bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 23: Detection of Atrial Fibrillation by Implantable Cardiac Monitoring After Acute Central Retinal Artery Occlusion
Authors: Mac Grory Brian C , Ziegler Paul D , Landman Sean , Delamerced Amador , Boyanpally Anusha , El Jamal Sleiman , Reznik Michael , Burton Tina , Cutting Shawna , Stretz Christoph , Sacchetti Daniel , Madsen Tracy , Furie Karen , Schrag Matthew , Yaghi Shadi
Published: June 2021

Introduction:
Central retinal artery occlusion (CRAO) is a form of ischemic stroke and necessitates a comprehensive workup, including for cardioembolic sources such as atrial fibrillation (AF). However, the incidence of new AF diagnosed after CRAO is unknown. We aimed to examine the incidence of new, cardiac device-detected AF after CRAO in a large population-based cohort.

Methods:
Using patient-level data from the Optum® de-identified EHR dataset (2007-2017) linked with Medtronic implantable cardiac device data, we identified patients that had a diagnosis-code corresponding to CRAO and no known history of AF, and who also had either a device in-situ at the time of CRAO or implanted ≤1 year post-CRAO with continuous AF monitoring data available. AF incidence was defined as ≥2 minutes of device-detected AF in a day.

Results:
Of 467,167 patients screened, 246/433 (56.8%) with CRAO had no history of AF, of whom 39 had an eligible implantable cardiac device (mean age 66.7±14.8, 41.0% female). Prevalence of vascular risk factors was high (hypertension, 71.8%; hyperlipidemia, 61.5%; coronary artery disease, 46.2%). Within 3 months, 7.7% of these patients (n=3) had device-detected AF. At 36 months, 33.3% of patients (n=13). The maximum daily AF burden post CRAO ranged from 2 minutes to 24 hours with a mean of 390±530 minutes. Of the patients with device-detected AF, 9 were found by an implantable cardiac monitor and 4 by pacemaker or defibrillator.

Discussion:
The rate of long-term AF detection after CRAO was high in patients with implanted cardiac devices, and appears comparable with rates seen after cryptogenic ischemic stroke and in other high-risk populations. Our findings warrant future prospective studies not limited by selection bias.
Abstract 44: Quality of Life for Younger Patients Following Lacunar Stroke: A Secondary Analysis of SPS-3
Authors: de Havenon Adam H , Wong Ka-Ho , Taylor Kirby , Dela Cruz Michael , Rock Theodore , Majersik Jennifer
Published: June 2021

Background:
The long-term quality of life (QoL) effects of stroke on younger patients has not been adequately compared to older stroke patients.

Methods:
We included patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, who had a lacunar stroke within the last 6 months. We divided the cohort into younger patients aged <55 years versus older patients aged ≥55. The primary outcome was a 12 domain stroke specific QoL scale (ss-QoL), measured at one year from enrollment. The ss-QoL scores range from 0-5, with higher scores indicating better QoL. We fit linear regression models to the 12 domains and their mean, and adjusted for 90-day mRS, gender, white race, history of MI, diabetes, HTN, COPD, and level of education. After identifying domains of interest, we examined specific questions within domains to compare the mean score on individual questions using Student’s t-test.

Results:
We included 2,542 patients with a mean (SD) age of 62.8 (10.7) and 64% were male. Younger stroke patients comprised 26.5% (673/2,542) of the cohort and had a mean (SD) ss-QoL score of 4.18 (0.75) compared to 4.24 (0.69) of the older patients, a difference which was significant in the adjusted model (p=0.015). Younger stroke patients had significantly lower scores on the following individual ss-QoL domains compared to older stroke patients: language, thinking, personality, mood, family roles, and energy (Table 1). The three questions that younger stroke patients had the most difference with older patients were “in the past week I was discouraged about my future” (young vs old, 3.7 vs 4.0, p<0.001), “…had little confidence in myself” (4.0 vs 4.3, p<0.001), and “…was irritable” (3.7 vs 3.9, p<0.001).

Conclusion:
After lacunar stroke, compared to older patients, younger patients score worse on stroke specific quality of life at 1-1.5 years after stroke, particularly in domains related to mood. This under-appreciated impact of stroke in the young warrants additional research.
Abstract 51: The Incidence of Perinatal Stroke is 1:1200 Live Births: A Population-Based Study in Alberta Canada
Authors: Dunbar Mary J , Kirton Adam
Published: June 2021

Introduction:
Perinatal stroke encompasses six cerebrovascular syndromes which occur between the 20
th
week of gestation and the 28
th
post-natal day. Morbidity is significant including motor, language, behavioral, and cognitive challenges, as well as epilepsy. Acute presentations include neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis (CSVT), and neonatal hemorrhagic stroke (NHS). Delayed presentations include arterial presumed perinatal ischemic stroke (APPIS), periventricular venous infarction (PVI), and presumed perinatal hemorrhagic stroke (PPHS). Inconsistent terminology and lack of population-based cohorts has limited accurate measurement of disease-specific perinatal stroke incidence. Our objective was to define the incidence of the subtypes of perinatal stroke using a population-based cohort.

Methods:
The Alberta Perinatal Stroke Project is a research cohort established in 2008 in Southern Alberta, Canada (population ~2.1 million). Leveraging universal health care at a single tertiary care pediatric center facilitated true population-based epidemiology. Patients included had neuroimaging-confirmed perinatal stroke. Case acquisition included exhaustive retrospective hospital and ICD code searches (1990-2008) and prospective enrollment from all NICU and neurology/stroke clinics (2008-2018). Live birth rate denominators were determined from the provincial census.

