bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP153: Tirofiban Increase Symptomatic Intracranial Hemorrhage After Endovascular Therapy In Cardio-embolized Stroke Patients: Insight From Rescue Bt Trial
Authors: Gao Lijie , Yu Yang , Peng Cheng , Zi Wenjie , Qiu Zhongming , Li fengli , Zeng Hongliang , Yuan Zhengzhou
Published: February 2023

Introduction:
Efficacy and safety of tirofiban in endovascular therapy among cardio-embolized ischemic stroke patients remains controversial. We aimed to assess effects of tirofiban before endovascular therapy in cardio-embolized stroke patients.

Methods:
This is a post hoc analysis of Endovascular Treatment With vs Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial. Before endovascular therapy, participants were randomized to tirofiban or placebo group in ratio of 1:1. Tirofiban was administrated as a bolus dose of 10 ug/kg, followed by continuous infusion of 0.15 ug/kg /min for up to 24-hour. We collected cardio-embolized stroke patients according to Trial of Org 10172 in Acute Stroke Treatment classification. The efficacy outcome was global disability at 90-day assed by modified Rankin Scale (mRS). The primary safety outcome was symptomatic intracranial hemorrhage (sICH) assessed by Heidelberg bleeding classification within 48-hour. Secondary safety outcome was any radiologic intracranial hemorrhage and death at 90-day.

Results:
406 cardio-embolized stroke patients were collected. Tirofiban did not correlated to favorable shift to lower 90-day mRS (adjusted odds ratio [aOR], 0.91; 95% CI, 0.64-1.3;
P
= 0.617). However, tirofiban subgroup had a significantly higher risk of sICH within 48-hour (aOR, 3.26; 95% CI, 1.4-7.57;
P
= 0.006) compared with placebo group. The aOR was 1.44 (95% CI, 0.94-2.19;
P
= 0.094) for any intracranial hemorrhage and

1.48 (95% CI, 0.88-2.52;
P
= 0.143) for death at 90-day.

Conclusions:
Tirofiban increased symptomatic intracranial hemorrhage after endovascular therapy in cardio-embolized stroke patients.

Figure 1
. Outcomes of endovascular therapy in cardio-embolic stroke participants in tirofiban vs placebo group.
Abstract WP159: Examining The Utility Of 2D DSA For Carotid Stenosis Hemodynamic Pressure Analysis
Authors: Dinh Huy , Szeder Viktor , Vinuela Fernando , Chien Aichi
Published: February 2023

Introduction:
Measurement of local hemodynamic behavior is useful for assessing the pathology of carotid stenosis. In this study, we explore a novel method using two-dimensional digital subtraction angiography (2D DSA) to provide time-dependent pressure data. We performed comparative validation with computational fluid dynamics (CFD) and flow guidewire measurements as reference methods.

Methods:
A silicone phantom model of a carotid stenosis was prepared, filled with physiological saline, and connected to a flow pump (Vascular Simulations, LLC Left Heart Replicator) applying pulsatile flow. The stenosis model narrowed from a diameter of 1.37 cm to 0.58 cm for a length of 0.64 cm (NASCET=40%). Iodinated contrast media was injected, and time dependent pressure profiles at four regions of interest: 2 cm proximal to the stenosis, proximal end of the stenosis, distal end of the stenosis and 2 cm distal to the stenosis were derived from contrast intensity (I) obtained from 2D DSA background-subtracted intensity plots using previously published PVEC software. A Volcano flow guidewire sensor was utilized at the same four locations to collect flow data. Pulsatile CFD flow analysis was performed to extract flow data.

Results:
DSA PVEC contrast analysis allowed observation of distinct flow pulsatility. At 30fps, strong agreement of DSA contrast waveform matching CFD and guidewire flow measurements was found at the distal end of the stenosis over a period of linear contrast increase (constant dI/dt). Bland-Altman analysis was used to compare derived pressure with the reference methods over 3.5 cardiac cycles, from 5.9 s to 8.7 s after the initial injection of contrast. 2D DSA-derived pressure showed a mean departure of -10.24% (std. dev 14.65%) pressure obtained from CFD analysis, and a mean departure of -15.32% (std. dev 14.24%) from guidewire measurements for the duration.

Conclusion:
A novel computational approach suggests 2D DSA can provide real-time results to approximate carotid flow from 2D DSA. We showed using this novel approach the flow data is comparable with guide wire and CFD methods. Future experiments may allow it to provide a supplementary, non-invasive means to examine local hemodynamic behavior that is relevant to the evaluation of carotid stenosis.
Abstract WP16: Automated Vessel Identification In The Circle Of Willis Using Deep Learning Models To Assist AI Based Lesion Detection In Cerebral Vasculature
Authors: Chien Aichi , Špiclin Ziga , Bizjak Ziga
Published: February 2023

Introduction:
Vascular diseases are among the top causes of death in the world. Automated approaches which allow comparison of vasculature enable both large population studies of vasculature and assist objective diagnosis of vascular disease. Accurate and robust methods for vessel labeling of angiography are an important step to automatically localize lesions or other features of interest.

Hypothesis:
using a deep learning approach, a model can be developed to identify cerebral arteries.

Methods:
We used 152 cerebral TOF-MRA angiograms from three publicly available datasets and automatically segmented vessels using a pre-trained nnU-net model. With the segmented vessels, we manually created reference labels for different cerebral arteries using 3DSlicer. After extracting vessel centerlines from the segmentations using VesselVio, we then associated each centerline point with the reference labels to assign individual arterial segments. Finally, in an ablation-type study, several PointNet++ point cloud models were trained and evaluated, using the centerline coordinates, local vessel radius and/or centerline point connectivity information as inputs.

