bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP102: Apolipoprotein E Mimetic Pentapeptide (CN 105) Improves Outcome in a Murine Model of Ischemic Stroke
Authors: Tu Tian Ming , Wang Haichen , Laskowitz Daniel
Published: June 2021

Introduction:
Apolipoprotein E (apoE) is an endogenous brain protein synthesized in response to brain injury and modifies neuroinflammatory responses by downregulating glial activation and release of inflammatory mediators. Due to its size, however, the intact apoE holoprotein does not cross the blood brain barrier, and thus has limited therapeutic potential. We have demonstrated that a small 5 amino acid apoE-mimetic peptide (CN-105) derived from the receptor-binding region of apoE retains the neuroprotective effects of the intact holoprotein, is well tolerated, and effectively crosses the blood brain barrier. This study investigates whether CN105 improves functional and histological outcomes in a murine model of transient focal ischemia and reperfusion.

Methods:
We used the transient middle cerebral artery occlusion murine model of ischemic stroke for all our experiments. Thirty-minutes ischemic occlusion time was used for infarct volume and survival analysis at 72 hours while 15 minutes ischemic occlusion time was used for functional outcome analysis performed 7 days post stroke. A dose of CN-105 (0.1mg/kg) in 100 μl volume was administered as a single dose 30 minutes post-perfusion via tail vein injection. Motor-sensory functional outcomes were evaluated using daily rotarod assessment for 7 days and 4-limb wire hanging test on days 2 and 7 days post injury. Infarct volume was evaluated using 2,3,5-Triphenyltetrazolium chloride staining method. Independent t-test was used for infarct volume analysis, repeated measures ANOVA was used for functional outcomes evaluation and log-rank test was used for survival evaluation. Experiments were performed in a randomized and blinded fashion.

Results:
Administration of CN-105 improved motor and sensory functional outcomes at 7 days in rotarod (p = 0.035) and 4-limb wire hanging test (p=0.013) when compared to vehicle. There was also a survival benefit (n = 8 (66.7%) vs n = 3 (25%), p=0.037) and a significant reduction of infarct volumes (79 ± 43 mm
3
) compared to vehicle (127 ± 31 mm
3
) (p = 0.039) at 72 hours.

Conclusion:
Intravenous administration of CN-105 is associated with functional, survival, and histological benefits in a murine ischemic stroke model when given at 30 minutes post-reperfusion.
Abstract TP105: Therapeutic Human Umbilical Cord Blood Cells in Ischemic Stroke
Authors: Wang Haichen , Fang Chuan , Tan Yanli , Tu Tian Ming , Bennett Ellen R , Kurtzberg Joanne , Laskowitz Daniel T
Published: June 2021

Introduction:
Stroke affects one in six people worldwide and is the leading cause of adult disability. No approved treatment for stroke exists outside of tissue plasminogen activator for immediate revascularization of thrombosed vessels in ischemic stroke. It has been suggested that a cell based intervention using unrelated donor, banked, umbilical cord blood (UCB) has potential to favorably alter the natural history of stroke. In this study, we evaluated multiple outcome measures to assess the effects of intravenous administration of human umbilical cord blood on functional and histological outcomes after transient occlusion of the middle cerebral artery in a murine model of focal ischemia and reperfusion.

Methods:
10-12 week male C57BL6 mice underwent induction of stroke (15 minutes of middle cerebral artery ischemia/reperfusion) on day 0, vehicle (100 μl dextran/ 5% albumin solution) or human umbilical cord blood cells (1 million cord blood cells per mouse in 100ul vehicle) infused intravenously on day 2 or 5 post-stroke. Vestibular-motor function tests (Rotarod) and neuroseverity score were examined at baseline, and on day 1, 2, 5 and 10 after stroke. Brain tissue loss was assessed on day 10 after stroke using 2,3,5-Triphenyltetrazolium chloride staining. Mice were randomized into different treatment groups and all procedures and assessments were performed in blinded fashion.

Results:
Reduction in rotarod and neurological deficit on day 10 was observed after cord blood infusion compared with vehicle treated mice. In addition, brain tissue was significantly preserved on day 10 in recipients of umbilical cord blood cells. There were no changes in outcome associated with the timing of cord blood administration (2 vs 5 days) following stroke.

Conclusion:
The intravenous administration of human UCB at 2 or 5 days following focal ischemia and reperfusion improves functional and histological outcomes in a murine model. These findings may have implications for the clinical translation of this therapeutic strategy.
Abstract TP109: Multiplicity of Atherosclerotic Risk Factors Predicts a Risk of Large Arterial Atherosclerosis and Long-term Mortality in Patients with Ischemic Stroke
Authors: Ahn Sungho , Lee Eun-Jae , Kang Dong-Wha , Kwon Sun U. , Kim Jong S.
Published: June 2021

Background:
The aim of this study was to investigate clinical significance of multiplicity of atherosclerotic risk factors to determine the type of stroke and long-term mortality in patients with large artery atherosclerotic (LAA) and small vessel occlusive (SVO) stroke.

Methods:
We retrospectively analyzed medical data of the prospectively registered stroke patients who were diagnosed as LAA and SVO type of ischemic stroke based on diffusion weighted MRI and magnetic resonance angiography between January 2005 and December 2013. Multiplicity of risk factors was defined as numbers of hypertension, diabetes, hyperlipidemia and smoking. Information on mortality as outcome was obtained and reconfirmed from the National Death Certificate system.

