bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP190: Predicting Intracranial Atherosclerosis-related Large Vessel Occlusion Using Deep Learning on Neuroimaging and Clinical Data.
Authors: Gonzalez-Riveros Jesus David , Canals Pere , Rodrigo-Gisbert Marc , Mayol Jordi , Garcia-Tornel Garcia-Camba Alvaro , Ribo Marc
Published: January 2025

Background:
Predicting recanalization in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) may help in optimizing treatment strategies but remains a critical challenge. Patients presenting intracranial atherosclerosis-related large vessel occlusion (ICAS-LVO) may benefit from performing an early bailout strategy after failed MT with conventional devices. Current predictive models often fail to effectively integrate complex interactions between clinical data and neuroimaging features. We aimed to explore predictive models for ICAS-LVO after an unsuccessful first pass, combining neuroimaging and clinical data.

Methods:
This retrospective, single-center study of patients presenting anterior LVO stroke from 2017 to 2023. ICAS-LVO was defined by fial angiographic stenosis >50% or failed MT (eTICI0-2a) with no evidence of other underlying etiology (i.e cardioembolic). Neuroimaging data included raw non-contrast CT and CTA volumes, automatic vascular segmentation, and CTP output values. Clinical data, such as patient demographics, stroke severity, and comorbidities, were incorporated into the model. A Dynamic Affine Feature Map Transform (DAFT) mechanism was used to integrate imaging data, encoded with a convolutional neural network, with clinical variables. A comparative analysis including several image-based deep learning models and known machine learning models trained on clinical data was performed. Data were split into 80% for training with four-fold cross-validation and 20% for testing.

Results:
A total of 262 patients (median age 81 IQR 69-88, 61% women; 11.83% with ICAS-LVO) with anterior LVO and failed MT first attempt (eTICI 0-2a) were included. Training sample was of 212 patients (12.73% with ICAS-LVO). A consecutive sample of 50 patients (8% with ICAS-LVO) was reserved for testing. The best-performing model achieved an AUC of 0.73 ± 0.10 (mean ± std), and a F1 of 0.44 ± 0.15 in validation and an AUC of 0.64 ± 0.12, and a F1 of 0.21 ± 0.09 on internal testing.

Conclusions:
Although effective prediction of ICAS-LVO remains challenging, models using multi-modal data were superior to those using imaging or clinical data alone emphasizing the importance of combining multiple sources of data to enhance predictive capabilities. This model could be useful to rapidly identify patients with suspected ICAS-LVO prior to MT and optimize endovascular treatment strategy after the initial attempt.
Abstract WP195: Determining Indications for Endovascular Treatment of Medium Vessel Occlusion Based on Perfusion Imaging Results
Authors: Uchida Kazutaka , Tanada Shunichi , Sakakibara Fumihiro , Shirakawa Manabu , Yoshimura Shinichi
Published: January 2025

Introduction:
Randomized clinical trials evaluating the effects of endovascular treatment (EVT) for medium vessel occlusion (MeVO) are ongoing. However, it remains unclear how clinicians determine the indication for EVT in MeVO cases in real-world practice

Hypothesis:
We hypothesize that in actual clinical practice, there is a threshold of clinical symptoms and perfusion imaging findings that guide the decision to intervene with EVT for MeVO.

Methods:
We conducted a single-center retrospective registry from April 2019 to April 2024, enrolling consecutive patients with acute ischemic stroke due to MeVO. We compared the outcomes of MeVO patients who received EVT with those who received medical treatment (MT). The primary outcome was defined as a good functional outcome, indicated by a modified Rankin scale score of 0-2 at 90 days post-stroke onset. Secondary outcomes included exploring the optimal thresholds for EVT intervention in real-world clinical practice, based on clinical symptoms indicated by the National Institutes of Health Stroke Scale and perfusion imaging using RAPID software.

Results:
We analyzed 162 patients (EVT, n = 102; MT, n = 60). The mean age was 80 years, with 53.7% being men. Recombinant tissue plasminogen activator was used more frequently in the EVT group (42.2% vs. 18.3%). The median NIHSS was higher in the EVT group (median [interquartile range, IQR]; 13 [6–19] vs. 7 [2–14]). In terms of perfusion imaging, there was no significant difference between the two groups in CBF < 30% (median [IQR]; 4 [0–17] vs. 4 [0–22]). However, the median T max > 6 sec and mismatch volume were significantly higher in the EVT group (median [IQR]; 44 [27–82] vs. 28 [6–49] and 35 [21–55] vs. 12 [2–28], respectively). The primary outcome was not significantly different between the EVT and MT groups (41 [40.2%] vs. 25 [41.7%]; adjusted odds ratio [aOR]: 1.10 [95% CI: 0.42–2.89]). Receiver-operating characteristic analyses showed that the areas under the curves for NIHSS, CBF < 30%, T max > 6 sec, and mismatch volume were 0.64, 0.49, 0.68, and 0.74, respectively. Mismatch volume had the best discriminatory power with respect to EVT intervention, with a threshold of 20 ml.

Conclusions:
A mismatch volume of ≥ 20 ml may be a useful criterion for determining EVT intervention in MeVO cases in real-world practice.
Abstract WP199: Profiles of Cortical White Matter Hyperintensity Burden Measured using the SPOTTY Tool Align with Fazekas Scores in ICH Patients.
Authors: Potter Thomas , Aamodt Eva , Borei Karim , Bako Abdulaziz , Khan Osman , Pan Alan , MacIntosh Bradley , Vahidy Farhaan
Published: January 2025

Introduction:
White matter hyperintensity (WMH) burden is associated with poor cognitive and functional outcomes after intracerebral hemorrhage (ICH). Grading WMH burden is commonly performed using morphometric scales like Fazeka’s scores, which require training and may be prone to subjectivity. Deep-learning models provide a potential alternative to quantify WMH burden. We compare WMH volumes calculated using the SPOTTY tool with categorical Fazekas scores.