Results:
The model trained only on centerline coordinates resulted in a high true positive rate (TPR) of 0.92, while models trained with additional features resulted in significantly higher (p<0.05) TPR of 0.95. Different PointNet++ models favored improved labeling of certain arteries, while the internal carotid artery, and posterior communicating artery were consistently the most and least accurately labeled arteries, respectively.

Conclusion:
We developed a complete pipeline utilizing a deep learning PointNet++ for automatic cerebral vessel identification that labels vessels based on automatically extracted centerlines. Results show that utilizing vessel radius as an additional feature significantly improved cerebral vasculature labeling. The overall TPR of 0.95 shows that our model can be used for fast and reliable artery labeling of cerebral MRA images.
Abstract WP160: Intravenous Dose-adjusted Cangrelor Use For Neuroendovascular Procedures: An Institutional Experience
Authors: Morsi Rami Z. , Desai Harsh , Kothari Sachin A , Thind Sonam , Carrión-Penagos Julián , Coleman Elisheva , Brorson James R , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass-Hout Tareq
Published: February 2023

Introduction:
The optimal antiplatelet therapy regimen for neuroendovascular procedures remains unclear. This study investigates the safety and feasibility of intravenous dose-adjusted cangrelor for neurovascular interventions.

Methods:
We conducted a retrospective review of consecutive patients who underwent neuroendovascular procedures and were placed on intravenous cangrelor between September 1, 2020 and March 13, 2022. Demographic characteristics, interventional variables, and clinical outcomes were collected.

Results:
Fifty patients were included. The mean age (years) was 56.0 ± 18.6, and 26 (52.0%) were males. Most patients were African American (n=39/48, 81.3%). The most common comorbidities were hypertension (n=25/49, 51.0%), active smoking status (n=14/40, 35.0%), and prior ischemic stroke (n=13/49, 26.5%). Intravenous thrombolysis was used in 4 patients (8.0%). Cangrelor infusion was used for the following procedures: embolization (n=10/50, 20.0%), embolization and stent placement (n=9/50, 18.0%), thrombectomy alone (n=5/50, 10.0%), thrombectomy and stent placement (n=10/50, 20.0%), and stent placement only (n=14/50, 28.0%). Stent placement occurred intracranially, remainder of carotid, and both intracranial and carotid arteries in 18, 12, and 3 patients, respectively. PRU levels were measured in 48 patients (96.0%), with 26 patients (54.2%) achieving a PRU level of 50-150 greater than or equal to 50% of the time. Approximately 51.5% of the patients had a favorable functional outcome with modified Rankin Scale (mRS) score of 0 to 2 at 90 days (n=17/33). During 1-year follow up, approximately 4 patients had recurrent or new strokes (9.5%), 1 patient had in-stent thrombosis (2.9%) and 1 patient with symptomatic sICH (2.4%), both while not on antiplatelet therapy, and 2 patients with asymptomatic ICH (4.8%). When stratified by PRU level, there were no significant differences in sICH (p=0.841) or asymptomatic ICH (p=0.853).

Conclusions:
To our knowledge, this is the first report in the largest cohort to date to demonstrate the safety and effectiveness of intravenous dose-adjusted cangrelor use for neuroendovascular procedures. Comparative studies to standard dose maintenance cangrelor are necessary.
Abstract WP169: Age And Sex Differences And Temporal Trend In Stroke Incidence In Latin America: A Systematic Review And Meta-analysis
Authors: Nuñez Marilaura , Delfino Carlos , Asenjo-Lobos Claudia , Gonzalez Francisca , Riviotta Amy , Urrutia Francisca , Schilling Andrea , Lavados Pablo M , Anderson Craig S , Munoz Venturelli Paula
Published: February 2023

Background:
Studies suggest divergent temporal trends in stroke incidence in high income countries, with increasing rates in younger people, particularly women. No age- and sex-specific stroke incidence data are available for Latin American and Caribbean (LAC) regions, despite large populations undergoing rapid structural changes.
Aim:
To determine temporal trends in age and sex stroke incidence in LAC populations.

Methods:
A systematic review in accordance with MOOSE and PRISMA guidelines was undertaken with a modified Cochrane Stroke Group search strategy of MEDLINE, WOS, and LILACS databases, to identify relevant references for prospective observational studies with sex-disaggregated data on stroke incidence in LAC populations from January 1997 to December 2021. Two independent reviewers screened titles/abstracts, and reviewed selected full text articles. Random-effects meta-analysis was conducted to estimate the pooled overall crude stroke incidence and relative temporal rate ratio (RTTR) by age-groups in all and sex-disaggregated data. The Joanna Briggs Institute’s risk of bias assessment was applied.

Results:
Of 9242 identified records, 6 LAC studies (9 periods) were selected. Overall crude stroke incidence was higher in men than women (incidence [men:women] rate ratio [IRR] = 1.12, 95% confidence interval [CI] 1.04-1.21 [I
2
=38.3%]). When analyzed for temporal trend, relative ratio of stroke incidence was greater in younger than older age-groups (<55 vs. ≥55 years; RTTR=1.65, 95%CI 1.50-1.80), before compared to after, 2010. Overall, less favorable trends occurred in women (RTTR=1.98, 95%CI 1.75-2.21) than men (RTTR=1.42, 95%CI 1.22-1.63).