Results:
The overall incidence of perinatal stroke in Southern Alberta from 2008-2018 was 81 cases per 100,000 live births, or 1 case per approximately 1200 live births. The incidence of NAIS was 31 per 100,000 (~1/3000), APPIS was 11 per 100,000 (~1/9000), PVI was 18 per 100,000 (~1/5500), and CSVT was 10 per 100,000 (~1/9800). The incidence of NAIS increased after implementing prospective case identification, from 8.5 (95% CI 5.3-11.6) per 100,000 to 31 per 100,000 (95% CI 24.4-38.2), p<0.00001, the remainder of stroke subtypes were stable over time.

Conclusions:
The overall incidence of perinatal stroke in Southern Alberta is 1:1200 live births. Population-based sampling of disease-specific states may explain why this rate is much higher than previous estimates.
Abstract 67: Effects of Single vs Dual Antiplatelet Therapy on Long Term Stroke and Death After Carotid Endarterectomy
Authors: Belkin Nathan , Fairman Alexander S , Jackson Benjamin M , Foley Paul J , Damrauer Scott M , Fairman Ronald M , Wang Grace J
Published: June 2021

Introduction:
Current evidence suggests that dual antiplatelet therapy (DAPT) reduces perioperative stroke, but increases bleeding after carotid endarterectomy (CEA). The long term effects of antiplatelet therapy after CEA have yet to be studied.

Methods:
A retrospective review of patients undergoing CEA in the national Vascular Quality Initiative database (2003-2018) was performed. Based on antiplatelet regimen at discharge, patients were propensity score matched on aspirin monotherapy vs. DAPT. Multivariable logistic regression and Kaplan-Meier analyses were used to investigate the long term effects of antiplatelet regimen on mortality and stroke/TIA.

Results:
Of the 72,122 patients undergoing CEA, 64.6% were discharged on aspirin, and 35.4% on DAPT. The DAPT group had higher frequencies of comorbidities (COPD, HTN, CHF, smoking, diabetes) as well as atherosclerotic diseases (PAD, CAD, prior PCI, prior CABG). After propensity score matching, two groups of 8,722 patients with comparable comorbidities were formed. While unmatched Kaplan-Meier analysis showed the DAPT cohort to have higher mortality (p=0.001), this difference dissipated after matching. The resultant matched DAPT cohort did not differ from the aspirin group in one year stroke/TIA (1.7% vs. 1.6%, p=0.70), or mortality (3.1% vs. 3.3%, p=0.55). At 5 years, however, patients treated with DAPT did exhibit a mortality benefit (6.4% vs. 7.3%, p=0.02) with multivariable logistic regression identifying DAPT as an independent predictor of reduced mortality (OR 0.94, 95% CI 0.88-0.99, p=0.04).

Conclusions:
Patients discharged on DAPT after CEA represent a significantly different cohort than those discharged on aspirin monotherapy. After propensity score matching, there was no difference at one year stroke/TIA or mortality outcomes, but DAPT was found to be protective against long-term mortality. Further study is warranted to investigate this finding.
Abstract 72: Temporal Trends in Stroke Incidence Over Time by Sex and Age in the Greater Cincinnati Northern Kentucky Stroke Study
Authors: Madsen Tracy E , Khoury Jane C , Leppert Michelle , Alwell Kathleen , Moomaw Charles J , Woo Daniel , Ferioli Simona , Martini Sharyl , Adeoye Opeolu , Khatri Pooja , Flaherty Matthew , De Los Rios La Rosa Felipe , Mackey Jason S , Mistry Eva , Demel Stacie L , Coleman ELISHEVA , Jasne Adam , Slavin Sabreena J , Walsh Kyle , Star Michael , Broderick Joseph , Kissela Brett M , Kleindorfer Dawn O
Published: June 2021

Introduction:
Data from the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) through 2010 showed that over time, stroke incidence rates decreased to a greater extent in men than in women. We aimed to determine whether this difference continued through 2015 and whether the differences are driven by particular age groups.

Methods:
Within the GCNKSS population of 1.3 million, all incident strokes among residents ≥20 years old were ascertained at all local hospitals during 7/93–6/94 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100,000 were adjusted for age and race, standardized to the 2010 U.S. Census. Trends over time by sex were compared (overall and age-stratified); a Bonferroni correction was applied for multiple comparisons.

Results:
In total over the five study periods, there were 9721 incident strokes (ischemic, ICH, and SAH); 56.4% were women. Incidence of ischemic strokes decreased from 254 (95%CI 236,272) in 1993/4 to 177 (95%CI 164,189) in 2015 among men (p<.0001 for trend over time) and from 204 (95%CI 192,217) in 1993/4 to 151 (95%CI 141,161) in 2015 among women (p<.0001). Incidence of ICH/ SAH did not change significantly over time in either sex. In age-stratified analyses, among women, incidence of all strokes decreased among older adults (65–84 years) but not in other age categories (Figure). Among men, incidence over time decreased among older adults (65–84 and ≥ 85 years) but increased in young adults (20–44 years).

Conclusions:
Stroke incidence decreased between the early 1990s and 2015 for both sexes, contrary to previous data on trends through 2010 which demonstrated a significant decrease in men but not women. Temporal changes are being driven by the 65–84 year age group in both men and women, as well as the ≥ 85 age group in men. Future prevention strategies should target young and middle age adults for both sexes as well as those over 85 for women.
Abstract 74: Relationship Between Preeclampsia and Subsequent Stroke: A Secondary Analysis of the Framingham Heart Study
Authors: de Havenon Adam H , Delic Alen , Theilen Lauren , Hanson Heidi , Schliep Karen , Stoddard Greg
Published: June 2021

Introduction:
Although prior studies have examined the later-life risk of stroke in women with a history of preeclampsia, they have relied on claims data or epidemiological studies with poorly detailed risk factor or outcome data. The Framingham Heart Study (FHS) is a landmark epidemiological study that began in 1948 and followed participants aged 30-59 at baseline until death. The study enrolled 5,209 residents of Framingham, Massachusetts, almost half of which were female. The adjudicated outcome of stroke was ascertained during follow-up visits until 2015, death, or loss to follow-up.

