bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP158: Hemiparesis May Predict The Development Of Epilepsy In Children With Perinatal Stroke
Authors: Chui Carrie , Hamel Maural , Kelly Daniel , Musolino Patricia L
Published: February 2023

Objective:
While we know that perinatal stroke is often comorbid with hemiparesis and epilepsy, less known are the timing and potential predictors of these outcomes. With a moderate size cohort and the longest follow-up to date, we aimed to better characterize these outcomes.

Methods:
We identified a retrospective cohort of 78 children with perinatal strokes. Motor outcomes from neurologic examinations and other comorbidities were identified at prespecified timepoints across the subjects' lifespans.

Results:
With a mean follow-up of 9.5 years, 36 (46%) of our cohort developed hemiparesis. In these patients, strokes involving combined cortical and subcortical structures (basal ganglia, thalamus, deep or periventricular white matter), as well as isolated periventricular white matter made up 91% of cases (69% and 22%, respectively). However, not all children with similar lesions developed hemiparesis. 20 children who may have carried risk for hemiparesis based on their lesions (19 combined cortical and subcortical; 1 periventricular white matter) did not develop hemiparesis. Among patients who developed hemiparesis, epilepsy had a high incidence. 20 (56%) patients with hemiparesis also had epilepsy, representing 83% of all children with epilepsy in our cohort. Conversely, in non-hemiplegic children who may have been at risk for hemiparesis, only 2 (10%) developed epilepsy. Hemiparesis manifested early in life; 78% of patients by their first follow-up (mean 10 mos) and 100% of patients by ages 2-4 (mean 2.7 yrs) had overt motor deficits. Epilepsy presentations were more delayed; 7 (35%) were diagnosed by ages 2-4 (mean 3 yrs) and 11 (45%) by ages 5-7 (mean 5.9 yrs).

Interpretation:
Survivors of perinatal stroke were vulnerable to developing hemiparesis. Those who developed hemiparesis were also more likely to develop epilepsy. This may be the result of more extensive strokes, particularly from lesions to both cortical and subcortical structures. Importantly, these patients can be identified in infancy and be more closely monitored for the development of epilepsy.
Abstract TP161: Predictors Of Undiagnosed Risk Factors For Cerebrovascular Ischemic Events: A Population-based Study
Authors: Weil Erika L , Ding Lili , Khoury Jane C , Kissela Brett M , Alwell Kathleen , Woo Daniel , De Los Rios La Rosa Felipe , Mackey Jason , Ferioli Simona , Mistry Eva , Demel Stacie L , Coleman Elisheva R , Jasne Adam S , Slavin Sabreena J , Walsh Kyle , Star Michael , Haverbusch Mary , Kleindorfer Dawn O
Published: February 2023

Introduction:
Primary prevention reduces the burden of acute ischemic stroke (AIS), yet cerebrovascular risk factors (RF) remain underdiagnosed in certain populations. We aimed to identify predictors of undiagnosed RF among patients with cerebrovascular ischemic events in a large bi-racial population.

Methods:
Individuals 20 years and older with an incident TIA or AIS from the population-based Greater Cincinnati/Northern Kentucky 2015 stroke study period were screened for inclusion. We included all hospital ascertained, physician-verified cases of AIS and TIAs. Outpatient and ED-only cases were excluded. Abstracted medical record data included determination of newly diagnosed hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD) or atrial fibrillation (AF). Multivariable models were used to identify predictors for each undiagnosed RF. Model variables included: age, sex, race, insurance status and number of cerebrovascular RF (additionally including coronary artery disease and smoking).

Results:
A total of 1604 ischemic events were included (1485 stroke, 119 TIA) with 52.9% female; 22.4% Black; median age 70 (IQR 59, 82)). Only 6% (n=102) had no history of RF. The prevalence of each undiagnosed RF was: HTN 4.1%; HLD 7.9%; DM 3.1%; AF 3.2%. In unadjusted bivariate analysis, uninsured/unknown status was predictive of undiagnosed HTN (OR = 3.97, 95% CI 1.48, 10.68;
p
=.006) and HLD (OR=5.53, 95% CI 2.68, 11.4;
p
<.0001). After adjustment, insurance status remained a predictor for only undiagnosed HLD (
Table 1
). No relationship was found with race.

Conclusions:
The most consistent predictor for an undiagnosed RF was absence of other RF and lack of insurance, both suggestive of suboptimal cardiovascular screening in this population. Further studies assessing known but undertreated RF and socioeconomic factors could be of benefit.
Abstract TP162: Age, Weight, And Prior Stroke Predicts Ischemic Stroke Despite Direct Acting Oral Anticoagulant Use In Patients With Atrial Fibrillation
Authors: Asad Syed Daniyal , Carvalho De Oliveira Lara , Ponciano Ana , Webb Andrew J , Yilmaz Pinar , anand viswanathan , Singhal Aneesh
Published: February 2023

Introduction:
Direct-acting oral anticoagulants (DOACs) and warfarin are standard of care for secondary prevention of ischemic stroke (IS) in persons with atrial fibrillation (AF). However, despite adequate anticoagulation (AC), patients may still experience recurrent IS. We aimed to study the characteristics of patients who developed IS despite therapeutic AC, specifically with DOACs.

Methods:
Between 2012 and 2021, patients admitted at our hospital with IS despite adequate AC for AF were enrolled. Clinical variables collected included National Institute of Health Stroke Scale (NIHSS), CHA
2
DS
2
-VASc and modified Rankin Score (mRS) at admission. Baseline characteristics were compared between patients taking DOACs and warfarin. Logistic regression analyses were performed to identify predictors of IS in patients using DOACs.

