bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP81: Severity of Aneurysmal Subarachnoid Hemorrhage (aSAH) as a Predictor for Early Deterioration in Patients Undergoing Interhospital Transfer (IHT) in a Large Urban Health System
Authors: Ortiz Edwin , Melo Leslie , Klavansky Dana , Carvalho Poyraz Fernanda , Majidi Shahram , Shoirah Hazem , Kellner Christopher , Bederson Joshua , Dangayach Neha
Published: January 2025

Introduction:
Patients with aSAH that are critically ill often undergo interhospital transfer (IHT) for multiple reasons including emergent treatment, physician second opinion, and patient preference.
1,2
Clinical and radiographic predictors of early death and transition to comfort care may help guide IHT decisions.
3
In this retrospective study, we seek to predictors for deterioration in aSAH patients undergoing IHT. We hypothesized that higher grade aSAH patients would be at a higher risk of early deterioration in the peri-interhospital transfer phase. Additionally, aSAH with early deterioration would be more likely to transition code status after IHT.

Methods:
In this retrospective cohort study, we include a sample of 102 consecutive aSAH patients undergoing IHT from 2019 to 2023 within a large urban health system for multidisciplinary management. These patients were admitted to a neuroscience intensive care unit (NSICU) at the only comprehensive stroke center within our health system. Narratives on patient transfers are screened to categorize patients as “Early Deterioration SAH” based on the criteria defined as: pre-IHT deterioration in mental status requiring intubation, suspected raised intracranial pressure (ICP) requiring interventions and seizures.

Results:
Of 102 patients with suspected aSAH undergoing IHT, 56% experienced pre-IHT early deterioration (n = 58). We found that women with suspected aSAH were more than three times likely to experience early deterioration when compared to men (OR 3.15, [95% CI, 1.38-7.20], p < 0.05). Hispanic patients, when compared to whites, with suspected aSAH were more likely to experience early deterioration (OR 1.28, [95% CI, 0.39-4.24], p < 0.05). Patients with increased SAH severity (HH >2) were more than 25 times more likely to experience early deterioration compared to those that did not deteriorate (OR 25.37, [95% CI, 8.82-73), p < 0.001). Transition of code status to DNR/DNI in patients with aSAH that experienced early deterioration was not disproportionately different compared to those that did not deteriorate (14% vs 7%, respectively, Z-score = 2.52, p-value = 1.98).

Conclusion:
In conclusion, for aSAH patients undergoing IHT, severity of aSAH, female sex, and Hispanic ethnicity were associated with a higher risk of early clinical deterioration. Patients experiencing deterioration do not disproportionately convert to DNR/DNI, when compared to patients that did not deteriorate.
Abstract TP82: Streamlining Stroke Transfers: Implementing RACE Score for Efficient Door in Door out in Primary to Comprehensive Stroke Centers
Authors: Leibowitz Amanda , Hollender Kimberly , Franke Emerson , Barden Michael , Kakadia Bhavika
Published: January 2025

The Rapid Arterial Occlusion Evaluation (RACE) score is a new and valuable tool that prehospital providers have to utilize for assessing patients for large cerebral arterial occlusions (LVOs). The RACE scale evaluates five clinical features: facial palsy, arm/leg paralysis, head/gaze deviation, and aphasia/agnosia. A score of 5 or higher suggests a potential LVO, with studies showing 85% sensitivity and 68% specificity[1] [1]. In May 2024, Community Medical Center, a primary stroke center in New Jersey, introduced a protocol to place critical care transport vehicles and/or a helicopter on standby when p[2] hysicians and paramedics identified a patient with stroke symptoms, an NIHSS >6 and a RACE score of >5. This initiative aimed to reduce door-in and door-out (DIDO) times for transfer to a comprehensive stroke center [2]. Pre-activation benefits have been noted in myocardial infarction cases, indicating potential advantages for stroke care [3].

A retrospective chart review was conducted using the EPIC electronic medical record for patients arriving to the ED and identified by the physician to meet the above criteria. We analyzed RACE scores and DIDO times for stroke patients transferred between January 1, 2023, and April 30, 2024, before the RACE implementation, and compared these to DIDO times from May 1, 2024, to July 31, 2024, after implementation.

Before the protocol, the mean DIDO for transferred stroke patients was 136.6 minutes. After the protocol's introduction, the mean DIDO for patients with a RACE score of 5 or greater decreased to 102.8 minutes, with a p-value of 0.0042.

While the project is still in its preliminary stages, the initial data suggests that early activation of transport resources for patients suspected of having an LVO is beneficial in decreasing time to transfer. Utilization of the RACE score by providers to decrease DIDO times can be advantageous, particularly in areas with significant distance to a comprehensive stroke center. Moving forward, we plan to collect more data on DIDO times to further evaluate and refine this protocol.
Abstract TP83: Statewide Collaborative Stroke Education to Enhance Stroke Care: Insight from Statewide Traveling Stroke Symposium
Authors: Shoemaker Camella , OWENS JACQUELYN , Morrison Amanda , Kamal Shaila , Gazi Melissa , Gray Jamie , Floyd Alice , Ross Tabatha , Minor Michael , Crawford William , Lyerly Michael , Bakradze Ekaterina , Gropen Toby
Published: January 2025

Introduction:
Alabama has among the highest stroke prevalence and mortality in the US. Strokes due to large vessel occlusion (LVO) have the largest morbidity among ischemic strokes. Stroke STAT is an observational trial designed to evaluate the sequential implementation of severity-based stroke triage (SBST) across Alabama’s six Emergency Medical Services (EMS) regions. The primary aim of Stroke STAT is to improve access of patients with LVO to reperfusion therapies.

