bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP200: Larger Perfusion Mismatch Volume Is Associated with Longer Hospital Length of Stay in Medium Vessel Occlusion Stroke
Authors: Mei Janet , Lakhani Dhairya , Alizada Sahar , Vagal Vaibhav , Koneru Manisha , Salim Hamza , Balar Aneri , Luna Licia , Deng Francis , Hyson Nathan , Dmytriw Adam , Wolman Dylan , Pulli Benjamin , Xu Risheng , Heit Jeremy , Faizy Tobias , Soman Salil , Albers Greg , Urrutia Victor , Marsh Elisabeth , Nael Kambiz , Aziz Yasmin , Sriwastwa Aakanksha , Yedavalli Vivek
Published: January 2025

Background and Purpose:
Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO.

Methods:
We conducted a retrospective analysis of prospectively maintained stroke databases, comprising of AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from noncontrast head CT. The perfusion mismatch volume (Tmax > 6s minus rCBF <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS.

Results:
A total of 133 patients (median age 71 [IQR 63-80] years, 59.4% females) were included in the study cohort). The perfusion mismatch volume significantly positively correlated with LOS (r=0.264, p=0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or TIA, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy, and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β=0.209, 95%CI 0.006-0.412, p=0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β=0.250, 95%CI 0.060-0.440, p=0.010) and mechanical thrombectomy (MT) (β=0.208, 95%CI 0.006-0.410, p=0.044). Among patients who underwent MT (N=83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β=0.248, 95%CI 0.019-0.471, p=0.033), while admission NIHSS did not retain significance (β=0.208, 95%CI -0.019-0.433, p=0.071).

Conclusions:
In our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.
Abstract WP202: Computed Tomography Perfusion-Based Imaging Score Outperform Other Imaging Scores in Basilar Artery Occlusions – An Agreement Study
Authors: Lun Ronda , Shah Parshva , Franco Lia Carolina , cereda carlo , Mlynash Michael , Yuen Nicole , Qureshi Abid , Hinduja Archana , Dehkharghani Seena , Goldman Yassen Adam , Hsieh Kevin Li-Chun , Giurgiutiu Dan-Victor , Gibson Dan , Carrera Emmanuel , Alemseged Fana , Faizy Tobias , Fiehler Jens , Pileggi Marco , Campbell Bruce , Albers Gregory , Heit Jeremy
Published: January 2025

Background:
Several semi-quantitative imaging scores exist to assess the extent of ischemic injury in basilar artery occlusions using various computed tomography (CT)-based modalities. Their inter-rater agreement has never been compared.

Methods:
We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions. Four imaging scores (PC-ASPECTS, CAPS, BATMAN, and PC-CTA) were assessed by two raters. Inter-rater agreement was compared using Cohen’s kappa statistic and reliability was assessed using the intraclass correlation coefficient (ICC).

Results:
98 patients were included for analysis. The CT perfusion-based CAPS score yielded the highest interrater agreement (kappa 0.64 [95%CI 0.52 – 0.75]) and highest reliability (ICC 0.82 [95%CI 0.73 – 0.91]). By comparison, CTA-based scores achieved fair agreement. The PC-ASPECTS score yielded the lowest levels of agreement overall (kappa 0.11 [95%CI 0.0061 – 0.21]) and in individual regions, with the lowest kappa values for midbrain (kappa 0.098 [95%CI 0.022 – 0.30]). Dichotomization resulted in some improvement in agreement for all approaches.

Conclusion:
CT Perfusion-based imaging score provide the highest interrater agreement and reliability for assessment of ischemic injury in patients with basilar artery occlusions among common posterior circulation scoring methodologies.
Abstract WP203: Ipsilateral Hemodynamic Failure of Extracranial Internal Carotid Artery is Associated with Severe Middle Cerebral Artery Atherosclerosis——a 4D Flow MRI Study
Authors: Liu Ying , Sun Aiqi , Wang He , DING Jing
Published: January 2025

Introduction:
The middle cerebral artery (MCA) is the most common site for inrtacranial atherosclerotic stenosis. Evidence has shown that carotid artery geometries are independently associated with ipsilateral MCA atherosclerosis. However, whether the role of the blood flow dynamics underlies this association remains uncertain. We aimed to investigate associations between the hemodynamics of internal carotid artery (ICA) and ipsilateral MCA atherosclerosis.

Methods:
Patients diagnosed with unilateral MCA atherosclerosis by computed tomography angiography were enrolled from July 2021 to June 2024. Demographic data, risk factors and the history of ischemic stroke of all patients were recorded. 4D Flow MR scan from both common carotid artery to the circle of Willis was performed on a 3.0T MR system equipped with a 16-channel head-neck coil for all patients. Hemodynamic parameters including lumen area, velocity, flow and wall shear stress (WSS) at the midpoint of ipsilateral C1 segment (C1
ips
) and contralateral C1 segment (C1
con
) were measured with GTFLOW. The hemodynamic characteristics in the C1
ips
and the C1
con
of all patients were investigated, the hemodynamic features at bilateral C1 between the MCA mild-moderate stenosis group and the MCA severe stenosis/occlusion group were compared. Associations between hemodynamics of C1 and MCA atherosclerosis were analyzed.