Results:
A total of 4099 patients comprising 2530 LAA stroke and 1569 SVO stroke were studied. After adjustment for differences in baseline risk profiles, multiplicity of risk factors (per 1-point increase, odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.02-1.18) was significantly associated with the LAA stroke than SVO stroke. Among patients with SVO stroke, patients with a higher multiplicity of risk factors had a higher long-term mortality (OR = 1.34, 95% CI = 1.10-1.65) during 8-year of observation.

Conclusions:
Atherosclerotic burden defined by multiplicity of risk factors for atherosclerosis could predict the probability of developing LAA stroke compared to the SVO stroke, and long-term mortality particularly in SVO stroke.
Abstract TP122: Are Aortic and Carotid Atherosclerosis Parallel or Divergently Associated with Cerebrovascular Disease in Systemic Lupus Erythematous?
Authors: Roldan Luis P , Green Ernest R , Roldan Paola C , Qualls Clifford R , Sibbitt Wilmer L , Roldan Carlos A
Published: June 2021

Introduction:
Aortic (Ao) and carotid (Ca) atherosclerosis (Athero) and cerebrovascular disease (CVD) are common and associated with high morbidity and mortality in systemic lupus erythematosus (SLE). However, it is unknown whether Ao and Ca Athero are parallel or divergently associated with CVD.

Methods:
77 SLE patients (age 37±12 years, 70 women) and 26 age-and-sex matched healthy controls (age 34±11 years, 22 women) underwent 1) transesophageal echocardiography and carotid ultrasonography for detection of Athero defined as intima-media thickening (≥2SD of the mean intima-media thickness in controls) or plaques (focal and protruding intima-media thickening that exceeds 50% of the surrounding vessel wall); 2) assessment of prevalent CVD defined as acute stroke/TIA, neurocognitive dysfunction, or focal brain injury on MRI; and 3) assessment of incident stroke/TIA, cognitive disability, or death during a median follow-up of 52 months.

Results:
Ao but not Ca Athero was more frequent in patients than in controls (42% versus 8%, p=0.006, and 17% versus 12%, p=0.75). Acute stroke/TIA occurred in 31% of patients, focal brain injury in 54%, neurocognitive dysfunction in 44%, or any CVD in 70% of patients. During follow-up, 26% of patients developed stroke/TIA, cognitive disability, or died. Ao but not Ca Athero was associated with prevalent focal brain injury (p=0.06), cognitive dysfunction (p=0.04), or any CVD (p=0.03) (
Table 1
). Ca Athero was associated with acute stroke/TIA (p=0.02), but Ao Athero detected more patients with these conditions (50% versus 33%). Although Ao and Ca Athero were associated with incident stroke/TIA, cognitive disability, or death (both p≤0.01), Ao Athero identified more patients with these events (65% versus 45%).

Conclusion:
In patients with SLE Ao as compared to Ca Athero is associated with higher prevalence and incidence of CVD and mortality. Therefore, Ao Athero may be a stronger pathogenic factor or marker for CVD in SLE than Ca Athero.
Abstract TP123: Efficacy of Staged Angioplasty to Prevent Cerebral Hyperperfusion Syndrome After Endovascular Revascularization for Carotid Artery Stenosis
Authors: Hayakawa Mikito , Hishikawa Tomohito , Sugiu Kenji , Yamagami Hiroshi , Sakai Nobuyuki , Iihara Koji , Ogasawara Kuniaki , Oishi Hidenori , Ito Yasushi , Matsumaru Yuji , Yoshimura Shinichi ,   STOP CHS study group
Published: June 2021

Background and aim:
Cerebral hyperperfusion syndrome (CHS) including intracranial hemorrhage (ICH) is a serious complication after carotid artery stenting (CAS). Staged angioplasty (SAP), undersized-balloon angioplasty followed by delayed CAS, was reported to be a potential preventable method against CHS. The aim of this study was to clarify the efficacy of SAP to prevent CHS after endovascular carotid revascularization for high-risk patients of CHS.

Methods:
The STOP CHS study is a multicenter, retrospective study which registered 535 high-risk patients of CHS from 45 Japanese centers, who underwent regular CAS, SAP or angioplasty performed by board-certified neurointerventionists between October 2007 and March 2014. Selection of high-risk patients of CHS was based on imaging tests, such as single-photon emission computed tomography with acetazolamide. We investigated the cumulative periprocedural rates of CHS, ICH and major adverse event (MAE: stroke, myocardial infarction and death) of patients scheduled for regular CAS or SAP (intention-to-treat [ITT] population) and the relationship between SAP and the cumulative incidence of CHS in ITT and as-treated (AT) populations (patients who underwent regular CAS or SAP).

Results:
A total of 525 patients (532 lesions, 74 women, 72.5±7.5 years old) was included. Angiographic stenosis was 86.2±9.2% and 337 lesions were symptomatic. Scheduled procedures were regular CAS in 419 lesions and SAP in 113 lesions, and final procedures were regular CAS in 428 lesions, SAP in 102 lesions and angioplasty in 2 lesions. The cumulative event rates were CHS in 9.2%, ICH in 4.3% and MAE in 11.5%, and these were higher in patients scheduled for regular CAS than in patients scheduled for SAP(10.5 % vs 4.4%, 5.3% vs 0.9% and 12.9% vs 6.2% with each p-value <0.05, respectively). After multivariate adjustment, schedule for SAP was negatively related to the cumulative incidence of CHS (OR, 0.25; 95%CI, 0.09-0.73). Same applied to implementation of SAP in AT population (OR, 0.28; 95%CI, 0.10-0.82).

