bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract DP4: When Does Clinical Worsening Begin in Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis?
Authors: Shakoor Rahim , Andrews Sarah , Couvillion Amy , McLaughlin Sylvia , Spencer Whitney , Lafranchise E , Warach Steven
Published: January 2025

Introduction:
Intravenous thrombolysis with alteplase (tPA) or tenecteplase (TNK) is a first-line treatment for acute ischemic stroke. The most serious risk associated with IV thrombolytics is symptomatic intracranial hemorrhage (sICH). Patients are usually monitored in intensive care units for neurologic decline signaling sICH for 24 hours, after which follow up neuroimaging is performed and antithrombotic secondary prevention may be initiated. However, the evidence surrounding the onset of neurologic decline in post-thrombolytic sICH is limited. The current study seeks to provide data regarding onset of clinical worsening in post-thrombolytic sICH, and to identify a subset of patient characteristics for a future clinical trial to test whether earlier imaging, transfer from ICU, and initiation of secondary prevention is feasible and safe.

Methods:
The current study is a multi-center collaboration between University of Texas - Dell Medical Center, Ascension Seton, and Ascension Saint Thomas. We reviewed stroke databases from 2017 to 2024 for patients who received IV thrombolysis with either tPA or TNK and developed sICH within 36 hours of treatment. sICH was defined as a hemorrhage that caused an increase in NIHSS by 4 or more points. Patient charts were reviewed to determine if a decline in neurologic exam prompted neuroimaging that discovered sICH, and for documentation of the timing of clinical worsening that prompted neuroimaging.

Results:
40 patients were identified during the study period to have sICH. Of those, 25 patients were discovered to have sICH after a decline in neurologic exam. 7 patients received tPA and 18 patients received TNK. The median time to documented neurologic decline in all patients was 251 mins (range: 7 mins to 1185 mins). For patients with pretreatment NIHSS < 10, the median time to documented neurologic decline was 134 mins (range: 57 to 259 mins).

Discussion:
All patients with neurologic decline resulting in neuroimaging and discovery of sICH had this decline documented within 20 hours. Among patients with NIHSS < 10, all patients had this decline within 5 hours. Our preliminary data suggests that there may be patients who receive IV thrombolysis who may be candidates for expedited neuroimaging or transition to step-down units and secondary preventive measures. Candidates would likely require stable neurologic exams that could be tracked over time. Further investigation to confirm these results on a larger sample is planned.
Abstract DP45: Antithrombotic trends before and after publication of randomized clinical trials in cervical artery dissection: A secondary analysis of the STOP-CAD Study
Authors: Penckofer Mary , Shu Liqi , Strelecky Lukas , Yaghi Shadi , Henninger Nils , Muppa Jayachandra , Bakradze Ekaterina , Heldner Mirjam , Katheryna Antonenko , Salehi Omran Setareh , Seiffge David , Arnold Marcel , Marialuisa Zedde , Zubair Adeel , Marto Joao Pedro , Ghannam Malik , Engelter Stefan , Traenka Christopher , Mac Grory Brian , Kam Wayneho , Elnazeir Marwa , Romoli Michele , Saleh Velez Faddi , Siegler James
Published: January 2025

Background:
The 2021 American Heart Association guidelines recommend antiplatelet or anticoagulation therapy for 3-6 months following acute cervical artery dissection (CeAD), driven by results from two randomized clinical trials which failed to demonstrate superiority of anticoagulation over antiplatelet therapy. This secondary analysis of STrOke Prevention in Cervical Artery Dissection (STOP-CAD) examined changes in oral antithrombotic strategies of CeAD following publication of these trials.

Methods:
This is a pre-specified secondary analysis of a retrospective multinational observational cohort study evaluating outcomes related to antithrombotic treatment for acute CeAD (2015-2021). Adult patients with acute CeAD treated with oral antithrombotics (excluding vessel stenting) within 180 days of diagnosis were included. Anticoagulation (AC) was defined as direct oral anticoagulant therapy or vitamin K antagonist and antiplatelet (AP) was defined as single or dual oral antiplatelet therapy. The odds of oral anticoagulant use (over single or combination oral AP) therapy across each year were estimated using multivariable logistic regression and joinpoint regression.

Results:
From 4,023 STOP-CAD patients, 3,345 had complete data regarding oral antithrombotic agent initiation and met inclusion criteria. Baseline characteristics per year did not differ significantly. Beginning in 2017, there was a decrease in the rate of oral AC (OAC) use with and without AP. Low NIHSS at baseline and single vertebral artery involvement were significantly associated with lower rates of oral AC use with or without AP use. Meanwhile; female sex, presence of an infarct on imaging, and presence of a partially occlusive thrombus were significantly associated with higher rates of OAC use. In joinpoint regression, the percentage of patients on OAC decreased and the percentage of patients on oral AP therapy increased over time. In 2015, 33.9% of patients received AC with or without AP, 18.7% received AC without AP and 81.3% received AP only. In contrast, in 2022 19.1% of patients received AC with or without AP 6.75% received AC without AP, and 93.4% received AP only.

