bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP116: Immuno-Modulatory Micro RNAs and Adipokine Lipocalin-2 in Aged and Post-Stroke Rat Brains
Authors: Wesley Umadevi V , Jaeger Jacob , Chagharvand Sepideh , Hatcher James , Dempsey Robert J
Published: January 2019

Aging and dysregulated immuno-regulatory molecules amplify the stroke incidence, and poor post-stroke outcome. Adipokine imbalance is linked to inflammation and cerebro-vascular diseases, emphasizing a need to better understand the adipokines in aging and post-stroke brains. Lipocalin2 (LCN2) is an acute response adipokine involved in immune functions and apoptosis. MicroRNAs modulate genes involved in the immune response, aging, and stroke. We examined the role of LCN2 in aging and post-stroke brain, and examined if microRNAs regulate LCN2 expression and function. Proteomic profiling was used to examine the expression of adipokines in pre- and post-stroke brains of 3 and 12 months rats. Stroke was induced by middle cerebral artery occlusion. Immunohistochemistry, real-time PCR, and biochemical analysis were employed. LCN2 was downregulated by SiRNA using cat-ionic lipid-particle transfection. MTT assay and TMRE staining detected cell viability and mitochondrial potential. Immunomodulatory miRNAs were identified using profiler qPCR arrays. MicroRNA target prediction software identified the microRNAs able to modulate the expression of LCN2. LCN2 levels were significantly elevated in the brains of older naïve rats, and in ipsilateral brains of both young and older rats during the acute phase of ischemia/re-perfusion. Circulating plasma LCN2 levels were increased as a result of aging and ischemic stroke. LCN2 was predominantly expressed in neurons of ischemic brain. LCN2 mRNA levels correlated with protein levels. Under oxygen glucose deprivation - in vitro ischemia, LCN2 decreased mitochondrial potential and augmented neuronal apoptosis. However, silencing of LCN2 by siRNA caused a significant reduction in LCN2 levels, and an increase in neuronal cell viability. Mechanistic studies in post-stroke brain identified down regulation of microRNAs 125, 138, and 383 that target 3’-UTR of LCN2. MicroRNA 138 and 383 were also decreased significantly in response to aging. This inverse correlation between these microRNAs and LCN2 expression strongly indicated miRNA-mediated regulation of LCN2. Potential downregulation of LCN2 by immunomodulatory miRNAs 125 and 383 may attenuate pro-inflammatory status, and may improve post-stroke outcome.
Abstract TP134: Exercise Enhanced the Function of Endothelial Progenitor Cell-derived Exosomes on Protecting Neurons Against Hypoxia/reoxygenation Insult
Authors: Wang Jinju , Chen Shuzhen , Liu Hua , Yang Yi , Bihl Ji
Published: January 2019

Our recent study has revealed that moderate exercise upregulates the levels of miR-126 in circulating endothelial progenitor cell-derived exosomes (EPC-EXs), accompanying with enhanced protective function on endothelial cells. Whether exercise can regulate the function of circulating EPC-EXs on protecting neurons against hypoxia/reoxygenation (H/R) injury remains unclear. Here, we isolated the circulating EPC-EXs from exercise mice (10 m/min) and investigated their role in neurons subjected to H/R. EPC-EXs were characterized by nanoparticle tracking and western blot analyses. Mouse neurons (N2a) cultured in hypoxia condition for 6 hr followed by 24 hr reoxygenation. The H/R-injured N2a cells were treated with EPC-EXs (4 x 10
7
EPC-EXs/ml) isolated from exercise (EPC-EXs
E
) or sedentary mice (EPC-EXs
s
). For mechanism study, N2a cells were transfected with miR-126 inhibitor or pre-treated with PI3k inhibitor (LY294002) for 2 hr. After 24 hr treatment, apoptosis and axon growth ability of N2a cells were determined. The growth factors (vascular endothelial growth factor/VEGF and brain derived neurotrophic factor/BDNF), miR-126 level and its downstream signal genes (PI3k and Akt) were measured. Our data showed that: 1) H/R insult induced decrease of VEGF and BDNF secretion as well as axon growth ability, increase of apoptosis of N2a cells; 2) EPC-EX
S
treatment raised miR-126 level and rescued N2a cells from H/R-induced injury, with better effect elicited by EPC-EXs
E
. 3) EPC-EXs
E
had better effect than EPC-EX
S
on activating the PI3k/Akt signal pathway, which was significantly reduced by miR-126 and PI3k inhibitors. Altogether, exercise boosts the effects of EPC-EXs on protecting neurons against H/R insult through activating the miR-126/PI3k/Akt signal pathway.
Abstract TP141: Mesenchymal Stem Cell Derived Exosomes as a Modulator of Neuroinflammation Following Cortical Injury
Authors: Go Veronica , Bowley Bethany , Rosene Douglas , Medalla Maria , Buller Benjamin , Moore Tara
Published: January 2019

