bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP65: Association Of Pre-mechanical Thrombectomy Collateral Scores With Functional Outcome In Short Versus Extended Window For Thrombectomy
Authors: Nisar Taha , Abu-hadid Osama , Lebioda Konrad , Tofade Toluwalase , Khandelwal Priyank
Published: February 2022

Introduction:
We aim to determine the association of pre-mechanical-thrombectomy (MT) collateral scores in the short (<6 hours from onset) versus extended (6-24 hours from onset) window for MT with a good functional outcome.

Methods:
We performed a retrospective chart review of patients who underwent MT for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 12/2020. A board-certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Miteff (ordinal), Mass (ordinal), and modified-Tan (dichotomous) to designate collateral scores on the pre-MT CT Angiogram. The patients were divided into short (<6 hours from onset) versus extended (6-24 hours from onset) groups depending on their timing of presentation to the emergency department. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, recanalization time, mean arterial pressure, blood glucose, location of the occlusion, atrial fibrillation, LDL, hemoglobin-A1C, and administration of intravenous-alteplase, with the pre-MT collateral grading scores as predictors. The primary outcome was a good functional outcome (3-month mRS≤2).

Results:
220 patients met the inclusion criteria.162 patients presented in the short window for MT. The pre-MT scales of Mass (OR, 0.35; 95%CI, 0.16-0.78; P 0.01) and modified-Tan (OR, 0.35; 95%CI, 0.16-0.78; P 0.01) were associated with a good functional outcome, unlike the Miteff scale (OR, 0.46; 95% CI, 0.18-1.18; P 0.103). 58 patients met our inclusion criteria for patients who presented in the extended window for MT. The pre-MT scales of Mass (OR, 0.75; 95% CI, 0.23-2.48; P 0.63), Miteff scale (OR, 0.78; 95%CI, 0.17-3.64; P 0.746) and modified-Tan (OR, 1.14; 95%CI, 0.1-12.98; P 0.918) were not associated with a good functional outcome.

Conclusions:
Our study demonstrates that good collateral grades on Mass and modified-Tan scales are associated with a good functional outcome for patients who present to the ED in the short window for MT. We did not find an association of any pre-MT collateral scores with a good functional outcome for patients presenting in the extended window for MT.
Abstract WMP68: Artificial Intelligence For Automated Detection Of Large Vessel Occlusion Using Relative Vessel Density (RAPID LVO): One Year Experience In A Multihospital Integrated Delivery Network
Authors: Chang Warren , Eisenmenger Laura , Cerejo Russell , Li Charles , Goldberg Michael F
Published: February 2022

Purpose:
RAPID LVO (RLVO) automatically detects anterior circulation large vessel occlusion (LVO) by quantifying MCA territory relative vessel density (RVD) compared to the contralateral side, allowing early mobilization of treatment teams. We present our one year experience in a multihospital health system for LVO detection in patients with stroke symptoms, effect on treatment time and clinical outcomes.

Materials/Methods:
The study was supervised by the local IRB. 1203 patients presenting with stroke symptoms receiving CTAs with RLVO were included. RLVO exams were positive at RVD < 60% (red or yellow color) and negative at RVD >60%. Radiology exams were positive if LVO (ICA/M1or M2 occlusion) or high grade stenosis (HGS) was found. All positive cases were reviewed by a second reader with 100% concordance. Expert reads were used as the gold standard and sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were calculated. Patients eligible for mechanical thrombectomy (MT) were transferred to a comprehensive stroke center for treatment. CTA to groin puncture time was calculated during one year time intervals before and after RLVO installation for patients undergoing MT. 90 day Modified Rankin Scores (mRS) were obtained.

Results:
126 patients had M1/ICA occlusion, 71 had M2 occlusion, and 134 had HGS of the ICA or MCA. RLVO had sensitivities of 90%, 82%, and 82%, specificities of 82%, 85%, and 95%, PPV of 37%, 52%, and 87% and NPV of 99%, 96%, and 93% in the detection of M1 occlusion, LVO, or HGS/LVO, respectively. CTA to groin puncture time was significantly lower after deployment of RLVO (93 minutes vs 68 minutes, p<0.05). Average 90 day mRS was lower with RLVO with a higher percentage of patients with functional independence (mRS ≤ 2) (p<0.05).

Conclusion:
RLVO detected HGS or LVO in patients presenting with stroke symptoms with high accuracy. After RLVO installation, time to treatment decreased and clinical outcomes were improved.
Abstract WMP76: Nogo-B Receptor Is Essential For Preserving HBO1-mediated Histone Acetylation In Brain Endothelial Cells And Preventing Cerebrovascular Hemorrhage
Authors: Fang Zhi , Hu Wenquan , Sun Xiaoran , Wang Xiang , Ma Ji , Palaia Thomas , Ragolia Louis , Miao Qing R
Published: February 2022

