bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP29: Safety and Efficacy of WEB Flow Disruption in Treatment of Bifurcation Aneurysms: Results in a Cumulated Population of 3 Good Clinical Practice Studies (WEBCAST, French Observatory, WEBCAST 2)
Authors: Pierot Laurent , Molyneux Andrew , Byrne James ,   WEBCAST, French Observatory, WEBCAST 2 Investigators
Published: March 2022

Introduction:
Flow Disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Initial series have shown a low complication rate with good efficacy.

Hypothesis:
To confirm the safety and efficacy of the WEB aneurysm treatment in the cumulated population of WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm), French Observatory, and WEBCAST 2 series.

Methods:
WEBCAST, WEBCAST 2, and French Observatory are single-arm, prospective, multicenter, GCP (Good Clinical Practice) studies dedicated to the evaluation of WEB treatment, conducted in Europe and France. Inclusion criteria were ruptured and unruptured aneurysms in both studies, located in basilar artery, middle cerebral artery, anterior communicating artery, and internal carotid artery terminus. Clinical data were independently evaluated. Post-operative, 6-months (in WEBCAST and WEBCAST 2), and 1-year aneurysm occlusion was independently evaluated using the 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. Evolution of aneurysm occlusion was evaluated using a simple 3-grade scale: stable, improved, worsened.

Results:
The cumulated population was 168 patients (112 females, 66.7%) with 169 aneurysms. WEB implant success was 96.4%. Mortality at discharge was 0.6% and morbidity 1.8%. At one-year (mean 12.6 months), complete aneurysm occlusion was observed in 56.0%, neck remnant in 26.0%, and aneurysm remnant in 18.0% (WEBCAST and French Observatory).

Conclusions:
The analysis in this large cumulated population of studies (WEBCAST, French Observatory, WEBCAST 2) confirms great safety and efficacy of WEB treatment.
Abstract WMP31: National Trends in Transfer of Patients With Intracerebral Hemorrhage to Teaching Hospitals
Authors: Vahidy Farhaan , Albright Karen , Donnelly John P , Shapshak Angela H , Savitz Sean I
Published: March 2022

Introduction:
The 2015 AHA guidelines for ICH management state that initial care of ICH patients should take place in an “ICU or a dedicated stroke unit with physician and nursing neuroscience acute care expertise”. This approach entails transferring ICH patients from community hospitals to centers with stroke expertise.

Hypothesis:
We explored national trends in transfer of ICH patients to teaching hospitals, and evaluated the differences in demographic, co-morbidity, resource utilization factors, and outcomes for transferred patients (TP) vs. directly admitted patients (DAP).

Methods:
From the National Inpatient Sample data for years 2006 to 2011, we identified patients with primary diagnosis of ICH (ICD-9 431). We assessed linear trends in the proportion of patients transferred over time using logistic regression. We constructed multivariate logistic regression models to explore the association of transfer status with inpatient mortality after controlling for significant factors. All analyses were performed using survey design variables, allowing us to report nationally-weighted estimates.

Results:
Our analysis subpopulation comprised of 232,009 patients, and 48,097 (20.7%, 95% CI: 17.8 - 23.9) were TP. There was a statistically significant increase in transfer over the 6 year period. (Figure 1). TP were younger, and were more likely to be white and have private insurance. The proportions of TP with hypertension, diabetes, congestive heart failure, and renal failure were also significantly smaller (Table 1). TP had lower adjusted odds of inpatient mortality as compared to DAP (Table 2).

Conclusion:
There is an increasing trend of transferring ICH patients to higher level of care. Care of transferred patients at specialized centers is associated with greater resource utilization and lower inpatient mortality. Evidence on optimal selection of patients benefiting from transfer, and long term functional outcomes are needed for policy planning.
Abstract WMP43: Microrna-210 Improves Long-term Outcome in the Ischemic Mice via La Regulation of BDNF
Authors: Zeng Lili , Yang Guo-Yuan
Published: March 2022

Objective:
MicroRNAs played an important role in the ischemia brain injury and repair. However, the key microRNA and its function in the stroke patients remain unclear.

Methods:
The blood miRNAs profile was analyzed by quantitative Polymerase Chain Reaction (PCR) methods in ischemic stroke patients in the acute phase (48 hours) and subacute phase (10 days), compared to healthy controls with vascular risk factors. The predicted network of differences in the expression of miRNAs was further explored by Ingenuity Pathway Analysis (IPA). The key miRNA was selected and its function and mechanism were explored in ischemic mice subjected to lentivirus vector mediated overexpression. The predicted target was confirmed by the dual luciferase reporter assay system.

Results:
After cerebral ischemia, 24 microRNAs were high or low differently expressed in the peripheral blood of stroke patients. The bioinformatics analysis showed a regulated network of stroke cascade, which was consisted of 10 miRNAs including mir-210 and their predicted targets. The lentivirus vector mediated miR-210 overexpression increased microvessel density and the number of neural progenitor cells via regulating brain-derived neurotrophic factor (BDNF) expression in normal and ischemia mice brain. MiR-210 overexpression could ameliorate neurobehavioral outcomes in ischemic mice. The dual luciferase reporter assay system identified that BDNF was the direct target of miR-210.

