bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP121: One-Year Risk of Recurrent Stroke Associated With Vertebral and Basilar Artery Stenosis and Occlusion in a Cohort of 10,515 Ischemic Stroke Patients
Authors: Qureshi Adnan , Qureshi Mushtaq , Jeng Jiann-Shing , Lien Li-Ming , Hu Chaur-Jong , Lee Jiunn-Tay , Lai Ta-Chang Lai , Liu Chung-Hsiang , Chen Chih-Hung , Chen Po-Lin , Chen Tsang-Shan , Li Jie-Yuan , Lin Cheng-Li , Hsu Chung
Published: October 2018

Background:
The risk of recurrent stroke in patients with ischemic stroke with vertebral/basilar artery stenosis remains to be systematically studied.

Methods:
We analyzed data from Taiwan Stroke Registry (TSR), with stroke registries provided by 59 hospitals. Patients who had diagnosis of ischemic stroke and were categorized into the “large artery atherosclerosis” group by TOAST who underwent CTA, MRA, or catheter- based angiography were identified for the present study. The patients were divided into 3 groups based on the extent of vertebral (VA) and/or basilar artery (BA) stenosis as follows: 0-49%, 50-99%, and 100% (total occlusion). Cox proportional hazards model was used to determine the hazard ratios (HRs) of recurrent stroke within 1 year of index event after adjusting for all relevant risk factors by univariable Cox model.

Results:
In the TSR data base, 84,831patients were in the ischemic stroke group. Based on TOAST, 20,220 patients were in the large-artery atherosclerosis group. Among these patients, a total of 10,515 were of age 18 or greater who had CTA, MRA or angiographic studies that included VA/BA. There were 6,972 subjects with VA/BA stenosis in the 0-49%, 3,137 in the 50-99% and 406 in the 100% (total occlusion) groups respectively. With VA/BA stenosis in the 0-49% range as the reference, HRs of recurrent stroke in one year by multivariable modeling with adjustment of all relevant risk factors by univariable Cox model was 1. 29 (95% CI, 1.05 - 1.58, p<0.05) in the 50-99% and 1.64 (95% CI, 1.07 - 2.52, p<0.05) in the 100 % group with P trend < 0.02, denoting that a greater extent of VA/BA stenosis was associated with a relatively greater risk of recurrent stroke in 1 year after stroke.

Conclusions:
Vertebral or basilar artery stenosis or occlusion was relatively prevalent among patients with ischemic stroke categorized in the large artery artherosclerosis group by TOAST with greater extent of VA/BA stenosis carrying greater risk of recurrent stroke within 1 year after stroke.
Abstract WP126: Profile of Reticulated Platelets and Red Cell Reticulocytes in Patients With Recently Symptomatic versus Asymptomatic Carotid Stenosis
Authors: Murphy Stephen , Lim Soon Tjin , Kinsella Justin , Enright Helen , Murphy Dymphna , Tierney Sean , Egan Bridget , Feeley Martin , Murphy Sinead , Walsh Richard , Collins Ronan , Coughlan Tara , O’Neill Desmond , Harbison Joseph , Madhavan Prakash , O’Neill Sean , Colgan Mary Pat , Cox Dermot , Moran Niamh , Hamilton George , McCabe Dominick
Published: October 2018

Introduction:
The mechanisms responsible for the disparity in stroke risk between asymptomatic and symptomatic carotid stenosis are not fully understood. Profiles of ‘reticulated platelets’ and red cell reticulocytes in carotid stenosis patients are poorly understood.

Methods:
This prospective, multi-centre, observational analytical study compared full blood count parameters and platelet production/turnover biomarkers in
early-phase
(≤4 weeks after TIA/stroke) and
late-phase
(≥3 months)
symptomatic
versus
asymptomatic
moderate-severe (≥50-99%) carotid stenosis patients. Reticulated platelets were quantified by whole-blood flow cytometry and by an ‘automated assay’ (Sysmex XE-2100™). Multiple linear regression analysis controlled for the potential influence of independent variables on observed differences between groups.

Results:
Data from 43 early-phase symptomatic and 37 late-phase symptomatic patients were compared with 34 asymptomatic patients. The mean platelet count in citrate-anticoagulated blood was higher in early-phase (P=0.040) and late-phase symptomatic (P=0.045) than asymptomatic patients. Mean platelet volume was higher in early symptomatic than asymptomatic patients (10.8
vs
. 10.45fl; P=0.04). There were no differences in % reticulated platelets between groups using flow cytometry. However, the ‘automated assay’ revealed a higher ‘unadjusted’ reticulated-platelet fraction (%RPF) in early-phase (5.78%; P<0.001) and late-phase symptomatic (5.11%; P=0.001)
vs
. asymptomatic patients (3.48%). The % red cell reticulocytes was lower in early (0.92%; P=0.035) and late symptomatic (0.93%; P=0.036) than asymptomatic patients (1.07%).

Discussion:
There is an ongoing stimulus to increased platelet production/secretion/reduced clearance, and an increased population of immature, potentially ‘more-reactive’ reticulated platelets in symptomatic carotid stenosis patients which may contribute to the higher risk of stroke in symptomatic
vs
. asymptomatic carotid stenosis.
Abstract WP127: Effects of EDAS Revascularization and Intensive Medical Management on the Cognitive Function of Patients With Intracranial Atherosclerosis
Authors: Gonzalez Nestor R , Barnard Zachary , Jiang Hao , Kurth Florian , Lyden Patrick D , Schlick Konrad H , Song Shlee , Liou Raymond , Alexander Michael , Schievink Wouter , Saver Jeffrey L
Published: October 2018

Introduction:
Cognitive decline after transient ischemic attacks (TIA) or stroke is common. Evaluation with the Montreal Cognitive Assessment (MoCA) tool has shown a decrease in cognitive scores in more than 30% of patients at 1 year. We hypothesize that indirect revascularization with EDAS plus intensive medical management (IMM) would decrease the rate of decline.

