bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 8: A Phase IIb Double-blind, Randomized, Placebo Controlled Study of GSK249320 for Stroke Recovery
Authors: Cramer Steven C , Enney Lori A , Russell Colleen K , Simeoni Monica , Thompson Thomas R
Published: June 2021

Introduction:
One class of potential post-stroke restorative therapy focuses on promoting axon outgrowth by blocking myelin-based inhibitory proteins such as myelin-associated glycoprotein (MAG). The aim of the current study was to extend preclinical and clinical findings of GSK249320, an IgG1-type monoclonal antibody to MAG, to explore effects on motor outcomes after stroke.

Methods:
This was a phase IIb double-blind, randomized, placebo controlled study (GSK funded; clinicaltrials.gov # NCT01808261). At 30 international sites, patients with ischemic stroke 24-72 hours prior and deficits in gait were randomized to two IV infusions of GSK249320 or placebo. Primary outcome measure was change in gait velocity from baseline to Day 90.

Results:
A total of 134 subjects were randomized. The two groups were overall well matched at baseline. The study was stopped at the pre-specified interim analysis because the treatment difference met the predefined futility criteria cutoff. Secondary endpoints, including gait analyzed categorically and upper extremity function (Box & Blocks score), were concordant. The two IV infusions of GSK249320 were well tolerated. Although direct evidence that the therapy reached the biological target was not available, indirect evidence of target binding was suggested by the substantial reduction in free MAG plasma levels with GSK249320 treatment.

Conclusions:
The monoclonal antibody GSK249320 administered IV within 72 hours of stroke onset demonstrated no improvement in gait velocity as compared to placebo. The antibody was well tolerated and showed low immunogenicity, findings that may prove useful to future studies aiming to use a monoclonal antibody to modify activity in specific biological pathways in order to improve recovery from stroke.
Abstract 91: An Objective Screening Tool Predicts Surgical Feeding Tube Placement in Acute Ischemic Stroke Patients
Authors: Brown Kristin , Barreto Andrew , Saed Umair , Cai Chunyan , Memon Aurangzeb , Jackson William , Xavier Andrea , Shoemaker Paige , Vu Kim , Deguzman Maria Isabel , Clayton Alana , Sharrief Anjail
Published: June 2021

Introduction:
Dysphagia is a common post-stroke complication, yet there are no standard tools to guide recommendations for placement of percutaneous endoscopic gastrostomy (PEG) tube. Prior prediction models in acute ischemic stroke (AIS) have had inconsistent findings and have not included objective swallowing assessments. We hypothesized that inclusion of an aspiration-based score would simplify the prediction model and be a strong independent predictor of PEG placement among patients referred for instrumental assessment of swallowing (IAS) after failed bedside swallow.

Methods:
Consecutive cases of AIS were identified from our inpatient registry (6/14- 4/15). Patients transferred to hospice or dying within 3 days of hospitalization were excluded. NIHSS and sub-items, medical history, and demographic data were included in the full model and subgroup analysis which included patients undergoing IAS. Univariate and multiple logistic regression were used to assess predictors of PEG placement. Penetration-Aspiration (PEN-ASP) scores (1-2 normal; 3-5, penetration, 6-8, aspiration) calculated using Fiberoptic Endoscopic Evaluation of Swallowing and Modified Barium Swallow Studies were included in the model for subgroup analysis.

Results:
Among 731 AIS patients, 17.9% (131) of patients received a PEG and 200 patients received IAS (39.5 % PEG). In the full model, arrival GCS and NIHSS, NIHSS level of consciousness score, and prior Diabetes Mellitus and ICH (p < 0.05). Among patients receiving IAS, arrival NIHSS, PEN-ASP score, and race (Hispanic v White) was associated with PEG placement.

