bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W P234: Blood Pressure Guideline Adherence in Patients With Severe Acute Cerebrovascular Events
Authors: Porto Guilherme B , Spiotta Alejandro M , Jauch Edward C
Published: July 2021

Background:
Patients with acute cerebrovascular injuries (ischemic stroke, intracranial hemorrhages) require strict physiologic control, especially in the first hours of injury, to minimize clinical deterioration, morbidity, and death. This study aimed to assess inhospital physiologic parameter guideline compliance in these patient populations.

Methods:
This IRB approved observational cohort study monitored patients with severe cerebrovascular disease admitted to the neurocritical care unit using multiple channels of physiologic data continuously recorded using the BedMasterEX (Excel Medical Electronics Inc, FL) system. This platform continuously collected hemodynamic variables (blood pressure and heart rate via arterial catheter), body temperature, and blood oxygen saturation in 5 second intervals. Raw data were initially analyzed using descriptive statistics.

Results:
Fifty patients, 48% male, mean age 59.7 ±13.9 years (15 subarachnoid hemorrhages, 9 unruptured aneurysms, 6 ischemic strokes, 6 subdural hematomas, 4 intracerebral hemorrhages, 3 ischemic strokes, 1 arteriovenous malformation, 1 intraventricular hemorrhage, and 5 miscellaneous vascular injuries) were enrolled. Data acquired represented 2259 total hours of continuous blood pressure monitoring. As an example of guideline compliance, systolic blood pressure (SBP) were compared to current SBP guideline parameters and were on average outside of recommended ranges 29.4 ±30.19% of the patient’s monitoring period. We have found specifically for SBP management 6%, 28%, 18%, 12% and 36% of our patients were 99%, 90%, 80%, 70%, and <70% of the time within the specified SBP goals.

Conclusion:
Hemodynamic management of patients with cerebrovascular injuries, based on current guidelines, yielded optimal control of SBP in only 34% of patients (within parameters ≥90% of time). More detailed data analyses are underway and additional physiologic variables concurrently collected with those presented here are also being studied. Future studies will further evaluate these data for potential correlation between changes in hemodynamics and clinical outcomes (worsening neurological condition, hematoma growth, re-rupture of aneurysm, hemorrhagic conversion of stroke).
Abstract W P240: The Effect of Telestroke Network on Tissue Plasminogen Activator Utilization and Door to Needle Time on Rural Hospitals.
Authors: Castellon Larios Karina , Rybka Katherine , Greene-Chandos Diana , Bergese Sergio , Torbey Michel
Published: July 2021

Introduction:
Stroke is the 4
th
leading cause of death in the United States. Only 2-3% of ischemic stroke patients are receiving Tissue plasminogen activator (t-PA) despite an increase in time window to 4.5 hours. With less than 85% of the US population living within 30 minutes of primary stroke centers, it is important to review the effectiveness of telestroke network in delivering t-PA. The Ohio State University Wexner Medical Center (OSUWMC) Telestroke network was established in May 2011. Currently the network expands across 24 spokes located in rural central Ohio. Most of these centers have not given t-PA prior to joining the network.

Objective:
Evaluate the effectiveness of the OSUWMC telestroke in delivering t-PA for acute ischemic stroke in a rural setting and compare the stroke quality metrics to Ohio Coverdell registered Hospitals.

Methods:
We conducted a retrospective data review from the OSUWMC Telestroke Network database from May 22, 2011 to November 30, 2012. This included demographics, diagnostic impression, NIHSS score, average symptom onset to ED arrival, average door to CT time, average consult duration. t-PA administration and transfer status to OSUMWC were also collected. Summary statistics were generated using Microsoft Excel (version 2010, Microsoft Corporation) and SAS (version 9.3, SAS Institute).

Results:
In this study, a total of 422 Telestroke consultations were completed. 180 patients were diagnosed with ischemic stroke (57.5%). Average NIHSS score was 5 ±6, average symptom onset to ED arrival time was 4 hours 26 minutes (n=378), and the average door to CT time was 26 minutes (n=204). Forty-four percent (n=80) were approved to receive IV t-PA; 60% within one hour of ED arrival. From this number of patients thirty percent received t-PA within one hour compared to 38% in Ohio Coverdell hospitals.

Conclusion:
The implementation of telestroke network can deliver care that is equivalent to primary stroke centers. This approach may be an effective tool for rapid evaluation of patients in remote hospitals that require neurologic specialists.
Abstract W P250: The Impact of Acute Hypertensive Response on Mortality After Intracerebral Hemorrhage Differs Among Patients With and Without Left Ventricle Hypertrophy
Authors: Pontes-Neto Octavio M , Martinez-Ramirez Sergi , Viswanathan Anand , Tan Timothy C , Nunes Maria C , Hung Judy , Auriel Eitan , Schwab Kristin M , Ayres Alison , Gurol Mahmut E , Ay Hakan , Rosand Jonathan , Greenberg Steven M , Goldstein Joshua N
Published: July 2021

Background:
While acute hypertensive response (AHR) predicts worse outcome in intracerebral hemorrhage (ICH), the INTERACT-2 trial recently failed to definitively demonstrate a major benefit of intensive blood pressure reduction on these patients. A possible explanation is that the detrimental effect of AHR on outcome may differ among ICH patients with and without previous chronic hypertension.

