bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T P380: Blood Pressure Management among Stroke Patients: The Impact of a Comprehensive Post-Stroke Model in Louisiana
Authors: Gaines Kenneth , Commiskey Patricia , Bridges Aaron
Published: March 2022

Background and Purpose:
Stroke is the 4
th
leading cause of death in the United States, and 38.4% of Louisiana residents report being told they have high blood pressure or hypertension in 2011. The American Stroke Association estimates that 80% of stroke can be prevented through effective blood pressure management, particularly for patients who have already had a stroke. Stroke Mobile, a novel, outpatient care program provides targeted follow-up care and patient/caregiver education for 12 months as part of Ochsner's Comprehensive Stroke Care Model. Stroke Mobile Care Teams, consisting of a Registered Nurse and Lay Health Educator, visit patients and their caregivers in their homes monthly to assess overall health, existing co morbidities, including blood pressure, and provide comprehensive patient/caregiver education and support. Stroke Mobile Care Teams can link back to providers to provide real-time intervention for patients whose blood pressure is elevated. This study will describe ongoing monitoring and intervention for participants in this innovative post-stroke care model.

Methods:
The study sample includes patients discharged with a final discharge of stroke who reside in St. Tammany or Jefferson Parishes in Louisiana and have completed 12 Stroke Mobile visits in 2013-2014 (n=33). Demographic characteristics and blood pressure management at hospital discharge and upon completion of the Stroke Mobile program was analyzed.

Results:
Of those who completed 12 visits (n=33), 60.6% had uncontrolled blood pressure levels when starting the Stroke Mobile program. Following monthly monitoring and intervention (as needed) for blood pressure control, 93% of patients who had uncontrolled blood pressure levels post-discharge were at or below their blood pressure goal. All patients were educated across multiple visits on stroke risk factors and blood pressure management and reduction strategies.

Conclusions:
These results suggest clear benefit from monthly post-stroke follow-up that includes consistent blood pressure assessment and maintenance strategies combined with targeted blood pressure education on management strategies post stroke
Abstract T P389: Asymptomatic Carotid Stenosis and Silent Ischemic Brain Lesions
Authors: Pigretti Santiago , Zurru Maria C , Alonzo Claudia , Brescacin Laura , Luzzi Ariel , Waisman Gabriel , Colla Machado Pedro , Cristiano Edgardo
Published: March 2022

Background and purpose:
several studies have investigated the relationship between asymptomatic carotid stenosis (ACS) and silent ischemic brain lesions (SIBL); most of them are descriptive and link SIBL with carotid plaque morphology in the carotid territory involved. There are few controlled studies aimed to explore the relationship between ACS and SIBLs. Our objective was to evaluate SIBLs in patients with unilateral carotid stenosis, and to compare SIBL burden both hemispheres.

Methods:
patients with unilateral ACS >70% diagnosed by means of two matching methods (ultrasound and CT-angiography, or ultrasound MR angiography) were retrospectively included in this analysis. SIBL burden (periventricular and deep white matter hyperintesities (WMH), lacunar infarcts, cortical infarcts and yuxtacortical lesions) was compared between affected and non-affected side; WMH were categorized according to Fazekas scale.

Results:
fifty nine patients (mean age 75±7, 32% female) were included. Vascular risk factors profile was: hypertension 95%, dislipidemia 86%, smoking 54%, peripheral vascular disease 32%, diabetes 29%, coronary heart disease 24% and abdominal aorta aneurysm 7%. Ninety percent of patients were receiving aspirin, 93% statins and 92% antihypertensives drugs. There were no differences between white matter hypertensities, lacunar or cortical infarcts and yuxtacortical lesion burden between both sides (table).

Conclusion:
We found no difference in deep or periventricular hyperintesities, cortical and lacunar infarct and yuxtacortical lesion infarct burden related to the presence of severe ACS, suggesting that ACS is a marker of atherosclerosis and affection of more vascular beds. In our cohort, ACS seems not to be involved in subclinical ischemic brain damage facilitating pathogenic mechanisms as chronic reduced blood flow or silent microembolism.
Abstract T P392: Optimal Combination Secondary Prevention Drug Treatment and Stroke Outcomes
Authors: Park Jong-Ho , Ovbiagele Bruce
Published: March 2022

Background:
Over the last decade there has been a documented decline in the stroke incidence and mortality in several developed nations around the world, which is thought to be due mainly to better treatment of traditional risk factors for stroke. It has been suggested that optimal combination(s) of individually proven secondary prevention drug classes, could reduce recurrent vascular events. However, the effect of combining antihypertensive agents (AH), lipid modifiers (LM), and antithrombotic agents (AT) on outcomes after stroke has not previously been studied.

Methods:
We analyzed the database of a multicenter trial involving 3680 recent ischemic stroke patients aged ≥35 years and followed for 2 years. Patients were categorized by appropriateness level 0 to III depending on the number of the drugs prescribed divided by the number of the drugs potentially indicated for each patient (0=none of the indicated medications prescribed and III=all indicated medications prescribed). Independent associations of medication appropriateness level with recurrent stroke (primary outcome), stroke/coronary heart disease (CHD)/vascular death (secondary outcome), and all-cause death (tertiary outcome) were assessed.

Results:
The unadjusted rate of stroke declined with increasing medication appropriateness level (15.9% for level 0; 10.3% for level I; 8.6% for level II; and 7.3% for level III). Compared to level 0: the adjusted hazard ratio (AHR) of stroke for level I was (0.51, 95% CI, 0.21–1.25), level II 0.50 (0.23–1.09), and level III 0.39 (0.18–0.84); of stroke/CHD/vascular death for level I 0.60 (0.32-1.14), level II 0.45 (0.25–0.80), and level III 0.39 (0.22–0.69); of all-cause death for level I 0.89 (0.30-2.64), level II 0.71 (0.26-1.93), and level III 0.35 (0.13–0.96).

