bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2741: S-Nitrosoglutathione Increases Benefit of Motor Exercise on Functional Recovery and Stimulates Neurorepair Mechanisms Following Experimental Stroke in Rats
Authors: Khan Mushfiquddin , Sakakima Harutoshi , Dhammu Tajinder S , Anandakumar Shunmugavel , Singh Inderjit , Singh Avtar K
Published: July 2021

Background:
Stroke is the leading cause of long-term physical disability and life-long neurologic deficits. The disability stems from acute neurovascular injury and injury-induced compromised neuroplasticity. This neuroplasticity can be restored by stimulating neurotrophic factors via two possible modalities: rehabilitation activity and neurorepair therapy. Improvement of neurologic function has been achieved following brain trauma by the neurovascular protective agent S-nitrosoglutathione (GSNO). Therefore, we investigated whether GSNO stimulates the expression neurotrophic factors and enhances the benefits of motor exercise, leading to functional recovery in a rat model of experimental stroke.

Methods:
Ischemic stroke was induced by middle cerebral artery occlusion (MCAO) for 60 min followed by reperfusion in adult male rats. Injured animals were either treated with vehicle (IR group), GSNO (0.25 mg/kg, GSNO group) or underwent rotarod exercise (EX group). In the third treatment group, GSNO was combined with rotarod exercise (GSNO+EX group). The groups were compared in terms of brain infarction, neurological score, motor function, cell death, tissue structure, and the expression of the neurotrophic factors BDNF, TrKB, and myelin.

Results:
All three treated groups (GSNO, EX and GSNO+EX) showed reduced infarction, improved motor and neurological functions, and decreased apoptotic neuronal cell death compared to the IR group. However, the combination group GSNO+EX showed a trend toward greater recovery than the GSNO or EX group alone. All the three treated groups also showed enhanced expression of neurotrophic factors and improved tissue histology. A delayed intervention (24 h after IR) by GSNO also aided the functional recovery. Furthermore, the protective effect of GSNO and exercise was blunted in another set of animals by an inhibition of AKT activity using the PI3 kinase inhibitor LY 294002 compound.

Conclusion:
GSNO, like exercise, aids recovery of functions in a long-term treatment by stimulating the expression of neurotrophic factors, reducing infarctions, and decreasing cell death. A combination of exercise and GSNO shows a greater degree of improvement in neurobehavioral function. Clinical relevance of the therapy is supported by an improved functional recovery even when GSNO was administered 24 h following IR. Mechanistically, the improvements by GSNO and exercise are dependent, at least in part, on AKT activity.
Abstract 2749: Amyloid-beta (1-42) is Reduced in CSF in Vascular Cognitive Impairment
Authors: Rosenberg Gary A , Prestopnik Jillian , Thompson Jeffrey , Gasparovic Charles , Huisa-Garate Branko N , Schrader Ronald , Adair John
Published: July 2021

Introduction:
Vascular cognitive impairment (VCI) and Alzheimer’s disease (AD) have a high degree of overlap in a number of large autopsy series. However, few studies have examined the overlap during life. VCI is a heterogeneous disorder due to large and small vessel vascular disease (SVD). Biomarkers of inflammation are present in the SVD, which is a progressive form of VCI that is characterized by MRI findings of lacunar strokes and white matter hyperintensities (WMHs), executive dysfunction, focal neurological findings, apathy, urinary problems and gait imbalance. Recently, we showed an association between a reduced matrix metalloproteinase-2 (MMP-2) CSF index and disruption of the blood-brain barrier (BBB) in SVD. We hypothesized that patients with both VCI and AD would show CSF and MRI biomarkers for both diseases.

Patients and Methods:
Patients (N=60) with VCI underwent neurological and neuropsychological testing. MRI was done with FLAIR, proton magnetic resonance spectroscopy (1H-MRS) to measure ischemia with N-acetylaspartate (NAA), and dynamic contrast-enhanced MRI (DCEMRI) to measure BBB transfer constants (K
i
). CSF (N=37) was obtained by lumbar puncture for measurements of albumin index, MMP-2 and MMP-9 indexes, ABeta 1-42, total-tau (T-Tau) and hyperphosphorylated-tau (P-Tau).

Results:
BD patients had large WMHs, while large vessel (multi-infarct and single strategic stroke) patients had small WMHs. NAA was used as a biomarker of lesion size due to ischemic damage in the white matter. ROC plots showed that a NAA cut-point of 12 separated patients with large WMHs (low NAA) from small WMHs (p<0.0001). K
i
transfer constants above 0.0018 (ROC; p<0.0001) and MMP-2 below 0.0099 (ROC; p<0.0001) were considered abnormal. SVD patients had reduced ABeta 1-42 compared to control CSF. P-Tau was unaffected. Abnormal values for K
i
and MMP-2 index were present in both large and small vessel disease patients.