Methods:
A statewide collaborative education program was an integral part of Stroke STAT. The educational program was a collaboration between an academic medical center, the state department of public health, and a multi-disciplinary association of health care professionals involved in the care of stroke patients. Key elements of the educational program included symposium hosted by each of Alabama’s six EMS regions; development of a standardized continuing medical education curriculum for Stroke Coordinators (SCs) including Stroke Certified Registered Nurse (SCRN) certification, physicians, and EMS providers; and timing of symposia in each region to spur development of region-specific plans for implementation of SBST. Participants completed structured evaluations before and after each symposium. The evaluations comprised eight questions assessing the participants self-perceived knowledge competency, using a Likert Scale from “not at all” to “very much so.”

Results:
A total of 137 Registered Nurses (RNs) attended the symposiums across the state, with 131 completing the post-course evaluations, achieving a 95.6% response rate. Out of all attendees 81% affirmed that “the information in this activity will help me do my job.” Additionally, 63 physicians and advanced practice providers (APPs), along with 154 EMS personnel, attended the symposiums. A total of 30 physicians and APPs completed a course evaluation achieving a 47.6% response rate. Of the providers 86.7% stated, “I will apply what I learned in this activity.” Prior to the symposium 55% of RNs reported minimal topic familiarity, post-symposium 98% of RNs and 87% of physicians and APPs reported significant improvement in knowledge.

Conclusions:
A traveling statewide collaborative education program was able to reach many stroke providers across Alabama. This educational model successfully engaged SCs and EMS personnel but was less effective in engaging physicians and APPs. We plan to explore reasons for differences in provider engagement.
Abstract TP84: Mapping the Access to Acute Stroke Care in Oklahoma - Preliminary Results of the MAPSTROKE Project
Authors: Bonin Pinto Camila , Carbonera Leonardo , De Souza Ana , Liu Briana , lee sophia , Oliveira Santos Ana Luyza , Dorneles Leonardo , DORN MARCIO , Boiani Mateus , SALEH VELEZ Hyatt , Vizcaya Daniel , Yabluchanskiy Andriy , Martins Sheila , Saleh Velez Faddi
Published: January 2025

Access to acute stroke care varies widely worldwide, with significant gaps in low- and middle-income countries and in rural areas. Ensuring equitable access requires a standardized approach to identify current coverage and potential sites for new stroke centers. In the U.S., stroke center distribution is inconsistent across states, with around 77% of rural counties deemed "medical deserts" due to a lack of healthcare services.

Methods:
We conducted a comprehensive survey of hospitals in Oklahoma to assess accessibility to acute stroke therapies. We gathered data on the availability of critical resources like thrombolysis, computerized tomography (CT), and neurology services at over 200 facilities. We performed quantitative spatial analysis using a geographic mapping tool to analyze travel distances from each area to the nearest three hospitals capable of providing acute reperfusion therapies to identify regions with limited access.

Results:
We showed that while most hospitals offer emergency services (82%), the availability of specialized stroke care varies markedly (Fig1). For instance, CT/radiology support is available 24/7 in over 80% of hospitals, which is crucial during stroke alerts. However, there is a gap in the availability of advanced stroke interventions, specifically, only 4% of hospitals offer mechanical thrombectomy (MT). Additionally, the availability of Neuro ICU and in-person Neurology support 24/7 is very limited, further emphasizing the disparity in advanced stroke care statewide. Although thrombolysis is available in 77% of the hospitals, their distribution is uneven, with rural and less densely populated areas, particularly in the southeastern region, facing significant challenges in accessing timely stroke care. In these regions, patients face lengthy travel times over one hour to reach hospitals capable of providing basic stroke care, significantly delaying their access to treatments (Fig2).

Discussion
Limited thrombolysis availability and long travel times to access acute stroke care were found in some regions, placing underserved areas at higher risk of poor outcomes due to these delays. We highlight the need for improved access to stroke treatments, particularly MT, to better serve stroke patients across Oklahoma. Initiatives that apply computational strategies analyzing actual stroke coverage, like the MAPSTROKE project, can guide better placement of future stroke units and standardize stroke center locations to address this issue
Abstract TP85: Large-Scale Systematic Review and Meta-Analysis of Data From Acute Stroke Blood Biomarker Investigations Identifies Need for More Translational Research Methods.
Authors: Smothers Christine , Gandhi Shivam , Chang Julia , Tahir Sadia , Kelley Jarrett , Wang Emily , Fareed Kareem , Mack Hannah , Dong Cindy , Witort Madaline , Armentrout Bethany , Crawford Darynaisha , Martha Sarah , Oconnell Grant
Published: January 2025

Background and Purpose:
Due to limitations associated with the symptom-based tools currently used for triage, up to 35% of strokes are missed at initial clinician contact in emergency medicine settings. As a result, there has been a decades-long push to identify blood biomarkers with utility for stroke recognition. Despite numerous studies reporting candidates with seemingly high levels of diagnostic performance, none have made their way into clinical use. It is possible this discrepancy is linked to translational limitations in how these prior biomarker discovery investigations have been designed and implemented. Thus, we performed a nontraditional systematic review and meta-analysis spanning 30 years of published acute stroke blood biomarker data in which we sought to explicitly quantify the effects of study design and reporting considerations on diagnostic performance estimates, and correct said estimates for such effects in order to provide better projections of how the candidate biomarkers that have been studied to date would perform in a true clinical use scenario.