Conclusions:
This study represents the largest cohort of AIS patients undergoing PEG placement and IAS. We demonstrated that the PEN-ASP score helps to predict PEG placement in AIS. Race also emerged as a predictor, and in future studies, we will examine patient and provider-level factors to explain this association.
Abstract 99: Prep2: A Refined Algorithm for Predicting REcovery Potential of Upper Limb Function After Stroke
Authors: Stinear Cathy M , Byblow Winston D , Smith Marie-Claire , Ackerley Suzanne J , Barber P Alan
Published: June 2021

Independence after stroke depends on the recovery of motor function, but this is difficult to accurately predict for individual patients. We have previously described an algorithm for predicting potential for recovery of upper limb function for individual patients after stroke. The Predict REcovery Potential (PREP) algorithm begins with a bedside assessment of paretic shoulder abduction and finger extension strength (SAFE score out of 10), followed by transcranial magnetic stimulation (TMS), and magnetic resonance imaging (MRI), as required. Patients are predicted to have potential for an Excellent, Good, Limited or Poor recovery of upper limb function within 12 weeks. The algorithm was developed with data from 40 patients with first-ever ischaemic stroke. This study evaluated and refined the algorithm with a larger, more heterogeneous cohort. Inclusion criteria were confirmed stroke (ischaemic or haemorrhagic), new upper limb motor symptoms, and age at least 18 years. Previous stroke, thrombolysis and thrombectomy were allowed. Exclusion criteria were cerebellar stroke, contraindications to TMS and MRI for those patients who required these tests, and reduced capacity for consent. The Action Research Arm Test was used to measure paretic upper limb function 12 weeks post-stroke. A sample of 192 patients was recruited within 3 days of stroke (106 men, mean age 72 y, 100 right hemisphere), and 157 patients completed the 12 week assessment. The algorithm was refined by combining the SAFE score with age (<80, ≥80 years) to more accurately distinguish between patients with an Excellent or Good prognosis; and by revising the MRI asymmetry index threshold from 0.15 to 0.125 to more accurately distinguish between patients with a Limited or Poor prognosis. These revisions improved accuracy from 59% to 75%. With the revised algorithm, the proportion of patients who need TMS is reduced from over half to around one third. The revised algorithm is therefore more accurate and more efficient. Alternative versions of the PREP2 algorithm will also be presented, which can be used when TMS and/or MRI are unavailable. The potential clinical and economic benefits of implementing the PREP2 algorithm will be discussed.
Abstract TMP10: Impact on Mechanical Thrombectomy Time Efficiencies Following Hospital Bypass Protocol Implementation: Northwest Ohio Experience
Authors: Panjwani Sharjeel , Shawver Julie , Abdelaziz Rami , Tietjen Gretchen , Jumaa Mouhammad , Zaidi Syed
Published: June 2021

Background:
Early stroke identification and treatment with mechanical thrombectomy (MT) increases likelihood of favorable outcome. We compared our MT time efficiencies before and after Rapid Arterial oCclusion Evaluation Alert (RACE) bypass protocol (RA) implementation in Lucas County (LC) Ohio.

Methods:
Our RA protocol mandates emergent comprehensive stroke center transfer for patients with RACE score ≥ 5. We compared MT cases for RA patients (N=37) from Jul 2015-Jun 2016 with procedures performed on Stroke Alerts [(SA) N=56] from preceding 2 years. Transfers from outside LC, private transport and inhospital cases were excluded and only patients brought via LC-EMS were included in the analysis. Basic demographics, risk factors, 911 call to treatment, and outcomes were compared.

Results:
Treatment times including 911 call to IV tPA treatment, groin puncture, and recanalization were all significantly faster in the RA cohort (see graphic). Overall RA patients achieved recanalization and favorable outcomes at higher rate, although the latter was not statistically significant.

