bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP165: Retinal Oxygen Metabolic, Anatomical, and Biochemical Changes in Experimental Carotid Artery Occlusion
Authors: Matei Nathanael , Leah Sophie , Auvazian Selin , Blair Norman P , Shahidi Mahnaz
Published: June 2021

Purpose:
Retinal ischemia has been implicated in vision-threatening diseases. Permanent bilateral common carotid artery occlusion (BCCAO) studies have reported retinal degeneration and gliosis, as well as cerebral degeneration. We hypothesized that BCCAO-induced long-term (3 to 14 days) impairments to oxygen delivery (DO
2
), extraction fraction (OEF), and metabolism (MO
2
) affect cellular morphology and biochemical pathways.

Methods:
Twenty-one rats underwent BCCAO or sham surgery. Blood flow and vascular oxygen tension imaging was performed in both eyes. Images were analyzed to derive retinal arterial and venous oxygen contents (O
2A
, O
2V
), arteriovenous oxygen content difference (O
2AV
), and total retinal blood flow (TRBF). The following equations were used: DO
2
=TRBF*O
2A
; MO
2
=TRBF*O
2AV
; OEF=MO
2
/DO
2
. After imaging, immunohistochemistry and histological assays were performed on retinal sections.

Results:
Compared to the sham group, DO
2
was reduced in 3-day (β=-622 nLO
2
/min), 7-day (β=-614 nLO
2
/min), and 14-day (β=-605 nLO
2
/min) BCCAO groups. MO
2
was reduced in 3-day (β=-215 nLO
2
/min), 7-day (β=-256 nLO
2
/min), and 14-day (β=-262 nLO
2
/min) BCCAO groups. Compared to the sham group, OEF was increased in 3-day (β=0.405) and 7-day (β=0.209) BCCAO groups. Compared to the sham group, the thickness of the nerve fiber (β=-14.6 μm), inner nuclear (β=-7.21 μm), outer plexiform (β=-6.70 μm), and inner retina (β=-30.7 μm) layers were decreased, while thickness of the outer nuclear layer was increased (β=7.88 μm) in the 14-day BCCAO group. Gliosis was increased in the 14-day BCCAO group compared to all other groups. Compared to the sham group, TUNEL-positive cells in inner and outer nuclear layers were increased in the 3-day BCCAO group.

Conclusions:
The findings confirm our hypothesis that BCCAO-induced reduction in retinal DO
2
resulted in increased OEF, impairment of MO
2
, and inner retinal cell death after 3 days, whereas increased gliosis and degeneration of inner retinal cells were observed after 14 days. When compared to brain literature, the retina—an extension of the diencephalon-- showed a similar reduction in blood flow and increase in both OEF and cell-death at 3-days following BCCAO.
Abstract WP168: Association of Stenosis, Proximal Flow and Distal Perfusion in Subjects With Middle Cerebral Artery Stenosis
Authors: Song Xiaowei , Chen Wenwen , Li Yunduo , Liebeskind David S , Li Rui , Zheng Zhuozhao , Wu Jian
Published: June 2021

Introduction:
Hemodynamic compromise caused by intracranial artery stenosis is one of the critical factors contributing to ischemic stroke. However, the association between flow and stenosis has not been well determined quantitatively, nor its correlation with distal perfusion. The purpose of this study was to investigate the association of blood flow in different grades of stenosis, as well as its association with distal brain tissue perfusion.

Methods:
Intracranial 4D flow and perfusion were obtained in 33 patients (mean 56 years old) with different grades of unilateral middle cerebral artery (MCA) stenosis. GTFlow was used to measure the flow at the proximal of stenosis and the symmetrical location of contralateral side (Fig 1a). Olea was accessed to calculate the perfusion parameters in MCA area. The average net flow at the proximal of stenosis was compared in patients with different grades(<30%,30-49%,50-69%, and ≥70%) of stenosis. Correlation between relative flow(stenosis/contralateral) and perfusion parameters were also compared in different pial collateral status.

Results:
Blood flow at the proximal of stenosis changes with the grades of stenosis increasing (Fig 1b,
p
=0.01). Subjects with <50% and ≥50% stenosis differ in MCA flow, rCBF and rTTP, but not in rCBV (Fig 1c).Spearman correlation analysis indicated that the relative flow was also associated with rTTP shown in distal brain tissue in subjects with poor collateral (Fig 1d, r=-0.69,
p
=0.02), but not in patients with good collateral. No association between relative flow and rCBF was detected in this group of population.

Conclusion:
In conclusion, decreased flow at the proximal of stenosis could result in the delay of perfusion in distal brain tissue in patients with poor collateral. Association of flow and stenosis, as well as its relationship with distal perfusion need further study, collateral status and potential compensatory mechanism should be considered in future study.
Abstract WP17: Stent Retriever versus Aspiration Thrombectomy for Distal Occlusions in Acute Stroke - Insights From the STAR Collaboration
Authors: Chalhoub Reda M , Alawieh Ali M , Anadani Mohammad , Almallouhi Eyad , Eid Maya , Arthur Adam , Kim Joon-Tae , De Leacy Reade , Grossberg Jonathan , Psychogios Marios , Maier Ilko , Rai Ansaar , Keyrouz Salah , Fargen Kyle , Dumont Travis , Kan Peter , Starke Robert M , Spiotta Alejandro
Published: June 2021

Introduction:
Aspiration thrombectomy using the ADAPT technique has been shown to have similar efficacy to stent retriever thrombectomy (SRT) in randomized trials of proximal large vessel occlusions. In this work, we investigated the differences in technical and clinical outcomes between ADAPT and SRT for distal vessel occlusions from the Stroke Thrombectomy and Aneurysm Registry (STAR).