Methods and Results:
A electronic database search was performed to identify previously reported human acute stroke blood biomarker investigations, which yielded 14,253 potential articles. 189 were included in our final analysis based on subsequent abstract and full-text screening. From each article, detailed methodological information for all reported diagnostic comparisons was manually extracted. Collectively, data from 705 different diagnostic comparisons involving 355 unique single analytes or multi-analyte panels were captured. The raw diagnostic performance estimates reported in the literature inferred that as high as 40% of previously investigated candidate biomarkers could be clinically useful for stroke recognition. However, multiple regression revealed that 47.2% of the variance in these diagnostic performance estimates could be attributed to a small number of confounding study design and reporting factors related to population sampling, timing of blood collection, blinding, and conflicts of interest. After using the model residuals to correct for these factors, not a single candidate biomarker displayed adequate evidence to suggest true clinical utility.

Conclusions:
Our results clarify the current state of the search for an acute stroke blood biomarker, and identify several translational limitations that need to addressed in future investigations if one is to be realized.
Abstract TP87: Validation of Prognostic Scales for Functional Outcome in Ischemic Stroke Patients Treated with Intravenous Thrombolysis in a Rural Setting: a preliminary data analysis
Authors: Henson Jessie , Wesler Julie , Loggini Andrea , Saleh Velez Faddi , Hornik Jonatan , Hornik Alejandro , Schwertman Amber
Published: January 2025

Background:
Early prediction of functional outcome after rtPA helps clinicians in prognostic conversations with stroke patients and their families. Three prognostic tools have been developed in this regard: DRAGON, MRI-DRAGON, and S-TPI scales. These tools, all performing with a comparable accuracy, have been internally and externally validated in tertiary care centers. However, their performance in rural areas remains uncertain. This study addresses this gap in the literature by evaluating the effectiveness of those prognostic tools in stroke patients treated in a rural area of the Midwest.

Methods:
We conducted a retrospective study of stroke patients treated with thrombolytics at Southern Illinois Healthcare Stroke Network from July 2017 to June 2024. Data on demographics, clinical presentations, laboratory values, neuroimaging, and stroke metrics were collected. modified Rankin Scale (mRS) at one month, classified into good (mRS ≤2) and poor (mRS ≥5) outcomes was noted. DRAGON and MRI-DRAGON scores were calculated. S-TPI model was built. Area under the receiver operating characteristic curve (AUC) with its 95% confidence interval was calculated for each prognostic model.

Results:
A total of 279 patients were included in this study. Of those, 43% (n=119) were male. Median age (IQR) was 69 (57-80) years. NIHSS at presentation (IQR) was 7 (4-13). 12% of the cohort (n=34) had posterior circulation stroke. At one month, 66% of patients (n=185) had mRS≤2, whereas 14% of patients (n=39) mRS≥5. MRI-DRAGON showed the highest accuracy in predicting both good (AUC=0.86, 95%CI:0.81-0.90) and poor outcomes (AUC=0.84, 95%CI:0.76-0.91). DRAGON also demonstrated high accuracy for good (AUC=0.85, 95%CI:0.80 -0.89) and poor (AUC=0.82, 95%CI:0.75-0.90) outcomes. Conversely, in our population, the S-TPI model had the lowest accuracy for good (AUC=0.56, 95%CI:0.49-0.63) and poor (AUC=0.68, 95%CI:0.61-0.76) outcomes.

Conclusions:
Among the available grading scores, MRI-DRAGON score can be considered the more accurate short-term prognostic tool for stroke patients treated with rtPA in the rural setting. As the care of acute stroke patients change, prognostic tools should be updated, and newer ones developed to aid clinicians in guiding prognostic conversations with patients and their families.
Abstract TP88: Validity and Reliability of the SWIFT Quantitative Instrument For Capture of Stroke Transfer Performance Metrics
Authors: Patterson Jennifer , Brewer Barbara , Stanfill Ansley , Alexandrov Andrei , Alexandrov Anne
Published: January 2025

Background:
Patients experiencing a hyperacute stroke and requiring transfer to higher level hospitals commonly incur transfer delays for which causative factors have not previously been quantified. We developed the valid and reliable SWIFT instrument to capture contributors to transfer delays.

Methods:
An exhaustive literature review was completed, and qualitative focus group interviews were conducted with clinicians experienced in managing transfers for acute stroke patients. Key contributors were identified (previously published) and used to develop quantitative measures covering the transfer process as well as Likert scale items examining perceptions of the quality of the transfer experience. Following analysis by Bartlett’s Test of Sphericity, construct validity was assessed using exploratory factor analysis; internal consistency and reliability were estimated using Cronbach’s alpha.

Results:
Data were collected on patient transfers from PSCs to CSCs occurring across the USA. Internal structure was analyzed on 78 cases that met all inclusion criteria. Bartlett’s test of Sphericity was significant (x
2
= 728.469,
df
= 276, p < 0.001), indicating presence of relationships among variables analyzed, supporting factor analysis. Three factors emerged accounting for 47% of the total variance:
System Responsiveness
;
Transfer Competence&Confidence
;
Transfer Facilitators&Constraints
. The overall instrument Cronbach’s alpha was .703, indicating acceptable internal consistency.

