bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W P335: The Impact of Electrolyte Abnormalities in Primary Intracerebral Hemorrhage
Authors: Alvi Muhammad , Boehme Amelia K , Lyerly Michael J , Bavarsad Shahripour Reza , Gadpaille Alissa , Shiue Harn , Harrigan Mark
Published: March 2022

Background and Purpose:
Electrolyte abnormalities are common in patients with hemorrhagic stroke. In subarachnoid hemorrhage for instance, hyponatremia is common and is independently associated with adverse outcomes. For patients with primary ICH, however, there is limited about electrolyte abnormalities. This study aims to examine the relationship between electrolyte abnormalities and outcomes in ICH patients.

Methods:
We retrospectively reviewed consecutive ICH patients in a single center stroke registry between 2008-2013. Patient demographics, clinical information including stroke severity (NIHSS) and ICH score, laboratory values and neuroimaging were collected. Admission electrolyte abnormalities for serum sodium, potassium and chloride were defined as any value outside the hospital’s reference range. Outcomes of interest included hematoma expansion, discharge mRS, length of stay (LOS) and poor discharge disposition (i.e., not to home or inpatient rehabilitation).

Results:
A total of 384 patients were included in this analysis. Serum sodium was abnormal in 47 patients (12.2%), potassium was abnormal in 46 patients (11.9%) and chloride was abnormal in 76 patients (19.8%). Hyponatremia was the most common sodium abnormality (46/47, 98%). Potassium and chloride abnormities were not associated with worse outcomes. Serum sodium abnormalities were associated with longer length of stay (11 vs 5 days, p=0.002), higher discharge mRS (5 vs 4, p=0.04) and poor disposition (60% vs 43%, p=0.03). There was no association with hematoma expansion. Although not significant for all hemorrhage severities, in patients with an ICH score ≤2, abnormal sodium was associated with a discharge mRS 4-6 (OR 2.49, 95% CI 1.16-5.39, p=0.02) and poor disposition (OR 2.55, 95% CI 1.29-5.02, p=0.01).

Conclusions:
Electrolyte abnormalities were not uncommon in our sample of ICH patients and hyponatremia was a frequent cause of abnormal serum sodium. Although potassium and chloride abnormalities were not associated with poor outcomes, serum sodium abnormalities were associated with worse functional outcomes, particularly in patients with milder hemorrhage severity. Further research is needed to determine if sodium correction can improve these outcomes.
Abstract W P341: Closing Gaps in Large Vessel Occlusions (LVO) Care: A Performance Improvement Project
Authors: Basignani Cherlynn , Anderson Gabriella , Napolitano Sarah , Donaldson Karin , Valez Arianna , Vannes Heather , Lovec-Theobald Rhonda , Bradley Aimie , Garmany Charla , Dyer Cindy , Bonwit Erin , Acosta Indrani
Published: March 2022

Background:
Stroke diagnosis and treatment require speed, efficiency, and coordination among different departments. We identified two gaps in our care for LVO patients: Lack of accountability and coordination among involved departments and LVO stroke education in the emergency department (ED).

Purpose:
Decrease Door to Groin (DTG) puncture to ≤ 120 minutes.

Methods:
We identified all departments involved and created a multidisciplinary team that included: ED, CT, Neuroradiology, Strokologist, and Interventional Radiology. We identified a champion in each department to participate in weekly meetings. We defined time goals within the process of DTG and began to remove barriers in real time. In addition, the ED staff was educated on recognizing LVO, ordering imaging in a timely manner, and preparing a room for code grey alerts. To assess the interventions, we collected DTG times on patients who were treated with tissue plasminogen activator (tPA) and neuro-intervention before and after our project.

Results:
Comparing the groups, our average DTG times improved from 209 minutes to 151 minutes, which was a reduction of 58 minutes and a 27.75% decrease. Breaking down department silos and focusing on the patients clinical needs allowed us to unify our stroke team.

Conclusion:
Efficient stroke care requires a multidisciplinary team to identify barriers in stroke care, implement simultaneous parallel processes to be activated, communicate among team members, and maintain accountability among departments. With an established team, we are now looking for opportunities to improve our DTG times to ≤120 minutes.
Abstract W P348: Decreasing Variability in Post Cerebral Angiogram Care
Authors: Hawkins Angela , Summers Debbie , Kelsey Jessica , Hunt Donna
Published: March 2022

Background:
A random chart (N 25) audit of angiogram post care protocol was completed to assess for nursing compliance in performance of defined frequency of vitals, neurological and groin assessment. The audit showed only 5 out of 25 (20%) had completed all post nursing care interventions. There were no groin complications in that small population but the inconsistency of care increased the risk of safe patient care in a large comprehensive stroke center where seven hundred diagnostic angiograms are performed annually.

Purpose:
The goal of this quality-initiated project was to explore post angiogram care and decrease variation in the assessment process and to eliminate or decrease potential complications.

Methods:
Data showed decreased compliance among nursing staff in the neuroscience units. Process variability included: two post angiogram order sets (neuro interventional and cardiovascular) with differing care protocol; multiple units care for patients; and unit staffing grid was not intended to manage patients with frequent assessment. Initially education was provided through 1:1 communication of protocol with all clinical staff and posters were hung in clinical areas. Next, administrative leaders recognized the burden on nursing and the risk of patient safety and supported care of the post procedure angiogram in the PACU for two hours. Lastly, the two physician groups reviewed the order sets together and agreed upon defined frequency of vitals and assessments.

Results:
There was an improvement of 350% over baseline at the last interval measure. To date, there have been no adverse events or complications reported in this patient population. The project succeeded in achieving its stated goals; monitoring is ongoing.