Methods:
An analytical group of adult (>18) ICH patients was created by randomly sampling from the Registry for Neurological Endpoint Assessment among patients with Ischemic and Hemorrhagic Stroke (REINAH) database, which includes Fazeka’s scores for ICH patients with available MRIs. Total Fazekas scores (Periventricular + Deep) were determined and patients were randomly selected at each level. T2 FLAIR images used for initial Fazekas scoring were retrieved and the previously trained SPOTTY tool was used mask WMH lesions and calculate total lesion volume in cm
3
. Calculated WMH volumes are reported as medians and interquartile ranges, with statistical differences assessed across Total Fazekas score (0-6), severe WMH burden in the periventricular (PV) (Fazeka’s score =3) and deep (Fazeka’s score ≥ 2) white matter, and in-hospital mortality using Mann Whitney Rank Sum and Kruskal Wallis tests of hypothesis.

Results:
The final cohort included 476 total patients admitted between May 2016 and August 2024. Patients had a median age of 68 [55-77] years and included 236 (49.5%) female and 86 (18.0%) Hispanic patients, with a racial distribution of 289 (60.6%) White, 131 (27.5%) Black, 43 (9.0%) Asian/Native Hawaiian or Pacific Islander, and 14 (2.9%). 147 (30.9%) had severe PV WMH, 251 (52.7%) showed severe deep WMH, and 72 (15.1%) died in-hospital. Significant differences were found between SPOTTY-calculated volumes for non-severe and severe PV WMH (4.40 [1.47-10.15] vs 24.01 [14.99-35.69] p<0.001), non-severe and severe deep WMH (2.51 [0.98-5.72] vs 18.45 [9.47-31.06]; p<0.001) (Figure 1), and across Total Fazekas Score (Figure 2; p<0.001). Patients who died in-hospital similarly had higher SPOTTY WMH volumes than those who did not (12.51 [3.84-24.43] vs 7.85 [2.31-19.29]; p=0.032).

Discussion:
The SPOTTY tool provides an avenue for automatic assessment of WMH burden in ICH patients.
Abstract WP204: Prolonged Venous Transit on Perfusion Imaging Is Associated With Prolonged Hospitalization in Acute Large Vessel Occlusion Strokes
Authors: Koneru Manisha , Lakhani Dhairya , Salim Hamza , Hillis Argye , Urrutia Victor , Marsh Elisabeth , Leigh Richard , Llinas Rafael , Albers Gregory , Dmytriw Adam , Guenego Adrien , Wintermark Max , Heit Jeremy , Faizy Tobias , Yedavalli Vivek
Published: January 2025

Introduction:
Prolonged venous outflow (PVT+) is a surrogate marker for venous outflow. The PVT is defined as the presence or absence of time-to-maximum >= 10 seconds timing in either the superior saggital sinus or torcula on visual time-to-maximum maps from perfusion imaging. This novel metric has been shown to be associated with higher odds of mortality and lower liklihood of functional recovery, despite successful reperfusion with mechanical thrombectomy. The study aims to assess the relationship between PVT and length of hospitalization. We hypotheisze that PVT+ will be associated with longer lengths of stay.

Methods:
Acute large vessel occlusion ischemic stroke patients successfully reperfused with thrombectomy between 01/2017-09/2022 were retrospectively reviewed. Primary outcome was length of hospitalization. Multivariable linear regressions were performed for the outcome of length of stay.

Results:
Of 109 patients, the median age was 71 (IQR 62-80) years. PVT+ patients had significantly longer lengths of stay than PVT- patients (9 days (IQR 6-18) versus 6 days (IQR 4-12), p=0.03). In multivariable regressions adjusting for other clinical covariables, PVT+ was significantly associated with two additional days of hospitalization compared to PVT- patients (p=0.03).

Conclusion:
Despite successful reperfusion, PVT+ was associated with two additional days of hospitalization on average comapred to PVT- patients. PVT is a simple, qualitative metric that demonstrates robustness in correlations with a range of short and long term clinical outcomes, and thus this novel surrogate of venous outflow may be informative for clinical practice.
Abstract WP206: MR-Negative Posterior Reversible Encephalopathy Syndrome: Clinical Characteristics are Similar in Hypertensive Encephalopathy without Vasogenic Edema and Typical PRES
Authors: Bates Molly , Fugate Jennifer , Mandrekar Jay , Rabinstein Alejandro
Published: January 2025

Introduction:
Posterior reversible encephalopathy syndrome (PRES) has been defined based on classic risk factors, clinical characteristics, and evidence of reversibility. Radiographic evidence of vasogenic edema, which is best seen on MRI, is considered a cornerstone of the diagnosis. Yet, severity of clinical presentation does not correlate with extent of edema on MRI. We sought to explore whether PRES can present with negative MRI by comparing clinical features between cases of PRES with classic MRI findings and cases of hypertensive encephalopathy without MRI changes.

Methods:
Patients diagnosed with hypertensive encephalopathy from August 1, 2008 to December 31, 2017 were identified retrospectively and matched by age (+/- 5 years) and sex in a 2:1 ratio to patients retrospectively identified as having PRES from January 1
st
, 2002 to November 30
th
, 2017. All patients had undergone MRI, and images were reviewed. A detailed review of clinical information from the medical records was performed and included analysis of presenting symptoms, risk factors, and medical history.

