bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP79: Mobility Impairment is Not Associated With Long-Term Valuation of Health by Survivors of Intracerebral Hemorrhage: A Mediation Analysis
Authors: Shah Vishank A , Carhuapoma Lourdes , Avadhani Radhika , Awad Issam A , Hanley Daniel F , Ziai Wendy C
Published: February 2024

Introduction:
Clinical trial outcomes such as the modified Rankin score (mRS) are heavily influenced by mobility. We examined if mobility impairment and functional disability influenced long-term overall health evaluation by survivors of intracerebral and intraventricular hemorrhage (ICH/IVH).

Methods:
We pooled data from MISTIE-III and CLEAR-III trials. ICH/IVH survivors performed a protocolized direct valuation of their overall health using time trade-off utility (TTO-U) at 6 months post-ictus. TTO-U asks responders to consider trading years off their current disability-stricken state in exchange for perfect health. TTO-U index ranges from 0-1, with lower scores indicating greater years traded off and poorer valuation of overall health. TTO-U scores were dichotomized as good (>=0.7) and poor (<0.7). Associations between functional outcomes, European quality of life 5 dimensions (EQ-5D) and poor TTO-U at 6-months were assessed in multivariable logistic regression. A mediation analysis evaluated if mobility impairment and persistent poor mRS (mRS4-5) mediated associations between significant covariates and poor TTO-U at 6-months.

Results:
Of 773 survivors at 6-months, 442 (57%) patients with median (IQR) mRS of 3 (3-4) reported median (IQR) TTO-U of 1 (0.7-1); 332 patients had good and 110 had poor TTO-U. In multivariable logistic regression, moderate to severe anxiety/depression and problems with selfcare (dressing/washing) were independently associated with poor valuation of overall health, but mobility impairment and poor functional outcome were not. In mediation analyses, mobility impairment and poor mRS (4-5) at 6-months did not mediate the effect of persistent anxiety/depression (controlled direct effect (CDE), 1.79 [1.10-2.89]; natural indirect effect (NIE) of mobility, 0.93 [0.58-1.49], p=0.75; NIE of mRS, 1.00 [0.91-1.10], p=0.96) and selfcare deficits (CDE, 4.85 [2.13-11.05]; NIE of mobility, 0.72 [0.42-1.26]; NIE of mRS, 1.04 [0.78-1.39]) on long-term valuation of health state.

Conclusions:
Long-term valuation of overall health in survivors after severe ICH/IVH was influenced by persistent dependence in caring for self and mood dysfunction. Mobility impairment and mRS did not mediate these associations.
Abstract WMP88: Intraarterial Tirofiban Through Deployed Stent-Retriever Bailout: A Potential Alternative to Angioplasty and Stenting
Authors: Rodrigo-Gisbert Marc , Garcia-Tornel Alvaro , Requena Manuel , Rizzo Federica , Rubiera Marta , Muchada Marian , Olive-Gadea Marta , Diana Francesco , Hernandez Morales David , De Dios Marta , Tomasello Alejandro , Ribo Marc
Published: February 2024

Background:
In stroke patients undergoing EVT, angioplasty and stenting (A&S) has been described as a bailout technique when thrombectomy fails or intracranial stenosis is suspected. We aim to investigate effects of the administration of intraarterial (IA) tirofiban through a deployed stent-retriever over the occluding lesion prior to A&S.

Methods:
Patients with LVO in the anterior circulation undergoing EVT were reviewed. We include patients in which stent-retriever/direct aspiration failed (TICI 0-2a) or underlying intracranial stenosis was suspected and received the loading dose of tirofiban prior to intended A&S bailout. A stent-retriever was deployed over the lesion to create a by-pass channel and 8 to 12 ml of tirofiban were locally infused during 10 minutes through a distal access catheter proximally positioned. The stent-retriever was re-sheathed into the microcatheter before retrieval. Additionally, 10-15 ml of tirofiban were administered intravenously. An angiogram was performed to determine recanalization grade and indicate potential A&S.

Results:
From 546 consecutive EVT patients, 14 (2.6%) were considered potential candidates for A&S bailout and received the study protocol: mean age 76 years, median admission NIHSS 17 (IQR 11-21). The occlusion locations were: ICA (3, 21,4%), M1-MCA (9, 64.3%), M2-MCA (2, 14.3%), Mean IA tirofiban dose was 10mg. Post-infusion angiogram showed succesful reperfusion (TICI2b-3) in 11 patients (78.6%). In 4 cases (28.6%) A&S was finally performed. At 24 hours median NIHSS was 14 (IQR 9-20) and the rates of reocclusion (follow-up imaging in 8/12) and SICH were 0%.

Conclusion:
In stroke patients undergoing EVT in which A&S is considered as bailout, IA administration of tirofiban through a deployed stentretriever may safely achieve sustained recanalization in a substantial number of patients, ultimately avoiding definitive stenting. Further prospective data is warranted.
Abstract WMP92: Mode of Onset Modifies the Effect of Time to Endovascular Reperfusion on Clinical Outcomes After Acute Ischemic Stroke: An Analysis of the DAWN Trial
Authors: Dohiem Mohamed , Jadhav Ashutosh , Aghaebrahim Amin , Frankel Michael , Jankowitz Brian , Budzik Ronald , Bonafe Alain , Bhuva Parita , Yavagal Dileep R , Hanel Ricardo , Hassan Ameer E , Ribo Marc , Cognard Christophe , Sila Cathy , Jenkins Paul , Morgan Patricia M , Smith Wade , Saver Jeffrey , Liebeskind David S , Jovin Tudor , Haussen Diogo C , Nogueira Raul G
Published: February 2024

Introduction:
In the early window, time to treatment with endovascular thrombectomy (EVT) is inversely associated with favorable clinical outcomes but this remains unclear in the extended window. We aimed to assess the impact of time to EVT on clinical outcomes in the DAWN trial.