Methods:
Patients undergoing thrombectomy for acute ischemic stroke at 12 comprehensive stroke centers in the US and Europe between 01/2013 and 12/2018 were reviewed. Data was collected retrospectively from patient charts, procedure notes, and patient follow-up in neurology clinics for patients with isolated distal artery occlusion including MCA2, MCA3/4, ACA1/2, and PCA2/3. Clinical endpoint was the modified Rankin score (mRS) at 90-days, and technical outcomes were procedure time, total attempts, and mTICI scores.

Results:
A total of 464 patients (mean age 69±13.5 years) were treated with ADAPT (56%) or SRT (44%) for distal occlusions during the study period. Patients in the ADPAT group were mainly treated using 3MAX (36%), 4MAX (21%), ACE68/64 (20%), 5MAX/ACE (12%). SRT group included the use of Trevo (50%), Solitaire (44%), or both (5%). There were no significant differences in rates of good outcomes or successful recanalization between ADAPT and SRT groups on multivariate logistic regression analysis controlling for significant confounding variables (p>0.1). Use of SRT in distal occlusions was an independent predictor of longer procedure times compared to ADAPT on linear regression (coefficient=23, p<0.001), and there was a trend toward higher odds of symptomatic hemorrhage in the SRT group (OR=2.6, p=0.06) on multivariate analysis. There were no differences in mortality and complication rates between the two groups.

Conclusions:
Both SRT and ADAPT thrombectomy lead to comparable rates of favorable outcome for distal vessel occlusion. SRT requires longer procedures and may be associated with higher rates of hemorrhage. Further randomized trials are needed to confirm whether either techniques may provide a better safety or efficacy profile in distal vessel occlusions.
Abstract WP172: Advancing Age is a Predictor of Poor Collaterals
Authors: Lin Michelle P , Brott Thomas G , Liebeskind David S , Meschia James F , Sam Kevin , Gottesman Rebecca F
Published: June 2021

Introduction:
Robust leptomeningeal collaterals protect the brain from ischemia, yet the determinants of poor collaterals have not been established. We aimed to identify predictors of poor collaterals in patients with large vessel occlusive stroke.

Methods:
Consecutive patients with large vessel occlusive stroke who underwent thrombectomy at 2 academic medical centers (derivation cohort/validation cohort) from 2012-2017 were included. Poor collaterals were defined as ≤50% filling on CT angiogram. Pre-specified predictors of poor collaterals were analyzed with adjusted logistic regression models: demographics (age, sex, race), risk factors (hypertension, diabetes, atrial fibrillation, smoking), hemodynamics (blood pressure, cardiac output, troponin), metabolic (hyperglycemia, hyponatremia, uremia), hematologic (anemia, leukocytosis, thrombocytosis) and neuroimaging evidence of chronic cerebral small-vessel disease and chronic steno-occlusive arterial disease.

Results:
Of the 248 total patients, poor collaterals were detected in 107 (43%). Mean age was 71±14y vs. 63±16y in patients with poor vs good collaterals, respectively (p<.001). There were 136 patients in the derivation cohort; 54 (48%) patients with poor collaterals. Multivariable modeling identified that older age (OR 1.8, p<.001), hyperglycemia (OR 2.4, p=.029) and white matter hyperintensities (WMH) (OR 6.1, p=.003) were independent predictors of poor collaterals in the derivation cohort. The validation cohort consisted of 136 patients; 53 (39%) had poor collaterals, of which older age (OR 1.4, p=.015), thrombocytosis (OR 24.0, p=.012), and WMH (OR 6.7, p=.018) were significant predictors of poor collaterals. Age and WMH were the only significant predictors of poor collaterals across the derivation and validation cohorts. When pooled the cohorts, older age (OR=1.5, p<.001), thrombocytosis (OR=7.6, p=.001) and WMH (OR=6.4, p<.001) were significant predictors of poor collaterals.

Conclusions:
We have identified that advanced age, WMH, and thrombocytosis are predictors of poor collaterals. Future studies to explore the effect of vascular aging on collateral therapeutics are indicated.
Abstract WP175: Similarities and Differences in Atherothrombosis, Aortogenic Embolism, and Branch Atheromatous Disease
Authors: Suzuki Satoshi , Fujimoto Shigeru
Published: June 2021

Introduction:
Branch atheromatous disease (BAD) and aortogenic embolism (Ao) are categorized as “unclassified” in accordance with “The Trial of Org 10172 in Acute Stroke Treatment (TOAST)” classification; however, their pathophysiology is similar to that of atherothrombosis (AT). We compared these categories of ischemic cerebrovascular disease (iCVD).

Methods:
A consecutive series of 1,079 patients with iCVD 7 days within onset were included. According to TOAST classification, 180 (16.7%), 159 (14.7%), 251 (23.3%), and 489 (45.3%) patients were classified as AT, lacunar, cardiogenic embolism, and unclassified, respectively. Of the unclassified, 145 and 82 patients were re-classified as Ao and BAD, respectively.

