bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W MP32: Localized Increase of Chemokines in the Lumen of Human Cerebral Aneurysms
Authors: Chalouhi Nohra , Points Lauren , Pierce Gary L , Ballas Zuhair , Jabbour Pascal , Hasan David
Published: July 2021

Introduction:
Inflammation may play an important role in the formation and rupture of cerebral aneurysms. Chemokines act as chemoattractants for leukocytes directing them toward sites of tissue inflammation. The purpose of this study was to determine whether chemokines and chemoattractant cytokines were increased in the lumen of human cerebral aneurysms.

Methods:
The concentrations of chemokines and other inflammatory molecules in blood samples drawn from the lumen of human cerebral aneurysms of 16 consecutive patients (harboring 18 aneurysms) were compared with blood samples from femoral arteries of the same patients. Specifically, the concentrations of the following molecules were determined: RANTES, monokine-induced-by-gamma-interferon (MIG), interferon-gamma-induced protein-10 (IP-10), eotaxin, interleukin (IL) 1-beta, IL 1 Receptor Antagonist, IL2, IL2 Receptor, IL4, IL5, IL6, I7, IL8, IL10, IL12, IL13, IL15, IL17, vascular endothelial growth factor, granulocyte colony stimulating factor, epidermal growth factor, basic fibroblast growth factor, granulocyte monocyte colony stimulating factor, tumor necrosis factor-alpha, interferon-alpha, interferon-gamma, macrophage inflammatory protein 1 alpha, macrophage inflammatory protein-1-beta, and monocyte chemoattractant protein-1 (MCP-1).

Results:
The mean plasma concentration of RANTES, MIG, IP-10, eotaxin, IL 8, and IL17 was significantly higher in samples taken from cerebral aneurysms compared with femoral arteries. In contrast, plasma concentrations of all remaining inflammatory molecules (except IL6) that were tested did not differ between cerebral aneurysms and femoral arteries. For unruptured aneurysms, there was a significantly higher mean plasma concentration of monocyte chemoattractant protein-1,RANTES, MIG, IP-10, eotaxin, IL8, and IL17 in samples obtained from cerebral aneurysms.

Conclusions:
High plasma concentrations of chemokines (monocyte chemoattractant protein-1, RANTES, MIG, IP-10, and eotaxin) and chemoattractant cytokines (IL8 and IL17) were found in the lumen of human cerebral aneurysms. These findings suggest that there may be an active recruitment of inflammatory cells into the aneurysm wall that may be exploited therapeutically.
Abstract W MP4: Psychometric Evaluation of an Instrument to Assess Perceived Benefits and Barriers to Exercise for Stroke Prevention among African Americans
Authors: Aycock Dawn , Clark Patricia
Published: July 2021

Exercise can reduce the risk of stroke and identifying perceived benefits and barriers to exercise relevant to African Americans (AA) may contribute to ways to facilitate exercise participation. However, standardized instruments to assess exercise beliefs for stroke prevention have not been well tested in AA.

Purpose:
To examine the psychometric properties of the Exercise Benefits and Barriers for Stroke Prevention Scale (EBBSP), a combination of the perceived benefits and barriers subscales from the Cerebrovascular Attitudes and Beliefs Scale - Revised and the Health Beliefs Related to Cardiovascular Disease Scale, adapted for stroke.

Methods:
A non-random sample of 66 at risk, young to middle-aged AA completed the EBBSP, a 16-item self-report, 5-point Likert scale. Cronbach's alpha procedure tested reliabilities and principal components analysis with varimax rotation was employed to assess construct validity. Self-report measures of current exercise performance and future intentions to exercise were administered and Spearman Rho analyses were used to examine predictive validity.

Results:
Cronbach’s reliability coefficients for the benefits and barriers subscales were 0.82 and 0.76. The Kaiser-Meyer-Olkin measure (0.69) and Bartlett’s test (p= .000) indicated the data were adequate to be factored. A four factor solution explained 64% of the common variance. Two factors pertained to benefits (i.e. health and support/resources) and two factors applied to barriers (i.e. sensory and time priority). Perceived health benefits explained the majority of the variance (33%), consistent with the most commonly reported motivator to exercise, “good/better health” (34%). Greater benefits to exercise was associated with greater future intentions to exercise (r

s

= 0.60, p< 0.01) but not with current exercise performance (p > 0.05), while fewer barriers to exercise was associated with higher exercise performance (r

s

= -0.25, p< .05) and greater future intentions to exercise (r

s

= -.29, p< .05).

Conclusion:
The p
sychometric evaluation
of the EBBSP revealed preliminary evidence of acceptable reliability and validity. The EBBSP may be useful in research with a focus on understanding, prediction, and promotion of exercise for stroke prevention among AA.
Abstract W MP57: Illicit Cocaine Use and Risk of Ischemic Stroke: The Stroke Prevention in Young Adults Study
Authors: Cheng Yu-Ching , Qadwai Saad A , Ryan Kathleen A , Cole John W , Kittner Steven J
Published: July 2021

Background:
Cocaine use has been associated with increased risk of ischemic stroke (IS). The prevalence of illicit cocaine use in the population differs by gender and ethnicity. The goal of this study was to determine the effect of cocaine on young-onset IS in Caucasian and African American men and women.

Methods:
A total of 1,101 cases and 1,154 controls, aged 15 to 49 years old, were recruited from the greater Baltimore-Washington area between 1992 and 2008. Cases and controls were interviewed to assess the presence of stroke risk factors and history of illicit drug use. Logistic regression was used to determine the association between cocaine use and IS.