Methods:
We examined a cohort of 2,136 women from FHS for an association of preeclampsia with stroke occurrence. With each subject having their own unique history of exposures and treatments that vary over time, standard approaches of adjusting for confounding are biased when time-dependent confounders exist. Using a marginal structural model, the effects of possible time-dependent confounders were controlled for using inverse-probability-of-treatment weighted estimators. At each of the study visits, potential confounders were evaluated. Variables controlled for, across the study visits, included age, blood pressure, cholesterol, weight, glucose, treatment for hypertension, treatment for hyperlipidemia, and smoking.

Results:
Two hundred women (9.4%) had preeclampsia and 380 women (17.8%) had strokes. As compared with the 1,936 women who did not have a history with preeclampsia, the 200 women with a history of preeclampsia had a significantly higher risk of stroke (adjusted Hazard Ratio, 2.29; 95% CI, 1.13 - 4.63) when controlling for time-dependent confounders.

Conclusion:
A history of preeclampsia is associated with a significantly increased risk of a future stroke. Prior approaches to analyses of this nature have not fully emphasized the importance of controlling for time-dependent confounders with methods such as marginal structural modeling. We plan on analyzing the mediators of the observed association to determine which risk factors might prove beneficial for disease-modifying treatment in midlife.
Abstract 75: Hemorrhagic Transformation After Acute Ischemic Stroke Due to a Large Vessel Occlusion is Associated With Less Treatment Benefit
Authors: van Kranendonk Katinka R , Kappelhof Manon , Chalos Vicky , Treurniet Kilian M , van Zwam Wim , van Oostenbrugge Robert J , Lingsma Hester F , Dippel Diederik W , van der Lugt Aad , Mitchell Peter J , Hill Michael D , Jovin Tudor G , Davalos Antoni , Campbell Bruce C , Saver Jeffrey L , White Phil , Bracard Serge , Guillemin Francis , Demchuk Andrew , Brown Scott , Muir Keith , Roos Yvo B , Marquering Henk A , Goyal Mayank , Majoie Charles B
Published: June 2021

Introduction:
Intracranial hemorrhage after acute ischemic stroke patients manifests as natural progression or as a complication of treatment with potential subsequent neurological deterioration. Currently it is unclear whether these hemorrhagic transformations (HT) contribute to the poorer functional outcomes observed in patients with large infarcts. The purpose of this study is to assess the association of HT with follow-up infarct volume (FIV) and functional outcome at 90 days after AIS. Additionally, we determined whether the development of HT was associated with a diminished endovascular therapy (EVT) effect.

Methods:
All patients from the HERMES collaboration with follow-up imaging were included. HERMES is pooled data from seven randomized controlled trials that assessed the efficacy and safety of EVT compared to usual care. Patients with HT were identified according to the ECASS classification and FIV was assessed on CT or MRI. Infarct and hemorrhage were included in the FIV. We assessed functional outcome using the modified Rankin Scale 90 days after stroke onset. Ordinal logistic regression with adjustment for potential confounders was used to determine the association of HT and FIV with functional outcome.

Results:
Of all included patients with follow-up imaging (n=1665), 42% had HT (n=698). Before and after adjustment for confounders HT and FIV were associated with a shift in the direction of poorer functional outcome (aOR:0.71,95%CI:0.58-0.86 and aOR:0.99,95%CI:0.99-0.99). EVT was beneficial in patients with and without HT, but effect was greater in patients without (aOR:1.70,95%CI:1.27-2.28 vs. aOR:2.51,95%CI:1.97-3.20)(figure 1.)

Conclusions:
In this analysis, patients with HT after AIS were less likely to have good functional outcome compared to those without HT, independent of the FIV. While the EVT effect was slightly diminished in patients who developed HT, EVT was always of significant benefit.
Abstract 76: Non-Contrast CT Markers and Pre- and Post-Surgical Hematoma Expansion in the MISTIE III Trial Surgical Cohort
Authors: Montano Nataly , Grabarits Christina , Avadhani Radhika , Goldstein Joshua N , Mould W. A , Awad Issam A , Hanley Daniel F , Ziai Wendy
Published: June 2021

Introduction:
A range of findings on non-contrast CT (NCCT) have been found to predict hematoma expansion after spontaneous ICH, but it is unclear whether these findings predict peri-procedural bleeding. We explored whether any specific NCCT marker(s) predict pre- or post-surgical hematoma expansion events.

Methods:
NCCTs were reviewed for presence of black hole sign, blend sign, swirl sign, and island sign in the surgical cohort from the MISTIE-III trial which evaluated minimally invasive surgery plus alteplase in ICH >30 mL. Hematoma expansion was defined as any expansion ≥6 mL or 33% ICH volume increase during pre-surgical period (Model 1) from diagnostic CT (DiagCT) to 24 hours post DiagCT and from stability CT (StabCT) to 24 hours post last dose of alteplase (Model 2). Blend sign was removed from analysis due to small sample size. Multivariable logistic regression analysis was performed to identify independent predictors of pre-op and post-op hematoma expansion.