Conclusion:
The cumulative periprocedural event rates of high-risk patients of CHS scheduled for regular CAS or SAP were actually high. SAP was a negative predictor of CHS in both ITT and AT populations.
Abstract TP125: Distinct Roles of Endothelial Dysfunction and Inflammation in Intracranial Atherosclerotic Stroke
Authors: Chung Jong-Won , Choi Hyun Ah , Lee Mi Ji , Lee Joon Hwa , Park Moo-Seok , Seo Woo-Keun , Kim Gyeong-Moon , Chung Chin-Sang , Lee Kwang Ho , Bang Oh Young
Published: June 2021

Aims:
Endothelial dysfunction and inflammation play a major role in the progression of atherosclerosis. This study aimed to evaluate the differential roles of endothelial dysfunction and inflammation in intracranial atherosclerotic stroke (ICAS).

Methods:
We prospectively recruited 262 patients with acute cerebral infarcts caused by ICAS and 75 individuals with no history of stroke as controls. Markers of endothelial dysfunction (asymmetric dimethylarginine, ADMA) and inflammation (lipoprotein-associated phospholipase A2, Lp-PLA
2
) were measured. Acute ischemic lesions were measured in terms of their size, composition, and patterns. Subclinical microangiopathy (degree of leukoaraiosis) and macroangiopathy (presence/number of tandem stenoses) were graded in each patient.

Results:
Compared to normal controls, serum levels of ADMA (0.69 ± 0.14 vs. 0.47 ± 0.10,
P
< 0.001) and Lp-PLA
2
(138.1 ± 116.8 vs. 19.0 ± 58.0,
P
< 0.001) were elevated in patients with ICAS. Although there was a significant correlation between ADMA and Lp-PLA
2
levels in patients with ICAS (r
2
= 0.235,
P
<0.001), some patients showed high Lp-PLA
2
but low ADMA levels, while others showed high ADMA but low Lp-PLA
2
levels. A high ADMA serum level was associated with a greater prevalence of preclinical microangiopathy and macroangiopathy. Contrastingly, an elevated serum Lp-PLA
2
level was associated with larger ischemic lesions, a greater number of lesions, and a larger cortical pattern.

Conclusion:
Endothelial dysfunction and inflammation have distinct effects in ICAS patents: endothelial dysfunction is associated with the underlying micro- and macro-atherosclerotic burden, whereas inflammation is associated with acute infarct volume and pattern.
Abstract TP129: Factor VIII in Acute Cerebral Ischemia Trial - Biomarker in Patients with Large Vessel Occlusion?
Authors: Navalkele Digvijaya D , Boehme Amelia , Albright Karen , Leissinger Cindy , El Khoury Ramy , Freeman Melissa , Schluter Laurie , Martin-Schild Sheryl
Published: June 2021

Introduction:
Baseline elevated Factor VIII (FVIII) level is a significant independent predictor of stroke occurrence and severity. We conducted a prospective serial laboratory cohort study to assess the correlation of FVIII levels in response to thrombolysis in patients with large vessel occlusion (LVO) and acute ischemic stroke (AIS).

Methods:
AIS patients with anterior circulation LVO were enrolled within 4.5 hours from last seen normal. Baseline and serial FVIII levels were obtained to determine whether FVIII serves as a surrogate marker of clot burden and if FVIII levels or changes predict (1) recanalization with intravenous tissue plasminogen activator (IV tPA) or (2) symptomatic intracranial hemorrhage (sICH) following tPA. Linear and logistic regression analyses were used to determine significant predictors.

Results:
Patients (n=29) had a mean age of 71years, median NIHSS of 15, 62% were of black race and 48% were female. Baseline pre -tPA FVIII was not significantly correlated with clot burden score (-0.15, p=0.45) or vessel recanalization (-0.13, p=0.50). Median FVIII decreased significantly from baseline to 6hrs post-tPA (282% to 161%, p=0.0024), but delta in FVIII level did not correlate with vessel recanalization (0.01, p=0.95). No patient had sICH. There was no difference between median FVIII level at baseline and 90 days post AIS.

Interpretation:
FVIII level decreased significantly after tPA, but baseline FVIII level and early change in FVIII level were not significant predictors of clot burden, vessel recanalization after treatment with IV tPA, or symptomatic hemorrhage. This trial provided no evidence to support the value of acute FVIII level as a biomarker in AIS due to LVO. The physiology behind the decrease in FVIII level after tPA remains unknown.
Abstract TP137: Robotic Upper Limb Therapy by a Trained Volunteer on an Inpatient Stroke Rehabilitation Unit
Authors: Spinelli Lisa , Trudell Christine , Edelstein Lisa , Reding Mike
Published: June 2021

Introduction:
Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer.

Methods:
The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses.

Results:
A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000.

