bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP55: Factors Associated With Delayed Diagnosis Of Cerebral Venous Thrombosis: Secondary Analysis Of ACTION-CVT Study
Authors: Bakradze Ekaterina , Yaghi Shadi , Shu Liqi , Henninger Nils , Siegler James E , Giles James A , De Marchis Gian Marco M , Dittrich Tolga , Heldner Mirjam , Antonenko Kateryna , Kam Wayneho , Prabhakaran Shyam , Liebeskind David S , Liberman Ava L
Published: February 2023

Introduction:
Few clinical features have been associated with delayed diagnosis of cerebral venous thrombosis with variable impact of delay on patient outcomes. We therefore sought to use the data from a recent, multicenter study ACTION-CVT (Anticoagulation in the Treatment of CVT) to identify factors associated with delayed CVT diagnosis and evaluate the effect of delay on functional outcome.

Methods:
All ACTION-CVT patients with available data on date of neurological symptom onset and date of CVT diagnosis were included. Delayed diagnosis of CVT was defined as diagnosis occurring in the fourth (final) quartile of days from symptom onset. We also report the proportion of patients who were discharged from hospital or ED within 3 months prior to index CVT admission for any neurological symptom without being diagnosed with CVT. The primary study outcome was an excellent functional outcome at 90 days defined as modified Rankin Scale (mRS) ≤1. Secondary outcome was partial or complete CVT recanalization on last available venous imaging. Chi-squared and Student’s t-tests were used to identify variables associated with delayed diagnosis. Logistic regression was used to identify independent predictors of delayed diagnosis in CVT as well as the association of delay with outcomes.

Results:
We included 935 CVT patients in our analysis. Median time from symptom onset to diagnosis was 4 days (IQR: 1-10). Delayed CVT diagnosis occurred in 212 (23%) patients (median time to diagnosis >10 days). Out of 212 patients with delayed CVT diagnosis, 64 (30.2%) patients were discharged from hospital/ED in the 3 months prior to their index CVT admission. Headache symptoms were a predictor of delayed diagnosis (OR: 2.36 [1.26-4.42]; p<0.01), and seizure was inversely related to delayed diagnosis (0.39 [0.21-0.74]; p=0.001). Delayed diagnosis was not associated with mRS ≤1 at 90 days (OR 0.83 [95% CI: 0.42-1.64]; p=0.58) or venous recanalization (OR 1.78 [95% CI 0.79-3.99]; p=0.16).

Conclusion:
In a large, multicenter cohort we found that CVT patients presenting with headache were at increased risk of delayed diagnosis, however, delayed diagnosis was not associated with adverse outcomes. CVT diagnosis should be considered in patients presenting with a new headache.
Abstract TMP56: Trends In Alcohol Abuse In Patients With Acute Ischemic Stroke: A 20-year Analysis Of The Nationwide Inpatient Sample
Authors: Downes Margaret , Hardigan Trevor , Rossitto Christina , Vasan Vikram , Schuldt Braxton R , Odland Ian , Devarajan Alex , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Introduction:
Heavy alcohol (EtOH) consumption has been long recognized for its damaging effects to the brain and is considered a risk factor for stroke. However, the relationship between EtOH abuse and stroke on in-hospital outcomes remains unclear.

Objective:
To characterize stroke patients with an EtOH abuse and examine the effects of alcohol abuse on patient outcomes over 20 years.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for EtOH abuse on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
A total of 10,415,286 patients with AIS were identified; 368,953 (3.5%) abused EtOH. EtOH abuse patients had higher Elixhauser Comorbidity Score (11.02 ± 10.38 vs. 9.72 ± 8.76; p<0.001) and NIH Stroke Score (7.19 ± 7.08 vs. 6.65 ± 7.30; p<0.001). Patients with EtOH abuse were more likely to be male, younger, smokers, covered on Medicaid, have atrial fibrillation, and be in the 0-25% percentile median income bracket (all p<0.001). After propensity matching, EtOH abuse patients had longer hospital stay (0.39 days; 95% CI: 0.28-0.5), lower hospital charges (-$3780.6; 95% CI: -$5053.16 - -$2508.04) and were less likely to be discharged home or short-term hospital (AOR 0.83; 95% CI: 0.81-0.85)(all p<0.001).

Conclusion:
In this 20 year nationally representative propensity matched analysis of patients with AIS, patients that abused EtOH had higher incidences of more severe disease with worse functional outcomes, as well as lower hospital charges despite longer hospital stays.
Abstract TMP6: Association Of Tirofiban With Outcomes After Thrombectomy In Stroke Due To Atherosclerosis: An Exploratory Analysis Of The RESCUE BT Placebo-controlled Randomized Trial
Authors: Sang Hongfei , Zi Wenjie , Wu Junxiong , Luo Jun , Hu Zhizhou , Wang Tao , Li Rongzong , Ke Yingbing , Zhu Xiurong , Xie Dongjing , Li Fengli , Yang Qingwu , Qiu Zhongming
Published: February 2023

Background:
The efficacy and safety of tirofiban, as an adjuvant medication of endovascular therapy (EVT), in patients with large vessel occlusion due to atherosclerotic thrombosis was still unclear.

Methods:
The Endovascular Treatment With versus Without Tirofiban in Stroke (RESCUE BT) trial was a randomized, double-blinded, placebo-controlled trial that was performed at 55 centers in China from October 10, 2018 to October 31, 2021. This was a post hoc exploratory analysis of the RESCUE BT trial and 435 patients were included in the intention-to-treat analysis. The primary outcome was the proportion of functional independence (defined as modified Rankin Scale 0-2) at 90 days. We estimated the efficacy and safety of EVT plus placebo versus EVT plus tirofiban using binary logistic regression analysis. A causal mediation analysis was also performed to assess the potential mediators of tirofiban on functional outcome.

