bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP59: Cultivating Stroke Nurse Champions Through Shared Governance
Authors: Sheehan Tiffany O , Schroeder Tracie , Felix Kendall , Heater Abbi , Kramer Wendy , Mills-Christy Kim , Stokes Debra , Warga-Lopez Wendy , Reynolds Ina , Salgado Ortiz Jessica , Williams Audra , Plueger Madona
Published: February 2024

Background and Issue:
Shared governance (SG) is an organized forum where bedside nurses are engaged in decision-making about professional practice, QI, and research to improve patient outcomes. Nursing engagement in SG has been linked to promoting improved nursing and patient outcomes. At a CSC, nurses did not have an organized forum to collaborate across units to develop EBP standards in the stroke population. Bedside nurses had limited knowledge of QI methodology and were unsure how to organize cross-unit projects.

Purpose:
To implement a SG forum aimed at improving the quality of care and patient outcomes in the stroke population through nursing engagement, collaboration, and effective communication.

Methods:
The Stroke Nurse Champion (SNC) Committee was assembled in November 2020. A charter was developed to organize the meeting. Members include bedside nurses, educators, managers, supervisors, stroke coordinators, nurse practitioners, and a CNS. Meetings were held monthly virtually and in person. The project outcomes were to (a) develop nurse practice standards, (b) enhance nursing education offerings, and (c) develop cross-unit stroke care QI initiatives.

Results:
SNCs developed and implemented local and corporate initiatives by reviewing literature, identifying barriers, recommending solutions, and identifying data to support evaluation. Initiatives included the creation of practice standards defining nursing assessments for the stroke population, implementation of the Yale Swallow Protocol, optimization of the EHR to address inefficient documentation of nursing assessments, and revision of written patient education to address literacy and grade levels. Peer-led in-hospital stroke alert case reviews prompted the implementation of a QI project to decrease time-to-treatment. To improve adoption of standards, unit-based checklists, tip sheets, stroke boards, and bedside resource books were developed.

Conclusion:
The SG forum provides a platform for effective collaboration across nursing units among bedside nurses and nursing leaders to develop practice standards, analyze data, identify QI initiatives, and enhance education.
Abstract TP62: Stroke Triage Checklist Decreases Door to Treatment
Authors: Koch Edward , Flores Shari , Francis Natalie , Wirtanen Shelby , Schroeder Tracie , Sheehan Tiffany O
Published: February 2024

Background and Issue:
Studies have shown that patients who arrive at the Emergency Department (ED) by privately operated vehicle (POV) vs. an ambulance have longer door to needle times. At a comprehensive stroke center, patients who arrived by POV experienced longer times from arrival to activation and door to needle than those arriving to the ED by ambulance.

Purpose:
To implement a standardized objective assessment triage checklist and evaluate its effectiveness of decreasing arrival to activation and door to needle times.

Methods:
This quality improvement (QI) project was guided by PDSA methodology. In 02.2023, a stroke nurse champion QI team was formed. Barriers to timely treatment were identified through the use of case timelines and a stroke nurse champion focus group. Patients arriving by POV and treated with a thrombolytic also had low NIHSS (1-4). During root cause analysis, triage nurses expressed a lack of confidence in calling a stroke alert for patients with mild symptoms. To address this barrier, a structured triage checklist was adapted to include the B.E.F.A.S.T. acronym, symptoms easily missed (e.g., difficulty walking, dizziness, headache), posterior stroke symptoms (e.g., diplopia, dysphagia), and a note to prompt activation from the triage room. The checklist was implemented on 04.15.2023. Data collected included patients who arrived by POV and were administered a thrombolytic. Door to alert and door to needle times were derived from a quality database and analyzed pre (01.2023-03.2023)and post implementation (05.2023-07.2023).

Results:
When comparing pre and post implementation data, there was a 5 min decrease in door to activation time (n=4, 10 min vs. n=3, 5 min) and a 23 min decrease (n=4, 58 min vs. n=3, 35 min) in door to needle time in patients who arrived by POV and received a thrombolytic. All patients treated with a thrombolytic in the ED, regardless of mode of arrival, saw a 26 min reduction in door to needle during this time period (n=15, 69 min vs. n=17, 43 min).

Conclusion:
Use of a standardized and objective triage checklist empowered nurses to activate a stroke alert prior to receiving provider input on patients arriving by POV with mild symptoms. Enabling quick allocation of resources to expedite thrombolytic administration.
Abstract TP64: Nursing Led Intervention Improves Thrombolytic Administration Time by Optimizing Emergency Department Code Stroke Pathways
Authors: Warren Sandra L , Velasco Angelie , Nguyen Quyen T , Gonzalez Elizabeth , Gaffney Denise , Taleb Shayandokht , Ajani Zahra , Sangha Navdeep S , Noorian Ali R
Published: February 2024

Background:
Timely efficient thrombolytic administration has been associated with better clinical outcome in acute ischemic stroke patients. Shortening the time from arrival to code stroke activation can lead to faster thrombolytic administration.

Methods:
Door to code stroke activation and door to needle times were calculated in consecutive code strokes in the emergency department (ED) from 1/2021-11/2021 Pre and 12/2021-12/2022 Post implementation of “Triage to CT” pathway. Our previous code stroke processes included initial evaluation by the triage nurse, followed by rooming and transferring the patient from triage to the ED room, and then to the CT suite. To improve our process, a staging area was set up where a gurney was placed adjacent to the triage area. This allows rapid assessment and activation of the code stroke protocol. ED staff were educated on sending the patient directly to CT after activation of code stroke by the triage physician. This process eliminates the need to room the patient prior to CT scan.

