bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 66: Diagnostic Accuracy of ChatGPT4.o for TIA or Stroke Using Patient Symptoms and Demographics
Authors: Khatri Ishaani , Zahiri Anita , Abdullahi Tassallah , Bacher Ian , Raman Sasha , Fraser Hamish , Madsen Tracy
Published: January 2025

Introduction:
Many patients may not recognize the initial symptoms of TIA or stroke and delay seeking urgent medical care, leading to missed treatments and worse outcomes. Diagnostic decision support (DDSS) systems may help these patients recognize and act on early symptoms of stroke or TIA. Large language models (LLMs) are available and utilized by the public. We evaluated the efficacy of GPT 4.o, a recent LLM, for the prediction of stroke or TIA from data collected at presentation among patients admitted to an emergency department TIA/Stroke observational unit (ED-OU).

Methods:
1466 patients admitted to the ED-OU for suspected TIA in a large, urban, academic ED, from 3/2013 - 2/2020 were included. A thorough history and physical were obtained, including presenting symptoms, symptom time course, vital signs, and past medical history. The outcome was a discharge diagnosis of stroke, TIA, or an alternate diagnosis, from a consulting neurologist and confirmed with neuroimaging. For a random sample of 500 records demographics and symptom data were entered into GPT 4.o via OpenAI’s Application Programming Interface (API). We used a validated prompt that requests the 5 most likely diagnoses. The sensitivity of the GPT 4.o diagnoses for the neurologist’s diagnosis was calculated as a match in the top 1 (M1), top 3 (M3) or top 5 (M5). Sensitivity to a combined diagnosis of TIA or stroke was also calculated. Results were compared to (1) a random sample of 100 patients from the same dataset manually entered into the ChatGPT4.o interface by a research assistant, and (2) results from evaluation of ChatGPT 4.0 with data from a study of patients requesting urgent primary care, who entered their clinical data into a DDSS app.

Results:
The 500 cases included 257 with TIA, 73 with stroke, and 170 with other diagnoses. Table 1 shows results of diagnostic matches. Diagnostic lists of 18.4% of cases had no match between GPT4.o and the neurologist’s diagnosis. 5.4% of cases had no clear neurologist diagnosis. GPT4 sensitivity just for combined diagnosis of TIA or Stroke was 98.8%.

Conclusions:
DDSS like ChatGPT/GPT4.o have potential to aid patients’ prompt recognition of TIA or stroke symptoms which could shorten time to care. To better define usability, accuracy and safety of DDSS, we are studying direct data collection from patients in the ED or urgent primary care, including stroke patients or their companions, and evaluating other DDSS tools including symptom checkers.
Abstract 7: RESCUE: Proof of Concept Trial With RNS60 Shows Safety, Reduced Infarct Growth, and Numerical Improvement in all Prespecified Efficacy Endpoints in Subjects With Ischemic Stroke Receiving Mechanical Thrombectomy
Authors: Ghosh Supurna , Dubow Jordan , Sutherland Jocelyn , Kalmes Andreas , Mock Jarrad , Baird Grayson , Smith Wendy , Cook Douglas , Madsen Tracy , Jayaraman Mahesh , Moldovan Krisztina , Torabi Radmehr , Ansari Sameer , Favilla Christopher , Chiu David , Clark Wayne , Liebeskind David , McTaggart Ryan
Published: January 2025

Objective and Background:
Developing cerebroprotective therapies for stroke remains an unmet need despite improvements in early reperfusion. RNS60 is an experimental cerebroprotective drug that showed significant promise in rodent and primate models of ischemic stroke. RESCUE is a proof-of-concept trial to test adjunctive treatment with RNS60 in subjects with large vessel occlusion and acute ischemic stroke undergoing endovascular thrombectomy (EVT).

Method:
The multicenter, placebo-controlled, double-blind, Phase 2 study enrolled 82 participants, randomized 1:1:1 for age, NIHSS, and ASPECTS to a 48-hour infusion (RNS60 0.5 mL/kg/h, RNS60 1 mL/kg/h RNS60, or placebo 1 mL/kg/h). Participants were followed for 90 days with safety as primary objective. The primary efficacy endpoints included dichotomized day-90 mRS, infarct volume at 48 hours, BI and EQ-5D-5L on day 90, and NIHSS at multiple time points.

Results:
The study met its primary endpoint of safety and mortality, with similar rates of SAEs in all arms and numerically lower numbers of deaths in the RNS60 groups compared to placebo. The RNS60 1 mL/kg/h group performed numerically better than placebo in all prespecified endpoints and reduced infarct growth at 48 hours post-EVT by 50% (p<.05). On Day 90, RNS60 1 mL/kg/h demonstrated i) a 16% higher number of subjects having mRS 0-2 compared to placebo (22% predicted probability, OR 3.7, p=.36), ii) a higher number of subjects with BI ≥ 95 (71% on RNS60 1 mL/kg/h vs. 43% on placebo; OR 5.8, p=.13), iii) improved EQ-5D-5L index score (0.74 ± 0.13 on RNS60 1 mL/kg/h vs. 0.58 ± 0.13 on placebo; p=.09) and iv) improved NIHSS score (absolute value and change from baseline) at each pre-specified time point. Although not all are statistically significant, these differences and odds ratios reflect a large, clinically meaningful difference.

