bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP28: Developing a New Hospital Into a Primary Stroke Center in Just Over a Year
Authors: Ronosky Kristen , Hackett Chris , Wood Mary , Farah Katie , Goodnow Steven , Agostoni Nolan , Latouf Kathleen
Published: February 2024

Background:
Stroke programs are often developed and implemented in well-established health care facilities. There is little data on certified stroke programs being established in new hospitals. Our primary goal was to establish a strong culture of engagement in the care of stroke patients from the day the hospital opened.

Methods:
A multidisciplinary stroke oversight committee was formed, which guided development of the stroke program and integrated leaders from all areas involved with direct or indirect stroke patient care. We began trending processes and overall stroke care based on the Get with the Guidelines (GWTG) STK measures. In this study we compared data from the opening of a 160-bed hospital until achieving Primary Stroke Center (PSC) certification (October 2021 - February 2023) to after certification (March 2023 - June 2023). Our primary outcome was to examine the proportion of IV thrombolysis prior to and after PSC certification. Secondary outcomes included: proportion of door-to-needle time within 60 minutes, proportion of EMS arrival and proportion of patients transferred prior to and after PSC certification. Primary and secondary outcomes were analyzed using backwards Wald binomial logistic regression models which were adjusted for age, sex and NIHSS.

Results:
Among 300 patients evaluated for potential stroke symptoms, 228 (76%) were assessed prior to PSC and 72 (24%) after. Mean age was 63.15±17.37 years and median [IQR] NIHSS was 1 [0, 2]. GWTG STK measures were achieved (> 85%) both before and after PSC certification. There was a higher proportion of patients treated with IV thrombolysis after PSC compared to before (9.7% versus 2.6%), adjusted Odds Ratio (aOR) = 3.66 [95% Confidence Interval (CI), 1.17 - 11.43], p = .026. There was no statistical difference in the proportion of IV thrombolysis patients treated within 60 minutes of arrival after versus before PSC, (57% versus 20%), aOR = 5.33 [95%CI, 0.38 - 75.78], p = 0.22. Additionally, there were similar proportions of EMS arrival and transfers after compared to before PSC, all p > .05.

Conclusions:
A successful stroke program can be implemented in a new hospital within a short duration of time.
Abstract WMP41: Neighborhood Social Vulnerability is Associated With Lower Frequency of Stroke Scale Assessment Among Patients With Suspected Stroke
Authors: Misra Anjali J , Goldberg Scott A , Zachrison Kori S , Crowe Remle P , Cash Rebecca E
Published: February 2024

Introduction:
High-quality prehospital care during initial assessment by EMS providers can affect downstream care for acute stroke patients. Prehospital guidelines strongly recommend assessing suspected stroke patients with a validated stroke scale and obtaining a blood glucose level, but EMS adherence varies widely. Neighborhood socioeconomic characteristics are associated with stroke incidence and outcomes, but there is little research evaluating their relationship to quality metrics in prehospital stroke care.

Hypothesis:
Greater neighborhood-level social vulnerability is associated with lower frequency of stroke scale assessment and blood glucose check by EMS for patients with suspected stroke.

Methods:
We conducted a cross-sectional evaluation of EMS activations for suspected stroke patients in the 2019 ESO Data Collaborative. We included 911 responses where EMS documented a field impression of stroke and excluded activations from an acute health care facility. Neighborhood-level social vulnerability, using CDC’s Social Vulnerability Index (SVI), was assigned to each encounter based on pick-up location. Descriptive statistics were calculated, and mixed effects logistic regression models were fit to assess any relationship between SVI and documentation of stroke scale and blood glucose assessments, controlling for patient and event characteristics and clustering by EMS agency.

Results:
Among 84,411 patients with suspected stroke, 46% were male, with an average age of 71 years. Stroke scale assessment was documented in 78% of cases, and blood glucose in 88%. Compared to patients in the least vulnerable SVI quartile, those in the most vulnerable SVI quartile had lower odds of documented stroke scale assessment (OR 0.91, 95% CI 0.82, 1.00, p=0.04), but similar odds of documented blood glucose (OR 0.97, 95% CI 0.89, 1.06, p=0.48). High agency-level variation was present for stroke scale (ICC 70%, 95% CI 69, 73).

Conclusions:
Higher social vulnerability areas may be associated with less frequent stroke scale assessment; however, high agency-level variation indicates that the best targets to improve EMS systems’ compliance with evidence-based guidelines for acute stroke care may be low-performing agencies, regardless of setting.
Abstract WMP51: Patient-Related Factors and Social Determinants of Health Associated With Discharge to Home Following Acute Ischemic Stroke: Findings From the Get With the Guidelines Stroke Registry
Authors: Sutherly-Bhadsavle Loretta J , Ido Moges S , Bayakly Rana , Bonilha Heather , Belagaje Samir R , Blanke Debra , Henriquez Laura , Starnes Danielle , Christopher Hannah , Cabral Jacqueline , Walczak Teri , Nahab Fadi B
Published: February 2024

Background:
Medical comorbidities and stroke risk factors explain only a proportion of stroke incidence and outcomes in different populations. Our analysis aimed to determine if social determinants of health (SDOH) are associated with discharge home following acute ischemic stroke (AIS) hospitalization.

Methods:
The analyses included AIS patients hospitalized from January 1, 2015 to December 31, 2019 who were ambulating at baseline and had a known county of residence in the GWTG stroke registry. The primary outcome measure was discharge to home. County-level SDOH included income, education, owner-occupied home, unemployment, foreign-born, and insurance coverage and were the main predictors. Estimates of county-level SDOH were classified into quartiles, and the relative odds of outcome were assessed using a multivariable logistic regression.

