bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP415: Implementation of a Secondary Stroke Prevention Program: Effect on Medication Adherence
Authors: Damush Teresa , Myers Laura , Anderson Jane , Yu Zhangsheng , Ofner Susan , Schmid Arlene , Williams Linda
Published: March 2022

We targeted both providers and patients for medication and lifestyle modification to reduce secondary stroke risk factors after stroke.

The specific aim of this study was to:

Conduct a quasi-experimental feasibility test of implementing the adapted VA stroke prevention program (VSPP) at two VA sites to evaluate the impact on medication adherence.

Program sessions targeted stroke risk factor management. The key stroke risk factors of interest were: 1) hypertension, 2) diabetes, 3) hypercholesterolemia. Medication possession ratios based upon patient medication refills were calculated to evaluate medication compliance for the randomized subjects using PBM data pre (6 months prior to the acute event) and post (6 months after the event). Based upon the literature standard of 80% compliance, we used this rate to dichotomize and model the data using logistics regression.

Results:
The final sample included 174 veteran patients with an acute stroke/TIA who were randomized to receive either the intervention (n=87) or a control program (n=87). In the intervention group, the odds of compliance to diabetes meds post stroke were significantly larger than the odds of compliance prior to the stroke (odds ratio=3.45 (1.08, 10.96) p <0.04). The control group saw a decrease in the likelihood of compliance from pre to post stroke hospitalization (odds ratio =0.51 (0.10, 2.70), p<.42). The comparison between groups was marginally significant (odds ratio=6.74 (0.88, 51.31), p=0.06) which indicates an intervention effect on compliance of DM drug. Both the intervention and control groups had significant increases in the odds of compliance to statin medications; however, there were no significant difference between groups. For compliance to hypertension medications, the intervention group showed significantly greater odds of compliance post intervention than pre intervention (odds ratio=3.68 (1.81, 7.48), p<.0004) but no difference in the control group. We observed over a threefold increase in diabetes medication compliance among stroke survivors who were diabetic and assigned to the intervention group and we observed a significant decrease in diabetic medication compliance among those assigned to the control group. Funded by VHA HSRD IAB 05-297-2
Abstract TP424: Timing Of Deep Vein Thrombosis Formation After Aneurysmal Subarachnoid Hemorrhage
Authors: Liang Conrad W , Su Kimmy , Liu Jesse J , Dogan Aclan , Hinson Holly E
Published: March 2022

Background:
Deep vein thrombosis (DVT) is a common complication following aneurysmal subarachnoid hemorrhage (aSAH). The time period of greatest risk of developing DVT after aSAH is not known. Early DVT detection may enable earlier treatment and prevent progression to symptomatic DVT or pulmonary embolism (PE). We tested the hypothesis that DVT most often occurs during the period of highest risk of delayed cerebral ischemia (3-14 days post-rupture).

Methods:
We performed a retrospective review of 154 patients admitted to the OHSU NeuroICU with aSAH between April 2008 and April 2010. 121 patients received periodic screening lower extremity ultrasounds, typically twice weekly, and prophylaxis with sequential compression devices (SCDs) but no chemoprophylaxis such as heparin. The remaining 33 patients did not receive screening studies due to withdrawal of care or attending physician preference.

Results:
26 of 121 patients (21.5%) who received ultrasound screening developed DVT after aneurysm rupture. 3 of 26 patients (2.5% of the total screened population) had symptomatic DVTs, as defined by documented clinical suspicion in chart notes, and 1 of these developed PE. DVTs were significantly more likely to be detected 3-14 days post-bleed (χ-square, p < 0.0006) and were detected on average 12.0 +/- 6.8 days (median 10 days) after aneurysm rupture. Because DVTs did not necessarily occur on the day of detection, we calculated the period at risk by determining the day of the last known ultrasound without DVT, or by the day of aneurysm rupture if the DVT was detected on the first screening scan. The average day beginning the period at risk was 5.7 +/- 6.7 days (median 2 days) after aneurysm rupture. The average number of days within the period of risk was 6.3 +/- 3.6 days (median 6.5 days).

Conclusion:
DVTs are significantly more likely to be detected 3-14 days after aneurysm rupture. Repeated screening allows for evaluation of the period of highest risk for developing DVT. The data suggest that this period occurs between 5.7 and 12.0 days on average (median 2-10 days) following aneurysm rupture. Prospective studies are needed to determine whether chemoprophylaxis targeted to this time window reduces DVT incidence while minimizing bleeding risk.
Abstract TP426: Candidate CSF Cytokine and Chemokine Biomarkers for Vasospasm and Poor Outcome in Human Subarachnoid Hemorrhage
Authors: Chou Sherry H , Elyaman Wassim , Bradshaw Elizabeth M , Secor Elizabeth A , Suh Sarah , Orent William , De Jager Philip L , Du Rose , Feske Steven K , Lo Eng H , Ning MingMing
Published: March 2022

Introduction:
Growing evidence suggest inflammation plays a key role in the pathogenesis of vasospasm (VSP) and secondary ischemic injury following subarachnoid hemorrhage (SAH). While elevations of select pro-inflammatory cytokines such interleukin (IL) 6 in cerebrospinal fluid (CSF) are linked to VSP in SAH, it is unclear which cytokines are measurable in SAH CSF. We explore a panel of cytokines and chemokines during peak VSP time window in human SAH in search for novel CSF biomarkers.

Methods:
CSF samples were collected through external ventricular drain from a prospective SAH cohort. Clinical outcome was evaluated at 3- and 6-months using modified Rankin scores (mRS). Poor outcome was defined as mRS>2. Angiographic VSP was defined as >50% reduction in caliber of any vessel on post-SAH day 7 cerebral angiogram. In 29 SAH subjects, we compared post-SAH day 5 CSF biomarker profile with respect to outcome and VSP using Milliplex panel (EMD Millipore) with 42 biomarkers. Continuous variables were compared using Wilcoxon rank sum test. Benjamin-Hochberg correction was used for multiple comparisons.