Results:
This study included 435 patients, including 197 patients assigned to the tirofiban group and 238 patients assigned to the placebo group. The median age was 65 [IQR, 56-72] years, and 311 (71.5%) patients were men. Tirofiban was associated with higher rates of functional independence at 90 days compared with the placebo (adjusted odds ratio with 95% CI, 1.68 [1.11–2.56],
P
= 0.014). There was no significant difference in mortality and symptomatic intracranial hemorrhage between the two groups, thought the rate of intracranial hemorrhage was numerically higher in the tirofiban group (29.1% versus 23.2%,
P
= 0.165). Tirofiban was also associated with fewer number of thrombectomy passes (beta, -0.48; 95% CI, -0.62 to -0.34;
P
< 0.001). Treatment-reduced passes explains 20.0% (95% CI, 4-76) of the beneficial effect of tirofiban on functional independence.

Conclusion:
Tirofiban plus EVT might be an effective and well-tolerated option for patients with anterior large vessel occlusion due to atherosclerosis. These findings are needed to be confirmed in future trials.
Abstract TMP63: Structural Network Changes In Children With Moyamoya Disease Prior To Surgical Intervention
Authors: Sellers Austin , Gatti John , Shimony Nir , Sun Lisa R , Jallo George , Felling Ryan J , Goldenberg Neil , Meoded Avner
Published: February 2023

Purpose:
Moyamoya disease/syndrome (MMD) is a progressive steno-occlusive disease involving the intracranial arterial circulation. Long term stenosis/hypoperfusion can lead to intellectual disability and cognitive impairment even in the absence of documented infarct. We aim investigate any underlying network abnormalities in MMD patients with no apparent ischemic injury.

Materials and Methods:
We retrospectively reviewed children with MMD with normal appearing parenchyma on conventional MRI. Control patients were selected from our existing database. Clinical, surgical and demographic data, including degree of stenosis as measured semi-quantitatively on MRA, were collected. Patients with documented infarcts, low quality DTI, and NF1 were excluded from the analysis. Group and correlational connectometry with degree of stenosis were performed.

Results:
A total of 28 patients were reviewed with 16 patients included in the study. Median (and interquartile range) age was 10.5 (8.5 - 13.5). Between group connectometry analysis identified infratentorial and supratentorial decreased connectivity in patients compared to controls, specifically in: middle cerebellar peduncle, corpus callosum, right parietopontine tract, superior cerebellar peduncle, left inferior fronto-occipital fasciculus. (Figure 1) In addition, we found negative correlation between the degree of stenosis and structural connectivity of multiple white matter pathways.

Conclusion:
Our findings reveal abnormal structural connectivity in children with MMD in the absence of infarcts on conventional MRI. Connectomics offers a unique opportunity to study the effect of long-term stenosis/hypoperfusion on cerebellar-cerebral networks and provide new insights into the mechanism of the structural plasticity/reorganization in these patients before bypass surgery. Future research is needed to determine longitudinal network changes before and after surgery.
Abstract TMP65: Robot-assisted Transcranial Doppler
Versus
Transthoracic Echocardiography For Right To Left Shunt Detection: “Real World” First-look
Authors: Rubin Mark N , Chang Ira , Waters Michael , Shah Ruchir , Devlin Thomas , Alexandrov Andrei V
Published: February 2023

Background:
Right to left shunt (RLS), including patent foramen ovale (PFO), is a recognized risk factor for stroke. RLS/PFO diagnosis can be made by transthoracic echocardiography (TTE) or transcranial Doppler (TCD). A multicenter, prospectively enrolled device trial of robot-assisted TCD (raTCD) vs TTE for RLS detection (BUBL, NCT04604015) was completed. This demonstrated raTCD detecting all and large RLS at approximately 3 times the rate of TTE (primary outcome, any RLS: raTCD 64% vs TTE 20% [absolute difference 43.4% (95% CI 34.3%-52.5%), p < 0.001]). It is unknown if these results are generalizable to routine practice.

Methods:
We conducted a multi-site retrospective review of prospectively collected “real-world” clinical data of raTCD for RLS diagnosis. All patients referred for a clinical study at the participating sites who underwent raTCD were included. raTCD was performed with standard TCD bubble study technique at all sites. Outcomes included demographics, rate of RLS detection, all and large (Spencer Logarithmic Scale ≥3), as well as “no window” rate. These results were compared to the results of BUBL with descriptive statistics and 2-sample proportion tests.

Results:
There were 350 patients who underwent clinical raTCD across three participating sites. In this population, the mean age was 56 ± 13 years compared to 59 ± 14 years in BUBL (p = 0.03, 95% CI 0.20-5.49). Both cohorts were 46% female. The clinical population had any RLS on raTCD in 54% (189/350) compared to 64% in BUBL, which was not a significant difference (p= 0.14, 95% CI -0.02-0.18). Large RLS was detected in 26% (91/350) of the clinical population as compared to 28% in BUBL, which was also not a significant difference (p = 0.89, 95% CI -0.08-0.11). The “no window” rate in the clinical population was 5% (18/350), compared to 8% in BUBL (p = 0.39, 95% CI -0.03-0.08).

Conclusions:
The same raTCD device that was safe and 3 times more likely to diagnose RLS than TTE in a device trial detected all and large RLS in clinical practice at a rate similar to that demonstrated in the device trial. These results further support the notion that raTCD may allow providers to achieve the known sensitivity of TCD for RLS and PFO detection without the need for an experienced operator, even in a “real world” clinical setting.
Abstract TMP73: Direct Valuation Of Long-Term Health State By Survivors Of Severe Intracerebral And Intraventricular Hemorrhage Using Time Trade-off Utility
Authors: Shah Vishank A
Published: February 2023

Objective:
To describe direct valuation of long-term health state by survivors of severe intracerebral and intraventricular hemorrhage (ICH/IVH) using time-trade off utility (TTO-U). TTO-U requires patients to choose between trading off years of their life in exchange for a hypothetical treatment that returns them to full functionality. Higher TTO-U (0-1) indicates lower desire to trade time off and thus a higher valuation of current health state.