Conclusions:
The SWIFT instrument demonstrates acceptable psychometric quality for use as a standard measure to quantify stroke transfer performance metrics. Measurement of transfer performance metrics using SWIFT on a large national sample will significantly improve knowledge of factors that slow door-in-door-out times, enabling interventions targeting improvement.
Abstract TP91: Comparison of telemedicine-administered thrombolytic therapy for acute ischemic stroke by neurology subspecialty: preliminary data analysis
Authors: Wesler Julie , Henson Jessie , Hornik Jonatan , Nelson Madison , Schwertman Amber , Demir John , Hornik Alejandro , Loggini Andrea
Published: January 2025

Objective:
To determine if any difference exists in safety and outcomes of patients treated with thrombolytic therapy via telemedicine, based on the subspeciality of the treating neurologist.

Methods:
We performed a retrospective cross-sectional study using data from our local stroke registry of patients evaluated via telemedicine and treated with thrombolytic therapy at our rural stroke network over five years. The cohort was divided into two groups based on the subspecialty of the treating neurologist: vascular neurology (VN) and neurocritical care (NCC). Demographics, clinical characteristics, stroke metrics, thrombolytic complications, and final diagnosis were reviewed. In-hospital mortality and mRS at 30 days were noted. Primary outcome was symptomatic intracerebral hemorrhage (sICH); secondary outcome was mRS 0-1 at 30 days.

Results:
Among 142 patients who received thrombolytic therapy via telemedicine, 44 (31%) were evaluated by a VN specialist, whereas 98 (69%) by an NCC specialist. There was no difference in baseline clinical characteristics between the VN and NCC groups. The stroke metrics, including door-to-needle time within 60 minutes (55% vs. 62%), and final diagnosis of ischemic stroke (64% vs. 60%), were similar between the two groups (p>0.5 for all). Compared to NCC group, VN group had a higher trend of sICH (7% vs. 1%, p=0.05). However, in a logistic regression analysis, after correcting for NIHSS, SBP, door-to-needle time, and baseline use of antiplatelet therapy, the type of neurology subspecialty was not independently associated with development of sICH (OR 0.141, SE 0.188, p=0.141). The rate of in-hospital mortality was also similar between VN and NCC (7% vs. 5%, p=0.8). In a model that accounted for stroke severity, no association was established between the type of neurology subspecialty and mRS at 30 days (OR 1.589, SE 0.662, p=0.266)

Conclusions:
In our population, safety and outcome of thrombolytic therapy via telemedicine were not influenced by the subspecialty of treating neurologist. Our study supports the continued use and expansion of telemedicine in acute stroke care, leveraging the expertise of both vascular neurologists and neurocritical care specialists to improve accessibility and outcomes for patients in rural and underserved areas.
Abstract TP93: Naming Decline after Left Hemisphere Stroke
Authors: Neal Voss , Zhang Wen , Faria Andreia , Hillis Argye , Stockbridge Melissa
Published: January 2025

Introduction:
Cognitive and language trajectory has been extensively studied following ischemic stroke, with large epidemiological studies showing
on average
a decline in naming and cognition acutely followed by continued decline over time. We tested the hypothesis that average decline reflects a marked decline in patients who show progressive brain atrophy (even in the uninfarcted hemisphere), but improvement in other patients without progressive atrophy. We quantified atrophy in the right (non-infarcted) hemisphere in each individual over time, and examined its relationship to naming change over time.

Methods:
Participants (n=71) in a longitudinal study of language and MRI over the first year after left hemisphere ischemic stroke were included if they completed an MRI and the Boston Naming Test (BNT) acutely and chronically (either 6m or 12m post-stroke). Stroke volumes were extracted from acute imaging, and atrophy was measured by comparing baseline scans to chronic scans for each individual. Pearson correlations between atrophy and change in BNT score were identified for each hemisphere.

Results:
Left hemisphere stroke volume correlated with increased left hemisphere atrophy (likely reflecting Wallerian degeneration) (r=0.50, p=0.0001), but not with right hemisphere atrophy (Figure 1). Naming improved
more
with less right hemisphere atrophy, but the correlation was statistically significant only when 3 outliers were removed (r= 0.56; p=0.0057; Figure 2). Conversely, naming tended to improve
less
with less left hemisphere atrophy (NS; Figure 3), likely reflecting smaller strokes, with less room for improvement.

Conclusions:
As right hemisphere atrophy is not significantly influenced by left hemisphere stroke volume, progressive decline in naming over the first year after stroke in a subset of patients with progressive right hemisphere atrophy likely points to a separate degenerative process. The subset of patients who show minimal right hemisphere atrophy show improvement, rather than continued decline, in naming over the first year after stroke.
Abstract TP95: Concurrent Recovery of Language and Motor Function during Inpatient Stroke Rehabilitation
Authors: Johnson Lorelei , Bushnell Cheryl , Kittel Carol , Quintero Stacey , Hirsch Mark
Published: January 2025

Background:
Stroke impairments are variable and multidimensional, encompassing language, motor, sensory, and cognition. Mechanisms underlying recovery across motor and language domains may be additive or competitive, but studies are lacking. We aimed to examine differences in change of language function in two patient groups: those who did and those who did not meet the minimal clinically important difference (MCID) in motor function after inpatient rehabilitation. We also evaluated differences in discharge disposition.

Methods:
This retrospective cross-sectional study used data from the eRehabData repository. Patients who discharged from 4 Charlotte, NC area rehab hospitals between 2016 and 2019, received therapy for stroke, and had an admission Functional Independence Measure (FIM) score of 5 or lower on at least 1 of 2 language-related FIM items [comprehension or expression; N=2774; 46.6% female, mean age 67(SD=14)] were included. Items on the FIM are scored on a 7-point scale (1=total assist, 7=complete independence). The primary outcome measure was the change in language FIM subscore. Patients were grouped by whether they met the MCID for the motor FIM subtotal (which combines the scores of 13 motor FIM items), defined as a 17-point change. The secondary outcome was discharge disposition with 67% discharged home (N=1863). We used a generalized linear model to examine the relationship between magnitude of language score change and motor FIM status (i.e., meeting the MCID or not), and we used logistic regression to examine factors predictive of discharge home. All models were adjusted for motor FIM status, length of stay, therapy hours, race, age, and sex.