Results:
Of 250 surgical subjects, 5 were excluded due to poor image quality. Expansion events occurred in 82 of 234 (35.0%) subjects in the pre-op interval and in 15 of 226 (7%) in the post-op interval. None of the markers were significant for pre-op expansion, but ICH volume and time from ictus to DiagCT were statistically significant predictors. Swirl sign, ICH volume, and posterior trajectory compared to lateral trajectory were independent predictors of post-op expansion events. Expansion volume pre-op and post-op were weakly associated with presence of swirl sign; Spearmans rho=0.3 p=0.065 and rho=0.60 p=0.047, respectively.

Conclusion:
This is the first analysis of impact of NCCT markers on re-bleeding post minimally invasive surgery from a large clinical trial. Despite an absence of association between NCCT markers and hematoma expansion in the pre-surgical period perhaps reflecting inclusion criteria for hemorrhage stability, swirl sign was associated with post-surgical rebleeding.
Abstract 77: Ongoing Leakage Revealed by Second Phase Spot Sign Volume Expansion in Multi-Phase Computed Tomography Angiography Strongly Predicts Intracranial Hemorrhage Growth
Authors: Al Sultan Abdulaziz , Teleg Ericka , Horn MacKenzie , Ojha Piyush , Kasickova Linda , Marzoughi Sina , Ohara Tomoyuki , Banerjee Ankur , Kulkarni Girish , Bobyn Amy , Neweduk Anneliese , Horn Kennedy , Rodriguez-Luna David , Goyal Mayank , Menon Bijoy K , Demchuk Andrew M
Published: June 2021

Background:
CTA spot sign is a predictor of intracerebral hemorrhage (ICH) expansion. This sign can fluctuate in appearance, volume, and timing. Multiphase CTA (mCTA) can identify spot sign through 3 time-resolved images. We sought to identify a novel predictor of follow up total hematoma expansion using mCTA.

Methods:
This cohort study included patients with ICH between 2012-2019. Quantomo software was used to measure total hematoma volume (ml) from baseline CT & follow-up CT/MRI blinded to spot sign in 3 mCTA phases. Spot sign expansion was calculated by subtracting 1
st
phase spot sign volume from 2
nd
phase spot sign volume measured in microliters.

Results:
199 patients [63% male, mean age 69 years, median NIHSS 11, IQR 6-20] were included. Median baseline ICH volume was 16.1 ml (IQR 5-29.9 ml). Amongst all three mCTA phases, spot sign was best detected on the 2nd phase (23% vs 17.5% 1
st
phase vs 22% 3
rd
phase). In multivariable regression, spot sign expansion was significantly associated with follow up total hematoma expansion (OR: 1.03 per microliter of spot sign expansion, p=0.01). Figure 1 shows the predicted total hematoma expansion by spot sign expansion. mCTA spot sign had a higher sensitivity for predicting total hematoma volume expansion than single-phase CTA (reported in meta-analysis of 14 studies), 86% vs 53%, respectively, while both having similar specificity, 87% vs 88%, respectively.

Conclusion:
Spot sign expansion on mCTA is a novel predictor of total hematoma expansion and could be used to select patients for immediate therapeutic intervention in future clinical trials. Using mCTA improves sensitivity while preserving specificity over single-phase CTA.
Abstract 84: Late (5-20 Years) Outcome After STA-MCA Anastomosis and Ultimate Indirect Bypass in Patients With Moyamoya Disease
Authors: Kuroda Satoshi , Nakayama Naoki , Yamamoto Shusuke , Kashiwazaki Daina , Uchino Haruto , Saito Hisayasu , Hori Emiko , Akioka Naoki , Kuwayama Naoya
Published: June 2021

Background and Purpose:
Surgical revascularization is now known to improve the outcome in patients with moyamoya disease. However, majority of previous studies reported their short-term (<5 years) outcome. Therefore, this study was aimed to evaluate long-term (5 to 20 years) outcome after STA-MCA anastomosis and ultimate indirect bypass, encephalo-duro-myo- arterio-pericranial synangiosis (EDMAPS).

Methods:
Cumulative incidence of late morbidity/mortality and disease progression were evaluated among 93 patients who underwent STA-MCA anastomosis and EDMAPS. All of them were prospectively followed up for longer than 5 years post-surgery (mean, 10.5±4.4 years). There were 35 pediatric and 58 adult patients. Clinical diagnosis included TIA or ischemic stroke in 80 patients, hemorrhagic stroke in 10, and asymptomatic in 3. STA-MCA anastomosis and EDMAPS were performed onto their 141 hemispheres. MRI and MRA were performed every 6 or 12 years during follow-up periods.

Results:
During follow-up periods, 92/93 patients were free from any stroke or death, but one recurred hemorrhagic stroke (0.10% per patient-year). Disease progression occurred in the territory of the contralateral carotid or posterior cerebral artery (PCA) in 19 hemispheres of 15 patients (1.5% per patient-year). The interval between initial surgery and disease progression varied from 0.5 to 15 years. Repeat bypass surgery for anterior and posterior circulations resolved ischemic attacks in all 10 patients.

Conclusion:
STA-MCA anastomosis and EDMAPS would be the best choice to prevent further cerebrovascular events for longer than 10 years by widely providing surgical collaterals to both the MCA and ACA territories. However, regular follow-up would be essential for longer than 10 years post-surgery to identify the disease progression in the territory of contralateral carotid artery and PCA and prevent late cerebrovascular events.
Abstract 90: Race, Ethnic, and Sex Disparities in Stroke Incidence in the Northern Manhattan Study
Authors: Gardener Hannah , Sacco Ralph L , Rundek Tatjana , Mora-McLaughlin Consuelo , Cheung Ying Kuen , Elkind Mitchell S
Published: June 2021

Background:
An excess incidence of strokes among blacks vs whites has been shown previously, but data on disparities related to Hispanic ethnicity remains limited. This study examines race, ethnic, and sex differences in stroke incidence in the multi-ethnic, yet largely Caribbean Hispanic, Northern Manhattan Study (NOMAS).