Results:
In this study, 28% of cases and 26% of controls reported a history of illicit cocaine use. Men were twice as likely as women to report a history of cocaine use (36% vs. 18%, P<0.0001), and African Americans slightly more likely than Caucasians (30% vs. 26%, P=0.01). Having a history of illicit cocaine use was not associated with IS in the overall sample or any of the gender and ethnic subgroups. However, reporting acute use of cocaine in the 24 hours prior to stroke was strongly associated with increased risk of IS in the overall sample (2.4% of cases vs. 0.4% of controls; age-adjusted OR=7.1, 95% CI: 2.4-20.3), and the strength of association was similar in Caucasians (age-adjusted OR=6.1, p=0.10) and African Americans (age-adjusted OR=6.7, p=0.002). Interestingly, the effect of acute cocaine use appeared to be stronger in females (OR=12.8, p=0.01) than males (OR=2.5, p=0.17) after adjusting for the effect of age, ethnicity and current smoking status although the gender difference in ORs was not statistically significant.

Conclusions:
Our data suggests that acute cocaine use significantly increases IS risk in young adults, and that the effect appears to be stronger in women despite the lower frequency of cocaine use in this subgroup.
Abstract W MP78: Small Changes in Intracellular pH Block Ischemic and Excitotoxic Cell Death by Suppressing Neuronal Superoxide Production
Authors: Won Seok Joon , Lam Tina , Brennan-Minnella Angela M , Shi Yejie , Sun Dandan , Swanson Raymond A
Published: July 2021

Tissue acidosis has long been recognized as a crucial variable affecting outcome after brain ischemia, with mild acidosis (pH 7.0 - 6.6) providing robust neuroprotection. pH in ischemic tissues is reduced by anaerobic glucose metabolism, and normalized by reperfusion. Superoxide produced by neuronal NADPH oxidase (NOX2) has recently been identified as a major source of oxidative stress in ischemia and excitotoxicity. Given that NOX2 in other cell types is highly sensitive to intracellular pH, we evaluated the possibility that pH effects on neuronal NOX2 activity mediate the neuroprotective effects of mild acidosis. In cultured neurons, reducing medium pH from 7.2 to 7.0 produced a comparable 0.2 pH-unit intracellular acidification and completely prevented NMDA-induced NOX2 activity, superoxide production, and cell death. These effects were observed even when extracellular calcium was elevated to overcompensate for reduced NMDA-induced calcium influx at the lowered pH. Intracellular H
+
produced by NOX2 is be extruded to permit continued NOX2 activity. Neurons treated with an inhibitor of Na
+
/H
+
exchange, cariporide showed a 0.2- 0.3 unit intracellular acidification (with no change in extracellular pH). Cariporide- treated neurons also showed no superoxide formation and no cell death in response to NMDA, with no change in NMDA-induced calcium influx. To evaluate this effect in vivo, mice were given stereotaxic striatal injections NMDA. NMDA induced superoxide production and subsequent neuronal death, both of which were blocked by co-injection with cariporide. Superoxide production and neuronal death were similarly blocked in mice with reduced expression of Na
+
/H
+
exchanger isoform 1 protein (NHE-1
+/-
mice). NHE-1
+/-
mice also exhibited much less superoxide production and neuronal death after forebrain ischemia-reperfusion. These findings identify a mechanism by which mild acidosis improves outcomes in ischemia and excitotoxicity. The findings may also help explain why superoxide production is greater in reperfused than non-reperfused brain, and why both NOX2 inhibitors and NMDA receptor antagonists are more neuroprotective in reperfused than non-reperfused brain.
Abstract W P126: Allostatic Load Predicts Stroke Mortality Risk in Older Danes: Findings From the 1914 Glostrup Aging Study
Authors: Salazar Christian R , Avlund Kirsten , Morse Douglas E
Published: July 2021

Allostatic load (AL) is a composite measure of cumulative biological damage derived from physiological markers across multiple systems. While previous reports have shown that AL predicts cardiovascular events at early old age, the prognostic value of AL on stroke mortality among the oldest old remains largely unexplored. The objective of this study was to evaluate the association between AL and stroke mortality risk in a birth cohort of older Danish adults from the 1914 Glostrup Aging Study. In total, 330 Danish participants completed a structured questionnaire at baseline (age 80) and were assessed for 10 physiological markers that spanned the cardiovascular (systolic and diastolic blood pressure, heart rate), metabolic (HDL, ratio of total cholesterol/HDL, BMI, triglycerides, serum albumin, blood glucose), and inflammatory (IL6, TNF-alpha) systems. Composite summary scores of AL ranging from 0-10 were computed for each participant using a count-based approach, with high and low cut-points of AL defined at the median. Using the Danish National Civil Death Registry, we ascertained deaths from cardiovascular disease and stroke for all participants and examined survival probability over a 15-year period with Cox regression. Overall, there were 106 cardiovascular disease-related deaths, of which 25 were due to stroke. Older adults with high AL had a 2-fold higher hazard risk of death from stroke than those with low AL (hazard ratio [HR]=1.96, 95% confidence interval [CI]: 0.89 - 4.35), after adjustment for conventional risk factors of stroke. When stratified by sex, men with high AL had about a 6-fold higher risk of death from stroke than those with low AL (adjusted HR= 5.67, 95% CI= 1.66 - 19.4). No association between AL and stroke mortality risk was observed in women (adjusted HR=0.78, 95% CI: 0.23 - 2.63) among whom there were only 6 stroke deaths. In a birth cohort of older Danish adults, AL showed promise as a prognostic tool for stroke mortality risk. Larger studies in more diverse populations are necessary to confirm our findings.
Abstract W P135: Pulse Wave Velocity is a Predictor of Mortality in Acute Ischemic Stroke
Authors: Kim Jinkwon , Song Tae-Jin , Lee Ki-Jeong , Kim Eun Hye , Song Dongbeom , Nam Hyo Suk , Kim Young Dae , Heo Ji Hoe
Published: July 2021

