bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP21: Consequences of Atrial Fibrillation Burden on Deep Cerebral Hemodynamic Related Structural Brain Damage
Authors: Rotschild Ofer , Gokcal Elif , Abramovitz Avia , Das Alvin S , Penadel Aguila Kim , Le Brian , Yaghi Shadi , Reddy Vivek Y , Helmer Karl , Greenberg Steven , Gurol Edip M
Published: February 2024

Background:
Recent data using ultrahigh-resolution brain MRI suggests that atrial fibrillation (AF) has adverse effects on wall shear stress and blood flow in lenticulostriate arteries (LSA). The structural consequences of such pathophysiological alterations and whether they contribute to cognitive impairment in AF are not known. We hypothesized that the AF burden is associated with the severity of MRI markers of ischemic and hemorrhagic injury related to LSA disease.

Methods:
We analyzed data from 560 patients with AF and no clinical history of stroke or neurodegenerative disease, who received brain MRIs at a tertiary referral center. Neuroimaging data were collected by a stroke neurologist who was blinded to the clinical data. The presence of paroxysmal/persistent vs permanent AF was the main measure of AF burden. The imaging outcome variables were counts of deep lacunes, deep cerebral microbleeds (dCMB), and presence of a peri-basal ganglia white matter hyperintensity pattern (peri-BG WMH).

Results:
The mean age of the 560 AF patients was 73
+
11 and 212 (38%) patients were female. Mean CHA
2
DS
2
-VASc was 3.4
+
1.5 and 86 (15.4%) had permanent atrial fibrillation. Deep lacunes were found in 26.6%, dCMBs in 6.3% and a peri-BG WMH pattern in 2.7% of patients. In univariate analyses, the presence of permanent AF was associated with higher mean deep lacune counts (0.84 vs 0.51, p=0.026), higher mean dCMB counts (0.25 vs 0.1, p=0.018), and peri-BG WMH pattern (7.1% vs 1.9%, p=0.016) when compared to paroxysmal/persistent AF. In separate multivariable analyses, permanent AF type remained an independent predictor of dCMBs (p=0.019) and peri-BG WMH pattern (p=0.028) after controlling for age, sex, and vascular risk factors. Permanent AF also showed a tendency for independent association with deep lacunes (p=0.06) in a similar model.

Discussion:
Our results show that AF burden independently correlates with parenchymal MRI markers of LSA disease in patients without history of stroke. Such deep brain damage might contribute to AF-induced cognitive changes. The effects of better rhythm control on visible brain damage and cognitive changes should be studied in randomized trials.
Abstract TP214: In-Silico versus In-Vitro Evaluation of a New Stent-Retriever Design: A Novel Approach to Pre-Clinical Device Development
Authors: Desai Shashvat , Bridio Sara , Konduri Praneeta , Arrarte Terreros Nerea , Luraghi Giulia , Atchaneeyasakul Kunakorn , Fregona Virginia , Rodriguez Matas Jose , Berti Francesco , Yavagal Dileep R , Yoo Albert J , Majoie Charles B , Jadhav Ashutosh , Marquering Henk , Migliavacca Francesco
Published: February 2024

Introduction:
In-vitro evaluation (analysis in a bench top flow model) is the gold standard for pre-clinical investigation of devices being developed for endovascular thrombectomy (EVT). In-silico evaluation (computer simulated analysis in a virtual stroke model) has the potential to test and optimize large number of stent-retriever design variations in a relatively time and cost-effective manner. We aim to validate the utility of in-silico evaluation when compared with in-vitro evaluation for the SuperNova Stent-retriever.

Methods:
In-silico analysis was performed using a virtual thrombectomy model, built using data from a fine-grained finite-element model, to estimate the probability of successful recanalization. Neurovascular anatomy of the virtual model was built based on digital subtraction angiography of an in-vitro model (Sim Agility, Mentice, Inc). Gravity Medical Technology’s SuperNova Stent-retriever was the device under investigation. Multiple thrombectomy scenarios were defined and validation analysis was performed.

Results:
We defined multiple thrombectomy scenarios including 1 cm red blood clot in M1 artery, 2 cm bifurcation M1-M2 red blood clot (Y-shaped clot), 1 cm white blood clot in M1 artery, and 1 cm white blood clot in superior M2 artery. The figure below demonstrates a pictorial representation of the first scenario- 1 cm red blood clot in M1 artery followed by mechanical thrombectomy simulation using the SuperNova stent-retriever. Per our in-vitro analysis (10 thrombectomy experiments), the rate of first pass effect and the rate of complete recanalization after a maximum of 3 passes using SuperNova stent-retriever was 50% and 90%, respectively. Preliminary data suggests 97% concordance.

Conclusion:
In-silico analysis has the potential to improve and expedite pre-clinical thrombectomy device development. Further studies are required to better understand the scope and potential of this technology.
Abstract TP223: Predicting Atrial Fibrillation in Embolic Stroke of Unknown Source
Authors: Aboul-Nour Hassan O , Ge Yi , Hasan S M Shafiul , Hu Xiao , Nahab Fadi B
Published: February 2024

Background:
A considerable portion of patients with embolic stroke of unknown source(ESUS)are later found to have occult atrial fibrillation (AF). Studies have shown that prolonged outpatient cardiac monitoring increases the chances of AF detection and impacts choice of antithrombotic therapy. The Brown ESUS-AF Score, a prediction tool utilizing age and left atrial enlargement has previously shown promise in predicting AF in ESUS patients. In this study we aimed to externally validate the Brown ESUS-AF score and compare its performance against a random forest classifier.

