bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP1: Complications Of Intravenous Tenecteplase For The Treatment Of Acute Ischemic Stroke: A Systematic Review And Meta-Analysis
Authors: Rose Deborah , Cavalier Annie , Kam Wayneho , Cantrell Sarah , Lusk Jay , Schrag Matthew , Yaghi Shadi , Stretz Christoph , De Havenon Adam H , Saldanha Ian , Wu Teddy Y , Ranta Anna , Barber Alan , Marriott Elizabeth , Poli Sven , Mac Grory Brian C
Published: February 2023

Introduction:
Prior systematic reviews have focused on a comparison of efficacy endpoints between tenecteplase (TNK) and alteplase. The objectives of this study are to determine whether the rate of treatment complications differs between patients treated with the two agents.

Methods:
This systematic review (CRD42022303835) was performed according to PRISMA guidelines. We included prospective, interventional studies and prospective and retrospective observational studies. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science and the ClinicalTrials.gov registry from inception through June 3
rd
2022. The primary endpoint was symptomatic intracranial hemorrhage (sICH) and secondary endpoints included any ICH, mortality, angioedema, gastrointestinal hemorrhage and other extracranial hemorrhage. We performed separate random effects meta analyses for each endpoint. Evidence was synthesized as relative risks, comparing subjects exposed to TNK versus alteplase as well as absolute risks in those treated with TNK.

Results:
Of 2,226 records identified, 26 were eligible for inclusion including 7,921 patients. Seventeen studies included alteplase as a comparator group and 10 were non-comparative. The relative risk of sICH in patients treated with TNK compared with alteplase was 0.93 (95% CI: 0.68-1.28). Across those treated with low, medium and high doses of TNK, the relative risks were 0.78 (95% CI: 0.22-2.82), 0.84 (95% CI: 0.58-1.20) and 2.31 (0.69-7.75) respectively. The unadjusted rate of sICH, including comparative and non-comparative studies, was 1%, 2% and 4% within the low, medium and high dose groups.

Discussion:
To-date, this is the most comprehensive systematic review examining relative complications of TNK and alteplase. The rate of treatment harms is broadly comparable between those treated with the two agents. We present evidence that the rate of sICH may be increased in those treated with higher doses of TNK.
Abstract WMP100: Association Of Clonal Hematopoiesis Of Indeterminate Potential With Clinical Features And Outcome Of Patients With Acute Ischemic Stroke
Authors: Lee Eung-Joon , Jeong Han-Yeong , Kang Dong-wan , Yang Wookjin , Kim Jeong-Min , Ko Sang-bae , Park Kyung-Il , Lee Seung-Hoon , KOH YOUNGIL , Jung Keun-hwa
Published: February 2023

Introduction:
Clonal hematopoiesis of indeterminate potential (CHIP) has been linked with incident cardiovascular disease and its outcome. However, the association between CHIP and acute ischemic stroke is not yet fully elucidated.

Methods:
This retrospective, observational cohort study included 366 acute ischemic stroke patients from a single center prospective stroke registry and 4,628 general population control (age over 40 years old). We compared the prevalence of CHIP between stroke patients and control groups. A multivariable linear or logistic regression model was used to assess the association between CHIP and initial stroke severity, hemorrhagic transformation and functional disability at 90-day (modified Rankin scale score >1) after stroke. The contribution of individual CHIP driving genes was also evaluated.

Results:
When comparing the acute ischemic stroke patients (N=366) and the general population (N=4,628), the prevalence of CHIP was significantly higher in stroke patients than in the general population (32.0% vs. 13.9% with variant allele frequencies of 1.5%, p<0.001). Most mutated genes in CHIP of stroke patients were DNMT3A, TET2, and PP1MD, in order. In the stroke patients group, the presence of CHIP was significantly associated with initial stroke severity (β=1.4350, p=0.0453). Furthermore, after adjusting covariates, presence of CHIP independently predicted the occurrence of hemorrhagic transformation (adjusted odds ratio [aOR]=7.261, 95% confidence interval [CI] 4.183-12.968, p<0.001) and functional disability after stroke (aOR=2.214, 95% CI 1.237-3.984, p=0.008). PP1MD was most strongly associated with the incident ischemic stroke, while DNMT3A was most highly related with a functional disability after stroke.

Conclusion:
CHIP was obviously increased in ischemic stroke patients. Furthermore, CHIP was significantly associated with stroke severity, hemorrhagic transformation, and functional disability at 90 days.
Abstract WMP108: Genomic Risk Scores And Oral Contraceptive-associated Ischemic Stroke Risk
Authors: Lin Forrest , Gaynor Brady , Cole John W , Mitchell Braxton D , Kittner Steven J , Putaala Jukka , Tomppo Liisa
Published: February 2023

Objective:
To evaluate whether a genomic risk score for ischemic stroke (IS) modifies oral contraceptive (OC)-associated IS risk.

Background:
OCs are generally safe but vascular risk factors are known to increase OC-associated IS risk. If a genomic risk score could identify a subset of women with substantially increased risk of OC-associated IS, this could influence prescribing guidelines and reduce stroke events.

Methods:
In the Genetics of Early-Onset Stroke (GEOS) study, there were 340 premenopausal women (143 IS cases and 197 controls) with data on OC use within 30 days prior to index event for cases or prior to interview for controls. Using a previously validated genomic risk score (metaGRS) for IS based on 19 polygenic risk scores of vascular events and risk factors, we stratified our sample into tertiles of genomic risk and calculated the association between OC use and IS within each tertile. We tested if the association between OC use and IS depended on genomic risk of stroke using logistic regression with an OC use*metaGRS interaction term.

