bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W P321: Stroke Outcomes and Usage of IV Alteplase During Pregnancy in the Nationwide Inpatient Sample 2005-2010
Authors: Song Sarah , Ouyang Bichun , Knopf Taylor , Conners James , Cutting Shawna , Lee Vivien , Smit Laurel , Kuklina Elena
Published: March 2022

Background:
Although alarmingly increasing trends of stroke in pregnancy has been reported in the US, few studies have investigated clinical outcomes, including outcomes of IV alteplase (tPA) treatment among pregnant women.

Methods:
Data was abstracted from the Nationwide Inpatient Sample, an all-payer inpatient care database. We identified pregnancy-related hospitalizations from 2005-2010 by ICD-9-CM diagnostic codes. We extracted diagnoses of acute ischemic stroke (AIS), intracerebral (ICH) and subarachnoid (SAH) hemorrhage, transient ischemic attack, cerebral venous thrombosis (CVT), unspecified, and other pregnancy-related complications. We also identified pregnant women with AIS who received IV tPA. Clinical outcomes included length of stay (LOS), discharge disposition, and in-hospital mortality.

Results:
An estimated 18,392 pregnant women were diagnosed with stroke from 2005-2010. CVT (26.8%) and hemorrhagic (ICH and SAH) stroke (22.8%) were the most common types of stroke, with about 20% of all stroke reported as unspecified in 2010. Mean LOS ranged from 6.5-7.2 days; linear regression did not reveal significant trends in LOS over time. The most common pregnancy-related stroke risk factors included hypertension (30.2%) and pre-eclampsia (13.4%). Decreasing trend of discharge home (from 78.3 to 72.6%, p=0.09) and increasing mortality rate (from 1.8% to 4.0% p for linear trend=0.02) were observed from 2005 to 2010. Of the estimated 70 pregnant AIS patients treated with IV tPA, LOS ranged 4-28 days; 78.6% were discharged home, 14.3% to skilled nursing facility, and 7.1% died.

Conclusions:
Stroke remains a serious complication in pregnancy, and mortality is increasing. Usage of tPA for AIS during pregnancy is minimal, with increased mortality compared to all strokes in pregnancy. Research efforts are needed to improve stroke outcomes during pregnancy.
Abstract W P341: Smartphone Applications as a Source of Information on Stroke
Authors: Dubey Divyanshu , Amritphale Amod , Pandey Ambarish , Sawhney Anshudha , Shrivastav Nupur
Published: March 2022

Introduction:
Smartphone applications (apps) have been increasingly identified as a novel platform for dissemination of healthcare related information. Many studies have evaluated the content quality of these apps for health conditions like cancer, diabetes and other chronic illnesses. However, there have been no studies done to evaluate the availability and content of stroke related apps.

Aim:
This study aims to identify and analyze stroke-related applications available on the Apple iTunes and Android Google Play Store.

Methods:
The Apple iTunes store and Android Google Play Store were searched for stroke-related applications on July 27, 2013 using keywords “stroke” or “brain attack”. The content of the applications was analyzed by two independent investigators for cost, target audience, type of information, validity, involvement of health-care agencies and usefulness based on audience reviews and ratings. Statistical analysis was done using SPSS Statistics 19.0 for Windows.

Results:
A total of 93 relevant applications (46.2% android and 53.8% iPhone) were identified of which 47.3% were available free of cost. 92.5 % of apps were identified as useful by the users and over 60% had scientifically valid information. Nearly one third of the available apps provided information regarding symptoms, management or prevention of stroke. There is a significant participation of healthcare agencies in dissemination of stroke related information with 47.3% apps being uploaded by them. Over half of all stroke related apps are aimed towards health care workers, 75% of which can be utilized as bedside tools for patient care and remainder had information related to recent research advances. The difference in scientific validity between the apps aimed at general population versus healthcare professionals was statistically significant (
P
<0.01). There was no statistical association between cost of app and scientific validity or usefulness.

Conclusion:
Smartphone apps are a significant source of information related to stroke. An increasing participation of healthcare agencies should be encouraged to promote dissemination of scientifically valid information.
Abstract W P346: Sex Differences in Outcome in the SPS3 Clinical Trial
Authors: Meyer Dawn M , Szychowski Jeff , McClure Leslie , Meyer Brett , Kelly Nancy , Guzik Amy , Hemmen Thomas ,   SPS3 Investigators
Published: March 2022

Background:
Few clinical stroke studies examine the effect of biologic sex on outcome. The Secondary Prevention of Small Subcortical Strokes (SPS3) study examined the effect of aspirin (asa) vs aspirin + clopidogrel (a+c) and higher (130-149 mmHg) vs lower (<130 mmHg) blood pressure goals in secondary stroke prevention. The purpose of this study was to assess sex differences in the primary and secondary outcomes in SPS3.

Methods:
Analyses included all participants randomized into the SPS3 clinical trial. Primary and secondary outcomes were assessed for differences within and between the female and male groups by both antiplatelet and blood pressure goal intervention. An interaction effect was assessed for both interventions to examine the effect of sex on outcome.