Conclusions:
Data to drive performance improvement. When patients are cared for in separate locations by a different team, there may be variations in the care processes. Communication and education are vital to ensure that excellent and safe care is being provided to the patients. All levels of management as well as the clinicians must be provided with the information needed to support the safest and highest quality of care to our patients.
Abstract W P360: Challenges,Successes and Nurse Perceptions of Implementation of the NIH Stroke Scale on Multiple Units
Authors: Snyder Meredith , Newsome Franklin , Holden Mary , Limon Shelly , Cox Stephanie , Case Kristen , Neumann Robert , Jones William , Poisson Sharon , Simpson Jennifer , Hartson Kimberly
Published: March 2022

Background:
Joint Commission Comprehensive Stroke Certification (CSC) standards include the use of a standardized stroke scale across the organization. Physicians were utilizing the National Institutes of Health Stroke Scale (NIHSS)and it was identified that nurses had a poor understanding of how to perform and interpret the scale.

Purpose:
To use Plan-Do-Study-Act methodology to guide a quality improvement project to increase understanding and utilization of the NIHSS by nursing staff. This includes training and certifying all the nurses in stroke patient care units; followed by implementation into nursing practice.

Methods:
A multidisciplinary team was created to assess the current situation,develop education and implement plans based on best evidence. A literature search was completed. A course was developed by the stroke team to train and certify 250 nurses. Course content included lecture, discussion and accepted training video offered by the National Stroke Association. The intent of the course was to expand nursing knowledge and comfort with NIHSS. A pilot course was offered to the providers outside of these three key units and feedback was used to modify the course. Nurse perceptions of the NIHSS were examined prior to the training (n=211) and 2 months after implementation of the scale into routine practice (n=68). Adjustments and resources were developed and implemented based on results.

Results:
The course offered a first time certification pass rate 96% and nursing documentation compliance was 83% a month after implementation. However, in the first 3 months, 80% of those who completed the survey reported feeling they could accurately perform the NIHSS but almost 60% had only performed the scale 1-6 times. Many nurses expressed concern about the scale to being too subjective (55%) and too time consuming (50%).

Conclusions:
Even though the staff has been trained and certified to complete the scale, steps in the scale are consistently reported as difficult to assess. Low patient volume, infrequent use and patient barriers may contribute to challenges with NIHSS.
Abstract W P361: The Little Red Book: Down and Dirty
Authors: Donnelly Rose M , Burns Jo-Ann
Published: March 2022

The complexity of nursing care and increasing acuity of patients places demands on the ability of nurses to make critical decisions regarding patient care. In a Comprehensive Stroke Center, which admits 1200-1300 stroke patients annually, the nurses in the neuroscience intensive care unit (NICU) are challenged to provide excellent care to the critical patients who experienced massive hemorrhagic and ischemic strokes. Easy access to educational material was needed for the NICU nurses. The process improvement team in the neuroscience intensive care unit decided to develop a RN-based reference book modeled after the material the physicians had been using for years. The result is the Neuroscience ICU Red Book, a pocket guide which provides essential neuroscience and intensive care information at the fingertips of the NICU nurse. The Red Book provides comprehensive neurology, cardiology, respiratory, and pharmacology material in a matter that is not overwhelming, visually pleasing and easily understood. This Red Book has been proven beneficial for new and experienced NICU nurses, and every new staff member receives a book at the time of hire. The evidence based material contained is updated biannually; the nurses provide feedback on the topics and information needed to keep the guide useful and meaningful. The use of the Red Book in the neuroscience ICU has been highlighted as a Best Practice within the organization and similar pocket guides are being developed on the neuroscience nursing divisions.
Abstract W P363: Improvement Door-to-Needle Time For Iv Tpa By Initiation Of Treatment On CT Table
Authors: Rozenfeld Dmitry , Wani Hasan , Ben Yakov Orna , Safran Yael
Published: March 2022

Background:
Rambam Medical Center is the biggest hospital in northern Israel, serving an estimated population of 2,000,000 people. Every year there are as much as 1000 patients hospitalized in Rambam with the diagnosis of acute ischemic stroke. Rambam hospital has facilities for giving all possible types of fibrinolytic treatment in patients with acute ischemic stroke.

Methods:
We use a special algorithm looking for immediate identification of acute ischemic stroke admitting to ER and then a special neurology nursing stroke team (in cooperation with stroke neurologist) provides fast and complete diagnostic work-up, including imaging battery. Since June 2013 we practice to start a thrombolytic treatment at CT department on CT table immediately after regular brain CT is completed.

Results:
Using the current approach the minimal time of door-to-needle was reduced to 27 minutes in 2014 as compared with minimal time of 43 minutes in 2012 and 46 minutes in 2011.

Conclusions:
Start of IV Tpa treatment on CT table significantly reduces door-to-needle time for acute stroke patients. Use of such protocol requires dedicated stroke neurology nursing team.
Abstract W P366: Increasing Utilization of Transitional Care Management (TCM) codes for Post-acute Stroke Care
Authors: Lycan Sarah , Condon Christina N , Riddle Paula , Bushnell Cheryl
Published: March 2022

Background and Issues:
Stroke patients discharged home often are medically complex with decreased functional independence, especially during the initial transitional period after discharge. The Centers for Medicare and Medicaid Services has set transitional care requirements with new TCM coding that includes a 48 hour phone call from a licensed health professional and provider visit within 14 days after discharge. Process improvement methods can help determine the necessary staffing in order to efficiently meet these guidelines and increase utilization of these codes.

Purpose:
To review our post stroke transitional care program for TCM code utilization before and after addition of an RN to perform the follow-up phone calls.