Conclusions:
Real-world clinical practices in the treatment of acute CeAD changed with a clearer understanding of the lack of definite benefit of OAC for all-comers with CeAD. While there may be certain subgroups for whom OAC is more effective than oral AP for CeAD, an increasing majority of patients receive AP over OAC.
Abstract DP49: Time Metrics in Acute Management of Anticoagulant-Associated Acute Intracerebral Hemorrhage: The Need for Speed
Authors: Brassard Catherine , Dumouchel Charles , Constantin Ilie Alexandru , Mendes George , Panetta Luca , Au Natalie , Babak Elena , Letourneau-Guillon Laurent , Gioia Laura
Published: January 2025

Introduction:
Intracerebral hemorrhage (ICH) is associated with poor outcomes in part due to a lack of perceived sense of urgency. In low to middle-income countries, a rapid approach including oral anticoagulation (OAC) reversal and intensive blood pressure (BP) reduction <60 minutes improves outcomes and reduces hematoma expansion (HE). We aimed to assess and quantify current time metrics in anticoagulant-associated ICH (AAICH) management and the relationship with HE and in-hospital mortality in a high-income academic setting.

Methods:
Consecutive AAICH patients admitted to a Canadian high-volume comprehensive stroke center from 2017-2023 were examined. Clinical data were merged with ICH imaging at baseline&follow-up CT. Imaging analyses were performed using 3D Slicer segmentation software. HE was defined as per revised criteria (≥33% relative or ≥6 mL absolute increase in ICH volume, or new presence or ≥1mL increase in intraventricular hemorrhage).

Results:
Among 75 patients, mean±SD age was 79.8±9.1 years, 33% female, median(IQR) NIHSS 19(12-26), and median ICH volume 15.7(6-48) mL. Direct OAC were used in 68% (96% FXa inhibitors), and 28% warfarin. Mean admission systolic BP was 177.2±28.6 mmHg, with a 140 mmHg BP target in 94%. At 60 minutes from arrival, BP target was achieved in 24%, with a median time to BP target of 87.5(61-207) min. OAC reversal agents were administered in 52(69%) patients, 30(59%) on FXa inhibitors, 20(95%) on warfarin, and 2(100%) on dabigatran. The median time to OAC reversal was 68(49-96) min, with 42% treated <60 mins. Of the 46 (61%) patients who received both BP and OAC reversal treatments, 30 (43.5%) reached the <60 min. target for one treatment and 5 (7%) for both treatments. In 48 patients with follow-up CT and without neurosurgical intervention, HE occurred in 27(56%). The proportion of HE was larger in those who did not receive rapid BP reduction (21/27 vs. 6/27) and rapid OAC reversal (13/20 vs. 7/20) compared to those who did, respectively. In-hospital mortality (33/75, 44% overall) was similar in patients who did not achieve one (38%) or both (40%) treatment targets.

Conclusions:
Current management of AAICH remains suboptimal in a high-income academic setting, where only 7% of patients received both BP treatment and OAC reversal <60 minutes from hospital arrival. HE was more common among patients whose treatments were delayed. These findings expose the need for better management strategies to rapidly treat AAICH
Abstract DP56: Efficacy of Matrix Metalloproteinase-12 Gene Silencing on Post-Stroke Neurological Recovery in Aged Mice and Hypertensive Rats
Authors: Challa Siva Reddy , Baker Isidra , Fornal Casimir A. , Sama Vinay , Veeravalli Sahil , Frakes Rachel , Unnam Pavani , Wang Billy , Pinson David , Klopfenstein Jeff , Veeravalli Krishna Kumar
Published: January 2025

Introduction:
We discovered a marked upregulation of MMP-12 levels in the brain following an ischemic stroke and demonstrated that reducing MMP-12 levels in otherwise healthy rodents decreases brain damage and facilitates functional recovery. This study aimed to assess the effectiveness of MMP-12 gene silencing in improving sensorimotor function recovery in aged mice and hypertensive rats.

Methods:
Both male and female C57BL/6 mice (≥16 months old) and male spontaneously hypertensive rats (SHRs) (2-3 months old) were subjected to 35-min and 1-h transient right middle cerebral artery occlusion (MCAO), respectively. Appropriate cohorts of animals (25 mice/group; 18 rats/group) received either control shRNA or MMP-12 shRNA plasmids (1 mg/kg) formulated as nanoparticles that were administered intravenously via tail vein 2 h after reperfusion. In mice, stroke symptoms were evaluated using the neurological deficit score at 2-4 hours and 1 day after reperfusion, while the modified neurological severity score was used in rats. Sensorimotor functions were assessed using the sticky tape test, pole test, and rotarod test at baseline (before MCAO) and at regular intervals post-MCAO (days 3, 5, and 7 in mice, and days 1, 3, 5, 7, and 14 in rats).

Results:
MMP-12 expression in the ischemic brain was significantly increased by 35-min MCAO in aged mice and 1-h MCAO in SHRs, as was previously observed in healthy young mice and rats that were subjected to 1-h and 2-h MCAO, respectively. In comparison to the control shRNA treatment, MMP-12 shRNA treatment facilitated a greater mean recovery of somatosensory function in aged mice (sticky tape latency was significant on day 3 and day 5; sticky tape interaction was significant on day 5) and in SHRs (sticky tape ratio was significant on day 14). Furthermore, MMP-12 shRNA treatment resulted in a greater mean recovery of motor function across all tested time points in aged mice (pole descent score was significant on day 7; rotarod latency was significant on day 7) and in SHRs (rotarod latency was significant on day 5 and day 14).