Results:
Approximately 60% of patients (N=1654) either met or exceeded the motor MCID. Patients who did not meet the motor FIM MCID were less likely to show larger change scores in expression (OR=0.603, 95% CI=0.551-0.658, p<.001) and comprehension (OR=0.657, 95% CI=0.601-0.719, p<.001). Patients who met the motor FIM MCID were more likely to discharge home (OR=6.605, 95% CI=5.495-7.940, p<.001).

Conclusion:
Patients who met the motor FIM MCID were more likely to have larger comprehension and expression change scores and discharge home, even after accounting for other demographic and clinical factors. If underlying mechanisms are indeed additive, there is much potential to build upon this natural synergy to further improve rehabilitation outcomes for stroke survivors.
Abstract TP97: Contactless and Cameraless Monitoring of Bed Transition Times in Stroke Survivors: A Novel Sensor-Based Approach
Authors: Adhikari Aakriti , Sur Sanjib , Sen Souvik
Published: January 2025

Objectives:
Bed transition times,
i.e.
, the duration to enter and exit a bed, are key indicators of functional recovery in stroke survivors. These transitions provide insights into rehabilitation progress and may trigger intervention needs. Traditional methods rely on video recordings or manual observations, which can be intrusive or impractical for long-term home monitoring. This study evaluates the accuracy of a novel contactless and cameraless sensor in estimating bed transition times for stroke survivors.

Methods:
We developed a contactless sensor system with a processing unit to estimate bed entry and exit times. The system uses low-power radio-frequency signals (similar frequency used in 5G smartphones) to capture reflections from a subject's body. It generates a bird's-eye-view of the environment from the reflected signals to identify the bed's geometry within the monitoring area. A time-domain signal cross-correlation module then isolates significant movement changes of the subject from a location to the bed and vice-versa, allowing estimation of bed entry and exit times. We compared the sensor's measurements with standard camera-based methods (Figures).

Results:
Ten stroke survivors (mean age 62.4 years, standard deviation or SD = 11.8) with bed entry durations of 4.2 to 22.0 seconds and exit durations of 2.1 to 88.0 s, along with ten control subjects (mean age 31.6 years, SD = 17.7) with entry durations of 2.1 to 6.0 s and exit durations of 2.0 to 5.2 s, were evaluated. For stroke survivors, the contactless sensor showed a high correlation (R = 0.99) with camera-based measurements for both entry and exit durations, with mean errors of 0.93 ± 0.79 s for entry and 1.86 ± 1.61 s for exit. For control subjects, the correlation was moderate for entry (R = 0.82) and low for exit (R = 0.57), yet the sensor maintained low error margins, with mean errors of 0.65 ± 0.39 s for entry and 0.79 ± 0.55 s for exit. These results suggest the sensor is well-suited for accurately estimating bed transitions despite variability in durations.

Conclusions:
This contactless sensor offers a viable alternative to camera-based monitoring for tracking bed transition times in stroke survivors. Its accuracy in detecting varying entry and exit durations highlights its potential for integration into home-based stroke rehabilitation. This sensor could improve stroke recovery management by providing continuous, real-time patient mobility data, enabling proactive interventions.
Abstract WMP108: Pericarotid Fat Associated with Major Adverse Cardiovascular Events after Carotid Endarterectomy
Authors: Kalina Samuel , Nogami Kai , Mahmoudi Elham , Mahmoudi Hamidabad Negin , Benson John , Saba Luca , Lanzino Giuseppe , Nardi Valentina , Lerman Amir
Published: January 2025

Background:
Previous studies have linked pericoronary artery adipose tissue attenuation to major adverse cardiac event (MACE). However, the association between pericarotid artery fat and prognosis remains underexplored. This study aimed to investigate the association between preoperative pericarotid fat characteristics and the subsequent prognosis in patients undergoing carotid endarterectomy (CEA).

Methods:
This study included patients with preoperative computed tomography angiography (CTA) followed by CEA. Preoperative neck CTA images were obtained and analyzed with novel methods using 3D Slicer software. We segmented the common and internal carotid arteries. The segment was horizontally trimmed, isolating the region around the bifurcation, extending 15 mm above and 10 mm below. Pericarotid fat was defined as adipose tissue within a 5 mm radial distance from the outer vessel wall, with Hounsfield units (HU) between -190 and -30
(Figure 1, carotid segmentation [green] and pericarotid fat [yellow])
. For each patient, we calculated the HU average and the volume (mm3) of the pericarotid fat. MACE was defined as a composite of all-cause mortality, myocardial infarction, and cerebrovascular events. The relationship between both pericarotid fat characteristics and MACE was investigated.