Conclusions:
MiR-210 is a key stroke related miRNA. Overexpression of miR-210 promotes focal angiogenesis and neurogenesis via directely regulating BDNF expression. Furthermore, miR-210 improves long-term outcomes in ischemic mice and proved to be a potential novel therapeutic target for stroke.
Abstract WMP56: Physical Inactivity and Slower Gait Speed in an Elderly Multi-ethnic Population: The Northern Manhattan Study
Authors: Willey Joshua Z , Moon Yeseon P , Cheung Ying K , Wright Clinton B , Sacco Ralph L , Elkind Mitchell S
Published: March 2022

Background:
Slower gait speed is associated with adverse outcomes of aging, such as falls and mortality. We hypothesized that physical inactivity, which is prevalent in the elderly, is a major risk factor for slowed gait speed independent of white matter hyperintensity volume (WMHV) and silent brain infarcts (SBI) on magnetic resonance imaging (MRI).

Methods:
In the Northern Manhattan MRI sub-study (n = 1290), 702 participants had physical performance measures a mean of 5 years after initial MRI. Assessment of gait speed was via a timed 5 meter walk test, averaged over 3 trials. Physical inactivity was assessed using a validated questionnaire at initial enrollment. Multi-variable linear and logistic regression models were fit to examine the association between physical inactivity and gait speed as a continuous outcome and binary outcome cut off at the lowest quartile. Models were adjusted for sociodemographics, hypertension, diabetes, waist circumference, osteoarthritis, and grip. Further mediation analyses were performed adjusted for WMHV and SBI.

Results:
The mean age at gait assessment was 74(±8.5) years, 61% women and 70% Hispanic; mean gait speed was 1.0±0.3 meter/second. In multi-variable models physical inactivity (54% of cohort), compared to physically activity, was associated with mean 0.04 m/s slower gait speed (p=0.03), and a greater odds of gait speed <0.85 m/s (lowest quartile)(adjusted OR=1.69, p-value=0.02). SBI (beta = -0.05, p= 0.04) and WMHV (beta = -0.02 per SD, p=0.02) were independently associated with gait speed. The association between physical inactivity and gait speed was unchanged after adjusting for WMHV and SBI.

Conclusion:
Physical inactivity is associated with slower gait speed independently of osteoarthritis, markers of sarcopenia, and subclinical ischemic brain injury. Modifying sedentary behavior poses a target for interventions aimed at reducing physical aging.
Abstract WMP64: Door to Groin Puncture Times in Patients Managed on a Mobile Stroke Unit: Pilot Data
Authors: Jagolino Amanda L , Cai Chunyan , Rahbar Mohammad H , Parker Stephanie , Bowry Ritvij , Grotta James C
Published: March 2022

Introduction:
The BEST-MSU study is an ongoing comparison of management of acute ischemic stroke (AIS) on a mobile stroke unit (MSU) versus standard management (SM) by emergency medical services. Recent trials have demonstrated that intra-arterial therapy (IAT) is safe and effective in select AIS patients. MSU management may allow prescreening and reduce door to groin puncture time (DTG).

Objective:
The purpose of this analysis is to look at IAT metrics in order to determine the sample size needed to compare MSU versus SM.

Methods:
Using preliminary data including data from the unblinded "run-in" phase, we identified 12 AIS patients (5/15/14-6/30/15) evaluated by MSU within 4.5 hours from last-seen-normal who went on to IAT. We report DTG and calculated the sample size needed to show a reduction of at least 30 minutes. We also did a preliminary analysis of DTG trends over time.

Results:
Baseline characteristics and clinical variables for our pilot patients are found in the table. In cases when the MSU pre-notified the inpatient stroke team and the patient was taken straight to CTA scan from the ambulance, DTG were 80 and 66 minutes. In general, over time the frequency of patients on MSU who underwent IAT increased and DTG decreased (Figure) but small sample size precludes statistical conclusions. Given the mean DTGs and variability, to be 80% confident with a 5% significance level that the MSU will shorten these times by at least 30 minutes, 46 patients will be needed in each group.

Conclusion:
MSU management may reduce DTG, but further study is needed to detect any difference between MSU and SM, as well as to address longterm outcomes.
Abstract WMP69: Access to Endovascular Treatment in Remote Areas: Analysis of the Reperfusion Treatment Registry of Catalonia
Authors: Dorado Laura , Pérez de la Ossa Natalia , Abilleira Sonia , Cardona Pere , Giralt Eva , Urra Xabier , Ribó Marc , Cánovas David , Garcés Moisés , Krupinski Jurek , Martí-Fábregas Joan , Pellisé Anna , Purroy Francisco , Saura Júlia , Serena Joaquín , Molina Carlos , Dávalos Antoni , Gallofré Miquel ,   Catalan Stroke Code and Reperfusion Consortium (Cat-SCR)
Published: March 2022

Background:
Benefit of endovascular treatment (EVT) for acute stroke has been demonstrated recently in several randomized clinical trials. This benefit is time-dependent and revascularization achieved at later times is associated with a poor risk-benefit ratio.

Hypothesis:
Stroke Code systems based on a drip-and-ship model have been implemented worldwide to accelerate iv-tPA treatment. However, access to EVT in remote areas is hampered due to long distances and delays related to inter-hospital transfers.

Methods:
We studied patients treated with EVT from a prospective multicenter population-based registry of acute stroke patients treated with reperfusion therapies (SONIIA) initiated in January 2011. Three groups were defined: (1) patients directly evaluated in comprehensive stroke centers (CSC) (n=895), (2) patients transferred from a remote hospital located less than 1 hour away from a CSC (n=191) and (3) patients transferred from a remote hospital located more than 1 hour away from a CSC (n=153). We compared population EVT rates (number of EVT/100000 inhabitants/year) and time from stroke onset to groin puncture between groups. The benefit of helicopter over ground transfer was evaluated in group 3.