Results:
Of 1,171,519 observations included in our analysis, median age was 71 years, 49% were female and 78% were of white race. As shown in the Table, demographic factors associated with lower likelihood of discharge home after AIS hospitalization included being female, black race, and age >80 years. County-level SDOH factors associated with increased likelihood of discharge home included education (lowest vs highest quartile), owner occupied home (lowest vs highest quartile), foreign-born (lowest vs highest quartile), self-pay/no insurance (vs Medicare). Income (lowest vs highest quartile) and unemployment (lowest vs highest quartile) were associated with lower likelihood of discharge home.

Conclusion:
County-level SDOH are associated with discharge to home after AIS. Our findings can be used to develop interventions that reduce inequity in AIS outcomes.
Abstract WMP56: Diagnosis of Acute Central Retinal Artery Occlusion With a Nonmydriatic Ocular Fundus Camera Combined With Optical Coherence Tomography in the Emergency Department: A New Paradigm
Authors: Biousse Valerie , Rodriguez Duran Mariana , Torres Soto Mariam , Pendley Andrew M , Benard-Seguin Etienne , Greene James G , Wright David W , Nahab Fadi B , Newman Nancy
Published: February 2024

Background:
Central retinal artery occlusion (CRAO) is a retinal infarction with causes/management similar to cerebral infarction. However, CRAO diagnosis is often delayed, resulting in missed opportunities for rapid treatment. Diagnosis by ophthalmologists is essential prior to management by stroke neurologists and may be challenging within a few hours of vision loss. Our goal is to provide a new paradigm in the emergency department (ED) with the implementation of a nonmydriatic ocular fundus camera (NMFP) combined with optical coherence tomography (OCT) to allow for ultrarapid remote diagnosis and stroke alert as soon as patients present to the ED.

Methods:
Prospective collection of data from consecutive patients who had NMFP-OCT for acute monocular vision loss in our general ED affiliated with a comprehensive stroke center. We collected timing of photographs; final diagnosis (CRAO/other causes of vision loss); time between vision loss onset and CRAO diagnosis; NMFP-OCT findings.

Results:
Over 9 weeks, 27 patients had NMFP-OCT obtained for acute monocular visual loss, including 9 CRAO [others included 7 retinal detachments; 8 vitreous hemorrhages; 3 temporal arteritis]. Diagnosis of acute CRAO was made remotely on NMFP-OCT obtained 30, 33, 36 min after arriving in ED in 3 patients presenting to ED within 3.5 hrs of vision loss. In all 3 patients, the ocular color photographs were almost normal and acute CRAO diagnosis was made primarily from the OCT showing inner retinal edema/hyperreflectivity.

Conclusion:
Incorporating NMFP-OCT into the ED workflow can be used as a substitute for funduscopic examination/pupillary dilation, allowing for remote diagnosis of CRAO by ophthalmologists who can provide real time recommendations before in person visit. These positive preliminary results suggest that this strategy accelerates the diagnosis of urgent vision loss, resulting in improved patient outcomes. Results of the first 6 months will be presented at the conference.
Abstract WMP72: Accurate LVO and MeVO Detection Using a Multiphase CT Angiography Perfusion-Based Tool
Authors: Souto Maior Neto Luis A , Golan Rotem , Usman Sadiq Muhammad , Duszynski Chris , Menon Bijoy K
Published: February 2024

Background and Aims:
Early and accurate detection of vessel occlusion is essential for the management of acute ischemic stroke (AIS). Current automated occlusion detection tools mostly rely on single-phase CTA (sCTA), which makes it challenging to accurately identify Medium Vessel Occlusions (MeVO). Multiphase CTA (mCTA), which consist of an additional two low-dose scans to the traditional CTA workflow, may be able to allow precise detection of MeVO occlusions. In this work, we aim to validate StrokeSENS mCTA Occlusion Detection in its ability to detect LVOs and MeVOs up to and including the M3/A3/P3 segments of the Middle/Anterior/Posterior Cerebral Arteries (MCA/ACA/PCA).

Methods:
Validation was performed on 512 studies of suspected AIS patients with baseline mCTA. Studies had MeVO (PCA:11, ACA:4, MCA:83), LVO (ICA:116, PCA:8, MCA:263), and no occlusion: 27. Expert neuroradiologists annotated the presence and location of the occlusion. StrokeSENS mCTA Occlusion Detection processed mCTA data to produce hypoperfusion extent probability maps, and presence or absence of occlusion. To validate the ability of the tool to detect occlusion, we used ROC analysis, specificaly the AUC and Sensitivity/Specificity metrics.

Results:
The full cohort AUC was 96.7% (95% C.I.: [94.7%,97.7%]). For LVO subgroups, ICA AUC=98.2%, MCA AUC=98.0%, PCA AUC=68.5%. For MeVO, MCA AUC=95.0%, ACA AUC=78%, PCA AUC=91.2%. At the selected operational point, overall Sensitivity was 86.0% (95% C.I.: [0.829, 0.891], N=485), and Specificity was 92.6% (95% C.I.: [0.766, 0.979], N=27).

Figure 1
shows examples of the hypoperfusion extent produced by the tool for LVO and MeVO cases.

Conclusion:
In this work, we evaluated the tool StrokeSENS Occlusion Detection in its ability to detect LVO and MeVO occlusions. The tool has shown very high accuracy in detection occlusions up to and including the M3/A3/P3 segments of the Middle/Anterior/Posterior Cerebral Arteries (MCA/ACA/PCA).
Abstract WMP81: Overweight Patients Had Higher Odds of Favorable Outcome After Both Deep and Lobar Intracerebral Hemorrhage
Authors: Duskin Jonathan , Singh Sanjula D , Senff Jasper , Kourkoulis Christina , Anderson Christopher , Rosand Jonathan , Yechoor Nirupama
Published: February 2024

Introduction:
Intracerebral Hemorrhage (ICH) leads to high rates of morbidity and mortality. Malnutrition is common in stroke patients and leads to worse outcomes. Body mass index (BMI) is a widely available marker of nutrition status, however studies on BMI and post-ICH outcomes are limited and have conflicting results. We aim to clarify this relationship by examining the relationship between BMI, nutritional lab markers, ICH severity, and functional outcome at discharge stratified by ICH location.