Results:
Of the 43 patients initially included, one was excluded due to an inability to perform segmentation caused by chronic total occlusion, leaving 42 patients (age 73 [67-78] years, 33 [76.7%] male). The comparison of mean pericarotid fat HU between the ipsilateral and contralateral sides showed no significant difference (-60.3±11.0 HU vs. -60.9 ±11.3 HU, p=0.437). However, the median ipsilateral fat volume was significantly higher than the contralateral volume (528 [248, 1100] mm3 vs. 328 [184, 697] mm3, p=0.020). When comparing patients with and without MACE, those with MACE had a significantly lower ipsilateral fat density (-59.4±10.2 HU vs. -66.8 ±11.1 HU, p=0.022) and a higher fat volume (468 [233, 746] mm3 vs. 845 [458, 1451] mm3, p=0.044). Kaplan-Meier analysis revealed that higher volume and lower fat density than the median were significant predictors of MACE (log-rank p=0.015 and p=0.042, respectively)
(Figure 2).

Conclusions:
Assessment of pericarotid fat using a novel CTA analytic method in patients undergoing CEA identified ipsilateral lower fat density and higher fat volume as predictors of adverse outcomes.
Abstract WMP109: Distinct Variations in Metabolites, Neurotransmitters, and pH Between Two Stroke Models Suggested by Chemical Exchange Saturation Transfer (CEST) MRI
Authors: Wang Kexin , Ju Licheng , Qiao Guanda , Liang Yajie , Wu Yihan , Chu Chengyan , Rogers Joshua , Li Yuguo , Cao Suyi , Dawson Valina , Dawson Ted , Walczak Piotr , Xu Jiadi
Published: January 2025

Introduction:
During acute ischemic stroke, energy depletion leads to a rise in creatine (Cr) as a buffer, increased extracellular glutamate from impaired neurotransmitter transport, and a pH drop due to lactic acid buildup. Understanding these changes is crucial for timely intervention, yet no current method captures all these alterations simultaneously. CEST, a novel MRI technique, non-invasively maps metabolites with high sensitivity, providing information on both concentration and pH. Our group recently demonstrated guanidino CEST (GuanCEST) at 3T, reflecting Cr levels, while amine CEST (amineCEST) at 9.4T likely indicates glutamate, and amide CEST (amideCEST) correlates with pH. We aim to use these techniques to investigate metabolic, neurotransmitter, and pH changes in two mouse models of middle cerebral artery occlusion (MCAO).

Methods:
Ten male C57BL/6 mice (aged 3–6 months) were used for two stroke models: permanent MCAO (pMCAO, n=4) and transient MCAO (tMCAO, n=4). MRI scans were conducted at 9.4T and 3T. Diffusion-weighted imaging identified stroke lesions, followed by T
1
and T
2
mapping on the selected slice. CEST scans were performed with a 2s saturation time across B
1
values ranging from 0.4 to 3.0 μT. We utilized Polynomial and Lorentzian Line-shape Fitting (PLOF) to simultaneously extract GuanCEST, amineCEST, and amideCEST from the CEST spectrum at each pixel, generating corresponding CEST maps. The average CEST values in the lesion and contralateral hemisphere were analyzed.

Results:
At a B
1
of 0.4 μT, GuanCEST (Fig. 1, red line) increased by 1.01±0.19% in pMCAO compared to the contralateral hemisphere but decreased by 0.32±0.27% in tMCAO, indicating a greater Cr rise in pMCAO. At higher B
1
, Cr effects diminished while pH effects increased. When B
1
exceeded 0.8 μT, amineCEST increased by 3.86±0.42% in tMCAO, nearly four times the rise in pMCAO (1.09±0.26%), possibly reflecting neurotransmitter changes due to cell membrane polarization and energy depletion. At 1.6 μT, amideCEST decreased by 0.53±0.05% in pMCAO but remained stable in tMCAO (0.49±0.48%), suggesting greater tissue acidification in pMCAO. Similar trends were observed at 3T, except amineCEST was undetectable.

Conclusion:
CEST MRI is a non-invasive technique capable of mapping metabolite, neurotransmitter, and pH changes in the stroke-affected brain, with strong potential for clinical translation.
Abstract WMP11: Temporal Pulse Pressure Trajectory Associated with Poor Prognosis in Acute Ischemic Stroke with Large Vessel Occlusion After Endovascular Thrombectomy
Authors: huo kang , Han Jiaxin , Su Hua , Qu Qiumin , Han Jianfeng
Published: January 2025

Background:
Endovascular thrombectomy (EVT) has improved both short-term and long-term outcomes for acute ischemic stroke (AIS) patients caused by large vessel occlusion (LVO). However, the relationships between blood pressure (BP) after EVT and outcomes had not been determined. As BP is dynamically changes, the present study investigated the effects of BP trajectories after EVT on the outcomes in AIS patients with LVO using Group-Based Trajectory Modeling (GBTM).

Methods:
This was a retrospective, single-center observational study. The AIS patients with LVO in the anterior circulation within 24 hours of symptom onset, baseline modified Rankin Scale (mRS) score ≤2, and Alberta Stroke Program Early CT Score (ASPECTS) score ≥6 were included. BP was monitored frequently post-EVT, and PP was calculated as the difference between systolic and diastolic BP. GBTM identified distinct PP trajectories over 0-6 hours and 0-48 hours post-EVT. Short-term outcomes included hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (SICH), while long-term outcomes included National Institutes of Health Stroke Scale (NIHSS) at 7 days and mRS score at 3 months.

Results:
Out of 506 screened patients, 313 were included in the final analysis. GBTM identified three distinct PP trajectories within the first 6 and 48 hours post-EVT. The 0–6 hour PP trajectory was significantly correlated with HT (OR=1.81, 95% CI 1.28-2.54), which remained significant after adjustment (OR = 1.72, 95% CI 1.17-2.53). An elevated PP trajectory was associated with a 3.04-fold higher risk of HT compared to the normal trajectory. Mediation analysis indicated the 7-day NIHSS score mediated 88.92% of the association between severe elevated PP trajectory and mRS.