Results:
VSP occurred in 45% of the SAH cohort, and 52% of this cohort had good outcome at 3 month. Of the 42 biomarkers, 39 were measurable in SAH CSF. Elevated CSF IL-4 showed strongest trend towards association with good outcome at 3-month (p=0.0049) and at 6-months (p=0.02). Other CSF biomarkers showing trend toward association with outcome include epidermal growth factor (p=0.035), fractalkine (p=0.045), and platelet-derived growth factor AA (p=0.024). Elevation of a different cluster of biomarkers showed trend towards association with VSP: IL-5 (p=0.041), IL-17A (p=0.049), and IL-2 (p=0.047). No single marker reached significance at p<0.05 level after adjustment for multiple comparisons.

Conclusions:
Differential expression of cytokine and chemokines are present in CSF post SAH. Results from this small pilot study suggest a possible association between elevation of CSF anti-inflammatory cytokine IL-4 and good SAH outcome. This is consistent with animal studies showing IL-4 attenuates ischemic injury and promotes neuroprotection. Larger targeted studies are necessary to investigate the role of cytokines and specifically CSF IL-4 in SAH outcome.
Abstract TP433: Free Leptin And Soluble Leptin Receptor: Novel Circulating Markers Of Carotid Plaque - Related Symptomatology And Potential Role In Plaque Stability (from The Opal-lille Carotid Endarterectomy Study)
Authors: Elkalioubie Ahmed , Zawadzki Christophe , Lavisse Charlotte , Chinetti-Gbaguidi Giulia , Tagzirt Madjid , Corseaux Delphine , Juthier Francis , Vaast Bertrand , Vanhoutte Jonathan , Ung Alexandre , JeanPierre Emmanuelle , Vincentelli Andre , Jude Brigitte , Haulon Stephan , Staels Bart , Susen Sophie , Van Belle Eric , Dupont Annabelle
Published: March 2022

Leptin, an adipocyte-derived cytokine with various effects on the cardiovascular system, circulates in a free biologically active form and a bound form to a soluble leptin receptor (sObR) involved in modulating leptin activity. The links between free leptin, sObR, human atherosclerotic carotid plaque phenotype remain unknown. In the present study, we investigated the potential links between serum/plaque free leptin, serum sObR, carotid plaque stability and related symptomatology in 146 consecutive patients (71 asymptomatic and 75 symptomatic) scheduled for carotid endarterectomy. Free leptin was assessed in serum (17.05±23.19 ng/mL, range 0.47-191) and carotid plaques (0.204±0.486 ng/mg protein) and sObR in serum (21.48±8.81 ng/ml). Serum free leptin concentrations were correlated negatively with serum sObR concentrations and positively with intra-plaque free leptin concentrations (p<0.0001, r=0.491, p<0.0001, r=0.726, respectively). Serum free leptin and sObR concentrations were independently associated with carotid artery symptomatology (ß=--0.048; 95%CI [-0.093;-0.002]; -0.102, 95% CI [-0.994;-0.026], respectively). Regarding plaque phenotype, histological examination of carotid endarterectomy specimens revealed plaque stability index (collagen to macrophages area ratio) and Vascular Smooth Muscle Cell (VSMC) content to be significantly higher in asymptomatic patients compared to symptomatic ones (2.1 (1.9-2.5) vs. 1.5 (1.1-1.8), p< 0.0001; 39.2 (35.9-55.0) vs. 20.4 (17.8-26.3), p= 0.0003, respectively). When serum or plaque leptin levels were above median value, plaque stability index, plaque VSMC content, plaque VSMC proliferation index and ERK activation were significantly higher (p< 0.02). Interestingly, via ERK pathway activation, at 20 ng/mL, leptin induced a migratory signal and higher collagen synthesis in human VSMC, followed by a proliferative response of VSMC at the concentration of 75 ng/mL. For the first time, we reported free leptin and sObR to be novel circulating markers of carotid plaque - related symptomatology. Free leptin could be an active player in carotid plaque stability via its effects on human VSMC.
Abstract TP435: Junctional Adhesion Molecule-a Deficiency Attenuate Leukocytes Trafficking And Inflammation In Brain Ischemic /reperfusion Injury
Authors: Andjelkovic Anuska V , SLadojevic Nikola , Stamatovic Svetlana M , Keep Richard F
Published: March 2022

Background:
Brain ischemic reperfusion (I/R) injury elicits an intense inflammatory response that causes secondary brain damage. Proinflammatory mediators trigger intensive inflammatory remodeling of the blood-brain barrier (BBB) that includes extensive changes of the brain endothelial cell surface and alteration of junctional complex in order to “receive and support” leukocyte migration into the brain parenchyma. Junctional adhesion molecule-A (JAM-A) is component of the brain endothelial junctional complex with dual role: the occlusion of the paracellular route and regulation of leukocyte docking and migration. In this study we have examined contribution of JAM-A in developing the postischemic inflammatory response.

Method:
Brain I/R injury was induced by transient occlusion of middle cerebral artery (tMCAO) for 30 min followed by reperfusion for 0-7 days. JAM-A role in brain I/R injury was investigated in condition of presence JAM-A on brain endothelial cells, JAM-A absence (JAM-A knockout -KO- mice) or in condition of inhibition via administration of JAM-A antagonist peptide (JAM-Ap, 1mg/ml), 6 hrs after tMCAO and for 6 consecutive days. Leukocytes infiltration was estimated by FACS analysis. The inflammatory mediators expression was evaluated by protein array, RT-PCR and ELISA.