Results:
A total of 595 patients were included. Of these, 291 patients (48.9%) were on DOACs with a mean age of 75.21 and 43.9% were female. The median CHA
2
DS
2
-VASc and NIHSS score in the DOAC group was 4 and 6, respectively. Compared to those on Warfarin, patients on DOACs were younger (75.21 vs. 78.99 p < 0.001), more likely to be men (55.3% vs. 45.2% p = 0.01) and had higher rates of prior TIA/IS (37.5% vs. 29.3% p = 0.04). Both groups had similar rates of hemorrhagic transformation, but more patients in the DOAC group were on antiplatelet agents concomitantly (21% vs. 6.9% p < 0.001). The most prescribed DOAC was apixaban (66.3%) and cardioembolism was the most common stroke etiology (63.6%), followed by cryptogenic, which was significantly higher in the DOAC group (18.2% vs. 8.3% p = 0.02). Notably, DOAC failure in preventing IS was associated with younger age, overweight/obesity, and prior TIA/IS
(Table)
.

Conclusions:
IS despite the use of DOACs is more likely to occur in younger people with prior TIA/IS and obesity. Focusing on preventative strategies and risk factor control for competing mechanisms in this subgroup may help prevent IS recurrence.
Abstract TP163: Antiplatelet Use And CADASIL: A Multicenter Analysis Of The Trinetx Research Database
Authors: Muppa Jayachandra , Yaghi Shadi , Goldstein Eric
Published: February 2023

Introduction:
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is hallmarked by a mutation in the NOTCH3 receptor resulting in impaired cerebrovascular autoregulation with subsequent vessel fragility and progressive accumulation of cerebral small vessel disease (CSVD). Antiplatelet medications are commonly prescribed for secondary stroke prevention though this is of unknown therapeutic benefit in preventing acute ischemic stroke (AIS). We aimed to identify whether antiplatelet therapy reduced incidence of AIS in those with reported CADASIL.

Methods:
Data was collected through the TriNetX Research Network database. Those included were adults with the ICD-10 code (I67.850) for CADASIL. The primary outcome was the validated ICD-10 code for AIS (I63) which were linked with hospital admission encounters. Demographic data and medication use was recorded. The primary exposure was use of an antiplatelet medication for at least 1 month prior to admission for AIS. Standard descriptive and regression analyses were used.

Results:
Our cohort included 455 individuals: mean age 57±14 years, 36% being female and with similar rates of vascular risk factors between the groups. The antiplatelet cohort was older (antiplatelet: 61 ± 12 yrs vs. unexposed: 57±14 yrs, p = 0.034) and included 40 (8.8%) participants. Rate of AIS trended higher in the antiplatelet group but was not significantly different (antiplatelet: 23%, 9/40 vs. unexposed: 14%, 60/415; p=0.18). Age adjusted logistic regression showed higher odds of AIS (OR 1.62, 95%CI 0.73 - 3.60, p = 0.23).

Conclusions:
In this hypothesis generating study, our data suggests that antiplatelet use did not significantly impact incidence of AIS. It is unclear if the likelihood findings are related to the natural history of the disease, though this model accounted for differences in age. Further studies are needed to improve power for robust statistical analysis to confirm or refute our findings.
Abstract TP170: Heterochronic Parabiosis Lowers Microglia Activation And Myeloid Infiltration In Aged Parabiont
Authors: Guzman Gary U , Banerjee Anik , Khan Romeesa , Honarpisheh Pedram , Maniskas Michael E , McCullough Louise D
Published: February 2023

Introduction:
Of the 795,000 people who suffer strokes annually, 75% are over the age of 65. Aging is a major risk factor for stroke. The risk of stroke doubles every decade after the age of 55. Aging leads to dramatic changes in peripheral myeloid cells and increases the activation state of microglia in the brain. Although age is an important determinant of stroke susceptibility and outcome, the contribution from the aged immune system remains unclear.

Hypothesis:
We hypothesize that aged mice (18-22 mo) parabionts paired with a young parabiont (2-3 mo) would have less microglia activation due to exposure to systemic factors from young mice when compared to aged mice paired with aged mice (18-22 mo).

Methods:
Young Pep-boy mice (haplotype CD45.1) were surgically paired with aged mice (haplotype CD45.2) for two months. The brains of these mice were then subjected to flow cytometry analysis. Brain single cell suspensions were isolated and immunophenotyped with a microglia specific panel.

Results:
Our results show that myeloid infiltration was decreased in the aged parabiont (paired with a young mouse) compared to its naïve counterpart (n=3-6/ grp,
p
= 0.0036). Microglia activation was assessed utilizing a homeostatic marker, P2RY12, and a microglia specific marker, Tmem119. Interestingly, the expression of Tmem119 on CD45
int
CD11b
+
cells was significantly increased in the aged parabionts compared to aged, naïve mice (n=3-6/ grp,
p
=0.0006), however, P2RY12 trended upward in the aged parabiont (n=3/6 /grp,
p
=0.0742). This suggests that the shared circulation created between the heterochronic pair led to a reduction in immune activation in the aged parabiont. Thus, the young parabiont allows the aged parabiont access to rejuvenating factors through the shared flow of blood which reduced neuroinflammation.

Conclusion:
Future studies are needed to identify the specific factors contributing to reduced microglial activation and lowered infiltration of peripheral immune cells induced by pairing with young animals. Studies examining the immune response to stroke in young and aged parabionts are needed.
Abstract TP172: Predicting Poor Response To Anti-coagulation Therapy In Cerebral Venous Thrombosis Using A Simple Clinical-radiological Score
Authors: Montalvan Victor , Neves Gabriel , Bueso Tulio , Windisch Thomas , Ota Riichi , Bushnaq Saif
Published: February 2023

Few studies target to identify predictors of poor response to anticoagulation therapy in Cerebral Venous Thrombosis (CVT). We aimed to determine the predictors of poor clinical response to therapeutic anticoagulation in acute CVT.

Methods:
We performed a retrospective analysis of patients therapeutically anticoagulated for acute CVT. We defined poor clinical outcomes as death, need for mechanical thrombectomy during the hospitalization, or a modified Rankin Scale (mRS) >3 at clinical follow-up. Multivariate analyses identified factors associated with poor outcomes in anticoagulated patients for acute CVT, and we used the identified factors to create the PRACT-CVT (Poor Response to Anticoagulation Therapy in CVT) score.