Methods:
The association between every 1-hour treatment delay with 90-day functional independence (modified Rankin Scale [mRS] 0-2), symptomatic intracranial hemorrhage (SICH), and 90-day mortality was explored in the overall population and in three modes of onset subgroups (wake-up vs witnessed vs unwitnessed) considering both time from last seen well (TLSW) and time from symptoms first observed (TSFO).

Results:
Out of the 205 patients, 98 (47.8%) and 107 (52.2%) presented in the 6-12-hour and 12-24-hour time window, respectively. Considering all three modes of onset together, there was no statistically significant association between TLSW to randomization with either functional independence or mortality at 90 days in either the EVT (mRS0-2 OR 1-hour-delay:1.07;95%CI[0.93-1.24]; mRS6 OR:0.84;95%CI[0.65-1.03]) or medical management (mRS0-2 OR1-hour-delay:0.98;95%CI[0.80-1.14]; mRS6 OR 1-hour-delay:0.94;95%CI[0.79-1.09]) groups. Moreover, there was no significant interaction between treatment effect and time (p=0.439 and p=0.421 for mRS 0-2 and 6, respectively). However, within the thrombectomy group, the models that tested the association between TLSW to successful reperfusion (mTICI≥2b) and 90-day functional independence showed a significant interaction with mode of presentation (p=0.013). This appeared to be driven by a nominally positive slope for both witnessed and unwitnessed strokes versus a significantly (p=0.018) negative slope in wake-up patients. There was no association between treatment times and SICH. Comparable analysis using TSFO yielded similar results.

Conclusion:
In extended window patients, the association between time to treatment and clinical outcomes seems to be primarily driven by successfully perfused patients with wake-up rather than witnessed or unwitnessed strokes suggesting that wake-up strokes do not behave as “slow-progressors”.
Abstract WP10: Impact of Dexmedetomidine in Neurocritical Care on Outcomes of Ischemic Stroke Patients With Large Vessel Occlusion
Authors: Winzer Simon M , Moustafa Haidar , Schoene Daniela , Siepmann Timo , Puetz Volker , Barlinn Kristian
Published: February 2024

Introduction:
While observational data suggest that dexmedetomidine may have neuroprotective effects on ischemic brain, its clinical use in acute ischemic stroke is limited due to concerns about cerebral vasoconstriction. We aimed to examine the impact of dexmedetomidine on outcomes in patients with anterior circulation large vessel occlusion (acLVO) requiring neurocritical care after endovascular therapy (EVT).

Methods:
We extracted data from our stroke registry for consecutive patients with acLVO who underwent EVT and subsequent neurocritical care (12/2019-12/2022). Patients were categorized based on dexmedetomidine treatment. Intravenous dexmedetomidine was given alone or adjunctively for endotracheal tube intolerance, withdrawal symptoms, sedation transition and delirium. Primary outcomes were favorable functional status (mRS≤2) and mortality at 90 days.

Results:
Of 402 patients, 76 (18.9%) received dexmedetomidine after a median of 4 [3] days post-stroke. Dexmedetomidine-treated patients were more often male (63.2% vs. 45.4%; p=0.01), had higher baseline NIHSS scores (17 [7] vs. 15 [9.5]; p=0.001), lower baseline ASPECTS (7 [3] vs. 8 [2]; p<0.001) and higher diabetes prevalence (45.9% vs. 32.6%; p=0.045) compared to patients not exposed to dexmedetomidine. While favorable functional outcome was less frequently observed in the dexmedetomidine than in the comparator group (7.9% vs. 32.5%; p<0.001), there was no difference in 90-days mortality (40.8% vs. 28.8%; p=0.24). Adjusting for age, baseline NIHSS, IV thrombolysis, post-EVT reperfusion status and intubation for EVT, dexmedetomidine was associated with lower odds of favorable functional outcome (aOR 0.20; 95% CI 0.08-0.49). Among patients receiving dexmedetomidine within 72 hours post-stroke, no significant association with favorable functional outcome was found (aOR 0.55; 95%CI 0.19-1.62).

Conclusions:
Dexmedetomidine could potentially have negative impacts on patients with acute ischemic stroke in neurocritical care. However, these results appear to be mainly related to delirium complications rather than critical vulnerability of ischemic stroke. Further research is warranted to elucidate the predictive role of dexmedetomidine in this patient population.
Abstract WP106: Patient Reported Outcomes as Ischemic Stroke and Transient Ischemic Attack Predictors
Authors: Gómez Dabó Laura , Colangelo Giorgio , Baladas Maria , Sánchez Ester , Paredes Carolina , Purroy García Francisco , Bustamante Alejandro , Rizzo Federica , Rodríguez Noelia , Guirao Cristina , Juega Jesus , Pagola Jorge , Olive Gadea Marta , Sargento Joao , Garcia-Tornel Alvaro , Taborda Belen , Requena Manuel , Rodrigo Gisbert Marc , Montalvo Olmedo Carmen , Ustrell Xavier , Serena Joaquin , Rubiera Marta , Ribo Marc , Molina Carlos , Muchada Marian
Published: February 2024

Introduction:
The risk of early stroke recurrence is higher in patients who have experienced a previous event. Multimodal strategies involving the active participation of patients and family members are likely the most effective therapeutic option, the perspective of which can be standardized and validated through Patient-Reported Outcome Measures (PROMs). We aimed to explore the impact of PROMs as predictors of recurrent ischemic stroke and TIA.

Methods:
A multicenter study based on a prospective cohort of consecutive patients with TIA and ischemic stroke between January 2022 and March 2023. Demographic and clinical data, as well as outcomes from the PROMS program, were collected through the NORA application, including the PROMIS Global Health survey, Hospital Anxiety and Depression Scale (HADS), Fatigue Assessment Scale (FAS), and the Morisky-Green Scale (MG) at 30 days.