Result:
I/R-induced neutrophils

transmigration was attenuated in both JAM-A-KO mice as well as in mice treated with JAM-Ap whereas transmigration of monocytes and T cells was JAM-A independent. Consequently with that, expression of inflammatory mediators was reduced in area of penumbra. JAM-A-KO and mice treated with JAM-Ap showed the reduction of infarct size and significantly improved neurological score. BBB permeability was reduced by the treatment with JAM-Ap.

Conclusion:
JAM-A has a prominent role in regulation of neutrophils infiltration after brain I/R injury and could be a new target in limiting the

postischemic inflammation.
Abstract TP437: Induced Pluripotent Stem Cells Attenuate Brain Ischemia/reperfusion Injury Via Mir-221- And Mir-320-dependent Mechanisms
Authors: Liang Qiujun , Meng Dan , Le Lili , Li Ning , Wang Xinhong , Quan Jing , Xiang Meng , Chen Alex F , Chen Sifeng
Published: March 2022

Objective:
Local injection of induced pluripotent stem cells (iPS) ameliorates stroke along with teratoma formation and mechanic injury. We hypothesize that intravenously administration may disseminate iPS in the tissues of target and therefore avoid teratoma formation while retaining therapeutic effect. MiR-221 and miR-320 involves in cell adhesion, migration and angiogenesis. They may regulate iPS function. The present study observes the effect of intravenous injected iPS on brain ischemia/reperfusion injury and the roles of miR-221 and miR- 320.

Methods:
156 mice were subjected to MCAO for 45 min followed by reperfusion. After 4h reperfusion, they were randomly divided into 6 groups and injected with iPS, con-siRNA-iPS, miR-221-iPS, miR-320-iPS, MEF or PBS intravenously. 12 and 14 mice per group were observed for 2 and 7 days, respectively. Neurologic dysfunction and infarct area were evaluated by neurological impaired use scores and TTC staining. 13 common pro-/anti-inflammatory mediators were measured by reverse transcription real time PCR. Heme oxygenase-1 (HO-1) was observed by immune histochemistry and Western blotting.

Results:
The survival rates for mice receiving iPS, con-siRNA-iPS, miR-221-iPS, miR-320-iPS, MEF or PBS were 11/12, 10/12, 9/12, 10/12, 8/12 and 9/12 for 2 days and 6/14, 6/14, 1/14, 2/14, 0/14 and 0/14 for 7 days, respectively. iPS decreased neurologic functional disorder and infarct area significantly, compared to animals treated with MEF or PBS. Transfection of iPS with miR-221 or miR-320 but not control siRNA blocked the beneficial function of iPS. iPS increased the ratio of inhibitory/stimulatory inflammatory mediators and HO-1 on day 2. Tracing of fluorescence-labeled cells found iPS and con-siRNA-iPS selectively located in infarct boundary zone. Some iPS differentiated into microglia and astrocytes on day 7. Only in occasion, MEF, miR-221-iPS or miR-320-iPS were found in injured brains. Five additional mice that received iPS were used to observe teratoma formation and were free of teratoma for at least 3 months.

Conclusion:
Intravenous administered iPS selectively engrafted in the infarction boundary zone and ameliorated brain I/R injury. MiR-221 and miR-320 are essential for the therapeutic effect of iPS.
Abstract TP440: The Discriminant Validity of the NINDS-CSN Harmonization Neurocognitive Battery in Detecting VCI in Singaporean Patients with Ischemic Stroke and TIA
Authors: Dong Yanhong , Slavin Melissa J , Venketasubramanian Narayanaswamy , Qiu Anqi , Sachdev Perminder , Collinson Simon L , Chen Christopher
Published: March 2022

Background:
An international standard for the diagnosis of Vascular Cognitive Impairment (VCI) is currently in development. We report preliminary findings of Singaporean contribution to theNINDS-Canadian Stroke Network (NINDS-CSN) neuropsychological protocol harmonization study.

Purpose:
We examined the discriminant validity of 3 neuropsychological protocols (60 Minute (M), 30M and 5M) by comparing cognitive performance of patients with stroke and TIA to cognitively normal controls.

Methods:
Patients (≥50 years old) with stroke or TIA and the controls were administered the NINDS-CSN harmonization neurocognitive battery by trained psychometricians blinded to the group status of the patients or controls. ANCOVA was conducted to compare the between group cognitive performance. ROC analyses were employed to examine the ability of the 3 protocols and the cognitive domains of the 60M protocol in discriminating patients with ischemic stroke or TIA from the controls.

Results:
52 patients and 64 controls were recruited. Patients were significantly older with lower level education and more self-reported depressive symptoms than the controls (mean age 67.7±9.2 vs 62.2±6.7, p<.001; years of education: 6.5±4.6 vs 11.5±4.1, p<.001; Geriatric Depression Scale: 3.0±3.7 vs 1.0±1.0, p<.01). Using age, education and GDS as covariates, ANCOVA showed that the performance of stroke and TIA group were significantly poorer than controls on the 5-min, 30-min and 60-min protocols (F statistics range from 7.1 to 38.7, p<.01). ROC analyses showed adequate discriminatory abilities of these 3 protocols (AUCs range from 0.80 to 0.84). Executive function and memory domains of the 60M protocol were two most sensitive and specific domains in discriminating patients with stroke and TIA from the controls (AUCs: 0.87, 0.81, respectively).