Conclusions:
Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.
Abstract TP150: Two Weeks of Ischemic Preconditioning Training on the Paretic Leg Improves Leg Strength and Delays Muscle Fatigue in Chronic Stroke
Authors: Durand Matthew J , Murphy Spencer A , Schmit Brian D , Gutterman David D , Hyngstrom Allison S
Published: June 2021

Introduction:
Individuals living with chronic stroke have weakness and increased neuromuscular fatigue in the paretic leg, which can limit walking ability and endurance. In cardiac and healthy populations, ischemic preconditioning (IPC) is a widely studied, effective, non-invasive stimulus which not only improves vascular function, but also motor performance. IPC occurs when the tissue of interest is exposed to repeated, short bouts of ischemia, which can improve motor function by enhancing vascular, neural and muscle function. IPC has not been tested as a method to improve motor function in individuals post-stroke.

Hypothesis:
Two weeks of IPC training on the paretic leg will improve leg strength and time-to-task failure (TTF) during a fatiguing muscle contraction.

Methods:
A feasibility study of 4 individuals (3 female, 1 male) with chronic stroke (20 ± 4 years) was conducted. A Biodex dynamometer was used to assess paretic leg knee extensor maximal voluntary contraction (MVC). To assess muscle fatigability, subjects maintained a sustained contraction equal to 30% of their MVC until failure using visual feedback. After baseline testing, subjects made six visits to the laboratory over a two week period to have IPC performed on their paretic leg. A blood pressure cuff was inflated on the thigh to 225 mmHg for five, five-minute bouts per session. Five minutes of rest was given between inflation cycles. After the last session, subjects returned within 48 hours to have MVC and TTF reassessed.

Results:
Three subjects completed all study procedures. One subject withdrew for medical reasons unrelated to the study. The IPC procedure was well tolerated by all subjects. After two-week IPC training, knee extensor MVC increased in the paretic leg (45.0 ± 2.7 Nm vs. 52.6 ± 5.7 Nm). Fatigability of the muscles was dramatically reduced after IPC training as TTF tripled (359 ± 180 seconds vs. 1097 ± 343 seconds).

Conclusions:
We are the first group to show that IPC is a well-tolerated and effective stimulus to improve paretic leg strength and reduce muscle fatigability in subjects with chronic stroke. The results of this pilot study warrant a larger study to determine whether IPC improves muscle performance post-stroke through neural, vascular, or muscle-related mechanisms.
Abstract TP156: Race, Age and Other Differences in the Perceived Harm of Having a Stroke: The REGARDS Study
Authors: Howard Virginia J , Allen Shauntice , Kleindorfer Dawn O , Aycock Dawn M , Anderson Aaron M , Howard George
Published: June 2021

Background:
Consequences of stroke can be devastating and long-term, impacting physical and mental functioning, quality of life, and other activities of daily living. Based on fear appeal research, perceived harm from having a stroke can be used to motivate people to engage in self-protective behaviors.

Methods:
REGARDS is a national, population-based, longitudinal study of 30,239 blacks and whites ≥ 45 years. The study used a centralized telephone interview and an in-home evaluation for baseline risk assessment with telephone follow-up every six months. Ten years after enrollment, participants underwent a 2
nd
risk factor assessment. As part of a Risk Behavior Diagnosis Scale, participants were asked their level of agreement with the statement “I believe that stroke is extremely harmful.” Data from the 10-year assessment were available on 15,312 participants. Logistic regression was used to examine the association of agreement with the statement by demographics, region, socioeconomic (SES) factors, previous stroke and hypertension.

Results:
Almost 500 (3%; 446/15,312) participants did not agree with the statement that stroke is extremely harmful. In the multivariable model (see table), the odds of blacks agreeing that stroke was harmful was only one-third that of whites. Older participants, those with previous stroke, and those with lower income or education were also much less likely to agree stroke was harmful. There was no significant association by sex, region, or hypertension.

Conclusions:
Despite public health campaigns and active participation in a long term observational study of stroke risk factors, the harmful repercussions from stroke are not perceived similarly for blacks and whites, across SES and age groups, and even in persons who have experienced a stroke compared to those who have not. Fear-based messaging intended to motivate stroke prevention behaviors may not be as effective in these subgroups.
Abstract TP165: Associations Between Parkinson Disease and Stroke
Authors: Kummer Benjamin R , Aaroe Ashley E , Kamel Hooman , Iadecola Costantino , Navi Babak B
Published: June 2021

Introduction:
Cerebral ischemia and vascular risk factors are associated with the development of Alzheimer disease (AD). While Parkinson disease (PD) is also a common neurodegenerative condition, the relationship between ischemic stroke and PD remains unclear. Some evidence suggests a shared pathogenic pathway between both diseases.

Methods:
We used inpatient and outpatient claims data from 2008-2014 in a 5% sample of Medicare beneficiaries ≥66 years of age. Our variables of interest were: 1) a hospital-based diagnosis of ischemic stroke and 2) an outpatient or hospital-based diagnosis of idiopathic PD. Previously validated
ICD-9-CM
code algorithms were used to identify all diagnoses. We used Cox proportional hazards modeling to characterize the relationship between ischemic stroke and PD, while adjusting for demographics and vascular risk factors. We assessed both the association between PD and subsequent stroke, as well as stroke and subsequent PD. In a separate but identically designed set of analyses, we characterized the relationship between ischemic stroke and AD as a point of comparison.

