bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP89: Comparative Outcome Of Patients With And Without Mild Pre-Stroke Morbidity Following Endovascular Treatment - Results From The Hermes Meta-analysis
Authors: McDonough Rosalie V , Ospel Johanna M , Majoie Charles B , White Philip , Dippel Diederik W , Brown Scott , Demchuk Andrew M , Jovin Tudor G , Mitchell Peter J , Bracard Serge , Campbell Bruce , Muir Keith W , Hill Michael D , Guillemin Francis , Goyal Mayank ,   HERMES collaborators
Published: February 2022

Introduction:
Analyses of the effect of prestroke functional levels upon outcome of endovascular therapy (EVT) have focused on the course of patients with moderate to substantial prestroke disability. The effect of complete freedom from pre-existing disability (modified Rankin Scale [mRS]=0) vs. predominantly mild pre-existing disability (mRS≥1) has not been well delineated.

Methods:
Data were from the HERMES collaboration, a meta-analysis of 7 randomized controlled trials that tested the safety and efficacy of EVT. Two multivariable ordinal logistic regression models were used to compare the association between EVT and 90-day mRS (primary outcome) in patients who were asymptomatic prestroke (mRS=0) and those who had predominantly mild disability prestroke (mRS≥1). Secondary outcomes included successful reperfusion (in the EVT subgroup) and symptomatic intracranial hemorrhage (sICH) at 24 hours.

Results:
We included 1764 patients in the analysis, of whom 223 (12.6%) had a prestroke mRS≥1 (162 mRS 1, 61 mRS≥2). Patients with prestroke mRS≥1 had worse outcomes compared to those with prestroke mRS=0 (adjusted odds ratio [aOR] 0.42 (95%CI:0.28-0.63). Nonetheless, a significant benefit of EVT was observed in the mRS≥1 subgroup (common OR:1.79 (95%CI:1.11-2.89, Figure). No significant differences were observed with regards to rates of reperfusion (aOR:0.91, 95%CI:0.52-1.57) and sICH (aOR:1.03, 95%CI:0.37-2.93) between patients asymptomatic vs. predominantly with mild disability prestroke.

Conclusion:
Patients completely asymptomatic prior to onset have better outcomes from EVT than those with mild disability. Patients with prestroke mRS=1 still do more often achieve good functional outcomes with EVT compared to conservative management, with similar rates of reperfusion and sICH. These findings indicate even mild pre-existing symptoms exert prognostic (outcome) but not predictive (different response to therapy) in patients eligible for EVT.
Abstract WP102: Risk Score Estimation For The Prognostication Of Post-stroke Functional Independence Using Data-driven Score Assignment With Clinical And Imaging Biomarkers
Authors: Hong Sungmin , Bonkhoff Anna , Bretzner Martin , Giese Anne-Katrin , Schirmer Markus D , Dalca Adrian , Donahue Kathleen , Nardin Marco , Jern Christina , Lindgren Arne G , Maguire Jane , Golland Polina , Rost Natalia S ,   MRI-GENIE and GISCOME Investigators,   International Stroke Genetics Consortium
Published: February 2022

Objective:
Accurate prognostication of functional outcomes after an acute ischemic stroke (AIS) is essential for the planning of post-stroke treatments. We sought to provide an improved risk score for the prognostication by leveraging an interpretable machine learning and neuroradiologic biomarker.

Data:
We evaluated 913 patients with available 90-day mRS and admission NIHSS from the MRI-GENIE study. Age, sex, hypertension, atrial fibrillation, diabetes, coronary artery disease, smoking and prior stroke were available. We quantified WMH volume (WMHv) on FLAIR images. We divided patients into development and validation sets from multiple sites, and an external validation set from an individual cohort (Figure (a)).

Methods:
We measured the unaccounted WMHv (uWMH) by the residual of the log-linear regression model of WMHv regarding the clinical characteristics. Excessive uWMH (eWMH) was defined as present vs. absent based on a uWMH higher than +1 standard deviation. The clinical characteristics, admission NIHSS, and presence of eWMH were used as the inputs of a constrained logistic regression model with variable selection (RiskSLIM) that estimated a risk score for the prediction of post-stroke functional independence (mRS 0-2).

Results:
Admission NIHSS, age, sex, diabetes, prior stroke, and eWMH were selected with assigned risk scores (Figure (b)). The estimated risk score outperformed the conventional THRIVE and SPAN100 in the development, validation, and external validation sets regarding the area under curve (AUC) and the brier score (Figure (c)).

Conclusion:
This proposed risk score leveraging the interpretable machine learning and imaging biomarkers improved the prognostication of the post-stroke functional independence. Since the proposed risk score system does not require high computational resources, it is expected to be widely used in daily clinical practices for centers with MR imaging capability.
Abstract WP109: Association Of Cisternal Blood Clot Burden And Ventriculoperitoneal Shunt Requirement In Subarachnoid Hemorrhage
Authors: Meyer Aiden , Forman Elyse , Moody Scott , Stretz Christoph , Potter Nicholas S , Wendell Linda C , Thompson Bradford , Reznik Michael , Furie Karen L , Mahta Ali
Published: February 2022

Background:
Aneurysmal Subarachnoid hemorrhage (aSAH) can be complicated by refractory hydrocephalus requiring a ventriculoperitoneal shunt (VPS). In an effort to optimize external ventricular drain (EVD) management, we sought to identify early radiographic predictors for refractory hydrocephalus requiring VPS placement.