Conclusions:
The results demonstrated preliminary evidence for the validity of the NINDS-CSN neurocognitive battery in discriminating patients with ischemic stroke and TIA from cognitively normal controls.
Abstract TP444: CNS Vasculitis: A Tertiary Care Center’s Experience
Authors: Al-Mufti Fawaz , Khan Imad , Coyle Patricia , Nuoman Rolla , Medin Karen , Guido Michael
Published: March 2022

OBJECTIVE:
CNS Vasculitis (CNSV) is a rare and ill-defined cause of stroke with limited available case series in the modern era of stroke management. The objective of this study was to evaluate CNS Vasculitis in a tertiary care cerebrovascular center

DESIGN/METHODS/RESULTS:
Between March 2009 and July 2012, 14 cases were coded as having cerebral vasculitis and fulfilled our criteria for CNSV which included acute onset of neurologic abnormalities in setting of angiographic guided multiple segmental narrowing in two or more CNS vessels. Patients included 5 males and 9 females between 11 and 88 years of which 3 were African-American and 11 were Caucasian. Presentations ranged from seizures in 28.6%(4/14) and stroke in 71.4% (10/14) with 40% (4/10) being hemorrhagic and 60% (6/10) ischemic, with a 33%(2/6)hemorrhagic conversion rate. 78.6% (11/14) were found to have Primary CNSV and 14.3% (2/14) had systemic vasculitis. Diagnostic modalities included cerebralangiography in 64.2% (9/14), MRA in 85% (12/14), computerized-tomographic angiography in 64%(9/14), and brain/leptomeningeal biopsies in 28% (4/14) of cases. Treatments were along the lines of acute reversal of vasoconstriction induced neurologic symptoms and immunomodulation. 71.4% (10/14) received systemic steroids,7%(1/14) received Mycophenolate mofetil and 57% (8/14) received Cyclophosphamide. Methotrexate was given in 7% (1 /14) and calcium channel blockers were given in 28% (4/14) with 14% administered in the cerebrovascular angio suite intraarterially. 57% (8/14) were transferred to acute rehabilitation facilities, 35.7% (5/14) discharged home, and there was a 7%(1/14)mortality rate.

CONCLUSIONS:
We found that primary CNSV was more common than systemic vasculitis and stroke was the most common presentation followed by seizures. Individuals younger than 20 who presented with seizures were less likely to have concomitant strokes. Despite our limited understanding of this rare condition 92%(13/14)of our patients were discharged to either home or acute rehabilitation, while the mortality rate was 7%(1/14)as was the recurrence rate. Further prospective studies are needed to allow for more systematic data collection and to better evaluate and manage CNSV patients.
Abstract TP447: Transvenous Approach Of Cavernous Sinus Dural Arteriovenous Fistula
Authors: KIN kyohei , SUGIU Kenji , TOKUNAGA Kouji , HIRAMATSU Masafumi , HARUMA Jun , OHKUMA, Yu , SHIMIZU Tomohisa , HISHIKAWA Tomohito , DATE Isao
Published: March 2022

Background:
Transvenous embolization (TVE) for cavernous sinus dural arteriovenous fistula (CSdAVF) is commonly performed via inferior petrosal sinus (IPS). However, TVE via IPS is sometimes difficult and we have to use adjunctive techniques or choose other approach routes.

Method:
44 patients with CSdAVFs were treated by TVE between January 2005 and June 2012. We retrospectively analyzed their techniques and approach routes.

Result:
The approach via IPS was possible in 37 patients (84%). 5 patients of them were treated via contralateral IPS of the lesions and 17 patients of them were treated via occluded IPS. As the adjunctive technique, we used triple catheter technique (TCT) in 11 patients, and the reopening technique using 0.035-inch guidewire, which opened a path for a subsequently inserted microcatheter in 6 patients. 7 patients (16%) were treated via the other approach routes. In 4 patients, we approached via facial vein. In 2 patients, we approached via middle temporal vein. In 1 patient, we approached via superior petrosal sinus and IPS at the same time using double catheter technique. As the adjunctive technique, we used TCT in 5 patients, direct puncture of internal jugular vein in 1 patient, compression of facial-angular vein in 1 patient. All of 43 patients were treated with coils and 2 patients were treated with N-butyl-2-cyanoacrylate (NBCA) which was injected to the inside of the sinus as additional treatment. Finally, complete occlusion was achieved in all of 43 patients.

Conclusion:
Adjunctive techniques enable us to access cavernous sinus via IPS in most of our patients. If it is impossible to access cavernous sinus via IPS, we must analyze vascular anatomies and choose appropriate approach routes.
Abstract TP5: Comparison of Primary Intraarterial Thrombectomy and Intravenous Thrombolysis Bridging with Intraarterial Thrombectomy for Acute Ischemic Stroke
Authors: Jeong Hyeseon , Song Hee-Jung , Kwon Hyun Jo , Ko Hyun Song , Kang Chang Woo , Kim Jei
Published: March 2022

Background and purpose:
It is not well-known whether intravenous thrombolysis (IVT) bridging with intraarterial mechanical thrombectomy (IAT) is more beneficial than primary IAT presenting within 3 hours after acute ischemic stroke. We assessed the safety and benefit of primary IAT in clinical outcomes by the comparison with bridging IVT-IAT.

Methods:
Clinical data of 65 patients (43; primary IVT, 22; primary IAT), who were underwent thrombolysis for the acute internal carotid (ICA) and/or middle cerebral (MCA) artery occlusions within 3hours from the symptom onset, were evaluated. IAT was performed using retrievable intracranial stent to remove thrombus impacted within ICA or MCA. Recanalization rate and hemorrhagic transformation after thrombectomy, and modified Rankin scale (mRS) checked at discharge and 3 months after discharge were compared between patients received primary IAT or bridging IVT-IAT.

Results:
Among primary IVT group, only 6 (14%) showed symptom improvement after IVT. In the other 37 patients, 26 patients were underwent additional IAT (bridging IVT-IAT group). Primary IAT and bridging IVT-IAT groups showed similar recanlization rate (IVT-IAT; 85%, IAT; 82%,
p
=0.548) and symptomatic intracerebral hemorrhage rate (IVT-IAT; 3.8%, IAT; 0%,
p
=0.421). The rate of favorable clinical outcome (mRS 0-2) was not different at discharge (IVT; 30%, IAT; 32%,
p
=0.556) and 3 months (IAT; 40%, IAT; 46%,
p
=0.472) after discharge in both groups.

