bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP100: Acute Ischemic Stroke in Young Adults: A Comparative Analysis of Outcomes and Mortality in Metabolically Healthy Obese vs. Normal Weight Individuals, 2016-2019 Cohort
Authors: Annam Saketh , Mahadevan Arankesh , Tullimalli Immanuel R , Gondi Yasho C , Valluri Jnana Pramod , Lakkimsetti Mohit , Raj Rohan , Rajbhandari Pranaya , Kaur Parvinder , Anil Peethambar Gowri , Desai Rupak
Published: February 2024

Introduction:
Rising obesity rates and the increasing prevalence of stroke in the metabolically healthy obese (MHO) necessitate examining its association in younger (18-44 year) populations. Analyzing acute ischemic stroke (AIS) trends and outcomes in MHO vs. metabolically healthy normal weight (MH-NW).

Methods:
Data from the National Inpatient Sample (2016-2019) was analyzed to identify young MHO and MH-NW AIS patients using ICD-10 codes. Demographics, trends, and outcomes were compared using multivariable statistical approaches.

Results:
Of 26,949,310 young metabolically healthy individuals studied between 2016 and 2019, 47,795 had AIS, 4,985 were MHO, and 42,810 were MH-NW. The median AIS patient age was 35. The MHO cohort was primarily female, white, in the lowest income quartile, with private insurance. Most were hospitalized in southern US urban teaching hospitals. Notably, the MHO cohort had higher rates of specific comorbidities like depression, chronic pulmonary disease, and obstructive sleep apnea but lower rates of drug abuse and peripheral vascular disease. The in-hospital mortality rate was significantly lower in MHO patients (6.0% vs. 8.6%). Hospitalization length and cost did not significantly differ between groups. From 2016 to 2019, AIS incidence rose slightly, significant only for the MH-NW cohort. Adjusted multivariable odds ratios revealed no significant difference in AIS occurrence between MHO and MH-NW overall (aOR: 1.02, p=0.701), in males (aOR: 0.88, p=0.161) or females (aOR: 1.06, p=0.363). However, MHO-associated AIS had lower odds of in-hospital mortality than MH-NW (aOR: 0.60, p=0.021).

Conclusion:
AIS incidence was consistent across young metabolically healthy groups regardless of obesity status. However, we noted a paradoxical 40% reduction in in-hospital mortality in the MHO cohort. This underscores the complex MHO-stroke relationship in young adults, signaling a need for in-depth research and tailored interventions.
Abstract TMP108: External Validation of the SI
2
NCAL
2
C Score for Mortality Following Cerebral Venous Thrombosis
Authors: Klein Piers , Shu Liqi , Lindgren Erik , de Winter Maria A , Siegler James E , Simpkins Alexis N , Salehi Omran Setareh , Heldner Mirjam , de Havenon Adam H , Abdalkader Mohamad , Al Kasab Sami , Stretz Christoph , Wu Teddy , Wilson Duncan , Asad Syed Daniyal , Almallouhi Eyad , Frontera Jennifer , Kuohn Lindsey , Rothstein Aaron , Bakradze Ekaterina , Henninger Nils , Zubair Adeel S , Sharma Richa , Kerrigan Deborah , Aziz Yasmin , Mistry Eva , Sanchez van Kammen Mayte , Tatlisumak Turgut , Krzywicka Katarzyna , Aguiar De Sousa Diana , Jood Katarina , Field Thalia S , Yaghi Shadi , Coutinho Jonathan M , Nguyen Thanh N
Published: February 2024

Background:
Prognostication following cerebral venous thrombosis (CVT) remains challenging. Mortality is an uncommon yet catastrophic outcome after CVT. We sought to externally validate the SI
2
NCAL
2
C score for mortality in an international cohort.

Methods:
The SI
2
NCAL
2
C score was developed from the International CVT Consortium Registry to predict mortality by 30 days and one year using the factors: female-
s
ex-specific risk factors,
i
ntracerebral hemorrhage, CNS
i
nfection,
n
eurological focal deficits,
c
oma,
a
ge, hemoglobin
l
evel, glucose
l
evel, and
c
ancer. ACTION-CVT was an international retrospective study that enrolled consecutive patients with CVT across 27 centers. Model performance was evaluated using the area under the curve (AUC) of the time-dependent receiver operating characteristic curve and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations.

Results:
After exclusion of one site which contributed data to the derivation cohort, 950 of 1,025 patients enrolled in ACTION-CVT were analyzed. Compared to the derivation cohort, the ACTION-CVT cohort was older (median 44 vs 40 years), less female (63.4% vs 69.8%), and with milder clinical presentation (focal deficits 38.6% vs 57.1%; seizures 22.6% vs 36.7%). Mortality was 2.5% by 30 days and 6.0% by one year. The SI
2
NCAL
2
C score achieved an AUC of 0.716 [95% CI 0.603-0.823] for mortality by 30 days and 0.820 [0.761-0.878] for mortality by one year. Calibration plots demonstrated an overestimation of predicted risk among patients with low observed mortality, concordant with score derivation (Fig 1, A-D).