In this study, we tested Mesenchymal Stem Cell derived exosomes as a therapeutic to enhance recovery in our established nonhuman primate model of cortical injury. After pretraining monkeys on fine motor hand task,10 aged female monkeys were randomly assigned to an exosome treatment group (n=5) or a vehicle control (PBS) group (n=5). Then, in a single surgery, monkeys received a lesion in the hand representation of M1. One day and 14 days after injury, monkeys were given 4x10
11
exosomes/kg or PBS intravenously. Fifteen days after surgery, motor assessments were resumed for 12 weeks. The five treated monkeys all returned to pre-operative latencies to retrieve on motor tasks while none of the control monkeys returned to pre-operative latencies. To assess recovery mechanisms, cerebrospinal fluid (CSF) collected across the post-injury recovery period and terminal brain tissue were analyzed for markers of neuroinflammation. Preliminary ELISA results in both groups showed a trend towards increased Myelin Basic Protein (MBP) in CSF 24 hours after cortical injury followed by a gradual decline over 6 weeks. Interestingly, MBP levels declined more rapidly in exosome-treated animals, suggesting a potential reduction in damage. Scholl analysis of microglia branching in perilesional grey matter showed that exosomes increased ramification length, branching complexity, and convex hull 3D coverage volume. These findings suggest an increase in the surveying capacity of microglia in treated monkeys that may serve to promote repair after injury. Further, optical density analyses of microglial markers revealed a lower expression in treated monkeys of IBA1/P2RY12 and the MHCII antigen-presenting marker, LN3. This is consistent with decreased microglial activation associated with exosome treatment. These results provide evidence for the translational potential of exosomes as a treatment for human stroke.
Abstract TP142: Post-Ischemic Cortical Excitability and Gene Expression are Modulated by Transplanted Human Neural Stem Cells
Authors: Azevedo-Pereira Ricardo L , Weerakkody Tanya , Vu Jennifer , Du Fang , Liang Xibin , Huguenard John , Bliss Tonya M , Steinberg Gary K
Published: January 2019

Human neural stem cell (hNSC) transplantation improves recovery in preclinical stroke models. However their effects on surviving sensorimotor circuits are not well understood. Here we performed a comprehensive electrophysiological assessment and RNA-seq analysis of the stroke-injured rat cortex after transplantation of two hNSC lines, G010 (fetal-derived) and NR1 (hES-derived). Vehicle, G010, or NR1 cells were transplanted into the ischemic cortex of Nude rats 1 wk after distal middle cerebral artery occlusion. Neurological recovery was accessed by the Whisker-paw test. Acute brain slices were prepared 1 wk post-transplantation for electrophysiological recording. A linear multichannel recording probe was placed in the peri-infarct motor cortex and local field potentials (LFPs) recorded simultaneously from all cortical layers following circuit activation in layer 2/3. For RNA-seq analysis, the transplantation area was dissected, RNA extracted and cDNA libraries prepared for RNA-seq. G010 and NR1 cells enhanced post-stroke behavioral recovery starting 1 or 3 wks post-transplantation, respectively. Current source density (CSD) analysis of evoked LFPs, a method used to more accurately localize synaptic currents, revealed that both G010 and NR1 cells restored circuit excitability in layer 2/3, through reduction in inhibitory/excitatory (I/E) balance. However, the mechanisms driving the I/E balance shift were different, with NR1 cells enhancing excitation while G010 cells reduced inhibition. RNA-seq analysis of the cortex revealed that stem cell- versus vehicle-treated animals had different gene expression patterns in all cortical layers. Moreover, NR1 and G010 cells affected different genes. Layer 2/3-specific genes significantly affected by G010 grafts include Arpp21, Enpp2, Gbe1, Mylk, Pea15, Pkig, Rcn1, Slit3, Uchl1 and Wfs1; while NR1 grafts altered expression of Hapln4, Kcnc1, Ppp1r1b, Scn1a, Slit3 and Slitrk1. GO analysis revealed that both stem cell treatments activated critical canonical pathways e.g. Actin Cytoskeleton Signaling and Synaptic Long Term Depression. Stem cell transplantation modulates host gene expression and this is associated with increased circuit excitability and motor-sensory function.
Abstract TP15: Percutaneous Transcarotid Puncture is a Viable Alternative for Thrombectomy in Acute Ischemic Stroke Patients With Difficult Vascular Access
Authors: Wang Anson , Cord Brandon J , Chouairi Fouad , Koo Andrew B , Porto Carl , Silverman Andrew , Kodali Sreeja , Strander Sumita , Hebert Ryan M , Falcone Guido J , Sheth Kevin N , Sansing Lauren H , Schindler Joseph L , Matouk Charles , Petersen Nils H
Published: January 2019

Introduction:
Although endovascular thrombectomy is a highly effective treatment for patients with large-vessel occlusion stroke, the procedure can be prolonged, or even impossible, due to difficult vascular access. We hypothesized that patients undergoing percutaneous transcarotid puncture (PTCP) as an alternative approach would have improved functional outcome compared to patients where a transfemoral approach was precluded.

Methods:
For PTCP, a 6F (5.5-cm) sheath was placed in the common carotid artery using an ultrasound-guided, micropuncture technique. Mechanical thrombectomy (MT) was performed using stent retriever with adjunctive aspiration. We compared patients with unsuccessful MT due to transfemoral access failure with patients who were treated using PTCP. Functional outcome was assessed using the modified Rankin scale (mRS) at 3-months. Associations with outcome were analyzed using ordinal regression, adjusted for age and admission NIHSS.

Results:
We included 34 patients in the study (82 years [SD 11], 25M, mean admission NIHSS 17). PTCP was performed in 20 cases. 14 patients who were well matched for age, gender and admission NIHSS served as historical controls. Carotid access was obtained in 19/20 patients (1 abandoned due to inability to safely cannulate the artery). Successful reperfusion (TICI 2b-3) was achieved in 16/19 (84%), with 28% achieving good outcome (mRS 0-3) at 90 days compared to 7% of historical controls (p=0.087, Figure 1). PTCP cases also had a trend toward smaller infarct volumes (median 10 vs 38 ml, p=0.084) and greater reduction in NIHSS (-3.4 vs +2.8, p= 0.083). A single patient suffered a fatal carotid blowout on post-MT day 4.