Conclusions:
Our results show that SVD patients have significantly reduced levels of ABeta 1-42 in CSF, suggesting impairment in amyloid metabolism associated with vascular disease. These findings conform to the autopsy findings and suggest that multimodal biomarkers may provide information during life about the presence of both AD and VCI.
Abstract 2762: Asymmetry of The Blood Oxygen Level-Dependent fMRI Response During Hypercapnia Is Reliable to Evaluate Cerebrovascular Reactivity in Patients with Severe Unilateral Carotid Stenosis
Authors: Mazzetto-Betti Kelley C , Castro-Afonso Luis H , Pinto Pedro T , dos Santos Antonio C , Abud Daniel , de Araujo Draulio B , Leite João P , Pontes Neto Octavio M
Published: July 2021

Background and Purpose:
Previous transcranial Doppler studies have suggested that, in patients with severe carotid stenosis, the lack of cerebrovascular reactivity (CVR) is an independent predictor of ipsilateral stroke. The BOLD (Blood Oxygenation Level-Dependent) fMRI contrast can be used to assess the CVR during normal condition and during hemodynamic stress, like hypercapnia. The purpose of this study is to evaluate the BOLD signal parameters on the Middle Cerebral Artery (MCA) territory, induced by auditory stimulus, during different levels of hypercapnia in patients with severe unilateral carotid stenosis, comparing the ipsilateral hemisphere (IH) to the contralateral hemisphere (CH).

Methods:
The images were obtained from 16 patients with severe unilateral carotid stenosis. Patients were submitted to an auditory stimulus (3s) in three different conditions: normocapnia and at EtCO2 increase of 5 and 10mmHg. The images were acquired with a 3T Philips MR, preprocessed and analyzed using an autoregressive method.

Results:
The BOLD signal from the IH was different from the CH during the basal condition and at 5mmHg (p<0.0001), but not at the 10mmHg ETCO2 increase. For each BOLD parameter, the major differences between the hemispheres were seen on the onset time (p<0.0001) and amplitude of BOLD signal (p<0.0001). The width difference was significant between the basal and 10mmhHg increase (p<0.01). In these three parameters, the BOLD signal of the IH presented no significant variations with the CO2 increment. However, the BOLD signal for CH showed an increase on the time-to-onset and width and amplitude decrease. The time to peak parameters of the BOLD signal showed no differences between the hemispheres and at hypercapnic conditions.

Conclusion:
In our results the IH did not respond to the hypercapnic stress as the CH. Therefore, among patients with severe carotid stenosis, BOLD can reliably identify some that have an exhausted CVR, which cannot respond to a vasodilatory stress like hypercapnia. Future studies using this technique may help to select patients for recanalization procedures.
Abstract 2764: Assessment Of Intravascular Ultrasonography Assisted Aneurysm Coil Embolization
Authors: Majidi Shahram , Khatri Rakesh , Watanabe Masaki , Siddiq Farhan , Chaudhry Saqib A , Hassan Ameer E , Qureshi Adnan I
Published: July 2021

Background:
Intravascular ultrasonography (IVUS) has been previously used for guiding intravascular stent placement in interventional cardiology.

Objective:
To evaluate the feasibility of aneurysm embolization using detachable coils under IVUS guidance.

Method:
Two different experimental models of aneurysm were used. IVUS guided embolization in conjunction with flouroscopic imaging and subsequently alone were performed in a silicone model with a side wall aneurysm. IVUS guided embolization in conjunction with flouroscopic imaging was also used in in-vitro model of side wall aneurysm created using sheep vessels. The visibility of aneurysm, microcatheter, and coils ascertained by the IVUS was graded as excellent, good, or poor based on visualization of these items as distinct structures. The agreement between simultaneously acquired angiographic and IVUS images for detecting increasing intra-aneurysmal coil mass and coil prolapse was assessed in 10 and 6 simultaneously acquired angiographic and IVUS images, respectively.

Results:
IVUS measurements of the aneurysm dimensions strongly correlated with actual dimensions and measurements acquired by contrast angiography (Pearson’s coefficient of 0.96 and 0.99 for silicone model and arterial segment model, respectively) (
Figure 1
). IVUS visualization of aneurysm, microcatheter tip, and coil loops were graded as excellent in the silicone aneurysm model and good in carotid artery model (
Figure 2
). The agreement between simultaneously acquired angiographic and IVUS images was very high, for detecting increasing intra-aneurysmal coil mass (Spearman’s rank correlation coefficient of 0.98) and coil prolapse (83% agreement). We were able to successfully perform and complete embolization of silicone aneurysm model with IVUS alone (complete obliteration confirmed by direct visualization).

Conclusion:
This study shows IVUS-guidance during aneurysm embolization may improve the procedure by providing intravascular aneurysmal measurements and visualization of devices used in the procedure.
Abstract 2783: Disparities in Ischemic Stroke Presentation and Outcomes Based on Human Development Index of a Nation: A Secondary Analysis of International Stroke Trial
Authors: Moradiya Yogesh , Modi Sneha
Published: July 2021

Background and Purpose:
Human Development Index (HDI), a comparative composite measure of health, education and standard of living of nations worldwide, is published annually by United Nations Development Programme (UNDP). Our aim was to study the disparities in presentation and outcomes of acute ischemic stroke based on HDIs of nations.

Methods:
We used the International Stroke Trial (IST) database which was recently made available for public use for novel secondary analyses by independent researchers. IST, one of the largest prospective randomized controlled trials of acute stroke, was conducted in 467 hospitals of 36 countries in years 1991-1996 and included 19435 patients to study the effect of early treatment with aspirin and heparin in acute ischemic stroke. The trial had 99% complete six month follow-up data. We used the internet tool available on UNDP website to find HDIs of participating nations for the year 1995. We calculated National Institute of Health Stroke Scale equivalent stroke severity scale from the clinical findings present on admission. We only included the cases with final diagnosis of acute ischemic stroke and with known HDI (n=17262) in our analysis. We used

χ
2

and one-way ANOVA to compare demographic and clinical characteristics between HDI groups. Multivariate logistic regression was used to study numeric HDI value multiplied by 100 as an independent predictor of various outcomes in stroke.

