bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP402: Developing Evidenced Based Practice: A Proposal for an Impairment-Based Rehabilitation Program Using Computerized Therapy
Authors: Brice Smith Ericka
Published: June 2021

Background:
According to the National Aphasic Association (n.d.), about 25-45% of stroke survivors experience aphasia. Treatments for aphasia have several forms focusing on restoring impaired spoken language, written expression, or reading comprehension (American Speech Language Hearing Association, n.d.). Impairment-based therapy (IBT) has demonstrated to be an approach focusing on in-home training using specific linguistic forms which utilize technology (Galletta & Barrett, 2014).

Clinical Question/PICOT:
In adult patients over 18 years of age, who recently experienced a stroke and diagnosed with aphasia, will the use of impairment- based therapy compared to standard treatment provide shorter recovery times from aphasia?

Summary of Evidence:
Eight studies included in the review of the evidence. Six randomized control trials, one meta-analysis, and one case study. Five articles supported evidence reflecting that impairment-based therapy can be useful in stroke recovery for aphasic patients. Two studies focused on the magnitude of impairment-based treatment in the community setting is clinically significant in the promotion of continuous therapy with a clinician. The case study investigated the effects of language therapy in first four months with aphasia. The evidence identified supports the proposal of using IBT with aphasic patients rehabilitation through computerized sessions in the community or home setting.

Results:
When incorporating the ACE Star Model, identifying issues relevant to the language and speech competence of aphasic patients as well as filling gaps in their existing communication therapy is essential. By developing an evidence-based practice (EBP) team comprised of clinicians , executive leaders and healthcare facilities, an evaluation of practice issues relevant to aphasic patients can occur. A pilot for practice change focusing on language and cognitive therapy tasks, a structured, personalized therapy will be provided using the digital application platform, Constant Therapy.

Conclusion:
By assessing preliminary results from the evidence-based project, this can be a benefit to patients with lifestyle intentions to improve cognitive, language and communication disorders associated with aphasia.
Abstract TP405: IV TPA Utilization and Outcomes in Young Stroke Patients
Authors: Cheng Pamela , Zheng Ling , Cen Steven , Nguyen Peggy , Bulic Sebina , Sanossian Nerses , Kim-Tenser May A
Published: June 2021

Objective:
Cerebrovascular disorders are among the top ten causes of death in the pediatric population. The incidence is felt to be 1-2 per 100,000, although this number could be higher due to poor recognition. Our objective is to describe the incidence, tPA utilization, inpatient mortality, length of stay, and cost associated with stroke in pediatric population.

Methods:
Ischemic stroke cases between the ages of 1 and 17 years were obtained from the Nationwide Inpatient Sample (NIS) for the period from January 1, 2000 through December 31, 2014. The primary outcome was inpatient mortality. The secondary outcome was LOS and total cost per day. National trend estimate followed HCUP methodical standard which adopted the design change at 2012 with appropriate trend weight. Weighted estimates were made via SURVEYMEAN procedure and presented as national estimate ± standard error from sampling. SAS9.4 was used for the analysis.

Results:
From January 2000 through December 2014, there were an estimated 12908±1087 pediatric cases with ischemic stroke, 157±28 (1.2%±0.2%) had TPA. Pediatric ischemic stroke patients were predominantly discharged from urban, large-bed-size, teaching hospitals (40.7%±3.9%), more likely to be white (39.3%±1.8%) and male (52.5%±1.2%), most prevalent among those aged 16 years old (10.3%±0.8%). Overall inpatient mortality was 3.0±0.3 per 100 discharges. Median LOS was 4.0±0.1 days. Median total charge per day was $ 8162±348. Majority of pediatric ischemic stroke patients discharged routinely to home or self-care (75.8%±1.2%).

Conclusion:
This study highlights that during the prespecified time frame of four years there was an estimated 12908±1087 ischemic strokes in the pediatric population and less than 2% of children received alteplase. Hospital mortality was 3.0% ± 0.3%. The average length of stay was 4 days with an estimated cost of $8162+/- 348 per day. The majority of pediatric patients were discharged home.
Abstract TP406: Risk of Recurrent Childhood Stroke Differs by Vasculopathy Subtype
Authors: Gatti John R , Sun Lisa R
Published: June 2021

Introduction:
Head and neck vasculopathies are the most frequent identifiable cause of childhood arterial ischemic stroke, and abnormal vascular imaging is associated with higher risk of stroke recurrence. Despite this, little is known about how vasculopathy subtype impacts risk of both initial and recurrent stroke. In this single-center retrospective analysis, we analyze differences in stroke recurrence by vasculopathy subtype.

Methods:
Using ICD codes, we identified children treated for a head or neck vasculopathy at our tertiary care center between 2003 and 2019. Inclusion criteria included imaging-confirmed head or neck vasculopathy diagnosed between the ages of 28 days and 18 years. Retrospective chart review was carried out with attention to vasculopathy subtype and occurrence/recurrence of stroke and TIA.

Results:
Ninety-three patient met inclusion criteria, including 55 who experienced a stroke. Five-year stroke recurrence rates differed significantly by vasculopathy subtype (n=28, p=0.030, Fisher exact test), as patients with moyamoya disease (MMD) and sickle cell, Down syndrome, or neurofibromatosis-related vasculopathy experienced higher recurrence rates. There was a non-significant increased rate of stroke recurrence among patients with secondary versus primary MMD.