Methods:
CLEAR III and MISTIE III trial survivors who recorded TTO-U at 180-days post-ictus were included. TTO-U was dichotomized into ≤0.6 versus >0.6. Multivariable logistic regression assessed factors associated with TTO-U≤0.6, including clinical variables, quality of life and depression scales.

Results:
Among 774 CLEAR III and MISTIE III survivors at day-180, 442 (57%) reported TTO-U; 305 (69%) were self-reported, 122 (28%) by a proxy. Mean (SD) age was 58.4 (11.8) years, 41% female, 25% black, 68% white and 7% other races. Mean (SD) ICH volume was 33.5 (22.8) mL, IVH volume 9.1 (14.8) mL, 70% had deep ICH. Median (IQR) 180-day mRS was 3 (3-4) and TTO-U was 1.0 (0.7-1). TTO-U of 1.0 was reported by 269 (61%) and ≤0.6 by 110 (25%) patients. Increasing age, white race, but not sex, were associated with lower TTO-U. Proxy-based TTO-U scores were lower (mean, 0.76 vs. 0.83, p=0.03). In multivariable logistic regression, age (aOR per 10-yrs, 1.24 [1.003-1.52]), race (white vs. other races, 4.8 [1.1-21.3]), proxy-based assessment (1.81 [1.02-3.21]), new ischemic stroke (2.01 [1.1-3.7]), sepsis (6.6 [1.1-40.3]), gastrostomy (0.40 [0.21-0.77]) were associated with TTO-U≤0.6 after adjusting for ICH severity. Among EuroQol 5-dimensions, difficulty with selfcare (3.3 [1.97-5.62]), and anxiety/depression (1.72 [1.07-2.74]) were independently associated with TTO-U≤0.6. CES-Depression score (in MISTIE III only) was also associated with TTO-U≤0.6 (per 1-point, 1.05 [1.02-1.07]).

Conclusion:
Majority of survivors of severe ICH/IVH highly valued their long-term health state and were unwilling to trade time off despite significant disability. Race, age, hospital complications, inability to care for self and anxiety/depression at day-180 were associated with lower valuation of long-term health state.
Abstract TMP74: HIF-1a And MTORC2 Co-regulate Macrophage Inflammation And Metabolism In Intracerebral Hemorrhage
Authors: Johnson Conor W , Askenase Michael H , Beatty Hannah E , Sansing Lauren H
Published: February 2023

Introduction:
Recruited macrophages are known to spur secondary inflammation-induced damage in intracerebral hemorrhage (ICH), and targeted metabolic modulation of these macrophages could limit inflammation. Recent macrophage transcriptomic work has associated increased expression of HIF-1a, master regulator of the hypoxia response, and mTORC2, the more recently-discovered mTOR kinase complex, with good patient outcomes. The goal of this work was to identify the inflammatory and metabolic effects of these factors, providing insight into their putatively beneficial role in acute brain injury.

Methods:
Human monocyte-derived macrophages were stimulated either with ICH-associated danger signals (DAMP) (S100A9 (2 ug/mL, R&D) + IL-1β (10 ng/mL, Biolegend)), or 1 ng/mL LPS (Invivogen). Echinomycin (Sigma Aldrich), NR1 (Aobious), JR-AB2-011 (Aobious), and Torin-1 (LC Labs) were used to inhibit HIF-1, mTORC1, mTORC2, and mTOR signaling respectively. Cytokine levels were quantified using cytometric bead array (BD) and prostaglandin-E2 (PGE
2
) levels were quantified using ELISA (Cayman). Metabolic flux was measured using the Seahorse platform (Agilent).

Results/Conclusions:
HIF-1a was necessary for the production of inflammatory and reparative cytokines, consistent with previous literature. Inhibition of mTORC1 or mTORC2 had little effect on cytokine levels, while broad inhibition of mTOR resulted in a step-wise decrease in chemokine secretion. mTORC2 was required for the production of PGE
2
(p<0.01; Figure 1A), a lipid mediator highly expressed in ICH patients with good outcomes. This effect was dependent on HIF-1a signaling (p<0.01; Figure 1A) and resulted in an increase in glycolytic flux (p<0.001; Figure 1B), suggesting a neuroprotective mTORC2-HIF-PGE
2
axis. Future research will explore the role of HIF-1a and mTORC2 in murine ICH models using pharmacological inhibition and LysM-Cre HIF-1a-floxed mixed bone marrow chimeras.
Abstract TMP75: Blood Brain Barrier Disruption And Neurologic Outcomes In Intracranial Hemorrhage Patients
Authors: Al-Kawaz Mais , Leigh Richard , Rossitto Christina , Mocco J D , Kellner Christopher P , Majidi Shahram
Published: February 2023

Introduction:
Patients with primary intracerebral hemorrhage (ICH) are known to demonstrate disruption of the blood-brain barrier (BBB) particularly in peri-hematomal regions. However, disruption of the BBB may also occur throughout the brain, even in areas remote from the acute bleed. We aimed to study the clinical significance of this finding.

Methods:
We performed a retrospective review of our prospectively collected ICH database from January 2020 to January 2022 to identify consecutive patients who had MR perfusion study performed within 5 days from admission. BBB permeability data was analyzed blinded to the clinical data. Baseline demographics, admission systolic blood pressure and NIH stroke scale (NIHSS) score were collected during the hospitalization. A measure of whole brain BBB permeability was computed from the perfusion MR scans. Primary outcome was good neurologic outcome defined as a modified Rankin Scale (mRS) score of 0-3 at 90 days. We examined the association between the BBB permeability and clinical outcome.