Conclusions:
The SI
2
NCAL
2
C score had acceptable performance in an international validation cohort despite differences in baseline characteristics between cohorts. The SI
2
NCAL
2
C score warrants additional validation studies in diverse populations and clinical implementation studies.
Abstract TMP117: Exposure to Single or Recurrent Hypoglycemia Increases Stroke Risk in Insulin-Treated Female Diabetic Rats
Authors: Rehni Ashish K , Cho Sunjoo , Raval Ami P , Perez-Pinzon Miguel , Dave Kunjan R
Published: February 2024

Stroke is a serious complication of diabetes. Intensive treatment of diabetes increases the risk of recurrent hypoglycemia (RH). Hypoglycemia exposure causes prothrombotic effects. Earlier, we demonstrated that exposure to single hypoglycemia (SH), 5-day RH (once every day), and twice-a-week RH for 6 weeks increases stroke risk in male insulin-treated diabetic (ITD) rats. In the present study, we determined the effect of SH and RH on stroke risk/thrombosis in female rats. Streptozotocin diabetic female rats were treated for hyperglycemia using insulin pellets (Figure A). Rats were randomly assigned to either hyperinsulinemic euglycemia (ITD+RH+Glucose, control) or hyperinsulinemic hypoglycemia (ITD+RH) groups (3 h duration) (Figure B). Separate groups tested the effect of SH, RH for 5 days, or RH for 6 weeks. Based on the results of the male studies, stroke risk after SH, 5-day RH, and 6-week RH were assessed on days 1, 7, and 3 post-last hypoglycemia, respectively. Groups were balanced (confirmed by Chi square test) in terms of the proportion of animals at different stages of the estrous cycle. To assess the risk of stroke, the carotid artery and jugular vein were linked with a shunt containing a suture, and the weight of the clot accumulated on the suture following 15 min of blood flow was quantified as a measure of stroke risk/thrombosis. The clot weight in the SH-exposed ITD group was significantly higher by 47% (22±3 mg, n=9, p<0.05) when compared to its respective control (15±1 mg, n=8). The clot weight determined 7 days after the 5-day ITD+RH group (18±1 mg, n=7) was significantly (p<0.05) higher than its control group (15±1 mg, n=9). The clot weight in the 6-week ITD+RH group was significantly higher by 47% (20±2 mg, n=9, p<0.01) when compared to its control (14±1 mg, n=7) (Figure C). Our results show that similar to male rats, SH and RH increase stroke risk in female ITD rats. We are currently evaluating the underlying mechanisms.

Acknowledgment:
NIH (NS122808).
Abstract TMP119: Evaluation of Cognitive Function and Plasma Biomarkers in a Microemboli-Based VCID Model in Rats: Applying Clinical Recommendations From MarkVCID and the Lacunar Intervention Trial-2 (LACI-2) to a Preclinical Model
Authors: Li Alice , Li Weiguo , Abdelsaid Kareem , Jamil Sarah , Abdul Yasir , Ergul Adviye
Published: February 2024

Diabetes doubles the risk of VCID. The underlying reasons are not understood, and preventive therapeutic strategies are lacking. We showed that diabetic but not control rats develop a progressive cognitive decline in a microemboli (ME) model of VCID. Given that cerebrovascular dysfunction is a common pathology between diabetes and VCID, we hypothesized that improvement of endothelial function in diabetes prevents ME-mediated cognitive impairment. Our treatment paradigm was based on the recently reported LACI-2 Trial which assessed the efficacy of isosorbide mononitrate (ISMN) and cilostazol (CZL) in the prevention of small vessel disease (SVD) progression. At 7-8 weeks after diabetes onset, control and diabetic rats were treated with ISMN/CZL for 4 weeks, then injected with cholesterol crystal ME and behavioral outcomes were monitored longitudinally for 16 weeks. Plasma biomarkers recommended by MarkVCID and
D
eterminants of
I
ncident
S
troke
C
ognitive
O
utcomes and
V
ascular
E
ffects on
R
ecover
Y
(DISCOVERY) Consortiums were measured using the angiogenesis (Flt-1, VEGF and FGF), neurology (GFAP, phosphoTau and Neurofilament Light NfL) and amyloid beta 42/40 panels from the Meso Scale Discovery. Behavioral deficits observed in the untreated diabetic rats were not noted in the treated group. Some of the biomarkers were unchanged (Table). This suggests that drug treatment with ISMN/CZL before ME injection prevented the possible deleterious effects of the latter in the diabetic rats by improving the endothelial integrity and it is a viable preventive and possibly therapeutic strategy for VCID.
Abstract TMP14: Population-Based Intracranial Vascular Imaging for Acute Ischemic Stroke is Suboptimal
Authors: Yu Amy Y , Austin Peter C , Silver Frank L , Mandzia Jennifer L , Jin Albert , Alonzo Rea , Fang Jiming , Carbonneau Anahita , Krings Timo , Linkewich Beth , Atzema Clare , Fralick Michael , Mamdani Muhammad , Swartz Richard H , Hill Michael D , Field Thalia S , Kapral Moira K
Published: February 2024

Introduction:
Endovascular thrombectomy (EVT) is the standard of care for patients with ischemic stroke and large vessel occlusion (LVO). Intracranial vascular imaging is required to determine the presence of an LVO. Although patients can be eligible for EVT up to 24h after last seen normal (LSN), current imaging protocols focus on the first 6h from LSN. We evaluated the use of intracranial vascular imaging in patients with ischemic stroke as a function of time since LSN in Ontario, Canada.