Conclusions:
In conclusion, the safety and clinical outcome of primary IAT was not inferior to bridging IVT-IAT for large intracerebral artery occlusions. This study suggested primary IAT, when it can be accomplished promptly, should be considered as a treatment within 3 hours.
Abstract TP6: Octogenerians Have High Rates Of Favorable Outcomes After Endovascular Therapy For Acute Stroke Due To M1 Occlusion If Final Infarct Volumes Are Small
Authors: Jadhav Ashutosh P , Nanduri Sunanda , Aghaebrahim Amin , Zaidi Syed , Jumaa Mohammad , Linares Guillermo , Reddy Vivek , Hammer Maxim , Jankowitz Brian , Wechsler Lawrence , Jovin Tudor
Published: March 2022

Background and Purpose:
Octogenerians have consistently been shown to have poor outcomes after endovascular therapy for acute stroke. On the other hand, final infarct volumes are predictive of outcomes. We sought to explore the relationship between final infarct volumes and outcomes in octogenerians with acute stroke due to M1 MCA occlusion treated with endovascular therapy at our institution.

Methods:
Retrospective analysis of an acute stroke endovascular database was performed. Inclusion criteria were acute M1 MCA occlusion and post procedural MRI allowing for final infarct volume analysis through an automated software application.

Results:
A total of 219 patients were identified of which 51 (23%) were 80 years or older. Median age in non-octogenerians was 65.5 versus 83 in octogenerians. Females were 51.8% versus 67%, respectively. Median admission NIHSS was 16 versus 17 (p=ns). Median final infarct volume was 43.6 cc vs. 43.3 cc (p=ns). Median time to treatment was 5.6 hours versus 5.5 hours. Successful recanalization rate (TIMI 2/3 flow) was achieved in 139/168 (83%) versus 45/51 (88%) (p=ns). Multivariate analysis, controlling for admission NIHSS score, recanalization and intubation and time from symptom onset to procedure, identified age (OR 0.9, p < 0.0001, 95% CI 0.86-0.93) and final infarct volume (OR 0.98, p < 0.0001, 95% CI 0.97-0.99) as predictors of favorable outcome (mRS 0-2 at 3 months). The rate of favorable outcomes was 89/168 (53%) versus 10/51 (19.6%) (p < 0.0001). Mean final infarct volume in non-octogenerians with good outcome was 40 cc versus 19 cc in octogenerians (p=0.014). In patients with less than 20 cc of final infarct volume, 84% (37 out of 44) of non-octogenerians had a favorable outcome versus 46% (6 out of 7) of octogenerians (p=0.01).

Conclusions:
Despite similar recanalization rates and final infarct volumes, outcomes after endovascular therapy for MCA occlusions in octogenerians are worse than in non-octogenerians. However, outcomes are strongly related to infarct volumes and consequently nearly half of octogenerians with final infarct volume of <=20 cc had favorable outcomes. A small final infarct volume is best predicted by successful recanalization and high pre-procedural ASPECT scores (9 or 10).
Abstract TP62: Outcomes After tPA in African American Women with Explicit Consideration of Baseline Factors
Authors: Mandava Pitchaiah , Martini Sharyl , Albright Karen C , Boehme Amelia K , Martin-Schild Sheryl , Alexandrov Andrei V , Simon Roger P , McGuire Dawn , Kent Thomas A
Published: March 2022

Introduction:
African American (AA) women have been reported to have higher mortality after stroke. Our prior analysis of the NINDS dataset also showed poorer outcomes after tPA for AA compared to Caucasian (C) females. Small numbers of AA patients available in a well characterized dataset and large differences in baseline factors hamper definitive conclusions about race-based outcomes. We developed analytical techniques for small samples that explicitly consider baseline factors rather than adjust or control for them. We applied these techniques to two stroke datasets and analyzed them separately and together with NINDS.

Methods:
pPREDICTS uses the placebo arms of all eligible stroke RCTs to generate a pseudo-control outcome model. The novel feature is generation of multi-dimensional statistical intervals to compare whether an individual trial’s outcome differed from this pooled sample at the trial’s specific baseline NIHSS and age. pPAIRS performs post-hoc Euclidean matching of subjects based on chosen factors and excludes outliers when no close match is found, generating a more homogenous population. We applied these techniques to assess outcomes of tpa-treated females from the NINDS, Tulane, and University of Alabama-Birmingham datasets. Matching factors were baseline NIHSS, age, glucose, race and stroke subtype. Outcomes were mRS 0-1, 0-2 and mortality at discharge or 90 days.

Results:
Pooled results from individual sites are reported here. Comparison of outcomes from each site with the pPREDICTS model did not show better outcomes for the newer datasets compared to NINDS. mRS 0-2 for tPA-treated AA females was near the p=.05 threshold for poorer outcomes compared to pooled controls. After outlier exclusion, 80 matched AA and C females were found by pPAIRS. After matching, median baseline NIHSS were similar: 12.5 for AA’s and 11.5 for C (p = 0.64). Final mRS 0-1 and mRS 0-2 for AA females were lower: 22.5% and 30% vs. 40% (p = 0.03) and 46.3% for C (p = 0.05). Mortality was 10% in AA and 7% in C (p=0.6).

Conclusion:
We confirmed in this larger pooled sample that AA females have a poorer functional outcome following tPA after baseline matching. Factors associated with these poor outcomes are being assessed and will be presented. A prospective study is warranted.
Abstract TP72: Predictors of IV tPA Use among Acute Ischemic Stroke patients presenting to a Regional Telestroke Network: The Partners Telestroke Center Experience
Authors: Ali Syed F , Ruff Ilana M , Feske Steven K , Rost Natalia S , Cohen Adam B , Viswanathan Anand , Schwamm Lee H
Published: March 2022

Intro:
Remote neurological consultation via telemedicine (TeleStroke) increases rates of IV tPA use and has gained acceptance through demonstrated reliability and similar outcomes to conventional tPA use. We sought to determine factors that predict tPA use among patients presenting to hospitals in our TeleStroke network.