Cerebral cavernous malformations (CCMs) are enlarged leaking vascular lesions in the brain caused by loss-of-function mutations in CCM1/2/3 genes or loss of expression. Although we previously showed that Nogo-B receptor (NgBR) knockout in endothelial cells (ECs) results in CCMs-like cerebrovascular lesions in the mouse embryo, the molecular mechanism by which NgBR regulates CCM1/2 expression has not been elucidated. Here, we show that temporal genetic depletion of NgBR in ECs at both the postnatal and adult stages results in CCM1/2 expression deficiency and consequently CCMs-like lesions such as enlarged vessels, blood-brain barrier (BBB) hyperpermeability, and intracerebral hemorrhage. These cerebrovascular defects in the brain of NgBR endothelial-specific knockout (ecKO) mice can be rescued by adeno-associated virus (AAV)-mediated overexpression of CCM1 and CCM2 genes. To reveal the molecular mechanism, we used RNA-seq analysis to examine changes in the transcriptome. Surprisingly, we found that acetyltransferase HBO1 was downregulated in NgBR deficient ECs. The mechanistic study elucidated that NgBR is required for maintaining the expression of CCM1/2 in ECs via HBO1-mediated histone acetylation. ChIP-qPCR data further demonstrated that loss of NgBR impairs the binding of both the HBO1 and acetylated H4K5/K12 at the promoter of CCM1 and CCM2 genes. Similarly, AAV-mediated overexpression of HBO1 restores the acetylation of H4K5/K12 and rescues the CCMs-like cerebrovascular defects in the brain of NgBR ecKO mice. Our findings on epigenetic regulation of CCM1 and CCM2 provide a perspective that NgBR and HBO1-mediated histone H4 acetylation may be targeted for preventing the onset of CCMs-like cerebrovascular disease.
Abstract WMP77: Anticoagulation-Associated Intracerebral Hemorrhage Incidence Rates: A Longitudinal Population-Based Assessment
Authors: Demel Stacie L , Khoury Jane C , Alwell Kathleen , Khatri Pooja , Adeoye Opeolu , Broderick Joseph P , Ferioli Simona , Mackey Jason , Woo Daniel , Flaherty Matthew , Martini Sharyl , De Los Rios La Rosa Felipe , Madsen Tracy , Star Michael , Coleman Elisheva R , Walsh Kyle B , Slavin Sabreena , Jasne Adam , Mistry Eva , Haverbusch Mary , Kissela Brett , Kleindorfer Dawn O
Published: February 2022

Background:
Anticoagulant-associated intracerebral hemorrhage (AA-ICH) quintupled in the Greater Cincinnati/Northern Kentucky (GC/NK) region from 1988 to 1999 in association with increasing warfarin use. Direct-acting oral anticoagulants (DOACs), available in 2010, have evidence of less bleeding risk, while atrial fibrillation detection rates have increased. We sought to determine if rates of AA-ICH continued to increase in the last decade within a large, bi-racial population.

Methods:
We identified all patients, 20 years or older, hospitalized with first-ever intracerebral hemorrhage (ICH) in GC/NK region in 1993/4, 1999, 2005, 2010 and 2015. AA-ICH was defined as ICH in patients prescribed warfarin, heparin or low molecular weight heparin, or a DOAC at the time of their ICH. Incidence rates were age-, sex- and race-adjusted to the 2010 US population. Change over time was tested using regression. All-cause case fatality was adjusted for age, sex and race and trend over time evaluated using a general linear model.

Results:
There was no significant change over time in the incidence rate for total ICH or AA-ICH from 1993 through 2015 (Table). As compared to ICH patients without anticoagulant use, patients with AA-ICH were more likely to be older, white, have hypertension, diabetes mellitus, hyperlipidemia, prior ischemic stroke and atrial fibrillation, but less likely to smoke. The age-, sex- and race-adjusted 30-day case fatality for ICH overall and AA-ICH also did not change significantly from 1993/4 to 2015 (Table). Warfarin utilization increased in our ICH population from 1993/4 (7.6%) to 2005 (17.7%), then decreased through 2015 (11.8%/DOAC 6.4%); p<0.0001.

Conclusion:
Despite increased incidence rates of AA-ICH in the late 1980s to 1990s, we observed no overall change in incidence or case-fatality rate from AA-ICH over the full 20-year period despite higher rates of atrial fibrillation detection which may be explained by higher rates of DOAC (vs warfarin) use.
Abstract WMP80: Pleiotropy Analyses Of Between Intracerebral Hemorrhage And β-amyloid Related Phenotypes
Authors: Marini Sandro , Chung Jaeyoon , Han Xudong , Farrer Lindsay A , Rosand Jonathan , Romero Rafael J , Anderson Christopher D
Published: February 2022

Introduction:
Combining biologically related traits in genome-wide association studies has been demonstrated to increase the power for genetic discovery and to identify new genes associated with intracerebral hemorrhage (ICH). Given the pathological relationship between lobar ICH and cerebral amyloid angiopathy (CAA), and between the latter and levels of CSF amyloid-β 42 (CSF-Aβ
42
), we leveraged genetic predisposition for lower CSF Aβ
42
levels, as a proxy phenotype for CAA, in pleiotropy analysis for lobar ICH.

Methods:
We used publicly available GWAS data for Aβ
42
levels (n=3,146) and for lobar ICH (n=1,813) from the International Stroke Genetics Consortium. To evaluate the association between lobar ICH risk and CSF-Aβ
42
, we computed a polygenic risk score (PRS) for CSF-Aβ
42
in lobar ICH patients. We then applied multi-trait analysis of GWAS (MTAG) for pleiotropy analysis of lobar ICH and CSF-Aβ
42
. Gene-level associations based on the MTAG result were further tested using S-Predixcan.

Results:
We found a significant association between CSF-Aβ
42
PRS and ICH risk (β = -0.35; P = 0.04). MTAG analyses identified one novel near-genome-wide significant association within
CDH9
(rs1007589; minor allele frequency=0.09; MTAG β = -0.12 and P = 5.4x10
-8
; lobar ICH β = 0.34 and P = 2.4x10
-3
; CSF-Aβ
42
β = -0.03 and P = 4.5x10
-6
). According to the BRAINEAC brain tissue gene expression database, rs1007589 is significantly associated with increased expression of
CDH9
in both temporal and occipital cortices.