Results:
Mean age was 75.3, 75.7, and 73.0 years in AT, Ao, and BAD, respectively. Male predominance was most apparent in AT (62.6%), followed by BAD (54.7%) and Ao (54.6%). Prevalence of hypertension, diabetes mellitus, and dyslipidemia was 80.7%, 39.4%, and 53.6% in AT, 83.8%, 30.5%, and 53.9% in Ao, and 74.7%, 33.3%, and 57.3% in BAD, respectively. Hemodialysis was more common in Ao (6.7%) than in BAD (2.7%) and AT (0.7%). Median (IQR) of National Institutes of Health Stroke Scale score on admission and at discharge was 3 (1-6) and 1 (1-3) in AT, 2 (0-4) and 0 (0-2) in Ao, and 5 (3-6) and 2 (1-5) in BAD, respectively. Neurological deterioration was more frequent in BAD (30.7%) than in AT (16.1%) and Ao (2.6%). Median (IQR) of modified Rankin scale (mRS) prior to iCVD and at discharge was 0 (1-2) and 2 (0-4) in AT, 0 (0-1) and 1 (0-2.25) in Ao, and 0 (0-1) and 2 (1-4) in BAD, respectively. The percentage of patients with mRS 2 or better prior to onset and at discharge was 83.2% and 63.9% in AT, 88.3% and 75.3% in Ao, and 89.3% and 58.7% in BAD, respectively. Recurrence of iCVD at 3 months after onset was more frequent in AT (12.9%) than in Ao (9.7%) and BAD (5.3%).

Conclusions:
Ao and BAD have many similarities with AT, but there are some differences. In Ao, symptoms were often mild and rarely worsened, but with recurrence of up to 10%. There were many dialysis patients in Ao. Worsening was observed in more than 30% of patients, and outcomes were often poor, but recurrences were few in BAD patients.
Abstract WP176: Contributing Factors Affecting the Occurrence of New Ischemic Lesions After Carotid Revascularization
Authors: Lee Jun , Jeong Daeun , Lee Hyewon
Published: June 2021

Introduction:
Although several large clinical trials have demonstrated that carotid revascularization including carotid endarterectomy (CEA) and carotid stenting (CAS) are effective treatments for symptomatic patients with internal carotid stenosis, the factors contributing to post-revascularization stroke have not yet well defined.

Objectives:
We aimed to analyze the factors that are associated with the presence of new ischemic lesions on diffusion-weighted MRI (DWI) after carotid revascularization.

Methods:
Consecutive clinical and imaging findings of patients who underwent CEA or CAS were collected (n=159). New ischemic lesions were defined based on DWI within 3 days after carotid intervention. Transcranial Doppler (TCD) monitoring findings during surgical operation including the number of microemboli (MES), status of collateral via Willis circle, and differences in pre- and post-operation peak systolic velocity and mean velocity were evaluated.

Results:
We analyzed 116 patients who underwent DWI before and after carotid intervention (72 in the CEA group and 44 in CAS group). DWI revealed new ischemic lesions in 53 patients (5 in females vs. 48 in males, p=0.579). This non-randomized study showed a higher rate of postprocedural ischemic lesion on DWI after CAS compared with CEA (70.5% vs. 30.6%, p<0.001). There was no significant association between new lesions on DWI and symptomatic stenosis (p=0.624) or degree of stenosis (p=0.498). The numbers of MES during TCD monitoring showed a trend for association with new lesions on DWI (p=0.056). Using a shunt during the operation was the only independent predictor of new lesions by multivariate analysis (OR 6.92, 95% CI 1.65 to 29.98, p=0.008).

Conclusion:
New ischemic lesions on DWI occur more frequently after CAS than CEA. Restriction of selective shunting during CEA can reduce new ischemic lesions after carotid intervention. Efforts to prevent the occurrence of new ischemic lesions are expected to lead to better outcomes.
Abstract WP177: Frequency of Carotid Plaque With High-Risk Features in Cryptogenic Stroke: Systematic Review and Meta-Analysis
Authors: Kamtchum Tatuene Joseph , Wilman Alan , Saqqur Maher , Shuaib Ashfaq , Jickling Glen C
Published: June 2021

Background and Purpose:
An ipsilateral non-obstructive carotid atherosclerosis (NOCA), defined as carotid plaque with <50% stenosis, is identified in 25% of cryptogenic strokes and could represent an unrecognized source of athero-embolism. We aimed to summarize available data regarding the frequency of NOCA with high-risk features in patients with cryptogenic stroke.

Methods:
A search of Pubmed and Ovid-Embase identified observational studies reporting carotid plaque imaging features in patients with cryptogenic stroke, from inception to July 15, 2019. The prevalence of NOCA with high-risk features in ipsilateral and contralateral carotid was determined by pooling study-specific estimates using a random-effect meta-analysis.

Results:
Six prospective studies enrolling a total of 255 participants with unilateral ischemic stroke in the anterior circulation were included. Carotid arteries were imaged with ultrasound, computed tomography or MRI to identify echolucency, ulceration, intraplaque hemorrhage, thrombus, or thickness ≥ 3 mm. The pooled prevalence of NOCA with high-risk features in the ipsilateral carotid was 34.0% (95% CI: 25.7 – 42.9) compared to 7.3 % (95% CI: 0.8 – 18.1) in the contralateral carotid. The odds ratio of finding a plaque with high-risk features in the ipsilateral versus the contralateral carotid was 4.1 (95% CI: 2.0 – 8.7).

Conclusion:
Plaques with high-risk features are four times more prevalent in the ipsilateral compared to the contralateral carotid artery in patients with cryptogenic stroke, suggesting a relationship to stroke risk. These features may aid in etiologic classification of stroke and risk stratification for secondary prevention therapy.
Abstract WP186: External Counterpulsation Enhances Endothelial Metabolism and Neurogenic Activity in Ischemic Stroke: New Evidence by Analyzing Transcranial Doppler Signals With Wavelet Analysis
Authors: Xiong Li , Liu Danyang , Wang Yawei , Wong Ka Sing Lawrence , Fan Yubo
Published: June 2021

Purpose:
We aimed to investigate whether external counterpulsation (ECP) may enhance endothelial metabolic and neurogenic activity by analyzing cerebral blood flow oscillation in transcranial Doppler (TCD) signals, and propose a new indicator for quantifying the enhancement.