Methods:
Using the Partners TeleStroke Network database, we analyzed all acute ischemic stroke (AIS) patients (n= 2,140/at 31 spoke hospitals) and the subset arriving ≤ 4.5 hr since last known well (LKW). All covariates associated with IV tPA use in univariate analysis at p-value <0.10 with less than 10% missing were included in multivariable logistic regression. Since NIHSS was only recorded for video consults, it was excluded from multivariable models.

Results:
Eighty percent (1720/2140) of all AIS patients that presented to spoke hospitals arrived ≤4.5 hr of LKW, and 38.1% (655/1720) of these received IV tPA. All patients who were not treated with tPA had a documented exclusion. Patients receiving tPA were more likely to be white, have higher NIHSS, arrive earlier from LKW time and trended toward younger, as compared to non-treated patients. They were also more likely to be evaluated by TeleStroke videoconferencing than telephone (Table 1). In multivariable analysis, decreasing LKW to arrival time [OR 1.01 per min, 95% CI 1.02-1.01] and use of videoconsultation [OR 3.64, 95% CI 2.65 - 5.00] were independently associated with rates of IV tPA use.

Conclusion:
Consistent with prior reports of conventional, front-door tPA use, age, stroke severity (NIHSS) and stroke duration (LKW to arrival time) also predict tPA use in TeleStroke environments. Use of videoconsultation is a novel independent predictor of tPA use, potentially due to increased confidence by providers in recommending treatment at a distance compared with the telephone alone. Replication of these findings in other independent telestroke network cohorts is recommended.
Abstract TP74: A Novel Virtual Stent Software for the Stent Assisted Coil Embolization of Brain Aneurysm
Authors: Nishimura Kengo , Mohamed Ashraf , Ishibashi Toshihiro , Ebara Masaki , Yuki Ichiro , Arakawa Hideki , Irie Koreaki , Takao Hiroyuki , Kajiwara Ikki , Misaki Kouichi , Murayama Yuichi
Published: March 2022

[Introduction]
In stent-assisted coil embolization for brain aneurysms, precise deployment of the delivered stent is essential to achieve optimal angiographical outcome. However, it is frequently difficult to predict where the proximal end of the delivered stent lands due to complicated 3D structure of the target artery. A new software “Virtual Stent (VS) (Siemens AG, Forchheim, Germany)”, is designed to simulates the location of proximal and distal ends of the delivered-stent based on the 3D angiogram, thereby the program help an interventionalist to choose the best suitable profile of the stent before delivery. To evaluate the accuracy of the program, retrospective analysis of the previously treated patients using VS was performed.

[Methods]
We retrospectively applied VS to post-treatment 3D DSA images in 44 aneurysm patients who were treated with stent-assisted coiling using Enterprise Stent®. Distal marker of VS was aligned to that of EP, and discrepancy between the proximal marker of VS and EP was measured. The mean/maximal discrepancy was calculated in three groups with different length of EP, and evaluation was performed.

[Results]
In all cases, VS was successfully applied on each 3D DSA image. Overall avarage discrepancy between the proximal marker of VS and that of EP was 1.20mm. The mean/maximum discrepancy varied among the 3 groups with different EP length, 22mm (8 cases): 2.29mm/3.7mm, 28mm (32 cases): 0.93mm/2.5mm, 37mm (4 cases): 1.21mm/1.8mm. In the anterior circulation cases, the mean/maximum discrepancy were 1.33mm/3.7mm respectively, while in the posterior circulation the discrepancy was 0.91mm/2.34mm. In every case, it was considered that the discrepancy between the EP and VS was minimal and the VS could be a good predictor of the final positioning of a delivered EP.

[Conclusion]
For stent assisted coil embolization of the brain aneurysms, VS simulation provides acceptable accuracy for planning the stent size and its positioning.
Abstract TP83: Impaired Cerebrovascular Reactivity to Acetazolamide in Parent Arterial Territory of Major Artery Aneurysms in Adult Patients with Moyamoya Disease
Authors: Ito Masaki , Houkin Kiyohiro , Niiya Yoshimasa , Uchino Haruto , Mabuchi Shoji , Nakayama Naoki , Kazumata Ken , Shichinohe Hideo , Sugiyama Taku , Ishii Nobuaki , Nomura Mikio
Published: March 2022

Background—
Recent studies have suggested that haemodynamic stress probably induces the formation of major artery aneurysms around the circle of Willis in adult patients with moyamoya disease (MMD). Theoretically, cerebrovascular reactivity (CVR) to acetazolamide (ACZ) is gradually reduced in the conditions that cerebral perfusion pressure is decreased. If arterial narrowing progress, CVR to ACZ would be reduced (Kuroda’s Type 2 or 3 ischemia) in the parent arterial territory of these aneurysms owing to elevated cerebrovascular resistance. This study was aimed to test the hypothesis whether the CVR to ACZ is reduced in the parent arterial territory of the major artery aneurysms.

Methods—
This retrospective study included 172 adult patients with MMD diagnosed at our institutes between 1980 and 2011. Eight major artery aneurysms was found in 7 (4.1%) of these patients, including 5 women and 3 men at the mean age of 47.4 years. Aneurysm location and perfusion territory of the parent artery were determined on digital subtraction angiography. Regional cerebral blood flow (CBF) was quantitatively measured, using
123
I-IMP SPECT. Subsequently, ACZ was intravenously injected to determine the reactivity of CBF. CVR to ACZ in the parent arterial territory was calculated (n=8). CVR in the contralateral arterial territory of the parent artery was utilized as a control (n=6).