Results:
Among 105 patients (77 men, mean age 63 years old) with unilateral MCA atherosclerosis, 50 patients presented with mild/moderate stenosis and 55 patients with severe stenosis or occlusion. Compared with the C1
con
, the C1
ips
showed decreased lumen area, velocity, flow and WSS in all patients. Patients with MCA severe stenosis/occlusion showed reduced lumen area, flow in the C1
ips
, along with higher PSV at the C1
con
than patients with MCA mild-moderate stenosis. After adjusting for age, gender, BMI and traditional risk factors, low flow (both the flow
avg
and flow
max
were less than the mean value of all patients' C1
ips
) was independently associated with ipsilateral MCA severe stenosis or occlusion (OR,7.65[95%CI (2.74-21.35), p<0.001).

Conclusions:
Both the lumen area and hemodynamics at the ipsilateral C1 were lower than those at the contralateral C1 in patients with unilateral MCA atherosclerosis. Low flow of the ipsilateral C1 was independently associated with MCA severe stenosis or occlusion, providing new insights into the pathophysiology of unilateral MCA progressive atherosclerosis.
Abstract WP218: Non-contrast computed tomography markers of hematoma expansion in the ultra-early timeframe: a potential trial target?
Authors: Mutimer Chloe , Sharma Sameer , Zhao Henry , Meretoja Atte , churilov leonid , Wu Teddy , Kleinig Timothy , Choi Philip , Cheung Andrew , Jeng Jiann-Shing , Ma Henry , Mai Duy Ton , Nguyen Huy Thang , Sharma Gagan , Campbell Bruce , Donnan Geoffrey , Davis Stephen , Yassi Nawaf
Published: January 2025

Background:
Identifying patients likely to have significant hematoma expansion (HE) has been a challenge in clinical trials of intracerebral hemorrhage (ICH). Non-contrast CT (NCCT) markers of HE have been described. Time from symptom onset to CT affects the predictive value of these markers, with limited data in the ultra-early time period (<3h from onset). We aimed to describe the frequency of NCCT markers in the ultra-early period of ICH, and their association with HE.

Methods:
We performed a pooled analysis of individual patient data from the STOP-AUST and STOP-MSU randomized controlled trials, which tested the effect of tranexamic acid on hematoma growth. We included ICH patients scanned within 2 hours of symptom onset. The presence of NCCT density and shape markers was assessed by two authors. HE was defined as an increase in hematoma volume of >33% or >6ml from baseline. Regression analyses were adjusted for treatment group and baseline hematoma volume.

Results:
There were 246 patients included in this analysis (median age 67 years, 38.8% female, median time from onset to imaging 75 min [IQR 59-88 min], 50.4% tranexamic acid), of whom 105 (42.7%) had HE on 24-hour imaging. Inter-rater agreement was excellent for all NCCT markers (kappa score >0.8). Most patients (85.7%) had ≥1 marker of HE. The most frequent marker was the swirl sign (74.3%) and the least frequent was the blend sign (7.3%) (Table 1). HE occurred more often in patients with any marker at baseline (45.5% vs 25.6%, p=0.03). The blend sign (15.2% vs 1.4%, p<0.01), island sign (38.1% vs 24.8%, p=0.01) and satellite sign (44.8% vs 34.8%, p=0.04) were more common in patients with HE than those without.

The presence of any marker was not independently associated with HE (aOR1.63 [95%CI 0.70-3.80], p=0.26). The blend sign was the only sign independently associated with HE (aOR 11.58 [95%CI 2.57-52.19], p=0.01). On diagnostic performance for HE, specificity was highest for the blend sign (0.99, 95% CI 0.95-1.00), with limited sensitivity of 0.15 (95%CI 0.09-0.24) (Table 1). The area under the receiver operator curve showed similar values for all markers suggesting low discriminative ability (Delong test p=0.81).

Conclusions:
NCCT markers are commonly present in the ultra-early period of ICH and associated with subsequent hematoma growth. Despite association with HE, the discriminative utility in the early timeframe appears insufficient, and the search for an optimal target should continue.
Abstract WP222: External Validation of an Automated Hemorrhage Detection and Segmentation Algorithm on Follow-up CT scans in the AcT trial
Authors: Zhang Jianhai , Kaveeta Chitapa , Alhabli Ibrahim , Bala Fouzi , Almekhlafi Mohammed , Menon Bijoy , Qiu Wu , Singh Nishita , Ganesh Aravind
Published: January 2025

Background and Aims:
Machine learning models have shown promising potential for automated hemorrhage detection and segmentation, alleviating highly time-consuming manual contouring and facilitating rapid clinical diagnosis. External validation is essential to assess model generalizability and performance across new dataset configurations. To this end, we externally validated a novel model for hemorrhage detection and segmentation in an unseen randomized-controlled trial dataset.

Methods:
A novel segmentation architecture based on denoising diffusion probabilistic models was utilized for segmenting hemorrhage. The model had been trained upon a set of 331 CT scans with manually segmented parenchymal hemorrhage lesions. External validation was conducted using the AcT (Alteplase compared to Tenecteplase) trial in which patients underwent post-thrombolysis follow-up CT scans. Ground truth regarding hemorrhage presence was determined by expert readers blinded to the algorithm’s results who performed manual contouring and graded hemorrhages using the Heidelberg classification. Model performance was then evaluated through using diagnostic performance measures and the Dice coefficient.