Results:
A total of 2589 patients were included, with a mean age of 72 +/- 13.8 years (42% females). Forty-five recurrences were observed with a mean time to recurrence of 257 days. Recurrent patients had a higher history of smoking (33.3% vs 14.8%; p<0.001) and anticoagulant use (33.3% vs 20.8%; p<0.041). Regarding the PROMs, these patients experienced greater fatigue (FAS 24.4 vs 19.69; p<0.031), a lower tendency for therapeutic adherence (MG 14.2% vs 12.5%; p=0.77), and less return to their work (12.5% vs 32.4%; p<0.02). After the second episode, recurrent patients engaged more in surveys (2.46x10
16
vs 2.46x10
16
) and self-education on stroke (2.44x10
16
vs 1.92x10
16
) (p<0.01). Hypertension, previous smoking, and lower MG scores independently predicted recurrence (OR=2.72, 95% CI 1.20-6.14; OR 2.65, 95% CI 1.40-4.99; OR 0.33, 95% CI 0.11-1.01).

Conclusions:
In our series of TIA and minor strokes, assessing PROMs seems to be a potentially effective strategy for identifying key factors to reduce the risk of stroke recurrence and optimize secondary stroke prevention.
Abstract WP110: DEVIATING: Determining Variability in Antiplatelet Timing in Stroke by Gender
Authors: Hansra Harjot , Shifflett Ben , Wood Carla N , Davila Claire H , Bu Julia , Meyer Dawn M , Meyer Brett C
Published: February 2024

Background:
Antiplatelet administration within 48 hours of acute stroke presentation is standardized as it reduces mortality and recurrent ischemic stroke rate. Gender disparities have been noted in acute stroke care, including IV tPA and thrombectomy. Limited data exists for gender disparities in antiplatelet administration by day 2 of hospitalization.

Methods:
In an IRB-approved analysis, we retrospectively assessed patients admitted with acute ischemic strokes from the prospectively collected UC San Diego Stroke Registry from 2013 to 2023. We reviewed baseline demographics, whether an antiplatelet agent was initiated by hospital day 2, and choice of antiplatelet agent. We grouped patients based on their gender identification: male versus female. Patients who transitioned to comfort care, had an embolic source, were treated with a therapeutic dose of anticoagulation, had hemorrhagic conversion of infarct, or had a contraindication to antiplatelet use were excluded. Chi-squared, Kruskal-Wallis and Fisher tests were utilized.

Results:
471 patients were included in this analysis (179 female, 292 male). We found no significant differences in medical history except diabetes (60 female, 69 male, p = 0.03). We found a significant difference in age (female 69.3 years, male 64.3 years, p < 0.01). We found a significant difference in patient race (p = 0.01). There was no significant difference in antiplatelet administration by hospital day 2 (171 female, 287 male, p = 0.14) or choice of antiplatelet (aspirin p = 0.29, clopidogrel p = 0.12, ticagrelor p = 0.67, dual antiplatelet p = 0.22).

Conclusions:
These findings suggest equality of care in antiplatelet administration for acute ischemic stroke between genders, which is reassuring. This data was collected at an academic comprehensive stroke center. Further studies should be completing including patients who were treated at various levels of stroke centers.
Abstract WP117: Improvement of Collateral Status in Thrombectomy-Eligible Stroke Patients During Inter-Hospital Transfer: Association With Clinical Factors and Outcome
Authors: Wouters Anke , Seners Pierre , Yuen Nicole , Mlynash Michael , Heit Jeremy J , Kemp Stephanie M , Christensen Soren , Albers Gregory W , Lemmens Robin , Lansberg Maarten G
Published: February 2024

Background:
Ischemic stroke patients who are eligible for endovascular therapy (EVT), can be transferred from a primary stroke center (PSC) to an EVT-capable comprehensive stroke center (CSC). Little is known about the dynamics of the collateral circulation in this time-window. We aimed to explore changes in collateral status during inter-hospital transfer among patients with poor collaterals on presentation to the PSC.

Methods:
Data from patients with an anterior circulation large vessel occlusion (LVO), transferred to two CSCs were prospectively collected. A CT perfusion was obtained at the PSC followed by an MRI immediately on arrival at the CSC. The hypoperfusion intensity ratio (HIR), a measure of collateral blood flow, was calculated as the ratio of the Tmax volumes of >10s and >6s. Only patients with stable LVO at the CSC and poor collateral status at the PSC (HIR ≥ 0.40) were included. An HIR < 0.40 in the CSC and a difference ≥ 0.10 was considered as HIR improvement.

Results:
Data from 104 patients with perfusion imaging at both PSC and CSC, were analyzed. Of them, we included 59 patients with an HIR ≥ 0.40 at the PSC. Sixteen (27%) patients experienced HIR improvement during transfer

(Figure 1)

. A smaller baseline core volume was independently associated with HIR improvement (OR for every 10 ml increase = 0.46 {95%CI 0.21-0.81}; p=0.03). Collateral improvement was associated with slower infarct growth during transfer (2.45 {95%CI 1.03-3.62} vs 7.77 {95%CI 4.56-17.86} ml/h; p<0.01) and a better functional outcome at 90 days post stroke (median mRS 3 {IQR 1-5} vs 4 {IQR 4-6}; p=0.01).

Conclusion:
During inter-hospital transfer spontaneous improvement in collateral status, as measured by HIR, is commonly seen, and associated with a smaller infarct core at the PSC, slower infarct growth during transfer, and better functional outcomes. Future neuroprotective trials targeted at collateral improvement, might consider the use of the HIR change as a surrogate outcome marker.
Abstract WP129: Half of Acute Cortical Lesions in Minor Acute Ischemic Stroke Patients Persist on Flair at 30-day
Authors: Sullivan Catrina S , Luby Marie , Griffin Allison D , Somani Sana , Hsia Amie W , Latour Lawrence L
Published: February 2024

Introduction:
Ischemic lesions seen on acute DWI often result in chronic infarction on FLAIR. However, in minor stroke a proportion of cortical lesions seem to disappear. The objective of this study was to characterize the persistence rate of acute cortical lesions on FLAIR and associated imaging markers on 3DT1 at 30-day.