Interpretation:
Optimal combination prescription of secondary prevention medication was associated with an independent lower risk of stroke, stroke/CHD/vascular death, and all-cause death in recent stroke patients over a 2 year follow-up period. While future studies are certainly warranted to confirm/disconfirm our findings, clinicians may want to ensure that for eligible recent stroke patients, all appropriate secondary prevention drug classes are prescribed and maintained.
Abstract T P395: Complement Activation in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage - An Autopsy Study
Authors: Vergouwen Mervyn , Knaup Veronique , Aronica Eleonora , Rinkel Gabriel , Meijers Joost
Published: March 2022

Background:
The pathogenesis of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. It has been hypothesized that an inflammatory response in the subarachnoid space and microthrombosis contribute to DCI. Previous studies showed that plasma levels of complement factors are associated with DCI and functional outcome after aSAH. We performed an autopsy study to investigate the relationship between complement activation, microthrombosis and DCI.

Methods:
In autopsy material from 7 patients who died from DCI, we isolated 9 areas of cerebral infarction and 15 areas without infarction. From autopsy material of 5 controls (myocardial infarction: n=3; heart failure: n=1; pulmonary embolism: n=1) we isolated 15 corresponding areas. We performed immunohistochemistry to investigate the presence of C1q, C3c, and fibrin(ogen) (which is strongly correlated with microthrombosis). Optical density measurements were used for quantitative assessments. Optical density values were compared between areas with infarction, without infarction, and controls, and analyzed with a Mann-Whitney U test. Spearman correlation tests were performed to investigate the relationships of C1q and C3c with fibrin(ogen).

Results:
Optical density values of C1q, C3c, and fibrin(ogen) were higher in areas of infarction than in areas without infarction or controls (Table 1, p<0.001 for all comparisons). Correlations were found between C1q and fibrin(ogen) (r=0.73, p<0.001) and C3c with fibrin(ogen) (r=0.74, p<0.001).

Conclusion:
Our results show that areas of cerebral infarction in patients with aSAH have more complement activation and microthrombosis than areas without infarction or control brains. A strong correlation was found between complement activation and microthrombosis. Future studies are needed to investigate if drugs targeting complement activation decrease the risk of DCI and improve outcome after aSAH.
Abstract T P397: Predictors Of Extubation Success In Acute Ischemic Stroke Patients
Authors: Lioutas Vasileios-Arsenios , Kumar Sandeep
Published: March 2022

Background:
Acute ischemic stroke (AIS) often necessitate intubation and mechanical ventilation (MV) for reasons unique to this patient population. Prolonged intubation and MV have several disadvantages. Conventional extubation criteria focused on respiratory parameters are insufficient to guide extubation in these patients. .

Objective:
To identify relevant clinical and neuroanatomical markers of successful extubation in AIS patients requiring mechanical ventilation.

Methods:
We retrospectively reviewed our patient database from 2007-2012 to identify consecutive patients admitted with AIS who were intubated during hospitalization. We assessed the effect of age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, level of consciousness, facial weakness, dysarthria, neglect, infarct location (right-, left-, bi-hemispheric and brainstem), dysphagia, and history of pneumonia on successful extubation by hospital discharge in a logistic regression analysis.

Results:
112 subjects were included in the analysis. The median age and NIHSS scores (median ± standard deviation) were 74.5 ± 16.1 years and 19 ± 9.8, respectively; 56 % were women (table). In a multivariate analysis, NIHSS score ≤ 15 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.8-8.9; p <0.007) and absence of dysarthria prior to intubation (odds ratio [OR] 2.9; 95% confidence interval [CI] 1.17-7.0; P < .02) were significant predictors of successful extubation. The c-statistic for the model was 0.754 indicating good discrimination.

Discussion:
Milder stroke deficit as defined by NIHSS and absence of dysarthria prior to intubation were found to be independent predictors of extubation success. Dysarthria probably constitutes a surrogate of buccopharyngeal musculature integrity and patients’ ability to handle oral secretions. Our findings could help inform extubation practices in patients with AIS though they merit prospective validation.
Abstract T P407: Functional MRI-measured Vascular Reactivity is Preserved in CADASIL, but not Cerebral Amyloid Angiopathy
Authors: Cheema Ikreet , Switzer Aaron , McCreary Cheryl R , Frayne Richard , Goodyear Bradley G , Smith Eric E
Published: March 2022

Objectives:
Previous studies have demonstrated that the magnitude of the blood oxygen dependent level (BOLD) functional MRI (fMRI) response to visual stimulation is reduced in cerebral amyloid angiopathy (CAA) relative to controls, reflecting impaired vascular reactivity. We wished to determine if BOLD responses were reduced in an associated small vessel disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

Methods:
BOLD fMRI data were collected using a visual stimulus (contrast-reversing checkerboard) and motor task (finger-tapping). BOLD responses in the visual cortex (visual stimulus) and motor cortex (motor task) were compared between 5 CADASIL (55.0 ±12.9 years; 3 females), 18 CAA (72.1 ± 7.2 years; 6 females) and 22 control subjects (67.0 ±10.0 years; 9 females). One-way analysis of variance and multivariable-adjusted generalized models, controlling for age and hypertension, were used to compare groups with Tukey-Kramer’s correction for multiple comparisons.

Results:
BOLD response varied by group for the visual stimulus (p<0.001) but not the motor task (p=0.48). After adjusting for age and hypertension, the estimated mean visual cortex BOLD response was 3.91% in CADASIL (95% confidence interval, CI, 3.12-4.70%), 1.71% in CAA (95% CI 1.23-2.20%), and 2.84% (95% CI 2.44-3.24%) in controls. In CADASIL, the BOLD response was greater than in CAA (p<0.001) and controls (p=0.04). In CAA, the BOLD response was less than controls (p=0.009). No significant differences were observed for the motor task (p=0.51).