Objective:
to explore whether the prognosis of patients with AHR during the acute phase of ICH differs according to the presence or absence of left ventricle hypertrophy (LVH), which is a marker of chronic hypertensive organ damage.

Method:
we performed a retrospective analysis of a prospective cohort of patients with primary ICH presenting to an academic hospital between January/2000 and December/2012 with age > 18 years, who had a transthoracic echocardiogram available. LVH was defined according to Penn convention. AHR was defined as systolic blood pressure > 180 mmHg on admission. Mantel-Haenszel test was initially used to assess if LVH status influenced the effect of AHR on mortality. For subsequent analyses, ICH patients were divided in 3 groups: without AHR (reference); AHR without LVH; AHR with LVH. A multivariate logistic regression model was then used to identify independent predictors of mortality at 30-days.

Results:
430 patients met inclusion criteria. AHR was present in 196 (46.6%), LVH was present in 233 (54.2%); 30-day mortality was 15.6%. On Mantel-Haenszel test, we found a trend (p=0.09) suggesting that absence of LVH increased AHR effect on mortality (OR:1.64; 95% CI: 0.95-2.8; p=0.07). On multivariate analysis, patients with AHR without LVH had significantly higher mortality (OR: 2.65; 95%CI: 1.15 to 6.1; p=0.022) when compared to patients without AHR, after adjusting for baseline characteristics. There was only a trend towards increased mortality in the group of patients with AHR and LVH (OR:2.22; 95% CI: 0.99-5.0; p=0.053).

Conclusions:
Patients without chronic hypertension appear to be more susceptible to the detrimental effects of AHR during the acute phase of ICH. Stratification of patients with ICH may help to identify those that will have greater benefit with intensive blood pressure reduction in the acute phase of ICH.
Abstract W P256: Influence of Withdrawal of Care on Spontaneous Intracerebral Hemorrhage Predictive Scales
Authors: Ortega Gutierrez Santiago , aranda calleja maria angeles , Shah Pankhil , Amaro Delgado Sergio , agarwal sachin , Cunningham Alyson , Sajjad Rehan , Szeder Viktor , Torbey Michel T
Published: July 2021

Background:
Various scoring systems combining different predictors have been developed to more accurately predict the short and long-term outcome after ICH. However, these different scoring systems do not take into account the major influence of the primary cause of mortality in ICH, namely the withdrawal of care (WC). We aim to compare the in-hospital mortality prediction performance after accounting for WC of three widely used scoring systems, the original ICH score (oICH), the ICH Grading scale (ICH-GS), and the simplified ICH score (sICH), in a cohort of ICH patients prior to the development of the aforementioned scales.

Methods:
Retrospective observational single center cohort study of adult patients presenting a confirmed diagnosis of ICH. Admission clinical and radiological criteria were obtained through review of medical records and CT at admission. In-hospital mortality was selected as a primary outcome and obtained from the medical records. In the event of death, groups weredivided into: ICH-direct cause of death (cardiac arrest or brain death) andneurological devastation leading to WC. Scoring systems were calculated in each individual patient. Receiver operating characteristic (ROC) analysis was used to assess the ability of each score to predict in-hospital mortality and the maximum Youden Index was identified to denote each score’s optimal predictive cutoff point for each scale. The area under the curve (AUC) between groups was compared by using the Delong et al method. P< 0.05 was set as statistically significant.

Conclusion:
Performance of ICH scoring systems accurately predicted in-hospital mortalityeven when WC care is taken into account.
Abstract W P259: ICH &FUNC Scores in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study
Authors: Sheth Kevin N , Sung Gene , Langefeld Carl D , Moomaw Charles J , Osborne Jennifer , Elkind Mitchell S , Martini Sharyl A , Vashkevich Anastasia , Koch Sebastian , Rosand Jonathan , Woo Daniel ,   ERICH Investigators
Published: July 2021

Introduction:
The Intracerebral Hemorrhage (ICH) Score and Functional Outcome (FUNC) Score are prediction scales used to estimate outcome. These scales have not yet been validated in large minority cohorts. Our goal was to evaluate the predictive ability of the ICH and FUNC Score for white, black, and Hispanic patients.

Methods:
ERICH is an ongoing study of genetic and environmental risk factors for spontaneous ICH. The analysis included 847 cases enrolled prior to 1/1/2013 that had chart abstraction, baseline interview, CT imaging, GCS, and 3-month follow-up data available. Spearman’s rank correlation was used to assess the correlation between each score and 3-month modified Rankin Scale (mRS) score by ethnicity. Regression models were used to determine the predictive ability of each score.

Results:
Patients analyzed were 42% non-Hispanic black, 34% Hispanic, and 24% non-Hispanic white. Black and Hispanic subjects were younger compared with white subjects (p<.0001) and had higher proportions of deep ICH (p=.0013). Spearman’s rank correlations for ICH Score/FUNC Score and mRS at 3 months post ICH were 0.53/0.53 for black subjects, 0.66/0.63 for Hispanics, and 0.55/0.54 for whites. Both ICH and FUNC Scores had better predictive ability for minorities compared with whites (ICH Score, B = 0.87 black, 1.02 Hispanic, 0.76 white, p<.0001; FUNC Score, B = 0.56 black, 0.65 Hispanic, 0.49 white, p<.0001). Multiple regression demonstrated independent contributions by both scores for each ethnicity. Figure 1 demonstrates distribution of mortality by score.

