bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W P319: Effect of Weekend Admission on Inhospital Outcomes AmongChildren with Ischemic and Hemorrhagic Strokes
Authors: Adil Malik M , Vidal Gabriel A , Malik Ahmed A , Khursheed Faraz , Qureshi Adnan I
Published: March 2022

Background and Objective:
Prior studies have demonstrated differences in the quality of care and clinical outcomes in adult stroke patients admitted on weekdays compared with weekends . The objective of this study was to determine the effect of weekend admission on clinical outcomes in children with ischemic stroke (IS) and hemorrhagic stroke (HS).

Methods:
Patients admitted to US hospitals between 2002 to 2011 with a primary discharge diagnosis of IS and HS (age 1-18 years) were identified by ICD-9 codes. Using logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) for in-hospital mortality, and discharge to nursing facilities among children (separately for IS and HS) admitted on weekends versus weekdays, adjusting for potential confounders.

Results:
Of 8,467 children with IS, 28 % were admitted on a weekend. Children admitted on weekends had higher rates of discharge to nursing facility (25.5 % versus 18.6 % p=0.003). In-hospital mortality was not different among children admitted on weekends compared with weekdays. After adjusting for age, gender, and confounding factors, discharge to nursing facilities [(OR) 1.5, 95% (CI) (1.1-1.9, p=0.006)] remains significantly high among children admitted on weekends as compared to those admitted on weekdays. Of 10,919 children with HS, 25.3 % were admitted on a weekend. Children admitted on weekends had higher rates of in-hospital mortality (12 % versus 8% p=0.006). Rates of discharge to nursing facility was not different among children admitted on weekends compared with weekdays. After adjusting for age, gender, and confounding factors, in-hospital mortality [(OR) 1.4, 95% (CI) (1.1-1.9, p=0.04)] remains significantly high among children admitted on weekends as compared to those admitted on weekdays.

Conclusion:
IS children admitted on weekends were more likely to be discharged to nursing facility while HS children admitted on weekends had higher rates of in-hospital mortality. Such observations point to prominent disparity in care on weekends among pediatric stroke patients.
Abstract W P321: Predicting Mortality in ICH: Redefining the ICH Score
Authors: McCracken D. J , Lovasik Brendan P , McDougal Margaret E , McCracken Courtney E , Pradilla Gustavo
Published: March 2022

Introduction:
The stated 30-day mortality rate for the original ICH score is 0%, 13%, 26%, 72%, 97%, and 99% for scores of 0-5, respectively. Although the score has been externally validated and widely used, recently proposed updates to the model have failed to improve its mortality prognostication. We hypothesized that precise quantification of ICH and IVH volumes more accurately reflect the severity of the disease and enhance its prognostic value.

Materials and Methods:
A modified ICH score was developed to quantify ICH volume, IVH volume (with the modified Graeb score), GCS at admission, and hemorrhage location. The modified score was as follows: GCS 11-15: 0 points, 6-10: 1 point, 3-5: 2 points; ICH volume <20 cm3: 0 points, 20-34 cm3: 1 point, 35-44 cm3: 2 points, >45 cm3: 3 points; mGraeb score 0: 0 points, 1-9: 1 point, >10: 2 points; cerebellar hemorrhage: 1 point; brainstem hemorrhage: 1 point. Possible scores ranged from 0-9 and were designed to provide a more accurate stratified prognostic reflection for 30-day mortality.

Results:
The modified score was tested in 362 patients previously evaluated with the original ICH score. Thirty -day mortality rates per group were 0%, 5%, 33%, 61%, 70%, and 91%, for ICH scores of 0-5, respectively. Median time to death in those that died within 30 days was 15.5, 3, 4, 1.5, and 1 day(s) for ICH scores of 1-5, respectively. Application of the proposed modified ICH score resulted in 30-day mortality rates of 0: 0%, 1: 5%, 2: 11%, 3: 4%, 4: 51%, 5: 73%, 6: 74%, 7: 90%, 8/9: 100%. Median time to death was 6, 13, 4, 4, 2, 2, 1, and 0 day(s), in scores of 1-8, respectively. In our patient population, 99% of patients who died within a 30-day period did so within 18 days. Furthermore, 75% died within the first week and 50% within the first 72 hours. Predicted 30-day mortality in the original ICH score had an area under the receiver-operating curve (AUROC) of 0.88, while the proposed new model showed a higher AUROC of 0.91.

Conclusions:
Improved outcomes in ICH therapy require better assessment and prognostic tools. By accurately determining hemorrhage volumes and increasing anatomical localization, stratification of ICH patients can result in better predictors of 30-day mortality. Further validation of this model is needed in larger patient populations.
Abstract W P324: The Influence Of Low Density Lipoprotein On Intracerebral Hemorrhage Volume
Authors: Khawaja Ayaz , Boehme Amelia K , Kicielinski Kimberly , Arora Kanika , Lyerly Michael , Alvi Muhammed , Kumar Gyanendra , Harrigan Mark
Published: March 2022

Background and Purpose:
High dose statin use either before (pre-morbid) or after an acute ischemic stroke has been associated with an increased risk of ICH. Prior studies suggest that premorbid statin use has a beneficial effect whereas lower LDL levels have a detrimental effect on functional outcomes in primary ICH. We sought to evaluate if pre-morbid statin use and serum LDL levels impacted ICH volume and outcomes in ICH.

Methods:
Patients with ICH admitted to our center from 2008-2013 were included. Demographic and clinical data were collected. Primary outcomes of interest were a large volume ICH (defined as volume greater than or equal to 30cc), and poor functional outcome at discharge defined as mRS of 4-6. Crude and adjusted logistic regression models were used to assess the relationship between LDL, statins and outcomes.