Conclusions:
Children with primary and secondary MMD have a higher risk of stroke recurrence than children with other vasculopathy subtypes. Further studies are needed to evaluate the effect of vasculopathy etiology and other radiographic and clinical characteristics on stroke recurrence risk so that appropriate treatment strategies can be implemented early in these high-risk patients.
Abstract TP410: Early Radiographic Recurrence or Extension Predicts Late Clinical Recurrence in Pediatric Acute Ischemic Stroke
Authors: Bonnet Wilmot V , Reisch Joan , Plumb Patricia , Dowling Michael M
Published: June 2021

Introduction:
Pediatric AIS has a high recurrence rate of 10-25%. We observed a high rate of early radiographic recurrence or extension of stroke on repeat MRI performed within 2 weeks of index stroke and hypothesized that early radiographic extension of stroke or recurrent stroke would predict late clinical recurrence.

Methods:
IRB approved retrospective chart review of children ages 1 week to 18 years with AIS in our institutional pediatric stroke database who had repeat MRI within two weeks of initial acute presentation. We collected clinical and demographic data and reviewed f/u MRI studies for the presence of extension, new stroke, and hemorrhage.

Results:
70 patients had early repeat MRI. 23 (33%) had early extension or new stroke on repeat MRI. Of these, 5 (21.7 %) had late clinical recurrence while only 1/47 (2.2%) who did not have early recurrence/extension went on to have late recurrence. 4/70 (5.7 %) had hemorrhagic conversion (only one was symptomatic -headache). Radiographic extension or new stroke on early repeat MRI was significantly associated with late recurrence (p=0.013). Using logistic regression, early extension/recurrence was found to be predictive of late recurrence, (OR 19.5, 95%CI 1.7-228).

Conclusion:
Children with AIS have a high rate of ongoing early, clinically silent, ischemic injury despite anticoagulation or antiplatelet therapy, which is associated with late clinical recurrence. This early imaging finding may serve as a biomarker that might prove useful as an endpoint in clinical trials comparing early antithrombotic therapies or to identify patients at higher risk of subsequent recurrent overt stroke who might benefit from intensified therapy. Given the high rate of early and late recurrence and low hemorrhage rates from current antithrombotic therapies, more aggressive therapy with dual antithrombotic agents should be investigated.
Abstract TP411: Improving Pediatric Stroke Recognition Among Pediatric Health Care Providers
Authors: Babadjouni Robin , Danielpour Kelly , Quintero-Consuegra Miguel , Nisson Peyton , Toscano Juan F , Chang Daniel , Eboli Paula , Gonzalez Nestor R
Published: June 2021

Introduction:
Pediatric acute ischemic stroke (P-AIS) is an under-recognized disease by pediatric healthcare providers, resulting in delay of its diagnosis. In spite of diagnostic tools such as the FAST and BE FAST mnemonics, lack of awareness leads to increased morbidity and mortality. This study aims to elucidate whether a brief educational activity would modify the identification and perception of P-AIS.

Methods:
Forty-nine pediatric healthcare providers were surveyed to assess their baseline skills in recognizing P-AIS. Providers attended a 30-minute activity outlining incidence, natural history, diagnosis, and examples of P-AIS treatment. The mnemonics “FAST” and “BE FAST” as applicable to children were futher expounded. Pre and post-surveys assessed providers’ profession, type of practice, ED service involvement, familiarity with the mnemonics, and P-AIS recognition performance for infants and children.

Results:
The forty-nine pediatric healthcare providers surveyed had the following degrees: 61% MD, 20% NP, 6% RN, 6% student, 4% PA, 2% DO. Futhermore, 78% work in private outpatient enviroments, 17% in academic outpatient institutions, 4% in private outpatient settings, and only 10% had emergency department involvement. Pre-Activity: 53% had heard of “FAST,” and 8% had heard of “BE FAST.” Correct knowledge of individual letters ranged between 12-39%, with the lowest recognition rates for “B” and “E.” At baseline, 65% of providers correctly recognized pediatric and specifically infant stroke cases. Post-Activity: 97% felt familiar with “BE FAST.”. Correct knowledge of individual letters following the educational activity improved to 100%. 95% of providers correctly recognized P-AIS, and 95% correctly identified infant stroke. Univariate logistic analysis showed that completing the training activity was the only significant factor improving the ability to identify P-AIS (OR: 10.35, CI: 2.2 to 48.2). Profession and type of practice were not significant.

Conclusion:
A 30-minute focused educational activity was sufficient to improve the perception and ability to recognize P-AIS among different levels of healthcare providers. The long-term effects of these interventions should be examined.
Abstract TP413: Compliance to Consistent Home Blood Pressure Monitoring Reduces the Risk of Vascular Cognitive Impairment in Stroke Patients
Authors: Deng Wenjun , McMullin David , Fisher Lindsay , Chou Richard , Jacobson Jared , Wang Andrew , Kelley Kaleb , Song Bo , Xu Yuming , Wang Xiaoying , Buonanno Ferdinando , Lo Eng , Xu Shuai , Ning MingMing
Published: June 2021

Background:
Hypertension (HTN) is a well-recognized risk factor for vascular cognitive decline. Poorly controlled HTN is common in the outpatient setting, with multi-factorial components including a lack of consistent, continuous and accurate reporting of blood pressure (BP) to help clinicians to tailor therapy. In the current prospective study, we explore the association of stroke patients’ at-home BP self-monitoring compliance with clinical and imaging risk markers of developing cognitive impairment.

Method:
146 consecutive stroke outpatients with diagnosed HTN were recruited per IRB protocol. All patients received BP education at their first clinical visit and were encouraged to monitor BP at home on a daily basis for two weeks three times during the course of the 5-year study. Compliance with BP monitoring was evaluated by completed BP log and questionnaire in follow-up visits at fixed intervals. At the end of the study, white matter disease (WMD) severity was estimated by Fazekas and Sheltens scores. Cognitive impairment was assessed using Montreal Cognitive Assessment (MoCA) scales.