Methods:
The study population included participants in the prospective population-based NOMAS, followed for a mean of 13±7 years. Cox proportional hazards models were constructed to estimate the hazard ratios and 95% confidence intervals (HR, 95%CI) for the association between race/ethnicity and sex with confirmed incident stroke of any subtype and ischemic stroke, stratified by age and adjusting for sociodemographics and vascular risk factors.

Results:
Among 3,298 participants (mean baseline age 69±10, 37% men, 24% black, 21% white, 52% Hispanic), 477 incident strokes accrued (394 ischemic, 43 ICH, 9 SAH). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years [PY]), followed by Hispanics (11/1000 PY), and lowest in whites (8/1000 PY), and this order was observed for crude incidence rates until age 75. By age 85 the greatest incidence rate was in Hispanics. Blacks had an increased stroke risk vs whites overall in fully adjusted models (HR=1.37, 95% CI=1.02-1.84), and stratified analyses showed that this disparity was driven by women age ≥70 (HR=1.69, 1.05-2.73). The increased rate of stroke observed for Hispanics (age/sex-adjusted HR=1.50, 1.15-1.94) was largely explained by education and insurance status (a proxy for socieoeconomic status; HR after further adjusting for these variables=1.15, 0.84-1.58), but remained significant for women age ≥70. Men had an increased rate of stroke compared to women (fully adjusted HR=1.48, 1.21-1.81).

Conclusions:
This study provides novel data regarding the increased stroke risk among Caribbean Hispanics. Results highlight the need to create culturally-tailored campaigns to reach blacks and Hispanic populations to reduce race/ethnic stroke disparities, and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.
Abstract NS2: Effect of Volume-Viscosity Swallow Test (V-VST) in Acute Ischemic Stroke Patients With Dysphagia: A Hospital-Based Case-Control Study
Authors: Ye Ting , Dong Yi , Huang Shengyan
Published: June 2021

Background:
The dysphagia screening in acute ischemic stroke plays an important role in patients with risk of dysphagia. The aim of this hospital-based case-control study is to explore if V-VST, as a new nurse-driven dysphagia screening tool for AIS patients, might help to reduce the rate of post-stroke pneumonia and early withdraw of feeding tube.

Methods:
1598 acute ischemic stroke patients were enrolled in this study. The standard protocol in AIS patients were assessed by WST (before intervention and plus with V-VST after intervention). The V-VST assessment were be trained in two senior nurses and all AIS patients were assessed by V-VST during July 1and Dec 30
th
, 2017. Among 299 AIS patients with suspected, all clinical data were analyzed. The comparison of their rate of pneumonia in hospital and withdraw rate of tubefeeding before discharge were performed between patients post-intervention (January 1, 2018-June 30, 2019)and those admitted before the intervention (January 1, 2016-June 30, 2017).

Results:
The baseline characteristics of the pre- and post- intervention AIS groups were similar in age, gender, NIHSS. The implementation of V-VST have a statistically significant reducing the risk of pneumonia with an adjusted HR (0.60, 95% CI 0.43-0.84, P=0.003). Additionally, follow-up V-VST were likely to be associated the withdraw rate of tube-feeding at discharge (29/168 vs 38/131 P=0.016).There is also a trend of length of tube-feeding decreasing (8.32±12.27 vs 6.84±8.61 P=0.241).

Conclusion:
In our study, the V-VST is a feasible bedside tool. The implemental might be associated with the reduction of post-stroke pneumonia. Therefore, it meets the requirements of a clinical screening test for dysphagia in acute stroke patients at bedside. Large prospective interventional study is needed to confirm our findings.
V-VST: Volume-viscosity Swallow Test WST: Water Swallow Test AIS: Acute Ischemic Stroke HR: hazard ratio
Abstract NS7: Needs for Returning to Work: Experiences of Young Adults With Stroke
Authors: Lo Suzanne Hoi Shan , Chau Janita Pak Chun
Published: June 2021

Background and Purpose:
Studies have reported that young stroke survivors often encountered challenges in supporting themselves or their family financially and socially. One of their priorities in rehabilitation was returning to work. The purpose of this study was to explore young adults’ experiences of returning to work after stroke.

Methods:
A qualitative study with face-to-face semi-structured interviews and non-participant observation was conducted. Community-dwelling adults who had a first-ever or recurrent ischaemic or haemorrhagic stroke at an age between 18 and 64 years were recruited from the community organisations or stroke support groups. All participants were asked to share their experiences of, and perceived barriers to and facilitators of returning to work after stroke. Non-participant observation for one day about the participants’ daily work was conducted. The interviews were recorded and transcribed verbatim for thematic analysis. The field notes obtained from observation was categorised to explain the interview data.

Results:
A total of 19 participants (mean age 58.6 years, SD 8.63) were interviewed. Five key themes were generated: (1) Capability to return to work was integral as it defined their identity and existence in the society, (2) Support from family members, colleagues and employers were key factors to their successful experience of returning to work, (3) Learning to learn new skills to assume pre-stroke or new work roles was difficult but integral to adapt to their physical and psychosocial challenges, (4) Age-appropriate services to support young stroke survivors to pursue employment opportunities was inadequate, and (5) Engagement in household works or valued everyday activities would be feasible to build social or work skills and motivation to prepare them for returning to work.