Conclusions:
We observed increased and unchanged BOLD responses in the visual and motor cortices of CADASIL patients, respectively. This suggests that cortical blood flow regulation by neuronal activity may be relatively preserved in CADASIL, in contrast to CAA where occipital vascular reactivity is impaired. Preserved reactivity in CADASIL may be because damage is primarily subcortical, whereas increased activation may reflect compensatory mechanisms for subcortical damage.
Abstract T P41: Combining Conventional MRI-DWI With Advanced Quantitative T2 Imaging For Characterizing Extent Of Infarction In Ischemic Stroke: The Heterogeneity Of The Evolving Ischemic Lesion
Authors: Trivedi Anurag , Kosior Robert , Mahajan Ajay , d’Esterre Christopher , Lauzon Louis , Frayne Richard , Barber Philip A
Published: March 2022

Background:
Cerebral ischemia causes cellular injury, involving not only neurons, but also cells of the neurovascular unit. DWI provides sensitive detection of cytotoxic injury during the early stages of stroke onset; however, measurement of free-water with quantitative T2 (qT2) is generally overlooked, and may provide important additional information about tissue properties not appreciated with DWI and ADC alone. Therefore, better characterization of the ischemic injury is required, particularly in the context of future stroke clinical trials.

Methods:
21 ischemic stroke patients were imaged within 6 hours of symptom onset and at 24 hours on a 3T MRI. qT2 mapping was performed using a CPMG sequence. DWI was also performed to provide ADC maps. Volumetric analysis was performed on DWI, FLAIR images, ADC and T2 maps using a combined manual and threshold-based approach.

Results:
Ischemic lesions were identified in 18/21 (86%) patients. tPA and/or endovascular treatment was administered in 83% of these patients (recanalization confirmed in 73%). Lesions were detectable at baseline in 16 (89%) of ADC maps, 17 (94%) of qT2 maps and 11 (61%) of FLAIR images; ADC lesions grew by a median of 112% while qT2 lesions grew by 54%. The median ADC/qT2 lesion overlap grew by 16%. qT2 lesions were larger than ADC in 72% of patients at baseline, and 67% of patients at 24 hrs.

Conclusions:
By combining conventional DWI and advanced qT2 imaging, we are able to better characterize the heterogeneity of infarct evolution. qT2 depicts a lesion size that is often larger than depicted by ADC, which may be important for defining lesion extent. DWI and qT2 are complementary sequences that are necessary in understanding stroke injury; reliance on one parameter alone would underestimate lesion extent.
Abstract T P48: Neuroimaging Markers of Swelling Predict Outcome After Acute Ischemic Stroke
Authors: Battey Thomas W , Karki Mahima , Singhal Aneesh B , Wu Ona , Sadaghiani Saloomeh , Campbell Bruce C , Davis Stephen M , Donnan Geoffrey A , Sheth Kevin N , Kimberly W. T
Published: March 2022

Introduction:
In malignant infarction, brain edema leads to secondary neurological deterioration and poor outcome. We investigated whether swelling is associated with outcome in a broader range of stroke severity.

Methods:
Two research cohorts (NBO and EPITHET) comprising 98 acute stroke subjects with prospective serial brain magnetic resonance imaging (MRI) were analyzed. The categorical presence of swelling and/or infarct growth (IG) was assessed on diffusion weighted MRI (DWI) by comparing baseline and 3-5 day follow-up scans. IG was defined using the ASPECTS system (small IG = decrease in ASPECTS ≥ 1; large IG = decrease in ASPECTS ≥ 2). The increase in lesion volume (ΔDWI) was then subdivided into swelling and IG volumes using region-of-interest analysis. The relationship of these imaging markers with outcome was evaluated using univariate and multivariate regression, with poor outcome defined as a 90 day modified Rankin Scale score of 3-6. Receiver operating characteristic (ROC) curve analysis was undertaken to define a threshold for prediction of poor outcome.

Results:
The presence of swelling independently predicted poor outcome after adjustment for age, admission NIH stroke scale score, admission glucose, and baseline DWI volume (OR4.55, 95%CI 1.21-18.9, p<0.02). Volumetric analysis confirmed ΔDWI was associated with outcome (OR4.29, 95%CI 2.00-11.5, p<0.001). After separating ΔDWI into swelling and IG volumes, swelling remained an independent predictor of poor outcome (OR1.15, 95%CI 1.02-1.43, p<0.02). While large IG was associated with poor outcome (OR7.05, 95%CI 1.04-143, p=0.045), small IG was not. ROC curve analysis identified a swelling volume of ≥11mL as the threshold with greatest sensitivity (77%) and specificity (75%) for predicting poor outcome (AUC=0.798).

Conclusions:
Both swelling and IG contribute to total lesion growth in the days following stroke. Swelling is an independent predictor of poor outcome in moderate to severe stroke.
Abstract T P53: Regional Vascular Status On Multi-phase CTA Correlates Well With Regional CT Perfusion Estimates And Final Tissue Fate
Authors: Trivedi Anurag , Ahn Seong Hwan , d’Esterre Christopher , Patil Shivanand , Qazi Emmad , Fainardi Enrico , Rubiera Marta , Khaw Alex , Lee Ting-Yim , Demchuk Andrew M , Goyal Mayank , Menon Bijoy
Published: March 2022

Introduction:
Multi-phase CTA (mCTA) is a new imaging tool that generates time resolved images of contrast filling-in and washout within pial vessels in ischemic brain regions. In this study, we seek to demonstrate criterion and predictive validity of this imaging tool regionally by comparing vascular status as assessed using mCTA with CT perfusion estimates and with final tissue fate.