Conclusions:
PTCP for emergent MT is a safe and effective strategy that yields high recanalization rates, and possibly improved functional outcome among patients with transfemoral access failure.
Abstract TP151: Stroke Mechanisms and Their Correlation With Prognosis in Medullary Infarction
Authors: Yamamoto Yasumasa
Published: January 2019

Introduction:
Prognosis in patients with medullary infarction (MI) has not sufficiently discussed, especially in terms of stroke mechanisms. Objective: To explore how underlying vascular lesions contribute to the prognosis of MI.

Methods:
We collected 81 consecutive patients with acute isolated MI including 50 patients with lateral MI (LMI), 30 with medial MI (MMI) and one with both LMI and MMI. The presumed stroke mechanisms were defined as follows: 1. Large artery occlusive disease (LAOD): infarcts with severe atherosclerotic stenosis or occlusion on the relevant arteries. 2. Penetrating branch disease (PBD): infarcts with normal to mild stenosis of the vertebral artery on the relevant side. 3. Dissection: infarcts with angiographic findings of the relevant arteries consistent with dissection. 4. Cardiogenic embolism: infarcts with abrupt onset with atrial fibrillation. We set the significant disability (SD) as a condition that includes the mRS ≥2 and/or dysphagia. Poor outcome was defined as SD at one year after onset.

Results:
There were 20 patients with PBD (40%), 18 with dissection (36.0%) and 11 with LAOD (22.0%) in LMI and 17 with PBD (56.6%), 10 with LAOD (33.3%) and 2 with dissection (6.6%) in MMI. The incidence of SD at discharge in LMI and MMI were not different between 3 stroke mechanisms. However, stroke mechanisms of LAOD and dissection compared with PBD were independently correlated with poor prognosis at one year after onset: (OR: 13.0, p=0.034 and OR: 10.7, p=0.029, respectively) after adjustment of lesion location in LMI. In MMI, LAOD compared with PBD significantly correlated with SD (OR: 13.4, p=0.014). Functional disability still improved after discharge especially in patients with PBD. Intensive treatment of combined use of antithrombotic agents in acute stage seemed to be effective.

Conclusions:
PBD was the most predominant stroke mechanism in MI and its prognosis was good despite the certain disability at discharge. Patients with LAOD or dissection may be predisposed to chronic hypo-perfusion over a long period of time. Underlying vascular lesions better predict outcome of MI than infarct extension or location in patients with MI.
Abstract TP159: Natural History of Carotid Intima-Media Thickness and Plaque in Real World Clinical Practice; A Single Center Experience
Authors: Cho A-hyun , Kwon Jee Hyun , Jeong Ha-Neul , Oh Yoon-Sang , Lim Eun Ye
Published: January 2019

Background:
Evaluation of carotid and vertebral artery with duplex sonography (DUS) is useful method for estimating systemic atherosclerotic risk. Regarding asymptomatic carotid plaque, how they change over time and how they should be properly managed are not well investigated yet. We investigated the natural history of carotid and vertebral arteries plaque or intima-media thickness (IMT) with best medical therapy in real clinical practice.

Methods:
We consecutively enrolled patients who undergone DUS more than twice. Severe symptomatic stenosis or cardioembolic steno-occlusion was excluded. The management was performed by physician’s discretion. Demographics and clinical variables were obtained. ‘Increased IMT’ was defined when average IMT was over 1mm. Plaque was defined as a focal structure encroaching into the arterial lumen at least 0.5mm or 50% of the surrounding IMT. Progress or regress of IMT was defined as more than 0.1mm change from the initial scan. Plaque progress was determined by semi-quantitative measurement (more than 0.1 mm change or supported by velocity change particularly when echolucent plaque) and visual exam. Increased IMT, plaque presence were interpreted at initial and follow-up scan. Factors related to progression or regression was analyzed.

Results:
Total 155 patients (64.5% men, mean age 64.9±10.2) were enrolled. There were 111 (71.6%) stroke or transient ischemic attack, and others, non-stroke such as dizziness, headache, and for medical check-up. The interval between initial and second DUS was 23.5±12.0 months. In 132 (85.2%) patients, increased IMT or presence of atherosclerotic plaque was observed on initial scan. On follow-up scan, progress of IMT or plaque was observed in 60 (38.7%). Regress was also observed in 8 (5.2%) patients. Subjects with progress were older than those without (66.9±9.5 vs 63.7±10.5, p=0.053). Sex, risk factors, time interval and use of statin were not associated with the progress. The dyslipidemia were significantly associated with the regress of IMT or plaque (p=0.064).

Conclusion:
During two years of follow-up, progression of IMT or plaque was observed in 38.7% and regression in 5.2%. Older subjects are likely to progress and regression was more common in patient with dyslipidemia.
Abstract TP163: Hypertrophic Olive Degeneration Causing Novel Neurological Symptoms After Stroke: A Case Series
Authors: Schaller Martin Alexander , Zoellner Johann-Philipp , Wagner Marlies , Foerch Christian
Published: January 2019

Background:
Ischemic and hemorrhagic strokes in the brainstem and cerebellum can affect the
dentate-rubro-olivary
-pathway. Lesions in this functional loop (called triangle of
Guillain
and
Mollaret
) may result in hypertrophic olivary degeneration (HOD). Characteristic symptoms include rhythmic palatal tremor, primarily vertical pendular nystagmus, and Holmes-tremor of the upper limbs. This case series explores the course of the disease and its clinical presentation, in order to provide an improved understanding of HOD after stroke.

Materials and methods:
The neuro-radiological database of our university hospital was scanned for the term
hypertrophic olivary degeneration
and related keywords (in German)
.
Between 2010 and 2017, a total of 27 HOD cases were identified, of which 12 patients had suffered a stroke in their medical history.