Discussion:
This pleiotropy analysis was designed to identify genetic determinants of lobar ICH driven by amyloid-related mechanisms. We identified a variant in one novel gene associated with both traits,
CDH9
, which causes differential expression in two brain regions characteristically affected by vascular amyloid pathology.
CDH9
encodes for one subtype of the cadherin superfamily, which regulates intercellular adhesion. Cadherins have been involved in blood-brain barrier integrity and are elevated in AD patients. Further analyses are warranted to understand the effects of the variant on the pathogenesis of ICH and its clinical significance.
Abstract WMP85: Postpartum Risk Of Cerebral Venous Thrombosis
Authors: Baig Tehniyat , Chaudhry Hamza , Murthy Santosh , Parikh Neal S , Liberman Ava , Kamel Hooman , Zhang Cenai , Merkler Alexander E
Published: February 2022

Background:
The postpartum state is associated with a heightened risk of thrombosis. The duration of heightened risk for postpartum cerebral venous thrombosis (CVT) is uncertain.

Methods:
Using claims data from the Healthcare Cost and Utilization Project (HCUP) from all emergency departments and acute care hospitalizations in Florida from 2005-2015 and New York from 2006-2015, we identified women aged ≥18 years old who were hospitalized for labor and delivery. CVT was ascertained using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), diagnosis codes. For women with multiple labor-related hospitalizations during a single 40-week period, we excluded cases of false labor by identifying delivery as the latest hospitalization during that time. Patients with claims for CVT before their first recorded delivery, and women with a second delivery during the follow-up period were also excluded. We compared the likelihood of a first-ever recorded CVT during postpartum days 0-41 compared with the same period 1 year later. We repeated this crossover-cohort analysis for consecutive 6-weeks periods after delivery, as compared with the corresponding 6-week period 1 year later. We used McNemar's to calculate odds ratios for each 6-week interval.

Results:
Among the 1,406,447 women with a first recorded delivery, the risk of CVT was markedly higher within the 6 weeks after delivery than in the same period 1 year later (22 versus 3 CVTs per million deliveries). This corresponded to an absolute risk difference of 19 events per million (95% confidence interval [CI], 11-27) and an odds ratio of 10.0 (95% CI, 3.1-51.2). There was no significant increase in the risk of CVT during the period of 7 to 12 weeks after delivery as compared with the same period 1 year later with an absolute risk difference of 6.0 events (95% CI, 0-11) per million deliveries and an odds ratio of 3.0 (95% CI, 0.9-12.8).

Conclusion:
There appears to be a heightened risk of CVT for 6 weeks after delivery.
Abstract WMP87: Effect Of Intensive Blood Pressure Treatment After Successful Reperfusion On Outcome According To End Of Procedure Blood Pressure: Insight From The Bp Target Trial
Authors: Anadani Mohammad , Maier Benjamin , Escalard Simon , Labreuche Julien , de Havenon Adam H , Sabben Candice , LAPERGUE Bertrand , Gory Benjamin , Richard Sébastien , Sibon Igor , Desilles Jean-philippe , Mazighi Mikael ,   BP TARGET
Published: February 2022

Backgroup:
The Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP TARGET) trial demonstrated no benefit of systolic blood pressure (SBP) intensive lowering treatment after successful reperfusion. However, it is still unknown whether end of procedure SBP modifies the treatment effect of SBP intensive lowering treatment after successful reperfusion.

Methods:
This is a post hoc analysis of the BP TARGET multicenter trial. Patients were enrolled in the BP TARGET trial if they achieved successful reperfusion with EVT and had systolic blood pressure (SBP) ≥130 mmHg at the end of procedure. Patients were randomized in 1:1 fashion to intensive SBP treatment (SBP target 100-129 mmHg to be achieved within 1 hour of randomization) or standard SBP treatment (SBP target 130-185 mmHg). In this study, patients were divided into two groups based on end of procedure SBP (<160 mmHg, ≥ 160 mmHg). Primary outcome was any intracerebral hemorrhage and secondary outcome was favorable outcome ( modified Rankin Scale 0-2 ) at 90 days.

Results:
A total of 290 patients were included in the present study (141 patients in the intensive treatment arm and 149 patients in the standard arm). A total of 105 patients had end of procedure SBP≥160 mmHg (53 in the intensive arm and 52 in the standard arm) and 185 patients had SBP<160mmHg (88 in the intensive arm and 97 in the standard arm). Intensive SBP treatment was not associated with any intracerebral hemorrhage or favorable outcome in both <160 mmHg and ≥160mmHg groups (Table 1). Moreover, there was no heterogeneity of treatment effect according to end of procedure SBP.

Conclusion:
End of procedure SBP did not modify the treatment effect of SBP lowering treatment after successful reperfusion.
Abstract WMP88: Endovascular Therapy For Large Vessel Occlusion Stroke With Low NIH Stroke Scale: A Population-Level Assessment
Authors: Kim Youngran , Salazar-Marioni Sergio , Abdelkhaleq Rania , Niktabe Arash , McCullough Louise , Zhang Guo-Qiang , Sheth Sunil A
Published: February 2022

Introduction:
There is increasing interest in endovascular therapy (EVT) for patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) presenting with low NIH Stroke Scale. Here, we assess the prevalence of LVO with low NIHSS and real-world trends in utilization of EVT in this population.

Methods:
We performed a cross-sectional study using the Texas Public Use Data File, which captures all inpatient admissions in the state from non-federal hospitals (10/01/2016-06/30/2020). AIS cases were defined as hospitalizations to acute care hospitals with a primary diagnosis of AIS using ICD-10-CM codes I63.x and NIHSS was determined using ICD-10-CM codes R29.700- R29.742. Low NIHSS was defined as <6 and high NIHSS as ≥ 6. LVO was determined by ICD-10-CM codes and EVT was determined by ICD-10 procedure codes. Comprehensive stroke center (CSC) designation was determined by Texas Department of Health Services published listings.