Results:
We identified 16 cases of hypertensive encephalopathy and 32 age and sex matched controls with PRES on MRI. There were no statistically significant differences in the odds of presentation with headache (OR=1.372, 95% CI [0.458, 4.106]), encephalopathy (OR=2.303, 95% CI [0.433, 12.236]), visual disturbance (OR= 0.826, 95% CI [0.185, 3.697]), or focal neurologic deficit (OR=4.000, 95% CI [0.767, 20.872]). Seizures were more common at presentation in patients with typical PRES with vasogenic edema (OR=0.082, 95% CI [0.010, 0.664]). There was no significant difference in baseline creatine (OR= 0.874, 95% CI [0.424, 1.799]), admission creatine (OR= 1.215, 95% CI [0.819, 1.803]), or odds of acute kidney injury (OR=2.90, 95% CI [0.679, 12.449]). There were no statistically significant differences in the odds of having a past medical history of malignancy (OR= 0.295, 95% CI [0.076, 1.152]), transplant (OR= 3.347, 95% CI [0.594, 18.880]), or autoimmune disease (OR= 0.400, 95% CI [0.104, 1.532]). Resolution to baseline was the norm and occurred similarly in both groups.

Conclusions:
Most presenting symptoms and key risk factors were not significantly different between cases of hypertensive encephalopathy without vasogenic edema on MRI and typical PRES, arguing that the diagnosis of PRES, at least in the setting of acute severe hypertension, should not depend on MRI confirmation.
Abstract WP216: Initial Imaging Markers Correlate with Increased Intracavitary Bleeding and Decreased Evacuation Rate Following Minimally Invasive ICH Evacuation
Authors: Rao Akhil , Kalagara Roshini , Bose Javin , Smith Colton , Mocco J , Kellner Christopher
Published: January 2025

Background:
Non-contrast computed tomography (NCCT) markers have been commonly used to characterize hematomas in intracerebral hemorrhage (ICH). This study investigates the relationship between pre-operative imaging markers and clinical outcome following minimally invasive surgical (MIS) ICH evacuation.

Methods:
This study included all patients presenting with ICH who underwent MIS ICH evacuation from 2016 to 2021. The presence of spot sign, swirl sign, blend sign, black hole sign, satellite sign, island sign, and cleft was identified on pre-operative CT imaging. Univariate and multivariate analyses were performed between CT markers and variables of operative outcome with R v 4.3.1.

Results:
221 patients met the inclusion criteria. Swirl sign was identified in 127 patients (57%), spot sign in 30 (14%), black hole sign in 60 (27%), island sign in 10 (5%), satellite sign in 63 (29%), blend sign in 32 (14%), and cleft in 59 (27%). On univariate analysis, presence of any hematoma characteristic was correlated with increased intracavitary bleeding score (2.61±1.35 vs. 2.00±1.94, p = 0.027). Spot sign was correlated with increased rate of surgical rebleed (3.7% vs 2.4%, p = 0.021). Satellite sign was correlated with increased rate of surgical rebleed (6.7% vs. 0.7%, p = 0.021) and marginally significant increased residual volume (12±17 mL vs. 8±11 mL, p = 0.066). Presence of a cleft within hematoma was correlated with decreased evacuation rate (0.76±0.21 vs. 0.85±0.2, p = 0.005), increased intracavitary bleeding score (3.03±1.44 vs. 2.39±1.22, p = 0.019), increased residual volume (14±13 vs. 7±12, p = 0.001), increased presence of amyloid (31% vs 17%, p = 0.034). Multivariate linear regression analysis of presence of cleft controlling for pre-operative hematoma volume predicted increased bleeding score by 0.56 (p = 0.026), and on separate analysis predicted decreased evacuation rate by 9% (p = 0.005). Multivariate ordinal regression analysis of presence of cleft controlling for pre-operative hematoma volume predicted increased probability of increased bleeding by 117% (OR 2.17, CI: 1.09 - 4.39, p = 0.029).

Conclusions:
Preoperative hematoma heterogeneity, specifically presence of cleft, is associated with increased intracavitary bleeding, decreased evacuation rate and increased residual volume following MIS ICH evacuation. Understanding the impact of hematoma characteristics is integral for patient selection in MIS ICH evacuation and postoperative care planning.
Abstract WP221: Impact of ICH Score on Mortality and Withdrawal of Life-sustaining Treatment: A Decade of Data from the Florida Stroke Registry
Authors: Massad Nina , Zhou Lili , Manolovitz Brian , Asdaghi Negar , Gardener Hannah , YING HAO , Gutierrez Carolina , Jameson Angus , Rose David , Kottapally Mohan , Merenda Amedeo , O'Phelan Kristine , Koch Sebastian , Romano Jose , Rundek Tatjana , Alkhachroum Ayham
Published: January 2025

Introduction:
The initial intent of the intracerebral hemorrhage (ICH) score was to improve communication and consistency among providers, rather than to be used as a precise predictor of outcome. We aimed to investigate time trends in rates of mortality and withdrawal of life-sustaining treatment (WLST) by category of ICH severity score.

Methods:
Patients with a recorded clinical diagnosis of ICH were identified using data from Florida Stroke Registry (FSR) hospitals participating in the American Heart Association (AHA) Get with the Guidelines- Stroke (GWTG-S). We included FSR patients from 2013-2022 who had ICH scores documented at presentation. Outcomes of WLST and in-hospital mortality were collected. ICH severity score was stratified into three groups: score 0-2; 3-4; 5-6. Importance plots were generated to identify the most predictive factors associated with WLST. AUC-ROC curves were generated for logistic regression (LR) and random forest (RF) models. Regression analysis was performed to evaluate temporal trends.

Results:
A total of 12,426 (26%) patients had documented ICH scores. Mean age was 69 (SD = 14.96), 55% male, 56% White, and 20% Hispanic; 84% were treated in a comprehensive stroke center with 49% were Medicare-insured. Baseline characteristics were similar to patients without documented scores. The most predictive factors associated with WLST were ICH score, age, state region, presenting level of consciousness, insurance status and race (RF AUC=.94, LR AUC=.82). In-hospital mortality rate for ICH group 0-2 was 6.6%, 41.5% for group 3-4 and 66% for group 5-6; mortality rates decreased over time for ICH groups 0-2 (r
2
=.8, p<.001), 3-4 (r
2
=.4, p=.049), and 5-6 (r
2
=.35, p=.07). Rate of WLST was 12% for ICH group 0-2, 58% for group 3-4 and 71% for group 5-6. Overall WLST rate remained stable across ICH groups; rate of early WLST (< day 2) decreased for ICH score 0-2 (r
2
=.91, p<.001) and 3-4 groups (r
2
=.78, p=.004).