Result:
Median Door to Code stroke activation time was significantly lowered after the implementation of “Triage to CT” pathway (17 min to 11 min, respectively, p<0.0001)

Conclusion:
In our study, “Triage to CT” pathway significantly shortened door to code stroke activation. Optimization of an emergency code stroke process by taking the patient straight to CT suite from the triage area decreases door to code stroke activation time and ultimately door to needle time.
Abstract TP69: Development of System-Wide Stroke-Specific Nursing Education for a Hospital System
Authors: Morhaim Holly , Rudolph Steven , Davy Connor M , Wheelwright Danielle , Roche Tara L
Published: February 2024

Background:
Stroke nursing education is a requirement for Stroke Center designation. Providing eight hours of stroke-specific education to hundreds of nurses annually can be challenging for any medical institution.

Purpose:
The purpose of our project was to improve the quality of stroke nursing education for a seven-hospital system in New York City and to reach a larger audience of nurses by creating a learning environment that is strong, evidence-based, engaging and interactive.

Methods:
We recruited stroke neurologists, nurse practitioners, and experienced stroke nurses to provide lectures during monthly stroke education days. The eight-hour curriculum was designed by stroke program directors and stroke coordinators. Topics included acute stroke management, imaging, stroke complications, NIHSS review, post-stroke rehab, swallow screen, and stroke trivia. At least two presenters were recruited for each topic to ensure coverage. We used a zoom platform to provide stroke education. We assessed nurses’ performance during the educational process. Lectures were interactive with multiple-choice questions, polling and trivia, and allowed nurses to engage and ask questions. Educational days were offered monthly, and the schedule was posted for the entire year on the system-wide educational platform. We continued to improve the quality and delivery of the content based on nurses’ feedback.

Results:
Following initiation of this program, monthly education days via a virtual platform allowed us to reach a wider nursing audience across the system and to achieve consistency and quality of stroke nursing education. Over 2,000 nurses took part in our educational days during years of 2020-2023. Based on 1575 nurses’ reviews and feedback, the ability to interact with the presenters, ask questions, and the interactive content delivered by stroke experts were most appreciated.:

Conclusions:
Virtual technology and our nurse-oriented stroke curriculum allowed us to reach a wider audience of nurses. Assigning designated topic-specific partner-lecturers ensured coverage in case of an unexpected event. This method allows nurse educators to provide system-wide evidence-based interactive nursing education by specialty experts and emphasize material in real time.
Abstract TP73: Outcomes in Mexican American Informal Stroke Caregivers and Differences by Ethnicity
Authors: Lisabeth Lynda D , Kwicklis Madeline , CASE Erin , Cox Melinda , Morgenstern Lewis B
Published: February 2024

Background:
Informal home care is the most prevalent type of post-acute care (PAC) in Mexican American (MA) stroke survivors, but data on the impact on caregivers is not available. The objective was to investigate strain, positive aspects of caregiving, familial obligations/support, and depression in stroke caregivers and ethnic differences in a population-based study.

Methods:
Data are from Brain Attack Surveillance in Corpus Christi PAC Study. Community-dwelling stroke survivors and their caregivers were recruited (n=307). Caregiver eligibility included: 1) residence in study county, 2) not cognitively impaired, 3) not providing care pre-stroke. Caregiver interviews at ~90 days included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (MCSI range 0-26, higher more), PAC scale by Tarlow et al (range 5-45, higher more), familial obligations/support scales by Sabogal et al (range 1-5, higher greater), and PHQ-8 (range 0-30, higher worse). Patient data were from interviews and medical records. Propensity score (PS) methods were used to balance caregiver and patient factors among MA and non-Hispanic white (NHW) caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and disability. PS were then included as a covariate in regression models considering the association between ethnicity and outcomes.

Results:
MA caregivers were younger, more likely female, and more likely a child than NHWs. Median MCSI, PAC scale, PHQ-8 were 11 (IQR:6-17), 36 (IQR:30-40), and 11 (IQR:9-15) in MAs and 13.5 (IQR:9-18.3), 30 (IQR:25-36.3) and 13 (IQR:10-16) in NHWS. MA ethnicity was associated with less caregiver strain (β=-2.22, 95% CI:-4.19, -0.26) and depression (β=-2.05, 95% CI:-3.48, -0.63) and more positive aspects of caregiving (β=2.96, 95% CI:0.91, 5.01), but not associated with familial obligations/support.

Conclusions:
Informal stroke caregivers report moderate levels of strain and depressive symptoms, with NHW caregivers reporting higher levels. MA caregivers report greater positive aspects of caregiving suggesting a possible intervention target to improve outcomes in MAs.
Abstract TP94: Exploring Trends in LVO EVT Treatment of Fringe Patients by Race
Authors: Iyyangar Rania , Iyyangar Ananya , Azeem Hussain , Ballekere Anjan Nagesh , Salazar-Marioni Sergio , Le Ngoc Mai , Sheth Sunil
Published: February 2024

Intro & Background:
Following the publication of the randomized clinical trials in 2015 and 2018 on endovascular stroke therapy (EVT), procedural utilization has increased. Guidelines have since been developed and followed regarding cut-offs for patient treatment eligibility. Here, we explore the trends in EVT treatment of patients categorized as “fringe” patients by race.