Results:
Among all women, OC use was significantly associated with IS (odds ratio = 2.4, p = 0.002). The odds ratio for IS associated with OC use decreased from 3.9 in the tertile with highest genomic risk of IS to 1.5 in the tertile with lowest genomic risk (see Table). The formal test of interaction was consistent with our hypothesis (p = 0.07) that the genomic risk score modifies the association of OC use with IS.

Conclusions:
The results of our exploratory analysis support the need for international collaboration to generate sufficient sample sizes to determine whether a genomic risk score could be clinically useful in reducing OC-associated IS.
Abstract WMP109: Aged Maternal Biome Impairs Offspring Health
Authors: Blixt Frank W , Honarpisheh Parisa , Khan Romeesa , Ganesh Bhanu P , McCullough Louise D , Kim Geonwoo
Published: February 2023

Background:
The gut and its microbiome have become highlighted because of their holistic effect on the body in health and disease. The bi-directional communication of the gut-brain axis is highly involved in, among others, the immune response. Additionally, the maternal gut microbiome affects offspring brain, immune system, and gut microbiome formation and development. Therefore, an aged and unhealthy maternal biome that is may increase both stroke risk factors among offspring.

Method:
Young female C57B6 mice 3-month (M) of age had their host gut bacteria cleared via antibiotic treatment prior to recolonization via fecal microbiome transplants from 3M control, and 18M reproductively senescent female mice. The subsequent offspring was aged to 18 months, followed by behavioral tests, glucose tolerance, and blood pressure measurement, prior to a transient 90-minute middle cerebral artery occlusion (MCAO).

Results:
Compared to control females with 3M biome, females with an aged biome had decreased fecundity from 26.4 days to 54.75 days at the onset of breeding to birth of pups (p=0.0018). There was no change in estrus cycle between the groups. The offspring gut microbiome had been affected in a sex specific manner. Female pups from dysbiotic, aged, biome mothers differed significantly in terms of b-diversity compared to those from control mothers (p=0.009) with pathogenic increases to firmicutes shifting the F:B ratio. There was a less pronounced trend in male offspring (p=0.241). Interestingly, no weight differences were observed in offspring depending on the maternal biome. At 2M of age, a depressive phenotype in tail suspension test was noted for male(p=0.0001) and female (p=0.0059). However, at 6M and older, the depressive phenotype subsided. Male offspring at 18M demonstrated a significant change (p=0.0001) in Glucose tolerance test compared to age matched females.

Conclusion:
The maternal microbiome has a significant impact on offspring biome composition and health. Mice from mothers with aged microbiome exhibited early life depressive phenotypes, slower glucose metabolism, and a pathogenic gut microbiome composition. Therefore, maternal gut has transgenerational health effects which may be exacerbating stroke risk and potentially outcome.
Abstract WMP111: MicroRNAs As A Therapeutic Target To Reduce Microglial Activation After Post-stroke Social Isolation
Authors: Banerjee Anik , Mooz Patrick , Lee Juneyoung , Venna Venugopal R , McCullough Louise D
Published: February 2023

Introduction:
Social isolation (SI) and loneliness are linked to all-cause mortality, as well as mortality from stroke and other vascular diseases. However, the mechanisms mediating the effects of social factors on stroke recovery are unknown. We hypothesized that differential expression of miRNAs contributes to the deleterious effects of post-stroke SI.

Methods:
Aged (18-20 months) C57BL/6 male mice were used to examine the detrimental effects of post-stroke SI on miRNA profiles in the brain. Mice were randomly assigned to either pair housing (PH), or single housing (SI) three days after a 60-minute transient right middle cerebral artery occlusion (MCAO). At this time point (post-stroke day 3), the infarct is complete, and was equivalent between groups, avoiding potential changes seen with differing infarct sizes. Temporal miRNA profiling of the ipsilateral hemisphere was assessed at two-time points (post-stroke SI D4 and D27). Brain cells were analyzed by flow cytometry.

Results:
Post-stroke SI resulted in significant alterations of distinct miRNA profiles within the brain across both acute and chronic time points (n=4/grp, FDR adjusted *
p
<0.05). MiRNA-mRNA interactional analysis revealed miR-10a-5p and miR-10b-5p as pivotal nodes within the pool of miRNAs that interacted with the largest subset of miRNAs for post-stroke at SI D4 and D27, respectively. Downstream pathway analysis utilizing an independent repository, the KEGG pathway showed 4 days of isolation resulted in the enrichment of pathways related to microglial activation and 27 days of isolation lead to the activation of neuronal-specific pathways that regulate cognition and motivation (FDR adjusted *
p
<0.05). Independent validation cohorts demonstrated significant activation of microglia at post-stroke SI D4 as assessed by the median fluorescence intensity (MFI) of purinergic receptor P2Y12 (P2RY12), in CD45
int
CD11b
+
P2RY12
+
cells in the brain. MFI of P2RY12 was significantly downregulated in post-stroke SI mice at D4 (n=7-8/grp, *
p
<0.05) compared to PH mice.