Methods:
We performed a retrospective review of our hospital-supported transitional stroke care program. Our program initially consisted of 2 NPs on rotating schedules between inpatient service and outpatient ambulatory clinics to provide continuity of care during the transitional period after discharge, followed by 2 week hospital follow up visit focused on stroke education, caregiver support, recovery, and complications. The 2
nd
phase included NPs performing high risk 48 hour phone calls after discharge thus allowing utilization of TCM codes. The 3
rd
phase included addition of an RN to perform 48 hour phone calls and coordinating care between discharge and the stroke NP clinic visit. To assess the increased benefit of adding an RN for phone calls, we searched our EMR for TCM codes during the 3 month period before and 3 month period after RN phone calls were performed (February 2014 through July 2014).

Results:
A total of 95 patients were discharged home with a stroke or TIA in 6 months. In the first 3 months, 9 TCM codes were utilized. The last 3 months after the RN focused on 48 hour calls, 20 TCM codes were utilized.

Conclusions:
The
a
ddition of an RN to help provide 48 hour phone calls to patients after discharge increased the utilization of TCM coding. Further assessment of our transitional care program and use of TCM coding will be focused on effectiveness of decreasing readmission rates and improving outcomes.
Abstract W P370: Acute Ischemic Stroke In Acute Myocardial Infarction Patients Receiving Iv Rt-pa: An Analysis Of Thrombolysis In Myocardial Infarction (timi) Ii Trial
Authors: Jahangir Nauman , Malik Ahmed A , Afzal Muhammad , Qureshi Mushtaq H , Qureshi Adnan I
Published: March 2022

Background:
Increased platelet activation is observed during acute myocardial infarction (MI) and further increased by administration of recombinant tissue plasminogen activator (rt-PA).

Methods:
We analyzed data from 3,339 patients between the ages of 18 and 75 years who received intravenous rt-PA within 4 hours of the onset of MI and were randomly assigned to an invasive strategy or a conservative strategy in TIMI II trial. We ascertained the occurrence of ischemic stroke within 72 hours of randomization and associated outcomes.

Results:
A total of 8 (0.23%) of 3331 patients suffered an ischemic stroke within 72 hours. The mean age (±SD) was 64.4 years (±6.3) and 7 were men. The proportion of patients who developed cardiogenic shock (37.5% versus 5.3%, p<0.0001) and renal failure (12.5% versus 1.7%, p=0.02) was higher among those who developed ischemic stroke. There was no difference in the rate of subsequent invasive strategy in those who developed ischemic stroke (50.0% versus 50.3%, p=0.9). The occurrence of intracranial hemorrhage (37.5% versus 0.7%, p<0.0001) and in hospital mortality (37.5% versus 4.8%, p<0.0001) was significantly higher among patients who developed ischemic stroke compared those who were stroke free.

Conclusions:
Ischemic stroke in the immediate period following IV rt-PA for MI is rare but associated with very high rates of intracranial hemorrhage and in hospital mortality.
Abstract W P373: Symptom Severity of Recent Stroke and Risk of Recurrent Vascular Events
Authors: Park Jong-Ho , Ovbiagele Bruce
Published: March 2022

Background:
Symptom severity of an index stroke is a powerful prognosticator of short term outcomes, especially functional status and mortality. It is widely recognized that stroke patients with greater initial symptom severity tend to have more unfavorable prognoses. However, little is relatively known about the possible association of symptom severity and risk of recurrent vascular events after a recent index stroke, particularly over the longer term. On one hand, stroke patients with greater baseline symptom severity may be at higher risk for recurrent vascular events due to reactive depression or impaired mobility leading to overall poorer regimen adherence; while on the other hand stroke patients that recover with minimal deficit or no deficit may be more vulnerable to a future events due to underlying unstable pathophysiology (i.e. ongoing thrombosis-thrombolysis).

Methods:
We reviewed the dataset of a multicenter trial involving 3680 recent non-cardioembolic stroke patients aged ≥35 years and followed for 2 years. Independent associations of stroke severity (as measured by National Institutes of Health Stroke Scale [NIHSS] score) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. NIHSS score was analyzed as a dichotomous (<4 vs. ≥4) and a continuous variable.

Results:
Among trial participants, 550 (15%) had NIHSS scores ≥4 (overall scores ranged from 0 to 18, median score was 1 [25
th
to 75
th
percentile 0 to 2]). NIHSS was measured median 35 days after the qualifying stroke. Scores ≥4 were independently linked to higher risk of recurrent stroke (HR 1.43, 95% CI: 1.06-1.92) and risk of stroke/CHD/vascular death (1.32; 1.07–1.64). Analysis of NIHSS score as a continuous variable also showed a higher risk of events with increasing symptom severity (recurrent stroke: 1.07; 1.01–1.13) and stroke/CHD/vascular death: 1.05; 1.01-1.09)

Conclusions:
Greater symptom severity of a recent stroke is associated with higher risk of recurrent vascular events including stroke. Future studies are needed to confirm this relationship and to clarify its underlying mechanisms.
Abstract W P378: Cerebrovascular Risk Factors and Carotid Plaque Stability: a Community Cross-Sectional Study in Chinese Stroke High-Risk Population
Authors: He Li , Qin Fengqin , Chen Ning
Published: March 2022

Introduction:
Previous carotid ultrasound studies have found that carotid plaques with low echogenicity which suggest poor stability had a higher risk of cerebrovascular events. Studies to investigate the relationship between carotid plaques stability and cerebrovascular risk factors in stroke high-risk population are rare. The aim of the present study is to examine the relationship between cerebrovascular risk factors and carotid plaques stability in stroke high-risk population in China.

Methods:
A community cross-sectional study was conducted from 2012 to 2013. A cluster random sample of 2558 Chinese participants aged 40 years or older was enrolled. The risk factors for cerebrovascular disease were assessed. Carotid plaque stability was conducted by high-resolution color Doppler ultrasound. Logistic regression model was used to analyze the association between cerebrovascular risk factors and carotid plaque stability.

