bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP5: Early Intubation Of Hyperacute Stroke Patients In The Emergency
Authors: Lee Mimi , Stuart Benjamin , Pooshpas Pardis , Mata Jorge , Kim-Tenser May A , Shkirkova Kristina , Liebeskind David S , Starkman Sidney , Saver Jeffrey L , Sanossian Nerses
Published: February 2022

Background:
Stroke patients at times will present to the emergency department in unstable condition necessitating early intubation. Given the time-sensitive nature of thrombolysis for ischemic stroke, we sought to characterize the rates and predictors of intubation on ED arrival for hyperacute stroke patients transported by paramedics.

Methods:
Subjects were participating in the NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial. Subjects were enrolled in the field ambulance within 2 hours of last known well and taken to their usual care emergency department. Early intubation was noted by study nurses on their initial NIHSS after ED arrival.

Results:
A total of 1700 cases were included, aged 69±13 years, 42.6% were women, median NIHSS on ED arrival was 9 [IQR 3-17], final diagnosis was cerebral ischemia in 73.3%, intracranial hemorrhage (ICH) in 22.8%, and a stroke-mimicking condition in 3.9%. The median time form last known to ED arrival was 59 minutes. Early ED intubation was more common in ICH compared to CI or mimic (18% vs. 1% vs. 3%, p<0.001). Early intubation was associated with higher NIHSS [32 v 9]. The final diagnosis for both stroke mimic cases with early intubation was seizure. Among the 88 cases intubated early in the ED, there were 71 (81%) ICH, 15 (17%) ischemia and 2 (3%) mimics. Rates of TPA utilization in cerebral ischemia cases were 53% in the intubated group and 36% in the non-intubated group.

Conclusion:
Early intubation in the ED was more common in the ICH cases and occurred in only 1% of cerebral ischemia cases.
Abstract TP51: The Effect Of Biological Sex On A County Prehospital Stroke Initiative
Authors: camacho nathalie , Belnap Starlie C , Rynor Helen , Nguyen Kelly , Oliva Jadthiel , Persaud Lisa , De Los Rios La Rosa Felipe
Published: February 2022

Introduction:
It has been found that women are disproportionately affected by stroke when compared to men. This can be partially attributed to the presence of non-traditional stroke symptoms in women but also sex variance in stroke care. The FAST-ED is a prehospital initiative used to triage patients presenting with typical stroke symptoms and serves as a proxy for stroke severity directing EMS transportation to the appropriate care center. This study explored sex discrepancies in our community’s prehospital stroke initiative and its effects on patient care.

Methods:
An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored the effects on patient outcome. This database contains two existing cohorts; one cohort prior to FAST-ED implementation and one cohort after implementation. Using this data set we added another cohort of cases 2-years after implementation. The inclusion criteria consisted of patients ≥18 years, arriving via EMS as stroke alerts. No exclusion criteria were included in this study. Variables that were evaluated for sex differences included EMS FAST-ED compliance, FAST-ED score, final diagnoses, door-to-needle DTN and door-to groin DTG, and stroke treatment volumes.

Results:
A total of 1419 cases were included in the dataset with 55% (n=781) being women. EMS FAST-ED compliance was 80.6% for men and 78.7% for women. The average FAST-ED score did not statistically differ between men (M=3.34, SD=2.34) and women (M=3.30, SD=2.25). There was also no sex difference in stroke treatment times or volumes. In this study, the only significant sex difference was in the final diagnoses’ code, where women were 54% (95CI: 51%-58%) CI) more likely to have CVA, 71% (95CI: 51%-88% CI) more likely to have a SAH, and 65% (95CI: 56%-74%) more likely to have a TIA when compared the men.

Discussion:
The results of this study did not show sex differences in the pre-hospital approach to stroke care in our community. Specifically, no difference in stroke EMS triage, stroke treatment times (DTN and DTG), or stroke treatment volumes. Our findings regarding sex differences in final stroke diagnoses code deserves further study.
Abstract TP53: The Frontiers In Stroke Care: The Disparities Of Telemedicine And Telestroke In Latin America
Authors: Moreno Gomez Veronica , Shoaib Maria , Mahmoud Noor , Hamilton Robert , Ortiz-Garcia Jorge
Published: February 2022

Introduction:
Stroke is the second leading cause of death worldwide, with more than a third of these deaths occurring in low-middle income countries, including most of Latin America (LATAM). However, the stroke care systems in LATAM are limited compared to high-income countries. Telestroke is an electronic communication system to deliver medical services from one site to another. Despite the optimal results increasing intravenous thrombolysis and endovascular therapy rates, its use in LATAM is scarce.

Objective:
The study aims to describe the current state of telemedicine (TM) and telestroke (TS) clinical applications in LATAM.

Methodology:
We conducted a systematic review of the literature according to PRISMA guidelines in PubMed/MEDLINE, Cochrane-Library, and Google-Scholar. The search was limited to English/Spanish languages using the search terms “telemedicine,” “telehealth,” “teleneurology,” “telestroke,” “Latin America.” In addition, we included randomized control trials, meta-analyses, observational cohorts, and literature reviews.

Results:
We identified 1,396 articles. After the screening and assessment for eligibility, 37 articles satisfied the inclusion criteria and revealed mixed results. The search showed that TM is widely used in different internal medicine subspecialties in LATAM than TS in Neurology. For example, the term “telemedicine” revealed 1,149 articles, and “telestroke” only 170 articles. Most of the articles reported the feasibility of TS (n=35), but the controlled comparison of TS with conventional services was barely reported (n=2). Brazil (n=7), Chile (n=4), Colombia (n=7), and Mexico (n=4) are the countries with the highest number of TS publications in LATAM.