Conclusions:
These results support our hypothesis that post-stroke SI exacerbates microglia activation, and results in the differential expression of microglial pathway-related miRNAs.
Abstract WMP112: Type 2 Diabetes Dampens Neuroprotection Against Ischemic Injury By Lipopolysaccharide-Induced Preconditioning
Authors: Sato Yoshimichi , Omodaka Shunsuke , Wong SuWai , Liu Jialing
Published: February 2023

Introduction:
Evidence suggests that lipopolysaccharide (
LPS
)
preconditioning
(PC) provides neuroprotection by inducing tolerance to subsequent lethal ischemia. Ischemic tolerance (IT) declines with age, yet it is unclear whether metabolic disease like type 2 diabetes (T2DM) also interfere with IT. The current study sought to determine whether T2DM reduces neuroprotection induced by LPS PC, and the molecular mechanisms underlying the dampened IT.

Methods:
Male and female diabetic db/db and control db/+ mice (8-10 months of age) were i.p. injected with Toll-like receptor (TLR)4 ligand LPS at 0.2 mg/kg or saline. Stroke was induced 3 days later by permanent distal occlusion of middle cerebral artery and temporary occlusion of ipsilateral common carotid artery for 60 min. Sensory and motor function was evaluated 1 day after stroke by a combination of tests. Infarct size was determined 3 days after stroke following TTC staining. The effect of LPS PC on the phenotypes of leukocytes in the brain parenchyma after stroke was quantified by Fluorescent activated cell sorter (FACS) 2 days after stroke with a panel of markers for subsets of myeloid cells. Transcriptome was determined by RNAseq of isolated monocytes from peripheral blood mononuclear cells. Differentially expressed genes were examined for distinct biological pathways via enrichment analysis.

Results:
LPS PC significantly reduced infarct in db/+ mice by one third and improved neurological scores, but it did not protect the db/db mice from stroke. FACS data showed that LPS PC reduced the number of Ly6G+ cells in db/+ but not db/db brains, suggesting that LPS PC curbed stroke-induced infiltration of neutrophils in the brain parenchyma. Pathway analysis suggests that diabetic mice exhibited down-regulated pathways in interferon signaling. The expression of Jak-Stat signaling (such as Stat1), MHC antigen presentation (H2A family), and Toll-like receptor (TLR) signaling (such as Irf7) were also reduced in diabetic mice after stroke.

Conclusions:
The dampened IT in the diabetic mice induced by LPS-PC is associated with increased neutrophil infiltration after stroke compared to control mice. Ongoing studies will seek toovercome the underlying defective molecular mechanisms in T2DM.
Abstract WMP113: Red Blood Cells From Stroke Patients With Admission Hyperglycemia Induces Brain Endothelial Dysfunction
Authors: Deng Wenjun , Lopez Mary , McMullin David , Jacobson Jared , Chou Richard , Wang Andrew , Buonanno Ferdinando , Lo Eng H , Ning MingMing
Published: February 2023

Background:
Beyond its traditional role as oxygen carriers, red blood cells (RBCs) are increasingly recognized to participate in regulating vascular function. Many RBC disorders, such as sickle cell disease, are associated with vascular complications resulting in stroke. Our recent study revealed that admission hyperglycemia in stroke patients intensifies oxidative stress in RBCs. We hypothesize that RBCs that are altered by hyperglycemia may perturb endothelial function.

Method:
Brain endothelial cells were incubated with RBCs isolated from stroke patients with admission hyperglycemia (hyper-RBC) and normoglycemia (normo-RBC) (n=3/group). Mass spectrometry was used to profile the changes in endothelial cells. Functional alterations were assessed by gene set enrichment analysis (GSEA). Significant changes were verified using qPCR and western blot.

Result:
Compared to normo-RBC, hyper-RBC activates cell adhesion process and toll like receptor signaling in brain endothelial cells (Fig A, B). Cell adhesion molecules (ICAM1, VCAM1) and toll like receptor TLR4 were upregulated at both mRNA and protein levels (Fig C, D), which may promote vaso-occlusion and inflammation. In contrast, vasoregulation was deactivated by hyper-RBC (Fig A, B). The expression of eNOS was downregulated and the bioavailability of vasodilator NO was decreased, consistent with impaired vasodilation (Fig C, D). Notably, the changes induced by hyper-RBC could be reversed by pretreating hyper-RBC with ROS scavenger TEMPOL. The upregulation of ICAM1, VCAM1 and TLR4 in hyper-RBC-treated cells was attenuated by TEMPOL pretreatment, and eNOS expression and NO bioavailability were also restored by TEMPOL (Fig C, D).

Conclusion:
Intensified oxidative stress in RBCs induced by admission hyperglycemia in stroke patients can cause endothelial dysfunction. Further studies are underway to validate these targets, and ask whether these mechanisms may exacerbate brain injury in stroke patients.
Abstract WMP115: Stroke Patient Cerebral Endothelial Cells And Their Exosomes Impair Cerebral Endothelial Cell Function
Authors: Chebl Alex , Li Chao , Alsrouji Owais , Teng Hua , Zhang Yi , Zhang Jing , Marin Horia , Kole Max , Chopp Michael , Zhang Zheng Gang
Published: February 2023

Background:
Cerebral endothelial cells (CECs) play a key role in mediating cerebral vascular hemostasis. The biological function of CECs in stroke patients remains unknown due to technical challenges to acquire patient CECs. We isolated and analyzed the function of CECs from living stroke patients.

Methods:
Cells were isolated from stent retrievers used for mechanical thrombectomy (MT) for patients with large vessel occlusion (LVO) after completion of the intervention as part of an IRB approved protocol. Patient endothelial cells (pCECs) were analyzed.