Methods:
We analyzed data from the Ontario Stroke Registry which performed primary data collection evaluating care and outcomes in 13,828 patients hospitalized with stroke across Ontario in the fiscal year 2019/20. This sampling strategy included 93.3% of all strokes in a province of 14.5 million residents. We used modified Poisson regression models to evaluate the association between time from LSN to first hospital presentation (<6h, 6-12h, 12-24h) and receipt of intracranial vascular imaging with computed tomographic angiography or magnetic resonance angiography. We adjusted for baseline differences and estimated the adjusted relative risk (aRR) of imaging.

Results:
Data collection is >75% completed and full results will be presented at the ISC. Of 8,482 patients with ischemic stroke, 6,345 (74.8%) presented within 24h of LSN (n=3,811 <6h; n=1,368 6-12h; n=1,166 12-24h). Median age was 76 years (IQR 66-85) and 3,002 (47.3%) were women. Overall, 5,196 (81.9%) patients had intracranial vascular imaging, but compared to those within 6h of LSN (86.8% imaged), patients presenting later were less likely to receive vascular imaging (77.2% for 6-12h, aRR 0.91 95%CI [0.88, 0.94] and 71.4% for 12-24h, aRR 0.85 95%CI [0.82, 0.88]). Of those imaged, 895 (17.2%) had an LVO (18.5% <6h; 16.4% 6-12h, 13.3% 12-24h, p<0.01) and 492 (55.0%) patients with LVO underwent EVT.

Conclusions:
On a population basis, over 80% of patients with ischemic stroke had intracranial vascular imaging, but gaps in care exist for those presenting in the later time window. Up to one in three patients presenting beyond 6h from LSN did not have vascular imaging. Systems of care must be optimized to support LVO identification and EVT access in later time windows.
Abstract TMP33: Do Social Networks Matter in Post-Stroke Communication Recovery?
Authors: Jones Jacqueline Nicole , Ellis Charles , Jacobs Molly
Published: February 2024

Purpose:
Current evidence highlights the value of social networks in stroke recovery. Social networks can be small or broad and are commonly associated with positive psychological, emotional, and physical stroke recovery outcomes. However, less is known about the relationship between social networks and post-stroke impairments such as communication disorders. This pilot study was designed to elucidate the relationship between types of social connections and post-stroke communication outcomes.

Hypothesis:
Social networks are positively associated with improvement in post-stroke communication outcomes, but the importance of social network subtypes differs among sociodemographic cohorts.

Methods:
Data was collected from 30 adults stroke survivors who completed the Stroke Impact Scale (SIS) Communication subtest and the Stroke Social Network Scale (SSNS). Regression analysis evaluated the relationship between the SIS Communication subtest score and SSNS network subtypes. Outcomes were evaluated across racial-ethnic groups to explore differential impacts.

Results:
The average SIS Communication scores differed significantly between Whites (81.75, SD=22.90) and Blacks (95.71, SD=4.95) (t=2.07, p=0.05) while SSNS Comprehensive scores were generally similar between the two groups (t=1.73, p=0.09). Both social ties (t=-1.73, p=.09) and satisfaction was higher among Black than White stroke survivors (t=1.85, p=0.08). SSNS Friend (β
Friends
=0.414, SE=0.414) and Group (β
Groups
=0.479; SE=0.266) subtest scores were positively associated with SIS Communication Impairment among both Black and White stroke survivors suggesting strong associations with lower impairment. However, the association between communication impairment and SSNS Children subtest scores differed between racial groups as noted by significant interaction effect (β
SSNS Childre
n*Black=0.821, SE=0.294).

Conclusions:
Lower levels of communication impairment were correlated with friendship and group attachments among Blacks and Whites. Social ties to children were observed among White stroke survivors with high levels of communication impairment, compared to Black stroke survivors who reported strong social ties to children at all impairment levels.
Abstract TMP40: The Impact of Social Determinants of Health on Stroke Readmissions and Recovery
Authors: Prologo-Richardson Paige , khalid Fatima , Brewster Pamela S , Castonguay Alicia , Rao Rahul , Jumaa Mouhammad A , James Elysia G
Published: February 2024

Introduction:
The consequences of increased morbidity and increased socioeconomic strain, for stroke survivors and their families, is well documented in stroke literature worldwide. Variables that determine readmission rates of stroke survivors may be complicated by the intersection of social determinants of health (SDOH). SDOH include race/ethnicity, insecurities, living conditions, social isolation, health literacy, income and education. This single center, prospective, observational study explores SDOH that lead to higher risk of readmission (within 30-days to 30-90 days) after discharge from the hospital once diagnosed with stroke or transient ischemic attack (TIA).

Methods:
A questionnaire was distributed to 100 patients admitted with acute stroke or TIA per the study inclusion criteria. Additional variables of interest collected included race, ethnicity, income, insurance status, treatment, baseline and discharge National Institutes of Health Stroke Scale score and modified Rankin scale (mRS) score, comorbidities, zip code and discharge disposition.

Results:
Univariate analysis found prior stroke/TIA and baseline mRS score of 0-2 to be statistically significant at predicting readmission within 30-days, p=0.07 and p=0.01, respectively. Multivariate analysis showed patients who find it difficult to eat healthy and participate in activities to improve their health, have history of prior TIA/stroke, coronary artery disease, diabetes and baseline mRS score were highly predictive for readmission.