Results:
Of the males (n=1902) and females (n=1118) enrolled, significant differences in baseline demographics were: age, baseline SBP, race, smoking, hypertension, hyperlipidemia, HbA1c, LDL, HDL, and total cholesterol (analyses were adjusted). For the antiplatelet intervention, 1869 males (957 asa, 945 a+c) and 1118 females (546 asa, 572 a+c) were enrolled. Within males, there was a significant difference in all-cause mortality (1.54% asa vs 2.18% a+c, HR 1.44, p=0.04) and vascular cause mortality (0.52% asa vs. 1.00% a+c,HR 1.91, p=0.03). Within females, there was a significant difference in other thromboembolic events (0.15% asa vs. 0.66% a+c, HR 4.38, p=0.02) and all-cause mortality (1.2% asa vs. 2.04% a+c, HR 1.71, p=0.04). Sex did not have a significant effect on the primary outcome of stroke recurrence in the antiplatelet arm (p=0.91). For the blood pressure goal intervention, 1902 males (990 higher, 912 lower) and 1118 females (529 higher, 589 lower) were enrolled. There were no differences in outcomes within the male groups. There was a significant increase in other thromboembolic events in the higher (0.67%) vs lower (0.18%) females (HR 0.28, p=0.03). Sex did not have a significant effect on the primary outcome of stroke recurrence (p=0.50).

Conclusion:
Overall, there was no significant effect of sex on outcome in the SPS3 study. This analysis supports the use of standard antiplatelet secondary prevention and blood pressure management in both men and women.
Abstract W P350: Pre-Stroke Antiplatelet Use and Outcomes in a Cohort of Ischemic Stroke Patients
Authors: Zurru Maria C , Alonzo Claudia , Brescacin Laura , Pigretti Santiago , Luzzi Ariel , Camera Luis , Waisman Gabriel , Cristiano Edgardo
Published: March 2022

Background and purpose:
previous studies had found that pre-stroke antiplatelet use reduces stroke severity. Our objective was to evaluate this issue in a cohort with good levels of pre-stroke vascular risk factors control.

Methods:
ischemic stroke patients were prospectively included in PROTEGE-ACV, a multidisciplinary prevention program. Demographic data, vascular risk factor profile and control before stroke were obtained from electronic records. Patients with functional impairment (Rankin ≥ 4), dementia or life expectancy less than three years were excluded. One month after discharge, the following tests were performed: MMSE adjusted by age and educational status, clock drawing test CDT (normal or abnormal), Barthel index, modified Rankin scale (≥3 functional impairment). Mortality and recurrence were evaluated after a mean follow-up of 2 years.

Results:
between December 2006 and April 2013, 1090 patients (55% female, mean age 75± 11 years) were included, 44% (n=472) were using antiplatelet drugs in the year before the stroke. This group had higher prevalence of major vascular risk factors (with good level of control in both groups) and burden of disease in other vascular beds. Stroke outcomes were worse in patients receiving antiplatelet drugs before stroke (Table). This lack of effect on functional outcomes persisted after a multivariate analysis including statins and antihpertensives.

Conclusion:
in contrast to published data, we did not found a beneficial effect of using of antiplatelet drugs before stroke on functionality and cognition, neither on recurrence and mortality prevention in our cohort.
Abstract W P356: The Effectiveness of the Stroke Educational Activities for Junior High School Students: The Tochigi Project
Authors: Matsuzono Kosuke , Yokota Chiaki , Takekawa Hidehiro , Okamura Tomonori , Miyamatsu Naomi , Nakayama Hirofumi , Ohyama Satoshi , Ishigami Akiko , Okumura Kosuke , Hirata Koichi , Muto Takashi , Toyoda Kazunori , Miyamoto Yoshihiro , Minematsu Kazuo
Published: March 2022

Background and Purpose:
Bringing stroke lessons into the compulsory education is promising for spreading of stroke knowledge nationwide. We produced stroke teaching materials using the FAST mnemonic. The aim of this study is to verify the effectiveness of a stroke education project using our teaching materials for stroke enlightenment, the Tochigi project.

Methods:
The subjects were 10,227 students of the 1
st
to 3
rd
grade (13-15 y.o.) in 53 public junior high schools in Tochigi prefecture, Japan. They were divided into 2 groups; 1,127 students in 9 schools received a 20-minute stroke lesson by their teachers and then watched our 10-minute animated cartoon and read our comic book for 10 minutes (group [[Unable to Display Character: І]]). The remaining 9,100 students in 44 schools had no teacher's lesson, but watched the animated cartoon and read the comic book (group II). Questionnaires on stroke knowledge were examined for all the students at baseline and immediately after the intervention.

Results:
The numbers of questionnaires collected at immediately after the intervention were 1,125 (99.8%) in the group I, and 9,067 (99.6%) in the group II, respectively. In the group I, frequencies of the correct answers increased for all questionnaires except for headache (68.3 vs. 68.0%, p=0.87) as a symptom after the intervention. In the group II, the correct answer rates decreased for the questions of headache (70.9 vs. 32.5%, P<0.0001) and hemi-sensory disturbance (58.1 vs. 56.5%, P<0.05) and increased significantly for those of the other symptoms after the intervention. The correct answer rates increased significantly for questions except for arrhythmia (47.6 vs. 40.6%, P<0.0001) as risk factors after the intervention. Ninety-one % of students understood correctly the “FAST” mnemonic immediately after the intervention in the group I, being higher than the rate of 76% in the group II (p<0.001).

Conclusion:
Our teaching materials of stroke enlightenment would be promising for conducting the FAST message to junior high school students.
Abstract W P36: Immediate Changes in Stroke Lesion Volumes Following Thrombolysis Predict Both Imaging and Clinical Outcomes
Authors: Luby Marie , Warach Steven J , Merino José G ,   for the LESION investigators
Published: March 2022

Objectives and Hypotheses:
Our objective was to quantify the DWI and MTT changes at 2 and 24 hours after IV-tPA and evaluate the effect of reperfusion and DWI change on immediate neurological improvement and clinical outcome using the latest available mRS up to 90 days.