Results:
Among 61,524 AIS cases, patients with low NIHSS accounted for 63% and were more likely to be younger, male and white than those with high NIHSS. LVO was twice as prevalent among high NIHSS AIS (52% vs 24% p<0.001) but 44% of LVOs presented with low NIHSS. EVT rates were much lower in low NIHSS LVOs compared to high NIHSS LVOs (4% vs 27%, p<0.001). EVT rates in LVOs increased during the study period (0.4% per quarter, 95% CI 0.3-0.6%, p<0.001), as well in low NIHSS LVOs (0.2% per quarter, 95% CI 0.1-0.3%, p=0.001). These findings, however, were only seen in CSC-certified hospitals, for both high NIHSS LVOs (1.0% per quarter, 95% CI 0.7-1.3%, p<0.001) and low NIHSS LVOs (0.3% per quarter, 95% CI 0.06-0.4%, p=0.010) but not seen in non-CSC hospitals.

Conclusions:
In this large state-level cohort, nearly one-quarter of low NIHSS patients were found to have LVO, and increasing trends in EVT use were observed in this group. The effectiveness and safety of EVT in low NIHSS LVOs need to be further evaluated in real world clinical settings.
Abstract WP110: Infarct Topography On MRI In Patients With Acute Ischemic Stroke And Atrial Fibrillation: Subgroup Analysis From PER DIEM Trial
Authors: Alrohimi Anas , Ishaque Noman , Menon Bijoy K , Quinn F. Russell , Shuaib Ashfaq , Hill Michael D , Buck Brian H , Exner Derek V , Butcher Ken
Published: February 2022

Background:
Atrial fibrillation (AF) is a common cause of ischemic stroke; however, it is often difficult to detect. It is unclear whether specific infarct topography on magnetic resonance imaging (MRI) is associated with underlying AF. We aimed to objectively assess the infarct patterns on MRI in patients with acute ischemic stroke and determine imaging characteristics that are associated with AF.

Methods:
We conducted a subgroup analysis on patients randomized in Post-Embolic Rhythm Detection with Implantable vs External Monitoring trial (PER DIEM; NCT02428140) who had brain MRI. Two raters blinded to clinical details reviewed the MRI findings. Patients were divided to two groups (AF and non-AF) and descriptive statistics were used to characterize findings. Variables associated with new AF were analyzed using logistic regression and reported as odds ratios (OR) with 95% confidence interval (CI) and
p
-values.

Results:
Of the 300 patients who were randomized in the trial, 249 (83%) patients (59.4% male) with a mean age of 64.3 ± 13.1 years had MRI brain and were included in the analysis. Median (IQR) NIHSS was 0 (0 - 1), number of lesions was 2 (1 - 3), and diameter of lesion (mm) was 10.4 (5.8 - 21.1) mm. In this cohort of patients, imaging characteristics were not significantly associated with the detection of AF.

Conclusions:
Association between infarct topography and AF detection was not found in this study. Imaging characteristics cannot be relied upon to predict or exclude an underlying AF. Large prospective studies are suggested to examine the link between infarct topography and underlying AF.
Abstract WP112: A Clinical Score To Predict Reduced Ejection Fraction In Acute Ischemic Stroke
Authors: JANOCKO NICHOLAS J , Weinsaft Jonathan W , Kim Jiwon , Devereux Richard B , Merkler Alexander E , Navi Babak , Parikh Neal S , Kamel Hooman
Published: February 2022

Introduction:
Transthoracic echocardiography (TTE) is valuable in evaluating stroke etiology. A left ventricular (LV) thrombus, the identification of which can immediately impact clinical management, is rarely seen unless the ejection fraction (EF) is less than 50%. A clinical prediction score to identify stroke patients with EF less than 50% may help guide the timing of TTE after stroke.

Methods:
The CAESAR registry includes all patients with ischemic stroke at our medical center. We derived a clinical prediction score using CAESAR data from calendar years 2011-2016. We included all patients who underwent TTE and had a quantitative EF measurement. We selected clinical factors, laboratory values, and vital signs based on biological plausibility and the results of multiple logistical regression with backward selection.

Results:
Of 2,116 patients with ischemic stroke from 2011-2016, 1,045 patients had an EF measurement. The mean age was 63 (SD, 15), 49% were women, and the mean EF was 63% (SD, 14%). Reduced EF was identified in 171 patients (16%). Our final model comprised historical variables (coronary disease, heart failure, and chronic kidney disease) and clinical parameters from the time of admission (NIHSS score, heart rate, serum potassium, and serum creatinine). The model AUC was 0.80 (95% CI, 0.76-0.85) and model calibration was good (Figure). At a predicted probability threshold of 0.1, the score’s sensitivity for reduced EF was 80% with a specificity of 62%. In a sensitivity analysis excluding patients with atrial fibrillation, the AUC was 0.77 (95% CI 0.70-0.83) and calibration remained good.

Conclusions:
We derived a clinical score with good performance for predicting reduced EF in acute ischemic stroke patients. If externally validated, such a score may help identify which patients are most likely to benefit from an expedited inpatient TTE.
Abstract WP116: A Pilot Study Of The Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool For Patients With Stroke
Authors: Reznik Michael E , Moody Scott , Drake Jonathan , Margolis Seth , Daiello Lori , Furie Karen , Jones Richard
Published: February 2022

Background:
Delirium occurs frequently in patients with stroke but is often underrecognized. We aimed to develop a novel delirium screening tool designed specifically for stroke patients, and to test its feasibility and accuracy in a pilot study.

Methods:
We designed an easy-to-use 5-point instrument called the Fluctuating Mental Status Evaluation (FMSE) and tested it in a cohort of patients with intracerebral hemorrhage (ICH) who had daily delirium assessments throughout their admission. Expert ratings were performed by an attending neurointensivist or behavioral neurologist each afternoon using DSM-5 criteria, and were derived from bedside assessments and clinical data from the preceding 24 hours. Paired FMSE assessments were performed by patients’ clinical nurses after brief training on the use of the tool. Nursing assessments were aggregated over 24-hour periods (including day and night shifts), and accuracy of the FMSE was analyzed on both a per-assessment day and per-patient basis.

