bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P627: Sleep Apnea Risk is Independently Associated With Functional Outcome After Stroke
Authors: Oliveira Alice S , Dantas Moises C , Jesus Pedro Antonio A , Farias Daniel S , Almeida Bruno M , Santos Caio S , Blumetti Camila R , Faria Carolina D , Costa Caroline C , Fernandes Daniela P , Fonseca Gabriela Q , Oliveira Isabelle Jacqueline Weber Oliveira J , Oliveira Isabelle Jacqueline Weber Oliveira J , Oliveira Isabelle J , Pinto Joao P , Oliveira-filho Jamary
Published: March 2021

Introduction:
Obstructive sleep apnea (OSA) is highly prevalent after stroke and associated with stroke recurrence. Several clinical scales have been used to predict OSA, but their relevance for functional outcomes are unknown.

Objective:
We aimed to determine if a sleep apnea risk score is associated with functional outcome in stroke patients.

Methods:
Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale (NIHSS) to quantify stroke severity and STOP-BANG questionnaire to quantify risk of OSA on admission (0 to 8, higher scores indicating higher risk). Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6.

Results:
We recruited 382 patients with ischemic stroke between October, 2018 and November, 2019, mean age 64 +/- 13 years, 189 (49.5%) female, median NIHSS 8 (interquartile range - IQR - 6 to 14) and median STOP-BANG score 5 (IQR 4 to 5). After 90 days, 216 (56.5%) had poor outcomes. Median STOP-BANG score was higher in patients with poor, when compared to good outcomes (4 vs 3, respectively, p=0.001). In multivariable logistic regression, STOP-BANG score was independently associated with poor outcome (odds ratio 1.56, 95% confidence interval 1.02 to 2.63, p=0.003), after adjustment for age, sex, NIHSS, cerebrovascular risk factors and stroke etiology. When STOP-BANG score was stratified by OSA risk, patients with mild, moderate and high OSA risk reached poor outcomes in 38.2%, 58.7% and 62.1%, respectively (p=0.004).

Conclusions:
A simple sleep apnea risk score (STOP-BANG) is independently associated with poor functional outcome in ischemic stroke patients.
Abstract P629: Genome-Wide Association Study of Individuals of Native Hawaiian Ancestry Reveals Unique Genetic Risk Factors for Stroke and Myocardial Infarction
Authors: Brown Stacy C , Both Cameron , Acosta Julian N , Szejko Natalia , Torres Victor , Leasure Audrey C , Nakagawa Kazuma , Gerschenson Mariana , Seto Todd B , Sheth Kevin N , Falcone Guido J
Published: March 2021

Background:
Several genetic susceptibility risk loci for ischemic stroke have been identified. However, the relative dearth of genetic data from populations of non-European ancestry has the potential to create disparities in access to genomics-based precision medicine strategies. Individuals of Native Hawaiian ancestry represent a particularly understudied group in stroke genomics research despite facing high rates of cerebrovascular disease.

Hypothesis:
Genetic variants associated with stroke differ between Native Hawaiians and previously studied groups of predominantly European ancestry.

Methods:
We conducted a genome-wide (GW) association study of stroke and myocardial infarction (MI) in an adult population of Native Hawaiian ancestry, using data from the Multiethnic Cohort study (MEC). Genetic information was ascertained via genome-wide array genotyping using the AB OpenArray and TaqMan platforms followed by imputation to 1000 Genomes reference panels. We pursued replication of variants that were GW significant (p<5x10
-8
) or yielded suggestive associations (p<5x10
-7
) in the prior stroke GW association study MEGASTROKE.

Results:
We identified 2,104 individuals (1,089 [51.8%] female) of Native Hawaiian ancestry, including 173 cases and 1,931 controls. We identified one novel susceptibility risk locus at a narrow intronic region located at chromosome q26.2 (top associated SNP 3:169096251, OR 2.48, 95%CI 1.81-3.41; p=1.93x10
-8
), overlying the
MECOM
gene. We also identified 9 other suggestive risk loci at p<5x10
-7
. When replicating in MEGASTROKE, q26.2 did not have available counterpart variants to analyze, and 3 out of 9 suggestive signals were associated with ischemic stroke subtypes at p<0.05.

Conclusions:
We report the first GW association study of ischemic stroke and myocardial infarction in a Native Hawaiian population. We identified one susceptibility risk locus at q26.2, located in a narrow intronic region of
MECOM,
a gene that codes for a histone-lysine N-methyltransferase that has transcriptional regulation and oncoprotein functions. The lack of available replication data for this locus in the large MEGASTROKE collaboration emphasizes the importance of developing genomic resources across ancestral groups.
Abstract P64: Longitudinal Brain Structural Changes After Stroke
Authors: Kern Kyle C , Wright Clinton B , Leigh Richard
Published: March 2021

Background:
Stroke causes focal and diffuse structural brain changes that may contribute to subsequent cognitive decline and dementia. We hypothesize that MRI structural measures can detect continued cerebral degeneration over the first year after stroke. We identify predictors for progression of brain atrophy, leukoaraiosis and diffusion tensor imaging (DTI) metrics.

Methods:
Patients with ischemic stroke were enrolled prospectively in an observational study that included serial brain MRI. Patients underwent MRI FLAIR and DTI at the time of acute stroke and were followed for at least 9 months with multiple MRIs between 30 days and 15 months post-stroke. We used FLAIR to measure brain atrophy as the percent brain parenchymal fraction (BPF) of the total intracranial volume (TICV) and white matter hyperintensity volume (WMHV) as a percentage of TICV. DTI was used to calculate Peak Skeletonized Mean Diffusivity (PSMD), a global measure of white matter integrity previously validated in cerebral small vessel disease. Longitudinal changes in BPF, WMHV or PSMD were measured from 30 days post-stroke onward using linear regression models that included age, stroke volume, baseline BPF and WMHV as predictors.