Methods:
We leveraged data from an ongoing longitudinal ICH study of adults with spontaneous primary ICH. Patients were divided into underweight, normal weight, overweight, and obese according to World Health Organization BMI criteria. Albumin, B12, total bilirubin, cholesterol, CRP, ferritin, iron, folate, hbA1c, HDL, LDL, hemoglobin, MCV, INR, ALT, triglycerides, and vitamin D were abstracted from health records. Associations between BMI, lab markers, ICH volume, and favorable outcome (mRS 0-2) were analyzed using univariate and multivariable logistic regression stratified by deep versus lobar hemorrhage location, with normal weight as the reference.

Results:
1,370 patients (719 with deep hemorrhage, 651 with lobar hemorrhage) were included. There was no association between BMI and ICH volume in patients with deep or lobar hemorrhage. Multivariable analyses adjusting for age, education, diabetes mellitus, coronary artery disease, alcohol use, ICH volume, and intraventricular hemorrhage showed that overweight, but not underweight or obese, subjects had higher odds of favorable outcome on discharge in the deep (OR 3.16, 95% CI 1.36-7.34) and lobar (OR 3.15, 95% CI 1.67-5.94) groups. Albumin (OR 2.27, 95% CI 1.05-4.90) and hemoglobin (OR 1.31, 95% CI 1.09-1.59) were the only labs associated with favorable outcome in the deep hemorrhage group while no markers were associated with favorable outcome in the lobar hemorrhage group. Albumin and hemoglobin were not associated with being overweight.

Conclusion:
Overweight patients had three times higher odds of favorable outcome after both deep and lobar hemorrhages. This was not driven by ICH severity or explained by lab markers. Future biomarker studies are needed to better understand this relationship.
Abstract WMP86: Mechanical Thrombectomy Frequency and Outcomes in Acute Ischemic Stroke With Mild Deficits in the Unites States
Authors: Gill Sandeep , Warach Steven J , Saber Hamidreza
Published: February 2024

Background:
More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice hasn't been well-delineated.

Methods:
Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0-5) from October 1, 2016 to December 31, 2020. Patient and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death) and in-hospital mortality.

Results:
Among 1,013,055 acute ischemic stroke admissions with recorded NIHSS during the 4-year study period, 601,645 (59.4%) had mild strokes (46.6% women; median age, 69 [interquartile range (IR), 59-79] years; median NIHSS score of 2 [IR, 1-3]). Among 70,765 hospitalizations with MT and documented NIHSS, mild deficits accounted for 8,900 (12.6%) of MT procedures (47% women; median age, 67 [IR, 57-77] years; median NIHSS score of 3 [IR, 2-4]). There was a gradual increase in the proportion of MTs performed among mild strokes during study period (10% to 13.5%, p<0.01). Favorable discharge outcome occurred in 65.8% of all mild strokes and in 56.9% of strokes with mild deficits following MT. In multivariable analysis among stroke patients with minor deficits with thrombectomy, favorable outcome was associated with younger age (OR, 0.96 [95% CI, 0.95-0.97], P<0.001), male sex (OR, 0.77 [95% CI, 0.62-0.95], P<0.001), lower NIHSS score (OR, 0.85 [95% CI, 0.80-0.90], P<0.001), history of atrial fibrillation (OR, 1.27 [95% CI, 1.01-1.60], P<0.001), and absence of diabetes (OR, 0.77 [95% CI, 0.60-0.98], P<0.001).

Conclusions:
In conclusion, we observed a recent trend of gradual increase in the use of MT in mild strokes in US. Favorable discharge outcomes were achieved in a significant proportion of mild strokes following MT. Further research and clinical trials should aim to refine patient selection criteria and treatment protocols to optimize the use of MT in mild strokes.
Abstract WMP9: Comparative Analysis of Endovascular Treatment Outcomes in Acute Large Vessel Occlusion Strokes: Intracranial Atherosclerotic vs. Non- Intracranial Atherosclerotic Occlusions
Authors: Mohammadzeh Nahid , Shu Liqi , Khan Farhan , Torabi Radmehr , Snow Ethan , Chang Kelvin , Moldovan Krisztina , Jayaraman Mahesh , Goldstein Eric , Kala Narendra S , Furie Karen L , Yaghi Shadi
Published: February 2024

Introduction:
Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke worldwide. We assessed the clinical outcomes of endovascular treatment in acute large vessel occlusion (LVO) strokes caused by ICAD and compared them with large vessel occlusion strokes not associated with intracranial atherosclerosis (non-ICAD LVO).

Methods:
Our study comprised 1390 adult patients diagnosed with LVO stroke that underwent endovascular therapy at Rhode Island Hospital from July 2015 to March 2023 and data collected retrospectively. Among these, 68 patients exhibited Intracranial Atherosclerotic Disease Large Vessel Occlusion (ICADLVO), while 1322 individuals were categorized as non-ICADLVO. In the ICADLVO group, 23 out of 68 patients underwent angioplasty, whereas 38 patients received stenting. We aim to compare treatment outcomes, including recurrent in-hospital large vessel occlusion, disability, and mortality between these two distinct groups, while also assessing demographic characteristics and medical risk factors. T-Test, Chi square and fisher’s exact tests were used for the comparison of groups.