Conclusions:
The use of TS is underdeveloped in LATAM compared to TM. Therefore, the collaboration of health authorities and non-governmental institutions is essential to continue building stroke care systems with TS in LATAM.
Abstract TP58: Potential Effect Of Antithrombotic Therapy On Outcome Of Cerebral Infarctionin Association With Hypercoagulability
,
Nationwide Inpatient Sample,2016-2018
Authors: Bir Shyamal C , Buchhanolla Prabandh Reddy , Kandregula Sandeep , Javalkar Vijayakumar , Chernyshev Oleg Y , Guthikonda Bharat , KELLEY Roger E
Published: February 2022

Objective:
The identification of hypercoagulability with acute ischemic stroke can impact on management and potential outcome. We sought to determine the potential effect of antithrombotic therapy on outcome in patients with identified hypercoagulability and cerebral infarct in a nationwide data bank of hospital admissions.

Method:
We assessed data from the Nationwide Inpatient Sample (NIS) from 2016 to 2018. We looked for the potential association of hypercoagulability, including protein C, protein S and antithrombin III deficiency, the diagnostic code for cerebral infarction, the use of various forms of antithrombotic therapy, and outcome in reference to inpatient mortality, average length of stay (LOS), and discharge to either a rehabilitation center (RC) or a skilled nursing facility (SNF). A P value of <0.05 was considered significant.

Results:
Among 124,902 patients coded for hypercoagulability, 35.1%, 2.1 %, and 61.4% patients were on anticoagulants, antiplatelets, and without antithrombotic group, respectively. The prevalence of cerebral infarct was significantly lower in the anticoagulant group, OR 0.61, CI-0.57-0.66, P<0.001 and this was significantly higher than in the antiplatelet group, OR 2.2, CI-1.92-2.59, P <0.001 and those without antithrombotics, OR 1.40, CI-1.32-1.52, P <0.001. The LOS (8 vs. 5 days, p=0.001) and discharge to either RC or SNF (40% vs. 35%, p=0.003) was higher in the patients without antithrombotics compared to the anticoagulant group. There was a trend toward reduced inpatient mortality rate in the anticoagulant group, but this was not significant (3.5% vs. 4.5%, p=0.22).

Conclusion:
Patients with hypercoagulability in association with cerebral infarct have a better outcome with anticoagulant therapy than either antiplatelet therapy or no antithrombotic therapy. The worse outcome in the antiplatelet group might reflect a higher risk population for which anticoagulant therapy is not felt to be appropriate or safe.
Abstract TP59: Higher White Blood Cell Count In The First Week After Stroke Predicts Worse Cognitive Outcomes In A Population With Smaller Ischemic Strokes
Authors: Musabbir Muhith , Kim Da Eun , Drag Lauren , Mlynash Michael , Mendez Maria , Lansberg Maarten G , Smith Craig J , Buckwalter Marion S
Published: February 2022

Introduction:
Infection after stroke is more common with large strokes and thus peripheral markers of inflammation are not well defined in stroke survivors with smaller strokes. We sought here to define the prevalence of infection, low grade fever (T≥38°C), and white blood cell count over 11x10
3
/mL (WBC>11) in the first week after stroke in subjects with smaller stroke sizes, and to ask how inflammation in the acute period affects cognitive outcomes in this population.

Methods:
We performed systematic chart review of hospitalization after ischemic stroke (up to 7 days) in 65 subjects enrolled in the StrokeCog study who returned for testing 5-13 months later (median stroke volume 6 mL, [IQR 0.5, 16.6]). We assessed infection (CDC consensus criteria), highest WBC, and presence of T≥38°C. Mann-Whitney U test and general linear models were used to assess whether WBC in the first week predicted outcomes at follow-up: MoCA, Stroke Impact Scale Depression (SIS3), a global cognitive score, and composite scores of memory, motor functioning, processing speed, language, and spatial ability. Models were adjusted when appropriate for age, sex, and stroke size or NIHSS at admission.

Results:
Infection and T≥38°C were each present in 8%, and WBC>11 in 18% of participants within 7 days of stroke. Since only high WBC was present in a substantial proportion of subjects, we compared outcomes in high (>11) vs. normal (≤11) WBC. Subjects with high WBC had larger strokes (13cc [6.6, 38.6] vs. 3.2[0.4, 10.6],
p=
0.027) and worse admission NIHSS (10[4,13)] vs 2[1,5],
p
=0.003). In addition, WBC>11 in the first week was associated with worse mood and lower scores in memory, language, and global cognition months later. After adjustment, WBC remained significantly predictive of mood (
p
=.039) and global cognition (
p
=0.003); language remained significant if adjusted for stroke size (
p
=0.010) but not NIHSS (
p
=0.19).

Conclusions:
Infection and T≥38°C are uncommon during acute hospitalization of ischemic stroke survivors who can return to complete comprehensive testing batteries 5-13 months later. WBC>11 within the first week after stroke may be a marker of later inflammation and predicts more chronic depression and worse cognitive outcomes in this population.
Abstract TP61: Can A Single Motion Sensor Identify Lower Limb Movement Alterations Among Stroke Survivors?
Authors: Abdollahi Masoud , Kuber Pranav Madhav , Shiraishi Michael , Soangra Rahul , Rashedi Ehsan
Published: February 2022

Introduction:
Hindrance in normal movement is common among stroke survivors (SS), leading to a larger prevalence of falling and serious injuries. Current methods for analyzing the movement restrictions (camera-based motion capture) are limited to laboratory/clinical environments. Meanwhile, the presence of Inertial Measurement Unit (IMU) sensors in our everyday lives (e.g., in smartphones) is ever increasing due to their portability, affordability, and accessibility. The purpose of this study was to determine whether a single IMU sensor can differentiate movements between SS and healthy control (HC).