Results:
We isolated 300-400 primary brain endothelial cells per retriever from 5 patients with LVO with ages ranging from 69 to 86 years. The pCECs exhibited a typical monolayer cobblestone appearance and expressed VE-cadherin, but not α-smooth muscle actin, indicating that these cells are CECs. Western blot analysis showed that compared to human primary brain microvascular endothelial cells (hBMECs, Cell System), pCECs expressed significantly increased iNOS, VEGF, and VEGFR2, but reduced eNOS and Ang1. In vitro endothelial permeability and angiogenesis assays showed that pCECs robustly increased cell leakage and angiogenesis, respectively. Moreover, treatment of healthy hBMECs with exosomes derived from patient CECs (pCEC-Exos) significantly increased cell leakage and reduced cell integrity, which were associated with the reduction of tight junction proteins ZO1 and Occludin. Blockage of the caveolin endocytotic pathway by nystatin abolished the effect of pCEC-Exos on hBMEC function.

Conclusions:
Our data demonstrate that: 1) pCECs from stroke patients can be harvested; 2) pCECs are dysfunctional, and 3) pCEC-Exos induce dysfunction of healthy CECs. These data provide novel insights into the mediation of stroke-induced neurovascular dysfunction by pCECs.
Abstract WMP116: Ifi27l2a Is A Novel Regulator Of Neuroinflammation And Neurodegeneration In The Post-stroke Brain.
Authors: Kim Gab Seok , Harmon Elisabeth , Doan Andrea , Andersohn Alexander , Wu Ting , Gutierrez Manuel C , Wythe Joshua D , Marrelli Sean P
Published: February 2023

Microglial cells (MG) serve as resident immune cells in the brain and play a critical role in the acute response and chronic recovery to stroke. We compared the MG transcriptomic response to stroke in young and aged mice by single-cell RNA sequencing (scRNAseq) and identified
Ifi27l2a
(a member of the interferon signaling family) as one of the most highly upregulated genes in MG following ischemic stroke. However, the functional role of Ifi27l2a in ischemic stroke is not known.

Methods:
Single cell suspensions were obtained from the brains subjected to permanent distal middle cerebral artery occlusion (pdMCAO) in young and aged mice of both sexes (3 & 20 months). scRNAseq was performed to explore the transcriptional signature in brains at 14-days post-stroke. qRT-PCR and RNAscope were used to validate our scRNAseq findings for Ifi27l2a expression and compare regional transcriptional changes. To determine the role of Ifi27l2a, we used WT and Ifi27l2a
+/-
(Het) mice. Infarction was measured at 3-day post stroke by TTC staining. Thalamic gliosis were detected by IBA1 and GFAP staining at 2 week post-stroke.

Results:
Using unbiased scRNAseq analysis, we identified
Ifi27l2a
as the most highly up-regulated gene in aged MG following stroke. Further analysis showed a positive correlation between
Ifi27l2a
and multiple “MG activation” genes and senescence-related genes. Our qRT-PCR results validated the scRNAseq findings and further showed that
Ifi27l2a
was significantly up regulated in thalamus of aged brains (p = 0.04) and trending in cortex (p=0.23, n=4-6) as well as other proinflammatory genes. Using knockout mice, we found that the thalamic gliosis was significantly reduced in the brains of Het, compared to WT (n=6, p<0.05). Primary cortical infarction also was reduced in Het brains compared to WT (n=4-5, p<0.05), suggesting the critical role of Ifi27l2 in evolving brain injury.

Conclusions:
We identified Ifi272la as a highly up-regulated gene in MG following stroke and demonstrated that Ifi27l2a partial deletion results in reduced brain injury acutely and chronically. Our findings suggest that Ifi27l2a is a novel mediator of neuroinflammation and neurodegeneration, and thus provide the basis for a new therapeutic target to reduce brain injury in aging and stroke.
Abstract WMP117: Exploring The Contribution Of Matrix Metalloproteinase 7 In Post-stroke Gut Permeability
Authors: Larochelle Jonathan , Tishko Ryland , Yang Changjun , Liu Lei , Gunraj Rachel , Candelario-Jalil Eduardo
Published: February 2023

Background:
Stroke is associated with profound immunodepression and aberrations of autonomic signaling which render the body more susceptible to infection from without and from within. Dramatic alterations of sensitive signaling networks within the gut after stroke along with systemic inflammation may promote pathways that evoke a leaky gut. The enzyme matrix metalloproteinase 7 (MMP-7) has been shown to play a prominent role in evoking gut permeability in models of systemic inflammation. We found that stoke elicits a profound increase in MMP-7 across the small intestine rapidly after injury.

Hypothesis:
We hypothesize that this increase in MMP-7 in the gut after stroke contributes to post-stroke gut permeability and that mice deficient in MMP-7 are protected from this effect.

Methods:
Young (2-5-month-old)
Mmp7
knockout (
Mmp7
-/-
) and wild type (WT) control littermates were subjected to 45min-tMCAO. At 3h post-tMCAO, mice were injected intraocularly with 200mg/kg FITC-inulin at 3h post-tMCAO and euthanized 1h later. Aged (24-month-old)
Mmp7
-/-
mice and WT control littermates were subjected to pMCAO, injected intraocularly with 200mg/kg FITC-inulin at 47h, and euthanized 1h later. Intestinal tissue was collected, homogenized, and used to detect FITC-inulin as well as for Western blotting and RT-qPCR.