Conclusions:
Reducing MMP-12 expression in the ischemic brain facilitates the recovery of both somatosensory and motor function in aged mice and hypertensive rats after transient focal cerebral ischemia. Our findings further reinforce the potential benefits of MMP-12 gene silencing as a therapeutic approach for improving recovery outcomes in stroke patients.
Abstract DP59: Selective Activation of Peritoneal TRPV1-Containing Visceral Afferents Activates Heat Defense and Promotes Sustained Mild Hypothermia and Neuroprotection Following Stroke:
Authors: Andersohn Alexander , Jarret Robert , Cantrell Charles , Marrelli Sean
Published: January 2025

Intro:
Mild hypothermia has proved clinically effective at improving outcomes in cardiac arrest patients for decades. Similarly, mild hypothermia has been shown to be neuroprotective in experimental stroke models. Unfortunately, hypothermia protocols in awake subjects are hampered by inconsistent temperature management due to incomplete suppression of cold defense mechanisms (e.g. shiver response). To address the need for better cooling strategies for conscious subjects, we previously demonstrated that pharmacological activation of the heat defense mechanism with TRPV1 agonists can promote sustained mild hypothermia and neuroprotection following stroke. Here, we examined the mechanism by which intraperitoneal delivery of a
non-pungent
TRPV1 agonist (mixed capsinoid extract; capsiate and dihydrocapsiate) promotes whole body cooling. We hypothesize that capsinoids activate TRPV1-containing visceral afferents in the peritoneal cavity, thereby activating heat defense mechanisms and promoting whole body cooling.

Methods:
Adult C57BL6 and TRPV1 knockout (KO) mice of both sexes were given the mixed capsinoids (40 mg/kg, i.p.) or vehicle control. Due to their high lability, capsinoids lack the ability to travel through the body, thereby restricting activity to delivery site. Core body temperature and tail temperature were measured throughout by wireless transponder and FLIR imaging camera, respectively.

Results:
Capsinoid administration led to a 1.5 +/- 0.5 C drop in core temperature, reaching its nadir around 20 minutes post-IP injection in C57BL6 males and females (p=0.0057, n=3/4). No temperature drop was evident in the TRPV1 KO mice. Within 2 minutes of capsinoid administration, the tail temperature rose 3.0 +/- 0.4 C (p<0.05, n=3/4), reflecting the activation of heat defense mechanisms (see Figure). Tail temperature did not increase in the TRPV1 KO mice, demonstrating the TRPV1 dependence of this response.

Conclusion:
We have previously shown that capsinoid-mediated hypothermia can provide neuroprotection following stroke. We now show that the mechanism of cooling results from selective activation of TRPV1-containing peritoneal visceral afferents and the activation of the heat defense response. Future studies seek to determine the specific nerve pathways linking visceral TRPV1 channel activation and activation of central heat defense mechanisms.
Abstract HUP14: A pilot interprofessional stroke education program trains students to plan and implement culturally tailored community-based stroke education.
Authors: Hellerslia Van , Bides Zachary
Published: January 2025

Introduction:
Community-based, culturally tailored stroke education is a recommended strategy to promote health equity in underserved communities. Interprofessional education (IPE) programs have a positive impact on community intervention efforts. We seek to evaluate the effect of IMPACT-Capacity, a pilot IPE stroke training program, on participant attitudes and ability to deliver community stroke education.

Methods:
Health professional students (HPS) from a single Philadelphia university were recruited through school announcements and social media to participate in an intensive 6-week training program to deliver culturally tailored community stroke education. The program consisted of 4 hours of didactic lectures and 8 hours of workshops where participants applied a PRECEDE-PROCEED implementation science framework to design and plan a culturally tailored stroke education program. Program outcome measures include HPS participation in the training program and implementation of community education. A questionnaire utilizing a 5-point Likert scale was used to assess attitudes on education, health equity, and self-efficacy.

Results:
A total of 12 students participated in the training program, ranging from 1-3rd year pharmacy (n=8) and medical (n=4) students. Eight students were assigned to engage 5th-8th grade students at a local elementary school. Four students were assigned to engage the Vietnamese-speaking community. One hundred percent of HPS completed the required training program, and 92% (11 of 12) of HPS participated in implementing their outreach program. Figure 1 shows results from the post-program questionnaire relating to self-reported confidence and interests from program participation. Themes from qualitative data suggest the program reignited participants’ passion for addressing health disparities, expanded their perspectives by working with other HPS and gave them a valuable experience engaging with the community.

Conclusion:
Our pilot data suggests that IMPACT-Capacity effectively trains health professional students to plan and implement culturally tailored community stroke education. This program highlights the positive impact that collaborative, interprofessional education has on impacting community knowledge. Our current results will inform future iterations of IMPACT-Capacity as it is expanded into broader contexts. Future studies will also investigate long-term knowledge retention and behavior changes following intervention.
Abstract HUP15: Combined Measures of Socioeconomic Status Associated with Cognitive Symptoms Following Acute Ischemic Stroke
Authors: Siegel Matthew , Corlin Laura , Miller James , Cote Kathryn , Leung Lester
Published: January 2025

Introduction:
Late complications after stroke (LCAS), including cognitive symptoms, impact quality of life and recovery. It is not known if neighborhood-level measures of socioeconomic status (SES) influence LCAS. This study assessed associations between combinations of SES measures including neighborhood income inequality (Gini) and area deprivation index (ADI), and cognitive symptoms after acute ischemic stroke (AIS) in a hospital leveraging active surveillance of LCAS.

Methods:
This retrospective cohort study included 570 patients hospitalized at Tufts Medical Center with AIS and with subsequent follow-up in the Stroke Clinic where clinicians routinely screen for LCAS symptoms between 0-12 months. Using zip code data at the time of hospitalization, patients were characterized as low Gini (n = 224) and high ADI (n = 325) by national and state means, respectively. These variables were combined indicating patients who were living in both a low Gini and high ADI neighborhood (n = 154) to evaluate the effects of living in a homogeneously deprived area. The multifactorial analysis assessed the frequency of cognitive symptoms, adjusting for basic demographics, NIHSS, thrombolysis, active LCAS surveillance, and ADI-Gini combination.

