South Georgia Medical Center

BACKGROUNDSimilar to many low‐ and middle‐income countries, the barriers limiting wider mechanical thrombectomy (MT) access in Georgia are largely unknown. Recently, the MT access score (MTAS) was introduced as a new tool for identifying and characterizing barriers to MT access. This study aimed to implement the MTAS in Georgia, a middle‐income country in Eastern Europe, to assess and characterize national barriers to MT.METHODSWe applied the MTAS, which comprises 12 weighted attributes, each scored on a 0–3 scale, resulting in a total score range of 0–36, 0 being the worst possible score. Eight members of the Mission Thrombectomy regional committee from different regions of Georgia were invited as panelists in this survey. The results of the survey are shown as a median with an interquartile range.RESULTSThe median MTAS for Georgia was 17. The lowest median scores were documented for 2 attributes: lack of prehospital large vessel occlusion‐specific screening [0.0 (0.0–0.0)] and telestroke networks [0.0 (0.0–0.0)], with 87.5% of panelists assessing the score as 0 for both attributes. The highest scores were obtained for emergency medical services use [3.0 (2.0–3.0)], availability of MT operators [2.0 (2.0–2.5)] followed by MT device availability and government/insurance coverage [2.0 (2.0–2.0) for each].CONCLUSIONMTAS is a valid tool for quantitatively assessing barriers to MT in Georgia. It identified a lack of information and the presence of physical barriers as major challenges. These findings underscore the need for targeted interventions through national stroke public health initiatives to improve access to MT.

BackgroundAppropriate use criteria (AUC) for coronary revascularization in patients with stable ischemic heart disease (SIHD) promote guideline-directed medical therapy, objective ischemia testing, and symptom-driven percutaneous coronary intervention (PCI). Despite national improvements, elevated rates of “rarely appropriate” (RA) PCI persist.Project RationaleBenchmarking at a community hospital revealed suboptimal performance on the AUC metric for RA PCI in patients with SIHD, with an average rate of 6.96% and a peak of 12.00%. This reflected gaps in documentation, ischemia assessment, and adequate medical therapy, highlighting the need for a performance improvement initiative.Project SummaryA multimodal intervention was implemented, integrating 4 key components: targeted education on AUC requirements, embedding AUC data fields into precatheterization templates, monthly case reviews, and promoting a “physiology-first” culture, with fractional flow reserve when noninvasive evidence was absent. The primary endpoint was the proportion of elective SIHD PCI cases classified as RA. After implementation, the average RA PCI rate decreased from 6.96% to 0% by the fourth quarter of 2023 and was sustained for 6 consecutive reporting quarters, through the first quarter of 2025.Take-Home MessageIntegrating AUC elements directly into clinical workflows supported by targeted education, a physiology-first approach, and continuous feedback can eliminate RA PCI in SIHD and sustain performance improvement over time.

Insulinomas are rare pancreatictumors that present with symptoms of hypoglycemia secondary to unregulated high levels of insulin. Literature has described thatrecurrent hypoglycemic events inducea sympathetic drive that could compromise cardiac function. Tumor resection eliminates the hypoglycemia source, halting the cycle of sympathetic overdrive and improving cardiac function. We present the case of a43-year-old patient who was hospitalized after a recent gastric bypass for recurrent episodes of confusion, mumbling, night terrors, and low glucose levels. She also had a chronic diagnosis of idiopathic dilated cardiomyopathy and heart failure with an ejection fraction of 30%. Imaging and laboratory studies demonstrated the presence of insulinoma. She underwent tumor resection with improvement in her exercise tolerance. Her ejection fraction improved from 30% to 35-40% eight months post-resection. This case is intended to review current data on the possible association between insulinomas and heart disease. To the best of our knowledge, our report stands out as one of the few case studies available that explores this potential association. It is crucial to recognize that tumor resection can significantly enhance cardiac function, making it imperative to thoroughly investigate the diverse cardiovascular effects linked to insulinomas.