Results:
Hypertension (odds ratio = 1.513; 95% confidence interval = 1.176-1.946), smoking (OR = 173.788; 95% confidence interval = 86.495-349.180), hyperlipidemia (OR = 1.566; 95% confidence interval = 1.245-1.969), diabetes mellitus (OR = 1.274; 95% confidence interval = 1.037-1.566) and hyperhomocysteinemia(OR = 1.009; 95% confidence interval = 1.000-1.017) are independently associated with development of carotid plaques. However, only triglyceride level (OR = 1.177; 95% confidence interval = 1.046-1.323) is an independent risk factor for carotid plaque stability.

Conclusion:
In subjects from the Chinese stroke high-risk population with unstable plaques, This founding suggest that triglyceride level may be associated with unstable carotid plaques, rather than other risk factors.
Abstract W P388: High Fat and High Glucose Synergistically Impair Brain Microvascular Endothelial Cell Survival and Angiogenic Potential After Hypoxia
Authors: Valenzuela John P , Qu Zhi , Li Weiguo , El-Remessy Azza B , Mohamed Islam , Fagan Susan C , Ergul Adviye
Published: March 2022

Diet-induced metabolic disease is the most rapidly increasing risk factor for ischemic stroke and the leading cause of long-term disability in the United States. We have shown that high fat diet-induced diabetes impedes vascular restoration and functional recovery after ischemic stroke. Accordingly, the objective of this study was to test the hypothesis that high fat and high glucose combination impairs brain microvascular endothelial cell survival and angiogenic potential after hypoxia in a synergistic manner. Primary brain microvascular endothelial cells (BMVECs) were cultured in normal glucose (Control), high glucose (HG, 12.5 mM, levels observed in the high fat diet-fed animals), palmitate (Pal, 200 μM, a saturated free fatty acid that has been shown to most rapidly increase in plasma after a high fat meal), or HG plus Pal for 14 hours before exposing to normoxia (N) or oxygen glucose deprivation (OGD), n=4-6. Cell survival (MTT assay and cell counts), angiogenic properties (migration and tube formation) and inflammatory mediators (TNFα and toll like receptor-TLR4) were measured. HG plus Pal combination significantly reduced cell number, % viability, % migration and tube length and increased TNFα and TLR4 levels especially under OGD conditions (Table). These results suggest that even mild elevations in glucose and free fatty acids promote inflammation and impair endothelial cell recovery mechanisms, and a second hit such as hypoxia exacerbates this effect.
Abstract W P389: Placental Ischemia Increases Seizure Susceptibility in Pregnant Rats
Authors: Warrington Junie P
Published: March 2022

Eclampsia is diagnosed in preeclamptic patients who develop convulsions and/or unexplained coma during pregnancy or postpartum. It is one of the leading causes of maternal and infant morbidity and mortality accounting for about 13% of all maternal deaths worldwide. While several factors contributing to the pathogenesis of preeclampsia have been identified, little is known about the mechanisms contributing to the pathophysiology of eclampsia, partly due to the lack of suitable animal models of eclampsia. The aim of this study was to test the hypothesis that placental ischemia, induced by reducing utero-placental perfusion, increases susceptibility to seizures and cerebral edema. Pentylenetetrazol (PTZ), a pro-convulsive drug, was injected into pregnant and placental ischemic rats (40 mg/kg, i.p.) on gestational day 19 followed by video monitoring of rats for seizure activity for a duration of 30 minutes. Seizure scoring was blindly conducted. Results indicate the placental ischemic rats (n=8) have reduced latency to first seizure (264.5 ± 78.7s) compared to normal pregnant rats (n=7) (835.7 ± 246.6s; p < 0.05). Placental ischemia increased brain water content in the cerebrum (78.8 ± 0.1%) compared to the normal pregnant group (78.4 ± 0.1%; p < 0.05) while PTZ treatment significantly increased brain water content in both the pregnant (78.8 ± 0.1%; p < 0.05) and placental ischemic group (78.9 ± 0.1%; p < 0.01). These data demonstrate that placental ischemia is associated with increased susceptibility to seizures and edema formation; thus the rat model of placental ischemia represents an excellent model for studying mechanisms of eclampsia-like symptoms. Further studies are required to elucidate the exact mechanisms contributing to increased seizure susceptibility following placental ischemia.
Abstract W P392: Incidence Of Ischemic Or Hemorrhagic Non-fatal Strokes In Hemophiliac Adults And Teenage Children
Authors: Bezzina Cara , Malik Ahmed A , Qureshi Adnan I
Published: March 2022

Background:
Persons with hemophilia are at high risk for spontaneous or prolonged bleeding, including intracranial hemorrhage. However, the incidence of ischemic or hemorrhagic stroke has not been studied in hemophiliac adults and teenage children.

Methods:
We analyzed data from the Second Multicenter Hemophilia Cohort Study (MHCS-II) that enrolled patients ≥13 years who had a congenital coagulation disorder [hemophilia A or B (congenital factor VIII or IX deficiency), von Willebrand's disease, or other], and who had serological or molecular evidence of HCV or HIV-1 infection. Participant’s medical history (including factor concentrate use), a targeted physical examination, and blood tests were performed at baseline and annually for three to four years. Person-years were estimated from the date of follow-up (the first blood sample) to the date of an event of interest (stroke), death, or censoring. We use Kaplan Meier analysis to estimate the probability of stroke or death in the study cohort.