Results:
Twenty-six patients had a median of 4 follow-ups over 9-15 months. Median age was 74 years (range 51-84) and 38% were women. Mean stroke volume was 4.5cc (0 - 30cc). Mean BPF was 78% (72 - 86%) and mean baseline WMHV was 1.1% (0.1 - 3.9%). BPF was associated with age and declined by 0.7% per year (t(111) = 2.7, p = 0.007). Progression was associated with baseline BPF (t(111) = -3.4, p < 0.001). WMHV in the non-stroke hemisphere was associated with age and increased by 0.10% per year (t(87) = -5.8, p < 0.001). Accumulation was associated with age (t(87) = 5.8, p < 0.001). PSMD was associated with baseline WMHV and had a relative increase of 1.9% per year in the non-stroke hemisphere and 4.5% in the stroke hemisphere (t(174) = -2.1, p = 0.03). Progression was associated with age (t(174) = 2.3, p = 0.03) and stroke volume (t(174) = 2.4, p = 0.02).

Conclusions:
During the months after ischemic stroke, BPF, WMHV and PSMD can detect persistent structural changes that may reflect later phases of stroke injury or ongoing contributions of aging, silent ischemia, or neurodegeneration.
Abstract P645: Sex Differences in the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial
Authors: Meyer Dawn M , Ranasinghe Tamra , Torres Dolores , Bavarsad Shahripour Reza , Figurelle Morgan , Dunsiger Shira
Published: March 2021

Introduction:
Sex differences have been noted in stroke and estrogen is associated with decreased platelet aggregation. The purpose of this study was to assess sex differences in the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) study.

Methods:
We performed a secondary analysis of the POINT study. Patients were analyzed by intention to treat group: 1) Males, standard (n=1351) aspirin; 2) Males, intervention (n=1335) clopidogrel+aspirin; 3) Females; standard (n=1098) aspirin; and 4) Females, intervention (n=1097) clopidogrel+aspirin. Groups were compared for baseline demographics via ANOVA followed by Mann Whitney U. A Cox Proportional Hazards Model was used to assess the primary safety and efficacy outcomes.

Results:
Baseline characteristics were significantly different only for race (p<.001) with white race being most represented. The primary outcome occurred in 6.4% of standard males, 6.7% of standard females, 5.1% of intervention males, and 4.8% of intervention females (p=0.12). Cox models suggest that male intervention participants had lower hazard rate compared to male standard participants (HR=0.79, CI:0.58-1.09) and female intervention participants had a lower hazard compared to male standard (HR=0.76, CI: 0.54-1.07) but this was not statistically significant. Major hemorrhage occurred in 0.4% of standard males, 0.5% of standard females, 0.8% of intervention males, and 1.1% of intervention females (p=0.11). Female intervention subjects had a significantly higher hazard rate of major hemorrhage compared to standard males (HR=2.99, CI:1.06-8.52) with no other between group differences.

Conclusion:
This study found that there were no significant sex differences in the reduction of recurrent vascular events in the POINT trial. The rate of major hemorrhage was higher in female intervention compared to male standard subjects, but there was no difference in rates between the female groups or the male intervention group. Future studies must provide a sample size with enough power to assess for sex differences to optimize care. Both males and females benefit from combination therapy but the risk of major hemorrhage must be considered.
Abstract P648: The Presence and the Features of Silent Brain Infarction Are Associated With Stroke Recurrence in Acute Ischemic Stroke Patients With Atrial Fibrillation
Authors: Kim Do Yeon , Jeong Han-gil , Lee Ji Sung , Lee Keon-joo , Kim Beom Joon , Han Moon-Ku , Choi Kang-Ho , Kim Joon-Tae , Shin Dong Ick I , Cha Jae-kwan , Kim Dae-Hyun , Kim Dong-Eog , Ryu Wi-sun , Park Jong-Moo , Kang Kyusik , Kim Jae Guk , Lee Soo Joo , Oh Mi Sun , Yu Kyung-Ho , Lee Byung-chul , Park Hong-kyun , Hong Keun-sik , Cho Yong-jin , Choi Jay Chol , Sohn Sung Il , Hong Jeong-ho , Park Moo-Seok , Park Tai Hwan , Park Sang-Soon , Lee Kyung Bok , Kwon Jee-hyun , Kim Wook-Joo , LEE JUN , LEE JUNEYOUNG , BAE Hee-joon
Published: March 2021

Background:
The significance of silent brain infarction (SBI) for stroke recurrence in acute ischemic stroke (AIS) patients with atrial fibrillation (AF) has yet to be elucidated. This study aims to evaluate SBI as an independent predictor and which characteristics of SBI are associated with stroke recurrence in AIS patients with AF.

Methods:
A multicenter prospective cohort recruited AIS patients with non-valvular AF from 14 centers from Oct 2017 to Dec 2018, and followed for ischemic stroke recurrence, all types of stroke and TIA, and all-cause mortality. Three patient groups; stroke patients with prior stroke history (PS), first-ever stroke with SBI [F-SBI(+)] and first-ever stroke without SBI [F-SBI(-)] were compared with Cox frailty model according to predetermined covariates. SBI subtypes; embolic-appearing pattern (EAP) and non-EAP, and SBI characteristics; size, numbers, and vascular territory involvements were assessed.