Methods:
Data is from PRove-IT, an ongoing multi-national prospective study that seeks to understand the utility of multi-modal imaging in the triage of acute ischemic stroke patients. Only patients with M1-MCA occlusions were included for the analysis. “Delay” in maximal pial vessel enhancement, “Extent” of maximal pial vessel enhancement and degree of “Washout” of contrast within these pial vessels was each graded on a 3-point scale in each of the 5 ASPECTS regions (M2-6)(Fig 1). CBF, CBV, MTT, T Max and T0 values were calculated within these same ASPECTS regions on CTP. Reperfusion status was assessed regionally using the Kim’s template. Final tissue fate per region was determined on 24 hr MR/CT.

Results:
We included 45 patients (225 ASPECTS regions) in the study. Specific parameters on mCTA correlated with specific perfusion estimates on CTP [Delay and T0 time (Kruskal-Wallis p=0.001), Washout and MTT (p<0.001), Extent and CBV (p<0.001)] regionally. On multivariable linear regression, Washout (p=0.04) and Extent grade (p<0.001) in each region were independently associated with ipsi-regional CBF. Classification and regression tree analysis (CART) discriminated between regional CBF thresholds ranging from <7ml/100gm/min to >15ml/100gm/min using a combined “Washout+Extent” grade on mCTA. In the early reperfusers, this combined “Washout+Extent” grade was related significantly with tissue fate regionally (Fisher’s p=0.04).

Conclusion:
Regional vascular status on mCTA provides similar information to CTP estimates and is capable of predicting final tissue fate regionally.
Abstract T P7: CT Perfusion Accurately Identifies Core and Penumbral Tissue in Large Vessel Occlusion Strokes: a Paradigm Validation Using a Large Cohort of Endovascularly-Reperfused and Medically-Treated Non-Reperfused Strokes
Authors: Dehkharghani Seena , Prater Adam B , Qiu Deqiang , Bammer Roland , Nahab Fadi , Straka Matus , Bowen Meredith , Nogueira Raul G
Published: March 2022

Introduction:
MRI core and penumbral imaging paradigms show promise in tissue fate prediction in large vessel occlusion strokes (LVOS). The comparability of CT perfusion (CTP) in this context remains to be established.

Hypothesis:
We hypothesized that initial CTP “
core estimates
” would strongly correlate with final infarct volumes (FIV) in Endovascularly-Reperfused patients, while initial CTP “
hypoperfusion estimates
” would correlate with FIV in Medically-Treated Non-Reperfused patients. We aimed to ascertain which CTP parameters best predict initial core and at-risk tissue volumes in reperfused vs. medically-treated patients.

Methods:
Retrospective analysis of AIS patients presenting within 12 hours was performed. Subjects were dichotomized into either successfully reperfused post-thrombectomy (TICI 2b/3) or non-reperfused (no IV/IA therapy or confirmed persistent occlusion post IV tpa) cohorts. CTP predictors of infarct core included cerebral blood flow and blood volume (rCBV, rCBF). Total hypoperfused tissue volumes were estimated at 2s increments of time-to-maximum of the residue function (Tmax) from 4-10s. Perfusion analysis was performed on a custom computational tool (RAPID). Imaging outcome measure included final infarct volumes (FIV) on follow-up imaging.

Results:
Among 92 total patients, 57 were reperfused (21 male, mean 64±14years) with median (IQR) NIHSS=18 (7); time (min) from symptom onset to reperfusion=370 (193); ICA lesions=10 (18%); MCA-M1=37 (64%); MCA-M2=11 (19%). Among 35 non-reperfused patients (12 male, mean 68±17 years) NIHSS=12 (IQR 13); ICA lesions=8 (23%); MCA-M1=19 (54%); MCA-M2=8 (23%). In reperfused patients, significant correlations with FIV were observed only with rCBF (Pearson’s Correlation 0.42, p=0.005) (median predicted core=10cc; FIV=13.9cc) and rCBV (0.30, p=0.05) core estimates. Among non-reperfused controls, strongest correlations were again observed with rCBF (0.72) (median rCBF=2cc; FIV=16cc, IQR=62cc) and rCBV (0.74) estimates (P<0.01); however, significant correlations in this cohort were present for all hypoperfusion estimates (p<0.01).

Conclusion:
Baseline CTP profiles correlate variably with imaging outcome, depending upon reperfusion status and parameter selection.
Abstract T P85: Mammalian Target of Rapamycin (mTOR) Signaling Pathway Mediates Cerebral Ischemic Brain Damage
Authors: Hei ChangChun , Yang Xiao , Liu Ping , Meli Yvonne , Li Haining , Yap Eugene , Ma WanRui , Li P. Andy
Published: March 2022

BACKGROUND:
Mammalian target of rapamycin (mTOR) signaling regulates cell energy metabolism and cell proliferation. Recent studies have demonstrated that mTOR activation is associated with increased cardiac infarct volume and necroptosis. The role of mTOR in cerebral ischemia has not been studied. The aim of this study is to explore how mTOR pathway behavior after cerebral ischemia and whether inhibition of mTOR reduces or increases ischemic brain damage.

METHODS:
Ten minutes of global ischemia was induced in Wistar rats (2-3 months old). Animals were either treatment with mTOR inhibitor rapamycin (6 mg/kg) or its vehicle. Animal brains were harvested after 3 hrs, 16 hrs and 7 days for histopathology and protein analyses. Sham-operated non-ischemic rats were used as control. Rapamycin was i.p. injected 1 hr after reperfusion in 7-day subgroups and injected 7 days prior to ischemia in 3 and 16 hrs subgroups.

RESULTS:
10 minutes of global ischemia caused neuronal damage to the striatum, hippocampal CA1, and neocortical regions at 7 days of reperfusion. Levels of p-mTOR, p-S6K were increased significantly after 3 and 16 hrs in both the hippocampus and cortex. In addition, p-Akt and cytochrome c were elevated in the hippocampi after 3 hrs, peaked at 16 hrs and remained elevated after 7 days of reperfusion. Post-ischemic treatment with rapamycin 1 hrs after reperfusion significantly reduced brain damage in the CA1 and cortical areas at 7 days of reperfusion. Levels of p-mTOR, p-S6K, p-Akt and cytochrome c were significantly suppressed by rapamycin in non-ischemic and ischemic animals.

