bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP12: Changes in Plasma Metabolites Reflect Lesional Iron Content and Permeability Imaging as Monitoring Biomarkers of Hemorrhage in Cavernous Angiomas
Authors: Hage Stephanie , Bi Dehua , Vera cruz Diana , Xie Bingqing , Kinkade Serena , Little Jessica , Sidebottom Ashley , Alcazar-Felix Roberto , Lee Juhyon , Stadnik Agnieszka , Shenkar Robert , Carroll Timothy , Girard Romuald , Ji Yuan , Awad Issam A
Published: February 2024

Background:
Increase in mean lesional iron content (≥6%) measurement by QSM and vascular permeability (≥ 40%) assessed by DCEQP MRI have been associated with new bleeding in cavernous angiomas (CA), and are used as monitoring biomarkers in clinical trial of pharmacotherapy in CAs with symptomatic hemorrhage (SH). Plasma metabolites have been associated with CA in unsupervised discovery, and linked mechanistically to the permissive microbiome and angiogenic and inflammatory mechanisms in CAs. To date, their levels change has not been compared to lesional QSM and DCEQP change during prospective monitoring.

Methods:
Fifty-nine paired plasma samples and MRI sequences were simultaneously acquired in 46 subjects at beginning and end of 1-year epochs in prospective follow-up of cases with CA enrolled in clinical trial after SH. Plasma levels of 14 metabolites previously associated with CA were assayed by liquid-chromatography mass spectrometry, and their changes were compared to changes in mean lesional QSM and DCEQP during the same epochs. Univariate correlations were followed by multivariate analyses combining multiple metabolites levels to minimize Akaike Information Criterion (AIC) or increase R
2
. Accuracy (AUC on receiver operating curves) and sum of squared error (SSE) are reported for associations achieving statistical significance with FDR correction.

Results:
Aceltyl.L.carnitine absolute change was correlated with QSM absolute change (p=0.01). Highest accuracy for lesional ΔθΣμ ινχρεασε ≥6% was reported for the absolute change of Arachidonic Acid + LPE.18.0 (AUC 99.7%; SD 0.003; p0.01). Relative change of Arachidonic Acid + Hypoxanthine + Piperine, and absolute change of LPE.18.0 + Pipecolic Acid + Piperine had the highest accuracy (AUC 99.1%; SD 0.008 and 98.0%; 0.013) for lesional DCEQP increase of ≥40%. Relative change in Phenylacetylglutamine and LPE.18.0+Piperine reported the lowest SSE (9.77; 438.33) with respective QSM and DCEQP relative change

Conclusion:
Changes in circulating metabolites accurately reflect changes in lesional iron content and permeability in CASH during yearly follow-up. Results are a proof of concept that blood tests could replace more complex and costly imaging biomarkers in monitoring CA hemorrhage.
Abstract TP134: White Matter Disease and Patterns of Infarction: A Single Center Study
Authors: Penckofer Mary , Koneru Manisha , Vigilante Nicholas , Wolfe Jared , Kamen Scott , Zhang Linda , Elgendy Omnea , Kalladanthyil Abyson , Ackerman Jiyoun , Kazmi Khuram , Khalife Jane , Schumacher Hermann , Siegler James E
Published: February 2024

Background:
Patterns of acute cerebral infarction can often reveal the underlying mechanism of ischemic injury. Despite the strong overlap between vascular risk factors and embolic infarct mechanisms (with multifocal infarct patterns), acute multifocal subcortical infarcts may be related to microangiopathic changes.

Methods:
A prospective stroke registry was queried for patients with acute infarction in >1 vascular territory on diffusion-weighted imaging (unrelated to any endovascular procedure). The odds of a multi-infarct subcortical pattern (vs. cortical pattern) were estimated for patients with higher Fazekas grade (2-3) versus low grade (0-1) patients using forward stepwise logistic regression with greatest minimization of corrected Akaike information criterion including all demographic covariates.

Results:
Out of 746 patients with acute infarcts and complete covariate data, 226 patients (30.3%) had a multi-infarct pattern, of whom 113 (50.0%) had high grade (Fazekas 2-3) white matter disease. Compared to patients with grade 0-1 Fazekas score, those with grade 2-3 more frequently had multifocal subcortical infarcts (4.4% vs. 10%, p=0.01). Following multivariable adjustment, the odds of multifocal subcortical infarcts were greater for patients with higher Fazekas grades (adjusted odds ratio [OR] 2.9, 95% confidence interval [CI] 1.3-6.7). The higher odds of multifocal subcortical infarcts were observed in a stepwise fashion for each Fazekas grade when compared to grade 0 (adjusted OR for grade 3 10.1, 95% CI 1.2-84; grade 2 OR 9.4, 95% 1.2-75.6; grade 1 OR 4.9, 95% 0.6-40.4).

Conclusions:
In this single center analysis we found that white matter burden is correlated with subcortical patterns of multifocal cerebral infarction. This suggests such infarcts may be caused by uncontrolled vascular risk factors rather than a proximal embolic source when chronic white matter disease is present.
Abstract TP146: Collateral Status-Based Model for Hemorrhagic Transformation in Successfully Recanalized Medium Vessel Occlusions
Authors: Koneru Manisha , Hoseinyazdi Meisam , Greene Cynthia , Dmytriw Adam A , Guenego Adrien , Heit Jeremy J , Albers Greg W , Nael Kambiz , Xu Risheng , Urrutia Victor C , Marsh Elisabeth B , Leigh Richard , Llinas Rafael H , Hillis Argye E , Yedavalli Vivek
Published: February 2024

Introduction:
Collateral status imaging parameters are associated with predicting hemorrhagic transformation (HT) in acute ischemic stroke caused by large vessel occlusions. The purpose of this investigation is to examine the association between imaging biomarkers of poor collateral status and HT occurrence in distal medium vessel occlusion (DMVO) stroke patients.