Conclusion:
Our experience indicates that RA protocol is highly effective in enhancing overall time efficiency for MT and may contribute to improved clinical outcomes. Further prospective studies are warranted.
Abstract TMP11: Endovascular Thrombectomy Has Benefits on Population-level Stroke-related Disability and Mortality Disproportionate to Its Numerical Frequency
Authors: Malhotra Konark , Saver Jeffrey L
Published: June 2021

Background:
Because endovascular thrombectomy (ET) is appropriate only for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO), it’s applicability is limited to a subset of ischemic stroke population. However, as patients with LVO-AIS typically present with severe deficits, larger infarct volumes, and worse final outcomes, ET’s contribution in reducing population-level stroke-related disability and death may be disproportionately higher.

Methods:
We conducted a systematic literature review to identify articles reporting, among consecutively encountered acute cerebral ischemia patients: 1) the frequency of LVO; 2) the proportion of disabled or fatal outcomes (mRS 3-6) due to patients with LVO (disability attributable fraction due to LVO); and 3) the proportion of fatal outcomes due to patients with LVO, (mortality attributable fraction due to LVO). We calculated pooled OR estimates and 95% CI using fixed-effects models.

Results:
Three studies met search criteria, enrolling 1487 acute cerebral ischemia patients with early vessel imaging. The proportion of all acute cerebral ischemia presentations due to LVO was 48.4% (95% CI 24.4-72.5). Disabled or worse outcomes were more frequent in LVO than non-LVO patients, 62.5% vs 26.8%, OR 4.5 (95% CI 3.6-5.7), p<0.0001. Consequently, the proportion of all disability or worse outcomes from ischemic stroke attributable to LVO patients was 55.2%. Fatal outcomes were also more frequent in LVO than non-LVO patients, 23.0% vs 6.8%, 4.1 (95% CI 2.5-6.6), p<0.0001. Consequently, the proportion of all fatal outcomes from ischemic stroke attributable to LVO patients was 73.1%. Using consensus projections that 24.8% of all AIS are due to LVOs treatable within 8h in a well-developed regional stroke system of care, patients treatable with thrombectomy account for 32.1% of disability or worse outcomes and 37.6% of fatal outcomes among all ischemic strokes.

Conclusion:
One-quarter of acute cerebral ischemia patients due to LVO are eligible for ET, but accounts for nearly one-third of ischemia-related disability, and more than one-third of ischemia-related death. Further dissemination of ET therapy may have substantial benefit on population health.
Abstract TMP112: Subsequent Hemorrhage in Children With Untreated Brain Arteriovenous Malformation: Higher Risk With Unbalanced Inflow and Outflow Angioarchitecture
Authors: Ma Li , Chen Yu , Zhao Yuanli
Published: June 2021

Instruction:
Children with brain arteriovenous malformations (bAVM) are at risk of life-threatening hemorrhage in their early lives. Our aim was to analyze various angiographic features of bAVM in conjunction with other morphological risk factors to predict the risk of subsequent hemorrhage during follow-up in children.

Methods:
We identified all consecutive children admitted to our institution for bAVMs between July 2009 and September 2015. Children with at least 1 month of treatment-free follow-up after diagnosis were included in further analysis. The effects of bAVM features on hemorrhagic presentation were studied. Annual rates of AVM rupture as well as several potential risk factors for subsequent hemorrhage were analyzed using Kaplan-Meier analyses and Cox proportional hazards regression models.

Results:
We identified 110 patients with a mean follow-up period of 2.1 years (range, 1 month-15.4 years). The average annual risk of hemorrhage from untreated AVMs was 4.3%. Risk factors predicting hemorrhagic presentation in multivariable analysis were no generalized venous ectasia, deep venous drainage, fast arteriovenous shunt, and deep location. No generalized venous ectasia in conjunction with fast arteriovenous shunt was predictive of subsequent hemorrhage (RR, 7.55; 95%CI, 1.96-29.06). The annual rupture risk was 11.1% in bAVMs without generalized venous ectasia but with fast arteriovenous shunt.