Werner syndrome (WS) was first described in 1904 by German physician Otto Werner. This is a rare autosomal recessive disorder characterized by premature aging and higher cancer risk. This is one of the few adult-onset syndromes of accelerated aging in which patients generally develop normally until they reach adolescence. The first sign, often recognized retrospectively, is a lack of a growth spurt and a relatively short stature as adults. WS patients are characterized by a defective gene product, WRN, that plays an instrumental role in the genomic stability of DNA structures. It typically manifests in late adolescence or early adulthood, leading to premature aging, age-related disorders like diabetes, and myocardial infarction, and an increased propensity for developing sarcomas, melanoma, and solid tissue cancer. We present a rare case of an 80-year-old female with WS developing five different primary cancers over a decade namely basal cell carcinoma (BCC) of the face, left-sided urothelial carcinoma, right-sided triple-negative breast cancer (TNBC), right-sided invasive colonic adenocarcinoma, and pancreatic intraductal papillary mucinous neoplasm (IPMN). The patient’s family history is significant for early-stage cervical cancer in her daughter and for diabetes and hypertension in her mother and sister. Our case report is unique in presentation it defies the expected life expectancy of the 50s seen in WS, with the patient currently exhibiting a stable clinical course. The development of five distinct malignancies diagnosed over 14 years in an individual well beyond the typical age of death for WS highlights both the intrinsic genetic factors as well as the extrinsic biological environment playing a significant role in survival. This case highlights the need for further research into the mechanisms behind extended lifespan and atypical tumor spectra in such patients, as well as the development of tailored therapeutic strategies, particularly with regard to chemotherapy.

Introduction(Cerebral arteriovenous malformations (AVMs) represent a complex vascular disorder, with an annual hemorrhage risk of 1-4%. While intracranial hemorrhage and ischemic stroke are recognized complications, post-embolization intracranial infections are underreported.)Case Description(A 37-year-old immunocompetent male presented in March 2022 with new-onset headache, memory impairment, weakness, and seizures. Evaluation revealed a giant (63×51mm) left frontal lobe AVM (Spetzler–MartinV, Buffalo score _5 points). Its blood supply originated from the internal and common carotid arteries, as well as vertebral arteries, drained through superficial and deep veins into the sagittal and transverse sinuses and was accompanied by a 13.1 × 13.6 mm deep vein aneurysm.Two sequential embolizations were performed with ’Onyx’ over several months. In June 2023, he developed motor aphasia, facial asymmetry, right hemiparesis, and fever, with MRI revealing an abscess causing midline shift. Surgical drainage revealed Enterohemolytic Escherichia coli (EHEC) sensitive to antibiotics. Despite antibiotic therapy (Amoxicillin-clavulanate 1.2gx2 daily) and initial improvement, recurrent abscesses persisted. Consequently, in April 2024, complete excision of the AVM was performed to prevent further recurrences.ResultsThe absence of previous illnesses or gastrointestinal issues, no infection upon whole-body examination, and normal blood tests (the patient declined lumbar puncture) distinguish this case from other rare instances of EHEC abscesses in medical literature. Prolonged, repetitive endovascular procedures and substantial embolization material usage can exacerbate inflammation and thrombus formation, increasing the risk of infectious complications post-surgery. Broader considerations beyond antibiotherapy or drainage and early total AVM removal, including its embolic material upon infection detection, may be advisable. P037 Figure 1–4 P037 Figure 5–8