Methods:
This is a prospective study of EDAS plus IMM in symptomatic patients with intracranial arterial stenosis of more than 70%. Patients had MoCA evaluations at baseline, 1 month, 6 months, and 12 months after EDAS. Differences in MoCA at baseline and follow-up were compared using mixed model repeated measures ANOVA.

Results:
Thirty-one patients with no aphasia or neglect were included. Mean age was 48.3 +/- 16.6 years. Twenty-one were females (70%). The mean MoCA scores at baseline and 12-months were 23.6 +/- 4.3 and 25.5 +/- 4.1, respectively. MoCA ≥ 1 improvement was seen in 78.9% at 12 months. However, differences in MoCA scores at these time points did not reach statistical significance (p= 0.49, Fig. 1). Only 9% of patients had a decline of ≥2 MoCA points at 12 months. These results are comparable to the twelve month MoCA data from the SAMMPRIS trial, which showed a mean MoCA for IMM of 25.4 +/- 3.73 and for percutaneous angioplasty and stenting (PTAS) of 25.6 +/- 3.89. The rate of decline of MoCA scores after EDAS plus IMM was significantly less than the reported natural history after TIA or strokes outside the SAMMPRIS trial (9% vs. 30%, p=0.03).

Conclusion:
Compared to historical data, the decline in MoCA scores after TIA and stroke was lower in patients treated with EDAS plus maximum medical therapy and has similar effects to those reported in the SAMMPRIS IMM and PTAS groups.
Abstract WP133: Intra Cerebral Atherosclerosis is the Major Risk Factor for Stroke in Post Coronary Artery Bypass Graft Surgery Patients
Authors: Buddha Sai Sandeep , Pothineni Ramesh Babu
Published: October 2018

Introduction:
Stroke is one of the most severe complications after Coronary artery bypass grafting (CABG) and is associated with high rates of morbidity and mortality.

Hypothesis:
We aimed to define the relationship between extracranial and intracranial carotid artery stenosis and the risk of stroke after CABG.

Methods:
A retrospective analysis of 1245 consecutive patients who underwent coronary artery bypass grafting (CABG) in our institution from March 2015 till March 2017 was performed. All of them had carotid duplex ultrasound as a routine preoperative assessment. Those patients who had severe extracranial carotid stenosis (>70%), underwent computed tomography angiogram of head and neck cerebral vessels. Our analysis was mainly focused on assessing the relation between incidence of post-CABG stroke and severity of intra and extra cranial cerebral atherosclerosis.

Results:
Of the 1245 patients who underwent coronary artery bypass grafting(CABG) the routine preoperative carotid Doppler revealed severe extracranial carotid artery stenosis of >70% in 160 patients, who eventually underwent computed tomography angiogram which has shown both extra and intracranial cerebral vascular stenosis in 124 patients. Total number of patients who had post CABG strokes are 42 (3.37%), out of which 39 (3.13%) had extensive extra and intracranial vascular stenosis whereas only 3 (0.24%) had isolated extracranial vascular stenosis. Patients with extensive extra and intracranial cerebral atherosclerosis has high rate of in-hospital strokes (within 14 days) compared with patients with isolated extracranial atherosclerotic disease.

Conclusion:
Extensive atherosclerosis including intra and extracranial cerebral arteries are major risk factors for stroke in patients undergoing CABG. Pre-operative assessment of both intra and extracranial cerebral arteries increases the probability of risk assessment in high risk CABG patients.
Abstract WP144: Variables Associated With Recovery of Communication After Stroke
Authors: Faria Andreia V , Wright Amy , Saxena Sadhvi , Suarez Adrian , Hillis Argye E
Published: October 2018

Background:
Communication deficits are common and disabling after both left hemisphere (LH) and right hemisphere (RH) stroke, and can be quantified by the number of Content Units (CU; concepts mentioned by healthy speakers) in describing the cookie theft picture from the NIHSS. In LH and RH stroke, CU correlates with lesion volume.

Hypothesis:
Communication recovery in LH and RH stroke is influenced by % damage to specific areas or vascular territories, independently of lesion volume and initial severity.

Methods:
25 acute ischemic RH (n=9) and LH (n=16) stroke patients were evaluated with DWI and described the NIHSS picture <24 from onset and again at 6 months. Communication recovery was measured by change in CU divided by baseline CU. A radiologist identified % damage to each cortical lobe, thalamus, basal ganglia, and each vascular territory on DWI, after co-registration to an atlas. We identified variables (age, infarct volume, initial CU, % damage to each region and vascular territory) associated with achieving the highest quartile of recovery (“best recovery”) using logistic regression.

Results:
Together, age, lesion volume, initial CU, and % damage to each cortical/subcortical area were strongly associated with best recovery (F(9, 15) = 12.55; p< 0.00001; r
2
= 0.88), but only initial severity (CU; t=-4.95; p<0.001) and % damage to basal ganglia (BG) (t=4.77; p<0.0001) independently predicted best recovery after adjustment for other variables. Likewise, age, lesion volume, initial CU, and % damage to each vascular territory were strongly associated with best recovery (F(10, 14) = 10.13; p = 0.0001; r
2
= 0.88), but only initial CU (t=-4.56; p<0.00001) and % damage to lenticulostriate territory (t=6.44; p<0.00001) independently predicted best recovery. To explore why higher % damage to BG predicted best recovery, we examined Day 1 PWI scans. Patients with BG strokes who showed best recovery had >50% damage to BG and had cortical hypoperfusion at Day 1. We speculate that good recovery was due to cortical reperfusion, but repeat PWI scans were not obtained.

