bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 95: Modeling Outcome After Intracerebral Hemorrhage Indicates No Benefit from Lowering Blood Pressure
Authors: Mandava Pitchaiah , Samson Yves , Kent Thomas A
Published: July 2021

BACKGROUND:
Outcome following ischemic stroke is strongly related to baseline severity. Differences in baseline balance between arms seen even in larger trials complicate analysis. We developed a method (pPREDICTS) that generates a pooled outcome model from baseline factors taken from randomized clinical trials (RCTs). It visualizes variability to assess whether an individual study treatment arm differs sufficiently from expected outcome to be considered positive if tested in a larger population, without need for any statistical corrections. Here we assessed whether intracerebral hemorrhage (ICH) could be similarly modeled and how blood pressure (BP) interventions fared considering between-trial variance.

METHODS:
pPREDICTS generates an outcomes and provides multi-dimensional ±p=.05 statistical surfaces to visualize the variance among these trials. ICH RCTs were selected that provided baseline NIHSS, age and 90 day outcomes. Individual results from 4 BP trials were tested against these models to determine whether outcomes surpassed the ±95% prediction interval surfaces. Mortality and mRS0-2, the most frequently reported outcomes were modeled.

RESULTS:
Outcome functions derived from 12 ICH RCTs representing 2766 subjects were generated (middle surface ± p=.05 surfaces; Fig 1a: Mortality: r
2
=0.84; Fig 1b:mRS0-2:r
2
=0.79; p≤0.005). Control management (green) and treatment arm (red) outcomes of ATACH, ICH-ADAPT, INTERACT and INTERACT2 were plotted (see Figs). No mortality or functional outcome different from control was seen as outcomes are mostly distributed along the middle surface. However, tier 3 of ATACH, BP goal of SBP 110-140 showed increased mortality (>+95%) and decreased mRS 0-2 outcome (<-95%).

CONCLUSION:
Outcome models for mortality and mRS 0-2 were successfully developed. No benefit was seen from any BP intervention. We suspect small differences in outcomes reported as positive are more likely random variation.
Abstract T MP105: Going to the Experts: Addressing Patients' Cognitive and Emotional Needs Before Discharge
Authors: Beland Dawn K , Tartar Sarah , Foster Mary , Lovejoy David
Published: July 2021

Background:
To improve the patient experience and delivery of patient care, a Stroke Center Patient Advisory Board was created in April 2011. A theme that emerged was the need for psychological and emotional support as an inpatient and after discharge. Common symptoms associated with acute stroke include cognitive impairment, depression, anxiety, and reduced independence in daily activities.

Per Advisory Board feedback, the subtle emotional and cognitive changes associated with stroke were not being identified and discussed during acute hospitalization. Literature suggests that 2/3 of patients have cognitive impairment after stroke, and similar rates of post-stroke depression are seen in first 3 months. Both cognitive impairment and mood disorders are associated with impaired function, increased mortality, and increased length of acute and rehabilitation stay after stroke.

Purpose:
Establish new best practice to better identify cognitive impairment and depression to more fully address patients’ needs prior to discharge.

Methods:
A Neuropsychological Continuum of Care was created. A routine neuropsychological (cognitive & emotional) screen was done for all patients admitted with an ischemic or hemorrhagic stroke, including those with TIA. After screening, psychoeducation is given to patients and/or families on cognitive strengths and weaknesses, emotional needs and expected recovery. Recommendations are made regarding discharge and compensatory strategies. The findings inform the need for outpatient services and referrals are made to Psychiatry for medication consultation if needed.

Results:
Over first 12 months, 849 patients with stroke/TIA were referred for inpatient neuropsychological consultation, as compared to 0 inpatient stroke referrals the prior 12 month period. Neuropsychologists provide psychoeducation and neuropsychological intervention during inpatient stay.

Discussion:
The development and implementation of this new standard of care has resulted in greater ability to educate and support patients and families in the critical acute stroke period. Early post-stroke cognitive and emotional concerns are identified to inform treatment and discharge planning.
Abstract T MP108: Decreasing Door-to-Needle Time a Collaborative Approach
Authors: McCall-Brown Angela N , Felberg Robert , Eboras Olivia Joy , Bertsch Lyn , Volturo John , Hogan Elizabeth
Published: July 2021

Background:
The Target Stroke guidelines recommend treatment initiation within 60 minutes of patients’ arrival in the emergency department (ED). In May 2012 we began an indepth review of our acute stroke (“Code Gray”) care process in an effort to improve our door to needle time (DTN).

Objectives:
To decrease the DTN time to 45 minutes or less, treating 50% or more of our patients within that time frame.

Methods:
A multi-disciplinary performance improvement team was formed and trained in Six Sigma methodology. A retrospective review of baseline data identified 75 data points spanning the 19- month period January 2011 to July 2012. A pilot study was initiated, which included tPA-eligible patients arriving in the ED who could be treated within 3-4.5 hours from the onset of symptoms.

Results:
Baseline data indicated that we achieved theTarget Stroke recommendations for 50% of eligible patients. The mean DTN time was 61 minutes, and standard deviation of 18 minutes. The average “Door to CT results” was 29 minutes. However there was significant variation in “Door to CT results” and “CT Results to Drug” times, contributing significantly to delays in DTN. It was determined that bringing the patient directly to CT on the EMS stretcher would be a high impact intervention. This new process incorporated more timely patient registration and immediate assessment by the ED physician. In our pilot group consisting of the 44 patients where pre-notification was available, the, average DTN time was 38 minutes, with the lowest DTN of 14 minutes. An additional 29 patients, for whom pre-notification was not provided, were not included in the pilot but benefited from this process change with an average DTN of 49 minutes. Average time for “Door to CT results” has decreased from the baseline average of 29 minutes down to 7 minutes for the patients in the pilot and to 20 minutes for all patients.