Results:
Among the 40 enrolled patients (mean age 71.1±12.2, median initial NIHSS score 16.5 [IQR 12-20]), 34 experienced delirium during their hospitalization. There were 306 total coma-free days with paired assessments, of which 208 (68%) were rated as days with delirium. Compared to expert ratings, an FMSE score ≥1 had 86% sensitivity and 74% specificity on a per-day basis, while a score ≥2 had 68% sensitivity and 83% specificity. On a per-patient basis, a score ≥1 at any point during admission had 97% sensitivity and 67% specificity in identifying patients who experienced delirium, while a score ≥2 had 94% sensitivity and 67% specificity.

Conclusion:
The FMSE is a feasible delirium screening tool in ICH patients, with high real-world sensitivity and specificity. Based on these results, we plan to validate the tool in a larger, more diverse cohort of stroke patients, using score cutoffs of ≥1 as “possible” delirium and ≥2 as “probable” delirium.
Abstract WP118: Characteristics And Short-term Outcomes Of Delirium After Acute Ischemic Stroke
Authors: Ahmad Mohammad Jamil , Anjum Sahar , Kumar Aditya , Sebaugh Jacob , Joseph Michele , Williams Bethany , Zha Alicia
Published: February 2022

Background:
Delirium after acute ischemic stroke is a common clinical occurrence, associated with longer hospital admissions, worse functional outcomes, and increased mortality. We aim in a prospective study to assess the characteristics and risk factors for delirium after acute ischemic stroke (AIS) in a US population.

Methods:
Between September 2019 and June 2021, patients diagnosed with AIS within 48 hrs of stroke onset were prospectively evaluated for delirium using the Confusion Assessment Method (CAM)-ICU daily for the first eight days of their hospital stay. Patients with severe stroke and expected mortality within the first month at the time of admission or with severe aphasia unable to follow commands were excluded. Data regarding demographics, co-morbidities, hospital stay, stroke metrics, lab work, and medications were analyzed.

Results:
Over 12 non-consecutive months (due to pandemic interruptions), we evaluated 213 patients, of which 179 could be assessed with the CAM-ICU. Delirium was present in 89 (49.7%), occurring within the first 24 hours of admission in 33.6% and for longer than one day in 32.0%. There were no statistically significant differences in age, gender, race, co-morbidities, or TOAST etiology among patients with and without delirium (Table 1). Patients with delirium had higher NIHSS and were more likely to receive tPA. Patients with delirium were more likely to be discharged to inpatient rehabilitation facilities than home (p=0.05). Only patients with delirium had unexpected mortality after admission, but this statistic failed to show significance.

Conclusion:
In a cohort of AIS patients without significant expected mortality on admission, the incidence of delirium is high. Our study confirms prior results demonstrating higher inpatient mortality, longer hospital admissions among patients with delirium, and more delirium in patients receiving tPA.
Abstract WP125: Methamphetamine Associated Psychosis In Acute Stroke
Authors: Yee Alan H , Samuel Rikki , Palchik Guillermo
Published: February 2022

Introduction:
Methamphetamine, an addictive stimulant, may lead to psychosis of which little is known about the impact in acute stroke. Despite its short half-life, we hypothesize that methamphetamine use in acute stroke is associated with the development of psychosis and extends hospital length of stay (LOS).

Methods:
Single-center retrospective analysis (2016-2019) of consecutive adult patients admitted for acute ischemic stroke, intracerebral hemorrhage (ICH), aneurysmal subarachnoid hemorrhage (SAH), and transient ischemic attack (TIA) with methamphetamine detected on urine drug screen and were compared to those who did not. Psychosis was defined as disturbed thoughts or perceptions with abnormal psychomotor behavior. Psychosis onset and duration, clinical characteristics, total hospitalization time and intensive care unit (ICU) LOS, as well as psychotic treatment interventions were documented.

Results:
138 patients were admitted for acute cerebrovascular events (87 ischemic strokes, 40ICH, 7 SAH, 2 TIAs). 69 patients tested positive for methamphetamine (68% male; mean age 53(range 26-68)) and were compared to 69 who did not (65% male, mean age 64 (range 30-93).Despite no differences in having any psychiatric illness history, 25% (17/69) of methamphetamine users experienced psychosis compared to only 3% (2/69) who did not test positive
(p
<0.0002). Although there was no statistical difference in hospital LOS (3.6 days in methamphetamine positive versus 2.9 days (
p
=.113)), substance use abusers had significantly longer ICU stays (48 hours versus 24 hours;
p
=.006). NIHSS and ICH Scores were not statistically different between those who tested positive or negative for methamphetamine.

Conclusions:
Methamphetamine use is strongly associated with developing psychosis and when present, leads to longer ICU stay.
Abstract WP128: Race Heterogeneity Potentially Drives The Association Between Hypercholesterolemia And In-hospital Mortality Among Patients With Primary Intracerebral Hemorrhage: Analysis Of 15-year Nationwide Data
Authors: Bako Abdulaziz T , Baig Eman , Johnson Carnayla , Meeks Jennifer , Potter Thomas , Pan Alan , Khan Osman , Tannous Jonika , Woo Daniel , Vahidy Farhaan S
Published: February 2022

Background:
The evidence of association between Intracerebral Hemorrhage (ICH) outcomes and hypercholesterolemia (HC) is equivocal. We provide nationwide estimates of ICH in-hospital mortality (IHM) among patients with HC, across race/ethnicity subgroups.