Results:
Among the 1338 patients with follow-up CT scans, two types of hemorrhages were adjudicated: (a) any kind of hemorrhage (230/1338) and (b) remote or local hemorrhages classified as PH1 or worse (170/1338). The algorithm achieved sensitivity of 89.4% (95% CI 84.8-94.1%) for hemorrhages ≥PH1 and 61.7% (95% CI 55.5-68.0%) for any kind of hemorrhage where specificity of 92.8% (95% CI 91.3-94.3%), positive predictive value of 64.0% (95% CI 57.6-70.3%), negative predictive value of 92.1% (95% CI 90.5-93.7%) and accuracy of 87.4% was achieved. Dice was 0.582 (95% CI 0.538, 0.629) for any kind of hemorrhage and 0.611 (0.555, 0.667) for hemorrhages ≥PH1.

Conclusions:
Our automated model for hemorrhage segmentation demonstrated robust performance in this external clinical trial dataset, achieving high sensitivity for large hemorrhages and high specificity for smaller hemorrhages. Future work will seek to further optimize the algorithm’s performance for detection and segmentation of smaller hemorrhages.
Abstract WP225: Fibrinogen Depletion and The Risk of Intracerebral Hemorrhage following Mechanical Thrombectomy
Authors: Aboul-Nour Hassan , Jumah Ammar , Albanna Abdalla , Mohamed Ghada , Alsrouji Owais , Schultz Lonni , Latack Katie , Miller Joseph , Uddin Khalid , Gunaga Satheesh , Muir Jason , Chebl Alex , Ramadan Ahmad Riad
Published: January 2025

Background:
Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the standard of care for select stroke patients with acute large vessel occlusion (LVO). Fibrinogen levels may drop after IVT, and a significant decrease in fibrinogen is associated with an increased risk of intracranial hemorrhage (ICH). Our Pilot study aimed to explore the relationship between fibrinogen levels and the development of ICH in MT-treated patients and whether bridging with IVT further increases that risk.

Methods:
This is a prospective pilot study that enrolled adults presenting to our center with a diagnosis of LVO stroke and eligible to receive MT with or without IVT between April 2020 and May 2023. All patients consented to enrollment.

Results:
Forty-one patients were enrolled. Median age was 68 years [IQR 56-79], 58.5% were females and 56.1% were black. Nineteen patients (46.3%) were treated with MT+IVT , and 22 (53.6%) were treated with MT only. There was no difference in baseline characters between both groups. Baseline fibrinogen levels were similar between MT+IVT and MT-only groups [391 vs 352 mg/dL, p=0.4]. Post MT, the MT+IVT group had lower fibrinogen levels compared to the MT-only group [224 vs 303 mg/dL, p<0.001]. Similarly, there was a significant drop in fibrinogen levels between baseline and follow-up in the MT+IVT vs MT-only group [106 vs 39.5 mg/dL, p=0.001]. Eight patients (19.5%) developed ICH; 5 (26.3%) in the MT+IVT group and 3 (13.6%) in the MT-only group. No significant differences were seen in baseline, follow-up, or change in fibrinogen levels between patients who developed ICH and those who did not. However, there was a significantly lower follow-up fibrinogen levels between patients who suffered an ICH in the MT+IVT arm compared to those without ICH in the MT arm (200 vs 301 mg/dL, p=0.006). There was also a negative correlation between the drop in fibrinogen levels and the number of MT passes (Spearman CC -0.33, p=0.03).

Conclusion:
This pilot study's preliminary data show that fibrinogen depletion contributes to hemorrhagic transformation in MT-treated patients. This suggests that fibrinogen monitoring in patients undergoing MT after IVT may help identify patients with an increased risk of ICH. Larger studies are needed to explore the cost-effectiveness of monitoring fibrinogen in patients undergoing bridging therapy and the benefit of repleting fibrinogen in this patient population.
Abstract WP234: Education and Outcomes in Intracerebral Hemorrhage: A Post-Hoc Analysis of the ERICH Study
Authors: Krothapalli Neeharika , Wong Ka-Ho , Littig Lauren , Kim Yvonne , Smith Harper , Calvario Erick , Champagne Alison , Narula Reshma , Sheth Kevin , Sansing Lauren , de Havenon Adam
Published: January 2025

Introduction:
Education, a key modifiable social determinant of health, plays a significant role in shaping outcomes related to ischemic stroke. Higher educational attainment has been linked to improved management of risk factors and greater adherence to medical treatments. However, the impact of education on patients suffering from intracerebral hemorrhage (ICH) remains underexplored.

Methods:
We conducted a post-hoc analysis of the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study to examine the impact of educational attainment on good functional outcome (modified Rankin Scale score of 0-3 at 90 days after ICH). A logistic regression model was adjusted for age, sex, race/ethnicity, insurance status, mechanical ventilation, systolic blood pressure, smoking status, diabetes mellitus, atrial fibrillation, hypertension, congestive heart failure, Glasgow Coma Scale, ICH location (side and deep), ICH volume on CT, and presence of intraventricular hemorrhage.

Results:
Among 1894 individuals included in this study, 584 patients (30.8%) had less than a high school (HS) education, 539 patients (28.5%) had a HS education, 641 patients (33.8%) had more than HS or a college education, and 130 patients (6.9%) had postgraduate education. See Table 1 for demographics by education group. The predicted probability of good outcome by education level was significantly different (Figure 1). Compared to those with <HS education, the odds ratio for good outcome in those with more than a HS or college education was 1.42 (95%CI 1.04-1.94, p=0.028) and for those with postgraduate education was 2.27 (95%CI 1.34-3.85, p=0.002).