Results:
Of 403 patients, 18.6% (n=75) were taking a statin prior to ICH onset. The odds of a large volume ICH decreased by 12% for each 10 point decrease in serum LDL (OR 0.888, 95%CI 0.81-0.97, p=0.0115). In statin-naïve patients, the odds of a large volume ICH decreased by 16% for each 10 point decrease in LDL value (OR 0.84, 95%CI 0.76-0.94, p=0.0019). Patients who were on a statin prior to their ICH had no association between large volume ICH and LDL (OR 1.07, 95%CI 0.88-1.32, p=0.49). Statin use prior to ICH had no significant association with volume and location of ICH, admission NIHSS and a discharge mRS of 4-6 compared to statin-naïve patients (see Table).

Conclusions:
Statin use prior to ICH onset had no significant association with ICH volume or location, admission NIHSS, or poor short-term functional outcomes in comparison to statin-naïve patients. Lower serum LDL values were significantly associated with a decreased odds of large volume ICH, with the effect being driven by statin-naïve patients.
Abstract W P329: Systemic Inflammatory Response Syndrome during Hospitalization for Intracerebral Hemorrhage Drives Poor Functional Outcome at Discharge
Authors: Boehme Amelia K , Kicielinski Kimberly , Kapoor Niren , Arora Kanika , Gadpaille Alyssa , Shiue Harn , Miller David , Elkind Mitchell , Harrigan Mark
Published: March 2022

Background and Purpose:
Systemic Inflammatory Response Syndrome (SIRS) has been identified as a predictor of poor functional outcome at discharge in acute ischemic stroke patients treated with tPA. We sought to examine the relationship between SIRS and outcomes in patients presenting with primary intracerebral hemorrhage (ICH).

Methods:
A retrospective review of consecutive patients presenting to a tertiary care center from 2008-2013 with primary ICH was conducted. Demographic and clinical data were collected for analysis. Patients who were placed on comfort care or were diagnosed with an infection at any time were excluded. SIRS was defined according to standard criteria as having 2 or more of the following: (1) body temperature less than 36°C or greater than 38°C, (2) heart rate greater than 90, (3) respiratory rate greater than 20, or (4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% polymorphonuclear leukocytes for more than 24 hours. The outcomes of interest were discharge modified-Rankin Scale (mRS) of 4-6, death, and poor discharge disposition (discharge anywhere but home or inpatient rehab). Logistic regression models were used to evaluate the association between SIRS and outcomes before and after adjusting for ICH score.

Results:
A total of 249 ICH patients met inclusion criteria. Of these patients, 53 (21.3%) developed SIRS during their hospital stay. SIRS was associated with mRS 4-6 at discharge (OR 6.08, 95%CI 2.86-12.9, poor discharge disposition (OR 4.41, 95%CI 1.92-4.77) and death (OR 2.25, 95%CI 1.02-4.95). Adjusting for ICH score at baseline, SIRS remains associated with mRS 4-6 (OR 5.25, 95%CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95%CI 1.58-4.83), but was no longer significantly associated with death (OR 1.75, 95%CI 0.58-5.32).

Conclusions:
SIRS occurred in 21% of patients with ICH. Even after adjusting for ICH score, patients with SIRS were at a 5 fold increased odds of having poor functional outcome at discharge. The high prevalence of SIRS, in addition to the increased risk of poor outcomes, necessitates further research to determine whether early intervention in treating SIRS will reduce the poor functional outcome seen in SIRS patients in the ICH population.
Abstract W P34: Voxel-Based Mapping of C-arm CT Cerebral Blood Volume to Infarct Probability in a Canine Model of Ischemic Stroke
Authors: van der Marel Kajo , Chueh Ju-Yu , Wakhloo Ajay K , Gounis Matthew J
Published: March 2022

OBJECTIVE:
Advances in C-arm cone-beam CT (CBCT) have opened up opportunities for imaging CBV during endovascular therapy. However, lack of quantitative and voxel-based evaluation of CBCT-CBV maps precludes widespread adoption in the angiography suite. The purpose of this study was therefore to determine the feasibility of voxel-based infarct probability mapping using CBCT-CBV.

METHODS:
Adult beagle dogs (n=10) received stroke by unilateral ICA-injection of an autologous blood clot. Baseline and contrast-enhanced CBCT images were acquired 4.5h after stroke onset to calculate CBV maps, immediately followed by ADC-mapping at 3T. One animal was excluded because of acquisition problems.

CBV maps were normalized by the value in the vertebral arteries. After co-registration, a supervised learning approach modeled infarct probability as a function of CBV. A generalized linear model (GLM) discriminated ischemic lesion (ADC < 5.3 * 10^-4 mm^2 s^-1) from healthy brain tissue voxels. Only subjects with significantly reduced CBV in the lesion (vs. contralateral control area) were evaluated (n=7) using leave-one-out cross-validation.

RESULTS:
The area under the ROC-curve for all predictions was 0.80, with a sensitivity and specificity of 73% and 75%, respectively, at the optimal operating point. The figure displays input and prediction images in one coronal slice for each animal, A-G. ADC maps [0-0.003] display a clearly defined lesion, whereas the normalized CBV maps [0-0.25] are more heterogeneous. Infarct probabilities [0-100%] were high in the lesion territories for subjects A-D and G. The discrepancy between ADC and CBV in subject E is likely due to a spontaneous complete recanalization around 4 hours post-stroke.