Methods & Materials:
We performed a retrospective cross-sectional analysis using the SVIN Registry with records from 2010 to 2021. This dataset includes all LVO AIS patients that underwent EVT. Patients were categorized as “fringe” or “non-fringe” based on NIHSS (<6), ASPECTS (<6), pMRS (>1), proximal vs distal occlusion, last known well to arrival time (>24 hours), and age (>85). Fringe cutoffs were determined using typical guidelines. Outcomes were compared between White patients and Black/African American patients to determine trends in treating fringe patients with EVT. Chi-squared analyses were utilized for outcomes.

Results:
Among the 7,018 patients 4,791 patients were White and 1,821 patients were black. Median age was 69 (IQR: 58-79). Median NIHSS was 17 (IQR: 11-22). Focusing on the White and Black/AA patient population, a greater percentage of LVO patients that underwent EVT and were considered “fringe” were Black/AA patients (66% vs 71%). We also found that there are significant differences among these fringe categories: age, (20% vs 7.9%, p<0.001 white vs black), proximal occlusion (52% vs 58%, p<0.001, white vs black), and of having sICH (4.2% vs 2.8% p=0.03 white vs black). Comparing fringe categories between races, White patients were more likely to be >85 years of age, have a distal occlusion, and have sICH than Black/AA patients.

Conclusion:
The overall fringe population showed greater percentage of the white population which we speculate leads to higher percentage of white population in the SICH criteria, they are receiving more off-guideline treatment. These findings indicate that there may be a presence of racial bias in treatment decision-making that should be further explored. Further, there is proof that indications for EVT interventions are being expanded past guidelines in order to provide treatment for a wider range of patients.
Abstract TP95: Stakeholder Perspectives Regarding Conventional and Alternative Funding Paradigms for Stroke Research: Results From the Perspect Qualitative Study
Authors: Ganesh Aravind , Drozdowska Bogna , Cristall Nora , Fladt Joachim , Jaroenngarmsamer Tanaporn , Sehgal Arshia , McDonough Rosalie V , Goyal Mayank
Published: February 2024

Background:
Stroke research is underfunded, but there is a paucity of data on the perspectives of researchers, funders, patients and the public about current funding paradigms. Understanding their priorities and opinions is important to guide meaningful innovation.

Methods:
The PERSPECT (Priorities & Expectations of Researchers, Donors, Patients and the Public Regarding the Funding & Conduct of Stroke Research) study involved in-depth, semi-structured one-on-one interviews with stroke researchers, funding organization representatives/philanthropists, patients, and members of the public. Participants were sampled using three axes (age, sex, ethnicity) to ensure diversity. They were asked to discuss thoughts about the state of stroke research funding and any potential or desired alternatives to current funding models. Qualitative analyses of transcripts included constant comparison and grounded theory content analysis. The study ended when the standard of thematic saturation was attained.

Results:
Forty-one interviews were completed (11 researchers, 10 research funders/philanthropists, 10 patients, 10 lay citizens). Researchers, philanthropists, patients, and public participants expressed a desire for greater transparency with grant funding processes, and voiced concerns that current models fostered bias towards certain topics and researchers. Patients and donors felt that conventional processes at times seemed disconnected from their interests. Crowdfunding was identified as an alternative strategy that could facilitate democratization in terms of topics studied, exploration of new frontiers, integration of diverse methods, and capacity building for less established researchers/centers. However, participants emphasized the importance of expert review, as in current processes, in building trust in proposal quality. They noted that successful crowdfunding strategies would require innovative approaches from researchers to promote their work.

Conclusions:
Our findings revealed stakeholder concerns about transparency and equity with current research funding paradigms. Stakeholders recognize crowdfunding as a useful alternative approach, but incorporation of expert review will be important to engender trust.
Abstract TP97: Feasibility and Reliability of Patient-Reported Scores to Assess Long-Term Functional Outcomes in Stroke: A Sub-Group Analysis of the MaRISS Trial
Authors: Saleh Velez Faddi G , Romano Jose G , Gardener Hannah , Campo-Bustillo Iszet , Smith Eric E , Khatrip Pooja , Schwamm Lee H ,   MaRISS Investigators
Published: February 2024

Obtaining delayed functional outcomes such as the modified Ranking score (mRS) after stroke is challenging in clinical practice, often resulting in missing data. Self-reported outcomes are an alternative to functional outcome collection, but their reliability and accuracy are not well-established

Methods:
In this subgroup analysis of the Mild and Rapidly Improving Stroke Study (MaRISS), we aimed to test the feasibility and reliability of the MaRISS Patient Reported Outcome (PRO) survey tool for obtaining delayed functional outcomes in low (0-5) National Institute of Health Stroke Scale ischemic stroke, particularly the modified Rankin Score (mRS), by assessing its inter-rater reliability with a score calculated by a clinician through a structured telephone interview. Other scores were compared as secondary outcomes. 125 surveys were distributed between January 2017 and July 2018. The tool consisted of an online survey aiming to collect information regarding the patient's functional status 90 days after stroke including the mRS (utilizing the mRS 9-Q version), Stroke Impact Scale-16 (SIS), Barthel Index (BI), European Quality of Life-5D-5L (EQ-Index). All participants also completed these scales administered by trained personnel through a structured telephone interview. Cohen's weighted kappa coefficients (κ) with 95% confidence intervals (CI) were calculated to assess the reliability of the PRO Tool