Results:
A total of 24 ICH patients were identified. Median age was 60 years old (Interquartile range (IQR) 57-70), with 11 females (45.8%) and 13 males (54.2%). Median hematoma volume was 40.3mL (IQR 14.9-53.2mL), with a median admission NIHSS of 17.5 (IQR 15-22). Thirteen out of 24 patients achieved a good neurologic outcome at 3 months (54.2%). Patients who achieved a good neurologic outcome were more likely to have a lower admission NIHSS (16 vs 20 p=0.04), smaller baseline hematoma volume (24.6mL vs 48.4 mL), (p=0.02), and a lower NIHSS at discharge (4 vs 19), (p=0.003). Median whole brain BBB permeability was insignificantly lower in patients who achieved a better neurologic outcome (1.8 vs 2.1, p=0.17). However, a threshold of whole brain BBB permeability less than 1.9% significantly correlated with improved neurologic outcome at 3 months (Odds Ratio=0.11, 95% Confidence Interval (0.02-0.71), p=0.02). Additionally, the same threshold was significantly associated with a lower NIHSS at discharge (5 vs 17.5, p=0.03).

Conclusion:
Diffuse disruption of the BBB in the days after presenting with ICH is associated with worse clinical outcome if the disruption is severe.
Abstract TMP79: Deep Learning Model For Prediction Of Supratentorial Intracerebral Hemorrhage (ich) Expansion
Authors: Tran Anh T , Zeevi Tal , Berson Elisa , Tharmaseelan Hishan , Haider Stefan P , Qureshi Adnan I , Sansing Lauren H , Falcone Guido J , Sheth Kevin N , Payabvash Sam
Published: February 2023

Purpose:
Hematoma expansion (HE) is associated with early clinical deterioration, worse long-term outcome, and higher mortality in ICH. Identification of patients at risk of HE may allow targeted anti-expansion therapies in future trials. We aimed to train and validate a deep learning model for prediction of HE based on admission non-contrast head CT.

Methods:
We utilized the clinical and imaging information from the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial and Yale ICH registry. All patients with spontaneous supratentorial ICH who had baseline head CT (<24 h from last know well), follow-up scan (within 16-48 h of baseline), axial slice thickness <5.7 mm, and slices numbers >28 were included. The HE was defined as an increase volume >33% or 6 ml. We trained a DenseNet121-based 3D convolutional neural network for prediction of HE (pipeline summarized in the Figure).

Results:
A total of 749 patients (610 from ATACH-2 and 183 from Yale) were randomly split (4:1) into 634 training/cross-validation (368 (58%) male, mean age of 62.8±13.1 years, median NIHSS 10, and 144 (23%) with HE); and 159 independent test set (92 (58%) male, mean age of 62.5±14.6 years, median NIHSS 12, and 36 (23%) with HE). The average of validation AUC in five-fold training/cross-validation was 0.62, with the best performing model achieving an AUC of 0.71 in validation fold. We then tested this model in the independent validation cohort isolated from training process, achieving an AUC of 0.67 in predicting HE. The attention heatmaps (Figure) confirm that deep learning model predictions were based on head CT regions containing ICH and perilesional edema.

Conclusion:
We could train, and independently validate a deep learning model for identification of supratentorial ICH patients at risk of impending HE. Compared to visual markers (including CTA spot sign), such model can provide an automated objective tool for future trial enrollment based on readily available non-contrast CT
Abstract TMP8: Admission Hemoglobin Concentration And Outcome After Endovascular Thrombectomy In Large Vessel Occlusion Stroke
Authors: Donnelly Joseph , Hong Jae Beom , Campbell Douglas , Yong Vivien T , Diprose William , Barber P A
Published: February 2023

Background:
After ischemic stroke, low and high hemoglobin levels have been shown to be detrimental in large epidemiologic studies. It is unclear whether admission hemoglobin levels have prognostic value in patients treated with endovascular thrombectomy (EVT).

Methods:
Consecutive anterior and posterior circulation stroke patients who presented for EVT were included in this retrospective analysis. Admission hemoglobin levels were divided into quintiles (Q1-Q5). Outcome measures included early neurologic deterioration (END), defined as an NIHSS increase of ≥ 4 points from admission to 24 hours, 90-day functional dependence (modified Rankin score >2) and 90-day mortality.

Results:
970 EVT patients (554 male, mean ± SD age of 67 ± 15, mean ± SD admission hemoglobin level of 138 ± 18) were included. In binary logistic regression adjusting for potential confounders, low admission hemoglobin predicted functional dependence at day 90 (Q1 vs Q3 OR 1.63; 95% CI 1.01 - 2.62, p=0.04) but did not predict END or death at day 90. High admission hemoglobin levels predicted END (Q5 vs Q3 OR 2.54 95%CI 1.20- 5.37, p= 0.01), death at day 90 (Q5 vs Q3 OR 3.11 95% CI 1.50 - 6.41, p=0.002) as well as a trend towards increased functional dependence at day 90 (Q5 vs Q3 OR 1.51 95% CI 0.93- 2.44, p=0.10). The increased mortality with elevated hemoglobin was apparent within the first week after stroke.

Conclusion:
In stroke patients treated with EVT, both low and high admission hemoglobin levels are associated with worse patient outcomes. Optimizing hemoglobin levels may be a therapeutic target in large vessel occlusion stroke.
Abstract TMP82: Changes In DTI Metrics In The Lateral Ventricle Of Patients With Intraventricular Hemorrhage (IVH)
Authors: Vyas Vedang , Boren Seth , Suchting Robert , Solberg Spencer , Gonzales Nicole R , Savitz Sean I , Aronowski Jaroslaw A , Haque Muhammad E
Published: February 2023

Objective:
To evaluate a non-invasive surrogate imaging marker for blood evacuation in patients with IVH.