Conclusion:
Adjunct treatment with RNS60 was generally safe and well tolerated, reduced infarct growth, and demonstrated numerical improvement in all efficacy outcomes. In the context of limited power, point estimates raise the possibility of benefit with respect to all efficacy endpoints tested. A Phase 3 study is in development.
Abstract 74: ADC-based Infarct Density – Validating a Novel Imaging Biomarker of Functional Outcome after Endovascular Thrombectomy
Authors: Favilla Christopher , Regenhardt Robert , Denny Braden , Simonsen Claus , Shakibajahromi Banafsheh , Patel Aman , Leslie-Mazwi Thabele , Dmytriw Adam , Schirmer Markus , Bonkhoff Anna , Rost Natalia , Messe Steven
Published: January 2025

Introduction:
Endovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the reduction in final infarct volume only accounts for a minority of the treatment effect. There is a need for surrogate imaging biomarkers that more strongly associate with functional outcome, to refine prognostication and facilitate development of EVT-adjuvant neuroprotective therapies. Our group recently developed a straightforward ADC-based metric of post-EVT
infarct density
(i.e. a measure of infarct severity). We aimed to validate this novel metric in a multicenter study of EVT patients.

Methods:
A retrospective cohort included consecutive patients with anterior circulation LVO who underwent EVT at two stroke centers. MRI was performed 12–48 hours post-EVT. Good functional outcome was defined as a 90-day modified Rankin Scale score ≤2. MR imaging was processed via RAPID, and final infarct volume was based on the standard ADC <620 threshold. Lesion volume was also assessed using ADC <470, and infarct density was calculated as the percentage of final infarct volume with ADC <470 (
Figure 1
). Multivariate logistic regression quantified the associations between clinical/imaging variables and functional outcome. Model performance was quantified by ROC analysis and compared to a model consisting solely of clinical variables and a model consisting of clinical variables and infarct volume.

Results:
Of 312 patients, 284 (92%) achieved successful recanalization (mTICI ≥2b), and 54% achieved a good outcome. The mean age was 69 years (+/- 14); 41% were female. The mean final infarct volume was 50mL (+/- 73). Infarct density was significantly lower in patients with a good outcome (8.3% vs 30.3%, p<0.0001).
Table 1
reports the univariate and multivariate analyses. Infarct density was robustly associated with outcome after adjustment for other significant factors including infarct volume (aOR: 0.954 per 1% increase in infarct density).
Figure 2
compares the AUC of the three prespecified models, and the best classification was achieved by including infarct density (AUC 0.87; 95%CI: 0.83-0.91).

Conclusion:
Infarct density after EVT is independently associated with long term clinical outcome and provides greater prognostic value than final infarct volume alone. Derived from routinely acquired MRI, infarct density is a potentially useful and easily calculable surrogate outcome measure that can be used in clinical trials of EVT-adjuvant therapies.
Abstract 75: The Uterus and Vascular Endothelial Growth Factor; A Novel Organ-Hormone Axis in the Pathogenesis of Intracranial Aneurysms
Authors: Nisson Peyton , Maeda Takuma , Uchikawa Hiroki , Cisneros Oscar , Gonzalez Nestor , Lawton Michael , Hashimoto Tomoki
Published: January 2025

Background:
Female gender is a well-established risk factor for intracranial aneurysms (IA), with women showing a 3:1 prevalence, 2:1 rupture risk, and higher aneurysm multiplicity. This risk has also been recapitulated in IA mouse models. While the ovaries-estrogen axis has been considered protective, it may not be the primary organ-hormone pair influencing IA pathogenesis. The uterus, through systemic release of vascular endothelial growth factor (VEGF) during the menstrual cycle, might play a central role in this pathway.

Methods:
IAs were induced in C57Bl/6 mice through stereotactic injection of elastase into the basal cisterns and hypertension via deoxycorticosterone pellets and 1% NaCl water. We compared aneurysm rupture rates, formation, and symptom-free survival across different groups: hysterectomy vs. sham-surgery, VEGF-receptor antagonist Sunitinib vs. vehicle, anti-VEGF monoclonal antibody (mAb) vs. isotype control (rat anti-IgG2a), and anti-VEGF mAb vs. isotype control in hysterectomized mice. VEGF plasma levels were measured using a Mouse VEGF ELISA kit.

Results:
Female mice had significantly higher plasma VEGF levels than males (46.0 pg/ml vs 27.8 pg/ml, p<0.001). Hysterectomized females had a lower rate of aneurysm formation (61% vs 94%, p=0.04) and longer symptom-free survival (p<0.01) compared to sham-operated females, though rupture rates were similar (75% vs 90%, p=0.56). Mice treated with Sunitinib showed lower aneurysm formation rates (45% vs 76%, p=0.04) and longer symptom-free survival (p=0.008), with no significant difference in rupture rates (72% vs 90%, p=0.32). Mice treated with anti-VEGF mAb had lower aneurysm formation rates (40% vs 60%, p=0.03) and longer symptom-free survival (p=0.02), with no significant difference in rupture rates (75% vs 83%, p=0.66). However, in hysterectomized mice the protective effect of anti-VEGF mAb was lost, showing no difference in formation rate (50 vs 50%, p=1), rupture rate (57% vs. 62%, p=1), or symptom free survival (p=0.65).

Conclusions:
Female mice exhibited higher systemic VEGF levels than males. Hysterectomy, anti-VEGF mAb, and VEGF-R blockade with Sunitinib all resulted in reduced aneurysm formation and longer symptom-free survival. After removing the uterus, the protective effect of anti-VEGF mAb was no longer present. These findings suggest that the uterine-VEGF axis may be a promising therapeutic target and highly relevant in understanding the gender-associated risks of IA.
Abstract 95: LILRB4 Inhibition Alleviates Ischemic Brain Injury by Reducing Microglial Necroptosis
Authors: Hu Jinglong , Chen Yan , Xu Yun
Published: January 2025

Objective:
Microglia, the central nervous system's immune cells, are crucial in neuroinflammation after ischemic brain injury. Previous single-cell and spatial transcriptomics showed that LILRB4 was upregulated in microglia after MCAO in C57BL/B6J mice, but its role is unclear. This study investigates LILRB4's function and mechanism in ischemic injury.