Result:
Only 16.4% (n=24) patients had “good compliance,” monitoring their home BP regularly and consistently as instructed. The compliant group had better controlled systolic and diastolic BP (Figure A, p<0.05). As measured by Fazekas and Sheltens scales, patients compliant with BP monitoring had lower WMD burden (Figure B, p<0.05), and higher MoCA scores (Figure C, p=0.012) compared to noncompliant patients.

Conclusion:
Compliance with at-home BP monitoring is essential for better BP control in vascular cognitive impairment (VCI) patients post stroke. Consistent home BP monitoring resulted in decreased imaging-apparent small vessel disease and better long-term cognitive performance. Expanded study with a larger patient cohort is ongoing to account for other behavioral and psycho-social factors and to create improved home monitoring technology and treatment strategies.
Abstract TP415: Regular Home Blood Pressure Monitoring Reduces the Risk of Stroke Recurrence
Authors: Deng Wenjun , McMullin David , Fisher Lindsay , Chou Richard , Jacobson Jared , Wang Andrew , Kelley Kaleb , Song Bo , Xu Yuming , Wang Xiaoying , Lo Eng , Buonanno Ferdinando , Xu Shuai , Ning MingMing
Published: June 2021

Background:
High blood pressure (BP) is a well recognized risk factor for ischemic stroke, and aggressive BP control is critical for secondary stroke prevention. However, hypertensive (HTN) outpatients are often found to have uncontrolled BP, in part due to poor compliance with daily at-home BP monitoring and consequent poor medication adherence. Here, we explore the association of patient home BP self-monitoring compliance with stroke recurrence.

Method:
Ischemic stroke patients with pre-existing HTN were prospectively recruited in accordance with IRB protocol for this observational study. All patients were trained on BP self-monitoring as per standard of care, and were asked to monitor BP at home daily consistently for 2 weeks. BP monitoring compliance, per completion of BP log, was assessed at each follow-up clinical visit by an investigator blinded to patient outcome. Stroke recurrence was followed for 5 years and independently adjudicated by two vascular neurologists.

Result:
In a total of 219 patients, only 36 patients (16.4%) were compliant in completing the home BP log as instructed. The compliant and non-compliant groups showed no baseline difference and no medication usage difference (p>0.05) (Table 1). Compliance with at-home BP monitoring was associated with well controlled systolic (p<0.001) and diastolic BP (p<0.001). Of note, 30 patients (16.4%) had recurrent strokes in the non-compliant group, while there were no recurrent strokes in the compliant group. BP self-monitoring compliance is associated with reduced incidence of stroke recurrence (p=0.030) and the significance remains robust after adjusting for multiple confounders (p=0.029) (Table 2).

Conclusion:
Regular home BP monitoring is associated with lower risk of stroke recurrence in HTN stroke patients. Study in expanded patient cohort is ongoing to leverage technology for better home BP monitoring and to create incentives for compliant behavior for better secondary stroke prevention.
Abstract TP425: The Impact of Social Determinants of Health on 1-Month Outcomes Post Aneurysmal Subarachnoid Hemorrhage
Authors: Prescott Drew , Cao Xueyuan , Baughman Brandon , Stanfill Ansley
Published: June 2021

Introduction:
Aneurysmal subarachnoid hemorrhage (aSAH) carries high disability rates. Depression and anxiety are also common for survivors, but little work has been done to investigate the role of social determinants of health (SDOH) on such outcomes. The purpose of this abstract is to examine the impact of SDOH on physical disability, depression, and anxiety at 1-month post-aSAH, in order to better identify factors that are amenable to intervention to improve quality of life for these patients.

Methods:
A retrospective chart review was conducted of aSAH patients (selected by ICD-9/10 code) seen at a high-volume neurology and neurosurgery clinic from 2002-2018. Standard patient demographic and clinical characteristics were collected. The outcomes of physical disability, depression, and anxiety were also collected at 1-month post-aSAH. The studied SDOH characteristics were: race, gender, marital status, employment, smoking, drug/alcohol use, and household income level category (defined as low or middle income per US Census Bureau standards).

Results:
These patients (N=970) were 52.9 (±14.5) years old, 59.5% Caucasian, and 67.4% female. In addition to stroke severity measures (i.e., Hunt/Hess Grade, Fisher, GCS at time of admission), physical disability at 1-month was also associated with female gender, drug abuse, and low household income (
p
≤0.05). Depression at 1-month was not associated with stroke severity measures but was associated with these same SDOH factors and also with unemployment prior to aSAH (
p
<0.0001). Anxiety was not associated with drug abuse or income in this group. Race, marital status, and smoking history were not found to be associated with these 1-month outcomes.

Conclusions:
This work demonstrates that measures of SDOH should be included in addition to clinical variables in a comprehensive predictive model of outcomes post-aSAH.
Abstract TP428: Missed Opportunities for Secondary Stroke Prevention in Embolic Stroke of Undetermined Source Patients in a Community Stroke Unit Setting
Authors: Jones David , Perez Yael , Wagman Hayley , Mehdiratta Manu
Published: June 2021