Conclusion:
We have made a statistical difference between our baseline and our pilot data. We have decreased our average time by 23 minutes for those patients that we received pre-notification, and we are currently 18 minutes under the national average for all patients combined. While the pilot has been limited to patients with pre-notification, it clearly has benefited all stroke patients.
Abstract T MP117: Rosuvastatin May Have Long-Term Clinical Benefits by Causing Plaque Regression and Improving Aortic Stiffness in Ischemic Stroke Patients
Authors: Kaneko Kazuyoshi , Saito Hiroki , Tsunoda Yuichi , Sugawara Shigeo , Akasaka Masahiro , Kanaya Tohru , Kubota Isao
Published: July 2021

Background:
Complicated aortic arch plaque (CAP) is important in recurrent ischemic stroke (IS) and prognosis. Keying on the reduced occurrence of IS observed in the large-cohort JUPITER Study, the current investigation assessed clinical benefits and pathophysiology of statin therapy.

Methods:
Of 112 consecutive acute cerebral embolism patients, 97 gave informed consent for our retrospective survey and were analyzed. All had transesophageal echocardiography (TEE) to assess presence or absence of CAP, defined as aortic wall thickness >4mm or plaque ulceration. Also assessed were aortic stiffness parameter β (Aoβ) and aortic arch wall motion velocity (WMV) evaluated by tissue Doppler imaging. Patients received appropriate conventional antithrombotic therapy as clinically indicated, and in addition we recommended that all patients with CAP receive 5 mg rosuvastatin/day. Patients were divided into 3 groups: those with CAP taking rosuvastatin (Group A, n=26, 68±7 years), those with CAP not taking rosuvastatin (Group B, n=13, 71±9 years), and those without CAP (Group C; n=58, 62±12 years). Follow-up TEE was performed at 6 months in Group A. In these 3 groups recurrent stroke and death were defined as major adverse cerebrovascular events (MACE).

Results:
Study duration was 710±405 days. CAP was detected in 39 patients (40%), and MACE occurred in 15 (15%). Kaplan-Meier analysis demonstrated that Group B had significantly higher MACE compare to other 2 groups (long-rank test; X2=6.553, p<0.05), while Group A did not differ from Group C despite being significantly older (p<0.05). Group A patients with a follow-up TEE at 6 months showed significant improvement in CAP diameter, Aoβ and peak WMV during the diastolic phase of contraction (5.8±2.0 vs. 4.9±1.9 mm, p<0.01; 19.5±14.6 vs. 12.9±6.5, p<0.05; 1.5±0.4 vs. 1.7±0.4 cm/s, p<0.01, respectively). In addition, CAP were morphologically improved in 15 patients, unchanged in 8, and worsened in 3.

Conclusions:
Rosuvastatin therapy causes plaque regression and improved aortic arch stiffness in IS patients with CAP, and may also have long-term clinical benefits.
Abstract T MP16: Impact of Circadian Clock Disruption on Infarct Volume in an Ischemic Stroke Model
Authors: Earnest David , Coffman Jason , Neuendorff Nichole , Selvamani Amutha , Sohrabji Farida
Published: July 2021

Background:
At perimenopause, women show increasing incidence of ischemic stroke and poor prognosis for recovery, suggesting that declining ovarian steroid levels alter the risk for neurovascular disease. Peripheral circadian clocks throughout the body may provide integral links between cycling levels of estrogen and neuroprotective responses. Circadian rhythm disruption may be a key factor coupling risk factors (ie, diabetes, obesity) to cardiovascular pathologies. Thus, the present study used an ischemic stroke model to determine whether environmental disruption of circadian rhythms in young adult female rats modulates estrous cyclicity and induces corresponding increases stroke volume and functional deficits similar to that observed in middle-aged females.

Methods:
Adult (5 mo) female rats were exposed for 8wks to either a fixed or shifted (12hr advance/5d) LD 12:12 cycle and then subjected to middle cerebral artery occlusion (MCAo). Pre and post sensorimotor testing was performed to assess functional deficits. Animals were terminated at 5d post MCAo. Brains processed for histological analysis of infarct volume. Before and after experimental manipulations, estrous cyclicity was assessed via vaginal smears in parallel groups of animals.

Results:
Circadian activity rhythms stably entrained to the fixed LD cycle but were severely disrupted in shifted LD rats. In contrast to the regular estrous cycles (~7d) in fixed LD animals, cyclicity was abolished and persistent estrous was evident in all shifted LD rats. Total infarct volume in shifted LD rats (0.47) was significantly increased (p<0.05) relative to that observed in fixed LD controls (0.27). Sensorimotor testing revealed a similar trend in which MCAo-induced functional deficits in shifted LD animals were greater than those in fixed LD rats.

Conclusion:
These results suggest that the loss of estrous cyclicity in young females due to circadian disruption exacerbates stroke outcomes, supporting the hypothesis that in females, middle-age may precipitate circadian disturbances that link reproductive aging to pathological changes in neuroprotective responses to injury.