Conclusions:
Both the ICH Score and FUNC Score were independently predictive of functional outcome at 3 months. Importantly, each score exhibits higher predictive ability in minority populations compared with whites. Whether or not this difference is attributed to minority status or baseline differences in age or ICH location requires further study.
Abstract W P263: Rapidly Resolving Symptoms..Stop the Race! No Symptoms, No Alteplase!
Authors: Smith Shannon L , Schultz Mark C
Published: July 2021

Background:
Research has shown that one-third of patients not treated with thrombolytic therapy due to minor or rapidly improving symptoms have poor outcomes that are considered disabling. The purpose of this study was to determine if opportunities were missed to treat with Alteplase.

Research Question:
What is the outcome of patients arriving to the emergency room with symptoms of an ischemic stroke not treated with Alteplase because of rapidly improving symptoms?

Method:
A retrospective analysis of patients between January 2012 and February 2013 with ischemic stroke or TIA, whose ICD-9 coding at discharge is in alignment with the Joint Commission and the American Heart Association. STK 4 from the Joint Commission was used to define the population. Patients with documentation from the physician stating that no Alteplase was given due to rapidly resolving symptoms were included. Magnetic resonance imaging and National Institute of Health scores were used along with clinical symptoms to diagnose potential stroke.

Results:
Of 47 patients reviewed, 34% had positive imaging and were coded with an ischemic stroke code and 66% had negative imaging and were coded with a transient ischemic attack code. Of the 34% with positive imaging, 38% were discharged to home with home health for therapy follow-up. Of the 66% with negative imaging, 19% were discharged home with home health for therapy follow-up. Of the 47 patients, 6% had a National Institute of Health stroke scale score of 1-3 with positive imaging and 4% had a score of 4 or greater with positive imaging.13% had a score of 0 on admit and 0 on discharge with positive imaging.

Conclusion:
We found a third of patients who did not receive Alteplase due to rapidly resolving symptoms did have a stroke and several required therapy services after discharge for residual deficits that were potentially disabling. In addition, the National Institute of Health Stroke Scale was not consistently beneficial in diagnosing acute stroke for patients with normal or low scores who were ultimately diagnosed with stroke.
Abstract W P268: Developing a Stroke Coordinator Consortium: Past, Present, and Future
Authors: Rindels Erin , Overton Angela ,   Iowa Stroke Coordinator Consortium
Published: July 2021

Background:
The fourth leading cause of death for all Iowans is stroke. In 2006 the American Heart Association in collaboration with healthcare professionals formed the Iowa Stroke Task Force (ISTF). At that time Iowa had six certified Primary Stroke Centers (PSC). Several stroke coordinators were members of the ISTF; however they discovered that their specific needs were not addressed during ISTF meetings.

Purpose:
The purpose of the Iowa Stroke Coordinator Consortium (ISCC) is to provide an environment where sharing experiences leads to the collaboration of stroke coordinators to improve stroke care.

Methods:
The stroke coordinators involved with the ISTF developed a toolkit for stroke care. The toolkit was posted on the Iowa Healthcare Collaborative (IHC) website which is known to all hospitals in Iowa as a resource for promoting improvement in healthcare. After the creation of the toolkit the coordinators created their own group dedicated to addressing needs specific to stroke coordinators. The charter membership consisted of seven members. The ISCC membership is involved with providing guidance to non-PSC hospitals, and participating on several state committees. The ISCC meets quarterly to discuss process improvement and share information.

Results:
There are currently 17 certified PSCs and one certified Comprehensive Stroke Center (CSC). Informal mentoring is evident through frequent exchanges of ideas occurring via email, phone calls, and at quarterly meetings. The founding members of ISCC serve as board members, and reach out to support new coordinators. ISCC members have conducted mock stroke drills as a statewide public awareness event and utilized a questionnaire at health fairs across the state to assess public knowledge on stroke symptoms and risk factors. Members of ISCC assisted with developing the Iowa Stroke Registry. The registry addresses stroke as a system of care in Iowa.

Conclusions:
In conclusion, the ISCC has provided an environment where sharing ideas and experiences led to the collaboration of stroke coordinators across the state to improve care through information sharing and increasing the number of certified stroke centers. The future of the group is continued collaboration and formalizing a mentorship program.
Abstract W P269: Collaboration in the Emergency Department Improves Stroke Care
Authors: Fussner Julie M , Awadallah Kiefah
Published: July 2021

Introduction:
The purpose of this project is to improve the timeliness of stroke care at University Hospitals Comprehensive Stroke and Cerebrovascular Center (UHCSCC). Several projects were implemented in the Emergency Department (ED): Brain Attack (BAT) Lab Turnaround, ED Medic Role Revision, Standardized Handoff Tool and Dedicated Stroke Patient Room.