CONCLUSION:
In conclusion, our results underscore the feasibility of voxel-level infarct probability mapping using angiographic CBV imaging.
Abstract W P342: The Effect of Risk Factors on Mortality and Length of Stay in 547 Acute Stroke and Transient Ischemic Attack Patients Treated at a Los Angeles Primary Stroke Center in 2012
Authors: Garland Jennifer , Antonio Anna , Amara Casandra , Daley Carolyn , Liu Antonio
Published: March 2022

Background and Purpose:
Multiple clinical risk factors are associated with increased mortality and increased length of stay in stroke patients. The purpose of the study was to examine the effect of clinical risk factors [hypertension (HTN), carotid stenosis, atrial fibrillation, coronary artery disease, depression, smoking, diabetes mellitus (DM), hyperlipidemia, and seizure] and rt-PA (recombinant tissue plasminogen activator) treatment on length of stay (LOS) and mortality. Methods: A retrospective medical record review of all acute stroke and transient ischemic attack (TIA) patients treated in 2012 at a primary stroke center in Los Angeles was conducted. Stroke program patient lists were matched against International Classification of Disease, 9th Edition (ICD-9) codes for 434.91, 431, 430, 435, 435.8, and 435.9. Patients that appeared on both lists were included in the study.Data were analyzed using poisson regression to model the effect of rt-PA and clinical risk factors on LOS. Binary logistic regression was used to examine the effect of rt-PA treatment on mortality. Probability value <0.0001 was considered statistically significant.
Results:
The total sample size included 547 patients treated for ischemic, hemorrhagic stroke and TIA. Non-tPA ischemic strokes comprised 240 (43.8%) patients in the sample, ischemic strokes treated with tPA totaled 62 (11.3%), ICH patients totaled 133 (24.3%) and TIAs totaled 112 (20.4%). Receiving rt-PA is significant (p<.0001) with a higher number of days in the hospital with a mean stay of 9.03 days versus non-tPA ischemic strokes with a mean stay of 3.12 days. Receiving rt-PA was not associated with increased mortality rate; mortality rate for rt-PA receiving patients was 3%. Diabetes mellitus and HTN were both significant clinical risk factors (p<.0001) for increased LOS, while the other clinical risk factors were not. Conclusions: Presence of HTN, DM, and receiving tPA were associated with longer LOS. Receiving r-tPA was not associated with increased mortality. This study demonstrates the safety of rt-PA treatment in this ischemic stroke population and the importance of prevention and treatment of stroke risk factors such as HTN and DM.
Abstract W P347: Correlation Between Follow-up Phone Call Post Discharge and Patient Satisfaction Scores
Authors: Elkins Kelley , Branson Pam
Published: March 2022

Background/Purpose:
Today’s health care systems track patient satisfaction to evaluate care delivery. Traditional quality measures have included mortality and re-admissions, but patient satisfaction is fast becoming an important measure. The stroke program of a large academic center began post discharge phone calls in 2013 on patients who were discharged home after a stroke. The purpose of the phone calls was to assess understanding of the discharge instructions, reinforce the discharge instructions, and care transition post hospitalization to home. Patient satisfaction scores were tracked as a secondary process measure.

Methods:
Call-backs utilized a standard template that focused on the patient’s understanding of medications, importance of the follow-up visit, signs and symptoms of a stroke, risk factors, and clarification of issues or concerns. The sample included all stroke patients who were discharged home. The call-back occurred within 7 days of discharge and two attempts were made to reach the patient. We reviewed the first two months of call-backs in 2013 and changes were made on the standard work to improve response rate. The changes included: consistent call-back days and times, verification of correct phone number before discharge, and informing patient of the phone call.

Results:
We attempted to reach 100% of the sample which averaged 45 patients per month. Current completed call-backs represent 58% of the sample. The call-backs resulted in an increase in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score in the “top box” care transitions domain by 5.8%. Pre call-back (January-March 2013), care transitions score was 80.7% (<40th percentile in the University HealthSystem Consortium peer group) compared to post call-back (January-March 2014) score of 86.5% (≥95th percentile). The HCAHPS score in the discharge domain during the same time period showed increase in the “top box” discharge domain by 9.8%. Pre call-back, the score was 87.0% (≥60th percentile) compared to post call-back score of 96.8% (≥95th percentile).

Conclusion:
The data supports a positive correlation between patient call-backs and patient satisfaction scores related to care transitions and discharge domains in the stroke population.
Abstract W P352: Integration of Acute Stroke Care Process Measures with Health Care Delivery System Characteristics Enhances the Understanding of Stroke Team Effectiveness
Authors: Loveless Mark , Plant Tamara , Wilson Andrew , Basden Latoya , Shah Samir , Levy Drew , Kamauu Aaron W
Published: March 2022

Introduction:
Effective therapy of acute ischemic stroke (AIS) is time dependent, and outcomes are influenced by the organizational capacity of each healthcare delivery system to successfully implement stroke treatment protocols that include time targets.

Objective:
Analyses of both workflow process and individual stroke care team structure and function will identify critical system characteristics associated with the delivery of thrombolytic therapy according to treatment guidelines in a real-world health care system.

Methods:
We performed a mixed method analysis (integration of medical outcomes, workflow process analysis and team personnel structure/function mapping) in 11 acute stroke care sites within a single health care system. Individual facility characteristics, variation of treatment delivery, and acute stroke care critical paths were evaluated at each care site. Formal and informal stroke care teams were mapped using network analytic software.

Results:
Based on these data, a benchmark hospital was identified. This site had 422 admissions for ischemic stroke in 2012, with the following median transition times for thrombolysis candidates: door to radiology (13.4 minutes), turnaround time for reporting lab results (40 minutes), time from order to scan result (20 minutes), and time from order to infusion (22 minutes). Network analysis of the team members revealed a robust, integrated team with high scores for centrality and density. The structure of the network was strongest in the workflow areas with the best performance.