Results:
We found no differences between the three groups in baseline characteristics (age, vascular risk factors and stroke severity). 48% of patients in group 1, 60% in group 2 and 62% in group 3 received iv-tPA previously to EVT, with time from symptom onset to iv-tPA of 120 min, 110 min and 137 min respectively. Population EVT rates were 4-fold higher in group 1 (6.69 in group 1, 2.07 in group 2 and 1.68 in group 3). Time from symptom onset to EVT was longer in group 2 (322 min [255-445]) and group 3 (365 min [312-450]) compared to group 1 (243 min [175-404]) (p<0.001). Helicopter transfer was used in 24% of patients in group 3 and reduced the time to groin puncture in 35 minutes.

Conclusions:
Accessibility to EVT in remote areas is hampered in comparison to areas depending directly on CSC. Time from symptom onset to EVT is 90-120 minutes longer in patients transferred from remote hospitals compared to patients directly evaluated in CSC. Based on these results, strategies to shorten inter-hospital transfer time or alternative mother-ship models should be considered.
Abstract WMP75: Infection is Strong Predictor of In-hospital Stroke and Mortality in Patients on Maintenance Hemodialysis -Ten Year Experience
Authors: Sachar Pawani , Dhakar Monica , Sunbulli Mohammed F , Rajamani Kumar
Published: March 2022

Introduction:
End Stage Renal Disease (ESRD) is associated with accelerated vascular disease of the cerebral circulation. Several studies have established that patients with ESRD on hemodialysis (HD) are at much higher risk of ischemic stroke than general population.

Objective:
To compare the outcomes of in-hospital stroke vs out of hospital stroke in maintenance hemodialysis and identify predictors of mortality.

Methods:
Patients >18 years admitted between 2005-2014 were screened using ICD-CM-9 codes 39.9 for Hemodialysis and 430-438 for stroke. Of the 620 patients with stroke and HD, 135 patients who had “in-hospital” acute ischemic stroke were identified. Patient demographics, comorbidities, type of stroke, and outcomes including discharge disposition and mortality were compared between the two groups. Logistics regression analysis was performed to identify independent predictors of mortality in these patients.

Results:
Rate of in hospital stroke was 28.8 % (135/468) and overall prevalence rate of infection was 47.3% (284/600) in overall cohort. Compared to out of hospital stroke, patients with in-hospital stroke had higher rate of atrial fibrillation (30.6 % vs 19.9%, p<0.05), anemia (74.0% vs 60.3%, p<0.05) and infection (69.7% vs 40.0%, p<0.001). They had higher mortality (35.5% vs 15.9 %, p<0.001) and longer length of stay (21.28±18.85 days vs 11.80±29.9 days, p<0.05). Using logistic regression, infection (OR 2.75, 95% CI 1.61- 4.09) anemia (OR 2.00, 95% CI 1.105-3.635) and carotid disease (OR 2.71 CI 1.11-6.63) were found to be independent predictor of in-hospital stroke. Similarly infection was found to be an independent predictor of mortality (OR 6.66, 95% CI 3.44-12.877).

Conclusion:
There is a high incidence of “in-hospital” stroke in patients with ESRD on HD. Certain clinical parameters such as infections and anemia significantly impact the outcomes in these patients. Further studies should be directed looking at these parameters to establish guidelines for better in-patient management of these patients.
Abstract WMP85: Significance of Cerebral Small Vessel Disease in Acute Intracerebral Hemorrhage: The INTERACT2 Study
Authors: Sato Shoichiro , Delcourt Candice , Heeley Emma , Arima Hisatomi , Zhang Shihong , Al-Shahi Salman Rustam , Stapf Christian , Woo Daniel , Flaherty Matthew L , Vagal Achala , Levi Christopher , Davies Leo , Wang Jiguang , Robinson Thompson , Lavados Pablo M , Lindley Richard I , Chalmers John , Anderson Craig S ,   The INTERACT2 Investigators
Published: March 2022

Background:
Uncertainty exists over the significance of structural changes arising from cerebral small vessel disease (CSVD), including white matter lesions (WML), lacunes and atrophy, for outcome after acute intracerebral hemorrhage (ICH). We determined associations of CT markers of CSVD and outcomes among participants of the INTERACT2 study.

Methods:
We graded WML (van Swieten scale), brain atrophy (two linear measurements, frontal ratio [FR] and third ventricle Sylvian fissure distance [TSD]) and the presence of lacunes for 2069/2839 patients with available baseline brain CT (<6hr ICH onset) by three independent neurologists blind to clinical data.

Results:
WML and brain atrophy were independently associated with death or disability (modified Rankin Scale score 3-6) at 90 days: adjusted odds ratios for WML (grade 3 and 4 vs. 1), FR and TSD (most vs. least severe atrophy quartile) were 1.42 (95% confidence interval 1.02-0.98), 1.47 (1.08-1.99) and 1.64 (1.21-2.22), respectively (all P for trend <0.05). There was no association between lacunes or any CSVD biomarkers and absolute ICH growth, and no significant differences in the effects of intensive BP lowering in each subgroup of CSVD.

Conclusions:
CSVD manifestations of WML and brain atrophy have prognostic value in acute ICH but they do not appear to influence ICH growth. Intensive BP lowering provided similar treatment effects irrespective of degree of CSVD.
Abstract WMP89: CT Hypodensities in Acute Intracerebral Hemorrhage Predict Hematoma Expansion
Authors: Boulouis Gregoire , Morotti Andrea , Charidimou Andreas , Brouwers H B , Auriel Eitan , Pontes-Neto Octavio , Ayres Alison , Vashkevich Anastasia , Schwab Kristin M , Rosand Jonathan , Goldstein Joshua N , Greenberg Steven M
Published: March 2022

Introduction:
Hematoma expansion (HE) is a potentially modifiable predictor of poor outcome following acute intracerebral hemorrhage (ICH) and a common therapeutic target in recent and ongoing clinical trials. Our ability to identify ICH patients likeliest to expand and therefore likeliest to benefit from HE-targeted treatments remains an unmet need. Hypodensities (hDs) within ICH on noncontrast CT (NCCT), sometimes referred to as “swirl sign,” have been suggested as a possible predictor of HE. We sought to determine whether hDs can predict HE independently of other known predictors of HE.