Results:
A total of 978 AF-AIS patients [27.5% PS, 29.1% F-SBI(+), 43.4% F-SBI(-)] were followed for 365 [348-374] days (median). Incidence of ischemic stroke recurrence in F-SBI(+) was higher than F-SBI(-), however, there was no significant difference compared to PS (p=0.860). Adjusted hazards for ischemic stroke recurrence and all kinds of stroke and TIA in F-SBI(+) were shown to be elevated [HR 3.87 (95% CI 1.53-9.16) and 2.60 (1.21-5.56)], and similar to PS [4.20 (1.73-10.24) and 2.90 (1.36-6.18)] when compared to F-SBI(-), respectively. Despite irrelevance in non-EAP SBI, a 4-fold increase of hazards in EAP SBI was observed [4.07 (1.63-10.13)]. Other SBI characteristics were not associated with outcomes. SBI and SBI features did not increase all-cause mortality.

Conclusions:
SBI and specifically, EAP SBI elevated stroke recurrence in AF-AIS patients as much prior stroke has increased the risk. Considering SBI to predict recurrence is suggested likewise prior stroke history is scored in AF thromboembolic risk estimation tools.
Abstract P652: Burden of Vascular Events Amongst TIA Patients - A Nationwide Estimate
Authors: Akbar Aelia , Francis Benedict , Deol Aran , Murtaza Zeba , Saravanan Lakshmi , Honganur Nagaraj Sanchitha , Zergham Azka , Kerakhan Yasameen , Jaiswal Pragya , Jaiswal Richa , Mehta Deep , Malik Preeti , Patel Urvish , Shah Shamik
Published: March 2021

Introduction:
Literature reported, 9-17% transient ischemic attack (TIA) patients have a vascular event within 90 days but there is limited data on long term risk involvement of vascular events following TIA.

Aim:
To identify prevalence and association of cardiovascular diseases (CVD) and cerebrovascular disorders (CeVD) amongst early and late TIA.

Methods:
We performed a retrospective cross-sectional analysis of Nationwide Inpatient Sample (2016-2017) in adults hospitalizations. Early TIA (primary diagnosis), late TIA (secondary diagnosis-within a year) and vascular events [CVD (AFib, IHD, acute MI angina) and CeVD (AIS, ICeH, SAH)] amongst TIA were identified using ICD 10 CM codes. Prevalence of vascular events were compared amongst patients with TIA and without TIA. Weighted analysis to account for sampling strategy using mix-effect multivariable survey logistic regression was performed to evaluate odds of having vascular events amongst TIA in comparison to non-TIA.

Results:
Amongst 58,259,589 US hospitalizations, 0.38% and 5.92% patients had early and late TIA, respectively. Patients with late TIA had higher prevalence of acute MI (4.9 vs 0.5 vs 3.4%), IHD (44 vs 28.6 vs 20.6%), angina (0.3 vs 0.2 vs 0.2%), AFib (22 vs 15.3 vs 10.9%), AIS (5.3 vs 0.6 vs 2%), SAH (0.2 vs 0.03 vs 0.1%) and ICeH (0.8 vs 0.04 vs 0.4%) compared to early TIA and no-TIA, respectively. (p<.0001) Patients with late TIA had 23% higher risk of having Afib [aOR 1.23; 95%CI 1.22-1.23] and higher odds of having IHD [1.52; 1.52-1.53], AIS [1.72; 1.70-1.74], and ICeH [1.29; 1.25-1.33].
(Table 1)

Conclusion:
We found a higher prevalence of late TIA amongst US hospitalizations. Additionally, late TIA patients had a higher risk of vascular events like Afib, IHD, and stroke. Hence, a thorough clinical investigation and long term followup of TIA patients may mitigate the risk of future vascular events and associated health care burden.
Abstract P653: Intracranial Artery Calcification Variations by Stroke Subtypes
Authors: Gurel Kursat , Khasiyev Farid , Santiago Marimer , Spagnolo-Allende Antonio , Bos Daniel , Gutierrez Jose
Published: March 2021

Introduction:
Intracranial artery calcification (IAC) is a common radiological finding on Computed Tomography (CT) scan. Although IAC occurs with aging, it is uncertain whether IAC varies by stroke subtypes.

Method:
We included patients admitted to our hospital with acute stroke. We quantified calcification volume of both clinoid and siphon carotid arteries, vertebral arteries at the V4 segment, and the basilar artery using an in-house quantification tool for non-contrast brain CT. Stroke etiological subtypes were determined according to the Trial of Organon in Acute Stroke Trial (TOAST) classification system independent of the calcification quantification. Demographic and clinical information was extracted from the medical records. We determined the prevalence of IAC in 51% of patients. (31% anterior, 7% posterior, and 14 % in both circulations)

Result:
We included 694 patients with stroke history (mean age 68 ± 16, range 21-101, 55% women, 71% nonwhite or mixed). IAC was associated with male sex (OR 1.47 [95%-CI 1.41-2.08), older age (OR 1.05 [95%-CI, 1.04-1.06]), hypertension (OR 1.55 [95%-CI, 1.01-2.36], dyslipidemia (OR 1.54 [95%-CI, 1.06-2.25]), and smoking (OR 1.79 [95%-CI, 1.18-2.71]). Anterior IAC was associated with dyslipidemia (OR 1.57 [95%-CI, 1.08-2.28], smoking (1.9 [95%-CI, 1.25-2.88]), and older age (OR 1.05 [95%-CI, 1.36-1.66). Posterior IAC was associated with myocardial infarction (OR 1.58 [95%-CI, 1.01-2.47] and older age (OR 1.02 [95%-CI, 1.01-1.03]. In multivariate analyses, any IAC was associated with small artery disease stroke (OR 1.01[95%-CI, 1.41-3.98]). Stratifying by circulations, however, demonstrated that the association was only with posterior (OR 1.22[95%-CI, 1.02-2.28]) and not anterior IAC (OR 1.20[95%-CI, 0.86-1.1.69]). There was no association between IAC and intracranial large artery stenoses OR (1.22[95%-CI, 0.78-1.1.92]).