Methods:
Consented minor stroke patients (NIHSS<6) presented acutely (<24 hrs) received MRI at baseline, 5-day, and 30-day. One qualifying cortical lesion per patient was evaluated on baseline DWI for volume, white matter involvement, and on follow-up FLAIR for signal intensity ratio (SIR): comparison of lesion vs contralateral homologous tissue. Three independent raters blinded to hemisphere and exact location of the DWI lesion evaluated 3DT1 and FLAIR on follow-up (Figure).

Results:
Of 159 consented patients, 30 met criteria, and lesions of 28 patients (18%) evolved as hyperintense on FLAIR at 5-day. The 28 patients had a median age of 70 years, 54% female, median admit NIHSS of 2, and 32% were treated with IV alteplase. Of the 28 lesions, 17 (61%) had white matter involvement at baseline, and 14 (50%) were not evident on FLAIR at 30-day. Comparing those hyperintense vs not evident on FLAIR, raters identified 79% vs 21% (p<0.003) cavitation in white matter, 36% vs 0% (p<0.01) cavitation in gray matter, 57% vs 0% (p<0.001) laminar necrosis, and 100% vs 14% (p<0.001) cortical thinning on 3DT1. Lesions that persisted on FLAIR vs lesions not evident at 30-day had larger baseline DWI lesion volume: 2.2mL vs 0.3mL (p=0.024), and differences in SIR: 1.63 vs 1.3 (p=0.009) at 5-day, and 1.56 vs 1.1 (p=0.003) at 30-day.

Conclusions:
Half of the acute cortical lesions persisted on FLAIR at 30-day. Imaging markers on 3DT1 were more frequently associated with FLAIR evident lesions, but in ~1/3 of lesions not hyperintense, readers identified 3DT1 changes. Quantitative analysis is underway to confirm this observation.
Abstract WP134: Door to Angiography in Large Vessel Occlusions Pre and Post Implementation of Automated Image Interpretation and Sharing Platform: A Single Center Study
Authors: Penckofer Mary K , Frost Emma , Zhang Linda , Sprankle Kenyon , Vigilante Nicholas , Elgendy Omnea , Ackerman Jiyoun , Kalladanthyil Abyson , Koneru Manisha , Khalife Jane , Hester Taryn , Schumacher Hermann , Love Chistopher , Siegler James E
Published: February 2024

Background:
Viz LVO is an FDA approved software that uses artificial intelligence to identify large vessel occlusions (LVOs) on computed tomography angiography (CTA) and facilitate communication between providers in a hub-and-spoke network. Whether this software expedites patient evaluation for treatment is unexplored.

Methods:
A single center retrospective registry was queried for patients with LVO of the internal carotid, proximal middle cerebral, or basilar artery in a stroke network (8 spokes, 1 hub). Eligible patients were in a 6-month period before (pre-Viz) and following implementation (post-Viz) of Viz LVO. Descriptive statistics and robust regression modeling were used to describe time from first contact to angiography (primary outcome) and other intervals between pre-Viz and post-Viz study groups.

Results:
Of 132 included patients (n=58 pre-Viz), small differences were found in demographics and non-significantly fewer patients underwent endovascular therapy (EVT) in the post-Viz period (73.0% vs. 86.2%, p=0.07). Time from spoke arrival to hub arrival among transferred patients was non-significantly shorter post-Viz (median 124 vs. 147 min, p=0.15). In patients who received EVT, there was a non-significant reduction in time from first contact to angiography (median 116 vs. 155 min, p=0.10) with shorter intervals for transferred patients (median 142 vs. 169 min, p=0.05) but not hub arrivals (p=0.81). For transferred patients, shorter intervals from initial contact to angiography were observed in adjusted robust regression, accounting for stroke severity, age, Alberta Stroke Program Early Computed Tomography Scale score, and use of perfusion imaging (β -32.4, 95% confidence interval -61.6 to -3.26, p=0.03).

Conclusions:
Implementation of the Viz LVO platform was associated with shorter intervals between initial hospital contact and neurointervention among transferred patients. Larger datasets are needed to validate these observations.
Abstract WP141: Leptomeningeal Competitive Flow Impact on Thrombectomy Reperfusion Grade Rating
Authors: Aboul-Nour Hassan O , Dolia Jaydevsinh N , Tarek Mohamed A , Grossberg Jonathan A , Pabaney Aqueel , Damiani Mateus , Al-bayati Alhamza , Nogueira Raul G , Haussen Diogo C
Published: February 2024

Background:
The extent of reperfusion following thrombectomy (MT) for large vessel occlusion strokes is predictive of outcomes. There is still inter-rater variability in the reperfusion scoring. We noticed that some patients present with retrograde contrast clearing of the distal branches from non-contrast-opacified flow originated from different territories. We aim to evaluate the frequency of this phenomenon (“competitive flow” (CF)), to evaluate if it has an association with the degree of leptomeningeal collaterals, and its impact on eTICI score.

Methods:
This is a retrospective-analysis of our MT database spanning 11/2020-12/2021. We included consecutive cases of intracranial internal carotid (i-ICA) and middle cerebral artery (MCA) M1 occlusions. CF was defined by the observation of retrograde clearing of distal MCA branches that were previously opacified by antegrade reperfusion. The clearance of the distal branches is presumed to occur due to CF via non-contrast-opacified PCA or ACA flow. The washout was considered CF if it cleared abruptly with or without forward reconstitution of antegrade opacification.