Results:
Of 125 surveys sent, 55/125 (46.4%) participants opened and started the survey but only 44/125 (36.8%) completed it entirely (mean age 62±12.5, 54.6% female, white 79.6%, NIHSS 2.3±1.8, ischemic stroke 84%, 16% TIA). 52 subjects completed both the online mRS 9-Q PRO and the telephone version (Table). The weighted kappa for the comparison of PRO mRS and the clinician-performed mRS was moderate [κ 0.53, SE 0.10; 95% CI (0.3-0.7)] as well as for the SIS (κ 0.43, SE 0.09) and EQ-Index (κ 0.40, SE 0.10) scores, whereas for BI was fair (κ 0.32, SE 0.15)

Discussion:
Engaging participants after hospital discharge remains difficult. Although participant completion rates for self-reported outcomes were low, the MaRISS PRO Tool showed moderate reliability. These findings should be confirmed in larger samples with a focus on improving participant engagement
Abstract TP98: Data Quality Review: Opportunities Through Transparency
Authors: Thomas Kathie , Oneill Kathleen , Peterpaul Haylee , Rutan Christine
Published: February 2024

Background:
Manual abstraction is still the leading source of registry data entry. Due to variability, information should be reviewed for accuracy. Clinical processes that impact quality of care and hospital metrics are abstracted and entered in the Get with The Guidelines® (GWTG) suite of registry programs. GWTG data is intended to be abstracted in accordance with specified coding instructions with high integrity. Created in 2023, the Data Quality Review Program (DQR) reviews the medical record concurrently with abstracted GWTG data to help streamline processes and ensure accuracy of data entry. The information is then compiled to form an inner-rater reliability (IRR) report including performance improvement opportunities.

Methods:
Site participation is voluntary and a percentage of annual charts is selected. Records in GWTG are compared to corresponding patient records via screen sharing for accuracy. Discrepancies and opportunities are reviewed with each case including clinical pathway performance, regulatory standards, and coding elements. Chart review includes data used for GWTG achievement and quality awards, time-sensitive activities and social disparities of health. IRR is further supported by individual risk and occurrence factors for each element reviewed along with a total composite IRR score guided by a standardized framework.

Results:
From April to July 2023, 50 hospitals have completed the DQR. Sites have varied geographically, in intervention capabilities, and accrediting body. Sites completed an experience survey after the DQR using Likert scale and narrative questions. 100% of survey respondents rated the DQR a 5 the top score, and valued evidence-based education and discussion of site abstraction processes. DQR reports were presented during regulatory body surveys in 6 cases which resulted in “no findings” note in this component for the site.

Conclusion:
While abstraction is not directly related to clinical care there are opportunities to connect registry data entry to improvement, both in quality and delivery of care. Sites participating in the DQR feel better prepared for certification, validation of current practices, and enhanced knowledge of coding instructions demonstrated through quality matrix recommendations.
Abstract WMP102: Risk Factors for MACE and Major Bleeding in Patients With Atrial Fibrillation Undergoing Elective Surgery: Insights From the BRIDGE Randomized Trial
Authors: Shu Liqi , Jack Naomi , Goldstein Eric D , de Havenon Adam H , Kala Narendra S , Khan Farhan , Nguyen Thanh N , Perelstein Elizabeth , Rana Maheen , Siegler James E , Stretz Christoph , Furie Karen L , Yaghi Shadi
Published: February 2024

Introduction:
Atrial fibrillation (AF) patients undergoing elective procedures are at risk for Major Adverse Cardiovascular Events (MACE) and major bleeding. This study aimed to identify risk factors to guide risk stratification and perioperative management.

Methods:
We performed a post-hoc analysis of the BRIDGE randomized trial. Patients who were randomized into the study with outcome follow-ups were included in the analysis. The primary outcome was MACE (stroke, myocardial infarction, and cardiovascular death) and clinically symptomatic major bleeding. Statistical techniques included standard univariate analysis, logistic stepwise regression, and Cox regression models with Schoenfeld residual test to validate proportional hazard assumption. Additional interaction analyses were performed to assess interactions between low-molecular-weight heparin bridge therapy with identified risk factors.

Results:
A total of 1,813 participants met inclusion criteria: mean age 71.6±8.8, 73.3% male. MACE occurred in 25 (1.4%) individuals, with pre-procedure clopidogrel use (adjusted hazard ratio [aHR] 7.73, 95% CI 2.63-22.72, p<0.001) and high CHA
2
DS
2
-VASc score (≥ 5; aHR 2.89, 95% CI 1.26-6.63, p=0.012) identified as risk factors. Major bleeding occurred in 41 (2.3%) individuals, with bridge therapy (aHR 2.53, 95% CI 1.29-4.96, p=0.007), history of renal disease (aHR 3.12, 95% CI 1.56-6.24, p=0.001), post-procedure aspirin use (aHR 3.02, 95% CI 1.61-5.68, p=0.001), post-procedure NSAID use (aHR 3.90, 95% CI 1.20-12.70, p=0.024), and major surgery (aHR 2.17, 95% CI 1.05-4.46, p=0.036) identified as risk factors. The interactions between above risk factors and bridge therapy for MACE and major bleeding outcomes were not significant (p>0.05).