Conclusion:
IAC is a marker of arterial disease, and its prevalence relates to vascular risk factors and small artery disease strokes. Understanding the mechanism by which IAC may relate to small artery disease may help us understand small artery stroke physiopathology and discover novel therapies for its treatment.
Abstract P658: Epidemiology and Stroke Complications of IVDU-Associated Endocarditis in the Heart of the Opioid Epidemic
Authors: hoang nguyen , Powers Ciaran , Nimjee Shahid M , Youssef Patrick , Shah Varun
Published: March 2021

Introduction:
The United States is experiencing a rapidly increasing rate of opioid drug abuse. Intravenous drug use related endocarditis and resultant septic embolic stroke, intracranial hemorrhage and infectious intracranial aneurysm (IIAs) cause significant morbidity and mortality and have a significant impact on cost and clinical care.

Methods:
We conducted a retrospective cohort study involving patients treated for infective endocarditis (IE) at a single institution over a 54-month period between 1/1/2014 and 07/01/2018. Concomitant intravenous drug abuse and infective endocarditis was analyzed to identify and demographics, risk factors, and attributed costs.

Results:
A total of 351 patients met inclusion criteria with 170 patients (48%) having history of IVDU-associated endocarditis. From 2014 to 2018, there was a 630% increased incidence of patients with IVDU-associated endocarditis. Compared to endocarditis of other etiologies, a significant number of patients with IVDU-associated endocarditis were homeless (5.9% v 1.1%, p=0.014), uninsured (10.0% v 2.8%, p=0.005), and unemployed (75.9% v 31.7%, p=0.0001). IVDU was associated with an increased prevalence of overall intracranial hemorrhage (25.9% v 13.9%, p=0.005), including intraparenchymal hemorrhage (12.4% v 5.1%, p=0.012), subarachnoid hemorrhage (17.6 v 4.4%, p=0.0001), and cerebral microbleeds (14.1% v 7.2%, p=0.022). IVDU was also associated with an increased prevalence of IIAs (10.6% v 1.8%, p=0.0001) and brain abscesses (4.7% v 1.1%, p=0.025).

Conclusions:
The opioid epidemic has increased the incidence of infective endocarditis and resultant neurovascular complications. IVDU-associated endocarditis is associated with increased hemorrhagic stroke and increase healthcare utilization and costs.
Abstract P668: Clinically Meaningful Weight Gain Before Menopause and Risk of Stroke
Authors: Zambrano Espinoza Maria D , Kersey Emma , Boehme Amelia K , Willey Joshua , Miller Eliza C
Published: March 2021

Background:
Obesity is an independent risk factor for stroke. Weight gain has been associated with a higher risk of cardiovascular diseases in postmenopausal women. It is unclear, however, if weight changes before menopause have similar effects. We hypothesized that clinically meaningful premenopausal weight gain, defined as Body Mass Index (BMI) change >5%, would be associated with a higher stroke risk later in life.

Methods:
Using data from the California Teachers Study, we identified women aged < 55 with no history of stroke. We used weight changes between 1995-2006 as proxy for premenopausal weight gain. We defined weight change as modest or moderate using BMI changes of 5-10% and >10% respectively. Stroke outcomes were obtained from linkage to California hospitalization records. We used Cox regression models to calculate hazard ratios with 95% confidence intervals for the association of weight change and future stroke, adjusting for vascular risk factors.

Results:
Of 17,295 women included in the study, 113 had a stroke. In comparison to women who maintained a stable weight, women with moderate weight gain during premenopausal years had 2.0 times the risk of stroke. In the adjusted analysis, women with moderate weight gain had 89.6% higher risk of stroke, compared to the reference group. We found no significant association with stroke in women who had modest weight changes.

Conclusion:
Moderate premenopausal weight gain significantly increased stroke risk in women. Younger women should be educated about the effects of weight gain on future brain health.

Count: 1836/1950
Abstract P671: Association Between Liver Fibrosis and Postoperative Stroke
Authors: Simonetto Marialaura , Zhang Cenai , Murthy Santosh , Navi Babak B , Kamel Hooman , Parikh Neal S
Published: March 2021

Introduction:
Chronic liver disease is associated with aberrant hemostasis, resulting in an increased risk of clotting and bleeding. We hypothesized that liver fibrosis, a manifestation of progressive chronic liver disease, is associated with stroke among people who have been subjected to the hemostatic stress of surgery.

Methods:
We conducted a retrospective, multicenter cohort study using data from 680 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a prospective registry of 30-day outcomes. Quality measures, such as stroke, have been validated and have 95% inter-observer agreement. We included adults who underwent major surgery, except neurosurgery, from 2005-2016. The exposure was the Aspartate aminotransferase to Platelet Ratio Index (APRI) liver fibrosis score, calculated from preoperative aspartate aminotransferase and platelet count. The primary outcome was incident stroke, reported by NSQIP as a composite of ischemic and hemorrhagic stroke. We used multivariable Cox proportional hazards models to assess the relationship between APRI and incident stroke, adjusting for demographics, comorbidities, and surgical characteristics (surgical type and American Society of Anesthesiologists preoperative fitness classification). In a sensitivity analysis, we also adjusted for preoperative platelet count and coagulation indices.