Results—
Four (50%) of 8 major artery aneurysms were located in the vertebrobasilar system. All aneurysms were saccular and small, ranging from 2.0 and 5.0 mm. CVR to ACZ were reduced in 5 (62.5%) of 8 parent arterial territory (Type 2 or 3). All the contralateral arterial territory of the parent artery had normal CBF and CVR to ACZ (Type 1). Compared with contralateral side (32.0 ± 10.7%), CVR to ACZ was not significantly reduced in the parent artery side (16.5 ± 19.0%, P=0.11; paired-t). Fisher’s exact test, however, demonstrated a significant association between the existence of major artery aneurysms and reduced CVR to ACZ in the parent arterial territory (P=0.03).

Conclusions—
These findings suggest that reduced CVR in the parent arterial territory of the major artery aneurysms indicates underlying hemodynamic vascular stress inducing aneurysm formation in adult patients with MMD.
Abstract TP89: Ultra Thin Bioabsorbable Polymeric Coating On The Surface Of Coil Materials For Brain Aneurysms Treatment
Authors: Yuki Ichiro , Suwarnasarn Arnold , Kan Issei , Fujimoto Motoaki , Mayor Fernando , Vinters Harry V , Kim Robert H , Vinuela Fernando A , Murayama Yuichi , Wu Benjamin , Vinuela Fernando
Published: March 2022

Purpose:
A novel bioactive coil material, which is composed of a bare platinum core coated with an ultrathin layer of 50/50 acidified PGLA was developed for the purpose of accelerating thrombus organization in the treated aneurysms. Experimental aneurysms were with the coils with novel bioactive coating and histologic analysis was performed. The results were compared with the histologic findings observed in the aneurysms treated with a currently available polymeric coil (Matrix II) and bare platinum coils (GDC).

Materials and Methods:
A swine aneurysm model, which is designed to perform quantitative analysis of histologic changes induced by the implanted coil materials, was used in this study. The novel bioactive coils, which is composed of a bare platinum core covered with an ultrathin - micron level - polymer coating composed of acidified 50/50 polyglicolic-polylactic acid (PGLA) was implanted in 4 experimental swine aneurysms (group A). Four aneurysms were treated with Matrix II® (group B) and 4 were treated with GDCs (group C). Fourteen days after the implantation, each aneurysm was harvested and histologic analysis of each sample was performed.

Results:
Histologic findings showed the most advanced thrombus organization - characterized by dense collagen deposition and prominent fibroblast migration - was observed in aneurysms of group A, followed by group B and C. The most prominent inflammatory reaction adjacent to the coil material at Day 14 was seen in group B, followed by group A and group C. However, group A showed a high degree of collagen organization with little immature thrombus remaining, indicative of late stage aneurysm healing.

Conclusion:
The novel bioactive coil material with ultrathin acidified 50/50 PGLA coating may accelerate the thrombus organization in the experimental aneurysms as compared to the currently available coil materials for brain aneurysm treatment.
Abstract TP91: Post-Stroke Assessment of Kinaesthesia with and without Vision using Robotics
Authors: Semrau Jennifer , Herter Troy , Scott Stephen , Dukelow Sean P
Published: March 2022

Stroke can lead to damage of brain regions and pathways involved in sensory processing of limb afferent and visual signals. While stroke rehabilitation research often focuses on motor recovery, there is limited knowledge about the prevalence of proprioceptive deficits and their impact on sensorimotor capabilities. The present study characterizes the presence of kinaesthetic (sense of motion) deficits and the ability of individuals to correct for these deficits with vision after stroke.

Individuals with subacute stroke (N = 107, median age = 59) and non-disabled controls (N = 101, median age = 47.5) performed a kinaesthetic matching task with and without vision using a robotic exoskeleton. The robotic exoskeleton passively moved the stroke patients’ affected arm at a preset speed, direction and magnitude of movement. Subjects were instructed to mirror-match the speed, direction and magnitude of the movement as soon as they felt the robot begin to move their affected arm. Stroke subjects also completed a standardized clinical assessment including vision screening, Behavioural Inattention Test (median ± SD = 141 ± 29.71), Chedoke McMaster Stroke Assessment - Impairment Inventory of Arm (5 ± 2.61) and Hand (5 ± 2.49) and Functional Independence Measure (FIM) (95.21 ± 23.54).

As compared to controls, 49% of subjects with stroke displayed larger initial direction errors when performing the task without vision. When vision was provided 25% of these subjects now performed within the control range. Surprisingly, 24% of subjects performed worse with vision. A similar pattern of impairments were observed for movement reaction time. As a group, subjects with field defects and/or hemineglect displayed significantly greater impairments than the rest of the subjects with stroke.

Our results suggest that kinaesthetic deficits are highly prevalent amongst patients who have had a stroke. The quantification and identification of these sensory deficits using the robotic technology has significant potential for improving diagnosis and prognosis of sensory and motor deficits and performance in daily activities.
Abstract TP94: Brain-computer Interface Controlled Functional Electrical Stimulation As A Novel Approach To Improving Foot-drop After Stroke
Authors: Do An H , Wang Po T , King Christine E , Schombs Andrew , Nenadic Zoran , Cramer Steven C
Published: March 2022

INTRODUCTION:
Foot-drop commonly affects gait after stroke, and current physiotherapy is incompletely effective. Orthoses are often used but benefits disappear on removal. The post-stroke brain has enormous potential to undergo plasticity in support of behavioral recovery. The current study builds on this, using an electroencephalogram (EEG) based brain-computer interface (BCI) to control a functional electrical stimulation (FES) system. Here, motor signals from intact motor cortex are detected then directly applied to the paretic limb to move it, bypassing the stroke. This reinforcement of motor cortex activation with supramaximal neuromuscular stimulation may promote Hebbian learning and lead to enduring changes in CNS organization and gait. The current report describes the safety of this system.