Results:
Mean age of the 12 patients was 51.4 (+/-13.6) years. Eight patients had intracerebral hemorrhage, 3 ischemic stroke and one subarachnoid hemorrhage as causative event. Lesions were located pontine (n=7), cerebellar (n=4), and ponto-mesencephalic (n=1). Leading symptoms were palatal tremor (55%), Holmes tremor (18%), pendular nystagmus (18%), and dysarthria (73%). Based on clinical findings and brain imaging we designed a model allowing to predicting the side of HOD according to lesion location (Figure). By this we were able to identify and illustrate lesion sites able to induce bilateral HOD.

Conclusions:
Strategic lesions within the
Guillain-Mollaret-Triangle
in the posterior fossa may lead to unilateral or bilateral HOD. Even though the clinical syndrome of HOD is characteristic, diagnosis is often prolonged due to imprecise examination and misinterpretation of the findings. Future studies are desirable defining the incidence of HOD and evaluating therapeutic options.
Abstract TP169: Discharge Planning for Stroke Survivors in the Northeast
Authors: Stein Joel , Borg-Jensen Pamela , Sicklick Alyse , Rodstein Barry , Hedeman Robin , Bettger Janet P , Hemmitt Roseanne , Silver Brian , Thode Henry C , Magdon-Ismail Zainab
Published: January 2019

Introduction:
The process of determining stroke survivor’s post-acute care is not well understood. This study sought to examine the factors influencing these decisions and barriers to obtaining care.

Methods:
23 hospitals in the northeastern US each contributed data on approximately 20 consecutive acute stroke patients. Discharge planners (DP) and physical therapists (PT) involved in the care of each patient were queried regarding the selection of discharge destination and any barriers encountered.

Results:
Data was analyzed for 427 stroke patients hospitalized from May 2015 - November 2016; 45% of the patients were female, the mean age was 71
+
15 and primary insurance was Medicare (50.8%), Medicaid (4.9%), Managed Care/Commercial (21.5%) or other/uninsured (3.3%); no response/unavailable (19.4%). One hundred and eighty-four patients (43.1%) were discharged directly home, 146 (34.2%) were discharged to an Inpatient Rehabilitation Facility, 94 (22.0%) were discharged to a Skilled Nursing Facility, and 3(0.7%) to a Long Term Acute Care Hospital. DPs and PTs agreed regarding preferred discharge destination in 355 (83.1%) of cases. The actual discharge destination matched the preferred discharge destination in 92.5% of these cases. There were 23 cases (6.5%) where the patient was discharged to a less intensive setting than preferred by both respondents, and in 8 (2.3%) insurance barriers were cited by at least one respondent as the reason for the discrepancy in discharge destination. In most of the remaining cases the discrepancy was accounted for by “patient/family preference”.

Conclusions:
Most stroke survivors in the Northeast are discharged to the “most appropriate” post-acute facility based on the opinion of their discharge planners and physical therapists. Most patients discharged to less intensive settings than preferred by their DPs and PTs, were attributed to patient/family preference, with only a small minority discharged to another type of setting based on insurance or other limitations. This supports the hypothesis that local referral preferences may be a larger driver of the variation in the utilization of post-acute care rather than insurance or other barriers. Further research is needed to clarify optimal care for this population.
Abstract TP171: Eloquence of White Matter Tracts in Acute Ischemic Stroke Patients
Authors: Rajashekar Deepthi , Singh Ravinder-Jeet , Menon Bijoy K , Forkert Nils Daniel
Published: January 2019

Background:
Clinical assessment scores after acute ischemic stroke are only moderately correlated with structural brain damage since lesion location is also an important confounding factor. Many studies have investigated gray matter eloquence but, general understanding about the importance of specific white matter (WM) tract involvement is limited. The aim of this study was to investigate the eloquence of major WM tracts with respect to 24 hours post-stroke NIHSS.

Methods:
Lesions in follow-up FLAIR MRI datasets acquired 1-7 days after acute stroke onset due to proximal MCA or ICA occlusion were manually segmented and non-linearly registered to a common atlas. Voxel-based lesion-symptom mapping (VLSM) using sparse canonical correlation analysis was used to generate a statistical eloquence map with normalized t-scores ranging from 0 to 1 with the 24h NIHSS as outcome score. The JHU probabilistic WM atlas was used to quantify the individual tract eloquence.

Results:
96 patients were included in this study (50 females, mean age 66.4±14.0 years, median NIHSS 5, IQR 2-9.5). Multivariate VLSM resulted in a major left-hemispheric and smaller right-hemispheric cluster of significant voxels overlapping with four WM tracts. The left corticospinal tract (motor function) showed an overlap of 3.52% (maximum t-score: 0.31; mean: 0.17±0.05), the right corticospinal tract an overlap of 7.33% (maximum t-score: 0.54; mean: 0.26±0.01), the left anterior thalamic radiation (sensory and motor relay) an overlap of 5.89% (maximum t-score: 0.44, mean: 0.18±0.07), and the inferior fronto-occipital fasciculus (auditory and visual association) an overlap of 21.31% (maximum t-score: 0.34, mean: 0.21±0.06).

Conclusions:
The significantly affected WM tracts identified are related to motor and cognition function, predominantly assessed by NIHSS, highlighting the importance of white matter tract involvement for recovery and rehabilitation.
Abstract TP183: Burden of Disability Among Stroke Survivors in the United States Between 2005 and 2017
Authors: Waziry Reem
Published: January 2019

Aims:
The aims of the present study are to assess burden of disability among stroke survivors: 1) in women compared to men; 2) by age group; 3) race &4) study period.