Results:
Our analysis encompassed nearly 1.6 million patients with a mean age of 73(+/- 8) years, of whom 57% were female. The annual incidence of ischemic stroke was 1.75% (95% confidence interval [CI], 1.67-1.85%) after a diagnosis of PD versus 0.96% (95% CI, 0.96-0.97%) in those without PD (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.19-1.32). In contrast, the annual incidence of ischemic stroke was 1.96% (95% CI, 1.89-2.03%) after a diagnosis of AD versus 0.96% (95% CI, 0.96-0.97%) in those without AD (aHR, 0.98; 95% CI, 0.95-1.02). The annual incidence of PD was 0.97% (95% CI, 0.92-1.03%) after ischemic stroke versus 0.39% (95% CI, 0.38-0.39%) in those without ischemic stroke (aHR, 1.62; 95% CI, 1.53-1.72). In contrast, the annual incidence of AD was 3.66% (95% CI, 3.56-3.78%) after a diagnosis of ischemic stroke versus 1.17% (95% CI, 1.16-1.17%) in those without ischemic stroke (aHR, 1.67; 95% CI, 1.61-1.72).

Conclusions:
Among Medicare beneficiaries, the relationships between stroke and PD were similar to those between stroke and AD. As in AD, a link may exist between cerebrovascular disease and PD.
Abstract TP168: A Community Education Program Across a Large Stroke Network Uncovers Disparities
Authors: Bellamy Lisa M , Elkins Kelley L , Richardson Jillian C , Vires-Smith Crystal D , Dobbs Michael R
Published: June 2021

Background and Purpose:
The stroke community outreach program was developed by nurses of a stroke program in 2008, and is now one of many components offered by the stroke care network of 28 affiliate hospitals in Kentucky and West Virginia. The network has compiled data results from educational presentations and education-based stroke risk screenings.

Methods:
All affiliates receive standardized training for community education including three components: education-based risk screenings, high school/adult educational sessions, and a pediatric education program, for children 5-12 years old. The affiliates utilize standard reports to collect and submit data elements after each event. Data was collected for system analysis.

Results:
From 2008 to 2016, 27,916 individuals received stroke education. 19,672 were during education-based risk screenings. 69.1% of screened individuals were females and 50.2% were under the age of 55. 83.1% reported as Caucasian and 9.5% as African American. Individuals self-reported stroke risk factors as follows: prior stroke or TIA (8.1%), hypertension (29.3%), atrial fibrillation (0.8%), high cholesterol (3.3%), and diabetes (1.9%). Objectively 18.7% had elevated blood pressure (≥140-159/90-99) and 22.5% had high elevated blood pressure (≥160/100).

Conclusions:
Self-reported risk factors are incongruent with expectations. We suspect that hyperlipidemia, diabetes and hypertension are under-recognized. A disparity of 11.9% was identified when comparing single readings of blood pressure compared to self-reporting. Great work has been done on stroke prevention; however, the fight goes on and the affiliates continue to diligently provide these free services to the residents in their communities and beyond.
Abstract TP173: Kidney Dysfunction and Silent Brain Infarction in Generally Healthy Adults
Authors: Kwon Hyung-Min , Kim Sang Hyuck , Shin Dong Wook , Yun Jae Moon , Lee Ji Eun , Lim Jae-Sung , Cho Be Long , Park Jin-Ho
Published: June 2021

Purpose:
The association between silent brain infarction (SBI) and estimated glomerular filtration rate (eGFR)-based kidney dysfunction has not yet been definitively confirmed. This study aimed to investigate the association in generally healthy adults without a previous history of stroke or overt kidney disease.

Methods:
A total of 2,594 subjects who underwent brain MRI as part of health screening were included. SBIs were identified using gradient-recalled echo MRI. Kidney dysfunction was defined as eGFR < 60 ml/min/1.73 m
2
.

Results:
The mean age was 56.8 ± 9.3 years, and 1,422 subjects (54.8%) were male. The mean eGFR level was 81.9 ± 15.4 ml/min/1.73 m
2
. The prevalence rates of kidney dysfunction and SBI were 5.1% and 7.1%, respectively. A higher proportion of subjects with SBI had kidney dysfunction than subjects without SBI (14.6% vs. 4.4%). The number of SBI lesions tended to increase with the progression of kidney dysfunction (p for trend < 0.001). In multivariate logistic regression analyses, kidney dysfunction was significantly associated with the presence of SBI (adjusted odd ratio = 1.99 to 2.21 in all four models). The same significant association was consistently identified in subgroup analyses using silent lacunar infarction (adjusted odd ratio = 1.71 to 1.87 in all four models).

Conclusion:
Kidney dysfunction was found to be an independent risk factor for the presence and number of SBI in generally healthy adults. Physicians treating patients with a decreased creatinine-based eGFR level should try to identify and modify the coexisting risk factors ofstroke followed by SBI.
Abstract TP174: Nonfocal Symptoms in Patients With Transient Ischemic Attack: The PROMISE-TIA Registry
Authors: Ishihara Toshiya , Sato Shoichiro , Uehara Toshiyuki , Ohara Tomoyuki , Hayakawa Mikito , Toyoda Kazunori , Minematsu Kazuo ,   PROMISE-TIA Registry Investigators
Published: June 2021

Background and purpose:
Patients with transient ischemic attack (TIA) occasionally accompany nonfocal symptoms, such as decreased consciousness, confusion, amnesia, and unsteadiness. The purpose of this study was to clarify characteristics and prognosis of TIA patients having nonfocal symptoms, using data of the PROspective Multicenter registry to Identify Subsequent cardiovascular Events after TIA (PROMISE-TIA).