Recent post-hoc analyses of the NAVIGATE ESUS trial suggested a reduction in stroke recurrence with anticoagulation in a subset of embolic stroke of unknown source (ESUS) patients with left atrial enlargement (LAE>4.6 cm). In addition, the recent COMPASS trial demonstrated that anticoagulation using low-dose factor Xa inhibition reduces ischemic stroke in patients with clinically-apparent coronary artery (CAD) and peripheral artery disease (PAD). Currently, the rates of LAE, CAD and PAD among patients sent for prolonged cardiac monitoring and the impact of earlier screening in a community setting is unknown. We examined the prevalence of LAE and COMPASS eligibility in a prior stroke cohort who underwent prolonged cardiac monitoring (PROCAM) and identified gaps in antithrombotic therapy at the time of discharge. Patients admitted to the stroke unit with a suspected cardioembolic stroke/TIA and completed both 30-day cardiac monitoring and a transthoracic echocardiogram were offered participation in PROCAM within 30 days of stroke onset. A Spiderflash-T ECG or Northeast DR 200 monitoring device programmed for detecting AF was used. The primary outcomes were number of patients with ESUS, AF, LAE and COMPASS eligibility. Antithrombotic therapy at the time of discharge was also assessed. Among 296 patients referred for prolonged cardiac monitoring with a mean (SEM) age of 69 (0.8) and left atrial diameter of 3.6 cm (0.04), 131 patients (44%) were considered to have ESUS at the time of discharge. Among those ESUS patients, 10 patients (7.6%) had moderate to severe LAE (>4.6 cm), comparable rates to those observed in NAVIGATE ESUS. Additionally, 13 ESUS patients (9.9%) met COMPASS eligibility criteria and 16 (12.2%) were found to have AF following 30-day cardiac monitoring. 33 patients with ESUS (25.2%) were found to have either LAE, COMPASS criteria or AF following 30-day cardiac monitoring and were discharged on antiplatelet therapy. In conclusion, this research provides insight into the necessity of comprehensive stroke work-up for heterogeneous ESUS patients, with particular consideration to 30-day cardiac monitoring, LAE and COMPASS criteria, given that 25% of ESUS patients in our community-based cohort may benefit from anticoagulation therapy.
Abstract TP430: A Family/Friend Network Approach to Secondary Stroke Prevention: Findings From the FURRThER Pilot
Authors: Boden Albala Bernadette , O'Connor Joyce , Appleton Noa , Parides Michael
Published: June 2021

Importance:
Despite prevention strategies with proven efficacy, recurrent stroke rates, especially in minority populations, remain high. Mobilizing stroke patients’ social networks on risk reduction goals may optimize secondary prevention efforts. Families/Friends Understanding Risk Reduction Through Educational Reinforcement (FURRThER) is a culturally-tailored, social network-based intervention facilitated by an interactive web portal and targeted at management of vascular risk factors.

Objective/ outcome:
To identify a signal of efficacy for the FURRThER intervention by evaluating changes in participants’ mean systolic blood pressure.

Methods:
Pilot study with pre-post design and 3 month follow-up. Participants are multi-ethnic patients with mild/moderate stroke prospectively enrolled in hospital. Participants (patients and family/friends) were CVD risk assessed (AHA Life’s Simple 7 survey). Family/friends networks’ identified risk reduction goals and worked together to reinforce positive behavior. Participants received follow-up call at 72 hours and via FURRThER web portal/phone weekly for 3 months. Portal communication included messages of encouragement, resources, reminders about selected goals and medical appointments.

Results:
The pilot recruited 13 family/friend networks in hospital (13 patients, 17 family/friends). Patients were 70% male; 61
+
8 yrs; 8% Hispanic, 15% black and 8% Asian. Average BP at baseline was 131/76 mmHg; at follow-up 123/72(p=0.04). Family/friend networks mostly choose to work together on diet and physical activity.. Some goals were network based (e.g., grocery shopping together). Medication adherence was reinforced with all groups. The pilot also identified significantly high unrecognized HTN in 30% of family/friends.

Summary:
FURRThER pilot demonstrated an 8mmHg decrease in SBP in patients. Involving family/friends allowed for the identification of risk factors within networks and for discussion of support/lifestyle modification towards risk reduction. Family/friend groups reported they continued to engage in lifestyle changes agreed upon in the goal setting session. A multisite, phase 2b/3A trial is needed to demonstrate efficacy.
Abstract TP431: Association of Systolic Blood Pressure and Cardiovascularrisk According to Hemoglobin Concentration
Authors: Chang Jun Young , Jang Se Young , Kwon Sun-uck
Published: June 2021

Introduction:
We evaluated whether the optimal cutoff of blood pressure to reduce cardiovascular risk is different according to hemoglobin (Hb) concentration and its changing pattern using the National Health Insurance Service-Health Screening Cohort.

Methods:
The study population consisted of individuals who underwent both 2002-2003 and 2004-2005 health examinations. Individuals who were diagnosed with cardiovascular disease or who died before index date of 1 January 2006 were excluded. The primary outcome of the study was the association between systolic blood pressure (SBP) and MACE (composite of myocardial infarction, stroke, and cardiovascular death) according to Hb concentration. Hazard ratios (HR) were calculated using Cox regression analysis adjusted for age and sex.

Results:
A total of 290573 were included in the analysis. During the follow up period from 1 January 2006 to 31 December 2013, a total of 18292 experienced MACE. There was a significant interaction between SBP and Hb concentration with regard to cardiovascular diseases (p for interaction= 0.07). Among the subjects with Hb <10, a significant increment of MACE was observed when SBP ≥140 mmHg. HR for MACE increased when SBP ≥130mmHg among the subjects with 10≤ Hb <11 and 11≤ Hb <12. HR for MACE increased when SBP ≥ 120 mmHg among the subjects with 12≤ Hb <13, 13≤ Hb <15, and 15≤ Hb. Cardiovascular risk was the lowest in SBP below 120mmHg and cut off value for increasing cardiovascular risk was 120 mmHg or above in subjects who maintain normal range of hemoglobin level and whose hemoglobin concentration changed from anemia to normal range. However, individuals who maintain anemic state and whose hemoglobin concentration changed from normal range to anemia, SBP threshold for increasing cardiovascular risk was equal or above 130 mmHg .