Supported by AHA
14GRNT18370013
to DE
Abstract T MP24: Vagus Nerve Stimulation Improves Motor Function After Chronic Stroke in Adult Rats
Authors: Khodaparast Navid , Casavant Reema , Ruiz Andrea , Rennaker Robert L , Kilgard Michael P
Published: July 2021

Background:
Stroke is the leading cause of serious long-term disability. Currently, there is no effective treatment for chronic stroke patients. Neuroplasticity within motor circuitry is believed to support recovery of function after stroke. We have developed a method using vagus nerve stimulation (VNS) paired with motor training to drive robust, specific plasticity in the motor cortex. Our recent studies indicated that VNS paired with rehab training significantly enhances recovery of forelimb function after cortical ischemic stroke. To further the translation potential of our therapy, we accessed the hypothesis that delivering VNS paired with rehab may improve functional recovery in rats that demonstrated chronic forelimb impairments.

Methods:
All female Sprague Dawley rats were trained on the Isometric Pull Task, which quantifiably measures forelimb force generation. Rats that achieved 5 consecutive days of over 85% hit rate on this task were given a unilateral cortical-subcortical ischemic lesion via injections of a vasoconstrictive peptide, endothelin-1. Following the lesion, rats returned to their home cage, and did not begin rehab training until 5 weeks post-lesion. Upon return, post-lesion forelimb impairment was accessed with the same task parameters used during pre-lesion training, which allowed for a direct comparison of performance. Rats were assigned to balanced treatment groups based on post-lesion baseline hit rate. Treatment groups consisted of VNS delivered during rehab training (Paired VNS; n=10), VNS delivered two hours after rehab training (Delayed VNS; n=10), and rehab training without VNS (Rehab; n=10).

Results:
At five weeks post-lesion, the unilateral ischemic insult significantly worsened performance in all three groups compared to pre-lesion (Paired VNS: 29.8 ± 5.7%, paired t-test, P < 0.001; Delayed VNS: 24.6 ± 2.7%, P < 0.001; Rehab: 30.4 ± 4.7%, P < 0.001). Following our therapy, the Paired VNS group demonstrated significantly better performance than both control groups (Paired VNS: 81.6 ± 2.3%, P < 0.01; Delayed VNS: 53.2 ± 6.5%, P < 0.01; Rehab: 49.8 ± 6.8%, P < 0.01).

Conclusion:
Our results indicate that VNS paired with rehab training can further enhance recovery of forelimb function in chronically impaired rats.
Abstract T MP33: Younger Age And Anticoagulation Are Risk Factors For Pseudoaneurysm In Cases Of Cervical Arterial Dissection
Authors: Sultan-Qurraie Ali , de Havenon Adam , Mossa-Basha Mahmud , Longstreth William T , Becker Kyra J , Tirschwell David L
Published: July 2021

Background:
Cervical artery dissection (CAD) is a frequent cause of ischemic stroke and pseudoaneurysm (PA) formation is a common complication. There is limited literature on the risk factors for PA formation. In particular, the influence of specific medical therapy for CAD_antiplatelet versus anticoagulation_is unknown. We hypothesized that anticoagulation in the treatment of CAD is a risk factor for PA formation.

Methods:
We retrospectively reviewed 250 cases of CAD admitted to a single hospital between 2011 and 2014. A neuroradiologist diagnosed CAD and PA by CTA. We reviewed patient charts for several risk factors: antithrombotic therapy, associated trauma, subsequent stroke, and age. Outcome (resolution or growth at 3 months) and largest size (at any point in time) of PA was recorded. Statistics were non-parametric.

Results:
35 patients had a diagnosis of CAD, PA, and follow-up vascular imaging at 3 months after onset. 27 patients presented concomitantly with CAD and PA; 8 patients later developed PA. Median patient age was 48 years, median PA length along longest axis was 8mm, 84% were treated with antiplatelets and 16% were treated with therapeutic anticoagulation. All patients treated with anticoagulation experienced PA growth versus 44% of those treated with antiplatelet agents (Fisher’s Exact p = 0.046). Younger age was also associated with PA growth (Wilcoxon rank sum test p = 0.0198) and there was a trend towards larger median pseudoaneurysm size in patients receiving anticoagulation (median size 17mm versus 5mm, p=0.09). Traumatic dissection and ischemic stroke were not associated with pseudoaneurysm development or size.

Discussion:
Our study finds that in the setting of CAD, treatment with anticoagulation and younger age are risk factors for PA growth; furthermore, patients on anticoagulation tend to have larger PAs. While the natural history of PAs is typically benign, many patients undergo invasive treatments and face the fear of other complications. Given the clinical equipoise surrounding CAD treatment, our findings may have important implications for patient care and should be replicated in a larger dataset.
Abstract T MP34: Perforator Proximity Is A Strong Independent Risk Factor For Peri-procedural Stroke In Intracranial Stenting For Atherosclerotic Disease With Aggressive Management Of Anti-platelet Therapy
Authors: Yu Wengui , Alexander Julia E , Nuno Miriam , Alexander Michael J
Published: July 2021

Introduction:
The majority of peri-procedural ischemic strokes in the SAMMPRIS trial were perforator strokes. Contemporary studies of intracranial stenting have not evaluated the proximity of atherosclerotic target lesions to major perforators.

Methods:
The current study evaluates a prospective aggressive anti-platelet therapy management approach at two institutions in a consecutive series of 158 patients with symptomatic intracranial atherosclerotic disease (ICAD) treated with angioplasty and stenting with self-expanding nitinol stents. Peri-procedural strokes were analyzed with respect to proximity of the target lesion to angiographically seen perforators and grouped as target lesion either within 2 mm, or greater than 2 mm from visible perforators.