Methods:
We included all patients with ESUS who underwent an inpatient stroke evaluation followed by outpatient cardiac monitoring between October 9,2015-March 31,2023. To validate the Brown ESUS-AF score, our cohort was divided between those who developed AF during follow-up versus those who did not. To develop the random forest classifier, we included demographics, medical comorbidities, lab records, echocardiographic and electrocardiographic findings. We did 80/20 train-test split to fine tune the model, and we identified features that had the greatest performance contribution.

Results:
Of 468 patients, 97(20.7%) patients had occult AF. AF patients were older(68.6±13.0 vs 60.1±15.6;p=0.0001), had a higher left atrial (LA) volume index(30.6±12.3 vs 26.2±10.0;p=0.0001) and larger LA diameter(3.8 ± 0.7 vs 3.5 ± 0.7;p=0.002) compared to those who did not develop AF. We found that a Brown ESUS-AF score of≥2 had lower sensitivity in our patient cohort than the original development cohort (42%vs63%). In comparing our random forest classifier to the Brown ESUS-AF score, our model had higher c-statistic (0.71vs0.64). The most important features we identified are age, LAVI, PR and QT Interval, triglyceride level and platelets.

Conclusion:
Our machine learning model incorporating 52 variables performed better than the Brown ESUS-AF score in predicting AF in our large and diverse ESUS cohort.
Abstract TP227: Correlation of Social Vulnerability Index and Stroke Patient Social Needs
Authors: Rissier Bennett , Ido Moges S
Published: February 2024

Introduction:
Social determinants of health (SDOH) have a significant role in stroke patients’ health outcomes. To assess the environments patients are discharged to, the AHA's GWTG tool collects data on ten social needs of hospitalized stroke patients. The CDC’s Social Vulnerability Index (SVI) evaluates the vulnerability of a community to hazards by considering sixteen components across four themes: Socioeconomic Status, Household Characteristics, Racial and Ethnic Minority Status, and Housing Type/Transportation. This study aims to assess the correlation between the GWTG social needs assessment and the SVI at the census tract level.

Methods:
Georgia Coverdell Acute Stroke Registry (GCASR) data from 2021 was matched with the Georgia Discharge Data System to obtain patients' residence coordinates. The data was then linked with 2020 SVI census tract data. Each SVI component was classified into deciles and assessed for correlation with the proportion of patients with a specific social need using Spearman correlation.

Results:
Among the 22,930 patients treated at GCASR participating hospitals, 10,019 had social needs data. No major sociodemographic or disease-related differences were noted between patients with and without social need data. 15 SVI components have a statistically significant correlation at the 0.05 alpha level with at least one social need. Correlation strength ranged from mild to strong.

Conclusion:
Most elements of the SVI at the census tract level are moderately or strongly correlated with one or more social needs, suggesting they may serve as proxy measures. SVI data, regularly updated by the CDC and freely available, could be incorporated into electronic medical records to assist with stroke patients' discharge process and transition of care.
Abstract TP243: The Association Between Frailty and Survival in Older Mexican Patients With Acute Ischemic Stroke
Authors: Martínez-Bravo Luis E , Hidalgo-Díaz Diego A
Published: February 2024

Introduction:
Frailty, a prevalent geriatric syndrome, has been consistently linked to unfavorable outcomes. Prior investigations have demonstrated a notable correlation between frailty and survival rates among individuals experiencing acute stroke. To our knowledge, there are not studies in Mexican stroke patients.

Objective:
We investigated the association between pre-stroke frailty status and 30-day survival in older Mexican patients with acute ischemic stroke.

Methods:
This prospective study included Mexican patients older than 60 years old hospitalized with acute ischemic stroke who were ineligible for reperfusion therapy between May and July 2023. Pre-stroke frailty status was assessed using the FRAIL score. The sample size was determined to be 190 individuals (α 0.1, β 0.2, p0 0.16, p1 0.05, and r1). Descriptive statistics and Kaplan-Meier survival analyses were performed. This research was authorized by our institution’s board, and informed consent was obtained.

Results:
A total of 133 patients were included, of whom 97 (72.9%) were frail. Frail group was older (77 vs. 72 years, p =.002), had more females (50 vs. 11, p = 0.031), had a higher NIHSS score (13 vs. 10, p = 0.01), had more history of previous strokes (50 vs. 5, p = 0.001), and had a longer hospital stay (8 vs. 5 days, p = 0.026) compared with the non-frail group. In 30 days, 45 deaths were recorded, of which 41 occurred in the frail group. The number of hospital deaths among frail patients was higher (31 vs. 1, p = 0.001). In the survival analysis, frailty was associated with decreased 30-day survival and, frailty increased the risk of death 12 times after 15 days of stroke (p = 0.021); other variables were not associated with survival in the frailty subgroup analysis.

Conclusion:
Pre-stroke frailty status is associated with decreased 30-day survival in older Mexican patients with acute ischemic stroke.
Abstract TP250: Poor Control of Hyperlipidemia Prior to Ischemic Stroke
Authors: Mok Kent , Mehndiratta Prachi , Chaturvedi Seemant
Published: February 2024

Introduction:
Hyperlipidemia is a key modifiable risk factor for ischemic stroke. Data suggest a strong correlation between low-density lipoprotein cholesterol (LDL) levels and the incidence of cardiovascular events. Few studies have addressed the scope of LDL undertreatment prior to ischemic stroke.