Discussion:
SDOH are thought to contribute to readmission rates for patients who experienced stroke or TIA. In conclusion, our preliminary study found that patients who admitted to difficulties maintaining a healthy lifestyle had a correlation with both 30-day and 30-90 day readmission. Further studies are needed to identify the SDOH variables that most accurately predict readmission after stroke/TIA. This will further the mandate for increased precision medicine, tailoring targeted interventions to improve the quality of life for stroke survivors.
Abstract TMP56: Accuracy of Dual-Energy Computed Tomography for Differentiation Between Cerebral Hemorrhage and Contrast Extravasation Following Mechanical Revascularization in Acute Ischemic Stroke: A Diagnostic Accuracy Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , Faraj Hazem Abdelkarem A , Msherghi Ahmed
Published: February 2024

Background:
Mechanical revascularization has become an essential treatment for acute ischemic stroke patients. Post-treatment imaging frequently displays hyperdense regions, prompting concerns regarding possible cerebral hemorrhage. Dual-energy computed tomography (DECT), as an advanced imaging modality, offers the potential to discern between hemorrhage and harmless contrast leakage.

Aim:
This study aims to assess the diagnostic precision of DECT in distinguishing cerebral hemorrhage from contrast extravasation post-mechanical revascularization in acute ischemic stroke cases.

Methods:
A comprehensive search was performed for PubMed, EMBASE, and the Cochrane Library until January 2023. We focused on studies that focused on the diagnostic efficacy of DECT for this specific application. R software (version 4.0.3) coupled with mada package facilitated the analyses pooling metrics such as sensitivity, specificity, false-positive rate estimates, diagnostic odds ratio, and positive and negative Likelihood Ratios. These metrics were reported with a 95% Confidence Interval (CI).

Results:
Our analysis included 5 studies involving 241 patients. DECT demonstrated a pooled sensitivity of 94.5% (95% CI: 25.9% to 99.9%, I
2
=0%) and a specificity of 99% (95% CI: 77.3% to 100%, I
2
=0%). The false-positive rate was minimal at 1% (95% CI: 0% to 22.7%). The positive likelihood ratio was calculated as 98.94 (95% CI: 3.34 to 2929.22), while the negative likelihood ratio was 0.05 (95% CI: 0.001 to 2.21). The diagnostic odds ratio was substantial at 1795.17 (95% CI: 10.04 to 321055.24), signifying a robust performance of DECT in making the differentiation.

Conclusion:
While DECT manifests impressive accuracy in differentiating cerebral hemorrhage from contrast extravasation after mechanical revascularization in acute ischemic stroke cases, the wide confidence intervals signify a degree of uncertainty in these estimates. Nevertheless, given its high diagnostic metrics, DECT can substantially influence post-intervention evaluations, paving the way for more informed clinical decisions and potentially reducing patient adverse outcomes. However, further studies with larger sample sizes might help refine these diagnostic estimates.
Abstract TMP6: Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes
Authors: Sanchez Sebastian , Ojeda Diego , Sagues Elena , Gudino Andres S , Saleem Arshaq , Wendt Linder , Hayakawa Minako , Chen Ching-Jen , Sheehan Jason , Kim Louis , Abecassis Isaac , Levitt Michael , Meyer R Michael , Guniganti Ridhima , Kansagra Akash P , Lanzino Giuseppe S , Giordan Enrico , Brinjikji Waleed , Bulters Diederik , Durnford Andrew , Fox W Christopher , Smith Jessica , Polifka Adam , Gross Bradley , Amin-Hanjani Sepideh , Alaraj Ali , Kwasnicki Amanda , Starke Robert , Chen Stephanie H , van Dijk J Marc C , Potgieser Adriaan R , Satomi Junichiro , Tada Yoshiteru , Phelps Ryan , Abla Adib , Winkler Ethan , Du Rose , Lai Pui Man Rosalind , Ortega-Gutierrez Santiago , Zipfel Gregory J , Derdeyn Colin P , Samaniego Edgar A
Published: February 2024

Background:
Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) and cortical venous drainage have been reported in small series. However, a comprehensive description of the angiographic features of this dAVFs is lacking. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a better characterization of this subset of dAVFs.

Methods:
The CONDOR Consortium, a multicenter repository comprising 1077 dAVFs, served as the study population. Among the dAVFs, patients with dAVFs-CI were analyzed. A propensity scores matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was employed to identify angiographic characteristics specific to dAVFs-CI. Post-treatment outcomes were analyzed.

Results:
A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, p = 0.027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, p < 0.001) and draining veins (OR 2.05, 95% CI 1.05-4.46, p = 0.004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, p = 0.024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, p = 0.09).

Discussion:
Venous hypertension is a key angiographic feature dAVFs-CI. dAVFs-CI exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, closure of the dAVF has the potential to reverse symptoms in certain cases (Figure).
Abstract TMP7: Disruption of Blood Brain Barrier is Associated With Silent Cerebral Infarcts in Patients With Sickle Cell Disease
Authors: Wang Yan , Astafiev Serguei V , Fellah Slim , Guilliams Kristin P , Fields Melanie E , Mirro Amy , Lewis Josiah B , Reis Martin N , Chen Yasheng , King Allison A , Lee Jin-Moo , An Hongyu , Ford Andria L
Published: February 2024

Background:
Microvascular thromboinflammation is a major pathomechanism underlying vaso-occlusive crisis in patients with sickle cell disease (SCD), yet its role underlying the elevated stroke risk in SCD is unclear. Tissue-based blood brain barrier (BBB) imaging, as a metric of cerebral thromboinflammation, has not been well studied in SCD. We hypothesized that BBB permeability would be increased in patients with SCD and associated with ischemic burden.