Results:
A total of 2569 hemophiliac persons (age range = 13-88 years, men n=2431 (94.8%)) were recruited at 52 collaborating hemophilia centers in North and South America and Europe. The severity of hemophilia was classified as mild (>5%) (n=511, 19.9%), moderate (1-5%) (n=490, 19.1%) and severe (<1%) (n=1561, 60.9%) based on von Willebrand Type (type 1,2,3 respectively). A total of 1996 (77.8%) and 584 (22.8%) had received transfusions with factor VII and factor IX, respectively. A total of 4 participants developed stroke (including 1 intracerebral hemorrhage) over 4.5 year’s follow-up period with an estimated incidence of 0.034 per person 100 years.

Conclusions:
The rate of stroke appears to be low in adults and teenage children in a cohort of hemophiliacs with predominantly moderate and severe disease.
Abstract W P393: Postural-related Cerebral Hemodynamic Responses Assessed by Near Infrared Spectroscopy in Patients with Chronic Cerebral Infarction
Authors: Irisawa Hiroshi , Odagiri Keiichi , Katayama Naoki , Mizushima Takashi , Watanabe Hiroshi
Published: March 2022

Introduction:
Near infrared spectroscopy (NIRS) is a non-invasive optical technique to monitor dynamic cerebral tissue blood volume. Although previous studies have implied cerebral blood volume changed slightly during acute orthostatic stress, the impact of chronic cerebral infarction (CI) on the cerebral hemodynamic response during postural change was unclear.

Hypothesis:
We hypothesized that chronic CI was independently associated with decreasing cerebral blood flow (CBF) during active orthostatic stress.

Methods:
We designed a cross sectional study to investigate the relation between chronic CI and the postural-related changes of CBF. A total of 100 subjects with or without chronic CI were enrolled in this study. Postural-related changes of average bilateral frontal cortical CBF were non-invasively and continuously measured by using NIRS (NIRO 100, Hamamatsu Photonics, Shizuoka, Japan) during orthostatic stress.

Results:
The proportion of decreasing CBF during active orthostatic stress was higher in patients with chronic CI than in those without chronic CI (76.3% and 30.6%, respectively, p<0.001). The changes in CBF during active orthostatic stress in patients with chronic CI were significantly lower than those in participants without chronic CI (-4.5±7.4% and 1.7±4.1%, respectively, p<0.001) In unadjusted model, the odds ratio (OR) (95% confidence interval) for decreasing CBF during active orthostatic stress in patients with chronic CI was 3.22 (1.52-6.81, p=0.002). After adjusted covariates, a multiple logistic-regression analysis revealed that the adjusted OR (95%CI) was 5.23 (1.68-16.32, p=0.004).

Conclusion:
Chronic CI was an independent risk factor for decreasing CBF during active orthostatic stress.
Abstract W P401: Comparison of MicroRNA Expression Profiles in Sera Between the Ischemic Stroke Patients Having No or Severe Stenoses on Intra- And Extra-cranial Vessels
Authors: Kim Jeeyeon , Kim Na-Young , Jeong Hye Seon , Hwang Juna , Kim Jei
Published: March 2022

Background and Objectives:
We evaluated differences of miRNA expression profiles of serum between ischemic stroke patients, who had no or severe stenoses on intra- and extra-cranial vessels.
Methods:
We compared miRNA expression profiles of sera obtained from 8 lacunar or transient ischemic stroke patients, who had severe stenosis of intra- and extra-cranial vessels, with other 8 patients, who had non-stenosis of the vessels. The miRNA expression profiling were performed with Taqman Low Density Array using TaqMan® Array MicroRNA Cards (Applied Biosystems®, Life Technologies). The significant expression change between the no and severe stenosis patients was defined as over 4-fold-up or less 0.25-fold-down regulations after log2 transformation of expression data in the stenotic versus no stenosis patients.
Results:
Seven miRNAs (miR597, 4.2; miR744, 4.6; miR891a, 5.9; miR372, 7.6; miR576-3p, 7.7; miR326, 10.4; miR301b, 18.1 folds, p<0.05) were found to be up-regulated in stenosis patients, instead, one miRNA (miR454, 0.2 fold, p<0.05) to be down-regulated in the stenoses patients. Even though some miRNAs of the present profiling analyses were described in tissue-based microRNA profiling using atherosclerotic tissues, up-regulation of miR576-3p and miR301b were only detected in sera of the present ischemic stroke patients having severe stenoses.
Conclusion:
The present study profiled two up-regulated miRNAs first described in only sera as well as others previously detected from atherosclerotic plaque in sera of ischemic stroke patients having severe stenosis on intra- and extra-cranial vessels. The two up-regulated microRNAs, miR576-3p and miR301b, could be a potential serum-biomarkers involved in processes of the stenosis of the cranial vessels like as other microRNAs involved in a potential way to affect atherosclerotic tissues.
Abstract W P413: Intravenous Delivery of the AAV9-sFLT Vector Reverses the Phenotype of Spontaneously Developed Brain Arteriovenous Malformation in Mice
Authors: Mao Lei , Shen Fanxia , He Yue , Zhan Lei , Lawton Michael T. , Su Hua
Published: March 2022

Background and Purpose:
Current therapies for brain arteriovenous malformation (bAVM) are invasive and have potential treatment-related morbidity. Excessive vascular endothelial growth factor (VEGF) expression is one of the key players in bAVM pathophysiology. The soluble VEGF receptor 1 (sFLT) possesses an anti-angiogenic effect. We hypothesize that intravenous delivery of adeno-associated viral vector serotype 9 (AAV9) expressing sFLT reverses the bAVM phenotype.

Methods:
SM22α-Cre transgenic mice were crossed with endoglin (Eng)-floxed mice to delete Eng. More than 95% of SM22 α-Cre;Eng-floxed mice spontaneously developed bAVM at age of 5 weeks. AAV9-sFLT (1x1011 viral genomes) was injected into the jugular vein of 5-week-old mice. AAV9-GFP was used as vector control. Brain vascular structure was analyzed using latex vascular casting 4 weeks after vector injection. The success of gene delivery, lymphocyte infiltration and neuronal loss was analyzed in the brain sections.