Methods:
In C57BL/B6J mice, LILRB4 expression was analyzed at various time points post-MCAO using Q-PCR, Western blot, and flow cytometry. A microglia-specific LILRB4 knockout mouse model (LILRB4-cKO) and control mice (LILRB4
fl/fl
) were established, and MCAO was induced. Infarct volume and behavioral changes were assessed by MAP2 staining, mNSS scoring, grip strength, gait, and rotarod tests. qPCR and Western blot were used to detect brain inflammatory factors and DAMPs, while microglial morphology, cell counts, and RIPK3 levels were analyzed by immunofluorescence and flow cytometry. In vitro, LILRB4 expression changes post-OGD were validated, and LILRB4 knockdown BV2 cells (sh-LILRB4 BV2) were constructed. Necroptosis was induced using RIPK3 inhibitor and OGD, and necroptosis markers were detected. The JASPAR database was used to identify ATF2 as a potential RIPK3 transcription factor, and its role in gene regulation was validated by transfecting ATF2 plasmid into sh-LILRB4 BV2 cells.

Results:
LILRB4 expression in microglia was upregulated after MCAO, peaking at day 3. LILRB4-cKO mice showed larger infarct volumes, greater neurological deficits, and higher pro-inflammatory cytokines (TNF, IL-6, IL-1β) than LILRB4
fl/fl
mice. Microglia from LILRB4-cKO mice had larger cell bodies, shorter processes, reduced numbers, and more RIPK3
+
necroptotic cells. In primary microglia and sh-LILRB4 BV2 cells, OGD increased LILRB4, RIPK3, MLKL, and cytokines, which were suppressed by GSK-872. The JASPAR database identified ATF-2 as a potential RIPK3 transcription factor, and its role in promoting RIPK3 transcription was confirmed. The JASPAR database identified ATF-2 as a potential RIPK3 transcription factor, and its role in promoting RIPK3 transcription was confirmed. Knockdown of ATF-2 reduced the elevated levels of inflammatory cytokines, DAMPs, and necroptosis markers induced by LILRB4 deletion.

Conclusion:
LILRB4 inhibits microglial necroptosis through the ATF2/RIPK3 pathway, reducing neuroinflammation and offering neuroprotection. Therefore, LILRB4 may serve as a potential therapeutic target for ischemic brain injury
Abstract DP10: The Use of Smartphone Based Educational Technology In Stroke Specific Nursing Education
Authors: Morhaim Holly , Rudolph Steven
Published: January 2025

Introduction:
Stroke center designation generally specifies required education for nurses. Our system provides stroke education to hundreds of nurses annually. Traditionally this education has been provided via live or remote lectures or online modules, where content is static, and students play a passive role. In that model, testing is performed at the conclusion of instructional units, known in education as summative assessment. We sought to create a learning environment that is more engaging and interactive, utilizing newer educational technologies.

Methods:
We investigated educational technologies developed for the K-12 educational space. We sought a platform that would provide the ability to monitor and assess students’ performance during live lectures and provide real-time feedback. Our choice of educational tool, the Nearpod© App, enables presentation of multiple question types (single and multiple choice, matching, polls) and allows the monitoring of students’ performance in real time. We used Nearpod© to track attendance, compliance, and test responses of individual nurses.

Ninety-eight nurses took part in our educational sessions during the period of September 2020 through November 2020. Sets of multiple-choice questions were presented on a smartphone, tablet, or computer during live presentations. The responses were monitored in real-time by a member of the educational team. Based on individual and group responses, the educators were able to provide immediate feedback, adjust instruction, and emphasize material learned.

Results:
The technology was easily and enthusiastically adopted by all nurses. No difficulties with technical implementation were encountered. Nurses received immediate feedback. We were able to track attendance, graph results, and provide live feedback and immediate test results to all nurses. Educators were able to assess which material required more focus and emphasize those specific topics. We achieved high compliance and competencies with our stroke specific education.

Conclusions:
Educational technology tools from non-medical settings can be easily adapted to nursing education. This technology can assist nurse educators with providing hospital wide topic specific nursing education, tracking attendance and compliance, and providing live feedback. It can be easily adapted to nursing education in institutions seeking to meet the educational requirement for disease specific certification.
Abstract DP18: Deep learning based CT volume and density measures are associated with infarct growth rate during interhospital transfer for endovascular treatment
Authors: van Voorst Henk , Liu Yongkai , Zamarud Aroosa , Wouters Anke , Seners Pierre , Mahammedi Abdelkader , Verhaaren Benjamin , Christensen Soren , Yuen Nicole , Mlynash Michael , Zaharchuk Greg , Lansberg Maarten , Albers Gregory , Heit Jeremy
Published: January 2025

Introduction:
Ischemic core growth rate in patients with a large vessel occlusion varies during transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for thrombectomy. Patients at risk for a high growth rate may be optimal candidates for neuroprotective treatments. We determined if deep learning based CT lesion (DLCT) volume and density measures are associated with growth rate.

Methods:
Patients with CT and CTP at the PSC and CTP or DWI at the CSC were included from the prospective CRISP 2 study. Growth rate per hour (mL/h) was measured as the difference between the CTP core volume (relative cerebral blood flow <30%) at the PSC and CTP ischemic core or manually segmented DWI lesion volume at the CSC. We used a validated deep learning model to segment the ischemic lesion on non-contrast CT and determined lesion volume, density in the lesion, and relative hypodensity; the percentage difference with contralateral voxels. Additional clinical, CT angiography, and CTP measurements were considered as independent variables (Figure 1). Stepwise regression with combined forward/backward selection optimized for the Akaike Information Criterion was used to select variables. For each variable, we report adjusted regression slopes with 95% confidence interval (aB[95%CI]) for their association with growth rate. R2 and adjusted R2 are reported to reflect model performance.