Results:
Among 2,729,995 patients, the mean age was 57 (SD, 17) years and 58% were women. A total of 6,886 patients had stroke within 30 days (0.25%). In unadjusted analyses, a 1-point increase in APRI was associated with a 3% increased risk of stroke (HR, 1.03; 95% CI, 1.02-1.03). The association remained significant in models adjusted for comorbidities and surgical characteristics (HR, 1.02; 95% CI, 1.01-1.03). Sensitivity analyses also adjusted for platelet count and coagulation indices were consistent (HR, 1.03; 95% CI, 1.01-1.04).

Conclusions:
A liver fibrosis score calculated from routine preoperative laboratory data was independently, albeit modestly, associated with an increased risk of stroke within 30 days after surgery. Whether preoperative assessment of liver disease markers has clinical utility requires investigation.
Abstract P676: Rates of Preventable Thrombectomy in Acute Ischemic Stroke
Authors: Lalla Rakhee , Dunlow Ryan , Yarbrough Karen L , Mehndiratta Prachi , Phipps Michael S , Jindal Gaurav , Cronin Carolyn A , Wozniak Marcella A , Cole John W , Kittner Steven J , Chaturvedi Seemant
Published: March 2021

Introduction:
The AHA notes that more than 76% of strokes are the first occurrence. There are class 1 recommendations for the management of common risk factors such as atrial fibrillation (AF), hyperlipidemia (HLD), hypertension (HTN), diabetes (DM), and vascular disease. The purpose of this study is to investigate the percentage of large vessel strokes that are potentially preventable with adequate management of vascular risk factors.

Methods:
A retrospective chart review was conducted on all patients undergoing endovascular therapy (EVT) from 2012-2019. Data was collected on vascular risk factors present prior to admission including HTN, DM, HLD, AF, and smoking. Preventable stroke was defined as having at least one of the following: untreated AF, untreated HLD, poorly controlled HTN (presence of left ventricular hypertrophy on transthoracic echo), history of vascular disease not on an antiplatelet agent, poorly controlled DM (A1c>10), current smoking. Groups were compared based on age, sex and 90 day functional outcomes, with favorable outcome defined as mRS ≤ 2.

Results:
Our sample included 396 patients who underwent EVT (mean age 65, 50% female). 42% of patients with Afib were not on anticoagulation, 31% of patients with HLD were untreated, 39% of patients with HTN were poorly controlled, 27% of patients with a history of vascular disease were not on an antiplatelet, 14% of patients with DM were poorly controlled, and 46% of all patients were smokers. In total, 78% of patients had at least 1 poorly controlled risk factor and 37% had at least 2. There was no difference in rates of preventable stroke between males and females (48% vs 52%, p=0.30) and between age groups above and below 70 (40% vs 60%, p=0.68). 64% of patients with well controlled risk factors had a favorable outcome compared to 51% with at least one poorly controlled risk factor (p=0.03).

Conclusions:
Our data suggests that despite guidelines on management of vascular risk factors, a large number of these are poorly controlled prior to admission for large vessel stroke, leading to a potentially preventable procedure. Not only could improved primary prevention save the wide array of resources utilized in EVT, but it could also influence long term outcomes in this cohort of patients.
Abstract P683: Thrombin Generation in Plasma of Stroke Patients With Atrial Fibrillation
Authors: Falcione Sarina , Sykes Gina , Kamtchum Tatuene Joseph , Munsterman Danielle , Joy Twinkle , Jickling Glen
Published: March 2021

Background and Purpose:
Thrombus formation is central to pathophysiology of stroke in patients with atrial fibrillation. Whether factors in plasma contribute to thrombus generation in patients with atrial fibrillation remains unclear. In this study we sought to determine whether plasma contributes to thrombin generation in patients with atrial fibrillation.

Methods:
There were 78 acute ischemic strokes with atrial fibrillation and 37 non-stroke controls. Plasma thrombin generation was measured by thrombin generation assay, resulting lag time, peak thrombin, time to peak and area under the curve was assessed. Thrombin generation capacity was compared in stroke patients with atrial fibrillation to non-stroke controls. The relationship to anticoagulation was assessed. In vitro, the effect of anticoagulation on plasma thrombin generation was determined.

Results:
Thrombin generation capacity was increased (shorter lag time and time to peak) in ischemic stroke patients with atrial fibrillation compared to non-stroke atrial-fibrillation controls (p<0.05 and p<0.01, respectively). Anticoagulation decreased plasma induced thrombin generation. Ischemic stroke patients with atrial fibrillation treated with anticoagulation (DOAC or warfarin) had lower plasma induced thrombin generation compared to atrial-fibrillation patients not on anticoagulation (p<0.05). Thrombin generation by plasma could be further reduced by DOAC in an in-vitro assay.

