bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract DP12: Leukocyte Telomere Length as a Predictor of Age-Related Brain Diseases: Evidence from the UK Biobank
Authors: Prapiadou Savvina , Kimball Tamara , Tack Reinier , Tan Benjamin Yong Qiang , Senff Jasper , Kourkoulis Christina , Rosand Jonathan , Singh Sanjula , Anderson Christopher
Published: January 2025

Introduction:
Stroke, dementia, and late-life depression (LLD) are age-related brain diseases that pose significant public health challenges. Leukocyte telomere length (LTL), a proposed marker of biological age influenced by a complex interplay of both lifestyle and heritable factors, may offer valuable insights into the modifiability of risk for these diseases. We aimed to study the association between LTL and these three outcomes, and whether healthy lifestyle choices modify this risk.

Methods:
We utilized data from the UK Biobank (UKB), including participants with valid LTL measurements. We accounted for modifiable lifestyle risk factors with the Brain Care Score (BCS), a 21-point metric validated in the UKB for age-related brain diseases. We used a modified 19-point BCS adapted to available UKB data. LTL measurements were divided into tertiles to examine associations with incident stroke, dementia, and LLD, with shortest LTL serving as reference. Kaplan-Meier curves assessed the relationship between LTL tertiles and outcomes. Cox proportional hazards models adjusted for age, sex, and a 5-point higher baseline BCS provided adjusted hazard ratios (HR). To meet the proportional hazards assumption, we stratified the Cox model into three age groups (<50, 50–59, and ≥60). A Mendelian Randomization (MR) framework was employed to investigate causal relationships between LTL and these diseases.

Results:
The analysis included 356,173 participants, with an average age of 56.97 years, of whom 46.31% were male. Kaplan-Meier plots showed associations between longer LTL and lower incidence rates for all conditions. The Cox model confirmed these findings: stroke HRs for intermediate and longest LTL tertiles were 0.89 (95%CI: 0.85-0.94) and 0.87 (95%CI: 0.83-0.92); dementia HRs were 0.86 (95%CI: 0.81-0.91) and 0.77 (95%CI: 0.72-0.82); and LLD HRs were 0.94 (95%CI: 0.90-0.97) and 0.88 (95%CI: 0.84-0.91). Interaction terms between BCS and LTL were non-significant, suggesting limited lifestyle modification of LTL-mediated risks. MR analysis showed no significant causal associations between LDL and these diseases.

Conclusions:
Longer LTL is linked to reduced risks of stroke, dementia, and LLD, independent of lifestyle factors measured by BCS. These findings emphasize LTL's complex role in age-related brain diseases and underscore the need for research into exposures influencing LTL, potentially elucidating new interventions or improved tools for risk prediction.
Abstract DP15: Increased Severity of Blood-Brain Barrier Disruption is Associated with Greater Burden of Cerebrovascular Disease in Asymptomatic Patients
Authors: Leigh Richard , Sasannia Sarvin , Wang Shimeng , Matsyuk Mykola , Zhang Jinwei , Shin Hyeong-Geol , Prince Jerry , Becker Lewis , Yanek Lisa , Vaidya Dhananjay , van Zijl Peter , Knutsson Linda , Nyquist Paul
Published: January 2025

Background:
White matter hyperintensities (WMH) of presumed vascular origin can be associated with vascular cognitive impairment and dementia. However, WMH are also seen in asymptomatic subjects. Blood-brain barrier (BBB) disruption is thought to play a role in the formation of WMH. In this study we measured BBB disruption in and around areas of WMH in asymptomatic subjects and compared it with the volume of WMH to test the hypothesis that more severe BBB disruption would be associated with a larger burden of WMH.

Methods:
Subjects being followed in the GeneSTAR study, an ongoing study of families enriched for vascular risk factors and cardiovascular disease, were included in this study if they had been scanned with dynamic susceptibility contrast (DSC), FLAIR and T1 MRI. FLAIR/T1 images were segmented to create WMH masks. Penumbra masks were made by dilating the WMH masks by 4 voxels to create a region of interest that reflects the normal appearing white matter adjacent to the WMH. BBB disruption was measured using DSC images voxel-by-voxel by isolating signal changes due to leakage of gadolinium contrast agent through the BBB. The BBB metric K2 was calculated and expressed as the fraction of the recorded signal that originates from the leakage of contrast through the BBB. To identify hotspots of BBB disruption, 100 voxels with the highest BBB leakage for each patient were averaged to create a BBB metric from the same volume of tissue for each subject. BBB was compared with WMH volume using linear regression.

Results:
There were 102 asymptomatic subjects included in the analysis, average age 63.2, of which 61% were women. BBB disruption measured in the WMH highly correlated with the volume of WMH (r
2
=0.47, p<0.001) suggesting that BBB disruption accounts for almost half of the disease burden (figure 1). BBB disruption measured in the penumbra also correlated with the WMH volume (r
2
=0.17, p<0.001) and although the association with WMH volume was weaker, the severity of BBB disruption was on average higher than when measured in the WMH (figure 2).