Results:
A total of 158 patients with symptomatic ICAD were treated from 2005 to 2014. The periprocedural complication rate was 3.8% (6/158) with 1 subarachnoid hemorrhage, 0 intraparenchymal hemorrhages, 5 perforator strokes, and no stent thrombosis. With a mean follow up of 2.3 years, the total ipsilateral stroke and death rate was 6.3% (10/154). Of the 158 patients, 61 (38.6%) arteries were stented in the Middle Cerebral Artery or Basilar Artery. Twenty one of the target lesions were within 2 mm of visible perforators, and there were 4 perforator strokes (19%) in this subgroup. Forty of the target lesions were greater than 2 mm of visible perforators with one perforator stroke (2.5%) in this group. There was an approximately sevenfold higher risk of stroke with lesions within 2 mm of perforators compared to lesions greater than 2 mm in the same arteries. This was statistically significant (Fisher’s exact test, p = 0.0437).

Conclusions:
With aggressive monitoring and management of anti-platelet medications, intracranial stenting complications of stent thrombosis and distal emboli can be reduced, although there is still a significant risk of perforator strokes, particularly in the middle cerebral artery and basilar distributions. Target lesions within 2 mm of angiographically visualized perforators had a sevenfold higher risk for periprocedural stroke (p = 0.0437) than other lesions in the same arteries.
Abstract T MP36: Association Of Thrombelastographic Parameters With Subsequent Ischemic Events After Intra/extracranial Stenting
Authors: Miao Zhongrong , Ma Ning , Wang Bo , Li Xiaoqing
Published: July 2021

Background and Purpose:
Thrombelastography (TEG) is widely used for the measurement of platelet function. However, few studies have investigated the TEG parameters in patients receiving extracranial or intracranial stenting for ischemic cerebrovascular disease. This pilot study sought to describe the association of TEG parameters before procedure with post -procedural ischemic events after extracranial or intracranial stenting.

Methods:
This was an institutional review board-approved prospective cohort study. Patients who had stenting performed for extracranial or intracranial stenosis (70%-99%) were recruited into the study. Blood samples were obtained for TEG to assess the platelet function before stenting. The primary end point was ischemic stroke or transient ischemic attack in the territory of the stented artery.

Results:
A total of 218 patients were included in this study. During a mean follow up period of 132 days (98-226 days), 18 (8.26%, 18/218) primary end point events were recorded. Compared with patients without ischemic events, the ADP-induced platelet-fibrin clot strength (MA
ADP
) was significantly higher (41.57±15.10
Vs
33.50±13.86,
P=
0.020), and the adenosine diphosphate (ADP) inhibition rate (ADP%) was significantly lower in patients with ischemic events (39.54 ±23.15
Vs
55.29±24.43,
P
=0.009). Multivariate analysis showed MA
ADP
and ADP% were identified as significant independent predictors of subsequent ischemic events with hazard ratios of 1.036 and 0.965 respectively. From receiver operating characteristic curve analysis, MA
ADP
>49.95mm had the best predictive value of ischemic events.

Conclusions:
Our study suggests that MA
ADP
and ADP% by TEG evaluation parameterswere associated with the subsequent ischemic events in patients with extracranial or intracranial stents.

Clinical Trial Registration-URL:
http://www.clinicaltrials.gov. Unique identifier: NCT01925872.

Key Words:

Thrombelastography:
Stent

Ischemic cerebrovascular disease
Abstract T MP55: Utility of 4D-MRA to Measure Blood Flow Velocity in Cerebral Major Arteries
Authors: Abumiya Takeo , Fujima Noriyuki , Kudo Kohsuke , Ishi Yukitomo , Gekka Masayuki , Shichinohe Hideo , Kazumata Ken , Nakayama Naoki , Houkin Kiyohiro
Published: July 2021

Transcranial
Doppler is widely used clinically to measure blood flow velocity (BFV) in cerebral major arteries. This method, however, has a limitation in that its successful measurement depends on the accessibility of patients’ cranial window and the technical ability of operators. We therefore developed a novel method to measure BFV in cerebral major arteries with 4D-MRA, which was less susceptible to patients and the conditions of the operators.

Methods:
4D-MRA was performed with a 3T MR unit (Achieva TX; Philips Medical Systems) using arterial spin labeling methods. The blood flow through the internal carotid arteries (ICA) and the basilar artery (BA) within imaging range was visualized by using look-locker readout methods. BFV was calculated by dividing the flow distance traveled in the arteries by the time elapsed. BFV of 34 patients (non-vascular disease:11, ICA stenotic disease:6, moyamoya disease:9, and cerebral aneurysm:8) were measured using the 4D-MRA method and the 2D phase contrast method.

Results:
In the case of patients with non-vascular diseases, mean BFV of the right ICA, the left ICA, and the BA was 24.5±7.0, 23.3±6.9, and 17.2±5.1 cm/sec, respectively. Correlation between BFV values from the 4D-MRA method and those from the 2D phase contrast method was statistically significant (r=0.78, p<0.01). In the case of patients with ICA severe stenosis (more than 90%), BFV of the stenotic ICA was decreased to 9~11cm/sec (40~50% of BFV of the contralateral ICA). In the case of patients with advanced-stage moyamoya disease, BFV of the ICA was decreased to 9~16cm/sec (30~50% of BFV of the BA). The BFV decreases were related to CBF reduction in some cases if the development of the collateral circulation was insufficient. In the patients with aneurysm, BFV of the artery proximal to aneurysm tended to be increased except for the decrease in cavernous ICA giant aneurysm.