Results:
There was a significant difference in all the studied stroke characteristics between different HDI groups (
Table 1
). With each unit increment in HDI by 0.01, odds of in-hospital mortality, complete functional recovery at six months and all-cause mortality at six months decreased by 2.3%, 3.6% and 2.8% respectively and odds of in-hospital recurrent ischemic stroke and functional dependence at six months increased by 4.8% and 2.7% respectively. HDI value could not predict intracranial hemorrhage or major non-cerebral bleeding significantly (
Table 2
).

Conclusions:
We identified significant disparities in ischemic stroke presentation and outcomes between countries with different levels of national development. The disparities may have important implications in international health policy making and planning of multinational clinical trials involving acute ischemic stroke.
Abstract 2790: Aggressive Atorvastatin Decreases Wall Shear Stress In The Carotid Artery
Authors: Li Zhi-Yong , Tang Tjun , Gillard Jonathan
Published: July 2021

Introduction:
Both wall shear stress (WSS) and inflammation play an important role in atherosclerotic plaque initiation and progression. Lipid-lowering therapy has been shown to be effective in stabilizing them by reducing plaque inflammation. However, its effect on WSS remains unknown. Therefore, the role of high- and low-dose lipid-lowering therapy using an HMG Co A reductase inhibitor - atorvastatin on WSS in carotid artery was investigated.

Methods:
Twenty-six patients included in the ATHEROMA study were assessed using phase-contrast magnetic resonance imaging (MRI). All patients demonstrated plaque inflammation by intraplaque accumulation of ultrasmall super paramagnetic particles of iron oxide (USPIO) on at baseline. They were randomized in a double-blinded manner to either 10mg or 80mg atorvastatin daily for 12 weeks. WSS at common carotid artery (CCA), maximum (MS) stenosis and internal carotid artery (ICA) were assessed from in vivo phase contrast MRI at both 0 and 12 weeks.

Results:
There were no significant differences in WSS in CCA, MS and ICA between the two groups at baseline. At 12 weeks, WSS in CCA and MS at end diastole were significantly lower in the 80mg group than those in the 10mg group (p=0.03 and 0.04 respectively). Significant reductions of WSS in all the three locations were observed in the 80mg group at 12 weeks (p= 0.01, 0.04 and 0.04 respectively) whereas no significant change was seen in the 10mg dose group.

Conclusions:
Aggressive lipid-lowering therapy is associated with a significant reduction in WSS. This suggests that reduction in WSS may be associated with reduction in plaque inflammatory burden and vice-versa. Lipid-lowering therapy may not only reduce inflammation but also improve the hemodynamics.
Abstract 2951: Role Of Transcellular Transport During Fibrinogen-induced Increase In Pial Venular Permeability In Mice
Authors: Muradashvili Nino , Khundmiri Syed Jalal , Tyagi Suresh C , Lominadze David
Published: July 2021

Many inflammatory diseases such as stroke, hypertension, and diabetes are accompanied by increased blood content of fibrinogen (Fg). We showed that high content of undegraded Fg causes macromolecular leakage in pial vessels and increases endothelial cell (EC) layer permeability affecting paracellular pathway causing changes in tight junction proteins. In this study we tested the hypothesis that Fg-induced cerebrovascular permeability involves transcellular pathway through activation of matrix metalloproteinase-9 (MMP-9). Fg (total blood content 4 mg/ml) or phosphate buffered saline (PBS) were infused to wild-type (WT, C57BL/6J) and MMP-9 gene knockout (MMP9-−) mice. After measuring pial venular leakage brain cortical cryo-sections were probed with antibodies against caveolin-1 (Cav-1) and plasmalemma vesicle associated protein-1 (PV-1) to define the role of functional caveolae in vascular permeability. Possible formation of caveolae also was observed in mouse brain endothelial cells (MBECs) with total internal reflection fluorescence microscopy. Expression of Cav-1 and PV-1 was more in Fg-infused (155 ± 4 % and 85 ± 4 % of baseline, respectively) compared to PBS-infused (110 ± 3 % and 51 ± 6 % of baseline, respectively) WT animals. In MMP9-− mice, Fg induced greater expression of Cav-1 and PV-1 (72 ± 4 % and 46 ± 3 % of baseline, respectively) than PBS infusion (43 ± 2 % and 18 ± 3 % of baseline, respectively), but the effects were lesser than in WT mice. High content of Fg increased formation of functional caveolae in MBECs compared to that in cells treated with PBS. These data suggest that at an increased level Fg compromises cerebrovascular integrity by enhancing caveolae formation. Thus, at higher contents, Fg increases microvascular permeability altering the transcellular transport in addition to the paracellular transport.
Abstract 2971: Atheromatous Plaques of the Middle Cerebral Artery in the Lateral Lenticulostriate Artery Territory Infarction
Authors: Tsujino Akira , Tateishi Yohei , Hayashi Kentaro , Suyama Kazuhiko , Kawakami Atsushi , Nagata Izumi , Tasaki Osamu
Published: July 2021

OBJECTIVES:
We evaluated the utility of black-blood double inversion recovery magnetic resonance imaging (BBDIR-MRI) for depiction of the intracranial branch atheromatous disease caused by occlusion at the vessel orifices of lager-caliber penetrating arteries.