Results:
The study findings highlight significant differences between the ICADLVO group and the non-ICADLVO group. The ICADLVO group had younger age (mean 66.6 ± 12.64 vs. 71.92 ± 14.56, p < 0.001) , higher proportion of individuals with Asian ethnicity (5.2% vs. 0.8%, p = 0.019), higher incidence of prior strokes (43.3% vs. 23.9%, p=0.000), higher prevalence of smokers (35.6% vs. 22.7%, p = 0.022), and a lower association with known atrial fibrillation (23.9% vs. 42.3%, p=0.003) compared to the non-ICADLVO group. Additionally, the ICADLVO group had a higher occurrence of recurrent large vessel occlusion during hospitalization (11.8% vs. 4%, p = 0.008). This analysis finds no significant difference in good 90-dayfunctional outcome (mRS <= 2) between the ICADLVO and NON-ICADLVO groups (OR = 0.62, 95% CI 0.34-1.13, p=0.118).

Conclusion:
Our study showed a higher incidence of recurrent large vessel occlusion during hospitalization in the ICADLVO group following endovascular therapy. However, we did not observe any statistically significant differences in long-term outcomes, including measures of disability and mortality.
Abstract WP112: Neighborhood Level Characteristics Associated With Adequate Transition of Stroke Care: The Transition of Care Stroke Disparities Study
Authors: Fakoori Farya , Zhou Lili , Gardener Hannah , Gutierrez Carolina M , Bishop Lauri , Johnson Karlon , Brown Scott C , Romano Jose G , Rundek Tatjana , Marulanda-Londono Erika
Published: February 2024

Objective:
Transition of Care Stroke Disparities Study is an observational prospective cohort aimed to investigate disparities in the transition of stroke care (TOSC) post-hospitalization to home and to identify factors associated with adequate TOSC and stroke outcomes. we have demonstrated that higher individual socioeconomic status is associated with adequate TOSC. The present study explores the association between neighborhood-level characteristics (NLC) and adequate TOSC in ischemic stroke patients 1 month after discharge.

Methods:
Data from 925 ischemic stroke patients discharged from 10 Comprehensive Stroke Centers (CSCs) was obtained from three sources: a. NLC: demographic composition, level of education, and median household income from publicly available data using participants’ Zip codes (independent variables); b. 30-day post-discharge data for 6 categories of TOSC-related behaviors (dependent variables) including medication adherence, weekly exercise, medical follow-up, rehabilitation attendance, toxic habit cessation, diet modification. c. Clinical characteristics from Get with the Guidelines-Stroke (covariates). The primary outcome was 100% adequate transition of care (ATOC), a combined index of ideal adherence to all applicable behavior modifications.

Results:
The sample included 46% Women, 23% Non-Hispanic Black and 22% Hispanic, the average age was 64 years. NLC ranged as follows: % Black (0-93.9, median 9.1), %Hispanic (3-99.9, median 82.3), % bachelor’s degree (6.3-77.3, median 26.2), and median household income ($18,920-159,914, median $48,816). Almost a third (34%) of participants achieved 100% ATOC. In the adjusted analysis of NLC variables, higher %Hispanic (OR=1.45, 95% CI=1.03-2.04), higher %bachelor's degree recipients (OR=1.62, 95% CI=1.21-2.18), and higher median income (OR=1.12, 95%CI=1.04-1.21) were significantly associated with achieving 100% ATOC.

Conclusions:
Results suggest that NLC plays a crucial role in adherence to care transition instructions, underscoring the importance of interventions targeted at lower socioeconomic status populations. Future work will determine the impacts of NLC on stroke recurrence and readmission.
Abstract WP115: Patient Reported Outcomes to Improve the Accuracy of Disability Evaluation After Endovascular Treatment-Successful Recanalization
Authors: Rizzo Federica , Olivé-Gadea Marta , Requena Manuel , Rodrigo-Gisbert Marc , Taborda Maria Belen , Muchada Marian , Canals Pere , Juega Jesus , Pagola Jorge , Rodriguez-Luna David , Rodriguez-Villatoro Noelia , Garcia-Tornel Alvaro , Colangelo Giorgio , Brunet Jordi , Paredes Carolina-Kina , Sanchez Ester , Guirao Cristina , Baladas Maria , De Dios Lascuevas Marta , Diana Francesco , Hernandez David , Tomasello Alejandro , Molina Carlos , Ribo Marc , Rubiera Marta
Published: February 2024

Background:
Complete recanalization is a well-known predictor of functional outcome among patients who undergo MT. However, trying to improve recanalization from successful (eTICI ≥ 2b) to complete (eTICI2c-3) with more passes is under debate. PROMS allow an accurate assessment of patients status in different domains after AIS.

Hypothesis:
In AIS patients undergoing MT, PROMS may allow a more precise characterization of the long-term outcome than the usual mRS according to different degrees of recanalization.

Methods:
Patients with anterior circulation AIS, treated with MT who achieved a successful recanalization (eTICI ≥ 2b) were included. Patients were classified in two groups according to the degree of recanalization: eTICI 2b (successful) vs eTICI 2c-3 (complete). The collected study variables were baseline, procedural characteristics, and 90 days outcome measures including: assessment of disability by a certified clinician blinded to recanalization status (mRS) and PROMS (PROMIS 10- Physical and Mental, HAD depression and Anxiety, visual EQ-5D scale)

Results:
From Jan 2020 to Dec 2022, 96 patients with PROMS collection at 90 days were identified: 21 had a final eTICI 2b and 75 a final eTICI2c-3. No differences in terms of age, sex and other baseline and procedural characteristic were observed between groups. Median 90-days mRS was similar in both groups (2 [IQR 1-3]; p= 0.517). At 90 days patients achieving TICI 2c-3 had significantly lower HAD depression score: 7 [3-10] vs 10 [7-15] (p=0.02). All other median PROMS values were numerically favourable for patients who achieved TICI 2c-3: visual EQ-5D scale: 64 [10-80] vs 50 [42-65] (p= 0.1), PROMIS 10-Physical and Mental (eTICI 2b: 12 [10-14] and 12 [9-15] versus eTICI 2c-3: 9[7-12] and 9 [7-12]; p=0.8 and p=0.6 respectively), except for HAD-anxiety score (eTICI 2b: 6 [3-9] versus eTICI 2c-3: 7 [4-9]), p=0.520). More than 250 patients will complete the 90 days follow-up in the next 6 months, analyses will be updated for presentation at the conference