Methods:
Ten young adults with SCD and 17 controls underwent dynamic contrast-enhanced and multimodal MRI to quantify BBB gadolinium leakage rates (Ktrans), white matter microstructural disruption (increased mean diffusivity, MD), and volume of silent cerebral infarcts (SCI). Infarct voxels were removed to avoid the confounding effects of measuring Ktrans in previously infarcted tissue. Whole brain mean Ktrans measures were compared between SCD vs. controls. Bivariate Spearman’s rank correlations measured relationships between Ktrans and SCI volume / MD.

Results:
BBB permeability, measured by whole brain Ktrans, was elevated in SCD vs. controls (Fig A). Compared to controls, Ktrans was elevated in SCD with infarcts (B), while SCD without infarcts did not differ from controls. In participants with infarcts, Ktrans, measured within non-infarcted tissue, positively correlated with SCI volume (Rho=0.6,
p
=0.015, C). Furthermore, whole brain Ktrans, positively correlated with MD in normal appearing white matter (Rho=0.5,
p
=0.01).

Conclusion:
Our preliminary data suggest BBB permeability is elevated and associated with stroke and microstructural injury in young adults with SCD. We are enrolling more participants. Children with SCD may also have BBB injury but will require a novel non-contrasted MR approach to assess. BBB permeability may provide new insight into the increased stroke risk in SCD. Targeting thromboinflammation and preserving BBB integrity may lead to novel neuroprotective pathways.
Abstract TMP72: Impaired Perfusion Predicts Early Recurrence in Symptomatic Intracranial Atherosclerosis
Authors: Yaghi Shadi , Shu Liqi , de Havenon Adam H , Khatri Pooja , Torabi Radmehr , Jayaraman Mahesh , Moldovan Krisztina , Liebeskind David S , Prabhakaran Shyam , Khan Farhan , Goldstein Eric , Furie Karen L
Published: February 2024

Background:
Intracranial Atherosclerosis (ICAS) leads to stroke by perforator disease, artery to artery embolism, and impaired distal flow/perfusion. While medical treatment is likely to stabilize atherosclerotic plaques, it is unlikely to improve distal perfusion in the acute setting. We hypothesize that medically treated patients with symptomatic ICAS with impaired perfusion have a high risk of recurrence.

Methods:
We included hospitalized patients with acute ischemic stroke due to ICAS involving the intracranial ICA, proximal MCA, intracranial vertebral artery, or basilar artery over a 3 year period. Patients were treated with medical treatment and followed for 30-days post stroke. Patients generally underwent perfusion imaging with MRI. The study outcome is recurrent ischemic stroke. We used univariate and multivariable Cox regression analyses to determine the association between risk factors, treatment strategies, perfusion delay at T
max
4 sec and 6 sec thresholds. To account for multiple admissions per patient, we used robust variance estimator clustering on individual patients.

Results:
Over the study period, we identified 96 hospitalizations for symptomatic ICAD over 3 years. The recurrence risk within 30 days was 17.7% (17/96). In univariate analysis, factors associated with recurrent risk at 30 days were lack of dual antiplatelet therapy (47.1% versus 22.8%, P=0.068), increased Tmax perfusion mismatch volume as 6 sec (10[0-51] versus 0[0-0], P=0.008) and at 4 sec (60[37-170] versus 13.5[0-91], P=0.050). Using Youden’s index, we identified cutoffs of 6.5 ml and 35.5 ml for Tmax 6 sec mismatch and Tmax 4 sec mismatch respectively. In Cox regression analyses, only predictors of recurrence were T max 6 sec perfusion mismatch > 6.5 ml (aHR 6.72 95% CI 2.01-22.45 p=0.002) and T max 4 sec perfusion mismatch > 35.5 ml (aHR 5.78 95% CI 1.53-21.81 p=0.010). Dual antiplatelet therapy was not associated with reduced recurrence risk (p>0.05) in all models.

Conclusions:
Patient with symptomatic ICAS and impaired distal perfusion are at high risk of early recurrence. Studies testing reperfusion should focus on this subgroup and enroll patients early, when the risk of recurrence in medically treated patients is highest and likely driven by reperfusion.
Abstract TMP80: Hematoma Radiomic Markers of Survival After Supratentorial Intracerebral Hemorrhage on Admission Non-Contrast Head CT
Authors: Zaman Saif , Dierksen Fiona , Haider Stefan , Qureshi Adnan I , Werring David J , Malhotra Ajay , Falcone Guido J , Sheth Kevin N , Payabvash Seyedmehdi
Published: February 2024

Background:
Radiomic features provide quantitative information about lesions morphology and texture on medical images. Recent studies have shown that intracerebral hemorrhage (ICH) radiomics on admission non-contrast head CT are associated with severity of symptoms at baseline and clinical outcomes - providing prognostic information beyond hematoma volume. In this study, we determined hematoma radiomic markers of post-ICH survival on admission head CT.

Methods:
Using the ATACH-2 trial dataset, we manually segmented ICH on admission head CTs and extracted 1130 radiomic features. Univariate and multivariate survival analyses were performed using the Cox Proportional Hazards model, Kaplan Meier Analysis, and logistic regression.