Introduction:
Arterial stiffness increases with aging, but is also suggested as a surrogate marker of atherosclerosis and a predictor of cardiovascular events. Brachial-ankle pulse wave velosity (baPWV) is a simple and non-invasive tool for measurement of arterial stiffness.

Hypothesis:
Measurement of baPWV in acute phase of stroke may have a prognostic value to predict all-cause and cardiovascular death.

Methods:
This was a hospital-based, retrospective observational study. We included patients who had admitted for acute ischemic stroke and undergone baPWV measurement. Date and causes of death were obtained from the database of the Korean National Statistical Office. All-cause and cardiovascular mortality after stroke onset was compared across to the tertile groups of baPWV.

Results:
Of included 1696 patients, mean age was 64.5 ± 12.5 years and male was 60.7 %. Mean value of baPWV was 21.04 ± 6.31 m/sec. During mean follow-up period of 1.91 ± 1.27 years, there were 126 all-cause deaths including 85 cardiovascular deaths. Kaplan-Meier survival analysis demonstrated an increased risk for all-cause and cardiovascular mortality in patients with higher baPWV (Figure). In multivariate Cox regression, patients in the highest tertile of baPWV (T3; >22.54 m/sec) were at increased risks for all-cause death [HR 1.95, 95% CI 1.13-3.36, p=0.017] and cardiovascular death [HR 2.18, 95% CI 1.11-4.25, p=0.023] compared to the lowest tertile (T1; <17.78 m/sec).

Conclusions:
This study suggested that measurement of baPWV during acute phase of stroke might be used to identify patients at a higher risk for long-term mortality.
Abstract W P139: Differential Impact of Preadmission Selective Serotonin Reuptake Inhibitor Treatment on Stroke Outcomes Among Ischemic and Hemorrhagic Stroke Patients? A Nationwide Propensity Score-Matched Follow-Up Study
Authors: Mortensen Janne K , Larsson Heidi , Andersen Grethe , Johnsen Søren P
Published: July 2021

Introduction:
SSRIs are widely used for treating post-stroke depression and pathological crying and appear to have antithrombotic effects that may increase the risk of bleeding. Increasing evidence further suggests a neuroprotective effect in stroke, however clinical data are sparse.

Aim and hypothesis:
We aimed to examine the implications of pre-admission SSRI use in patients with ischemic and hemorrhagic stroke. We hypothesized a neuroprotective and antithrombotic effect leading to less severe strokes and decreased 30-day mortality among the ischemic strokes, and a possible reverse effect among the hemorrhagic strokes.

Methods:
We did a nationwide registry-based follow-up study among ischemic and hemorrhagic stroke patients in Denmark between 2003 and 2011. We identified 4348 pre-admission SSRI users (556 hemorrhagic strokes) and 4348 propensity score-matched non-users in the Danish Stroke Registry. Multiple conditional logistic regression was used to compute odds ratios (OR) of severe stroke (as measured on the Scandinavian Stroke Scale) and death within 30 days after stroke. Analyses were repeated after excluding patients with hemorrhagic stroke.

Results:
For the stroke types combined, pre-admission SSRI use was associated with a higher risk of severe stroke (adjusted OR, 1.12; CI, 1.00-1.25) and a non-significantly higher risk of death within 30 days (adjusted OR, 1.27; CI, 0.73-2.19). In contrast, no statistically significant difference in risk of severe stroke (adjusted OR, 1.06; CI, 0.92-1.21) or death within 30 days (adjusted OR, 0.81; CI, 0.38-1.77) was found between pre-admission SSRI-users and non-users after excluding patients with hemorrhagic stroke.

Conclusion:
Our results suggest that pre-admission SSRI use may be associated with a higher risk of severe stroke and case-fatality in patients with hemorrhagic stroke, but not in patients with ischemic stroke. Further studies are warranted to explore the possible neuroprotective and hemorrhagic effects of SSRI treatment in patients admitted with acute stroke.
Abstract W P14: Endovascular Treatment for M2 Occlusions. A Descriptive Multicenter Experience on Behalf of the Catalan Stroke Code and Reperfusion Consortium (Cat-SCR).
Authors: Flores Alan , Tomasello Alejandro , Cardona Pere , De Miquel M Anges , Gomis Meritxell , Garcia Bermejo Pablo , Obach Victor , Urra Xabi , Joan Martí-Fábregas , Canovas David , Roquer Jaume , Abilleira Sonia , Ribó Marc
Published: July 2021

Background:
Patients with M2-MCA occlusion are not always considered for endovascular treatment. We aimed to study patients with an M2 occlusion treated with endovascular procedures.

Methods:
We studied patients prospectively included in the SONIIA register (January 2011-December 2012), a mandatory and externally audited register that monitors quality of reperfusion therapies in Catalonia under routine practice conditions. Baseline characteristics including NIHSS and occlusion location were collected. Complete recanalization was defined as a post-procedure TICI>2a, dramatic recovery: NIHSS drop>10 points or NIHSS<2 and good outcome as mRS<3 at 3 months. 24 hours CT scan determined the presence of hemorrhagic transformation (ECASS criteria) and infarct volume.