Results:
We included a 125 patients. Median age was 64years, 51%were males. Baseline median NIHSS was 17 and ASPECTS 9. Median last-known-well-time to puncture was 7 hours, 30.4% received tPA. Final eTICI2c-3 was achieved in 81.6%. CF was present in 32(25.6%)patients. Baseline characteristics were similar between both groups. The CF arm had better leptomeningeal single-phase-CTA-collaterals(p=0.01) and smaller CTP malignant hypoperfusion volume(p=0.06) VS non-CF. The inter-rater-agreement for eTICI score was moderate when CF was present and excellent in its absence (Krippendorf’s alpha=0.65 and 0.81,respectively). There was poor agreement (K-value=0.3) for the presence versus absence of CF between both operators. Reviewer 1 (2-year-post-training) had correctly identified 46% of patients with consensus CF vs 90% to Reviewer 2 (9-year-post-training) after the consensus read.

Conclusion:
CF was observed in 32% of patients. CF was found to be associated with better collateral flow, and to impact the reported procedural eTICI rating.
Abstract WP145: Quantifying Blood Pressure Variability Within the First Hour Following Endovascular Therapy
Authors: Gitlevich Rebecca , Chee Christopher , Zhou Sonya , Favilla Christopher G
Published: February 2024

Background:
Blood pressure variability (BPV) during the first 24 hours following endovascular therapy is associated with poor functional outcome. However, to be a viable treatment target, BPV needs to be recognized very quickly after large vessel recanalization.

Hypothesis:
We hypothesized that high frequency arterial line data will facilitate BPV quantification within 1 hour of large vessel recanalization, which will correlate with 24-hour BPV.

Methods:
This single-center retrospective cohort included acute stroke patients who underwent endovascular therapy during 2022 for large vessel occlusion. Eligible patients had an invasive radial artery catheter for continuous blood pressure monitoring during and after endovascular therapy. Systolic and diastolic blood pressure were recorded at 1Hz. For both systolic and diastolic, BPV was calculated over one hour and 24 hours following endovascular therapy using four techniques: (1) standard deviation, (2) coefficient of variation, (3) successive variation, and (4) average real variation. Correlation between the two time windows was evaluated for each BPV metric.

Results:
Of 198 patients who underwent EVT during the study time frame, 108 had the required arterial line data. BPV metrics calculated based on systolic blood pressure were at least moderated correlated between the 1-hour and 24-hour window. When calculated based on diastolic blood pressure, BPV metrics were strongly correlated between the 1-hour and 24-hour window (
Table
).

Conclusions:
With high frequency arterial line data, BPV, in particular diastolic variability can be reliably assessed within the first hour following large vessel recanalization. Given the previously observed relationship between BPV and functional outcome, future study is needed to explore the possibility of leveraging BPV as a treatment target during post-endovascular supportive care.
Abstract WP152: Association Between Cerebrospinal Fluid Interleukin-6 Levels and Cerebral Autoregulation After Aneurysmal Subarachnoid Hemorrhage
Authors: Olexa Madelynne , Begunova Yelyzaveta , Yan Jennifer , Herman Alison , Gilmore Emily , Kim Jennifer , Beekman Rachel , Magid-Bernstein Jessica , Matouk Charles C , Sheth Kevin N , Miller Eliza C , Ortega-Gutierrez Santiago , de Havenon Adam H , Sansing Lauren H , Petersen Nils H
Published: February 2024

Introduction:
Elevated levels of Interleukin-6 (IL-6) levels in cerebrospinal fluid (CSF) have been correlated with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, the role of neuroinflammation in SAH pathophysiology remains incompletely understood. In a pig stroke model, IL-6 antagonist prevented hypotension-induced pial artery impairment, suggesting a role in post-stroke vascular derangement. This research assesses serial CSF IL-6 levels' relationship with cerebral autoregulation in aSAH patients.

Methods:
We prospectively enrolled aSAH patients at Yale-New Haven Hospital. Autoregulatory function was measured by interrogating changes in near-infrared spectroscopy-derived tissue oxygenation response to changes in mean arterial pressure (MAP). The resulting autoregulatory index was used to trend the MAP range at which autoregulation was most preserved. Percent time that MAP exceeded the upper limit of autoregulation or decreased below the lower limit of autoregulation was calculated for each patient. IL-6 levels were assessed through serial CSF samples and correlated with hemodynamic parameters.

Results:
We calculated limits of autoregulation for twenty-two patients (mean age 60 ± 9 years, mean Hunt Hess score 3.4 ± 1.2, mean modified Fisher score 3.7 ± 0.58, average monitoring time 10.1 ± 7.3 hours). Optimal MAP and limits were calculated an average of 74% ± 20% of monitoring time. Our study provides preliminary support for a potential association between IL-6 levels and percent time that MAP was within limits of autoregulation (b = -0.31, p=0.009, Fig. 1A). Additionally, there was a significant correlation between IL-6 levels and the extent to which MAP deviated from computed optimal MAP (r= 0.636, p=0.009, Fig. 1B).

Conclusions:
IL-6 may contribute to impaired autoregulation post aSAH. Further studies are needed to validate findings and refine MAP management for improved outcomes in aSAH patients.
Abstract WP156: Temporal Changes in Blood Viscosity in Acute Ischemic Stroke and Its Relationship With Infarct Growth and Hemorrhagic Transformation
Authors: Kim Do Yeon , Oh Ju Seok , Kim Kang Hoo , Kang Jihoon
Published: February 2024

Background:
Blood viscosity (BV) affects blood vessel wall shear stress. Yet, temporal changes of BV in acute stroke patients and correlation with infarct growth and hemorrhagic transformation remain unclear.

Method:
This prospective observational study included acute ischemic stroke patients admitted within 24h of the last known well time, who gave an informed consent and had adequate blood sampling. Consecutive BV measurements (at 10Hz) were taken upon admission (1
st
), at 24h (2
nd
), and between 5-7 days post-admission. Each patient underwent initial and follow-up MRI. Outcomes were 1) infarct growth or recurrence, and 2) increased hemorrhagic transformation (HT) in follow-up MRI compared to the initial MRI. We assessed whether the ratio of the 2nd BV to the 1st BV and 3
rd
BV to the 1
st
BV were associated with outcomes.