Results:
We demonstrate that MMP-7 levels rapidly increase throughout the small intestine after stroke at 6h and 24h post-stroke. This increase in MMP-7 is accompanied by a concurrent decrease in tight junction proteins and increase in intestinal permeability at 3h post-transient middle cerebral artery occlusion (tMCAO) and 48h post-permanent (p)MCAO. Interestingly, MMP-7 deficient mice are protected from gut permeability after stroke.

Conclusion:
Our data identify a novel causative agent in the phenomenon of gut permeability observed after stroke and prompt further study of the role of MMP’s in promoting gut permeability after stroke.
Abstract WMP120: Development Of Smartphone Enabled Machine Learning Algorithms For Autonomous Stroke Detection
Authors: Raychev Radoslav I , Saver Jeffrey L , Liebeskind David S , Penkov Svetlin , Angelov Daniel , Stoev Krasimir , Todorv Todor , Sakelarova Teodora , Kalpachka Dobrinka , Pelyova Hristiana , Ruseva Rostislava , Velcheva Svetlana , Kostadinova Emanuela , Dimov Denislav , Anna Kolarova , Manolova Teodora , Alexiev Filip , Milanov Ivan
Published: February 2023

Background:
We developed an automated smart phone application for detection of acute stroke using machine learning (ML) algorithms for recognition of facial asymmetry, arm weakness, and speech changes.

Methods:
We analysed prospectively collected data from patients admitted to 4 major metropolitan stroke centers with confirmed diagnosis of acute stroke. Speech and facial data were captured via video recording and arm data was captured via device sensors. A. Face. This module extracts 68 facial landmark points that are passed through a dimensionality reduction step and an asymmetry classifier. We implemented and compared 26 classification methods with neurologists' clinical impression and determined Quadratic Discriminative Analysis as the best one in terms of accuracy and interpretability. B. Arm. Using data extracted from 3D accelerometer, gyroscope, and magnetometer , we designed a grasp agnostic classifier based on AdaBoost to process motion trajectories and detect arm weakness.C. Speech. We developed an algorithm based on frequency analysis and Mel Frequency Cepstral Coefficients (MFCC) to detect abnormal/slurred speech. All tests were conducted within 72 hours of admission. Each of the three ML outputs was correlated with neurologists’ clinical impression.

Results:
Among the 269 analysed patients, 41% were female, the median age was 71, % had hemorrhagic and % had ischemic stroke. Final analyses of 18311 facial images revealed 99.42% sensitivity, 93.67% specificity, and 97.11% accuracy in detection of facial asymmetry. The results for 43 arm trajectories revealed 71.42% sensitivity, 72.41% specificity, and 72.09% accuracy in detection of arm weakness. Preliminary analysis of MFCC algorithms confirmed adequate features for abnormal speech detection

Conclusions:
Our preliminary results confirm that smartphone enabled ML-algorithms can reliably identify acute stroke features with accuracy comparable to neurologists’ clinical impression.
Abstract WMP19: When Minutes Count: Addition Of Stroke Transfer Coordinator
Authors: Sawyers Carrie , Murphy Karen , Campbell Margie L , Lee Jessica D
Published: February 2023

The treatment of hyper acute ischemic stroke is time critical, requiring a coordinated team response. It is common among primary and comprehensive stroke centers to have a “stroke alert” process, activating physicians, laboratory, radiology, and nursing support. In our center, the stroke alert included activation of a stroke program coordinator during day hours to assist with data gathering and time tracking. A clinical nurse expert would attend stroke alerts as able to on nightshift. At times, there were gaps when no personnel were available, and data was backtracked. In 2021, the use of Viz.AI was implemented. The Viz app allows streamlined communication amongst the treatment team (MD, ED Charge, Bed Capacity, etc.). Information including COVID status, time of Contrast given, imaging studies, and family contact information are exchanged prior to the patient’s arrival. Six Stroke Transfer Coordinators (STC) were hired, whose primary focus was attending stroke alerts, monitoring CT scans through the Viz app, and facilitating the transfer of patients with Large Vessel Occlusion (LVO) for thrombectomy treatment.

Methods:
This is a single center retrospective cohort study. Basic demographic data, presence of LVO, time of last known well, time of imaging, time of transfer acceptance, NIHSS, and thrombolysis prior to transfer were recorded. Door-in-door out, door-to-angiogram, and door-to-groin puncture times were also collected. We compared and analyzed data from 12 months prior to implementation of the STC (August 2020-July 2021) to the 12 months post-implementation (August 2021 to July 2022).

Results:
Total number of Stroke Alerts (SA) in the pre-STC time period was 1479, with 136 thrombectomy alert. Post-TSC the total number of SA was 1306, with 179 thrombectomy alerts. The mean door-to-intervention time pre-STC was 24 minutes (median=25 minutes). Post implementation of the STC, the mean door-to-intervention time was 17 minutes (median= 12 minutes).

Conclusions:
STC’s improved the door-to-intervention time by mean of 7 minutes (median= 13 minutes). When every minute counts in re-establishing brain perfusion, this improvement may lead to better patient outcomes. Further study is necessary.
Abstract WMP21: Virtual Reality Module For Stroke Education
Authors: Millsaps Erika R , Swihart Allison
Published: February 2023

Introduction:
E-learning has been used to evaluate competency in hospital staff for many years, with virtual reality (VR) education becoming more popular over the last fifteen years. In 2020, a rural hospital in Indiana partnered with a local technology vendor to create a VR experience for stroke education. The goal was to train nurse and physician staff on the triage, assessment, and care of acute stroke patients in the emergency room setting, upholding the standards set forth by the accrediting agency. Research began to provide qualitative data regarding this educational platform.