Conclusions:
bAVM angiographic features suggesting unbalanced inflow and outflow might be helpful to identify children at higher risk for hemorrhage. No generalized venous ectasia and fast artriovenous shunt might be associated with an increased risk for hemorrhagic presentation and subsequent hemorrhage in pediatric patients with untreated bAVM.
Abstract TMP2: Postoperative Luxury Perfusion on Arterial Spin Labeling MRI Indicates Reperfusion Injury and Hemorrhagic Complication After Endovascular Mechanical Thrombectomy
Authors: Sadakata Eisaku , Horie Nobutaka , Morofuji Yoichi , Tateishi Yohei , Izumo Tsuyoshi , Morikawa Minoru , Tsujino Akira , Matsuo Takayuki
Published: June 2021

Background and Purpose:
Endovascular thrombectomy is of benefit to most patients with acute ischemic stroke caused by major intracranial vessel occlusion. Reperfusion injury is, however, one of the critical complications after successful recanalization, which has not been fully evaluated. The aim of this prospective study was to assess the impact of hyper-intensity signal on postoperative arterial spin labeling (ASL) MR imaging on hemorrhagic complications and clinical outcome after endovascular treatment.

Methods:
Consecutive patients showing acute stroke with major intracranial vessel occlusion were prospectively analyzed. All the patients underwent endovascular thrombectomy, and MR imaging including ASL was performed at pre-, postoperative day 1 and day 7. Clinical and radiological outcomes were evaluated especially focusing on arterial spin labeling findings.

Results:
Of 81 patients, 21/81 (25.9%) showed hyper-intensity signal on ASL (ASL+) at postoperative day 1. There were no significant differences in baseline characteristics between the groups with and without ASL+, including preoperative NIH stroke scale, door to puncture time, occlusion vessel and TICI score. Interestingly, 15/21 (71.4%) patients developed minor bleeding or hemorrhagic changes in ASL+ group, which was detected only in 3/60 (5.0%) in ASL- group. Modified Rankin Scale was not different between the groups at postoperative day 90 under strict control of blood pressure. Multivariate regression analysis showed that ASL+ is significantly related to postoperative hemorrhagic complications (Adjusted OR: 21.68, P=0.004).

Conclusions:
Postoperative hyper-intensity signal on ASL MRI indicates vasoparalysis and luxury perfusion even successful recanalization after endovascular thrombectomy, which has a risk for hemorrhagic complications.
Abstract TMP21: Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke in Patients with Thrombocytopenia
Authors: Mowla Ashkan , Kamal Haris , Lail Navdeep , Magun Rick , Mehla Sandhya , Crumlish Annemarie , Deline Christopher , Ching Marilou , Sawyer Robert N
Published: June 2021

Objective:
To evaluate the rate of symptomatic intracranial hemorrhage (sICH) in patients who received Intravenous tPA(IVT) for acute ischemic stroke(AIS) and were later found to have platelets less than 100,000

/mm
3

.

Background:
With increasing use of IVT for AIS and more studies on its risk and benefits, many of the initial exclusion criteria which were part of the pivotal NINDS trial have been challenged with well-designed case series and reports. Based on the latest scientific statement from the AHA/ASA on the exclusion and inclusion criteria for IVT in AIS published in February 2016, the safety and efficacy of IVT in AIS is unknown for the patients with platelet count <100,000(Class III, Level of evidence C). The platelet threshold of 100,000 /mm
3
was derived from expert consensus in the NINDS trial and since many of the exclusion criteria have been challenged, this value also comes into question.

Methods:
We retrospectively reviewed the charts of all patients who received IVT for AIS from the beginning of 2006 till the end of August 2015 at our large volume comprehensive stroke center (SUNY Buffalo). Those with platelets <100,000/mm
3
were identified. Head CT done in 24 to 36 hours Post-thrombolysis was reviewed to evaluate the rate of sICH. sICH was defined as ICH with an increase in National Institute of Health Stroke Scale of at least 4 points.