Conclusions:
Patients who had the most room to improve on our measure of communication showed the most recovery. Independently of initial severity, more damage to left or right BG was associated with best recovery.
Abstract WP152: Exploration of the Factors That Influence Spontaneous Bimanual Arm Use After Stroke: Implications for Clinical Rehabilitation
Authors: Varghese Rini , Winstein Carolee J
Published: October 2018

After a stroke, returning to activities of daily living requires the use of the two hands together for bimanual tasks, such as cutting bread, buttoning a shirt etc. Here, we sought to first, identify spontaneous volitional arm use patterns adopted for two distinct bimanual tasks, and, next, determine if and to what extent the degree of impairment, side of stroke, task demands, self-reported confidence, and single-limb (paretic and non-paretic) measures of functional performance can predict the observed task use patterns. Fifty pre-morbidly right-handed stroke survivors (Upper Extremity Fugl-Meyer, UEFM 42±10, 25 right-hemiparesis, RHP) performed 2 bimanual tasks (letter-envelope and photo-album) without explicit instructions. Arm use patterns were classified by: 1) whether one or both arms were used, and 2) the nature of paretic arm use. Logistic regression and receiver-operator characteristics (AUC) were used to examine the influence of impairment (UEFM, more severe < 41, less severe ≥ 41), side of lesion, task demand, self-reported confidence (CAHM), and single-limb functional performances (paretic and non-paretic log-transformed distal component time-scores of Wolf Motor Function test, ln-WMFT) on bimanual arm use. Those more severely impaired and LHP were less likely to choose a bimanual strategy for either task (β = 14.64, p<0.001). For the photo-album task, probability of bimanual use was greater for RHP than LHP group, especially in less impaired; whereas, for the letter-envelope task, probability of use for RHP > LHP only in the more impaired (β = -1.45, p< 0.001). LHP, but not RHP, who reported greater confidence in the use of the paretic arm were more likely to use a bimanual strategy (ρ > 0.34, p<0.05). Finally, paretic arm ln-WMFT was a fair predictor of use patterns for both LHP (AUC = 0.79) and RHP (AUC = 0.80) groups, while the non-paretic arm time-score was a good predictor of use patterns
only
for the RHP (AUC = 0.85), but not the LHP group (AUC = 0.55). Taken together, spontaneous bimanual arm use is modified by impairment, task demands, confidence in paretic arm, and non-paretic arm function, but the effect depends on the side of stroke. Thus, consideration of side of lesion is important when developing interventions to improve bimanual arm use.
Abstract WP158: Supervised, Self Administered Tablet Based Cognitive Assessment in Neurodegenerative Disorders
Authors: Sloane Kelly L , Wright Amy , Saxena Sadhvi , Hillis Argye E
Published: October 2018

Introduction:
The diagnosis of vascular cognitive impairment relies on bedside tools to quantify the degree of disease burden. Given the critical importance of implementing early interventions, it is becoming increasingly important to investigate more sensitive and easily administered tools for accurately characterizing these deficits.

Hypothesis:
The current study aims to evaluate the effectiveness of using Miro, a tablet-based mobile application, developed by The Cognitive Healthcare Company, designed to measure the same cognitive domains as traditional pencil-and-paper tests but (1) require less administration time; (2) provide reliable scoring; (3) offer greater ease of use; and (4) capture and analyze informative data, like speech, fine motor function and eye movements, that are not typically used in clinical settings.

Methods:
Subjects were recruited from the Stroke and Cognitive Disorders Clinic. Subjects were randomized to undergo pencil-and-paper or iPad testing first. The battery of tests in each medium take roughly 60 minutes to complete. In this ongoing study, there will be 3 total participant visits over one year, to evaluate rate of decline or improvement in each medium.

Results:
11 subjects have been enrolled in the study thus far. These subjects have a mean age of 64.6 ± 9.48 and years of education 16.3 ± 2.61.There were strong Spearman rho correlations between pencil and paper testing and iPad testing on digit span forwards (0.848, p < 0.002), digit span backwards (0.946, p < 0.001), symbol digit coding (0.936, p < 0.001), Trails A and B (0.794, p < 0.006). When asked to rate their preference on a 7-point Likert scale (1=iPad based, 4=no preference, 7=paper based), subjects reported a mean score of 3.36 (SD 1.55), demonstrating a slight but not statistically significant preference for iPad. Technicians uniformly found the iPad app easier to administer and less time-consuming for them.

Conclusions:
Given the growing population of individuals with vascular cognitive impairment, it is crucial to test whether this accessible, cost-effective, mobile testing modality can be effectively utilized to assess change in cognitive function after stroke. Our preliminary results indicate that iPad based interventions area promising means to meet this goal.
Abstract WP159: Predictors and Outcomes of Epilepsy and Seizure in Acute Ischemic Stroke Hospitalization
Authors: Jani Vishal , Patel Urvish K , Sankaraneni Rammohan R , Lunagariya Abhishek , Khan Asif , Singh Sanjay P
Published: October 2018

Background:
Acute ischemic stroke (AIS) is the most commonly identified cause of acute seizures and secondary epilepsy in adults. There is a lack of large data base study regarding the predictors and outcome of epilepsy in post-AIS patients.

Methods:
We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2003-2013) in adult hospitalizations for AIS with epilepsy to compare the outcomes (Mortality, Risk of Death and Loss of Function, discharge status) using ICD-9-CM codes. We performed weighted analyses using chi-square, t-test, and Cochran Armitage trend test. Multivariate survey logistic regression was done to evaluate post-AIS epilepsy outcomes and predictors.