Methods:
Twenty-seven patients with unilateral ischemic stroke in the anterior circulation territory (15 ones with 35 daily 1 h ECP treatment sessions and 12 ones without ECP treatment) were recruited. TCD monitoring of bilateral middle cerebral arteries was performed before and after ECP at day 1 and week 7. The index
I,
for quantitatively evaluating the enhancement of endothelial metabolism and neurogenic activity, was defined as the ratio of the oscillation amplitude of TCD signal in the dedicated frequency interval at different time points with wavelet analysis. TCD data were analyzed using wavelet analysis based on ipsilateral or contralateral to the infarct side. An overall change in National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) scores were recorded.

Results:
The index
I
at baseline of week 7 compared with day 1 were significantly higher on both ipsilateral and contralateral sides in ECP group (ipsilateral, 1.28±0.30; contralateral, 1.28±0.30) than those in No-ECP group (ipsilateral, 1.02±0.06; contralateral, 1.00±0.06) (all
P
<0.05). The
I
during ECP of week 7 compared with day 1 also increased on both sides in ECP group (ipsilateral, 1.31±0.36; contralateral, 1.29±0.34) than those in No-ECP group (ipsilateral, 0.99±0.06; contralateral, 1.00±0.07) (all
P
<0.05). There were positive correlations of
I
with favorable changes in NIHSS and BI in ECP group.

Conclusions:
ECP treatment can enhance endothelial metabolic and neurogenic activity. The index
I
may be used as an indicator of enhancement of endothelial metabolic and neurogenic activity, as well as clinical outcome, in ischemic stroke following ECP treatment.
Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes
Authors: Breen Joan C , Andrusin Jeanne , DiCarlo Julie , Keenan Julia , Fortuna Paula , Rodriguez Juliette , Garth Hannah
Published: June 2021

Background:
Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self-efficacy, functional outcomes, stroke knowledge or characteristics of survivors who achieve these goals.

Methods:
Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factor/stroke knowledge, self-efficacy, psychosocial, driving and vocational issues.

Results:
190 consecutive patients(117 men, 73 women, average age 62(18-90), 66 aphasic) with baseline modified Rankin Scores of 5(1%); 4(25%); 3(56%); 2(15%); 1(3%), and average NIHSS score of 6(range 0-18) were treated between 12/2011-7/2019. 136 Patients suffered ischemic strokes and 54 had hemorrhages. Locations were: 65 left, 69 right, 26 bilateral hemisphere, 30 brainstem. 41% had MCA territory strokes. Of 104 patients working pre-stroke, 50% returned to work and an additional 7% were work capable upon completion of program. 95% of patients driving pre-stroke could not drive on admission. After training, 43%(67/157) returned to driving. Patients had improvements in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 23%. Patients received an average of 33 physical therapy visits with average percent improvement of 72% and 41% on 6” walk and Berg Balance scores. Average percent improvement in Stroke Self Efficacy Scores was 29%. After individualized cardiovascular risk, stroke and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life’s Simple 7’s curriculum, stroke and risk factor knowledge quiz scores improved an average of 29%. Average length of stay was 5(range .5-24) months. Multiple other demographic and outcome measures are collected.

Conclusions:
Outcome data show a community-based team rehabilitation program can successfully combine CV/stroke education with rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self-efficacy for many types of stroke survivors with moderate to severe disability.
Abstract WP189: Application of a Continuous Quality Improvement Framework: Longitudinal Results From Year 1 of the Stroke Survivor to Survivor Program
Authors: Gruhot Sandi , Pietrzak Janna , Santana Adela , Winiecki Christine
Published: June 2021

In 2018, the Mission Lifeline North Dakota (ND) initiative adopted and began to implement Stroke Survivors Empowering Each Other, Inc.’s (SSEEO’s) Stroke Survivor to Survivor (SS2S) program. The SS2S program is a post-stroke support program that aims to facilitate survivors’ efforts to recover after stroke. Volunteers, who are themselves survivors, call participants monthly at least twice following discharge from the hospital and provide them with stroke-related resources and support. The adaptation and implementation of the Chicago-borne SS2S program in ND was embedded within a continuous quality improvement framework to ensure ongoing performance monitoring data could inform programmatic improvements as needed.

Key questions:

• How has the Chicago-borne SS2S program been adapted to fit the unique characteristics and environment of ND, while maintaining fidelity?

• What are performance monitoring findings from the first three quarters of implementation?

Between Oct 2018- Feb 2019, four of the six ND tertiary hospitals implemented the SS2S program. These hospitals provide monthly quantitative and qualitative data on program implementation. From Oct 2018 to May 2019, SS2S volunteers made 153 calls to survivors, with 57% (n = 87 of 153) of calls answered by a prospect, including stroke survivors (n=74) and their caregivers (n=13). Thirteen percent (n = 9 of 69) of stroke survivors calls required additional follow-up by hospital staff. SS2S volunteers mailed additional resources to stroke survivors for 48% percent of the calls where the prospect was reached (n= 33 of 69). Seventy percent (n = 48 of 69) of survivors reached were able to identify at least one sign of stroke. Preliminary results suggest that both volunteers and stroke survivors may benefit from the program. Importantly, performance monitoring data also identified opportunities for programmatic improvements.