Methods:
First, the BAT lab project addressed the need to expedite lab results since there was no prioritization of specimens. Working with a multidisciplinary team including the ED Lab Quality committee, a new process was developed for the BAT labs using a colored requisition. Second, the ED Medic role was identified to assist with communication of incoming transfers At UHCSCC communication of all patients arriving by EMS or transfers from other facilities is directed through the UH Transfer Center. With an average of 150 patients arriving per day, this requires 8.1 hours of telephone calls placed to the ED charge nurse a month. Third, documentation of the handoff from transporting personnel was written inconsistently in multiple locations. A standardized hand off form was implemented for the nurse to obtain consistent and readily available information to provide efficient care for the stroke patient. Finally, when a new ED was built in 2011, a dedicated stroke room was designed with an attaching CT scanner to further improve the time of diagnosis for the stroke patient.

Results:
With the new prioritization process for lab specimens, the turnaround times dramatically improved. Average result times decreased by 23 minutes for CBC, 47 minutes for BMP and 35 minutes for PT/ INR. The Medic role revision decreased the telephone calls placed to the ED charge nurse by 5.5 hours a month to allow more time spent assisting with patient care. Handoff documentation improved from 33% to 90% compliance. Finally, in the new ED with the stroke room attached to the CT scanner, the average time from arrival to CT completion decreased from average of 32 to 20 minutes.

Conclusions:
The implementation of the BAT Lab Turnaround, ED Medic Role Revision, Standardized Handoff Tool and Dedicated Stroke Patient Room projects have all demonstrated that collaboration between the ED and other disciplines has improved the stroke care provided.
Abstract W P272: An Innovative Strategy for Providing Stroke Education to Patients With a Visual Impairment
Authors: Cummins Jennifer , Deitch Cheryl
Published: July 2021

Background and Purpose:
An educational gap was identified at our institution when a patient with a chronic visual impairment was admitted for Ischemic Stroke. Contemporaneously, the hospital Stroke Committee came together to discuss this patient’s diagnosis and to discuss strategies for providing stroke education. The purpose of this project was to meet the stroke education and discharge planning needs of visually impaired patients utilizing an audio format. Two stroke committee members, in turn, designed an innovative strategy to offer stroke education to this specific patient population. In researching the availability of audio materials available for stroke patients, no resources were found from professional organizations or county centers for the blind. Approximately 30 patients per year are admitted to our hospital with a pre-existing visual impairment or suffer a visual defect post-stroke.

Methods:
Several members of the hospital stroke committee volunteered to record the stroke education on CD’s. Topics covered during the audio recording ranged from stroke risk factors to complications, addressing all core measures. In order to secure funds to support this project, a hospital based grant was applied for and awarded in order to buy the necessary equipment including portable CD players and headphones. Patients were provided a CD player while hospitalized and given a personal CD player to take home. Finally, the staff members on our stroke unit were in-serviced on this project.

Results:
Several patients have benefited from receiving this education since implementation, and our committee has received positive feedback from them. Since this was received so positively, the Stroke Committee made the commitment to expand the project beyond the visually impaired population by providing all stroke patients with the audio CD upon discharge. Patients now have an alternative method for reviewing this important education that meets their needs.

Conclusions:
In conclusion, this innovation project was a satisfier for visually impaired patients. This particular patient population benefited from receiving their stroke specific education in a non-traditional and innovative format.
Abstract W P280: Collaborative Community Outreach through the Midwest Stroke Action Alliance
Authors: Masor Minna B , Kim Elizabeth , Klassman Lynn , Jennrich Mary Kay , Rossman Deborah , Hoelzel Sandra , Reilly Ginger , O'Neill Kathleen ,   on behalf of the Midwest Stroke Action Alliance
Published: July 2021

Objective:
Research is limited regarding the impact of community education on time critical response to stroke symptoms. Collaborative efforts by the Midwest Stroke Action Alliance (MSAA) conducted throughout the Chicago-land area strive to influence the early activation of 911 and patient outcomes.

Methods:
The purpose of this abstract is to demonstrate the impact of MSAA’s collaborative community awareness events in the Chicago area. MSAA began stroke outreach using the platform of Stroke Awareness Day/Month during May. In 2011, MSAA members provided materials on stroke signs and symptoms and EMS activation at different venues including train stations, hospitals, churches and community centers. In May of 2012 and 2013, the stroke awareness campaign continued and outreach grew to supermarkets, health centers and physician offices. In September 2012, MSAA further collaborated with Retreat and Refresh Stroke Camp and Genentech to launch “Strike Out Stroke” (SOS) which took place at US Cellular Field with the Chicago White Sox.

Results:
Throughout Stroke Awareness Day/Month, MSAA members provided educational materials at a variety of events. As demonstrated by the graph, one can see the number of individuals impacted continues to increase each year with the number of events, MSAA members and participating hospitals. In September of 2012, a SOS event took place with over 19,000 in attendance and 40,000 audio listeners. The number reached in 2013 will be further increased with the SOS event planned September 15, 2013.

Conclusion:
Targeted community education promotes increased awareness of stroke signs and symptoms and encourages earlier EMS activation. Ongoing community education must be sustained to impact patient outcomes. Measurement through a new Get With the Guidelines-Stroke benchmark group representing MSAA members in Illinois Regions 7,8,9,10 &11 will drive future efforts to improve the health of our community.
Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?
Authors: Paletz Laurie , Song Shlee , Steiner Nili , Robertson Betty , Wolber Nicole , Guerra Sonia , Lyden Patrick
Published: July 2021

Introduction/Background information:
At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5
th
hospital in the nation to receive this certification.