Results:
We included 269 patients; 113(42%) women, median age was 71(IQR:60-80) years, 185(69%) had witnessed onset of stroke symptoms. The stepwise optimized regression model had an R2 of 0.44 (adjusted R2: 0.41). DLCT variables with significant associations with growth rate were volume (aB/10mL:3.2[95%CI:2.3; 4.1]), >20% relative hypodensity volume (aB/10mL:-8.5[-11.6; -5.3]), and density standard deviation in the lesion (aB/HU:2[0.8; 3.2]). Penumbra volume (aB/10mL:-0.5[-0.8; -0.2]) was associated with core growth rate, while ischemic core volume (aB/10mL:0.62[-0.03; 1.27]) was not. Tan collaterals score (aB per point:-4.7[-6.6; -2.9]), clot burden score (aB/point:-1.6[-2.1; -1.0]), female sex (aB:-3.2[-5.7; -0.7]), and admission systolic blood pressure (aB/10mmHg:0.7[0.3; 1.2]) were also significantly associated with core growth rate.

Conclusion:
DLCT based volume and density measures have a strong association with ischemic core growth rate during interhospital transfer which might indicate that DLCT also identifies tissue at risk for irreversible ischemic damage.
Abstract DP19: Stroke Systems of Care: Evaluating Disparities after Stroke Legislation Implementation in Rhode Island
Authors: Teshome Abigail , Taman Mazen , Perelstein Elizabeth , Proulx Jeffrey , Feler Joshua
Published: January 2025

Introduction:
While the implementation of Stroke Systems of Care (SSOC) policies have proven beneficial to the general population, their effectiveness among racial minorities and economically disadvantaged groups remains uncertain. This study investigates the effects of the Stroke Prevention and Treatment Act of 2009 in Rhode Island and subsequent changes in mortality rates across different racial and socioeconomic groups.

Methods:
Publicly available data from the Rhode Island Department of Labor and Training, CDC Atlas of Heart Disease and Stroke, and US Census Bureau for the years 2005-2014 informed the study. Multivariate regression was employed to analyze the relationship between county-level racial demographics and mortality rates from ischemic, hemorrhagic, and all stroke. A difference-in-difference analysis compared stroke mortality rates among White, Black, and Hispanic residents before and after the Act’s passage. Trends identified in these analyses were further validated using a mixed-effects model.

Results:
After SSOC policy implementation, the overall population demonstrated significant decline in ischemic (-13.6%;
P
<0.001), hemorrhagic (-5.5%;
P
=0.011), and all strokes (-12.9%;
P
<0.001). White residents showed significant reductions in ischemic (15.0%;
P
<0.001), hemorrhagic (-5.0%;
P
=0.021), and all stroke (-13.6%;
P
<0.001) mortality. However, Black residents showed an insignificant drop in hemorrhagic stroke mortality (-13.1%;
P
=0.235), with insignificant increases in ischemic (11.6%;
P
=0.877) and all stroke (12.8%;
P
=0.187) mortality. Hispanic residents experienced a significant decrease in overall stroke mortality (-12.1%;
P
=0.003), though reductions in ischemic (-9.1%;
P
=0.058) and hemorrhagic (-21.7%;
P
=0.064) stroke mortality were not statistically significant. There were insignificant changes in total (
P
=0.997), White (
P
=0.740), Black (
P
=0.667), and Hispanic (
P
=0.903) populations before and after policy implementation.

Conclusion:
SSOC policies significantly reduced stroke mortality among the general population and White residents in Rhode Island, but these benefits did not extend equally to Black and Hispanic groups. This disparity highlights the need for future stroke legislation to consider social determinants of health and the unique barriers faced by minority populations to enhance overall care.
Abstract DP21: Polygenic Resistance to Vascular Risk Factor Control in Stroke Survivors
Authors: Huo Shufan , Rivier Cyprien , Clocchiatti-Tuozzo Santiago , Renedo Daniela , Torres Lopez Victor , Sunmonu N. Abimbola , Petersen Nils , de Havenon Adam , Sheth Kevin , Falcone Guido
Published: January 2025

Background:
Stroke patients are at risk for secondary vascular events, but risk factor control is often insufficient. Vascular risk factors like hypertension, diabetes, and hyperlipidemia are highly heritable, and persons with higher polygenic predisposition are less likely to achieve risk factor control. The combined impact of these polygenic effects on clinical management of stroke patients is unknown.

Hypothesis:
We hypothesize that the combined polygenic effect of the most important vascular risk factors leads to higher rates of treatment failure and secondary vascular events in stroke survivors.

Methods:
In our genetic association study in stroke patients (ischemic or hemorrhagic) from the UK Biobank, we created polygenic risk scores (PRS) for systolic blood pressure, diabetes, and LDL from genome-wide association summary statistics. We added them to a metaPRS for overall genetic risk for all three risk factors, categorized into low, intermediate, and high risk (<20, 20-80, >80
th
percentiles). Outcomes at baseline were uncontrolled (at least one of: systolic blood pressure >140mmHg, HbA1c >7.0%, or LDL >100mg/dl) and resistant risk factors (uncontrolled despite treatment). Longitudinal outcomes were recurrent stroke, myocardial infarction, and all-cause death, from via EHR follow-up. We performed logistic regression adjusted to age, sex, and genetic principal components to assess the relationship between the metaPRS and outcomes.

Results:
In 6,290 stroke patients (mean age 61, female sex 42%), high polygenic risk was associated with 37% increase in uncontrolled (OR 1.37, 95% CI 1.16-1.63, p-trend <0.001) and a 2-fold increase in resistant risk factors (OR 2.09, 95% CI 1.77-2.48, p-trend <0.001). Poor risk factor control translated into clinical outcomes: high polygenic risk was associated with a 20% increase of recurrent stroke (OR 1.21, 95% CI 0.99-1.48, p-trend 0.05), 58% increase of myocardial infarction (OR 1.58,95% CI 1.13-2.23, p-trend 0.02), 31% increase of death (OR 1.31,95% CI 1.07-1.60, p-trend 0.02), and 35% higher composite risk of any events (OR 1.35, 95% CI 1.14-1.60, p-trend <0.001, see Table).