Methods:
Turning (360°) was selected as the activity since it is a common and complex motion. Data was collected from 12 participants (6 SS, 6 HC) using an IMU sensor (Xsens®) placed on unaffected leg (shank) and was analyzed using a 3-step process: filtration (5 Hz cutoff frequency), segmentation (cycles – consecutive foot placement), and feature extraction. Analyzed features included duration of task (sec), number of cycles, mean angular velocity (deg/sec) of shank per cycle, ratio of stance-time to the duration of task (%), and range of flexion angle (deg) for shank.

Results:
Obtained values were larger in SS for number of cycles (SS: 5.8, HC: 3.2, p-value<0.01) and duration of task (7.8, 3.4, <0.01). Meanwhile, HC showed higher velocity of shank (unaffected) flexion (1.2, 1.7, <0.01) and the ratio of stance-time to the duration of task (57.7, 32.3, <0.01).

Conclusion:
A single IMU sensor successfully detected kinematic disparities between two groups. Meanwhile, further work is required to examine the robustness and detection improvements upon using other sensor locations. The use of a single IMU sensor, also present in most smartphones/smartwatches, could enable this accessible technology to be used as a remote assessment/monitoring tool, extending the reach of diagnostic tools and rehabilitation programs.
Abstract TP63: Predictors Of Rapid Swallow Recovery And Avoidance Of Percutaneous Endoscopic Gastrostomy Placement In Preparation For Inpatient Rehabilitation
Authors: Tariq Muhammad , Ibrahim Lamya , Ahmad Mohammad Jamil , Hsieh Billie , Guerra Castanon Felix , Silos Christin , Fabbrini Georgia , Howard Melissa , Green Charles , Jagolino-cole Amanda L , Savitz Sean I
Published: February 2022

Background:
Enteral tube feeding is required for adequate nutrition in post-stroke patients with dysphagia. Nasogastric tube (NGT) feeding is used short-term, while percutaneous endoscopic gastrostomy (PEG) is utilized when dysphagia persists. Furthermore, most post-acute care facilities, including inpatient rehabilitation (IR), do not accept patients with NGT. We assessed factors associated with quick recovery of swallowing function, to identify which patients may avoid unnecessary PEG placement during hospitalization and reduce associated complications.

Methods:
Using a prospectively collected registry of stroke patients admitted in our system of 5 IRs, we found 806 patients with stroke (1/2018 to 6/2019). At discharge from hospitalization or IR, 83 patients had either a PEG or NGT. We divided patients into two groups based on whether PEG was used for nutrition at discharge from IR or if dysphagia improved and they were able to resume a PO diet. We performed predictive modeling with RIDGE regression analysis using age, sex, marital status, initial NIHSS, infarct location, change in dysphagia outcome and screening scale (DOSS) at first two evaluations, and days hospitalized.

Results:
Median age was 65 (IQR 60-71) years and 28 (34%) were female. Twenty-eight patients (34%) required nutritional support upon IR discharge. Mean initial NIHSS for patients who passed swallow testing prior to IR discharge was 15 (7.3), similar to patients who failed swallow testing prior to discharge 13.7 (8.0) (p=0.50). Patients who passed swallow testing prior to IR discharge had comparable median length of hospitalization to those who did not (14.9 and 14.3, respectively, p=0.84). Predictive modeling indicated that age, sex, marital status, initial NIHSS, location of infarct, change in DOSS and length of hospitalization can predict passing swallow evaluation satisfactorily (AUC=0.673). Of the 12 patients with NGT at discharge from hospital, no patients required PEG placement.

Conclusion:
Our model shows that age, sex, marital status, initial NIHSS, location of infarct, change in DOSS and length of hospitalization can satisfactorily predict passing swallow evaluations. However, additional factors involved in the process will be explored to improve the model.
Abstract TP66: Sex Differences In Neuromuscular Fatigability During Submaximal Isometric Knee Extension Exercise Post Stroke
Authors: Zhou Zhilun , Alqahtani Saad , Nguyen Jennifer , Raab Stephanie , Kroll Zachary , Durand Matthew , Schmit Brian , Hunter Sandra , Hyngstrom Allison
Published: February 2022

Introduction:
Annually, 55,000 more females than males are affected by stroke in the United States. Females also tend to experience more severe strokes with worse functional outcomes, which result in poorer health-related quality of life. Despite the marked differences in long-term recovery between males and females with stroke, little is known about the sex differences in motor performance that may contribute to the differences in recovery and what therapies could be used to optimize recovery, especially for female stroke survivors. In this study, we aimed to determine if sex-related differences in neuromuscular fatigability exist post stroke.

Methods:
Sixteen chronic stroke survivors (at least 6 months post stroke, 9 females, 58 +/- 14 years) and thirteen neurologically intact controls (7 females, 59 +/- 12 years) performed a submaximal isometric fatiguing knee extension contraction with either the paretic (stroke) or the dominant (control) leg. The submaximal fatiguing contraction torque was equivalent to 30% of the maximal voluntary isometric contraction (MVIC) of the knee extensors. The participants were asked to sustain at the target torque until one of the two criteria for fatigue was met: (1) if the participant’s torque cannot maintain within a 10% window of error for more than 5 seconds; or (2) if there are more than 5 deviations from the 10% error window in a consecutive 10-second time period. Time to task failure (TTF) was measured.

Results:
Overall, both male and female stroke survivors tended to have lower MVIC than their healthy counterparts (male: 151 +/- 60 Nm vs. 206 +/- 39 Nm; female: 58 +/- 17 Nm vs. 121 +/- 27 Nm). On average, males tended to fatigue similarly between stroke and control groups (259 +/- 164 s vs. 249 +/- 96 s, respectively); while female stroke survivors tended to have a briefer TTF compared to female controls (207 +/- 69 s vs. 311 +/- 129 s).