Researchable question:
Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care?

Methods:
We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time.

Results:
In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC).

Conclusion:
We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.
Abstract W P29: Comparison of Multiple and Single Intracranial Aneurysm Population in a Large Referral Center. Is the Risk Higher or the Same?
Authors: Aran Shima , Brouwers Bart H , Hirsch Joshua A , Gonzalez R G , Romero Javier M
Published: July 2021

Introduction:
The knowledge of the outcome in patients with multiple intra-cranial aneurysms is crucial in the management of these patients. We compared the outcome between patients with single aneurysm and those with multiple aneurysms in a large single referral center.

Hypothesis:
We assessed the hypothesis that the risk of rupture and mortality is higher in patients with multiple aneurysms compared to patients with a single aneurysm.

Methods:
In an IRB-approved study, we evaluated 32.100 head CT angiogram examination reports, (from Dec-2001 to Aug-2010) 2.624 patients had n intracranial aneurysm. Patients were classified into a single aneurysm (SA) or a multiple aneurysms (MA)group. The rupture and mortality rate was calculated per total number of patients and aneurysm for each group. Statistical analysis was performed with Student's t-test and chi-square.

Results:
There was a significant differences in the occurrence of SAH (SA: 22.7% vs. MA: 11%), IVH (SA: 16.4% vs. MA: 6.9%) and IPH (SA: 7.3% vs. MA: 2.1%) when the comparison was made based on aneurysm occurrence. (p<.0001). Significant difference was observed for the rupture of the aneurysms between the two groups (SA: 25.6% vs. MA: 12.2%; p<.0001). This relationship inverts when the analysis is based on individual patients, with a slightly higher rupture rate in the MA (0.28) compared with SA (0.26).Only 2 patients died in the SA group (mortality rate: 0.09) without a significant difference between the two groups (p>0.05).

Conclusion:
Patients with SA have as individuals a higher incidence of rupture than patients with MA. When rupture rate per aneurysm was calculated, again the SA (0.28) had a higher rate than MA (0.12) in this population. Prospective studies in patients with multiple aneurysms should be initiated.
Abstract W P303: Clinical Inertia in the Management of Blood Pressure after a Stroke
Authors: Cheng Eric M , Jaynes Heather A , Myers Laura J , Zillich Alan J , Bravata Dawn M , Roumie Christianne
Published: July 2021

Background:
Control of blood pressure (BP) is required in the year after a stroke because that is when the risk of stroke recurrence is highest. Although the management of BP has been improving in the general population, it has not been extensively studied in the post-stroke period. Our objective was to examine BP control and BP medication adherence and intensification in a cohort of Veterans in the year after their stroke.

Method:
We reviewed the medical charts of 3987 Veterans, representing an 80% subsample among all Veterans admitted with a diagnosis of acute ischemic stroke in fiscal year 2007 to a Veterans Administration (VA) Medical Center. We identified 2832 Veterans who had visits to VA primary care clinics both in the year prior to and in the year after the hospitalization for stroke. We used administrative databases to obtain BP values and prescribed BP medications in the year before and after index stroke hospitalization. Medication adherence was assessed by calculating the mean medication possession ratio among individual BP medications. We identified opportunities for treatment intensification if a Veteran had a systolic BP value ≥ 160 mm Hg (Stage 2 hypertension). We defined treatment intensification as any BP medication dose increase or addition of a new BP medication within 14 days of the intensification opportunity. We used paired t-tests to compare changes across the two years.

Results:
There were significant improvements in the mean systolic BP and the proportion of patients with controlled BP. Medication adherence was high both before and after the stroke. However, of the 640 opportunities for treatment intensification, we observed that intensification occurred only 193 (30%) times.

Conclusion:
Blood pressure control did improve in the year after a stroke. However, there remains a group who do not have their BP controlled. Among patients with very high systolic BP values, there remain missed opportunities for treatment intensification.
Abstract W P323: Factors Influencing Perception of Quality of Life Following Stroke
Authors: Ozark Shelly , Boan Andrea D , Turan Tanya N , Ellis Charles , Bachman David L , Lackland Daniel T
Published: July 2021

Background:
Stroke is a leading cause of adult disability and reduction in quality of life, but little is known about the social, demographic, clinical and functional elements that contribute to perceived quality of life after stroke.

Objective:
To determine the factors associated with patient perception of the effect that stroke has on quality of life.

Methods:
The STEP-South Carolina Project surveyed 162 stroke survivors one year after their event, assessing clinical and functional outcomes and patient perceptions of the magnitude of the impact of stroke on their quality of life (“no effect”, “some effect”, or “great effect”). Multivariate analyses were performed to determine the relationship between the patients’ perceived effect of stroke on quality of life and demographic features, functional abilities, stroke severity, and medical comorbidities.

Results:
Multivariate analyses showed no difference in age, race, gender or insurance status. As shown in the table, multivariate analyses (adjusted for NIHSS, age, race, gender, and insurance status) demonstrated that a history of prior stroke, use of therapy services, lower functional independence in ADLs, not driving, and history of diabetes were associated with a patient’s perception of a “greater effect” on quality of life.