CONCLUSION:
Cerebral ischemia activates mTOR signaling pathway and inhibition of mTOR activativity reduces ischemic brain damage.
Abstract T P93: Blood Pharmacokinetics Of Dodecafluoropentane Following Administration Of Dodecafluoropentane Emulsion To Rabbits
Authors: Arthur Christine , Brown Aliza T , Skinner Robert D , Culp William C , Hendrickson Howard
Published: March 2022

Objective:
Intravenous injection of Dodecafluoropentane emulsion (DDFPe) increases oxygen transportation and reduces brain infarct volume in rabbit stroke models. Many potential applications in stroke, blood loss, ischemic states, and high risk angiography are yet undefined. Previous studies suggested a blood elimination half-life of <2 min but therapeutic effects last >90 min after injection. In this report, we show a two-phase DDFP pharmacokinetic profile with rapid distribution and longer elimination half-life.

Methods:
New Zealand White rabbits (N=6) were administered an I.V. bolus of DDFPe (12 mg DDFP/kg). Blood samples were taken at pre-dose and then every 3-min for 40 min following the dose. Samples were transferred to headspace vials and stored at -20 0C until analyzed by headspace sampling coupled to GC-MS analysis. Pharmacokinetic parameters were determined using compartmental analysis with exponential terms calculated using the curve-stripping method (PK Solutions 2.0).

Results:
A 2-compartment model was the best fit to the DDFP blood concentration-time profiles in each of the animals tested. A rapid distribution phase followed by a longer elimination phase was observed. The distribution phase half-life was 1.15 ± 0.6 min, while the elimination half-life was 13.5 ± 11 min (N=4).

Conclusions:
A traditional serum pharmacokinetic approach toward development of proper dosing regimens for DDFPe stroke therapy is not feasible given the short half-life relative to the known pharmacodynamic model that shows efficacy for 90-min following a dose of DDFPe. Organ specific pharmacokinetics of DDFP in tissues such as the brain will likely lead to more effective pharmacokinetic models of DDFP following administration of DDFPe.
Abstract T P95: Stroke Physical Rehabilitation: Impact on Motor Functional Recovery in Drug Treated versus Vehicle Treated Rats
Authors: Ragas Moner A , Balch Maria , Hensley Amber , Reynolds Kenney , Wright Danny , Kerr Bryce , Corbett Adrian M
Published: March 2022

Background:
Post-stroke physical rehabilitation has been considered essential for enhancing sensorimotor functional recovery. We assessed the hypothesis that physical rehabilitation would improve functional task performance in drug-treated rats compared to vehicle-treated ones.

Methods:
Adult female Sprague-Dawley rats, which have previously been trained on Montoya Staircase and Forelimb Asymmetry tasks, were subjected to endothelin-1-induced middle cerebral artery occlusion. The rats were treated daily using either a drug combination of 5 mg/kg Fluoxetine and 1 mg/kg Simvastatin or a vehicle control beginning 6-12 hours after stroke. On post-stroke day 8, the rats were underwent voluntary rehabilitation every other day for a period of five and half weeks. Behavioral tests were performed to assess motor functional recovery after stroke induction.

Results:
In drug-treated rats, both rehabilitated and non-rehabilitated groups showed a 34% recovery in contralateral limb function; whereas, in vehicle-treated rats, animals that underwent physical rehabilitation showed a mean of 26% recovery in contralateral limb function versus 8.6% recovery in non-rehabilitated ones. The ipsilateral limb of non-rehabilitated (control and drug-treated) rats showed a significant (~23% versus -0.1%) difference in functional recovery from rehabilitated rats. There was also significance difference in the baseline ipsilateral deficit between rehabilitation and non-rehabilitation groups which may help explain this statistical difference in the ipsilateral limb performance. The starting time for drug delivery may have negatively influenced the functional recovery. The early delivery (6-12 hours after stroke induction) of this drug combination resulted in a larger infarct size than had previously been seen when this drug treatment was delivered beginning 20-26 hours after stroke induction. Early delivery of the drug combination may result in secondary hemorrhagic stroke.

Conclusion:
This study proves that our drug combination treatment allows for sensorimotor functional recovery after ischemic stroke in those individuals for whom physical rehabilitation may not be possible, giving slightly better motor functional recovery in grasping.
Abstract W MP1: Collateral Grade Drives the Importance of Time to Reperfusion in the Stentriever Era: The ENDOSTROKE Registry
Authors: Liebeskind David S , Berkefeld Joachim , Niederkorn Kurt , Deutschmann Hannes , Reich Arno , Wiesmann Martin , Gröschel Klaus , Boor Stephan , Nolte Christian H , Bohner Georg , Neumann-Haefelin Tobias , Hofmann Erich , Stoll Anett , Bormann Albrecht , Scalzo Fabien , Weimar Christian , Schlamann Marc U , Singer Oliver C ,   for the ENDOSTROKE Study Group
Published: March 2022

Background:
Time to angiographic reperfusion has been hailed as paramount to all other factors in achieving good clinical outcomes after endovascular stroke therapy (EVT). Heterogeneity in collateral status, however, may dictate the individual timecourse of therapeutic risk/benefit in a given patient. Time to earliest reperfusion (Thrombolysis in Cerebral Ischemia 2A or TICI2A) has not been previously analyzed and this measure may considerably decrease with recent use of modern stentriever devices.

Methods:
ENDOSTROKE is an industry-independent, centrally-monitored multicenter registry evaluating EVT in routine clinical practice. Central reading of angiographic data blinded to clinical information was performed by the core lab. For these analyses, we selected only proximal MCA occlusions proven as TICI 0 before EVT, with available ASITN collateral grade and final TICI 2B-3. The data center analyzed the relationship of these angiographic parameters with clinical variables, including 90-day mRS 0-2 (good clinical outcome).