Conclusions:
The findings supported that the young stroke survivors had a strong need for returning to work to unleash their potentials and continue their contributions to the society. More age-appropriate services are needed to enhance their capability to learn new skills to assume their pre-stroke or new employment opportunities.
Abstract TMP108: Stroke Continuum of Care in a Diverse, Inner City Community: A Case Study
Authors: Solloway Michele , Cannell Thomas , Shea James , Thompson Greg , Girouard Shirley
Published: June 2021

Background:
Stroke is the leading cause of disability in the US. According to the AHA, system fragmentation is the most important barrier to helping stroke survivors recover with the least possible disability. Lack of coordinated post-hospital care contributes to high and unnecessary 30-day readmission rates. Transitional stroke care is fragmented, poorly organized, rarely patient-centered and contributes to suffering and caregiver burden. Patients are often discharged without a clear understanding of the implications and disease process; caregivers do not receive adequate education and training. The literature suggests that the best interventions to prevent and treat stroke - such as coordinated care transitions and care management to support treatment adherence - are not widely disseminated.

Purpose:
to describe the organization and delivery of stroke care in a diverse, urban community and identify opportunities to improve services for stroke survivors transitioning from hospital to community.

Methods:
A qualitative, case-study method was used to study the hospital and community stroke system of care in an academic medical center. Eight key informant interviews were conducted by trained interviewers following IRB approval. Data were analyzed using the Colazzi method.

Results:
Various perspectives about the organization, delivery, financing of prevention and treatment and opportunities to improve continuity were identified. Discontinuities existed in discharge and transition to community/home, leading to poor follow-up, missed appointments, early readmissions and poor outcomes. Large variation in insurance rules are also barriers to quality care. Suggested improvements include enhanced patient- staff ratios, better communication between hospital and discharge facilities, and improved patient/caregiver education. More role clarity, especially for primary and specialty care, is needed.

Conclusions:
This study highlights barriers and opportunities for improvement. Innovative strategies are needed to optimize the processes of stroke care within health systems and health outcomes for stroke patients. Needs-based implementation studies are suggested.
Abstract TMP115: Common Transcriptomic and Biomarker Signatures in the Aging Brain and in Mendelian Neurovascular Disease, Cerebral Cavernous Malformation
Authors: Girard Romuald , Koskimaki Janne , Polster Sean P , Li Yan , Zhang Dongdong , Romanos Sharbel , Carrión-Penagos Julián , Stadnik Agnieszka , Lightle Rhonda , Moore Thomas , Lyne Seán B , Hobson Nicholas , Cao Ying , Srinath Abhinav , Shenkar Robert , Dimov Alexey , Carroll Timothy , Christoforidis Gregory A , Awad Issam A.
Published: June 2021

Background:
Cellular senescence is associated with gene expression dysregulation affecting endothelial barrier function as well as angiogenic and inflammatory processes. These pathological changes occur in cerebral cavernous malformations (CCMs), a neurovascular anomaly predisposing patients to hemorrhagic stroke. We hypothesize common transcriptomic and biomarker signatures between the aging brain and CCMs.

Method:
Brain specific genes dysregulate in Younger (age < 30) and Older (age > 50) human brain parenchyma were identified using the Genotype-Tissue Expression database, and compared with differential transcriptome in microdissected neurovascular units of human CCM lesions. Brain white matter vascular permeability in areas devoid of lesions was measured in non-CCM (23 Younger, 27 Older), Sporadic-CCM (S-CCM) (26 Younger, 37 Older) and Familial-CCM (F-CCM) (41 Younger, 17 Older) using dynamic contrast-enhanced quantitative perfusion MRI. Plasma levels of 6 proteins with reported roles in CCMs were quantified, including VEGF, angiopoietin (ANG 1 & 2), CRP, thrombospondin 2 (THBS 2), and endoglin (ENG). All reported correlations were significant at P< 0.05, FDR corrected.

Result:
We identified 320 genes (absolute fold change≥1.5) commonly dysregulated in aging brain and CCM, related to inflammation and extracellular matrix organization pathways. Brain permeability was greater in Older non-CCM and S-CCM compared to Younger subjects. Brain permeability was higher in Younger F-CCM harboring germ line CCM mutations, than in both Younger non-CCM (p<0.001) and S-CCM (p<0.05) lacking those mutations. No difference was observed in Younger or Older F-CCM and Older S-CCM or controls. Plasma levels of VEGF, ANG-2 and CRP were greater in both Older non-CCM and S-CCM compared to Younger. No difference was found in Older or Younger F-CCM. No differences were observed in THBS2, ENG and ANG1.

Conclusion:
There are common transcriptomic, and brain permeability and plasma biomarker signatures in the aging brain and CCM, suggesting common dysregulated pathways. Biomarkers and potential therapies identified in a well characterized Mendelian neurovascular disease may be applicable to mitigate the same mechanistic aberrations in the aging brain.
Abstract TMP17: Revacept, an Inhibitor of Platelet Adhesion in Patients With Symptomatic Carotid Artery Stenosis. Safety Data From the International Randomized Multicenter Revacept CS02 Phase 2 Study
Authors: Uphaus Timo , Richards Toby , Weimar Christian , Neugebauer Hermann , Poli Sven , Weissenborn Karin , Imray Christopher , Michalski Dominik , Rashid Hisham , Loftus Ian , Ritter Martin , Hauser Till-Karsten , Münch Götz , Poppert Holger , Gröschel Klaus
Published: June 2021

Introduction:
Revacept is a novel vascular lesion-directed inhibitor of platelet adhesion and thrombus formation, exhibiting no effects on the homeostatic functions of circulating platelets.