Methods:
hDs were analyzed by 2 independent blinded raters in consecutive ICH patients with baseline CT/CT Angiography (CTA) and follow-up NCCTs. The association of hDs and HE (>6cc or 33% of baseline volume) was determined by multivariable logistic regression controlling for other variables (including the CTA spot sign) associated with HE in univariate analyses with p≤ 0.1.

Results:
Among 414 patients, 114 (27.5%) baseline NCCTs demonstrated hDs (Figure, white arrowheads; kappa for interrater reliability 0.87). In univariate analyses, hDs were strongly associated with HE (40.3% hDs in patients with HE, 10.3% in patients without, p<0.0001) and with warfarin use, shorter time to CT, larger baseline ICH volume, CTA spot sign presence, and older age. The association between hDs and HE remained significant (OR = 2.89 [95%CI 1.5-5.6], p=0.001) in a multivariable model controlling for the above factors and sex; other independent predictors of HE were CTA spot sign, shorter time to CT and older age (all p<.001).

Discussion:
hDs within an acute ICH on NCCT are a reliable and strong predictor of HE, independent of other clinical and imaging predictors. This novel marker may help clarify the mechanism of HE and serve as a useful addition to clinical algorithms for determining HE risk.
Abstract WMP96: Incidence of Ischemic Strokes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR) Phase III Clinical Trial
Authors: Rivera Lara Lucia A , Nekoovaght-Tak Saman , McBee Nichol , Dlugash Rachel , Ram Malathi , Thompson Richard , Awad Issam A , Hanley Daniel F , Ziai Wendy ,   Clear III Investigators
Published: March 2022

Background:
Concomitant acute ischemic lesions are detected in 0-39% of patients with spontaneous intracerebral hemorrhage (ICH). Etiology and impact on functional outcomes are poorly understood nor is it known if intraventricular recombinant tissue plasminogen activator (rtPA) impacts incidence.

Methods:
Prospective analysis of incidence and etiology of ischemic lesions in all 500 patients enrolled in the CLEAR III trial, a multicenter, double-blind, randomized study comparing EVD + intraventricular rtPA vs. EVD + placebo for treatment of obstructive intraventricular hemorrhage (IVH) and ICH volume <30cc. Two independent stroke neurologists (WZ and LR) evaluated clinical ischemic events reported during acute hospitalization.

Results:
Ischemic strokes occurred in 19/500 (3.8%) at median [iqr] 10[5,19] days after ICH onset. Mean age was 57.3±10.5 years. Median NIHSS was 18[12.5-37]. ICH locations were basal ganglia (15/19), frontal lobe (1); 3/19 had primary IVH. All strokes but one were distant from the ICH (7 contralateral, 6 bilateral, 3 ipsilateral,1 infratentorial). Compared to patients without strokes, patients with strokes had similar ICH (8.1[12.5] vs. 7.7[10.9]cc) and IVH volumes (23.2[30.1] vs. 24.6[25.3]cc), non-significantly higher admission systolic (201[43] vs. 193[53]mmHg) and diastolic (111[22] vs. 107[35]mmHg) blood pressure (BP), and larger decrease in SBP from admission to randomization (54.5[38] vs. 48[54]mmHg, p=0.13). Mortality was significantly higher in patients with strokes at 30 (26.3% vs. 8.5%, p=0.008) and at 180 days (33.3% vs. 13.7%, p=0.02). Mortality was significantly associated with ischemic stroke after adjustment for ICH and IVH volumes, age and Glasgow Coma Scale (p=0.03 for both day 30 and 180). There were no significant differences in comorbidities between the two groups.

Conclusions:
Incidence of ischemic strokes in the CLEAR III trial was low but significantly associated with increased early and late mortality. Mass effect and stroke risk factors did not appear to contribute. Acute phase BP reduction may be a predisposing factor. These results permit future correlation of ischemic complications with treatment rendered (thrombolysis versus placebo), with upcoming unblinding of the trial.
Abstract WP103: Mitochondrial/endoplasmic Reticulum Dysfunction Exacerbates Oxidative Damage in Aging White Matter Ischemia
Authors: Baltan Selva , Bastian Chinthasagar , Stahon Katharine , Griffith Shelby , Brunet Sylvain
Published: March 2022

White matter (WM) is frequently affected by stroke. Aging WM recovers less following stroke compared to younger WM. Free radicals accumulate with aging resulting in increased oxidative stress. Mitochondria/endoplasmic reticulum (ER) interactions are crucial for protection from oxidative stress. We hypothesized that aging WM is more susceptible to oxidative stress damage mediated by mitochondrial/ER dysfunction, leading to decreased ATP synthesis and impaired Ca2+ homeostasis.