Conclusions:
In this population of asymptomatic subjects, the burden of WMH was largely accounted for by the severity of their BBB disruption within the lesions. In areas adjacent to the WMH, BBB disruption was also apparent but may be more indicative of future WMH progression.
Abstract DP24: Trends in Stroke Incidence Over Time by Sex in the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS)
Authors: Madsen Tracy , Demel Stacie , Ding Lili , Adeoye Opeolu , Broderick Joseph , Flaherty Matthew , ferioli simona , Haverbusch Mary , Jasne Adam , Khatri Pooja , DeLosRiosLaRosa Felipe , Mackey Jason , Martini Sharyl , Mistry Eva , Coleman Elisheva , Aziz Yasmin , Wechsler Paul , Menzies Lauren , Wright Shea , Nobel Lisa , LaPorta Joseph , Robinson David , Slavin Sabreena , Star Michael , Stamm Brian , Stanton Robert , Walsh Kyle , Woo Daniel , Kissela Brett , Kleindorfer Dawn
Published: January 2025

Background:
Ongoing surveillance of stroke incidence over time by demographic groups is critical to understand trends in disease burden and effective interventions. Our objective was to examine changes in stroke incidence by sex and age over 27 years.

Methods:
In a population-based stroke surveillance study covering a 5-county region of southern Ohio and northern Kentucky, hospital cases of stroke were ascertained and adjudicated by trained study physicians during six 1-year periods (07/1993–06/1994, 1999, 2005, 2010, 2015, 2020). Temporal trends in stroke incidence were evaluated by sex, age, and subtype (ischemic (IS), hemorrhagic (ICH), subarachnoid hemorrhage (SAH)). Stroke incidence rates per 100,000 people were calculated using U.S. Census data and age-, race-, and sex-standardized as appropriate. Trends in incidence over time were evaluated using linear regression, weighted with the inverse of the standard error of the estimated incidence rate. Female:male risk ratios (RRs) were reported in each of the study periods for the overall population stratified by age, and the trend over time was evaluated using linear regression using inverse weighting of the standard error.

Results:
11,813 stroke events occurred in total, 56% in females and 20% in Black patients (Table 1). The trend over time for any stroke (IS, ICH, SAH or unknown) was not significant in females (208 [95%CI 195-221] in 1993/4 to 187 [95%CI 176-198] in 2020, per 100,000, p=0.06) or males (251 [95%CI 233-269] in 1993/4 to 220 [95%CI 207-234] in 2020, per 100,000, p=0.13). The decreasing trend in IS was significant in females (p=0.03) but not males (p=0.07). Trend in ICH was not significant in females (p=0.75) or males (p=0.06), and trend in SAH was not significant in either sex (all trend data in Figure 1). For female: male RRs for any stroke, overall (combined age groups) RRs ranged from 0.83 (95%CI 0.75-0.91) in 1993/4 to 0.97 (95%CI 0.88-1.06) in 2010; trend over time was not significant (p=0.82). RRs varied with age (2020 data in Figure 2) with a U-shaped relationship.

Discussion:
Over 27 years in a population-based stroke surveillance study, trends over time in any, IS, ICH, and SAH appear to be stabilizing with the only significant decrease seen in females with IS. Though findings suggest that previously reported decreasing incidence rates in stroke appear to be trending upward in 2020, future work is needed to understand the effect of COVID on 2020 rates and to continue surveillance.
Abstract DP25: Recurrent Strokes in the ARCADIA Trial
Authors: Tirschwell David , Elkind Mitchell , Kamel Hooman , Kronmal Richard , Longstreth W
Published: January 2025

Introduction:
The ARCADIA trial intention to treat (ITT) analysis did not show decreased stroke recurrence using apixaban over aspirin in patients with recent cryptogenic stroke (CS) and evidence of atrial cardiopathy. One reason for trial neutrality could be that recurrent strokes were often non-CS and thus unlikely to be reduced by apixaban. Details of the recurrent stroke events are thus described.

Methods:
ARCADIA stroke outcome events were adjudicated via review of a packet of medical records by non-study stroke neurologists. Stroke types and subtypes were determined by 2 study neurologists (WL, DT) via information from packets and adjudicators’ notes. Stroke subtypes were classified using a modified TOAST scheme classified as: large artery atherosclerotic (LAA), small vessel disease (SVD), or cardioembolic (CE) if an evident finding was identified OR otherwise CS, even if workup was incomplete.

Results:
Adjudicated strokes were recorded in 82 ARCADIA patients. Two events classified as CS occurred after study closure and were not included in the ITT analysis; patients were off study medication. Of the 80 strokes included in the ITT analysis, 4 patients never took study medication, with strokes including 2 CS, 1 SVD and 1 LAA. Of the 76 patients that took study medication for some duration, 20 had discontinued study medication when they had their stroke; strokes were 14 (70%) CS, 3 (15%) non-ischemic, 2 (10%) CE and 1 (5%) SVD. Of the remaining 56 patients who were on study medication when stroke occurred, 22 were in the apixaban group and 34 in the aspirin group; strokes were 44 (79%) CS, 4 (7%) LAA, 4 (7%) CE, 3 (5%) non-ischemic, and 1 other (endocarditis and LAA) without heterogeneity of recurrent stroke types between randomized treatments. Overall, 60/80 (75%) of the recurrent strokes included in the ITT analysis were CS.