Methods:
We conducted a retrospective case-control study of patients admitted for aSAH to a referral academic center from 2016 to 2021. We included those who survived their hospital course and compared radiographic features on admission non-contrast head CTs of patients who required a VPS and those who did not. We calculated modified GRAEB scores and measured total blood clot thickness (blood clot cisternal score) in the basal cisterns including interpeduncular, ambient, crural, prepontine, suprasellar, and interhemispheric cisterns plus bilateral Sylvian fissures (in mm). Binary logistic regression was used to test the association of VPS requirement with radiographic features. Receiver operating characteristics (ROC) curve analysis was performed to compare predictive accuracy of cisternal score to other predictors.

Results:
Our inclusion criteria yielded 176 patients (mean age of 54.9 years [SD 12.8]; 57% female, 70% white) of which 29 (16.5%) required a VPS. Cisternal score was greater in patients who required a VPS than those who did not (median 61.6 mm, IQR 49.8-74.3 mm vs 26.8mm, IQR 12.4-46.7; p<0.001). Binary logistic regression showed higher blood clot cisternal score on admission head CT scan was associated with higher odds of developing refractory hydrocephalus with VPS requirement (odds ratio 1.06 per each millimeter increase, 95% CI 1.03-1.09; p<0.001), independent of age, Hunt and Hess grades and modified GRAEB scores. Blood clot cisternal score has higher accuracy in predicting VPS requirement than modified GRAEB score (AUC 0.83, 95% CI 0.74-0.93 vs AUC 0.72, 95% CI 0.63-0.82) and other clinical or radiographic predictors on admission.

Conclusions:
While further validation is needed, our model suggests that blood clot cisternal score on admission head CT scan has high accuracy in predicting VPS requirement. This may allow for more efficacious and cost-effective treatment of hydrocephalus in aSAH patients.
Abstract WP122: Clinical Indicators To Identify Non-early Improvement After Stroke Treatment In The Extended Treatment Window Era
Authors: Emmerson Danison , Zacharewski Nicholas , Elmashad Ahmed , akram nida , Miller Ethan , Wynne Kolu , Tunguturi Ajay
Published: February 2022

Background:
There are few clinical indicators beyond imaging to aid in the prediction of improvement after treatment for acute ischemic stroke. We aimed to identify patient characteristics that serve as predictors to identify patients who may be less likely to have a clinically significant improvement after treatment.

Methods:
We performed a retrospective chart review of ischemic stroke treatment cases (tPA, EVT or both) at Hartford Hospital between January 1st, 2020 to December 31st, 2021. Stroke was diagnosed with MRI imaging. Patients were divided into those who had early improvement and those who did not have early improvement. Early improvement was defined as a reduction in NIH of 50% or more at 24 hours post treatment. We excluded patients who did not receive a routine CT scan at 24-hours for surveillance of hemorrhage. We identified potential predictors by comparing two demographic (age, gender) and 19 patient health characteristics between groups. Any variables that were significantly different (P<.05) between groups were then examined as a predictor in a multivariate logistic regression analysis, while controlling for therapeutic intervention and time to treatment in the model.

Results:
A total of 363 patient records met inclusion criteria; 223 had early improvement and 140 did not. Patients were aged 71.74±15.65yr and 52.1% were female. There were eight potential predictors identified and included in the regression analysis. Higher blood pressure [odds ratio (OR)=0.991; 95% confidence interval (CI)=0.98, 1.00; P=.02], and statin use (OR=0.276; 95% CI=0.16, 0.47; P<.001) were associated with a decreased likelihood of early improvement.

Conclusion:
Our findings indicate that patients who are taking statins and/or have high blood pressure have a decreased likelihood of having an early improvement following stroke treatment. Clinicians should consider these factors when putting together treatment plans for ischemic stroke patients. The association between statin use as well as systolic blood pressure and improvement after stroke treatment should be further examined in a randomized controlled trial.
Abstract WP127: Cerebral Microbleeds, Cerebral Amyloid Angiopathy, And Their Relationships To Quantitative Markers Of Neurodegeneration
Authors: Beaman Charles , Kozii Khrystyna , Hilal Saima , Liu Minghua , Spagnolo-Allende Antonio , Chen Christopher , Cheng Ching-Yu , Zambrano Daniela , Arikan Burak , Del Brutto Victor J , Wright Clinton , Flowers Xena E , Leskinen Sandra P , Rundek Tatjana , Mitchell Amanda , Vonsattel Jean Paul , Cortes Etty , Teich Andrew F , Sacco Ralph L , Elkind Mitchell S , Roh David , Gutierrez Jose
Published: February 2022

Introduction:
Age-related cognitive impairment is driven by the complex interplay of neurovascular and neurodegenerative disease. There is a strong relationship between cerebral microbleeds (CMBs), cerebral amyloid angiopathy (CAA), and the cognitive decline observed in conditions such as Alzheimer’s disease. In the early, preclinical phase of cognitive impairment, the extent to which CMBs and underlying CAA impact volumetric changed in the brain related to neurodegenerative disease remains unclear.

Methods:
We performed cross-sectional analyses from 3 large cohorts: The Northern Manhattan Study (NOMAS), Alzheimer’s Disease Neuroimaging Initiative (ADNI), and the Epidemiology of Dementia in Singapore study (EDIS). We conducted a confirmatory analysis of 82 autopsied cases from the Brain Arterial Remodeling Study (BARS). We implemented multivariate regression analyses to study the association between two related markers of cerebrovascular disease – MRI-based CMBs and autopsy-based CAA, as independent variables, and volumetric markers of neurodegeneration, as dependent variables.