Results:
Amongst 4,566,282 AIS hospitalizations, 271,519 (5.9%) had seizure or epilepsy. There was a decrease in trend (6.3% in 2003 to 5.9% in 2013; p<0.001). The mean length of stay was longer for 2 days (p<0.001) and cost of hospitalization was higher by $12,754 (p<0.001) in post-AIS epilepsy patients compared to those without. They had significant higher mortality rates (9.1% vs 5.1%; aOR: 1.93; 95%CI: 1.84-2.01), adverse discharge event (65.2% vs 58.2%; aOR: 1.34; 95% CI: 1.31-1.38), loss of function (56.8% vs 37.8%; aOR: 2.29; 95%CI: 2.23-2.36), and risk of death (38.7% vs 22%; aOR: 2.35; 95%CI: 2.28-2.41) as compared to those without epilepsy. Predictors for post-AIS epilepsy were Afro-American (aOR: 1.42; 95%CI: 1.38-1.47), CNS disorders (aOR: 7.56; 95%CI: 6.91-8.28), AV malformation (aOR: 2.35; 95%CI: 1.81-3.06), drug abuse (aOR: 1.81; 95%CI: 1.14-2.87), alcohol (aOR: 1.36; 95%CI: 1.28-1.44), amyloidosis (aOR: 1.68; 95%CI: 1.13-2.49), AIDS (aOR:1.25; 95%CI:1.03-1.52), SLE (aOR: 1.52; 95%CI: 1.32-1.74), hemorrhagic transformation (aOR: 1.60; 95%CI: 1.46-1.75), hypercoagulable state (aOR: 1.38; 95%CI: 1.23-1.55), and H/O TIA (aOR: 1.24; 95%CI: 1.18-1.30). Treatment with aspirin (aOR: 0.89; 95%CI: 0.84-0.94), rt-PA (aOR: 0.71; 95%CI: 0.66-0.77), and mechanical thrombectomy (aOR: 0.68; 95%CI: 0.53-0.87) were significantly protective against post-AIS epilepsy.

Conclusion:
Early identification of risk factors and prompt management with antiepileptic prophylaxis in such patients help to improve the chance of survival amongst stroke patients.
Abstract WP17: Endovascular Therapy for Large Vessel Occlusion Acute Stroke in Nonagenarians versus Octogenarians
Authors: Bouslama Mehdi , Haussen Diogo C , Grossberg Jonathan A , Barreira Clara M , Bianchi Nicolas A , Belagaje Samir R , Anderson Aaron M , Frankel Michael R , Nogueira Raul G
Published: October 2018

Background:
Little is known on the outcomes of nonagenarians treated with endovascular therapy for acute large vessel occlusion stroke. It is unclear whether they have worse clinical outcomes than octogenarians.

Methods:
We reviewed our prospectively collected endovascular database at a tertiary care academic institution between Sep 2010-Dec 2016. All patients older than 80 years that underwent endovascular therapy for large vessel occlusion acute ischemic stroke were included and categorized into two groups: 80-89 years (octogenarians), and 90-99 years (nonagenarians). Baseline, procedural, and radiological characteristics, as well as outcome parameters were compared.

Results:
Thirty-one nonagenarians and 181 octogenarians were treated over the 6-year study period. When compared with octogenarians, nonagenarians had lower glucose levels (121±26 vs 138±46, p<0.01) and were less often males (16% vs 34%, p=0.05). Other baseline characteristics including comorbidities, NIHSS, ASPECT scores and stroke location as well as procedural parameters were comparable between groups. In terms of outcomes, rates of successful reperfusion (mTICI 2b-3) (87.1% vs 87.9%, p=1.0), parenchymal hematomas (12.9% vs12.7%, p=1.0), and 90-day mortality (51.6% vs 41.4%, p=0.3) were comparable. There was a non-significant trend toward better 90-Day independent outcomes (modified Rankin scale, mRS 0-2) favoring octogenarians (12.9% vs 27.2%, p=0.09) while ambulatory outcomes were more similar (mRS 0-3) (29% vs 41.4%, p=0.2). In multivariate analysis, only baseline NIHSS (Beta -0.09 95%CI[-0.18_-0.02], p=0.02) and successful reperfusion (Beta 1.61 95%CI[0.16-21.23]) were associated with independent outcome.

Conclusions:
Our study shows that there is no significant difference in procedural and clinical outcomes between nonagenarians and octogenarians treated with endovascular therapy. Baseline stroke severity and successful reperfusion are the main drivers of favorable functional outcome in patients ≥80years old.
Abstract WP171: Predictors and Outcomes of Stroke After Trans-Catheter Aortic Valve Replacement in the United States, 2012-2014
Authors: Garg Aayushi , Agarwal Sunil , Tang Gilbert , Chopra Saurav , Yudi Matias , Dangas George , Mehran Roxana , Baber Usman , Narula Jagat , Kini Annapoorna , Sharma Samin
Published: October 2018

Introduction:
Stroke is a dreaded complication after transcatheter aortic valve replacement (TAVR) and identifying the patients at risk and their prognosis is important in guiding appropriate patient selection. We sought to estimate the incidence, predictors and outcomes of in-hospital stroke in patients undergoing TAVR.

Methods:
We used the National Inpatient Sample, a 20% random sample of hospital discharges in 1,000 US hospitals to identify the patients who underwent TAVR in 2012-2014. Pertinent variables were identified using hospital discharge codes. Predictors of in-hospital stroke were analyzed using multivariable logistic regression models. In-hospital mortality and length of hospital stay were compared between the patients with and without stroke.

Results:
In-hospital stroke occurred in 2.6% of 41,050 patients undergoing TAVR in the US during 2012-2014. Though the stroke rates declined from 3% in 2012 to 2.3% in 2014, the comorbidities-adjusted difference by year was not statistically significant. In multivariable model, advanced age was positively associated (adjusted odds ratio [adjOR] for every 5-year increment in age=1.17, p<0.05); while hypertension (adjOR=0.69, p<0.05) and coronary artery disease (adjOR=0.64, p<0.01) were negatively associated with stroke. Also, post-procedure bleeding and use of IABP were associated with higher stroke rates. In contrast, hospital characteristics such as, teaching status, bed size and TAVR volume were not associated with occurrence of stroke. Patients with stroke had higher in-hospital mortality (adjOR=3.35, p<0.001), and longer length of hospital stay (adjusted mean difference= +3.8 days, p<0.001) than those without stroke.