Conclusion:
The differences observed between patients achieving successful versus complete recanalization indicate that PROMs may be more adequate tool than the usual mRS for a fine-tune characterization of long-term outcome in different quality of life domains
Abstract WP120: Portable Bedside Low-Field Magnetic Resonance Imaging Acute Infarct Detection on Floor Level Acute Ischemic Stroke Patients
Authors: Shay James , Nimjee Shahid M , Forrest Cassandra , Shujaat Mohammad , Morales Jorge , Lee Vivien H
Published: February 2024

Introduction:
FDA approval of Hyperfine has led to interest in using low-field Magnetic Resonance Imaging (MRI) in acute ischemic stroke (AIS). Portable MRI (pMRI) has practical advantages over high-field MRI (hMRI), and prior studies have evaluated pMRI predominantly in the ICU settings. We sought to determine performance of pMRI on floor level AIS patients.

Methods:
We retrospectively reviewed floor status AIS patients who had pMRI obtained during their hospitalization. We reviewed pMRI for ability to visualize confirmed infarcts on hMRI. hMRI was considered gold standard. Incomplete or technically limited scans were excluded. Our institutional pMRI (Hyperfine) is 0.064 Tesla and our protocol sequences include diffusion-weighted imaging (DWI), Apparent diffusion coefficient, and fluid-attenuated inversion recovery (scan time 24 minutes). Infarct size was measured based upon maximum longitudinal axis on MRI DWI.

Results:
Among 12 AIS patients, the mean age was 58.5 years (range, 25 to 88) and 7 (58.3%) were female. Mean time from hMRI to pMRI was 46.2 hours (range, -0.9 to 126.9 hrs). Mean Time from LKN to pMRI was 3.6 days (range, 0.87 to 7.8 days). In most 9/12 (75%) patients, pMRI demonstrated acute infarcts (7/12 pMRI scans demonstrated all infarcts seen on hMRI, while 2/12 pMRI scans identified some but not all infarcts). Three 3 (25%) pMRI DWI were negative. On 12 hMRI scans, 15 infarct lesions were demonstrated. Infarct distribution was as follows: cortical (9), deep (1), medullary (1), thalamus (3), and cerebellar (1). Among the 15 infarcts demonstrated on hMRI, 10/15 (67%) were also visible on pMRI. The mean size of infarcts that were not visible on pMRI was 7.7 mm, compared to pMRI visible infarct mean size of 21.7mm (p 0.0436). The smallest infarct that was visible on the pMRI was 7.7mm.

Conclusions:
pMRIs performed reasonably well on floor-level AIS patients and was able to detect the majority of acute infarcts seen on hMRI. There was a correlation between infarct size and visibility on pMRI, with pMRI performing better on larger sized infarcts. Understanding limitation of pMRI will allow clinical teams to maximize patient selection for use in AIS population.
Abstract WP124: Dual Energy Head CT Immediately Following Mechanical Thrombectomy Rarely Leads to Changes in Clinical Management
Authors: Hemphill Kafi R , Langaroodi Lilac , Walker Melanie , Levitt Michael R , Tirschwell David L , Davis Arielle P
Published: February 2024

Introduction:
No guidelines exist regarding imaging after mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Dual Energy Head CT (DECT) can differentiate between contrast staining and intracranial hemorrhage (ICH). We obtained routine DECT for AIS patients immediately following MT. We aimed to understand the impact of DECT on clinical management.

Methods:
We conducted a single-center retrospective study of AIS patients who underwent MT and immediate post-procedure DECT between March 2021 and February 2023. Patients were grouped by whether or not DECT results changed management, compared to our standard post-thrombectomy protocol and as documented in clinical notes. Continuous variables were compared using Wilcoxon Rank-Sum tests, and categorical variables were compared using Chi-square tests.

Results:
Of 173 patients who met inclusion criteria, 13 (7.5%) had documented changes in management following DECT. Management changes included delayed anti-thrombotic administration, lowered systolic blood pressure goals, and serial imaging. There were no statistically significant differences in age, gender, initial NIHSS, ischemic core size pre-MT, or treated vessel between patients with and without a change in management. Patients with management changes were more likely to have had procedural complications, contrast staining, any ICH, and symptomatic ICH (Table). While 34 patients had ICH on DECT, this only led to a documented change in management for 11 (32.4%) patients.

Conclusion:
Routine DECT immediately after MT rarely changed clinical management. Immediate DECT may be reserved for patients with intraprocedural complications or those with clinical suspicion of ICH.
Abstract WP135: Coexistence of Enlarged Perivascular Spaces and Other MRI Markers of Cerebral Small Vessel Diseases
Authors: Shahjouei Shima , Chaudhary Durgesh , Sadighi Alireza , Li Jiang , Abedi Vida , Zand Ramin
Published: February 2024

Objective:
Enlarged Perivascular Spaces (EPVS) have gained recognition as potential indicators of cerebrovascular pathologies. In this study, we investigated the association between the presence and severity of EPVS and other MRI Markers of cerebral small vessel diseases.

Method:
Our study was conducted on a subset of the Geisinger DiscovEHR Initiative Cohort. A predefined protocol was employed to evaluate each brain magnetic resonance imaging (MRI) data by two trained reviewers. The total numbers of EPVS were categorized into five grades (0-4) in centrum semiovale and basal ganglia regions. We compared patients with EPVS and an age-, gender-, body mass index-, and hypertension-propensity-score-matched cohort lacking EPVS.