Conclusion:
The importance of perioperative assessment in AF patients is underscored by our findings, which identify distinct predictors for MACE and major bleeding. Guided by these insights, clinicians may generally avoid bridging and concomitant post-operative aspirin and NSAID use, thereby optimizing perioperative management to minimize the risk of adverse outcomes.
Abstract WMP116: A P2X4 Inhibitor Dramatically Suppresses the Progression of Cervical Internal Carotid Artery Stenosis - An Attempt to Develop a Therapeutic Agent for Carotid Artery Stenosis Focusing on the Role of Hemodynamic Factors-
Authors: Fukuda Shunichi , Niwa Youko , Ando Joji , Yamamoto Kimiko , Suzuki Takashi , Yasoda Akihiro
Published: February 2024

Introduction:
Medical treatment of internal carotid artery stenosis consists of treatment of underlying conditions such as hypertension, dyslipidemia, and diabetes mellitus, as well as antiplatelet therapy. Hemodynamic studies suggest that endothelial cells sense disturbances and stagnation of blood flow caused by vessel geometry, which trigger the progression of stenosis. Similarly, cerebral aneurysms are known to progress due to hemodynamic effects. We have shown in animal studies that inhibition of P2X4 purinoceptor, an endothelial blood flow sensing-related protein, significantly inhibits the development of cerebral aneurysms. In the present study, we examined whether P2X4 disruption can suppress the progression of internal carotid artery stenosis using an animal model of carotid artery stenosis.

Methods:
Carotid stenosis coils were implanted in the left carotid artery of 7-week-old P2X4(-/-) and (+/+) mice fed a high-cholesterol diet. Four weeks after placement, the carotid arteries were removed and the occlusion rates of the carotid arteries were compared. The expression of known stenosis-related inflammatory factors was also examined by Western blotting.

Results:
The carotid occlusion rate was significantly lower in the P2X4 gene-deficient mice, with 5 of 16 occlusions, compared with 9 of 13 occlusions in the control group (p=0.0394, Student's t-test). The expression levels of MCP-1, COX-2, TNFα, and IL-1β were significantly increased in the carotid arteries of P2X4(+/+) mice with the coil compared to the non-operated group (p=0.0073, 0.0012, 0.0016, 0.0031, respectively, Wilcoxon's signed rank test). The carotid arteries of P2X4(-/-) mice with coils showed significantly lower expression of all of the above compared to those of P2X4(+/+) mice (p=0.0233, 0.0020, 0.0098, 0.0046, respectively).

Conclusions:
These results suggest that inhibition of endothelial blood flow sensing by P2X4 disruption may have reduced the progression of carotid artery stenosis by suppressing the expression of a group of inflammatory factors associated with carotid artery stenosis. This may lead the way to new drug therapies for carotid artery stenosis.
Abstract WMP21: Life's Essential 8 and Brain Health Clinical Outcomes in Middle-Aged Adults
Authors: Clocchiatti-Tuozzo Santiago , Rivier Cyprien , Renedo Daniela , Huo Shufan , Torres-Lopez Victor , Hawkes Maximiliano , de Havenon Adam H , Sheth Kevin N , Gill Thomas M , Falcone Guido J
Published: February 2024

Background:
Mounting evidence points to a connection between cardiovascular risk during middle age and brain health later in life. The American Heart Association’s Life’s Essential 8 (LE8) constitute a research and public health construct capturing key determinants of cardiovascular health. We tested the hypothesis that worse LE8 profiles are associated with higher composite risk of the most important clinical endpoints related to brain health.

Methods:
We conducted a two-stage (discovery and replication) prospective study using data from the UK Biobank (UKB) and All of Us (AoU). We excluded participants with stroke, dementia, or late-life depression (LLD) at baseline. The exposure of interest was the LE8 score, a validated tool that captures the LE8 components (blood pressure, glucose, and cholesterol, body mass index, smoking, physical activity, diet, and sleep duration), organized in 3 categories. The outcome of interest was a composite of stroke, dementia, or LLD. We evaluated the associations of interest via multivariable Cox proportional hazard models.

Results:
The discovery stage included 334,505 UKB participants (mean age 56, 47% female), in whom the unadjusted risk of the composite outcome of interest was 471 (0.7%), 2,224 (1.1%) and 1,143 (1.7%) in participants with optimal, intermediate, and poor cardiovascular health (p<0.001). This association remained significant in multivariable Cox models (optimal versus poor cardiovascular health OR 2.14; 95% CI 1.92 - 2.39; p<0.001). The replication stage included 92,551 AoU participants (mean age 57, 59% female), in whom the unadjusted risk of the composite outcome was 547 (3%), 3,451 (6.2%) and 1,833 (10%) in participants with optimal, intermediate, and poor cardiovascular health (p<0.001). This association remained significant in multivariable Cox models (optimal versus poor cardiovascular health OR 2.20; 95% CI 1.99 - 2.42; p<0.001).