Methods:
Data from two comprehensive stroke centers between 2019 and 2023 were retrospectively reviewed for acute ischemic stroke patients with M2-M4 segment middle cerebral artery occlusions. For inclusion, patients must have been successfully recanalized by mechanical thrombectomy with or without intravenous thrombolytic and ultimate modified thrombolysis in cerebral infarction (mTICI) score 2B/2C/3. Occurrence of HT was determined from post-interventional imaging, and HT subtype was defined by the ECASS 2 criteria. Significant univariate predictors were included in a forward stepwise logistic regression for outcome of HT, and adjusted odds ratios (aOR) were reported.

Results:
Of 60 patients, 17 (28.3%) patients had HT. Average age was 74 [IQR 64-81] years, 34 (56.7%) were female. The multivariate model (area under curve = 0.93) had three significant predictors: diabetes mellitus (aOR 36.5, 95% CI 4.9-272.2, p<0.001); proximal versus distal occlusion (reference: distal, aOR 0.06, 95% CI 0-0.4, p=0.006); CBV index (aOR 0.0002, 95% CI 0-0.1, p=0.007).

Conclusions:
Lower CBV index (a marker of poor collateral status), presence of distal occlusions, and history of diabetes mellitus are significant predictors associated with increased odds of HT in successfully recanalized DMVO stroke patients. Larger studies are necessary to further validate our findings.
Abstract TP148: The Hemispheric-Aspects Scale: An Expanded Scan Assessment System Appropriate for ICA Occlusions
Authors: Rodriguez Maria Paz , Taleb Shayandokht , Lee Jenny J , Liebeskind David S , Saver Jeffrey L
Published: February 2024

Background:
Distinctive aspects of acute ischemic stroke (AIS) due to internal carotid artery occlusion (ICAO) include severe presenting deficits, extensive infarct volumes, frequent poor functional outcome, and mortality. Decision-making for thrombectomy, hemicraniectomy, and palliative care depends crucially upon infarct extent but the most widely used current image rating scale, ASPECTS, assesses only 10 regions confined to the MCA field.

Methods:
We developed the hemispheric-ASPECTS (H-ASPECTS) rating scale that assesses the entire extent of the ICA-supplied brain. The 16-point H-ASPECTS score adds to original MC-ASPECTS (10 regions), assessments of 3 ACA regions, 2 supratentorial PCA regions (thalamus, occipital - potentially fetal ICA-supplied), and 1 anterior choroidal artery region (Figure). We rated initial and 24h CT/MR in consecutive AIS-ICAO patients.

Results:
Among the AIS-ICAO patients (n=17), age was 68.5 (±15.8), 52.9% female, NIHSS median 20 (IQR 14-22). Occlusion locations were: carotid T 47%; cervical 47%; isolated intracranial ICA 6%. Treatment included EVT ± IV lysis in 59% and hemicraniectomy in 6%. Time from last known well to 1st imaging was 9.6h and 2nd imaging 35h. On 1st imaging H-ASPECTS scores were median 12 (IQR 11-14); on 2nd imaging 10 (IQR 6.5-12.5). Involvement of regions outside MCA, detected by the H-ASPECTS, occurred in 47% of patients, including ACA in 35%, PCA in 12%, and AChA in 6%. Second image H-ASPECTS correlated strongly with discharge mRS, r=0.66 (p=0.007).

Conclusions:
H-ASPECTS expands the scope of AIS imaging scores, captured abnormalities outside the MCA field in 47% of patients with ICAO, and correlated well with discharge disability level outcome. The additional information H-ASPECTS provides may enhance decision-making in ICAO patients with large ischemic cores, including for endovascular thrombectomy and hemicraniectomy.
Abstract TP149: Pretreatment Parameters Predicting Excellent Recanalization of Large Vessel Occlusion in Patients With Acute Ischemic Stroke
Authors: Koneru Manisha , Hoseinyazdi Meisam , Greene Cynthia , Dmytriw Adam A , Guenego Adrien , Heit Jeremy J , Albers Greg W , Nael Kambiz , Xu Risheng , Urrutia Victor C , Marsh Elisabeth B , Leigh Richard , Llinas Rafael H , Hillis Argye E , Yedavalli Vivek
Published: February 2024

Introduction:
In large vessel occlusion (LVO) ischemic stroke patients, better functional outcomes are associated with achieving modified thrombolysis in cerebral infarction (mTICI) score 2C/3 in comparison to 2B. The purpose of this study was to identify pretreatment and interventional predictors of mTICI 2C/3 over 2B reperfusion in patients with LVOs treated successfully with thrombectomy.

Methods:
Data from two comprehensive stroke centers between 2019-2023 were retrospectively reviewed for LVO acute ischemic stroke patients treated successfully (mTICI 2B/2C/3) with thrombectomy. Primary outcome measure was achieving mTICI 2C/3 (i.e., excellent) revascularization. Demographic variables, CT perfusion parameters, and intervention-related parameters were evaluated as univariate regressors of primary outcome. Significant univariate predictors were included in a forward stepwise multivariate logistic regression, and adjusted odds ratios (aOR) were reported.

Results:
Of 149 patients, the median age was 70 years old (IQR: 65-78.5), and 57.7% were female. Multivariate logistic regression analyses (AUC = 0.79, 95% CI: 0.68-0.86, p<0.001) showed that patients had a higher likelihood of excellent recanalization with lower admission NIHSS (aOR 0.93, p = 0.036), no history of diabetes mellitus (DM) (aOR 0.42, p = 0.050), no prior stroke (aOR 0.27, p = 0.007), cerebral blood volume (CBV) index >= 0.7 (aOR 3.75, p = 0.007), and thrombectomy with aspiration alone (aOR 2.89, p = 0.012).