Results:
There was no association between high ADI (OR: 0.74 – 1.70, p = 0.60) or low Gini (OR: 0.82 – 2.00, p = 0.26) alone and cognitive symptoms after AIS. However, the combined variable analysis demonstrated increased frequency of cognitive symptoms in the high ADI-low Gini group (OR: 1.01 – 2.60, p = 0.047). In this model, active surveillance of LCAS was significantly associated with a higher detection rate of cognitive symptoms (OR: 4.30 – 10.49, p < 0.001).

Conclusion:
This study suggests that individuals living in homogeneously deprived neighborhoods report higher frequencies of cognitive symptoms after AIS. Further studies with increased power are needed to investigate the underlying causes of these disparities and to develop interventions to reduce these complications.
Abstract HUP5: Impact of Life’s Essential 8 on Mortality after Stroke
Authors: Scott Lisa , Lian Kendra , Markovic Daniela , Towfighi Amytis
Published: January 2025

Background:
Life’s Essential 8 (LE8) is a cardiovascular health (CVH) metric proposed by the American Heart Association (AHA) that includes blood glucose, blood pressure, lipid levels, diet, physical activity, nicotine exposure, body mass index, and sleep duration. LE8 is used as a tool to assess and improve CVH outcomes. Little is known about the association between LE8 and mortality after stroke.

Methods:
We included data from participants aged 20 and older with self-reported stroke who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Data was linked with National Death Index mortality data through 2019. The association between poor and ideal LE8 scores and all-cause mortality and CV mortality rates after stroke were determined in 3 models: (1) unadjusted; (2) adjusted for sociodemographic factors (age, sex, race/ethnicity, poverty income ratio (PIR)) and (3) further adjusted for comorbidities (Charlson Comorbidity Index).

Results:
During the study period, 1,019 out of 26,670 individuals reported a prior stroke. When assessing mortality in those with poor CVH, although the direction of the hazard ratios (HR) suggested an increased risk of CV mortality with higher numbers of poor LS8 metrics, the associations were not significant in any of the models. However, for all-cause mortality, the risk increased with a higher number of poor CVH metrics. Possessing at least 4 poor CVH metrics was associated with a higher risk of all-cause mortality (Model 1 HR 1.69, 95%CI 1.13-2.52; Model 2 HR 2.25, 1.51-3.35; Model 3 HR 2.10, 1.39-3.20). Conversely, possessing at least 4 ideal metrics was associated with lower CV mortality in the unadjusted model, (HR 0.35, 0.15-0.85) but this association was no longer significant in Models 2 and 3. Possessing at least 4 ideal CVH characteristics was associated with lower all-cause mortality in all 3 models (Model 1 HR 0.50, 0.29-0.85; Model 2 HR 0.54, 0.31-0.92; Model 3 HR 0.56, 0.33-0.96). Higher LE8 scores were associated with lower CV mortality in Model 2 (HR per point LE8 score 0.98, 0.96-0.99) and Model 3 (0.98, 0.96-0.99) and all-cause mortality in Model 2 (0.98, 0.97-0.99) and Model 3 (0.98, 0.97-0.99).

Conclusion:
A higher LE8 score correlates with an increased risk of both CV and all-cause mortality in stroke survivors. Possession of at least 4 ideal CVH metrics is associated with a nearly two-thirds risk reduction in CV mortality and 50% risk reduction in all-cause mortality.
Abstract NS5: Application of Digital Health Interventions in Quality of Life and Psychological Status of Stroke Patients: Systematic Review and Meta-analysis
Authors: Chen Lu , Shang Zhiying , He Manlan
Published: January 2025

Background and purpose:
The aim of this study is to assess the impacts of digital health interventions on quality of life and mental status in stroke patients. Stroke is one of the leading causes of death and disability worldwide, and patients are often associated with emotional problems such as depression and anxiety during recovery, hence, it is important to explore effective interventions. Digital health intervention technologies, including virtual reality (VR), telemedicine, and robotic assistance, are the focus of this study because of their innovation and potential effects.

Methods:
Following predefined protocols, the study searched four databases up to November 2023, screened for relevant randomized controlled trials (RCTs), and extracted data on quality of life and psychological status, including depression/anxiety. A total of 17 studies involving 1437 participants were included. The study used different digital health interventions, including VR, robotic-assisted and telemedicine, and standardized mean differences (SMD) and 95% confidence intervals (CI) were used to assess intervention effectiveness.

Results:
The data show that digital health interventions are more effective than conventional treatments in improving the quality of life of stroke patients and reducing the incidence of psychological disorders. In particular, significant differences were observed in the intervention groups for VR (SMD = 0.90, 95% CI = [0.07, 1.73]), robotic-assisted (SMD = -0.65, 95% CI = [-1.11, -0.19]) and telemedicine (SMD = 0.27, 95% CI=[0.11, 0.44]). In addition, the study found that digital health interventions were effective in reducing the incidence of depression in stroke patients, thereby improving their psychological well-being.