METHODS:
BBDIR-MRI was performed on 15 consecutive patients with acute cerebral infarcts in the territories of lateral lenticulostriate arteries, which were classified into small artery occlusion by TOAST criteria. Abnormal wall thickening of the horizontal part (M1) of the middle cerebral artery was considered as the atheromatous plaque causing the occlusion of the vessel orifices. The clinical characteristics including the prevalence of various vascular risk factors, the final size of infarcts and the rate of disease progression were compared between two groups with and without the atheromatous plaque.

RESULTS:
By BBDIR-MRI, the atheromatous plaques were detected in 8 patiennts (53%), while Time of flight (TOF)-MRA revealed the irregular stenosis in one patient. All of them had the eccentric wall thickening with iso-signal intensity on T1- and T2-weighted images of BBDIR-MRI. The large infarcts exceeding 1.5 cm in diameter tended to be more often in patients with the atheromatous plaque (100%) than those without it (57%). However, there were no significant differences of clinical characteristics between the two groups with and without the atheromatous plaque.

CONCLUSIONS:
BBDIR-MRI could reveal the atheromatous plaque at M1 portion of the middle cerebral artery more easily than TOF-MRA. It might be useful to distinguish the intracranial branch atheromatous diseases from the other types of infarcts in the territories of lateral lenticulostriate arteries.
Abstract 3000: Epidemiology of Cerebrovascular Diseases Among Chinese with Diabetes Mellitus in Toronto: A Retrospective Ten Years Case-mix Study
Authors: Lam Susy , Chu Joseph Y
Published: July 2021

BACKGROUND:
An article published in Neurology Asia(2006;11:13-18) by Chu etal provided essential data to investigate whether specific genetic or environmental differences exist within the diabetic-Chinese stroke community. Insight into distinctive epidemiologic and cerebrovascular patterns will bring forth effectively focused treatment and prevention. From that basis, we hypothesized: Chinese who had stroke-history within 15 years are more commonly diabetic than Europeans, and Chinese more frequently have small vessels disease (SVD) than Europeans.

METHODS:
Patients seen during 2001-2011 at the Toronto Queensway Professional Center Neurology clinic and at William Osler Health System, Brampton Site, were investigated. Chinese diabetic stroke patients were selected by last name and birth country; similarly diagnosed European patients were age-sex matched correspondingly. Risk factors were acknowledged if patients were given explicit medical treatments. Otherwise, guideline values were obtained from the WHO criteria. Data was collected through screening patient charts for the following: diabetic prevalence through screening stroke patients (122 Chinese, 880 European) excluding TIAs, subarachnoid and subdural haemorrhages; etiology and stroke type comparison in patients with DM (48 Chinese, 127 European); risk factors differences between Chinese and Europeans with DM. Odds ratios and unpaired two-sample t-testing were used to confirm significance.

RESULTS:
Significance confirmed (P<0.05): Chinese had higher DM and stroke incidence than Europeans (28.7% vs. 23.2%). Diabetic Chinese more frequently had SVD (51.1% vs. 44.1%), specifically lacunar stroke (47.9% vs. 36.4%). The co-morbidity of SVD risk factors of hypertension, hyperlipidemia and overweight were more frequent in Chinese (Table 1.0). Furthermore, SVD frequency dominated over large vessels disease (LVD) in the Chinese (Table 1.1). Table 1.0 - RISK FACTOR INCIDENCE Overweight HBP HPL Chinese, SVD 26.9% 53.8% 36.5% European, SVD 16.5% 33.1% 23.6% OR Chinese/Euro.1.86 2.36 1.86 Table 1.1 - STROKE TYPE AND RISK Overweight, SVD Overweight, LVD Hyperlipidemia, SVD Hyperlipidemia, LVD Hypertension, SVD Hypertension, LVD : Chinese 26.9% 7.7% 36.5% 15.0% 53.8% 25.0% OR SVD/LVD 4.42 3.26 3.50 European 16.5% 7.9% 23.6% 15.0% 33.1% 26.0% OR SVD/LVD 2.32 1.76 1.41

CONCLUSIONS:
Chinese with stroke are more frequently diabetic than Europeans. Diabetic Chinese are especially susceptible to small vessels disease and certain stroke risk factors are more frequent compared to the Europeans. Risk factor prevalence and stroke types differ considerably between Chinese and Europeans within Toronto, which may imply that specific treatment strategies are required to target towards each population.
Abstract 3039: Temporal Trends in the Prevalence of Dermatoses in Patients with Stroke and Transient Ischemic Attack in the United States
Authors: Kupetsky Erine A , Maltenfort Mitch , Waldman Scott , Rincon Fred
Published: July 2021

Background.
We sought to determine the prevalence of skin conditions traditionally associated with acute ischemic stroke (AIS) and transient ischemic attacks (TIA) in the U.S.