Conclusions:
Robust collateral status (as represented by CBV index), absence of diabetes mellitus, no prior stroke history, lower initial stroke severity, and aspiration thrombectomy were associated with increased likelihood of excellent recanalization amongst technically successfully revascularized LVO stroke patients. Preventative comorbidity management, collateral status on imaging, and thrombectomy technique may optimize chances for excellent recanalization.
Abstract TP169: Cannabidiol as a Therapy for Experimental Subarachnoid Hemorrhage
Authors: Whitnel Laura , Ferguson Robert , Fraser Justin , Roberts Jill
Published: February 2024

Subarachnoid hemorrhage (SAH), commonly caused by a ruptured aneurysm, carries a high rate of disability and death. Patients who survive the initial bleed continue to be at risk of secondary insults. Preclinical studies demonstrate SAH induces dysregulation of the cerebrovasculature and increases neuroinflammation, which contributes to early brain injury and delayed cerebral ischemia. Few treatment options currently exist for SAH patients, making it imperative to identify novel therapies to improve outcomes following SAH. Cannabidiol (CBD) has gained attention for its potential therapeutic properties and widespread mechanistic actions. First utilized for the treatment of pain, preclinical studies demonstrate CBD has anti-inflammatory, neuroprotective, and vascular stabilization properties in experimental models of injury. Our objective was to determine the novel therapeutic potential of CBD for SAH injury. Male and female C57Bl/6J mice were subjected to the endovascular perforation model of SAH and treated daily with CBD (10 mg/kg; intraperitoneal (i.p.)) or vehicle control. We demonstrate that fewer mice developed ischemic cortical infarcts following CBD treatment compared to controls, indicating CBD reduces the potential development of delayed cerebral ischemia following SAH. Consistently, we demonstrate a significantly lower mortality rate in animals treated with CBD following SAH. We also detected a CBD-mediated decrease in astrocyte and microglia activation 1-7 days post-injury, as well as reduced levels of iron (Prussian blue), which contributes to apoptosis and cognitive dysfunction. Overall, treatment with CBD following experimental SAH may act to normalize vascular and inflammatory responses to decrease mortality, risk of delayed infarcts, and neurodegeneration, though further investigation is required.
Abstract TP171: Nationwide Diurnal Pattern Among Intracerebral Hemorrhage Incidence and Volume
Authors: Sreekrishnan Anirudh , Lun Ronda , Albers Gregory W
Published: February 2024

Introduction:
Intracerebral hemorrhage (ICH) incidence follows both seasonal and diurnal patterns noted in the literature. These differences have been attributed to variations in the coagulation cascade, blood pressure, and sleep-wake cycle that all have their own noted rhythmicity. The purpose of this analysis was to validate these trends in a large nationwide database of automated ICH detection scans and evaluate for differences in hematoma volume by image acquisition time.

Methods:
Serial non-contrast head CT (NCHCT) data, processed with an automated imaging software (iSchemaView), was acquired from U.S. hospitals between 1/1/2020 and 12/31/2021. Final exclusion criteria included: (1) patient age ≤ 25, (2) hematoma volume ≥ 100 ml, (3) hematoma volume ≤ 0.4 ml. Imaging time was subdivided into three epochs: (1) Night: 23:00h-06:59h, (2) Day: 07:00h-14:59h, and (3) Evening: 15:00h-22:59h.

Results:
A total of 19,397 scans were included in the final analysis with a median ICH volume of 2.9 ml; 15.6% of these scans had volumes above 30 ml. Peak imaging occurred around noon. Hematoma volume was significantly different across timepoints (p = 0.003), with ICHs presenting at night (average volume 14.2 ml) larger than those presenting during the day (12.9 ml, p = 0.002) or evening (13.0 ml, p = 0.012).

Conclusion:
In this real world, multi-site data set, we show similar diurnal trends in ICH incidence and can detect subtle differences in volume based on time of imaging. Further research is required to elucidate the potential underlying mechanisms for these differences.
Abstract TP172: Rising Trends in Cervical Artery Dissection Admissions: A Nationwide Study From 2005 to 2019
Authors: Shu Liqi , Jacobson Austin , Xiao Han , Liao Steven , de Havenon Adam H , Nguyen Thanh N , Siegler James E , Salehi Omran Setareh , Goldstein Eric D , Khan Farhan , Stretz Hanns Christoph , Furie Karen L , Yaghi Shadi
Published: February 2024

Introduction:
A recent regional study suggested an upward trend in the incidence rates of spontaneous cervical artery dissection (sCAD). Utilizing a comprehensive nationwide database, we investigated these trends on a national scale.

Method:
We analyzed adult patients diagnosed with sCAD in the United States National Inpatient Sample database from 2005 to 2019, employing validated standard ICD-9 and ICD-10 diagnostic codes. By integrating the survey-weighted annual total of CAD cases with annual Census data, we estimated the incidence over the study period. The annualized percentage change (APC) over the study period was estimated using regression models and visually represented with an exponential regression line. Trends were further stratified by sex, age group, and race.

Result:
From 2005 to 2019, we identified 557,063,391 patients, of whom 125,102 (0.02%) had non-traumatic CAD. The incidence of CAD increased from 10.5 cases per million population in 2005 to 45.5 cases per million population in 2019 (
P
< 0.001), revealing a significant increase in admissions with CAD. Regression analysis estimated an APC of 9.6%, with a 95% CI of 8.4% to 10.7% (P < 0.001) (Figure). This upward trend persisted across all strata of sex, age, and race.