Mouse optic nerves (MON) obtained from C57BL/6J and Thy-1 CFP(+) mice at 1 (young) or 12 months (aging) of age were used. Axon function was quantified by recording evoked compound action potentials. Mitochondrial/ER structure and interactions were determined by 3D-electron microscopy, Western blotting, ATP assays, and CFP (+) fluorescent mitochondrial imaging. Oxidative stress was assessed by NOS and glutathione assays and by Western blotting for oxidative stress markers, 3-NT and 4-HNE. Oxygen-glucose deprivation (OGD) for 60 min resulted in decreased axon function recovery of aging WM. Aging WM showed elevated NOS activity and increased levels of by-products of lipid peroxidation (4-HNE) and protein nitration (3-NT), indicating aggravated oxidative stress. Structurally, aging axons were larger, with thicker myelin, and were characterized by longer and thicker mitochondria due to altered levels of mitochondrial shaping proteins. This was further confirmed by 3D-EM and CFP (+) imaging and may underlie the decreased ATP levels detected in aging WM. Moreover, mitochondrial-ER interactions were compromised due to decreased association between the organelles and due to decrease in levels of mitochondrial trafficking protein miro-2, which suggests defective Ca2+ homeostasis in aging axons. Calnexin, an ER stress response chaperone protein, was decreased under baseline conditions in aging axons, but did not show upregulation following OGD when compared to young axons, suggesting a defect in unfolded protein responses.

We conclude that aging WM is increasingly vulnerable to stroke because of inherent structural changes in axons and mitochondria/ER interactions, leading to depletion of ATP and defective Ca2+ dynamics, resulting in increased oxidative stress.
Abstract WP118: Low Free Triiodothyronine May Predict Poor Functional Outcome in Patients With Acute Ischemic Stroke
Authors: Suda Satoshi , Muraga Kanako , Kanamaru Takuya , Okubo Seiji , Matsumoto Noriko , Abe Arata , Aoki Junya , Suzuki Kentaro , Sakamoto Yuki , Kimura Kazumi
Published: March 2022

Objectives:
Thyroid dysfunction has been associated with increased short-term mortality in intensive care unit and long-term mortality in cardiovascular disease. However, the association between thyroid function and clinical characteristics in patients with acute ischemic stroke has not yet been thoroughly studied. The purpose of the present study was to test the hypothesis that thyroid hormone is associated with functional outcome after acute ischemic stroke.

Methods:
We enrolled 398 consecutive patients admitted to our stroke center from July 2010 to April 2012. General blood test including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), were performed on admission. Neurological severity was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores on admission and modified Rankin Scale (mRS) scores on discharge. A poor outcome was defined as mRS score of 3-5 or death (mRS score 6). The impact of thyroid function on discharge outcome was evaluated using multiple logistic regression analysis.

Results:
Discharge poor functional outcome was observed in 165 patients (40.3 %). Age (P = 0.0025), male gender (P = 0.0301), admission blood glucose level (P < 0.0001), admission NIHSS score (P < 0.0001), smoking (P = 0.0077), dyslipidemia (P = 0.0254), and arterial fibrillation (P < 0.0001) were significantly associated with poor functional outcome, but no relationship between FT4, TSH and poor functional outcome were found. On multivariable logistic regression analysis showed that poor functional outcome were independently associated with high blood glucose on admission (≧ 124 mg/dl; odds ratio [OR], 3.05; 95% confidence interval [CI], 1.74-5.46; P < 0.0001), old age (≥80 years; OR, 4.12; 95% CI, 2.22-7.82; P < 0.0001), high NIHSS score (≧ 7; OR, 14.64; 95% CI, 7.73-29.06; P < 0.0001), prior stroke (OR, 1.89; 95% CI, 1.01-3.55; P = 0.0448), and low FT3 (≦ 2.29 pg/ml; odds ratio [OR], 2.70; 95% confidence interval [CI], 1.50-4.88; P = 0.0009).

Conclusions:
These findings suggest that low FT3 on admission may predict a poor discharge outcome in acute ischemic stroke. Further researches are needed to assess the impact of thyroid hormone as a potential marker for long term prognosis.
Abstract WP135: How to Get More From the NIH Stroke Scale
Authors: Goggins Maria B , Davis Cameron L , Wright Amy , Kim Grace , Agis Daniel , Meyokazaki Keity , Oishi Kumiko , Oishi Kenichi , Hillis Argye E
Published: March 2022

Introduction:
Previous studies show that the NIH Stroke Scale (NIHSS) underestimates volume of right hemisphere (RH) relative to left hemisphere stroke.

Hypothesis:
Analysis of descriptions of the “Cookie Theft” picture from the NIHSS yields quantitative measures of severity of RH cortical deficits that, when added to NIHSS scores, better account for infarct volume than NIHSS score alone in acute RH stroke.

Methods:
We evaluated 26 patients with acute ischemic RH stroke within 48 hours of onset with NIHSS, analysis of the “Cookie Theft” picture, and DWI, and compared them to 26 age-matched controls. Picture descriptions were evaluated for: total content units (CU; based on published norms), syllables per CU; left CU:right CU; % interpretive CU. A neurologist blinded to clinical data measured lesion volume and % damage to gray and white matter regions of interest (ROI) on DWI after registration to an atlas. Multivariable linear regression was used to generate a model that best predicted stroke volume. Pearson correlations were calculated between behavioral scores and % damage to each ROI. Group means were compared by t-tests.

Results:
Lesion volume correlated more strongly with syllables per CU (r2 = .39; p=0.0006) than with NIHSS score (r2=.38; p=0.0008). Moreover, lesion volume was best accounted for by a model that included: total CU, syllables per CU, left CU:right CU, % interpretive CU; NIHSS score, and age (r2 =.80; p<<.00001). Syllables per CU, % interpretive CU, and NIHSS each independently (p<0.05) accounted for some variance in lesion volume. Mean values for picture description scores were significantly different in RH stroke versus age-matched controls by t-tests (p=0.0001 to 0.028), and each score correlated with % damage to a distinct RH region: total CU with % damage to inferior frontal gyrus (r=-.47; p= 0.017) and superior temporal gyrus (STG; r=-.63; p=0.0006); CU per minute with % damage to supramarginal gyrus (r=-.40; p=0.046); left CU:right CU with % damage to STG (r=-.46; p=0.018), and NIHSS score with % damage to insula (r=.55; p=0.0005) and putamen (r=.48; p=0.012).