Conclusion:
Health care delivery systems can access basic data on stroke management and health outcomes; however, these data sources are incomplete with respect to the complex interactions of personnel and processes associated with effective acute stroke care. A mixed method model of real-world stroke care teams provides new insights into the key system-level solutions for the rapid delivery of thrombolytic therapy.
Abstract W P355: Emergency Room Stroke Nurse Facilitator Improves Door to Needle IV rtPA Time in a Rural Hospital
Authors: Marsh Dianne , Rankin Pauline , Edwards Mary
Published: March 2022

The National Institute of Neurological Disorders and Stroke benchmark treatment time for acute ischemic stroke with intravenous rtPA door to needle time is 60 minutes or less. Hospitals identified as Primary Stroke Centers will be required to treat 50% of their patients who qualify for rtPA within that time frame. Acute stroke care requires the skills of a multidisciplinary stroke team with nursing playing a pivotal role in the emergency room setting, including meeting the benchmark for IV rtPA administration. Review of the literature reveals that nurses comprehend the importance of and have a desire to provide timely and quality acute stroke care but there may be barriers to achieving that end including; lack of proficiency with the NIH stroke screen assessment, other emergency department demands and staffing challenges that affect stroke care. As part of the ongoing process improvement program at our 180 bed primary stroke care center in rural northwestern Pennsylvania, we hypothesized a need for an emergency room stroke nurse facilitator to meet the 60 minute door to needle IV rtPA time. Our hospital treated an average of 14 patients per year with IV rtPA from 2010 to 2013. We used a sample population of 31 participants representing all those presenting to the emergency department qualifying for IV rtPA: 13 patients from January to November 2013 before starting the stroke nurse facilitator role, 18 patients from December 2013 to May 2014 after starting the stroke nurse facilitator role. Data was collected from Get with the Guidelines stroke data base. Results revealed that before starting the role of the stroke nurse facilitator, the average door to needle IV rtPA time was 68 minutes with mean time of 70 minutes. After starting the role of the stroke nurse facilitator the average IV rtPA door to needle time was 60 minutes with a mean time of 47 minutes. In conclusion, a stroke nurse facilitator appears to provide improvement of door to needle IV rtPA time in the emergency room setting. Our goal is to maintain the stroke nurse facilitator and follow outcomes to determine if this improvement is sustainable.
Abstract W P376: Primary Stroke Prevention in Women
Authors: Berekashvili Ketevan , Tark Brian , Balucani Clotilde , Adeishvili Grigol , Gabbur Nagaraj , Steinberg Leah , Adler Zachary , Chekuru Lavanya , Abulafia Ovadia , Weiss Steven , Levine Steven
Published: March 2022

Background:
Approximately half of American women identify their Obstetric-Gynecologists (Ob/Gyn) as their primary care physician (PCP).

Objectives:
(a) Evaluate awareness of primary stroke prevention (PSP) guidelines among Ob/Gyn compared to internists and (b) Identify barriers to address improving PSP in women

Methods:
Pilot survey of Ob/Gyn and Internal Medicine (IM) physicians from two urban academic medical centers and attendees of the 2013 American Congress of Obstetricians & Gynecologists (ACOG) District II Meeting in New York. Demographics, type of practice, and opinions on existing barriers of effective PSP were queried. Awareness of stroke prevention was assessed based on 2011 AHA/ASA prevention guidelines and educational materials [Personal Review of Learning in Obstetrics & Gynecology (PROLOG) for patient management in the office]. True/false, multiple-choice and case scenarios were distributed by e-mail (SurveyMonkey®) and paper.

Results:
Of 263 attendings and residents completing the survey, 188 were Ob/Gyn (71%) and 75 were IM (29%). Mean correct answers = 11± 3 (SD); Ob/Gyn (11±3) more than IM (9±3), p=.0001; 65% answered ≥11 questions correctly. Attendings from Ob/Gyn and IM were more likely to consider referring to specialists vs. residents (p=0.0001) and Ob/Gyn were more likely to refer to specialists than IM (p=0.0001). IM were more likely to answer correctly about diabetes as a risk factor vs. Ob/Gyn (66% vs 19% p=0.0001). Ob/Gyn were more likely to answer correctly about which type of oral contraceptives to be used in migraine with aura vs. IM (87% vs 48% p=0.0001). About half of all participants thought the most likely barrier to adhere to PSP guidelines is the lack of awareness and familiarity with PSP guidelines (49% IM vs 60% Ob/Gyn, p=0.29) and 23% attributed lack of adherence to guidelines to external barriers (no difference between two groups, p=0.23).

Conclusions:
Our pilot data suggest that Ob/Gyn and IM both have moderate awareness of PCP guidelines, correctly answering approximately 2/3 of questions, with Ob/GYN performing better than IM. Educational gaps and barriers have been identified in both groups and efforts through interventional trials to promote their improvement are needed.
Abstract W P39: Relationship Between Lesion Topology and Clinical Outcome In Anterior Circulation Large Vessel Occlusions
Authors: Rangaraju Srikant , Streib Christopher , Jadhav Ashutosh , Jovin Tudor G
Published: March 2022

Background:
Final infarct volume is a robust predictor of outcome in large vessel occlusion (LVO) patients but lesion location may also impact outcomes in these patients. DWI ASPECTS on follow-up MRI imaging, like infarct volume, is predictive of outcome in addition to providing information regarding lesion location. We aim to determine whether individual DWI ASPECTS regions have an impact on clinical outcome in anterior circulation large vessel occlusions.