Introduction(Cerebral arteriovenous malformations (AVMs) represent a complex vascular disorder, with an annual hemorrhage risk of 1-4%. While intracranial hemorrhage and ischemic stroke are recognized complications, post-embolization intracranial infections are underreported.)Case Description(A 37-year-old immunocompetent male presented in March 2022 with new-onset headache, memory impairment, weakness, and seizures. Evaluation revealed a giant (63×51mm) left frontal lobe AVM (Spetzler–MartinV, Buffalo score _5 points). Its blood supply originated from the internal and common carotid arteries, as well as vertebral arteries, drained through superficial and deep veins into the sagittal and transverse sinuses and was accompanied by a 13.1 × 13.6 mm deep vein aneurysm.Two sequential embolizations were performed with ’Onyx’ over several months. In June 2023, he developed motor aphasia, facial asymmetry, right hemiparesis, and fever, with MRI revealing an abscess causing midline shift. Surgical drainage revealed Enterohemolytic Escherichia coli (EHEC) sensitive to antibiotics. Despite antibiotic therapy (Amoxicillin-clavulanate 1.2gx2 daily) and initial improvement, recurrent abscesses persisted. Consequently, in April 2024, complete excision of the AVM was performed to prevent further recurrences.ResultsThe absence of previous illnesses or gastrointestinal issues, no infection upon whole-body examination, and normal blood tests (the patient declined lumbar puncture) distinguish this case from other rare instances of EHEC abscesses in medical literature. Prolonged, repetitive endovascular procedures and substantial embolization material usage can exacerbate inflammation and thrombus formation, increasing the risk of infectious complications post-surgery. Broader considerations beyond antibiotherapy or drainage and early total AVM removal, including its embolic material upon infection detection, may be advisable. P071 Figure 1–4 P071 Figure 5–8

Nuclear KIFC1 (nKIFC1) predicts worse outcomes in breast cancer, but its prognostic value within racially distinct triple-negative breast cancer (TNBC) patients is unknown. Thus, nKIFC1 expression was assessed by immunohistochemistry in 163 African American (AA) and 144 White TNBC tissue microarrays (TMAs) pooled from four hospitals. nKIFC1 correlated significantly with Ki67 in White TNBCs but not in AA TNBCs, suggesting that nKIFC1 is not merely a surrogate for proliferation in AA TNBCs. High nKIFC1 weighted index (WI) was associated with significantly worse overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) (Hazard Ratios [HRs] = 3.5, 3.1, and 3.8, respectively; P = 0.01, 0.009, and 0.007, respectively) in multivariable Cox models in AA TNBCs but not White TNBCs. Furthermore, KIFC1 knockdown more severely impaired migration in AA TNBC cells than White TNBC cells. Collectively, these data suggest that nKIFC1 WI an independent biomarker of poor prognosis in AA TNBC patients, potentially due to the necessity of KIFC1 for migration in AA TNBC cells.

81 Background: The Georgia Cancer Control Consortium’s Survivorship Working Group conducted a needs assessment to understand physical, psychological, practical, and spiritual needs of adult survivors. Results were used to assess survivors’ level of distress and how effectively their needs were being met. Methods: Cross-sectional online and paper-based surveys developed using NCCN and Commission on Cancer (CoC) guidelines. Surveys were distributed through survivorship programs of CoC hospitals (n = 40) and cancer organizations via email, social media and mail. 740 responses received September-December 2014. Results: Respondents were primarily female (78%) married (65%), college-educated (55%) and insured (97%). 83% were White,16% were African American and 3% were Hispanic. 36% of respondents were within 1 year of treatment; 45% were 1 - 5 years post treatment. Survivors reported positive experiences with provider communication. Responses of ‘often’ or ‘very often’ were: provider gave them a chance to ask questions (90.6%); provider involved them in healthcare decisions (84.7%), provider spent enough time with them (78.5%) and provider helped with feelings of uncertainty about health issues or treatment (75.7%). Physical and emotional needs were not as effectively met as spiritual or practical needs. A higher proportion of survivors reported moderate to extreme levels of emotional distress with: depression (32.7%), anxiety (32.1%), stress (30.2%), fear of recurrence (28.2%) and defining a “new normal” (25.9%). 81% of survivors found information and assistance online (56%), in print materials (41%) and from providers/cancer centers (41%). 37% received a survivorship care plan (SCP); 98% reported the SCP was helpful. Conclusions: Results demonstrate the need for providers in Georgia to be educated about and responsive to survivors’ unmet needs and levels of distress. Survivors report positive communication with providers but lower levels of having physical and emotional needs addressed. Survivors actively seek resources and benefit from SCPs. Providers can contribute to addressing needs and reducing distress by maintaining strong communication, guiding survivors to evidence-based resources and implementing SCPs.