Objective:
The effects of Revacept on plaque-mediated thrombosis were investigated in patients with symptomatic stenosis of the internal carotid artery (at least 50%, following ECST-criteria).

Methods:
Within an international, prospective, multicenter (n=16), randomized trial 158 patients could be randomized to receive placebo, or 40/120 mg Revacept by intravenous infusion over 20 minutes. Cerebrovascular events and cardiovascular complications were followed up to 3 months.

Results:
158 patients were finally included in the study. Of these, 127 (80.4%) received carotid endarterectomy, 12 received carotid stenting (7.6%) and 19 were referred to intensified conservative treatment (12.0%). Safety data showed cardiovascular events such as transitory ischemic attack (TIA) and ischemic stroke 24 hours after drug administration in 1 (0.6%) and 5 (3.1%) patients, and 3 months after drug administration in 5 (3.1%) and 9 (5.7%) patients, respectively. With regard to bleeding complications, intracerebral hemorrhage was not observed in any of the patients within 24 hours, and in 1 patient (0.6%) at 3 months follow up. Postoperative hematoma of any kind was observed in 9 patients (5.7%). Two other bleeding events (GI-bleeding and ear-bleeding) occurred within 3 months follow up. Coronary vascular events, defined as Troponin-I-elevation, were observed in 2 patients (1.3%) at 24 hours, and in 7 patients (4.4%) at 3 months after drug administration. Coronary intervention was necessary in 1 patient (0.6%) and 5 patients (3.1%), 24 hours and 3 months after Revacept infusion, respectively. These complications rates are comparable to the rate at day 30 follow up within the ICSS-study: ischemic stroke (91 patients 5.3%), intracerebral hemorrhage (8 patients, 0.5%) and any wound hematoma (81 patients, 4.7%)

Conclusions:
The addition of Revacept to guideline-recommended anti-thrombotic therapy in patients with symptomatic stenosis of the internal carotid artery did not increase bleeding complications within the overall study population compared to previous studies.
Abstract TMP18: Early versus Late Start of Direct Oral Anticoagulants After an Ischemic Stroke Related to Atrial Fibrillation - An Individual Patient Data Analysis
Authors: De Marchis Gian Marco , Seiffge David J , Schädelin Sabine , Wilson Duncan , Caso Valeria , Acciarresi Monica , Tsivgoulis Georgios , Koga Masatoshi , Yoshimura Sohei , Toyoda Kazunori , Cappellari Manuel , Bonetti Bruno , Macha Kosmas , Kallmünzer Bernd , Lyrer Philippe A , Cereda Carlo , Paciaroni Maurizio , Engelter Stefan T , Werring David J
Published: June 2021

Background:
The optimal timepoint of starting DOAC after an acute ischemic stroke (IS) related to atrial fibrillation (AF) remains unclear. We aimed to compare an early (≤ 5 days of IS) versus late (>5 days of IS) DOAC-start.

Methods:
Individual patient data analysis of 7 European and Japanese prospective observational cohort studies. We included patients with IS or TIA related to non-valvular AF where a DOAC was started within 30 days. We excluded patients with an intracranial bleeding (ICH) after the index event but prior to DOAC-start. We compared the 30-day rates of recurrent IS and ICH between the groups of early versus late DOAC-start with a landmark analysis at day 5.

Results:
Overall, 2550 patients were included. Median age was 77 years (IQR 70-84). DOAC were started early in 1362 (53%) patients, late in 1188 (47%). In the whole cohort, 37 patients suffered from a recurrent IS (1.5%), 16 patients (43%) of whom before any DOAC was started. 6 patients (0.2%) had an ICH. In the early DOAC-start group, 23 patients (1.7%) suffered from a recurrent IS after DOAC-start and within 30 days; two patients (0.1%) suffered from ICH after DOAC-start. In the late DOAC-start group, 14 patients (1.2%) suffered from a recurrent IS before DOAC was started; 4 patients (0.3%) suffered from ICH after DOAC-start. In the comparison of late versus early DOAC-groups, no difference in the hazard ratios was observed for the endpoint of recurrent IS (HR

= 1.15, 95%CI 0.48-2.73, p=0.76) and ICH (HR = 4.71, 95%CI 0.51-43.10, p=0.17).

Conclusion:
Our results do not corroborate the concern that early anticoagulation - at least when performed with DOACs - increases the risk of hemorrhagic transformation of the brain infarct compared to late anticoagulation. Given the seven times higher risk of recurrent IS - with almost half of recurrent IS occurring before any DOAC-start - an early DOAC-start after AF-related IS may be reasonable, if inclusion in the ongoing trials (the recommended option) is not possible.
Abstract TMP3: One-stop Management of 230 Consecutive Acute Stroke Patients Report of Procedural Times and Clinical Outcome
Authors: Psychogios Marios , Maier Ilko , Tsogkas Ioannis , Hesse Amelie , Brehm Alex , Behme Daniel , Schnieder Marlena , Schregel Katharina , Papageorgiou Ismini , Liebeskind David , Goyal Mayank , Liman Jan
Published: June 2021

Introdruction:
Rapid thrombectomy for acute ischemic stroke caused by large vessel occlusion leads to improved outcome. Optimizing intrahospital management might diminish treatment delays. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion.

Methods:
We performed a single center, observational study from June 2016 to November 2018. Imaging was acquired with the latest generation angiography suite at a comprehensive stroke center. Two-hundred-thirty consecutive adults with suspected acute stroke presenting within 6 hours after symptom onset with a moderate to severe National Institutes of Health Stroke Scale (≥ 10 in 2016; ≥ 7 since January 2017) were directly transported to the angiography suite by bypassing multidetector CT. Noncontrast flat-detector CT and biphasic flat-detector CT angiography were acquired with an angiography system. In case of a large vessel occlusion patients remained in the angiography suite, received intravenous rtPA therapy and underwent thrombectomy. As primary endpoints, door-to-reperfusion times and functional outcome at 90 days were recorded and compared in a case-control analysis with matched prior patients receiving standard management.