Results:
Of the 571 registered patients that received endovascular treatment, 65 (11.4%) presented an M2 occlusion on initial angiogram: mean age 66±15, female 47.7% median pre-procedure NIHSS 16(IQR:6). Mean time from symptom onset to groin puncture was 289±195 minutes, 35 patients (54%) received iv tPA before the procedure. Patients were treated with mechanic thrombectomy (n=49, 75.4%), ia tPA (n=3, 4.6%), both (n=7, 10.8%) or only diagnostic angiogram (n=6, 9.2%) according to interventionalist preferences. Patients who achieved complete recanalization (78.5%) had more often dramatic improvement (48% Vs 14.8%, p=0.023) smaller infarct volumes (8 vs. 82cc, p=0.013) and better outcome (66.3% Vs 30%; p=0.032) than those who did not recanalize. Rate of SICH was 9%.

Independent predictors of dramatic improvement was complete recanalization (OR: 0,169 p=0.03 CI95%: 0.034-0.838) adjusted for age and baseline NIHSS Independent predictors of good outcome at 3 months were age (OR 1.067 p=0.033 CI95%: 1.005-1132) and baseline NIHSS (OR: 1.162 p=0.007 CI95%: 1.041-1.297)

Conclusion:
Endovascular treatment of M2 MCA occlusion seems safe. Induced recanalization may double the chances to achieve a favourable outcome
Abstract W P148: CHA2DS2VASc and R2CHADS2 Scores as Prognostic Tools for Stroke in Patients with Prior History of Coronary Artery Disease
Authors: Hoshino Takao , Ishizuka Kentaro , Uchiyama Shinichiro
Published: July 2021

Background:
Recent reports revealed that CHADS2 scores can be applied to assess stroke risk in patients with coronary artery disease (CAD), irrespective of atrial fibrillation (AF) presence. Furthermore, we previously reported that the score can also predict poor functional outcome of stroke after CAD. In this study, we evaluated the usefulness of CHA2DS2VASc and R2CHADS2 scores as prognostic tools for stroke patients with prior CAD.

Methods:
We enrolled 802 consecutive patients hospitalized with acute ischemic stroke. Inclusion criteria were (1) independent living before stroke onset, and (2) a CAD diagnosis before stroke. Pre-admission CHA2DS2VASc and R2CHADS2 scores were retrospectively calculated. Comparisons were made between patients with good (modified Rankin scale [mRS] <3) and poor (mRS ≥3) 3-month functional outcomes with regard to baseline characteristics. Furthermore, multivariate analysis was performed to assess the predictive value of CHA2DS2VASc and R2CHADS2 scores for poor outcome.

Results:
Of all enrolled patients, 153 patients (mean age, 74.3 years; male, 77.1%) were eligible for analysis. The patients with good and poor outcomes were found to have significant differences in CHA2DS2VASc scores (mean, 4.3 vs. 5.0, P = 0.003), R2CHADS2 scores (mean, 2.7 vs. 3.5, P = 0.003), carotid artery stenosis (23.9% vs. 41.9%, P = 0.020), intracranial artery stenosis (14.9% vs. 31.4%, P = 0.018), AF (16.4% vs. 31.4%, P = 0.031), and admission NIHSS scores (median, 4.5 vs. 11, P < 0.001). The figure shows the distributions of patients with poor outcome for the different CHA2DS2VASc and R2CHADS2 scores. According to the multivariate analysis, R2CHADS2 was a better determinant of poor functional outcome than CHA2DS2VASc (OR 1.60, 95% CI 1.18-2.24, P = 0.004; OR 1.33, 95% CI 0.99-1.81, P = 0.06, respectively).

Conclusions:
Both CHA2DS2VASc and R2CHADS2 scores are potentially useful tools for predicting functional outcome in stroke patients with a history of CAD.
Abstract W P149: High-Sensitivity C-Reactive Protein, but Not Lipoprotein-Associated Phospholipase A2, May Predict the Unfavorable Outcome After Acute Ischemic Stroke
Authors: Kim Jae Guk , Ko Youngchai , Lee Soo Joo
Published: July 2021

Background and Objectives:
Inflammation plays an important role in atherosclerosis and its clinical sequelae. Their relationship to stroke is not settled. We assessed the hypothesis that relative elevations of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels at the time of first stroke are associated with stroke severity and prognosis.

Methods:
First ischemic stroke patients who was admitted within 7days after stroke onset, were prospectively enrolled. High-sensitivity C-reactive protein and Lp-PLA2 level were assayed using the enzyme-linked immunoassay. Vascular risk factors, stroke subtypes, and initial stroke severity were assessed. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and was categorized as mild (NIHSS score<6), moderate (NIHSS score of 6-13), or severe (NIHSS score≥14). The unfavorable outcome was defined as the modified Rankin Scale of 2-6 at 3month after stroke onset.