Conclusions:
Divergent temporal trends in stroke incidence are apparent in LAC, with less favorable trends in younger age-groups and especially in young women. Further studies are needed to understand these findings and establish strategies targeting prevention in younger populations.
Abstract WP175: Cardiovascular And Cerebrovascular Disease Risk Assessment Amongst Patients With Status Migrainosus And Migraine With Aura - A Nationwide Study
Authors: Shah Dhaivat , Patel Kulin , Pathak Stuti , Nadella Adithya , Shah Khushboo , Shelar Vrushali , Sundararaju Ponrasu , Somi Shamima A , Pelidis Michael , Igbenabor Christiana , Vimalathithan Vinith , Charishma Sabbineni , Thompson Chadane , Patel Urvish K , Belletieri Christopher
Published: February 2023

Introduction:
Headache disorders have been linked with enhanced atherosclerosis, cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, and cervical artery dissection. We aimed to evaluate the risk of cardiovascular and cerebrovascular disorders amongst patients with status migrainosus and migraine with aura.

Methods:
We planned a cross-sectional observational study from nationwide inpatient data from 2016-2018. Patients with status migrainosus with intractable migraine, migraine with aura, migraine without aura (simple migraine) were identified and compared with population without no migraine (control) using ICD-10-CM codes. Chi-square test) and mix-effect multivariate survey logistic regression analysis adjusted for vascular events were performed to identify prevalence and risk of association between cerebrovascular and cardiovascular disorders and migraine.

Results:
We identified 1184130 migraineurs out of which 60140 had status migrainosus with intractable migraine, 45285 had migraine with aura, and 16860 had migraine without aura. Prevalence of identified acute ischemic stroke (AIS) (5.5% vs no-migraine: 1.71%), transient ischemic attack (TIA) (3.99% vs 0.38%), subarachnoid hemorrhage (SAH) (0.13% vs 0.08%), angina (0.07% vs 0.06%) was higher in patients with migraine with aura compared to non-migraineurs. (p<0.0001) In regression analysis, migraine with aura was associated with higher odds of AIS (aOR: 3.7, 95%CI 3.4-4.1) and TIA (11.8, 10.5-13.2). In risk adjusted effect modification analysis, patients with AIS (1.5, 1.2-1.9) and TIA (3.0, 2.1-4.3) had higher odds of severe and extreme disability (APR DRG Severity) in patients with migraine with aura compared to patients with intractable migraine.

Conclusion:
We found that the patients with migraine with aura had higher risk of stroke than patients with intractable or simple migraine. More prospective studies should be planned to evaluate the effect of long-term management of migraine with aura to mitigate the burden of cerebrovascular events and associated disability. Further studies should be directed towards identifying the relationship between migraine and cardiovascular disorders.
Abstract WP178: Markers Of Coagulation And Hemostatic Activation Predict Occult Malignancy In Cryptogenic Stroke Patients
Authors: Cardel Patrick , RANGARAJU Srikant , Lemuel-Clarke Manet , Henriquez Laura , Nahab Fadi B
Published: February 2023

Introduction:
One potential cause of embolic strokes of undetermined source (ESUS) is occult malignancy. The objective of the study was to evaluate the frequency of and potential predictors of occult malignancy among ESUS patients.

Methods:
Consecutive ESUS patients seen at a single institution from May 1, 2017 to March 1, 2021 were included in this analysis. Patients with occult malignancy were defined as those who had newly diagnosed malignancy within one year of index stroke. We evaluated demographics, blood biomarkers and imaging to identify predictors of occult malignancy diagnosis after ESUS.

Results:
Of 365 patients [Median age: 66 (IQR 53-75), female 60%), non-White 52%], 35 (9.6%) had a history of malignancy before the index stroke and 8 (2.5%) were diagnosed with occult malignancy within 12 months of index stroke. Occult malignancies included colorectal cancer (4), blood cancer (3), and bladder cancer. Stage 4 malignancy was found in 1 (13%) patient diagnosed with occult malignancy. Elevation in ≥2 markers of coagulation and hemostatic activation (MOCHA) (d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) was significantly more frequent in occult malignancy versus other patients (88% vs 42%, Fisher exact p=0.023, OR=9.6 95%CI 1.2-79, p=0.035). MOCHA elevation in ≥2 markers for the detection of occult cancer had sensitivity 87.5%, specificity 57.9%, PPV 4.7%, NPV 99.5%.

Conclusions:
Hematologic markers such as MOCHA may be potentially useful to identify patients more likely to have underlying malignancy after ESUS. MOCHA abnormalities in <2 markers effectively rules out occult malignancy as the cause of ESUS.
Abstract WP179: Menopause Is Related To Accelerated Accumulation Of White Matter Hyperintensity Burden In Small Artery Occlusion Strokes
Authors: Schirmer Markus D , Bonkhoff Anna , Giese Anne-Katrin , Rost Natalia S
Published: February 2023

Introduction:
Sex differences in white matter hyperintensity (WMH) burden exist and are affected by menopausal status. Here, we investigate the difference in age-related WMH burden with respect to stroke subtype (TOAST) and menopausal status.

Methods:
We reviewed 4443 patients across 18 sites with information on age, TOAST, prior stroke, hypertensive (HTN) and diabetic (DM2) status, smoking history, and WMH and brain volume. WMH load was defined as the ratio between WMH and brain volume and Box Cox transformed. All variables underwent z-score standardization. Pre- (PRM), peri- (PEM), and post-menopausal (POM) categories were defined using age (PEM: 45-59 years). WMH load was modeled using age, prior stroke, HTN, DM2, smoking status, and interaction terms between age, TOAST, and sex/menopausal status. A second model included TOAST as an independent variable. Models accounted for acquisition site and were compared using Bayes Information Criteria (BIC). Significance was set to p<0.05.

Results:
Of all patients (median age: 64), 42% were female (6%, 10%, and 26% PRM, PEM, and POM, respectively). The model without TOAST as an independent variable was selected (BIC 9237 compared to 9779). Our results (Figure 1) show (beta [95% confidence interval]) prior stroke (0.22 [0.15-0.29]), smoking (0.09 [0.04-0.14]), HTN (0.19 [0.14-0.25]), DM2 (0.08 [0.01-0.15]), and age (0.54 [0.43-0.65]) as independent factors. TOAST did not affect age-related WMH load in men and PRE. Effects of age were modified for small artery occlusion strokes in POM (0.40 [0.03-0.76]), increasing the age-related disease burden.