Results:
Due to the severity of the AVM lesion in this model, 3 of 9 AAV9-GFP-treated mice and 2 of 8 AAV9-sFLT-treated mice died during the 4-week treatment period. One paralyzed mouse in the AAV9-GFP group was euthanized before the treatment period ended. Only 1 of the 6 surviving mice in the AAV9-sFLT group had detectable bAVM, whereas all 5 mice in the AAV9-GFP group had it. GFP expression was detected in the bAVM lesion of AAV9-GFP-treated mice. Neither lymphocyte infiltration nor neuronal loss was observed.

Conclusion:
Because intravenous delivery of AAV9-sFLT reverses the bAVM phenotype without inducing intra-brain lymphocyte filtration and neuronal loss, AAV-mediated sFLT delivery could thus be developed into a specific, non-invasive therapy for patients with bAVM.
Abstract W P418: Trigeminal Neuralgia due to Arterialization of the Superior Petrosal Vein in the Context of Dural or Cerebral Arteriovenous Shunt
Authors: Robert Thomas , Blanc Raphael , Ciccio Gabriele , Redjem Hocine , Bartolini Bruno , Pistocchi Silvia , Piotin Michel
Published: March 2022

Trigeminal neuralgia (TN) was rarely the symptom and the discovery mode of dural or cerebral arteriovenous shunt. Few isolated cases described the association between TN and arteriovenous shunt. We presented our experience concerning cerebral AV shunt revealed by a TN. Between 2003 and 2013, 548 bAVM and 268 dAVF had been treated in our department and retrospective analysis permitted us to identify 10 consecutive cases with TN. We reviewed data from these patients to understand the pathophysiology of the neuralgia. Among the 10 patients (mean range: 37 years), 5 presented a bAVM and 5 a dAVF. TN was contralateral to the AV shunt in 2 cases (20%). AVM nidus was located in the cerebellum in all cases without pontine extension. dAVFs were located in the cerebello-pontine cistern (3 cases) , cerebello-medullary cistern (1 case) or at the free margin of the tentorium (1 case). The superior petrosal vein (SPV) was arterialized in all cases. Only in two cases (20%), an ectasia of the SPV explained TN by compression of the trigeminal nerve DREZ. For other cases (80%), no compression was noted. It seemed that venous hyperpression in the ponto-trigeminal vein (tributary of the SPV) could better explained the TN than a compression. This hypothesis permitted us to understand controlateral side of pain and the correlation between TN and reflux in the latero-mesencephalic vein. Contrary to other publications published on this topic, the compression of the nerve seems not to be the first etiology of the TN but the venous reflux into tributaries of the superior petrous vein and in particular the ponto-trigeminal vein.
Abstract W P426: Vascular Filling Defect Shape and Density Of Thrombus In CT/CT-Angiography Predict Results Of Thrombectomy
Authors: Cardona Pedro , Quesada Helena , Lara Blanca , Cano Luis , Rubio Francisco , Aja Lucia , Barranco Roger , Escrig Ana M. , Mora Paloma
Published: March 2022

BACKGROUND:
In acute thromboembolic stroke, mechanical recanalization with retrieval stents may result in immediate flow restoration and improve prognosis of patients. However, in up to 20% of cases, mechanical thrombectomy with stent retrievers results in poor angiographic outcomes (TICI 0-2a). Radiological findings on baseline CT scan and CT-angiography could predict recanalization rate and clinical outcome after thrombectomy.

METHODS:
We performed a retrospective analysis of patients with acute MCA or TICA occlusion treated with thrombectomy using retrievable stents between July 2010 to May 2014. We analyzed thrombus attenuations (Hounsfield Units, HU) in baseline noncontrast CT (NCCT), and shape of vascular filling defect in CT-angiography (CTA) that we correlate with arteriography study. Successful recanalization was considered with TICI 2b-3.

RESULTS:
A total of 183 patients were analyzed (142 had a M1 segment occluded, 25 a M2 and 16 a TICA occlusion on the admission CTA). Fifty-three percent of patients had received previously rtPA.

The mean age was 64.5 years+/-12 (46% women).The median NIHSS at presentation was 17 (range 6-26). Recanalization TICI 2b-3 was achieved in 78% of patients. Symptomatic hemorrhage occurred in 8% and good 90-day functional outcome (mRS ≤2) was achieved by 54%. Eighty percent of patients had a hyperdense thrombus evident on the baseline NCCT (mean 61+/-26 HU). In receiver operating characteristic (ROC) analysis attenuations of the clots was associated with higher rate of recanalization TICI 2b-3 ( AUC=0.782; p:0.001).

The shape of vascular filling defect contacting the thrombus by CTA (hook, sharp and abrupt shapes) correlates exactly in 98.5% with angiography series. Recanalization rates (TICI2b-3) were significant different in hook shape compared with sharp and abrupt shape group (85% vs 25%; p:0.001). Patients with hook shaped defect were associated with better clinical outcome compared with other shapes of filling defects (90 days mRS 0-2: 71% vs 38%, p:0.001).