Conclusion:
Our nationwide analysis demonstrates a significant rise in admissions with CAD from 2005 to 2019 across all demographic groups. The change in trend could be attributed to greater disease awareness leading to more frequent coding of CAD diagnoses, and/or to increased use of CT angiogram coinciding with the rise of mechanical thrombectomy for stroke. This underscores CAD's increasing clinical prevalence, warranting further investigation into its causes, prevention, and treatment.
Abstract TP179: Reversible Cerebral Vasoconstriction Syndrome (RCVS): A Retrospective Analysis of 79 Cases
Authors: Jacobson Samuel , Ramaswamy Srinath , Marshall Randolph
Published: February 2024

Background:
RCVS is characterized by severe thunderclap headaches often triggered by medications or sexual activity. Convexity subarachnoid hemorrhage, and less commonly, ischemic stroke and intracerebral hemorrhage can occur. There are few studies of the clinical-imaging features of RCVS (Singhal, 2011; Ducros, 2007). The pathogenesis is yet to be understood, and further studies looking into various triggers and outcomes, such as our present one, is essential to characterize the condition and develop targeted treatments.

Methods:
We performed an EMR search (2012-2023) for patients over 18Y of age with a diagnosis of RCVS in inpatient and outpatient settings. We retrospectively analyzed clinical (demographics, triggers, and discharge mRS)) and imaging features (CTA, MRA, DSA, and transcranial doppler (TCD)) to confirm RCVS diagnosis. RCVS score was calculated. Discharge mRS was inferred from EMR. Diagnosis adjudication was performed by RSM. Student t-test and Chi-square test were used to analyze outcomes.

Results:
Seventy-nine patients were identified (mean age 40±11.5Y, 91% women). The most common triggers were medications (39%), sexual activity (11.4%), and marijuana use (5%). One-third (35%) had chronic headache history (migraines 22%). Twenty-nine (37%) were postpartum (n=19) or pregnant (n=10). Fourteen had concurrent pre-eclampsia (17%). Twelve (15%) also had imaging features of posterior reversible encephalopathy syndrome (PRES). Vasoconstriction was seen on DSA (n=15), CTA (n=25), and MRA (n=23); In 14 patients, vasoconstriction was evident only on TCD. SAH occurred in 26 (33%), ischemic stroke in 8, and ICH in 9. Median RCVS score was 7 (IQR 6-9, range 4-10). CSF profile (n=19) was normal, aside from mildly elevated lymphocyte count (n=2, range 10-13 cells) or protein (n=5, range 50-80 mg/dL). Discharge mRS was 0-1 in 83%. Patients without RCVS trigger (n= 40) had higher ischemic stroke or hemorrhage occurrence (
χ2
= 3.8,
P=0.05
). RCVS scores in pregnant/postpartum patients were similar to others (
t
= 2.01,
P
= 0.06).

Conclusion:
In this case series, absence of an RCVS trigger was associated with occurrence of stroke or hemorrhage. Most patients had favorable prognosis. These findings need to be confirmed in prospective studies.
Abstract TP190: Higher Pre-Hospital Blood Pressure is Associated With Lower Mismatch Volume and Poorer Collateral Status in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusions
Authors: Galecio-Castillo Milagros , Quispe-Orozco Darko , Farooqui Mudassir , Begunova Liza , Dibas Mahmoud , Vivanco-Suarez Juan , Rodriguez Aaron , Petersen Nils H , Ortega-Gutierrez Santiago
Published: February 2024

Introduction:
Immediately after AIS onset, blood pressure variability (BPV) arises as the result of a complex interplay between brain and systemic physiological hemodynamic responses. In this study, we examined the effect of BPV on early infarct growth in patients with large vessel occlusions (LVO) during their prehospital transfer.

Methods:
We included consecutive patients with AIS-LVO from 2 large comprehensive stroke centers. We collected the BP values from emergency medical services arrival to hospital admission. Patients with <3 BP recordings were excluded. BPV was assessed using the standard deviation (SD) of the systolic (SBPv), diastolic (DBPv), and mean BP (MBPv). Initial infarct volume (IIV) was defined as rCBF <30%, penumbra area as time to maximum concentration (Tmax) >6s, and mismatch volume as the difference between these two volumes (Tmax 6 - rCBF<30%). Collateral status was evaluated using the hypoperfusion intensity ratio (HIR), defined as the Tmax>10s/Tmax>6s ratio. We used linear regression to investigate associations between these variables, using log-transformation to achieve normality, and final exponentiation for a better interpretability of the results.

Results:
We included 171 patients, mean age was 70.9± 13.7, 51.5% female, 88.3% white, median NIHSS was 15. Mean BP: SBP=12.37
+
6.8, DBP=10.2
+
7.1, and MBP=8.9
+
5.9. CTP values: rCBF >30% (5 [IQR 0.001 - 22]), Tmax >6s (103 [60.5 - 158.5]), and HIR (0.38 [0.17 - 0.54]). Higher SBP variability was significantly associated with lower mismatch volumes. Furthermore, higher SBP tertiles were associated with worse collaterals (high HIR)
(Figure)
.

Conclusion:
Pre-hospital BPV is associated with lower mismatch volume, likely mediated by the effect of BP on collateral status. Our findings are consistent with previous studies; the association between higher pre-treatment blood pressure and poorer collaterals might be due to an imbalance in the need of increasing perfusion to the ischemic tissue.
Abstract TP195: Impact of Intracranial Atherosclerotic Disease on Thrombectomy Outcomes in Acute Cerebral Infarction With Large Vessel Occlusion
Authors: Nakada Ryoji , Sakuta Kenichi , Okumura Motohiro , Kida Hiroyuki , Kitagawa Tomomichi , Takatsu Hiroki , Sato Takeo , Miyagawa Shinji , Komatsu Teppei , Sakai Kenichiro , Mitsumura Hidetaka , Yaguchi Hiroshi , Iguchi Yasuyuki
Published: February 2024

Introduction:
In acute cerebral infarction with Large Vessel Occlusion (LVO), Intracranial Atherosclerotic Disease (ICAD) often causes vascular occlusion. Previous studies have noted that ICAD-related LVOs, compared to embolic occlusions, have longer procedural times and lower successful reperfusion rates. However, clinical outcomes remain similar. This study compares post-thrombectomy outcomes in both groups, matched by initial NIHSS scores.