Conclusions:
Digital health interventions have been shown to be effective in improving the quality of life and psychological well-being of stroke patients. However, it is worth noting that anxiety levels did not significantly improve among patients with digital health interventions. This suggests that future research should adjust its focus to explore whether specific factors associated with stroke patients correlate with the effectiveness of digital interventions in improving anxiety states. It is also necessary to assess the long-term effects of digital health interventions. Further exploration is needed to optimize the approach, intensity, and frequency of digital health interventions for stroke patients.
Abstract TMP11: Imaging-Based Approach To The Pathophysiology Of Moyamoya Disease Among Diverse Ethnicities
Authors: Hara Shoko , Zhao Moss , Cheng Michelle , Alexander Sasha , Steinberg Gary
Published: January 2025

Introduction:
Moyamoya disease (MMD) is a rare cerebrovascular disease causing nonatherosclerotic intracranial arterial stenosis in children and young adults. The
RNF213
gene variant plays an important role in the pathophysiology of MMD, particularly among East Asian populations. However, this variant is rarely found in patients of other ethnicity. Previous studies have shown that
RNF213
gene variant is related to vascular structures such as the extent of moyamoya collaterals and posterior cerebral artery involvement. In this study, we utilize an imaging-based approach to investigate vascular structural features in MMD, which may offer novel insights into the pathophysiology of MMD.

Methods:
We retrospectively reviewed 770 patients with MMD or Moyamoya syndrome (MMS) from diverse ethnic backgrounds at Stanford University Medical Center treated between 2015 and 2024 (Fig. 1). After selecting sporadic non-hemorrhagic bilateral MMD patients aged 18-50 years old, the vascular structures acquired on MRA were visually assessed to evaluate the degree of intracranial arterial stenosis and basal moyamoya collaterals. T2 weighted images were reviewed to assess negative remodeling - shrinkage of the outer diameter of middle cerebral arteries (MCA) and internal cerebral arteries (ICA) as defined by Kuroda et al.2015, Neurol Med Chir (Tokyo).

Results:
Detailed demographic and clinical characteristics of 107 patients evaluated were listed in Table 1. By reviewing MRA, we have identified a subset of patients with unique imaging features characterized by ICA stenosis localized proximal to the terminal portion of ICA, differing from the typical lesion sites seen in MMD (Fig. 2). This non-terminal ICA stenosis was more frequently observed in Caucasian than in Asian patients (17.5% vs. 5.7%, P=0.007). Compared to patients with terminal ICA and/or MCA stenosis, patients with non-terminal ICA stenosis were older (P=0.03), had less advanced disease stages (P<0.001), and displayed fewer basal moyamoya collaterals (P=0.002).

Conclusion:
Using the imaging-based approach of vascular structural features, we have identified a potential subtype of moyamoya disease characterized by non-terminal ICA stenosis. This subtype may have a different pathophysiology from patients with typical ICA terminal stenosis, potentially driven by distinct genetic and epigenetic factors. Ongoing investigations are focused on elucidating these factors and their implications in MMD.
Abstract TMP13: Reimagining Stroke Education: Non-Traditional Strategies for Community Outreach
Authors: Ronosky Kristen , Noah Patty , Hackett Chris
Published: January 2025

Background:
Stroke education plays a critical role in improving the public’s awareness of stroke and identifying stroke symptoms, ultimately reducing the morbidity and mortality associated with stroke. While health fairs are a common venue for such education, expanding efforts beyond these events may reach a broader audience. This abstract explores the advantages of providing stroke education in diverse settings.

Methods:
A Systems of Care Model was utilized for community stroke education which involved coordinating outreach efforts by key stakeholders within a large healthcare system. This approach was developed to ensure comprehensive and effective stroke education was presented to community members in everyday environments. BEFAST was discussed to provide education on the signs and symptoms of stroke, activation of 911, along with modifiable and non-modifiable risk factors. By integrating stroke education into everyday environments, a culture of continuous learning where stroke awareness becomes part of routine conversations, rather than a once -a-year event. This approach allows tailored messages that are specific to the needs of the communities, addressing unique risk factors and cultural considerations that otherwise would not be addressed in the traditional delivery of community stroke outreach.

Results:
Over 5,000 individuals were educated throughout the year ranging from children to senior citizens. Individualized education was provided to meet the unique needs of each audience and environment across a wide range of diverse settings, which included the service industry, sales, sporting events, religious congregations, magazine advertisements, and other media. Rapport was established during initial individual interviews in these settings resulting in follow-up visits providing personalized stroke education. Feedback from the community suggested the education was effectively delivered for stroke symptom and risk factor recognition. Personal accounts were shared by eight (8) community members who then sought emergency care for stroke symptoms either for themselves, co-workers or family members.

Conclusions:
Expanding stroke education beyond health fairs is a strategic approach to engage a larger proportion of our community. This proactive approach has the potential to improve early detection and treatment outcomes, ultimately reducing the long-term impact of stroke on individuals and communities.
Abstract TMP20: Characteristics of Patients with Intracerebral Hemorrhage after Receiving Intravenous Tenecteplase for Acute Ischemic Stroke
Authors: Ly Doanh , Zrelak Patricia
Published: January 2025

Background:
Despite the increasing use of intravenous (IV) tenecteplase (TNKase) for acute ischemic stroke (AIS), little is known about the characteristics of patients who suffer intracerebral hemorrhage (ICH) and opportunities to prevent this often-fatal complication.
PURPOSE:
The aim of this retrospective review was to investigate the characteristics of AIS patients with ICH complication and opportunities in patient management after receiving IV TNKase in the emergency departments (EDs) and to report preliminary results.

Methods:
Retrospectively, the EHRs that suffered ICH complication after receiving TNKase (0.25 mg/kg) were reviewed from 21 hospitals in a large integrated health system between November 2020 to December 2023. Data collection included demographics, risk factors, blood pressures (BPs), and other variables such as the National Institute of Health Stroke Score (NIHSS), presence and types of large vessel occlusion, and severity of the hemorrhage (symptomatic or asymptomatic).