Methods:
We used the clinical variables collected in the National Alzheimer’s Coordinating Center (NACC) Uniform Data sets downloaded in February 2018. Thirty-four National Institutes of Health (NIH) funded Alzheimer’s Disease centers contributed to the data. Visits conducted between 2005 and 2017 were included. Self-reported and clinician-based disabilities were assessed in women and men, and by age-groups, race and study period.

Results:
Over the study period, there were a total of 9,957 observations among 2,769 stroke survivors. Women represented 54% with a mean year of birth=1930 (SD=9). Compared to men, women had less years of education (14% vs 16% years), were less often married (32% vs 75%). In terms of medical history, women stroke survivors were less likely to have history of atrial fibrillation (12% vs 14%), angioplasty (2% vs 5%), transient ischemic attack (5% vs 6%), Parkinson disease (1% vs 2%), seizures (2% vs 3%), hypercholesterolemia (61 vs 66), or vitamin b12 deficiency (6 vs 7). But more likely to have history of heart failure (6 vs 5), hypertension (72 vs 68), and thyroid disease (27 vs 12). In terms of self-reported disability, women were less likely to report vision impairment (25 vs 26), using vision correction (70 vs 71), hearing aid (15 vs 23), memory complaints (21 vs 25), judgment (20 vs 23), personal care (8 vs 9), motor disability (11 vs 13) or appetite changes (16 vs 21). In terms of clinician-based judgment of motor and memory disability, women were less likely to have gait disorders (25 vs 32), tremors (9 vs 15), slowness in movement (23 vs 28), memory decline (64 vs 74), cognitive memory (62 vs 72), judgment impairment (51 vs 59), language disability (37 vs 40), attention (32 vs 37) or cognitive fluctuation (5 vs 9).

Conclusion:
In a representative sample of stroke survivors, women showed a significantly lower burden of disability following stroke diagnosis indicating a better quality of life and better prognosis. Further investigations will be conducted to assess patterns of disability by age groups, race and study period.
Abstract TP194: Farmalarm: A Mobile Application to Improve Stroke Awareness
Authors: Requena Manuel , Montiel Estefania , Rubiera Marta , Muchada Marian , Boned Sandra , Molina Carlos A , Ribo Marc
Published: January 2019

Background:
Risk factor control and treatment compliance in the following months after stroke are often poor. We aim to validate a digital platform for smartphones designed to raise awareness in patients about the need to perform healthy lifestyle changes, improve communication with medical staff and increase treatment compliance

Methods:
Farmalarm is an app for smartphones designed to increase stroke awareness by: medication visual alerts and compliance control, chat communication with medical staff, sharing didactic video files, exercise monitoring... Stroke patients discharged home were screened for participation and divided in two groups: to follow the FARMALARM program during 3-4 weeks or standard of care follow-up. We determined risk factor control goals at 90 days in all patients.

Results:
During 16 months, from all patients discharged home, 159 were included in the study: FARMALARM n=107; age 58±12, Control n=52, age 59±11. There were no significant differences in baseline characteristics between groups. At 90 days, mean of total cholesterol (156±37 vs. 169±50, p=0.01) and low-density-lipoprotein cholesterol (87±31 vs. 101±43, p<0.01) were lower in the FARMALARM group. Achievement of risk factor control was higher in the FARMALARM group (p=0.03) and the rate of patients with 4/4 risk factors under control was higher in the FARMALARM group (42.2% Vs 14.7%; p=0.01). A regression model adjusted for age and gender showed that the only variable independently associated with all risk factors under control at 90 days was the use of Farmalarm (OR: 2.87; 95% CI:1.2-6.9;p=0.01).

Conclusion:
FARMALARM is a reliable mobile application to monitor medication compliance and increase stroke awareness in stroke patients discharged home and it could improve the control of vascular risk factors.
Abstract TP197: Risk of Epilepsy in Elderly Stroke Patients: 10-Year Nationalwide Population-Based Study
Authors: Lee JunHong , Park JaeHyeon , Hwang Sung-Hee
Published: January 2019

Background and objective:
The incidence of epilepsy in elderly stroke patients has been significant attention because planning future needs for health services and improved primary and secondary prevention of stroke are important. We evaluated the relationship between stroke and the subsequent development of epilepsy within 10 years follow-up.

Methods:
This retrospective, nationwide, longitudinal study used National Health Insurance Service -Senior cohort (NHIS-Senior) 2002-2013, which was released by the KNHIS in 2016, comprising 550,000 random subjects who were selected from over than 60 years old. This study included a cohort of 42,925 patients who were first diagnoses as stroke between 2004 and 2006. To match each stroke patient, 218,478 control subjects were selected from the data-base.

Results:
In this cohort, the prevalence of stroke was higher in female(62%) than in male(38%). A higher prevalence of stoke was observed in the 60-70 years age and more than 80 years age group in urban area. The incidence of stroke was increased from 2002 to 2009, but decreased from 2010 to 2013. The diagnosis of epilepsy was done at averagely 20 months after the diagnosis of stroke. Cox regression analysis showed that the HR of epilepsy was 7.658 times greater for patients with stroke (95% CI: 7.402-7.923) than for control group after adjusting for other risk factors. The HR of epilepsy was 1.08 (95% CI: 1.045-1.116) in female patients, 1.66(95% CI: 1.607-1.715) in diabetic patients, 1.679(95% CI: 1.625-1.734) in hypertensive patients, 1.831(95% CI: 1.626-2.062) in chronic kidney disease and 1.647(95% CI: 1.593-1.703) in hypercholesterol patients.