Method:
From October 2017 to March 2023, we studied LVO cases undergoing thrombectomy for acute ischemic stroke. Our primary focus was on evaluating thrombectomy outcomes within two distinct groups— ICAD-related LVO group (ICAD group) and Embolic LVO group (Embolic group)—matched based on preoperative NIHSS scores. ICAD group was defined as persistent occlusion or residual stenosis at the initial occlusion site. Patient outcomes at 3 months were assessed using modified Rankin Scale (mRS) scores, defining devastating outcomes as mRS 5-6. Successful recanalization was defined as Thrombolysis in Cerebral Ischemia score ≥2b. Logistic regression identified factors independently associated with devastating outcomes.

Result:
Analyzing 2407 cases, we extracted matched pairs (33 each) adjusted by NIHSS. ICAD group had lower atrial fibrillation frequency, lower BNP levels, more M1 occlusions, and fewer M2 occlusions compared to the Embolic group. In treatment outcomes, ICAD group had lower successful recanalization (82% vs 43%,
P
=0.001), higher reocclusion rates (0% vs 21%,
P
=0.005), and longer puncture-to-reperfusion time (median 51 vs 88 minutes,
P
<0.001). Devastating outcomes were higher in ICAD group (15% vs 39%,
P
=0.027). Multivariate analysis showed ICAD's independent association with devastating outcomes (Odds ratio, 6.54; 95% CI, 1.56-27.4;
P
=0.010) along with age, NIHSS, and tPA absence.

Conclusion:
In thrombectomy-treated LVO patients, matching based on admission NIHSS scores revealed significantly higher devastating outcomes in the ICAD group when compared to the Embolic group.
Abstract TP196: Ischemic Stroke With Large Vessel Occlusion and Systemic Acidosis: Associations With Functional Outcomes and Mortality
Authors: Andreev Alexander , Vu Stephanie , Young Michael , Awad Amine , Barrette Ryan , Cesanek Nicole , Hossain Ayesha , Forsman Daniel , Arora Rohan , Lioutas Vasileios-Arsenios , Regenhardt Robert
Published: February 2024

Introduction:
Systemic acidosis is common in critical conditions, including severe myocardial infarction, renal and liver injuries, and traumatic brain injury. However, the potential connection between ischemic stroke involving large vessel occlusion (LVO) and acidosis has not been extensively explored. With this study we aimed to assess the prevalence of respiratory and metabolic acidosis in ischemic stroke with LVO and their potential links to functional outcomes and mortality.

Methods:
Retrospective single center cohort of patients with ischemic stroke and LVO status post endovascular thrombectomy. Univariate logistic regression was used to examine the relationship between acidosis on admission and (1) hospital mortality and (2) 90-day modified Rankin Scale (mRS) dichotomized as unfavorable (>3) vs favorable (≤3). In addition, we investigated association with acidosis and symptomatic ICH. Metabolic acidosis was defined by the presence of one of the following: Serum bicarbonate <22 mEq/L, lactic acid >2 mmol/L or pH <7.35. Respiratory acidosis was defined by pCO2 >45 mmHg.

Results:
There was a total of 346 patients, average age was 68.5 (±15) years, 169 (49%) were females. 168 (49%) patients were acidotic on admission, 4 (1%) had respiratory acidosis, 7 (2%) had mixed acidosis and the remaining 157 (45%) had metabolic acidosis. There was no statistically significant association between systemic acidosis with either hospital mortality (p=0.31]) or 90-day favorable functional outcome (p=0.23]). There was no association between acidosis with symptomatic ICH (p=0.47).

Conclusion:
In our retrospective cohort study, we observed that approximately half of the patients with stroke and LVO had systemic acidosis. Unlike other critical neurological conditions like traumatic brain injury, we did not identify a substantial correlation between systemic acidosis and either mortality or the functional outcome at the 90-day mark. Given the high prevalence of acidosis in patients with LVO, larger multi-center studies are needed to further investigate its association with the outcomes and mortality.
Abstract TP198: Factors Associated With Need for Decompressive Hemicraniectomy After Mechanical Thrombectomy in Stroke Patients
Authors: Elawady Sameh Samir , Cunningham Conor , Matsukawa Hidetoshi , Uchida Kazutaka , Sowlat Mohammad-Mahdi , Lee Nawabi Noah , Zandpazandi Sara , Orscelik Atakan , Maier Ilko , Jabbour Pascal M , Kim Joon-Tae , Quintero Stacey C , rai ansaar , Starke Robert , Psychogios Marios , Shaban Amir , Arthur Adam S , Yoshimura Shinichi , Cuellar Hugo , Howard Brian , Alawieh Ali M , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles C , Park Min S , Levitt Michael , Brinjikji Waleed , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade A , Chowdhry Shakeel A , Ezzeldin Mohamad , Spiotta Alejandro M
Published: February 2024

Background:
Mechanical thrombectomy (MT) has significantly reduced morbidity and mortality in acute ischemic stroke (AIS). This study aims to analyze the outcomes and factors associated with decompressive hemicraniectomy (DHC) in AIS patients who underwent MT.

Methods:
We retrospectively analyzed data from an ongoing, multicenter database to investigate AIS patients who underwent MT for ICA, M1, or M2 occlusion. We compared clinical and procedural variables between patients who underwent DHC and those who did not. Propensity score (PS) matching between the two groups was conducted using age, sex, admission NIHSS, occluded vessel, ASPECTS, time from symptoms onset to arterial puncture, intracranial hemorrhage (ICH), and symptomatic ICH (sICH).