Results:
We included 2657 participants with available MRI data and 82 autopsy cases from the BARS. In a meta-analysis of NOMAS, ADNI and EDIS, superficial CMBs were associated with larger gray (β=4.49 ± 1.13, P=0.04) and white (β=4.72 ± 2.1, P=0.03) matter volumes. The association between superficial CMBs and larger white matter volume was more evident in participants with one CMB (B=5.17 ± 2.47, P=0.04) than in those with ≥ 2 CMBs (β=1.97 ± 3.41, P=0.56). In the BARS, CAA was associated with increased cortical thickness (β = 6.5 ± 2.3, P=0.016) but not with increased brain weight (β=1.54 ± 1.29, P=0.26).

Discussion:
Superficial CMBs are associated with larger morphometric brain measures. This association is strongest in brains with fewer CMBs, suggesting that the CMBs/CAA contribution to neurodegeneration may not relate to tissue loss, at least in early stages of disease.
Abstract WP150: Influence Of Body Mass Index On Adenosine Deaminase And Infarct Volume In Mechanical Thrombectomy Subjects
Authors: Maglinger Benton , McLouth Christopher , Frank Jacqueline , Sands Madison , Sheikhi Lila E , Pahwa Shivani , Dornbos David L , Rupareliya Chintan , Harp Jordan , Trout Amanda L , Turchan-Cholewo Jadwiga , Stowe Ann M , Fraser Justin , Pennypacker Keith R
Published: February 2022

Background:
Emergent Large Vessel Occlusion (ELVO) strokes are devastating ischemic vascular events for which novel biomarkers and therapies are needed. The purpose of this study is to investigate the role of Body Mass Index (BMI) on protein expression and signaling at the time of ELVO intervention.

Methods:
The Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) is a continually enrolling tissue bank (clinicaltrials.gov NCT03153683) from stroke patients undergoing mechanical thrombectomy (MT). N=61 human carotid plasma samples were analyzed for inflammatory and cardiometabolic protein expression by Olink Proteomics.

Results:
The 61 subjects studied were broken into three categories: Normal weight (BMI 18.5-24.9) which contained 19 subjects, Overweight (BMI 25-30) which contained 25 subjects, and Obese (BMI ≥30) which contained 17 subjects. When compared to Normal weight and Overweight categories, the Obese category had significantly higher levels of adenosine deaminase (ADA) expression (p=0.01 and p=0.039, respectively). Elevated levels of ADA were found to have a significant positive correlation with both infarct volume and edema volume (p=0.013 and p=0.041, respectively), and were associated with a more severe stroke (NIHSS on discharge) and greater stroke-related disability (mRS on discharge) with significance of p=0.053 and p=0.032, respectively). When controlling for age and sex, increased infarct volumes were predicted by higher ADA levels in the Obese population (p=0.009), while increased ADA levels were not predictive of increased infarct volumes in the Normal weight category.

Conclusions:
When examined according to BMI, subjects undergoing MT for ELVO demonstrate significant differences in the expression of certain plasma proteins including ADA. The protein ADA is a deaminating enzyme that degrades adenosine, which has been shown to be neuroprotective in ischemia. Increased levels of ADA in the Obese group were predictive of increased infarct volumes. Further testing will explore the relationship of BMI and ADA on cognitive function outcomes. These data provide novel biomarker candidates as well as treatment targets while increasing the personalization of stroke prognosis and treatment.
Abstract WP161: Patients With Lower Stroke Scales Take Longer To Treat With Endovascular Thrombectomy Because Of A Longer Time To Identify Their Lvo Not Because Of Longer Procedural Time: Time To Identify And Triage An Lvo Is More Important Determinant Of Treatment Speed Than Procedural Time
Authors: Stuchiner Tamela L , Baraban Elizabeth , Martin Neil , Kelly Dan , Teitelbaum George P , Ovando Renee , Tarpley Jason W
Published: February 2022

Introduction:
The seminal trials of thrombectomy in 2015/16 enrolled a relatively homogenous population of patients with ICA terminus or M1 occlusion and a consistent mean NIHSS of 17. However, with advancing techniques and technology, our ability to use EVT for rapid, effective and safe treatment is broadening EVT eligibility to include patients with more distal occlusions, lower NIH Stroke Scales and larger core infarcts. Given the importance of speed in achieving the most favorable outcomes, here we evaluate treatment speed in patients with low NIHSS scores compared to those who have higher NIHSS scores. We also evaluated whether identification of EVT candidacy (door to puncture) or procedural time (puncture to first pass) was a stronger determinant of treatment speed.

Methods:
Retrospective data from 17 hospitals within the Providence St Joseph Health System were analyzed and included 2,365 acute ischemic stroke patients who received EVT between January 2015 and May 2021. Generalized linear models were used to assess if admission NIHSS impacted the following treatment benchmark times: door to groin puncture (GP) in < 60 minutes, GP to first pass (FP) in <30 minutes or door to FP in < 90 minutes. Patients with an NIHSS of ≥11 were compared to those with an NIHSS of ≤10. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported.

Results:
There were a total of 2,365 EVT patients included, 1,649 (70.0%) with NIHSS ≥ 11 and 707 (30.0%) with NIHSS ≤10. Patients with NIHSS ≥ 11 were more likely to have door to GP < 60 minutes (AOR=1.87, 95% CI: 1.42, 2.47) and door to FP <90 minutes (AOR=1.56, 95% CI: 1.22, 2.00) but not GP to FP <30 min (AOR=.997, 95% CI: .772, 1.29) compared to patients with an NIHSS </=10.