Conclusion:
Our study demonstrated that higher educational attainment was associated with a greater likelihood of favorable outcome (mRS 0-3 at 90 days) in ICH patients, with the most significant effect observed in those with postgraduate education. Further study is needed to understand the mediators of this observation (i.e. socioeconomic status, medication adherence, etc.).
Abstract WP236: Inflammartory score can predict the risk of hemorrhagic transformation after ischemic stroke
Authors: Li Zhixin , Chu Heling , HAN Xiang , Tang Yuping
Published: January 2025

Background:
A novel inflammatory score has been validated for hematoma expansion and poor outcomes in patients with intracerebral hemorrhage. This study aimed to explore its capacity of predicting hemorrhagic transformation risk and prognosis in patients suffering ischemic stroke.

Method:
We retrospectively analyzed ischemic stroke patients in three clinical centers from 1 January 2012 to 31 December 2023 based on hospital electronic case records. A matched case-control study was conducted for reducing the impact of various confounding factors. Inflammatory score (0-9) was developed with the combination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, lactate dehydrogenase, and C-reactive protein. Logistic regression models were used for exploring the association between inflammatory score and hemorrhagic transformation and poor outcomes. Additionally, receiver operating characteristic analysis facilitate to find an optimal cutoff point of inflammatory score in developmental cohort and then confirmed in the validation cohort.

Result:
A total of 426 stoke patients from three clinical centers were enrolled. Inflammatory score was significantly higher in patients with hemorrhagic transformation. The multivariate logistic regression analysis revealed inflammatory score was independently associated with severe ECASS (European Cooperative Acute Stroke Study) classification, in-hospital infection, reperfusion failure and poor modified Rankin scale (4-6). Moreover, inflammatory score greater than or equal to 5 was selected as the optimal cutoff point, which was consistent with results from a previous intracerebral hemorrhagic study. Additional, the increased inflammatory scores have been obserbed in intracranial hemorrhage potentially secondary to uncommon causes, such as infective endocarditis, cerebral amyloid angiopathy and tumor.

Conclusion:
The inflammatory score can predict early hemorrhagic transformation risk and prognosis in patients with ischemic stroke. Besides, the score might imply cetain uncommon cause of intracranial hemorrhage as well.
Abstract WP244: Continuous non-invasive optical brain pulse monitoring during endovascular clot retrieval for stroke.
Authors: Petautschnig Sigrid , Teo Elliot , Sanders Lauren , Jhamb Ashu , Maingard Julian , Lee Jean , Dixon Barry
Published: January 2025

Introduction:
Stroke is a leading cause of global mortality and morbidity, affecting approximately 15 million people annually, with ischemic stroke accounting for 85% of cases. Endovascular clot retrieval (ECR) has become a key treatment for large vessel occlusion (LVO) strokes. While ECR significantly improves outcomes, it carries risks, including emboli to new territories. This cohort study evaluates the feasibility of Optical Brain Pulse Monitoring (OBPM) for detecting stroke-related events during ECR, aiming to enhance patient safety by providing real-time feedback on cerebral blood flow changes.

Methods:
Sensors from a non-invasive OBPM (Cyban, Australia) were placed bilaterally over the middle cerebral artery (MCA) territories in 11 LVO stroke patients undergoing ECR. The OBPM uses both red and infrared light to detect brain pulse waves associated with blood volume and oxygen changes with each cardiac pulse. A qualitative assessment of unique brain pulse waveforms associated with stroke was completed.

Results:
Abnormal brain pulse waveforms were observed in all 11 strokes. Changes were present over the ipsilateral and contralateral hemispheres. The brain pulse waveforms were similar to waveforms found in the central venous circulation. Abnormal waveforms were split into two categories based on the degree of venous features; 1) The Hybrid waveform which demonstrated a mix of arterial and venous features and 2) The Venous waveform in which venous features dominated (Figure 1). All patients displayed one or both of these abnormal waveform classes. Patients exhibiting the Venous waveform were more likely to have a larger stroke at presentation and worse outcomes, with more days in hospital (adjusted for death), compared to individuals displaying the Hybrid waveform (p<0.05).

Discussion:
This study underscores the use of OBPM during ECR. The brain pulse waveforms may also offer pathophysiological insights suggesting the venous circulation has a dominate influence on the cerebral microcirculation in LVO strokes due to reduced arterial pressure levels. The presence of the Venous waveform may indicate a large region with very low arterial pressure and cerebral blood flow, as well as larger stroke and poor prognosis.

Conclusion:
OBPM shows promise during ECR by characterizing abnormal waveforms, providing insights into the pathophysiological mechanisms underlying stroke and brain injury, thus offering new avenues for early detection and prognostication in stroke.
Abstract WP252: Impact of intracranial stenosis on mechanical thrombectomy outcome
Authors: Jablonska Magda , tomasello alejandro , Diana Francesco , De Dios Lascuevas Marta , Hernandez Morales David , Requena Manuel , Rodrigo-Gisbert Marc , Gadea Marta , Ribo Marc
Published: January 2025

Introduction:
Underlying Intracranial atherosclerotic disease (ICAD) may influence mechanical thrombectomy recanalization, leading to an increased number of passes before rescue techniques are adopted. Initial suspicion of underlying ICAD could help in the early adoption of rescue techniques, reducing the total number of passes and increasing the chances of sustained final recanalization and favorable outcomes. We aimed to evaluate whether the presence of intracranial stenoses other than the target occlusion is related to potential underlying symptomatic ICAD, influencing recanalization success.