Methods:
Patients were selected from the Lesion Evolution in Stroke and Ischemia On Neuroimaging (LESION) Project if they had a baseline MRI with evaluable DWI and PWI, were treated with standard IV-tPA, had post-treatment MRI at 2 or 24 hours and FLAIR at follow-up. A reader measured the DWI, MTT and FLAIR volumes using a validated technique. A vascular neurologist scored the NIHSS at pre-treatment, 2 and 24 hours and the mRS at discharge, 5, 30 and 90 days.

Results:
Seventy-one patients met the study criteria with mean (±SD) age of 71.6 (±16.4) years, 58% women, median baseline NIHSS 9 (IQR: 4-18), median onset to triage 45 minutes (30-65) and median first MRI to IV-tPA 47 minutes (39-59). For the 43 patients with baseline DWI ≥ 5 ml, 60% of patients with a decrease at 2 hours had a favorable outcome versus 18% of no decrease (p=0.014). There was also a significant difference in mRS distribution between groups, (0-3 versus 2-6, p=0.008). Using linear regression, the 2 hour DWI (p=0.037), change in 2 hour DWI (p<0.000) and change in 24 hour NIHSS (p=0.041) but not the 2 hour NIHSS or its change were predictive of follow-up FLAIR volume. For the 53 patients with a baseline MTT ≥ 5 ml, 42 patients (79%) had a decrease in MTT > 7 ml and 11 (21%) had an increase or no change (p<0.0001) at 24 hours. The latest available mRS was 0-1 in 45% of the patients with a MTT decrease and in 0% of the patients with no decrease (p=0.002). There was also a significant difference in mRS distribution between these groups, (0-5 versus 4-5, p=0.020). Using linear regression, age (p=0.040), admit NIHSS (p<0.000) and change in 24 hour NIHSS (p=0.002) were predictive of mRS distribution.

Conclusions:
In patients with a substantial baseline DWI lesion, the decrease of DWI volume at 2 hours post-thrombolysis is a significant predictor of good imaging and clinical outcomes. In patients with a substantial baseline MTT lesion, the decrease of NIHSS and MTT volume at 24 hours post-thrombolysis are significant predictors of good imaging and clinical outcomes.
Abstract W P373: Resting Cerebral Blood Flow in Healthy Subjects Varies by Gender and Blood Pressure
Authors: Cucchiara Brett L , Zhang Quan , Kasner Scott E , Detre John A
Published: March 2022

Background:
Quantitative measurement of cerebral blood flow is a critical parameter in neurovascular research. Relatively little is known about factors altering resting CBF in healthy subjects.

Methods:
We performed the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) study, a prospective, observational, case-control study. Migraine with aura (MWA), migraine without aura (MwoA), and control subjects between the age of 25-50 were enrolled in a 1:1:1 ratio. Subjects with manifest vascular disease of any type were excluded. 3T arterial spin labeled perfusion MRI was performed to measure CBF. Blood pressure was measured with an automated cuff at study enrollment. As there were no differences in CBF between migraine and control groups, data were pooled for overall analysis

Results:
Mean age of the 156 included subjects was 33 ± 7 years; 78% were female. Baseline SBP was 126 ± 18 mmHg, and DBP 82 ± 12 mmHg. A history of hypertension was present in 4% of subjects. CBF (ml/100g/min) was similar between MWA, MwoA, and control subjects (MWA 51 ± 11, MwoA 51 ± 12, control 51 ± 11, p=0.97), but significantly higher in women compared to men (53 ± 11 vs. 44 ± 10, p <0.001). Global CBF was inversely related to SBP (r= -0.23, p=0.004) and DBP (r= -0.24, p=0.003). While global CBF declined with increasing age, this finding was not significant (r=-0.12. p=0.14). After adjustment for age and sex, the association between SBP and CBF was attenuated (p=0.32), however the association with DBP remained significant (p=0.01).

Conclusions:
Resting CBF is substantially higher in women than men, and inversely related to DBP. These critical factors must be considered in studies utilizing CBF measurement.
Abstract W P375: The Relationship between the State of Preparedness, Social Support, Coping Strategies, and Family Circumstances of Family Caregivers of Stroke Patients before Transition to Home in Japan
Authors: Hayashi Miyoko
Published: March 2022

Background:
In recent years, the early return home of stroke patients has been promoted in Japan, and families must consider at-home care not long after the patient’s stroke. There is, therefore, a need to examine methods of home care assistance from an early stage.

Purpose:
This study aims to elucidate the relationship between the state of preparedness, social support, coping strategies, and family circumstances of family caregivers of stroke patients before transition to home in Japan.

Methods:
This study was an exploratory study of factor relationships. Data on family caregivers of stroke patients prior to discharge was gathered using demographic data, the Japanese version of the Preparedness for Caregiving Scale, the Japanese version of the Social Support Questionnaire short-form, and the caregivers’ coping strategies scale. Pearson’s correlation coefficient and a Student’s t-test were used for the analysis.

Results:
There were 95 subjects (approximately 70% of whom were caring for their spouse). Approximately 80% patients were experiencing paralysis, and the mean number of days until transfer from hospital to home was 21.8 days (SD ± 26.7).The state of preparedness had correlation between social support(r=.362, p=.001) and coping strategies(r=.604, p=.001). State of preparedness was higher in non-spouses (t=-2.406, p=.05) and tended to be higher when someone else was living in the house . Furthermore, social support was higher when a care collaborator was present (t=2.714, p=.005). The age and employment of the caregiver, as well as the degree of activities of daily living independence of the patient and number of days until discharge, had no relation to state of preparedness.