Conclusions:
The ARCADIA trial hypothesis is that recurrent CS in randomized patients could be reduced by apixaban over aspirin, as the stroke mechanism is hypothesized to be like that in atrial fibrillation. The vast majority (75%) of recurrent stroke events included in the ARCADIA ITT analysis were CS, so recurrent stroke being non-CS is not an explanation for the overall neutral ARCADIA results. Only 56/80 (70%) of recurrent strokes occurred while patients were taking study medication, with numerically fewer in the apixaban than the aspirin arm; further analysis of this on-study-medication group are ongoing.
Abstract DP26: Neuronal eSINE-RNAs modulate post-stroke outcomes in the mouse brain
Authors: Patel Ankit , Limam Sarra , Dharap Ashutosh
Published: January 2025

Introduction:
Short interspersed nuclear elements (SINEs) are an abundant class of noncoding retrotransposons that can be transcribed by RNA polymerase III. Some SINEs have also been shown to act as genomic enhancers, thus giving rise to what are known as enhancer SINE-RNAs (eSINE-RNAs). The function of these novel RNAs within the post-stroke brain remains virtually unexplored. In this study, we map the genome-wide cortical expression of eSINE-RNAs in response to stroke, characterize their cell-type&subcellular localization, and determine their role in affecting post-stroke infarct volumes.

Methods:
Ischemic stroke was induced in male C57BL/6N mice using 1h middle cerebral artery occlusion (MCAO) followed by 6h of reperfusion (or sham surgery). Genome-wide RNA-seq and H3K27ac ChIP-seq (n=3/group/experiment) were performed on ipsilateral cortices to identify stroke-responsive enhancer RNA transcripts, which were then overlaid with genomic SINEs to identify eSINE-RNAs. Immunohistochemistry and RNA-FISH were used in tandem to determine the cell-type and subcellular localization of several highly expressed eSINE-RNAs. Select eSINE-RNAs were ablated via intracerebroventricular injection of antisense oligonucleotides followed by 1h MCAO and 24h reperfusion. Infarct volumes following knockdown were evaluated using cresyl violet staining (n=5-7/group).

Results:
We discovered 46 eSINE-RNAs upregulated in the cortex following MCAO, 33 of which were unique to stroke and not detected in the sham group. These RNAs were derived from several families of SINEs, including 24 from the B1 family, 20 from the B2 family, and one each from the less ubiquitous ID and MIR families. The expression of several abundant eSINE-RNAs was specific to the nuclei of neurons within the prospective infarct and peri-infarct territories, including the sensorimotor cortex and hippocampus. Ablation of select eSINE-RNAs resulted in significantly higher infarct volumes versus controls, suggesting that these eSINE-RNAs serve a neuroprotective role in the brain following ischemic stroke.

Conclusion:
Our study is the first report to characterize the expression of eSINE-RNAs in the post-stroke brain and begin to elucidate their function as regulators of post-stroke pathophysiology. Our results suggest that the transcription of eSINE-RNAs represents a robust neuroprotective response to transient focal ischemia, thus positioning them as potential molecular targets for modulating post-stroke outcomes.
Abstract DP29: A specific tRNA derived fragment, tRF-Gly-GCC, contributes to cerebral ischemic injury in both young and aged mice in an experimental stroke model
Authors: Dong Wen , Zhao Shunying , Wen Shaohong , Chen Qingfang , Han Pinglei , Ye Weizhen , Liu Xiangrong
Published: January 2025

Introduction:
The potential role of tRNA derived fragment (tRF&tiRNA) in ischemic stroke remains largely unknown. Here, our study discovered the profile of tRFs and tiRNAs in cerebral cortex and clarified the role of candidate tRF, tRF-Gly-GCC, after ischemic stroke.

Hypothesis:
tRF-Gly-GCC contributes to ischemia injury.

Methods:
Cerebral ischemia was induced in male young (2-3 months old) and aged (18 months old) C57BL/6 mice using permanent distal middle cerebral artery occlusion (dMCAO). Small RNA sequencing analyses were conducted to explore the differentially expressed tRNA derived fragments. Real-time PCR was performed to confirm relative expression of candidate tRFs and tiRNAs. Regional cerebral blood flow was monitored before and after dMCAO. The infarct volume was verified by magnetic resonance imaging, and neurological functions were assessed using the modified Garcia test. RNA pull-down assays followed by liquid chromatography-tandem mass spectrometry were conducted to analyze the proteins that interact with tRF-Gly-GCC. To determine the role of tRF-Gly-GCC, tRF-Gly-GCC antisense inhibitors (antagomirs) were injected intracerebroventricularly.

Results:
tRF-Gly-GCC levels were significantly elevated in cerebral cortex after ischemia in both young and aged mice. Administration of synthetic tRF-Gly-GCC antagomirs into the right ventricle significantly reduced the infarct volume in both young and aged mice compared to control antagomir-treated groups. Additionally, tRF-Gly-GCC antagomir improved relative apparent diffusion coefficient values in the peri-infarct region of ipsilateral cortex. Neurological assessments were significantly improved in tRF-Gly-GCC antagomir treated young/aged mice compared to control antagomir-treated groups. To mimic ischemia in vitro, primary astrocytes were exposed to conditioned medium from oxygen-glucose deprivation-treated primary neurons, resulting in increased tRF-Gly-GCC expression in the astrocytes. As a candidate RNA binding protein, PARP9 relative expression was evaluated after ischemia, but not other candidate RNA binding proteins, such as Ykt6, hnRNPA1 and Tardp. Moreover, PARP9 expression was decreased in tRF-Gly-GCC antagomir treated group compared to control group.