Methods:
Patients with intracranial ICA, M1 and M2 MCA occlusions who underwent endovascular therapy between 2007 and 2014 at UPMC were included. Baseline demographics and outcomes including final infarct volume and 3-month mRS were collected. DWI ASPECTS based on follow-up MRI (12-72 hrs) was assessed by two observers. The impact of each DWI ASPECTS region on predicting poor outcome (mRS 3-6) was assessed by logistic regression analysis.

Results:
213 patients were included in the analysis (mean age 66.1±1.0 yrs, median NIHSS 15 [IQR 11-18], 19.5% ICA and 72% M1 MCA occlusions, 3-month mRS 3-6 of 46.8%). Inter-rater reliability was good for DWI ASPECTS (Deep ASPECTS regions: Kappa=0.72, Cortical ASPECTS regions: Kappa=0.63). All DWI ASPECTS regions with the exception of “putamen” were significant predictors (p<0.05) of poor outcome in univariate analysis. In a multivariate analysis with all 10 ASPECTS regions included, only M4 (OR=0.33 95%CI 0.16-0.70, p=0.003) and M6 (OR 0.39, 95%CI 0.18-0.85, p=0.018) significantly predicted poor outcome while deep regions (caudate, putamen and internal capsule) did not. After controlling for final infarct volume, M4 (p=0.045) and M6 (p=0.018) regions remained significant predictors of poor outcome. M6 was independently associated with poor outcome in right hemispheric lesions (OR 0.13 95%CI 0.04-0.47, p=0.002) while M4 (OR 0.14 95%CI 0.04-0.48, p=0.011) predicted poor outcome in left hemispheric lesions.

Conclusions:
Involvement of the right parieto-occipital (M6) and left superior-frontal (M4) regions seem to have a significant impact on outcome in LVO patients. While these results need to be replicated in other patient cohorts, lesion topology may also need to be considered in outcome prediction in LVO patients.
Abstract W P391: Obesity Causes Endothelium Dysfunction in Rat Cerebral Parenchymal Arterioles
Authors: Dorrance Anne , Pires Paulo , Jackson William
Published: March 2022

Obesity is a risk factor for dementia. The diameter and dilatory ability of cerebral parenchymal arterioles (PAs) regulates local perfusion to discrete neuronal populations matching nutrient delivery to neuronal demand. A mismatch in this process could lead to neuronal loss and dementia development. Thus, we hypothesized that feeding rats a high-fat (HF) diet would impair endothelium-dependent dilation and cause inward remodeling of PAs. Three-week-old male Sprague-Dawley rats were fed a HF diet for 17 weeks. Rats fed regular chow were controls. PAs branching from the middle cerebral artery were isolated and cannulated in a pressure myograph, and pressurized to 50mmHg. After the development of spontaneous myogenic tone endothelium-dependent dilation was assessed with carbachol (1nM - 100μM). PAs were then placed in 0Ca2+-PSS with 2mM EGTA+100μM sodium nitroprusside to assess of passive diameter and wall thickness. Data are means±SEM, Control vs. HF (n=3 in each group). Myogenic tone generation (% tone: 27.5±2.9 vs 22.8±2.2, p=0.12) and PA resting diameters (50.7±3.7 vs. 51.5±2.9μm, p=0.43) were not different between HF and control rats. PAs from HF rats showed a marked reduction in dilation to carbachol (change in diameter from baseline at 100μM: 5.3±0.7 vs. 1.1±0.7μm, p=0.01) and a trend towards an increase in the logEC50 (-7.2±0.2 vs. -5.9±0.8, p=0.08). No changes were observed in PAs passive lumen diameter (70.5±1.8 vs. 69.6±6.6μm, p=0.45) or wall thickness (5.3±0.4 vs. 5.2±0.8μm, p=0.46). These data suggest blood flow regulation to the parenchyma may be impaired in obese rats. Therefore we assessed the mRNA expression of proteins that have been linked to neuronal health and blood brain barrier function (n=6-8 in each group). Cortical mRNA expression of doublecortin, a marker of new neurons, was reduced by 38.8±9.4% (p<0.05) in HF rats. In HF rats the mRNA expression of synaptophysin, a marker of synapses, was reduced by 45.7±13.5% (p<0.05), and the expression of claudin 5; a blood brain barrier protein was reduced by 16.0±8.5% (p<0.05). These data suggest that diet-induced obesity causes endothelial dysfunction in PAs from rats, and that this leads to impaired neuronal and blood brain barrier function that could potentially culminate in dementia.
Abstract W P398: PFO Closure Reduces High Homocysteine Level in Atrial Blood of Stroke Patients
Authors: Deng Wenjun , Wickham Thomas , Feeney Kathleen , Chen Lei , McMullin David , Inglessis Ignacio , Palacios Igor , Buonanno Ferdinando , Lo Eng H , Ning MingMing
Published: March 2022

Background:
PFO allows venous clots to bypass pulmonary filtration, leading to strokes. We previous found in metabolite screening that PFO endovascular closure lower markers of oxidative stress and homocysteine levels in peripheral venous blood. Here we study changes of homocysteine during endovascular closure in cardiac atrial blood to better understand the central metabolism of PFO in circulation.

Method:
PFO stroke patients are propectively recruited according to IRB approval with plasma sampled from left (LA) and right (RA) atria pre- and post- PFO closure (n=97). Total homocysteine (tHCY) level was measured by selected reaction monitoring using mass spectrometry.

Result:
tHCY level decreased significantly in both RA and LA post PFO closure (Fig. 1A, p = 0.0014; RA: reduced by 8.54% Fig. 1B, p = 0.0304; LA: reduced by 9.90% Fig. 1C, p = 0.0470). Notably, tHCY reduction was skewed towards patients with higher tHCY levels before PFO closure (Fig. 1D and E, Kolmogorov-Smirnov test, RA: p = 0.0413; LA: p = 0.0010), such that more patients with higher tHCY level had a more significant reduction in tHCY levels compared to those with lower/normal levels.