CONCLUSIONS:
We found a significant association between characteristics of thrombus by NCCT/CTA and successful recanalization (TICI 2b-3). Shape and attenuation of thrombus could be predictive of technical success of thrombectomy.
Abstract W P49: Optimizing Ct Perfusion for Prediction of Ischemic Core in Acute Stroke With an Open-source Benchmarking Tool to Standardize Stroke Imaging Research
Authors: Cereda Carlo W , Christensen Søren Christensen , Campbell Bruce C , Mishra Nishant K , Levi Christopher , Mlynash Michael , Straka Matus Straka , Bammer Roland Bammer , Albers Greg W , Parson Mark W , Lansberg Maarten G
Published: March 2022

Background:
Multiple studies have investigated the optimal CT perfusion (CTP) parameter for identification of the ischemic core. Differences in methodology have led to results that are not easily comparable. The aim of this project was to create and test a benchmarking tool that will standardize the evaluation of CTP-software. Methods: We developed a tool consisting of: 1) an imaging library and 2) a statistical analysis algorithm. The imaging library includes pre-processed DWI and CTP scans from a large cohort of 104 acute stroke patients from 2 centers who underwent DWI within 2 hours of CTP. Pre-processing included manual delineation of the acute infarct on DWI (DWI-ROIs) and motion-correction, time-correction, and co-registration of the CTP images. The statistical analysis algorithm evaluates the performance of CTP-software by determining the sensitivity, specificity and volumetric accuracy of the CTP-software’s ischemic core (CTP-ROIs). The tool was tested with CTP-ROIs based on relative CBF (rCBF) thresholds (ranging from 0.00 to 1.00 in 0.02 increments), generated by in-house developed CTP-software (RAPID). Results: We successfully pre-processed the DWI and CTP data of 104 patients. Median time between CT and start of MR was 36 min (IQR 25-77). The tool’s statistical analysis algorithm successfully determined the performance metrics of our in-house CTP-software: Volumetric accuracy of the CTP-ROIs was optimal at an rCBF threshold of 0.36. At this threshold the median absolute volumetric difference between the CTP- and DWI-ROIs was 10 ml (4-17 IQR), sensitivity 64% and specificity 90%.Conclusion: This open-source CTP benchmarking tool provides the scientific community, for the first time, with a method to directly compare the accuracy of CTP-software packages. This may lead to major improvements in CTP-software, as researchers worldwide can use it to determine the optimal algorithm for identifying the ischemic core with CTP.
Abstract W P51: A Higher Neutrophil Count Before Thrombolysis Is Associated With Worse Outcome
Authors: Maestrini Ilaria , Strbian Daniel , Gautier Sophie , Haapaniemi Elena , Moulin Solene , Sairanen Tiina , Dequatre-Ponchelle Nelly , Sibolt Gerli , Cordonnier Charlotte , Melkas Susanna , Leys Didier , Tatlisumak Turgut , Bordet Regis
Published: March 2022

Objective:
to determine whether higher neutrophil counts before administration of intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) for ischemic stroke are associated with symptomatic intracerebral hemorrhages (sICH), and worse outcomes.

Methods:
we conducted this study in patients treated by i.v. rt-PA in the stroke units of Lille and Helsinki. Blood samples for leukocyte, neutrophil, and lymphocyte counts were drawn before thrombolysis. The primary endpoint was sICH (ECASS-2 definition). Secondary endpoints were excellent outcome (modified Rankin Scale [mRS] 0-1), good outcome (mRS 0-2), and death at 3 months.

Results:
we included 846 patients (median age: 71 years; 50.8% men). Neutrophil count was independently associated with sICH (adjusted odds ratio [adjOR] for 1,000 increase =1.21; 95% confidence interval [CI]: 1.11-1.32), death (adjOR 1.16; 95%CI: 1.08-1.24), excellent (adjOR 0.87; 95%CI: 0.82-0.93) and good (adjOR 0.86; 95%CI: 0.80-0.91) outcomes. The Neutrophil to lymphocyte ratio (NLR) was independently associated with sICH (adjOR 1.11; 95%CI: 1.06-1.17), death (adjOR 1.08; 95%CI: 1.03-1.13), excellent (adjOR 0.85; 95%CI: 0.81-0.90) and good (adjOR 0.91; 95%CI: 0.86-0.95) outcomes. Total leukocyte count was associated with none of the 4 endpoints. The best discriminating factor for sICH was a NLR ≥4.80 (sensitivity 66.7%, 95%CI 63.5%-69.9%; specificity 71.3%, 95%CI 68.3%-74.3%; likelihood ratio 2.32). Patients with NLR ≥4.80 had a 3.71-fold increased risk for sICH (95% CI adjOR: 1.97-6.98).

Conclusions:
higher neutrophil counts are independently associated with sICH, death, and worse functional status at 3 months. The identification of mediators of this effect could help identifying new targets for neuroprotection in patients treated by rt-PA.
Abstract W P56: Using The M2 Vessel Diameter And Baseline NIHSS To Identify Which M2 Occlusions Should Be Treated Endovascularly?
Authors: Appireddy Ramana M , Menon Bijoy K , Horn Michelle , Wee Patrick , Patil Shivanad , Stewart Teri , Desai Jamsheed , Burns Paul A , Puig Josep , Sohn Sung-II , Calleja Sanz Ana I. , Dowlatshahi Dar , Poppe Alexandre , Asdaghi Negar , Mikulik Robert , Asli Talip , Boulanger Jean-martin , Ahn Seong Hwan , Jin Albert , Francois Moreau , Goyal Mayank , Demchuk Andrew M ,   INTERRSeCT Study Group
Published: March 2022

Introduction:
IV tPA is the primary acute treatment for M2 occlusions yet outcomes and recanalization rates are less than optimal. Endovascular treatment may be a more suitable treatment option in some but not all M2 occlusions yet are excluded from most current endovascular trials. Current methodologies to characterize M2s are complex and quite subjective. A simple and practical approach to evaluating M2s quickly for endovascular treatment is needed. We measured M2 cross-sectional diameter to determine if this method predicted 24-hour infarct volumes.

Methods:
Patients from the ongoing prospective multicenter INTERRSECT recanalization study with an M2 occlusion identified by baseline CTA were included. Two readers measured M2 diameter on baseline CTA at the most distal point of normal vessel upstream to the clot by consensus. Recanalization (modified AOL score 2-3) was assessed on 4 hour follow-up CTA. Infarct volume was measured on 24 hr CT/MRI.