Results:
We included 109 patients anticoagulated with acute CVT. Twenty-one (19%) patients had poor clinical outcomes. Age >65 or <10 years (OR: 3.16, 95% CI: 1.06-9.44), a GCS ≤12 upon presentation (OR: 19.2, 95% CI: 4.05-91.4), focal motor deficits at admission (OR: 5.03, 95% CI: 1.64-15.44), clinical deterioration following admission (OR: 28.18, CI: 4.81-164.86), seizures following admission (OR: 5.59, 95% CI: 1.27-24.51), evidence of brain bleeding/ischemia on admission (OR: 4.67, 95% CI: 1.42-15.34), involvement of the superior sagittal sinus (OR: 3.88, CI: 1.33-11.32), or involvement of both transverse sinuses (OR: 3.87, 95% CI: 1.01-14.90) predicted poor clinical outcome despite therapeutic anticoagulation. A PRACT-CVT score (0-22 points) of ≥7 points provided a sensitivity of 71% and a specificity of 95% for predicting poor clinical outcomes with anticoagulation alone.

Conclusion:
Patients with acute CVT, presenting with a GCS ≤12, with focal motor deficits, showing clinical deterioration after admission, having seizures during hospitalization, with brain bleeding/ischemia on initial imaging, involvement of the superior sagital sinus, or involvement of both transverse sinuses had poor response to anticoagulation.
Abstract TP174: The Impact Of Serum Triglycerides On Stroke Severity And Prognosis. Analysis In 6558 Patients (2014-2022)
Authors: Akhtar Naveed , Singh Rajvir , Kamran Saadat I , Joseph Sujatha , Morgan Deborah , Uy Ryan T , Treit Sarah , Shuaib Ashfaq
Published: February 2023

Hypothesis:
Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller with HT. We explored the relationship between triglyceride and stroke risk factors, severity and outcome in a large prospective database.

Methods:
We interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between vascular risk factors, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with and without HT.

Results:
6558 patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) with normal (<1.7 mmol/L) in 4161 (63.4%) and high (≥1.7 mmol/L) in 2397 (36.6%) were analyzed. Patients with HT were younger (53.1 ±11.4 versus 55.4 ±13.6, p <0.001), and had more diabetes, obesity, and active smoking. Stroke severity was higher with normal triglycerides (NIHSS: <1.7 mmol/l - 5.5 ±5.6 vs. >1.7 mmol/l - 4.4 ±4.6; p<0.001). Lacunar stroke was more common with HT (53.4% vs. 45.7%, p<0.001). mRS of 3-6 was more common with normal triglycerides (i.e. poorer outcome) at discharge (42% vs 35.5 p<0.001) and 90-days (31.7% vs 25.5%, p<0.001). Multivariate analysis showed that age, hypertension, HT, obesity, active smoking, and diabetes were independently associated with stroke severity.

Conclusion:
Onset of stroke occurs earlier in HT. The lower severity of symptoms and better prognosis evident with HT may in part be related to higher rates of lacunar stroke. Long-term MACE are however more frequently seen in HT subjects.
Abstract TP176: Lipids, Apolipoproteins And CSVD: A Mendelian Randomization Study
Authors: yanchen lv
Published: February 2023

Aims:
The role of dyslipidemia in cerebral small vessel disease (CSVD) has not been well established. Our primary aim was to apply the Mendelian randomization (MR) design to investigate the associations of lipid and apolipoprotein traits with CSVD manifestations. We also used drug target MR to analyze the effects of lipid-modifying strategies on the outcomes.

Methods and Results:
We conducted a Two-sample MR analysis using the levels of HDL-C, LDL-C, TG, ApoB and ApoA-I as exposures and CSVD manifestations including lacunar strokes, cerebral microbleeds (CMBs) and white matter integrity as outcomes. In addition, we analyzed the effects of TG lowering and LDL-C lowering genetic variants on CSVD manifestations. In univariable MR, increases in HDL-C reduce the occurrence of lacunar strokes (OR: 0.86; 95% CI: 0.76-0.99; p=0.03), increases in TG (OR: 0.73; 95% CI: 0.54,0.99; p=0.04) and ApoA-I (OR: 0.61; 95% CI: 0.46-0.83; p=0.001) respectively reduce all and deep CMBs, elevated ApoA-I levels were associated with lower FA (β: -0.381; 95% CI: -0.72, -0.04; p=0.028) and higher MD (β: 0.386; 95% CI: 0.02, 0.75; p=0.036). Multivariable MR revealed that HDL-C could help prevent lacunar strokes (OR: 0.86; 95% CI: 0.34-0.91; p=0.019), elevated ApoA-I was related to lower risk of both lobar (OR: 0.37; 95% CI: 0.18, 0.79; p=0.01) and deep (OR: 0.31; 95% CI: 0.10, 0.95; p=0.04) CMBs while HDL-C lead to higher risk of lobar CMBs (OR: 2.70; 95% CI: 1.32, 5.49; p=0.006), ApoA-I (β: -0.23; 95% CI: -0.41, -0.05; p=0.013) and HDL-C (β: 0.19; 95% CI: 0.01, 0.36; p=0.034) were closely related to WMH. Besides, increases in LDL-C (OR: 0.26; 95% CI: 0.07, 0.99; p=0.049) and TG (OR: 0.63; 95% CI: 0.46, 0.88; p=0.007) both lead to lower risk of lobar CMBs. Drug-target MR indicated that both LDL-C lowering and TG lowering therapies might help prevent CSVD manifestations.