Methods:
Patients with TIA within 7 days of onset were consecutively enrolled in the Japanese nationwide registry. Factors associated with nonfocal symptoms and 1-year risk of ischemic stroke and ischemic heart disease were assessed in logistic regression and Kaplan-Meier models, respectively.

Results:
We studied 1348 patients with TIA (871 men, mean age of 69.4±12.4 years). Two hundred and nineteen patients (16%) had nonfocal symptoms. Patients with nonfocal symptoms were more likely to have both diffusion-weighted imaging (DWI)-positive lesions and stenosis/occlusion on vascular examination (magnetic resonance/computed tomographic angiography, or carotid ultrasound) in posterior circulation than those without (11% vs. 4%, p<0.001, 20% vs. 11%, p<0.001), but were otherwise broadly similar with respect to other baseline characteristics. Although 1-year risk of ischemic stroke was not different between the two groups (7.5% vs. 8.2%, p=0.756), the risk of ischemic heart disease was higher in patients with nonfocal symptoms (3.1% vs. 1.2%, p=0.046).

Conclusions:
Both ischemic changes and arterial stenosis/occlusion in posterior circulation were more frequently observed in TIA patients with nonfocal symptoms and they seem to be at high risk of ischemic heart disease.

Clinical Trial Registration:
URL:
http://www.clinicaltraial.gov
. Unique identifier: NCT01581502.
Abstract TP179: Sex Differences in Stroke Risk Factors and Severity at Presentation
Authors: McCaslin Kathryn K , Dula Adrienne , King Ben , Warach Steven
Published: June 2021

Introduction:
While men suffer from more strokes in younger and middle age, the incidence of stroke is higher among women in older age. Specifically, 60% of stroke fatalities occur in females and 40% occur in males. Recent findings have attributed these sex-specific differences to a surge in the prevalence of cardiovascular risk factors among women. Traditionally, men have presented more frequently with micro-vascular complications (hypertension, diabetes, hyperlipidemia, and obesity), but now these risks are increasing in women.

Hypothesis:
Whether the modifiable risk factors examined, both alone and together, will differ in their ability to predict stroke severity across sex.

Methods:
A retrospective analysis of 811 primary stroke cases from two comprehensive and two primary stroke centers in a single region were analyzed for prevalence of modifiable and non-modifiable risk factors. Risk factors such as medical comorbidities, clinical findings and behavioral risk factors were compared across sexes and then assessed for correlation with initial presentation severity and ambulatory status. The relative influence of risk factors on sex differences in stroke severity (NIH Stroke Scale) and symptomatology were tested.

Results:
Females were more likely to present as non-Hispanic, with history of migraines and more severe levels of hypertension, with hypertensive crisis status at presentation relative to normal hypertensive state (all p < 0.05). Males were more likely to present with history of coronary artery disease, documentation of drug or alcohol use, higher fasting blood sugar, A1c, and BMI levels at presentation (all p < 0.05). Multivariate models improved the observed association between female sex and severe NIHSS score (OR = 2.1 [1.03-4.35]) through inclusion of hypertension, fasting blood sugar, and diabetes status.

Conclusions:
While the sex differences in strokes are well studied, the complex interrelationships between sex, variance in known medical risk factors, and severity of stroke presentation are not so well understood. This study identifies new patterns in risk by building independent models for odds of stroke severity for each sex, which may in turn help to explain sex differences in stroke presentation phenotype.
Abstract TP182: Early Sleep Apnea in Acute Ischemic Stroke
Authors: Yoon Cindy W , Park Hee-Kwon , Kim Soo Jeong , Lee Eungseok , Oh Dan A , Lee Sangwon , Park Hae-in , Rha Joung-Ho
Published: June 2021

Background and Purpose:
Sleep apnea (SA) is emerging as a risk factor of stroke, and stroke itself can also influence the sleep. However, investigation of SA in acute ischemic stroke is scanty. We evaluated the prevalence of SA in early stage of stroke and analyzed the SA degree and ischemic stroke subtypes and severity.

Methods:
We prospectively performed overnight polysomnography (PSG) in consecutive acute ischemic stroke patients who were admitted to the stroke unit within 72 hours from onset. PSG was performed on the first night, and severe stroke patients who could not stand the PSG were excluded. The apnea-hypopnea index (AHI) was calculated using the total number of apneas and hypopneas per hour sleep, and categorized into mild (AHI 5-14/hour), moderate (15-29), and severe (≥ 30). Ordinal logistic regression was performed to predict the factor associated with severity of SA (no, mild, moderate and severe).

Results:
From Aug 2015 to March 2016, a total of 141 patients were enrolled: mean age 63.5 ± 13.3 years, 69.5% male, median (IQR) NIHSS 3 (1-6). Among them, 124 (87.9%) patients had SA (AHI ≥ 5/hour) of any degree: 41.1% mild, 21.8% moderate, and 37.1% severe. Higher NIH stroke scale was associated with SA severity (
p
= 0.010). According to the stroke subtype by TOAST classification, cardioembolism was associated with more severe SA (
p
= 0.043).