Results:
103 patients (mean age 74.1 yrs, SD=12.7; 46.5% male; median baseline NIHSS 8, IQR=7) had M2 occlusion on baseline CTA. 76/103 received IV t-PA. Recanalization was noted in 46/92 (50%) patients. Median 24-hr infarct volume was 4.28 ml (IQR=22.67 ml). In multivariable linear regression, M2 diameter (p<0.01) and baseline NIHSS (p=0.01) were associated with final infarct volume but not recanalization (p=53). Median final infarct volume was 41.6 ml (IQR=50.4) in patients with M2 diameter>2mm and baseline NIHSS>5 vs < 10 ml in all the other 3 groups (p<0.01; equality of medians test; see figure).

Conclusion:
Patients with M2 diameter > 2 mm just proximal to the occlusion and baseline NIHSS > 5 have much higher final infarct volumes suggesting a role for ultra-early recanalization that is offered by endovascular treatment. Such patients could be selected for endovascular therapy in future trials or clinical practice.
Abstract W P6: Transfer for Intra-Arterial Stroke Treatment and its Impact on Clinical Outcome
Authors: Ogami Kyle , Chen Michael , Zaidi Syed , Jumaa Mouhammad , Adams Andrea , Espinosa Aixa
Published: March 2022

OBJECTIVE:
Patients referred to stroke centers from community hospitals for intra-arterial stroke treatment (IAT) may experience significant delay during the transfer process. We sought to determine the difference in clinical outcomes amongst patients presenting directly to stroke centers (PD) versus those transferred from outside community hospitals (TR).

METHODS:
We reviewed records of patients who underwent IAT at our center from July 2012 – July 2014. All patients had intracranial large vessel occlusion and a baseline ASPECT score of ≥ 6. Patients demographics, risk factors, admission clinical and neuroimaging findings, treatment times and methods, procedure related complications and modified Rankin score (mRS) at 90 days were analyzed. For patients who are not yet at 90 days post-treatment, mRS at hospital discharge was used in the final analysis. A favorable outcome was defined as mRS 2 or less at 90 days.

RESULTS:
Overall 141 consecutively treated patients were identified. Of these, 89 (63.1%) were transferred from community hospitals for IAT. Median time from last known well to stroke center arrival was 50 mins for PD and 245 mins for TR group (T-test p<0.01). Despite this difference final infarct volume, favorable outcome and mortality rates were comparable between the groups (see table). Multivariate logistic regression model identified lower final DWI infarct volume (OR 0.97, 95%CI 0.95-0.99, p<0.01) and low presentation NIHSS (OR 0.85, 95% CI 0.73-0.99, p=0.04) as predictors of favorable outcome.

CONCLUSION:
Our results indicate that patients with favorable baseline head CT, referred from outlying facilities, may achieve similar clinical outcomes following IAT when compared to those presenting directly to a designated stroke center. Further randomized studies on an intent to treat design are needed to corroborate these findings.
Abstract W P60: Blood Pressure Reduction In Acute Ischemic Stroke Does Not Affect Ischemic Core Tissue Perfusion
Authors: Kate Mahesh , Asdaghi Negar , Gioia Laura , Buck Brian , Jeerakathil Thomas , Shuaib Ashfaq , Butcher Kenneth
Published: March 2022

Introduction:
Blood pressure (BP) reduction in acute ischemic stroke patients can potentially decrease cerebral blood flow (CBF) in ischemic tissue due to disrupted autoregulation, particularly in the ischemic core. We tested this hypothesis using a 3 group non-randomized controlled study of serial CBF measurements in ischemic stroke patients.

Methods:
Patients with acute ischemic stroke ≤72h of symptom onset were recruited. Groups were assigned according to baseline mean arterial blood pressure (MAP): patients with MAP >120mmHg were treated with intravenous labetalol and sublingual (SL) nitroglycerin and those with MAP 100-120 mmHg were treated with SL nitroglycerin. The BP reduction target was 10% of the baseline MAP. Patients with MAP<100 mmHg formed the control group. Patients underwent MR perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) before and after BP reduction. Blinded planimetric assessment was done to determine PWI deficits and DWI lesion volumes in the ischemic core region.

Results:
A total of 48 patients with mean±SD age of 65.4±13.2 years were enrolled at 23.4±15.3h after symptom onset. The mean time difference between perfusion scans was 25.6±9.5 min.Median(IQR) DWI volume was 11.1 (96.8) ml. Mean MAP was 126±7.5 mmHg in the MAP>120 group(n=13), 109.9±4.9 mmHg in the MAP 100-120 group (n=16), and 89.9±6.2 mmHg in the controls (n=19). Mean BP reduction in the treated patients was 11.9±6.7 mmHg (95% CI 15.6-3; p=0.04). Baseline mean relative CBF (rCBF) in ischemic core tissue was 1.1±0.47 in the MAP >120 group, 0.87±0.35 in the MAP 100-120 group and 0.78±0.32 in controls. The mean change in rCBF following BP reduction did not differ between the MAP >120 group (0.03±0.17), MAP 100-120 group (0.06±0.17) and controls (0.08±0.25) (p=0.28). Similarly, there was no difference in the mean relative cerebral blood volume (p=0.3) and relative mean transit time (p=0.58) before and after BP reduction. In patients treated with SL nitroglycerin (n=17), there was no improvement in mean lesional rCBF (0.04±0.17 vs.-0.02±0.18, p=0.25).

Conclusion:
Modest BP reduction does not lead to an immediate decrease in CBF, within the ischemic core. Acute antihypertensive therapy may be less directly harmful than has been postulated.