For example, these data informed edits to the volunteers’ phone scripts to clarify signs-of-stroke patient-education. Ongoing feedback from the hospitals have also informed improvements to the performance monitoring processes.
Abstract WP190: Development of a Comprehensive Neuropsychological Battery to Assess Post-Stroke Cognitive Functioning
Authors: Drag Lauren , Aghaeepour Nima , Mlynash Michael , Osborn Elizabeth , Rah Esther , Buckwalter Marion , Lansberg Maarten
Published: June 2021

Introduction:
Cognitive outcomes vary widely following stroke and there is need for further research identifying the trajectory of post-stroke cognitive functioning. This requires a neuropsychological test battery that takes into account the unique challenges of testing cognition post-stroke (e.g., aphasia, hemiparesis) and that is relatively brief yet assesses cognition across multiple domains. The aim of this study was to develop such a battery and describe its characteristics.

Methods:
StrokeCog is a prospective longitudinal cohort study examining cognitive trajectories following stroke. A 60-minute neuropsychological battery including 10 tests (yielding 17 neuropsychological variables) was administered to 86 participants 6-12 months after stroke. Raw scores for each of the 17 variables were transformed to age-corrected z-scores. A pair-wise undirected Pearson correlation graph was created using all available variables to visualize the correlation network representing the variables and to identify the cognitive domains assessed by these variables.

Results:
Participants ranged in age from 26-87 (M = 63.85, SD = 12.58); 59% of the sample was male. Sixteen cognitive variables loaded onto five cognitive domains: memory, expressive language, processing speed, visuospatial functioning, and fine motor functioning. 62% of participants demonstrated impaired cognition in at least one domain with 22% demonstrating impairment in 2 or more domains. Memory and processing speed were most commonly impaired (45% and 53% of participants, respectively). Visuospatial functioning was least impacted (14% of participants).

Conclusions:
A comprehensive assessment of cognition in post-stroke patients can be obtained using a 60-minute cognitive test battery, allowing repeated annual assessments to elucidate cognitive trajectories post-stroke. The results show a high rate of cognitive impairment in at least one cognitive domain among the participants.
Abstract WP191: Ipsilesional Mu Sensorimotor Rhythms Track With Hand Function Recovery in Stroke Survivors
Authors: Remsik Alexander B , Bjorklund Erik , Gjini Klevest , Williams Leroy , van Kan Peter L , Nair Veena , Caldera Kristin , Williams Justin , Prabhakaran Vivek
Published: June 2021

This research seeks to identify source localization of neuromechanical changes associated with gains in hand grip function following BCI intervention sessions for upper extremity motor recovery. Mu rhythm desynchronization (ERD) of contralateral brain motor areas is thought to occur during movement and changes in brain motor area ERD relate to changes in behavioral measures, hand grip function, with BCI intervention. N=16 right hemisphere survivors participated in 9-15 sessions with BCI. Participants executed hand movements in response to visual cues on a computer screen with the corresponding audio instructions (e.g., Left, Right, Rest). The sessions (i.e. pre and post BCI intervention) contained two runs, each consisting of 15 trials for rest, left hand, and right hand movements (i.e., 5 trials for each of the three conditions) presented in random order. Data from the pre and post conditions were then grand averaged. sLORETA estimates were calculated as follows: 1) Clean EEG data segmented (LEFT hand attempted movements and REST) separately for PRE and POST conditions. 2) Cross-spectra (MU[8-12 Hz]) were computed then averaged (i.e. 1 average per each subject separately for left, right and rest trials. 3) sLORETA of MU power estimates at 6239 cortical locations/voxels were obtained, normalized across subjects. In the sLORETA implementation, computations made in realistic head model using the MNI152 template, with 3D solution space restricted to cortical gray matter, as determined by the probabilistic Talairach atlas. The specific frequency band cross-spectra (frequency-domain) obtained from the average-reference potential data, were the inputs for source localization. 4) sLORETA estimates between the 2 conditions [Movement - Rest] were then calculated in cortical space. Pearson correlation of voxel-wise Mu ERD with the change in Hand Grip were calculated. A stronger Mu ERD in the ipsilesional primary motor cortical area (BA 4) at ‘post’ intervention (i.e., more negative values compared to ‘pre’) was associated with a greater change in hand grip (r=-0.435, p=0.046 [1-tailed]). Increases in functional recovery of the impaired upper extremity (Hand Grip) have a direct correlation with greater changes in Mu ERD of ipsilesional motor brain areas.
Abstract WP193: A Pilot Study of Expanded Home-Based Telerehabilitation After Stroke
Authors: Cramer Steven C , Dodakian Lucy , Le Vu , McKenzie Alison , See JIll , Augsburger Renee , Zhou Robert , Raefsky Sophia , Nguyen Thalia , Vanderschelden Benjamin , Wong Gene , Bandak Danial , Nazarzai Laila , Woytowicz Elizabeth , Dhand Amar , Scacchi Walt , Heckhausen Jutta
Published: June 2021

Introduction:
High doses of activity-based rehabilitation therapy help but many patients do not receive this, e.g., due to access, cost, and low compliance. Home-based telerehabilitation (TR) can address these issues. A prior study found 6 weeks of TR targeting arm motor deficits after stroke comparably efficacious vs. therapy delivered in-clinic. Here, we evaluated a program expanded in TR dose and scope.