Conclusions:
Menopausal status affects age-related WMH burden for different TOAST.
Abstract WP180: Gender-specific Risk Of Stroke In Patients With Peripheral Artery Disease
Authors: Zhong Qiaoqing , Yunus Rayaan , Khan Adnan , Mahmood Feroze , Sharkey Aidan , Bu Yifan , Rehman Taha , Sohail Ahmed , Matyal Robina
Published: February 2023

Objective:
Peripheral artery disease (PAD) is a common atherosclerotic disease associated with increased morbidity and mortality. We conducted a retrospective review to investigate the role of gender in influencing the incidence of stroke after surgery for PAD.

Methods:
We conducted a retrospective review using data from the Vascular Quality Initiative database for patients who underwent supra-inguinal and infra-inguinal surgery between 2010 and 2020. The relationship between gender and 30-day post-operative outcomes was calculated as an odds ratio; the threshold of significance was
p
=0.05 for univariate and multivariable analysis. Gender-based influence of age and adjusted probability of stroke was plotted using Sigma Plot.

Results:
A total of 79,981 patients were included based on our eligibility criteria, 34% of which were female. Although only 0.6% of patients experienced stroke, risk of stroke was significantly higher in female patients (
p
<0.001). Female patients were more commonly hypertensive (
p
=0.007) and diabetic (
p
=0.003), while also presenting decreased pre-operative use of statin (
p
<0.001) and aspirin (
p
<0.001) as compared to males. Additional predictors of post-operative stroke include age > 65 years (
p
=0.015), hypertension (
p
=0.002), and pre-operative use of beta blockers (
p
<0.001). Overall, females had higher risk of all-cause morbidity (
p
=0.004), stroke (
p
<0.001), mortality (
p
<0.001), and major adverse cardiovascular events (
p
<0.001), while males had increased risk of returning to the operating room (
p
=0.006). Regression analysis revealed a significantly stronger bearing of high age on probability of post-operative stroke in women (
p
<0.001).

Conclusion:
Our data suggests that incidence of post-operative stroke and other cardiovascular complications is influenced by gender in surgery of PAD. Future research investigating underlying gender-based mechanisms is necessary to personalize treatment in patients with PAD.
Abstract WP181: Trends In Ischemic Stroke Patients With Central Nervous System Infections: A Propensity Score Matched 20-year Analysis Of The National Inpatient Sample
Authors: Chapman Emily K , Hardigan Trevor , Vasan Vikram , Rossitto Christina , Schuldt Braxton R , Devarajan Alex , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Introduction:
Infection of the central nervous system (CNS) - including meningitis, encephalitis and brain abscess - is a feared complication in hospitalized patients. Studies of CNS infection in patients with acute ischemic stroke (AIS) are scarce. We aimed to characterize AIS patients with CNS infections and assess their clinical outcomes over a 20-year period.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 434.01, 434.11, 434.91, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of CNS infections on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
Total of 10,415,286 patients with AIS were included; 74,731 (0.7%) had CNS infection. Infected patients had higher Elixhauser Comorbidity Score (12.02 ± 9.24 vs. 9.75 ± 8.82; p<0.001) and NIH Stroke Score (8.78 ± 8.86 vs. 6.65 ± 7.29; p<0.001). After propensity matching, these patients had lower rates of smoking, COPD and CKD, and higher rates of systemic inflammatory disease and burr hole drainage (p<0.001). Infected patients had longer hospital stay (3.88 days; 95% CI: 3.45-4.3), higher hospital charges ($49633.46; 95% CI: $44199.59-55067.33) and were less likely to be discharged home or short-term hospital (0.78; 95% CI: 0.74-0.82)(all p<0.001).

Conclusion:
In this 20 year nationally representative propensity matched analysis of patients with AIS, those with concomitant CNS infections had higher rates of comorbidities and had higher NIHSS. In addition to having longer and more expensive hospital stays, these patients were less likely to have good functional outcomes.
Abstract WP182: Diastolic Dysfunction With Elevated Left Ventricular Filling Pressures Is Associated With Embolic Stroke Of Undetermined Source And Atrial Fibrillation Detection After Ischemic Stroke
Authors: Shu Liqi , Bashir Zubair , Chen Edward W , Wang Shuyuan , Goldstein Eric D , Rana Maheen , Kala Narendra , Dai Xing , Mandel Daniel , Yaghi Shadi , Has Phinnara , Xie Mingxing , Wang Tao , Simmons James , Song Christopher , Haines Philip
Published: February 2023

Introduction:
Diastolic dysfunction, particularly with elevated left ventricle filling pressure (LVFP) is known to be a strong independent predictor of all-cause mortality and major cardiac events. There is limited data on the role of diastolic function in ischemic stroke. We hypothesize that diastolic dysfunction with elevated LVFP is more likely to be present in patients with Embolic stroke of undetermined source (ESUS) compared to non-cardioembolic stroke and is associated with AF on cardiac monitoring in the ESUS group.

Methods:
This is a single center retrospective study that included adult patients with a diagnosis of acute ischemic stroke from 2014 to 2016. We excluded patients with confirmed cardioembolic stroke and those with indeterminate diastolic function. ESUS was defined as no ipsilateral stenoses ≥ 50%, cardiac telemetry for at least two weeks without evidence of atrial fibrillation or atrial flutter, and a LVEF ≥ 30%. A transthoracic echocardiogram was performed and interpreted by cardiologists. Baseline patient characteristics and clinical variables were compared among patients with and without diastolic dysfunction. Potential associations between diastolic dysfunction, ESUS and AF detection in ESUS patients were assessed using logistic regression.