Conclusions:
In conclusion, tRF-Gly-GCC aggravated ischemic injury, suggesting that it may serve as a potential therapeutic target for cerebral ischemia.
Abstract DP36: Efficacy of Endovascular Treatment for Idiopathic Intracranial Hypertension：Cerebral Venous Sinus Stenosis Treated by Stenting
Authors: Chen Jian , Wu Di , Ji Xunming
Published: January 2025

Objective:
To explore the diagnosis of cerebral venous sinus stenosis(CVSS) in idiopathic intracranial hypertension(IIH)，and to evaluate the efficacy and risk of venous sinus stenting treatment for CVSS．

Methods:
50 patients with refractory IIH complicated with CVSS underwent examination with magnetic resonance venography (MRV)，digital subtraction angiography(DSA) and direct retrograde cerebral venography and manometry to confirm morphologic features of IlH and measure venous pressure．The CSF pressure on lumbar puncture ranged from 250 to 500 mmH
2
O with normal composition. All patients had headache, and funduscopic examination demonstrated papilledema for all patients. 38 patients who showed severe stenosis of venous sinuses with the pressure gradient across the stenosis >100 mmH
2
O were treated with venous sinus stenting and were followed-up for more than 12 months．Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome during the follow-up period.

Results:
Sinus stenting angioplasty was successful in all 38 patients．In all patients venous sinus stenosis was improved after stenting procedure (the residual stenosis rate<20％) and intrasinus pressure was reduced (the pressure gradient vanished or<20 mmH
2
O )．The clinical symptoms in all the patients were improved or disappeared at discharge and intracranial pressures were normalized within 3 months after the procedure．During the follow-up period of (12.3±11) months (range 12 to 24 months)，no patient had recurrence of IIH．In all cases，DSA or MRV was performed at 12-month follow-up and demonstrated the absence of sinus thrombosis or in-stent stenosis.

Conclusions:
Patients with refractory IIH should be assessed for CVSS．MRV or DSA was recommended for these patients as a routine work-up．Cerebral venography and manometry are helpful to evaluate the relation between venous outflow obstruction and intracranial hypertension．If severe CVSS is presented in patients who experienced medical treatment failure, endovascular stent placement could be an alternative to classic surgical approaches. Additional randomized and controlled clinical research is deserved.
Abstract DP44: Mexican Americans Have Worse Patient Reported Outcomes After Stroke When Compared to non-Hispanic Whites
Authors: Chhabra Nikita , Kwicklis Madeline , Lisabeth Lynda , Morgenstern Lewis
Published: January 2025

Introduction:
Patient reported outcomes post-stroke may be more sensitive to meaningful differences than the modified Rankin Scale (mRS). We aimed to compare patient reported outcomes (PROMs) in Mexican Americans (MAs) and non-Hispanic Whites (NHWs) in a community-based study. We also explored the correlation of PROMs with the mRS at 3 months post-stroke.

Methods:
All patients with ischemic and hemorrhagic stroke (ICH) from mid 2019-2023 in the Brain Attack Surveillance in Corpus Christi (BASIC) project were enrolled. PROMs and mRS were assessed at 3 months post-stroke. PROMs were assessed by the Patient-Reported Outcomes Measurement Information System, (PROMIS), Work and Social Adjustment Scale (WSAS), Economic Quality of Life Survey (EQOL) and ability to return to work and driving.

For unadjusted analyses, medians and IQRs were reported for continuous and ordinal variables, with t-test p-values. Chi-squared tests were used for binary variables. For adjusted models, logistic, multinomial, or proportional-odds cumulative logit models were used as appropriate. Multitier inverse probability weighting (IPW) addressed sample attrition, and covariates included age, sex, initial NIHSS, comorbidity count, ischemic vs ICH, and previous stroke.

Results:
A total of 913 patients were included. Table 1 provides the main results. In the adjusted analysis, MA had significantly lower (worse) PROMIS Global Mental Health score (mean ethnic difference: -2.24, 99% CI: -3.93 to -0.54, p<0.01) and (worse) WSAS score (pOR: 2.15 99% CI 1.48 to 3.12, p<0.01) vs NHWs. On EQOL, MA were significantly less likely to have enough income to meet needs (p<0.01), enough income to pay bills (p<0.01), more likely to delay health care (p<0.01), and less likely to always afford personal care (p<0.01) vs NHWs. MA were significantly less likely to return to driving (OR 0.56 99% CI 0.34 to 0.90, p<0.01) vs NHWs. PROMIS scores were moderately correlated with mRS at 3 months (Table 2).

Conclusions:
MA have significantly worse long-term PROMs when compared to NHWs and PROMs are not very highly correlated with mRS. Efforts to understand the etiology of these ethnic differences are needed. This data supports the need to collect PROMs in stroke patients.
Abstract DP51: Migraine with Aura is Associated with Increased 90-day Ischemic Stroke Risk
Authors: Shu Liqi , Strelecky Lukas , Spears Roderick , Bakradze Ekaterina , Field Thalia , Nguyen Thanh , Fang Ton , Salehi Omran Setareh , Siegler James , Stretz Christoph , Furie Karen , Yaghi Shadi
Published: January 2025

Background:
Migraine with aura (MA) is recognized as an independent risk factor for acute ischemic stroke (AIS). However, the short-term risk of stroke, particularly within 90 days of hospitalization, has not been thoroughly evaluated on a national scale. This study aims to address this gap by examining the association between MA and 90-day AIS readmission.