Conclusion:
The threshold of SBP which increases cardiovascular risk may be different according to the hemoglobin concentration and change pattern of hemoglobin.
Abstract TP440: Effect of Smoking Habit on and Cardiovascular Disease Among Patients With Newly Diagnosed Dyslipidemia Patients in Korea
Authors: Ko Ahryoung , Choi Seulggie , Park Sang Min
Published: June 2021

Introduction:
This study aimed to investigate the effects of smoking habit pattern on the risks of all-cause mortality and cardiovascular diseases (CVDs) among patients with newly diagnosed dyslipidemia using the Korean National Sample Cohort data.

Methods:
The study population consisted of 32,639 newly diagnosed dyslipidemia male patients from the Korean National Health Insurance Service – Health Screening Cohort during 2003-2012. Afterwards, the participants were followed-up until 31 December 2015 for cardiovascular disease event (CVD). Dyslipidemia was defined as those who were prescribed statin medication under the International Classification of Disease, Tenth Revision (ICD-10) codes for dyslipidemia (E78). CVD was composed to coronary heart disease (CHD, ICD-10 codes I20-25) and total stroke (ICD-10 codes I60-69). Cox proportional hazards regression analysis was used to determine the risk of developing CVD according to smoking habit change before and after diagnosis of dyslipidemia.

Results:
Quitters (adjusted hazard ratio [aHR], 0.82; 95% confidence interval [CI], 0.68–0.99) , sustained ex-smokers (aHR 0.71, 95% CI 0.62-0.82) and never smokers (aHR 0.70, 95% CI 0.62-0.80) showed reduced risk of CVD compared with continual smokers. Quitters also tended to have reduced risk for CHD (aHR 0.83, 95% CI 0.66-1.05) and acute myocardial infarction (aHR 0.68, 95% CI 0.44-1.05) compared to continual smokers. Finally, compared to continual smokers, those who quit after dyslipidemia diagnosis tended to have reduced risk for total stroke (aHR 0.84, 95% CI 0.64-1.11).Our study suggested smoking reduction after dyslipidemia diagnosis may have potential positive effects and have definite benefits on the health outcomes.

Conclusion:
Smoking cessation after dyslipidemia diagnosis could reduce the risks of cardiovascular disease among patients with newly diagnosed dyslipidemia. Therefore, physicians should advice patients with newly diagnosed dyslipidemia on the importance of smoking cessation in order to reducing risk for CVD.
Abstract TP444: New Ischemic Lesions on Brain MRI in Patients With Blunt Traumatic Cerebrovascular Injury
Authors: Harrigan Mark , Griffin Russell , Deveikis John , Prattipati Veeranjaneyulu , Chimowitz Marc , Jansen Jan
Published: June 2021

Introduction:
Patients admitted after high energy blunt trauma with extracranial cerebrovascular injuries on screening neck computed tomography angiography (CTA) represent a unique group of patients at risk of thromboembolic stroke. These arterial dissections account for >1,000 ischemic strokes in the United States per year. Although stroke prophylaxis with antithrombotics is widely used in this setting, the risk of ischemic brain injury is unknown.

Methods:
This prospective observational study included 20 adult blunt trauma patients admitted with a screening CTA showing extracranial carotid or vertebral artery injury. All subjects had no initial clinical evidence of ischemic stroke, were managed with antiplatelets and observation and had brain magnetic resonance imaging (MRI) within 14 days of admission. The MRIs included diffusion, susceptibility, and FLAIR sequences to distinguish acute ischemic lesions from contusions and chronic infarctions and were read by two neuroradiologists blind to the findings of the neck CTA. A negative binomial regression adjusted for age and Injury Severity Score (ISS) was used to assess association between artery injury and lesion counts.

Results:
There were 12 carotid injuries and 11 unilateral or bilateral vertebral artery injuries. Mean interval between injury and MRI scan was 6.9 days. New ischemic lesions in the territory of the affected artery were present in 10 (43%) of the injured artery territories. The mean number of ischemic lesions was 7.8 (range 2-25), which was higher for territories with artery injury (mean=3.17) than those without injury (mean=0.14). None of the lesions were symptomatic. Adjusted for age and ISS, those with artery injury had a 23-fold higher average count of lesions (p=0.0004). In a sensitivity analysis excluding lesion counts >1.5 standard deviation units, the association remained 11-fold higher count for artery injury (p=0.0107).

Conclusions:
In blunt trauma patients with CTA evidence of extracranial cerebrovascular injury and treated with antiplatelets, >40% of arterial injuries are associated with ischemic lesions on MRI. Ischemic lesions on MRI may be a useful endpoint for future clinical trials of antithrombotic strategies in patients with blunt cerebrovascular injury.
Abstract TP450: Characteristics and Disability Outcomes of Left Ventricular-Assist Device Associated Cerebrovascular Events in Setting of Infectious Intracranial Aneurysms: A Retrospective Single Center Study
Authors: Panchal Shyam , Garg Tanu , Nisar Tariq , McCane Charles D , Jason Lee , David Chiu , Gadhia Rajan
Published: June 2021

Introduction:
Stroke and infection are among the more common complications of LVAD therapy related to higher rates of mortality. The characteristics and disability outcomes of LVAD-associated cerebrovascular events and infections, particularly in the setting of infectious intracranial aneurysms (IIA), have not been defined.

Methods:
A single-center retrospective review of patients having undergone LVAD implantation between 2011-2017 was conducted using institutional registries and screened for hemorrhagic and ischemic strokes. Patients with hemorrhagic stroke were assessed for concurrent bacteremia; neurovascular imaging was then used to isolate patients with associated IIA. Review of comorbidities, imaging characteristics, and management were performed to determine predictors of disability outcomes, as defined by 90-day modified Rankin scales (mRS).