Conclusions:
We could steadily obtain BFV in all patients by using the 4D-MRA method without any operational difficulties. In this preliminary study, we observed BFV decrease in ICA stenotic disease and moyamoya disease, and BFV increase in cerebral aneurysm. This novel 4D-MRA method to measure BFV may become a promising tool for pathophysiological evaluation of cerebrovascular diseases.
Abstract T P103: Global Oxygen Extraction Fraction by Blood Sampling to Anticipate Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting
Authors: Iwata Tomonori , Mori Takahisa , Aoyagi Yoshinori , Tanno Yuhei , Kasakura Shigen , Yoshioka Kazuhiro
Published: July 2021

Background:
Cerebral hyperperfusion syndrome (CHS) sometimes occurs after carotid revascularization in patients with severe hemodynamic failure. The incidence of CHS following carotid revascularization is not high. However, once it occurs, it may result in disabled clinical outcome. Therefore, it is very important to anticipate CHS. To anticipate CHS, single-photon emission computed tomography (SPECT) or PET may be useful, but it is impractical for all patients.

Purpose:
The purpose of our study was to investigate whether or not global oxygen extraction fraction (OEF) by blood sampling anticipated CHS following carotid artery stenting (CAS).

Methods:
When patients underwent elective CAS from September 2010 to June 2014, we performed blood sampling for OEF calculation before and immediately after elective CAS. Elective CAS was defined as CAS in asymptomatic patients or CAS in patients who experienced a last ischemic attack 30 days or more previously. Data were collected prospectively. OEF was calculated from arteriovenous oxygen difference as follows: OEF = (Ca02-Cv02)/Ca02 where Ca02 is arterial oxygen content and CvO2 is the jugular vein oxygen content. We evaluated baseline features of patients, pre-CAS OEF, post-CAS OEF and the occurrence of CHS.

Results:
In overall 131 patients, the median pre-CAS OEF was 0.41 (0.37-0.46; IQR), and median post-CAS OEF was 0.42 (0.38-0.47; IQR). Seven patients presented CHS. Between the two groups with and without CHS, there were no differences in patient characteristics. Between the two groups, there were not statistically significant differences of pre-CAS OEF (0.47 vs 0.41). However, patients in CHS group had higher post-CAS OEF than patients in non_CHS group (0.51 vs 0.42) (Mann-Whitney’s U test, p<0.05). Binary logistic regression analysis demonstrated that post-CAS OEF {relative risk; (95%CI); 1.12 (1.01-1.25), p<0.05} was an independent predictor of CHS. The area under the ROC curve for the post-CAS OEF for probable CHS diagnosis was 0.79 and the cut-off value was 50% (sensitivity of 86% and specificity of 88%) for probable CHS. Increase of post-CAS OEF was significantly related to probable CHS.

Conclusion:
Elevation of blood sampling OEF immediately after CAS anticipated post-CAS CHS.
Abstract T P108: MRI Measurements of Intracranial Atherosclerosis in the ARIC Neurocognitive Study: Methods, Reliability and Descriptive Statistics
Authors: Qiao Ye , Liu Li , Zhang YiYi , Anwar Zeeshan , Mirbagheri Saeedeh , Xie Yuan Yuan , Nezami Nariman , Intrapiromkul Jarunee , Zhang Shuqian , Guallar Eliseo , Suri Fareed , Wasserman Bruce A
Published: July 2021

Introduction:
A 3D high resolution MRI (HRMRI) vascular protocol was designed to measure intracranial atherosclerosis in a biracial population from the multicenter ARIC Neurocognitive (ARIC-NCS) study.

Hypothesis:
HRMRI provides reliable intracranial vessel wall measurements in a population-based study.

Methods:
1980 ARIC-NCS participants (mean age, 77.2±5.3 years; 40% male; 71% white, 28% black) underwent a brain HRMRI protocol designed to identify atherosclerosis in major intracranial arteries, that included 3D time-of-flight MRA and 3D black blood MRI (both acquired at 0.5-mm
3
resolution). Among 1980 participants, 102 were recruited for repeat MRI exams to estimate scan and reader variability. Participants were selected based on identification of at least one intracranial plaque on the baseline MRI scan with adequate or excellent image quality. Exam pairs were read by the same reader to exclude inter-reader variation. Presence of plaque by vessel segment was recorded. Quantitative MRI measurements included lumen size and stenosis, wall/plaque thickness, area, and volume, normalized wall index over each vessel segment, and the largest plaque identified for each vascular territory (Table 1). Reliability was assessed by percent of agreement, kappa statistics and intraclass correlations (ICC).

Results:
There were 272 pairs of repeated interpretations. Percent agreement, of plaque identification per participant was 87.0% (inter-reader), 89.2% (intra-reader), and 89.9% (between scans). The reliability for plaque identification was not impacted by the vessel segment. Repeat scan and repeat reader reliability (ICC) for quantitative measurements ranged from 0.69 to 0.98 (Table 1).

Conclusion:
HRMRI provides reliable MRI measurements of intracranial vessels, and reliability was not impacted by plaque location.
Abstract T P115: Sarcopenia and Physical Function in Chronic Stroke
Authors: Ryan Alice S , Hartstein Joseph , Hafer-Macko Charlene , Ivey Frederick
Published: July 2021