Methods:
Using the National Readmission Database between 2016 and 2019, we identified patients admitted with a principal or non-principal diagnosis of migraine. The reference group for analysis contained all adult patients admitted during the study period without migraine. The primary outcome was subsequent AIS admission within 90 days. Diagnoses were identified using standard ICD-10-CM codes. A multivariable Cox regression model was employed to assess the risk of AIS readmission risk in patients with MA, adjusted for significant cardiovascular risk factors. Interaction analyses were conducted to determine whether traditional cardiovascular risk factors influenced the association between MA and subsequent AIS risk.

Results:
Among 106,608,073 patients (mean age 46.48, 57.86% female) admitted during the study period, 1,711,841 (1.61%) patients were admitted with any migraine diagnosis and 101,278 (0.10%) were admitted with MA. Within 90 days, 411,850 (0.39%) patients had a subsequent admission for AIS. After adjusting for sex, coronary artery disease, atrial fibrillation, hypertension, hyperlipidemia, diabetes mellitus, and smoking, patients with MA demonstrated an elevated risk for 90-day AIS (adjusted hazard ratio [aHR] 1.76, 95% CI 1.56-1.99, p < 0.001). Migraine without aura was not associated with increased AIS risk (aHR 1.02, 95% CI 0.84-1.23, p=0.846). Significant interactions were observed with age, sex, hypertension, and atrial fibrillation (Figure).

Conclusions:
In this large patient cohort, migraine with aura was associated with an increased risk of AIS readmission within 90 days, particularly in patients without traditional cardiovascular risk factors. These findings underscore the need for potentially more aggressive stroke prevention strategies in patients with MA. Future research should investigate the pathomechanisms underlying this association.
Abstract DP53: Drivers of Disparities in Stroke Outcomes by Neighborhood Socioeconomic Status: A Causal Mediation Analysis
Authors: Stulberg Eric , Miller Robert , Hartman Nicholas , de Havenon Adam , Lisabeth Lynda
Published: January 2025

Introduction:
Identification of modifiable drivers of the disparity between neighborhood socioeconomic status (nSES) and stroke outcomes remains elusive. Using a causal inference framework, we evaluate the degree of mediation by modifiable individual- and neighborhood-level characteristics in the association between worse nSES and worse 90-day stroke outcomes.

Methods:
Our analytic sample was composed of 90-day community-dwelling stroke survivors with non-missing data between 2010-2020 from the Brain Attack Surveillance in Corpus Christi (BASIC) cohort. Variables were derived from BASIC, Redfin and the National Neighborhood Data Archive (NaNDA). The census-derived nSES index was our exposure. 90-day outcomes were functional status via the average of the 22-item ADL/IADL Scale, post-stroke depression symptoms via the PHQ-8, and quality-of-life via the average of the Stroke Specific QoL Scale (SS-QOL). Confounder-adjusted multi-level Bayesian G-computation causal mediation analysis was used to determine to what extent hypothetical interventions on individual level (receipt of thrombolysis or thrombectomy) and neighborhood level (density of home health services, walkability, transportation access, density of recreation centers, and density of rehabilitation providers) characteristics would reduce the disparity of 90-day outcomes by nSES. We repeated the analyses stratified by stroke severity (NIHSS ≤ 5 or >5).

Results:
Among the 2,118 stroke survivors in 68 census tracts, 47% were female and 59% were Mexican-American. The respective median (IQR) values of nSES, PHQ-8, IADL/ADL score, and SS-QOL were: -0.7 (-1.2 – -0.2), 5.0 (1.0 – 11.0), 2 (1.3 – 3.0), and 3.5 (2.6 – 4.3). Figure 1 displays the total, direct and decomposed mediated indirect effects by groupings of correlated mediators. Figure 2 displays the results stratified by stroke severity. Table 1 displays the indirect effects mediated by each specific characteristic in our total and stratified samples.

Discussion:
Lower nSES portends worse stroke outcomes. However, this disparity was not significantly driven by receipt of hyperacute treatment, neighborhood walkability, transportation access, density of rehabilitation providers, density of home health services, or density of recreation centers irrespective of stroke severity. Future work should explore other potential intervenable drivers of the disparity such as time-to-treatment and discharge destination using a similarly rigorous framework.
Abstract DP6: Multicultural Recommendations to Guide Stroke Care: A Document Review of International Stroke Guidelines
Authors: Baih Shegaw , Drury Peta , Allida Sabine , Ferguson Caleb
Published: January 2025

Introduction:
Stroke represents a major global public health challenge, with 12.2 million new cases, 6.5 million deaths, and over 143 million disabilities occurring annually, leading to significant economic and social repercussions. Structural racism deleteriously influences stroke care and outcomes, making it essential to integrate multicultural considerations throughout the stroke care continuum to enhance outcomes and reduce disparities. A document analysis was conducted to assess the extent to which stroke guidelines address cultural diversity in stroke care.

Method:
A document review of international stroke guidelines was employed based on the framework established by Steinberg et al. A Google search was conducted to identify international stroke care guidelines published in English within the last five years (2019 – 2024). The quality of these guidelines was assessed using the Appraisal of Guidelines for Research&Evaluation (AGREE-II) tool. Paired reviewers independently screened the guidelines and identified recommendations related to multicultural stroke care, defined as ‘
practices aimed at ensuring care delivery is culturally competent, sensitive, safe, equitable, and adaptable’
.