Results:
Of 383 patients with HeartMate II LVAD implantation, 46 all-cause stroke events were identified across 38 (12%) patients. 31 ICH events were identified, with 22 complicated by bacteremia (evidenced by chronic driveline infection and/or positive blood cultures on admission). Of patients with ICH and bacteremia, Staphylococcus aureus (n=12, 54.5%) and Pseudomonas aeruginosa (n= 10, 45.5%) infection were the highest associated causal organisms; severe disability or death (90-day mRS
>
4) was seen in 16 (72.7%) patients. 7 (31.8 %) patients had confirmed findings of IIA on diagnostic cerebral angiogram, and were associated with distal MCA territory involvement (100%), concurrent Pseudomonas infection (83.3%), and INR > 3.0 (66.7%). Despite endovascular intervention in patients with IIA, 4 patients failed management and were withdrawn from care.

Conclusion:
Our results indicate Pseudomonas aeruginosa and Staphylococcus aureus bacteremia are associated with greater incidence of hemorrhage and neurological disability. Further investigation is warranted to better define management of these patients. Future considerations may include pre-implantation cerebrovascular imaging to assess for vascular pathology as a screen for higher risk patients, as well as more aggressive antibiotic therapy at bacteremia onset.
Abstract TP458: High Accuracy of Predictive Models for SAH Using Different Machine Learning Approaches
Authors: Litvak Paul , Medikonda Jeevan , Menon Girish , Mandava Pitchaiah
Published: June 2021

Background:
Patients suffering from subarachnoid hemorrhage (SAH) have poor long-term outcomes. There are predictive models for ischemic and hemorrhagic stroke. However, there is paucity of models for SAH. Machine learning concepts were applied to build multi-stage Neural Networks (NN), Support Vector Machines (SVM) and Keras/Tensor Flow models to predict SAH outcomes.

Methods:
A database of ~800 aneurysmal SAH patients from Kasturba Medical College was utilized. Baseline variables of World Federation of Neurosurgeons 5-point scale (WFNS 1-5), age, gender, and presence/absence of hypertension and diabetes were considered in Stage 1. Stage 2 included all Stage 1 variables along with presence/absence of radiologic signs vasospasm and ischemia. Stage 3 includes earlier 2 stages and discharge Glasgow Outcome Scale (GOS 1-5). GOS at 3 months was predicted using 2-layer NN/SVM/Keras-TensorFlow models on the five point categorical scale as well as dichotomized to dead/alive and favorable (GOS 4-5) or unfavorable (GOS 1-3). Prediction accuracy of models was compared to the recorded GOS.

Results:
Prediction accuracy shown as percentages (See Table) for all three stages was similar for SVM, NN and Keras/TensorFlow models. Accuracy was remarkably higher with dichotomization compared to the complete five point GOS categorical scale.

Conclusions:
SVM, NN, and Keras-TensorFlow based machine learning models can be used to predict SAH outcomes to a high degree of accuracy. These powerful predictive models can be used to prognosticate and select patients into trials.
Abstract TP459: Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Cerebral Venous Thrombosis
Authors: Liu Kai , Li Shen , Song Bo , Xu Yu
Published: June 2021

Background:
Increasing evidences suggest that neutrophil-to- lymphocyte ratio (NLR) is an independent predictor of poor prognosis in patients with cardiovascular disease. However, it is not clear about the relationship between NLR and prognosis in patients with cerebral venous thrombosis (CVT).

Methods:
Consecutive CVT patients from November 2011, through January 2017 were retrospectively identified. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 3-6. Multivariate analysis and Cox regression analysis were conducted to evaluate the predictive value of NLR for unfavorable prognosis.

Results:
A total of 223 CVT patients were included. Multivariate analysis suggested that elevated NLR value, as a continuous variable, was significantly associated with a high risk of poor outcome (adjusted odds ratio [OR]=1.106, 95% confidence intervals [CI] 1.012-1.207,
P
= 0.025) and mortality (adjusted OR = 1.118; 95% CI, 1.017-1.230;
P
= 0.021).Receiver operating curve (ROC) analysis showed that the area under the ROC curves for NLR was 0.753 and the optimal cut-off value was 4.8 (sensitivity 81.1%, specificity 62.4%).Multivariate Cox regression analysis demonstrated that NLR>4.8 increased the risk of mortality (adjusted hazard ratio[HR]=6.111, 95% CI 1.680-22.232,
P
=0.006) and multivariate analysis further showed that NLR>4.8 was a significant predictor of poor functional outcome (adjusted OR=3.607, 95% CI 1.307-9.957,
P
=0.013).

Conclusions:
Elevated NLR value is associated with the long-term poor functional outcome and mortality. Future well-designed studies and experiments are needed to confirm the relationship and explore the potential mechanisms. Table 1 Results of multivariate logistic regression analysis ofpredictors for poor clinical outcome in CVTpatients. WBC,white blood cell; ANC, absolute neutrophil count; ALC, absolute lymphocyte count; *The multivariate model is adjusted for age, sex, coma, intracerebral hemorrhage, and straight sinus and/or deep CVT Figure 1. Kaplan-Meier curves of patients stratified according to the NLR value. The Kaplan-Meier curves showed a significant difference between the NLR>4.8 and NLR≤4.8 categories.
Abstract TP461: Screening CT Angiography to Identify Patients at Low Risk for Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage
Authors: Nguyen Andrew , Williamson Craig A , Pandey Aditya S , Sheehan Kyle M , Rajajee Venkatakrishna
Published: June 2021

Introduction:
Delayed Cerebral Ischemia (DCI) occurs during a risk period of 3-21 days following aneurysmal subarachnoid hemorrhage (aSAH) and is associated with worse outcomes. The identification of patients at low risk for DCI might permit triage to less intense monitoring and management. While large-vessel vasospasm (LVV) is a distinct clinical entity from DCI, the presence of moderate-severe LVV is associated with a higher risk of DCI.