Results:
Two hundred two patients (mean age, 67.5 years; 52.5% male) were included; 104 (51.5%) had unfavorable outcome. Levels of hs-CRP and Lp-PLA2 were weakly correlated (Spearman’s rho=0.174, p=0.01). In univariate analyses, female (p=0.03), patients with large artery atherosclerosis of stroke subtypes (p<0.01), severe NIHSS score (p=0.01), and unfavorable outcome (p<0.01) showed the higher mean value level of hs-CRP level than the others. Patients with hypertension (p=0.03), large artery atherosclerosis (p<0.01), severe NIHSS score (p<0.01), and unfavorable outcome (p=0.01) also had the higher mean value of Lp-PLA2 level than the others. After adjusting for age, sex, vascular risk factors, and initial stroke severity, the high level of hs-CRP was associated with unfavorable outcome (1.71±4.2 vs. 0.26±0.45, odds ratio (OR) 1.82, 95% confidence interval (CI) 1.02-3.27, p=0.04). However, after adjusting for the confounders, Lp-PLA2 was not associated with unfavorable outcome (191.33±77.78 vs. 162.02±61.54, OR 1.00, 95% CI 0.99-1.01, p=0.66).

Conclusion:
Our findings suggest that the level of hs-CRP and Lp-PLA2 were associated with stroke severity, but only hs-CRP may be useful to predict functional outcome at 3 month after ischemic stroke.
Abstract W P155: Antiplatelet Therapy Benefit in Secondary Stroke Prevention in Patients With Suboptimally Controlled Treatable Cerebrovascular Risk Factors
Authors: Umer Muhammad , Kurako Kateryna , Galvez-Jimenez Nestor , Salgado Efrain
Published: July 2021

Objective:
To assess the impact of antiplatelet therapy for secondary stroke prevention in patients with suboptimally controlled treatable cerebrovascular risk factors per guidelines.

Results:
Of the 1755 patients, 219 (12.47%) patients had a second stroke event between November 2006-December 2012. Mean age of this group of patients was 66.4 years old with male predominance (M:F=1.5:1). 192 (88%) patients were on antiplatelet therapy at the time of the second stroke. 27 (12 %) were not on antiplatelet therapy.

Of the total cohort, treatable risk factors were poorly controlled in 130 (59%) patients: 121 (55%) hypertension; 78 (36%) hyperlipidemia, 44 (20%) diabetes.

Antiplatelet agents included aspirin, clopidogrel alone or in combination with aspirin, and extended-release dipyridamole. The data showed no significant difference among antiplatelet agents for secondary stroke prevention (p<0.05).

Stroke classification was as follows: 162 (74%) ischemic and 57 (26%) hemorrhagic. Categories of ischemic stroke were as follows: large-artery atherosclerosis 40 (18%), small vessel disease 45 (21%), cardioembolic 42 (19%), 35 (16%) cryptogenic / stroke of undetermined etiology. Of the 192 patients on antiplatelet therapy with stroke, 116 (60%) had poorly controlled risk factors.

Conclusions:
This study suggests that the use of antiplatelet therapy, regardless of which agent, for secondary stroke prevention may not be important or beneficial in the absence of optimal treatable cerebrovascular risk factor control. Further studies are needed to support this finding including further analysis of our data to assess risk factor control in those patients on antiplatelet therapy who did not suffer a second stroke during the period of surveillance
Abstract W P164: Effects of Extracranial Carotid Stenosis on Intracranial Blood Flow
Authors: Shakur Sophia F , Amin-Hanjani Sepideh , Bednarski Caroline , Du Xinjian , Aletich Victor , Charbel Fady , Alaraj Ali
Published: July 2021

Objectives:
To determine the effects of degree of stenosis, stenosis length, and residual lumen on intracranial blood flow in patients with extracranial carotid stenosis.

Methods:
Records of patients who underwent stenting for extracranial carotid stenosis at our institution between 2004-2012 and had flow rates obtained using quantitative magnetic resonance angiography were retrospectively reviewed. Measurements of degree of stenosis, stenosis length, and residual lumen were made from cerebral angiography images.

Results:
18 patients had both complete anatomic and flow data available. Mean age was 66 years. Degree of stenosis ranged from 60% to 90%. 61% had symptomatic stenosis. Univariate analysis demonstrated that higher percentage of stenosis and smaller residual lumen (mm) are associated with a significant decrease in ipsilateral internal carotid artery (ICA) flow (
P
=0.027 and
P
=0.007, respectively). Stenosis length (mm) was not significantly associated with ipsilateral ICA flow (
P
=0.08). On multiple regression analysis, both degree of stenosis and residual lumen remained predictive of ipsilateral ICA flow (
P
=0.005 and
P
=0.007, respectively). Neither degree of stenosis, stenosis length, or residual lumen were significantly associated with ipsilateral MCA flow (P=0.38, 0.18, and 0.86, respectively), and baseline ICA flow was not predictive of ipsilateral MCA flow (
P
=0.37).

Conclusions:
Degree of stenosis and residual lumen diameter are highly predictive of ICA, but not MCA flow, in the setting of carotid stenosis. Local hemodynamic effects of the stenosis do not translate directly to the distal vasculature, as intracranial flows can be maintained through collateral flow.

Figure:
Ipsilateral ICA flow and residual lumen. Increasing residual lumen is associated with significant ipsilateral ICA flow increase (
P
=0.007, correlation coefficient=0.61).
Abstract W P174: Association of Moyamoya Disease With Thyroid Autoantibodies and Thyroid Function: A Case-control Study and Meta-analysis
Authors: Lei Chunyan
Published: July 2021

Background and Purpose:
Evidence suggests that elevated thyroid function and elevated levels of thyroid autoantibodies are associated with risk of Moyamoya disease (MMD). Therefore we performed a meta-analysis of all available evidence, including unpublished data from our own center, in order to assess this association.