Methods:
A retrospective analysis was conducted on patients with ischemic stroke to study patterns of hyperlipidemia undertreatment using LDL levels as a marker. A total of 826 patients admitted from 2018-2020 were stratified into three LDL categories: 1) High (130-159), 2) Very High (160-189), and 3) Extremely High (190 or higher). A chi-squared analysis was performed to determine if there was a significant difference in proportion based on sex, race, age, diabetes (DM) status, history of heart disease and statin use among patients across the three LDL categories. An ANOVA analysis was also performed to determine if a significant difference exists between the mean ages of the three LDL categories.

Results:
Of the 826 patients, there were 178 patients (21.5%) whose LDL-C values were greater than 130. 106 (12.8%) were classified as High, 50 (6.0%) as Very High, and 22 (2.7%) as Extremely High. For the High group, 61 (57.5%) were male, 29 (27.4%) had DM, 32 (30%) were older than 70, and 89 (84%) had a history of heart disease. For the Very High group, 16 (32%) had DM and 40 (80%) had a history of heart disease. For the Extremely High group, 32% had DM and 36% had heart disease. There was no significant correlation between the three LDL categories and the various patient characteristics.

Conclusion:
A broad group of patients (including those of different sexes, races, and ages) presented with markedly elevated LDL at the time of an ischemic stroke. Despite the recommendation for intensive LDL lowering with DM and heart disease, a large portion of patients with these conditions were poorly controlled. Achieving guideline adherence for lipid control could reduce the stroke rate, especially for those with DM and prior heart disease.
Abstract TP251: The Influence of Obstructive Sleep Apnea on Post-Stroke Complications: A Systematic Review and Meta-Analysis
Authors: Kurra Nithin , Gandrakota Nikhila , Ramakrishnan Manju , Sudireddy Kavya , Boorle Naga Vijaya Lakshmi Divya , Jillella Dinesh
Published: February 2024

Objective:
Evidence has shown that obstructive sleep apnea (OSA) is associated with the development of stroke. However, there is limited data on how OSA can influence the development and severity of post stroke complications. This study was done to investigate the potential relationship between OSA and post stroke complications and systematically review the current literature available on the topic.

Methods:
PubMed, Web of Science and Scopus Databases were used to collect data from the published literature up to December 2022. The studies that met the inclusion criteria were selected and Review Manager 5.4.1 was used for statistical analysis of data. Pooling of data with heterogeneity was done using a random-effects model. The findings were presented by using the standard mean differences within their 95% confidence intervals.

Results:
The analysis showed that stroke patients experiencing OSA do not significantly have higher post-stroke complications (i.e mild cognitive impairment, dementia, insomnia, fatigue, sleep quality, post-stroke depression, anxiety, recurrent strokes) compared to those stroke patients who do not have OSA (RR=1.05, 95% CI 0.97 to 1.13). Similarly, stroke patients experiencing OSA did not have any statistically significant risk of depression (RR=0.92, 95% CI = 0.58 to 1.48) or cognitive impairment (RR=1.05, 95% CI –0.90 to 1.23). Among patients with high stroke severity, those who have OSA have higher risk of post-stroke complications than those patients without OSA (RR=1.06, 95% CI –1.01 to 1.12)

Conclusion:
This systematic review and meta-analysis attempted to consolidate the literature and potentially suggested a possible positive relationship between OSA and post-stroke complications mainly with neuropsychiatric comorbidities including cognitive impairment, depression and anxiety. Further studies are required to explore the impact of OSA on post stroke complications.
Abstract TP254: The Incidence Rate and Risk Factors of In-Hospital Onset Stroke Among 83,990 Hospitalized Patients
Authors: HATAKE Seira , Suzuki Kentaro , Saito Tomonari , Kimura Kazumi , Nishino Takuya , Hayashi Daisuke
Published: February 2024

Introduction:
Clinical characteristics of patients with in-hospital onset stroke (IHOS) compared to those with out-of-hospital onset stroke are reported to be late detection of stroke onset, less use of rt-PA, presence of atrial fibrillation, and poor outcome. Among hospitalized patients, however, clinical characteristics of patients with IHOS has not been clear. The purpose of this study is to clarify the incidence rate of IHOS among hospitalized patients and to investigate the risk factors associated with IHOS.

Methods:
Patients consecutively admitted to the Nippon Medical School hospital between April 2018 and March 2023 were assessed. Patients under 18 years and discharged within 24 hours were excluded. Furthermore, patients admitted in Neurology and Neurosurgery also were excluded to remove in-hospital onset recurrent stroke from our study. First, we calculated the incidence rate of IHOS among hospitalized patients. Next, all patients were divided into two groups, Stroke group had IHOS and Control group did not, and investigated the risk factors associated with IHOS using multivariate analysis.

Results:
Of 98,225 patients hospitalized, 83,990 patients (median age was 69 [54-77] years and 55.3% were male) were enrolled into this study. The number of IHOS patients were 101. Thus, the incidence rate of IHOS was 0.12%. A half of them (n=49) had stroke onset within 1 week after admission. Stroke group had higher mortality (14.9% vs. 2.7%, p < 0.01) and longer length of stay (36 days vs. 8 days, p < 0.01) than Control group. Multivariate analysis demonstrated that risk factors associated with IHOS were old age (OR 1.03, p < 0.01), hypertension (OR 1.57, p = 0.04), diabetes mellitus (OR 1.61, p = 0.03), atrial fibrillation (OR 2.43, p < 0.01), emergency admission (OR 3.38, p < 0.01) and low serum albumin level (OR 0.66, p = 0.03).