Results:
There were 509 patients, the mean age was 64.19, 54.81% were male, and 146 had LVFP data. Diastolic dysfunction overall was not associated with ESUS (adjusted OR 1.44, 95% CI 0.91-2.28, p = 0.125) or AF detection on cardiac monitoring (adjusted OR 1.87, 95% CI 0.75-4.70, p = 0.183). However, diastolic dysfunction and elevated LVFP was associated with ESUS subtype (adjusted OR 2.26, 95% CI 1.03-4.93, p = 0.041) and AF detection on cardiac monitoring (adjusted OR 3.58, 95% CI 1.07-12.01, p = 0.039).

Conclusion:
Our study suggests that diastolic dysfunction with elevated LVFP is associated with ESUS stroke subtype and AF detection on cardiac monitoring. Therefore, the presence of diastolic dysfunction with elevated LVFP may identify a population of stroke patients more likely to have ESUS, particularly in the setting of occult AF. Studies are needed to confirm our findings and test the safety and efficacy of anticoagulation in patients with ESUS and diastolic dysfunction with elevated LVFP.
Abstract WP186: Fewer Self-reported Memory Problems Are Associated With Better Blood Pressure Control Post-stroke
Authors: Gibbs Brooke , Wing Jeffrey J , Draughter Darnisha , Drum Emily , Gutierrez Desiree , Albala Bruce , Boden-Albala Bernadette
Published: February 2023

Introduction:
Memory problems, a common cognitive issue, can have a negative influence on one’s ability to function and contributes to increased risk of secondary stroke.

Objective:
To examine the association between self-reported memory problems at 6 months and blood pressure control at 12 months post-stroke.

Methods:
This study utilized follow-up data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) stroke risk factor reduction trial (n=226). Sample size was restricted to those who answered memory questions and had a 12-month blood pressure (BP) reading. Exclusion criteria for DESERVE included any significant memory disorder prior to the baseline stroke. Seven memory domain questions (Table 1) from the Stroke Impact Scale were used separately to assess the association with systolic BP, with control defined as ≤120mmHg, at 12 months in logistic regression models adjusted for race, gender, education, age, and intervention status. Models were additionally adjusted for 6-month BP control as a mediator.

Results:
Participants were almost equally white (28%), Black (33%), or Hispanic (34%) and 52% were female with a mean age of 65 (SD=13). About 25% had BP control at 6 or 12 months. Memory measures were not significantly associated with BP control prior to adjusting for BP control at 6 months. After adjusting for 6-month BP control, participants with less difficulty remembering things that people just told them (OR=1.69, 95% CI: 1.09, 2.63) or remembering to do things (OR=1.76, 95% CI:1.09, 2.86) had better odds of having their BP controlled at 12 months. Memory items 2 and 4-7 did not show an association with better BP control.

Discussion:
Stroke survivors who were better at remembering what people told them and remembering to do things were more likely to achieve blood pressure control 1-year post-stroke. Evaluating early memory post-stroke may be an important target for secondary prevention strategies and should be further researched.
Abstract WP19: Association Between Thoracic Aortic Diameter And Intracranial Aneurysm Size
Authors: Laukka Dan , Rantasalo Ville , Gunn Jarmo , Rahi Melissa , Rinne Jaakko
Published: February 2023

Background:
Intracranial arteries and thoracic aortas vascular smooth muscle cells are derived from the same developmental tissue during embryogenesis. We reported earlier the association between thoracic aortic aneurysms/dilatations and intracranial aneurysms. IA size is related with rupture risk, but factors affecting the IAs size is poorly studied. In this study we investigated if thoracic aortic diameter correlates with IA size.

Methods:
In this retrospective cohort study, all IA patients diagnosed in Turku University Hospital between 2006 and 2016 were reviewed. IA patients with available imaging of thoracic aorta were included (n=398). Diameter of the IA (ruptured or largest unruptured) from DSA/MRA or CTA, and dimeter of thoracic aorta were measured from CTA/MRA. Patients were also categorized by IA size (<7mm and ≥7mm) and by IA status (ruptured and unruptured). Thoracic aortic diameter′s association to IA size and status (ruptured or unruptured) was investigated.

Results:
Patients with IA ≥7mm had greater diameter in ascending aorta (33.9 vs 23.5, p=0.001), aortic arch (29.6 vs 28.5, p=0.002) and descending aorta (25.7 vs 24.5, p=0.001) than patients with IAs <7mm. Diameter of ascending aorta (β=0.132 SE 0.07, p=0.041), diameter of aortic arch (β=0.175, SE 0.07, p=0-016) and age (β=0.05, SE 0.02, p=0.03) were associated with increased IA size, unadjusted. All aortic diameters were associated with the risk for IA ≥7mm with odds ratios of 1.07 (1.02-1.12, p=0.004) for ascending aorta, 1.07 (1.01-1.12, p=0.013) for aortic arch and 1.10 (1.03-1.17, p=0.005) for descending aorta.

Conclusions:
Thoracic aortic diameters are greater in patients with larger IAs. Increasing thoracic aortic size is associated with the risk of larger IAs. Common characteristics in pathophysiology are possible.
Abstract WP192: Comparison Of Ischemic Stroke Outcomes At A Safety Net Hospital And Academic University Hospital
Authors: Kambhampati Sarita , Jones Erica
Published: February 2023

Introduction:
Healthcare disparities continue to be a critical barrier to achieving good stroke outcomes in all populations including those with least access to care. With this study, we hope to understand barriers to stroke management between two different populations at a safety net hospital (SNH) and academic university hospital (AUH) by examining the differences in risk factor profile and short term outcomes.