Hypothesis:
The absence of moderate-severe LVV on screening CT angiography (CTA) performed within the first few days of the DCI risk period will accurately identify patients at low risk for subsequent DCI.

Methods:
Our institutional SAH outcomes registry was queried for all aSAH patients admitted 2016 - 2019 who underwent CTA brain between days 4-8 following ictus. We excluded patients who suffered DCI prior to this CTA study. All variables are prospectively entered into the registry, and outcomes including DCI and LVV are prospectively adjudicated. We evaluated the accuracy of moderate-severe LVV on CTA performed 4-8 days from ictus for the prediction of subsequent DCI, with a focus on the Negative Predictive Value (NPV).

Results:
A total of 243 aSAH patients were admitted during the study timeframe and 76 (31%) underwent CTA during the 4-8 day window following ictus. Of these, 22 were excluded for occurrence of DCI prior to the CTA study. Of 54 patients meeting eligibility criteria, 11 (20%) had moderate-severe LVV on the screening CTA study performed during the risk period. Seven of 11 (64%) patients with moderate-severe LVV on the day 4-8 screening CTA, vs 6 of 43 (14%) patients without, subsequently developed DCI. The NPV of CTA performed during days 4-8 for the subsequent development of DCI was 86% (95%CI 77-92%). Sensitivity was 54% (25-81%), Specificity 90% (77-97%) and Positive Predictive Value 64% (38-83%).

Conclusions:
The NPV of screening CTA performed between days 4-8 following SAH for the subsequent development of DCI was moderate, at 86%. The population studied likely represents a high-risk cohort, however, prospective studies of alternate risk-stratification strategies are necessary.
Abstract TP466: Apolipoprotein L1 Gene Risk Variants Are Not Associated With Increased Volume of Brain Lesions
Authors: Hoversten Knut , Reddy Vivek , Majersik Jennifer , de Havenon Adam
Published: June 2021

Background:
There are conflicting data regarding the association between apolipoprotein L1 gene (APOL1) risk variants and cardiovascular disease. Some data suggest a protective effect of APOL1 variants on subclinical atherosclerosis, despite an increase in the risk of kidney disease in African American patients. We sought to further explore this potentially paradoxical association.

Methods:
This is a secondary analysis of Systolic Blood Pressure Intervention Trial (SPRINT). We included African American patients who had APOL1 renal-risk variants genotyped. The primary outcome is volumetric measurements of lesions in four brain components: white matter (WM), gray matter (GM), basal ganglia (BG), and total brain (TB). The primary predictor is APOL1 risk genotype. We fit linear regression models to the primary outcomes and adjusted for age, sex, cigarette smoking, diabetes, hypertension, African ancestry admixture, and total brain volume.

Results:
We included 215 patients, with a mean (SD) age of 65.0 (7.8) years. The number of patients with 0, 1, and 2 APOL1 variants was 86, 105, and 24. The mean values for the volumetric measurements are seen in Table 1, which were not statistically different. The adjusted regression models did not show a significant relationship between APOL1 status and white matter lesions (β coef -0.36, 95% CI -1.20-0.48, p=0.398), gray matter lesions (β coef -0.002, 95% CI -0.07-0.07, p=0.945), basal ganglia lesions (β coef -0.01, 95% CI -0.03-0.02, p=0.542), or total brain lesions (β coef -0.36, 95% CI -1.21-0.49, p=0.403).

Conclusion:
There is no association between APOL1 risk variants and brain lesions in African American patients. These data support prior studies that found no relationship between APOL1 and chronic microvascular disease or brain volume. Despite these findings, further research would be needed to fully disprove an association, given conflicting reports in the literature and the smaller sample size of this study.
Abstract TP467: Effects of the Tortuosity of the Cervical Internal Carotid Artery on Procedural Outcomes of Stent Placement
Authors: Akhtar Iqra N , Hyder Raza S , Balasetti Vamshi , Kumar Nitish , Kraus Jacqueline J , Gomez Camilo R , Qureshi Adnan I
Published: June 2021

Introduction:
Severe tortuosity of the cervical internal carotid artery distal to the stenosis may prevent successful placement of distal protection device and increase the risk of dissection and/or ischemic stroke.

Objective:
To assess and categorize the effects of tortuosity of the cervical internal carotid artery distal on procedural times, and peri-procedural complications in patients treated with carotid artery stent placement.

Material and Methods:
We analyzed the angiographic images and clinical data for a consecutive series of patients treated with stent placement over an 18-month period and graded the tortuosity as follows: Grade 0 is no vessel turns; Grade 1 (MILD) is 1 vessel turn, >90 degrees; Grade 2 (MODERATE) is 1 vessel turn, ≤90 degrees; Grade 3 (SEVERE) is 2 vessel turns, any angle; Grade 4 (SEVERE) is two vessel segments which are parallel to due to interspersed loop; Grade 5 (SEVERE) is a complete vessel loop (360 degrees). Technical complications including unsuccessful attempts to cross the stenosis with interventional devices, unutilized distal embolic protection, iatrogenic dissection, and ischemic events were ascertained.