Conclusions:
Patient’s with lower stroke scales take longer to treat with endovascular thrombectomy. This delay in time to treatment is driven by increased time in identification and triage rather than procedural time.
Abstract WP177: Trends In The Clinical Phenotype Of Infective Endocarditis Related Stroke From 2005-2015: A Population-Based Study Of The Greater Cincinnati/ Northern Kentucky Region
Authors: Ridha Mohamed , Aziz Yasmin , Ades Laura M , Alwell Kathleen S , Woo Daniel , Khoury Jane C , Khatri Pooja , Adeoye Opeolu M , Broderick Joseph P , Ferioli Simona , Mackey Jason , Martini Sharyl R , Demel Stacie , De Los Rios La Rosa Felipe , Madsen Tracy , Star Michael , Coleman Elisheva R , Walsh Kyle B , Slavin Sabreena , Jasne Adam , Mistry Eva , Haverbusch Mary , Kissela Brett M , Kleindorfer Dawn O , Flaherty Matthew L
Published: February 2022

Background:
Prior studies have demonstrated a rising incidence of infective endocarditis related stroke (IERS) in the US due to the opioid epidemic. The Greater Cincinnati/Northern Kentucky (GCNK) region has one of the highest opioid abuse rates in the nation. A modern epidemiologic description is necessary to understand the impact of the opioid epidemic on the clinical phenotype of IERS.

Methods:
Using the GCNK Stroke Study, all patients hospitalized with IERS in 2005, 2010, and 2015 were abstracted and physician reviewed. IERS was defined as an acute stroke clinically attributed to infective endocarditis in patients meeting modified Duke Criteria for possible or definite endocarditis. Comparison between years were by chi-square or Fisher’s exact test for categorical variables; ANOVA or Kruskal-Wallis test for numerical variables. Cochran-Armitage test was used to examine trend. Secondary analysis compared characteristics between intravenous drug users (IVDU) and non-IVDU.

Results:
A total of 54 patients with IERS were identified in 2005, 2010, and 2015. Over the period, there was a significant decline in hypertension (91.7% in 2005, 36.0% in 2015; p=0.0005) and increase in IVDU (8.3% in 2005, 44.0% in 2015; p=0.02). They trended towards increased white race, younger age, and fewer vascular risk factors. Compared to non-IVDU, IVDU were significantly younger (41.1±14.1vs 63.1±14.3 years; p<0.001), less often female (12.5% vs 47.4%; p=0.02), had higher rates of sepsis (50% vs 18.4%; p=0.04), less atrial fibrillation (0% vs 31.6%; p=0.01), and less renal disease (0% vs 23.7%; p=0.045). The incidence of IERS per 100,000 increased from 1.31 (CI: 0.56-2.06) in 2005, to 1.66 (CI: 0.87-2.45) in 2010, and to 2.41(CI:1.46-3.36) in 2015.

Conclusion:
From 2005 to 2015, IERS was increasingly associated with IVDU and an absence of hypertension. These trends likely reflect the demographics of the opioid epidemic, which has affected younger patients with less comorbidities.
Abstract WP202: Comorbidities, But Not Mechanism, Are Associated With Long-term Mortality After Stroke
Authors: Rahman Salwa , Spagnolo-Allende Antonio , Gurel Kursat , Bueno Pedro , Kozii Khrystyna , Khasiyev Farid , Elkind Mitchell S , Marshall Randolph S , Gutierrez Jose
Published: February 2022

Introduction:
Stroke is one of the leading causes of death worldwide. Our study aimed to investigate clinical variables that influence long-term mortality.

Methods:
A retrospective study was done in patients admitted with stroke to Columbia University Irving Medical Center - New York Presbyterian Hospital between 1990 and 2020 from whom data adjudication and long-term outcome were available at the time of analyses. Stroke was classified as cardioembolic, large vessel, small vessel and cryptogenic. We established 5 models which were progressively adjusted for cardiovascular risk factors and treatment modalities. Data was analyzed using cox proportional regression analysis to obtain hazard ratios (HR) with 95% confidence intervals (CI).

Results:
The study included 775 patients with a mean age of 67±16 years; 47% were men, 32% had diabetes, 39% had dyslipidemia and 22% had a history of atrial fibrillation (AF). On discharge, 84% received statin therapy. After 8.9±5.9 years (0-17 years) of follow-up, 257 (33.2%) of the initial cohort died. In univariate analysis, stroke due to AF was the only predictor of long-term mortality compared to other mechanisms (HR 1.9, 95% CI 1.5-2.3), but the effect size and statistical significance were progressively attenuated after adjusting for confounders (HR 1.2, 95% CI 0.9-1.6). In the fully adjusted model, statin therapy on discharge (HR 0.6, 95% CI 0.5-0.9) was associated with decreased long-term mortality whereas higher NIHSS score on admission, older age and a history of diabetes were associated with higher long-term mortality (Table 1).

Conclusion:
Comorbidities, and not stroke mechanism
per se,
are determinants of long-term mortality after stroke. Advanced age, diabetes mellitus, high NIHSS score are associated with higher long-term mortality whereas statin prescription upon discharge is associated with lower mortality. Post-stroke care strategies need to be targeted to reduce the risk of mortality in high-risk patients.
Abstract WP220: Ischemic Stroke In Young Adults With Heart Failure
Authors: Ibeh Chinwe , Esenwa Charles , Gutierrez Jose
Published: February 2022

Background:
Heart failure (HF), traditionally considered a disease of the elderly, is the second leading cause of cardioembolic stroke. In young adults however the prevalence and outcomes following HF-related stroke remain unclear. Here we investigate the prevalence of HF among young adults with ischemic stroke and analyze in-hospital outcomes.