Conclusion:
The perception of the impact of stroke on quality of life is influenced by both functional outcomes and clinical factors post-stroke. Further study is needed to find ways of mitigating these factors to improve patient perceived quality of life.
Abstract W P324: Acute NIHSS Profiles Predict Differential Outcomes After Mild Ischemic Stroke
Authors: Edwards Dorothy F , Chen Hui -Chun , Tiffany Deirdra G , Kidwell Chelsea S , Dromerick Alexander W
Published: July 2021

Background:
A NIHSS total score ≤ 5 is a common criteria for mild stroke. Persons with scores in this range are often considered too mild for tPa treatment and not in need of rehabilitation. There may be distinct patterns of stroke symptoms, possibly not all deficits or combination of deficits produce similar levels of disability.

Aim:
To investigate if patient profiles created by analysis of initial NIHSS item scores predict 90 day and 1 year outcome on the Modified Rankin Scale (mRS) and Stroke Impact Scale (SIS).

Methods:
Patients with ischemic stroke and initial NIHSS score ≤ 5 enrolled in the PROTECT DC trial were included. Latent class analysis of NIHSS items was used to create discrete symptom profiles: patients with similar item responses were grouped within the same profile group. Logistic regression using profile groups as independent variables predicted 90 day and 1 year mRS scores. Kruskal-Wallace tests examined differences on Stroke Impact Scale (SIS) Participation scores across the groups.

Results:
153 participants were included in the latent class analysis, yielding a 3-profile model. Profile A (82 patients, 54%) represented mild strokes with low probability of abnormality on all NIHSS items. Profile B (16 patients, 11%) patients had right-side motor impairment and sensory deficits. Profile C (55 patients, 36%) patients were more likely to have facial palsy and dysarthria. The median NIHSS score decreased from the most severe Profile B (mdn=3.00) to the most mild Profile A (mdn=1.00), with Profile C (mdn=2.00) between the two extremes. Profile B had significantly higher rates (p<.05) of unfavorable outcomes on mRS (mRS ≥ 2) at 90 days (64%) and 1-year (62%). After adjusting for age, sex, premorbid mRS, and comorbidities, Profile B had 6.56 (CI: 1.45-29.72) times and Profile C had 1.77(CI: 0.73-4.27) times higher odds of being disabled then Profile A at 90 days. One year mRS findings were similar. Profile B also presented with lower levels of participation than Profiles A and C for 1-year SIS participation scores.

Conclusion:
Patients with initial NIHSS scores ≤ 5 with right-side motor weakness and sensory deficits had more unfavorable outcomes. We suggest that mild strokes are not a homogenous group and should not be treated equally in clinical settings.
Abstract W P329: Oxygen Desaturation Index by Apnea Link as Prognostic Factor in Acute Ischemic Stroke
Authors: Gongora-Rivera Fernando , Muruet Walter , Chavez Beatriz , Villarreal-Montemayor Hector Jorge , Villarreal-Velazquez Hector Jorge
Published: July 2021

Objective:
To determine the association between the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI) with the functional outcome in Acute Ischemic Stroke Patients and describe the prevalence of sleep respiratory disorders in this population.

Methods:
Patients with Acute Ischemic Stroke and NIHSS≤20, within 5 days of admission were tested with Apnea Link device. We analyzed demographic, clinical, and functional characteristics (mRS, NIHSS and Barthel) at outcome, 3 and 6 months after discharge.

Results:
We included 111 patients, 62% male, with 64.4 ± 12 years-old and Body Mass Index (BMI) of 27 (18-60). NIHSS was ≤12 in 82% of patients. 30% had an AHI ≥30. Patients were divided in 2 groups according to mRS score (0-3 and ≥4) at discharge, 3 and 6 months follow-up. No statistically significant difference was found between groups regarding demographic, clinical and risk factors with symptoms associated with sleep disorders. At 6 months, ODI were associated with a worse functional outcome (p=0.017), but not with AHI (p=0.157). Multivariate analysis revealed that NIHSS (p=0.01) and the ODI (p=0.021) were associated with a mRS ≥4 at 6 months follow-up after adjusting for age, gender and BMI.

Conclusions:
There is a high prevalence of sleep respiratory disorders in our population. The correlation found between ODI and the mRS at the 6 months follow-up suggests a prognostic potential in Ischemic Stroke.
Abstract W P331: Management of TIA Patients Referred to Ontario Secondary Stroke Prevention Clinics From the Emergency Department
Authors: Hall Ruth , Khan Ferhana , Zhou Limei , Silver Frank L , Kapral Moira K
Published: July 2021

Background:
Previous studies have found that patients with TIA discharged from the emergency department (ED) have low rates of testing and treatment for secondary stroke prevention. Secondary Stroke Prevention Clinics (SPCs) were established in Ontario to increase access to diagnostics, treatment, and risk factor education programs for patients at risk of stroke. We aimed to characterize the management of patients with transient ischemic attack (TIA) and ischemic stroke referred to the SPCs following discharge from the ED.

Method:
The Ontario Stroke Registry performed a chart audit of 40 of 41 operational SPCs between April 1, 2011 and March 31, 2012. We included patients discharged from the ED and referred to a SPC with a diagnosis of probable stroke or TIA, and evaluated processes of best practice care. Using encrypted health card numbers, we linked to administrative databases to identify 7, 30 and 90 day outcomes after the index event.