Conclusion:
In our study, aggregate polygenic risk for three main vascular risk factors correlates with poor risk factor control and treatment resistance in stroke patients, but also with recurrent stroke, myocardial infarction, and death. Further research should evaluate the benefit of tailored therapies for stroke survivors with adverse genomic profiles.
Abstract DP22: The NOMAS-CBI Score: Development of a Risk Factor-Based Score to Detect Covert Brain Infarcts on MRI
Authors: Ramaswamy Srinath , Liu Minghua , Khasiyev Farid , Brahmaroutu Ankita , Elkind Mitchell , Rundek Tatjana , Gutierrez Jose
Published: January 2025

Introduction:
Covert brain infarcts (CBIs) are associated with risk of stroke and dementia. It is unknown whether surveillance for CBIs and medical management can mitigate this risk. Stratification tools to identify patients who have CBIs may prove useful in clinical and research settings. We devised a vascular risk-factor-based scoring system to detect CBIs on MRI using a retrospective analysis of the Northern Manhattan Stroke Study (NOMAS) population-based cohort and compared it to the Atherosclerotic Cardiovascular Disease Score (ASCVD).

Methods:
Inclusion criteria were age > 40 years, no prior stroke or TIA, and available MRI brain scan. Exclusion criteria: missing information on risk-factor variables. We retrieved demographics and vascular risk factor information at the time-point closest to the MRI. Logistic regression modeling was used to identify variables that had strongest association with CBIs on MRI. Three models (CBI score, CBI score 1, CBI score 2) with varying number of variables were devised to identify abbreviated versions of the score. We estimated cut-offs for the three scores, sensitivity, specificity, positive and negative predictive values (PPV, NPV), and area under the receiver operating characteristic curve (AUROC).

Results:
Among 1,290 included patients, 237 (18.4%) had CBI. The CBI, CBI score 1, and CBI score 2 scores had 8, 6, and 4 risk-factor variables, respectively (Table 1). The median CBI score was higher in patients with CBIs compared to those without (Table 2). Two cut-offs, ≥ 2 and ≥ 3, were chosen for sensitivity analysis based on the median scores. The sensitivity of the three scores for identifying CBIs was higher at a cut-off ≥ 2 (0.81) compared to ≥ 3 (0.59) (Table 3). The AUROC indicated moderate accuracy (0.66) for predicting CBI. The Atherosclerotic Cardiovascular Disease (ASCVD) risk score (>7.5%) had higher sensitivity (0.96) but similar accuracy (0.66) in comparison to the CBI scores. Compared to the CBI score, the shorter CBI score 2 had lower sensitivity (0.63) and similar accuracy (0.66) at a cut-off of ≥ 2.

Conclusion:
The NOMAS-CBI score uses vascular risk factor information and detects CBI on MRI with high sensitivity and moderate accuracy. A point-of-care variant, the CBI score 2, had lower sensitivity but similar accuracy. The score is comparable to the ASCVD and is easier to perform. Further analysis on the validity of the scores across other prospective cohorts is underway.
Abstract DP23: Risk factor analysis and novel prediction system for intracranial aneurysm growth based on artificial intelligence
Authors: Otsuka Ryotaro , Ikedo Taichi , Ogata Soshiro , Nishimura Kunihiro , Kataoka Hiroharu
Published: January 2025

Objective:
The growth of unruptured intracranial aneurysms (IAs) is regarded as a critical precursor to aneurysmal rupture. Accurately predicting aneurysm growth is crucial for appropriate therapeutic interventions to prevent rupture in high-risk aneurysms. The UCAS Japan score has been widely used for rupture risk assessment in Japan; however, its relationship to aneurysm growth is unclear. The present study aimed to examine whether the UCAS Japan score can accurately predict aneurysm growth and to develop a novel prediction system using artificial intelligence (AI)-based machine learning.

Methods:
We retrospectively analyzed 2,399 unruptured IAs from our single institutional database between 2012 and 2021. Cases with low-quality MRI images or short follow-up periods within 12 months were excluded, resulting in 725 included IAs. IAs with 1mm or more growth during follow-up were categorized as the growth group and compared with the non-growth group. Univariate and multivariate analyses were performed based on UCAS Japan scores and possible risk factors regarding patient characteristics and aneurysmal morphology. AI-based prediction model using XGBoost method was developed and compared with the logistic analysis model and conventional ELAPSS scoring system.

Results:
A total of 150 aneurysms were classified into the growth group and 525 into the non-growth group. The average age was 63.9±11.7 years, with 74.9% female. Univariate analysis showed significant differences between the two groups in age (65.1 vs 63.3, p=0.01), hypertension (63.3% vs 52.3%, p=0.02), maximum diameter (6.5 mm vs 4.3 mm, p<0.01), and daughter sac presence (53.3% vs 10.4%, p<0.01). The UCAS Japan score was only slightly higher in the growth group (4.90 vs 4.70, p<0.01). Multivariate analysis identified daughter sac presence (OR 8.27, 95%CI 5.16–13.30) and family history of SAH (OR 2.52, 95%CI 1.37–4.64) as independent risk factors. The AI-based model showed strong predictive performance (AUC 0.91, accuracy 91%, sensitivity 71%, specificity 96%), surpassing the ELAPSS score (AUC 0.67) and logistic regression (AUC 0.84, p<0.01).