Methods:
Using the National Inpatient Sample (2012-2018) we performed a retrospective analysis of all ischemic stroke hospitalizations among young adults (18-45) using previously validated ICD-9 and 10 codes. Presence of HF and relevant covariates were also extracted. Poor functional outcome was defined as either discharge to nursing facility, placement of percutaneous endoscopic gastrostomy tube or tracheostomy. Multivariable logistic and linear regression models were used to compare outcomes.

Results:
65,160 young adults were hospitalized for ischemic stroke, 12% with comorbid heart failure. A greater proportion of patients with HF were men (61% vs 50% p < 0.001), of Black race (35% vs 24%, p < 0.001) and of the lowest income quartile (40% vs 34% p < 0.001). Along with traditional vascular risk factors (atrial fibrillation, hypertension, diabetes, and coronary artery disease, all p < 0.05), renal failure and COPD were also more prevalent in young adults with HF (24% vs 7% and 5% vs 2%, both p <0.001). HF was associated with longer hospitalizations (15.0 [0.23] vs 8.5 [0.06] days, p<0.001) and greater total charges ($240,665 vs $125,201, p<0.001). In crude analysis, HF was associated with significantly increased odds of poor functional outcome (OR 1.72, 95% CI: 1.64-1.81) and death (OR 2.86, 95% CI: 2.69-3.05). After adjustment for demographics, hospital factors, comorbidities, and disease severity, mortality remained significant (1.38, 95% CI: 1.27-1.51).

Conclusion:
Disparities in prevalent HF exist among young adults with ischemic stroke. HF is associated with longer and more expensive stroke hospitalizations in young adults and significantly greater odds of death. Along with traditional vascular risk factors, pulmonary and renal disease are more prevalent in young stroke patients with HF. Further research may identify prevention strategies to improve outcomes in these young, high-risk patients.
Abstract WP225: Composition Of Egocentric Networks Among Stroke Survivors
Authors: Valencia Connie , Wing Jeffrey J , Drum Emily , Boden-Albala Bernadette
Published: February 2022

Background:
Social networks provide emotional and social support that may help prevent the onset of secondary stroke. Little is known about egocentric networks among stroke survivors and the type of support they provide.

Objective:
To develop an understanding of the supportive role alters or personal contacts provide to stroke survivors and gain insight of participants' egocentric network.

Methods:
Data obtained from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, a skills-based, culturally tailored discharge educational intervention. Participants (n=552) identified up to 5 alters. Descriptive analyses were conducted to assess the relationship between participants and alters.

Results:
Approximately, 34% of participants identified as Non-Hispanic (NH) Black followed by Hispanic (33%), NH White (28%), NH Asian Pacific Islanders (API) (3%). Majority of participants (n=462, 83%) reported having at least one alter. Most participants with ≥1 alter (92%) indicated talking to alter every day or several times a week. Yet all with an alter stated that they can talk to alter about an important health problem or medical decision. Among participants (n=543, p=.002), NH Blacks (n=38, 45%) and Hispanic (n=33, 39%) were more likely to report no alters compared to NH White (n=14, 16%; Figure).

Conclusions:
Majority of participants reported having at least one person within their social network that they can talk to about their health problems. We are unable to determine if the first person that participants indicated may be the most influential person in health-related matters. The implications of these results may be relevant for future stroke interventions. Additional studies are needed to understand the type of influence alters have on stroke survivors in health-related behaviors and decisions that may help improve post-stroke outcomes. Further studies are also needed to assess health outcomes among isolated stroke patients by race.
Abstract WP232: The Importance Of Time-varying Confounding And Selection Bias In Stroke Research: The Example Of Anticoagulation And Health Related Quality Of Life
Authors: Stulberg Eric , Delic Alen , Zheutlin Alexander , Steinberg Benjamin , yaghi shadi , de Havenon Adam H
Published: February 2022

Background:
Guidelines support anticoagulation for primary stroke prevention in those with atrial fibrillation and additional risk factors. Primary endpoints in longitudinal studies such as mortality and morbidity over time are impacted by various forms of selection bias such as differential attrition and competing risks, as well as time-varying covariates such as medical comorbidities. We aim to demonstrate how different modelling strategies accounting for time-varying covariates and selection bias influence the association estimates between warfarin use and health-related quality of life over time in those with atrial fibrillation.

Methods:
We performed a secondary analysis of the AFFIRM trial quality of life substudy (N=716). Dichotomized warfarin use was ascertained at study baseline, 2 months later, and annually for up to 6 years. Generic health related quality of life was measured at every time point using a self-reported ordinal 5-point Likert-scale (lower score represents better health-related quality of life). Static and time-varying covariates were ascertained throughout the study period. Confounder-adjusted generalized linear mixed model regressions were used to demonstrate the traditional association between anticoagulation and health related quality of life. Inverse probability of treatment and censorship weights were used to ascertain the influence of time-varying confounding and selection bias respectively. Stratified analysis by age (age≥70 years) evaluated for effect modification.

Results:
The association of warfarin use with better health-related quality of life over time in those with atrial fibrillation was strengthened when accounting for time-varying confounding and selection bias (OR 0.33, 95% CI: 0.16-0.68) compared to traditional regression analyses (OR 0.61, 95% CI: 0.0.38-0.98). The association was most pronounced in those >70 years upon stratified analysis.