Methods:
In a pooled cross-sectional analysis of adult (≥ 18 years) primary ICH patients in the National Inpatient Sample (2004 - 2018), we used ICD 9 / 10 codes to identify patients with HC. We fit survey design multivariable logistic regression models to provide nationwide estimates of the association between IHM and HC as adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results:
Among a total of 803,230 ICH hospitalizations, we identified 56,635 HC ICH patients. HC patients, compared to patients with no hypercholesterolemia (NHC), were older (72.3 vs. 68.7 years), had higher proportional (%) burden of diabetes (35.8 vs. 26.4), hypertension (90.0 vs. 80.9), obesity (9.2 vs. 8.0), atrial fibrillation (22.1 vs. 19.3) and past / current use of anticoagulation (11.9 vs. 9.8). However, HC patients (vs. NHC) were less likely to have extreme loss of function (21.4 vs. 28.7) or receive invasive treatment, including extra-ventricular drain (5.2 vs. 7.6), invasive ventilation (5.7 vs. 7.9), tracheostomy (2.4 vs. 4.2) and gastric tube placement (6.0 vs. 8.5). Overall, and non-Hispanic whites (NHW), non-Hispanic black and Hispanic, HC patients (vs. NHC) had lower IHM (aOR, CI for overall effect: 0.85, 0.81 - 0.90) (Figure 1). The HC - IHM association was significantly modified by age among NHW, whereby the likelihood of IHM among HC (vs. NHC) significantly increased with advancing age (aOR, CI: 1.01, 1.00 - 1.02) (Figure 2).

Conclusion:
HC is associated with lower ICH severity and IHM, albeit with significant race/ethnic variations. Further evaluation of potential role of genetic, environmental and treatment factors, across race/ethnicity sub-groups, in the relationship between HC and ICH outcomes is warranted.
Abstract WP136: Recurrent Intracerebral Hemorrhage In Patients With Cerebral Amyloid Angiopathy
Authors: Garg Aayushi , Ortega-Gutierrez Santiago , Farooqui Mudassir , Nagaraja Nandakumar
Published: February 2022

Background:
Studies suggest an increased risk of recurrent intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA). In this study, we sought to compare the rates of recurrent cerebrovascular events in patients admitted for ICH with and without CAA.

Methods:
We utilized the National Readmissions Database 2016-2018 to identify hospitalizations with the primary discharge diagnosis of ICH with and without a concomitant diagnosis of CAA. Hospitalizations with age >55 years, survival to discharge, and known discharge disposition were included for further analysis. Propensity score matching was used to match for the differences in demographics, comorbidities, and disease severity between the CAA and no CAA groups. Survival analysis was performed to evaluate the rates of recurrent ICH, subarachnoid hemorrhage (SAH), and acute ischemic stroke (AIS) in the propensity-matched groups.

Results:
A total of 194,290 patients with ICH met the study inclusion criteria; 8,247 with CAA and 186,043 without CAA. After propensity score matching, we identified 7,857 hospitalizations with CAA and 7,874 without CAA. Patients with CAA were more likely to be readmitted due to ICH [hazards ratio (HR): 3.4, 95% confidence interval (CI): 2.6-4.6,
P
<0.001] and SAH (HR: 2.5, 95% CI: 1.2-5.4,
P
0.007) during the mean follow-up period of 6 months. However, there was no statistically significant difference in readmissions due to AIS (HR: 0.7, 95% CI: 0.5-1.0, P 0.061) [Figure 1]. Age (HR: 0.96 per year increase in age, 95% CI: 0.95-0.98, P <0.001) and Medicare payer (HR: 3.23; 95% CI: 1.92-5.41, P <0.001) were independently associated with readmissions due to ICH.

Conclusions:
Patients admitted for ICH with a secondary diagnosis of CAA are three times more likely to have readmissions for recurrent ICH compared to patients without CAA.
Abstract WP143: Stroke Severity Mediates The Association Between Neighborhood Socioeconomic Deprivation And Poor Outcomes Among Patients With Intracerebral Hemorrhage
Authors: Potter Thomas , Bako Abdulaziz , Meeks Jennifer , Tannous Jonika , Pan Alan , MCCANE Charles D , Garg Tanu , GADHIA RAJAN R , Misra Vivek , Volpi John J , Chiu David , Vahidy Farhaan S
Published: February 2022

Background:
Relationships between neighborhood socioeconomic deprivation (NSD) and Intracerebral hemorrhage (ICH) outcomes are not well characterized. We sought to evaluate the impact of NSD on ICH outcomes and assessed mediating pathways for association between NSD and poor outcomes.

Methods:
Clinical data were extracted from the electronic medical records and 90-day modified Rankin Scale (mRS) scores were obtained from a prospectively collected stroke registry at a large healthcare system. Presentation NIHSS score was used to assess ICH severity. Exact patient addresses were geocoded, and state-level Area Deprivation Index (ADI) was calculated, with high NSD (H-NSD) categorized as top 15% of ADI scores. The outcome was severe disability or death (SDD) (mRS ≥ 4). Age-adjusted logistic regression models were fitted, and mediation analyses were performed utilizing structured equation modeling. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported.

Results:
Final analyses included 486 patients with complete data (mean age: 65.6 years, 45.9 % female, 28.8% non-Hispanic Black, 20.2% Hispanic, median presentation NIHSS: 10, and median 90-day mRS 4). In separate age-adjusted models, both high NIHSS scores (OR, CI: 1.24, 1.20 - 1.29) and H-NSD (OR, CI: 1.59, 1.02 - 2.46) were associated with SDD. In a mediation analysis, H-NSD significantly contributed to higher NIHSS scores (OR, CI: 14.30, 1.44 - 141.61) and in turn higher NIHSS scores were significantly associated with SDD (OR, CI: 1.03, 1.03 - 1.04). In this analysis, H-NSD did not retain a significant direct effect on SDD (OR, CI: 1.38, 0.96 - 1.12) and was instead fully mediated by high NIHSS scores (Figure 1).