Conclusions:
During submaximal isometric knee extension exercise, female stroke survivors had a shorter task duration than female controls, while this stroke-related difference was not observed in males. Our results indicate that, although stroke impairs muscle strength in both sexes, fatigability may be exacerbated to a greater extent in females than in males post stroke.
Abstract TP77: Patient Understanding Of And Satisfaction With Acute Stroke Treatments
Authors: Vanguru Husitha , Blaginykh Elena , Cierny Marek , Handshoe Lacy S , Uchino Ken
Published: February 2022

Background:
We aimed to assess patient and family understanding of and satisfaction with communication regarding acute stroke treatments of intravenous thrombolysis (IVT) and endovascular therapy (EVT).

Methods:
The study was conducted at a health system in the United States from November 2020 to May 2021. A structured interview with open-ended and multiple choice questions was conducted over telephone or in person within 72 hours of therapy to patients or surrogates with whom acute stroke treatments were discussed. The respondent satisfaction and self-reported understanding were rated on a Likert scale. Responses to open ended questions on recall of diagnosis, purpose, risks, and benefits of treatments were evaluated by two blinded raters.

Results:
Of 128 patients who met inclusion criteria, 15 refused, 54 were unavailable and 56 completed interviews. Twenty four participants were patients and 32 were surrogates. Forty-two participants were white and 39 had education of high school graduation or above. Thirty five received IVT alone, 11 IVT and EVT, 12 EVT alone. Forty participants were extremely satisfied with the care patients received in the stroke care unit. Forty-six (71%) reported to have no difficulty in understanding the purpose of treatments, and 36 (64%) reported no difficulty understanding risks. Upon specific evaluation, 83% (38/46) had a good recall of the purpose but only 17% (8/46) named 2 or more risks for IVT. For EVT, 87% (20/23) had a good recall of purpose and 9% (2/23) named 2 or more risks. “Bleeding in the brain” was the most reported risk for IVT (n=22) and “lack of benefit” for EVT (n=11).

Conclusions:
Most patients and surrogates are extremely satisfied with acute stroke treatment. Despite the majority reporting no difficulty in understanding the risks of acute stroke treatments, only a small minority were able to recall and verbalize two or more risks.
Abstract TP81: Cost Effectiveness Of Cilostazol Added To Aspirin Or Plavix For Secondary Stroke Prevention Following Non-cardioembolic Stroke
Authors: Zhou Lily , Kraler Lironn , Lansberg Maarten G
Published: February 2022

Background:
The objective of the study is to compare the cost-effectiveness of cilostazol (a selective phosphodiesterase 3 inhibitor) added to aspirin (ASA) or Plavix in patients with non-cardioembolic stroke for secondary stroke prevention.

Methods:
A Markov model decision tree was used to examine lifetime costs and Quality Adjusted Life Years (QALYs) of patients with non-cardioembolic stroke treated with either single antiplatelet (ASA or Plavix) or with additional cilostazol 100 mg twice daily. Cohorts were followed until all patients died from competing risks, ischemic or hemorrhagic stroke. Input parameters are shown in Table 1. Probabilistic sensitivity analysis using Monte-Carlo simulation was used to model 10 000 cohorts of 10 000 patients.

Results:
The addition of cilostazol to ASA or Plavix is strongly cost saving (Figure 1). In all 10 000 simulations, the cilostazol strategy resulted in lower health care costs compared to ASA or Plavix alone (mean $14 450 lower per patient, SD $8 466 USD). In 9 998/10 000 simulations, the cilostazol strategy resulted in higher QALYs (mean 0.6016 QALY per patient, SD 0.0704). This result remained robust across a variety of sensitivity analyses varying cost inputs and treatment effects.

Conclusion:
Based on best available data, the addition of cilostazol to ASA or Plavix for secondary prevention results in significantly reduced healthcare costs and higher lifetime QALYs for patients with non-cardioembolic stroke. Confirmation with high quality data from a randomized trial including a high proportion of non-Asian patients is needed to increase generalizability.
Abstract TP82: Gaps In Clinical History And Diagnostic Evaluation For Young Women With Ischemic Stroke - We Need An Updated Approach
Authors: Amin Shalene , Shah Ekta , Cohen Audrey S , Drake Madeline , Neela Niharika , Garrett Sydney , Poisson Sharon N , Jones Erica , Afifi Rana O , Chiadika Simbo , McCullough Louise , Gonzales Nicole R , Sharrief Anjail Z
Published: February 2022

Introduction:
Young women with stroke represent a unique patient population. There are a variety of sex-specific etiologies that warrant a different approach to evaluation and secondary prevention in young women. Secondary prevention begins during the acute hospitalization, thus, certain aspects of the history and evaluations may be indicated early after stroke. We describe our center’s experience with young women presenting with stroke over a 2.5-year period.

Methods:
We performed a retrospective review of women between 18-45 years, identified from our stroke registry (1/2015 to 5/2018). An assessment of key variables regarding common stroke risk factors (RFs), sex-specific RFs, (pregnancy history, estrogen use, migraine, autoimmune conditions) and workup (pregnancy test, hypercoagulable states, substance use) was conducted.

Results:
Of 198 women with acute ischemic stroke in our study period, medical RFs of hypertension, diabetes, hyperlipidemia, and atrial fibrillation were each ascertained for more than 98% of women. Lifestyle RFs of tobacco use and alcohol use were reported for 85.9% and 87.6%, respectively and urine drug screens were performed in 67%. Obstetric history (gravida/para) was obtained in only 19.7%, pregnancy tests were conducted in 69.2%, and hypertensive disorders of pregnancy were only reported in patients who were pregnant (2%) or post-partum (5.6%). Oral contraceptive (OCP) or hormone replacement (HRT) was reported in 6.6% and migraine with or without aura in 12.6%. Among 76 patients (38.4%) with cryptogenic stroke, obstetric history was reported in only 25%, OCP/HRT use in 5.3%, and antiphospholipid antibody syndrome was assessed in 64%.