Results:
Among the 3,135 MT patients who met our inclusion criteria, 113 underwent DHC. A 1:3 propensity matching yielded a well-matched cohort of 113 in the DHC group versus 339 in the non-DHC group. The DHC group had a significantly higher rate of successful recanalization (mTICI ≥ 2C) (175 [51.6%] versus 36 [31.9%], P < 0.001) and a longer procedure duration, with a median of 30 minutes (IQR: 17-54) compared to 44 minutes (IQR: 25-78) in the non-DHC group (P = <0.001). Further comparison of patients with low ASPECTS (≤ 5) who underwent DHC (n = 36) with those who did not (n = 99) showed no significant difference in successful recanalization rates (15 [41.7%] versus 43 [43.4%], P > 0.90). However, procedure duration was significantly longer in the DHC group with a median of 29 minutes (IQR: 13-52), compared to 39 minutes (IQR: 27-86) in the non-DHC group (P = 0.02).

Conclusions:
Successful recanalization can help in preventing DHC in AIS patients with high ASPECTS, but not those with low ASPECTS. Procedure duration is independently related to DHC following MT, especially in low ASPECTS patients.
Abstract TP20: Microglial-Derived Extracellular Vesicles Protect From Neonatal Arterial Focal Stroke
Authors: Fukuzaki Yumi , Faustino Joel , Vexler Zinaida S
Published: February 2024

Background:
The developmental stage of the brain at the stroke onset plays a key role in the pathophysiology of injury, with neuroinflammation as a major injury modulator (Rayasam et al 2022; Hagberg et al. 2015). We reported that in the neonatal brain microglia secrete extracellular vesicles, exosomes and microvesicels, under physiological conditions and that microglial activation after transient MCA occlusion (tMCAO) in postnatal day 9 (P9) mice alters “cargo” of microglial-derived extracellular vesicles (MEV) and increases MEV uptake by microglia in vitro (Lecuyer et al., Neurobiol Dis. 2021). Here, we examined whether MEV administration protects the neonatal brain from stroke.

Methods:
P9 C57BL6 mice were subjected to a 3h tMCAO, microglia isolated from naïve mice and from injured (Inj) and contralateral (Contra) regions 24h after reperfusion using CD11b-conjugated beads, and cultured for 4 days in10% exosome-free FBS. MEV were purified from culture medium by multistep centrifugation [x300 g (Phase1, p1), x1,200 g (p2), x12,000 g (p3), and x100,000 g (p4)], concentration determined by Nanosight, MEV labelled with Claret-FR. MEV uptake by microglia from Inj and Contra regions was examined in vitro. 0.5 or 3.0 x 10
8
MEV were injected retro-orbital 2h after reperfusion. Behaviour outcomes (24h) and injury (at 4 days) were determined.

Results:
Post-vivo, uptake of p4C or p4I was increased by microglia from Inj, but not from Contra regions and reduced cell size and morphology within 30 min. Administration of p4-MEV from naïve (p4N-MEV), Contra (p4C-MEV) or Inj (p4I-MEV) regions significantly improved performance on Open Field test and reduced injury, whereas p3N-MEV did not affect inury. MEV increased survival (100%) compared to non-treated (77%) and vehicle-treated (83%) mice. We are defining p4 and p3 identity (exosomes Vs. microvesicles).

Summary:
p4-MEV but not p3-MEVprotect from neonatal stroke.

Funding:
R01 NS44025, R01 HL139685, R21 NS098514
Abstract TP205: Intracranial Stenting With Mechanical Thrombectomy in Acute Ischemic Stroke in the United States
Authors: Abdurashidova Megan , Khatibi Kasra , Ponce Luciano , Warach Steven J , Saber Hamidreza
Published: February 2024

Background and Purpose:
Large vessel occlusion secondary to intracranial atherosclerotic disease (ICAD-LVO) has an estimated prevalence of 10-30%. Registry-based reports from high volume centers indicate that about 4-7% of mechanical thrombectomy (MT) due to LVO are accompanied with intracranial rescue stenting in the US, yet the trend and utilization of rescue stenting in US is unknown.

Methods:
Analysis of US National Inpatient Sample of strokes with mechanical thrombectomy with or without concomitant intracranial stenting from October 1st, 2016, to December 31st, 2020, was performed. Patient- and hospital-level characteristics were analyzed. Outcomes included favorable disposition (discharged to home) and in-hospital mortality.

Results:
Among 68,975 of stroke MT with recorded NIHSS during the study period (51.1% women; mean age, 69.1 [SD, 14.6] years; mean NIHSS score of 15.1 [SD, 7.7]), 1,635 (2.3%) underwent concomitant intracranial stenting (44% women; mean age, 64.8 [SD, 13.7] years; mean NIHSS score of 13.8 [SD, 8.1]). Characteristics associated with intracranial stent utilization were male sex, history of diabetes, hypertension, or chronic kidney disease, absence of atrial fibrillation or CHF, and southern US region. Favorable outcome was achieved in 23.6% of MT with stenting versus 32.3% without stenting (P<0.001). In-hospital mortality occurred in 17.1% of MTs with stenting versus 10.5% without stenting (P<0.001). In multivariable analysis among MTs with concomitant intracranial stenting, favorable outcome was associated with lower presenting NIHSS (OR, 0.91 [95% CI, 0.87-0.95], P<0.001), and absence of DM (OR, 0.41 [95% CI, 0.20-0.85], P<0.01). In-hospital mortality was associated with male sex (OR, 3.08 [95% CI, 1.38-6.87], P=0.005) and concomitant IV lytic administration (OR, 2.45 [95% CI, 1.01-5.96], P=0.02).