Conclusion:
We found that PFO closure efficiently reduced tHCY level in both venous and arterial systems of stroke patients with high tHCY level. This effect is more pronounced in patients with higher levels suggesting PFO closure may help change the pathophysiology of hyperhomocysteinemia; further studies are ongoing to understand the underlying mechanism.
Abstract W P4: Prediction of Antegrade Flow Using FLAIR and GRE in Hyperacute Stroke
Authors: Ryoo Sookyung , Lee Mi Ji , Kwang Ho Lee
Published: March 2022

Background:
Recanalization of an occluded vessel has been shown to improve clinical outcomes in hyperacute ischemic strokes. Presence of antegrade flow across the occluded vessel has been regarded as one of predictors of successful recanalization after endovascular treatment. We aimed to predict antegrade flow non-invasively using FLAIR and GRE images.

Methods:
We collected patients who had acute ischemic stroke within 6 hours from onset and 50 patients who underwent endovascular treatment were included. All patients had ICA or MCA steno-occlusion. FLAIR hyperintense vessels(FHVs) were defined as linear or curved hyperintensity were observed on FLAIR. Dark intensity on GRE(GRE vein) and sulcal effacement(SE) were also assessed. We divided patients into 2 groups according to FHV, GRE vein and SE: (1) Group 1 = patients with insular FHVs(M2 and/or M3 of MCA) and distal SE or GRE vein(beyond M4 area); 2) Group 2 = patients who not allocated into group 1. We evaluated angiographic findings and clinical outcome.

Results:
Of 50 patients, 25(50.0%) patients had insular FHVs and distal SE or GRE veins. Antegrade flow on DSA were more frequently observed in group 1(22 [88%] vs. 5 [20%], p<0.001). Group 1 showed more successful recanalization than group 2 (22[88%] vs. 12[50%], p=0.004). Clinical outcomes were also better in group 1. Early neurological improvement(ENI; ΔNIHSS at 24 hours≥8 or NIHSS at 24 hours≤2) and favorable outcome at 3 months(mRS 0-2) were more frequently seen(ENI, 13[52.0%] vs. 2[9.1%], p=0.002; favorable outcome, 19[79.2%] vs. 3[12.0%], p<0.001). Nine patients in group 1 showed diffusion lesions in the insular area (i.e. FHV (+) within the infarct). We performed subgroup analysis. Diffusion volume was not different (52.1[6.4-95.9] vs. 62.2±6.9mL, p=0.492). Antegrade flow and successful recanalization were more common in FHV(+) within the infarct group and clinical outcome was also better.

Conclusion:
FLAIR-GRE sign (insular FHVs with distal SE or GRE vein) may be a marker for antegrade flow in hyperacute stroke. FLAIR-GRE sign is associated with higher recanalization rates and good clinical outcome.
Abstract W P406: Regulation Of MicroRNAs By Angiotensin II In Neurovascular Niche
Authors: Chabrashvili Tinatin , Sawaya Bassel
Published: March 2022

In adult brain, neuronal stem cells (NSC) are located in the neurovascular niche therefore, vascular cells play an important role in creating a healthy environment for adult neurogenesis. Several laboratories including ours have demonstrated that Angiotensin II (AngII)-induced hypertension affects numerous vascular functions by causing oxidative stress, vascular inflammation and endothelial dysfunction. Further, the available evidence suggests that blood-brain barrier (BBB) deregulation is an indirect consequence of cerebrovascular inflammation. Of these, AngII effect on BBB dysfunction has been reported, and is implicated in the pathogenesis of stroke, small vessel disease, vascular dementia and Alzheimer’s disease. In this regard, miRNAs emerged as key players in the development of vascular and neurodegenerative diseases. In here, we studied the effects of AngII on adult NSC and brain endothelial cell (BEC) miRNAs regulation and their interaction focusing on a specific miRNAs that were selected due to their role in other vascular systems. We used primary mouse NSC and BEC culture model to study the effects of AngII on miR-15, -34a, -155 and -let7 expression using qPCR. AngII 100nm induced expression of miR-15 in both neurospheres and BEC by 2 and 2.5-fold respectively after one hr. miR-34a expression was induced by 3.5-fold in neurospheres and by 3-fold in BEC in 24-hr. Mir-155 expression was elevated in neurospheres by 2-fold and in BEC by 3-fold after 45-min. miR-let7 was increased in neurospheres and BEC by 4-fold in 15 min, and remained induced in EC for one hr. These miRNAs expression changes were accompanied by increased protein expression of C/EBPβ, pCREB, and p38MAPK. However, Ets1 expression was downregulated in both neurospheres and BEC. These results indicate that AngII has major effects on NSC and BEC through deregulating miRNAs and protein levels involved in this phenomenon. Further studies are needed to explore the mechanisms involved.
Abstract W P409: Hypertension Impairs Myogenic Reactivity Without Increasing BBB Permeability of Isolated Parenchymal Arterioles: Role of TRPV4
Authors: Cipolla Marilyn , Sweet Julie , Nelson Mark T
Published: March 2022

Introduction:
Arterioles within the brain (parenchymal arterioles, PAs) are the target of hypertensive small vessel disease, and yet our understanding of how hypertension negatively impacts these vessels is limited.

Hypotheses:
Hypertension increases blood-brain barrier (BBB) permeability and impairs myogenic activity of PAs that leads to loss of local autoregulation of CBF and white matter lesions. We further hypothesized that inhibition of transient receptor potential vanilloid type 4 (TRPV4) channels would prevent these changes, as these channels are involved in BBB permeability and vasodilation.