Results:
A total of twenty-five guidelines were included, with the majority originating from Western countries such as Australia, the United States, the United Kingdom, Canada, and various European societies. Only four of the twenty-five guidelines explicitly addressed multicultural considerations. Most of the recommendations were based on low levels of evidence or consensus and related to dietary and cultural considerations, and the management of diverse patient needs in stroke care.

Conclusion:
A paucity of recommendations for multicultural considerations in stroke care were identified. Current stroke care guidelines fail to address multiculturalism adequately, which may reflect the maturity of the available evidence to inform guideline recommendations. Further research is needed to identify enablers and barriers to incorporating multicultural considerations in stroke care and the development of future guidelines. New evidence is needed in this regard to improve clinical outcomes of diverse populations.
Abstract DP7: Harmonizing Haste: Emergency Department and Interventional Radiology Collaboration for Enhanced Thrombectomy Efficiency
Authors: Deely Kathleen , Burnham Nicole , Bosel Jessica , Laurence Shenee , Reagin Richard
Published: January 2025

Introduction:
Acute ischemic stroke (AIS) requires immediate identification and efficient treatment. Particularly, Large Vessel Occlusions (LVOs) may necessitate thrombectomy to restore brain blood flow. Rapid treatment times from symptom onset and hospital arrival to revascularization are critical for improved outcomes. When a thrombectomy candidate is identified, swift transport to our Neurological Interventional Radiology (NIR) Cath Lab (CL) is necessary. The introduction of a new hospital building in 2019 required new transportation workflows, which were updated in 2022 due to concerns about delayed transport times. As a Comprehensive Stroke Center (CSC), we evaluate each thrombectomy case and track key metrics as part of our commitment to provide swift, safe treatment. These metrics are part of The Joint Commission's Comprehensive Stroke core measures.

Method:
Organizational improvement projects use an A3 structured approach. A workgroup comprising of stakeholders from CSC’s Stroke Department, ED, and NIR CL, focused on analyzing current metrics and gaps, leading to revising the transportation workflow. Focus areas included turnover-induced knowledge gaps, limited preparation time, miscommunication, and heavy workloads hindering prompt communication. These resulted in delayed transport to CL. To rectify this, the team improved communication and clarified roles via a novel workflow (Fig. 1). Now, the CL RN coordinates with the ED RN to organize patient transport. The transition towards task-specific roles reduced educational requirements and increased efficiency. This framework went live in October 2022.

Results:
See image 3.

Conclusion:
With the successful implementation of the new workflow, thrombectomy patients saw 20-21% treatment time improvements (Fig. 2). The CSC continues to monitor these metrics for further improvement.

Standardizing workflows, with a focus on improved communication, can decrease LVO patient’s arrival-to-treatment times and is applicable to other acute care facilities.
Abstract HUP10: Dissociation Between Perceived Racial Discrimination and SDOH Among Black and Hispanic Stroke Patients
Authors: Valdes Eduard , Corkrum Michelle , Cadena Tejada Angel , Harris Jennifer , Naqvi Imama , Marshall Randolph , Williams Olajide
Published: January 2025

Stroke disparities are well-documented, with Black and Hispanic populations experiencing worse outcomes compared to White patients. Beyond traditional medical risk factors, social determinants of health (SDOH) and perceived racial discrimination (PRD) have been implicated in these disparities. However, the interplay between SDOH and PRD among these groups remains unclear. This study explores the relationship between SDOH and PRD among stroke survivors across racial groups. We hypothesized that PRD scores would differ across racial groups, potentially independent of the burden of SDOH.

We conducted a cross-sectional analysis of 67 stroke survivors, categorized as Black (N=38), Hispanic (N=17), or White (N=12), from an urban tertiary care center. Perceived discrimination was assessed using an adapted PhenX tool, and SDOH were evaluated using a modified PhenX survey covering five domains: education, economic stability, healthcare access, neighborhood, and social support. Statistical analyses included ANOVA and multivariable linear regression models adjusting for age, sex, stroke severity, and neighborhood disadvantage.

Significant differences in PRD were observed among racial groups (P = 0.0118). Black participants reported the highest discrimination scores (mean 10.4, SD 10.00), compared to Hispanic (mean 4.4, SD 7.01) and White participants (mean 3.3, SD 4.38). Despite this, the prevalence of ≥3 SDOH barriers was similar between Black and Hispanic participants and lower in White participants. Multivariable analysis revealed that Black individuals had significantly higher PRD scores than both Hispanic (Beta estimate -6.90, 95% CI: -12.38 to -1.42, P = 0.0144) and White individuals (Beta estimate -7.72, 95% CI: -13.43 to -1.42, P = 0.0089). No significant differences in other SDOH domains were found except for neighborhood disadvantage, which was more prevalent among Hispanic participants (P = 0.0202).