Results:
Our study sample included 8,501 patients discharged from the ED and referred to a SPC with probable stroke/TIA. After evaluation in the SPC, 1,902 were given a final diagnosis of TIA and 1,126 ischemic stroke. The median age was 72 years and 46.6% were female. The median time from ED discharge to clinic visit was 8 days for TIA patients and 7 days for ischemic stroke patients. The majority of patients (>92%) received neuroimaging, carotid imaging and antithrombotic therapy, and rates of treatment were similar in those with TIA and stroke. The rate of death or recurrent stroke admission at 30 days was 3.6% among patients with confirmed ischemic stroke, and 0.4% in those with TIA.

Conclusion:
Ontario patients with TIA and ischemic stroke discharged from the ED with stroke secondary prevention clinic follow up receive high quality best practice secondary stroke prevention care. Further work will examine whether TIA patients discharged from EDs without SPC follow up have similar care and outcomes.
Abstract W P340: Effects of Stroke Enlightenment on Guardians by Educating Junior High Students: the Tochigi Project
Authors: Ohyama Satoshi , Yokota Chiaki , Takekawa Hidehiro , Okamura Tomonori , Miyamatsu Naomi , Nakayama Hirofumi , Matsuzono Kosuke , Ishigami Akiko , Okumura Kosuke , Hirata Koichi , Muto Takashi , Toyoda Kazunori , Miyamoto Yoshihiro , Minematsu Kazuo
Published: July 2021

Background and Purpose:
School-based interventions of stroke enlightenment are not only beneficial for students but also expected to deliver stroke message effectively to their parents. We produced stroke teaching materials using FAST mnemonic. The aim of this study is to verify the effectiveness of stroke education project (the Tochigi project) for delivering stroke message to their parents through their children, using our teaching materials of stroke enlightenment.

Methods:
Subjects were guardians of 1,125 students (13-15 y.o.) in 9 public junior high schools in Tochigi prefecture, Japan. All students received a 20-minute stroke lesson by their teacher using the FAST mnemonic, and then watched a 10-minute animated cartoon and read the comic book. At the close of the lesson, the teacher asked the students to take back the comic book and talk about stroke with their guardians while showing the comic book. Questionnaires on stroke knowledge were examined for all the guardians before and immediately after the conversation about stroke with their children.

Results:
There were 915 guardians (81.3%, 94%; parents) participated in the present study. Correct answer rates for the questions of headache (81.1 vs. 72.8%, p<0.0001) and hemi-sensory disturbance (69.3 vs. 72.5%, p=0.14) after the conversation were not improved compared with those before. Frequencies of correct answers increased for the other questionnaires of symptoms and risk factors except hypertension after the conversation. The rate of correct answer for hypertension was high before and after the conversation (91.0 vs. 91.7%). The number of the guardians with correct answer for the meaning of the “FAST” mnemonic was as same as that of students (92.7 vs. 91.0%).

Conclusions:
Our teaching materials of stroke enlightenment for junior high school students would be promising means of delivering the stroke message effectively to their guardians.
Abstract W P358: SOD overexpression Accounts for the Neurovascular Protection in Rats Following Ischemic Stroke
Authors: Coucha Maha , Li Weiguo , Abdelsaid Mohammed , Hafez Sherif , Fagan Susan C , Ergul Adviye
Published: July 2021

Acute hyperglycemic stroke (AHS) is associated with poor stroke outcomes and functional recovery. We recently showed that myogenic response; the ability of blood vessels to maintain adequate blood flow despite changes in pressure; was impaired after AHS. Experimental studies showed that acute elevation of blood glucose at stroke onset enhances oxidative stress that impairs effective reperfusion. Copper/zinc-superoxide dismutase (SOD1), an antioxidant enzyme that catalyzes the dismutation of superoxide into oxygen and hydrogen peroxide, has been shown to be highly protective against ischemia/reperfusion injury (IRI). Yet, the mechanism by which SOD1 improves stroke outcomes is still unresolved.

Hypothesis:
SOD1 overexpression improves cerebral myogenic behavior leading to neurovascular protection after AHS

Methods:
Wild-type Sprague Dawley (SD) and human SOD1 transgenic rats (n=6-8) were subjected to 30 min middle cerebral artery occlusion (MCAO)/45 min or 24 hr reperfusion. Hyperglycemia was induced by intraperitoneal injection of 40 % glucose solution 10 min before procedure. Myogenic tone of isolated MCAs, infarct size, edema and neurological deficits were determined.

Results:
IRI impaired myogenic response of MCAs isolated from SD rats compared to sham (***p<0.001). Normoglycemic and hyperglycemic SOD1 rats maintained a well developed myogenic response after IRI. Infarct size and edema were significantly reduced in the SOD1 transgenic rats compared to SD rats (**p<0.01). SOD1 overexpression significantly improved beam walk score and grip strength deficit compared to SD rats (*p<0.05). Hyperglycemic SOD1 transgenic rats showed smaller infarct size and edema (**p<0.01) and experienced improved neurological behavior (*p<0.05) compared to hyperglycemic SD rats.