Clinical Relevance:
Extension of intracerebral hemorrhage (ICH) to the ventricles increases the 48 hours mortality by 43%, requiring external ventricular drains (EVD) to mitigate hydrocephalus and monitor intracranial pressures. Blood increases CSF viscosity, altering the diffusion coefficient. We hypothesize change in lateral ventricle (LV) DTI metrics, fractional anisotropy (FA) and mean diffusivity (MD), can be used as a marker for blood removal after IVH.

Methods:
A sub-cohort of 20 patients in SHRINC trial with ICH and IVH were serially imaged at day 1 (T1=20), 14 (T1=20), 28 (T3=16), and 42 (T4=13) on a 3T MRI system. The serial T1w, segmented LV (JHU WM atlas) volumes, FA, and MD maps were registered. The FA and MD of ipsi and contralesional LV were recorded. Clinical assessment (NIHSS) was associated with the change in FA and MD of LV. A mixed model statistical analysis was performed.

Results:
We serially imaged 11M/9F with average age 55.4±8.7 years. The baseline hematoma volume and NIHSS were 22.1±18.5 cc and 16.1±8.7 respectively. The patients had basal ganglia (n=12) and thalamic (n=8) ICH extended into LV. The ipsilesional FA was significantly (T1=0.24, T4=0.15, p<0.001) decreased (1.17% /day), and MD was significantly (T1 = 1.49*10
-3
mm
2
/sec, T4 = 2.37 *10
-3
mm
2
/sec, p<0.001) increased (2.4 x 10
-5
mm
2
/sec/day). At T4, there was no relationship (p=0.919) between ipsilesional and contra-MD of LV (Fig-1). Patients with higher baseline NIHSS had a significant temporal decline in FA than those with lower NIHSS (p<0.05). Temporally, ipsilesional MD was negatively associated with the baseline NIHSS (p=0.039).

Conclusion:
The data suggest that DTI metrics of FA and MD are associated with blood clearance from the ipsilesional ventricle.
Abstract TMP83: Optimal Timing For Resumption Of Anticoagulation After Intracranial Hemorrhage In Patients With Mechanical Heartvalves
Authors: Forman Rachel , Barra Megan , Bianca Long-Fazio Bianca , Merkler Alexander E , Izzy Saef , Sharma Richa
Published: February 2023

Introduction:
Anticoagulation in patients with acute intracranial hemorrhage (ICH) and mechanical heart valves (MHV) is often held to mitigate the risk of ICH expansion or recurrence; however there exists a competing risk of acute ischemic stroke (AIS). Optimal timing to resume anticoagulation after ICH remains uncertain.

Methods:
We retrospectively studied ICH patients with MHV at two academic hospitals from April, 2000-August, 2018. The primary outcome was a composite endpoint of symptomatic hematoma expansion or new ICH, AIS, and intracardiac thrombus up to 30 days post-ICH. The exposure was timing of re-initiation of anticoagulation classified as early if therapeutic anticoagulation was resumed up to 7 days after ICH; late if ≥7 and up to 30 days after ICH; and never if not resumed or resumed after 30-days post-ICH. Cox proportional hazard models were built adjusted for age, sex, and covariates significantly different in univariate analysis at a pre-specified p-value threshold of 0.05.

Results:
We identified 184 patients with ICH and MHV (65 anticoagulated early, 100 resumed late, 19 not resumed by day 30 post-ICH). We observed 12 AIS, 16 new ICH, and 6 intracardiac thromboses. The mean time from ICH to anticoagulation in the cohort was 12.7 days. Patients resumed early versus late were more likely to have atrial fibrillation (62% versus 42%), and less likely to be reversed (75% versus 94%), to undergo hematoma evacuation (23% versus 43%), have midline shift (27% versus 52.9%), and to have intracerebral involvement (26% versus 49%). There was no significant difference in the hazard of AIS, new or symptomatic ICH expansion, or the composite outcome among those resumed early versus late. Patients not resumed within 30 days post-ICH had a significantly higher risk of AIS compared to those resumed within 30 days (HR 15.9; 95% C.I.1.9-129.7, p=0.0098).

Discussion:
In this study of ICH patients with MHV, there was no difference in the 30-day thrombotic and hemorrhagic brain-related outcomes in patients anticoagulated within 7 days versus 7-30 days. Withholding anticoagulation within the first 30 days was associated with a significantly higher risk of AIS. Our findings provide a discrete time window to guide resumption of anticoagulation in MHV patients with ICH.
Abstract TMP84: Contemporary Nationwide Estimates For Outcomes Associated With Craniotomy Among Patients With Intracerebral Hemorrhage
Authors: Bako Abdulaziz T , Potter Thomas B , Pan Alan P , Tannous Jonika , Britz Gavin W , Hanley Daniel F , Vahidy Farhaan S
Published: February 2023

Introduction:
Contemporary nationwide estimates of outcomes associated with craniotomy procedures (CP) among patients with primary intracerebral hemorrhage (ICH) are lacking.

Methods:
From the nationwide inpatient sample (2016 - 2019), we identified adults discharged with primary ICH diagnosis and those who received CP. We fit a series of multivariable logistic regression models to report the adjusted odds ratios (aOR) and 95% confidence interval (CI) for factors associated with receiving CP and the association of CP with in-hospital mortality, home discharge, and development of major complication (MCC): brain abscess, sepsis, deep vein thrombosis, urinary tract infection, and pneumonia. We also fit generalized linear model (γ family) to report the adjusted mean ratio (aMR) and CI for the association of craniotomy with length of stay (LOS) and cost of care.