Conclusions:
Among 83,990 hospitalized patients, the incidence rate of IHOS was 0.12%. Risk factors associated with IHOS were old age, hypertension, diabetes mellitus, atrial fibrillation, emergency admission and low serum albumin level. Therefore, among hospitalized patients, cases with emergency admission and cerebrovascular risk factors including atrial fibrillation should be payed attention to prevent in-hospital onset stroke.
Abstract TP261: Cocaine Use on Patients With Acute Ischemic Stroke: Classification of Subtype, Management, and Clinical Outcomes
Authors: Behera Anit K , Desai Harsh , Kothari Sachin A , Mendelson Scott J
Published: February 2024

Introduction:
There are several pathogenic mechanisms that have been theorized for cocaine-related ischemic strokes (CRIS). However, there are limited studies to date that have classified them under a subtype of the Trial of ORG 10127 in Acute Stroke Treatment (TOAST) criteria. This study aims to describe CRIS by the TOAST criteria, treatment, and clinical outcomes.

Methods:
A retrospective chart review was performed at our comprehensive stroke center from 2020-2022 to identify patients with acute ischemic stroke (AIS) with a cocaine-positive status on admission. Baseline demographics, urine toxicology, National Institute of Health Stroke Scale (NIHSS) scores, neuroimaging, TOAST criteria, location of stroke, home medications, comorbidities, medical management, and inpatient outcomes including modified Rankin Score (mRS) were reported.

Results:
A total of 74 patients were identified to have a positive cocaine status on admission with a diagnosis of new AIS from 2020-2022. The mean age was found to be 60.8 years old with a majority male population at 73.0%. Seventy-eight percent were found to be cocaine positive on admission via urine toxicology with the remaining endorsing a history of cocaine use. The most common category under the TOAST criteria was large artery atherosclerosis (39.2%). Among the cocaine-positive cohort, 10.8% of patients received thrombolytics and 18.9% underwent endovascular thrombectomy. The majority of patients had intracranial atherosclerotic disease (62.2%) on imaging and in the area of the stroke (55.4%). Overall mortality was low (97.3% alive) and modified Rankin score (mRS) at discharge was less than 3 for 59.5% of patients.

Conclusion:
Our data suggests that CRIS may have a higher association with large artery atherosclerosis. This study highlights the importance of future larger studies to investigate atherosclerosis as a contributor to cocaine-induced ischemic strokes.
Abstract TP268: Markers of Coagulation and Hemostatic Activation in Ischemic Stroke Patients With Reduced Ejection Fraction on Antiplatelet Therapy
Authors: Glover Patrick , Nahab Fadi B
Published: February 2024

Introduction:
Heart failure with reduced ejection fraction (HFrEF) is a risk factor for ischemic stroke. However, antithrombotic choice in a patient with HFrEF remains challenging. We set out to evaluate serum markers of coagulation and hemostatic activation (MOCHA) among ischemic stroke patients with HFrEF.

Methods:
We performed a retrospective analysis of ischemic stroke patients with HFrEF (<40%) from July 28, 2017-June 13, 2023 seen at the Emory Stroke Clinic who underwent a MOCHA profile (serum D-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) ≥2 weeks after the index stroke; abnormal MOCHA profile was defined as ≥2 elevated markers. We excluded patients who were on anticoagulation therapy at the initial visit.

Results:
Overall, 40 patients (mean age 60 +/- 13.1, 53% female, 85% nonwhite) met criteria; median EF was 25% (IQR 15%-30%). Frequency of abnormal MOCHA profile was 43% in EF ≥25% and 58% in EF <25% (p = 0.52). No MOCHA components were associated with reduced EF in multivariate linear regression analysis (R2 = 0.03, p = 0.28). Over mean follow-up of 2.3 years, recurrent stroke occurred in 5.3 / 100 patient-years and major adverse cardiac events (MACE) occurred at 7.4 / 100 patient-years. Compared to patients with EF <25%, patients with EF ≥25% had higher recurrent stroke rates (6.46 vs 3.07 per 100 patient-years) and MACE (9.69 and 3.07 per 100 patient-years) Patients on antiplatelet regimens and anticoagulant regimens experienced MACE events at a rate of 4.25 and 10.62 per 100 patient-years, respectively. Patients with abnormal MOCHA profiles (n=20) had no recurrent strokes, but experienced other MACE events at a rate of 3.86 per 100 patient years, while patients with normal MOCHA profiles (n=20) experienced 11.73 MACE events per 100 patient-years, all of which were recurrent strokes.

Conclusion:
In HFrEF patients with an ischemic stroke, the MOCHA profile was not associated with ejection fraction. No difference in recurrent stroke and MACE events was seen among patients with normal vs abnormal MOCHA profile.
Abstract TP270: Development and Validation of a Nomogram Model for Predicting Early Neurological Deterioration in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis
Authors: Wang Lanjing , Tian Tian , Xu Jiali , Jia Yujie , Xue Kun , Huang Shuangfeng , Shen Tong , Luo Yumin , Min Lianqiu , Li Sijie
Published: February 2024

Objective:
A proportion of acute ischemic stroke (AIS) patients suffer from early neurological deterioration (END) within 24 hours following intravenous thrombolysis (IVT), which greatly increases the risk of poor prognosis of these patients. Therefore, we aimed to explore the predictors of early neurological deterioration of ischemic origin (END
i
) in AIS patients after IVT and develop a nomogram prediction model.