Results:
A total of 835 patients received IV rtPA for AIS in our center during a 9·6-year period. Fifty one patients (6.1 %) were found to have sICH. A total of 5 patients (0.6 %) were identified to have platelet count <100,000

/mm
3

. One of them (20%) developed sICH post IV tPA administration .The mean platelet count of those 5 patients was 63,000 ± 19,000

/mm
3

(Range: 38,000 - 85,000

/mm
3
)

. To the best of our knowledge, only 21 thrombocytopenic patients have been reported to receive IV rtPA for AIS in the medical literature. Combining our 5 cases with 21 patients previously reported, we have 26 AIS patients who had platelet count <100,000

/mm
3

and received IV rtPA, with 2 of them developed sICH (7.7 %). Comparing the rate of sICH among this group with the patients with normal platelet count in our cohort, there was no statistically significant difference (7.7% versus 6.04%, p-value = 0.73).

Conclusion:
Although our extremely low number of cases precludes any solid conclusion, IV rtPA for AIS might be safe in patients with platelet count <100,000/

mm
3

and it is reasonable not to delay IV rtPA administration while waiting for the platelet count result, unless there is strong suspicion for abnormal platelet count.
Abstract TMP27: Role of HIV-related Immune Activation and Plaque Vulnerability: Results From the Brain Arterial Remodeling Study
Authors: Hunter Madeleine , Shenoy Adele , Elkind Mitchell , Goldman James , Morgello Susan , Marshall Randolph S , Gutierrez Jose
Published: June 2021

Introduction:
By virtue of their infection, HIV+ patients are subject to chronic inflammation, and show an increased risk for stroke when compared to uninfected controls. We hypothesized that HIV infection would be associated with increased atherosclerotic plaque vulnerability.

Methods:
Large brain arteries from 162 autopsied individuals (84 with HIV) were stained for metalloproteinase (MMP)-2, MMP-3, MMP-9, Caspase-3, and tumor necrosis factor (TNF)-α, factors reported to increase plaque vulnerability. We measured intensity of staining for each protein in the fibrous cap and scored each as 0 (most intense staining not in cap) or 1 (most intense staining in cap). We then added the ratings from the five stains and created a vulnerability score ranging from 0-5. CD3+ cells (lymphocytes) and CD68+ cells (macrophages) were also rated using semi-quantitative scores. Rating was blind to HIV status. We constructed multilevel models to obtain the β estimates and their 95% confidence intervals (β, 95%CI), adjusting for demographic characteristics, vascular risk factors, and HIV-related immune variables.

Results:
For the entire sample, the plaque vulnerability score was associated with higher degree of luminal stenosis (0.04, 0.02-0.06) and larger arterial size (0.5 per mm, 0.2-0.8), but not with HIV (-0.65, -2.24-0.95). However, in a subset of individuals with atherosclerosis (n=21), there was a statistical interaction (P<0.04) between HIV and vulnerability score. In a stratified model in HIV+ cases only, a CD4 count of > 200 cells/ul at death was associated with higher vulnerability score (1.42, 0.08-2.76) compared with subjects who remained immunosuppressed. Predictors of vulnerability score among HIV+ subjects included higher CD3 score (1.12, 0.15-2.09), older age (0.18 per year, 0.12-0.25), diabetes (3.00, 1.69-4.24), lower CD4 nadir (-0.01, -0.02to -0.007), antiretroviral use at death (-2.08, -3.84 to -0.32).

Conclusions:
Plaque vulnerability is positively associated with a higher blood CD4 count, lower CD4 nadir and higher lymphocytic inflammation in brain arteries among HIV+ cases. Investigating the role of HIV-related chronic inflammation and plaque vulnerability may help us better understand the higher risk of stroke among those with HIV.
Abstract TMP31: Hyperacute Extracranial Internal Carotid Artery Stenting vs Angioplasty: Which is the Best for Recanalization?
Authors: Rodriguez-Villatoro Noelia , Rodriguez-Luna David , Ribó Marc , Muchada Marian , Pagola Jorge , Boned Sandra , Juega Jesus M. , Coscojuela Pilar , Vert Carla , Rubiera Marta , Álvarez-Sabin José , Tomasello Alejandro , Molina Carlos A.
Published: June 2021

Background:
Up to 20% of acute intracranial occlusions have an associated extracranial internal carotid artery (ICA) severe stenosis or occlusion, and they often need specific treatment. However, it remains unclear which is the best option for extracranial revascularization. We aimed to study differences in restenosis, complications, and stroke recurrences between patients treated with stenting and those who underwent angioplasty without stenting.