Methods:
Patient data was prospectively collected from 1/2021 to 6/2022, including sex, race/ethnicity, thrombolytic administration, initial NIHSS, insurance, and discharge mRS. All documented patients who presented with and admitted for acute stroke were included. Data was compared between our institution’s hospital and academic university hospital. Statistical analysis was conducted by t-test and chi-square analysis.

Results:
Over the 18 months that data was collected, 556 patients were seen at the SNH and 575 patients at the AUH. Risk factor profile and insurance status varied between both patient populations (p-value <0.001). SNH patients had fewer known risk factors at admission but demonstrated higher blood pressure, hemoglobin A1c, and cholesterol. There was no difference in rate of thrombolytic administration between both hospitals (p-value .599). SNH patients had significantly higher rates of home discharge (68.4 vs 36.2, p-value <0.001) while AUH showed higher rates of discharge to acute care facility which includes inpatient rehabilitation (55.5 vs 26.5,p < 0.001)

Conclusion:
Though the acute treatment of stroke remained similar between both patient populations, there was evidence of differences in access to care. SNH patients appear to be receiving less post-stroke rehabilitation which could worsen long term outcomes. SNH patients were less likely to have their stroke risk factors diagnosed at admission suggesting need for increased surveillance and primary care access.
Abstract WP20: Patterns Of Alert And Management Of Cerebral Aneurysms Using An Incidental Aneurysm Alert System
Authors: Fukuda Keiko A , Ghochani Yasmin , Enzmann Dieter , Arnold Corey , Liu Xiang , Morales Jose , Kimball David , Beaman Charles B , Duckwiler Gary , Jahan Reza , Szeder Viktor , Kaneko Naoki , Nour May
Published: February 2023

Introduction:
Incidentally discovered cerebral aneurysms are increasingly common as patients are more frequently imaged. To aid in this management, we developed an aneurysm alert system. Here we describe the effectiveness and outcomes of our Incidental Aneurysm Alert System (IAAS).

Methods:
IAAS received MRA and CTA reports from our Radiology department. Reports were parsed using natural language processing to identify ‘aneurysm’, automatically generating alerts for the interventional neuroradiologists. Background demographics, referral patterns, risk factors and management were then assessed.

Results:
From March to December 2020, 145 consecutive reports were reviewed. A 87% cerebral aneurysm detection accuracy rate resulted after excluding duplicates and non-vascular lesions, resulting in 117 unique cases. Median age was 65 and 65% were female. Most frequent races were 53% non-Hispanic White, 19% other, 9% Asian, 6% Black; 26% were of Hispanic ethnicity. The most common indication was acute stroke (29%). Of the detected aneurysms, 49% resulted in consultation with an interventionalist. Neurology was the most common referring specialty (37%). Of those referred, 49% underwent diagnostic and/or therapeutic angiography. Sixty eight percent who underwent cerebral angiography were intervened upon immediately or within 2 years of discovery. Seven percent were ruptured on discovery. Aneurysms were most frequently treated with flow diversion (37%), coiling (37%), and clipping (16%).Mean PHASES score of referred patients was 4.3, conferring 0.9-1.3% 5-year rupture risk. Asians and Hispanics had higher PHASES scores on presentation of 6.1 (1.7% 5-year rupture risk) and 5.2 (1.3% 5-year rupture risk) respectively, compared to Non-Hispanic Caucasians of 3.8 (0.9% 5-year rupture risk). For Hispanics, mean age was 55 and mean aneurysm size 9.8 mm as compared to 66 and 5.6 mm in non-Hispanic Caucasians. There were no significant differences in aneurysm risk factors.

Conclusions:
IAAS is an effective alerting system. Hispanics were younger with larger aneurysms on detection. IAAS may have potential value in connecting general physicians with cerebrovascular specialists, improving the management of incidentally discovered cerebral aneurysms.
Abstract WP206: Acute Ischemic Stroke And Vocal Fold Paralysis: A Propensity Matched 20-year Analysis Of The National Inpatient Sample
Authors: Vasan Vikram , Hardigan Trevor , Devarajan Alex , Rossitto Christina P , Chapman Emily K , Schuldt Braxton R , Downes Margaret H , Odland Ian C , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Introduction:
Lower cranial nerve motor dysfunction is a well-distinguished feature in acute ischemic stroke (AIS). As a result, patients can present with vocal dysfunction, including vocal fold paralysis (VFP). Few studies have examined VFP in AIS patients.

Objective:
To identify the incidence and characteristics of patients presenting with VFP after AIS.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for VFP on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
10,415,286 patients with AIS were included; 11,328 (0.1%) had VFP. At baseline, a higher percentage of patients with VFP were younger, male, insured by Medicaid, had a higher Elixhauser Comorbidity Score, and were more likely to have a tracheostomy and ventilator use (all p<0.001). Following propensity matching, multivariate analysis revealed that patients with VFP were less likely to be discharged home (AOR 0.32; 95%CI: 0.18-0.57; p<0.001) with no effect of VFP on in-hospital mortality, length of stay, or total hospital charges (p> 0.001)

Conclusion:
This is the first study to report on national trends of patients with VFP after AIS, and we found that VFP patients were more male, younger, higher overall disease burden, and required more in-hospital procedures. Though rare, VFP causes significant morbidity for patients after AIS. Patients experience significant functional deficits at discharge, as represented by the low rate of home discharge.
Abstract WP208: Cd14+ Monocytes Mediate The Immunological Environment In Aneurysmal Subarachnoid Hemorrhage Through Cxcl10 Secretion
Authors: Sanchez Sebastian , Raghuram Ashrita , Krug Randall G , Miller Jacob M , Lu Yongjun , Hasan David M , Samaniego Edgar A
Published: February 2023

Introduction:
Robust evidence suggest that aneurysmal subarachnoid hemorrhage (aSAH) triggers a potent respone from innate and adaptive inmunities. An increase in CD8+CD161+ cells has been observed in the acute phase of patients with aSAH. However, the role of this cells is poorly understood.