Methods:
The VR platform included video education, hospital specific resources, and an immersive 360 video assessment of an acute stroke patient videotaped on the hospital’s campus. An introductory video demonstrated how to use the learning platform. The module was competency based, meaning staff could receive a maximum of 58 questions, with the quiz function shutting off after the participant scored an 80%. Thirty-five hospital staff were asked to complete the beta test. Twelve of those staff members completed the module and provided feedback via an anonymous eight question survey embedded in the VR platform. The survey included three open ended questions that provided an opportunity for staff to share feedback.

Results:
Overall, participants expressed that the educational platform was hospital specific, engaging, and technologically advanced. All participants were able to achieve a passing score on the first attempt. Unfortunately, there was a glitch in the system that made the passing score 68%, which was lower than the desired competency of 80%. Over half of the participants rated the VR module as very good or excellent on a five point scale. Staff feedback revealed multiple technical issues with video lag time and challenges with the automated narration of the quiz questions.

Conclusion:
In conclusion, the VR educational module was found to be an effective form of stroke education for hospital staff. Following the analysis of the beta test results, the core research team was able to adjust the VR module to decrease lag time, remove the auto narration, increase the passing score to 80%, and improve the navigation features to make the learning environment more learner friendly.
Abstract WMP34: Neighborhood Density Of Recreation, Civic, And Social Sites And Post-stroke Recurrence And Mortality
Authors: Delhey Leanna , Shi Xu , Morgenstern Lewis B , Brown Devin L , Smith Melinda A , Case Erin , Lisabeth Lynda
Published: February 2023

Introduction:
Neighborhood socioeconomic status is associated with stroke recovery and mortality. Researchers suggest increased recreation, civic, and social sites (referred to as sites) may support physical, social, and cognitive activity resulting in more favorable outcomes.

Hypothesis:
Stroke survivors in neighborhoods with lower versus higher number of sites will have a higher rate of mortality and stroke recurrence; these associations will be modified by stroke severity, ethnicity, and sex.

Methods:
We included non-Hispanic white and Mexican American first-ever stroke survivors enrolled in the Brain Attack Surveillance in Corpus Christi project (2009-19), a population-based cohort in Nueces County, Texas. From a national database, we linked sites per square mile by census tract. We censored at second stroke (stroke recurrence model), death, or 1/1/2020, whichever occurred first. We fit cox regression models using a shared frailty model, adjusting for individual, interpersonal, and neighborhood factors. We considered interactions with stroke severity, sex, and ethnicity. We applied inverse probability weighting and multiple imputation to account for missing data.

Results:
There were 1,688 survivors; 408 deaths, 189 stroke recurrences, over median follow-up of 1372 days. Median age was 64 years, 74% with mild stroke, 54% male and 60% Mexican American. There was no association between site density and mortality (HR comparing 75
th
to 25
th
percentile=1.01, 95% CI=0.83-1.23) or stroke recurrence (HR=0.98, 95% CI=0.74-1.30). Stroke severity, sex, and ethnicity did not modify the effect of site density on post-stroke mortality (p=0.33, p=0.17, p=0.58, respectively) or stroke recurrence (p=0.43, p=0.91, p=0.99, respectively).

Conclusions:
We did not observe associations between neighborhood density of sites and post-stroke recurrence or mortality. Future research is needed to determine if other neighborhood features may support secondary stroke prevention or post-stroke survival.
Abstract WMP35: Distinct Multivariate Models Predict 3 Month Disability Outcomes From Day 4 Modified Rankin Scale In Patients With Acute Cerebral Ischemia Vs Patients With Intracranial Hemorrhage
Authors: Taleb Shayandokht , Lee Jenny J , Asanad Samuel , Starkman Sidney , Conwit Robin A , Sanossian Nerses , Hamilton Scott , Gornbein Jeffrey , Saver Jeffrey L
Published: February 2023

Background:
Long-term disability after stroke is standardly assessed 3m post-onset, using the modified Rankin Scale (mRS), but clinical trial patients lost to follow-up require imputation of likely outcome. An early post-onset, e.g. day 4, mRS is often available but its utility to forecast outcome in ischemic and in hemorrhagic stroke patients has not been delineated.

Methods:
We analyzed all patients with acute cerebral ischemia (ACI) and with intracranial hemorrhage (ICH) enrolled in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) Phase 3 trial. The performance of ordinal day 4 mRS, alone and as part of multivariate models, in predicting ordinal day 90 mRS was assessed using Spearman correlation coefficients (r
s
) and kappa (chance corrected agreement) statistics.

Results:
Among the 1206 acute cerebral ischemic patients, age was 70.9, 45.5 % were female, and initial NIHSS was 9.28 ± 8.28. In univariate analysis, day 4 mRS and day 90 mRS correlated strongly, r
s
= 0.76, weighted kappa = 0.71 increasing in multivariate analysis to r
s
= 0.78 and weighted kappa = 0.76 (Figure 1A). Among the 367 intracranial hemorrhage patients, age was 65.4, 32.7% were female, and initial NIHSS was 18.3 ± 11. In univariate analysis, day 4 mRS and day 90 mRS also correlated moderately r
s
= 0.64, weighted kappa = 0.63, increasing in multivariate analysis to r
s
= 0.81 and weighted kappa = 0.78 (Figure 1B). In the multivariate predictive models, day 4 mRS was the most determinative variable along with age and initial NIHSS for both ICH and ACI.