Methods:
Prospective study of consecutive patients with non-cardioembolic ischemic stroke and occlusion or severe stenosis of the extracranial ICA, who underwent hyperacute endovascular procedure from April 2013 to December 2015. We divided patients depending on the extracranial treatment they received. We compared the rate of stenosis >50% or occlusion of the ICA at 24 hours (evaluated by carotid ultrasound or CTA). Besides, we analyzed differences in complications and stroke recurrences within 1 year of follow-up.

Results:
From 97 patients who underwent hyperacute revascularization of the extracranial ICA, 63 fulfilled the inclusion criteria: mean age 65.6±13.6 years, median time from symptoms onset to treatment 249 [161-330] minutes. Thirty-one (49.2%) were treated with angioplasty and 32 (50.8%) with stent. Both groups were comparable in demographic data, vascular risk factors, previous treatment (including antiplatelets), and ASPECTS score. Thirty-seven (58.7%) received intravenous rtPA and 58 (92.1%) intracranial thrombectomy. Patients who underwent angioplasty presented stenosis >50% or occlusion at 24h more frequently than those who underwent stenting (67.7% vs 21.9%
, p
=0.002), regardless the degree of residual stenosis after the angioplasty. Thirteen (38.1%) of the angioplasties were permeable at 24 hours, nevertheless 39.1% needed a deferred stenting. There were no differences in complications, including intracranial hemorrhage, despite intravenous rtPA or early double antiplatelet therapy, as well as in stroke recurrences within 1 year (
p
>0.05 for all comparisons).

Conclusions:
Hyperacute extracranial ICA stenting seems to have a lower risk of restenosis compared to angioplasty, without a significant increase of complications and stroke recurrences
Abstract TMP32: Ultrasonography Grading of Internal Carotid Artery Disease: Multi-Parametric DEGUM versus SRU Consensus Criteria
Authors: Winzer Simon M , Puetz Volker , Rickmann Henning , Kitzler Hagen H , Abramyuk Andrij , Krogias Christos , Strohm Henning , Rabahi Ali , Barlinn Jessica , Siepmann Timo , Graehlert Xina , Schwanebeck Uta , Arnold Sebastian , Mönnings Peter , Pallesen Lars-Peder , Bodechtel Ulf , Mudra Harald , Linn Jennifer , Reichmann Heinz , Gahn Georg , Weiss Norbert , Barlinn Kristian
Published: June 2021

Introduction:
The novel multi-parametric ‘DEGUM’ duplex ultrasonography (DUS) criteria may improve accuracy of extracranial carotid artery grading but have not been compared with the established Society of Radiologists in Ultrasound (SRU) consensus criteria yet. We sought to investigate the diagnostic agreement between these two widely used DUS approaches for grading of carotid artery steno-occlusive disease.

Methods:
This was a sub-analysis of the complete dataset from a prospective multicenter study, where a total of 120 patients underwent both DUS and catheter angiography for validation of the multi-parametric DEGUM ultrasound approach. In this analysis, two ultrasonography experts independently interpreted documented B-image, color-flow and Doppler spectra findings utilizing DEGUM and SRU criteria. Carotid arteries were categorized into clinically relevant NASCET strata: moderate (50-69%), severe (70-99%) and occlusion. On angiography, ICA was graded using the NASCET approach. Inter-rater and between-methods reliability was assessed through weighted Cohen’s kappa. Overall accuracy for both ultrasound approaches was computed using catheter angiography as the gold standard.