Conclusion:
We concluded that family caregivers of stroke patients before moving home in Japan improve their state of preparedness by receiving support from surrounding individuals and improving their own coping strategies; the state of the patient and family circumstances, however, have no influence. The results of this study suggest that nurses need to provide incrementally improving support from an early stage to increase the support capabilities of those surrounding the patient’s family and enhance the care capabilities of family caregivers.
Abstract W P4: Time to Angiographic Reperfusion: A Decision Analysis
Authors: Vagal Achala , Eckman Mark , Broderick Joseph , Tomsick Thomas , Yeatts Sharon , Khatri Pooja
Published: March 2022

Introduction:
The Interventional Management of Stroke (IMS) III trial found no significant difference in outcomes between the combined intravenous (IV) t-PA/endovascular and IV t-PA groups. A suggested reason for lack of IV/IA effect is that good clinical outcome following angiographic reperfusion is strongly time dependent; this was shown in IMS I/II and validated in IMS III. Using decision modeling we addressed the following question: How quickly should reperfusion with IA therapy be achieved to demonstrate superiority of IV/IA therapy versus IV t-PA alone?

Methods:
We developed a decision analytic model using IMS III trial data and comprehensive literature review. Base case: large vessel occlusion, IV t-PA within 3 hours, time from stroke onset to reperfusion 325 min, reperfusion rate with IA therapy 0.76, probability of good outcome after IA reperfusion 0.40, probability of good outcome after no IA reperfusion 0.10. IV t-PA rates of good outcome were based on subset of IMS III subjects with large vessel occlusion on baseline CTA. Utilities were assigned to mRS outcome levels based on previously published data.

Results:
The IV t-PA alone approach yielded expected utility of 1.26 quality-adjusted life years (QALYs) compared to 1.08 QALYs for the IV/IA approach. One-way sensitivity analyses for time to reperfusion demonstrated superiority of IV t-PA alone above a reperfusion time of 273 minutes. IV/IA approach could be superior if reperfusion times were shorter.

Conclusion:
If mean reperfusion time can be reduced to ≤ 273 minutes our analysis suggests that IV/IA therapy could be superior to IV t-PA alone using the IMS III revascularization approaches given the original sample size of IMS III. Further analyses will be included in the abstract presentation, by which time the IMS III database will be closed and additional relevant data available to investigators. We then will be able to more accurately estimate the various time components modeled, including: time from onset to IV start, IV start to groin puncture, groin puncture to IA start and time from IA start to IA end, as well as the impact of reperfusion delay and reperfusion rates on clinical outcomes along with probabilistic sensitivity analyses.
Abstract W P41: Predicting Future Atrophy from White Matter Connectivity Disruption in Ischemic Stroke
Authors: Kuceyeski Amy , Kamel Hooman , Navi Babak B , Iadecola Costantino , Raj Ashish
Published: March 2022

Background:
The Network Modification (NeMo) Tool uses a library of brain connectivity maps from normal subjects to quantify the amount of structural connectivity loss caused by focal brain lesions. We hypothesized that the NeMo Tool could predict remote brain tissue loss caused by Wallerian degeneration after stroke.

Methods:
Baseline and follow-up MRIs from 27 patients with acute ischemic stroke were collected (74±14 years, initial NIHSS 2±3, 5.7±2.8 months b/w scans). Diffusion-weighted image derived lesion masks were superimposed on the NeMo Tool’s connectivity maps in order to predict changes to the structural connectivity network and to investigate correlations with future atrophy. Regional connectivity losses were estimated via the Change in Connectivity (ChaCo) score, i.e. the percent of “injured” tracks going through lesions that connect to a given region. ChaCo scores and longitudinal tissue changes were calculated using a standard 116 region atlas.

Results:
Lesion location and size varied greatly, but they occurred more frequently in the left hemisphere. The ChaCo scores, which were generally higher in regions near stroke lesions, reflected this heterogeneity. In general, ChaCo was higher in the left hemisphere than the right and was high in the postcentral and precentral gyri, insula, middle cingulate, thalami, putamen, caudate nuclei, and pallidum. Moderate correlations were found between ChaCo scores at baseline and measures of subsequent tissue loss (change in volume and average mean diffusivity [MD] from baseline to follow-up, see Figure 1).

Conclusions:
ChaCo scores varied greatly, but the most affected regions included those with sensorimotor, perception, learning and memory functions. Moderate correlations were found between ChaCo scores at baseline and subsequent tissue loss. These results suggest that the NeMo Tool could enable more accurate prognosis, as it may identify regions most susceptible to degeneration from remote infarcts.
Abstract W P51: Clinical Outcomes following Thrombolysis for Acute Ischemic Stroke in Patients with Systemic Malignancy: A Nationwide Case-Control Study
Authors: Murthy Santosh , Karanth Siddharth , Shah Shreyansh , Shastri Aditi , Rao Chethan , Bershad Eric , Suarez Jose
Published: March 2022

Background:
The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes following thrombolysis in stroke patients with cancer.

Methods:
Acute ischemic stroke (AIS) patients who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample using ICD-9 codes. Patients with cancer associated strokes (CS) and non-cancer strokes (NCS) were compared based on demographics, comorbidities, and outcomes.