Conclusion:
For both acute cerebral ischemia and intracranial hemorrhage patients, long-term, 3m mRS disability outcomes can be predicted well using mRS assessment on day 4, alone and even more accurately in combination with baseline prognostic variables. Age and baseline NIHSS exert more additional influence on 3m mRS outcome in ICH than ACI, likely reflecting the better functional recovery among ICH than ACI stroke survivors.
Abstract WMP36: Pain In Stroke Patients At Hospital Discharge
Authors: Dishman Deniz , Lal Tia , Silos Christin , Green Charles , Aggarwal Seema , Chen Luyao , Jiang Xiaoqian , Savitz Sean I
Published: February 2023

Introduction:
Persistent pain after stroke significantly impacts patients’ function, ability to participate in rehabilitation, and quality of life. We examined characteristics of stroke survivors discharged with pain.

Methods:
The sample consisted of 824 stroke patients admitted to a large, urban university based acute care facility in Texas with a completed pain assessment (numeric rating scale or Behavior Pain Scale) at discharge. Descriptive analysis of means and frequency distributions was conducted using a two-sided t-test for continuous variables and a Chi-squared test for categorical variables. Univariable and multivariable logistic regression models were used to determine the association between pain at discharge and type of stroke, adjusting for age, sex, race, smoking status, prevalent hypertension, BMI, and length of stay (LOS). We also tested for statistical interactions between stroke type and age, sex, and race.

Results:
The mean age was 64 years, with 56% (n=462) being males. Of the 824 stroke patients, 584 (71%) had ischemic stroke while 237 (29%) had hemorrhagic (ICH) stroke. At discharge, 43% (n=358) reported pain. In unadjusted analyses, those reporting pain were younger (p<0.001), had a higher BMI (p=0.009), had longer LOS (p<0.001), and were less likely to have ischemic stroke (p<0.001). Only sex modified the association between stroke type and pain at discharge (p=0.002; AUC=0.716). In sex-stratified analysis females with ischemic stroke had lowered odds of reporting pain at discharge by 75% compared to those having ICH (OR=0.25; 95% CI: 0.15-0.41).

Conclusions:
Our study finds that 43% of stroke survivors reported pain at discharge. Younger females with an increased BMI and an increased LOS were more likely to report pain. Our model AUC suggests that post stroke pain may be a complicated phenomenon that requires more complex models.
Abstract WMP39: Effects Of A Home Visiting And Phone Coaching Self-management Program For Stroke Survivors: A Randomized Controlled Trial
Authors: Lo Suzanne Hoi Shan , Choi Kai Chow , Kwan Jackie Cheuk Yin , Iu Issac Hok Lai , Chau Janita Pak Chun
Published: February 2023

Introduction:
Systematic reviews show that self-management interventions were associated with significant improvements in stroke survivors’ activities of daily living and quality of life. However, the programmes were largely group-based and held in community settings. It may limit access by stroke survivors who have greater physical impairment or are more vulnerable to adverse events.

Aim:
This study aimed to develop and evaluate the effects of a new, 8-week, individual-based self-management program on stroke survivors’ self-efficacy in performing self-management behaviors and level of community reintegration.

Methods:
A 2-arm randomized controlled trial was conducted. A convenience sample of adults who had a first-ever/recurrent ischemic/hemorrhagic stroke were recruited from community-based rehabilitation organisations and support groups. The participants in the intervention group received the self-management program and usual care. The program included four home visits and five phone coaching sessions held weekly over eight weeks. It was led by a healthcare professional who conducted home visits and supported by a trained volunteer who provided phone coaching. Access to the program website and a workbook with essential information about self-management and peer survivors’ sharing of survival experiences in videos was also provided. The generalised estimating equations (GEE) model was used to compare the difference in outcomes between the intervention and control groups at post-intervention compared to baseline.

Results:
A total of 134 participants (mean age=64.06 years; SD=12.69) were recruited. The mean years after a stroke was 4.19 years (SD=5.07). The adjusted GEE analysis results showed that participants in the intervention group improved significantly more in total scores of the Stroke Self-Efficacy Questionnaire and the Reintegration into Normal Living Index at follow-up with respect to baseline compared to those in the control group.

Conclusions:
The results supported the benefits of the self-management program. The model of collaboration between healthcare professionals and trained volunteers in the program delivery could be further explored to optimize the continuity of self-management support to stroke survivors.
Abstract WMP4: Bridging Thrombolysis In Stroke Patients With Low Aspects Prior To Endovascular Thrombectomy
Authors: Donnelly Joseph , Hong Jae Beom , Yong Vivien T , Diprose William , Caldwell James , Lee Shane , McGuinness Ben , Brew Stefan , Barber P A
Published: February 2023

Background:
In stroke patients with large vessel occlusion and extensive early ischemic change, the role of bridging thrombolysis prior to endovascular thrombectomy (EVT) is still to be determined.

Aim:
To examine the impact of ischemic change on the efficacy and safety of bridging thrombolysis in patients treated with EVT.

Methods:
Consecutive anterior circulation EVT patients from a prospectively collected registry were included in this retrospective analysis. Alberta stroke programme early CT scores (ASPECTS) were evaluated from initial non-contrast CT scan with lower score indicating larger areas of early ischemic change. Outcome measures included symptomatic intracranial hemorrhage and functional independence (modified Rankin scale score 0-2) at day 90. Multivariable logistic regression models with interaction terms between ASPECTS and bridging thrombolysis were created. ASPECTS was treated as numeric variable in the primary analysis and trichotomized (ASPECTS ≤5, 6-8, 9-10) in a sensitivity analysis.