Conclusion:
Anticoagulation is associated with improved quality of life over time in patients with atrial fibrillation. While constrained by the secondary nature of the analysis, we demonstrate how time-varying confounding and selection bias may influence longitudinal effect estimates in stroke prevention research.
Abstract WP239: Sexually Dimorphic Amygdala Dysfunction In A Mouse Model Of Global Ischemia
Authors: Vigil Jose , Tiemeier Erika , Chalmers Nicholas , Herson Paco S , Quillinan Nidia
Published: February 2022

Introduction:
Advances in modern medicine have greatly increased chances of survival following traumatic events such as cardiac arrest, stroke, or heart attack. With more people able to recover from these ischemic insults, it is becoming apparent that survivors experience long-term effects as it relates to brain function. Despite clinical and animal model evidence of emotional dysfunctions following global ischemia, no study has attempted to identify amygdala dysfunction after Cardiac Arrest and subsequent Cardiopulmonary Resuscitation (CA/CPR). Utilizing a mouse model of CA/CPR-induced global ischemia, we have identified amygdala dysfunctions that are dependent on biological sex. We hypothesize that global ischemia results in deficits in amygdala-dependent learning tasks and circuit specific deficits of LTP in the basolateral amygdala (BLA).

Methods:
Seven days post CA-induced global ischemia, male and female adult C57BL/6 mice underwent amygdala dependent delay fear conditioning. In a separate cohort of animals acute-transverse slices were prepared seven days post global ischemia and extracellular field potential recordings were collected from the BLA.

Results:
We have revealed a sexually dimorphic deficit in amygdala dependent fear learning and memory. Both male and female mice display a previously reported contextual fear deficit (Male: 78.6 ± 2.6% sham freezing vs. 51.2±8.7% CA/CPR freezing, n=7; Female 70±5.1% sham freezing vs. 50.2±8.5% CA/CPR freezing, n=9), however, only male mice display a diminished freezing response to cued fear (56.4 ± 7.2% sham freezing vs. 31 ± 6.7% in CA/CPR, n=7). Similarly, plasticity involving cortical inputs to the basolateral amygdala is also disrupted in a sexually dimorphic manner, with only males displaying diminished LTP relative to sham controls (153.4 ± 8.1% of BL in controls, n=4 vs. 102.4 ± 3% of BL in CA/CPR, n=7).

Conclusion:
These results support the role of the amygdala in cognitive-affective impairments after CA-induced global ischemia and provide new insights into the role that biological sex plays in mediating brain dysfunction following CA. In the future, we will continue to unravel the mechanisms by which this sexually dimorphic impairment occurs and identify therapeutic targets.
Abstract WP243: Intraperitoneal Igf1 Treatment Modulates The Chronic Impact Of Ischemic Stroke In Reproductively Senescent Female Rats By Repairing The Gut While Icv-igf-1 Does Not
Authors: El-Hakim Yumna , Mani Kathiresh Kumar , Pandey Sivani , Eldouh Amir , Sohrabji Farida
Published: February 2022

Background:
Our previous studies have shown that reproductively senescent (RS) female rats, who have lower circulating levels of the peptide hormone Insulin-like Growth Factor (IGF-1), display worse outcomes after a stroke event than young adult female rats. ICV administration of IGF-1, decreases infarct volume, improves sensory motor performance, and reduces cytokine levels in the ischemic hemisphere of RS females as compared to vehicle-treated controls. Yet, icv IGF1 administration failed to attenuate peripheral inflammation cognitive decline and depressive behaviors in the chronic phase of stroke. In view of the evidence that stroke induces gut dysbiosis, and that gut dysfunction is implicated in depressive and cognitive behaviors, we hypothesize that, unlike icv administration of IGF-1, which is restricted to the brain, systemic i.p. administration of IGF1 would repair the gut, attenuate peripheral cytokine levels and improve long-term behavior outcomes.

Methods:
Acyclic middle-aged Sprague Dawley female rats (9-11 mos) were subjected to endothelin-1 induced middle cerebral artery occlusion (MCAo) or sham operation. Animals received IGF1 via i.p. injections 4h post MCAo and 24 h post MCAo, or icv infusions, while controls received vehicle. Sensory motor tests, blood and gut samples were acquired pre and post MCAo. Animals were terminated either in the acute phase (2d) or chronic phase (20d). The latter group was also subject to tests of cognition and depressive-like behavior.

Results:
In contrast to icv treatment, i.p.-IGF-1 did not reduce infarct volume or acute sensory motor impairment but significantly attenuated circulating levels of TNFα and IL12p70. In addition, ip-IGF-1 significantly attenuated post stroke gut dysmorphology, by preserving villus:crypt ratio and expression of tight junction proteins ZO1 and claudin-2. In addition, i.p. IGF1 treatment attenuated the reduction of social interaction and novel object preference post MCAo.

Conclusion:
Since long term disability after stroke is correlated with elevated levels of peripheral cytokines, our data suggest that systemic IGF1 may be a better therapeutic option for long term cognitive and depressive behaviors after stroke.
Abstract WP25: Utilization And Outcomes Of Acute Revascularization Treatment In Ischemic Stroke Patients With SARS-CoV-2 Infection
Authors: Qureshi Adnan I , Baskett William I , Huang Wei , ISHFAQ Muhammad , Naqvi Syed H , French Brandi R , Siddiq Farhan , Gomez Camilo R , Shyu Chiren
Published: February 2022

Objectives:
Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus maybe candidates for acute revascularization treatments (intravenous thrombolysis and/or mechanical thrombectomy).

Materials and Methods:
We analyzed the data from 62 healthcare facilities to determine the odds of receiving acute revascularization treatments in severe acute respiratory syndrome coronavirus infected patients and odds of composite of death and non-routine discharge with severe acute respiratory syndrome coronavirus infected and non-infected patients undergoing acute revascularization treatments after adjusting for potential confounders.