Results:
The mean age of the 195 cases was 75.4 (SD = 13.46). There were no sex differences (p=.87). Race breakdown was 50% (n = 98) Whites; 15% (n = 98) Hispanics/Latinos; 20% (n = 39) Asians, and 10% (n = 20) Blacks. Majority of patients (73%) arrived via EMS. History of was present in 75.4% of patients, followed by diabetes (58%), hyperlipidemia (55%), atrial fibrillation (20%), and history of stroke (18%). Anti-coagulants use was 8% (n=17). The initial mean NIHSS in the ED was 11.8 (SD=8.65). On initial presentation, the mean systolic and diastolic BPs was 164 (SD=27.1) and 90 (SD=19.46) respectively. Large vessel occlusions (LVOs) were identified in 35.9% (n=70) of patients. Of the LVO cases (n=70), 68.6% (n=48) of the ICH were asymptomatic.

Conclusions:
Based on the preliminary results, there were some patient-level risk factors that may have contributed to ICH complications after IV TNKase. Tighter control of BPs with anti-hypertensives before and after IV TNKase may also decrease bleeding risk. There were a few opportunities identified with patient assessment and monitoring. The use of both “full” NIHSS and abbreviated NIHSS varied between facilities, which may have delayed the identification of post-TNKase ICH as the abbreviated NIHSS did not provide a total score to assess for change in patient condition and about 40% of patients did not have an increase in the NIHSS. In-depth data reviews and analysis would be necessary to ascertain clinical significance.
Abstract TMP25: Potential of Rapid GFAP Levels in Acute Undifferentiated Stroke <24 Hours from Onset Using A Point-Of-Care Platform: An Exploratory Analysis of a Prospective Study
Authors: Paul Julien , Bairi Yasmine , Brassard Catherine , Matin Sayed , Margarido Clara , Larochelle Catherine , Arbour Nathalie , Stapf Christian , Gioia Laura
Published: January 2025

Introduction:
Glial fibrillary acidic protein (GFAP), highly brain-specific, is emerging as an attractive blood biomarker in acute stroke. GFAP can discriminate stroke type (ischemic stroke (IS), intracerebral hemorrhage (ICH), stroke mimics (SM) in the first hours after stroke onset. Rapid GFAP levels using novel point-of-care technology (results <15 minutes) may also offer insights in IS, particularly among those with unknown onset. In this study, we aim to evaluate the potential of rapid GFAP levels to distinguish among stroke types in acute undifferentiated stroke <24h from onset, as well as provide insights in IS of unknown onset.

Methods:
An exploratory analysis of an ongoing prospective study of patients with suspected undifferentiated stroke <24h from onset. Rapid plasma GFAP levels (pg/mL) are measured at hospital arrival using the i-STAT Alinity
®
instrument and commercially-available cartridges. Study endpoints include quantitative GFAP levels according to final diagnosis (ICH, IS, SM), time from stroke onset/last seen well (<4.5h, 4.5-24h), and ASPECTS score (8-10 vs. <8).

Results:
Among the first 101 patients recruited (mean (±SD) 70.8±14.5 years, 48% female, median (IQR) NIHSS 9 (3-20), median ASPECTS (10 (8-10)), final diagnosis was IS (n=67 (33 LVO)), ICH (n=5), and SM (n=29). Median rapid GFAP levels were highest in ICH (3104 (2088-8622) pg/mL), and differed compared to IS (54 (30-100) pg/mL) and SM (29 (29-42) pg/mL), p<0.001. In IS, 58% patients presented <4.5h from onset, and 28% were wake-up strokes. Rapid GFAP levels were undetectable in 13/39 (33%) of IS <4.5h compared to 3/28 (11%) in IS >4.5h, p=0.03. Median GFAP levels was significantly higher in IS >4.5h (87 (42-134) pg/mL) compared to earlier presentations (44 (29-62) pg/mL, p=0.03). Lastly, median GFAP levels had fairly good discriminative ability to detect ASPECTS <8 (AUC 0.73 (95% CI: 0.55-0.91), p=0.003), with an optimal GFAP cutoff of 77 pg/mL (sensitivity 76.9%, specificity 76.9%).

Conclusion:
Rapid GFAP levels using novel point-of-care technology is feasible and show promise in acute stroke management. Beyond discrimination of stroke type, rapid GFAP levels appear to increase during the first 24 hours from IS onset and with extent of ischemic injury. These findings, although preliminary, suggest that rapid GFAP levels may inform treatment decisions in IS of unknown onset as well as optimize prehospital triage of acute undifferentiated stroke <24hours from onset.
Abstract TMP26: Acute Stroke Treatment Metrics and Outcomes in Telestroke vs Non-Telestroke Care within the Paul Coverdell Michigan Stroke-Registry
Authors: Stamm Brian , Whitney Rachael , Royan Regina , Ibrahim Ghada , Nickles Adrienne , Ferber Rebecca , Hsu Wan-Ling , Hayward Rodney , McDermott Mollie , Scott Phillip , Sheth Kevin , Reeves Mathew , Levine Deborah
Published: January 2025

Introduction:
Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. Yet few studies have compared acute stroke treatment metrics and outcomes in patients treated using telestroke versus standard in-person stroke evaluation.