Results:
We split our dataset (n=871) to training (n=580) and testing (n=291) cohorts. Increased “original first order Energy” radiomic feature was associated with a higher probability of death (Hazard Ratio=1.64, p <0.0001). LASSO Cox Proportional Hazards modeling also identified “original first order Energy” alongside age, NIHSS, and baseline INR as significant predictors of death. The ROC analysis confirmed the prognostic capability of this feature at 7 days, 30 days, and 90 days post-ICH in training and test cohorts. Kaplan Meier analysis demonstrated that increased “original first order Energy” is associated with a higher probability of death (p < 0.05 at all time points). Logistic regression also showed that this feature is an independent predictor of post-ICH mortality (Odds ratios=2.04, p < 0.001).

Conclusions:
The “original first order Energy” radiomic feature of hematoma on admission non-contrast head CT scans is a main predictor of survival in supratentorial ICH. This radiomic feature represents the magnitude of voxel values confounded with lesion volume - i.e. brighter larger hematomas on head CT have higher " original first order Energy ", and are associated with higher mortality rates after supratentorial ICH.
Abstract TMP86: Effects of Tenecteplase versus Alteplase in Stroke Patients With Large Vessel Occlusions Who Achieve Full Recanalization
Authors: Gedansky Aron , Patterson Thomas , Toth Gabor
Published: February 2024

Introduction:
Tenecteplase improves reperfusion and functional outcomes in stroke patients with large vessel occlusion. TNK is more specific for fibrin than TPA, however, it is unclear if this effect could increase efficacy of mechanical thrombectomy (MT). We aimed to determine if TNK is associated with higher recanalization rates and better clinical outcomes than TPA in patients who undergo MT.

Methods:
Electronic medical record review of acute stroke patients with LVO, age over 18 years, who received both thrombolysis with either TNK or TPA, and underwent MT at a tertiary medical center from January 2017 to April 2023 was performed. Use of TPA was converted to TNK on 1/11/2022 per hospital policy. Number of passes and time to full recanalization (defined as TICI 3) were recorded. Primary outcome was mRS at 90 days. Secondary outcomes were NIHSS at 24 hours and at discharge. Primary safety outcome was parenchymal hematoma type 2 (PH2) intracerebral hemorrhage. A t-test was used to examine association between outcomes and thrombolysis type. Fischer’s exact test was used to determine differences in recanalization and hemorrhage rates.

Results:
Of the 284 patients included, 213 received TPA and 71 received TNK. Mean age was 68, and 50.0% were females. Forty-three patients (60.6%) who received TNK, and 96 patients (45.1%) who received TPA achieved TICI 3 score (P=0.028). There was no difference in time to recanalization (38.5 min versus 32 min, p=0.872), median number of passes (1 versus 1, p=0.934), median 90-day mRS (2 versus 1.5, p=0.434), or the rate of PH2 hemorrhage (0% versus 2.3%, p=0.336) for TNK vs TPA in patients with TICI 3 recanalization. Median NIHSS at presentation (18.0 versus 16.0, p=0.398), at 24 hours (8.0 versus 7.0, p=0.406), and at discharge (3.0 versus 4.0, p=0.383) were similar for all patients receiving TNK and TPA, respectively.

Conclusions:
In our retrospective analysis, TNK showed a higher rate of TICI 3 recanalization for patients with LVO, who both received thrombolysis and underwent MT. There was no difference between TNK and TPA for number of passes, time to recanalization, parenchymal hematoma rate, and clinical outcomes in patients who achieved TICI 3. Overall clinical outcomes were also similar, irrespective of recanalization grade.
Abstract TMP91: Clinical Change During Inter-Hospital Transfer for Thrombectomy: Incidence, Associated Factors and Relationship With Outcome
Authors: Seners Pierre , ter Schiphorst Adrien , Wouters Anke , Yuen Nicole , Mlynash Michael , Arquizan Caroline , Heit Jeremy J , Kemp Stephanie M , Christensen Soren , Sablot Denis , Wacongne Anne , Lalu Thibault , Costalat Vincent , Albers Greg , Lansberg Maarten G
Published: February 2024

Background:
Patients with acute ischemic stroke harboring a large vessel occlusion (LVO) admitted to non endovascular-capable centers often require inter-hospital transfer for thrombectomy. We aimed to describe the incidence of substantial clinical change during transfer, the clinical and imaging factors associated with change, and its relationship with 3-month outcome.

Methods:
We analyzed data from two prospectively collected cohorts of acute stroke patients transferred for thrombectomy to a comprehensive center (Stanford, USA, Nov 2019-Jan 2023; Montpellier, France, Jan 2015-Jan 2017). Patients were included if they had evidence of an LVO at the referring hospital and had an NIHSS score documented before and immediately after transfer. Inter-hospital clinical change was categorized as improvement (>=4 points and >=25% decrease between the NIHSS score in the referring hospital and upon comprehensive center arrival), deterioration (>=4 points and >=25% increase), or stability (neither improvement nor deterioration). The stable group was considered as the reference, and was compared to the improvement or deterioration groups separately.

Results:
A total of 504 patients were included, of whom 22% experienced inter-hospital improvement, 14% deterioration, and 64% were stable. Pre-transfer variables independently associated with clinical improvement were intravenous thrombolysis use, more distal occlusions, and lower serum glucose; variables associated with deterioration included more proximal occlusions and higher serum glucose. On post-transfer imaging, clinical improvement was associated with arterial recanalization and smaller infarct growth; and deterioration with larger infarct growth. As compared to stable patients, those with clinical improvement had better 3-month functional outcome (adjusted common OR=2.39; 95%CI=1.57-3.64), while those with deterioration had worse outcome (adjusted common OR=0.56, 95%CI=0.34-0.92).