Conclusion:
Our findings suggest that stoke may be independent risk factor for epilepsy in elderly patients(HR 7.658, 95% CI: 7.402-7.923). So we need to control and pay attention to epilepsy in elderly stroke patients.
Abstract TP209: Women Report More Symptoms of Depression Post-Stroke With Routine Screening
Authors: Si Kevin , Kapoor Arunima , Yu Amy Y , Swartz Richard H
Published: January 2019

Introduction:
Stroke is a leading cause of mortality and morbidity. Important sex differences have been observed in stroke outcomes. Compared to men, women have poorer outcomes, but the reasons for this observation are unclear. Depression affects approximately one-third of patients post-stroke and is associated with poor outcomes. We aimed to determine any sex differences in the prevalence of symptoms of depression in stroke survivors.

Methods:
We identified a cohort of adult patients with stroke or TIA from the prospective, multi-centered Depression, Obstructive sleep apnea, and Cognitive impairment (DOC) study. All patients systematically completed a depression screening tool (Patient Health Questionnaire-2). A score of 4 or more out of 6 indicates that the patient is at high risk of depression. We used logistic regression with and without adjustment for age, event type (TIA or ischemic stroke), education level, vascular risk factors, cognitive symptoms, cancer, and disability to determine the association between sex and risk of depression.

Results:
We included 2,379 patients (mean age 68 years (SD = 14.8), 1310 men (55.1%). There were 222 (9.3%) patients at high risk for depression. Women were more likely to be at high risk (Odds Ratio OR 1.4, 95% CI [1.1, 1.9]) in univariable analysis. This association remained true after adjustment for covariates (OR 1.6, 95% CI [1.2, 2.1]).

Conclusion:
With systematic screening post-stroke, women are at higher risk for depression than men, even after controlling for baseline differences. Further research into whether our findings mediate the sex differences in outcomes post-stroke and the implications on treatment of depression post-stroke is needed.
Abstract TP214: Descriptive Epidemiology of Ischemic Stroke Patients With Atrial Fibrillation: EAST-Af study from South Korea and Japan
Authors: Kim Beom Joon , Koga Masatoshi , Lee Keon-Joo , Tanaka Kanta , Mizoguchi Tadataka , Park Eun Lyeong , Lee Juneyoung , Toyoda Kazunori , Bae Hee-Joon
Published: January 2019

Introduction:
We present a descriptive epidemiology data of ischemic stroke patients with atrial fibrillation from South Korea and Japan.

Methods:
Based on prospective registries from South Korea (CRCS-K registry) and Japan (SAMURAI-NVAF study), we collected acute ischemic stroke or transient ischemic attack (TIA) patients with documented atrial fibrillation between 2011 and 2014. Data elements, data fields, and their definitions were harmonized to generate a single dataset. A total of 6036 patients were includedin the analysis (4844 from CRCS-K and 1192 from SAMURAI-NVAF).

Results:
Regarding baseline characteristics, noticeable differences were found in the following variables between South Korea and Japan; mean age at onset (73.7 ± 10.1 vs 77.7 ± 9.9), TIA as an index event (2.3% vs 4.3%), diabetes (28.6% vs 20.1%), dyslipidemia (28.1% vs 32.9%), smoking (28.3% vs 36.9%), antiplatelets before stroke (39.5% vs 24.3%), anticoagulants before stroke (16.9% vs 31.8%), and recanalization treatment (31.6% vs 22.3%). Median [interquartile range] NIHSS score at admission was comparable (9 [3 - 16] vs 8 [2 - 18]). Functional recovery and event outcomes were different between two countries; mRS score 0 - 1 at 3 months (31.9% vs 36.9%), mortality at 3 months(16.8% vs 6.3%) and at 1 year (22.8% vs 15.4%) and recurrent stroke until 1 year (6.2% vs 10.6%).

Conclusions:
In spite of common ethnic and cultural background, ischemic stroke patients with atrial fibrillation in South Korea and Japan differ in the following points; 1) favorable recovery and event outcomes of Japanese patients in spite of older age at onset, 2) lower pre-morbid anticoagulants in South Korea, and 3) lower rate of acute recanalization treatment in Japan.
Abstract TP218: Functional Dynamics of Neutrophil After Ischemic Stroke
Authors: Hu Mengyan , Cai Wei , Liu Sanxin , Lu Zhengqi
Published: January 2019

Background and purpose:
Neutrophil is forerunner to the brain lesion after ischemic stroke and exerts elaborate functions. However, temporal alterations of cell count, polarity, extra cellular trap formation and clearance of neutrophil remain poorly understood. The current study aimed at providing basic information of neutrophil functional time course.

Methods:
A total of 225 patients were included in the study. Correlation of neutrophil in peripheral blood and stroke outcomes were analyzed. Dynamics of neutrophil cell count and immune-modulatory functions were assessed with flow cytometry, immune-staining, quantitative PCR. In vitro study was conducted to describe the impact of neutrophil phenotype to macrophage and neuronal death after ischemic injury.

Results:
Higher neutrophil count in patient blood within 24 hours after symptom onset indicated detrimental stroke outcomes. The peak of neutrophil in ischemic brain lesion (1-2d) was right after that of peripheral blood (12h) in mice. Expression of CD206, a N2 marker, was relatively stable in infiltrated neutrophil within stroke lesion. Clearance of neutrophil peaked at 2d after stroke and extra cellular traps were most detected at 2-3d after stroke. N2 phenotype facilitated neutrophil clearance by macrophage and did not further induced neuronal death after ischemic injury. Conditioned medium of ischemic neurons drove neutrophil away from the protective N2 phenotype and increased formation of extracellular traps.