Methods:
PAs were dissected from 18 wk female normotensive WKY (n=9) vs. hypertensive SHRSP (n=6) rats and studied isolated and pressurized in the absence or presence of the TRPV4 antagonist GSK2193874 (3 μM) intraluminally (n=6-7). PAs were perfused with 3000 MW fluorescent dextran with luminal flow (5 μl/min) and permeability assessed as the amount of dextran passing through the vessel wall at 60 mm Hg relative to a standard curve, measured using fluorescent spectroscopy. Myogenic tone was assessed by measuring changes in lumen diameter vs. pressure. The slope of the diameter vs. pressure curves was used as a measure of myogenic reactivity.

Results:
BBB permeability was similar between WKY vs. SHRSP (2.78 ± 0.63 vs. 2.49 ± 1.31 x10
-6
μM/mm
2
/min; p>0.05) that was unaffected by GSK219. Myogenic tone was increased in PAs from SHRSP vs. WKY (47 ± 2% vs. 36 ± 4% at 40 mm Hg; p<0.05) that was unaffected by GSK2193874 (42 ± 5% vs. 34 ± 2%; p>0.05). However, the slope of the diameter vs. pressure curves was positive and ~ 3-fold greater in SHRSP vs. WKY (m = +0.077 ± 0.064 for WKY and +0.208 ± 0.028; p=0.08), suggesting impaired autoregulation. Inhibition of TRPV4 channels improved myogenic reactivity in both WKY and SHRSP, making both slopes negative (m= -0.174 ± 0.071 for WKY;p<0.05 and -0.142 ± 0.047;p<0.01).

Conclusions:
These results suggest that impaired local autoregulation of PAs occurs earlier in the sequelae of chronic hypertension than an elevation of BBB permeability. In addition, TRPV4 antagonism improved myogenic reactivity, suggesting that overactivation of TRPV4 channels and vasodilation may contribute to impaired autoregulation of PAs during hypertension.
Abstract W P42: Automated Perfusion Computer Axial Tomography Predicts Acute Stroke Deficits
Authors: Rorden Christopher , Fridriksson Julius , Thors Helga , Hillis Argye , Krebs Kaitlin , Fridriksson Johann F , Graham C B , Hubbard Isabel , Hanayik Taylor , Sen Souvik
Published: March 2022

Background:
Perfusion Computerized Axial Tomography (pCT) is a modality gaining popularity for acute stroke management decisions. We investigated the role of automated pCT in prediction of deficits measured by NIH Stroke Scale (NIHSS).

Method:
Acute stroke patients underwent pCT and NIHSS. Digital Imaging and Communications in Medicine (
DICOM
) images were assessed for maximum intensity (MI) and cerebral blood flow (CBF). MI scans (where there is little acute abnormality) were used to transform each scan into standard space. The CBF images were the continuous measure for abnormality. The regional CBF was estimated for 150 regions of interest. Statistical analyses used 4000 permutations to correct for multiple comparisons. Additionally support vector machines (SVM) were used to assess the ability of machine learning to classify the deficit severity.

Results:
PCT scans for 83 patients where analyzed (mean age ± SD=64.2 ±14.8, 63% males). Traditional analyses revealed (p < 0.01) that reduced blood flow in the large regions of the right hemisphere were associated with left motor impairment, while regional reductions in the left hemisphere were associated with motor impairment on the right side as well as language impairments. We were accurately able to predict diagnosis based purely on perfusion. Reliable detection (all p < 0.001) of aphasia (74.7% accuracy or ACC, 86.1% specificity or SP, 56.8% sensitivity or SN), left upper motor (69.3% ACC, 87.9% SP, 42% SN), right upper motor (74.6% ACC, 84.4% SP, 57.3% SN), left lower (68.9% ACC, 87.5% SP, 43.7% SN) and right lower (71.2% ACC, 87.5% SP, 51.1% SN) impairments were accomplished.

Conclusion:
We describe a reliable automated pCT method to predict neurological deficit in acute stroke patients. The methodology may be useful in patients in who neurological assessment is not possible (e.g. unconscious or intubated patients) or assessment may be at risk of observer bias (e.g. in clinical trials).
Abstract W P420: Impact of Embolization Therapy on Venous Congestion in Patients with Transverse-sigmoid Sinus Dural Arteriovenous Fistulas - A Semi-quantitative Susceptibility-weighted MRI study
Authors: Akioka Naoki , Kashiwazaki Daina , Kuwayama Naoya , Noguchi Kyo , Kuroda Satoshi
Published: March 2022

Background and Purpose:
Dural arteriovenous fistulas (DAVFs) often provoke intracerebral hemorrhage (ICH) and progressive neurological deficits due to chronic venous congestion. Trans-arterial and/or trans-venous embolization (TAE/TVE) is known useful to dramatically improve cerebral hemodynamics. However, the methodology to non-invasively visualize venous congestion due to dAVFs has not been established yet. In this study, therefore, the authors evaluated the usefulness of susceptibility-weighted imaging (SWI) to evaluate the degree of venous congestion due to transverse-sigmoid sinus DAVF before and after TAE/TVE.

Methods:
This prospective study included totally 13 patients with transverse-sigmoid sinus DAVFs who underwent TAE/TVE in our hospital. SWI images were binarized and the number of pixels with the low intensity was automatically counted on each slice. Finally, the ratio of low-intensity pixels to total pixels on each slice was defined as the low intensity ratio (LIR).