Methods:
We retrospectively analyzed 200 consecutive patients who underwent mechanical thrombectomy for acute ischemic stroke at our center between November 2022 and January 2024. Baseline angiograms were reviewed to assess the presence or absence of intracranial stenosis lesions (IS+ Vs IS-) different than the target occlusion. We evaluated the impact of IS+ on different efficacy outcome variables: final complete recanalization (eTICI2c-3), total number of passes, procedural duration, and use of bailout technique (angioplasty, stenting, GP2b2a infusion)

Results:
Of the 200 evaluated patients, 52 (26%) IS+ were found. There were no significant differences in baseline characteristics between IS+ and IS- patients. Patients with IS+ achieved less often complete recanalization after the final pass (47.7% Vs. 69.1%;p=0.012) and underwent a higher total number of thrombectomy passes (mean: 2.4 vs. 1.9; p<0.01). Bailout strategies were required more often in the IS+ group (34.6% Vs12.8%; p=0.001), and procedural times were longer (56.6 Vs 69.7 minutes; p=0.018). At discharge, patients in the IS+ group had a higher NIHSS score (7.5 Vs 3; p=0.036).

Conclusions:
Our findings suggest that the presence of an intracranial stenosis different than the target occlusion on the initial angiogram may not only predict the complexity of the procedure but also suggest its underlying etiology. Active identification of these lesions on baseline angiograms could help anticipate treatment strategies, potentially advancing the adoption of bailout strategies. Further research is warranted to explore the diagnostic value of multiple intracranial stenosis in patients undergoing mechanical thrombectomy.
Abstract WP258: Aneurysm neck width reduces flow diversion in new generation stent placed at high curvature ICA segment
Authors: Chien Aichi , Szeder Viktor , Boyle Noel , Colby Geoffrey , Duckwiler Gary
Published: January 2025

Introduction:
Surpass Evolve (SE) is an updated flow diverter stent. While shown to be effective and safe for treating intracranial aneurysms (IA), blood flow analysis is still limited. In this study we constructed IA models with patient-specific internal carotid artery geometry and conducted hemodynamic flow analysis of treatment with implanted SE.

Hypothesis:
IA neck size affects the flow changes induced by SE.

Methods:
A model of a patient left internal carotid artery was prepared from the UCLA clinical database. Using computer automated design (CAD) software, two variations of a 4 x 4 mm saccular IA were constructed on the ophthalmic segment: a mid-sized neck (~2 mm) and a wide neck (~5 mm). For each case, a SE device measuring 3.25 mm in diameter and 17 mm in length was added to model treatment, and computational flow dynamic (CFD) simulations of pulsatile blood flow were performed. Post-treatment blood flow was quantitatively compared between IA models, specifically intra-aneurysmal flow velocity, pulsatility index (PI), turbulence, vorticity, and wall shear stress (WSS).

Results:
Significantly higher flow pulsatility was observed at the neck of the wide neck IA compared to the mid-sized neck IA (PI = 2.96 and 1.66 respectively). Likewise, peak systolic flow velocities were 32.9% and 118% higher at the body and dome respectively in the wide neck case (Fig. 1). Peak systolic WSS values were observed in both cases at the neck facing the direction of blood flow, in which values exceeded 15 Pa for the wide neck case. In the mid-size neck case, WSS in excess of 3 Pa was not observed beyond the neck region, whereas notable propagation of WSS to the body and dome regions were observed in the wide neck case (Fig. 2). Higher flow vorticity was observed in all regions of the IA for the wide-neck case. Flow within the IA of both mid-size and wide neck cases remained mostly laminar with no observable turbulence relative to that in the parent vessel.

Conclusion:
SE treatment reduced the flow entering the IA at a high curvature area of the ICA. When comparing IA of the same size, increased neck size may reduce the flow reduction effects by 2-fold. We also observed high WSS concentrated at the distal side of the IA neck. As WSS relates to vascular remodeling, following up for distal neck remodeling in post procedure scans could be beneficial to monitor regrowth for SE-treated wide neck IAs.
Abstract WP260: The Role of Fibrinogen in the Pathogenesis of Intracranial Atherosclerosis-Related Large Vessel Occlusion Strokes
Authors: Liu Yimeng , Zhao Hongchen , Ling Yifeng , Chen Fangzhe , Wang Zigao , Mao Yiting , Dong Qiang , Cao Wenjie
Published: January 2025

Background:
The mechanisms by which intracranial atherosclerosis (ICAS) contributes to large-vessel occlusion strokes (LVOS) remains unclear. Our investigation focused on delineating the distinctive features of ICAS-related LVOS to explore its underlying pathology.

Methods:
This is a cross-sectional comparison from a prospective, single-center cohort study of acute ischemic stroke from January 2017 to January 2023. We recruited three groups of patients: ICAS-LVOS, LVOS caused by atrial fibrillation (AF) and symptomatic ICAS (sICAS) without LVOS. Clinical information and lab results were collected and analyzed.