Conclusions:
In US practice, less than 3/100 MT’s are performed with concomitant intracranial stenting which is well below the prevalence of failed thrombectomy rates due to underlying ICAD-LVO. Further studies are needed to improve outcomes in this subset of patients.
Abstract TP213: Predictors of Functional Independence Among Acute Ischemic Stroke Patients Treated With Intra-Arterial Thrombolysis as Adjunct to Mechanical Thrombectomy
Authors: Gillani Syed A , Ma Xiaoyu , Maqsood Hamza , Ahmed Rehan , Bains Navpreet , Fakih Rami , Siddiq Farhan , French Brandi R , Gomez Camilo R , Qureshi Adnan I
Published: February 2024

Background and Purpose:
Although intra-arterial thrombolysis (IAT) is widely used as adjunct with mechanical thrombectomy in acute ischemic stroke patients, the patients who are likely to benefit are not known. We analyzed real world data to identify acute ischemic stroke patients who are likely to benefit with IA as adjunct to mechanical thrombectomy.

Methods:
Acute ischemic stroke patients who underwent IAT with tissue plasminogen activator (tPA)/urokinase as adjunct to mechanical thrombectomy in the Trevo Retriever multicenter registry were analyzed. Primary endpoint was functional independence at 90 days post mechanical thrombectomy defined by a modified Rankin scale (mRS) of 0-2. We compared the variables including age, gender, pre-procedure National Institute of Health Stroke Scale (NIHSS) score, baseline Alberta Stroke Program Early CT (ASPECT) score, location of occlusion, procedure time, Thrombolysis in Cerebral Infarction (TICI) score pre- and post IAT, and number of thrombectomy passes.

Results:
A total of 145 patients treated with IAT tPA/urokinase after undergoing mechanical thrombectomy were analyzed. 74 patients (51%) had an mRS of 0-2 while 71 (49%) had an mRS of 3-6 (p=0.48). The procedure time for the patients in group A was 66.52±35.44 minutes as compared to group B, which was 99.01±62.97 (p=0.004). Pre-procedure NIHSS score, NIHSS at discharge, and baseline ASPECT scores were comparably lower for group A (p<0.001). Number of passes during thrombectomy correlated significantly with 90-day mRS with a value of 2.31±1.49 in group A and 3.25±2.01 in group B (p=0.002). Clot location, previous stroke, TICI scores, and stent location did not show any statistical significance.

Conclusion:
We did not identify any differences in mRS in patients who were treated with IAT after mechanical thrombectomy. Minimum procedure time and lesser number of passes for thrombectomy are related with good neurological outcomes at 90 days.
Abstract TP231: Incidence of Stroke and Transient Ischemic Attack in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis
Authors: Bilski Amanda , Kochav Jonathan , Waldrop Greer , Mammadli Gular , Sariyeva Mehriban , Argenio Melissa , Willey Joshua Z , Ibeh Chinwe , Rosenbaum Marlon , Lewis Matthew , Miller Eliza C
Published: February 2024

Introduction:
Congenital cardiac lesions result in abnormal flow patterns that increase risk of cerebrovascular events. We investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD).

Methods:
A systematic review was performed per PRISMA guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were age 16 and older with congenital heart disease, and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% confidence intervals. The Newcastle-Ottawa Scale for risk of bias was applied. This systematic review is registered (CRD42022322144).

Results:
Of 11,028 identified abstracts, 27 studies met inclusion criteria. 22 studies reported mean or median age, which was less than 60 years in 18 studies. 39 estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person years, with significant heterogeneity between studies (95% CI 0.39-0.86, I2 97.8%, p<0.001). Secondary analyses were performed stratified by CHD and outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person years (95% CI 0.36-0.95, I2 98%, p=0.01).

Conclusions:
This meta-analysis found that the incidence rate of stroke and TIA is higher in ACHD than age-adjusted global estimates, and similar to the American Heart Association reported global ischemic stroke incidence rate for individuals >60 years (0.52 per 100 person years).
Abstract TP233: Cerebral Microbleeds Are More Frequent With BRCA Mutations: A Single-Center Retrospective Study
Authors: Shen Edward , Shu Liqi , Yaghi Shadi , Goldstein Eric D
Published: February 2024

Introduction:
Breast cancer susceptibility gene (BRCA) mutations are well-known causes of systemic cancers. We have previously identified that those with BRCA mutations have a higher likelihood of cerebral microbleeds (CMBs) on brain MRI compared to BRCA wildtype. We aimed to confirm our prior findings in a subsequent cohort.

Methods:
We performed a single-center retrospective review of all individuals with a confirmed diagnosis of BRCA 1 or 2 mutation and a standard-of-care brain MRI. All individuals were ≥ 18 years old, without intracranial radiation, cerebral metastases, or other cerebral processes which may impact interpretation. Our comparative cohort were individuals with breast cancer who have a genetically confirmed BRCA wildtype status. The primary outcome was the presence of CMBs, defined by consensus criteria. Standard descriptive techniques were used. Likelihood ratios were calculated by binary logistic regression and adjusted for significant variables.

Results:
We identified 49 individuals who met inclusion criteria: 15 with BRCA mutation and 34 with BRCA wildtype. Only one patient was with aspirin use in the BRCA mutation cohort. All cancers were of breast origin with 4 BRCA mutations patients with cancer staging ≥ 3 compared with 14 in the BRCA wildtype cohort. Chemotherapy rates did not differ. Patients with BRCA were younger, less often with hyperlipidemia, and more commonly had CMBs, Table 1. The presence of BRCA mutation trended towards higher odds of having a CMB (OR 5.8, 95%CI 0.93 - 36.16,
p
= 0.059) after adjustment for age and hyperlipidemia.