Results:
Out of 3054 (mean age of 67.5 years, 97% white of Caucasian descent) randomly selected participants, 1465 (47.9%, mean age 69.9 years) showed evidence of EPVS in their imaging. Propensity score matching resulted in 1310 participants in each group. The presence of EPVS in basal ganglia was linked to higher white matter hyperintensity according to the Fazekas scale in deep white matter (OR, 1.4; 95% CI, 1.2-1.6), as well as global cortical atrophy (OR, 1.22; 95% CI, 1.1-1.4) on MRI scans. Other factors, such as cerebral aneurysm (OR, 2.3; 95% CI, 1.4-3.8), heart failure (OR, 1.85; 95% CI, 1.3-2.6), smoking (OR, 1.43; 95% CI, 1.1-1.8) exhibited associations. Moreover, an increased burden of EPVS correlated with higher Fazekas scales in periventricular and deep white matter.

Conclusion:
The presence and severity of EPVS exhibited are associated with MRI markers of white matter hyperintensity and global cortical atrophy. EPVS may be a marker of an aging brain and cerebral small vessel diseases. It might be associated with cerebrovascular risk factors.
Abstract WP136: Impaired Venous Outflow Impacts Functional Outcomes in Acute Small Subcortical Infarcts: A Single-Center Retrospective Analysis
Authors: Oh Amy , Shu Liqi , Yaghi Shadi , Goldstein Eric D
Published: February 2024

Introduction:
Acute small subcortical infarcts (SSI), colloquially acute lacunar stroke, are a radiographic diagnosis representing a myriad of pathophysiologic processes. One such pathophysiologic subgroup is venous collagenosis which serves as a pathologic indicator that aberrant venous outflow may contribute to SSI development. We aimed to identify whether impaired venous outflow (IVO) impacted functional outcomes in individuals presenting with SSI.

Methods:
We performed a single-center retrospective study of individuals who presented to the Rhode Island Hospital Comprehensive Stroke Center. Included individuals were ≥ 18 years with the diagnosis of SSI, as defined per consensus criteria, on brain MRI diffusion weighted imaging. The primary exposure is the presence of impaired venous outflow (IVO) defined radiologically in accordance with prior studies, as hyperintensity of the jugular, sigmoid, or transverse sinuses along the skull base on MR angiogram time of flight, Figure. The primary outcome was a favorable function outcome at hospital discharge defined as a modified Rankin Scale (mRS) of ≤ 3. Standard descriptive and regression statistical techniques were used for data interpretation.

Results:
We identified 39 patients who met criteria with 12 (30.8%) with IVO. Age and vascular risk factors did not significantly differ amongst the cohort. Twenty-six (66.7%) had a favorable hospital discharge outcome favorable functional outcome with IVO being less common [IVO present: 5/26 (19.2%) versus LVO absent: 21/26, (80.8%),
p
= 0.034]]. After adjusting for age and hypertension, IVO was associated with an odds ratio of 8.33 (95%CI 1.41-49.3,
p
=0.019).

Conclusion:
We found that IVO may be an independent contributor to fewer favorable functional outcomes. This data highlights that not only the arterial vessels are of relevance in acute SSI.
Abstract WP137: A CT Perfusion Based Computational Modeling for Improved Risk Stratification of Haemodynamically Significant ICAD
Authors: Boopathy Sethu raman , Soren Christensen , Nemes Andras , Pavlin-Premrl Davor , Mohammadzadeh Milad , Monajemi Sadaf , Paul Bhogal , Andersson Tommy , Yeo Leonard L , Campbell Bruce
Published: February 2024

Aim:
In endovascular ICAD treatment, an individualized patient-specific treatment pathway may be very helpful. Patient selection for endovascular treatment based on anatomical markers has not been shown to be effective in past clinical trials. This pilot study combines CT perfusion (CTP) analysis and computational fluid dynamics to identify hemodynamically significant patients for a reliable pathway for intervention planning.

Methods:
We assessed patients from two stroke centers with 50-99% ICAD lesions. Using a novel technique, CTP scans generated acute vascular territory maps for major cerebral arteries (ACA,MCA,PCA) with perfusion Time-to-peak (TTP) maps. Patient-specific blood flow simulations using physiology-informed boundary conditions calculated stenotic pressure ratios for both the patient’s acute and a population-based healthy scenario. The changes in affected territory volumes and pressure ratio between healthy and acute conditions and the acute TTP delays were presented to an expert reader who stratified cases into three clinical groups (A) non-hemodynamic, (B) hemodynamically hazardous with insufficient collateral support and (C) hemodynamically stable due to collateralisation. These results were compared against patient outcomes of recurrent ischemic events attributed to the target stenosis using the commonly used 70% threshold.

Results:
(95%CI in brackets) Patients (n=47, age: 73±11Y, 23F/24M) were stratified across the three categories A) 30, B) 15, C) 2. Of the patient groups with follow-up (n=31), categorisation of hemodynamic ICAD against recurrent ipsilateral stroke in territory (n=8) yielded a sensitivity of 75% [34-97] and specificity of 91% [72-98]. Mean±standard deviation of stenosis degree (SD) 55±14% for patients across each cohort was A) 50±11%, B) 70±9%, C) 70%. This is compared to using 70% stenosis threshold for dichotomising patients against risk of recurrent stroke, which yielded a sensitivity of 62.5% [24-91], and specificity of 87% [66-97].