Conclusion:
Among patients admitted across multiple centers in Florida with documented ICH scores, we noted an overall improvement in in-hospital mortality between 2015-2022, along with slight increase in rates of WLST across ICH severity scores. Early rates of WLST did appear to decrease for lower ICH score severities but remained stable for higher ICH score patients. We identified the most predictive variable associated with WLST to be the ICH score. These findings suggest a continued influence of the self-fulfilling prophecy in ICH.
Abstract WP223: The effect of Remote Ischemic Condition in patients with Intracerebral Hemorrhage: a subgroup analysis from the RESIST trial
Authors: Bilgin-Freiert Arzu , Andersen Grethe , CEHOV BORIS , Gude Martin , Oerskov Kim Morgenstjerne , Hjort Niels , Hindsholm Mette , Lech Pedersen Niels , Valentin Jan Brink , Homburg Anne-Mette , Modrau Boris , Brink Behrndtz Anne , von-Weitzel Mudersbach Paul , Johnsen Soeren , Hess David , Simonsen Claus , Blauenfeldt Rolf
Published: January 2025

Background:
It remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective supplement to standard-of-care management of intracerebral hemorrhage (ICH)

Objective:
To evaluate whether RIC can reduce hematoma expansion and peri-hematoma edema in patients with ICH.

Design, Setting and Participants:
This is a predefined substudy to a randomized clinical trial conducted at four stroke centers in Denmark. Among the subset of participants with ICH, brain imaging was performed at admission, after 24 hours and at 7 days. Hematoma expansion over time was assessed on non-contrast CT or MRI using susceptibility weighted sequences.

Intervention:
RIC was induced by using an inflatable cuff on the upper extremity with a cuff pressure of at least 200 mm Hg and sham cuff pressure of 20 mm Hg. Each treatment application consisted of 5 cycles with 5 minutes of inflation followed by 5 minutes of deflation.

Main Outcomes and Measures:
The primary end point was the risk of hematoma expansion defined as absolute growth exceeding 6 mL or a relative growth of more than 33% from the initial scan. Difference in 7 days hematoma reabsorption rate was a secondary outcome and was defined as the difference in hematoma volume between the baseline and day 7.

Findings:
Among 1500 patients who were prehospitally randomized, 165 patients had an ICH. Of them, 87 patients were randomly assigned to RIC and 78 to sham treatment. The median age was 71 (60, 77), 73 (44%) were females, and the median onset to randomization was 40 minutes (30, 69). The median National Institute of Health Stroke Scale score was 12, and 19 patients (12%) had either hematoma evacuation or placed an external ventricular drain. There was no difference on the risk of 24-hour hematoma expansion in RIC treated, -0.052 (-0.20-0.10), p=0.504 (ref: Sham, unadjusted) nor the 7-day hematoma reabsorption rate (day 7 - baseline) in the RIC treated patients 5.47mL (-4.570mL-15.52mL), p=0.280. Supplementary analysis will be presented at the conference.

Conclusions and Relevance:
RIC initiated in the prehospital setting and continued in the hospital did not reduce hematoma expansion or peri-hematoma edema in patients with ICH.

Trial registration:
ClinicalTrials.gov:NCT03481777.
Abstract WP228: Anatomic Location and Volume Expansion Thresholds Predict Outcome after Intracerebral Hemorrhage
Authors: Senevirathne Kaneel , Hanley Daniel , Sharrock Matthew
Published: January 2025

Introduction:
Intracerebral hemorrhage (ICH) volume and expansion are important predictors of clinical outcome. Recent results show volumetric thresholds for prediction of poor outcome differ based on the anatomic location (lobar vs deep) of the ICH. In this study we add further atlas-based anatomic detail including lobar and subcortical locations to determine location-specific volume and expansion thresholds for the prediction of poor clinical outcome, hypothesizing that these cut-offs will vary by location.

Methods:
We analyzed 286 subjects from the MISTIE3 trial that had not undergone surgery prior to imaging analysis. Admission and follow-up CT scans at 24 hours ± 6 hours were analyzed. ICH locations (Basal Ganglia, Thalamus, Frontal, Occipital, Parietal, Temporal) were determined using adjudication and atlas-based methods from day 30 scans. ICH expansion was defined as a 33% or 6ml volume increase. Poor outcome was defined as modified Rankin Scale 4-6. We performed univariate and multivariate analysis using ICH location, age, ICH volumes, time from ictus to scan to identify variables associated with expansion and outcome (P < 0.05). Cutoffs at each location for volume and expansion, and their sensitivity and specificity for predicting outcome were determined using receiver operator characteristic curves.

Results:
Baseline CT volumes averaged 42.68ml with 41% showing expansion. Multivariate results indicated that the volume in temporal, parietal, occipital and basal ganglia locations and volume expansion in the temporal, parietal, basal ganglia were significant predictors of poor outcome. Volume thresholds for the prediction of poor outcome at the different lobar locations were frontal (46.4ml), temporal (53.7ml), parietal (48.9ml), occipital (57.6ml), basal ganglia (45.0ml). Expansion thresholds for prediction of poor outcome were frontal (13.7ml), temporal (1.20ml), parietal (2.52ml), occipital (6.1ml), basal ganglia (6.20ml). Temporal, parietal and basal ganglia volume and expansion thresholds were significant.