Conclusions:
Adding picture description scores improves NIHSS in accounting for lesion volume in RH stroke and yields complementary information about lesion localization.
Abstract WP168: The Impact of Intracardiac Thrombi on Recurrent Ischemic Events in Acute Ischemic Stroke Patients With Non-valvular Atrial Fibrillation the Samurai-nvaf Study
Authors: Kinoshita Naoto , Yamagami Hiroshi , Todo Kenichi , Kimura Kazumi , Furui Eisuke , Terasaki Tadashi , Shiokawa Yoshiaki , Kamiyama Kenji , Takizawa Shunya , Okuda Satoshi , Okada Yasushi , Kameda Tomoaki , Nagakane Yoshinari , Hasegawa Yasuhiro , Shibuya Satoshi , Ito Yasuhiro , Nakashima Takahiro , Takamatsu Kazuhiro , Nishiyama Kazutoshi , Yagita Yoshiki , Kario Kazuomi , Higashida Kyoko , Yoshimura Sohei , Arihiro Shoji , Koga Masatoshi , Nagatsuka Kazuyuki , Toyoda Kazunori
Published: March 2022

Objective:
The intracardiac thrombus is associated with an increase in the risks of stroke and thromboembolism for primary prevention. However, it remains unclear in the setting of early management of patients with acute ischemic stroke/TIA. The purpose of this study was to clarify the impact of intracardiac thrombi on recurrent ischemic events in acute ischemic stroke/TIA patients with nonvalvular atrial fibrillation (NVAF).

Methods:
In the SAMURAI-NVAF study (an ongoing prospective, multicenter, observational study), 1192 acute ischemic stroke/TIA patients with NVAF were registered. Of these, the patients who underwent transesophageal echocardiography (TEE) and/or transthoracic echocardiography (TTE) during acute hospitalization were included. We evaluated the association between the prevalence of intracardiac thrombi and recurrent ischemic events (composite of ischemic stroke/TIA and systemic embolism) during hospital stay (median 29 days).

Results:
A total of 1091 patients (474 women, 77.6±9.9 y.o) were studied. Of these, 48 patients had intracardiac thrombus (4.4% [95% CI, 3.3-5.7%]). In acute hospital stay, 29 recurrent ischemic events (2.7% [1.9-3.8%]; 24 ischemic stroke, 3 TIA, and 2 systemic embolism) occurred. Patients with intracardiac thrombi had higher incidence of recurrent ischemic events than those without (12.5% versus 2.2%, p<0.001). The thrombus was an independent predictor for ischemic events after adjusted for age, sex and platelet count (OR 6.5; 95% CI 2.28-16.36, p=0.002). Detectability of thrombi increased when only patients undergoing both TEE and TTE were studied (34/216, 16%).

Conclusion:
In acute ischemic stroke/TIA patients with NVAF, intracardiac thrombi are associated with risk of recurrent ischemic events. The evaluation of intracardiac thrombus should be considered in acute phase of ischemic stroke/TIA.
Abstract WP179: Global Risk Reduction: A Novel Method To Estimate The Impact Of Multiple Intervention Trials To Reduce Stroke Disparities
Authors: Richards Adam K , Bryg Robert J , Cheng Eric M , Towfighi Amytis , Jackson Nicholas , Brown Arleen F , Barry Frances , Li Ning , Vickrey Barbara G
Published: March 2022

Introduction:
Reduction of recurrent stroke risk requires a comprehensive suite of proven interventions but most community-based trials are insufficiently powered to compare observed rates of “hard” outcomes such as time to recurrent stroke. Demand exists for innovative approaches to estimate the cumulative impact of interventions addressing multiple risk factors.

Hypothesis:
estimation of the cumulative relative effect on recurrent CVD events of multi-component risk factor interventions is feasible.

Methods:
For each of four stroke risk factors we identified meta-analyses of RCTS and observational studies. We modeled global risk reduction assuming a multiplicative relationship for the relative risks for each risk factor. We then used data on observed changes in systolic blood pressure (SBP) and LDL cholesterol and on medication adherence from the SUSTAIN trial (a multi-ethnic randomized community trial) to model estimated relative reduction in risk for recurrent stroke due to the SUSTAIN intervention Estimates of uncertainty capture two sources of variation in the outcome of estimated CVD risk: bootstrap methods capture sample-related uncertainty, and probabilistic sensitivity analysis capture uncertainty related to the benefit associated with each risk factor.

Results:
Among 272 SUSTAIN participants with complete 12-month data, most were non-white (73%) and Spanish speaking (62%). Changes in individual risk factors and medications, including SBP, smoking, aspirin and warfarin were similar in intervention and control groups (p>0.2) with the exception of LDL cholesterol, which was lowered by 11.4 mg/dL more in the intervention group (p=0.04). The estimated combined reductions in the relative risks of stroke were 0.42 and 0.37 in the intervention and control groups, respectively, with a non-significant relative risk difference of 5% (uncertainty interval -6 to 21).