Results:
872 EVT patients (384 female, mean ± SD age of 67 ± 15, baseline NIHSS 16 [IQR 11-20], median ASPECTS 8 [range 2-10]) were included. 436 (50%) received bridging intravenous thrombolysis with alteplase. There was no significant main effect of ASPECTS on sICH (main effect OR 0.73 95%CI 0.45-1.21, p=0.24) and no modifying effect of thrombolysis (interaction p=0.65). With decreasing numeric ASPECTS, the probability of functional independence reduced (main effect OR 1.34 95%CI 1.20-1.49, p<0.001), and this the reduction was steeper in those without bridging thrombolysis (interaction p=0.035). The interaction was not significant when ASPECTS was split into the 3 categories (p=0.28).

Conclusion:
In anterior circulation patients treated with EVT, bridging thrombolysis was associated with a higher probability of functional independence in those with more extensive early ischemia as determined by ASPECTS. These results suggest patients with large ischemic cores may still benefit from bridging thrombolysis, but this will need to be evaluated in further studies.
Abstract WMP40: Patterns And Predictors Of Smoking Cessation Pharmacotherapy Provision After Stroke And Transient Ischemic Attack: Findings From The Get With The Guidelines-Stroke Registry
Authors: Parikh Neal S , Zhang Cenai , Salehi Omran Setareh , Restifo Daniel , Carpenter Matthew , Schwamm Lee H , Kamel Hooman
Published: February 2023

Introduction:
We analyzed data regarding smoking cessation medication use after stroke/TIA in the United States.

Methods:
We performed a retrospective analysis using data from the Get With The Guidelines®-Stroke registry, which includes data for adult patients receiving acute care for stroke and TIA across the United States. Our outcome of interest was provision of cessation medication (nicotine replacement therapy [NRT], bupropion, varenicline) among patients who were active smokers at the time of stroke/TIA. We used unadjusted and multivariable regression models to explore factors associated with provision of cessation medications. We specifically evaluated whether event type (TIA and hemorrhagic stroke versus ischemic stroke) and burden of smoking-related cardiovascular conditions (≥1 versus 0) were associated with cessation medication provision.

Results:
Of 1,589,760 patients with stroke/TIA, 187,501 were smokers with available smoking treatment data. The mean age was 59.9 years (SD, 11.6); 42% were women. Most patients (97.7%) received some form of cessation intervention. As for specific treatments, 29.8% were provided cessation medication (NRT: 16.2%; varenicline or bupropion: 13.0%; multiple/other: 2.3%). The remaining 68.5% received counseling alone. In multivariable models, patients with hemorrhagic stroke (OR, 0.81; 95% CI, 0.76-0.86) and TIA (OR, 0.68; 95% CI, 0.64-0.73) had lower odds of receiving cessation medications than ischemic stroke patients. Cardiovascular disease burden was not associated with cessation medication provision (OR, 0.98; 95 CI, 0.94-1.02). However, multivariable models revealed demographic differences. Black (OR, 0.78; 95% CI, 0.74-0.82) and Asian (OR, 0.72; 95% CI, 0.58-0.87) patients had lower odds of receiving cessation medication, compared to White patients. Hispanic ethnicity was also associated with lower odds of cessation medication provision (OR, 0.65; 95% CI, 0.56-0.73).

Conclusions:
Approximately 30% of smokers were provided a smoking cessation medication during hospitalization. Compared to ischemic stroke, TIA and hemorrhagic stroke were associated with lower rates of smoking cessation medication provision, and racial and ethnic disparities were identified.
Abstract WMP42: Differences In Antihypertensive Prescribing And Smoking Cessation Counseling After Acute Ischemic Stroke 2003-2016: The National Regards Cohort Study
Authors: Hart Stephanie , Howard Virginia J , Cummings Doyle M , Albright Karen C , Howard George
Published: February 2023

Background:
Limited population-based evidence is available about risk factor management following stroke. We examined age, race, sex, and regional (Stroke Belt vs. other) differences in discharge antihypertensive prescribing and smoking cessation counseling after ischemic stroke using population level data from a national cohort study.

Methods:
Medical record data was abstracted from 1042 participants enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had an adjudicated ischemic stroke between 2003-2016. Participants with a history of prior stroke, in-hospital death, hospice discharge, incomplete records, and non-smokers for smoking cessation analyses were excluded resulting in 798 cases for discharge antihypertensive prescribing and 117 cases for smoking cessation counseling in the final analyses. Differences were assessed using modified Poisson regression adjusting for patient and hospital level factors.

Results:
Overall, 86% received discharge antihypertensives while 50% of current smokers received counseling at discharge. Participants who were older, female, had a greater number of CV risk factors, and higher BMIs were significantly more likely to receive discharge antihypertensives compared to younger participants, males, those with fewer risk factors and lower BMIs, respectively (age RR 1.05; 95% CI, 1.02-1.09; female sex RR 1.09; 95% CI, 1.03-1.16; total risk factors RR 1.07; 95% CI, 1.04-1.10; BMI RR 1.01; 95% CI, 1.00-1.01). There was an increasing trend in receipt of smoking cessation counseling over time (RR 1.12; 95% CI, 1.04-1.21).

Conclusions:
Discharge antihypertensive prescribing varies modestly by patient-level variables. There were no differences in smoking cessation counseling by age, sex, race, or study region. Smoking cessation counseling has improved over time, yet only half of smokers received cessation counseling.