Conclusion:
Substantial inter-hospital clinical changes are frequently observed in LVO-related ischemic strokes, with significant impact on functional outcome. There is a need to develop treatments that improves the clinical status during transfer.
Abstract TP103: Association Between Neighborhood-Level Disadvantage and Patient-Reported Mental Health Outcomes in Intracerebral Hemorrhage Survivors
Authors: Taylor Christopher L , Zabinska Julia , Falcone Guido J , Lalwani Dheeraj , Peasley Emma , Sansing Lauren H , Arora Rohan , Mena-Hurtado Carlos , Forman Rachel , de Havenon Adam H , Okpala Munachi N , Bushnell Cheryl D , Mullen Michael T , Cohen Jordana , Cohen Debbie L , Messe Steven , Sheth Kevin N
Published: February 2024

Introduction:
The influence of social determinants of health (SDH) is well-documented across a range of medical conditions and health outcomes. Less clear is the impact of SDH on patient-reported outcomes, particularly mental health outcomes, in intracerebral hemorrhage (ICH). This study examines the association between the Area Deprivation Index (ADI), a measure of neighborhood-level disadvantage, and self-reported health outcomes in ICH survivors.

Methods:
This investigation is nested within the REDUCE clinical trial, an ongoing, randomized trial comparing standard-of-care to spironolactone-containing hypertension regimens in ICH survivors. Participants complete the PROMIS Global Health survey at baseline. Global Mental Health (GMH) and Global Physical Health (GPH) scores are standardized to t-scores (GMH 21.2-67.6; GPH 16.2-67.7) around a reference population mean (50 ± 10). ADI uses elements of income, education, employment, and housing quality to assign a composite score (1-100), with a higher score signifying greater disadvantage. Patients were grouped into tertiles based on ADI. GMH and GPH scores were analyzed against the reference mean via a one-sample t-test and across tertiles with a one-way ANOVA. Bivariable linear regression examined ADI as a continuous variable. Multivariable models adjusted for sex, age, race, ethnicity, ICH to baseline interval, and baseline mRS.

Results:
Fifty patients were included in the analysis. Those in the third, most disadvantaged, tertile had significantly lower GMH scores (39.5 ± 8.17) than the reference population (p<0.001), the first tertile (54.10 ± 10.20, p<0.001), and the second tertile (50.4 ± 8.90, p=0.003). In multivariable analysis, these differences remained significant (T3 vs. T1, B= -18.31, p<0.001; T3 vs. T2, B= -14.67, p<0.001). Further, ADI as a continuous variable was significantly associated with GMH scores in bivariable (B= -0.22, p<0.001) and multivariable analysis (B= -0.23, p=0.005). No significant relationship was found between ADI and GPH.

Conclusions:
Higher ADI is associated with worse patient-reported mental health outcomes after ICH. Neighborhood disadvantage, and its constituting factors, should be considered in reporting post-ICH patient care and outcomes.
Abstract TP105: Neurointervention Simulation Workshop for Neurology Residents
Authors: Tarasaria Karan , Mehta Tapan
Published: February 2024

Background:
Endovascular Thrombectomy is now standard of care and widely used treatment for large vessel occlusion strokes in appropriately selected patients. Neurology Residents have minimal exposure to formal neuro-interventional procedures which may lead to limited technical understanding and comfort in discussing the procedure with patient and interdisciplinary teams.

Methods:
A prospective quasi-experimental, pretest/posttest study was conducted. Participants included 18 Neurology Residents in a standardized simulation of endovascular thrombectomy procedure using a flow model supervised a neuro-interventionalist followed by a debriefing session. Questionnaire included items on technical knowledge of endovascular thrombectomy as well as assessment of subjective comfort related to procedure and consent process. Responses were analyzed using Pearson coefficient.

Results:
On a 10-point Likert scale, median score for trainee comfort in discussing endovascular thrombectomy with patient/family and stroke attending increased from 5 to 8 (p < 0.05) and 4 to 7 (p < 0.05) respectively. Residents also reported improvement in procedural understanding with median score of 7 following simulation compared to 2 prior (p < 0.05).

Conclusion:
Observable enhancements in procedural comprehension, accompanied by increased subjective comfort in engaging in discussions concerning the endovascular thrombectomy procedure with patients and/or their family members, were clearly identified among Neurology Residents following their engagement in simulation-based training. The utilization of neuro-interventional simulation presents a promising avenue for complementing the skill development of trainees involved in the management of patients with acute large vessel occlusion, who are being evaluated for potential mechanical thrombectomy interventions.
Abstract TP106: Intravenous Thrombolysis Door-to-Needle Times of English and Non-English Speaking Patients
Authors: Huang Holly Y , Dobson Ana , Harman Tyler D , Moreno-Gomez Veronica , Wiggins Judea , Majersik Jennifer J
Published: February 2024

Introduction:
Language barriers between acute ischemic stroke patients and clinicians can create challenges in use of intravenous thrombolysis (IVT) as successful administration hinges on quick information gathering, shared decision making and consent with the patient and family. Our objectives were to compare IVT door-to-needle (DTN) times and consent between English and non-English speaking patients.

Methods:
We conducted a single institution retrospective chart analysis from 2018-2023 via manual data extraction of the electronic medical record to determine any disparities in quality metrics between English and non-English speakers treated with IVT. Standard time-based metrics were pulled from the AHA Get with the Guidelines registry. We included adult patients treated onsite, excluding telestroke encounters. We used standard descriptive statistics and a 2-paired t-test to compare treatment times.