Conclusion:
Multivariate analysis identified family history of SAH, daughter sac presence, and aneurysm size as independent risk factors for IA growth. We developed an AI-based powerful prediction system, which potentially change IA management dramatically.
Abstract DP37: Role of Light Transmission Aggregometry values predict diffusion weighted image change after Stent assisted Coil Embolization for Intracranial Aneurysm: a retrospective propensity score-matched study
Authors: KAN ISSEI , Fuga Michiyasu , Ishibashi Toshihiro , Kato Naoki , Hataoka Shunsuke , Nagayama Gota , Sano Tohru , Murayama Yuichi
Published: January 2025

Object:
The introduction of antiplatelet agents is essential in stent-assisted coil embolization (SACE) for the treatment of intracranial aneurysms, and preoperative drug efficacy assessment is important in reducing the risk of ischemic complications. Light Transmission Aggregometry (LTA) is used in our institution to assess drug efficacy, and we analyzed the association between patient background factors, including preoperative LTA values, and perioperative complications in patients who underwent SACE in a retrospective analysis.

Methods:
Patients who underwent SACE for unruptured cerebral aneurysms from 1 March 2017 to 30 June 2024 were included. Two antiplatelet drugs (aspirin 100 mg and clopidogrel 75 mg /or prasugrel 3.75 mg) were administered 7 days prior to the procedure, and LTA measurements were performed on the day of surgery. The association of each patient's background factors with ischemic complications during the hospitalization period (≥1 mRS drop) and DWI and SWI positivity rates on the day after surgery was analyzed. To investigate whether LTA value affect DWI positive rate, propensity score-matched analysis was employed to control for age, sex, alcohol consumption, smoking, family history, medical history, aneurysm shape, multiple aneurysms, symptomatic aneurysms, maximum diameter, neck diameter, aneurysm site, left or right, first treatment or not, stent type, number of stents, clopidogrel or prasugrel.

Results:
During the observation period, 1021 unruptured cerebral aneurysms received endovascular treatment, of which 548 (453 Neuroform Atlas, 17 Enterprise, 78 LVIS) underwent coil embolization with stenting. The mean LTA value on the day of surgery was 44.2 (20-74). Symptomatic ischemic complications were present in two patients (0.4%), but no associated factors were found. Propensity score matching was successful for pairs of 184 aneurysms in the DWI negative group and 184 aneurysms in the DWI positive group. LTA value was still significantly higher in DWI positive group than in DWI negative group (46.96 vs 42.14, p<0.001). The cut off value of LTA for DWI positivity was 46.0 ( AUC 0.613, 95% CI 0.566 - 0.66).

Conclusion:
Pre-operative LTA values correlated with the post-operative DWI positivity rate; confirming and adjusting preoperative LTA values may contribute to reducing the DWI positivity rate and further reducing perioperative ischemic complications.
Abstract DP38: Impact of Age and Posterior Circulation Collateral Status on Outcomes in Vertebrobasilar Artery Occlusion Patients Undergoing Endovascular Thrombectomy
Authors: Doheim Mohamed , Al-Qudah Abdullah , Katano Takehiro , Rios Rocha Lucas , Bhatt Nirav , Starr Matthew , Lang Michael , Gross Bradley , Al-Bayati Alhamza , Raul Nogueira , Rocha Marcelo
Published: January 2025

Background:
Endovascular therapy (EVT) has emerged as a first-line intervention for vertebrobasilar artery occlusion (VBAO) patients, supported by two recent landmark randomized controlled trials. However, EVT outcomes may vary based on patient age and collateral status. This study examines the interaction between age and collateral status on EVT outcomes in VBAO patients.

Methods:
We retrospectively analyzed VBAO patients who underwent EVT from a prospectively maintained database between January 2014 and January 2024. Patients were categorized into non-octogenarians (age <80 years) and octogenarians (age ≥80 years). Collateral status was assessed using the BATMAN score, with ≥7 indicating favorable collaterals. Outcome measures included favorable functional outcomes (modified Rankin Scale [mRS] 0-3 at 90 days) and mortality within 90 days.

Results:
The study cohort comprised 195 VBAO patients, including non-octogenarians (n=148) and octogenarians (n=47), with a median age of 69 years (IQR: 58-79). Males accounted for 54.9% of the cohort. Non-octogenarians achieved higher rates of favorable functional outcomes (mRS 0-3: 46.3% vs. 24.4%, p=0.01) and lower mortality (43.4% vs. 68.3%, p=0.005). After adjustment for baseline imbalances, age ≥80 years was independently associated with increased mortality (aOR 4.84, 95% CI [1.55-15.16], p=0.007) and poorer functional outcomes (aOR 0.20, 95% CI [0.06-0.71], p=0.01). In subgroup analysis based on collateral status, favorable BATMAN scores (≥7) were associated with better functional outcomes in non-octogenarians (mRS 0-3: 55.3% with BATMAN ≥7 vs. 41.6% with BATMAN <7) despite not reaching statistical significance (p=0.13). Non-octogenarians with favorable BATMAN scores also had a trend towards lower mortality (31.9% vs. 49.4%, p=0.05), although this did not reach statistical significance in adjusted analysis. Among octogenarians, BATMAN ≥7 did not significantly affect clinical outcomes (mRS 0-3: 18.8% vs. 28.0%, p=0.50; mortality: 68.8% vs. 68.0%, p=0.96), further confirmed in adjusted analyses.

Conclusion:
While favorable collaterals (BATMAN ≥7) significantly mitigate adverse effects in younger patients, their impact is less evident in octogenarians possibly due to increased frailty. These findings highlight the importance of considering the interaction between age and collateral status when selecting VBAO patients for EVT. Further studies are needed to confirm these contentions.
Abstract DP40: Association of Automated Anatomical Vascular Measurements and Procedural Outcomes in Patients undergoing Endovascular Treatment of Stroke
Authors: Sastre Blanca , Canals Pere , Garcia-Tornel Garcia-Camba Alvaro , Ribo Marc
Published: January 2025

Introduction:
Challenging anatomy and tortuous vessels have been associated with poor outcomes in endovasculat treatment (EVT) of stroke. We aim to examine the relation between intracranial vascular features and EVT outcomes.