Conclusion:
The acute stroke hospitalization is a critical period for identification of stroke etiology and assessment of cardiovascular risk. There are known sex disparities in standard evaluation and management of stroke. In pre-menopausal women, gaps in care may be even greater if the history and assessment are not completed with sex-specific variables in mind. We suggest a standard approach to the history and assessment of young women. We plan to implement this approach in our patient population while tracking the impact on care.
Abstract TP85: A Collaborative Approach In The Reduction Of Hospital Acquired Infections In A Neuroscience ICU
Authors: Estem Kristecia , Tam Christina , Lengyel Kimberly , Rorden Emily , Polonchak Jillian , Dorosan Elmer , Crane Caroline , Emanuel Benjamin , Bulic Sebina , Nguyen Peggy , Winfrey Elizabeth , Gonzalez Elizabeth , Carpenter Sean , Nanda Neha , Kim-tenser May A
Published: February 2022

Intro:
HAIs such as catheter associated urinary tract infections (CAUTIs) and central line associated bloodstream infections (CLABSIs) increase morbidity, mortality, healthcare cost, and account for a significant burden of patient harm. We describe efforts between nursing, Infection Prevention (IP), and clinicians in the reduction of HAI-CAUTIs and HAI-CLABSIs on a neuroscience intensive care unit (NeuroICU) in an academic acute care hospital.

Methods:
Using the Centers for Disease Control and Prevention’s (CDC) Targeted Assessment for Prevention (TAP) framework [Target, Assess, Prevent], IP identified the Neuro-ICU as having an excess burden of HAI-CAUTIs and HAI-CLABSIs and facilitated interdisciplinary engagement. In partnership, nursing, IP, and Neuro-ICU clinicians, developed action plans focused on foley catheter (FC) and central line (CL) utilization, FC bundle compliance, FC maintenance competency validation, and training on central line maintenance. Monthly meetings to discuss progress and identify barriers were performed. Neuro-ICU clinicians and nurse managers performed device rounds twice a day to discuss device necessity utilizing a nurse-driven protocol, and verified FC and CL removal. This project used the CDC’s National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) tracking system to compute standardized infection ratios, HAI events, FC utilization, and CL utilization. CLABSI and CAUTI bundle compliance were evaluated using an electronic audit tool. Staff competency validation and education attendance were tracked. The project period was from September 2020-July 2021 for CAUTI and January 2021-July 2021 for CLABSI.

Results:
HAI-CAUTI events decreased from 6 to 1, the standardized infection ratio (SIR) reduced from 3.003 to 0.593, and the FC utilization ratio decreased from 0.36 to 0.31 from October 2019- August 2020 to September 2020-July 2021. HAI-CLABSI events decreased from 1 to 0, CL utilization ratio decreased from 3.31 to 2.81 from June 2020- December 2020 to January 2021- July 2021.

Conclusions:
These results suggest that an interdisciplinary approach and robust IP practices may be an effective approach to improving patient safety and reducing patient harm.
Abstract TP86: Depression And Anxiety After Stroke In A Young Adult Population
Authors: Ignacio Katrina H , Diestro Jose Danilo , Medrano Jose Miguel , Salabi Sitti Khadija , Logronio Alvin , Factor Sedric John , PASCUAL JOSE LEONARD R , Ignacio Sharon , Pineda-Franks Maria Carissa
Published: February 2022

Background and Objectives:
We aimed to determine the prevalence of poststroke depression (PSD) and anxiety as well as to identify their predictors in a population of young Filipino adults.

Methods:
We performed a cross-sectional epidemiologic study in the largest tertiary hospital in the Philippines. The study involved the administration of a structured survey tool and review of medical records. The Hospital Anxiety and Depression Score was used to screen for anxiety and depression. Chi-square tests and Fisher’s exact tests were used to compare between groups with anxiety or depression and those without. Multivariable logistic regression analysis was performed to determine significant socio-economic and clinical risk factors of PSD and anxiety.

Results:
In our study population of 114 young adult stroke patients, the prevalence of depression was 20.2% while the prevalence of anxiety was 34.2%. Significant predictors of PSD were the presence of anxiety (OR 1.84; CI 1.05-3.22), lower mRS scores (mRS 3-5 OR 5.52; 95% CI 1.09-8.03) and diabetes (OR 2.09; 95% CI 1.67-6.26). Meanwhile, significant predictors of poststroke anxiety included depression (OR 7.5; 95% CI 5.02-21.94) and dependence (Barthel Index scores 95-100; OR 0.32; 95% CI 0.14-0.71). Relationship status, educational attainment, stroke subtype and stroke location were not found to be significant predictors of PSD and anxiety.

Conclusion:
Our study showed that young adult patients who suffer from stroke are at risk for adverse socio-economic and psychiatric consequences. A significant proportion of the population had depression and anxiety after stroke. Clinicians should be aware of these conditions that influence the outcomes of young adult stroke patients.
Abstract TP93: Interaction Of Ethnicity And Arrival Method On Thrombectomy Delay: The Society Of Vascular And Interventional Neurology Multicenter Collaboration
Authors: Siegler James E , Ortega-Gutiérrez Santiago , Hester Taryn , Haussen Diogo C , Nogueira Raul G , Liebeskind David S , Zaidat Osama , Vora Nirav , Desai Shashvat , Jadhav Ashutosh P , Roach Eileen , Linfante Italo , Hassan Ameer , Farooqui Mudassir , Jillella Dinesh V , Nahab Fadi B , Sharrief Anjail Z , Czap Alexandra L , Bach Ivo , Khandelwal Priyank , Visser Willy , Nguyen Thanh
Published: February 2022

Introduction:
Compared to White patients, non-White minority populations are less likely to receive acute treatment for ischemic stroke, and when they do, it can be delayed.