Results:
There were 1,135,574 AIS in 2009-2010. Thrombolysis was administered to 807 patients out of 50,437 CS (1.6%), and 31,769 patients out of 1,085,137 non-cancer strokes (2.9%). The prevalence of stroke risk factors such as hypertension (p<0.001) and hyperlipidemia (<0.001) were significantly higher in non-cancer strokes (NCS). CS had a significantly higher percentage of patients in the third and fourth Elixhauser quartiles (p<0.001). Hospitals with > 450 beds were more likely to treat cancer patients with thrombolysis for acute stroke (p=0.011), while the hospital teaching status did not play a significant role. In the univariate analysis, CS was associated with a lower proportion of home discharge in the overall thrombolytic treatment group (OR: 0.57, CI: 0.48-0.68, p<0.001) but mortality was not significant. ICH rates were also comparable in the two groups (6.3% vs 6.4%, p= 0.927). In the regression model, there was no difference in mortality or ICH rates between CS and NCS following thrombolysis. Subgroup analysis of IV thrombolysis only and endovascular treatment also showed no difference in outcomes. Another subgroup analysis showed that compared to liquid cancers, patients with solid had worse home discharge (OR: 0.178, CI: 0.109-0.290, p<0.001), and higher in-hospital mortality (OR: 3.018, CI: 1.37-6.646, p=0.006) following thrombolysis. Metastatic cancers had poorest outcomes.

Conclusions:
Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of ICH or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolytic therapy. Prospective confirmation and attention to long-term outcomes is warranted.
Abstract W P59: Hemodynamic Changes in Wall Shear Stress in Arteriovenous Malformation Feeding Vessels Post Embolization
Authors: Alaraj Ali , Amin-Hanjani Sepideh , Mostafa Hassan , Khan Sajeel , Aletich Victor , Charbel Fady
Published: March 2022

Objective:
Arterio-venous malformations (AVM) feeders are known to remodel with time: increase in diameter when the AVM is present and decrease after the AVM is treated. In this study we used quantitative magnetic resonance angiography (QMRA) to evaluate changes in WSS, flow, and diameter of feeder vessels pre and post treatment with endovascular embolization/ surgery.

Methods:
55 patients with AVM were evaluated with QMRA on presentation, 19 patients had QMRA post embolization (1-8 sessions), and 13 post-surgical resection. WSS, flow, and diameter of proximal feeder vessels (MCA, PCA and/or ACA) and their contralateral counterparts were derived from QMRA. These parameters were studied at baseline and compared between the feeder and contralateral artery pre and post embolization/surgery.

Results:
At baseline, WSS in feeder vessels (n=66) was greater than in the corresponding contralateral vessel (33.55 Dyne/cm2 vs. 24.76 Dyne/cm2; P<0.0001). These corresponded to a higher flow (296.7mL/min vs. 164.5mL/min; P = 0.0002) as well as a larger diameter (3.643mm vs. 3.257mm; P=0.0002). For embolized AVMs (n=28 feeder vessels), at the conclusion of final embolization, there was a drop in WSS (33.56 Dyne/cm2 to 22.97 Dyne/cm2; P =0.0003), flow (370mL/min to 176 mL/min; P = 0.0005), and diameter in (3.77mm to 3.522mm; P=0.0438) in feeder vessel. No significant change was seen in WSS in the contralateral vessel (23.2mm to 22.85mm; P =0.8770) post embolizations. The difference in WSS between the feeder and contralateral vessel became non-significant post embolization (22.97 Dyne/cm2 vs. 22.85 Dyne/cm2; P=0.8926). As compared to baseline, WSS dropped after surgery from 32.72 Dyne/cm2 to 20.5Dyne/cm2 (P= 0.0007).

Conclusion:
Arteriovenous malformation feeding vessels are subjected to a higher WSS secondary to higher blood flow. The feeders demonstrate a corresponding enlargement in diameter, as a presumed compensatory response to the high flow. However, the vessel enlargement is insufficient to normalize the WSS at baseline. There was decrease in diameter of the feeder vessel and normalization of the WSS post reduction of blood flow with embolization/surgery.
Abstract W P69: Y and X Stent-Assisted Coiling of Complex and Wide-Neck Bifurcation Aneurysms in 100 Procedures
Authors: Bartolini Bruno , Blanc Raphaël , Pistocchi Silvia , Redjem Hocine , Piotin Michel
Published: March 2022

Purpose:
Stent-assisted coiling with two stents in Y or X configuration has been described in some series for the treatment of complex and wide-neck bifurcation aneurysms. Our purpose is to present our experience with double stents in “X” and “Y” configurations, with emphasis on safety, feasibility and efficacy.

Methods:
Clinical and angiographic outcomes of patients for whom the strategic therapeutic chosen option was the stent-assisted coiling technique in “Y” and “X” fashion to reconstruct the neck from June 2006 to June 2013, were retrospectively analyzed from our prospectively gathered database.

Results:
One hundred and five aneurysms in 97 patients were treated during 100 consecutive procedures. There were 54.2% (57/105) MCA, 28.6% (30/105) AcoA, 16.2% (17/105) basilar tip and 1.0% (1/105) ICA termination aneurysms. Clinical presentations were: incidental discovery 75.2% (79/105), compression 1.0% (1/105), recurrences of previously coiled aneurysms 19.0% (20/105), SAH 4.7% (5/105). A “Y” stenting was used to treat 87 aneurysms in 85 procedures; a “X” stenting was used to treat 7 aneurysms in 6 procedures, while 9 procedures failed for 11 aneurysms. Permanent neurological deficits were noted in 11.0% (11/100) of the procedures, including 1 death. Immediate complete occlusions were noted in 47.6% (50/105) of the aneurysms, partial (neck or sac remnant) occlusions in 52.4% (55/105). To date, 74.3% (78/105) of the aneurysms had been followed up (mean: 16 months) with DSA, disclosing a recanalization in 4.8% (5/105), and an improvement in 34.3% (36/105). No aneurysm (re)bled during the follow-up period.