Results:
116 patients met these strict inclusion criteria. Median age was 72 years (63, 76) with median initial NIHSS 15 (12, 19). 80 had good collaterals (ASTIN grades 3-4), 36 patients had poor collaterals (ASITN grades 0-2). Both groups did not differ significantly concerning age or initial NIHSS. Good clinical outcome was reached by 51% with good and 42% with poor collaterals (p=0.339). Time from symptom onset to the start of angiography was similar in both groups (200 min vs. 186 min in good vs. poor collaterals, p=0.393). However, in the poor collaterals group, time to TICI 2A was significantly shorter in patients with good clinical outcome (177 min (151, 221)) than in patients with poor clinical outcome (261 min (184, 326), p=0.012). In patients with good collaterals, no significant difference of the time to TICI 2A was found between good (229 min (152, 281)) and poor outcome (230 min (178, 298), p=0.779).

Conclusions:
Time to angiographic reperfusion, from symptom onset to earliest reperfusion (TICI 2A) dominates endovascular procedure time. Time
is
paramount in those with
poor
collaterals, whereas time may be irrelevant in those with
good
collaterals.
Abstract W MP104: tPA Administration and Dosing Errors within a Regional Stroke System
Authors: Chung Lee S , Tkach Aleksander , Lingenfelter Erin M , Dehoney Sarah B , Hannon Peter M , Wold Jana J , Rollo Jeannie , Grantz Matthew R , Wang Haimei , Weathered Natalie R , Majersik Jennifer J
Published: March 2022

BACKGROUND:
Utilization of systemic IV tPA in acute ischemic stroke (AIS) requires weight-based dosing and a standardized infusion rate. We describe the frequency and types of tPA administration errors made in a comprehensive stroke center (CSC) and at stroke receiving facilities prior to transfer. METHODS: Using a prospectively-collected stroke quality database, all patients included received IV tPA from 2010-11 either at the CSC or prior to transfer (“drip-and-ship”). Retrospective data collection included pharmacy, air transport, and nursing records. RESULTS: We identified 131 tPA-treated AIS cases: 51% female; mean age 68 years; 33% treated at CSC; and 67% treated pre-transfer (including 16% by telestroke) from 22 facilities. Treatment of stroke mimics was more common at the CSC (12% vs 9%, p=NS). Pre-tPA blood pressure was more frequently not recorded in transfers (64% vs 7%, p<0.0001). tPA dosing/administration errors were present in 49.6% of all patients (26% at CSC; 61% of transfers, p=0.0001): infusion > 60 minutes (14%), total dose >90mg (5%), suspension/discontinuation of infusion (5%), or delayed tPA delivery to bedside (4%). Body weight discrepancies between institutions were frequent among transfers (42%). Parenchymal hematomas (PH) occurred in 7.5% of all patients (or 6.2% with tPA errors, 9.1% without errors); in-hospital death occurred in 10.7% overall (or 9.2% with errors, 12.1% without errors). PH, mortality and mRS did not differ between CSC-treated patients and transferred patients nor between those with and without errors. See table. CONCLUSION: tPA errors were very common in our large, regional stroke system, particularly among patients treated as “drip-and-ships”. Though in this study errors were not associated with outcomes, CSCs should include tPA dosing/administration education and quality assurance mechanisms within their systems in order to reduce avoidable, systematic errors.
Abstract W MP107: Palliative Care Referrals are Under-used
Authors: Richetts Renee E , Afshar Katherine , Berger Lynn , Cantonis Matthew , Corbin Timothy , Guerrero Jackie , Olson-Mack Lindsay , Rockwell Jean
Published: March 2022

Introduction:
The National Institutes of Health Stroke Scale (NIHSS) is a well-validated predictor of 90-day functional outcomes. A score of ≥16 forecasts a high probability of death or severe disability. The palliative care (PC) needs of patients with serious or life-threatening stroke are enormous. Per PC standards and the American Stroke Association’s position statement on PC after stroke, customized PC should be available to patients and their families throughout the entire course of illness. Palliative care can be initiated in the hospital setting without limitations on life expectancy. The purpose of this project was to quantify NIHSS scores on admission compared to the percent of PC referrals made at 3 urban hospitals that use neurological pre-formatted orders, and have in-patient PC programs.

Hypothesis:
We hypothesized that In-patient PC referrals for stroke patients with NIHSS scores of ≥16 are low, in the context of pre-formatted orders that set the referral trigger at ≥ to 25.

Methodology:
Ischemic and hemorrhagic stroke cases discharged from Nov. 1, 2013-May 31, 2014 were reviewed retrospectively (674 total). NIHSS assessments were scored by stroke-certified RN staff on admission. Excluded were patients whose full NIHSS score was not documented, patients referred directly to hospice, and patients who left Against Medical Advice. Cases were examined for NIHSS score, and whether or not they were referred to PC.

Results:
Of 615 qualifying patients, 51 (8.3%) were referred for PC during their in-patient stay. The percentage with a NIHSS score on admission </= 6, was 3.5% (11/313). At a score of 7-15, 7.8% (15/188) received referrals. At scores ≥ 16, 21.9% (25/114) were referred.

Conclusion:
While the poor 90-day outcomes for patients with NIHSS scores ≥ 16 have been well-validated, just under 22% of the patients in this study received in-patient referrals to palliative care. Previously conducted studies relating NIHSS scores and 90-day outcomes suggest that there is an opportunity to improve the quality of life for more of these patients and their families through increased palliative care referrals.
Abstract W MP118: Influence of Do-Not-Resuscitate Orders on Length of Stay and Cost of care after Intracerebral Hemorrhage after Charlson's Comorbidity Index adjustment in United States
Authors: Jani Vishal B , Lahewala Sopan , Patel Achint , Arora Shilpkumar , Hussain Syed I , Razak Anmar , Solanki Shantanu , Kassab Mounzer , Chaudhary Saqib , Hassan Ameer , Suri Fareed , Qureshi Adnan
Published: March 2022

Background:
The trends in utilization of Do-Not-Resuscitate Orders (DNR) and its effect upon outcomes among patients with intracerebral hemorrhage (ICH) is not studied within a national representative population.