Conclusions:
CSVD manifestations are associated with conventional lipids levels as well as apolipoproteins and certain lipid-modifying strategies could help alleviate CSVD manifestations.
Abstract TP177: Comparison Of Baseline Serum Glucose Concentration Between Fast And Slow Progressor Phenotypes Of Anterior Circulation Large Vessel Occlusion Stroke
Authors: Kayyali Mohammad N , Choi Jessica M , Song Shlee S , Rocha Marcelo
Published: February 2023

Introduction:
The determinants of fast and slow progressor phenotypes of infarct growth in anterior circulation large vessel occlusion (ACLVO) remain poorly understood. Previous studies have shown a potential link between baseline serum glucose and acute infarct growth. We assessed whether presenting serum glucose is independently associated with fast or slow progression of infarct growth in ACLVO stroke.

Methods:
Retrospective analysis of patients with acute stroke due to intracranial ICA or proximal MCA occlusion across two comprehensive stroke centers from 2014-2019. Baseline CTP or MRI were obtained within 24hours of stroke onset. Fast progressors (ischemic core > 70ml, 0-6 h) and slow progressors (</= 30ml, 6-24 h) were identified. Serum glucose levels were compared in two groups: fast vs. non-fast progressors (0-6 h), slow vs. non-slow progressors (6-24 h). Mann-Whitney test was used for univariate group comparisons. Pearson correlation tested the association between serum glucose and infarct growth rate (core volume / time of stroke onset to imaging).

Results:
A total of 350 participants were included (n=178 imaged < 6 hours of stroke onset; n=172 imaged at 6-24 hours of stroke onset). Amongst early presenters, the median glucose was 127 mg/dL for fast progressors (n=32) versus 122 mg/dL in non-fast progressors (n=146), p=0.45. Amongst late presenters, the median glucose was 122 mg/dL for slow progressors versus 133 in non-slow progressors (p=0.085). The correlation between serum glucose concentration and infarct growth rate was 0.03 (p=0.57).

Conclusion:
While a numerical trend suggesting lower glucose levels was observed in slow progressors, no significant correlation between hyperacute serum glucose and infarct growth rate was established.
Abstract TP178: Cerebral Infarction after Hematopoietic Stem Cell Transplantation (HSCT) in Adult Patients with Sickle Cell Disease
Authors: Bicher Nathan , Pinna Pranusha , Lightfoot Nathan , Norato Gina , Hsieh Matthew , Tisdale John , Lynch John K
Published: February 2023

Introduction:
Symptomatic and silent cerebral infarcts (SCIs) are common in children and adults with sickle cell disease (SCD). SCIs are associated with cognitive performance and risk of future symptomatic stroke. The incidence of overt stroke and SCI post HSCT is low in children, but there is limited information in adults. We sought to determine the impact of HSCT on the rate of new symptomatic and silent cerebral infarcts in adults with SCD.

Methods:
The study population included patients with SCD (HbSS, HbSC, and HbS/beta-thalassemia) that were enrolled in NIH studies (14-H-0077, 09-H-0225) and underwent HSCT from 2004-19 and received pre- and post-transplant MRI studies. MRI FLAIR, T1, and T2 images were reviewed by two independent readers and scored for presence of prior ischemic stroke and silent cerebral infarct (≥ 3mm on T2 or FLAIR images in 2 imaging planes). Changes in SCIs and ischemic strokes were compared before and after transplantation.

Results:
Eighty-four patients were included in the study, mean age 32.3 yrs. (range 10-65 yrs.) and 57% male. Median follow-up period was 3.3 yrs. (range: 6 months -17 yrs.) for a total of 412 patient-years. Overall, 60% had evidence of SCI and or prior ischemic stroke at transplant; 54% (45/84) with SCI and 23% with imaging evidence of a prior stroke. During the follow-up period, 13% (11/84) patients developed new ischemic injury, two patients developed a new stroke and nine patients developed new SCIs. The post-HSCT incidence rate of new stroke was 0.49 events/100 patient-years, and SCIs was 2.2 events/100 patient-years. Patients who progressed compared to those who did not were older at transplant (36.1 yrs. vs. 31.2 yrs.; p=0.09), had a prior history of stroke (27% vs. 22%, p=0.71), had a prior history of SCI (64% vs. 52%, p=0.47), and a prior history of stenotic vasculopathy (18% vs. 14%, p= 0.65).

Conclusions:
The incidence of new ischemic events after HSCT for SCD in adults is low. Our rates are comparable to incidence rates reported in children with SCD after HSCT. While rates of progression were higher in patients with prior stroke, SCI, and vasculopathy, we did not find a significant difference between groups.
Abstract TP181: Identification Of Hub Genes In Endothelial Cells Under Oscillatory Flow
Authors: Li Shuang , Zheng Lina , Tian Xuan , Liu Yuying , Leng Xinyi , Leung wai hong Thomas
Published: February 2023

Objective:
Abnormal blood flow can influence gene expression of endothelial cells. Atherosclerotic plaques are more likely to form at the arterial bifurcation or the downstream of stenosis with low or oscillatory wall shear stress (WSS). However, the mechanism remains elusive. This study aims to explore the hub genes and the transcription factors (TF) regulating endothelial gene expression under oscillatory flow through bioinformatics.

Methods:
Microarray expression profile (GSE16706) was obtained from the Gene Expression Omnibus database to explore differentially expressed genes (DEGs) of human umbilical vein endothelial cells (HUVECs) under oscillatory flow (time-average 1 dyne/cm2; range: -11 - +11 dynes/cm2; 1 Hz). Enrichment analysis was conducted to infer the function of DEGs. Protein-protein interaction network was also plotted to further explore hub genes. TF for hub genes were predicted through NetworkAnalyst.

Results:
303 DEGs, with 219 up-regulated genes and 84 down-regulated genes, were identified by comparing gene expression of HUVECs under oscillatory flow or static condition. 4 hub genes (CCNA2, CDC45, BUB1B, KIF20A) related to cell cycle were verified in GSE83476. ELF1 which could regulate all these 4 hub genes was selected as a key TF.