Conclusions:
Neutrophil functions had important impact on stroke outcomes. Neutrophil in patient blood could be an early indicators of stroke outcomes. N2 neutrophil facilitated macrophage phagocytosis and was less harmful to ischemic neurons. Directing neutrophil towards N2 phenotype could be a promising therapeutic scheme for ischemic stroke.
Abstract TP226: Impact of Non-Vitamin K Antagonist Oral Anticoagulant Withdrawal on Stroke Outcomes
Authors: Han Sang Won , Park Joong Hyun , Park Jae Hyeon , Baik Jong Sam , Ahn Seong Hwan , Lee Jong Yun , Lee Kyung-Yul , Kim Young Dae
Published: January 2019

Introduction:
Discontinuation of antithrombotics can be associated with an increased risk of cardiovascular events and poor outcomes. Abrupt warfarin withdrawal may also induce a rebound or a paradoxical prothrombotic state, subsequently leading to an increased incident risk of stroke for up to 3 months.

Hypothesis:
Considering the potent anticoagulant effect of non-vitamin K oral anticoagulants (NOACs) on the suppression of thrombogenesis, NOAC withdrawal may be associated with profound hypercoagulable state, leading to severe stroke and poor outcomes in patients with non-valvular atrial fibrillation (NVAF) related stroke. The aim of this study was to compare the initial stroke severity and functional outcome associated with NOAC withdrawal to those associated with other prior medication statuses including warfarin withdrawal in patients with NVAF.

Methods:
A total of 719 patients with ischemic stroke or transient ischemic attack and NVAF who were admitted at five regional hospitals between January 2013 and December 2016 were included. Prior medication status was categorized into seven groups such as no antithrombotics, antiplatelet-only, warfarin with a subtherapeutic intensity, warfarin with a therapeutic intensity, NOAC, warfarin withdrawal, and NOAC withdrawal. We compared initial National Institute of Health Stroke Scale (NIHSS) scores between groups.

Results:
The mean age was 73.9 ±10.2 years, and 397 (55.2%) patients were men. Median CHA
2
DS
2
-VASc score was 4 (interquartile range [IQR] 3-5). Among 719 patients, the NOAC withdrawal group had the highest median NIHSS scores at stroke onset (16, interquartile range, IQR [4-20]), followed by the warfarin withdrawal group (11, IQR [3-17]), the no antithrombotic group (5, IQR [2-16]), and the warfarin with subtherapeutic intensity group (5, IQR [2-13]). Multivariable analysis demonstrated that NOAC withdrawal was independently associated with higher NIHSS scores at stroke onset (B 4.645, 95% CI 0.384-8.906, P=0.033).

Conclusions:
Stroke occurred after discontinuing oral anticoagulants, particularly NOAC, was independently associated with severe stroke severity.
Abstract TP234: Which Age-Groups are at Highest Risk for Early Readmission After Hospitalization for an Index Ischemic Stroke in the United States?
Authors: Girotra Tarun , Lekoubou Alain , Bishu Kinfe , Ovbiagele Bruce
Published: January 2019

Background:
Studies assessing the relationship between age and readmission rates in stroke survivors have yielded conflicting results. Limitations of these studies have included small sample size, database limited to a single or few centers, and exclusion of patients below 65 years of age.

Objective:
To explore the contemporary influence of age on early stroke readmission rates in the United States

Methodology:
The National Readmission database (NRD) from 2014 was used to identify patients admitted in the US with the primary diagnosis of ischemic stroke based on ICD-9 codes. Patients were grouped into 4 age categories: 20-44y, 45-64y, 65-84y, and ≥85y. Multivariate logistic regression was used to calculate independent odds ratio (OR) for readmission within 30 days of discharge from the index hospitalization among various age groups.

Results:
From the total of 502,604 admissions in 2014 with a primary diagnosis of ischemic stroke, we used a weighted sample of 230,774 admissions for the analysis. Among these, there were 7,092 (3.1%) readmissions (Age distribution - 20-44y: 2.8%; 45-64y: 31.7%; 65-84y: 53.3%; ≥ 85y: 12.2%). Multivariate logistic regression analysis showed that compared to 20-44 y, readmission rates were significantly higher in 45-64y (OR 1.57; 95% CI 1.33-1.86) and 65-84y (OR 1.6; 95% CI 1.35-1.9) but not for ≥85y (OR 1.18; 95% CI 0.97-1.44). Other factors significantly associated with lower risk of 30-day readmission were women (OR 0.86; 95% CI 0.81-0.91), urban teaching hospital (OR 0.92; 95% CI 0.85-0.99), and discharge to skilled nursing facility/rehabilitation (OR 0.65; 95% CI 0.60-0.71) compared to discharge to home.

Conclusions:
Recent U.S. stroke survivors between the ages of 45 to 84 years have higher early readmission rates compared to their counterparts aged <45 and ≥85 years. This finding may reflect the prognosis of stroke mechanisms, co-morbidities, or a survival bias, but underscores a need to better address avoidable readmissions and healthcare expenditure associated with them.
Abstract TP239: The Correlation Between Ultrasound Characteristics of Carotid Web and Ischemic Stroke
Authors: Hua Yang , Yang Jie , Li Qiuping
Published: January 2019

Objective:
Carotid web is one of the etiologic factors contributed to cryptogenic ischemic stroke. This study aimed to analyze the correlation between ultrasound characteristics of carotid web and ischemic stroke (IS).

Methods:
Patients with carotid web initially examined by ultrasonography (US), confirmed by computed tomography angiography (CTA) subsequently, were retrospectively enrolled from January 2018 to July 2018. All patients were divided into IS group and no IS (NIS) group for comparative analysis. The degree of carotid artery stenosis (CAS) caused by the carotid web, and the angle between web and carotid wall were measured. The incidence of CAS > 50%, web angle < 70°, and the thrombus occurrence between the two groups were compared.