Discussion:
Our analyses uniquely identify higher stroke severity as a potential causal pathway between NSD and poor ICH outcomes. These findings warrant comprehensive understanding of factors that may predispose the disadvantaged to experience higher ICH severity and greater neurological deficit.
Abstract WP152: Changes In Thrombus Fibrin Content By Time In Patients Undergoing Thrombectomy
Authors: Fraser Justin F , Vicari James , Rivet Dennis , Woodward Britton K , Nanda Ashish , Cheng-Ching Esteban , Rapoport Benjamin , Baltan Selva , Sohrabji Farida , Pennypacker Keith , Kellner Christopher P
Published: February 2022

Introduction:
Understanding clot composition and associated genomic, epigenomic, and proteomic signatures could provide insight into thrombus biology and etiology, and aid in prognosis in stroke. We report preliminary analysis of histology evaluations in subjects enrolled in the INSIGHT Registry, a multicentered ‘multi-omic’ analysis of thrombi associated with acute hemorrhagic and ischemic stroke this multi-omic clot collection registry. Our aim was to determine potential histology differences in thrombi as a consequence of infarct time (time from last known normal to thrombectomy).

Material and Methods:
Subjects age ≥18 years, treated frontline with the Penumbra System for thrombectomy are included in this analysis. Patient demographics, medical history, radiographic, and procedural information are collected in conjunction with extracted clot and concurrent extracranial arterial blood. Enrollment, data collection, and data monitoring are ongoing for the INSIGHT registry. While the protocol includes analysis for proteomics and transcriptomics, for this analysis we used automated histology. An MSB Trichrome stain was used to evaluate the tissue. Composition was determined by automated pixel analysis, with the values representing ratios of the overall clot.

Results:
Samples from 60 subjects who were enrolled from 10 sites between 02/2021 and 07/2021. Analysis of the thrombi successfully determined the relative portions of fibrin, red blood cells (RBCs), and platelets (PLT). The median percentage of fibrin in the thrombi was 44.0% (IQR 29.0 - 57.6; N=60). The median time interval from Last Known Well to recanalization was 4.0 hours (IQR 2.9-12.8 hours; N=55). There was no correlation between the time interval of stroke and the percent of fibrin in the thrombus (Pearson correlation coefficient -0.01, p 0.94).

Conclusion:
These preliminary results demonstrate a lack of relationship between time interval of the stroke and clot histology composition with relation to fibrin. Thrombus fibrin composition is likely more related to other factors, and not predominantly related to time. We are currently investigating potential relationships to demographics and co-morbidities.
Abstract WP156: Association Of Thrombus Histopathology And Prognosis Of Successful Recanalization
Authors: Arturo Larco jorge , Abbasi Mehdi , Madhani Sarosh Irfan , Dai Daying , KADIRVEL Ram , Savastano Luis , Kallmes David F , Brinjikji Waleed
Published: February 2022

Introduction:
Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). Clinical outcome of successful recanalization (mTICI 2b or higher) varies greatly and is associated with some baseline characteristics. Many studies have reported the relation of thrombus composition with MT outcomes however the association of thrombus composition with the prognosis of successful recanalization remains to be elucidated.

Hypothesis:
thrombi retrieved from patients with good clinical outcome may have different compositions compared to that of patients with poor clinical outcome.

Methods:
Thrombi retrieved from AIS-LVO patients with successful recanalization were included. Patients were divided according to modified Rankin Scale at 90 days (mRS-90days) into good clinical outcome (mRS-90days 0-2) and poor clinical outcome (mRS-90 days 3-6). Representative slide for each thrombus was stained with Martius Scarlet Blue (MSB) for red blood cells (RBCs), white blood cells (WBCs), fibrin (FIB), and platelet (PLT). Immunohistochemistry (IHC) was also performed for NETs (anti-citrullinated H3; CitH3) and vWF in thrombi. The overall mean value of each thrombus composition was calculated. Thrombus was considered rich in given composition if that composition was higher than its overall mean. We compared the thrombus composition and type between patients with good and poor clinical outcomes.

Results:
A total of 94 patients were included. Fifty-six patients had good clinical outcome. The overall average percentage of RBCs, WBCs, fibrin, platelet, NETs (CitH3), and vWF components in thrombi were 44.3%, 3.6%, 29.3%, 22.8%, 20.3% and 12.5% respectively. There was no association between thrombus type (including RBC-rich, FIB-rich, PLT-rich, vWF-rich, and NETs-rich) and clinical outcomes (P values>0.05). Multivariate logistic regression analysis showed no association between thrombus composition and clinical outcome (good vs poor) while adjusting for age, initial NIHSS score, ASPECT score, pre-MT IV-tPA, and MT technique and number of the device passes.

Conclusion:
we found no association between thrombus composition and clinical outcome after successful recanalization.
Abstract WP157: Outcomes Of Reversible Cerebral Vasoconstriction Syndrome: Analysis Of The National Inpatient Sample Databases, 2016-2018
Authors: Nazari Pouya , Golnari Pedram , Ansari Sameer A , Cantrell Donald R , Shaibani Ali , Potts Matthew , Jahromi Babak
Published: February 2022

Introduction:
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches accompanied by reversible segmental vasoconstriction of cerebral arteries. Ischemic and hemorrhagic stroke are considered major complications of RCVS. We aimed to assess outcomes of RCVS patients with and without stroke, and to compare presentation with ischemic or hemorrhagic stroke.