Conclusions and Relevance:
Among middle-aged UKB and AoU participants, poorer LE8 cardiovascular health profiles were strongly associated with a higher risk of developing a composite endpoint that captures the most important diseases related to brain health. These findings support the utilization of this endpoint in clinical trials focused on brain health.
Abstract WMP26: Sex Differences in the Expression of Mood Disturbances Post-Stroke
Authors: Pen Alice Y , Phianhasin Lalipat , Martha Sarah R
Published: February 2024

Background and Purpose:
Stroke is one of the leading causes of death and disability globally with sex specific differences in symptoms and outcomes. Approximately 30-50% of post-stroke patients have emotional and mood disturbances (e.g., anxiety, anger, irritability, aggression). Post-stroke mood disturbances may affect stroke survivors from returning to work, poorer quality of life (QOL), and stroke reoccurrence. Women experience worse outcomes compared to males following stroke (e.g., greater age of onset, stroke severity, misdiagnosis). The identification of mood disturbances as a cause of stroke is important because management may help improve QOL and recovery. The purpose of this study was to assess sex differences in expression of mood disturbances post-stroke.

Methods:
We conducted a scientific review of relevant literature published between 2008 and 2023 by searching PubMed and CINAHL databases using the keywords, “sex differences”, “emotion”, “anxiety”, “anger”, “irritability”, “aggression”, “stroke”, “pathophysiology” “treatment”, and “management”. Articles not pertaining to post-stroke anxiety, anger, irritability, and aggression were excluded.

Results:
We included 32 studies. Women were associated with higher severity of anxiety, anger, irritability, and poorer QOL when compared to men post-stroke. Positive emotions (e.g., anticipation, trust, joy) were significantly higher (p<0.001) in women, while negative emotions (e.g., disgust, fear, sadness) were significantly higher (p<0.001) in men. The pathogenesis of post-stroke mood disturbances and association to lesion locations remain uncertain. Mood disturbances may be treated or prevented by pharmacological therapy, counseling, and education. However, treatment and management are limited and not sex specific.

Conclusions:
Stroke survivors present with complications of mood disturbances. Women exhibit different mood disturbances than men, however treatment and management options are limited and not sex specific. This highlights the need for long-term screening of mood disturbances in the stroke population and investigation of underlying factors for sex differences.
Abstract WMP30: Real World Experience With Tenecteplase on a Mobile Stroke Unit
Authors: Haller J. Tyler , Sheehan Tiffany O , Gonzalez Daniel , Wang David Z , Waters Michael F
Published: February 2024

Background:
Tenecteplase (TNK) administered on a mobile stroke unit (MSU) has demonstrated superior rates of early reperfusion compared to alteplase. Current guidelines include TNK as a second-tier option for large vessel occlusions as TNK has many benefits, including rapid IV administration and ease of dosing. The objective of this study was to describe real world utilization of TNK on a MSU.

Methods:
This was a retrospective observational study of patients receiving TNK as compared to alteplase between February 2021 and April 2023 at a large academic comprehensive stroke center. Baseline demographics, GCS, NIHSS, as well as time of initial imaging were collected. Primary endpoint was time from MSU door to thrombolytic administration. Secondary endpoints included: MSU door to imaging interpretation, dispatch to thrombolytic administration, and provider decision time to thrombolytic administration. Safety endpoints included symptomatic ICH within 24 hours.

Results:
During the studied time period 40 patients received alteplase and 32 patients received TNK on the MSU. The median age was 65.7 years and median NIHSS score was 9. There was no difference in time from MSU door to thrombolytic administration (15 vs 17.5, p=0.30). There was also no difference in time from MSU door to imaging interpretation, dispatch to thrombolytic administration, or provider decision time to thrombolytic administration. No hemorrhagic conversion occurred.

Conclusion:
This is the largest series to date describing real-world utilization of TNK administration in a MSU. There were no significant differences in time to therapy in any of the time points evaluated. This data is promising for the treatment of ischemic stroke in which time to administration of thrombolytic therapy is paramount and TNK is administered as a rapid IV injection as compared to alteplase infusion.
Abstract WMP33: Translating Evidence Into Practice: Early Supported Discharge in Intracerebral Hemorrhage
Authors: Nobles Kristen
Published: February 2024

Background:
The 2022 guidelines from the American Heart Association/American Stroke Association underscore the significance of coordinated multidisciplinary care and early discharge planning for spontaneous intracerebral hemorrhage (ICH) patients. Early Supported Discharge (ESD) programs have been found to curtail hospital stays for ICH patients.

Purpose:
This Quality Improvement initiative aimed to optimize our ESD program, originally designed for acute ischemic stroke patients, by expanding eligibility to encompass mild to moderate spontaneous ICH patients. The primary objectives were to evaluate the effects on the hospital length of stay and discharge-to-home rates.

Methods:
In 2020, a collaboration between our acute care hospital and homecare organization led to the development of an ESD program, Homeward Stroke Recovery, for ischemic stroke survivors in local catchment areas. Eligibility criteria were broadened to include ICH patients in July 2022. Descriptive statistics were used to track the program's performance, specifically discharge-to-home rates and hospital length of stay for ICH survivors discharged with Homeward Stroke Recovery.

Results:
Following the expansion of Homeward Stroke Recovery Program eligibility, the discharge-to-home rate for ICH patients at the site increased by 14.2% (27.5% to 41.7%). Additionally, the median length of stay decreased by 2 days (6 days to 4 days).

