOs.MethodsThis retrospective study analyzed data from the Stroke Thrombectomy and Aneurysm Registry. The primary outcome was the 90-day functional outcome. Secondary outcomes included mortality and degree of revascularization. Safety outcomes included periprocedural complications. Inverse propensity scoring and regression adjustment (IPSWR) addressed non-random treatment selection. To correct for multiple hypothesis testing, especially with significant post-hoc changes, the Sidak (1967) correction to p-values will be utilized and the Sidak-adjusted p (ps) will be reported. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported.ResultsThe study included 244 TO patients, with 132 undergoing CAS and 112 undergoing BA. The CAS group had higher rates of successful reperfusion (95% vs 83.9% ORTUGA, p<0.001) but similar rates of good functional outcome and mortality compared to the BA group. IPSWR found no significant difference between CAS and BA for good functional outcome (ATE -0.13, 95% CI -0.29 to 0.02, p=0.08, ps=0.29), mortality (ATE 0.05, 95% CI -0.06 to 0.15, p=0.37, ps=0.87), or symptomatic ICH (ATE 0.04, 95% CI -0.05 to 0.13, p=0.40, ps=0.85). On Weighted regression, older age (aOR: 0.95, 95% CI 0.91–0.99; p=0.01, ps=0.15) and higher admission NIHSS (aOR: 0.93, 95% CI 0.87–0.99; p=0.02, ps=0.32) were associated with lower odds of functional independence. Intravenous thrombolysis was independently associated with higher odds of symptomatic Intracranial hemorrhage (sICH) (aOR: 6.62 [95% CI, 1.44 - 30.5]; p=0.02, ps=0.22), but not on its interaction analysis with CAS (aOR: 0.23 [95% CI, 0.03 - 1.89]; p=0.17, ps=0.95). Alberta Stroke Program Early Computed Tomography scores between 8–10 were associated with lower odds of sICH compared to 0–7 (aOR: 0.22 [95% CI, 0.07 - 0.69]; p=0.01, ps=0.14).ConclusionThis study found CAS and BA to be comparably safe and effective when combined with mechanical thrombectomy for TOs, but CAS tied to higher sICH from lower ASPECTS and IVT use, leaving uncertainty over the best approach. A limitation of our study is the statistical analysis when accounting for comparisons, mitigated by employing the Sidak-class method, revealing nonsignificant differences and emphasizing comparable functional outcomes between CAS and BA procedures. Nevertheless, further randomized trials are warranted to definitively determine the optimal endovascular approach.Disclosures M. Essibayi: None. E. Almallouhi: None. M. Anadani: None. R. Medeiros: None. S. Yaghi: 2; C; Nonfunded research collaboration with Medtronic. I. Maier: 6; C; Speakers honoraria from Pfizer and Bristol- Myers Squibb. P. Jabbour: None. J. Kim: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. 3; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. A. Shaban: None. A. Arthur: 1; C; Balt, Medtronic, Microvention, Penumbra and Siemens. 2; C; Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Perfuze, Scientia, Siemens, Stryker. S. Yoshimura: 2; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. B. Howard: None. A. Alawieh: None. I. Fragata: None. H. Cuellar: 2; C; Medtronic, Penumbra and Microvention. A. Polifka: 2; C; Depuy Synthes and Stryker. J. Mascitelli: None. J. Osbun: None. C. Matouk: 1; C; R21NS128641. 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. M. Park: 2; C; Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Cerebrotech, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. T. Dumont: None. R. Williamson: 2; C; Medtronic, Stryker, and Synaptive Medical. D. Altschul: 1; C; Grant from Bee foundation. 2; C; Microvention. A. Spiotta: 1; C; Research support from Penumbra, Stryker, Medtronic, RapidAI, Avail. 2; C; Penumbra, Stryker, Terumo, and RapidAI. Equity Avail. S. Al Kasab: 1; C; Grant from Stryker for RESCUE-ICAS registry.