Conclusions:
Stroke patients with atrial fibrillation have a higher plasma induced thrombin generation compared to atrial fibrillation controls. Factors in plasma such as leukocyte derived tissue factor likely contribute to thrombus formation in patients with atrial fibrillation. As such, components in plasma may represent new targets to reduce thrombus formation and stroke risk in patients with atrial fibrillation.
Abstract P684: Treatment of Hypercoagulability-Induced New Neurovascular Events Using Enoxaparin vs DOACs (THINNED): A Retrospective Study
Authors: Golub Danielle , Sabadia Sakinah , Yaghi Shadi , Patel Aneek , Hernandez Christopher , Torres Jose
Published: March 2021

Introduction:
The incidence of stroke is higher in patients with malignancy, especially within a few months of diagnosis and in more aggressive cancers. This phenomenon may be explained by an inherent hypercoagulable state, tumor embolism, vessel infiltration, or as a side effect from cancer treatment. Notably, stroke in cancer patients is associated with poor functional outcomes and reduced survival. Currently, however, there are no clear guidelines for antithrombotic management for prevention of recurrent strokes in these patients.

Methods:
We conducted a single-center retrospective chart review from 2013-2019. All adult patients with an ischemic stroke occurring with active malignancy and who then received either a direct oral anticoagulant (DOAC) or low molecular weight heparin (LMWH) were included. Patients with hemorrhagic stroke, an intracranial malignancy, or who were immediately admitted to hospice were excluded.

Results:
A total of 55 patients were included with a mean age of 71.8 years (range 28-96), 60% females, 87.3% first-time strokes, and 54.9% with metastatic disease. After stroke, 25 patients received a DOAC and 30 received LMWH for anticoagulation with a mean follow-up of 403 days. Between these two groups, most presentation and treatment characteristics were similar except for baseline hypertension, hyperlipidemia, additional initiation of an antiplatelet, and follow-up time. There was no difference in either stroke recurrence (DOAC vs LMWH: OR 2.61 [0.51-13.45], p=0.252) or time to recurrent stroke (DOAC vs LMWH: HR 1.68, p=0.446), but both analyses required adjustment for additional initiation of an antiplatelet—which was significantly protective regardless of anticoagulation choice (p=0.021* and p=0.017*, respectively). There was a trend towards improved survival if placed on a DOAC (HR 0.27, p=0.051), even after adjusting for metastatic disease.

Conclusions:
In this initial study of cancer patients with ischemic stroke, anticoagulation choice made no difference on stroke recurrence; however, addition of an antiplatelet agent was significantly protective. There was also a trend towards improved survival on a DOAC. Additional prospective data incorporating a larger sample size could further validate these findings.
Abstract P693: Sex Disparity in Long-Term Stroke Recurrence and Mortality in a Rural Population in the United States
Authors: Lambert Clare M , Olulana Oluwaseyi , Chaudhary Durgesh , Shahjouei Shima , Avula Venkatesh , Li Jiang , Abedi Vida , Zand Ramin
Published: March 2021

Introduction:
Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aimed to investigate if women had a higher risk of all-cause mortality and recurrence after an ischemic stroke in a rural population in central Pennsylvania, United States.

Methods:
We analyzed consecutive ischemic stroke patients captured in our comprehensive research database from 2004 to 2019. Kaplan-Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine-Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors.

Results:
Among 8,900 adult ischemic stroke patients (median age of 71.6 [IQR:61.1-81.2] years and 48% women), women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared to a 65.7% survival in men (p=0.003) at five years; however, the survival difference was not present after adjustment by the associated factors of age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome.

Conclusion:
Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.
Abstract P698: Coming Together in a Time of Distancing: Creating Community Messaging for Emergency Care During Covid
Authors: Olson-Mack Lindsay L , Kenner Brininger Amelia , Reeling Carol A , Davis Cecile , Sundby Christine , Perrinez Emily , Rockwell Jean M , Burley Jessica , Libby Kathyrn J , Bueno Olena , Couts Linda , Januszewicz Lourdes , Kenny Luisa J , Nabulsi Mohammed , Schoenheit-Scott Paige , McGurk Penny , Calara Robin M
Published: March 2021

Introduction:
In the early months of COVID-19 pandemic, a decline in stroke hospital admissions were reported nationwide. In a large, diverse region of Southern California, a collaborative effort was made to collect real-time data trends in stroke code activations and to assess this impact locally. The San Diego (SD) County Stroke Receiving Centers demonstrated a notable decrease of 30% in stroke code activations from March-May 2020 as compared to the same timeframe in 2019, which motivated the group to dedicate time and resources to pursue a united community messaging focused on seeking emergency treatment for stroke.

Methods:
A unified marketing campaign was created in collaboration with SD County EMS and the SD region American Heart Association/American Stroke Association. A single graphic message was utilized that emphasized the importance of seeking emergency treatment when suffering signs of stroke, along with the slogan “We are here for you. Every minute matters.” Impact of the campaign was gauged by quantifying the number of times our message was viewed on social media and number of stroke code activations after the campaign ended.

Results:
The unified social media campaign was posted by 14 of the 18 SD County stroke receiving hospitals during the month of June 2020. The team utilized Facebook, Twitter, Instagram and LinkedIn to convey the message. The campaign yielded a total of 26,727 views. The median monthly stroke code activations in July 2020 increased to 34, as compared to 26.5 for March-May 2020.