Conclusions:
“Y” and “X” stent-assisted coiling of complex bifurcation intracranial aneurysms is a feasible and effective technique for endovascular treatment of wide-neck bifurcation aneurysms. However, we encountered a high rate of complications with permanent neurological deficits. Improvement of stent design and newer antiplatelet drugs may improve the procedural safety in the future.
Abstract W P72: Coiling of Large and Giant Aneurysms: Complications and Long-Term Results of 334 Cases
Authors: Chalouhi Nohra , Tjoumakaris Stavropoula , Gonzalez L Fernando , Dumont Aaron S , Starke Robert M , Hasan David , Wu Chengyuan , Singhal Saurabh , Rosenwasser Robert , Jabbour Pascal
Published: March 2022

Background and purpose:
Despite increasing and widespread use of endovascular techniques, little is known about the morbidity rates, rehemorrhage rates, and long-term angiographic results of coiling in large and giant aneurysms. In addition, predictors of treatment outcome have not been identified. In this study, we analyze the complications and long-term results of coiling in the largest series of large and giant aneurysms (≥ 10 mm) to date.

Material and Methods:
A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Aneurysm size was 15 mm on average. 225 aneurysms were treated with conventional coiling, 88 with stent-assisted coiling, 14 with parent vessel occlusion, and 7 with balloon-assisted coiling.

Results:
Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33% respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome.

Conclusion:
Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared to conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
Abstract W P79: Computational Fluid Dynamics Analysis in Roles of Hemodynamic Factors on the Development of Cerebral Aneurysms
Authors: Fukuda Shunichi , Shimogonya Yuji , Tsukahara Tetsuya , Imoto Yasuhide , Fukuda Miyuki
Published: March 2022

Cerebral aneurysms are known to be more induced in the asymmetric-shaped circle of Willis, suggesting that hemodynamic stress is involved in aneurysm development. We have made a series of reports on an animal model of experimentally induced cerebral aneurysms, which are induced in the circle of Willis where blood flow is increased in compensation for ligation of unilateral common carotid artery and renal hypertension. Our morphological and molecular studies suggest that enhanced wall shear stress (WSS) at the local area in the circle of Willis initiates aneurysm development (Fukuda S, Circulation 101:2532-2538). We examined here roles of hemodynamic factors on the development of cerebral aneurysms with computational fluid dynamics (CFD) techniques using 3-dimentional CT angiographic images of human cerebral aneurysms.

In order to clarify the effect of hemodynamic factors on aneurysm growth, we virtually reconstructed arterial geometry of human middle cerebral and internal carotid artery aneurysms just before the development of aneurysms by artificial removal of the aneurysm as we reported previously (Shimogonya Y, J Biomech 42:550-554), and compared values of hemodynamic factors between aneurysm-developed side and non-developed normal side. Time-averaged WSS gradient was significantly higher in the aneurysm-developed side than normal side. The data suggest that an increase in wall shear stress be associated with an early stage of the aneurysm formation, which is consistent with our previous data using an animal model.
Abstract W P88: Impact of Post Stroke Isolation on Sociability and Depressive Behavior
Authors: Verma Rajkumar , Friedler Brett , Harris Nia , Venna Venugopal R , McCullough Louise D
Published: March 2022

Background and Purpose:
Social isolation (SI) has been linked epidemiologically with high rates of morbidity and mortality following stroke. Clinically, social support and coping strategies have been shown to be significant factors in caregiver’s health-related quality of life. In order to discover the biological mechanisms underlying the benefits of social interaction the development of pre-clinical animal models are needed. The goal of our study was to examine the effect of post stroke pair housing and SI in different behavioral paradigms, which can be used as a validated model to assess chronic functional recovery.

Methods:
C57BL/6 male mice (8-12 weeks) were paired for 14 days before 60 min of transient intraluminal middle cerebral artery occlusion (MCAO) or sham surgery (n=8-10/group) and randomly assigned to six different housing conditions: 1. Stroke isolated (STiso), 2. Stroke pair housed (PH) with sham, 3. Stroke PH with stroke and their respective sham controls (Gps 4, 5, and 6). Behavioral assessments (3 Chamber sociability task, tail suspension test and sucrose consumption test), were performed at 42 days (Cohort 1) or every 7Th day for 6 weeks (Cohort 2). Brain atrophy was calculated using cresyl violet staining and blood samples were collected for interleukin-6 (IL-6) measurements.

Results:
Post stroke PH mice, either with sham or stroke partner showed significantly higher (p<0.05) sociability after MCAO. In the 2nd cohort, a two-factor interaction ‘group versus days’ showed a significant difference between post stroke SI and PH groups (F 3,24 = 5.41; p< 0.01, RM ANOVA with Bonferroni correction). Post stroke SI mice showed reduced sucrose consumption (p<0.05) and increased immobility (p<0.05) indicating a depressive phenotype. Post stroke SI mice had significantly more tissue loss (40.8 ± 1.3% in SI vs. 17.5 ± 1.5% in PH; p<0.001) and showed higher levels of IL-6, a biomarker of social stress and inflammation.