Conclusion:
Occurrence of stroke after TAVR is associated with significant mortality, other concurrent complications, and increased length of hospital stay. Further research is needed to define the role of cardio-embolic protection devices in prevention of stroke after TAVR.
Abstract WP181: CNS Vasculitis in the United States: Demographics and Complications
Authors: Gaines Nathan , Cen Steven , Sanossian Nerses , Saver Jeffrey L , Liebeskind David S
Published: October 2018

Introduction:
Primary and secondary CNS vasculitis encompass a range of disorders that are notoriously challenging to diagnose. While rare, their protean clinical presentations make them frequent considerations in the differential diagnosis of various clinical scenarios. This study investigates the scope of primary and secondary CNS vasculitis in the US inpatient population and identifies risk factors for mortality and non-routine discharge.

Methods:
A subset of adult patients (age ≥18 years) with a discharge diagnosis of “cerebral arteritis” (ICD-9-CM 437.4) were identified in the HCUP National Inpatient Sample database for years 2000-2011. We report patient characteristics and outcomes as well as complications and comorbidities. Logistic regression analysis was performed to identify factors associated with in-hospital death and non-routine discharge.

Results:
A total of 6,269 discharges were identified, including 1,561 with cerebral arteritis as the primary discharge diagnosis. Mean age was 53.6 years (SD 16.7); sex was 67% female (n=6264). Mean Charlson Comorbidity Index was 1.2 (SD 1.5) indicating low comorbidity burden. The most common complications or comorbidities included disorders of cognition (15%, n=6269), ischemic stroke (12.2%, n=6269), any late effect of stroke (12%, n=6269), any intracranial hemorrhage (8.6%, n=6269), TIA (7.6%, n=6269), seizures/epilepsy (6.3%, n=6269), headache (4%, n=6269) and hydrocephalus (1.8%, n=6269). Combined, a range of inflammatory disorders were common (22.4%, n=6269) but individual diagnoses were not highly represented except SLE (9.2%) and RA (3.5%). In-hospital mortality was 5.1% (n=6269); discharges were routine for 48.9% (n=6269). Major complications associated with in-hospital mortality were hydrocephalus (OR 2.4, CI 1.2-4.8) and intracranial hemorrhage (OR 1.8, CI 1.3-2.7). Conditions associated with non-routine discharge were weakness (OR 2.2, CI 1.8-2.7), cognitive diagnoses (OR 1.9, CI 1.6-2.4) and ischemic stroke (OR 1.3, CI 1.1-1.6).

Conclusions:
Cognitive disorders, in addition to various stroke subtypes, are the most prominent complications of CNS vasculitis in the US. In-hospital mortality in CNS vasculitis is linked with hydrocephalus and intracranial hemorrhage.
Abstract WP183: Trends in Young Adult Stroke and Acute Myocardial Infarction, is Atherosclerosis to Blame?
Authors: Leppert Michelle H , Burke James , Campbell Jonathan , Bernard Timothy , Traystman Richard , Perraillon Marcelo , Sillau Stefan , Ho Michael , Poisson Sharon
Published: October 2018

Background:
Atherosclerotic risk factors (ARF) are known causes of stroke and acute myocardial infarction (AMI) in older adults. However, their role in young adult stroke incidence is largely unknown.

Hypothesis:
We hypothesized that if the trend in incidence of young adult strokes is driven by premature atherosclerosis then we would observe similar trends in young adult AMI.

Methods:
A 10% random sample of all enrollees, from a commercial claims database between 2001-2014, was used. Enrollees were divide into ages 15 to 45 for young adults and 55 to 75 for older adults. Individual claims for first ever stroke or AMI hospitalizations were identified using ICD-9 and ICD-10 codes. Annual incidence rate was adjusted for age in both groups. A simple linear regression model was used to plot trend lines for incidence.

Results:
Included in the analysis were 3,770,474 young adults with mean age 28 and 1,552,351 older adults with mean age 60. Of all young adults, there were 3,078 strokes and 3,408 AMIs compared to 38,707 strokes and 26,094 AMIs in older adults. Both older adult stroke and AMI incidence showed an annual decline with 36.8 and 21.9 less cases per 100,000 enrollees, respectively (R
2
= 0.85 and 0.81). Young adult stroke showed a slight increase in incidence overtime with overall, with 0.29 more cases a year per 100,000 enrollees (R
2
= 0.24). Meanwhile, young adult AMI incidence showed a slight decline overtime with 0.19 less cases a year per 100,000 enrollees (R
2
= 0.139). Though neither change was significantly different from 0, taken together their slopes are different from each other with p = 0.035.

Conclusion:
Despite the decreasing incidence of stroke and AMI in older adults, young strokes and AMI incidence remain largely unchanged. The slightly divergent trends between young adult stroke and AMI suggest that there may be more than atherosclerosis at play that is driving the increased incidence young adult strokes, which have been observed in other studies.
Abstract WP189: Prevalence and Risk Factors for Cerebral Enlarged Perivascular Spaces in Relation to Race and Stroke Severity
Authors: Penton Ashley , Lau Helena , Babikian Viken , Aparicio Hugo , Cervantes Anna , Shulman Julie , Greer David , Romero Jose Rafael
Published: October 2018

Purpose:
Racial minorities have a higher prevalence of vascular risk factors (VRF), as well as higher incidence and greater severity of stroke. Enlarged perivascular spaces (EPVS) are considered a marker of small vessel disease reflecting the long term effect of VRF. We aim to determine the prevalence and burden of EPVS in racial minorities, and examine their association with VRF and stroke severity.

Methods:
We included 894 consecutive stroke patients who underwent brain MRI admitted to an academic stroke center. EPVS were rated in the basal ganglia (BG), centrum semiovale (CSO) and midbrain (MB) following a standardized method, and dichotomized for analyses (mild <20 vs severe ≥20). Race was assessed based on US census procedures and categorized as White, Black or Other racial groups (ORG). Stroke severity was determined at time of admission using the NIH stroke scale. We used univariate analysis to assess the relation of VRF and EPVS severity, and multivariable logistic regression analysis to relate EPVS and stroke severity.