IntroductionReal-world data showed that less than half of the acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (2–5) achieved favorable outcomes at 90 days after mechanical thrombectomy (MT). In this study, we aim to investigate the relationship between the number of MT passes at which successful recanalization is obtained and outcomes in LVO-related AIS patients with low ASPECTS.MethodsThis retrospective cohort study was performed on the data from 31 thrombectomy-capable centers between 2013 to 2022. Successful recanalization was defined as modified Thrombolysis in Cerebral Ischemia Score ≥ 2b. The primary outcome was a 90-day modified Rankin Scale (mRS) of 0–3. Secondary outcomes were symptomatic intracranial hemorrhage and intracranial hemorrhage within 24 hours and mortality at 90 days. Outcomes were compared among patients with unsuccessful recanalization, successful recanalization at first, second, third, and more than four passes.ResultsA total of 297 patients with a median age of 70 [IQR 59–78] years were included and 140 (47.1%) were female. In 239 (80.4%) patients, successful recanalization was achieved: 88 patients (29.6%) with 1 pass, 59 patients (19.9%) with 2 passes, 35 (11.8%) patients with 3 passes (11.8%), and 57 patients (19.2%) with more than 4 passes. Compared to unsuccessful recanalization, successful recanalization at first pass (adjusted OR 5.25, 95% CI 1.78 - 17.1), second passes (adjusted OR 5.20, 95% CI 1.68 - 17.6), and passes 4 (adjusted OR 4.90, 95% CI 1.68 - 17.6) was related to 90-day mRS 0–3. Recanalization status and MT attempt number were not related to secondary outcomes except for 90-day mortality. Compared to unsuccessful recanalization, successful recanalization at second and third passes were inversely related to 90-day mortality (adjusted OR 0.37, 95% CI 0.14 - 0.93; adjusted OR 0.33, 95% CI 0.11 - 0.95, respectively).ConclusionThe present results indicated that successful recanalization was related to 90-day good outcome regardless the number of MT passes but the odds of achieving favorable outcome declined with each pass.Disclosures M. Sowlat: None. S. Samir Elawady: None. H. Matsukawa: 2; C; B. Braun. 6; C; Daiichi-Sankyo, Stryker. J. Isidor: None. C. Cunningham: None. R. Abo Kasem: None. A. Orscelik: None. I. Maier: 6; C; Pfizer, Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health (R01NS111119–01A1) and (UL1, Medtronic and Balt. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial, Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant). 3; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. 6; C; Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. E. A Samaniego: 2; C; Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 6; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Medtronic and Microvention. J. A. Grossberg: 2; C; Cognition, Imperative Care. 6; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst. A. Alawieh: None. A. Alaraj: 2; C; Cerenovus. M. Ezzeldin: 2; C; Viz.ai and Imperative care. 4; C; Galaxy Therapeutics. D. G. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Q’apel Inc, Steinberg Foundation. 2; C; Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. 6; C; Microvention Inc, Medtronic Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Penumbra and Silk Road Medical. M. S. Park: 2; C; Medtronic. M. R. Levitt: 1; C; Medtronic and Stryker. 2; C; Medtronic, Aeaean Advisers and Metis Innovative. 6; C; Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical, editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. W. Brinjikji: 2; C; Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 6; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular, He receives royalties from Medtronic and Balloon Guide Catheter Technology, He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. M. Moss: None. E. Daglioglu: None. R. Williamson Jr.: 2; C; Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Imperative Care and Stryker Neurovascular. 4; C; Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Cerenovus, Stryker Neurovascular and Sim & Cure. 6; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc., PI for Imperative Trial. S. Chowdhry: 2; C; Medtronic, Microvention. D. J Altschul: 2; C; MicroVention, Stryker, and Cerenovus. A. M. Spiotta: 2; C; Penumbra, Terumo, RapidAI, Cerenovus.