Methods:
This study collected 244 AIS patients with post-thrombolysis END
i
as the derivation cohort and 155 patients as the validation cohort. In the derivation cohort, multivariable logistic regression analysis was used to identify the independent risk factors for END
i
, which were subsequently used to establish the nomogram predictive model. Furthermore, the validation cohort data were used for external validation of the nomogram.

Results:
The results of multivariable logistic regression analysis showed that neutrophil to lymphocyte ratio (NLR) (OR 2.616, 95% CI 1.640-4.175, P<0.001), mean platelet volume (MPV) (OR 3.334, 95% CI 1.351-8.299, P=0.009), body mass index (BMI) (OR 1.979, 95% CI 1.285-3.048, P=0.002) and atrial fibrillation (AF) (OR 8.012, 95% CI 1.341-47.873, P=0.023) were significantly associated with END
i
. The area under the curve of the prediction model constructed from the above four factors was 0.981 (95% CI 0.961-1.000) and the calibration curve was close to the ideal diagonal line. Furthermore, decision curve analysis showed a significantly greater net benefit of the nomogram. These results were successfully validated internally and externally.

Conclusions:
NLR, MPV, BMI and AF were independent risk factors and predictors of END
i
. The nomogram prediction model based on these four factors exhibited good discrimination and calibration power. It might be a reliable and easy-to-use tool to predict post-thrombolysis END
i
in AIS patients.

Keywords:
Acute ischemic stroke; early neurological deterioration; intravenous thrombolysis; nomogram; prediction model
Abstract TP274: Challenging the Guidelines or Merely an Observation on Transthoracic Echocardiography
Authors: Zahid Ayesha , ikram Jibran , Ghaffar Rahmat
Published: February 2024

Introduction:
Accurate detection of left atrial appendage (LAA) clot is critical in patients before Balloon Mitral Valvotomy (BMV). There is an elevated risk of thrombus formation and ischemic stroke in Rheumatic Heart Disease (RHD). The yearly prevalence of new stroke is 3-7.5% in RHD. Transesophageal Echocardiogram (TEE) has traditionally been the gold standard for LAA clot detection. But it is semi-invasive and have risks. The need for alternatives in this clinical context has prompted this comparative study.

Hypothesis:
Visualizing LAA on Transthoracic Echocardiogram (TTE) is facile in severe mitral stenosis due to increased LAA size, which is vital for stroke prevention.

Methods:
In this comparative study, we assessed the diagnostic accuracy of TTE as a non-invasive alternative to TEE for LAA clot detection in patients scheduled for BMV. A total of 150 patients admitted to a tertiary hospital underwent both TTE and TEE before BMV, with TEE as the reference standard for evaluation.

Results:
The mean age of our study population was 41.4 years, the majority were females (64.7%). The incidence of thrombus in TEE was 30%, with a significant difference in females (37%) vs. males (17%). TTE missed LAA clots in 18.8%, this discrepancy rate was 6% in males and 26% in females, signifying a significant reduction in clot detection in females. TEE exhibited no such limitations in clot detection between genders. TTE displayed sensitivity of 98% and specificity of 81%. The accuracy rate of TTE was 43.3%.Pearson Correlation coefficient and Fishers Exact test confirms significance. The non-invasive nature of TTE, devoid of procedural complexities, positions it as a Cost-effective option.

Conclusion:
Our study provides compelling evidence supporting the hypothesis that TTE is an effective and practical alternative to TEE for LAA clot detection in RHD patients Further studies are needed in this regard so that the current Class 1C recommendation for TEE before any BMV may need to be revised.
Abstract TP280: Monogenetic Stroke Syndrome Testing in Adults: A Single Center Experience
Authors: Curran Courtney , Silver Mitchell , Lambertson Elise , Yaddanapudi Sridhara
Published: February 2024

As access and coverage of genetic testing has increased, it is being used more commonly in adults with strokes. However, no clear guidelines exist for who should undergo genetic testing. Our retrospective review aims to provide guidance in this regard and show our experience.

Genetic testing was ordered at our comprehensive stroke center between June 2022 and September 2023. Tests were ordered from GeneDx and genetic material was collected by buccal swab after consent was obtained. Most of the testing was done routinely in the outpatient setting, but was rarely performed inpatient when diagnosis would change acute management.

Genetic testing was ordered for 41 patients. Tests ordered included whole exome sequencing, mitochondrial genome sequencing, Marfan syndrome and thoracic aortic aneurysm and dissection panel, Disorders of connective tissues panel and expedited whole genome sequencing. Indications for testing included evaluation of carotid and vertebral dissections, recurrent stroke, cryptogenic stroke, and leukoencephalopathy. The average age of tested patients was 47. Of these patients, 6 had not had a stroke and the testing was ordered to evaluate etiology of vertebral or carotid dissections. Of the 35 patients being evaluated for stroke etiology, 60% had at least one stroke or TIA prior to presentation. Of patients tested, 14 had evidence of dissection in the carotid arteries or vertebral arteries. At the time of analysis, 27 patients had results available, of which 15 had negative results. Positive results with pathogenic variant were seen in 4 patients. Pathologic variants detected included mutations in ABCC6, NOTCH3, MT-TL1, HBB, and MCCACHC genes. Variants of unknown significance were seen in 8 patients. These variants included mutations in MYLK, COL5A1, COL5A2, KRIT1, CCM2, XPR1, MT-CYB, MT-ND4, and MT-ATP6 genes.