The findings reveal a dissociation between PRD and SDOH burden among stroke survivors. Black stroke survivors report higher perceived discrimination despite similar SDOH burdens as Hispanic participants. These results underscore the importance of addressing perceived discrimination independently of SDOH in interventions aimed at reducing racial disparities in stroke outcomes. Further research is needed to explore the mechanisms driving these differences and to develop targeted strategies for mitigating their impact.
Abstract HUP12: Communities Beliefs, Attitudes, Practices And Recommendations For Improving Stroke Prevention And Stroke Care In Rural And Urban Communities In Nigeria.
Authors: Uvere Ezinne , Jenkins Carolyn , Melikam Ezinne Sylvia , Arulogun Oyedunni , Ajala Omotolani , Ayodele Adewale , Adebajo Olayinka , Adeleye Osi , Ogunronbi Mayowa , Nwimo Chukwuemeka , Nichols Michelle , Popoola Oluwafemi , Akinyemi Joshua , Tagge Raelle , Akinyemi Rufus , Akpa Onoja , Salami Ayodeji , Taiwo Olalekan , Adebayo Ayodeji , Olowoyo Paul , Ilori Temitope , Olaniyan Olanrewaju , Walker Richard , Ovbiagele Bruce , Owolabi Mayowa
Published: January 2025

Introduction:
The African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) study is focused on developing an integrated mHealth community-based interactive Stroke Information and Surveillance System. This is the first paper to qualitatively investigate and contrast community beliefs, attitudes, and practices related to stroke prevention, risk factors and care from alternative/complementary medicine providers/healers, orthodox/modern medicine/health care providers, community members and leaders in Nigeria.

Methods:
Six focus groups with community members and leaders (n=57) and key informant interviews with health providers (n=24) from alternative/complementary medicine providers and orthodox/modern medicine providers were conducted to qualitatively explore beliefs, attitudes, practices, and recommendations related to stroke in urban (Ibadan) and rural (Ibarapa) communities in Nigeria. The Health Belief Model and Social Ecological Model guided the questions and thematic analysis of the qualitative data.

Results:
Participants perceived stroke as disabling though manageable but with odds of repeat stroke for survivors. High blood pressure, stress, sleep issues, heredity, and lifestyle factors were some stroke risk factors perceived by participants from both sites although God, witchcraft/evil people were reported by rural participants. Hospital visits and consumption of herbal concoction, self-medication and visit to church for prayers were some actions taken to manage stroke by both urban and rural participants. Low literacy levels, limited funds, fear of and distance to hospitals, and absence of insurance were some barriers to uptake of recommendations from orthodox medicine practitioners which are drivers to unorthodox practitioners. To improve stroke care and prevention across communities, free risk factor screening, indigenous stroke awareness programs via print, audio-visual and electronic media were suggested by all participants.

Conclusion:
Diverse beliefs and practices are related to stroke risk factors, prevention and care and barriers with obtaining care. There is need to work across systems to improve stroke prevention and care in communities.
Abstract HUP16: Evaluating the Role of a Community Stroke Education Initiative for the Nashville Asian American and Pacific Islander Population
Authors: Kang Jieun , Chen Anne , Du Jennifer , Brown Kiersten , Acosta Lealani Mae Y.
Published: January 2025

Background:
Prior studies demonstrate an increased prevalence of primary intracranial hemorrhage with lengthened hospital stays within the Asian American and Pacific Islander (AAPI) population. AAPI patients who experience acute ischemic strokes may be less likely to receive intravenous thrombolytic therapy despite presenting with strokes of greater severity. Yet, minimal research has been conducted to explore why these disparities exist.

Purpose:
To assess for gaps within stroke education (symptom identification, risk factors, and primary prevention measures) and evaluate the utility of a stroke outreach initiative in the Nashville AAPI community.

Methods:
A stroke outreach initiative was designed and administered to provide education on stroke symptoms using the FAST acronym, risk factors, and the importance of regular follow-up with primary care. Participants also received stroke educational materials in English, Simplified Chinese, Japanese, Korean, or Vietnamese from reliable sources (e.g., the American Heart Association, MedlinePlus). Pre- and post-education surveys assessed knowledge of stroke symptoms and primary stroke prevention. Proportional analysis and non-parametric analysis of paired comparisons (McNemar test) are reported.

Results:
Twenty-two API community members at an AAPI festival in Nashville, TN participated in the initiative. Pre-initiative surveys revealed 8/22 (36%) participants were unable to identify stroke symptoms, 9/22 (40%) participants did not know what actions to take if someone is experiencing a stroke, and 10/22 (45%) participants did not follow up with primary care at least yearly. Post-initiative surveys showed a statistically significant improvement (p<0.05) where 21/22 (95%) participants correctly reported two of the FAST symptoms. 8/8 (100%) participants who previously were unable to identify stroke symptoms identified at least two symptoms post-initiative. All participants found this initiative beneficial.

Conclusion:
An education initiative reviewing FAST symptoms, stroke risk factors, and primary stroke prevention through regular follow-up with primary care can improve the quality of stroke education in the Nashville AAPI population. Additional instruction and increased frequency of the initiative may improve retention of knowledge and further encourage stroke awareness and primary stroke prevention to a wider AAPI audience.
Abstract HUP18: Barriers in Acute Stroke Care for Patients with Limited English Proficiency
Authors: Trang Ivan , Ali Amir , Ganne Chaitanya , Perez Malagon Carlos David , Nguyen Thy , Sharrief Anjail
Published: January 2025

Introduction:
Research shows that ischemic stroke patients with limited English proficiency (LEP) experience disparities in stroke care, including increased time to treatment with intravenous thrombolysis. During code strokes, translation devices are necessary to evaluate stroke patients with LEP, but the devices may not be readily available or may have poor reliability (e.g., poor connection, poor audio quality). This study aims to systematically evaluate the challenges that clinicians, nurses, and other healthcare professionals encounter when assessing stroke patients with LEP.