Methods:
Adults with stroke and arm motor deficits saw a licensed OT/PT who performed a live exam then supervised home-based TR (6 days/week, 1 hour/day) through games, exercises, and education. New features examined herein included (a) extending therapy to 12 weeks, (b) treating both arm and leg motor deficits, (c) augmented reality games, (d) wireless smart devices, (e) ingesting a daily experimental (placebo) pill, (f) using functional objects, (g) evaluating social networks, and (h) automated actionable reports.

Results:
Patients (n=13) were median age 61 [IQR=52-65.5], and 129 [52-486] days post-stroke. Patients initiated therapy on 79.9% of the 72 assigned days and completed >30 min on 65.7% of days, for a 12-week total therapy dose of 50.4 [33.3 - 56.7] hours. Non-compliant days during weeks 7-12 were double those of weeks 1-6. Modified Rankin scores improved by 1 level in 6/13 patients, 3 of whom were > 3month post-stroke. Fugl-Meyer motor scores increased by 6 [2.5-12.5] points in the arm and 1 [-0.5 - 5] point in the leg, mainly in weeks 1-6. Geriatric Depression Scale scores fell from 3 [1-5] at baseline (3/13 with depression) to 1 [0-4] (0/13 with depression) at week 12. Augmented reality gaming and functional objects were well received. Communication with smart devices was challenging. The experimental pill was taken, with photo verification, on 90.9% of days. Enrollees had large social networks. Automatic reports reliably notified study personnel when compliance was low or behavioral scores were concerning.

Conclusions:
High doses of home-based TR targeting arm and leg motor deficits are feasible and improve functional outcomes, motor deficits, and mood. The current system automates experimental pill ingestion and actionable reports to clinicians. Compliance declined over time, suggesting the need for novel approaches to extended periods of TR.
Abstract WP195: Accelerated Repetitive Transcranial Magnetic Stimulation (rTMS) as a Treatment for Subacute Post-Stroke Depression (PSD)
Authors: Frey Jessica , Najib Umer , Petrone Ashley , Tirumalai Padmashree , Sherman Jay , Moore Louise , Lilly Christa , Casingal Christian , Colantonio Lea , Clairmont Callista , Adcock Amelia
Published: June 2021

Introduction:
Depression affects more than 50% of stroke survivors, reducing quality of life and increasing adverse outcomes. As stroke survivorship improves, the need for innovative treatments for associated stroke morbidity such as PSD is even more urgent. Alternative therapies are necessary due to the limited efficacy of antidepressants and counseling. rTMS is well established as an effective treatment for Major Depressive Disorder (MDD) and some small trials have shown that rTMS may be effective for chronic PSD; however, no trials have looked at an accelerated rTMS protocol in the subacute stroke period for PSD.

Hypothesis:
An accelerated rTMS protocol will be a safe and feasible option to effectively reduce PSD symptoms within 6 months of ischemic stroke onset.

Methods:
Patients (N = 6) with radiographic evidence of ischemic stroke within the last 2 weeks to 6 months who had Hamilton Depression Rating Scale (HAMD-17) scores ≥ 8 were recruited for an open label study using an accelerated rTMS protocol as follows: High frequency (20 Hz) rTMS at 110% resting motor threshold (RMT) was applied to the left dorsolateral prefrontal cortex (DLPFC) during 5 sessions per day over 4 consecutive days for a total of 20 sessions. Forty trains of 2 second duration were applied with a 12 second intertrain interval for a total of 1560 pulses per session. Before and after the 4-day neurostimulation protocol, outcome measures were obtained for the HAMD, modified Rankin Scale (mRS), functional independence measures (FIM), and National Institutes of Health Stroke Scales (NIHSS). These same measures were obtained at 3-month follow up.

Results:
HAMD significantly decreased (Wilcoxon p = 0.03) from M=15.5 (2.81) to 4.17 (0.98) following rTMS, a difference which persisted to the 3-month follow-up (p=0.03). No statistically significant difference in FIM, mRS, or NIHSS were observed. No significant adverse events related to the treatment were observed.

Conclusions:
Our preliminary results indicate that an accelerated rTMS protocol is safe and feasible, and may be an effective alternative or adjunctive therapy for patients suffering from PSD. Future planned studies include a larger, randomized controlled trial in this population.
Abstract WP196: Selective Serotonin Reuptake Inhibitors (SSRI) for Depression and Functional Recovery After Stroke: A Meta-Analysis
Authors: Dhasakeerthi Thirumalaivasan , Ishfaq Muhammad , Krishnaiah Balaji , Alexandrov Andrei , Tsivgoulis Georgios
Published: June 2021

Background:
Post-stroke depression is common and it impedes rehabilitation and function recovery after stroke, and numerous trials evaluated SSRI’s for depression prophylaxis. The objective of this study is to assess the use of SSRI for prevention of poststroke depression and the potential effect on functional recovery after stroke.

Methods:
We searched electronic databases up to July 2019 for randomized controlled trials of SSRI’s for patients with stroke versus placebo. We calculated pooled odds ratios and 95% CIs by using random-effects models. The primary end points were depression and good functional outcome (modified Rankin Scale score of 0-2) at 90 days post-randomization. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results:
Twelve randomized control trials assessing 4,887 patients have been included in the meta-analysis. SSRI treatment after stroke decreased the odds of depression compared to control group (OR = 0.48, 95% CI - 0.30 to 0.78, p=0.003). There was no heterogeneity between the trials (Cochran’s Q statistic 4.623, df 5; P = .337, I
2
=5.626%). The proportion of subjects who achieved mRS 0-2 at 90 days was similar between SSRI and control groups (OR= 3.471, 95% CI - 0.59 to 20.38, p=0.168).