Methods:
A pre-existing automatic vascular analysis software of vessels on head-and-neck baseline CTA, was adapted to semi-automatically extract the vascular centerline segment from the internal carotid artery (ICA) origin to the thrombus site. Manual intervention was limited to approximate thrombus location placement and side of occlusion. For each vascular segment, the tortuosity index (TI), the overall mean diameter of the entire segment (OMD) and the last 5 mm (diameter at occlusion site) were computed. We defined: first pass effect (FPE: eTICI≥2c at first pass), successful recanalization (mTICI ≥ 2b), excellent recanalization (mTICI ≥ 2c), intracranial hemorrhage (ICH) and symptomatic ICH (sICH).

Results:
437 cases with intracranial vessel occlusions in the anterior circulation, treated with EVT between 2017 and 2022 (41% women, median age 81 [IQR 70-88] years), were analyzed (M1: 261 (59.7%); proximal M2: 111(25.4%); M2 distal: 65 (14.9%). Significant differences were found in the diameter at the occlusion site: distal M2: 2.42±0.74mm, proximal M2: 2.43±0.77mm, M1: 2.93±0.80mm (p<0.001) and in the TI: distal M2: 0.52±0.06, proximal M2: 0.50±0.08, M1: 0.47±0.08 (p< 0.001). In the entire population, a larger OMD predicted a lower likelihood of FPE (OR:0.51 (95% CI:0.32-0.80) and a higher risk of ICH (OR:1.79 (95% CI:1.08-2.98). Additionally, a larger diameter at the occlusion site predicted a higher risk of ICH (OR:1.36; 95% CI: 1.05, 1.77) for the entire population and especially for proximal M2 occlusions (OR: 1.91, CI:1.05-3.47).

Conclusions:
Anatomical vascular features automatically extracted from CTA before the procedure can help predict the likelihood of recanalization or the risk of hemorrhagic complications. Further analysis will explore specific anatomical markers that increase the risk of complications, especially in distal occlusions.
Abstract DP54: Anticoagulation is Superior to Antiplatelets in Occlusive Cervical Artery Dissection
Authors: Yaghi Shadi , Shu Liqi , Mandel Daniel , Kaufmann Josefin Emelie , Harshfield Eric , Engelter Stefan , Markus Hugh
Published: January 2025

Background:
Randomized trials and observational of patients with cervical artery dissection showed no significant difference in ischemic stroke risk with anticoagulation versus antiplatelet therapy. Occlusive dissection is a high-risk subgroup that may potentially benefit from anticoagulation. In this study, we aim to determine whether anticoagulation is effective in reducing ischemic stroke rates in patients with occlusive cervical artery dissection using subgroup data from the Cervical Artery Dissection in Stroke Study (CADISS), Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection (TREAT-CAD), and Antithrombotic therapy for Stroke Prevention In Patients with Cervical Artery Dissection (STOP-CAD).

Methods:
We stratified patients across the antiplatelet versus anticoagulation groups in the TREAT-CAD, CADISS, and STOP-CAD studies by occlusion status (occlusive versus non-occlusive dissection). The outcome was ischemic stroke during follow up. We performed a meta-analysis for ischemic stroke with anticoagulation vs. antiplatelet using relative risks.

Results:
We identified a total of 1626 patients with occlusive cervical artery dissection. In patients with occlusive cervical artery dissection, the risk of ischemic stroke was 1.7% on anticoagulation vs. 6.3% on antiplatelet therapy (RR 0.33 95% CI 0.16-0.68, p<0.001) without significant statistical heterogeneity (I
2
= 0%). This effect was numerically more pronounced in randomized controlled trials but with overlapping confidence intervals (RR 0.19 95% CI 0.02-1.55, p = 0.12, I
2
= 0%).

Conclusion:
The subgroup analysis of TREAT-CAD, CADISS, and the STOP-CAD studies showed a lower risk of ischemic stroke with anticoagulation in patients with occlusive dissection.
Abstract DP57: Neutrophil Response to Acute Injury in Neonatal Hypoxic-Ischemic Encephalopathy is Sexually Dimorphic
Authors: Carrera Mario , Korf Janelle , Mendoza Jennifer , Harrington Laura , Findley Tina , Ritzel Rodney , Liu Fudong , McCullough Louise , Caretti Viola
Published: January 2025

Introduction:
Neonatal Hypoxic-Ischemic Encephalopathy (nHIE) is a leading cause of infant mortality and long-term morbidity, with males experiencing higher mortality rates and poorer neurological outcomes than females. The underlying causes of this sex difference remains unclear but may be due to sex-specific inflammatory responses to acute brain injury.

Hypothesis:
We hypothesized that the neutrophil response to neonatal brain injury is sexually dimorphic and contributes to outcomes after nHIE.

Methods:
We conducted a retrospective study at a single academic institution, analyzing data from 2011 to 2021 (n=310). Inclusion criteria were gestational age ≥ 36 weeks, mild to severe HIE by Sarnat staging, CBC reported within the 1st day of life, and exclusion of concomitant infection (eligible group n= 201). In neonatal mice, we utilized the Rice-Vannucci Model of nHIE at postnatal day 9 (PND9) in C57BL/6 pups. Hypoxic-ischemic injury was induced via permanent ligation of the right common carotid artery followed by 50 minutes of hypoxia (n=14), with controls receiving sham surgeries (n=14).