Conclusions:
We provide evidence that SOD1 overexpression preserves the myogenic behavior of MCAs achieving neurovascular protection in conditions associated with poor stroke outcomes. Further studies are required to unravel the exact mechanism by which SOD exerts its beneficial role on vascular reactivity, and to identify new therapeutic targets for stroke management.
Abstract W P361: Telomere G-tail Length Shortening is Associated With Endothelial Dysfunction in Patients With Chronic Cerebrovascular Disease and Comorbidity
Authors: Nezu Tomohisa , Hosomi Naohisa , Aoki Shiro , Takahashi Tetsuya , Anno Kumiko , Maruyama Hirofumi , Higashi Yukihito , Tahara Hidetoshi , Matsumoto Masayasu
Published: July 2021

Background and Purpose:
Telomere length of leukocytes is associated with cardiovascular risk as well as ischemic stroke and poststroke mortality. In addition, leukocyte telomere length shortening is thought to be associated with increased carotid intimal medial thickness (IMT) and endothelial dysfunction evaluated by flow mediated dilation (FMD). Recently, telomeric 3’-overhang (G-tail) lengths has been essential for the biological effects of telomere dysfunction. The aim of this study was to investigate the associations between telomere G-tail lengths of leukocytes and the physiological studies.

Methods:
Patients with cerebrovascular diseases history and other neurological problems were enrolled in this study (n=63; 39 male, 69.8±10.0 years). Telomere G-tail lengths were measured by G-tail telomere hybridization protection assay (H Tahara et al. Nat Methods. 2005). The mean value of maximal IMT measured in the distal CCA far wall (CCA-IMT) and plaque score were measured by carotid ultrasonography. Endothelial dysfunction was defined as a FMD≤4.5%.

Results:
Telomere G-tail length (18947.0±4066.6 RLU/μg DNA) was positively correlated with total telomere length (230330.8±25830.9 RLU/μg DNA; R
2
=0.261, p<0.001). In addition, telomere G-tail length was negatively correlated with age (R
2
=0.217, p<0.001) and positively correlated with FMD (R
2
=0.136, p=0.003). Telomere G-tail length was not related to CCA-IMT and plaque score. The patients with endothelial dysfunction (n=39, 61.9%) were older (72.4±7.6 vs. 65.5±11.8, P=0.007), more frequently male (74.4% vs. 41.7%, P=0.016) and more frequently had hypertension (89.7% vs. 37.5%, P<0.001) than the patients without. After multivariate analysis with age, sex, presence of stroke and comorbidities, the lowest quartile of telomere G-tail length was independently associated with the endothelial dysfunction (OR 3.85, 95%CI 1.58-12.42, P=0.002), although there was no significant association between total telomere length and endothelial dysfunction on multivariate analysis.

Conclusion:
Telomere G-tail length might be more useful marker for the endothelial dysfunction which was evaluated by FMD than total telomere length.
Abstract W P363: Mechanism of Protection by Soluble Epoxide Hydrolase Inhibition in Type 2 Diabetic Stroke
Authors: Zuloaga Kristen L , Krasnow Stephanie M , Zhang Wenri , Shangraw Robert E , Marks Daniel L , Alkayed Nabil J
Published: July 2021

Hyperglycemia worsens stroke, yet rigorous glycemic control does not improve neurologic outcome. An alternative is to target downstream molecular mediators triggered by hyperglycemia. Soluble epoxide hydrolase (sEH) is a potential mediator of ischemic injury via its metabolism of neuroprotective epoxyeicosatrienoic acids (EETs). We previously demonstrated that sEH mRNA is overexpressed in type 1 diabetic (T1D) mice, and specific sEH blockade protects the brain from the deleterious effect of T1D on stroke. We tested the hypothesis that type 2 diabetes (T2D) exacerbates injury following middle cerebral artery occlusion (MCAO) in part by up-regulating expression of EPHX2 (gene encoding for sEH) and decreasing brain concentrations of neuroprotective EETs. T2D was produced by combined high-fat diet, nicotinamide and streptozotocin in male C57BL/6J mice. T2D and control mice were treated with vehicle or the sEH inhibitor trans-4-[4-(3-Adamantan-1-yl-ureido) -cyclohexyloxy]-benzoic acid (t-AUCB; 1mg/kg, i.p., 7 days), then subjected to 60-min MCAO. Compared to normal chow-fed mice, high fat diet-fed mice exhibited a 1.7 fold upregulation of EPHX2 mRNA in brain (p<0.05, n=7). T2D mice had increased blood glucose levels compared to control mice before, during and after MCAO (p<0.001, n=4-5). Relative laser-Doppler perfusion of the MCA territory after reperfusion was decreased in T2D mice compared to controls (p<0.05, n= 4-5). Vehicle-treated T2D mice sustained larger cortical infarcts than vehicle-treated control mice (p<0.05, n=5-7). t-AUCB decreased fasting glucose levels at baseline and throughout ischemia (p<0.001, n=4-5) and improved cortical perfusion after MCAO (p<0.001, n=4-5) in T2D mice. In line with these improvements, t-AUCB significantly reduced infarct size in T2D mice (p<0.05 vs. T2D vehicle, n= 5-7). We conclude that increasing EETs bioavailability via sEH inhibition improves stroke outcome in T2D in part by improving glycemic status and improving post-ischemic reperfusion in the ischemic territory.