Results:
A total of 80 patients were identified who underwent stent placement; mean (SD) 67.4 (8), 60 (75%) were men. Forty-three patients (53.8%) had evidence of stroke on non-invasive imaging prior to stent placement. In sixty-five cases, stent placement was performed electively (81.3%), emergently in fifteen cases (18.8%). The tortuosity was graded as 1 (46.2%), 2 (11.3%), 3 (15%), 4 (6.3%), and 5 (2.5%). Of the 80 patients, eighteen (22.5%) had severe tortuosity of grade 3 or higher. Mean procedural time (SD) was significantly greater with severe vessel tortuosity compared to mild to moderate vessel tortuosity (51.6 (6.2) versus 42.3 (5.2) minutes, p=.042). Technical complication rates were not significantly different with severe vessel tortuosity compared with mild to moderate vessel tortuosity (7% vs 9% p=.53). One intra-procedural dissection occurred in a case of severe tortuosity (grade 5).

Conclusions:
Severely tortuous internal carotid arteries distal to the stenosis can be seen in one fifth of patients undergoing carotid stent placement and is associated with increased procedural times.
Abstract TP47: Mitral Regurgitation Might Prevent the Neurological Recovery After Endovascular Thrombectomy in Patients With Atrial Fibrillation
Authors: Aoki Junya , Kimura Ryutaro , Numao Shinichiro , Sawada Kazutaka , Katano Takehiro , Sakamoto Yuki , Suzuki Kentaro , Kanamaru Takuya , Suda Satoshi , Nishiyama Yasuhiro , Kimura Kazumi
Published: June 2021

Hypothesis:
Some of hyperacute stroke patients had unfavorable outcome even when the occlusive artery was successfully opened. We hypothesized that moderate-to-sever mitral regurgitation (significant MR) might inhibit cerebral reperfusion, and thus decrease the rate of good clinical outcome after endovascular thrombectomy (EVT) in patients with atrial fibrillation (AF).

Method:
From our prospective EVT registry, patients received transthoracic echocardiography (TTE), were retrospectively analyzed. Only patients with AF were included. Based on the presence of the moderate-to-sever MR, all patient were divided into group with and without significant MR (MR group, and non-MR group). Clinical background, laboratory findings, and TTE parameters were compared between the 2 groups. Favorable outcome was defined as mRS 0-1 at 3 months.

Result:
From 2014 September to 2018 December, 316 patients treated with EVT, and 246 received TTE. Among them, data on 127 patients with AF were analyzed. TTE found 25 (20%) patients had significant MR. Patients in MR group were older (p=0.05) and had higher plasma level of brain natriuretic peptide (p=0.05). NIHSS, DWI-APSECTS, TICI ≥2b reperfusion, onset-to-reperfusion time, ICA occlusion (p=0.96, 0.26, 0.52, 0.33, and 0.80) were similar between the 2 groups. Regarding TTE parameters, although ejection fraction was similar (p=0.28), left atrial area (p=0.02), right atrial area (p<0.01), and tricuspid regurgitation area (p<0.01) were elevated in the MR group. At 3 months, favorable outcome was seen in only 9% in the MR group, while 26% had it in the non-MR group (p=0.04), Group with favorable outcome had higher rate of TICI ≥2b reperfusion (p=0.04), lower NIHSS score (p=0.04), however, above mentioned TTE parameter except significant MR, were not associated favorable outcome. When we conduct multivariate regression analysis, moderate-to-sever MR the negative independent parameter of favorable outcome (odds ratio 0.17, 95%CI [0.03-0.89], p=0.04).

Conclusion:
The presence significant MR was related to the unfavorable outcome independent of the neurological symptom and reperfusion status on cerebral angiography.MR might prevent the clinical recovery in patients with atrial fibrillation.
Abstract TP472: The Interplay Between Subclinical Micro- and Macro-Vascular Disease in Asymptomatic Individuals
Authors: Yetim Ezgi , Arsava Ethem M , Oguz Kader K , Topcuoglu Mehmet A
Published: June 2021

Introduction:
Pathophysiological changes within large arteries, among many other factors, are considered to contribute to cerebral small vessel disease. Craniocervical sonography is a valuable tool in this regard to evaluate various physiological metrics of extra- and intra-cranial large arteries. Herein, we tried to evaluate the interplay between markers of small vessel disease, and internal carotid (ICA) and middle cerebral artery (MCA) pulsatility, carotid distensibility and intima media thickness (IMT).

Methods:
We prospectively evaluated a total of 278 subjects without any prior history of stroke using transcranial and cervical Doppler ultrasound, and magnetic resonance imaging. Pulsatility index was determined by Gosling’s index from bilateral MCA’s and ICA’s. We also measured carotid distensibility and IMT (by AutoIMT
TM
) from both carotids and calculated their mean values. The relationship of all these sonographic metrics with imaging markers of chronic small vessel disease [lacunes, microbleeds, perivascular spaces (PVS), white matter hyperintensities (WMH)] were evaluated in multivariate models where age and cardiovascular risk factors were included as additional covariates.

Results:
The study population consisted of 108 males and 170 females with a mean±SD age of 64±9 years. In bivariate analyses, higher carotid IMT, higher MCA and ICA pulsatility indices, and lower carotid distensibility were significantly associated with high burden of WMH (Fazekas score of ≥2), basal ganglia PVS (PVS score ≥2) and presence of lacunes, but not with microbleeds or centrum semiovale PVS. In multivariate models, each 0.1 mm change in IMT increased the odds of severe WHM by 1.4 (95%CI 1.0-1.9), severe basal ganglia PVS by 1.4 (1.0-1.8) and lacunes by 1.6 (1.0-2.6), while no significant association remained for pulsatility index or distensibility.

Conclusion:
Our analyses highlight that IMT, is not only a subclinical marker of atherosclerosis, but also emerges as a factor intimately related with cerebral small vessel disease. These findings raise the possibility that IMT and cerebral small vessel disease might together reflect downstream events that culminate in vascular disease involving the large and small vessels of the brain.