Conclusion:
SA is frequently found in acute phase of ischemic stroke. Higher degree of SA is associated with severe stroke and cardioembolic etiology.
Abstract TP184: Impact on Ischemic Stroke Subtypes of Fasting and Non-fasting Triglycerides
Authors: Kim Jun Yup , Han Moon-Ku , Lee Kyung Bok , Hong Keun-Sik , Cho Yong-Jin , Park Tai Hwan , Park Sang-Soon , Park Jong-Moo , Kang Kyusik , Lee Soo Joo , Ko Young-Chai , Lee Jun , Cha Jae-Kwan , Kim Dae-Hyun , Lee Byung-Chul , Yu Kyung-Ho , Oh Mi-Sun , Lee Ji Sung , Lee Juneyoung , Bae Hee-Joon
Published: June 2021

Introduction:
Remnant cholesterol, comprising triglycerides(TG)-rich lipoproteins, accumulates in intimal foam cells and causes atherosclerosis. Fasting TG is reported to be associated with atherosclerotic stroke, but relationships between non-fasting TG (NFTG) and ischemic stroke subtypes are unknown. Recently NFTG was found to produce endothelial dysfunction. This study aimed to elucidate the association of fasting and NFTG with ischemic stroke subtypes, especially large-artery atherosclerosis (LAA) and small vessel occlusion (SVO).

Methods:
Using a prospective multicenter stroke registry (Clinical Research Center for Stroke - 5th division), we identified acute ischemic stroke patients, hospitalized within 48 hours of onset, and whose fasting and non-fasting TG values were available. We measured lipid profiles in each individual twice; at presentation and after overnight fasting. Initial TG were regarded as NFTG when measured within 8 hours from last mealtime.

Results:
Total 3,170 patients were analyzed. Stroke subtypes were categorized as LAA (37.9%), SVO (18.7%) and non-LAA and non-SVO (43.4%). Lipid levels according stroke subtypes are presented in Table. Lipid levels were divided by quartiles and the highest quartile was compared to others. In multinomial analyses compared to non-LAA and non-SVO group, fasting TG was associated with LAA (adjusted ORs 1.33 [95% CIs 1.09 - 1.62]) and SVO (1.61 [1.27 - 2.04]). NFTG was associated not with LAA (1.05 [0.87 - 1.28]), but with SVO (1.36 [1.08 - 1.71]). With respect to other lipid levels, fasting and non-fasting LDL were associated with both LAA (1.57 [1.29 - 1.90], fasting; 1.89 [1.56 - 2.29], non-fasting) and SVO (1.40 [1.11 - 1.77], fasting; 1.74 [1.38 - 2.19], non-fasting).

Conclusions:
This study may be the first one to demonstrate an association between non-fasting TG and SVO. It should be explored further on mechanisms of differential effect of fasting and non-fasting TG on ischemic stroke subtypes.
Abstract TP187: Low Sensitivity and High Specificity of Administrative Data for Transient Ischemic Attacks in the Emergency Department
Authors: Yu Amy Y , Quan Hude , McRae Andrew , Wagner Gabrielle O , Coutts Shelagh B , Hill Michael D
Published: June 2021

Introduction:
Accurate surveillance of TIA is important for monitoring disease burden and evaluating temporal trends. Passive surveillance is a time and cost-effective method to identify TIA using administrative data. Although TIA is primarily managed in the emergency department (ED) without admission to hospital, prior administrative data validation studies have mainly evaluated inpatient databases. We determined the validity of the ICD-10 codes to identify TIA in an ED administrative database.

Methods:
The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic. Stroke mimics were actively recruited. Patients enrolled between December 1st 2013 and October 30th 2015 with an ED visit were included in the current study. ED discharge diagnoses were obtained from the National Ambulatory Care Reporting System database. We determined the sensitivity, specificity, and positive predictive value (PPV) of the ICD-10 TIA codes by using two reference standards: 1) the ED chart abstraction and 2) the 90-day final diagnosis, both adjudicated by stroke neurologists. Different case definition algorithms were tested.

Results:
We included 417 patients. ED adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic stroke, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any positions with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Comparing the final 90-day diagnosis with coding showed similar results.

Conclusions:
TIA can be identified with high specificity, but low sensitivity from ED discharge diagnoses. By including patients with stroke mimics, we determined both the false positive and negative rates, allowing for the calculation of sensitivity and specificity. We used two reference standards to verify the accuracy of administrative data. Future studies are necessary to understand the reasons for the low sensitivity of administrative data for TIA and whether the miscoded patients are systematically different from the accurately coded ones.
Abstract TP192: Epidemiological Characteristics and Outcomes of Takayasu’s Arteritis in Acute Ischemic Stroke Hospitalization
Authors: Bhesania Siddharth , Patel Urvish K , Lunagariya Abhishek , Patel Achint , Dave Mihir , Patel Janki , Shah Harshil , Poojary Priti , Saha Aparna , Lavado Liseth , Mehta Parag , Jani Vishal , Qureshi Adnan
Published: June 2021

Background:
Takayasu’s arteritis (TA) is an uncommon disease, characterized by granulomatous vasculitis of medium and large arteries especially aorta and its branches. The incidence of TA is calculated to be 0.26-case/100,000/ year in the USA. Neurological involvement is reported in only a minority of patients and occurrence of neurological syndromes as the first manifestation of the disease has been rarely reported. We are describing epidemiological characteristics of a rare disease.