Conclusion:
In a time when social distancing has become the norm, it is more important than ever to band together as a community. This endeavor demonstrates that virtual messaging serves as a viable option for community education during the COVID-19 pandemic and in the future. A unified social messaging campaign targeting the importance of seeking emergency care for stroke during the COVID-19 pandemic is an effective way to reach large numbers of people regionally.
Abstract P7: Prior Antithrombotic Medication May Affect Outcomes Following Alteplase at 0.6mg for Unknown Onset Stroke: THAWS Randomized Clinical Trial
Authors: Koga Masatoshi , Inoue Manabu , Miwa Kaori , Yoshimura Sohei , Fukuda-doi Mayumi , Aoki Junya , Asakura Koko , Ohtaki Masafumi , Kamiyama Kenji , Igarashi Shuichi , Doijiri Ryosuke , Ito Yasuhiro , Takagi Yasushi , Ihara Masafumi , Sasaki Makoto , Kitazono Takanari , Kimura Kazumi , Minematsu Kazuo , Yamamoto Haruko , Toyoda Kazunori
Published: March 2021

Background and purpose:
To assess the potential effect of prior antithrombotic medication for thrombolysis using alteplase at 0.6mg/kg in unknown onset stroke.

Methods:
This was a prespecified sub-analysis of a THAWS trial (an investigator-initiated, multicenter, randomized, open, blinded-endpoint trial). Stroke patients with a time last-known-well >4.5 h who had a mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery were randomly assigned (1:1) to receive alteplase at 0.6mg/kg or standard medical treatment (SMT). Patients were dichotomized by taking prior antithrombotic medication. The favorable outcome defined as a modified Rankin Scale score of 0-1 at 90 days and any intracranial hemorrhage within 22-36 h were compared in each group.

Results:
Of 126 patients (intention-to-treat population), 68 received alteplase and 58 had SMT. Seventeen in the alteplase group and 23 in the SMT group took antithrombotic medication (10 with antiplatelet alone, 5 with anticoagulant alone and 2 with both in the IVT group, and 14, 8 and 1, respectively, in the SMT group) before stroke onset. Antithrombotic therapy was more frequently initiated within 24 hours after randomization in the SMT group than in the alteplase group (86% vs. 12%, p<0.0001). Both any intracranial hemorrhage (26% in the alteplase group vs. 14% in the SMT group) and favorable outcome (47% vs. 48%) were comparable between the two treatment groups. There was a significant treatment-by-cohort interaction for favorable outcome between patients with prior antithrombotic medication and those without (p=0.006). Favorable outcome was more common in the alteplase group than in the SMT group in patients with prior antithrombotic medication (59% vs. 26%; RR 2.25, 95% CI 1.02 to 4.99), but it tended to be less common in the alteplase group than in the SMT group in those without prior antithrombotic medication (43% vs. 63%; RR 0.69, 95% CI 0.46 to 1.03). The frequency of any intracranial hemorrhage did not differ significantly between the two treatment groups in any dichotomized patients.

Conclusions:
Alteplase at 0.6mg/kg appears more beneficial in patients with prior antithrombotic medication.
Abstract P705: Lesion Symptom Mapping of Cardiac Autonomic Dysfunction in Patients With Acute Ischaemic Stroke: A Prospective Cohort Study
Authors: Kessler Anna-Lena , Pham My Hanh , Ikenberg Benno , Wiestler Benedikt , Haber Georg , Wunderlich Silke , Seifert Christian , Mueller Alexander , Schmidt Georg
Published: March 2021

Introduction:
About 15% of patients with stroke show elevated Troponin T levels without presenting an acute coronary syndrome. Dysbalance in the autonomous nervous system is discussed as a possible reason. However, it remains unknown which brain regions affect specific autonomous biosignals.

Methods:
Prospectively from July 2018 to May 2019 we performed simultaneous non-invasive 30-min recordings of autonomous biosignals with all patients at our centre suffering from an ischaemic stroke within the last 7 days. Previously described autonomous risk factors were investigated and a lesion symptom mapping based on MRI was done.

Results:
In total, 100 patients with ischaemic stroke were measured. Subsequently 10 patients had to be excluded because of atrial fibrillation during recording, resulting in a study population of 90 patients. Mean age was 64.9 years, 38 patients (42.2%) were female. Mean NIHSS-Score at first admission was 3.7 points.

The five parameters baroreflex sensitivity (BRS), deceleration capacity of the heart rate, expiration-triggered sinus arrhythmia, mean heart rate and average respiration rate were analysed for their association with ischaemic lesion location. Using established dichotomy limits in the lesion symptom mapping we could find risk factor related overlaps in different brain regions, such as an association of disturbed BRS with pontine strokes.

Conclusion:
Previous studies show that patients with abnormalities in autonomous parameters have higher cardiovascular risk. Identifying brain regions that affect the cardiac autonomous system is relevant for better understanding the underlying pathophysiology as well as early identification of these patients at risk. It is interesting to speculate if patients with lesions in these brain regions could benefit from early cardiologic surveillance. We are currently validating our findings with a higher sample size and follow up data.
Abstract P722: Triglyceride-Glucose Index is Associated With Early Neurological Deterioration in Single Subcortical Infarction
Authors: Nam Ki-woong , Jung Keun-hwa , Ko Sang-bae , Yoon Byung-woo
Published: March 2021

Introduction:
Single subcortical infarction (SSI) has usually favorable prognosis, but early neurological deterioration (END) often occurs in their clinical courses. Fasting glucose and triglyceride are both risk factors for END. Therefore, the triglyceride-glucose (TyG) index that combines them can be a potent predictor of END.

Hypothesis:
We evaluated the relationship between TyG index and END in patients with SSI.

Methods:
We included consecutive patients with SSI within 72 hours of symptom onset between 2011 and 2015. END was defined as an increase of ≥ 2 on the total NIHSS score or ≥ 1 on the motor NIHSS score within the first 72 hours of admission. TyG index was calculated according to the following formula: TyG index = Ln [fasting triglyceride (mg/dL) x fasting glucose (mg/dL)/2]. Considering the effect directly on the formula, patients currently taking glucose- or lipid-lowering agents were excluded.