Results:
A total of 230 patients (123 women, median age of 78 years (IQR 69-84)) were included. Median symptom-to-door time was 130 min (IQR 70-195). Large vessel occlusion was diagnosed in 166/230 (72%) patients; 64/230 (28%) had conditions not suitable for thrombectomy. Median door-to-reperfusion time for M1 occlusions was 64 min (IQR 56-87). Compared to 43 case-matched patients triaged with multidetector CT, median door-to-reperfusion time was reduced from 102 (IQR 85-117) to 68 min (IQR 53-89;
P
<0.001). Rate of good functional outcome was significantly better in the one-stop management group (
P
=0.029). Safety parameters (mortality, sICH, any hemorrhage) did not differ significantly between groups.

Conclusions:
One-stop management for stroke triage reduces intrahospital time delays in our specific hospital setting.
Abstract TMP35: Neural Recovery Following Cerebral Ischemia is Exacerbated by Loss of DNA Polymerase-Beta
Authors: Bregy M. Victoria , Xu Mingyue , Hassan Sulaiman , Shi Yejie , Zhao Jingyan , Chen Jun , Bennett Michael V , Stetler R Anne
Published: June 2021

Oxidative DNA damage (ODD) after cerebral ischemia/reperfusion injury occurs rapidly and has been implicated in the patholgenesis of ischemic injury. Ischemic ODD in the brain are primarly characterized as apurinic/apyrimidinic (AP) sites and single strand breaks (SSB). Following ODD, key enzymes in the base excision-repair (BER) pathway including AP endonuclease-1 (APE1) and the DNA polymerase-beta (PolyB) are critical to repair AP sites and SSB, and to mitigate cellular damage. Global knockout of either APE1 or PolyB leads to embryonic lethality. We have previously demonstrated that conditional deletion of APE1 in the adult heightens sensitivity to ischemic injury. PolyB is a highly inducible gene, and its expression is increased after sublethal brain injury, yet the contribution of PolyB to ischemic brain recovery remains unknown. PolyB conditional knockout (cKO) mice were generated by subjecting PolyB-CAG-CreER mice to tamoxifen administration for 5 days. Transient middle cerebral artery occlusion (tMCAO) was induced for 45 min following STAIR guidelines, and behavioral recovery and grey/white matter injury were assessed by over 35 days after ischemia. Cortical action field potentials (CAFP) and compound action potentials (CAP) were used to assess functional integrity of grey and white matter. PolyB cKO mice were significantly impaired up to 35 days after ischemic injury compared to WT mice, displaying exacerbated neuronal tissue loss, extensive demyelination in the CC/EC, and diminished CAFP and CAP compared to WT mice. In addition, accumulation of AP sites and SSBs were evident in the ischemic PolyB cKO. These results were compared to to APE1 cKO ischemic outcomes. PolyB cKO was associated with PARP1 activation, NAD
+
depletion, necrotic neuronal cell death, and neuronal release of HMGB1, and PJ34, a specific PARP-1 inhibitor, significantly improved stroke outcomes in PolyB cKO mice. Along with APE1, PolyB plays an essential role in ischemic brain recovery in both grey and white matter. However, the molecular mechanisms between exacerbation of injury in ischemic neurons by PolyB vs APE1 may be distinct. DNA base excision repair pathway may potentially serve as a therapeutic target for long-term neurological recovery after stroke.
Abstract TMP39: Further Evidence of Safety and Tolerablity on 4 mA Transcranial Direct Current Stimulation (tDCS) in Patients With Ischemic Stroke
Authors: Chhatbar Pratik Y , DeVries William , Grattan Emily , Kautz Steven A , Feng Wuwei
Published: June 2021

Introduction:
By the proof of concept, a phase I tDCS current escalation safety study established the safety and tolerability of up to 4 mA with single session application in ischemic stroke patients; however, the sample size is relatively small with only 3 subjects received 4 mA dose in the 3+3 design. We aim to further investigate the safety and tolerability of tDCS at 4 mA currents with multiple sessions.

Hypothesis:
tDCS in 4 mA strength is safe and tolerable in three montage conditions (anodal, cathodal and bihemispheric)

Methods:
Eighteen aging stroke patients underwent 3 sessions of 4 mA tDCS that are at least 2 days apart: anodal (Anode: lesional C3/C4, Cathode: non-lesional FP1/FP2), cathodal (Anode: lesional FP1/FP2, Cathode: non-lesional C3/C4), or bihemispheric (Anode: lesional C3/C4, Cathode: non-lesional C3/C4). We monitored safety by looking for any adverse event (AE) or serious adverse event (SAE). We measured tolerability using questionnaire/examination. We implemented biometric monitoring (body resistance, skin temperature at tDCS application sites) to ensure the patient safety.

Results:
All 18 patients completed all 54 sessions of tDCS (3 sessions per subject) without any adverse event or serious adverse event. Per Questionnaire, the most common tolerability issue was transient redness at tDCS application sites (70% at anode, 48% at cathode, see A). Body resistance was comparable across montages and skin temperature was below body temperature in all tDCS sessions (see B).

Conclusion:
Our findings provide further evidence that tDCS at 4 mA is safe and tolerable. The efficacy of 4 mA tDCS is being investigated by NIH StrokeNet-funded study called TRANSPORT2.