Conclusion:
Severely elevated PP trajectory post-EVT is independently associated with poor short-term outcomes in AIS patients with LVO. Effective management of PP in the acute phase post-EVT may be crucial for improving prognosis of AIS patients with LVO.
Abstract WMP117: SARS-CoV-2 infection worsens neuroinflammation and brain senescence in an endothelial nitric oxide synthase deficient model of vascular dementia.
Authors: Ismael Saifudeen , Umar Meenakshi , Ouvrier Blake , Bix Gregory
Published: January 2025

Introduction:
SARS-CoV-2 causes various neurological sequelae in COVID-19 survivors including fatigue and cognitive dysfunction. Endothelial dysfunction, a key mechanism in COVID-19 illness, is also a major risk factor for vascular dementia (VaD). Clinical evidence suggests that reduced nitric oxide (NO) bioavailability is a likely pathogenic factor of endothelial dysfunction in COVID-19 patients, and eNOS levels decline with advancing age, a risk factor for both COVID-19 morbidity and VaD . We hypothesize that endothelial nitric oxide synthase (eNOS) deficiency contributes to brain endothelial dysfunction in SARS-CoV-2 infection and that SARS-CoV-2 infection accelerates the onset of VaD in eNOS-deficient mice.

Methods:
6-month-old eNOS+/- (pre-cognitively impaired experimental VaD) and WT male mice were infected with 1X10
4
-pfu mouse-adapted (MA10) SARS-CoV-2 intranasally, and animals were evaluated acutely out to 3-days-postinfection (3dpi) for changes in body weight and clinical signs of illness. Viral copy numbers and nuclear capsid were also quantified in lung and brain. Quantitative PCR and immunofluorescence were used to analyze markers of brain inflammation and senescence.

Results:
eNOS+/- infected mice exhibited more disease-associated weight loss (~15%) than WT-infected mice (~5 %). While infected WT and eNOS+/- had comparable pulmonary viral load, neither had detectable virus in the brain. Quantitative PCR analysis of whole brain-isolated mRNA showed increases in multiple proinflammatory mediators such as CCL2 and IL-6 and senescence markers such as p53 and p21 (eNOS
+/-
>> WT). Similarly, immunofluorescent analysis showed increased Iba1 (microglia marker) fluorescent intensity in the cortex of infected mice (eNOS
+/-
>> WT).

Conclusions:
eNOS+/- deficiency, a clinically relevant model of VaD, worsens acute SARS-CoV-2-associated morbidity, neuroinflammation and markers of brain senescence despite comparable pulmonary viral load (to WT-infected animals) and absence of virus in the brain. While the potential effects of SARS-COV-2 on cognitive decline in this model will be assessed in future studies, this is the first experimental evidence demonstrating a link between eNOS and neuropathology associated with COVID-19.
Abstract WMP14: Spatial Transcriptomics Glean Homologous Mechanisms in the Pathophysiology of Human and E4FAD Mouse Cerebral Microbleeds
Authors: Srinath Abhinav , Vera Cruz Diana , Li Ying , Lightle Rhonda , Debiasse Dorothy , Bindal Akash , Pytel Peter , Girard Romuald , Awad Issam
Published: January 2025

Introduction:
Cerebral microbleeds (CMBs) are age-related manifestations of microangiopathies predisposing patients to hemorrhagic stroke (HS) and cognitive decline. Little work has currently been done to elucidate mechanisms in the pathophysiology of CMBs. Herein, we report transcriptomic signatures of CMBs, as well as important location/etiological and sex-specific differences, to glean mechanistic insights in human autopsy tissue and a murine E4FAD model.

Methods:
Fourteen human CMB lesions were identified at autopsy by a neuropathologist (n=9 lobar and n=5 deep brain lesions). In addition, 6 CMB lesions were identified from E4FAD mice (n=3 male and n=3 female) sacrificed at 8 months. For each lesion, contralateral control brain tissue was also obtained from the same brain. Serial sections were obtained for each lesional and control region. The first section was stained for non-heme iron to localize CMB and control regions. The second section was then used for paired GeoMx bulk spatial transcriptomics. Downstream differential expression analyses were completed using DeSeq2, with enriched pathway analyses using Ingenuity pathway analysis (IPA).

Results:
Spatial transcriptomics identified 781 differentially expressed genes (DEGs) in human CMB and 448 in E4FAD mouse lesions compared with controls (p<0.05, FDR corrected). Pathway enrichment identified 110 homologous pathways between human and E4FAD mouse CMBs, related to vascular permeability, senescence and neuroinflammation (p<0.05, FDR corrected). Furthermore, lobar compared to deep microbleeds showed 52 IPA pathways related to similar functions, particularly in relation to extracellular matrix deposition (p<0.05, FDR corrected). Notable differences identified etiologic-specific pathways, such as arteriolosclerosis and amyloid processing. Male compared with female mouse CMBs identified 12 common mechanisms involved in blood brain barrier dysfunction and neuroinflammation with differences related to sex-specific neurotransmitter and hormonal variances (p<0.05, FDR corrected).