Results:
Among 271 840 ICH hospitalizations (mean age [SD] 68.2 [14.9] years; 48% females), 15.3% received CP. Utilization of CP increased from 14.6% in 2016 to 15.8% in 2019 (aOR, CI: 1.10, 1.00 -1.21). Factors independently associated with lower odds of receiving CP (aOR, CI) are older age (0.97, 0.97 - 0.97); Hispanic ethnicity (0.87, 0.78 - 0.97) and Asian race (0.84, 0.73 - 0.96) (vs. Non-Hispanic White); congestive heart failure (0.86, 0.79 - 0.95); diabetes (0.79, 0.72 - 0.87) and renal failure (0.68, 0.62 - 0.74). Private (vs. Medicare) insurance (1.23, 1.13 - 1.34); and residence in large metropolitan (vs. non-metropolitan) counties (1.14, 1.03 - 1.25) is associated with higher odds of receiving a CP. CP is associated with significantly lower odds of in-hospital mortality (aOR, CI: 0.66, 0.61 - 0.72) and home discharge (0.51, 0.45 - 0.57). However, CP ICH patients had longer LOS (aMR, CI: 1.79. 1.75 - 1.84) and higher cost of care (1.82, 1.79 - 1.85). CP is not associated with MCC (aOR, CI: 0.99, 0.92 - 1.07).

Conclusions:
Modern-day craniotomy procedures likely improve ICH in-patient survival and are not associated with major complications. Large, pragmatic clinical trials for ICH patients are needed to evaluate effectiveness of craniotomy, particularly minimally invasive procedures, on longer term mortality and functional outcomes.
Abstract TMP88: Prognostic Scoring System Of Mechanical Thrombectomy For Elderly Acute Ischemic Stroke Patients
Authors: Arimura Koichi , Miki Kenji , Matsuo Ryu , Tokunaga So , Ido Keisuke , Yamaguchi Shinya , Yoshida Hidenori , Kameda Katsuharu , Iihara Koji , Ito Osamu , Kurogi Ryota , Koyanagi Yuya , Karashima Satoshi , Okuda Tomohiro , Iwaki Katsuma , Takagishi Soh , Nishimura Ataru , Nakamizo Akira , Yoshimoto Koji
Published: February 2023

Background:
The number of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in elderly patients has increased, but the feasibility and safety are still debated. We aimed to investigate the risk factors and produce a prognostic scoring system for MT in elderly AIS patients.

Methods:
We analyzed data from 763 consecutive patients who underwent MT for AIS between January 2013 and January 2020 at seven comprehensive stroke centers for derivation group. We defined elderly patients as ≥ 75 years of age. We investigated the risk factors of MT among these elderly patients and developed a prognostic scoring system assigned weighted points proportional to their standardized coefficient values. We conducted a subsequent validation study that included 287 consecutive patients treated between February 2020 and December 2021.

Results:
In total, 251 elderly patients in derivation group were analyzed retrospectively. According to the multivariable analysis, we developed a scoring system (SNA
3
P score) consisting of six factors, including age ≥ 90 (2 points), female sex (2 points), a pre-modified Rankin Scale (mRS) score of 2 (1 point), anticoagulant drug use (2 points), the NIHSS score (4 points), and the ASPECTS (4 points). A score ≤ 5 predicted an mRS score of 0-2 at 90 days with a sensitivity of 74% and a specificity of 65%, and the area under the curve (AUC) was 0.76. In the validation study, a score ≤ 5 predicted an mRS score of 0-2 at 90 days with a sensitivity of 70% and a specificity of 60% (AUC was 0.74).

Conclusions:
We created the novel scoring system to predict the functional outcome of elderly AIS patients undergoing MT. This simple scoring system may provide the information for indication of MT for elderly AIS patients, but further investigation for external validation is needed.
Abstract TMP90: The Harm Sign As A Trial Biomarker Of Reperfusion Injury: Frequency, Determinants, And Outcomes In EVT Patients With Successful Reperfusion
Authors: Farooq Salman , Liebeskind David S , Jahan Reza , Yoo Bryan , Rao Neal M , Nour May , Colby Geoffrey , Sharma Latisha K , Starkman Sidney , Saver Jeffrey L
Published: February 2023

Introduction:
With successful reperfusion (SR, mTICI 2b-3) now being achieved in the great preponderance of patients undergoing endovascular thrombectomy (EVT), prevention of blood-brain barrier disruption and reperfusion injury is an emerging therapeutic target. For trials of agents to reduce BBB injury, the hyperintense acute reperfusion marker (HARM) sign is a potentially useful physiologic biomarker. However, past studies of HARM have generally failed to disaggregate non-EVT patients, EVT patients without SR, and EVT patients with SR.

Methods:
In a prospectively maintained database, we analyzed consecutive patients with SR (mTICI 2b-3) after EVT for anterior circulation large vessel occlusion undergoing post-gadolinium MRI scans at 3-6h and 24h after thrombectomy.

Results:
Among 48 SR patients meeting study entry criteria, the HARM sign was present in 65%. Patients with HARM sign, compared to those without, did not differ in age or NIHSS, but were more often female (54% vs 10%), more often had history of hypertension (65% vs 47%), and had higher initial SBP (156 vs 144). Patients with HARM sign more often received IV TPA (39% vs 29%), had longer time from onset to achievement of SR (median 352 vs 264 mins), underwent more passes (2.5 vs 1.9), and less often had complete (mTICI 3) reperfusion (13% vs 41%). With regard to outcomes, HARM patients more often had radiologic hemorrhage (75% vs 24%), less often were ambulatory at discharge (23% vs 59%), had less functional independence (mRS 0-2) at 90d (33% vs 59%), and had higher in-hospital mortality (16% vs 0%).

Conclusion:
The HARM sign is present in two-thirds of EVT patients with successful reperfusion; is associated with higher blood pressure, IV lytic therapy, longer time to reperfusion, more procedure manipulations, and less than complete macro-reperfusion; and is strongly associated with hemorrhagic transformation and worse clinical outcomes. The HARM sign is a promising biomarker for use in trials of treatments to avert reperfusion injury.
Abstract TMP95: Infarct Growth During Inter-facility Transfer In An Integrated Stroke Network
Authors: Potluri Anvita , Abarca Nancy , Miller Malgorzata , Stowe Alicia , Wideman Brian , Tsai Jenny , Kremers Meghan , Tubergen Tricia , Kline Andrew , Mulderink Todd , Min Jiangyong , Wees Nabil , Khan Nadeem I , Ahrar Asad , Singer Justin , Mazaris Paul , Oostema John A , Khan Muhib
Published: February 2023

Background:
Perfusion imaging is used to determine eligibility for mechanical thrombectomy (MT) in patients presenting with large vessel occlusion (LVO) in acute ischemic stroke. The utility of CT perfusion (CTP) imaging in spoke hospitals remains controversial. The aim of the study was to compare the imaging parameters, functional and safety outcomes in patients selected for MT based on CTP availability in regional hospitals.