Results:
Acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments (odds ratio 0.6, 95% confidence interval 0.5-0.8, p=0.0001). Among ischemic stroke patients who received acute revascularization treatments, severe acute respiratory syndrome coronavirus infection was associated with increased odds of death or non-routine discharge (odds ratio 3.0, 95% confidence interval 1.8-5.1). The higher odds death or non-routine discharge (odds ratio 2.1, 95% confidence interval 1.9-2.3) with severe acute respiratory syndrome coronavirus infection were observed in all ischemic stroke patients without any modifying effect of acute revascularization treatments (interaction term for death (p=0.9) or death or non-routine discharge (p=0.2).

Conclusions:
Patients with acute ischemic stroke patients with severe acute respiratory syndrome coronavirus infection were significantly less likely to receive acute revascularization treatments. Severe acute respiratory syndrome coronavirus infection was associated with a significantly higher rate of death or non-routine discharge among acute ischemic stroke patients receiving revascularization treatments.
Abstract WP261: Encephalomyosynangiosis Improves Angiogenesis And Recovery In Mice After Transient Ischemic Stroke
Authors: Paro Mitch , Gamiotea-Turro Daylin , Blumenfeld Leslie , Bulsara Ketan R , Verma Rajkumar
Published: February 2022

Background and Purpose:
The ability of the brain to self-heal after stroke is limited by inadequate blood supply and acute inflammation. Hence, we hypothesized that improved blood supply via promoting neoangiogenesis will reduce acute inflammation and improve recovery after stroke. Encephalomyosynangiosis (EMS) is a neurosurgical procedure that achieves angiogenesis with low morbidity in patients with moyamoya disease, reducing risk of stroke. EMS has never been studied in ischemic stroke. Here, we developed a novel model of EMS after ischemic stroke induced by middle cerebral artery occlusion model (MCAo) in mice. We demonstrated that this novel EMS procedure can induce angiogenesis and improve recovery after stroke.

Methods:
After 60 minutes of MCAo, mice were randomized to MCAo or MCAo+EMS groups. After 3-4 hours, EMS was performed. In brief, EMS involves a craniotomy and placement of a vascular temporalis muscle flap on the pial surface of the ischemic brain. Mice were sacrificed at day 7 or 21 after MCAo. Viability of temporalis muscle was measured using a nicotinamide adenine dinucleotide reduced tetrazolium reductase assay. ARY015 Proteome Profiler Mouse Angiogenesis Array (R&D Systems) was used to quantify angiogenic and neuromodulating protein expression. Immunohistochemistry was used to visualize immune infiltration by measuring F4/80 positive macrophages.

Results:
EMS after ischemic stroke did not increase mortality despite dual invasive surgery. Grafted temporalis muscle remained viable up to 21 days after EMS. We found a significant increase in FGF-acidic (0.677±0.007 vs. 0.585±0.014, p=0.045) and decrease in osteopontin (0.692±0.007 vs. 0.758±0.014, p=0.048) protein levels in the MCAo+EMS group 21 days after stroke, suggesting improved angiogenesis and recovery respectively. Mice in the MCAo+EMS group also showed reduced F4/80+ve macrophage accumulation in the peri-lesional territory of ischemic tissue, suggesting attenuated inflammation after stroke.

Conclusions:
These proof-of-concept data support that our novel EMS procedure is well-tolerated and may improve angiogenesis and recovery after stroke. EMS after MCAo is a promising new method of improving angiogenesis and recovery after stroke.
Abstract WP49: Mri Based Thrombolysis For Unwitnessed Stroke Patients Is Feasible At Primary Stroke Centers
Authors: Wong Eric , Gaffney Denise , Rho Howard J , Ly An , Sangha Navdeep S
Published: February 2022

Background:
The 2018 WAKE-UP Trial established the safety and efficacy of administering IV-tPA in patients who presented within 4.5 hours of symptom discovery based on specific MRI sequences. Implementation of the study results remains limited at Primary Stroke Centers (PSCs). We assessed the feasibility of a Comprehensive Stroke Center (CSC) MRI based unwitnessed thrombolysis protocol at 13 PSCs.

Methods:
A committee consisting of vascular neurologists, neuroradiologists and MRI technologists developed the protocol. The protocol was utilized at the CSC for one year, and subsequently expanded to the PSCs. A specific "WAKE-UP MRI”" order was created which consisted of only DWI, GRE and FLAIR sequences. MRI technologists were trained to ensure that the "WAKE-UP MRI” would take priority over other patients; eg: if there was no one in MRI, it would be held for the stroke patient, and if MRI was occupied, the stroke patient would be next. The acute stroke care was managed by an integrated telestroke system at the PSCs. All telestroke providers were educated on the protocol. Standard stroke time metrics were collected and analyzed over 2 years. Data from the CSC was compared with its 13 PSC spokes. A student’s t-test was used for data analysis.

Results:
A total of 190 patients who arrived with 4.5 hours of symptom discovery were screened; 62 at CSC and 128 at PSCs. Forty underwent emergent MRI at CSC and 29 at PSCs. Median door to MRI time was longer for patients presenting to PSC compared to CSC (78 vs 53.5 mins; p = 0.0002). Twenty-one vs 9 patients received tPA at CSC and PSC hospitals respectively. Median door to needle (DTN) times were longer for patients at PSC vs CSC (106 vs 67 mins; p = .018). The most common reasons for not administering IV-tPA was a negative MRI (40% at PSCs vs 47% at CSC) and a lack of DWI and FLAIR mismatch (40% at PSCs vs 42% at CSC).