Sarcopenia is defined as an age-related loss in skeletal lean muscle mass and strength and is as a leading contributor to the development of frailty. Stroke survivors have muscle atrophy in paretic (P) vs. nonparetic (P) legs that could contribute to whole body sarcopenia. The purpose of this study was to determine the sarcopenic index in a large population of chronic stroke survivors and compare this group to age, gender, and BMI-matched non-stroke controls. Chronic stroke survivors aged 40 to 84 yrs (n=180, 61% female, 59% African American, BMI: 29±1 kg/m
2
, X±SEM) with mild to moderate gait deficits underwent whole body DXA scans to assess sarcopenic index (appendicular lean mass/ht
2
). The cutoffs for sarcopenia, by the European Working Group on Sarcopenia, were used and defined as a skeletal muscle index of <7.23 kg/m
2
in men and <5.67 kg/m
2
in women. In the entire group, the prevalence of sarcopenia in stroke survivors (13%) did not differ significantly from that of populations reported previously in the literature. In 61-70 year olds, 87% (n=63) had normal muscle mass and 13% (n=9) were sarcopenic. In 71-80 year olds, 79% (n=30) had normal skeletal muscle index and 21% (n=8) were sarcopenic. Stroke survivors (n=39) were matched with 39 controls on the basis of race, gender, age ±4 years and BMI±2.5 units. After matched pair analysis, 5.1% of the controls had sarcopenia while 12.8% of the control group were sarcopenic (P<0.0001). Sarcopenic index was related to six-minute walking speed (r=0.28, P<0.01). In conclusion, stroke survivors may be at an elevated risk for sarcopenia when considering age, gender, and race to non-stroke individuals which is related to functional mobility in this population.
Abstract T P128: Ethnicity and the Availability of Rehabilitation Facilities in the Brain Attack Surveillance in Corpus Christi Project
Authors: Reeves Sarah , Aaron Micah , Fuentes Michael , Morgenstern Lewis , Lisabeth Lynda
Published: July 2021

Background:
Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One explanation may be ethnic differences in post-stroke rehabilitation; despite its effectiveness, non-clinical factors such as geographic availability may influence use of certain rehabilitation venues. We investigated ethnic differences in availability of stroke rehabilitation venues in a bi-ethnic community.

Methods:
Stroke survivors were identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project from 2011-2013 in Nueces County, a bi-ethnic, mostly urban community in southeast Texas with a population of 340,000. Addresses of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) providing stroke rehabilitation were identified by phone/internet and geocoded. Availability was defined as distance to and supply of each type of venue in relation to the survivor’s home. Supply was calculated as the count of each type of venue within a given radius (defined as the 90th percentile of distribution of distances to reflect a reasonable market area). Associations between availability and ethnicity were modeled using linear regression adjusted for census tract-level median household income, proportion <65 years, and population density as obtained from the 2012 American Community Survey.

Results:
A total of 942 survivors were eligible (62% MA, 38% NHW); 3 IRFs and 21 SNFs were identified. The average distances from the survivors’ homes to an IRF or SNF were 5 miles (SD=6) and 2 miles (SD=3), respectively. Supply was calculated within radii of 16 miles for IRFs and 4 miles for SNFs. The average count of rehabilitation venues within these radii was 2.6 IRFs (SD=0.9) and 7.9 SNFs (SD=4.7). There were no ethnic differences in the distance or supply of IRFs; however, MAs were on average 1 mile (CI:0.6-1.5) closer to and had 0.8 (CI:0.2,1.3) more SNFs within the radius than NHWs.

Conclusions:
Availability of rehabilitation venues was high for both ethnic groups; however, MAs have greater availability of SNFs compared to NHWs. Additional study is necessary to understand how the availability and quality of services within rehabilitation venues impact post-stroke rehabilitation among MA stroke survivors.
Abstract T P13: Effect of Pre-treatment Cerebral Blood Volume and Time to Recanalization on Good Clinical Outcomes in Endovascular Thrombectomy
Authors: Yoshie Tomohide , Ueda Toshihiro , Takada Tatsuro , Nogoshi Shinji , Miyashita Fumio , Takaishi Satoshi , Fukano Takayuki
Published: July 2021

Introduction:
Previous studies suggested that faster times to recanalization led to better clinical outcomes in patients after endovascular thrombectomy.

Hypothesis:
We assessed the hypothesis that an association between time to recanalization and clinical outcomes depends on cerebral blood volume (CBV) obtained from pre-treatment CT perfusion (CTP).

Methods:
In consecutive patients with acute ischemic stroke who were obtained successful recanalization (TICI 2A-3) by endovascular thrombectomy for internal carotid artery or middle cerebral artery M1 occlusion, we retrospectively analyzed the influence on clinical outcome of time to recanalization and relative CBV value (rCBV) evaluated by pre-treatment CTP. The patient population was divided into 3 groups according to rCBV: severe decreased rCBV group (rCBV <0.6), mild decreased rCBV group (rCBV 0.6 to 0.9) and normal rCBV group (rCBV >0.9). In each group, we compared time to recanalization from onset and CTP between good clinical outcome group (modified Rankin Scale score ≤2 at day 90) and poor clinical outcome group (modified Rankin Scale score ≥3).

Results:
Fifty-seven patients were eligible for this study. The mean age was 75.3 years and median baseline NIHSS was 17. Nineteen patients (33.3 %) achieved good clinical outcome. In the severe decreased rCBV group, mean time to recanalization from onset and CTP were 192 and 115 minutes, respectively, but no patient had a good clinical outcome. In the mild decreased rCBV group, mean time to recanalization from onset (180 versus 311 minutes, p=0.034) and CTP (102 versus 169 minutes, p=0.007) were significantly shorter in the good clinical outcome group. In the normal rCBV group, no association was found between clinical outcome and time to recanalization from onset (311 versus 313 minutes) and CTP (177 versus 184 minutes).