Conclusion:
We found 4 hub genes and 1 TF associated with oscillatory flow treated HUVECs, which might also be involved in oscillatory flow induced atherosclerosis.
Abstract TP183: Impaired Kidney Function Small Vessel Disease Markers And Its Association With Periventricular White Matter Hyperintensities
Authors: Murguia-Fuentes Ricardo , Khasiyev Farid , Gurel Kursat , Spagnolo-Allende Antonio , Rahman Salwa , paiva pedro , Kozii Khrystyna , Marshall Randolph , Elkind Mitchell , Gutierrez Jose
Published: February 2023

Introduction:
Small vessel disease (SVD) is a condition associated with aging and vascular risk factors to which the brain and kidney are susceptible. However, whether kidney dysfunction may directly contribute to brain SVD as opposed to both organs being affected as an epiphenomenon of aging is less clear. We hypothesize that impaired kidney function is differentially associated with brain markers of SVD, and the association is greater with SVD markers restricted to deep, penetrating arteries.

Methods:
We leveraged existing data from the Columbia University Irving Medical Center/ New York Presbyterian Hospital Stroke Registry. Odds ratio (OR), estimate, confidence intervals (CI), and p values were calculated. We rated visually the presence an anatomical location of cerebral microbleeds and chronic lacunar infarcts and used the Fazekas scale to semi-quantitate white matter hyperintensities. We created linear regression models adjusted for age, sex, race/ethnicity and vascular risk factors to evaluate the relationship between kidney function (defined as self-reported chronic kidney disease or creatinine on admission).

Results:
We included 973 patients (mean age 65±16 years, 51 % female). The prevalence of self-reported CKD/ESRD was 14% and the mean creatinine on admission was 1.61±2.04 mg/dl. The prevalence of chronic brain infarct was 40%, cerebral microbleeds 24%, and all had some degree of white matter hyperintensity.

Conclusion:
There is association between previous history of CKD-ESRD and creatinine levels on admission with periventricular WMH. These data also hint a possible association between CMB of deep location with history of CKD-ESRD, but a bigger sample is required for significance.
Abstract TP185: Lipoprotein(a) Levels In Patients With Embolic Stroke Of Undetermined Source And Its Association With Non-stenotic Atherosclerotic Disease
Authors: Mohamed Ghada A , Daly Daquan , Rodriguez Morales Paola , Alabyad Darwish , Minja Frank , Lemuel-Clarke Manet , Henriquez Laura , Navalkele Digvijaya , Sperling Laurence , Lundberg Gina P , Mehta Anurag , Nahab Fadi B
Published: February 2023

Background:
Lipoprotein(a) [Lp(a)]has been linked to increased atherosclerotic cardiovascular disease risk however there is limited data on Lp(a) in ischemic stroke subtypes. Current cholesterol management and ASCVD prevention guidelines include Lp(a) >50 mg/dL as a risk enhancer.

Methods:
This is a retrospective cohort of consecutive embolic stroke of undetermined source (ESUS) patients seen at the Emory Stroke Clinic and underwent Lp(a) testing in the outpatient setting from January 1, 2020 to March 31, 2022. Abnormal levels were defined as ≥ 30 mg/dl. Cerebrovascular imaging was reviewed by a board-certified neuroradiologist who was blinded to Lp(a) data.

Results:
Of 105 ESUS patients [median age 57 years (IQR 44-68), 51% female, 44% African American (AA)], median Lp(a) was 40 mg/dl (IQR 15-74) with 67 patients (64%) having Lp(a) ≥ 30 mg/dl, 45 (43%) ≥ 50 mg/dl and 30 (29%) having Lp(a) ≥ 70 mg/dl. Lp(a) levels were higher in AAs compared to other races (median 46 mg/dl vs 26 mg/dl , p= 0.002). Lp(a) level ≥ 30 mg/dl was associated with a higher serum D-dimer level median 536 (IQR 337-947, p=0.02), non-large vessel occlusion (LVO) stroke on initial imaging (p=0.012) and absence of MRI-FLAIR sequence abnormalities (p=0.044). In the subset of ESUS patients who underwent CT angiography of the head and neck (n=46), patients with Lp(a) level ≥ 50 mg/dl were more likely to have non-stenotic atherosclerotic plaque ipsilateral to the stroke territory (OR 6.1, 95% CI 1.3-28, p= 0.02).

Conclusion:
Lp(a) level ≥ 50 mg/dl was present in 43% of our cohort. This may be an under-recognized risk factor in ESUS. Further investigation is needed regarding the impact of Lp(a) on ESUS however our results suggest that ESUS patients with ≥ 50 mg/dl may benefit from a careful assessment of cerebrovascular imaging for ipsilateral non-stenotic atherosclerotic plaque in the territory of the stroke.
Abstract TP19: Multicenter Experience With A Novel Cadasil Severity Grading System.
Authors: Anisetti Bhrugun , Goldstein Eric , Elahi Fanny , Worrall Bradford , Petrosian Derek , Chiang Chia-Chun , Liu Michael D , Ross Owen A , Stojadinovic Eldina , Meschia James F
Published: February 2023

Introduction:
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic, progressive microangiopathy caused by mutations in the
NOTCH3
gene. Patients often present with migraine and progressive subcortical infarcts resulting in vascular cognitive impairment and death. Currently, there are no disease modifying treatments. Limiting future trials is the lack of an objective construct to classify and monitor severity of disease. The purpose of this study was to gain experience with a novel CADASIL severity grading system.

Methods:
Neurologists at 5 academic centers retrospectively reviewed charts of those with confirmed CADASIL. Demographic and clinical data were recorded. The CADASIL severity grades were then assigned: 0 (asymptomatic), 1 (migraine alone), 2 (stroke or mild cognitive impairment), 3 (gait impairment or early dementia) and 4 (bedbound) based on available data. Standard descriptive statistical analyses were used.

Results:
We identified 138 patients; overall mean age of 50.9±13.1 years, 42.8% were men. 15 (10.9%) were grade 0, 50 (36.2%) were grade 1, 41 (44.2%) were grade 2, 12 (8.7%) were grade 3, and none were grade 4. Those with less severe disease tended to be younger, more likely men, had a lower rate of hypertension and diabetes mellitus and were less frequently tobacco users, Table 1. Increasing number of vascular risk factors was associated with higher severity grading.