Results:
A total of 24 patients finally diagnosed with carotid web were enrolled (10 in IS group, 14 in NIS group). The mean age was 57 years (range 30-75 years), 14 patients were male (58.3%). Thirteen patients diagnosed with carotid web through initial US examination (54.2%, 13/24), and all other 11 patients (45.8%) were misdiagnosed as ulcer-plaque (9 patients) and dissection (2 patients) prior to final diagnosis. There was no significant difference in the incidence of CAS > 50% between IS and NIS groups (10% versus 35.7%, P=0.341). The incidence of thrombus occurrence in IS group was higher than NIS group (80% versus 35.7%, P=0.047). In addition, the proportion of web angle ≤ 70° in IS group was higher than NIS group (90% versus 42.9%, P=0.033). Patients with web angle ≤ 70° had a higher incidence of thrombus than those angle > 70° (73.3% versus 22.2%, P=0.033). However, the incidence of CAS > 50% was higher in patients with web angle > 70° (55.6% vs 6.7%, P=0.015).

Conclusion:
Ultrasonography could evaluate the specific imaging characteristics of carotid web. The web angle > 70° accounted for CAS > 50%. The angle ≤ 70° was related to developing thrombus, which may cause recurrent ischemic stroke.
Abstract TP241: Correlation of Mri Cerebral Perfusion Parameters and Carotid Plaque Characteristics
Authors: Peckham Miriam E , Kim Seong-eun , Parker Dennis L , Shah Lubdha M , de Havenon Adam , McNally Scott
Published: January 2019

Purpose:
Recent evidence suggests that MRI-detected intraplaque hemorrhage (IPH) improves stroke prediction in all carotid stenosis categories, placing the role of stenosis and impaired perfusion in question. The goal of this study was to determine if carotid stenosis or IPH are associated with baseline perfusion impairment measured by dynamic susceptibility contrast (DSC) and cellular diffusion and perfusion measured by intravoxel incoherent motion (IVIM).

Method and Materials:
After IRB approval and informed consent, we recruited 25 patients with >=50% stenosis in at least one carotid. Carotid MRI and brain IVIM and DSC were performed at 3T. IVIM was acquired with b-values of 20, 40, 50, 100, 250, 500, and 2000. Post-processing was performed (IVIM with Osirix, and DSC with Olea Sphere). Bilateral regions of interest were drawn in the centrum semiovale with the following measurements obtained for IVIM: percent perfusion fraction (f), tissue diffusion (D), pseudodiffusion (D*) and blood flow related parameter (fD*). DSC parameters included cerebral blood flow (CBF), blood volume (corrected CBV), mean transit time (MTT), and time to peak (TTP). Generalized estimating equations (GEE) and multivariable linear regression was performed accounting for two carotid arteries per patient, to determine the association of each IVIM and DSC perfusion parameter with carotid imaging factors including stenosis, occlusion, near-occlusion, and IPH.

Results:
Near-occlusion was rare (2/50 carotids) but was the only factor associated with DSC parameters (CBF: coefficient=-9.7, p=0.016, corrected CBV: coefficient=-0.36,p=0.042, MTT: coefficient=1.1,p=0.010, and TTP: coefficient=2.2,p=0.008). Near occlusion was also the only factor associated with the IVIM parameters f (coefficient=1.7, p=0.057) and fD* (coefficient=44, p=0.045). Carotid IPH was the only factor associated with D (coefficient=45, p=0.002). None of the factors were significantly associated with D*.

Conclusion:
These results suggest that carotid stenosis does not result in decreased baseline cerebral perfusion except in the rare setting of near-occlusion. While these patients may benefit from flow restoration, most patients may primarily benefit from embolic protection.
Abstract TP245: RCVS
2
Score and Diagnostic Approach for Reversible Cerebral Vasoconstriction Syndrome
Authors: Rocha Eva A , Topcuoglu M. Akif , Silva Gisele S , Singhal Aneesh B
Published: January 2019

Objective:
To develop a method to distinguish reversible cerebral vasoconstriction syndrome (RCVS) from other large/medium-vessel intracranial arteriopathies.

Methods:
We identified consecutive patients from our institutional databases admitted 2013-2017 with newly diagnosed RCVS (n=30) or non-RCVS arteriopathy (n=80). Admission clinical and imaging features were compared. Multivariate logistic regression modelling was used to develop a discriminatory score. Score validity was tested in a separate cohort of patients with RCVS and its closest mimic, primary angiitis of the central nervous system (PACNS). Additionally, key variables were used to develop a bedside approach to distinguish RCVS from non-RCVS arteriopathies.

Results:
The RCVS group had significantly more women, vasoconstrictive triggers, thunderclap headaches, normal brain imaging results, and better outcomes. Beta coefficients from the multivariate regression model yielding the best c-statistic (0.989) were used to develop the RCVS
2
score (range, -2 to +10;
R
ecurrent/single thunderclap headache;
C
arotid artery involvement;
V
asoconstrictive trigger;
S
ex;
S
ubarachnoid hemorrhage). Score ≥5 had 99% specificity and 90% sensitivity for diagnosing RCVS, and score ≤2 had 100% specificity and 85% sensitivity for excluding RCVS. Scores 3-4 had 86% specificity and 10% sensitivity for diagnosing RCVS. The score showed similar performance to distinguish RCVS from PACNS in the validation cohort. A clinical approach based on recurrent thunderclap headaches, trigger and normal brain scans, or convexity subarachnoid hemorrhage, correctly diagnosed 25 of 37 patients with RCVS
2
scores 3-4 across the derivation and validation cohorts.

Conclusion:
RCVS can be accurately distinguished from other intracranial arteriopathies upon admission, using widely available clinical and imaging features.