Methods:
Data was extracted from the National Inpatient Sample (NIS) spanning 2016 to 2018. All adult patients diagnosed with RCVS were identified using ICD-10 codes after excluding patients with a concurrent diagnosis of primary angiitis. Measured outcomes included adverse events during hospitalization and discharge disposition. Standard bivariate statistical tests were applied to compare groups.

Results:
Of 3170 patients (mean age 48.0±15.7 years; 73.3% female) who were admitted with the diagnosis of RCVS, 1565 patients (49.4%) had no stroke and 1605 patients (50.6%) presented with stroke. In patients who presented with stroke, 375 patients (26.1%) had only ischemic stroke and 1060 (73.9%) presented with only hemorrhagic stroke. Rates of routine discharge were higher in patients with no stroke (75.4% vs 57.9%, p<0.001) versus those presenting with stroke (Table). In patients who presented with stroke, rates of percutaneous gastrostomy (PEG) placement were higher in ischemic stroke group compared to patients with hemorrhagic stroke (5.3% vs 2.4%, p=0.004), whereas rates of ventilation/intubation were higher in patients with hemorrhagic stroke (10.8% vs 4.0%, p=0.001). Routine discharge was more frequent in RCVS patients presenting with hemorrhagic rather than ischemic stroke (66.0% vs 48.0%, p<0.001).

Conclusions:
More than half of patients admitted with a diagnosis of RCVS presented with stroke. RCVS patients presenting with ischemic stroke have higher rates of PEG placement and lower rates of routine discharge than those presenting with hemorrhagic stroke.
Abstract WP162: Endovascular Thrombectomy In Hispanic Stroke Patients Along The Texas-Mexico Border: Direct Comparison With The HERMES Trial
Authors: Kenawy Ahmed E , Dibas Mahmoud , Tekle Wondwossen , Hassan Ameer
Published: February 2022

Background and Purpose:
Current evidence has shown that race and ethnicity impact the outcomes in acute ischemic stroke (AIS) patients secondary to large vessel occlusion. However, there is limited evidence concerning the utility of endovascular thrombectomy and AIS outcomes in Hispanic Americans. This study aims to compare the characteristics and outcomes between a majority Hispanic population and patients from the HERMES trial.

Methods:
We conducted a retrospective analysis from January 2013 to August 2020 to retrieve data related to Hispanic individuals in an understudied area along the Texas-Mexico border. Then, the characteristics and outcomes were compared between this cohort (n=637) and the HERMES trial (n=634). Categorical variables were compared using the chi-squared test.

Results:
The median [IQR] age for our cohort was 72 [±20] years and 68 [±20] years for the HERMES cohort. Similar rates of females were observed in both groups. Our cohort had lower rates of smoking, but higher rates of hypertension and diabetes mellitus (p<0.05). The median [IQR] admission NIHSS was 17.0 [11.0] vs. 17 [6.0], respectively. We observed significantly lower rates of intravenous tissue-type plasminogen activator (IV tPA) in this cohort as compared to the HERMES trial. The modified Rankin Scale score after 90 days was similar between the two groups. However, this cohort had significantly higher rates of mortality (19.7% vs. 15.3%, p=0.042) and symptomatic intracranial hemorrhage (sICH) (10.3% vs. 4.4%, p<0.001).

Conclusion:
There are significantly higher rates of mortality and sICH in Hispanic AIS patients which can most likely be explained by the higher rates of hypertension, diabetes mellitus, and the lower rates of IV tPA utilization.
Abstract WP163: Factors Affecting Door To Recanalization Times At A Comprehensive Stroke Center
Authors: Nisar Taha , Lee Jorge Rodriguez , Patel Jimmy , Singla Amit , Khandelwal Priyank
Published: February 2022

Introduction:
Timely recanalization is strongly associated with functional independence in patients who undergo mechanical thrombectomy (MT) for a large vessel occlusion (LVO). The American Heart Association recommends Door to Recanalization/Reperfusion (DTRp) time of ≤120 minutes. We aim to identify factors associated with a delayed DTRp at a comprehensive stroke center (CSS).

Methods:
We performed a retrospective chart review of patients who underwent MT for an anterior circulation LVO at a CSS from 7/2014 to 12/2020. We compared various presenting variables and technical parameters between patients who achieved DTRp in ≤120 minutes vs. ≥120 minutes. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, presenting mean arterial pressure (MAP), presenting serum calcium level, Hb A1C, LDL, intravenous alteplase, left hemispheric location, location of the clot (internal carotid artery vs. middle cerebral artery), ≥50% ipsilateral stenosis, ASPECTS≥6, general anesthesia, transradial approach, number of passes, arrival to the emergency department on night shift (7 pm to 7 am) and on weekends.

Results:
217 patients met our inclusion criteria. The mean age was 64.09±14.4 years. In our cohort, arrival on weekend (66.84% vs. 4.76%; OR, 0.02; 95% CI,0.01-0.37; P 0.012), higher serum calcium level (9.02±0.62mg/dL vs. 8.4±0.9mg/dL; OR, 6.7; 95% CI,1.77-25.31; P 0.005), left hemispheric occlusion (52.55% vs.14.29%; OR, 0.05; 95% CI,0.01-0.33; P 0.002), general anesthesia (81.67% vs.61.90%; OR, 0.16; 95% CI,0.03-0.81; P 0.026), higher presenting MAP (105.33±21.05 vs.91.93±10.79; OR, 1.1; 95% CI,1.03-1.17; P 0.004) and female sex (47.96% vs.33.33%; OR, 5.61; 95% CI,1.09-28.87; P 0.039) were associated with DTRp of ≥120 minutes.

Conclusion:
Parameters of arrival on the weekend, higher serum calcium level, higher MAP, left hemispheric occlusion, use of general anesthesia, and female sex were associated with DTRp of ≥120 minutes.