Conclusion:
Our study highlights the ability of this severity scale to separate those with CADASIL into an ordinal system. As known in the literature, more advanced phenotypes of CADASIL tend to have more vascular risk factors. Future trials may consider utilizing this ordinal construct to monitor disease progression, response to therapy, or as a screening tool.
Abstract TP190: Association Of Kidney Function And Stroke: Analysis Of The National Health And Nutrition Examination Survey 2017 - 2020
Authors: Tantisattamo Ekamol , Thimphitthaya Chanattha , Chaisrimaneepan Nattanicha , Pangkanon Watsachon , Wannaphut Chalothorn , Wattanachayakul Phuuwadith , Lalitnithi Pakin , Lopimpisuth Chawin , Naunsilp Piengpitch
Published: February 2023

Background:
Abnormal kidney function is one of the risk factors for cardiovascular diseases. Whether the association between a wide range of kidney functions from normal to advanced chronic kidney disease and stroke risk is unclear.

Methods:
A cross-sectional study involving participants (≥ 18 years old) in the 2017 - 2020 NHANES was examined for the association between serum creatinine (SCr) and history of stroke informed by a doctor or other health professional by multiple logistic regression analysis.

Results:
Of 9,211 participants, the mean±SD age was 51±18 y/o and 52% were female. White accounts for 35% followed by Black (27%), Asian (12%), Mexican American (11%), Hispanic (10%), and others (5%). Up to 485 participants (5%) ever had a stroke. Median (IQR) SCr was 0.84 (0.71 - 1.01) mg/dL. Stratified SCr among 7,865 participants with SCr data into quartile (Q), mean SCr were 0.62, 0.78, 0.92, and 1.34 mg/dL, respectively (Figure 1A). Compared to participants in Q1, strokes were 1.72 and 3.45 times as likely to occur in those in Q3 and Q4, respectively (Q3: 95%CI 1.24, 2.39, P 0.001; Q4: 95%CI 2.55, 4.67, P <0.0001); while participants in Q2 were 1.41 times as likely to have strokes but not statically significant (95%CI 0.99, 2.00, P 0.055; Figure 1B). After adjusting for age, gender, race, BMI, only participants in Q4 were 1.64 times as likely to have a stroke compared to those in Q1 (95%CI 1.09, 2.45, P 0.017); while strokes were 1.158 and 1.21 times as likely to occur among participants in Q2 and Q3, respectively but not statically significant (Q2: 95%CI 0.78, 1.72, P 0.468; Q3: 0.81, 1.80, P 0.348). There were effect modifications between SCr in Q4 and some races (Hispanic, White, and others; P
interaction
0.04, 0.013, and 0.011, respectively).

Conclusions:
SCr was positively associated with the likelihood to have a stroke. Longitudinal cohort studies are required to further elucidate the relationship.
Abstract TP192: Compared To Men, Women Have Worse Outcome In Acute Stroke: An Eight-years Prospective Study From Qatar
Authors: Naveed Hiba , Almasri Muna , Kazani Bahram , Nauman Areej , Singh Rajvir , Aljerdi Salman , Akhtar Naveed , Shuaib Ashfaq
Published: February 2023

Hypothesis:
There is considerable evidence that women have poor outcome following acute stroke when compared to men. We report our experience from a large prospective stroke database from Qatar.

Methods:
The Qatar stroke database is a prospective study, which began enrolling patients in 2014. We collected data on the demographics, clinical presentation, investigations, treatments, hospital complications and outcome (measured as 90-days modified Rankin Score [mRS]) on all patients admitted with acute stroke to the Hamad General Hospital where ~95% of stroke patients in Qatar are admitted. Multivariate analysis of risk factors, stroke type and severity, and in-hospital complications were compared to determine 90-days and one-year outcome in men and women.

Results:
There were 7300 stroke patients (women:1406 [19.3%], men:5894 [80.7%] admitted between 2014-2021. Multivariate analysis revealed significantly higher rates of obesity (OR 2.51), increasing age (age>65 years [OR 3.79]) and atrial fibrillation (OR 1.26) in women, p<0.001. In women, thrombolysis was less frequent and poor outcome (mRS 3-6) was more frequent (OR 1.62, p< 0.001) after adjustment for risk factors, stroke severity and in-hospital complications. The one-year mortality was significantly higher in women (11.7% versus men: 5.1%, p<0.001).

Conclusions:
In this large series of prospectively collected acute stroke patients from Qatar, our study reveals that women are more likely to have a poor outcome when compared to men. Although there was a higher incidence of obesity and previous CAD in women, we were unable to explain the reasons for the poor outcome at 90 days and one year.
Abstract TP195: Risk Factors And Outcome Of Cerebrovascular Complications In Transplant Recipients
Authors: Cadena Angel J , Grewal Parneet , Gregoski Mathew , Ozark Shelly
Published: February 2023

Introduction:
Post Transplant patients experience a great variety of cerebrovascular (CV) complications including ischemic stroke (IS), TIA, SAH, ICH, and posterior reversible encephalopathy syndrome (PRES). These increase mortality & morbidity in an already susceptible population but the incidence of these complications, risk factors, and outcomes in transplant recipients have not been examined in detail.

Methods:
Design:
A retrospective observational study.
Population:
Patients >18 years of age who underwent solid organ transplantation since 2012 at a tertiary care center. Patients were divided into 2 groups, with CV complications and without.
Outcomes
of interest were the proportion of CV complications, length of stay (LOS), discharge disposition, functional outcomes (defined by a mRS), and survival time post-transplant.