Results:
EPVS were present in the entire sample (219 White, 455 Black, 220 ORG). Severe EPVS prevalence for Whites, Blacks and ORG was for BG 19.6%, 18%, and 15.4%; for CSO, 38.8%, 42.6%, and 33.6%; and for MB, 88.6%, 84.8%, and 84.1%, respectively. In univariate analyses, increasing age was associated with severe EPVS in the BG and CSO in all racial groups (p=< .0001); White and Black women were more likely to have severe EPVS in the BG and CSO (p<0.05). Hypertension was associated with EPVS severity in the BG in the entire sample (p=0.0004), with severe EPVS in MB and BG among Blacks, and with severe EPVS in BG and CSO in ORG (p<0.0001). Dyslipidemia was associated with severity of EPVS in BG only in ORG (p=0.01), while diabetes showed an inverse relation with EPVS severity in BG among Blacks only (p=0.003). EPVS severity was not associated with stroke severity when evaluating different NIHSS thresholds.

Conclusion:
Race was not related to EPVS severity in our study, but traditional risk factors were, supporting their role as markers of small vessel disease. Severe EPVS were more frequent in MB, CSO and less common in BG. Further studies are required to clarify the relation of EPVS with stroke severity, assessing other measures and functional outcomes.
Abstract WP192: Last Known Well to Arrival Times in Midwest Hospitals Indicate Need for Further Community Education
Authors: Godbolt Shannon , Mallas-Serdynski Lynn , Cook Mindy
Published: October 2018

Background & Objectives:
Timely administration of IV Alteplase in ischemic stroke patients can lead to reduction in the severity of disability and improve patient outcomes. The treatment window for IV Alteplase is within 3 hours of last known well (LKW) and up to 4.5 hours in certain eligible patients. Community education of the message “time is brain” is a critical component in the chain of survival for stroke patients. The American Heart Association and the American Stroke Association have focused community awareness efforts on signs & symptoms recognition and the importance of acting F.A.S.T.
©
when stroke symptoms occur. Our objective is to determine if ischemic stroke patients are arriving to the hospital within the timeframe to be eligible for IV Alteplase treatment.

Methods:
Get With the Guidelines (GWTG) -Stroke® is a quality improvement initiative to improve care by promoting adherence to scientific guidelines. A retrospective review was conducted of 337, 407 ischemic stroke patients from over 325 hospitals using GWTG-Stroke® in the Midwest from 2011 through 2016. LKW to hospital arrival times were analyzed.

Results:
The percentage of patients arriving within 3 hours of LKW was as follows: 23.3% in 2011, 22.5% in 2012, 23.1% in 2013, 22.5% in 2014, 23.4% in 2015, and 23.3% in 2016. The percentage of patients arriving within 4.5 hours of LKW: 29.1% in 2011, 28.2 % in 2012, 28.9% in 2013, 28.4% in 2014, 29.5% in 2015, 29.4% in 2016.

Conclusions:
Throughout the six years of this study, an average of only 23% of ischemic stroke patients arrived to the hospital within 3 hours of LKW, with slightly more, 29%, of patients arriving within the extended window (4.5 hrs of LKW) to be considered eligible for IV Alteplase treatment. With greater than 70% of patients arriving too late to receive this clot-busting drug, this data identifies the continued need for community education regarding acting F.A.S.T.
©
in recognizing signs and symptoms of stroke.
Abstract WP196: Prevalence of Stroke in Argentina: A Population Based Epidemiological Study (EstEPA)
Authors: Gomw-Schneider Maia M , Pujol-Lereis Virginia A , Dossi Daiana E , Hawkes Maximiliano A , Alet Matias , Rodriguez-Lucci Federico , Povedano Guillermo , Gonzalez Claudio D , Melcon Mario O , Ameriso Sebastian F
Published: October 2018

Introduction and objectives:
Stroke is a leading cause of mortality and disability worldwide. Regional data is essential to assess the local impact of the disease and to plan rational adjudication of public health resources. Stroke prevalence data in Latin America are scant with only one prevalence study completed in Argentina in 1991. We determined prevalence of stroke in a sample representative of the Argentinean population.

Methods:
EstEPA is a population-based study to assess the prevalence, incidence and mortality of stroke in General Villegas, Buenos Aires, Argentina. A prevalence study was performed in two phases in an urban area of 18,275 habitants. First, a door-to-door survey of randomly selected houses was taken using a structured questionnaire for the detection of possible strokes. This was followed by a neurological evaluation for final adjudication. Data about stroke subtypes, vascular risk factors, medications and diagnostic tests were collected.

Results:
A total of 2156 door-to-door surveys were conducted and 294 were positive for possible stroke. After neurological evaluation, there were 41 confirmed stroke cases. The prevalence of stroke adjusted to Argentinean population older than 40 years was 1981 per 100,000 habitants with higher prevalence in men than women (27,75‰ vs 13,72‰, p=0.003). Prevalence increased with age with a higher prevalence at 70-75 years. Prevalence was 16.5‰ for ischemic stroke and 3‰ for intraparenchymal hemorrhage. Also, 6 transient ischemic attacks were diagnosed with a prevalence of 3‰. Most common vascular risk factors in stroke cases were hypertension (88%), obstructive sleep apnea (51%) and dyslipidemia (46%). At the time of evaluation 88% of ischemic stroke subjects were taking antiplatelets and/or anticoagulants.