Conclusions:
We report on a CTP derived method for stratifying hemodynamically significant ICAD. The methodology has potential in both in assessing symptomatic chronic ICAD and identifying cohorts who would benefit from endovascular intervention.
Abstract WP140: Perfusion Collateral Index Predicts Infarct Growth in Successfully Reperfused Patients With Acute Ischemic Stroke
Authors: McArthur Mark , Kim Daniel , Tavakkol Elham , Qiao Xin , Salehi Banafsheh , Cai Stephen , Ledbetter Luke , Cankurtaran Ceylan , Bahr-Hosseini Mersedeh , Szeder Viktor , Colby Geoffrey , Jahan Reza , Duckwiler Gary , Saver Jeffrey L , Liebeskind David S , Nael Kambiz
Published: February 2024

Introduction:
Robust collaterals are associated with lower rates of infarct growth and improved clinical outcomes in patients with acute ischemic stroke. Perfusion Collateral Index (PCI) and Hypoperfusion Intensity Ratio (HIR) have been shown to correlate with angiographic collaterals. We aimed to assess and compare the ability of PCI and HIR to predict infarct growth in anterior circulation large vessel occlusion (AC LVO) patients who underwent successful reperfusion.

Methods:
In this retrospective study, AC LVO stroke patients were included if they had pretreatment perfusion (CT or MR), successful reperfusion (mTICI
>
2b), and follow up MRI within 24 hours from treatment. HIR (defined as volume of Tmax >10 sec/volume of Tmax >6 sec) was calculated by RAPID software (Version 5.0.4). PCI (defined as volume of delay
2-6 seconds
x rCBV) was calculated using Olea software (SP.23). Infarct growth was calculated by subtracting baseline ischemic core (ADC <620 х 10
–6 mm2/s
on MRI or rCBF <30% on CTP) from post-treatment MRI volume of DWI hyperintensity.

Results:
A total of 80 patients were included; 46 female, age (mean
+
SD): 70.2
+
13.1 years, NIHSS (median, IQR): 14, 8-19, and time from stroke-onset to reperfusion (mean
+
SD): 389
+
236 minutes. The infarct growth volume was 27
+
52 mL (mean
+
SD); 47 patients (58.7%) had infarct growth
>
10 mL. ROC analysis for prediction of infarct growth
>
10 mL revealed AUC/sensitivity/specificity of 0.70/55.3/84.8 for PCI at threshold <60, which was significantly higher (P=0.006) than HIR at threshold of >0.4 (0.50/74.5/24.2) (Figure). Multivariate logistic regression showed PCI (p=0.004) and time-to treatment (p=0.024) were the only independent variables to predict infarct growth.

Conclusion:
In conclusion, in patients with AC LVO stroke, poor baseline collateral perfusion defined by PCI <60 predicts infarction growth
>
10 mL despite successful reperfusion. PCI was superior to HIR in the prediction of infarct growth.
Abstract WP149: Duration of Lead-In Parenteral Therapy and Outcomes in Individuals Treated With DOAC for Cerebral Venous Thrombosis: The ACTION-CVT Study
Authors: Shu Liqi , Zhou Lily , Klein Piers , Siegler James E , Nguyen Thanh , Yaghi Shadi , Field Thalia S ,   ACTION-CVT Investigators
Published: February 2024

Background:
Direct oral anticoagulants (DOACs) are suitable for some patients with cerebral venous thrombosis (CVT). The optimal transition strategy from parenteral anticoagulation (PA) to DOAC is not known. We examined duration of PA prior to DOAC initiation and outcomes in ACTION-CVT, an international retrospective study.

Methods:
We compared three groups: no lead-in PA, 1-4 days (d) of PA, and 5-21d of PA. The primary outcome at day 90 (D90) was a composite of CVT recurrence/extension and symptomatic intracranial hemorrhage (sICH). Secondary outcomes (D90) were complete venous recanalization and mRS of 0-2. We evaluated outcomes using descriptive statistics and crude and adjusted logistic regression modeling.

Results:
Of 231 patients treated with DOAC, 11.7% had no lead-in PA, 64.5% 1-4d, 23.8% 5-21d. Compared to those with <5d, those with 5-21d had worse clinical-radiological presentations at baseline, including more focal deficits, encephalopathy, and ICH (Table 1). Primary outcome events were low overall; all 6 occurred in the <5d group. Odds of complete recanalization were lower in the <5d group, although this difference attenuated with adjustment for baseline characteristics. There were no differences in odds of mRS 0-2. (Table 2)

Conclusions:
Individuals treated with DOAC for CVT who received 5-21d of PA had more severe clinical and radiological presentations compared to those with <5d. Rates of CVT extension, recurrence and sICH were too low to reach conclusions regarding safety of one strategy over another. Odds of complete recanalization were higher in those with 5-21d PA, but these differences attenuated after adjustment for baseline patient characteristics.
Abstract WP15: Early Neurological Improvement in Ischemic Stroke and Risk of Cardiac Complications
Authors: Ibrahim* Lamya , Brahmaroutu* Ankita , Miller Jenna , Zhou Sonya , Kasner Scott E , Rosso Michela
Published: February 2024

Introduction:
Cardiac complications are seen in 15-20% of acute ischemic strokes (AIS). We hypothesized that early neurologic improvement (ENI) with or without revascularization would be associated with lower risk of cardiac complications after AIS.

Methods:
We retrospectively screened consecutive AIS patients for elevated initial cardiac troponin (cTn) and ≥1 additional cTn within 48h. Minor strokes (NIHSS≤3) or comorbidities impacting cTn were excluded from primary analysis. ENI was defined as ≥4 pt improvement in NIHSS or 24h NIHSS≤ 1. Post-stroke acute myocardial injury (PSAMI) refers to dynamic cTn pattern (rise/fall>20% in serial cTn levels) in the absence of acute atherosclerotic coronary disease or cardiac death. Secondary analysis assessed full range of NIHSS at baseline and at 24h in relation to cardiac outcomes.