Results:
Twenty-six patients met eligible criteria and had adequate blood sampling. BV demonstrated a decreasing trend during the admission (1
st
BV: median 20.2 [IQR 14.8-23.2], 2
nd
BV: 17.9 [14.8-20.2], 3
rd
BV: 15.3 [12.0-22.0]). The ratios of 2
nd
BV to 1
st
BV and 3
rd
BV to 1
st
BV decreased after admission (P=0.41 and P=0.015 with Wilcoxon rank test, respectively). While the ratio of 2
nd
BV to 1
st
BV between patients with and without increased HT (1.28 [1.04-1.41] vs. 0.89 [0.67-1.33], p=0.67 with Wilcoxon rank test) was similar, it showed a tendency to rise in patients with infarct growth or recurrence (1.25 [0.78-1.63] vs. 0.80 [0.66-1.21], P=0.11 with Wilcoxon rank test) (Figure). The ratio of 3
rd
BV to 1
st
BV was higher in patients with increased HT (0.96 [0.82-1.27] vs. 0.72 [0.59-0.81], P=0.25 with Wilcoxon rank test).

Conclusion:
BV at the 24h post-admission appears to correlate with infarct growth or recurrence during the acute stroke period. BV was likely to persistently increase in patients with HT. Further investigations with a larger dataset are recommended to elucidate the predictive value of 24h BV in acute stroke patients.
Abstract WP164: Social Determinants of Health and Functional and Psychological Outcomes After Hemorrhagic Stroke
Authors: Talkad Harshita , Lewis Ariane , Lord Aaron S , Gurin Lindsey , Ishida Koto , Torres Jose , Zhang Cen , Brush Benjamin , Zhou Ting , Kahn D. Ethan , Frontera Jennifer , Melmed Kara
Published: February 2024

Introduction:
Patients who have had hemorrhagic strokes experience psychological and functional deficits after hospital discharge. Social Determinants of Health (SDoH) can also impact outcomes. The relationship between SDoH and psychological outcomes following hemorrhagic stroke has not been well studied.

Methods:
This is a prospective cohort study including patients ≥18-years-old hospitalized in Manhattan for non-traumatic hemorrhagic stroke, including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage, between 2015 and 2022, aiming to determine the relationship between SDoH, functional and psychological outcomes. SDoH were reported on admission by patients or their surrogate, and included education level, occupation, insurance, marriage status, median household income (MHI) by zip code, and race/ethnicity. Questionnaires for the Barthel Index and Quality of Life in Neurological Disorders (T-score >50 abnormal) were completed at 3 and 12 months. Pearson’s Chi-Square and Mann Whitney U test were used to explore the relationship between SDoH and abnormal psychological outcomes.

Results:
We identified 120 patients with hemorrhagic stroke that had follow up psychological outcome testing. The median age [interquartile range (IQR)] was 64 [51-75], 46% female, median ICH score [IQR] was 1 [0-2], median Hunt-Hess scale [IQR] was 2[1-3]. Patients whose highest level of education was high school or below (21% of the cohort) were more likely to be dependent than independent with activities of daily living (33% vs 8%, p≤0.01) at 3 months. The median MHI by zip code [IQR] was $90,306 [$68,220-$131,038]. Patients with impaired communication were more likely to be from areas with lower MHI ($57,770 [$56,572-$68,221] vs. $90,871 [$72,895-$129,705], p=0.01) at 3 months. Employed patients (49% of cohort) were more likely to have cognitive executive dysfunction at both 3 (71% vs 39%) and 12 months (70% vs 34%, p<0.01 for both). Employed patients were also less likely to report overall good well-being (61% vs 29% at 3 months, 61% vs 20% at 12 months, p<0.01 for both).

Conclusion:
Psychological and functional outcomes for patients with hemorrhagic strokes are associated with SDoH. Interventions specifically addressing SDoH should be considered.
Abstract WP171: Sex Differences in Risk Factors and Outcomes in Young Patients With Intracerebral Hemorrhages
Authors: Kherani Danish , Vyas Vedang , Dongarwar Deepa , Kondapalli Swathi , House Kayla , Seol Hyeyoung , Dominique Norris , Sharrief Anjail Z
Published: February 2024

Introduction:
While the attention on racial, ethnic, and gender differences in ischemic stroke has progressed beyond reporting to evaluating corrective activities, less is known about disparities in hemorrhagic stroke evaluation and care, especially amongst young population. Since hemorrhagic stroke is associated with significantly higher short-term and long-term mortality than ischemic stroke and has a rising incidence, it is important to review disparities in its evaluation and management.

Methods:
We obtained data for our patients (18-45 years) who presented at our comprehensive stroke center with ICH from 10/2016 to 11/2019. We examined the various risk factors and outcomes among males and females and the statistical differences were tested using student’s t-test for continuous outcomes and using chi-squared test for categorical variables. A 5% error rate was assumed and all statistical tests were two-tailed.

Results:
A total of 430 patients (268 males,162 females) were studied. Overall, men were older than women (41.5±7.7 years vs 39.4 ±8.5 years respectively, p=0.01). More women were insured compared to men (73.5% vs 63.1%, p=0.06). More women had access to primary care compared to men (51.2% vs 38.4%, p<0.01). Men had significantly higher systolic blood pressure compared to women on arrival (181.3 ± 45.9 vs 159.6 ± 43.7 respectively, p <0.01) and similar trend was noted for diastolic blood pressure as well (105.6 ± 28.4 vs 92.9 ± 28.2 respectively, p <0.01). Men with ICH had significantly higher hemoglobin A1c on admission compared to women (14.2 ± 2.5 vs 12.4 ± 7.3 respectively, p <0.01). On baseline echo, men had more evidence of diastolic dysfunction compared to women (20.1% vs 13.0%, p=0.01). Men also had significantly higher history of smoking and alcohol abuse compared to women (p<0.01). There were no statistically significant sex differences noted in the outcomes. In hospital mortality was 20.4% in women and 19.4% in men (
p
= 0.45), and discharge outcome among survivors (modified Rankin Scale [mRS] score 3-5) 74.7% in women and 79.9% in men (
p
= 0.26).