Results:
Of 13 patients, 3 presented with ICH and two developed venous infarction. Cerebral angiography showed diffuse RLVD (retrograde leptomeningeal venous drainage) in four patients and PPP (pseudo-phlebitic pattern) in five. Before embolization, the mean LIR was 10.2±5.6%, ranging from 4.6 to 24%, being significantly higher than the control value (2.7±1.2%, n=5). Angiographical signs of venous congestion were closely related to high LIR values. Endovascular embolization markedly improved the sign of venous congestion on cerebral angiography in all patients. The LIR significantly decreased from 10.2±5.6% to 7.0±3.8% after TAE/TVE (P<0.05). None of them recurred cerebrovascular events due to DAVFs during a mean follow-up period of 20 months.

Conclusions:
The findings strongly suggest that SWI can non-invasively quantify venous congestion due to DAVFs with high sensitivity and provide reliable information on the efficacy of endovascular treatments.
Abstract W P46: Specific Infarct Locations Define Troponin Elevation in Acute Ischemic Stroke
Authors: Mitsias Panayiotis , Strubakos Christos , Penstone Patricia , Dakka Ahmed , Jafari-Khouzani Kourosh , Schultz Lonni , Soltanian-Zadeh Hamid
Published: March 2022

Introduction:
Myocardial injury is often encountered in acute ischemic stroke (AIS). Specific infarct locations have been considered as involved in its pathophysiology but there has been no systematic study involving MRI volumetric analyses. We aimed to define the imaging factors related to elevated troponin levels in AIS.

Hypothesis:
Specific infarct locations would be associated with AIS-related myocardial injury.

Methods:
We analyzed prospectively collected stroke registry data of patients with AIS admitted in one calendar year and included all patients with clinical and diffusion-weighted imaging (DWI) proven diagnosis of AIS, serum troponin measured within 24 hours of onset, and DWI studies of sufficient quality to permit analyses. Serum troponin ≥ 0.04 was considered elevated. A brain atlas was co-registered to each DWI volume by affine transform with 12 parameters representing pre-specified brain regions, including temporal, parietal, frontal, occipital lobes, insula and brainstem. Lesion volumes were calculated and the percent of total lesion volume within each region was computed. The relationship between troponin status (elevated vs. normal) and presence of ischemic lesion in a brain region was assessed using χ2 test. Multivariate logistic regression models with stepwise selection were done to determine which combination of brain regions were associated with elevated troponin levels.

Results:
We included 266 patients; 138 (52%) were men, mean age was 66(±14) years. Elevated troponin level was found in 72 (27%) and normal in 194 (73%) patients. There was no age difference between the two groups. Patients with elevated troponin levels had larger infarct volumes than those with normal levels [21,446(±35,414) mm3 vs. 13,058 (±38,100) mm3, p=0.001). Patients with elevated troponin levels were more likely to have left parietal (OR=2.74, 95%CI=1.48 to 5.07, p=0.001) and right frontal (OR=2.05, 95%CI=1.06 to 3.94, p=0.032) infarct location.

Conclusions:
Myocardial injury is often encountered in AIS, especially in patients with larger infarct volumes. Left parietal and right frontal infarct locations are independent predictors of myocardial injury. Further study will help define the clinical and prognostic significance of our findings.
Abstract W P53: Hydration After IV tPA Predicts Outcome for Acute Ischemic Stroke: A Substudy of THIRST-O
Authors: Torok Ildiko , Korya Daniel , Lahrmann Jeffrey , Chaudhry Saqib , Galea Bernard , Mehta Siddhart , Panezai Spozhmy , Rodriguez Gustavo , Moussavi Mohammad , Kirmani Jawad F
Published: March 2022

Background and Objective:
Dehydration is potentially a precipitating factor in patients at risk for stroke. Patients who suffer from acute ischemic attacks are warned not to become dehydrated. Early animal models and studies on dehydration were linked to the development of hypercoagulation and thrombus formation. Previous studies have looked deeper into the enzymatic reactions occurring in the coagulation cascade and discovered the role of dehydration in catalyzing thrombus formation. Our objective was to study the effect hydration has on outcomes after IV tPA as a sub-study of our previous work on the Hydration Influence on the Risk of Stroke Outcome (THIRST-O) study.

Methods:
We reviewed the laboratory findings, clinical exam and overall hydration status of all patients who received IV tPA for the treatment of acute ischemic stroke from 2011-2013 at a university affiliated comprehensive stroke center. SPSS Software Version 22 was used to obtain descriptive statistics with frequencies, and the Spearman’s rho correlation coefficients were determined. Higher BUN/Creatinine ratio and serum osmolarity were used as markers for dehydration and were compared with the NIH Stroke Scale at admission, at 24-hours and discharge. Modified Rankin Scale at discharge (DCmRS) was recorded

Results:
Of the 1,565 ischemic stroke patients evaluated, 188 received IV tPA, and 162 met study criteria. Patients were mostly female [n=85, 52.7%), with the mean age of 73.4 (SD= 13.6). Patients with higher initial and later serum osmolarity had higher initial, 24-hour and DCNIHSS as well as higher DCmRS (r=.196, r=.207, r=.247, r=.411; p<.01). The initial BUN/Creatinine ratio correlated well with the ratio before discharge (r=.450; p=.0001). Patients with elevated BUN/Creatinine ratios were significantly more likely to have higher initial NIHSS, 24-hour NIHSS, DCNIHSS and DCmRS (r= 235, .216, .324, .431; p<.01).

Conclusion:
Dehydrated patients with acute ischemic stroke who received IV tPA had significantly worse clinical presentations and outcome. Our study suggests patients who receive IV tPA should be well hydrated for a better outcome. Our data needs to be validated in larger, prospective trials.