This study highlights that in the right clinical population, like young patients with recurrent stroke, genetic testing can be helpful to elucidate the etiology of cerebrovascular disease when standard stroke work up is inconclusive. With retrospective review, we aim to provide guidance on indications for genetic testing in adults with stroke and dissection.
Abstract TP285: Chronic Remote Ischemic Conditioning (C-RIC) and Physical Exercise Attenuate NLRP3 Inflammasome Activation Induced by Chronic Cerebral Hypoperfusion in the BCAS Mouse Model of VCID
Authors: Khan Mohammad B , Siddiqui Shahneela , Kamat Pradip , Nisar Mohammad , Williams Dylan , Hattaway Tyler , Anas Affan , Baban Babak , DHANDAPANI Krishnan , Arbab Ali S , Hess David C
Published: February 2024

Background and Purpose:
Inflammation plays a significant role in acute and chronic cerebral ischemia. The bilateral carotid artery stenosis (BCAS)-induced chronic cerebral hypoperfusion activates the NLRP inflammasome in brain tissue. We aimed to determine if C-RIC and physical exercise (EXR) attenuated the increase in the NLRP3 inflammasome and related cytokines in the BCAS model.

Methods:
Microcoil-induced BCAS was used for chronic hypoperfusion, a model for VCID. Middle-young (5 months old) and old-aged (14 months old) C57Bl/6 mice were randomly assigned to Sham, BCAS, and BCAS+EXR (four weeks treadmill exercise) for middle-young mice and to Sham, BCAS, and BCAS+RIC (four months C-RIC treatment) for old-aged mice of both sexes. qPCR was run for NLRP3, TNFa, IL-1B, IL-6, IL-10, ICAM1, VCAM1 in brain tissue.Biochemical assays and histopathological staining of NLRP3 were also assessed on the brain tissues.

Results:
Four weeks of exercise in middle-aged mice and 4 months of C-RIC in aged RIC groups attenuated the increased NLRP3, cytokines (IL-1B, IL-6, IL-10, TNFα), and inflammatory markers (ICAM-1 & VCAM-1) induced by BCAS in middle-aged (exercise) and aged mice (CRIC). Western blot and immunohistopathological studies also attenuated the increased NLRP3 expression after physical exercise and C-RIC treatment.

Conclusions:
C-RIC and Physical exercise attenuated the increase of NLRP3 inflammasome and cytokines (IL-1B, IL-6, IL-10, TNFα) induced by chronic cerebral hypoperfusion in the BCAS mouse model of VCID. This may be an important mechanism of action of physical exercise and C-RIC in VCID.
Abstract TP303: Perfluorocarbon Oxygent Limits Functional Impairment and Brain Damage Following Subarachnoid Hemorrhage
Authors: Ahmed Mohammad E , Akhter Naseem , Fatima Sumbul , Giri Shailendra , Hoda Nasrul , Ahmad Abdullah S
Published: February 2024

Introduction:
Subarachnoid hemorrhage (SAH) is the deadliest form of hemorrhagic stroke. Post-SAH vasospasm induces brain tissue hypoxia-ischemia resulting in brain injury and functional impairments. However, translational studies focused on post-SAH brain tissue oxygenation for functional improvements remain limited. We propose the use of Oxygent, a perfluorocarbon (PFC) based lipid emulsion oxygen carrier, as a promising therapy to improve post-SAH functional outcomes. Here we propose the use of Oxygent, a perfluorocarbon (PFC), as effective therapeutics. Oxygent-PFC comes as a lipid emulsion of micro-particles with great flexibility. The ultra-smaller size of these particles as compared to RBCs lets them flow even when there is just a trickle of residual plasma and efficiently deliver oxygen to prevent tissue damage. We tested the hypothesis that Oxygent-PFC would attenuate post-SAH functional and anatomical impairments.

Methods:
Adult C57BL/6 wildtype mice were subjected to the endoperforation model of SAH followed by an i.v injection of Oxygent-PFC or saline (9ml/kg at 6h after SAH). At 48h after SAH, mice were tested for functional outcomes followed by blood collection through cardiac puncture. Thereafter, mice were transcardially perfused, and brains were harvested to assess various immunohistochemical and biochemical outcomes.

Results and Conclusion:
We found that SAH resulted in significant neurologic and motor deficits while Oxygent-PFC treatment attenuated these functional deficits. There was a significant neuronal death after SAH as compared with the sham group and Oxygent-PFC prevented neuronal death. Moreover, mitochondrial activity as assessed by OXPHOS was markedly decreased after SAH while Oxygent-PFC treatment significantly improved the mitochondrial activity as compared to the vehicle-treated SAH group. These data show that Oxygent-PFC treatment preserves mitochondrial activity, dimmish tissue damage, and improve functional outcomes. Our novel preliminary study in SAH encourages us to investigate the mechanism of action of Oxygent-PFC and a comprehensive preclinical trial to test its efficacy in different animal models of SAH.
Abstract TP306: Anemia Causes Hematoma Expansion, Cerebral Hypoxia-Driven Microglial Activation, and Early Mortality in Mice With Intracerebral Hemorrhage
Authors: Cottarelli Azzurra , Kumar Aditya , Mao Eric , Ji Robin , Konofagou Elisa , Connolly Edward , Hod Eldad , Roh David
Published: February 2024