Conclusion:
Our results add specific lobar locations and their threshold values. Our volumetric expansion associations with outcome suggest that small expansions in the temporal and parietal lobes may be more clinically significant than in other locations. These results indicate that targeting of therapeutic interventions to reduce ICH expansion may have different effects based on specific lobar and deep locations.
Abstract WP242: Comparison Between Right and Left Transradial Approach for Carotid Artery Stenting Using a 6-French Simmons Guiding Sheath
Authors: Ito Hidemichi , Ueda Toshihiro , Uchida Masashi , Murata Hidetoshi
Published: January 2025

Background:
The transradial approach (TRA) using a Simmons catheter has increasingly been employed for diagnostic cerebral angiography and neurointervention. Typically, the right radial artery is used in neurointerventions. However, in interventional cardiology, the left TRA has demonstrated clear clinical benefits, particularly for right-handed patients. To our knowledge, no studies have directly compared the right and left TRA for carotid artery stenting (CAS). This study aimed to evaluate the safety and technical feasibility of left TRA-CAS in comparison to right TRA-CAS.

Methods:
We conducted a retrospective review of consecutive patients who underwent TRA-CAS using a 6-French Simmons guiding sheath between 2019 and 2024. The right TRA was performed as a first-line approach from 2019 to 2021, with the left TRA being used thereafter. Patients who underwent proximal balloon-protected CAS were excluded. We analyzed patient characteristics, clinical outcomes, and the presence of lesions on postprocedural diffusion-weighted imaging (DWI lesions).

Results:
A total of 106 patients underwent TRA-CAS, with 46 in the right TRA group and 60 in the left TRA group. The mean age, percentage of male patients, and incidence of symptomatic cases were 73.9 years, 83.7%, and 53.5% in the right TRA group, and 74.8 years, 85.5%, and 45.5% in the left TRA group, respectively, with no significant differences. The two groups exhibited similar patient characteristics, anatomical factors including aortic arch, and clinical outcomes. Crossover to another approach was required in two patients in each group. The number of catheters and wires used, as well as the duration of cannulation from the radial to the targeted common carotid artery, were significantly higher in the right TRA group. Although there was no significant difference in the number of patients with postprocedural DWI lesions in the cerebrum ipsilateral to the carotid lesion, fewer patients in the left TRA group exhibited DWI lesions on the contralateral side of the carotid lesion. All carotid stenoses were successfully dilated. Except for one patient in the right TRA group who developed transient ischemia, no patients experienced symptomatic stroke or other procedural complications.

Conclusions:
Both right and left TRA-CAS were successfully performed with a high success rate. Left TRA may offer a safer and more reliable approach for various aortic arch configurations and for both right- and left-sided carotid lesions.
Abstract WP243: Number of failed thrombectomy attempts before intracranial stenting among patients with large vessel occlusion: the RESISTANT International registry
Authors: Ribo Marc , Kaesmacher Johannes , geyik serdar , SENADIM SONGUL , Salcuni Andrea , Moreu Manuel , Hassan Ameer , Bergui Mauro , Sousa Joao Andre , Gomes Fabio , Alexandre Andrea , Pedicelli Alessandro , Rosi Andrea , Machi Paolo , Scarcia Luca , Kalsoum Erwah , Ortega Santiago , Rodriguez Aaron , Renieri Leonardo , Barcena Eduardo , Abdalkader Mohamad , Yavagal Dileep , VEGA PEDRO , Özgan Atilla , Smajda Stanislas , Khalife Jane , Biraschi Francesco , Siddiqui Adnan , Navia Pedro , Ntoulias Nikolaos , Velo Mariano , ZAMARRO JOAQUIN , Zaidat Osama , Marto Joao Pedro , Olive-Gadea Marta , Requena Manuel
Published: January 2025

Background:
Previous studies suggest that in patients who fail to recanalize with devices approved for mechanical thrombectomy, early bailout with intracranial stenting might lead to better outcomes. We aimed to investigate weather the number of previous failed thrombectomy attempts (FTA) impacts outcomes after stenting.

Methods:
The RESISTANT registry is a multicenter and international retrospective registry of patients with large vessel occlusion stroke presenting within 24 hours of symptom onset that underwent intracranial stenting due an acute stroke from 2016 to 2023. Number of failed thrombectomy attempts (FTA) with approved devices, final recanalization (TICI 2b-3) and 90 days favorable outcome (mRS 0-2), symptomatic intracranial hemorrhage and in-hospital mortality were recorded.

Results:
Among 890 patients enrolled, 862 fulfilled inclusion criteria. Median age was 67.0 years (IQR 59.0-77.0) and 558 (64.7%) were males. Occlusion location was proximal in 758 (87.9%) patients and anterior circulation was affected in 613 (71.1%) patients (390 M1-MCA, 142 terminal ICA). The median number of FTA before stenting was 2 [1-3]. Baseline characteristics associated with higher number of FTA are shown in the table. A higher number of FTA before stenting was associated with lower final recanalization (OR:0.66, 95%CI:0.55-0.79;p<0.001) and favorable outcome (OR: 0.78, 95%CI: 0.71.0.86;p<0.001). FTA was not associated to symptomatic intracranial hemorrhage or in-hospital mortality.

Conclusion:
The number of failed thrombectomy passes before definitive stenting negatively impacts procedural and clinical outcomes. Prompt identification of patients who are likely to require definitive stenting could minimize unnecessary reperfusion delays and enhance patient outcomes.
Abstract WP27: Disparities in the surgical treatment of ruptured and unruptured brain arteriovenous malformation: a population-based study across 5 diverse US states
Authors: Bako Abdulaziz , Khan Osman , Britz Gavin
Published: January 2025

Objectives:
We evaluate the sociodemographic and clinical factors associated with receiving surgical AVM treatment and the likelihood of rupture using data from five states with large and diverse populations in the United States.