Objective:
To identify the contemporary rate of utilization impact of DNR status on length of stay (LOS) and cost of care among patients (pts) admitted with ICH.

Methods:
We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2011 for ICH using ICD 9-CM code (431) as a primary diagnosis. We defined patients’ DNR status with ICD CM code - V49.86 as a secondary diagnosis. Comorbid conditions were defined by Charlson's Comorbidity Index (CCI). Cost to charge ratio files were merged with NIS to calculate cost of care. LOS was calculated only in pts who were alive. T test was utilized for univariate analysis for continuous variable. Hierarchical multilevel regression models were generated to determine independent predictors of LOS and cost of care.

Results:
Total of 13440 pts (weighted: 64617) with ICH were analyzed, out of which 2029 pts (weighted: 9713) had DNR orders. Average LOS and cost of care for all ICH pts were 8.76 ± 0.12 days and $ 19386 ± 261, respectively. In univariate analysis, LOS and cost of care were lower in DNR pts (LOS: 5.76 ± 0.34 vs. 9.04± 0.13, p <0.001; Cost: $11020 ± 400 vs. $20916 ± 298, P <0.001). In multivariate analysis, the results were (days/cost, 95% CI, P-value) (LOS: -1.30 days, -2.26 - -0.35, p<0.001; cost: $ -5509, -6851 - -4168, p<0.001). Elective admission was associated with decrease in cost (Cost: $ -2439, -4506 - -372, p=0.02). Pts with private insurance were more likely to have decrease LOS and cost of care (LOS: -1.62, -2.35 - -0.90, p<0.001; Cost: -1439, -2745 - -132, p=0.03) as compared with Medicare/Medicaid. Hospital teaching status was associated increase in cost of care while self pay/others was associated with decrease in cost of care. CCI >= 3 was associated with increase in both cost of care and LOS as compared to CCI= 1.

Conclusions:
DNR status in patient with ICH is a predictor of a significantly lower LOS and cost of care. Appropriate use of DNR status may reduce LOS and cost of care in ICH patients and decrease inappropriate resource utilization.
Abstract W MP24: Improving Collateral Circulation Evaluation Accuracy: Multiphase CTA on Acute Stroke
Authors: Rubiera Marta , Carvalho Vanessa , Bonet Sandra , Flores Alan , Carcamo Daniel , Lemus Miguel , Coscojuela Pilar , de Bonadona David , Ponciano Rafael , Muchada Marian , Rodriguez-Luna David , Pagola Jorge , Sero Laia , Tomasello Alejandro , Menon Bijoy K , Goyal Mayank , Ribo Marc , Molina Carlos A
Published: March 2022

Good collateral circulation (CC) associates favourable outcomes on acute stroke patients, but which is the best technique to evaluate it is controversial. Single-phase CTA (sCTA) is widely used, but lacks of temporal resolution, and may mislabel CC. We aim to evaluate a new, quick (not post processing), time resolved technique to evaluate CC: multiphase CTA (mCTA).

METHODS:
Consecutive <4.5h stroke patients evaluated for reperfusion therapies with confirmed M1-MCA or TICA occlusion by sCTA were included. Two more cerebral CTA acquisitions with 10 and 20 seconds delay were performed for mCTA. CC evaluation is described in the Table. sCTA and mCTA were compared as predictors of clinical, radiological and functional endpoints. Recanalization (REC) was assessed by TCD at 24h.

RESULTS:
78 patients were included. Mean age: 66.3±13.6y, median NIHSS 17.5 (IQR 6.3), 52 (66.7%) M1- and 26 (33.3%) TICA-occlusions. Mean time from onset to CTA: 2:32±1:31h. On sCTA, 61.8% patients presented good CC whereas on mCTA, 54.7%. Only on mCTA good CC was an independent predictor of low infarct volume at 24h (OR 3.6, CI 95% 1.3-10.5, p=0.017).

Moreover, only mCTA-CC status was associated with lower 24h median NIHSS (good CC:5 vs poor CC:17, p<0.001), and 3 months favourable outcome (mRS0-2: good CC 57.1% vs poor CC 11.5%, p<0.001).

Association with outcome was especially significant in patients without REC: among poor CC patients, mRS0-2: 0% in non REC Vs 50% in REC (p<0.01).

In a logistic regression model including age, NIHSS, ASPECTS and REC, only good CC on mCTA predicted favourable outcome (OR 6.8, CI 95% 1.6-29.2, p=0.009).

CONCLUSION:
CC evaluation on mCTA improves accuracy of clinical and radiological endpoints as compared with sCTA. Good CC on mCTA is an independent predictor of low infarct volume and good outcome, especially if REC is not achieved.
Abstract W MP27: Treatment with Intravenous Thrombolysis in Acute Ischemic Stroke is Associated with Reduced Bed Day Use: A Nationwide Propensity Score Matched Follow-Up Study
Authors: Terkelsen Thorkild , Schmitz Marie Louise , Simonsen Claus Z , Hundborg Heidi , Christensen Hanne , Ellemann Karsten , Geisler Karin , Iversen Helle , Madsen Charlotte , Rasmussen Mary-Jette , Vestergaard Karsten , Andersen Grethe , Johnsen Søren P
Published: March 2022

Introduction:
Several studies have demonstrated the beneficial effects of intravenous tissue-type plasminogen activator (IV-tPA) on neurological outcome in acute ischemic stroke. It is uncertain whether the improved neurological outcome also translates into less morbidity and lower need for hospital admissions during follow-up.