Conclusions:
Early successful recanalization resulted in better clinical outcome in patients with mild decreased rCBV. Severe decreased rCBV did not provide good outcome regardless of early successful recanalization.
Abstract T P134: Size of Patent Foramen Ovale and Recurrent Stroke: A Systematic Review and Meta-Analysis
Authors: Tsivgoulis Georgios , Katsanos Aristeidis H , Zand Ramin , Giannopoulos Sotirios , Zompola Christina , Alexandrov Anne W , Malkoff Marc D , Alexandrov Andrei V
Published: July 2021

Background&Purpose:
There are contradictory data on the potential association between size of patent foramen ovale (PFO) or coexisting atrial septal aneurysm (ASA) and risk of recurrent stroke. We performed a meta-analysis to evaluate the relationship of PFO size and concomitant ASA with recurrent stroke in medically-treated stroke patients with PFO.

Subjects&Methods:
We conducted a systematic review and meta-analysis according to PRISMA guidelines of all available prospective studies reporting recurrent cerebrovascular events defined as stroke and/or transient ischemic attacks (TIA) in medically treated patients with PFO diagnosed by echocardiography and/or transcranial Doppler (TCD). Shunt size was stratified according to validated transeosophageal (TEE) or TCD criteria as “small”, “moderate” or “large”. Coexisting ASA was diagnosed using TEE criteria.

Results:
We identified 6 eligible studies including a total of 1,727 patients. PFO size (large vs. moderate-small PFO) was not associated with a combined higher risk of recurrent stroke/TIA (RR=1.27; 95%CI= 0.52-3.08; p=0.60; Figure, Panel A) or a higher risk of recurrent stroke alone (RR=1.14; 95%CI= 0.56-2.32; p=0.72; Figure, Panel B). Coexisting ASA was not associated with a combiner higher risk of recurrent stroke/TIA (RR=1.63; 95%CI= 0.89-2.98; p=0.11; Figure, Panel C). There was no evidence of heterogeneity for all analyses (I squared statistic < 50%, p > 0.1 Cohran Q test) across the included studies.

Conclusions:
Our meta-analysis failed to detect any association between PFO-size and risk of recurrent cerebrovascular events in medically-treated stroke patients with PFO. Similarly, the presence of ASA was not related to risk of recurrent cerebral ischemia.
Abstract T P146: The Impact of Pre-stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke
Authors: Sharrief Anjail Z , Sánchez Brisa N , Lisabeth Lynda D , Skolarus Lesli E , Zahuranec Darin B , Baek Jonggyu , Case Erin , Garcia Nelda , Morgenstern Lewis B
Published: July 2021

Background:
Fatalism and depression have been linked to post-stroke mortality and stroke recurrence. Our objective was to evaluate the impact of pre-stroke fatalism, depressive symptoms, and social support on neurological, functional, and cognitive outcomes after stroke.

Methods:
Ischemic strokes (2008 -2011) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. At baseline interviews, pre-stroke depressive symptoms, fatalism, and social support were assessed using Patient Health Questionnaire (PHQ-9; 0-27; higher worse), modified Mental Adjustment for Stroke and Pearlin scales (8-40; higher worse), and a 7-item social support scale (0 -14; higher better); respectively. Outcome among survivors was assessed at 90 days using the National Institutes of Health Stroke Scale (NIHSS; 0-44, higher worse); activities/ instrumental activities of daily living (ADL/IADL; 1-4, higher worse); and Modified Mini-Mental State Exam (3MSE; 0-100, lower worse). Regression models were used to evaluate associations of interest, adjusting for demographic and clinical factors.

Results:
Among 364 participants with outcome interviews and complete covariate data, mean age was 66, 49.5% were female and 58.8% were Mexican American. In adjusted models, higher pre-stroke fatalism (median 17; IQR 12, 20) was associated with poorer functional (0.17 point higher ADL/IADL score per IQR higher fatalism score; 95% CI 0.05, 0.30) and cognitive (2.81 point lower 3MSE per IQR higher fatalism score; 95% CI 0.95, 4.67) outcomes. Similarly, higher pre-stroke depressive symptoms (median 3; IQR 0, 9) were associated with poorer functional (0.16 point higher ADL/IADL per IQR higher PHQ-9; 95% CI .04, 0.28) and cognitive (2.28 point lower 3MSE per IQR higher PHQ-9; 95% CI 0.46, 4.10) outcomes. There were no significant associations between fatalism or depressive symptoms and NIHSS or between social support (median 10; IQR 7, 12) and 90-day outcomes.
Conclusions:
Among ischemic stroke survivors, pre-stroke fatalism and depressive symptoms, but not social support, impact 90-day functional and cognitive outcomes. These findings reinforce the importance of evaluating and addressing psychological factors in stroke care.
Abstract T P150: NIHSS Zero Strokes: Immeasurable but Not Innocent
Authors: Eskioglou Elissavet , Amiguet Michael , Michel Patrik
Published: July 2021

Aims:
Patients with acute ischemic stroke (AIS) lasting >24 hours may have an immeasurable deficit on the admission NIHSS score. We sought to better characterize factors that are associated with NIHSS zero strokes and evaluate their long term outcome.

Methods:
We used all AIS patients with a measurable admission NIHSS in the Acute STroke Registry and Analysis and of Lausanne (ASTRAL) from 2003 - 2012. We then retrospectively analyzed and compared patients with an admission NIHSS of zero with all other patients regarding demographics, clinical characteristics, radiological and laboratory findings in uni- and multivariate analyses. Patients with a pre-stroke NIHSS>0 were also considered “NIHSS zero strokes” if a clearly described preexisting deficit accounted for the current deficit and no new NIHSS points were found. Outcome was assessed at 3 months using the modified Rankins score corrected for pre-stroke disability (corrected mRS) and considered favorable if it was ≤ 1. Combined stroke & TIA recurrences and rehospitalisation rates over 12 months were compared.