Methods.
This is a cross-sectional study of data derived from the National Inpatient Sample from 1988-2008. We searched for admissions of patients <18 years, with a primary diagnosis of AIS, TIA, and the following secondary diagnoses (dermatoses): Psoriasis, Behcet’s Disease (BD), Dermatomyositis (DM), Systemic Lupus Eythematosis (SLE), Pseudoxanthoma Elasticum (PXE), Progressive Systemic Sclerosis or Scleroderma (SCD), and Bullous Pemphigoid (BP). Definitions were based on ICD9CM codes, and adjusted incidence rates for the U.S census and prevalence proportions were then calculated.

Results.
Over the 20-year period, we identified 9,085,147 admissions that corresponded to a primary diagnosis of AIS and TIA of which 53,060 had a secondary diagnosis of dermatoses, for a total prevalence of 0.6%. The adjusted rate of AIS/TIA increased from 71/100,000 in 1988 to 200/100,000 in 2008. Among the secondary diagnosis, the most prevalent condition after AIS/TIA admissions was SLE (54%), psoriasis (34%), SCD (9%), BP (2%), DM (1%), PXE (0.5%), and BD (0.14%). The prevalence of these dermatoses increased from 0.2% in 1988 to 0.8% in 2008 (
Figure 1
).

Conclusion.
Despite an overall increase in the prevalence of dermatoses, these skin conditions remain a rare occurrence in AIS/TIA. The over-representation of traditional risk factors for AIS/TIA in patients with these dermatoses, may explain the observed epidemiological phenomenon.
Abstract 3063: Nitroglycerin Treatment Attenuates APP and BACE1 Protein Levels In Cerebral Microcirculation
Authors: Austin Susan A , Katusic Zvonimir S
Published: July 2021

Several cardiovascular risk factors are associated with an increased incidence of Alzheimer’s disease (AD); however, the mechanistic link is unknown. A common feature of cardiovascular risk factors is endothelial dysfunction, specifically, loss of bioavailability of endothelial nitric oxide (NO). Recently, we demonstrated that loss of endothelial NO led to increased protein levels of amyloid precursor protein (APP), β-site APP cleaving enzyme 1 (BACE1) and beta amyloid (Aβ) peptide. APP, the parent protein, when sequentially cleaved by BACE1 and γ-secretase generates amyloidogenic, Aβ, the primary component of AD plaques. Our data was the first to demonstrate a possible mechanism linking endothelial dysfunction, via loss of endothelial NO, with the upregulation of important AD related proteins in the cerebral microvasculature. Therefore, we sought to determine if supplementation of cultured human brain microvascular endothelial cells with NO, by utilizing the NO donor, DETA NONOate, would attenuate APP and BACE1 protein. DETA NONOate, 10
-8
to 10
-6
M, reduced expression of APP and BACE1 as compared to untreated control cells (n=3). To test the effects of NO supplementation in vivo, we treated endothelial nitric oxide synthase deficient (eNOS
-/-
) mice with 30 mg/kg nitroglycerine b.i.d. or vehicle via subcutaneous injections for 3 days. No difference was observed in blood pressure between animals treated with vehicle (n=7) or nitroglycerine (n=6) (P>0.05) or before and after nitroglycerine treatment (n=6, P>0.05). As expected, cerebral microvessles of eNOS
-/-
animals treated with nitroglycerine displayed increased levels of cGMP as compared to vehicle (n=7-8; P<0.05). Moreover, APP and BACE1 protein levels were statistically lower in cerebral microvessels from eNOS
-/-
mice treated with nitroglycerine as compared to vehicle treated (n=6-7, APP, P<0.05; BACE1, P<0.05). These data indicate that supplementation with NO is able to suppress APP and BACE1 levels in the cerebrovascular endothelium. Our findings suggest that preservation of NO/cGMP signaling may be an important therapeutic target in preventing and treating mild cognitive impairment as well as AD.
Abstract 3067: Independent Quality Assurance for Carotid Endarterectomy
Authors: Maas Matthew B , Rordorf Guy A , Kwolek Christopher J , Hirsch Joshua A , MacKay Cheryl , Rosenfield Kenneth , Jaff Michael R
Published: July 2021

Background:
A systematic bias leading to the underreporting of carotid endarterectomy (CEA) complications has been suggested in published reports. The possibility of an evidence-practice gap in conjunction with uncertainties regarding operator and institutional performance impede clinical decisions by practitioners for carotid revascularization.

Methods:
A prospective, independent monitoring system was implemented alongside an ongoing retrospective, self-reported quality assurance (QA) system for CEA at a major metropolitan tertiary care academic medical center. Independent, trained monitors from the neurology department examined all patients undergoing CEA both preoperatively and postoperatively at 24 hours and 30 days. Data was collected on patient demographics, medical history, and procedural and anatomical variables. Outcome data from the independent QA system was compared against self-reported data for the same cohort of patients, excluding CEA performed concurrently with another procedure (typically cardiac surgeries) or non-vascular surgeons.

Results:
From July 2008 through June 2010 vascular surgeons performed 462 isolated CEA at the institution. Stroke and death was detected at greater frequency by the independent QA system than was self-reported by the surgical staff (3.7% versus 1.7%, p=0.05). Self-reported outcomes from the study cohort matched those previously published in a peer-reviewed journal using the same self-reporting system (1.7% versus 1.4%, p=0.52).