Results:
A total of 305 patients with SSI were included. In multivariable analysis, TyG index [adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI): 1.58-5.45] and age (aOR = 1.05, 95% CI: 1.01-1.09) were positively associated with END. In subgroup analysis based on the presence of diabetes, TyG index showed a meaningful association only in patients with diabetes history. In the analysis by type of SSI, TyG index and END were related only in patients with proximal SSI. When examined in accordance with the involved vascular territory, TyG index was associated with END in both the anterior circulation and posterior circulation. When examined in accordance with the involved vascular territory, TyG index was associated with END in both anterior circulation (aOR = 2.66, 95% CI: 1.24-5.68) and posterior circulation (aOR = 3.55, 95% CI: 1.03-12.26), but the posterior circulation had a larger aOR value.

Conclusions:
TyG index was associated with END in SSI patients. This tendency depends on the presence of diabetes and the location of the SSI lesion.
Abstract P729: Glp-1 Receptor Nitration Contributes to Brain Pericytes Dysfunction in Diabetes
Authors: Bailey Joseph , Barrett Amy , Coucha Maha , Abdelsaid Mohammed A
Published: March 2021

Brain pericytes are unique, multi-functional mural cells located at the center of the NVU. Pericytes maintain the blood-brain barrier (BBB), promote vascular stability, and control the capillary blood flow. We have previously shown that diabetes alters the functions of the pericytes causing BBB damage and increased cerebrovascular pathological neovascularization. GLP-1 agonists, used in the management of diabetes, showed vascular protective effects. However, the underlying mechanisms are unclear. We hypothesis that GLP-1 receptor nitration contributes to the loss of pericytes functions in diabetes.

Methods:
Expression of GLP-1R in pericytes was assessed in the brain of control and diabetic mice and human brain microvascular pericytes using IHC, RT-PCR, and Western blots. BBB was assessed using Western blot/IHC of Occludin, VEGF, and MMPs gelatinase. Vascular integrity was determined by measuring cerebrovascular neovascularization indices (vascular density, tortuosity, and branching density). GLP-1R nitration was determined by immunoprecipitation and slot blotting.

Results:
In the present study, we provide novel evidence that the human brain pericytes express the GLP-1R (P<0.05). Moreover, diabetes increased GLP-1R expression in pericytes (P<0.05). Diabetes caused BBB dysfunction, loss of cerebrovascular integrity, and increased all pathological neovascularization indices (P<0.05). Diabetes increased nitration of GLP-1R. Treatment of pericytes with Exendin-4, a GLP-1 agonist, under diabetic conditions, decreased diabetes-induced inflammation, oxidative stress, and pericytes migration, which ameliorated the integrity of the BBB, and prevented the pathological neovascularization (P<0.05).

Conclusion:
Our results provide novel evidence that pericytes express GLP-1R and that diabetes increased receptor expression and nitration. Treatment of pericytes with GLP-1R agonist exerts neurovascular protective effects, making it a promising strategy in preventing diabetes- mediated cerebrovascular microangiopathy.
Abstract P735: QPCR Panel Profiling Reveals MiRNAs That Modulate Microglial Activation in Aged Males Isolated After Stroke
Authors: Banerjee Anik , Chokkalla Anil Kiran , Shi Julia , Lee Juneyoung , Venna Venugopal Reddy , Vemuganti Raghu , McCullough Louise D
Published: March 2021

Introduction:
Social isolation (SI) after stroke is associated with increased ischemic injury and significantly delayed recovery due to exacerbation of microglial activation and immune mediated pro-inflammatory mechanisms. Studies have identified miRNAs that modulate and regulate this inflammatory transition through inflammasome NLRP3 activation. However, studies examining miRNA-based microglial activation in SI within the neuro-immune landscape are limited. We investigated miRNA profiles in aged mice to provide biomarkers and to identify underlying mechanisms related to microglial activation within the cerebral environment to mitigate this pathological microglial phenotype.

Methods:
Aged C57BL/6 male mice (18-20 months) were subjected to a 60-minute middle cerebral artery occlusion (MCAO) followed by reperfusion and were assigned to either (SI) or continued pair-housing (PH) immediately after stroke. On day 15, mice were sacrificed, and plasma samples were subjected to microRNAome (miRNAome) analysis. Top miRNAs were identified using bioinformatics frameworks and pathway analysis was performed using KEGG platform. Flow Cytometry (FACS) was performed on brain tissue and blood to determine if stroke or SI leads to changes in microglial and systemic myeloid activation.

Results:
The whole miRNAome panel analysis revealed 12 differentially expressed miRNAs (FC of 3 or higher) within the plasma following volcano plot and unsupervised hierarchical clustering analysis confirmed by qPCR validation (P< 0.05). Network analysis revealed miR-495-3p as a pivotal node that targeted the largest subset of immune specific genes (P< 0.05); most notable for the inflammasome NLRP3, a regulator of microglial activation. Significant microglial activation was seen in post-stroke SI mice compared to pair-housed cohorts, identified through MHC-II presentation and the intracellular release of pro-inflammatory cytokines.

Conclusion:
This study provides an overview of the miRNA changes induced by post-stroke isolation. Additionally, these results suggest that there is potential to use plasma-based miRNAs as a source of novel biomarkers. Further, microglial inflammasome specific pathways appear to be involved in post-stroke social isolation.