Methods:
We reviewed the English- and Chinese-language literature in major databases to identify studies examining the association between MMD and thyroid function or thyroid autoantibodies. We combined these data with those from our own prospective study conducted in our hospital.

Results:
In our center, 28 patients with MMD and 28 age-matched control patients with non-MMD stroke were included. Based on our literature searches, we identified two studies for inclusion in our meta-analysis, to which we added our own prospective study described above. Data from our hospital study indicated an association between risk of MMD and elevated thyroid autoantibodies (OR 9.00, 95% CI 1.03 to 78.94), but not between risk of MMD and elevated thyroid function (OR 5.87, 95% CI 0.64 to 53.93). Meta-analysis of our data with findings from the literature further supported the association with elevated thyroid autoantibodies (OR 8.77, 95% CI 4.45 to 17.29) and also indicated an association with elevated thyroid function (OR 9.74, 95% CI 2.18 to 43.49).

Conclusions:
Evidence strongly suggests that elevated thyroid autoantibodies and elevated thyroid function are independently associated with MMD. These clinical variables may require regular monitoring in patients with MMD.
Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result
Authors: Dunbar Scott , Hoffecker Theresa , Schwenk Avery
Published: July 2021

Background:
Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time.

Methods:
Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error.

Results:
The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively).

Conclusions:
Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.
Abstract W P216: Inducible Glutamate Oxaloacetate Transaminase: A New Target for Stroke Therapy
Authors: Rink Cameron , Gnyawali Surya , Heigel Mallory , Roy Sashwati , Sen Chandan K , Khanna Savita
Published: July 2021

Introduction:
Elevated extracellular glutamate plays a central role in mediating ischemic brain damage. The current work stems from our key observation demonstrating that induction of glutamate oxaloacetate transaminase (GOT), a glutamate metabolizing enzyme in the brain, can attenuate stroke-induced injury. At the stroke site, inducible GOT (iGOT) catalyzes the metabolism of extracellular glutamate via a truncated TCA cycle to generate energy and limit concentrations.

Hypotheses:
Phytoestrogen Biochanin induces GOT. iGOT inducer Biochanin protects against stroke in vivo.

Methods:
In vitro.
Primary cortical neuronal cells were isolated from the cerebral cortex of C57/BL6 mice feti and seeded in 12-well plates maintained for 24h under standard media and culture conditions prior to experimental treatment. After 24h, cells were incubated with vehicle control (DMSO) or one of several screened phytoestrogen isoflavones for 72h. After 72h sample were collected for mRNA and protein expression analyses of GOT.

In vivo.
Mice (C57/BL6) received daily IP injection of vehicle control (75% DMSO in water, n=4) or Biochanin A (10mg/kg body weight, n=6) for 3 weeks prior to 90min middle cerebral artery occlusion (MCAO). Following 48h, mice were subjected to 11.7T MRI for determination of stroke induced lesion volume and brain tissue were collected for downstream mRNA and protein expression analyses of GOT.

Results:
The following phytoestrogen isoflavones were screened for their ability to induce GOT: biochanin A, flavaprenin, diadzein, formononetin, glycitin, and genistein. Biochanin A was identified as a potent (3-fold) inducer of GOT. Biochanin A significantly induced GOT mRNA expression in neural cells. In an
in vivo
setting of acute ischemic stroke, Biochanin A treated mice had significantly (n=6; p<0.05) smaller stroke-induced lesions as compared to vehicle controls.

Conclusion:
In this work we have identified a natural small molecule inducer of GOT - Biochanin A. Biochanin A is a safe, naturally occurring phytoestrogen isoflavone that represents a therapeutic target that lends itself to be translated to clinical study.
Abstract W P279: A Multi-Campus Health System's Approach to Achieving the Highest Level of Quality Through Standardization of Practices
Authors: Clarkson- Afshar Katherine , Richetts Renee , Olson-Mack Lindsay , Bajkiewicz Christopher , Berger Lynn
Published: July 2021

Background:
With healthcare reform, non-value added variation will be difficult to maintain while remaining a financially successful healthcare institution under new legislation. Our organization began looking at the highest levels of quality throughout our 5 campus system, and standardizing practice in order to achieve the same high quality standards across all sites.

Methods:
Acute ischemic stroke (AIS) accounts for approximately 85% of the all stroke patients; therefore, we prioritized establishing structure around AIS patients first, in order to achieve greatest impact. The first piece of the structure developed was the Preformatted Order (PFO). It is completed by the healthcare provider and a large driver in the consumption of healthcare. It was decided by setting the ‘structure’ or PFO at the point of admission could dramatically impact the care provided throughout the hospitalization. Each hospital had an individualized PFO for ED Stroke Code, IV tPA Administration, Admission Order for patients receiving IV tPA, and Admission Orders for patients with AIS/TIA without IV tPA. All were independently built with the AHA’s Clinical Practice Guidelines but site specific variation persisted. Best practices and data were analyzed from each campus to identify elements for a system PFO in each of the above. Quality and CPGs remained the driver for decision making while PFOs were built. Once agreed upon by medical staff, the system-wide PFOs were rolled out across all sites.

Results:
Significant improvements in dashboard metrics were identified when compared with the prior year’s data (same timeframe). The most significant, was a reduction of 0.9 days in the patient’s average length of stay (ALOS), when examined year-over-year. (FY12Q3 ALOS 4.73 days, FY13Q3 ALOS 3.80 days). The campus with the highest cost and longest ALOS, was able to demonstrate a reduction of 1.76 days in the patient’s ALOS, examined year-over-year. (FY12Q3 ALOS 5.04 days, FY13Q3 ALOS 3.28 days).