Conclusion:
We found that CMBs were more common in the BRCA mutation cohort, with a trend towards a 5-fold higher likelihood in the regression analysis. While underpowered, our findings support prior data highlighting this association. Further studies with larger sample sizes are warranted.
Abstract TP234: A Predictive Model for Early Neurologic Deterioration in Small Subcortical Infarcts
Authors: Goldstein Eric D , Shu Liqi , Lopez-Navarro Edgar R , Yang Dixon , Gutierrez Jose , Yaghi Shadi
Published: February 2024

Introduction:
Roughly a quarter of patients with an acute small subcortical infarct may develop early neurologic deterioration (END) hallmarked by progressive or stuttering neurologic deficits. Importantly, END results in worse short- and long-term functional outcomes. However, despite its importance, there is an inability to identify those at risk for END, thereby creating a barrier to designing future treatment and preventative trials. We aimed to generate a simple predictive scoring model for END in patients with an acute SSI.

Methods:
We performed a retrospective chart review of all adult patients admitted to Rhode Island Hospital with an acute SSI between 2015 and 2022. Clinical and demographic data were extracted. Radiographic variables included: 1)infarct signal intensity ratio ≤ 1.15 (analogous to the MR-WITNESS trial), 2) infarct morphology, and 3) infarct size. The primary outcome was END, defined as a ≥ 2-point increase in NIHSS or progressive disabling stroke-related deficits while hospitalized attributed to the index acute SSI. Standard descriptive statistical techniques were used. We then employed a backward stepwise logistic regression with a 0.05 threshold to discern factors associated with END, with each factor contributing one point to the model. An external validation cohort was ascertained from Columbia University. The area under the curve (AUC) was used to assess the utility of the predictive model.

Results:
A total of 252 patients met inclusion criteria. Demographic and clinical histories did not differ amongst the primary or validation cohorts. A signal intensity ratio ≤ 1.15, “finger-like” SSI morphology, and the presence of SSI on > 3 axial diffusion weighted imaging slices were predictive of END. Allocating one point for each domain (minimum 0, maximum 3) yielded an AUC of 0.88. A score of 2 points captured 91.6% of all END cases. Applying this model to the external validation cohort (n=43) yielded an AUC of 0.68.

Conclusion:
In sum, we found that a radiographic ordinal model including signal intensity ratio ≤ 1.15, “finger-like” SSI morphology, and infarct presence on > 3 axial diffusion weight imaging slices was helpful in predicting END. Future studies are needed to expand the external cohort size to test this model’s validity.
Abstract TP235: The Association Between Asthma and the Risk of Ischemic Stroke: A Mendelian Randomization Analysis
Authors: Kim Do Yeon , Ahn Choonghyun , Nam Ki-Woong , Kwon Hyung-Min
Published: February 2024

Background:
Several studies suggest that asthma may elevate the risk of ischemic stroke. However, the genetic connection between the two conditions hasn't been clarified.

Methods:
We used the genome-wide association study (GWAS) data from Biobank Japan (BBJ) to identify SNPs related to both diseases and further examined atrial fibrillation, a condition linked to asthma and a recognized risk factor for ischemic stroke. We employed two-sample Mendelian randomization in our study.

Results:
We included 8,216 cases of asthma and 201,592 controls, 8,180 cases of atrial fibrillation and 28,612 controls, and 17,671 cases of ischemic stroke with 192,383 controls. In the Mendelian randomization analysis between asthma and atrial fibrillation, 9 single nucleotide pairs (SNPs) showed significant associations. For the relationship between asthma and ischemic stroke, 12 SNPs for all sexes, 3 SNPs for males, and 7 SNPs for females were found and included in the MR analysis to investigate the causal relationship between asthma and atrial fibrillation, asthma, and ischemic stroke in all population, asthma and ischemic stroke in male/female. Asthma raises the risk for atrial fibrillation (OR [95% CI]; 1.15 [1.01-1.30]). However, there wasn't a significant genetic association between asthma and ischemic stroke overall (0.98 [0.91-1.07]). Furthermore, no significant link was found between asthma and ischemic stroke in females (1.01 [0.89-1.15]), but a reduced risk of ischemic stroke was noticed in males (0.89 [0.91-0.98]).

Conclusion:
While asthma does increase the risk for atrial fibrillation, it doesn't show a genetic association with ischemic stroke in this study.
Abstract TP237: Acute Risk Factors Associated With Health Service Use Within 90 Days Before Stroke: A Systematic Review and Meta-Analysis
Authors: Kalpakavadi Serah , Sun Alexandra , Kodithuwakku Vimarsha , Rehman Sabah , Gall Seana
Published: February 2024

Background:
While traditional risk factors are chronic in nature, it is difficult to predict the risk of stroke with respect to time. Identifying certain acute risk factors, particularly associated with a health service contact, may help to prevent stroke. We performed a systematic review to understand the acute risk factors having health service contact within 90 days before incident strokes.

Methods:
PubMed, Embase and Scopus were searched for studies within last 10 years (2013- September 2022). Studies selected using PRISMA guidelines underwent quality assessment with Newcastle Ottawa scale. Three reviewers independently reviewed and included case control, case-crossover, self-controlled case series and cohort studies that reported raw data or estimates of association between acute events having healthcare contact within 90 days and stroke.

Results:
106 studies across 14 countries were included from 12,628 records. Most studies reported all types of strokes as the outcome, with the most evaluated risk-periods being 30 and 90 days before stroke. Groups of acute risk factors were identified based on the reason for healthcare contact. Surgeries(n=43) and medical conditions(n=37) were the commonest groups identified for contacting health services in the acute period before stroke, followed by medications(n=14) and other reasons(n=12) including vaccinations and pathology tests. Subgroups were identified based on the type of acute risk factor (Figure 1). The most commonly examined acute risk factors included infections, myocardial infarction, cardiac surgeries, use of antipsychotics and influenza vaccines. Detailed meta-analyses summarizing the magnitude of effect under each sub-group will be presented.

Conclusion:
Potential acute risk factors having healthcare contact within 90 days preceding stroke have been identified. Further research to assess the role of interventions in health services addressing the risk of stroke from these events is warranted.