Results:
A total of 94 patients met the inclusion criteria (31% (n=29) with CV complications vs 69% (n=65) patients without). The median age was 57.5 years (51.41 vs 45.75 p>0.05). IS was the most prevalent CV complication (n=13, 44%, most common etiology was cryptogenic 76.9% (n=11)) followed but ICH (n=6, 20%), and most of CV complications occurred within 1 year post-transplant (n=17, 58.6%). Patients with past history of TIA or stroke were more likely to have a CV complication post-transplant (OR 0.66 vs 4.89, p=0.05) but there was no significance for the other cardiovascular risk factors when compared to transplant recipients with no complications. Patients with complications were more likely to have lung transplants (p<0.05) and to be discharged to hospice or dead than those without complications, who were more likely to have kidney transplants (p<0.05) and to be discharged home (p<0.001). There was no difference for the other outcomes of interest (p>0.05).

Conclusions:
Post-transplant patients, especially lung transplants, have a high incidence of CV complications including stroke and higher case fatality. There was an association between a history of TIA or IS and subsequent CV events in our patient population. We did not demonstrate any difference in LOS, demographical characteristics, use of antithrombotic, or length of survival post-transplant in both the groups.
Abstract TP197: Obstructive Sleep Apnea Associated With Lower All-Cause Mortality In Ischemic Stroke Patients
Authors: Ahmed Ibrahim
Published: February 2023

Introduction:
Obstructive sleep apnea (OSA) is a sleep disorder associated with cardiovascular risk factors similar to those associated with cerebral infarction (CI). Our aim was to characterize patient demographics and to investigate the effect of OSA in CI.

Methods:
Retrospective cohort study using 2019 National Inpatient Sample. Adults with diagnoses of CI and OSA were included. Primary outcome was all-cause mortality, and secondary outcomes were length of stay (LOS) and total charge in USD.

Results:
Out of 700175 CI patients, 49735 had OSA. Compared to Non-OSA-CI cohort, OSA-CI cohort were younger (67.38 vs 69.67 years,p<0.001) and had fewer females (37.36% vs 50.09%,p<0.001), Black (15.50% vs 17.38%,p<0.001), Hispanic (5.21% vs 8.26%,p<0.001), API (1.91% vs 3.15%,p<0.001), Medicaid (7.79% vs 10.26%,p<0.001), alcohol abuse (3.53% vs 4.75%,p<0.001), dementia (7.25% vs 12.06%,p<0.001), drug abuse (2.56% vs 3.33%,p<0.001), systolic heart failure (0.55% vs 6.36%,p<0.001), atrial fibrillation (1.12% vs 10.25%,p<0.001). OSA-CI cohort had more White (72.59% vs 65.58%,p<0.001), depression (17.25% vs 10.97%,p<0.001), chronic pulmonary disease (28.79% vs 16.25%,p<0.001), complicated hypertension (45.72% vs 33.57%,p<0.001), complicated diabetes mellitus (36.67% vs 23.80%,p<0.001), hypothyroidism (16.19% vs 14.02%,p<0.001), and obesity (43.22% vs 12.87%,p<0.001). OSA-CI cohort had lower all-cause mortality rate (4.32% vs 6.50%,p<0.001), mortality OR 0.73 (95%CI 0.65-0.81,p<0.001), lower mean LOS (6.17 vs 6.67 days,p<0.001), lower mean total hospitalization charge ($91,762.00 vs $99,993.00,p<0.001).

Conclusion:
Among patients admitted with CI, the presence of OSA was associated with lower all-cause mortality, odds of mortality, mean LOS and mean total hospitalization charge. OSA had a higher prevalence in younger White males and was associated with more depression, hypertension, diabetes mellitus, and obesity.
Abstract TP198: Periodontitis Enhances Cerebral Microhemorrhage Development In A Mouse Model Of Hypertension
Authors: Fang Chuo , Lee Donghy , Araujo Davi , Monajemzadeh Sepehr , Liu Jihua , Paganini Hill Annlia , Lau Wei Ling , Cribbs David H , Pirih Flavia , Fisher Mark
Published: February 2023

Introduction:
Periodontitis is a highly prevalent disorder that is increasingly recognized as a risk factor for cerebrovascular disease. In this study we examined the role of periodontitis in the development of cerebral microvascular disease.

Methods:
Hypertension was induced in aged (17 months old) male C57BL/6J mice via infusion of angiotensin II (ATII) at 1000 ng/kg/min via Alzet pump over 4 weeks. Periodontitis was induced by giving
P. gingivalis
-LPS (20 μg in 2 μL) injections between the first and second maxillary molars on both the right and left sides twice a week for six weeks. At end of six weeks, we collected mouse brains (N=5 each for Hypertension, Periodontitis, Hypertension + Periodontitis, and Control) and performed standard histology using Prussian blue staining to detect cerebral microhemorrhages (CMH) formation at 20x magnification. The average number, total area, and size of Prussian blue-positive deposits were quantified.

Results:
ATII-induced hypertension in animals (Systolic blood pressure: 113±2 mmHg to 156±3 mmHg, mean+SE, p<0.0001; Diastolic blood pressure: 82±2 mmHg to 119±3 mmHg, p<0.0001). Presence of hypertension produced significant increase in number of CMH compared to controls (1.97±0.29 per cm
2
vs. 1.24±0.20 per cm
2
, p<0.05). Presence of periodontitis did not alter the number of microhemorrhages (1.68±0.13 per cm
2
vs.1.97±0.29 per cm
2
). However, size of microhemorrhages doubled in the presence of periodontitis with hypertension (10.58±2.55 μm
2
per cm
2
vs. 5.05±1.15 μm
2
per cm
2
, p<0.05).

Conclusions:
In this mouse model of ATII-induced hypertension, periodontitis appears to increase size of CMH rather than induce development of new lesions. These findings suggest a role for periodontitis in cerebrovascular disease by modifying and exacerbating pre-existing stroke risk factors rather than acting as an independent risk factor.
Abstract TP200: Factors Associated With Physical Activity And Sedentary Behavior Among Community-dwelling Stroke Survivors
Authors: Jeong Hae-Bong , Lee Eung-joon , Kim Seung Jae , Park Chan-Young , Bae Jeonghoon , Park Kwang-yeol
Published: February 2023

Background and Aims:
Although insufficient physical activity (PA) and sedentary behavior (SB) are established independent risk factors for stroke, stroke survivors may ultimately be at a higher risk of physical inactivity. Thus, we investigated the factors associated with PA and SB in stroke survivors in a community setting.