Methods:
A survey was distributed to clinicians, nurses, and other healthcare personnel who provided care to stroke patients over a six-month period. We collected information regarding role (e.g., physician, nurse), availability of translation devices, and reliability of translation devices in this survey. Descriptive statistics were used to analyze the data.

Results:
Of the clinician respondents, 71% (12/17) reported inaccessibility to translation devices during code strokes. Additionally, 65% (11/17) experienced technical difficulties with translation devices during code strokes. Furthermore, 76% (13/17) of clinicians believed that inadequate or unreliable translation services have compromised their ability to manage code strokes for LEP patients. A significant majority of overall respondents, 88% (28/32) expressed interest in a mobile application to aid in evaluating stroke patients with LEP and 81% (26/32) showed interest in learning how to perform the NIH Stroke Scale in another language.

Conclusion:
Despite the availability of translation services, issues with reliability and accessibility hinder the quality of care for stroke patients with LEP, highlighting the need for systemic improvements. Many clinicians call for improved services and technology, which our group will focus on developing.
Abstract HUP2: Geographical Trends in Cerebrovascular Disease Mortality in the United States, 1999-2020
Authors: Tran Joseph , Pasia Gab , Flores Sanchez Dajhanna , Westhoff John
Published: January 2025

Introduction:
Cerebrovascular disease, a leading cause of death in the U.S., presents ongoing public health challenges, particularly in understanding geographic and demographic disparities in mortality. Although mortality trends by sex, race, and ethnicity are well-documented, geographic variations across the U.S. remain underexplored. This study describes cerebrovascular disease mortality trends from 1999 to 2020, focusing on state and urban-rural differences.

Methods:
This retrospective cohort study analyzed 5,387,782 death certificates from 1999 to 2020, obtained from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database, focusing on cerebrovascular disease, defined by ICD-10 codes I60-I69. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated based on the 2000 U.S. standard population. Temporal trends in mortality rates, stratified by urban-rural classification (large central metro, large fringe metro, medium metro, small metro, rural) and state, were characterized using the Joinpoint Regression Program, version 5.2.0 (National Cancer Institute). Statistical analyses were performed using RStudio 4.4.1, with p < 0.05 indicating significance. This study used deidentified, publicly available data and was deemed not human research by the University of Nevada, Reno IRB.

Results:
From 1999 to 2020, the overall U.S. AAMR for cerebrovascular disease declined, with an average annual percent change (AAPC) of -2.03% (95% CI: -2.34 to -1.80, p < 0.001). Rural areas consistently had the highest AAMRs throughout the 22-year study period, though they decreased from 113.9 per 100,000 in 1999 to 78.6 in 2020. A significant upward trend was observed from 2018 onwards across all urban-rural classifications, with rural areas experiencing a 5.31% (95% CI: 2.53 to 6.95, p < 0.001) increase in AAMR between 2018 and 2020. State-level analysis showed significant variability among states, with states like Mississippi having persistently high AAMRs, despite overall declines.

Conclusion:
This study highlights a significant overall decline in U.S. cerebrovascular disease mortality from 1999 to 2020, alongside a recent concerning increase beginning in 2018, particularly in rural areas and certain states. These findings underscore the need for targeted public health interventions to address emerging disparities in cerebrovascular disease outcomes by region and urbanization level.
Abstract HUP20: Assessing Social Vulnerability's Effect on Patient Outcomes in Los Angeles County Stroke Patients Among a Health System and Its Impact on Health Disparities
Authors: Mayorga Lina , Bohn Joe , Levin Dr Bruce L , Kim-Tenser May , Sanossian Nerses , Towfighi Amytis
Published: January 2025

Background:
In Los Angeles County, the impact of high social vulnerability on stroke patient outcomes is a critical area of concern, given the region's diverse socioeconomic landscape and significant health disparities. High social vulnerability among stroke patients can significantly impact their outcomes in several ways, from poorer functional outcomes, access to care, and higher risk for pre-existing conditions, including increased history of behavioral health issues.

Objective:
This study aims to explore how high social vulnerability affects stroke outcomes among patients in Los Angeles County Health System, pre-existing co-morbidities, recovery trajectories, and overall health status. And evaluate differences between race, gender and age.

Methods:
We conducted a social vulnerability index analysis of stroke patients in the Los Angeles County Health System, utilizing data from medical records, socioeconomic indicators, and healthcare access metrics. Social vulnerability was assessed using indices incorporating factors such as income, education, housing stability, and access to healthcare.

Results:
Findings reveal that stroke patients with high social vulnerability experience poorer functional outcomes (p<.05)and increased stroke severity (p<.05), including increased mortality rates, lower functional recovery, and higher rates of complications. Additionally, patients in socioeconomically disadvantaged communities are more likely to face barriers in accessing quality healthcare services, which exacerbates the disparities in stroke outcomes. Latinos faced a twofold increase in poorer outcomes in comparison to other races.

Conclusion:
High social vulnerability significantly impacts stroke patient outcomes in Los Angeles County. The findings highlight the need for targeted interventions to improve healthcare access, enhance support services, and address socioeconomic barriers to mitigate the adverse effects on stroke recovery and overall health. Addressing these disparities is essential for reducing health inequities and improving patient outcomes in diverse urban populations.