Conclusion:
Men had a higher risk of ICH than women. Women had more access to primary care and insurance. Further research is needed to determine whether social factors can drive disparities in ICH risk.
Abstract WP181: Treatment of Unruptured Small and Medium Wide-Necked Aneurysms of the Internal Carotid Artery Using the 64-Wire Surpass Evolve: Results of the SEASE International Registry
Authors: Vivanco-Suarez Juan , Dibas Mahmoud , Lopes Demetrius Klee , Rodriguez-Calienes Aaron , Fifi Johanna T. , Devarajan Alex , Toth Gabor , Patterson Thomas E. , Altschul David J , Cortez Gustavo M. , Hanel Ricardo A. , Liu Eileen , M. Pereira Vitor , Kühn Anna L. , Puri Ajit S , Guerrero Waldo R. , Bach Ivo , Khandelwal Priyank , Edhayan Gautam , Kan Peter T. , Martinez-Galdamez Mario , Given Curtis A , Gross Bradley A. , Narayanan Sandra , Galecio-Castill Milagros , Farooqui Mudassir , Derakhshani Shahram , Ortega-Gutierrez Santiago
Published: February 2024

Introduction:
The management of wide-necked internal carotid artery (ICA) aneurysms is technically challenging with established endovascular and microsurgical techniques that are limited by the associated morbidity and/or recurrence. The PREMIER study first demonstrated high rates of complete occlusion without parent vessel stenosis or permanent neurological complications after the treatment of wide-necked small and medium-sized intracranial ICA aneurysms with the 48-wire pipeline. We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve (SE) flow diverter for the treatment of the same intracranial ICA aneurysm population.

Methods:
This is a sub-analysis from the Safety and Effectiveness Assessment of the Surpass Evolve (SEASE) registry, an observational cohort study including 15 academic institutions in North America and Europe spanning between 2020-2023. Analysis included patients with unruptured wide-necked saccular aneurysms (not previously treated), measuring <12 mm along the ICA segments. Primary effectiveness was complete occlusion (Raymond Roy Class 1) without retreatment at 1-year follow-up (core lab adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death.

Results:
129 cases were included (median age 58 years, IQR: 50-67 years, 85% females). Median aneurysm and neck size were 5.8 mm (IQR: 4.0-7.5) and 4.1 (IQR, 3.0-5.5). Most aneurysms were in the ICA C6 segment (66.7%, 86/129), followed by the C7 segment (21.0%, 21/129). Successful implantation was encountered in 99% (128/129) of the cases. At a median 10.1 months (IQR: 6.3-12.6), the rate of complete occlusion was 75.2% (91/121), ≥50% in-stent stenosis 7% (9/129), and retreatment 0.8% (1/129). Major stroke and overall mortality were reported in 1.6% (2/129) of the cases.

Conclusion:
Our study evaluating outcomes from the SEASE international multicenter registry found that patients with wide-necked unruptured saccular small to medium-sized aneurysms can be effectively treated with the 64-wire chrome-cobalt SE. Furthermore, the SE showed a considerable safety profile for this patient population.
Abstract WP186: The Burden of White Matter Hyperintensities on Function Outcomes in Patients Treated for Acute Ischemic Stroke: A Post-Hoc Analysis of the IMS-III Trial
Authors: Mehta Amit , Elmashad Ahmed , Narula Reshma , Broderick Joseph P , de Havenon Adam H
Published: February 2024

Objective:
This study is a post-hoc analysis of the Interventional Management of Stroke (IMS) III trial investigating the burden of white matter hyperintensities (WMH), using the van Swieten Scale (VSS), on functional outcomes for acute ischemic stroke (AIS) patients treated with either intravenous thrombolysis (IVT) or IVT with mechanical thrombectomy (MT).

Background:
WMH are a well-established marker for underlying cerebral microvascular disease. VSS quantifies the disease burden from zero to four with higher numbers signifying more advanced disease. A higher burden of WMH is associated with poor functional outcomes after IVT. However, early studies regarding WMH and outcomes after MT have been conflicting.

Methods:
We included IMS-III trial patients in either treatment arm whose VSS was graded on initial brain CT and 90-day function outcomes were not missing. The primary study outcome was a 90-days modified Rankin Scale of 0-2, termed good outcome.

Results:
There was a total of 656 patients enrolled in the trial and 618 patients were included in this analysis. The VSS grades of WMH range from 0-4 and included 476 (77.02%), 56 (9.06%), 38 (6.15%), 24 (3.88%), and 24 (3.88%) patients, respectively. Overall, higher VSS grade was associated with a lower probability of achieving a good functional outcome, even after adjustments (Figure 1). Of the 142 patients with any degree of WMH, only 22.5% had a good functional outcome compared to 46.6% of 476 patients without WMH (Table 1).

Conclusions:
Patients enrolled in the IMS-III trial with any burden of WMH on brain CT had a statistically significant lower odds of a good functional outcome compared to patients without WMH.
Abstract WP192: Impact of Second Line Thrombectomy Technique Following Failed First Pass Thrombectomy for Anterior Circulation Stroke: To Switch or Not to Switch?
Authors: Matsukawa Hidetoshi , Uchida Kazutaka , Alawieh Ali , Matouk Charles , Al Kasab Sami , Sowlat Mohammad-Mahdi , Elawady Sameh S , Maier Ilko , Jabbour Pascal , Kim Joon-Tae , Wolfe Stacey Q , Rai Ansaar , Starke Robert M , Psychogios Marios-Nikos , Samaniego Edgar , Arthur Adam , Cuellar Hugo , Howard Brian , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Park Min S , Levitt Michael , Brinjikji Waleed , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade , Chowdhry Shakeel , Ezzeldin Mohamad , Yoshimura Shinichi , Spiotta Alejandro M
Published: February 2024

Introduction:
Despite comparable outcomes for different frontline techniques in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), there are sparse data regarding if and when to switch techniques if the first pass is unsuccessful. We aimed to investigate the impact of converting from one MT technique to another on the second MT attempt for AIS among patients with large vessel occlusion (LVO).