Conclusions:
Data from community trials can be used to estimate the combined impact of multi-component interventions on risk of recurrent stroke and stroke disparities. We propose this global risk approach as an a priori secondary outcome for SUCCEED, an ongoing community-based trial.
Abstract WP20: Pre-Notification of Large Vessel Occlusion Reduces Transfer Time for Endovascular Procedures
Authors: Olson-Mack Lindsay , Tafreshi Gilda , Kalafut Mary , Ammirati Giuseppe , Pakbaz R Sean , Deskin Sara , Rockwell Jean , Berger Lynn , Elshire Cortlyn , Richetts Renee , Cantonis Matt , Patterson Scott , Perias Melinda
Published: March 2022

Introduction:
The American Heart and American Stroke Associations’ revised guidelines for acute ischemic stroke recommend rapid transfer of patients with large vessel occlusions (LVO) eligible to receive mechanical endovascular procedures (MEP) if initial receiving facility does not offer MEP. Initiating the transfer process to MEP capable facilities is often delayed until LVO is confirmed on imaging.

Hypothesis:
We hypothesized that initiating a pre-notification process (PNP) by which emergency medical system (EMS) is notified of patients arriving to the emergency department (ED) with symptoms of LVO would reduce transfer turn-around-times (TATs).

Methods:
A pre- and post-interventional study involving 735 patients presenting to 2 EDs in a 5 campus hospital system from January 2014-June 2015. Both EDs began a PNP to alert EMS of potential MEP candidates. EMS then dispatched a critical care transport (CCT) ambulance with a CCT nurse to the ED to await transfer decision. Transfer TATs pre- and post-process change were reviewed. Inclusion criteria: patients with stroke code (SC) initiations in the ED who were transferred for possible MEP, or had PNP to EMS initiated. Exclusion criteria: patients with SC initiations that were not transferred or did not have PNP initiated.

Results:
Sixty patients met inclusion criteria; 52 were transferred pre-process change, and 8 were transferred post-process change with PNP initiated. Median time from decision to EMS arrival in the ED decreased from 22.5 minutes to -1 minute, with ambulance arriving to ED prior to decision. Median time of decision to EMS departure from ED decreased from 56 to 39 minutes, and overall median transfer TATs to MEP capable facility decreased from 78 to 69.5 minutes. Of the 8 patients with PNP to EMS, 6 (75%) were transferred to MEP capable facility.

Conclusions:
Pre-notification from ED to EMS of patients arriving with symptoms of LVO can reduce transfer times to an MEP capable facility. This study highlights the importance of early EMS involvement upon initial recognition of potential LVO patients, and implementation of rapid transfer protocols. Additional opportunities may exist to streamline care within the ED to further reduce transfer TATs.
Abstract WP218: A Blood Test Capable of Discriminating Between Real Strokes and Mimics
Authors: Restrepo Lucas , Sheth Sunil A , Stafford Phillip , Saver Jeffrey , Johnston Stephen A
Published: March 2022

Introduction:
stroke diagnosis is not always easy. Many non-vascular medical and neurological problems can mimic stroke, featuring focal neurological signs and symptoms of sudden onset. These patients can potentially be harmed by stroke-specific treatments, including fibrinolysis. Hence, a test capable of unveiling stroke mimics would be useful.

Hypothesis:
A proteomic platform called immunosignaturing may be useful to distinguish between acute ischemic stroke and imitators.

Methods:
plasma samples from 12 patients brought to the ER because of a stroke code were analyzed: 6 were diagnosed with acute ischemic stroke and 6 with seizures mimicking a stroke. Additional 12 samples from healthy volunteers were used as controls. Immunosignatures use microarrays with 10,000 random sequence peptides, which behave as antibody mimotopes. Antibody binding to microarray peptides is detected with secondary antibodies labeled with fluorescent dyes, then scanned with a laser. Resulting profiles are unique to each individual. Samples were run in duplicates, with good correlation between replicates, high signal and low background. Mann-Whitney U-test and Fisher‘s exact test were used to compare groups.

Results:
samples were obtained within 130 minutes after symptoms onset. We found no differences between groups related to age, gender, or cardiovascular risk factors. Analysis of signature profiles revealed striking separation between stroke and seizure cases. The Figure depicts a heatmap comparing the stroke (yellow bar underneath) and seizure patients. Peptides with QADAP or QADLP motifs helped differentiate the groups.

Conclusions:
We describe the first application of an antibody-profiling platform called immunosignaturing to the study of ischemic stroke and its imitators. Despite the small sample, these very preliminary results suggest that antibody signatures may help distinguish acute ischemic strokes from other conditions, deserving future research.
Abstract WP22: Differential Effect of Intra-arterial Treatment for Acute Ischemic Stroke on Motor versus Language Deficit. A Post-hoc Mr Clean Subgroup Analysis
Authors: Dippel Diederik W , Crijnen Yvette , Nouwens Femke , Lingsma Hester F , de Lau Lonneke , Visch Evy , van de Sandt-Koenderman Mieke , Berkhemer Olvert A , Fransen Puck S , Beumer Debbie , van den Berg Lucie A , Roos Yvo B , van der Lugt Aad , van Oostenbrugge Robert J , van Zwam Wim , Majoie Charles B ,   MR CLEAN Investigators
Published: March 2022

Introduction:
Clinical observations suggest that language deficits in acute ischemic stroke do not respond as rapidly to reperfusion therapy as motor deficits. We tested for a differential effect of intra-arterial treatment with retrievable stents on recovery from aphasia and upper limb paresis in MR CLEAN.

Hypothesis:
The early effect of IAT on recovery from language and motor deficits is similar in size.

Methods:
All patients with aphasia who were randomized in MR CLEAN were included. Primary outcomes were the score on the NIH stroke scale item for upper extremity paresis contralateral to the affected hemisphere, and the score for language, at 24 hours and 5-7 days after treatment. We estimated the effect of IAT on the shift on these item scores and tested for a differential effect of IAT on language versus motor recovery, by introducing a multiplicative term in a multilevel multivariable ordinal logistic regression model.