Conclusion:
Approximately 2% of subjects older than 40 years are stroke survivors. This prevalence, likely representative of the Argentinean population at large, was higher than previously described in the region. It was comparable to data from Western developed countries with similar age and gender distribution. Aging of the Argentinean population in recent years and better preventive strategies may be responsible, at least in part, for these findings.
Abstract WP199: Left Atrial Volume Index and PR Interval Are Independent Predictors of Atrial Fibrillation in Embolic Stroke Patients With Insertable Cardiac Monitor
Authors: Ching Marilou I , Zhang Charles , Vaughn Caila , Lail Navdeep , Leahy Thomas , Kandel Amit , Deline Christopher , Sawyer Robert , Alfaro Franco Carina
Published: October 2018

Introduction:
The use of insertable cardiac monitors (ICM) improved the detection rate of atrial fibrillation (AF) in patients with embolic strokes (ES). However, given cost of the device, current indications and availability of implant procedure, the optimal patient population that would benefit from the device remains unknown.

Objectives:
We sought to determine 1) the incidence of AF in patients with ES in our population and 2) whether certain variables are predictive of AF in patients with ES.

Methods:
A case control study was conducted from January 1, 2015 to June 23, 2017. Patients admitted to the Gates Vascular Institute with ES on MRI and CT angiogram but no evidence of AF on telemetry underwent Reveal LINQ ICM implant prior to discharge. Demographics, EKG and echocardiographic variables were assessed. Statistical analysis was conducted using SPSS version 22 and R v.1.0.44. Independent T tests were applied for continuous variables and Chi Square or Fisher’s exact test for categorical variables. Cox proportional hazard model was used to analyze whether certain variables were associated with increased odds of AF. A p-value of <0.05 was considered statistically significant.

Results:
A total of 177 patients were enrolled and followed for 478 ± 179 days. AF was detected in 31% (n=55). Mean age ± SD (positive vs. negative AF on ICM) was 71.1 ± 12.0 vs. 68.6 ± 11.8, p=0.20. Age, gender, race, BMI, systolic, diastolic blood pressures, cholesterol and HBA1c were not significantly different between the two groups. Significant univariate predictors of AF included PR interval (hazard ratio [HR] 1.19 per 10 milliseconds, p < 0.001) and Left Atrial Volume Index (LAVI) (HR 1.04 per 1 mL/m
2
, p = 0.01). In multivariate analysis, both PR interval and LAVI remained significant predictors of AF (HR 1.3, p < 0.001; HR 1.05, p < 0.001, respectively). Using a risk-score formulated from these predictors, we found that patients in the top quartile had a five fold higher rate of AF detection compared to the lowest quartile.

Conclusion:
In summary, our atrial fibrillation detection rate was 31%. PR interval and Left Atrial Volume Index were found to be both independent and multivariate predictors of atrial fibrillation in embolic stroke patients with insertable cardiac monitor.
Abstract WP2: Trends of Endovascular Treatment in Cerebral Venous Thrombosis: Estimations From Nationwide Inpatient Sample
Authors: Siddiqui Fazeel M , Weber Matthew , Dandapat Sudeepta , Aksan Nazan , Scaife Steve , Ortega-Gutierrez Santiago , Coutinho Jonathan
Published: October 2018

Background and purpose:
Although Anticoagulation remains the mainstay of treatment after cerebral venous thrombosis (CVT), 15% of patients may not respond. Evidence of endovascular treatment (ET) in CVT remains limited to case reports. The Nationwide Inpatient Sample (NIS), the largest all-payer inpatient health care database in the United States, represents a 20% stratified sample of community hospitals and approximately 7 million annual hospital admissions. We aimed to evaluate the trends of ET using NIS.

Methods:
We extracted data from the NIS between 2004- 2013. CVT patients were identified through ICD 9-CM codes: 437.6, 325 and 671.5. Mechanical thrombectomy (MT) and/or thrombolysis were searched using ICD 9 (CPT) codes 39.74 for Endovascular removal of obstruction from head and neck vessel(s) and 99.10 for any injection or infusion of thrombolytic agent. We compared categorical variables using chi-squared tests and continuous variables with Student t test or Wilcoxon rank-sum tests as indicated. Trends were assessed using a Cochran-Armitage test.

Results:
Of 8,891 cases of CVT (un-weighted count), 8676 (98%) cases received only medical management. When the weights were applied, total CVT cases were 42,889. 215 (2%) patients (un-weighted count) received ET. Weighted estimates for ET was 1058. 50 (23%) patients received MT and thrombolysis (weighted 248), 38 (18%) patients received MT alone (weighted 194) and 127 (59%) patients received thrombolysis alone (weighted 616). There was a significantly increasing trend of utilization of the MT over thrombolysis alone over the years (Figure 1).

Conclusion:
There is a significant rise in the number of ET cases for CVT over the years, with a trend favoring towards MT over thrombolysis alone.
Abstract WP20: Reasons Patients Don’t Receive Endovascular Therapy and Their Outcomes
Authors: Wang Han , Rizvi Macym , Dickey Trisha , Bozorgi Alireza , DeGeorgia Michael , Furlan Anthony , RamosEstebanez Ciro , Sila Cathy , Xiong Wei , Sundararajan Sophia
Published: October 2018

Objective:
Many examine patient outcomes following endovascular therapy for acute ischemic stroke, but we wanted to better understand why patients presenting within the window for this therapy did not receive it and their outcomes.

Methods:
We retrospectively examined a cohort of 275 patients with a discharge diagnosis of ischemic stroke, NIHSS≥6 and last known normal (LKN) time<6 hours prior to arrival. We determined why patients did not receive endovascular therapy and collected demographics, admission NIHSS, pre-admission modified Rankin scale (mRS), LKN time, decision time for no endovascular therapy, discharge NIHSS, disposition and mRS at follow-up. We used STATA 12.0 for statistical analysis and student’s t-test to compare mean decision time for individual groups of patients to other patients in the cohort.