Results:
Comparing 109 NIHSS zero with 2’189 other strokes in multivariate analysis, patients with NIHSS zero stroke had lower pre-stroke disability levels, longer onset-to-hospital delays, and more lacunar and infratentorial strokes. When comparing radiological and laboratory finding in the two groups, NIHSS zero patients were less likely to have acute ischemic changes on acute NCCT, less arterial pathology on acute cervical and intracranial imaging and lower creatinine levels. In unadjusted analysis, NIHSS zero patients were more likely to have favorable corrected mRS (zero vs. others: 83.2% vs. 44.6%) and less likely to die (3.9% vs. 13.3%) at 12 months. Recurrence rates were similar (9.2% vs. 12.9%).

Conclusion:
Patients with NIHSS zero strokes as compared with all other patients have more frequently lacunar and infrantentorial strokes, normal acute CT, and less arterial pathology. However a significant minority faces persisting handicap at 12 months and recurrent ischemic events. These findings suggest that NIHSS zero stroke patients have better outcomes but still require support and aggressive secondary prevention.
Abstract T P160: Influence of Polyunsaturated Fatty Acids on Cognition in Elderly Alzheimer's Disease Patients
Authors: Yamazaki Takashi , Nagata Ken , Takano Daiki , Maeda Tetsuya
Published: July 2021

Background:
Many genes and environmental factors linked to Alzheimer’s disease (AD) risk affect lipid metabolism or the cardiovascular system, strongly implicating cerebrovascular and metabolic dysfunction in AD pathogenesis. Although some PUFAs may improve cognitive function in aging individuals, it is still unclear how different PUFAs influence AD neuropathology and cognitive function.

Objective:
To examine the influence of polyunsaturated fatty acid (PUFA) metabolism on AD-associated cognitive decline, we investigated the relationship between serum PUFA profile and neuropsychological test performance.

Methods:
Cognitive functioning in patients with probable AD (n = 174, mean age 77.6 years) was examined using the Mini-Mental State Exam (MMSE) and clock drawing test (CDT). Serum samples were obtained for PUFA profile, including the eicosapentaenoic acid/arachidonic acid (EPA/AA) ratio, and measurement of brain natriuretic peptide (BNP) concentration. In the follow-up study, 47 subjects repeated MMSE and CDT after 1 year, According to the second MMSE score, the subjects were divided into the following 2 groups: those with unchanged or improved MMSE score and those with lower MMSE score. A receiver operating characteristic curve was used to evaluate the relationship between the EPA/AA ratio and 1-year cognitive stability.

Results:
In the cross-sectional study, total MMSE score correlated positively with the EPA/AA ratio and systolic blood pressure (SBP), and negatively with age and diastolic blood pressure (DBP) (p < 0.05). In the follow-up study, the MMSE score was lower than baseline in 20 subjects, whereas it was improved or unchanged in 29 patients. The EPA/AA ratio in the stable group was significantly greater than that in the deteriorating group, suggesting an association between higher EPA/AA ratio and cognitive stability over 1 year. The EPA/AA ratio predicted stability of cognitive performance with a sensitivity of 66% and specificity of 70% (odds ratio = 4.43) when the cut-off was 0.67.

Conclusion:
Our results suggest that serum EPA concentration strongly influences cognitive performances in AD patients. The EPA/AA ratio was a sensitive indicator of cognitive stability in this patient group.
Abstract T P191: Using Clinical Trial Data to Generate Causative Classification System (CCS) Ischemic Stroke Phenotypes for the NINDS Stroke Genetics Network (SiGN)
Authors: Chapman Smith Sherita , McClure Leslie A , Gamble Dale , Benavente Oscar R , Brown Robert D , Kittner Steven J , Ay Hakan , Meschia James F , Worrall Bradford B
Published: July 2021

Background:
Recruitment and phenotyping constitute major costs in stroke genetics research. Clinical trial datasets that include biological samples provide an opportunity to leverage richly phenotyped cases for genomic research. However, the heterogeneity of stroke and methodological differences across studies present challenges. We developed and validated a systematic method of mapping data abstracted from a multicenter randomized clinical trial to the inputs of the CCS stroke subtyping system for the SiGN study.

Methods:
The SiGN Phenotype Committee and the Secondary Prevention of Small Subcortical Strokes (SPS3) research team systematically reviewed SPS3 case report forms (CRF) to identify key elements required to generate CCS subtyping, and drafted and refined mapping rules using a derivation set of 30 charts. The resultant algorithm was compared to manual entry of clinical information into the CCS in a test set of 30 randomly selected charts. This identified problems due to multiple versions of CRFs (up to 7 versions) and prompted revision of the mapping rules. We assessed the revised algorithm in an independent test set.

Results:
None of the subtype classifications agreed in the initial testing prompting revision to allow capture information from different versions of the CRFs. The revised mapping algorithm applied to the same test set performed well; 29/30 agreed - 20 small artery occlusion (SAO) evident, 4 SAO possible, 2 SAO probable and 3 supra-aortic large artery atherosclerosis evident). The one chart that disagreed was classified as SAO evident by manual entry but as undetermined by the data mapping rules. In the 2nd independent test set, 30/30 agreed: 22 SAO evident, 4 SAO possible, 3 supra-aortic large artery atherosclerosis evident and 1 undetermined unknown - incomplete evaluation.

Conclusions:
We created mapping rules using CRFs from a clinical trial to allow reliable subtype classification using the CCS. Issues related to multiple iterations of CRFs presented challenges. Highly phenotyped stroke cases from clinical trials represent a cost-effective opportunity for genomic research.