Conclusion:
SSRI treatment for the stroke patients reduces the incidence of depression but it does not increase the odds of good functional recovery.
Abstract WP199: Change of Corticospinal Tract Integrity and 6-month Motor Outcome After Stroke: DTI Study
Authors: Jun Soo Noh , Yoonhye Na , Cho Minjae , Hwang Yu Mi , Tae Woo-Suk , Pyun Sung-Bom
Published: June 2021

Objective:
Corticospinal tract (CST) changes with time after stroke. However, few studies have investigated longitudinal change of CST and its relationship with motor outcomes. Primary goal of this study is to investigate the changes of CST after stroke using diffusion tensor image (DTI) and the relationship between CST changes and functional motor outcome in upper and lower extremities at 6 months after onset of stroke.

Methods:
We collected data from STroke Outcome Prediction (STOP) database that is prospective data collecting system for functional recovery prediction after stroke based on neuroimaging study. Fifty-five patients with first-ever stroke who performed functional assessment and underwent DTI at 30 days and 6 months poststroke were included. Clinical evaluation included Fugl-Meyer Assessment (FMA), Manual Function Test (MFT), Berg Balance Scale (BBS), and Functional Ambulation Category (FAC). DTI parameters were fiber number (FN), average fiber length (AL), fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), radial diffusivity (RD), laterality index (LI) and delta (Δ) changes of these values. Also type of CST by diffusion tensor tractography was included for analysis.

Results:
FA decreased and diffusivity indices (AD, MD, RD) increased in ipsilesional hemisphere; Decrease of FA and increase of RD were also noted in contralesional side. Type of CST were changed in 19 patients (34.6%). Spearman correlation analysis showed strong correlations between DTI values (FN, AL, FA, RD) and motor outcomes (FMA, MFT, BBS, FAC) at 30 days and 6 months. However, ΔFA or ΔRD did not show significant correlation with Δ changes of motor outcomes. In the CART analysis, overall prediction accuracy of DTI parameters for 6-month motor outcome ranged from 81.8 to 90.9 %.

Conclusion:
The integrity of CST changed not only on the lesion side but also on contralesional side. Integrity of CST using DTI at early phase of rehabilitation is useful to predict 6-month motor outcome after stroke.

Acknowledgement:
No potential conflict of interests relevant to this article were reported. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1A2C2003020).
Abstract WP201: Left Atrial Enlargement Predicts 3-Month Outcome in Acute Embolic Stroke
Authors: Kim Seung Min
Published: June 2021

Introduction:
Although previous studies have shown that the role of left atrial enlargement (LAE) on ischemic stroke, the association with long-term clinical outcome is less clear. We hypothesized that LAE might be associated with long-term outcome in acute ischemic stroke most likely related to embolism (cryptogenic and cardioembolism).

Methods:
This was a prospective study for patients with acute ischemic stroke as documented by MRI. Echocardiographic LAE was categorized as normal, mild, moderate and severe. Poor outcome was defined as modified Rankin Scale at 3-month of 2-6. The association between LAE and clinical outcome was explored using multivariate analysis adjusting for demographics and other clinical variables.

Results:
Of 178 patients enrolled, 87 (48.9%) had no LAE, whereas 50 (28.1%) had mild, 30 (16.9%) had moderate and 11 (6.1%) had severe LAE. Infarct volume on MRI was larger in severe LAE (36.53±30.11 cm
3
) followed by moderate (32.81±28.84 cm
3
), mild (13.4±16.53 cm
3
), and normal (11.9±13.16 cm
3
; p<0.001). At the 3-month follow-up, the poor outcomes were more common in moderate to severe (67%), followed by mild (51%), and normal LAE (46%; p<0.001). In multivariable models adjusted for confounders including heart failure, moderate-to severe LAE compared to normal LAE was associated with poor clinical outcome (odds ratio 1.54, confidence interval 1.04-4.55). Mild LAE was not associated with poor outcome.

Conclusions:
Our present study shows that LAE is an independent predictor of 3-month clinical outcomes in acute embolic stroke.
Abstract WP208: Lower Fractional Anisotropy in White Matter Tracts is Associated With Decreased Manipulative Manual Dexterity Higher Circulating Ceramide Levels in Healthy High-Risk Middle-Aged Individuals
Authors: Hannawi Yousef , Yanek Lisa , Kral Brian , Becker Lewis , Vaidya Dhananjay , Haughey Norm , Becker Diane , Nyquist Paul A
Published: June 2021

Introduction:
We previously reported impaired manipulative manual dexterity measured by grooved peg-board test (GPBT) in healthypeople with increased total brain ischemic white matter hyperintensities. We hypothesized that preclinical white matter tract damage (WMTD), measured as lower regional fractional anisotropy (rFA), is associated with functional decrements measured with GPBT, and with a biomarker of white matter disease, serum ceramides.

Methods:
Participants were recruited from the GeneSTAR study in families with a history of coronary artery disease. Diffusion tensor imaging was acquired on a Phillips 3T MRI and rFA was calculated using the 181 Eve segmented atlas. 48 susceptible regions for WMTD were analyzed.Liquid chromatography was used to measure ceramides (C). Spearman’s rank correlation (SRC) was used to test statistical associations and Bonferroni method was used to correct for multiple comparisons. Multivariate analysis (GEE) adjusting for age, sex, race and education was performed for associations that were significant in the univariate analyses.