Anemic intracerebral hemorrhage (ICH) patients are observed to have poor clinical outcomes with increased risk of hematoma expansion (HE) and impaired cerebral oxygenation. To assess whether anemia causes these observations, we assessed neuroimaging evidence of HE and neuropathological changes of hypoxia and blood brain barrier (BBB) dysfunction in anemic vs non-anemic mice with ICH. Anemia was generated in 3 month old female C57/BL6 mice using iron-deficient chow. Age and sex-matched controls were fed iron-replete control diet. Anemia was verified using modified Drabkin assays. Collagenase was used to induce ICH. ICH volume and HE were quantified using serial T2-weighed MRI at 1, 4, and 24 hours after ICH. Early 24 hour mortality was recorded. After the last MRI, surviving mice were euthanized by intracardiac perfusion and the brain was processed for histological analysis of vascular permeability (IgG), microglia number and activation (Iba1 and CD68), and response to hypoxia (HIF1α). Statistical analyses were performed using two-tailed ANOVA. Compared to controls, anemic mice displayed larger final ICH lesion volumes (anemia: 7.7 mm
3
vs control: 6.1 mm
3
), greater HE at 24 hours (anemia: 111.4% vs control: 23.6%) and increased early mortality (anemia: 30% vs control: 0%). Histological analyses revealed that, while microglial activation and BBB permeability to serum IgGs in control mice were restricted to the ipsilateral hemisphere and mostly localized perilesionally, anemic mice had increased immune infiltration and increased BBB permeability in both hemispheres. Similarly, non-ICH anemic mice showed increased and widespread immune cell infiltration and increased BBB permeability compared to non-ICH control mice, suggesting that consistently low hemoglobin concentrations may increase cerebrovascular susceptibility to injury.Future studies will be needed to further clarify cellular and molecular mechanisms driving our findings and whether anemia can be a treatable target to improve ICH outcomes.
Abstract TP307: oxLDL Preconditioning Intensifies Ischemic-Like Injury Mediated Alterations in Human Male Brain Endothelial Cell Tight Junction Protein Levels and Proinflammatory Mediators
Authors: Wendt Trevor S , Gonzales Rayna J
Published: February 2024

Introduction:
Acute ischemic stroke (AIS) triggers endothelial activation and induces cerebrovascular inflammation which can result in vascular function and integrity loss leading to worsened stroke outcome. A clinically correlated risk factor for stroke shown to mediate vascular dysfunction and injury is elevated levels of oxidized low density lipoprotein (oxLDL). We hypothesized that oxLDL would exacerbate acute ischemic injury mediated alteration of endothelial proinflammatory mediator and integral barrier protein levels.

Methods:
Primary adult male human brain microvascular endothelial cells (HBMEC) were preconditioned with human oxLDL (50 or 100ug/dL; 6, 12, 24, or 36h) or vehicle, using a serum dose reported in AIS patients. HBMECs were then exposed to normoxia (21% O
2
) or ischemic-like injury, hypoxia plus glucose deprivation (HGD; 1% O
2
), for 3 or 6h. HBMEC levels or expression of barrier markers, adhesion molecules, and inflammatory mediators were examined using qRT-PCR, in cell western, and FIJI mediated immunocytochemical analysis. Secondary analysis was performed on RNA sequencing of adult male aortic endothelial cells (HAoECs) exposed to oxLDL (50ug/mL; 3, 6, 12, 24h) obtained from GEO dataset GSE13139.

Results:
HGD injury concomitantly decreased HBMEC claudin-5, occludin, and ZO-1 as well as increased IL-1b, ICAM-1, VCAM-1, iNOS, and TNF-a. OxLDL exacerbated an HGD mediated decrease in HBMEC barrier levels and increase in proinflammatory levels in a dose and time dependent manner. HAoEC barrier, adhesion, and proinflammatory levels were not altered by oxLDL.

Conclusion:
OxLDL may preferentially alter brain endothelial barrier and proinflammatory levels, as opposed to aortic endothelial cells in dose and time dependent manner. Mitigating the effect of oxLDL on brain endothelial permeability and inflammation, possibly via receptor inhibition may be a novel, viable therapeutic target in the treatment of AIS.
Abstract TP313: LouiS: A Web Application for Identifying and Locating Vascular Syndromes in Stroke Patients
Authors: Pardini Thales , Andrade Joao B , Pontes-Neto Octavio M , Camilo Millene
Published: February 2024

Background:
– Current applications for identifying stroke locations are limited inproviding detailed information on brainstem vascular syndromes, separating syndromesby eponyms, or determining the affected side. The study aims to develop a webapplication (LouiS) to identify the vascular syndromes.

Methods:
– We created a databasewith the main ischemic stroke syndromes. Users input symptoms, and the applicationranks the four most probable vascular syndromes, associating them with respectivelocations and arteries involved in the central nervous system.

Results:
– Sixty-eightneurovascular syndromes features were described, encompassing 17 posterior circulationinfarcts. It provides users with a selection of at least 120 signs and symptoms. The webapplication is accessible at https://louis-stroke.com/. The application also incorporatedmagnetic resonance images and informative notes.

Conclusions:
– LouiS pinpoints strokelocations precisely, enhancing diagnostic accuracy and informing treatment decisions. The application allows users to offer suggestions for improvement, enhancing itscapabilities. LouiS holds promise for refining the study of vascular syndromes andmaking neurology topography more accessible to students, neurology residents, and othermedical professionals. In addition, it may help emergency professionals to recognizestroke symptoms more quickly and improve patient care.
Abstract TP318: Evaluating Hypothalamic Injury in a Rat Model of Subarachnoid Hemorrhage
Authors: Takemoto Yushin , Kanamaru Hideki , Huang Lei , Sherchan Prativa , Mukasa Akitake , Tang Jiping , Zhang John H
Published: February 2024

Background and purpose:
Hypothalamus is one of the most affected parts of the brain by subarachnoid hemorrhage (SAH). There are some reports that hypothalamic disorders are important determinants of poor prognosis after SAH from acute to chronic phase. However, there have never been any reports on the development of therapeutic strategies targeting the hypothalamus for SAH, and few reports have even demonstrated immunohistological evidence of hypothalamic injury after SAH. Here, we demonstrated on the investigation of temporal changes in hypothalamic injury from the hyperacute phase to the chronic phase after SAH in a rat model of SAH.