Results:
A total of 279 patients were included, comprising 70 ICAS-LVOS patients, 78 AF-LVOS patients, and 131 sICAS patients. Compared to AF-LVOS, ICAS-LVOS patients exhibited associations with younger age (OR: 0.947; P = 0.043), previous stroke (OR: 4.749; P = 0.017), posterior circulation involvement (OR: 6.417; P = 0.017), higher fibrinogen levels (OR: 2.049; P = 0.023), and higher triglyceride levels (OR: 2.905; P = 0.019). Relative to sICAS, ICAS-LVOS patients demonstrated associations with higher body mass index (OR: 1.176; P = 0.002), white blood cell counts (OR: 1.234; P = 0.002), and fibrinogen levels (OR: 1.600; P = 0.029). Among ICAS-LVOS patients, those with a greater thrombus burden showed associations with hypertension (OR: 6.071; P = 0.029) and higher fibrinogen levels (OR: 2.322; P = 0.046). Among patients with lower fibrinogen levels (< 3.2g/L), intravenous thrombolysis was associated with a reduced number of thrombectomy device passes.

Conclusions:
Fibrinogen plays a significant role in facilitating thrombosis and the occurrence of LVOS in patients with ICAS.
Abstract WP264: Endovascular Therapy Versus Best Medical Treatment for Medium Vessel Occlusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: De Souza Abner Lucas , Reis Soares Filipe , Ventura Artur , de Vasconcelos Anna Victoria , WAGNER FERNANDA , Moro Izabela , Queiroz Ivo
Published: January 2025

Background:
Medium vessel occlusion (MeVO) accounts for approximately one-third of all acute ischemic strokes and presents distinct management challenges, despite being less severe than large vessel occlusion (LVO). While endovascular treatment (EVT) has proven superior to best medical treatment (BMT) in LVO, its efficacy and safety in MeVO are not yet fully established. The recently published DUSK trial, which did not demonstrate significant benefits of EVT for MeVO, has not been included in prior reviews, making it essential to integrate and critically evaluate the implications of this new evidence.
Aim:
This meta-analysis aims to evaluate the efficacy and safety of EVT compared to BMT in patients with MeVO.

Methods:
We conducted a systematic search of PubMed, Embase, and the Cochrane Library up to August 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our analysis focused exclusively on peer-reviewed randomized controlled trials (RCTs) that compared the efficacy of EVT with BMT in patients with MeVOs. The primary outcomes were excellent functional outcome (defined as modified Rankin Scale [mRS] 0-1) and functional independence (defined as mRS 0-2) at 3 months. Effect sizes were computed as odd ratio (OR) with random-effect models.

Results:
Three RCTs with 862 patients (448 randomized into EVT vs. 414 randomized into BMT) were included. The pooled analysis demonstrated that EVT did not significantly increase the likelihood of achieving an excellent functional outcome (mRS 0-1: OR 0.89, 95% CI 0.67–1.18, p = 0.42) or functional independence (mRS 0-2: OR 0.93, 95% CI 0.62–1.40, p = 0.73) at 3 months compared to BMT. Additionally, EVT did not significantly elevate the risk of symptomatic intracranial hemorrhage (sICH: OR 1.13, 95% CI 0.55–2.33, p = 0.75) or mortality (mRS 6: OR 1.19, 95% CI 0.53–2.65, p = 0.67).

Conclusions:
Our systematic review and meta-analysis suggest that EVT for MeVO is not associated with a significant improvement in functional outcomes or an increased risk of adverse events such as sICH and mortality at 3 months, when compared to BMT. These findings underscore the need for further investigation, particularly with forthcoming RCTs to clarify the role of EVT in this patient population.
Abstract WP271: Low Endothelial Shear Stress is Associated with Early Neurological Deterioration in Patients with Single Subcortical Infarction
Authors: Nam Ki-Woong , Kwon Hyung-Min , Lee Yongseok
Published: January 2025

Introduction:
Patients with single subcortical infarction (SSI) have relatively favorable prognosis, but they often experience early neurological deterioration (END) in a clinical course. Endothelial shear stress (ESS) applied to the vascular wall may also be one of the causes.

Hypothesis:
We would like to analyze the association between ESS and occurrence of END in SSI patients.

Methods:
We included consecutive patients with SSI within 72 hours of symptom onset between 2010 and 2020. END was defined as an increase of ≥ 2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 hours of admission. As a parameter for ESS, the signal intensity gradient (SIG) value was obtained at the vessel boundary in time-of-flight image in initial brain magnetic resonance angiography. The maximum, minimum, mean, and standard deviation of SIG were obtained from all intracranial vessels. Among them, the SIG value of the relevant vessel that caused SSI was taken as the main independent variable.

Results:
A total of 495 patients with SSI were evaluated (median age: 67 years, END prevalence: 17.2%). In multivariable analysis, the mean SIG value of relevant vessels was significantly associated with END (adjusted odds ratio = 0.81, 95% confidence interval: 0.68-0.97). However, maximum, minimum, or standard deviation SIG value of relevant vessel was not associated with END. Additionally, the mean SIG value of the whole intracranial vessel also showed no correlation with the occurrence of END. The statistical correlation between the average SIG value of relative vessels and END was clearly evident in distal SSI, but the correlation was lost in proximal SSI. Age or proximal type SSI also showed an association with END regardless of SIG value.

Conclusions:
In patients with acute SSI, the mean SIG value of relevant vessels showed a negative association with the occurrence of END. In other words, if the ESS applied to the relevant vessel where the index stroke occurred is weak, END may occur relatively easily. This tendency was more evident in patients with distal SSI lesions.
Abstract WP272: Cancer and Left Atrial Enlargement in Patients with Ischemic Stroke
Authors: Pawar Anokhi , Beyeler Morin , Buffle Eric , Zhang Cenai , Liao Vanessa , Liberman Ava , Pabst Thomas , Berger Martin D. , Jung Simon , Kamel Hooman , Navi Babak
Published: January 2025

Background:
Cancer is associated with an increased risk for atrial fibrillation. However, there are no existing data supporting an independent relationship between cancer and atrial cardiopathy, another atrial pathology associated with increased acute ischemic stroke (AIS) risk. We investigated the relationship between atrial cardiopathy and cancer among patients with AIS.