Result:
Subjects (n=112) were 49±11 years; 49% male and 39% African American. rFA was correlated with decrements on GPBT in the left (L) anterior corona radiata, L genu of the corpus callosum (LGCC), L external capsule, and L & right fornix (RF) (P=0.0009, 0.0008, 0.0002, 0.0003 and 8.2E-07, respectively). Additionally, rFA was negatively correlated with C18:0 in the RF and LGCC (P=1.27E-05 and 2.58E-05, respectively) and C20:0 in RF (P=6.09E-06). C18:0 was correlated with decrements on GPBT (P=0.0025). GEE showed associations between decremental GPBT and rFA in the RF (B = -0.52, 95% CI -1 - 0.03, p= 0.037), between rFA in the RF and Ceramide (C18:0, B= -0.03, 95% CI -0.046--0.0073, p=0.007, C20:0, B=-0.0002, 95%CI -0.0003-0, P= 0.018), as well as rFA in LGCC and Ceramide (C18:0, B=-0.0097, 95% CI -0.019--0.006, P=0.037). GBPT and ceramides were not associated when adjusted for rFA (B = 0.0002 95% CI -0.052 - 0.052 P= 0.99).

Conclusion:
These analyses support our hypothesis that preclinical WMTD represented by reduced rFA, may undermine neural networks affecting manipulative manual dexterity, with concomitant elevation in serum ceramides in healthy high risk people.
Abstract WP209: Relationship Between Liver Fibrosis and Ischemic Stroke Subtype
Authors: Parikh Neal S , Jesudian Arun , Salehi Omran Setareh , Merkler Alexander E , Gupta Ajay , Murthy Santosh B , Navi Babak B , Kamel Hooman
Published: June 2021

Background:
Liver disease has been associated with cardiac structural abnormalities and atrial fibrillation. We hypothesized that advanced liver fibrosis - commonly subclinical in the general population - is associated with cardioembolic stroke subtype. Secondarily, we hypothesized an association with cryptogenic stroke, based on its suspected embolic etiology.

Methods:
Among patients prospectively enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011-2016, we selected patients who had liver function tests within 7 days of admission. We calculated each patient’s Fibrosis-4 score, a validated, non-invasive liver fibrosis score derived from age, transaminase values, and platelet count. The primary exposure was advanced liver fibrosis, defined using a validated threshold of > 3.25; these patients were compared to patients without liver fibrosis. The primary outcome was cardioembolic stroke subtype, adjudicated using TOAST classification. The secondary outcome was cryptogenic subtype. We used logistic regression to separately evaluate the association between advanced liver fibrosis and these stroke subtypes, as compared to non-cardioembolic stroke. Models were adjusted for demographics, atrial fibrillation, hypertension, diabetes, dyslipidemia, coronary artery disease, congestive heart failure, peripheral vascular disease, and chronic kidney disease.

Results:
Among 1,586 ischemic stroke patients in our study, the mean age was 71 (SD, 15) years, and 50% were women. Overall, 18% had liver fibrosis; 34% and 27% of strokes were cardioembolic and cryptogenic, respectively. Advanced liver fibrosis was associated with cardioembolic stroke after adjusting for demographics and vascular risk factors (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.1-6.9) compared to patients without liver fibrosis. There was a significant, albeit attenuated, association with cryptogenic stroke (OR, 1.9; 95% CI, 1.0-3.4).

Conclusion:
Advanced liver fibrosis is associated with cardioembolic stroke and, to a lesser degree, cryptogenic stroke. Whether liver fibrosis is a marker or independent causal factor of cardioembolism is to be determined.
Abstract WP215: Residential Greenspace Protects Against Stroke
Authors: Rovin Richard , Cheruvalath Heloise , Homa Jennifer , Singh Maharaj , Cook Jonathan , Triscari David , Vilar Paul , Kassam Amin
Published: June 2021

Introduction:
Greenspace, both residential and public, is associated with improved outcomes for a variety of medical conditions. Its effect on stroke incidence is not as well established. In this study, we sought answers to three questions: Does an increase in residential greenspace, as measured by the Normalized Difference in Vegetation Index (NDVI), lessen the odds of stroke? Is socioeconomic status (SES), as measured by the Area Deprivation Index (ADI), correlated with NDVI? Is proximity to a public park a risk factor for stroke?

Methods:
This is a matched (1:4) case-controlled study. The cohort was adult patients admitted to Aurora St Luke’s Medical Center in Milwaukee, WI between 2016 and 2018. Non-stroke controls (N=328,868) were matched to stroke cases (N=2336) on known cardiovascular risk factors after excluding patients with prior stroke, addresses outside of Milwaukee County, and residences within 250 meters of a water feature. The matched study sample included 5870 patients (stroke cases=1174 and non-stroke controls = 4696). The mean NDVI within a 250 meter radius around the patients’ residence and distance to a public park were calculated using satellite imagery and geographical information systems (GIS) software. State decile and national percentile ADI were obtained from the Neighborhood Atlas. A Spearman’s rank-order correlation determined the relationship between the NDVI, state and national ADI, and proximity to parks. Conditional logistic regression was used to examine the relationship between a stroke event and NDVI, ADI, and proximity to public parks.

Results:
We found a protective association between higher NDVI values and stroke (OR = 0.33, 95% CI = 0.111-0.975, p = 0.045). There was a negative correlation between NDVI and national (rs(5870) = -.548, p < .001) and state (rs(5870) = -.550, p < .001) ADI, both statistically significant. There was no association between proximity to parks and stroke (OR = 1.00, 95% CI = 1.000 – 1.000, p = 0.456).

Conclusion:
An increase in residential NDVI significantly decreases the odds of stroke. Distance to a public park did not impact the odds of stroke. These findings have implications for city planning and mitigation of social disparities in health.