Methods:
This was a retrospective cohort study of acute ischemic stroke patients age ≥18 presenting to 53 Paul Coverdell Michigan hospitals between 2022 and 2023 who were potentially eligible for thrombolysis (i.e., presented ≤ 4 hours of last known well, no contraindications to thrombolysis). The primary exposure was telestroke (vs non-telestroke), and primary outcomes were receipt of thrombolysis and door-to-needle (DTN) time. Secondary outcomes included discharge ambulatory status and door-in-door-out (DIDO) time in transferred patients. Multivariable hierarchical models evaluated associations between the telestroke (vs. non-telestroke) activation and outcomes, sequentially adjusted for demographics, medical history, presenting/arrival, and hospital characteristics.

Results:
Among the 4974 stroke patients potentially eligible for thrombolysis (mean age 69.2 [SD: 14.6], 48.3% female), 1078 (21.7%) were evaluated using telestroke and 3896 (78.3%) without telestroke. Telestroke patients were more commonly at primary stroke centers (71.1% vs 39.0%) and less at comprehensive stroke centers (13.3% vs 53.9%; P<0.001). Thrombolysis was administered to 56.8% of telestroke patients (at the site of telestroke initiation) versus 54.7% of patients without telestroke (P=0.23). Telestroke patients had longer DTN times (55 vs. 47 minutes, P<0.001), longer DIDO times (166 vs. 142 minutes, P<0.001), and a lower likelihood of ambulating independently at discharge (P<0.001). After adjusting for patient demographics, medical history, and presenting/arrival factors, telestroke patients had significantly longer DTN times (8.1 minutes longer, 95% CI 1.9, 14.3). This difference was attenuated after adjustment for hospital characteristics, including stroke center status.

Discussion:
Acute stroke treatment metrics, including DTN and DIDO times, were significantly worse in telestroke vs. non-telestroke cases from the Paul Coverdell Michigan stroke registry. Differences in DTN were partially explained by hospital-level systems factors, such as stroke center status, which may serve as targets for future studies and quality improvement initiatives.
Abstract TMP28: Synergistic Effect of Hospital Prenotification and RAPIDAI on Thrombectomy Times in Large Telemedicine System
Authors: Sevilis Theresa , Avila Amanda , Boyd Caitlyn , Gao Lan , McCoy Megan , Mayer Laurie , Sambursky Jacob , Devlin Thomas
Published: January 2025

Background:
The utilization of artificial intelligence (AI) platforms to provide rapid access to images, LVO detection, and team communication in acute stroke protocols is expanding globally. The VALIDATE study showed that Viz.ai was correlated with significant decrease in arrival to neurointerventionalist notification time of 40 minutes and a synergistic effect with hospital pre-notification. The study aims to assess if these findings are generalizable to other AI platforms specifically RAPIDAI.

Methods:
Acute stroke consultations seen in the emergency department in 103 facilities (35 RAPID AI and 68 no-AI) in 24 states from July 1, 2021 to December 31, 2021 were extracted from the TeleCare by TeleSpecialists
TM
database. The encounters were reviewed for demographics, LVO, accepted for intervention, arrival to NIR notification time (ATN), and RAPIDAI software used. Patients were classified into two groups based on use of RAPIDAI or no AI software as well as hospital pre-notification of teleneurologist vs pre-notifications cases excluded. The median arrival to NIR notification times were compared.

Results:
A total of 14,159 patients were included: No AI group (7,433), and RAPIDAI (6,726). The median arrival to NIR notification time for No AI group was 88.5 minutes when compared to RAPIDAI groups 57.5 minutes was significantly longer, p <0.0001. For pre-notification cases, the No AI group was 80.5 minutes and the ATN time for RAPIDAI was 47 minutes, p <0.0001. When pre-notifications were excluded, the ATN times for No-AI were 94.5 minutes vs RAPIDAI were 69 minutes, p = 0.0001.

Conclusions:
The use of the RAPIDAI platform was associated with a significant, 31-minute reduction in the patient arrival to neurointerventionalist notification time. When looking at the subgroup of hospitals with RAPIDAI where a teleneurologist was also notified prior to the patient’s ED arrival, the ATN was even shorter at 33.5 minutes. Our data supports the conclusion that Best Practice for improving patient times to thrombectomy includes the combination of a pre-hospital notification to the teleneurologist and the use of an AI platform for LVO patients.
Abstract TMP29: Evaluation of Missed Strokes on Scene by a Mobile Stroke Treatment Unit
Authors: Davis Nicolle , Lykens David , Lavender Lauren , Fayed Mahmoud , Singh Amita , Peng Teng , Khanna Anna
Published: January 2025

Introduction:
Mobile Stroke Treatment Units (MSTU) are improving clinical outcomes by significantly shortening the time-to-treatment. On scene, the specialized staff, including a registered nurse and critical care paramedic, are able to rapidly assess the patient for acute stroke symptoms. This rapid treatment algorithm can potentially lead to missed strokes as compared to those patients transported via standard Emergency Medical Services (EMS). Therefore, we evaluated the rate of missed stroke diagnosis through MSTU assessment in the field as compared to the standard EMS-to-Emergency Department (ED) pathway.

Methods:
A retrospective analysis of patients with potential stroke evaluated by the MSTU crew between 7/25/23 and 5/31/24 was performed. Admission criteria includes age 18 years or older, last known well within 24 hours, one or more cardinal signs of stroke, and exclusions of any other suspected diagnosis outside of stroke or neurological disorders. Our study evaluated patients who were excluded from MSTU admission based on failure to meet said admission criteria. These patients were transported to the hospital by standard EMS. Patient demographics, symptoms, and final hospital diagnoses were extracted to complete univariate and multivariable regression analyses.