Conclusions:
In the same cohort of patients, the reported periprocedural stroke and death rate for CEA is higher comparing prospective, independent, trained monitors to surgeon self-reporting. As public health policy mandates rigorous assessment of outcome, and ultimately, performance-based reimbursement, the validity of QA systems merits heightened attention.
Abstract 3275: Early Neurological Improvement After Intravenous Thrombolysis in Acute Stroke Predicts Long-Term Functional Outcome
Authors: Yeo Leonard L , Shen Liang , Wakerley Ben , Ahmad Aftab , Ng Kay W , Loh Pei K , Paliwal Prakash R , Venketasubramanian N , Ong Benjamin K , Wong Lily Y , Jie Su , Seet Raymond C , Teoh Hock L , Chan Bernard P , Sharma Vijay K
Published: July 2021

Background:
Intravenously administered tissue plasminogen activator (IV-TPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in the rates and timing of neurological recovery are observed in thrombolyzed patients. While all IV-TPA treated patients are routinely evaluated for neurological recovery at 24-hours, considerable improvement occurs in some cases within 2-hours of treatment initiation. We evaluated whether early neurological improvement at 2-hours after IV-TPA bolus (ENI-2) can predict functional outcomes in thrombolyzed AIS patients at 3-months.

Methods:
Data for consecutive stroke patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolyzed registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure levels before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA bolus and at 2-hours. ENI-2 was defined as a reduction in NIHSS score by more than 10-points from baseline score or an absolute score of 4-points or less at 2-hours after IV-TPA bolus. Functional outcomes at 3-months were determined by modified Rankin scale (mRS). Data were analyzed by SPSS 19.0.

Results:
Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome (mRS 0-1) at 3-months. Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, presence of atrial fibrillation, baseline NIHSS, onset-to-treatment time (OTT) and ENI-2. However, multivariable analysis demonstrated NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969) and ENI-2 (OR 4.926 95%CI 1.66-15.15) as independent predictors of favorable outcome at 3-months.

Conclusion:
Early Neurological improvement at 2-hours after IV-TPA bolus is a strong predictor of the functional outcome at 3-months in acute ischemic stroke patients.
Abstract 3303: Detection of cerebral vasospasm using Dynamic CT: Analysis of Volume Perfusion CT Maps and 4D-CT Angiography
Authors: Schramm Peter , Dolatowski Karoline , Schramm Ramona , Froelich Andreas , Klotz Ernst , Knauth Michael
Published: July 2021

Introduction:
Cerebral vasospasm with a raised risk for secondary ischemia is a frequent complication after subarachnoid hemorrhage (SAH). The early diagnosis of focal or global cerebral hypoperfusion is important in order to allow treatment before irreversible ischemic damage occurs (intensive care and/or neurointervention). We tested, whether the implementation of “whole brain” volume Perfusion CT (VPCT) for the examination of patients with suspected cerebral vasospasm delivers relevant information about the localization and characteristics of arterial vasospasm and the volume at risk of secondary infarction.

Patients and Methods:
Patients were eligible for this study, if they had been admitted to our department with suspicion of cerebral vasospasm due to SAH. Patients first received a non-contrast CT of the brain to exclude acute hydrocephalus. After that, VPCT was performed. CT angiographic axial and coronal maximum-intensity projections (MIP) were generated from thin slice recons of the VPCT dataset at peak arterial time. Images were assessed for presence of arterial vasospasm or occlusion and compared with conventional CTA or DSA. The distribution of ischemic lesions was analyzed on 3D perfusion parameter maps of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to drain (TTD).

Results:
11 patients with SAH were examined with VPCT. In all patients, focal areas of cerebral hypoperfusion were detected on the color coded VPCT parameter maps. The highest sensitivity was found for MTT and TTD. Focal reductions of CBV strongly correlated with infarction on follow-up CT. 8 patients (73%) had focal stenotic lesions of intracranial artery segments due to vasospasm visible on the thin MIP reconstructions of the 4D CTA arterial phase. All of these stenotic lesions were also visible on conventional CTA or DSA, resulting in 100% sensitivity of the 4D CTA reconstructions. In 2 patients, balloon angioplasty of the vasospastic segments was performed subsequently; in both patients, VPCT showed normalization of both the perfusion maps and the vessel diameter afterwards.

Conclusion:
VPCT is a non-invasive method that allows detecting cerebral vasospasm in patients suffering from SAH. It has the potential to demonstrate brain areas with a focal perfusion deficit as well as vasospastic arterial segments. DSA will remain the gold standard for detection of cerebral vasospasm, but VPCT has the potential to improve diagnosis and treatment decisions in patients suffering from vasospasm due to SAH.
Abstract 3311: Acute stroke and endovascular outcomes in Elderly Population: A Single Center Experience.
Authors: Shams Tanzila , Sharma Jitendra , Jung Richard , Blackham Kristine
Published: July 2021

Background:
In the setting of acute ischemic stroke, endovascular intervention, once considered experimental, is now gold standard of care of appropriately selected patients. Among the elderly, aged 80 and above, patients have multiple comorbidities, and little data exists regarding clinical outcome for those undergoing different endovascular treatment modalities.