Results:
Infants diagnosed with nHIE had significantly higher neutrophil counts than control infants admitted to the NICU within 24 hours after birth. Female infants with nHIE exhibited significantly higher neutrophil counts than males (15.2 vs.10.8 k/cm^3 ,p < 0.01), while there was no sex-difference in the control group (n=109). In PND9 mice, 72 hours after nHIE, females had a higher overall neutrophil count in blood and brain (p < 0.02). Male neutrophils produced significantly higher levels of pro-inflammatory cytokines, including IL-1β and TNF-α (p < 0.03,p < 0.01). Female neutrophils exhibited enhanced neuronal phagocytosis (increased intracellular NeuN, p < 0.03) and higher levels of anti-inflammatory/tissue recovery markers such as AHR and MMP9 (p < 0.02). Lastly, consistent with the dimorphic clinical outcomes observed in neonates with nHIE, female mice exhibited enhanced locomotion compared to males (reciprocal social test, p<0.05).

Conclusions:
These findings suggest a sex-specific polarization of neutrophil phenotypes following acute brain injury in neonates, with males predominately expressing an N1 (pro-inflammatory) and females an N2 (anti-inflammatory) phenotype. Understanding the sex-specific pathways that govern neutrophil polarization could lead to the development of sex-specific therapies for perinatal brain injury.
Abstract HUP11: Life's Essential 8 Among Stroke Survivors
Authors: Lian Kendra , Scott Lisa , Markovic Daniela , Towfighi Amytis
Published: January 2025

Background:
The AHA uses “Life’s Essential 8 (LE8)” to quantify cardiovascular health (CVH). These metrics assess eight essential components of nicotine exposure, sleep duration, physical activity, diet, body mass index, lipid levels, blood glucose, and blood pressure to calculate a CVH score. However, little is known about LE8 scores in patients with history of stroke compared to the general population.

Methods:
Data was included on individuals aged 18 and older who participated in the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2018. A LE8 score ranging from 0 (lowest) to 100 (highest) was calculated for all participants. Subscores of 0 to 100 points were also calculated for each of the metrics. The total LE and individual metric scores of participants with a self-reported history of stroke were compared to those who did not. The characteristics of all participants were stratified across age, gender, race/ethnicity, poverty/income ratio (PIR), education level, insurance status, alcohol consumption, high cholesterol, high high density lipoprotein, and histories of hypertension, diabetes, and/or myocardial infarction.

Results:
1,019 participants self-reported a history of stroke of 27,670 total participants. When adjusted for age, sex, race/ethnicity, education and PIR, the mean LE8 score was significantly lower in those who reported a history of stroke at (59.2, 95% CI, 57.8-60.5) compared to those who did not (63.8, 95% CI, 63.4-64.2) in those who did not. Stroke survivors had significantly lower mean subscores in 6 of 8 metrics on nicotine exposure (range 66.2-71.5), blood glucose (range 70.8-74.7), physical activity (range 30.8-36.9), diet (range 35.3-40.1), sleep duration (range 73.3-77.7), and blood pressure (range 58-62.4) compared to other participants (p<.001). Conversely, stroke survivors had higher mean lipid subscore (range 66.8-71.6) compared to other participants (range 63.0-64.3). In contrast to general participants who showed improvements over time in smoking, lipid levels, and sleep subscores, stroke survivors did not exhibit significant changes over time in any of these scores.

Conclusions:
Stroke survivors have inferior overall cardiovascular health and lower total LE8 scores compared to the general population. More intensive and tailored secondary stroke interventions are necessary to ensure improvement in overall cardiovascular health among stroke survivors.
Abstract HUP8: Safety-net Hospitals in the U.S. Have Worse Outcomes than Non-safety Net Hospitals for Ischemic Stroke
Authors: Zhan Michelle , Man Shumei
Published: January 2025

Background:
Safety-net hospitals (SNHs) are crucial in serving uninsured, underinsured, and socioeconomically disadvantaged populations, who often face financial limitations and resource shortages compared to their counterparts. We hypothesized that patients with ischemic stroke treated at SNHs would have inferior outcomes compared to non-SNHs, which may be related to the patient's socioeconomic status and care allocation.

Methods:
The National Inpatient Sample Database was queried to identify adult patients (≥18 years) who were hospitalized for ischemic stroke from 2016 to 2019. Patients with safety-net features were those with Medicaid or no insurance. Hospitals were ranked based on the percentage of patients with safety-net features. Hospitals in the top quartile were defined as SNHs, and the remaining hospitals were defined as non-SNHs. The characteristics and outcomes of the patients with or without safety-net features treated at SNHs vs non-SNHs were compared after adjusting for patient and hospital characteristics. A composite overall outcome variable was also generated to include in-hospital mortality, acute renal failure, tracheostomy, and sepsis.

Results:
We identified a weighted total of 1,823,985 patients, including 501,345 treated at SNHs and 1,550,100 at non-SNHs. The patients treated at SNHs were more likely to be non-white, had lower socioeconomic status but higher neurological severity, and more frequently required endovascular thrombectomy. They were associated with higher in-hospital mortality (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.09-1.19, p<0.001) and composite outcome (aOR 1.17, 95% CI 1.14-1.19), and longer hospital length of stay (5.6±7.7 vs 4.5±5.4 days, p<0.001) (Figure 1). Patients without safety-net features who were cared at SNHs had higher neurological acuity and worse outcomes compared to those treated at non-SNHs including in-hospital mortality (aOR 1.14, 95% CI 1.09-1.19), acute respiratory failure (aOR 1.24, 95% CI 1.20-1.29), tracheostomy (aOR 1.45, 95% CI 1.30-1.63), acute renal failure (aOR 1.16, 95% CI 1.13-1.19), and sepsis (OR 1.42, 95% CI 1.33-1.51) (Figure 2).

Conclusions:
Patients treated for ischemic stroke at SNHs, regardless of their socioeconomic status and safety-net features, have higher in-hospital mortality and an increased risk for composite adverse outcomes. These findings support changes in resource allocation and efforts to improve the care of ischemic stroke in SNHs.