Methods:
We used the ICD-10 code Q28.2 to identify patients with a diagnosis of AVM from the statewide inpatient and emergency department databases of Florida, Georgia, Maryland, New York, and Washington (2016-2019). Patients with a history of primary intracerebral hemorrhage or subarachnoid hemorrhage at baseline were classified as ruptured AVM (rAVM) patients. ICD-10 procedure codes were used to identify surgically treated AVM patients (Table 1). Multivariable logistic regression models were used to evaluate the sociodemographic and clinical factors associated with receiving craniotomy. A mixed-effects logistic model with patient-level random effects was used to identify the independent predictors of subsequent rupture. Adjusted odds ratios (aOR) and 95% confidence interval (CI) are reported.

Results:
Overall, 4,144 AVM patients (50.3% female; 54.5% non-Hispanic White [NHW]), with a median age (IQR) of 54 (38-67) were included, of which 761(18.4%) were rAVM patients, 1 016(24.5%) received surgical treatment (22.0% in unruptured and 35.7% in rAVM patients), and 161(3.9%) experienced subsequent rupture (2.0% in unruptured and 12.0% in rAVM patients). Non-Hispanic Black (NHB), vs. NHW patients (0.80, 0.64 – 0.99) and females (0.75, 0.64 -0.87) had lower odds of receiving surgical AVM treatment, whereas Asian (vs. NHW) patients (1.76, 1.20 – 2.58) and privately insured (vs. Medicare) patients (1.82, 1.45 – 2.26) had higher odds of receiving surgical AVM treatment (Table 1). Furthermore, rAVM patients were over 10 times more likely to experience a subsequent rupture (aOR, CI: 10.82, 6.95-16.83). Although surgical AVM treatment was not significantly associated with subsequent rupture in the overall AVM population 0.69 (0.36-1.30; Table 2), among patients with rAVM, surgical treatment was significantly associated with lower odds of subsequent rupture (0.29, 0.11-0.73).

Conclusion:
Patients with ruptured AVM are over 10 times more likely to experience a subsequent rupture. Although surgical treatment significantly reduces the likelihood of subsequent rupture among ruptured AVM patients, sociodemographic disparities in receiving surgical treatment persist. Further research is warranted to address these inequities and improve outcomes.
Abstract WP28: Can the reduction of mutant endothelial cells hold promise for treating brain arteriovenous malformation?
Authors: Shabani nabikandi Zahra , Prado Leandro , shaligram sonali , Zhang Rui , Zhu Wan , Liang Rich , Yadav Alka , Wang Calvin , Su Hua
Published: January 2025

Background and Purpose:
Brain arteriovenous malformation (bAVM) is an important risk factor for intracranial hemorrhage. There is no FDP approved drug available to bAVM patients. More than 95% of bAVMs are sporadic and about 5% are familial. Activated KRAS gene somatic mutations have been detected in endothelial cells (ECs) in sporadic bAVMs. Hereditary hemorrhagic telangiectasia (HHT) represents one of the familial forms. More than 80% of HHT patients have mutations in endoglin (ENG) or activin receptor-like kinase-1 (Alk1) gene. Transgene mediated Alk1overexpression in ECs reduced AVM severity in mice with
Alk1
or
Eng
gene deletion. However, it is difficult to express Alk1 or correct KRAS expression in all ECs in patients.

Hypothesis:
Reduction of ECs with bAVM causative gene mutations alleviates bAVM severity.

Methods:
To test the effect of
Alk1
mutant ECs,
Pdgfb
iCreER;
Alk1
f/f
mice were treated with low (0.01 mg/25g of body weight) and high doses (1.25 mg/25g) of tamoxifen (TM). To test the effect of
Eng
mutant ECs, R26RCreER;
Eng
f/f
mice that have a Rosa promoter driving and TM-inducible WT cre expression globally, and PdgfbiCreER;
Eng
f/f
mice that have a Pdgfb promoter driving and TM-inducible icre (a codon mutant cre) expression in ECs were used. Due to the location of
Eng
in chromosome, an increase of TM dose cannot enhance
Eng
deletion. R26RCreER;
Eng
f/f
and PdgfbiCreER;
Eng
f/f
mice were treated with the same dose of TM (2.5 mg/g for 3 days) at the beginning of model induction. The brains were taken 8 weeks after AVM induction to study vessel density, abnormal vessels, mural cell coverage, and microhemorrhage.

Results:
Compared to the low TM dose treated, high TM dose treated
Pdgfb
iCre;
Alk1
f/f
mice have a lower level of Alk1 protein in the brain and more Alk1
-
ECs, which were associated with increased number of abnormal vessels in bAVM lesion. Compared to R26RCreER;
Eng
f/f
group, PdgfbiCreER;
Eng
f/f
mice have a lower level of Eng proteins and more Eng
-
ECs, and more abnormal vessels, CD68
+
microglia/macrophages and hemorrhage, less vascular pericyte and smooth muscle coverage in bAVM lesion. The number of Alk1
-
or Eng
-
ECs were positively correlated with bAVMs severity.

Conclusion:
We showed a correlation between the number of ECs with mutant bAVM causative genes and bAVM severity. Reduction of mutant ECs can alleviate bAVM severity and be used to develop new therapies for bAVMs.
Abstract WP296: Personality Traits Related to Prehospital Delay During Acute Stroke Syndrome in the Time is Brain Study
Authors: Johnson Ian , Berner Marisa , Lalwani Dheeraj , Peasley Emma , Dhongade Vrushali , Brigger Hailey , Smith Joel , Champagne Alison , Rothfeld-Wehrwein Zach , Dhand Amar , Sheth Kevin
Published: January 2025

Background:
Prior research has identified a strong relationship between individual personality characteristics and prehospital delay in acute myocardial infarction. However, it is unclear whether these trends are present among stroke patients.