Methods:
A cross-sectional study was performed using representative data from the Korea National Health and Nutrition Surveys from 2016 to 2020. We compared the level of moderate to vigorous aerobic PA, resistance exercise, and sedentary time between stroke survivors and controls. Then we performed a multivariate analysis to investigate the factors associated with physical inactivity and long sedentary time. The recommended level of aerobic PA was at least 150 min of moderate-intensity activity or at least 75 min of vigorous-intensity activity or an equivalent combination of moderate and vigorous-intensity activity throughout the week. The sufficient level of resistance exercise was defined as ≥2 days/week. Long sedentary time was defined as spending ≥8 h/day on SB.

Results:
Physical inactivity was significantly more prevalent among stroke survivors. The older age (odds ratio [OR]=5.448, p=0.001), and living in rural areas (OR=1.911, p=0.020) were associated with low levels of aerobic PA. Female sex (OR=0.427, p=0.007) was associated with a low degree of resistance exercise. Finally, Living without economic activity (OR=2.224, p=0.001), subjective unhealthy (OR=1.458, p=0.027), a single life (OR=1.611, p=0.049), and old age (OR=1.231, p=0.046) were independent predictors of long sedentary time.

Conclusions:
Based on these results, further research and policy studies are needed to increase the physical activity of stroke survivors.
Abstract TP202: Sex-specific Differences In Risk Profiles For Cancer Among 19702 Japanese Patients With Ischemic Stroke: The Biobank Japan Project
Authors: Shimoyama Takashi , Matsuda Koichi , Kamatani Yoichiro , Nagata Yasunobu , Yamaguchi Hiroki , Kimura Kazumi
Published: February 2023

Background:
There is limited data on sex-specific differences in subtypes and risk profiles of cancer among ischemic stroke patients.

Methods:
Among the subjects registered in the BioBank Japan database, 19702 ischemic stroke patients (n= 12241 male and n= 7261 female, median age 71 years old) were analyzed. We compared the prevalence of 20 cancer types between men and women. The multivariate logistic analysis was used to explore the association between risk factors and cancer by sex.

Results:
Any cancer was present in 1656 (8.4%) subsets of the overall cohort. The prevalence was highest for colorectal cancer (1.9%) followed by gastric cancer (1.6%), prostate cancer (1.2%), breast cancer (0.8%), and lung cancer (0.5%). Incidence was significantly higher in men than women for any (8.7% vs. 7.8%, P=0.029), colorectal (2.1% vs. 1.5%, P=0.003), gastric (2.0% vs. 1.0%, P<0.001), lung (0.6% vs. 0.4%, P=0.013), bladder (0.7% vs. 0.2%, P<0.001), pharyngeal/laryngeal (0.4% vs. 0.1%, P<0.001), and kidney (0.4% vs. 0.1%, P<0.001) cancer. By contrast, sex-specific cancer was more frequently observed in women than men (3.0% vs. 1.8%, P<0.001). In men, older age (ORs 1.80, 95%CIs 1.67-1.94, P<0.001], chronic renal failure (ORs 1.74, 95%CIs 1.24-2.46, P=0.002), atrial fibrillation or flutter (ORs 1.37, 95%CIs 1.07-1.76, P=0.014), and smoking (ORs 1.27, 95%CIs 1.09-1.48, P=0.002) were independently associated with cancer. In women, older age was the only independent factor associated with cancer (ORs 1.15, 95%CIs 1.05-1.25, P=0.002).

Conclusion:
Men have a higher prevalence of cancer including shared 6 anatomic sites, while sex-specific cancer was more common in women. Male predominance is largely explained by risk profiles including older age, chronic renal failure, atrial fibrillation or flutter, and smoking. These results indicate that cancer among stroke patients shares common risk factors for stroke or cardiovascular disease in men but not women.
Abstract TP203: Annual Population Burden Of Major Adverse Event From Statin Overuse In Acute Cerebral Ischemia Patients Without Indications
Authors: Sung Eleanor M , Saver Jeffrey L
Published: February 2023

Background:
Statin agents play a major role in secondary prevention after acute cerebral ischemia (ACI) events but are not indicated in all ischemic stroke and TIA patients. National guidelines recommend statins for patients: 1) with ACI of large or small vessel atherosclerotic origin; and 2) without these stroke mechanisms, but co-existing CAD or primary prevention indications. The potential adverse effects of statin overuse in the remaining ACI patients has not been well delineated.

Methods:
Per PRISMA guidelines, we performed systematic meta-analyses of: 1) statin RCTs to determine absolute risk increases for 6 major adverse events; and 2) large clinical series to determine the proportion of ACI events due to large or small vessel atherosclerotic disease and the proportion of remaining patients with CAD/primary prevention statin indications.

Results:
For adverse effects, data was available from 63 RCTs enrolling 155,107 patients. Statin therapy increased the risk of occurrence of 6 conditions: diabetes, myalgia, myopathy, liver disease, renal insufficiency, and eye disease. Across 16 large series enrolling 16,161 patients, rate of ACI due to large and small artery atherosclerosis was 45.9% (LAA 19.3%, SVD 17.9%), rate of remaining patients with CAD/primary prevention statin indications 24.0%, and rate of patients without statin indication 30.0%. Data synthesis indicated that, in the US, were all ACI without statin indications treated with statins, a total of 8902 patients would develop needless adverse events each year, most commonly diabetes, myopathy, and eye disease (Table).

Conclusion:
Nearly one-third of acute cerebral ischemia patients do not have an indication for statins and statin overuse in these patients could annually lead to nearly 9000 needless adverse events, including diabetes, myopathy, and eye disease. These findings emphasize the importance of adhering to guideline indications for the start of statin therapy in acute cerebral ischemia.