Results:
Our final analysis included 235 patients (mean age 66.3, 56.0% women) evaluated by the MSTU crew, but not admitted due to lower concern for stroke. In our study cohort, 11 had a final diagnosis of stroke that were missed upon initial MSTU evaluation. Patients with missed stroke were significantly older (OR 1.04 (95%CI 1.01 - 1.08), p=0.04) and had a nonsignificant trend towards female sex (OR 0.44 (95%CI 0.14 – 1.45), p=0.17). We did not see any differences among specific MSTU staff performing the evaluation or time of day and day of week. Of the 11 patients with a final stroke diagnosis, none received any acute interventions on arrival to the hospital.

Conclusion:
Our MSTU admission criteria resulted in an overall low rate of true stroke misses with none of the “missed strokes” receiving an acute intervention at the hospital. Rapid patient evaluation on scene by an expert stroke crew adhering to a standardized admission criterion does not lead to acute stroke interventions being performed upon arrival to the ED. Older patients with stroke-like symptoms evaluated by a Mobile Stroke Treatment Unit are more likely to be misdiagnosed, which deserves further investigation.
Abstract TMP37: Racial disparities in long-term survival after acute ischemic stroke among Medicare fee-for-service beneficiaries: Medicare cohort 2000-2022
Authors: Yang Quanhe , Tong Xin , Merritt Robert
Published: January 2025

Introduction:
Limited studies have examined racial disparities in long-term survival after acute ischemic stroke (AIS) with inconsistent findings. We examined these disparities among Medicare fee-for-service (FFS) beneficiaries in U.S.

Methods:
We analyzed data on 1,997,487 Medicare FFS beneficiaries aged ≥65 years hospitalized with incident AIS (ICD-10 code I63) and survived >30 days from January 1, 2000 to December 31, 2017, and were followed-up until December 31, 2022. Cox proportional hazard models estimated the adjusted hazard ratio (aHR, 95% CI) and adjusted survival curves by race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), Hispanic and Other). Models were adjusted for age, sex, and comorbidities.

Results:
The median age at AIS hospitalization was 78 years (IQR 72.0-84.0); 57.0% were women; 81.8%, 10.8%, 4.8% and 2.6% were White, Black, Hispanic and Other, respectively. Over a median follow-up of 4.9-years (IQR 1.7-8.8), there were 1,738,452 all-cause deaths. Adjusted 5-year survival after AIS improved from 2000-2004 to 2015-2017 for White (46.5% (95% CI 46.4-46.6) to 50.9% (50.7-51.1)), and Black (46.0% (45.8-46.3) to 48.9% (48.3-49.2)). For Hispanic and Other, survival remained largely unchanged: 54.4% (54.1-54.8) to 54.2% (53.6-54.8)) for Hispanic and 55.9% (55.4-56.4) to 54.7% (54.0-55.5) for Other. A clear pattern of long-term survival after AIS emerged by race/ethnicity showing similar survival between Hispanic and Other and between White and Black people (Figure). Stroke mortality risk was ~25% higher for White and Black compared to Hispanic and Other (aHR 1.25 (1.24-1.26)). This pattern was consistent across age groups and sex.

Conclusions:
Long-term survival after AIS has improved for White and Black Medicare FFS beneficiaries over time, while it remained largely unchanged for Hispanic and Other groups. This indicates persistent racial disparities in stroke outcomes.
Abstract TMP39: Feasibility Study of Advance Consent in Acute Stroke Trials: Preliminary Results
Authors: Cummings Emma , Udoh Ubong , Dewar Brian , Seeger Rena , Dowlatshahi Dar , Shamy Michel
Published: January 2025

Obtaining consent for participation in acute stroke trials is particularly challenging due to the time pressure of delivering immediate treatment. As a result, patients are often not able to provide informed consent to participate in clinical trials. Modifications to standard consent practices such as
deferral of consent
,
surrogate consent,
or
2-physician consent
can produce problems including violating patient autonomy, disadvantaging patients through their participation and biasing results. Alternatively,
advance consent
, in which patients at risk of stroke consent to participate in RCTs before they experience a stroke, could address these challenges. In this study, we assessed the acceptability of advance consent to people at risk of stroke.

Methods:
We approached patients deemed at risk of stroke in the Stroke Prevention Clinic of the Ottawa Hospital, a tertiary care facility in Ontario, Canada. Eligible patients were invited to complete a questionnaire regarding advance consent. Patients who responded positively to questions about advance consent were offered the opportunity to consent in advance to the EASI-TOC and/or FASTEST clinical trials.

Results:
We screened 1547 patients over a 1-year period (July 2023 – July 2024), of whom 431 (28%) were eligible to participate. Of the 431 eligible participants, 157 (36%) completed the initial questionnaire. Of these, 96% (151/157) either agreed or strongly agreed that inviting stroke patients to provide advance consent to participate in clinical research trials is appropriate. Further, 95% (149/157) of participants either agreed or strongly agreed that they would provide advance consent to specific acute stroke clinical research trials, and 69% (108/157) either agreed or strongly agreed that they would provide advance consent to all acute stroke research trials, whether or not they were given the details of the trial. Ultimately, 123 respondents were eligible to be offered advance consent, of whom 45 (37%) provided advance consent to participate in at least one ongoing trial. One participant (0.8%) specified in advance that they would not want to participate in these trials.

Discussion:
Preliminary results of this feasibility study show that patients were open to the idea of providing advance consent to participate in acute stroke research and a sizable portion of patients were willing to provide advance consent for ongoing trials.