Methods:
Moderate to severe endovascular perforation model of SAH was created using 300g - 450g Sprague-Dawley rats, and they were divided into two groups: Sham operated and SAH group.The endpoints were 3, 6, 12, 24, and 72 hours after SAH, and 7 days and 4 weeks after SAH, and physiological findings and neurological symptoms were measured and hypothalamic injury and related factors in the hypothalamus were studied immunohistochemically.

Results:
The SAH group showed significant neurological deterioration, and the expression of FJC, indicative of cell death, and TUNEL-positive cells, indicative of apoptosis, in the hypothalamus was significantly elevated in the early phase and decreased over time compared to the sham SAH group. On the other hand, oxytocin, a hypothalamic hormone associated with neuronal protection, was significantly decreased in the SAH group during the acute phase.

Conclusions:
The present study shows that hypothalamic injury appears hyper acute phase of SAH and persists at least during the acute phase of SAH. These findings suggest that the hypothalamus may be an important therapeutic target in the acute phase of SAH.
Abstract TP36: Angiotensin II Induced Hypertension Increases the Brain Expression and Enzymatic Activity of CD38
Authors: Ewees Mohamed , Amro Hani , Dodd Daniel , Gallego-Perez Daniel , Zweier Jay L , Hannawi Yousef
Published: February 2024

Introduction:
CD38 is an ectoenzyme that was shown to mediate the age-dependent decrease in NAD
+
levels. We have shown that CD38 expression and enzymatic activity are increased in the brain of spontaneously hypertensive stroke-prone rats, a model of human cerebral small vessel disease. Therefore, we hypothesized that hypertension (HTN) induced by angiotensin II (ANG-II) infusion leads to an increase in CD38 expression and enzymatic activity.

Methods:
Male C57BL/6J mice (10-13) weeks of age underwent subcutaneous infusion of ANG-II (600 ng/kg/min) or saline for a 2-week duration through implanted osmotic pumps. CD38 expression was measured by immunofluorescence and Western Blotting. CD38 enzymatic activity was assessed in the brain homogenate by measuring the NAD
+
analogue conversion to the fluorescent product (ε-ADPR). Dihydroethidium, diaminofluorescein, JZL1707 sensor, and immunohistochemistry were used to measure the levels of superoxide, nitric oxide (NO), NAD(P)H, and endothelial nitric oxide synthase (eNOS) in the brain, respectively.

Results:
Ang-II infusion caused a slow rise of blood pressure leading to HTN. The brain of ANG-II infused mice showed 48% increase in the expression (P=0.013) and 73% increase in enzymatic activity (P=0.044) of CD38 compared to control mice. The expression of CD38 localized mainly to the endothelial cells in the ANG-II infused mice brains. The brains of ANG-II infused mice also had 26% lower levels of NAD(P)H (P<0.0001), 226% higher superoxide (P<0.0001), 32% lower NO (P<0.0001) and 30% lower eNOS levels (P=0.003) compared to control mice.

Conclusions:
ANG-II induced HTN increases CD38 expression and enzymatic activity with oxidative stress and lower levels of NAD(P)H. These results suggest a potential role of elevated CD38 enzymatic activity in the pathogenesis of cerebrovascular dysfunction induced by ANG-II as well as that seen in other models of HTN.
Abstract TP43: Optimizing System-Wide Nursing Assessment Documentation in the Stroke Population
Authors: Baird Kevin M , Sheehan Tiffany O , Johnson Michael , Jacobson Dawn
Published: February 2024

Background:
Stroke centers following AHA guidelines for the treatment of acute ischemic stroke, are challenged by compliance with documentation of vital sign, neuro and neurovascular assessments post thrombolysis interventions. Standardizing documentation in the electronic health record (EHR) increases compliance and reduces patient harm. In a large healthcare system, multiple sites received corrective action findings from regulatory agencies for missed nursing assessments. The centers did not have a documentation workflow aligned with the EHR to capture assessments in the stroke population.

Purpose:
To create a system-wide documentation workflow that captures nursing assessments in the EHR.

Methods:
In 2019 a task force of stroke coordinators and clinical informaticists convened to define evidence-based nursing assessments in stroke patients post intervention, define within normal limits for each component, and identify barriers to documentation in the EHR. The EHR was evaluated for component location and other areas in need of optimization. Components were scattered across different EHR locations, leading to missing documentation and assessments were difficult to trend. The task force led the development and implementation of a single EHR location to document nursing assessments. The EHR revisions were implemented in July 2022 after being vetted by system EHR governance, nurse practice council, and stroke coordinator collaborative.

Results:
A single grouping was developed in the EHR including vitals, focused neurological and neurovascular assessments. This grouping was strategically placed within nursing’s existing workflow. Reference text addressing each element of the grouping and its “within defined limits’ definition were added to align with the organization's documentation standards. To increase visibility of documentation, trending, and the auditing process, a single results view was developed which included all documented assessment components.

Conclusion:
A system-wide documentation workflow aligned with the EHR optimized documentation workflow, improved visibility of assessments, reduced audit time and regulatory findings. Stroke centers should carefully consider the layout of nursing documentation in the EHR.