Methods:
This was a retrospective observational study using data from the large multicenter international Stroke Thrombectomy and Aneurysm Registry (STAR). Data from 29 stroke centers for 10,229 AIS patients treated with MT for LVO between January 2010 and December 2022 was investigated. The primary outcome measure was successful recanalization defined as modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2b or higher. 90-day modified Rankin score (mRS) 0-2, mortality and symptomatic hemorrhage were used as secondary outcomes. Clinical and technical outcomes after the second MT attempt were compared between those with or without technique conversion.

Results:
Among 10,229 AIS patients, 1,797 AIS patients with LVO failed first pass recanalization and were included in this retrospective analysis. 927 patients were female (52%) and median (interquartile range) age was 72 (61-81) years. Converting to alternative techniques following a first failed attempt was more likely to be associated with successful recanalization at the second attempt (adjusted odds ratio 2.30, 95% CI: 1.37-3.86, P = 0.002) and 90-day good clinical outcome (adjusted odds ratio 2.10, 95% CI: 1.15-3.85, P = 0.02) after multivariate adjustment.

Conclusions:
This study demonstrates better clinical and technical outcomes with conversion of MT technique for the second attempt in AIS patients with LVO who failed first pass recanalization.
Abstract WP201: Post 90 Day Outcomes of Acute Ischemic Stroke Patients Who Undergo Mechanical Thrombectomy: Analysis of Real-World Data
Authors: Qureshi Adnan I , Baskett William , Maqsood Hamza , Siddiq Farhan , Gomez Camilo R , Shyu Chiren
Published: February 2024

Background:
Previous studies have focused on 90-day outcomes in acute ischemic stroke patients who undergo mechanical thrombectomy (MT), although long-term outcomes are not well understood.
Aims:
To determine the long-term survival and risk of new ischemic stroke among acute ischemic stroke patients who did and did not undergo MT.

Methods:
We analyzed 4,123 acute ischemic stroke patients who underwent MT and 4,123 propensity-matched controls of acute ischemic stroke patients who did not undergo MT using the Cerner Real World data. The risk of death or palliative care and new ischemic stroke following >90 days post-admission was ascertained using Cox proportional hazards regression analysis to adjust for potential confounders. We also estimated the rate of new stroke and palliative care-free survival using Kaplan Meir survival analysis.

Results:
Among 4,123 acute ischemic stroke patients who underwent MT, 2,756 patients either died or received palliative care or developed new ischemic stroke (median follow-up period of 762.5 days post initial stroke admission; interquartile range Q1=341 days, Q3=1,343 days). The risk of new ischemic stroke, palliative care, or death was significantly higher in acute ischemic stroke patients who underwent MT compared with those who did not undergo MT (odds ratio [OR], 1.35, 95% CI, 1.28-1.43) after adjustment for potential confounders. The risk of palliative care or death was not significantly different (OR, 1.05, 95% CI, 0.91-1.2), but the risk of new stroke was significantly higher (OR, 1.42, 95% CI, 1.34-1.51) among patients who underwent MT. The 2-year new stroke and palliative care-free survivals were 37.9% and 50.2% among patients who did or did not undergo MT, respectively.

Conclusions:
We observed that the risk of new ischemic stroke, palliative care, or death after 90 days was significantly higher among acute ischemic stroke patients who undergo MT highlighting the need for dedicated long-term preventive interventions in this patient population.
Abstract WP204: Impact of Reperfusion Grade and First Pass Effect in Large vs Small Core Patients Undergoing Mechanical Thrombectomy
Authors: Dolia Jaydevsinh N , Nascimento Pedro , Tarek Mohamed , Damiani Monteiro Mateus , Grossberg Jonathan A , Pabaney Aqueel , Al-Bayati Alhamza , Schachter Daniel , Nogueira Raul G , Haussen Diogo C
Published: February 2024

Introduction:
While patients with small core stroke (SCS) and large core stroke(LCS) benefit from Mechanical Thrombectomy(MT), the impact of reperfusion (Thrombolysis in Cerebral Infarction (eTICI) grade and the first pass effect (FPE)) on clinical outcomes remains poorly understood. We aim to study the interplay between these factors in LCS and SCS patients.

Methodology:
Retrospective analysis of a comprehensive stroke center prospective database for patients with MCA-M1 or ICA-T occlusions who underwent MT between November 2010-March 2023. Logistic regression models assessed ASPECTS and eTICI score relationships and their impact on outcomes, adjusted for age, NIHSS, tPA, hypertension, general anesthesia and clot location.

Results:
Of 1548 included patients (mean age 65±16 years, 50.0% males)Table 1, 9.1%(141/1548) were categorized as a LCS (ASPECTS 0-5: 3.5% ASPECTS 0-2 and 96.0% 3-5) while 90.9%(1407/1548) as a SMC (53.0% ASPECTS 6-8 and 47.0% ASPECTS 9-10)(Table1). Lower rates of FPE were achieved in the LCS cohort (26%) compared to the SCS cohort (36%). First pass effect had comparable relative impact on independence rates on LCS and SCS (Figure1A; p>0.05). Final reperfusion rates were comparable LCS and SCS cohorts; In LCS, 5%, 11%, 26%, and 49% achieved eTICI grades 0-2a, 2b50, 2b67, and 2c-3, while in SCS, the percentages were 5.3%, 11%, 18%, and 66%. The relative benefit of final eTICI2c-3 vs 2b50 was comparable between LCS and SCS (p>0.05;Figure1B)

Conclusion:
The magnitude of benefit of achieving FPE as well as final full reperfusion (eTICI2c-3 vs eTICI2b) is comparable in large and smaller core strokes.