Methods:
Consecutive adult patients treated for LVO after initially presenting to regional spokes between Jan 2021 to Dec 2021 were included in the analysis. Our standard Acute Stroke Imaging Protocol included CT/CT angiogram. CT perfusion was added to the protocol in April 2021. Demographics, NIHSS, imaging metrics (ASPECTS, CTA collateral score, reperfusion (mTICI 2b/3) rates), hemorrhage (per ECASS III) and functional outcomes (modified Rankin Scale of 0-2 at 90 days) were compared between patients who did vs. did not undergo CTP at regional. Core infarct volume growth and rate (ml/min) was assessed for patients with CTP data both at the regional and at the Comprehensive Stroke Center (CSC).

Results:
A total of 29 patients met inclusion during the study period. Of these, 14 patients were transferred to CSC for possible MT without CTP at the regional facility and 15 were transferred with CTP at regional. Age (p=0.44), NIHSS (p=0.08) and onset-to-regional facility arrival time (p=0.54) were similar in both groups. For all patients, repeat imaging at the CSC showed significantly decreased ASPECTS (p=0.002) but stable CTA collateral score (p=0.94). For patients who underwent CTP both at the regional facility and CSC, median core infarct volume grew significantly (0[0, 7] ml vs. 7 [0, 14] ml, p=0.022), with a median growth rate of 0 [0, 0.07] ml/min. No patients were excluded from thrombectomy due to core infarct growth. Rates of successful reperfusion (p=0.83) and hemorrhagic transformation (p=0.49) did not differ significantly between the groups. Rates of mRS 0-2 were similar in both groups (p=0.85).

Conclusion:
Our study suggests that core infarct grows during interfacility transfers without an impact on selection for thrombectomy and outcomes. A larger study is needed to assess the need for repeating perfusion imaging at CSC.
Abstract TMP97: Comparison Of Severity And Mortality Among Patients With Atrial Fibrillation Who Developed Ischemic Stroke During Anticoagulation With Warfarin And Non-vitamin K Antagonist Oral Anticoagulants
Authors: KIM Ji Hwa , Hong Jung Hwa , Lee Hancheol , Ok Taedong , Seo Kwonduk
Published: February 2023

Introduction:
Non-vitamin K antagonist oral anticoagulant (NOAC) has been the drug of choice for preventing ischemic stroke in patients with atrial fibrillation since 2014. In previous studies, the stroke risk while taking warfarin was known to be 2 per 100 patient-years and 1.5% per year while taking NOACs. We hypothesized that even if ischemic stroke occurred during anticoagulation therapy with NOACs, the prognosis was likely to be better than that of warfarin.

Methods:
We obtained data from the nationwide claim database from 2009 to 2019. Patients with atrial fibrillation were identified using the International Classification of Disease Codes. After the diagnosis of atrial fibrillation, patients who developed ischemic stroke during anticoagulation were extracted. The severity of ischemic stroke in the patients was evaluated by the stroke severity index (SSI) calculated by the combination of claim codes. Patients who died within 3-months and within 1-year after ischemic stroke were identified. The patients were divided according to the drug of anticoagulation (warfarin, dabigatran, apixaban, rivaroxaban, edoxaban).

Results:
A total of 206,848 patients who were newly diagnosed with atrial fibrillation and started anticoagulation therapy were analyzed. Among them, 10,658 patients developed ischemic stroke during follow-up. The anticoagulants administered to these patients were warfarin in 4,423, dabigatran in 965, apixaban in 2,320, rivaroxaban in 1,702, and edoxaban in 1,248. The SSI was highest in the warfarin group (11.43±3.85), and lower in the edoxaban group (8.93±4.03). The order of mortality at 3-months after ischemic stroke was warfarin (17.88%), rivaroxaban (12.34%), dabigatran (9.53%), apixaban (8.28%), and edoxaban group (8.25%). The 1-year mortality rate also showed the same trend. Among NOACs, apixaban had the lowest hazard ratio (HR), HR for 3-months mortality was 0.431 (95% CI 0.367-0.505, p<0.0001), and HR for 1-year mortality was 0.455 (95% CI 0.407-0.510, p<0.0001).

Conclusions:
In our study, we confirmed that NOAC could lower the risk of death from ischemic stroke than warfarin in patients with atrial fibrillation. Except for rivaroxaban, there was no difference in mortality in the other three NOAC groups.
Abstract TMP98: Identifying Stroke Patients At Risk For Atrial Fibrillation Using Electronic Health Record Data And Machine Learning
Authors: Su Tongli , Hasan S M Shafiul , Nahab Fadi B , Hu Xiao
Published: February 2023

Background:
Atrial fibrillation (AF) detection after cryptogenic stroke (CS) or transient ischemic attack (TIA) carries important therapeutic implications. Machine learning (ML) algorithms may help to identify AF risk from electronic health records (EHR). The study aimed to develop and validate a new ML method to identify CS patients at risk for AF using EHR data.

Method:
We conducted a retrospective cohort study of CS patients from January 1, 2017, to February 28, 2022, utilizing EHR data to query for AF onset based on billing codes. A ML model was established to predict the occurrence of AF during follow-up. The features used in the model included data from 34 variables in EHR linked to AF in other studies.