Conclusions:
In conclusion, our Quality Improvement project has successfully enhanced the Homeward Stroke Recovery program. This was achieved by aligning eligibility criteria with evidence-based recommendations for patients with mild to moderate spontaneous ICH, leading to a substantial positive impact on patient outcomes. The outcomes of this initiative not only affirm the efficacy of broadening eligibility for ESD programs but serves as a beacon and blueprint to widen scope through evidence-guided improvements.
Abstract WMP4: Dual Antiplatelet Therapy versus Alteplase in Adult Patients With Minor Ischemic Stroke: A Systematic-Review and Meta-Analysis
Authors: Viana Patricia , Hoffmann Relvas Jessica , Dias Delfino Cabral Thamiris , Menegaz de Almeida Artur , Zanchi Persson Jorge Eduardo , Zanchi Persson Marina , Oliveira Marques Marcos Vinicius
Published: February 2024

Introduction:
The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are not well established. Therefore, we aimed to perform a meta-analysis to determine the best strategy for patients with minor stroke.

Methods:
MEDLINE, EMBASE, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. The main outcome was a 90-day functional outcome assessed by modified Rankin Scale (mRS). Statistical analysis was performed using Rstudio Software. Quality assessment and risk of bias were performed according to Cochrane recommendations. Subanalyses were performed restricted to: a) non-disabling minor strokes and b) NIHSS score ≤ 3. The meta-analysis protocol was registered prospectively in PROSPERO.

Results:
We included 5 studies with 6,195 patients, of whom 3,964 (64%) received DAPT, and 69.6% were male. Mean follow-up was 90 days. There was no significant difference for individual outcomes of mRS 0-1 (84% vs. 84%; OR 1.26; 95% CI 0.85-1.89; p=0.25; Figure 1A), mRS 0-2 (94% vs. 94%; OR 0.99; 95% CI 0.68-1.43; p=0.95), or all-cause mortality (0.5% vs. 0.5%; OR 0.84; 95% CI 0.21-3.28; p=0.79; Figure 1B) between groups. We found similar results, in mRS 0-1 and mRS 0-2 outcomes, in both a subgroup analysis of patients with an NIHSS score ≤ 3 and a subgroup of patients with non-disabling minor strokes.

Conclusion:
To our knowledge, this is the first meta-analysis comparing DAPT with IV alteplase in patients with acute minor ischemic stroke. We found no statistically significant difference in 90-day outcomes between the groups, considering mRS scores of 0-1, 0-2, or in mortality rates. Our results indicate that both DAPT and Alteplase can be viable treatment options for these patients.
Abstract WMP53: Neighborhood Deprivation and Functional Outcomes Following Ischemic Stroke
Authors: Kleinberg Leah M , Clocchiatti-Tuozzo Santiago , Rivier Cyprien , Torres Lopez Victor M , Kim Jisoo , Kitlen Eva , Kampp Michael C , Jasak Sara , Schindler Joseph L , Sansing Lauren H , Sheth Kevin N , Falcone Guido J
Published: February 2024

Introduction:
The association between neighborhood deprivation and risk of disease is well-documented. However, the role of neighborhood deprivation in long-term outcomes following acute brain injury remains understudied. We tested the hypothesis that neighborhood deprivation leads to unfavorable long-term functional outcomes following acute ischemic stroke (AIS).

Methods:
We conducted a nested study within the Yale Longitudinal Study of Acute Brain Injury, a prospective study which follows patients with acute brain injury admitted to the Yale Health System. The present study focused on AIS survivors and assessed neighborhood deprivation using the Area Deprivation Index (ADI), a metric that uses 9-digit zip codes to rank neighborhoods based on income, employment, education, and housing quality. Patients were stratified into tertiles based on their ADI, designated as low, intermediate, or high deprivation. Functional outcomes were evaluated using the modified Rankin Scale at one-year post-stroke, dichotomized into favorable (scores 0-2) and unfavorable (scores 3-6). Our analysis employed multivariable logistic regression for adjusted analyses.

Results:
Among 2,540 AIS patients enrolled between 2018 and 2021, 2,164 patients had zip code and outcomes data (mean age 69 years, 48% female, 7.5% Black, 7.7% Hispanic). The one-year unadjusted risk of poor outcomes was 35%, 40% and 46% for patients residing in neighborhoods with low, intermediate, and high deprivation, respectively (unadjusted p=0.001). These findings remained significant in multivariate analyses that controlled for confounding factors: compared to patients living in neighborhoods with low deprivation, those living in areas with intermediate and high deprivation had 44% (OR 1.44, 95% CI 1.11-1.86) and 107% (OR 2.07, 95% CI 1.58-2.72) greater risk of unfavorable outcomes (test-for-trend p<0.001).

Conclusion:
Our study, focusing on survivors of AIS participating in a prospective acute brain injury study, underscores the connection between neighborhood deprivation and an elevated risk of unfavorable outcomes. We validate the utility of the ADI as a valuable analytical tool for evaluating neighborhood deprivation as a composite for several social determinants of health.
Abstract WMP58: Underrepresentation of Racial and Ethnic Minorities in Stroke Clinical Trials
Authors: Izeogu Chigozirim , Bhojwani Manish , Ahmed Mariam , Chang Kelly , Mehta Amol , Ibrahim Lamya , Rocha Eva , Jones Erica , Ifejika Nneka L , Gonzales Nicole R , Sharrief Anjail Z
Published: February 2024

Background:
Stroke impacts Black and Hispanic individuals disproportionately compared to White individuals. Equitable inclusion in stroke research for disproportionately affected populations is critical for addressing stroke inequities. Prior literature has reported a lack of racial diversity in acute stroke trials, but data are lacking for trials conducted across the stroke care continuum.