Conclusions:
Developing a structure aiming at the highest quality can result in an overall cost reduction and decreased ALOS. This structure will allow us to retain the same high level of care across all hospital sites, while allowing for customization of care, tailored to specific patient needs.
Abstract W P288: Stroke Central: An Innovative Approach to Coordinated Comprehensive Stroke Care
Authors: Egger Raymond , Jennings Bethany , Commiskey Patricia , Bridges Aaron , Dadlez Gregory , Gaines Kenneth
Published: July 2021

Background:
Stroke care involves a costly and time-sensitive interdisciplinary approach, which requires a supportive platform in order to explore novel patient care strategies. Our initiative aims to reduce costs and poor outcomes for stroke patients through increased coordination across the continuum of care.

Methods:
This innovative care model includes an inpatient component, Stroke Central. Stroke Central utilizes an intra-professional team of specialists, including vascular neurologists, advance practice nurses, and a registered nurse (RN) coordinator who serves as the central contact to handle all stroke-related concerns from staff and patients.

The goal of Stroke Central is to provide comprehensive monitoring of patients throughout care, resulting in early detection and intervention in any complications. The role of the RN coordinator is vital as a facilitator for Stroke Central communication, care monitoring, and ongoing education and training among patients and healthcare professionals. The RN coordinator is charged with improving compliance with standard of care guidelines throughout the continuum of care and collaborating with other team members to monitor patients both remotely and directly.

Results:
After initiation of Stroke Central, results show improved patient outcomes for the 434 patients seen in the first two quarters of 2013 compared with the 822 patients seen in 2012. Lengths of stay indices have decreased in cases of hemorrhagic stroke (10%), ischemic stroke (19%) and transient ischemic attacks (31%). Complication and mortality rates in hospitals have also decreased; expected complication rate index for ischemic stroke decreased 10%, while the risk adjusted mortality index for ischemic stroke decreased 40%. Initial cost analyses indicate decreased costs for the inpatient component.

Conclusion:
Having a dedicated staff member, as a first and continual facilitator for contact has been essential in this innovative model. Incorporating this key role into primary stroke care can lead to an overall improvement in stroke outcomes in diverse hospital settings.
Abstract W P338: Association of Triglyceride-HDL Cholesterol and LDL Cholesterol HDL Cholesterol Ratios With Symptomatic Intracranial Atherosclerosis
Authors: Jani Vishal B , Chaudhry Saqib S , Jadhav Vikram , Hussain Sayed , Safdar Adnan , Qureshi Adnan I
Published: July 2021

Background:
Emerging data suggest that a triglyceride (TG): HDL-C ratio and LDL: HDL-C ratio may be a better predictor of vascular risk than the traditional lipid measures such as total cholesterol and LDL-C.

Methods:
A cohort of 40 Patients was selected with symptomatic intracranial atherosclerotic disease (ICAD) who underwent intracranial stent placement and lipid profiles within 90 days of the treatment,. Age and gender matched asymptomatic controls were selected from the Multi-Ethnic Study of Atherosclerosis (MESA) involving more than 6,000 men and women from six communities in the United States.

Results:
Case control continuous variable analysis in a logistic regression model demonstrated higher TG/HDL-C ratio was directly associated with ICAD (OR 1.36, 95% CI 1.13-1.65 p= 0.001) while higher LDL/HDL ratio was not associated with ICAD (OR 1.14, 95% CI 0.77-1.69 p= 0.495). After adjusting for diabetes mellitus, hypertension, smoking, cigarette smoking and alcohol use, higher TG/HDL ratio was directly associated with ICAD (OR 1.26, 95% CI 1.0-1.58 p= 0.048) but the LD/HDL ratio was not associated with ICAD (OR 0.85, 95% CI 0.48-1.64 p= 0.696).

Conclusion:
TG: HDL-C ratio was associated with symptomatic ICAD and may represent a therapeutic target for optimizing intensive medical treatment.
Abstract W P359: Activation of Prostacyclin Receptor (IP) in Human Brain Microvascular Endothelial Cells Stimulates Production of SAPPa
Authors: He Tongrong , Lu Tong , Katusic Zvinomir
Published: July 2021

Previous studies have established that cerebral blood vessels possess high capacity to synthesize prostacyclin (PGI
2
). Substantial evidence indicates that amyloid precursor protein (APP) and soluble APPα (sAPPα) have neurotrophic and nueroprotective properties. We hypothesized that activation of IP-cAMP pathway stimulates non-amyloidogenic processing of APP in cerebral endothelial cells. Western blotting was used to detect protein expression; real time RT-PCR was employed to measure mRNA levels of APP, and a disintegrin and metalloprotease 10 (ADAM10, an α processing enzyme); sAPPα secretion was detected in condition medium derived from culturing human brain microvascular endothelial cells (BMVECs), by ELISA. After human BMVECs were treated with PGI
2
analog iloprost (0.01, 0.05, 0.1, or 0.5 μM) for 3 days, protein levels of ADAM10 (n=7-9, P<0.05) and APP (n=6, P<0.05) were significantly increased in a concentration dependent manner, while β amyloidogenic processing enzyme BACE1, and other α processing enzymes such as ADAM9 and ADAM17 were not changed. mRNA levels of APP (n=7, P<0.05) and ADAM10 (n=4, P<0.05), as well as sAPPα production in human BMVECs (n=6, P<0.05) were also significantly augmented in response to iloprost treatment. Moreover, stimulation of human BMVECs with forskolin (40μM) significantly enhanced APP and ADAM10 protein expression. Most notably, iloprost significantly augmented protein expression of peroxisome proliferation-activated receptor-δ (PPARδ) and SIRT1. We further explored the role of PPARδ in APP processing. ADAM10 expression (n=6, P<0.05), but not APP and BACE1, was significantly increased in human BMVECs treated with PPARδ ligand GW501516 (30 or 100 nM). GW501516 (100 nM) also significantly increase sAPPα production (n=9-10, P<0.05). siRNA against PPARδ significantly suppressed basal levels of ADAM10, and blocked iloprost-induced ADAM10 expression (n=4, P<0.05). These findings suggest that activation of IP-cAMP pathway enhances non-amyloidogenic processing of APP and consequently increases production of neurotrophic molecule sAPPα in human BMVECs. Activation of PPARδ in part mediates iloprost-induced α processing of APP.
Abstract W P368: Longitudinal Change in fMRI Blood Oxygen Level Dependent Signal in Cerebral Amyloid Angiopathy
Authors: Switzer Aaron R , McCreary Cheryl R , Frayne Richard , Goodyear Bradley G , Smith Eric E
Published: July 2021