Hypothesis:
To evaluate the interaction between arrival method (transfer vs. emergency medical services [EMS] vs. private vehicle) and race/ethnicity (non-Hispanic Black [NHB] vs. non-Hispanic White [NHW] vs. Hispanic) on door-to-arterial puncture (DTAP) time in thrombectomy.

Methods:
Multicenter retrospective cohort study of consecutive patients (≥18 years) treated with endovascular thrombectomy at 14 US Comprehensive Stroke Centers (1/1/2019-07/31/2020). Door (arrival) to arterial puncture (DTAP) was evaluated using a linear mixed model to estimate the effect of race/ethnicity and arrival mode on treatment time.

Results:
Of the 1,908 included patients, 356 (19%) of whom were Hispanic, stroke severity was similar between race/ethnicity groups, however Hispanic and NHB patients experienced significant delays in DTAP compared to NHWs (adjusted β
Hisp
= 0.32, 95%CI 0.08-0.55; β
NHB
= 0.23, 95%CI 0.04-0.41). In the final linear mixed model, more severe neurologic deficits were associated with shorter DTAP (β
NIHSS
per point -0.03, 95%CI -0.04- -0.03), and arrival via EMS or private vehicle versus transfer were associated with longer delays (β
EMS
= 0.57, 95%CI 0.41-0.74; β
PV
= 1.27, 95%CI 0.85-1.70). There was a significant interaction between Hispanic ethnicity and arrival by EMS (p=0.03) or private vehicle (p=0.04) in a direction favoring shorter treatment delays.

Conclusions:
Endovascular therapy is delayed in Hispanic and NHBs when compared to NHWs. While arrival by EMS or private vehicle (vs. inter-hospital transfer) also contributed to treatment delays, Hispanic ethnicity modified this effect such that there was less delay in DTAP. This may be related to communication barriers between caregivers and healthcare providers when a patient is suddenly disabled from stroke.
Abstract TP96: Mild Luminal Stenosis Of Parent Artery And Neurologic Deterioration After Acute Lacunar Stroke
Authors: Yang Dixon , Gutierrez Jose , Cutting Shawna M , Raz Eytan , Gurel Kursat , Torres Jose L , Mac Grory Brian , Scher Erica , Pirooz Sahnaz , de Havenon Adam H , Ishida Koto , Furie Karen , Elkind Mitchell S , Yaghi Shadi
Published: February 2022

Introduction:
Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarcts and may lead to severe disability, but underlying pathophysiology of ND remains poorly understood. We sought to identify risk factors and clinical characteristics associated with ND.

Methods:
This retrospective observational study included consecutive patients with acute lacunar stroke admitted to New York University Langone Health and Brown University (NYU/Brown). Lacunar stroke was defined as a subcortical infarct <1.5 cm on CT or <2 cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. We defined ND as any neurologic deterioration referable to the lacunar stroke and not related to a medical or non-cerebrovascular neurological complication. We used logistic regression analyses to determine associations between ND and luminal stenosis (<50%) vs no luminal stenosis, after adjustment for key confounders. Furthermore, we attempted to validate findings using the Columbia University (CU) stroke registry and perform a meta-analysis combining the derivation and validation groups due to expected small samples and event rates.

Results:
The NYU/Brown sample included 205 patients, of whom 41 (20%) had ND. In adjusted models, we found no definite association between luminal stenosis and ND (aOR 1.74, 95% CI 0.73-4.14). From CU, 361 total patients were included, of whom 59 (16%) had ND. In adjusted models, we found an association between luminal stenosis and ND (aOR 2.28 95% CI 1.15-4.50). Meta-analysis of both cohorts found luminal stenosis associated with ND (RR [95% CI]: 1.75 [1.23-2.49]).

Conclusions:
In this multi-center study, luminal stenosis (<50%) may be associated with ND following an acute lacunar infarct. Larger studies using high-resolution vascular imaging modalities such as vessel wall imaging are needed to validate our findings.
Abstract WMP1: Results From A Phase 2a Study Of TMS-007, An SMTP Family Anti-inflammatory Prothrombolytic, On Patients With Acute Ischemic Stroke Up To 12 Hours After Onset
Authors: Nishimura Naoko , Niizuma Kuniyasu , Wald Michael , Hasegawa Keiko , Tominaga Teiji , Hasumi Keiji
Published: February 2022

Approved thrombolytic agents are limited in their use for the treatment of acute ischemic stroke (AIS) due to their benefit-risk profile beyond 4.5 h since last known normal (LKN). TMS-007 is a small molecule, SMTP family member with a novel mode of action: promotion of plasminogen-fibrin binding to enhance physiological thrombolysis while inhibiting inflammation at the site of thrombosis. TMS-007 may extend the treatment time window based on nonclinical pharmacological evidence. We evaluated TMS-007 in a randomized, placebo-controlled, double-blind, dose-escalation phase 2a study. TMS-007 or placebo was administered as a single intravenous infusion at a dose of 1, 3, or 6 mg/kg to AIS patients who were ineligible for t-PA or thrombectomy within 12 h of LKN. The number of patients allocated to placebo and TMS-007 at doses 1, 3, and 6 mg/kg were 38, 6, 18, and 28, respectively. The combined TMS-007 dosing group (Group T; n = 52) was compared with placebo group (Group P; n = 38). The average age was ~72 years old and time since LKN to treatment was ~9 h in both groups (not significantly different). The incidence of symptomatic intracranial hemorrhage (ICH) with worsening NIHSS score of <=4 points per site physician (primary endpoint) was 0% in Group T compared to 3% (n = 1) in Group P. The number of ICH event within 24 h, including symptomatic and asymptomatic, was 6 in Group T and 5 in Group P. Total number of AE was 207 in Group T and 162 in Group P, with gastrointestinal diseases as the most common events in both groups (n = 40 and 32, respectively). TMS-007 was associated with a significant improvement in functional independence at 90 days (secondary endpoint): 40% of patients in Group T achieved a score of 0 or 1 on the mRS, compared to 18% in Group P (p < 0.05). Recanalization, defined by any improvement in arterial occlusive lesion score on magnetic resonance angiography in those with visible occlusion at baseline per central neuroradiologist, occurred in 58.3% (14/24) of Group T compared to 26.7% (4/15) of Group P (odds-ratio, 4.23; 95% CI, 0.99 to 18.07). TMS-007 was generally safe and well tolerated up to 6 mg/kg. TMS-007 may expand the treatment time window for the treatment of AIS. Due to the small study size, more data on efficacy is warranted in patients with visible occlusion.
Abstract WMP103: Associations Between Multimorbidity At Stroke/transient Ischaemic Attack Onset With All-cause Mortality Are Not Explained By Blood Biomarkers: A Population-based Study
Authors: Downer Matthew B , Li Linxin , Burgess Annette I , duerden julia M , Rothwell Peter
Published: February 2022