Methods:
Time is Brain is a current multicenter observational trial assessing the impact of social network dynamics on pre-hospital delay in stroke patients. Demographics, social network data, personality metrics, and hospital arrival timelines were collected from patients with acute stroke syndrome presenting to Yale New Haven Hospital and Mass General Brigham. Personality scores in eight domains were assigned to each participant based on their responses to an abbreviated version of the Big Five Inventory (OCEAN). Average personality scores for fast (<6 hours) and slow arrivers (>6 hours) were compared using an unpaired two-tailed
t
test. Subsequently, logistic regression analysis was performed to compare personality metrics between arrival groups while adjusting for known risk factors of prehospital delay including age, stroke severity, emergency medical services usage and living alone. All analyses were performed in R version 4.1.1.

Results:
183 patients with acute stroke syndrome were enrolled between Jan 2023 and Jul 2024 (mean age 66.35 ± 18.63, 53.1% Male, median NIHSS 2). 92.3% (n=169) self-identified as non-Hispanic and 19.7% (n=36) as Black. 31.1% (n=57) were considered low SES either by education level or income. When comparing personality metrics between fast and slow arrivers, slow arrivers had significantly higher compassion scores (mean 4.80 v. 4.57, 95% CI: 0.01-0.44, p=0.04). This difference remained significant when adjusting for the effect of patient age, NIHSS, EMS usage, and living alone (p=0.01). Additionally, when accounting for the effect of these risk variables, slow arrivers had significantly higher negative emotionality scores (mean 2.41 v. 2.31, p=0.03).

Conclusion:
In the present cohort, patients with delayed hospital arrival following the discovery of stroke symptoms had more compassionate personalities, a difference that remained significant when controlling for the effect of established delay risk variables. Additionally, slow arrivers had higher negative emotionality when adjusting for these same factors. This preliminary analysis will inform future investigation of the role of personality in stroke prehospital delay.
Abstract WP297: Sex-specific Trends in the Prevalence of Stroke Risk Factors and Medication Use in the GCNKSS
Authors: Madsen Tracy , Ding Lili , Robinson David , Stanton Robert , Khoury Jane , Rademacher Eric , Anderson Aaron , Broderick Joseph , Kissela Brett , Kleindorfer Dawn
Published: January 2025

Background:
Existing data indicate recent increases in the prevalence of stroke and relevant risk factors as well as predicted continued increases in coming years. Our objective was to evaluate population-based data on the prevalence of stroke risk factors and related medication use by sex through 2021.

Methods:
Data on the prevalence of stroke risk factors and medication use were taken from our general population random-digit dial survey conducted during 6 time periods: 1995, 2000, 2005, 2011, 2016, and 2021. Due to survey sampling design, survey participants' characteristics (sex, race, age) are representative of the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) ischemic stroke study population. We examined the proportion of females vs. males who reported having hypertension (HTN), hyperlipidemia (HL), diabetes (DM), and current smoking and who reported using antihypertensive medications, lipid-lowering agents, aspirin, and anticoagulants (AC).

Results:
Over 6 study periods, a total of 12,336 participants completed the survey; 59% were female, and 25% were Black. Mean age of participants (in years) went up over time in both females (64 [SD 16
.
3] in 1995 to 69 [SD 16.4] in 2021) and males (61 [SD 15.7] in 1995 to 67 [SD 16.8] in 2021), p
trend
<0.0001 for both). Prevalence of HTN, DM, and HL increased over the 6 study periods in both females and males, and current smoking decreased (Figure 1, all p
trend
<0.0001). All preventive medications (anti-hypertensives, lipid-lowering, aspirin, and AC) assessed increased over time (Figure 2). In 2021, similar proportions of females vs. males had HTN, DM, DL, and were current smokers (p>0.05). Further, similar proportions of females vs. males were on antihypertensives, lipid-lowering medications, and aspirin, though more men than women were on AC (15% vs. 10%, p<0.05).

Conclusions:
In this population-based survey of residents of a 5-county region of southern Ohio and northern Kentucky, the reported prevalence of stroke risk factors increased over a 26-year period in both females and males, as did use of medications used to modify these risk factors. An increasing burden of cardiometabolic risk factors may increase stroke event rates in the future and points to the need for improved primordial prevention.
Abstract WP302: Colchicine After Non-Cardioembolic Acute Ischemic Stroke or Transient Ischemic Attack: A Meta-Analysis of Randomized Controlled Trials
Authors: Salha Issa , Rizwan Ahmed Aisha , koppanatham aishwarya , Punukollu Anuraag , Varkey Thomas
Published: January 2025

Introduction:
Colchicine, an anti-inflammatory medication, has demonstrated significant benefits in reducing inflammation and decreasing subsequent vascular events in patients with acute coronary syndrome and myocardial infarction (MI). This has prompted interest in its potential role in secondary prevention of vascular events in individuals who have experienced a stroke or transient ischemic attack (TIA). This abstract explores the evidence supporting colchicine's efficacy and safety in this context.

Methods:
We searched PubMed, Cochrane, and Embase databases for randomized controlled trials investigating the effect of colchicine in patients who experienced stroke or TIA of non-cardioembolic origin. Our primary outcomes were any new vascular event (a composite of stroke, TIA, MI, or vascular death) or ischemic stroke. We also assessed the incidence of relevant side effects. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were pooled using a random-effects model.

Results:
Two studies were included with a total of 11,487 patients. Colchicine did not reduce vascular events after ischemic stroke or TIA both in long term (RR 0.91; 95% CI 0.79 to 1.05; p = 0.18; I2= 23%) (HR 0.92; 95% CI 0.80 to 1.04; p = 0.18; I2= 0%) and short term (RR 0.83; 95% CI 0.56 to 1.23; p = 0.35; I2= 64%) compared with placebo. There was also no significant advantage in the reduction of recurrence of ischemic stroke in the colchicine group (RR 0.90; 95% CI 0.74 to 1.09; p = 0.28; I2= 44%) (HR 0.91; 95% CI 0.75 to 1.10; p = 0.31; I2= 40%). There were no unforeseen side effects in the Colchicine group (RR 3.78; 95% CI 1.52 to 9.40; p= 0.001; I2= 91%).