Objectives:
To assess the safety and efficacy of different endovascular treatment modalities in elderly, aged 80 and above, compared to patients younger than 80 with acute ischemic stroke

Methods:
Restrospective chart review was performed in 150 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2008 and 2011, between age range 17 -93 years. Elderly patients (EP) age 80 and above (n=34) were compared to nonelderly patients age <80 (NEP) (n=116). The patients in both groups underwent mechanical (including MERCI and or Penumbra and/or angioplasty and stenting) and/or chemical thrombolysis (intra-arterial tPA). We compared the specific outcome parameters of EP vs NEP groups, including discharge NIHSS, modified Rankin Scale (mRS), rate of partial to complete recanalization (TIMI 2-3), symptomatic intracerebral hemorrhage (ICH), and all cause mortality.

Results:
In EP, mean age was 84.9 ± 3.3, with 32.3% (n=11) males and 67.6% (n=23) females. In NEP mean age was 63.6 ± 13.1, with 50.9% (n=59) males and 49.1% (n=57) females. 91.3% (n=106) In EP vs NEP, mean initial NIHSS were 19±7 and 16±6, and discharge NIHSS 9±7 and 12±8, respectively. Rates of recanalization occurred in 67.6% (n=23) in EP, and 71.6% (n=83) in NEP. Discharge mRS 3 or less was 2.9% (n=1) in EP, and 17.2% (n=20) in NEP. Symptomatic ICH occurred in 20.6% (n=7) in EP and 14.7% (n=17) in NEP. All cause mortality rate at discharge in EP group was 41.2% (n=14) and 19.8% (n=23) in NEP.

Conclusions:
In our experience EP had poor clinical outcomes with increased mortality and hemorrhage rate compared to NEP irrespective of similar recanalization rate. Further prospective trial is warranted to evaluate safety and efficacy of endovascular treatment in patients aged 80 years old and above.
Abstract 3329: Multimodal Predictors of Massive Ischemic Stroke Presentation and Favourable Outcome.
Authors: Bill Olivier , Zufferey Philippe , Faouzi Mohamed , michel patrik
Published: July 2021

Background:
Severe stroke carries a high case fatality and disability rate. The aims of this study are to determine the characteristics of patients with initially severe (“massive”) ischemic stroke, and to identify acute and subacute predictors of favourable clinical outcome in such patients.

Methodology:
Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we compared all patients with massive stroke defined as a NIHSS ≥ 20 on admission with all the other patients. In a multivariate analysis, associations with a demographic, clinical, pathophysiological, metabolic and neuroimaging factors and were determined. Furthermore, we analyzed predictors in the subgroup of massive stroke patients with favourable outcome (mRS ≤3 at three months).

Results:
Among 1’915 consecutive patients, 243 (12.7%) had massive stroke. It was significantly associated with cardio-embolic stroke mechanism (OR=1.74 / 95% CI 1.193 - 2.548), unknown stroke onset (OR=2.35 / 95% CI 1.143 - 4.831), more early ischemic findings on neuroimaging (mostly CT, OR=2.65 / 95% CI 1.795 - 3.924), arterial occlusions on acute imaging (OR=0.03 / 95% CI 0.0158 - 0.0862), less chronic radiological infarcts (OR=0.43 / 95% 0.258 - 0.719), lower haemoglobin concentration per g/l (OR=0.97 / 95% CI 0.965 - 0.987), and higher white cell count per 1000 cells/l (OR=1.05 / 95%CI 1.001 - 1.109). In the 68 (28%) patients with favourable outcome, this was predicted by lower age (OR=0.943 / 95% CI 0.917 - 0.971), previous cerebrovascular events (OR=3.00 / 95% CI 1.009 - 8.964), hypolipemic pre-treatement (OR= 3.82 / 95% CI 1.341 - 10.895), lower acute temperature (OR=0.427 / 95% CI 0.232 - 0.785), lower subacute glucose concentration (OR=0.739 / 95% CI 0.565 - 0.966), and spontaneous or treatment-induced recanalisation at 24 hours (OR= 4.51 / 95%CI 1.957 - 10.407).

Conclusion:
Massive stroke presentation is predicted by multiple clinical, radiological and metabolic variables, several of which are modifiable. Predictors in the 28% of patients with favourable outcome despite massive stroke include hypolipemic pretreatment, lower acute temperature, lower glucose levels at 24 hours and arterial recanalisation. Massive ischemic stroke is a serious, preventable and treatable condition.
Abstract 3333: Serum Lipids and Inflammatory Markers as Predictors of Thrombus Composition in Acute Ischemic Stroke
Authors: Rao Neal M , Sanossian Nerses , Saver Jeffrey L , Starkman Sidney , Ali Latisha K , Kim Doojin , Kidwell Chelsea , Jahan Reza , Duckwiler Gary R , Tateshima Satoshi , Gonzalez Nestor R , Viñuela Fernando , Vinters Harry V , Yong William H , Liebeskind David S
Published: July 2021

Introduction:
Histopathology has shown that thrombi retrieved acutely from cerebral arteries in acute ischemic stroke patients typically have intermixed fibrin-platelet-dominant and red blood cell (RBC)-dominant regions. Knowledge of the proportions of fibrin-platelet and RBC components in an individual patient could help with pharmacologic and/or device intervention selection. Whether serum markers of inflammation and coagulation status reflect clot composition has not previously been investigated.

Methods:
We analyzed consecutive patients undergoing mechanical thrombectomy for acute middle cerebral artery ischemic stroke with retrieved thrombi available for histopathologic analysis. Percent of retrieved thrombus that was RBC-dominant, WBC-dominant, and platelet/thrombin-dominant was calculated and compared with routine serum indices of inflammatory and coagulation status obtained on admission.