Introduction:
Multimorbidity is highly prevalent in patients with transient ischaemic attack (TIA) or stroke, and is associated with increased short- and long-term mortality thereafter. Underlying mechanisms behind this relationship are unclear, and it is unknown whether increased inflammatory or prothrombotic factors might explain increased mortality.

Methods:
Using the population-based Oxford Vascular Study (OXVASC), we used a panel of 16 blood biomarkers relating to inflammation (IL-6, CRP, NGAL, sTNF-R1), thrombosis/atherogenesis (TM, fibrinogen, vWF, P-Selectin, PZ, D-Dimer, Anti-PC, ADAMTS-13), and cardiac or neuronal cell damage (NT-proBNP, hFABP, NSE, BDNF). Samples were obtained at stroke/TIA onset, and patients were followed up to 10 years. Biomarker levels were log-transformed to facilitate analysis. Multimorbidity immediately prior to TIA/stroke onset was assessed using the Charlson Comorbidity Index (CCI). Partial correlations (age-adjusted) were obtained between CCI and log-biomarker levels. Crude and adjusted hazard ratios (HRs) for all-cause mortality were obtained using Cox models, censoring at 2, 5, and 10 years.

Results:
1297 participants (median age 75.2, interquartile range: 65.3 - 83.2) were recruited from 2002-2012. 596 patients (46.0%) had no CCI comorbidity, 266 (20.5%) had 1, and 435 (33.5%) had 2 or more. After adjustment for age, CCI was correlated with IL-6, NGAL, sTNF-R1, TM, fibrinogen, vWF, D-Dimer, NT-proBNP, and hFABP (all
p
<0.05). CCI was associated with all-cause death at 10 years follow up (HR 1.51, 95%CI 1.38 - 1.64). This association remained significant after adjustment for age, sex, and stroke severity (HR 1.37, 95%CI 1.26 - 1.49) and after further adjustment for inflammatory markers (HR 1.43, 95%CI 1.26 - 1.62), thrombotic/antiatherogenic markers (HR 1.37, 95%CI 1.20 - 1.56), or markers of cardiac or neuronal cell damage (HR 1.33, 95%CI 1.21 - 1.47). Censoring at 2 or 5 years follow-up provided similar estimates.

Conclusion:
Multimorbidity was predictive of all-cause mortality after TIA/stroke, but the association was not explained by our panel of biomarkers. Further work is needed to explain the excess risk of mortality associated with multimorbidity in stroke/TIA patients.
Abstract WMP107: Back To The Future: Recurrent Stroke Genome Wide Association Study
Authors: Aldridge Chad M , Davis Armstrong Nicole , Sunmonu N. Abimbola , Hsu Fang-Chi , Keene Keith L , Sale Michele M , Worrall Bradford B
Published: February 2022

Introduction:
Genetic reference panels and imputation approaches have improved greatly in the last 10 years. The development of the TOPMed reference plane has led to enhanced imputation quality and quantity of single nucleotide polymorphisms (SNPs) due to greater sample diversity among various population ancestries. We revisited our prior GWAS of recurrent stroke by utilizing the TOPMed imputation server.

Methods:
This GWAS used a Cox proportional hazards model of time to recurrent stroke with the Vitamin Intervention for Stroke Prevention clinical trial cohort. There were 2,100 genotyped patients (64% male) in total with an average age of 67.2 (±10.8) years and ancestry distribution of 1,725 (82%) European, 258 (12%) African, and 117 (6%) Other or Mixed ancestry. Genotyped samples underwent a strict quality control process. We utilized TOPMed for imputation which totaled 10,467,887 biallelic SNPs which was 14 times greater in number compared the original analysis.

Results:
Recurrent stroke was observed in 182 (8.7%) patients. We identified seven novel SNPS on chromosome 1 in addition to our previous finding, rs6664786. Interestingly all chromosome 1 SNPs were located within the LINCO1362 gene. This gene has an acute change in expression in the presence of smoking even after adjustment of relevant clinical factors. Two novel SNPs were found on chromosome 16 located in gene desert nearest the pseudo-gene RNU6-21P in an intergenic region downstream of the Cadherin-8 (CDH8) gene. Both SNPs and RNU6-21P have no previously reported clinical relevance, except for their relative position to CDH8. CDH8 is highly expressed in brain tissue.

Conclusions:
We identified several novel SNPs associated with recurrent stroke. Capitalizing on genetic imputation advancements allows potential new insights and discoveries with past trial cohorts. Understanding these insights may provide further mechanistic knowledge of recurrent stroke to develop potential therapeutic targets.
Abstract WMP109: Prenatal Alcohol Exposure Worsens Stroke Outcomes In Young Rats And Exacerbates Brain Damage In Ischemic Middle-aged Rats
Authors: Bake Shameena , Pandey Sivani , Hurst David , Pinson Marisa , Miranda Rajesh , Sohrabji Farida
Published: February 2022

Background and Purpose:
Endocrine imbalances and cardiovascular diseases in post-natal life have been linked to adverse prenatal environment. There is very little information on the developmental origin of adult diseases, particularly prenatal alcohol exposure and stroke outcomes. Recent studies indicate that adults with prenatal adult exposure (PAE) are at agreater risk for obesity, hypertension and hyperglycemia, all of which increase the risk for severe stroke. The present study tested the hypothesis that prenatal alcohol exposure (PAE) elevates stroke severity in young and middle-aged rats.