Conclusions:
Our findings suggest that post stroke isolation reduces sociability and exacerbates depressive behavior, whereas pair housing aids early functional recovery. Moreover, the sociability (“empathy”) task can be a useful model for chronic post stroke behavioral recovery.
Abstract W P89: Adoptive Regulatory T Cell Therapy Preserves Systemic Immune Homeostasis Following Cerebral Ischemia
Authors: Li Peiying , Hu Xiaoming , Mao Leilei , Chen Jun
Published: March 2022

Background and Purpose:
Cerebral ischemia has been shown to result in peripheral inflammatory responses followed by long-lasting immunosuppression. Our recent study demonstrated that intravenous delivery of Tregs markedly protected against transient cerebral ischemia by suppressing neutrophil-derived matrix metallopeptidase-9 production in the periphery. The impact of Tregs on systemic inflammatory responses and immune status, however, has not been fully characterized.

Methods:
Cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) for 60 minutes in mice or 120 minutes in rats. Tregs were isolated from donor animals by CD4 and CD25 double selection and transferred intravenously into ischemic recipients at 2 hours after MCAO. Animals were sacrificed on different days after reperfusion. The effects of Tregs on systemic inflammation and immune status were evaluated using flow cytometry, ELISAs, and immunohistochemistry.

Results:
Flow cytometry showed the percentage of CD25 and Foxp3 double positive cells were 2.8±0.2% in the blood, 13.9±1.7% in the lymph node and 11.2±0.5% in the spleen after MCAO; intravenous administration of 2х106 purified Tregs raises functional Tregs up to 4.6±0.6% in the blood, 18.5±1.9% in the lymph node and 15±0.9% in the spleen. The exogenous Tregs as labeled by CD45.1 remain in the blood and peripheral organs for at least 12 days. Functionally, Treg adoptive transfer markedly inhibits MCAO-induced elevation of inflammatory cytokines (IL-6 and TNF-α) in the blood as measured at 1 day, 3 days and 7days after ischemia. Furthermore, Treg treatment corrects long-term lymphopenia and improves cellular immune functions after ischemic brain injury. As a result, Treg-treated animals exhibited decreased bacterial loads in the blood during the recovery from cerebral ischemic attack.

Conclusions:
Treg treatment did not exacerbate post-stroke immunosuppression. On the contrary, Treg-treated animals displayed improved immune status after focal cerebral ischemia.
Abstract W P93: Drag-Reducing Polymer Improves Microcirculation and Outcome after Permanent Middle Cerebral Artery Occlusion in Rats
Authors: Bragin Denis E , Peng Zefeng , Liu Wenlan , Thomson Susan , Statom Gloria , Kameneva Marina V , Nemoto Edwin M
Published: March 2022

Introduction:
Current treatments for ischemia after stroke have not focused directly on the physiological effects of restoring or improving cerebral microvascular perfusion. Nanomolar concentrations of drag-reducing polymers (DRP) have been shown to improve hemodynamics and survival in animal models of the ischemic myocardium and peripheral circulation. We recently demonstrated that DRP improved microvascular perfusion in normal and traumatized rat brain. We hypothesized that DRP restores microvascular perfusion after focal ischemia and improves neurologic recovery in the rat.

Methods:
The suture permanent middle cerebral artery occlusion (MCAO) model in the rat was used. DRP was injected i.v. 90 minutes after MCAO. Controls were injected with an equal volume of saline. Using in vivo 2-photon laser scanning microscopy over the parietal cortex, we studied the acute effects of DRP on microvascular blood flow velocity, tissue oxygenation (NADH) and blood brain barrier (BBB) permeability for 5 hr after MCAO. Doppler cortical flow, rectal and cranial temperatures, arterial pressure, blood gases and electrolytes were monitored. Cerebral infarction was evaluated by triphenyltetrazolium chloride (TTC) staining 24 hr after MCAO and motor function by Rotarod at one week.

Results:
MCAO resulted in a progressive decrease in microvascular flow in the penumbra of the parietal cortex with hypoxia and increased BBB permeability during 5 hr monitored. DRP partially restored microvascular flow compared to control (21±6.7%, Mean ± SEM, p<0.05, n=4) and reduced the progression of ischemia and BBB permeability by 14±4.6 and 18±6.5%, respectively (p<0.05). Infarction volume was reduced by 24±8.1% in DRP treated rats (n=2, p<0.05). The Rotarod tests showed that one week after MCAO, DRP treated rats performed better than saline treated rats with times of 75.6±16.0% and 47.3±16.0%, respectively, as percent of normal rats.

Conclusions:
DRP restores cerebral microvascular flow after MCAO reducing tissue hypoxia and BBB damage. The improvement in flow is reflected by a reduction in infarct size 24 hours after MCAO and by improved motor neurological recovery at one week after MCAO. DRP can be a new effective therapy for ischemic stroke targeting microvascular perfusion.
Abstract W P97: A Single Intravenous Dose of the Pyrazole CNB-001 Induces Long Term Behavioral Improvement and Reduces Stroke Volume in a Rat Ischemic Stroke Model
Authors: Lapchak Paul A , Lyden Patrick D , Lamb Jessica A , Zhao Lifu , Rajput Padmesh S
Published: March 2022

Future stroke therapy will require pleiotropic drugs with multi-mechanisms of action. We studied a safe pyrazole compound, CNB-001, which has multiple potent neuroprotective and neurotrophic activities. Previously, we found that CNB-001 improves clinical function following small clot embolic stroke in rabbits, increase cortical brain-derived neurotrophic factor (BDNF) content and activates BDNF signaling pathways.