Results:
Among the 50 patients meeting entry critera, mean age was 66 (SD 21), 48% were female, and median pretreatment NIHSS was 19 (IQR 15-22). Two serum indices demonstrated correlations with cerebral thrombus histopathology: serum WBC count inversely correlated with thrombus fibrin percentage (R -.317, p=0.024) and partial thromboplastin time positively correlated with thrombus WBC percentage (R 0.336, p=0.032). No relations were found for other serum tests, including hemoglobin, neutrophil count, lymphocyte count, prothrombin time, erythrocyte sedimentation rate, high sensitivity C-reactive protein, homocysteine, fibrinogen, factor VIII, total cholesterol, LDL, and HDL.

Conclusions:
Serum measures of inflammation and coagulation may provide clues to target thrombus composition in acute ischemic stroke. Systemic inflammation, including during infections, may lead to upregulation of clotting factors and less fibrin-platelet and more RBC and WBC-laden clots.
Abstract 3339: Cardiovascular Benefits of Wii-based Movement Therapy for Upper Limb Post-stroke Rehabilitation
Authors: McNulty Penelope A , Trinh Terry , Scheuer Sarah E , Shiner Christine T , Lin Gaven G , Thompson-Butel Angelica G
Published: July 2021

Persistent motor disability limits the capacity of stroke patients to retain or regain physical fitness. Increased metabolic demands of hemiparetic gait, physical deconditioning, and secondary muscle changes including atrophy and a shift in muscle fibre phenotype, combine to reduce post-stroke aerobic capacity by ∼50%. Fitness may be overlooked in rehabilitation programs when primary goals are centred on speech and effective locomotion. In this study we investigated whether cardiovascular fitness could be improved using Wii-based movement therapy that specifically targets hand and upper limb function. We studied 15 male and 3 female patients with post-stroke hemiparesis, mean age 61.4 years (range 22-75 years), mean time post-stroke 21.7 months (range 5-91 months). All patients completed the 2 week program with one hour of formal therapy on 10 consecutive weekdays augmented by home practice using the standard Wii Sports games of baseball, bowling, boxing, golf and tennis. Heart rate was recorded continuously using wireless telemetry during formal therapy sessions at three time points: early, mid and late therapy. During the same sessions the number of steps during tennis and boxing was counted from video recordings. Functional ability was assessed before and after therapy using the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL). Peak heart rate significantly increased from early to late therapy (p<0.001), becoming 38% higher on average than resting rates by late therapy. A sport-specific gradient was evident with increases in peak heart rate ranging from 20.9% in golf to 49.0% in boxing (p<0.001). A concomitant improvement in exercise endurance was also noted. These changes occurred despite most patients being treated with beta blockers and ace-inhibitors. Functional ability improved by 23% (WMFT, p=0.037) which transferred to everyday tasks with a 127% improvement (MAL) (both p<0.001). In conclusion these results suggest that Wii-based movement therapy not only improves upper limb function but also provides a cardiovascular challenge, mitigating the marked reduction in fitness commonly reported post-stroke. The differential effect on heart rate of the basic Wii Sports games provides a further avenue to tailor therapy for individual patients according for cardiac status and fitness levels.
Abstract 3343: Hemodynamic Instability During Carotid Angioplasty And Stenting - Relationship Of Calcified Plaque And Its Characteristics
Authors: Jeon Jin Sue , Sheen Seung Hun , Shin Hyae Young
Published: July 2021

Background and Purpose-
During carotid angioplasty and stenting (CAS), hemodynamic instability due to bradycardia and hypotension can occur and it may cause ischemic complications after procedure. The goal of this study was to investigate the risk factors of hemodynamic instability (HDI) and characteristic of calcified plaque that lead to HDI.

Methods-
Thirty nine patients who had CAS were retrospectively evaluated for HDI. Prolonged HDI was analyzed with the relation of characteristics of calcified plaque such as eccentric and invasiveness.

Results-
Nineteen (48.7%) patients had HDI. Ten of the 19 had bradycardia and hypotension together and nine of the 19 had only bradycardia. Every bradycardia was treated well with transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension (lasting for over 30 minutes) in spite of recovery of bradycardia. A calcified plaque was a related factor associated with HDI (Odds Ratio, 8.571; 95% Confidence lnterval, 1.321 to 55.62; p = .024). Extensive plaque, eccentric and invasive calcified plaque was associated with prolonged hypotension (p = .04, p = .028, p = .028 respectively)

Conclusion-
The calcification of plaque is a reliable factor for HDI during and after CAS and its extensive plaque, eccentric and invasive calcified plaque may be related to the prolonged HDI.
Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population
Authors: Antillon Daphne , Valle Natalie , Lin Kaiwen , Tai Waimei , Gallup Mary Ann , Ovbiagele Bruce , Towfighi Amytis
Published: July 2021

Background:
Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population.

Methods:
Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race.

Results:
The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% >1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p<0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure > 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol > 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (<40 mg/dL for men and <50 mg/dL for women)(83% vs. 79%, p <0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p<0.01), and alcohol abuse (28% vs. 7%, p<0.01). After adjustment for race and age, women were more likely than men to have total cholesterol > 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m
2
(OR 1.55, 95% CI 1.03-2.34), systolic blood pressure >140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level > 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11).

Conclusions:
In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.