Conclusions:
This is the first report to address transcriptomic changes within the CMB microenvironment, while addressing mechanistic differences by sex and lesional location. Further studies shall aim to delineate mechanisms that lead CMBs to develop into larger HS. The results also pave the way for identification of mechanistically linked circulating molecules in biomarker discovery as well as for potential therapeutic targets.
Abstract WMP19: Mitigating Adverse Brain Health Outcomes Through Longitudinal Changes in Brain Care Score: A UK Biobank Study
Authors: Kimball Tamara , Marini Sandro , Parodi Livia , Tack Reinier , Prapiadou Savvina , Senff Jasper , Tan Benjamin Yong Qiang , Rivier Cyprien , Kourkoulis Christina , Falcone Guido , Yechoor Nirupama , Rosand Jonathan , Singh Sanjula , Mayerhofer Ernst , Anderson Christopher
Published: January 2025

Background:
The Brain Care Score (BCS) is a novel tool developed to address modifiable risk factors for the incidence of age-related brain diseases such as stroke, dementia, and late-life depression (LLD)
(Fig 1)
. Previous data showed that a lower baseline BCS is associated with higher disease risks. This study examines the associations between longitudinal BCS changes on the incidence of these three outcomes.

Methods:
UK Biobank (UKB) participants with primary care data available for longitudinal assessment of a 19-point modified BCS were included. We evaluated baseline BCS and changes over time (delta BCS), applying a weighted model to standardize changes relative to the time interval between assessments. Participants were grouped by mean delta BCS into i) improvement, ii) no change, or iii) deterioration. A logistic regression model was employed to assess the impact of BCS deterioration on outcomes, adjusting for baseline BCS, age, and sex. Multivariate Cox models evaluated associations between baseline BCS, 5-point improvement in BCS over time, and outcomes, adjusting for age and sex. Secondary analyses stratified individuals by genetic risk, using polygenic risk scores for stroke and LLD, and APOE e4 status for dementia.

Results:
Among 176,693 participants (54.1% females, 45.9% males), the mean age was 56.9 years, with a median follow-up of 12 years (IQR 11-13). A total of 70.84% had improvement in BCS, 17.86% experienced deterioration and 11.2% had no significant change. Participants with BCS deterioration had an increased risk of stroke (OR 1.29; 95%CI 1.11-1.50), LLD (OR 1.60; 95%CI 1.31-1.94), and a trend for dementia (OR 1.09; 95%CI 0.93-1.27). A 5-point increase in BCS over time significantly reduced the risk of all three diseases: stroke (HR 0.73; 95%CI 0.67-0.79), dementia (HR 0.79; 95%CI 0.79-0.96) and LLD (HR 0.60; 95%CI 0.56-0.64)
(Fig 2)
, independently of baseline BCS, age and sex. Secondary analyses demonstrated that an incremental 5-point increase in the BCS significantly reduced the risk of stroke (HR 0.61, 95%CI 0.54–0.71) and LLD (HR 0.62, 95%CI 0.55–0.70), even among individuals with the highest genetic predisposition
(Fig 3)
.

Conclusions:
Higher BCS can mitigate the risk of stroke, dementia, and LLD. Improvements in BCS over the 12-year observation period significantly lowered the incidence of these outcomes even in those with high genetic predisposition, supporting the effectiveness of the BCS as a tool for brain health.
Abstract WMP23: Recognition of Modifiable Risk Factors for Dementia and Stroke Risk with Corresponding Health-related Behaviors in a U.S. Cohort: A Cluster and Network Analysis.
Authors: Senff Jasper , Tack Reinier , Yq Tan Benjamin , Prapiadou Savvina , Kimball Tamara , Ng Sharon , Duskin Jonathan , Shah Ostrowski Mark Jun , Nunley Courtney , Brouwers H , Chemali Zeina , Fricchione Gregory , Tanzi Rudolph , Pouwels Koen , Rosand Jonathan , Yechoor Nirupama , Anderson Christopher , Singh Sanjula
Published: January 2025

Background:
Dementia and stroke are major contributors to mortality and morbidity, largely due to modifiable risk factors. Despite widespread awareness, health-related behaviors that reduce these risks remain suboptimal. This study aims to (i) cluster and characterize subgroups based on their recognition of modifiable risk factors and associated health-related behaviors for dementia and stroke, and (ii) identify the corresponding facilitators and barriers.

Methods:
We conducted an online survey of the U.S. population via Prolific. Participants were assessed on their recognitions of the importance of eight modifiable risk factors for maintaining brain health (alcohol, diet, physical activity, smoking, sleep, stress, social relationships, and purpose in life) and the corresponding health behaviors based on international guidelines. Hierarchical cluster analysis was performed to identify clusters, which were then compared based on demographics. A correlation network analysis was conducted to explore relationships between recognitions, health behaviors, facilitators, barriers, and demographics.

Results:
Among 1,478 participants (mean age: 45.5y ; 51.8% female), the proportion who perceived a risk factor as important for brain health was higher than the proportion who engaged in the corresponding healthy behaviors across all eight risk factors (Fig 1). Three clusters emerged: (I) high recognition/low health-related behavior, (II) high recognition/high health-related behavior, and (III) lower recognition/low health-related behavior (Fig 2). Individuals in the high recognition/high health-related behavior cluster were significantly older, more educated, and reported fewer barriers, such as financial and time constraints, and more facilitators, including personal motivation and experiences with dementia and stroke. The network analysis revealed that financial barriers had the highest centrality and were strongly correlated with health-related behaviors (Fig 3).

Conclusion:
While most participants recognized the importance of modifiable risk factors for brain health, fewer engaged in the corresponding health-related behaviors. The three clusters exhibited varying levels of recognition and healthy behaviors, along with significant differences in demographics, barriers, and facilitators. These findings suggest that targeted interventions should focus on enhancing recognitions in some groups and supporting the translation of recognitions into healthy behaviors in others.