METHODS:
An integrated BCI-FES system for ankle dorsiflexion was developed by the authors. EEG was recorded as subjects alternated between idling and attempted paretic foot dorsiflexion for 10 mins. A prediction model was generated from this data and used to classify online EEG into idling or dorsiflexion states. This model facilitates brain control of the FES device by producing dorsiflexion when a subject’s intent to dorsiflex is detected. Subjects operated the BCI-FES system by idling or attempting to elicit BCI-FES mediated dorsiflexion in response to alternating 10-sec cues. Each run was 200 sec long and was repeated over 1-2 hours, with breaks. Subjects underwent 3 weekly sessions.

RESULTS:
Two patients with stroke (ages 38-60, 22-25 mo post-stroke, NIHSS score 4-9), who had foot-drop for which each used a commercial FES system were enrolled and completed the regimen. There were no adverse events and no safety concerns. Both subjects achieved purposeful control of the BCI-FES system. Active range of motion for dorsiflexion after the BCI-FES regimen increased from 5 to 8° in S1 and from 0 to 3° in S2.

CONCLUSIONS:
The current study examined a BCI-FES system that aims to promote CNS plasticity based on Hebbian theory. The results provide preliminary evidence that BCI-FES therapy is safe and may lead to neurological improvement. Therapy based on BCI has the potential to help a wide range of patients, particularly those with severe impairments.
Abstract TP98: SMTP-7, A Novel Thrombolytic With An Anti-inflammatory Potential, Improves Thrombotic Stroke With Little Bleeding Risk
Authors: Matsumoto NAOKI , Suzuki ERIKO , Zhuang JIE , Hasumi KEIJI
Published: March 2022

Extending the time window for acute stroke therapies is important in increasing the number of stroke patients who might benefit from treatment. SMTP-7, a novel small-molecule plasminogen modulator, has a time window of ~6 h in thrombotic stroke in animal experiments. The excellent activity of SMTP-7 is attributable to an anti-inflammatory action as well as thrombolysis due to plasminogen modulation. We recently identified soluble epoxide hydrolase (sEH) as an intracellular target of the anti-inflammatory action of SMTP-7. SMTP-7 inhibits sEH that hydrolyzes anti-inflammatory fatty acid epoxides, and this action possibly plays a role in the protection of nervous tissues from inflammatory damage. We report here that SMTP-7 treats thrombotic stroke with little bleeding risk. In thrombotic stroke models of monkey and mouse, SMTP-7 (10 mg/kg) significantly ameliorated neurological deficits, cerebral infarct, and hemorrhage transformation. The efficacy of SMTP-7 in thrombolysis at 10 mg/kg was comparable to that of t-PA at 0.55 mg/kg in a rat carotid artery thrombosis model. In a mouse tail amputation assay, SMTP-7 at < 30 mg/kg did not prolong bleeding time, and bleeding was observed at 100 mg/kg. t-PA significantly prolonged bleeding time at >0.1 mg/kg. These effects of SMTP-7 and t-PA were canceled by tranexamic acid, an inhibitor of fibrinolysis. Thus, at the pharmacological thrombolytic dose, t-PA but not SMTP-7 increases bleeding time. The difference can be explained by that, unlike t-PA that directly activates plasminogen, SMTP-7 is a plasminogen modulator that alters plasminogen conformation to be susceptible to proteolytic activation by endogenous plasminogen activators, and acts through a physiological on-demand system coping with thrombotic events. In addition, anti-inflammatory action of SMTP-7 through an sEH inhibition may contribute to lower risk of hemorrhagic transformation.
Abstract WMP105: Risk-benefit Profile of Warfarin vs. Aspirin in Patients with Heart Failure and Sinus Rhythm: A Meta-Analysis
Authors: Lee Meng , Saver Jeffrey L , Hong Keun-Sik , Wu Hsiu-Chun , Ovbiagele Bruce
Published: March 2022

Objective:
To comprehensively investigate the comparative risk-benefit profile of warfarin compared to aspirin in patients with heart failure who are in sinus rhythm.

Methods:
Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from 1966 to June 2012 were systematically searched to identify relevant studies. The primary outcome was time to first stroke or death from any cause; secondary outcomes included any stroke, ischemic stroke, and major bleeding. We included randomized controlled trials that included a comparison of warfarin with aspirin, and in which the total number of patients and events were reported separately for active warfarin and aspirin groups. Relative risk (RR) with 95% confidence interval (CI) was used as a measure of the association between warfarin vs. aspirin therapy and risk of stroke or death, pooling data across trials using a random-effects model. Between-study heterogeneity was assessed using the
I
2
statistic.

Results:
The search identified 4 randomized controlled trials of warfarin vs. aspirin therapy, enrolling 3663 patients, in which composite endpoint of stroke or death was reported as an outcome measure. Overall, there was no significant difference between the two treatments for the primary endpoint (warfarin vs. aspirin: RR 0.94, 95% CI 0.84 to 1.06, p=0.31) (Figure); and no heterogeneity across all trials (p=0.66,
I
2
=0%). However, warfarin (vs. aspirin) was associated with lower risk of any stroke (RR 0.56, 95% CI 0.38 to 0.82, p=0.003) and ischemic stroke (RR 0.45, 95% CI 0.24 to 0.86, p=0.02) but a higher risk of major bleeding (RR 1.95, 95% CI 1.37 to 2.76, p=0.0002).

Conclusion:
Among patients with heart failure who were in sinus rhythm, warfarin is no better than aspirin in preventing stroke or death from any cause. The observed stroke preventive benefit seen with warfarin appears to be offset by a significantly higher risk of major bleeding.