Results:
We included 215 English speakers and 19 non-English speakers in our analysis. Consent was obtained in 92% (197/215) of English speakers and 90% (17/19) of non-English speakers, the remaining implied consent or consent was undocumented. Mean DTN times were 48.8 min and 48.2 min for English and non-English speakers, respectively, and differences were not statistically significant.

Discussion:
Previous studies have reported lower IVT use, longer DTN times and poorer clinical outcomes in patients who required an interpreter. However, others reported no difference in DTN times in non-English patients, attributing availability of translating services and diversity of healthcare providers. In our population, DTN times remained equally fast, but we remain unsure if our non-English speakers are appropriately consented, understanding their acute care. Future directions include improving consent documentation, and conducting qualitative interviews of English and non-English speakers who receive IVT. Our ultimate goal is to ensure quality of care for this vulnerable population.
Abstract TP11: Familial Cerebral Cavernous Malformations: Impact of Lesion Number and Size on Functional Status and Quality of Life
Authors: Vassar Rachel , Nelson Jeffrey , McCulloch Charles , Akers Amy , Lee Cornelia , Zabramski Jospeh , Mabray Marc , Hart Blaine , Morrison Leslie , Kim Helen ,   Brain Vascular Malformation Consortium CCM Investigator Group
Published: February 2024

Introduction:
Individuals with familial cerebral cavernous malformation (FCCM) syndrome may experience a wide variety of psychosocial challenges beyond the known neurologic sequelae of headache, seizure, and intracerebral hemorrhage. Little is known about how number and size of CCMs correlate with overall function and quality of life. This study aims to better characterize the impact of CCM burden on function and quality of life using a standardized metric.

Methods:
Patients with FCCM from four institutions were included for analysis. Functional status and quality of life were measured using the Neuro-QoL (available at www.NIHToolbox.org). Lesions were manually counted on brain MRI at time of enrollment; lesions ≥5mm were considered large lesions. Log-squared residuals were determined for each subject to adjust lesion count based on age and sex. Linear regression analysis was performed to assess association between adjusted number of lesions and Neuro-QoL scores.

Results:
96 patients with FCCM were included from four organizations. FCCM genetic subtype was known in 59/96 (61%) of cases (CCM1: n= 53; CCM2: n=4; CCM3: n=2); the remainder were diagnosed based on clinical criteria. Median mRS was 1; 41% had experienced intracerebral hemorrhage. Increased number of lesions was associated with higher emotional dysregulation (p=0.045) and less positive affect (p=0.022). Increased number of large lesions was associated with increased stigma (p=0.033) and decreased social participation (p=0.041) and social satisfaction (p=0.031). Anxiety, depression, upper and lower extremity function, and cognition showed no significant association with number of lesions regardless of size.

Conclusions:
This study highlights that mood may be associated with number of CCM lesions and social participation may be associated with number of large lesions. Motor function and diagnoses of anxiety and depression showed no significant association with CCM burden. As treatments emerge for individuals with FCCM, metrics such as the Neuro-QoL allow for standardized measurement of impacts of treatments on patient-centric outcomes such as function and quality of life.
Abstract TP114: Financial Well-Being Among US Adults the Impact of Vascular Conditions and Social Disadvantage
Authors: Jacobs Molly , Evans Elizabeth , Ellis Charles
Published: February 2024

Background:
“Financial toxicity” refers to the deleterious impact of healthcare expenditures or conditions. Using the Consumer Financial Protection Bureau’s (CFPB) Financial Well-Being (FWB) Scale, this study evaluated the impact of cardiovascular disease (CVD), stroke, high blood pressure (BP), and high cholesterol on individual FWB.

Methods:
Using data from the Understanding America Survey—a nationally representative, longitudinal panel of approximately 6,000 adults—we identified adults with self-reported diagnoses of high cholesterol, high BP, stroke, and CVD between 2014 and 2020. Scored between 0 and 100, the FWB Scale can be used to compare a person’s self-assessed financial circumstances including income, savings, debt, financial distress, and preparedness. To assess the potential financial toxicity of these conditions, we used separate stratified, longitudinal mixed regression models for each condition. Model covariates included sex, age, marital status, household size, household income, education, race/ethnicity, insurance, body mass index (BMI), and an indicator of the condition of interest. Differential financial toxicity was captured through interactions between sociodemographic characteristics and condition indicators.

Results:
Whites had the highest FWB scores (69.0, SD=21.8), followed by other (i.e., Asian, American Native, Hawaiian/Pacific Islander, multiracial) racial groups (66.7, SD=21.0), Hispanics (59.3, SD=21.6), and Blacks (56.2, SD=21.4). After controlling for income, education, and household characteristics, average FWB of individuals with vascular conditions was not statistically different from those without. However, compared to Whites, Blacks with CVD (-7.4, SD=1.0), stroke (-8.1, SD=1.5), high cholesterol (-5.7, SD=0.7), and high BP (6.1, SD=0.7) had significantly lower FWB. Similarly, Hispanics with high BP (-3.0, 0.6) and CVD (-6.3, 1.3) had lower FWB. Income, education, insurance, and marital status were also significantly correlated with FWB for each condition.

Conclusions:
Findings indicated that FWB was lower among Blacks and Hispanics diagnosed with vascular conditions. These results indicate the potential financial toxicity of vascular conditions.