Methods:
Cerebrospinal fluid of patients with aSAH and non-aneurysmal SAH (nasSAH) was analyzed. Single cell RNA sequencing (scRNAseq) of CD8+CD161+ cells sorted from the CSF of patients with aSAH was performed. Specific cell populations were identified based on gene clustering. Additionaly ten genes were identified. The levels of these genes were then quantified with real-time quantitative polymerase chain reaction (RT- qPCR) and were compared in patients with aSAH and patients with naSAH. Finally highly expressed proteins were quantified with ELISA.

Results:
Gene clustering suggested that CD14+ monocytes, NK cells and T cells expressed CD8+CD161+ in the CSF of patients with aSAH. Ten differentially expressed genes of clinical interest were then identified: CCL55, CCL7, APOE, SPP1, CXCL8, CXCL10, HMOX1, LTB, MAL, HLA-DRA1/HLA-DRB1 and their mRNA levels were quantied. CXCL10 and HMOX1 levels were higher in aSAH samples than in naSAH (p=0.02 and p=0.076, respectively). CXCL10 was the most significantly different expressed gene in aSAH compared to naSAH samples, and it was chosen for further analysis with ELISA. Protein levels of CXCL10 were higher in patients with aSAH [median(IQR) = 598(635) pg/mL] compared to patients with naSAH [median(IQR) = 31(214) pg/mL, p=0.04].

Conclusion:
CD14+ monocytes, NK cells and T cells are CD8+CD161+ in patients with aSAH. CD14+ may be involved in the inflammatory response after aSAH through the expression of the pro-inflammatory cytokine CXCL10.
Abstract WP21: Staged Implementation Of A Rapid, Intensive And Sustained Blood Pressure Protocol In Patients With Acute Intracerebral Hemorrhage
Authors: Pancorbo Rosal Olalla , Sanjuan Estela , Requena Manuel , García Tornel Álvaro , Rodriguez Villatoro Noelia , Juega Jesus , Boned Sandra , Muchada Marian , Pagola Jorge , Rubiera Marta , Molina Carlos A , Rodriguez-Luna David
Published: February 2023

Background and Purpose:
The potential benefit of blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients is time-dependent and is an easy and modifiable treatment applicable to different hospital scenarios. However, previous clinical trials did not establish consensus about the best BP strategy to achieve a rapid and sustained BP control. We aimed to assess the impact of learning a staged implementation of rapid-intensive-sustained BP protocol on time targets and BP control rate over the first 24 hours of ICH.

Methods:
We conducted a retrospective analysis of data prospectively collected of consecutive patients with spontaneous ICH (<6h) and systolic BP (SBP) >150 mmHg under a rapid (antihypertensive IV bolus by a stroke nurse at CT scan), intensive (SBP target <140 mmHg within 1 hour after BP agent onset),and sustained (antihypertensive continuous infusion immediately after IV bolus) 24-hour BP protocol during a 6-year period. BP was recorded regularly according to the following schedule: every 15 minutes (0-6 hours); every 30 minutes (6h to 12h), and every 60 minutes (12h to 24h). We recorded the time from BP treatment onset to SBP target achievement and the rate of SBP sustention below target (<140 mm Hg) at all time frames. The protocol implementation was divided in 6 consecutive year periods.

Results:
A total of 207 patients were included in the study. Compared between the periods, the frequency of SBP target achievement during the first hour was increased steadily over different periods(33.3% vs. 54.5% vs. 69.2% vs 69.4% vs 75% and 59.7%;
P=0.024
); median time to SBP target achievement tended to be lower during the evolution of protocol assessment (120 [45-240] min; 49.5 [30-101] min; 53 [29-82] min; 47 [28-74] min; 48 [27-66] min; 50 [30-85] min;
P=0.054
) and SBP sustention rate below the target improve during the acute phase at different time frames, including 2h (26.3% vs. 71.9% vs 60% vs 73.9% vs. 57,7% vs 59.5%;
P= 0.012
), 4h (57.1% vs. 63.3% vs 87.5% vs 85% vs. 61.5% vs. 69.2%;
P= 0.05
), 6h (60.9% vs. 58.6%, vs 95.5% vs 84.4% vs 58.3% vs. 75%;
P=0.009
).

Conclusions:
Rapid-intensive-sustained BP protocol is a good intervention to both achieve a rapid BP target and reduce time delays,and improve the rates of BP control over the acute phase of ICH patients.
Abstract WP211: Mir-34a Modulates Outcomes After Experimental Stroke In Mice
Authors: Ren Xuefang , Sarkar Saumyendra , Evans Max , Simpkins James , O'Keefe Lena , Gusdon Aaron , Kitagawa Ryan , Choi Huimahn , Hu Heng
Published: February 2023