Results:
Of 2,609 patients screened, 165 (ENI=62, no-ENI=103) were included in our primary analysis. (Fig.1). In patients with ENI, a dynamic cTn pattern and PSAMI were present in 55% (n=34) and 34% (n=21) respectively, compared to 45% (n=46) and 24% (n=25) in the no-ENI group (
P
=0.20 and
P
=0.18). Adjusted regression analysis did not show any statistical association of cardiac outcomes with ENI. Secondary analysis including NIHSS≤3, was associated with a 4-fold greater risk of PSAMI in NIHSS >15 at 24h (Fig.1). Analysis of patients intervened with MT or tPA (n=77) also showed no statistical association between ENI and PSAMI (Fig 1.)

Conclusion:
SENI was not associated with a lower risk of cardiac complications after AIS. NIHSS at 24 hours was a strong predictor of PSAMI. Larger studies should investigate if revascularization decreases risk of PSAMI.
Abstract WP176: Hemoglobin Decrement is Associated With Ischemic Lesions on Brain MRI of Patients With Acute Intracerebral Hemorrhage
Authors: Carvalho Poyraz Fernanda , Ridha Mohamed , Simonetto Marialaura , Kumar Aditya , Hess Evan , Cottarelli Azzurra , Connolly Sander , Ghoshal Shivani , Agarwal Sachin , Park Soojin , Claassen Jan , Roh David
Published: February 2024

Background:
We have previously identified that hemoglobin decrements and new-onset anemia during an intracerebral hemorrhage (ICH) hospitalization is frequent, rapid, and associates with poor outcome. Though this association may be related to impaired cerebral oxygen delivery, it is unclear whether these changes relate to cerebral ischemia. We investigated the relationship of hemoglobin decrements over time and ischemic lesions on brain MRI during an ICH hospitalization.

Methods:
Consecutive patients with acute spontaneous ICH enrolled into a single-center, prospective cohort study between 2009 and 2019 were assessed. Patients who had a brain MRI and serial hemoglobin measurements were included. Change in hemoglobin from admission to date of brain MRI (delta Hgb) was defined as the exposure. The outcome was the presence of remote ischemic lesions, defined as foci of diffusion restriction >10 mm away from the hematoma on brain MRI. A regression model assessed relationships between delta Hgb and DWI brain lesions, adjusting for baseline demographics, ICH severity, and time to MRI. Separate sensitivity models were adjusted for admission systolic blood pressure and hemoglobin.

Results:
We identified 189 ICH patients with brain MRI and serial hemoglobin measurements during their hospitalization. The mean age was 66.5 (SD 14.8) and 49.2% were female. Mean admission hemoglobin was 13.5 g/dL (SD 2.0), mean change in hemoglobin from admission to day of MRI was -1.6 (SD 1.6), median time from ICH onset to MRI was 2 (IQR 1-4) days, and 31.7% of patients had ischemic lesions on MRI. We identified an association of greater decrements in hemoglobin with ischemic lesions in our primary model (adjusted OR 0.79, 95%CI 0.64-0.99, p=0.04). Sensitivity analyses adjusting for admission systolic blood pressure and hemoglobin did not change this association.

Conclusions:
Greater hemoglobin decrements associate with remote ischemic lesions on brain MRI of patients with acute ICH. Further work is needed to assess drivers of anemia after ICH and possible causal mechanisms for ischemic brain injury to assess whether anemia is a modifiable treatment target to improve ICH outcomes.
Abstract WP177: Hemorrhagic Transformation in the Thrombectomy Era: Clinical Predictors, Subtypes and Symptomatic Outcomes
Authors: Khezri Nicole , Saver Jeffrey L , Sharma Latisha K , Alfonso Rodel C , Chatfield Fiona , Liebeskind David S
Published: February 2024

Background:
Hemorrhagic transformation (HT) is the principal adverse event of thrombectomy. Definitions of symptomatic HT developed during the intravenous thrombolysis (IVT) era are outdated in the endovascular thrombectomy (EVT) era but continue to be widely used. Symptomatic intracerebral hemorrhage (sICH) underestimation may result due to failure to categorize: 1) as sICH-causing hemorrhage types common with EVT but not IVT, such as SAH, IVH; and 2) as sICH-qualifying clinical deterioration patterns common with EVT but not IVT, such as moderate worsening after dramatic initial improvement.

Methods:
Retrospective, blinded, core lab (2 independent imaging readers), single-center analysis of 149 consecutive thrombectomy patients. Clinical characteristics, technical considerations associated with thrombectomy, severity and subtypes of HT (Heidelberg) and clinical outcomes were analyzed.

Results:
HT was adjudicated present in 70 out of 149 (47.0%) consecutive thrombectomy patients. Radiologic subtypes were: hemorrhagic infarction (HI-1) (51.4%), HI-2 (25.7%), parenchymal hematoma (PH-1) (4.3%), PH-2 (4.3%), subarachnoid hemorrhage (SAH) (34.3%), intraventricular hemorrhage (IVH) (12.8%), and subdural hemorrhage (SDH) (0%). Coexisting subtypes were present in 27.1 % of HT cases. A total of 8 patients had sICH (5.4% of all patients and 11.4% of patients with HT), conservatively defined by a decline in NIHSS of at least 4 points from baseline to 24 hours post thrombectomy. Only 25% of sICH patients were classified as PH-2, while 62.5% had SAH and 12.5% PH-1.

Conclusion:
Assessment of HT in EVT requires adoption of later-generation, thrombectomy appropriate classification systems. Multiple, co-existing, radiologic subtypes were present in 1 in 4 EVT patients, making single anatomic categorizations infeasible. Symptomatic hemorrhages were due to subarachnoid hemorrhage in more than half and PH-2 in only one-quarter of symptomatic hemorrhages in this EVT series.