Methods:
We performed a comprehensive review of completed trials registered from January 1, 1990, to April 20, 2023, in the ClinicalTrials.gov registry. Trials for stroke treatment in hyperacute, acute, and post-acute care settings were included if they were at least partially conducted in the U.S., enrolled ≥ 50 participants aged 18 and older, and published their results in a peer-reviewed journal available on PubMed or Embase.

Results:
2461 trial records were retrieved, of which 69 stroke trials were included and are reported in this analysis. Overall, 34 of 69 trials (49%) included data on some racial or ethnic demographics in the primary manuscript. For trials conducted exclusively in the U.S., 20 of 30 trials (67%) reported data on race. Among international trials which also included the U.S., 14 of 39 trials (36%) reported data on race. Among trials exclusively conducted in the U.S., 74% of study participants were white. Among trials conducted exclusively in the U.S., 57% of trials funded by government reported race, whereas, 71% of trials funded by industry reported on race.

Conclusion:
This review shows under-reporting of race, ethnicity, and other sociodemographic data in stroke trials across the care continuum. When race and ethnicity are reported, most studies show over-presentation of White individuals, especially considering the disproportionate burden of stroke in Black and Hispanic groups. There is an urgent need to develop and implement strategies to increase diversity in stroke clinical trials to effectively understand and address inequities in stroke care and outcomes.
Abstract WMP61: Assessment of Carotid Artery Plaques With Chemical Exchange Saturation Transfer Imaging
Authors: Kanematsu Yasuhisa , Kenji Shimada , Korai Masaaki , Izumi Yamaguchi , Nobuaki Yamamoto , Yuki Yamamoto , Yasushi Takagi
Published: February 2024

Background:
Assessing carotid artery plaques in stenosis is crucial for treatment strategies and safety. Chemical exchange saturation transfer (CEST)-MRI, particularly Amide proton transfer (APT) imaging, shows promise in molecular imaging. This study explores the correlation between APT imaging and histopathological findings of carotid artery plaques in 34 consecutive patients who had carotid endarterectomy. We investigated the utility of CEST-MRI as a preoperative plaque diagnostic tool.

Methods:
APT imaging evaluated plaques prior to the procedures. APT signal values were derived from concentration maps. Plaques were categorized into Group A (APT signal values ≥ 1.90 E-04) and Group B (APT signal values < 1.90 E-04). Postoperative histopathological assessments were conducted on the excised plaques. Histology slides were categorized following AHA’s classification, distinguishing type VI lesions with intraplaque hemorrhage from non-type VI lesions.

Results:
Type VI lesions accounted for 64.7% (22 cases), while non-type VI lesions were 35.3% (12 cases). Type VI group showed significantly higher mean APT signal values (2.72 ± 1.96 E-04) compared to non-type VI group (0.70 ± 0.59 E-04) (p < 0.001). Pathologically, Group A had a significantly higher proportion of Type VI lesions (100%) than Group B (45%) (p < 0.01). Symptomatic patients or patients with worsening stenosis rates were significantly higher in Group A (75%) than Group B (36%) (p < 0.01).

Conclusion:
Elevated APT signals were observed in unstable plaques with intraplaque hemorrhage and in plaques of symptomatic or progressive stenosis patients. CEST-MRI evaluation is valuable for assessing plaque characteristics and activity.
Abstract WMP67: Pump Brain - A Leading Cause of Cortical Cerebral Microbleeds
Authors: Beba Abadal Kanita , Hairston Marla , Renati Swetha , Murtagh Ryan , Kumar Ambuj , Lozonschi Lucian
Published: February 2024

Introduction:
A major cause of cerebral microbleeds (CMBs) is underrecognized and has been attributed to cerebral amyloid angiopathy (CAA) throughout modern medicine. CMBs are acquired by patients undergoing cardiopulmonary bypass (CPB). CPB is utilized for heart and lung transplants, aorta repairs, valve surgeries, mass resections, and coronary artery bypass grafting (CABG) which alone accounts for 400k patients per year. CABGs can be done off CPB in certain patients. Due to their distribution, these CMBs are attributed to CAA, leading to confounding research and suboptimal patient care, especially in those requiring anticoagulation.

Methods:
This was a single-center, IRB approved, retrospective cohort study of patients who underwent CPB and had postop MRI between 11/1/11 and 3/1/23. Preop and additional postop MRIs were analyzed if available. Outcomes included number and distribution of CMBs, presence of superficial siderosis, FAZEKAS, and CPB duration. We also analyzed MRIs of patients who had off CPB CABG during the same period.

Results:
Out of 60 patients who underwent CPB, 60 had predominantly cortical CMBs on postop MRI, with a mean of 50 CMBs, and mean age of 61. The 6 patients who had CABG off CPB had 0 CMBs. Higher CMBs were associated with longer CPB duration and with procedures that are associated with more blood loss (p< 0.05). Despite having CMBs, no CPB patients had superficial siderosis, and they had relatively low FAZEKAS scores. Nineteen of the CPB patients had future MRIs and had no evidence of CMB progression.

Conclusion:
Cortical CMBs are associated with procedures that use CPB and are not seen in off CPB CABG. The CMBs may be related to utilization of cardiotomy suction that exclusively uses roller pumps. CBP related CMBs are a unique clinical entity that is not associated with the progressive cognitive changes and bleeding risk of CAA. While no significant short-term changes are noted, their mechanism and natural history requires further investigation.