Results:
In total, 288 patients had an aphasia score of 1 or more. Of these 126 (44%) were assigned to IAT and 162 (56%) to no IAT. The common odds ratio (cOR) for improvement in language and motor score at 24 hours was 1.68 (1.06 to 2.67) and 2.51 (1.57 to 4.03) (p=0.006). At 5-7 days the cOR was 1.87 (1.18 to 2.98) for aphasia score and 2.41 (1.47 to 3.95) for motor deficit (p=0.011). The proportion of patients with good recovery at 5-7 days was similar (Figure).

Conclusion:
The early effect of IAT on language deficit is smaller than the effect on motor deficit, but final recovery after 1 week is similar.
Abstract WP245: Emergency Medical System Medics' Understanding of Time Last Known Normal for Certain Strokes is Low but Can Be Significantly Improved With Education.
Authors: Allen Evan , Banerjee Paul , Husty Todd , Richards Donald , Lovec Rhonda , Wally Megan , Morgan Walter , Acosta Indrani , Basignani Cherlynn
Published: March 2022

Introduction:
Washington University in St. Louis research shows 53% of EMS time last normal (TLN) for wake up strokes differ by 208 minutes (mean) from Stroke Neurologists' TLN. Multiple factors contribute to this discrepancy. We hypothesized a major factor is misunderstanding differences between TLN and the time of first awareness (TFA) of symptoms communicated by patients, family and others. We hypothesized EMS understanding could be improved for TFA, TLN and other confounders by a 20 minute education module.

Method:
179 EMS medics in Polk (n=87) and Seminole (n=92) counties in West Central Florida received a 20 minute lecture and 4 pre/post-test questions on 4 different stroke scenarios with potentially discordant TLN and TFA: Wake up strokes, TLN Uncertain, "Found" strokes (defined as: initially absent historian returns to find non-verbal patient with new stroke symptoms) and "waxing/waning strokes" (defined as: new symptoms BOTH fully resolve to baseline AND recur
>
1 time in a 24 hour period). Instruction was 100% live for Polk EMS and 70% pre-recorded for Seminole EMS.

Results:
Response rates were 74% pre-test and 85% post-test. EMS Pretest comprehension was initially low, but tripled after education on Wake up, Found, and TLN Uncertain stroke scenarios (Pre: 29% vs Post: 76%, p <0.001). The improvement was slightly greater for Wake up strokes (Pre: 18% vs Post: 72% p <0.001) than for Found or TLN uncertain strokes (Pre: 28%, 39% vs Post: 79%, 78%, respectively, p <0.001 for both). Comprehension of these 3 stroke scenarios was slightly higher with live rather than pre-recorded instruction (85% vs 74%). Unfortunately, the doubling of pre/post comprehension for the waxing/waning stroke scenario (24% vs 53% p <0.01) still left comprehension levels unacceptably low.

Conclusion:
Baseline EMS comprehension of TLN with possible discordance between TLN and the time of first awareness (TFA) of symptoms communicated by patient, family or caregivers is likely low, but improves with a 20 minute education module that is most effective live rather than pre-recorded. Additional research is needed to further improve EMS comprehension of TLN in waxing/waning strokes and to prove that improved comprehension will lead to more accurate EMS TLN assessment in the field.
Abstract WP248: Comparison of Large Vessel Occlusion Prediction Scores
Authors: Gropen Toby , Boehme Amelia , Martin-Schild Sheryl , Albright Karen , Perrin Brian , Samai Alyana , Pishanidar Sammy , Janjua Nazli , Levine Steven R , Brandler Ethan S , Rosenbaum Dov
Published: March 2022

Background:
There is an urgent need to rapidly identify patients with acute ischemic stroke due to large vessel occlusion (LVO) to improve access to endovascular therapy.

Aim:
To derive a scale to improve pre-hospital detection of LVO.

Methods:
A retrospective review of consecutive patents enrolled in our prospective Comprehensive Stroke Center registry from 2008-2013 was conducted. Patients were excluded if they were < 18 yrs, not ambulatory, or did not have MRA or CTA. Demographic and clinical characteristics were compared between patients with and without LVO, defined as occlusion of the intracranial internal carotid artery, basilar artery, or middle cerebral artery. We compared a novel Large Vessel Occlusion Scale (LVOS) to the Cincinnati Prehospital Stroke Severity Scale (CPSSS) by constructing ROC curves and determining their area under the curve (AUC).

Results:
A total of 1,663 patients were identified (mean age = 62 yrs, SD = 14, 45.6% women and 66.8% Black). LVO was present in 171 patients (10.3%). The LVOS is a 6 point scale derived from the NIHSS that includes 2 points for abnormal speech or language (NIHSS ≥ 1 for either), 1 point for gaze preference (NIHSS ≥ 1), 1 point for facial asymmetry (NIHSS ≥ 1), 1 point for asymmetrical arm drift (RUE ≠ LUE), and 1 point for asymmetrical leg drift (RLE≠LLE). The LVOS had an AUC of 0.688 (95% CI 0.736 - 0.640), compared to 0.646 (95% CI 0.693 - 0.598) for the CPSSS and 0.678 (95% CI 0.0.723 - 0.633) for the NIHSS. A LVOS score ≥ 3 was 75.4% sensitive (95% CI 68.5 - 81.4) and 50.3% specific, positive likelihood ratio of 1.517 and negative likelihood ratio of 0.162 in predicting LVO. A CPSSS score ≥ 2 was 46.8% sensitive (95% CI 39.7 - 54.0) and 90.0% specific, positive likelihood ratio of 2.870 and negative likelihood ratio of 0.238 in predicting LVO.

Conclusions:
The LVOS compares favorably to the CPSSS in its ability to identify patients with LVO. Prospective prehospital validation is needed.