Ischemic stroke is one of the leading causes of death worldwide and causes significant morbidity among survivors. Studies have shown correlations between small noncoding RNAs (microRNAs, miRNAs) and stroke. We have previously reported that miR-34a depletion decreases infarct volume and attenuates neurological deficits in stroke mice. To further investigate the role of miR-34a in stroke, we utilized inducible miR-34a overexpression (miR-34a
TG
) mice. Transient middle cerebral artery occlusion (tMCAO) was performed on 6-month old doxycycline-induced miR-34a
TG
mice compared to wild-type (WT) controls. We confirmed that miR-34a
TG
mice had a ~5-fold increase of miR-34a in plasma at 24 hours post-stroke as detected by real-time PCR compared with WT naive controls (p < 0.0001) and WT-stroke controls (p < 0.0001). Following ischemia due to 60 min tMCAO, overexpression of miR-34a significantly exacerbated neurological deficit scores (p = 0.0035) and increased infarct volume compared to WT control mice at 24 hours of reperfusion (p = 0.002). Systemic delivery of a locked nucleic acid (LNA)-modified miR-34a inhibitor, antagomir-34a, in stroke mice substantially reduced infarct volume (p = 0.0021) and improved neurological deficits (p = 0.0057) at 24 hours post-stroke. Our post-stroke behavioral study revealed that antagomir-34a significantly improved functional outcomes including motor function assessed by accelerated rotarod tests at 2 weeks post-stroke (p = 0.0046) and memory deficits assessed by Morris Water Maze tests at 4 weeks post-stroke (p = 0.0012). These data demonstrate that miR-34a plays an important role in modulating acute stroke outcomes and suggest that miR-34a may be a promising therapeutic target for stroke therapy.
Abstract WP214: Inhibition Of 12/15-Lipoxygenase Attenuates Delayed Vasospasm After Subarachnoid Hemorrhage In Mice
Authors: Dienel Ari , Hong Sungha , Thomas Sithara , Torres Kiara , Rao Gadiparthi N , Thankamani Pandit Peeyush , Blackburn Spiros , McBride Devin
Published: February 2023

Approximately 30% of subarachnoid hemorrhage (SAH) patients who survive the initial ictus develop delayed cerebral ischemia (DCI) 4 to 10 days following SAH. Multiple clinical studies indicate the cause of DCI is multifactorial and includes vasospasm. 12/15-Lipoxygenase (LOX), enzymes that metabolize arachidonic acid into bioactive lipid metabolites, such as 12-HETE and 15-HETE, are expressed in several cell types of the brain including neurons, and microglia. Previous work has shown that 12/15-LOX has detrimental effects on brain vasculature and neurons, triggers inflammation, and thrombosis. In a previous study, inhibition of 12/15-LOX was beneficial in reducing early brain injury in mice after SAH. We hypothesize that inhibition of 12/15-LOX would attenuate delay vasospasm and reduce DCI in SAH mice. C57BL/6 mice of both sexes were randomized into Sham+Vehicle, SAH+Vehicle, SAH+ML351. Vehicle and ML351 (LOX inhibitor, 25mg/kg) were intravenously injected 15 minutes after SAH. 12/15-LOX
-/-
mice of both sexes were randomized into sham or SAH. Behavior was assessed daily until euthanasia on day 5 for analysis of vasospasm. Following SAH, there, there was an increased expression of 12/15-LOX in brain endothelial cells. Inhibition of 12/15-LOX in C57BL/6 males reduced large artery vasospasm and microvessel constriction, improved functional outcome, and lowered DCI incidence. In female C57BL/6 mice, inhibition of 12/15-LOX also reduced vasospasm and microvessel constriction, and ameliorated behavioral deficits. 12/15-LOX
-/-
displayed better behavior and have less delayed vasospasm. The findings of this study suggest that inhibition of 12/15-LOX is therapeutically beneficial for male and female mice after SAH via preventing delay vasospasm and DCI.
Abstract WP215: Increase In CD11b Positive Inflammatory Cells In Cardioembolic And Cryptogenic Strokes: A Study Of Thrombi From Stroke Patients
Authors: Emara Gomana , Finger Carson , ChunFeng Tan , Dongarwar Deepa , Sheth Sunil , Manwani Bharti
Published: February 2023

Introduction:
Around 25-40% of ischemic strokes are cryptogenic or strokes of undetermined etiology. Determination of stroke etiology can be challenging, requiring extensive diagnostic testing including long term monitoring for occult atrial fibrillation. Recent studies suggest that inflammation (monocytes/ macrophages driven) and fibrosis in the atrial substrate leads to atrial fibrillation/ cardioembolic strokes. Therefore, we hypothesized that clots collected from patients with cardioembolic stroke during thrombectomy will have increased myeloid derived inflammatory cells as compared to other stroke etiologies.

Methods:
54 thrombi were obtained during mechanical thrombectomy in patients with ischemic strokes after consent. They were formalin fixed, embedded, sliced and stained with CD11b, a marker for myeloid derived cells and some lymphoid cells. Mean of five 20x images from two slices per patient was quantified by image J and used for analysis. The relationship between stroke etiology (TOAST) and number of CD11b positive cells was assessed using Mann-Whitney U test and multilinear regression models.

Results:
Mean patient age was 64.2±12.5 years, 33.3% were women, 81.5% had hypertension, 22.2% had diabetes mellitus, and 37% had hyperlipidemia. Thrombi with cardioembolic etiology had significantly higher number of CD11b positive cells (248.2±137.4, n=27) as compared to strokes from large artery atherosclerosis (133.3±95.7, n=11), p=0.02. Cryptogenic strokes also had significantly higher number of CD11b positive cells, (212.1± 104.8, n=13) when compared to strokes from large artery atherosclerosis, p=0.04, n=11, even after controlling for hypertension, hyperlipidemia, heart disease, diabetes mellitus and age. No difference was seen in CD11b positive cell numbers between cardioembolic and cryptogenic strokes, p=0.4.

Conclusion:
Cardioembolic and cryptogenic stroke thrombi have increased CD11b positive cells as compared to strokes from large artery atherosclerosis. The shared histology of cardioembolic and cryptogenic strokes suggests that many of the cryptogenic strokes may be due to undiagnosed cardioembolism. Future studies using flow cytometry on thrombi can be a novel area of research for stroke etiology.