Methods:
We conducted a retrospective cross-sectional study among consecutive patients hospitalized with AIS at a quaternary care center in New York City from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m
2
as determined by echocardiography. We used multivariable logistic regression, adjusting for relevant confounders, to evaluate the relationship between active cancer and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS).

Results:
The final cohort included 1104 patients with AIS, of whom 10% had active cancer and 47% had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 years versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6% of patients with atrial cardiopathy (n=50/520) and 10.4% of patients without (n=61/584). In multivariable models, there was no association between active cancer and atrial cardiopathy among the overall AIS cohort (adjusted odds ratio, 0.91; 95% confidence interval, 0.60-1.37) nor in patients with ESUS (adjusted odds ratio, 0.64; 95% confidence interval, 0.30-1.36).

Conclusion:
When defining atrial cardiopathy according to left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with AIS, including among patients with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy.
Abstract WP273: Selection of Antithrombotic Therapy in Patients with Atrial Fibrillation who Experience an Ischemic Stroke While on Anticoagulant Therapy
Authors: Wang Duanduan , Obrien Emily , Xian Ying , Sherrod Charles , Chan Paul , Laskowitz Daniel , Peterson Eric , Fonarow Gregg , Schwamm Lee , Smith Eric , Bhatt Deepak , Ayodele Iyanuoluwa , Matsouaka Roland
Published: January 2025

Introduction:
Anticoagulation therapy plays a pivotal role in stroke prevention for people with atrial fibrillation. Despite its efficacy, some patients still have an ischemic stroke while on therapy. Since it remains unclear how best to modify risk in these cases and guidance for clinical decision-making is limited, understanding real-world patterns is crucial for improving outcomes.

Methods:
Using data from the Get With The Guidelines-Stroke Registry between 2016 and 2023, we assessed the real-world strategies clinicians use for ischemic stroke patients with atrial fibrillation who experience stroke despite being on anticoagulation therapy. Multivariate logistic regression models with generalized estimating equations were used to identify factors associated with changes in oral anticoagulants (OAC).

Results:
Of 60,334 ischemic stroke patients with atrial fibrillation who were taking OAC but were not on antiplatelet prior to stroke, 14.4% were taking warfarin with subtherapeutic INR, 8.9% therapeutic warfarin, and 76.7% direct oral anticoagulant (DOAC) prior to stroke (4.7% dabigatran, 20.4% rivaroxaban, and 51.6% apixaban). The distribution of discharge antithrombotics is shown in the
Figure
. Among patients taking DOAC prior to stroke, 83.3% remained on the same DOAC at discharge, of whom 45.5% added an antiplatelet agent. Among patients on warfarin, 37.0% switched to DOAC at discharge. For those who remained on warfarin, 47.8% added an antiplatelet agent. Patients on warfarin with subtherapeutic INR (aOR 1.86), dabigatran (aOR 1.58), or rivaroxaban (aOR 1.09) were more likely to switch OACs, while those on apixaban (aOR 0.27) were less likely to switch as compared with those on warfarin with therapeutic INR prior to stroke.

Conclusion:
Among people with AF who were anticoagulated prior to hospitalization for ischemic stroke, switching OACs or adding an antiplatelet agent is common. Understanding the factors influencing treatment selection after stroke underscores the need for a prospective study of treatment strategies and could support the development of personalized antithrombotic strategies to reduce recurrent stroke risk.
Abstract WP278: High Sensitivity Cardiac Troponin T Elevation association with Stroke in Patients with Atrial Fibrillation; A Systematic Review and Meta-analysis.
Authors: Shrestha Abhigan , Afroze Tanzina , Shrestha Sajina , Singh Harendra , Rayamajhi Sushil , Shrestha Aayush , Sharma Abhishek , Jaiswal Vikash
Published: January 2025

Background:
The elevation of high-sensitivity cardiac troponin T (hsTnT) in patients with atrial fibrillation (AF) is associated with adverse outcomes. However, the extent of this association for risk stratification is not clear.

Hypothesis:
This study aims to evaluate the association between hsTnT elevation and cardiovascular outcomes.

Methods:
We conducted a thorough literature search for relevant articles available until March 2024 on PubMed, Google Scholar, and Embase. Outcomes were pooled using the random effects DerSimonian-Laird model and reported as hazard ratio (HR) with a 95% confidence interval. A p-value of <0.05 was considered statistically significant.

Results:
A total of 19,471 patients with atrial fibrillation (normal hsTnT: 7,400 and elevated HsTnT: 12,071) from seven studies were included in the analysis. The mean follow-up was 39.3 months. Elevated hsTnT was significantly associated with an increased risk of stroke (HR 2.14, 95% CI: 1.56-2.71, p<0.005). Similarly, a significant association was found for major bleeding (HR 2.01, 95% CI: 1.49-2.52, p<0.005), cardiovascular death (HR 3.51, 95% CI: 1.39-5.64, p<0.005), and all-cause mortality (HR 4.49, 95% CI: 2.83-6.15, p<0.005).