Methods:
We conducted a register-based nationwide propensity score-matched follow-up study among ischemic stroke patients in Denmark (2004-2011). IV-tPA-treated patients were propensity-score matched with IV-tPA eligible but non-treated ischemic stroke patients from stroke centers not offering tPA. The adjusted Hazard ratio (HR) for first readmission was estimated by multivariable Cox regression among patients who survived the initial stroke admission. Total all-cause bed day use in the first year after stroke admission was determined for patients with a potential follow-up time of at least one year and was compared between groups by a paired t-test after logarithmic transformation.

Results:
We identified 1896 IV-tPA-treated and 1896 corresponding propensity-score matched non-treated patients surviving the initial stroke admission. A total of 43.2% of the patients were readmitted to hospital during a median of 0.8 years. The adjusted HR for first readmission was 0.93 (95% CI: 0.79-1.09) when comparing IV-tPA-treated with non-treated patients. In 1462 matched pairs followed the first year after stroke the median all-cause bed day use was 10 (IQR: 4-37) in the group of tPA-treated and 16 (IQR: 6-43) in the group of non-treated patients. The relative bed day use was 0.81 (95% CI: 0.74-0.88) when comparing IV-tPA-treated with non-treated patients.

Conclusion:
Use of IV-tPA in ischemic stroke patients was associated with lower long-term all-cause hospital bed day use.
Abstract W MP29: Stroke Severity and Thrombolysis-Induced Intracerebral Haemorrhage: Thrombolysis Practice and Outcomes in England and Wales at the Extremes of the NIHSS
Authors: Bray Benjamin D , Campbell James , Cloud Geoffrey C , Hoffman Alex , James Martin , Paley Lizz , Tyrrell Pippa J , Rudd Anthony
Published: March 2022

Background:
The safety and outcomes of thrombolysis with intravenous tPA in patients with mild stroke or very severe stroke are still debated. We describe the use and outcomes from thrombolysis across the full range of stroke severity in England and Wales.

Methods:
The Sentinel Stroke National Audit Programme (SSNAP) is the prospective stroke register for England and Wales, with 100% population coverage. Data are entered by clinical teams using a secure online web portal. Symptomatic intracranial haemorrhage (SIH) was defined pragmatically (evidence on imaging plus clinical deterioration).

Results:
58,769 ischaemic stroke patients were admitted from April 2013-March 2014, and 7598 (12.9%) received tPA; median NIHSS was 4 (IQR 2-9). Of the 6578 (86.9%) patients treated with tPA with documented NIHSS, 816 (12.4%) were mild (NIHSS 0-4) and 650 (10.0%) were very severe (NIHSS ≥ 22). The overall incidence of SIH was 4.0% (95% CI 3.5-4.5). Risk of SIH increased with stroke severity: 1.4% with NIHSS 0-4, 3.1% with NIHSS 5-14, 5.7% with NIHSS 15-21 and 8.8% with NIHSS ≥22. The association between NIHSS and SIH was similar across stroke onset-tPA times of 0-3 hrs, 3-4.5 hrs and >4.5 hrs. Compared to patients with NIHSS 5-14, patients with NIHSS 0-4 or NIHSS ≥22 had an adjusted odds ratio for SIH of 0.47 (0.3-0.9) and 2.6 (1.9-3.7) respectively. Outcomes in patients with NIHSS ≥22 treated with tPA were poor: 30 day mortality was 36% and 71% of survivors had a poor outcome (modified Rankin Scale score 3-5). Most patients (77%) with mild stroke treated with tPA had a good outcome (mRS 0-2) and 30day mortality was 2.4%.

Conclusions:
Thrombolysis in mild or very severe stroke is common practice in England and Wales. Risk of SIH following IV tPA is strongly related to stroke severity; the risk is significantly higher among severe strokes, for whom outcomes with tPA remain poor.
Abstract W MP30: Multi-Center Experience With Low Dose Intravenous Abciximab in Large Vessel Posterior Circulation Stroke
Authors: Mandava Pitchaiah , Rosso Charlotte , Samson Yves , Kent Thomas A
Published: March 2022

BACKGROUND:
Although a phase 3 trial using cardiac dose of the GP IIb/IIIa inhibitor abciximab was halted, we previously reported that a 30% lower total intravenous (IV) abciximab dose achieved optimal platelet inhibition (92%) and showed benefit in patients ineligible for tPA when compared using a rigorous matching process to historical controls (Mandava et al, TSR 2010). Given lack of proven alternatives, we were interested in abciximab specifically in the posterior circulation.

METHODS:
0.2 mg/kg IV bolus followed by 0.05 ug/kg/hr infusion over 12 hrs of abciximab was administered with suspected large vessel posterior circulation occlusion after informed consent and presentation of alternatives. Patients were ineligible for tPA mostly from time window (24 hrs, later changed to 12 hrs) or elevated INR < 2.5. A weight based heparin protocol was used in most patients to achieve PTT 46-70. Ninety day follow up was obtained. To assess benefit, patients’ baseline characteristics were compared to the NINDS control arms subjects restricted to large vessel and cardioembolic subtypes. Matching was performed for 5 hour baseline NINDS NIHSS, age, glucose, and posterior stroke. An excess of posterior strokes in the abciximab group permitted 2:1 matching with outlier elimination. McNemars test compared 90 day mRS 0-1/0-2, mortality, and hemorrhage

RESULTS:
26 subjects were treated in 3 university centers. Post-match baseline variables were slightly more severe in the abciximab group and they were treated later (Table). 90-day functional outcomes were higher in the abciximab group (mRS 0-1:54.5% vs 23.1%, mRS 0-2: 63.6% vs 30.8%; p<0.008). Non-significant higher mortality was seen in the NINDS group while symptomatic hemorrhage rate was non-significantly higher after abciximab.

CONCLUSION:
Low dose IV abciximab in extended time window for large vessel posterior stroke shows promise. Given lack of proven alternatives, these results need to be verified prospectively.