Conclusion:
Use of emergent MRI in unwitnessed stroke for thrombolysis is feasible at PSCs. There remain barriers to implementation, with PSCs showing more delayed access to MRI and thrombolysis compared to CSC.
Abstract WP7: Critical Importance Of Enrollment Hours For Successful Recruitment In Acute Stroke Trials
Authors: Broderick Joseph P , Elm Jordan J , Adeoye Opeolu M , Barreto Andrew D , Grotta James C , Deeds Shannon , Bentho Oladi , Streib Christopher D , Staugaitis Abbey , Demel Stacie , Vollmer Abigail , Franklin Jamey D , Janis Lawrence , Khatri Pooja
Published: February 2022

Introduction:
Recruitment into hyperacute stroke trials is challenging but ultimately depends on on-call availability of treating investigators, study coordinators, and pharmacists. These data may not be considered in initial decision-making for site selection and estimates of site recruitment are frequently based upon registry data from sites that includes all clinical cases.

Hypothesis:
Site recruitment on a per month basis is associated with time open for enrollment.

Methods:
We surveyed all Multi-arm Optimization of Stroke (MOST) trial centers open for enrollment to determine which were open for trial recruitment during business hours during Monday through Friday only, business hours 7 days a week, extended hours beyond business hours, or 24 hours/7 days a week. We also surveyed about pharmacy availability. Descriptive statistics were used to compare the average monthly enrollment by survey responses.

Results:
Sites open for enrollment only during business hours, Monday through Friday recruited at a rate of 0.14 participants per month compared to 0.36 per month for sites that enroll 7 days a week (see graphic). Restriction of pharmacy availability to business hours Monday through Friday was associated with decreased recruitment rate as well.

Conclusions:
Ability to recruit trial participants 7 days a week should be the standard for site selection, successful acute stroke trial recruitment, and estimates of needed sites. Methods to increase financial support for hours outside of week-day business hours is a potential method to enhance recruitment into acute stroke trials.
Abstract WP76: Patients Express Satisfaction With Acute Video Telestroke Consultations
Authors: Peng Teng J , Vlieks Kelsey , Parker Ranisha L , Nystrom Karin V , Salas Samantha , Schindler Joseph L , Sansing Lauren H , Sharma Richa , Forman Rachel , Petersen Nils H , Jasne Adam , Narula Reshma , Amin Hardik
Published: February 2022

Introduction:
Video telestroke consultations are increasingly utilized to provide acute stroke care virtually, yet it remains uncertain whether patients are satisfied with this medium of care. We aimed to evaluate patient perception of their care during video telestroke consultations in a HUB and SPOKE telestroke network.

Methods:
Patients from Yale New Haven Health System and affiliate hospitals evaluated by video telestroke were screened for enrollment and contacted between 7-14 days from telestroke encounter to administer a telephone survey. Patients were excluded if the suspicion for cerebrovascular event was low, if primary language was not English, if in hospice, and if patient had confusion, cognitive impairment or aphasia during telestroke encounter or survey. The survey asked patients to rate the quality of the telestroke encounter and their satisfaction with various aspects of clinical care (Figure). Patient responses were evaluated using Chi-square analysis with SPSS v23.

Results:
A total of 325 video telestroke consultations occurred between May 8, 2021 and August 5, 2021. Eighty-nine patients met criteria to be contacted for a follow up survey. Of those, thirty-one patients responded to the survey (15 female, mean age of 58.9 years old) and 80.6% of patients did not have any prior telemedicine experiences. Only 6.7% of patients perceived shortcomings in the ability of the emergency staff to use videoconference equipment and 13.3% observed difficulties with audio quality. Difficulties with equipment and audio quality were not associated with patient’s ability to understand their diagnosis (p=0.787 and p=0.782) and treatment recommendations (p=0.558 and p=0.684). All patients expressed good or very good satisfaction with video telestroke use and perceived that the video consultation was as good as a bedside visit.

Conclusions:
Despite encountering some technical difficulties, patients expressed satisfaction with video telestroke encounters.
Abstract WP77: Racial Disparities Of Post-stroke Hospital Discharge
Authors: Man Shumei , Bruckman David , Tang Anne S , Schold Jesse D , Uchino Ken
Published: February 2022

Objective:
Early post-acute care for stroke survivors affect their morbidity, mortality, and long term disability and quality of lives. This study aimed to understand the utilization of post-acute services among different racial/ethnicity population.

Methods:
We examined the discharge destinations amongst patients admitted directly from the emergency department for ischemic stroke and transient ischemic attack (TIA) in 2017-2018 using the National Inpatient Sample, a 20% stratified sample of all discharges from U.S. community hospitals.

Results:
This study included 1,000,645 live ischemic stroke/TIA discharges with good racial/ethnicity representations (Table). Compared to their White counterpart, Hispanic patients were more likely to be discharged to home without home health care (49.1% vs 42.1%, OR 1.33, 95% CI 1.27-1.38), as well as Native Americans (47.5%, OR 1.24, 95% CI 1.06-1.46). Conversely, Hispanics are less likely to be discharged to inpatient rehabilitation or skilled nursing facilities than White (29.1% vs 36.5%, OR 0.71, 95% CI 0.68-0.74), as well as Native Americans (32.7%, OR 0.85, 95% CI 0.72-0.99). Facility discharge rates were comparable among Black and White (OR 0.99, 95% CI 0.97-1.03).

Conclusion:
Hispanics and Native Americans are more likely to be discharged to home without home health care and less likely to be discharged to facilities after stroke. Further study are need to understand the attributes of the discharge disparities after stroke hospitalization.