Abiding by RIGOR guidelines (blinding and randomization), we studied CNB-001 in rat stroke model [filament middle cerebral artery occlusion (MCAo)] where Sprague-Dawley (SD) rats were subjected to 3 hours MCAo. After a delay of 1 hour during reperfusion, CNB-001 (10 mg/kg) or vehicle (n=12 per group) was infused through the jugular vein over 5 mins as a single dose. One week after stroke onset, these animals were tested using a cylinder test, a measure of limb-use-asymmetry, and further cylinders tests were done at week 2 and 4 following stroke, and then followed by Barnes Maze analysis, to quantitate spatial learning and memory. CNB-001-treated rats showed significant improvement (p<0.05, ANOVA with Tukey’s) in limb use asymmetries compared to control at week 1, 2 and week 4, and learning and memory (learning curve and latency time) using Barnes maze (p<0.05). Additional SD rats were subjected to MCAo varying duration between 5 and 80 minutes in order to construct a quantal analysis curve to calculate a P
50
value (minutes), which represents the occlusion time required to induce behavioral deficits in 50% of the population. IV CNB-001 treatment administered 5 minutes following the end of occlusion, significantly (p<0.05, t-test) reduced stroke-induced behavioral deficits (improved function) and increased the P
50
value to P
50
= 46.71±7.58 minutes (n=21) compared with the control group (P
50
= 24.9±6.07 minutes, n=20). Moreover, CNB-001 significantly reduced infarct volume by 60-95%(p<0.05) independent of occlusion duration, confirming its neuroprotective activity. We show that a single IV treatment with CNB-001 effectively improves cognition and motor skills in MCAo rats, and also reduces infarct volume. CNB-001 should be further tested in a blinded fully randomized stroke clinical trial.
Abstract W P99: A Time Window of Heightened Plasticity to Training After Ischemic Stroke in the Mouse is Extended By Fluoxetine if Provided Within the First Week After Stroke
Authors: Ng Kwan , Gibson Ellen M , Hubbard Robert , O'Brien RIchard J , Krakauer John W , Zeiler Steven
Published: March 2022

Background:
and purpose - Data in humans and in non-human animal models suggest that most recovery from motor impairment occurs in the first 4 weeks after stroke and is mediated in part by increased responsiveness to training in this short time period. We tested the hypothesis that there is a gradient of diminishing responsiveness to training in the first week after stroke in the mouse. We then tested whether fluoxetine can extend the time window over which large training-related gains can be expected.

Methods:
Adult C57Bl/6 mice were trained to perform a skilled prehension task to an asymptotic level of performance after which they underwent photocoagulation-induced stroke or sham stroke in the caudal forelimb area (CFA can be considered rodent primary motor cortex). The mice were then retrained after a 1- or 7-day delay in the presence or absence of fluoxetine injected IP daily beginning after a 1- or 7-day delay.

Results:
Training-associated recovery of prehension was complete if training was initiated after a 1-day delay but incomplete if training was initiated after a 7-day delay, even with additional training days. Daily fluoxetine administration after stroke was associated with complete recovery of prehension even if training was delayed 7 days but only if fluoxetine was administered beginning 1 day but not 7 days after stroke.

Conclusions:
We conclude that there is a sensitive period 7 days after stroke during which motor training is more likely to promote recovery and that this period can be extended by fluoxetine only if administration begins during the first week after stroke. Our mouse model, with all of the attendant genetic benefits, may allow us to determine at the cellular and molecular level how behavioral training and endogenous plasticity interact to mediate recovery.
Abstract 101: Incidental Subclinical Intraparenchymal Hemorrhages And Risk Of Subsequent
Authors: Chughtai Morad , Khan Hashim , Malik Ahmed , Suri Habibullah , Suri Ayesha , Qureshi Adnan I
Published: March 2022

Background:
Subclinical intraparenchymal hemorrhages (IPH) are infrequently detected on brain magnetic resonance imaging (MRI), although the prognostic significance of such findings remains unknown.

Methods:
We analyzed data from the cohort of 5,888 study participants aged 65 years and older recruited in the Cardiovascular Health Study (CHS) from four U.S. communities. Each participant underwent assessment of medical history, cardiovascular risk factors, and brain MRI at baseline. We identified participants who had asymptomatic IPH on MRI and selected 3 age- and gender-matched controls without IPH. We compared the rates of cardiovascular events using logistic regression analysis including incident myocardial infarction, stroke and death between those with and without asymptomatic IPHs.

Results:
A total of 23 participants had asymptomatic IPHs classified as acute (n=3), subacute (n=4), and chronic (n=16). There were no differences in the proportion of participants with chronic hypertension (65.2% versus 71.0%) and previous stroke (8.7% versus 7.2%) between those with (n=23) and without asymptomatic IPHs (n=69). The proportion of participants with concurrent small (17.4% versus 11.6%) and large lacunar infarctions on MRI (43.5% versus 39.1%) was similar. Over a 14 year follow-up period, the risk of incident stroke (relative risk [RR] 0.6, 95% confidence interval [CI] 0.2-2.0), myocardial infarction (RR 0.3, 95% CI 0.06-1.4) and death (RR 0.6, 95% CI 0.2-1.7) was not different between participants with IPH compared with controls. There was no difference between the two groups in regards to time to ischemic stroke or time to death by Kaplan Meier analysis.

Conclusions:
The risks of stroke, myocardial infarction, and death are similar between persons with asymptomatic IPHs detected on MRI compared with age- and gender-matched controls.