Conclusion:
Colchicine did not prevent recurrent vascular events or ischemic strokes in patients after a non-cardioembolic stroke or TIA in a large sample size of greater than 11,000 patients. Further well-designed randomized controlled trials are needed to conclusively determine its efficacy and safety in this context. Nevertheless, the early data does not seem to indicate that it will provide benefit to this target population.
Abstract WP307: Decreased Left atrial ejection fraction and left atrial systolic volumes on speckling tracking echocardiography are associated with ischemic stroke despite therapeutic anticoagulation in patients with atrial fibrillation
Authors: Asad Syed Daniyal , Peshwe Krithika Umesh , Balabhadra Anvesh , Kolupoti Abhigna , McMahon Sean , Silverman David
Published: January 2025

Background:
Left atrial myocardial function can be studied by measuring Left atrial (LA) strain using speckle tacking echocardiography. Decreased LA strain has been shown to increase thromboembolic risk. This dynamic measure of LA dysfunction may provide insight into echocardiographic factors associated with ischemic stroke despite therapeutic anticoagulation (AC) in patients with atrial fibrillation (AF).

Methods:
This was a retrospective observational study on consecutive ischemic stroke patients with AF between June 2018 and December 2020 admitted to our institution. Patients were divided in two groups: those on AC and those off AC at the time of the stroke. We then performed Speckle tracking echocardiography using TOMTEC™ 2D strain analysis software to compare different measures of LA function including LA volume index (LAVI), LA Systolic Volume (LAESV), LA Diastolic Volume (LAEDV), LA Ejection Fraction (LAEF) in both groups.

Results:
A total of 239 patients met the criteria and 178 pts underwent LA strain assessment. There were 34 patients in the on-AC group (Mean age: 78 years, SD 10) and 144 pts in the Off-AC group (Mean age: 79 years, SD 11.5). Mean LAVI was 42 ml in on-AC group (SD 14.5ml) vs. 44ml (SD 19 ml) in off-AC group (P value = 0.31). LAEF was significantly lower in the on-AC group (19%, SD 21.3%) compared to off-AC group (21% SD 18%), P value < 0.0001. LAESV was significantly lower in the on-AC group (67 ml [SD 28 ml] vs. 79 ml [SD 34 ml], P value = 0.035). LAEDF was also significantly lower in the on-AC group (51 ml [SD 27 ml] vs. 64 ml [SD 30 ml], P value = 0.015).

Conclusion:
Patients with atrial fibrillation who experience an ischemic stroke despite therapeutic anticoagulation have significantly lower LAEF, LAESV, LAEDV on LA strain analysis using speckle echocardiography. This suggests that left atrial structural dysfunction plays a key role in AC failure and this tenchnique can identify such high risk patients. More studies are needed to identify potential treatment targets and individualized management plans for patients with these echocardiographic markers of atrial cardiopathy.
Abstract WP309: Long-Term Efficacy And Safety Of Patent Foramen Ovale Closure In Elderly Patients Over 60 Years With Cryptogenic Stroke: A Systematic Review And Meta-Analysis
Authors: Sebastian Sneha Annie , Dominic Jerry Lorren , Paul Haris , Dhulipala Vishal
Published: January 2025

Background:
Patent foramen ovale (PFO) is commonly diagnosed in patients over 60-65 years with cryptogenic stroke. Despite robust evidence and guidelines supporting PFO closure in individuals aged 18-60, the efficacy of this intervention in preventing recurrent ischemic strokes in elderly patients (>60 years) with PFO and cryptogenic stroke remains uncertain, as existing evidence is inconclusive.

Objective:
We aimed to synthesize findings from observational studies until July 2024 to evaluate the long-term efficacy and safety of PFO closure in elderly patients over 60 years of age, with the primary outcome focused on its impact on reducing the composite risk of recurrent ischemic stroke/transient ischemic attack (TIA).

Methods:
We analyzed data using RevMan 5.4 with a random effects model, employing the inverse variance method pooling outcomes as odds ratios (OR) with 95% confidence intervals (CI). Our study protocol is registered in PROSPERO (CRD42024564171).

Results:
Our study included 9 observational studies comprising 3,525 subjects, of whom 1,572 were elderly patients aged over 60 years. The average follow-up period ranged from 2.5 to 14 years. Upon pooled analysis comparing the primary composite outcome of recurrent ischemic stroke/TIA after PFO closure, the elderly cohort (aged >60 years) demonstrated a significant reduction in risk compared to the non-elderly (18-60 years), with an OR of 3.47 (95% CI: 2.01 to 5.99, p < 0.00001), and no significant heterogeneity was observed. Secondary outcomes revealed a statistically significant reduction in all-cause mortality among the elderly following PFO closure (OR: 7.83, 95% CI: 2.59 to 23.65, p = 0.0003), as well as a decreased incidence of recurrent strokes (OR: 3.97, 95% CI: 1.58 to 9.97, p = 0.003). Furthermore, there was no statistically significant difference in the occurrence of post-procedure new-onset atrial fibrillation between elderly and younger patients (OR: 1.31, 95% CI: 0.67 to 2.57, p = 0.43).

Conclusion:
PFO closure in elderly patients may be as effective and safe as in younger patients. However, there is a pressing need for further multicenter large randomized controlled trials to specifically include patients over 60 years of age. These trials should evaluate the safety and long-term efficacy of PFO closure, with the goal of reassessing and refining current treatment guidelines to optimize outcomes for elderly patients with PFO and cryptogenic stroke.