Introduction:
Previous cross-sectional studies show that cerebral amyloid angiopathy (CAA) is associated with reduced blood oxygen level dependent (BOLD) signal change in response to a visual task, and that this reduction is due to impaired vascular reactivity. However, there are no data on the rate at which the BOLD signal changes over time in CAA. We hypothesized that fMRI activation would decline in CAA, representing progressively impaired vasoreactivity, and this decline would be associated with increased white matter hyperintensity (WMH) volume.

Methods:
fMRI BOLD amplitude was measured in response to a visual task (alternating checkerboard pattern) at study entry and 1-year follow-up for 18 patients with probable CAA by Boston criteria, and 15 healthy controls. fMRI data were matched to a canonical BOLD signal using a general linear model resulting in z-statistic images with a significance threshold of p<0.05 using FSL. The amplitude of the BOLD signal percent change from baseline was measured in the 200 most active voxels in the primary visual cortex. WMH were identified on fluid attenuated inversion recovery (FLAIR) images and the volume was measured using Quantomo software (Cybertrials Inc, Canada).

Results:
BOLD amplitude was lower at follow-up than baseline in CAA, but the difference was not significant (mean change -0.14±0.55, p=0.30). Mean BOLD amplitude was similar at baseline and follow-up in controls (mean change 0.20±0.49, p=0.14). The difference in rate of change over time between CAA and controls was borderline significant (p=0.04). fMRI was lower at follow-up than baseline in 11/18 CAA compared to 4/15 controls (p=0.08). In CAA patients, WMH increased over time (median 1.44 mL interquartile range -0.22 to 9.70mL, p=0.01). However, BOLD amplitude change and WMH change were not related (r=-0.01, p=0.96).

Discussion:
Although we did not see significant fMRI BOLD signal reduction from baseline to 1 year in CAA, we did see a difference in change over time between CAA and controls, consistent with our hypothesis that impaired vasoreactivity is a feature of CAA. Studies with larger numbers of patients, or longer duration of follow-up, are needed to more precisely determine the rate of change over time in reduction of fMRI BOLD amplitude in CAA.
Abstract W P49: Brain Complications and Neurocognitive Outcome After Cardiac Valve Surgery
Authors: Kajimoto Katsufumi , Nagatsuka Kazuyuki
Published: July 2021

Background and Purpose:
In the operation on the heart diseases, the mortality and the incidence of complication of major cerebrovascular disorders decrease. However, it was reported that the neurocognitive disorders developed frequently after coronary bypass surgery and in the most of them the neurocognitive disorders were restored, but in the part of them the neurocognitive disorders were persist for a long time. On the other hand, there are few reports about the neurocognitive disorders after cardiac valve surgery. In this study, we evaluated the incidence of the neurocognitive disorders after the cardiac valve surgery and the associated risk factor with neurocognitive disorders, and the MRI findings by a multicenter prospective cohort study.

Methods:
A total of 153 patients (95males; mean age, 58.9 years old) who underwent mitral valve surgery between Jun 2004 and March 2006 in 11 institutions were included. MRI imagings were performed before and at 2 weeks, 1 year and 2 years after surgery. The neurocognitive testing were performed before and at 2 weeks, 6 months, 1 year and 2 years after surgery with a neuropsychological test battery that included 9 parameters from 5 tests. Cognitive dysfunction was defined as a 20% reduction in at least 20% of the parameters compared with baseline.

Results:
The number of silent ischemic brain lesions increased by postoperative MRI images in 12 cases of 153 (7.8%). In 26 cases that we could perform T2*-weighted gradient-echo imaging (GRE) before cardiac valve surgery, 19 cases (69%) developed new GRE lesions after cardiac valve surgery. Cognitive dysfunction was identified 74 of 141 cases (52.5%) at 2 weeks and 33 of 120 cases (27.5%) at 2 years after surgery. The ratio of elderly patients 65 years or older was significantly higher in exacerbation group than cognitive function non-exacerbation group (29/74 patinets (39%) vs 15/67 patients (22%), p<0.05).

Conclusion:
The brain damage including the neurocognitive disorder occurs after cardiac valve surgery similar to after coronary bypass surgery. Further examination is necessary about the cause and the clinical significance about the neurocognitive disorder after cardiac valve surgery.