Methods:
We performed a retrospective cohort analysis of the Nationwide Inpatient Sample (NIS) (years 2000-2011) in adult hospitalizations for AIS to compare the outcomes [Death, All Patient Refined Diagnosis Related Groups (APRDRGs) Risk Mortality (likelihood of dying), Discharge Disposition, APRDRG severity (loss of function)] of patients with TA using ICD-9-CM codes. The APRDRGs are assigned using software developed by 3M Health Information Systems. We also compared their epidemiological characteristics like age, race, gender, preexisting comorbidities, length of stay, and expenditure for treatment. We performed weighted analysis using chi-square and t-test.

Results:
Among 5,223,800 AIS hospitalizations, 274 were diagnosed with TA. Analysis revealed most TA patients were female (90.7%) and younger in age (Mean: 50.3 years), in compare to non-TA. It was more common in white population. With high likelihood of dying, TA cohort had higher percentage of major loss of function in compare to non-TA. AIS with TA were having longer length of stay and higher cost of treatment (Table).

Conclusion:
Even though AIS hospitalizations with TA are relatively rare, further research is needed to determine other associations of TA, as it is a burden on healthcare, which has higher association with disability and higher cost.
Abstract TP194: Past Treatment With Antithrombotic Agents and the Presence of Cerebral Microbleeds in Patients With Acute Ischemic Stroke
Authors: Nakamura Asako , Yasaka Masahiro , Kuwashiro Takahiro , Gotoh Seiji , Takaguchi Go , Nakanishi Yasuyuki , Okada Yasushi
Published: June 2021

Introduction:
The relationship between treatment with antithrombotic agents and the presence of cerebral microbleeds[CMBs] remains unclear. We investigated the relationship between the type of past treatment with antithrombotic agents and the presence of CMBs in acute ischemic stroke patients.

Methods:
A total of 493 acute ischemic stroke patients (mean age 71; 60% male) who had undergone 1.5T gradient-echo T2*-weighted MR imaging after acute ischemic stroke onset were enrolled. The patients were classified into 6 groups according to the type of past treatment with antithrombotic agents: 337 patients with no antithrombotic agent, 58 patients treated with aspirin only, 33 patients with a single antiplatelet agent other than aspirin, 34 patients with aspirin and other antithrombotic agents, 5 patients with antiplatelet agent other than aspirin and other antithrombotic agents and 26 patients with anticoagulant only. The associations between the type of antithrombotic agents and the presence of CMBs were studied using a logistic regression analysis.

Results:
A total of 173(35%) of 493 had CMBs. Of theses, 35(7%) had strictly lobar CMBs and 138(28%) had deep or infratentorial CMBs. The presence of CMBs were significantly associated with age (P<0.001), history of stroke (P<0.001), chronic kidney disease (P<0.001), low LDL-cholesterol (P=0.027), aspirin only (P=0.0006), and aspirin and other antithrombotic agents (P=0.009), but were not associated with antithrombotic agents other than aspirin. The multivariate analysis revealed that aspirin was associated with the presence of CMBs (aspirin: odds ratio 1.99; 95% confidence interval, 1.06-3.74; compared with reference group of no antithrombotic agent), after adjustment for confounders.

Conclusions:
It seems that past treatment with aspirin is associated with the presence of CMBs in acute ischemic stroke patients.
Abstract TP196: Incident Atrial Fibrillation After Ischemic versus Hemorrhagic Stroke
Authors: Witsch Jens , Merkler Alexander E , Gialdini Gino , Navi Babak B , Sheth Kevin N , Kamel Hooman
Published: June 2021

Background:
Atrial fibrillation (AF) is often newly diagnosed during heart-rhythm monitoring after ischemic stroke. It is unclear what proportion of these AF cases represent pre-existing disease and what proportion are triggered by stroke itself. Vascular brain injury that is either ischemic or hemorrhagic may be associated with subsequent AF.

Objective:
To compare the incidence of newly diagnosed AF after ischemic versus hemorrhagic stroke.

Methods:
We performed a retrospective cohort study using inpatient and outpatient claims data from a 5% sample of Medicare beneficiaries. We included all patients hospitalized with ischemic or hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) from 2009-2014. Patients with any AF diagnosis before or during the index stroke hospitalization were excluded. The primary outcome was an incident diagnosis of AF. All variables were defined using previously validated
ICD-9-CM
diagnosis codes. Kaplan-Meier survival statistics were used to calculate cumulative rates of AF. Cox proportional hazards analysis was used to determine the association between stroke subtype and incident AF while adjusting for demographics, vascular risk factors, discharge disposition, and whether any post-discharge heart-rhythm monitoring was performed. We performed sensitivity analyses excluding patients with any post-discharge heart-rhythm monitoring and adjusting for the total number of post-stroke follow-up visits.

Results:
We identified 38,947 patients with ischemic stroke and 5,133 patients with hemorrhagic stroke. By 5 years, the cumulative rate of AF was 23.9% (95% confidence interval [CI], 23.2-24.7%) in patients with ischemic stroke versus 15.5% (95% CI, 13.8-17.3%) in those with hemorrhagic stroke. After adjusting for potentially confounding factors, patients with ischemic stroke were more likely to develop incident AF (hazard ratio, 1.3; 95% CI, 1.1-1.4). This association remained unchanged in our sensitivity analyses.

Conclusions:
New AF diagnoses are common after hemorrhagic stroke but even more common after ischemic stroke. Our findings suggest that AF found on heart-rhythm monitoring after ischemic stroke represents a mix of both pre-existing disease and stroke-induced dysrhythmia.