Results:
Of 390 CS patients (62±16 years, 56.4% male), 79 (20%) developed AF after index stroke. Of the 34 original variables, ten clinical variables best predicted the occurrence of AF: Age, BMI ≥30, diabetes, dyslipidemia, duration of dyslipidemia, hypertension, chronic kidney disease stage III/IV/V, duration of chronic kidney disease, mitral valve disease, and duration of mitral valve disease. We fitted a cox proportional hazard model to each of the 34 features respectively and ranked them by concordance index. The ten most informative features were selected using a grid search that looped through different combinations of features sequentially and evaluated each combination with 3-fold cross validation. In a Cox proportional hazard model, these ten variables predicted the occurrence of AF with good model discrimination reflected by Harrell’s concordance index of 0.73.

Conclusions:
ML algorithms using EHR data can be effectively used to identify CS patients at risk for AF. Further study is required to determine if ML algorithms can identify CS patients who may benefit from long-term outpatient cardiac monitoring.
Abstract TMP99: Neighborhood Disadvantage And Outcomes Following Intracerebral Hemorrhage
Authors: Kim Jisoo , Rivier Cyprien , Renedo Daniela , Torres Lopez Victor M , Schlechter Maia , Kitlen Eva , Kampp Michael , Jasak Sara , Sansing Lauren H , Sheth Kevin N , Falcone Guido J
Published: February 2023

Introduction:
Neighborhood disadvantage is associated with various health factors. Given the mounting evidence linking social determinants to risk of, and outcomes after, spontaneous intracerebral hemorrhage (ICH), we tested the hypothesis that higher neighborhood disadvantage leads to poorer outcomes following ICH.

Methods:
We conducted a nested study within an ongoing longitudinal study that prospectively follows patients with acute brain injury admitted to Connecticut’s largest healthcare system. The nested study included ICH survivors and evaluated neighborhood deprivation using the Area Deprivation Index, a publicly available metric that uses 9-digit zip codes to rank neighborhoods’ socioeconomic disadvantage based on factors such as income, employment, and education. Patients were given a tertile designation according to the Area Deprivation Index: low, intermediate, and high deprivation. Functional outcome was evaluated through the 6-month post-ICH Modified Rankin Scale, dichotomized as 0-3 (good outcome) and 4-6 (poor outcome). We used chi-square tests and multivariable logistic regression for unadjusted and adjusted association analyses, respectively.

Results:
Out of 687 ICH patients enrolled from 2018 to 2022, 518 (mean age 67, 47.5 % female, 19% Black, 8% Hispanic) had 9-digit zip code and outcomes data. The unadjusted risk of poor outcome was 40%, 55%, and 61% for patients living in neighborhoods with low, intermediate, and high disadvantage (unadjusted p=0.02). This association was confirmed in multivariable analyses adjusting for potential confounders: compared to patients living in low-disadvantage neighborhoods, those living in neighborhoods with intermediate and high disadvantage had 66% (OR 1.66, 95% CI 0.82-3.40) and 2.5 times (OR 2.44, 95% CI 1.17-5.19) higher risk of poor outcomes (test-for-trend p=0.01).

Conclusion:
Among ICH survivors enrolled in a prospective study of acute brain injury, increased neighborhood disadvantage was associated with a higher risk of poor outcomes. Our results validate the Area Deprivation Index as a useful tool to assess the numerous social determinants of health. Additionally, our findings highlight the negative role of these social determinants in patients' recoveries.
Abstract TP102: Automated Assessment Of Ischemic Core On Noncontrast Computed Tomography: A Comparative Analysis With CT Perfusion
Authors: Kihira Shingo , tavakkol elham , Qiao Xin , Polson Jennifer , Zhang Haoyue , Bahr-Hosseini Mersedeh , Colby Geoffrey , Nour May , Tateshima Satoshi , Jahan Reza , Duckwiler Gary , Ledbetter Luke , Villablanca Juan , Arnold Corey , Saver Jeffrey L , Liebeskind David S , Nael Kambiz
Published: February 2023

Introduction:
Application of machine learning (ML) algorithms has shown promising results in estimating ischemic core volumes using routine non-contrast CT (NCCT). We aimed to assess the performance of the e-Stroke Suite software (Brainomix, Oxford, United Kingdom) in assessing ischemic core volumes on NCCT compared to CTP in patients with acute ischemic stroke.

Methods:
In this retrospective study, consecutive patients with anterior circulation large vessel occlusions who underwent pretreatment NCCT and CTP and posttreatment MRI were included. Ischemic core volumes were automatically calculated on NCCTs using e-Stroke Suite (Brainomix) which uses a combination of traditional 3D graphics and ML classification techniques to identify ischemic core voxels. Estimated ischemic core volumes were also automatically calculated from CTP using Olea Sphere (Olea Medical SAS, SP23) using a combination of rCBF<25% and differential Time-to-peak (dTTP)>5 sec. Estimated core volumes were compared against the final infarct volume on posttreatment MRI in patients who achieved successful reperfusion (mTICI ≥2b).

Results:
83 patients [52 female; age (mean ± SD): 73.1 ±15.3] were included. The estimated ischemic core volumes (mean ± SD) were 18.9 ± 13.5 mL on NCCT and 17.5 ± 16.5 mL on CTP, not significantly different (p=0.54) and demonstrated significant correlation (r=0.51, p<0.001) (
Figure 1
). Among patients with successful recanalization (n=49), there was no significant difference in estimated ischemic core volume between NCCT vs. CTP (p=0.80) and NCCT vs. MRI (p=0.38). There was significant correlation between estimated ischemic core volume on NCCT vs. CTP (r=0.75, p<0.001) and vs. final MRI infarct volume (r=0.75, p<0.001).

Conclusions:
Results show estimated ischemic core volumes obtained automatically by ML-based approach (Brainomix) on NCCT correlates well with ischemic core volumes on acute CTP and with post-treatment MR infarct volume.