Conclusion:
The hsTnT level elevation is independently associated with a raised risk of stroke, all-cause mortality, major bleeding and cardiovascular death. These findings highlight the importance of monitoring hsTnT levels in AF patients to identify those at higher risk and to improve patient management.
Abstract WP280: Telehealth Enhanced Assessment and Management after Stroke-Blood Pressure: A Feasibility Study Preparatory to a Comparative Effectiveness Trial
Authors: Jones Berkeley Sara , Rowland Bryce , Rosamond Wayne , Halladay Jacquie , Gesell Sabina , langdon sarah , Robb Amber , Lutz Barbara , Pastva Amy , Cummings Doyle , Valint Arielle , Tijerino-Ortega Jonathan , Johnson Anna , Baldwin Jakita , Dobson Deja , Lundy-Lamm Gladys , Morrison-Brooks Typhany , Faircloth George , Gordon Neil , Bushnell Cheryl
Published: January 2025

Background:
Effective interventions to lower blood pressure (BP) after stroke are needed, especially for vulnerable populations such as Black individuals and those with post-stroke disability. The TEAMS-BP trial is designed to compare the effectiveness of two evidence-based interventions among stroke survivors with uncontrolled BP.

Methods:
The Telehealth Enhanced Assessment and Management after Stroke-BP (TEAMS-BP) trial compares Intensive Clinic Management (ICM, in-person medical management with home BP monitoring via daily paper logs and health promotion messaging) vs Intensive Tailored Telehealth Management (ITTM, digital transmission of BP and physical activity, medical management via telehealth, and health coaching) to achieve SBP control (<130 mm Hg). Feasibility outcomes included rates of consent, follow-up, and adherence to study procedures in addition to 3-month BP control and participant experience.

Results:
Overall, 608 cases were ascertained from 10/1/2022 to 6/1/2023. Of these, 474 (78%) pre-screened eligible, 264 (54%) were invited to participate, and 31% consented (Figure 1). Consent rates varied by demographics (33% Black, 26% non-Black; 14% age 75+, 34% <75). Fifty participants from 3 sites were randomized to three months of ICM or ITTM (50% female, 32% Black, 60% with disability, mean age 66 years [SD 9.9]). Participant adherence to protocol-specified provider visits and coaching sessions was high (Figure 2). The 3-month follow-up rate was 90% (22 of 26 ITTM, 23 of 24 ICM). Fifty-five percent achieved the 3-month target SBP, and the 3-month change in SBP was -10.2 (18.4). Ninety percent of participants reported an excellent experience with the study.

Discussion:
The randomization rate was lower than projected despite expected consent rates. This feasibility study achieved consent, follow-up, and adherence targets for race and disability subgroups but not age. As one of the first Phased Large Awards for Comparative Effectiveness Research (PLACER), these feasibility data informed the main trial design, refinement of the interventions and data collection, and identified opportunities for improving recruitment. Study adherence was excellent, supporting patient acceptance and feasibility of the main trial.
Abstract WP288: The Impact of COVID-19 on Stroke Hospitalizations in California: A Seven-Year Analysis of Trends and Outcomes
Authors: Badhan Sugamjot , Kondle Soham , Sahni Jaskarn , Wadhawan Arnav , DILIBERO RALPH , Ratnasiri Anura
Published: January 2025

Background:
The COVID-19 pandemic disrupted healthcare systems and altered patient behaviors, potentially affecting stroke prevalence and outcomes. This study examines trends in stroke-related hospitalizations by age and sex in California from 2016 to 2022, focusing on the pandemic years (2020-2022).

Methods:
A retrospective analysis of patient discharge data from the California Department of Health Care Access and Information was conducted, screening nearly 25 million inpatient events for stroke-related ICD-10-CM codes (I60-I63) among individuals aged 20 and older. Age-and-sex-standardized hospitalization rates per 100,000 population were calculated. Multivariate logistic regression (MLR) assessed the impact of pre- and post-COVID-19 periods on stroke-related admissions, adjusting for age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).

Results:
The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). From 2016 to 2019, stroke-related hospitalization rates were stable (257.7 to 259.2 per 100,000). A significant decrease to 242.6 occurred in 2020, followed by an increase to 253.7 in 2021, coinciding with peak COVID-19 cases. By 2022, the rate slightly declined to 251.0, indicating stabilization but not a return to pre-pandemic levels. While the overall trend from 2016 to 2022 was not statistically significant (p=0.400), fluctuations reflect the pandemic's impact, particularly in 2021.

Age and gender analyses showed distinct trends. The age-adjusted rate for males remained stable (p=0.774), while females faced a notable decrease (p=0.018). Among those aged 20-44, stroke-related hospitalizations increased by 19% (RR=1.19, p<0.001) and by 9% for those aged 45-54 (RR=1.09, p<0.001). Conversely, individuals aged 75 and older saw a 15.5% decrease (RR=0.85, p<0.001). MLR analysis indicated a 31% increase in hospitalizations (AOR=1.31, p<0.001) during the post-COVID period compared to pre-COVID levels. Stroke prevalence was 25.3% higher in males than females and 53.9% higher in Asians than Whites.

Conclusion:
This seven-year analysis highlights the COVID-19 pandemic's significant impact on stroke-related hospitalizations, particularly in 2021, and the observed gender disparity. These findings emphasize the need for targeted interventions to address the increased stroke burden, especially among vulnerable populations, during and after the pandemic.