Results:
Reasons patients did not receive intervention were patent major intracranial vessels (32%), no penumbra on CT or MRI (11.7%), large core infarct (16%), low NIHSS or significant improvement (8%), cerebral ischemia not suspected at admission (6.6%), poor baseline (6.2%) and advanced age (4.4%). Mean decision time for patients without penumbra or large core infarcts was not different from other patients in the cohort. Inability to treat patients within 6 hours was associated with a longer decision time (119 minutes longer, CI 54-185, p value =0.0004), but the time increase was due to transfer, not decision time relative to arrival at the tertiary care center. Patients for whom ischemic stroke was not considered at admission were most likely to present with seizure (33%) or posterior circulation symptoms (22%). Patients not receiving endovascular therapy due to mild/improving symptoms had significant deficits at discharge (mean mRS of 3; 18% discharged to a skilled nursing facility; 41% to an acute rehabilitation facility). At 3 months the mean mRS was 2.

Conclusion:
The most common reasons patients did not receive endovascular therapy were patent major intracranial vessels, no penumbra and large core infarct. These patients would be unlikely to benefit and might be harmed by intervention. Conversely, patients not treated due to mild/improving symptoms had significant deficits at discharge and 3 months and may have benefited from intervention.
Abstract WP200: Development and Validation of a Score to Detect Paroxysmal Atrial Fibrillation During Long-term Holter-monitoring After Acute Ischemic Stroke
Authors: Uphaus Timo , Weber-Krüger Mark , Grond Martin , Toenges Gerrit , Jahn-Eimermacher Antje , Jauss Marek , Kirchhof Paulus , Wachter Rolf , Gröschel Klaus
Published: October 2018

Introduction:
Atrial fibrillation remains one of the most common causes of ischemic stroke. The diagnosis of paroxysmal atrial fibrillation (pAF) frequently escapes routine diagnostic due to its intermittent and asymptomatic occurrence. Currently prolonged monitoring times (72h) are recommended, but did not find their way into everyday practice. Therefore an individual patient selection for prolonged ECG-monitoring might increase the diagnostic yield of pAF in a resource-saving and cost-effective manner.

Methods:
We used individual patient data from three prospective studies (n
total
=1556) which performed a prolonged Holter ECG-monitoring (at least 72 h) and centralized data evaluation after ischemic stroke (IDEAS 72h monitoring, Find-AF 7 days and Find-AF
randomised
3 times 10 days

monitoring) in patients presenting with sinus rhythm. The score was developed on the IDEAS cohort and internally (bootstrapping) and externally (Find-AF and Find-AF
randomised
data) validated following the TRIPOD guideline.

Results:
pAF was detected in 77 of 1556 patients (49 (4.3%) IDEAS, 20 (9.0%) Find-AF, 8 (4.0%) Find-AF
randomized
). After logistic regression analysis with variable selection, age and the qualifying stroke event (categorised as stroke with NIH-SS <=5 (OR 2.4; 95%CI 0.8-6.9, p=0.112) or stroke with NIH-SS >5 (OR 7.2; 95% CI 2.4-21.8, p<0.001) were found to be predictive for the detection of pAF within the prolonged Holter monitoring and were included in the final score (
A
ge,
S
troke
S
everity: NIHSS >
5
,
ASS5
). The score was shown to keep its discriminative performance (IDEAS, AUC 0.76) on the external validation cohort (Find-AF, Find-AF-randomized, AUC 0.75). When ASS5-score and CHADS2-score were applied to classify patients into high and low-risk patients according to the score’s particular Youden-index, the ASS5-score was statistically significant better in discriminating between high- and low-risk patients than the CHADS
2
-score (NRI 0.22 with p=0.047; ROC-AUC 0.75 for ATISS5 and 0.61 for CHADS
2
-Score with p = 0.0032).

Conclusion:
ASS5-score can be used by clinicians to select patients for prolonged ECG-monitoring after ischemic stroke to detect pAF.
Abstract WP203: Left Atrial Appendage Morphology is Similar in Embolic Stroke of Undetermined Source and Cardioembolic Stroke and Different From Atherothrombotic Subtypes
Authors: Yaghi Shadi , Chang Andrew D , Hung Peter , Mac Grory Brian , Collins Scott , Gupta Ajay , Reynolds Jacques , Finn Caitlin B , Hemendinger Morgan , Cutting Shawna M , McTaggart Ryan A , Jayaraman Mahesh , Leasure Audrey , Sansing Lauren , Panda Nikhil , Song Christopher , Chu Antony , Merkler Alexander , Gialdini Gino , Sheth Kevin N , Kamel Hooman , Elkind Mitchell S , Greer David , Furie Karen L , Atalay Michael
Published: October 2018

Background:
The left atrial appendage (LAA) is the main source of thrombus in atrial fibrillation (AF), and there is an association between non-chicken wing (NCW) LAA morphology and stroke. We hypothesized that the prevalence of non-chicken wing LAA morphology would be higher among patients with cardioembolic (CE) stroke and embolic stroke of undetermined source (ESUS) than among those with non-cardioembolic stroke (NCS).

Methods:
This multi-center retrospective study included consecutive patients with ischemic stroke from three comprehensive stroke centers who previously underwent a qualifying chest CT. Patients underwent inpatient diagnostic evaluation for ischemic stroke, and stroke subtype was determined based on ESUS criteria. LAA morphology was determined using clinically performed contrast enhanced thin-slice chest CT by investigators blinded to stroke subtype. The primary predictor was NCW LAA morphology and the outcome was stroke subtype (CE, ESUS, NCS).

Results:
We identified 172 ischemic stroke patients who had a clinical chest CT performed. Mean age was 70.1±14.3 years and 51.7% were male. Compared to patients with NCS, the prevalence of NCW LAA morphology was higher in patients with CE stroke (58.7% vs. 46.3%, p=0.1) and ESUS (58.8% vs. 46.3%, p=0.2) but this difference did not achieve statistical significance.

Conclusion:
The prevalence of NCW LAA morphology is similar in patients with ESUS and CE, and may be higher than that in those with NCS. Larger studies are needed to confirm this association.