Methods:
Pregnant Sprague Dawley rats (bred in-house) were exposed to 10% alcohol or air, for 1 hour from gestational day 8 through18 using the rodent alcohol inhalation system. Plasma IGF-1 levels were determined using an ELISA kit. Adult offspring (5 and 12 mo old) were subjected to endothelin-1 induced MCAo and outcomes were evaluated after 2 days. Acute stroke-induced disabilities were assessed by neurological scores and vibrissae evoked fore-limb placement task as well as the extent of infarction.

Results:
While plasma IGF-1 levels were higher in young control males than females, levels were significantly reduced in young-PAE males (p<0.04) compared to control males. MCAo significantly increased mortality in young PAE-males compared to control-males or PAE and control females. Behavioral analysis indicates that young-PAE animals exhibited greater neurological deficits as determined by their higher composite neurological score compared to controls (p<0.03), although their infarct volume was not significantly different from control animals. However, MCAo in the middle-aged PAE rats caused significant behavioral deficits: higher neurological scores (p<0.03), greater cross midline impairment (p<0.03), and increased brain infarction (p<0.04) compared to control stroke rats.

Conclusions:
The present findings support the hypothesis that PAE contributes to adverse effects on stroke outcome as indicated by greater mortality and poor neurological function in young rats, which is exacerbated by age during the acute phase.(Funding support, NIAAA, AA026756)
Abstract WMP111: Microvascular Occlusion Precedes Delayed Deficits In Mice With Subarachnoid Hemorrhage
Authors: Hong Sung-Ha , Thankamani Pandit Peeyush , Blackburn Spiros , McBride Devin
Published: February 2022

Subarachnoid hemorrhage (SAH) induces delayed cerebral ischemia (DCI) in about 30% of patients which is characterized by functional decline. Microvascular occlusion, via microvessel constriction or microthrombi, may be a cause of DCI. Our hypothesis is that microvascular occlusion and reduced cerebral blood flow (CBF) precede the onset of delayed deficits in mice with SAH. Mice were randomly assigned into sham, SAH+saline, and SAH+A3P5P+Clopidogrel (platelet antagonists). Laser speckle imaging (to assess large and microvessel perfusion) and behavior were assessed daily. All outcomes were performed and data was analyzed by a blinded investigator. Both large artery and microvessel/tissue perfusion recover to baseline in SAH mice which do not get delayed deficits. However, in SAH mice which develop delayed deficits, microvessel/tissue perfusion has a prolonged reduction (Figure 1A). Interestingly, large artery perfusion recovers in these mice. Antiplatelets prevent microthrombi, attenuating microvessel occlusion, and reduce delayed deficits (Figure 2B-C). Our findings suggest that 1) microvessel occlusion and prolonged tissue perfusion are causative factors for DCI and 2) preventing platelet activation may be a therapeutic target to reduce the incidence of DCI. Our data also suggests a sex difference in the response to platelet antagonists (data not shown).
Abstract WMP112: Cyb5r3 Provides Resilience Against Cerebral Infarct And Hemorrhagic Transformation In Mice Following Stroke
Authors: Wood Katherine C , Hahn Scott , Bhuiyan Mohammad I , Sun Dandan , Straub Adam C
Published: February 2022

Introduction:
Cytochrome B5 reductase 3 (CYB5R3) is a heme reductase, ubiquitously expressed in red cells and somatic cells. We discovered a novel role for smooth muscle cell (SMC) CYB5R3 in reducing oxidized heme (Fe
3+
) of soluble guanylate cyclase back to its reduced form (Fe
2+
) to enable nitric oxide signaling for cyclic guanosine monophosphate production and vessel dilation. We have published higher systemic and pulmonary artery pressures in mice with conditional SMC-specific CYB5R3 knockdown. While there are over 40
CYB5R3
variants, the T117S loss-of-function (~50%) variant is interesting as it is enriched (0.23 minor allele) in persons of African ancestry. We hypothesized that the T117S variant increases risk for stroke with poor outcomes.

Methods:
We studied transient middle cerebral artery occlusion (50 min) in mice with CRISPR-Cas9 induced T117S
CYB5R3
(T117S), Cre/Lox induced endothelial cell-specific CYB5R3 knockdown (EC-KD), Cre/Lox induced SMC-specific CYB5R3 knockdown (SMC-KD), global CYB5R3 overexpression (OE), and wild-type (WT) mice; all were adult males on a C57Bl6 background. Cerebral infarct volume (mm
3
) was determined 24 hr later using 2,3,5-Triphenyltetrazolium chloride (TTC) and ImageJ.

Results:
Infarct volume was larger in T117S (132 vs 71; P=0.002) versus WT controls, which SMC-KD replicated (123 vs 70; P=0.01) and OE reversed (49 vs 100; P=0.02); EC-KD had little effect (88 vs 72). Hemorrhagic transformation was greatest in EC-KD (7/8 vs 5/9) and SMC-KD (3/6 vs 1/6), whereas there was no effect for T117S or OE.

Conclusion:
A congenital global point mutation causing CYB5R3 loss-of-function (T117S) enhances area at risk for cerebral infarct after stroke, while conditional deletion of EC and SMC CYB5R3 contribute to hemorrhagic transformation. Determining T117S carrier status of patients may help predict stroke risk and allow CYB5R3-targeted precision therapy approaches to stroke management.