Results:
We analyzed a total of 162 carotid artery pairs on catheter angiography and DUS. There was almost perfect agreement between both ultrasonography diagnostic approaches in describing all clinically relevant grades of the disease (k

w

0.91, CI95%: 0.89-0.94). Inter-rater reliability was found to be comparably high for both the DEGUM (k

w

0.97, CI95%: 0.94-0.98) and the SRU (k

w

0.98, CI95%: 0.97-0.99) ultrasonography approaches. Compared with catheter angiography, overall accuracy for moderate and severe stenosis ranges did not differ between the DEGUM (73% and 73%, respectively) and the SRU (73% and 70%, respectively) approaches. There was also no difference for detection of carotid artery occlusion (96% and 96%, respectively).

Conclusions:
Our analysis showed almost perfect diagnostic agreement between the DEGUM and the SRU approaches for ultrasonography grading of carotid artery steno-occlusive disease. Therefore, our data do not support superiority of one approach over the other in the evaluation of clinically relevant grades of the disease.
Abstract TMP52: Psychiatric Hospitalization Increases Short-Term Risk of Stroke: A Case-Crossover Analysis
Authors: Zuflacht Jonah P , Shao Iris Y , Elkind Mitchell S , Kamel Hooman , Boehme Amelia K , Willey Joshua Z
Published: June 2021

Introduction:
Recent evidence suggests that psychological distress, including symptoms of psychiatric illness, may acutely increase the risk of stroke. However, current studies are limited by small sample sizes, inherent recall bias, and poorly defined criteria for what constitutes psychological distress.

Methods:
We used a case-crossover design, where each patient serves as his/her own control, to assess the relationship between the diagnosis of a psychiatric condition (defined by ICD-9 codes) and stroke (combined hemorrhagic and ischemic events) in adults over the age of 18. Data were utilized from the Healthcare Cost and Utilization Project (HCUP) for the state of California from 2007 - 2009. Cases in which both stroke and psychiatric diagnoses were present on arrival were excluded from the analysis. The relationship between psychiatric hospitalization and stroke was assessed through conditional logistic regression, with separate analyses conducted for 15, 30, 90, 180, and 365-days pre-stroke.

Results:
A total of 52,068 strokes were identified. Psychiatric conditions diagnosed within 1 year of stroke were found in 3,337 (6.4%) patients. Compared to patients without (n = 48,731), patients with a recent psychiatric hospitalization had a higher proportion of women (59.67% vs. 50.11%) and longer hospital course (8.9 days vs. 6.9). The presence of a psychiatric condition leading to hospitalization was associated with increased odds of stroke within all five pre-defined time periods (Table 1), with the highest odds of stroke occurring in those who most recently experienced a psychiatric visit (15 day OR = 3.48, 95% CI; 2.68-4.52).

Conclusions:
Psychiatric hospitalization increases the short-term risk of stroke, particularly within the 15-day period following the diagnosis. This risk decreases but persists for at least 1 year.
Abstract TMP53: Preeclampsia Leads to Long Term Cerebral White Matter Damage and Cortical Atrophy: a Magnetic Resonance Imaging Study
Authors: Siepmann Timo , Boardman Henry , Bilderbeck Amy , Griffanti Ludovica , Kenworthy Yvonne , Zwager Charlotte , McKean David , Francis Jane , Neubauer Stefan , Yu Grace Z , Lewandowski Adam , Sverrisdottir Yrsa B , Leeson Paul
Published: June 2021

Introduction:
Women with a history of preeclampsia have a two-fold higher risk of acute ischemic stroke even after controlling for classic cardiovascular risk factors. We determined whether specific patterns in cerebral damage are present after preeclampsia that may explain this risk.

Methods:
We performed brain magnetic resonance imaging in women between 5 and 15 years after either a preeclamptic or normotensive pregnancy. Analysis of white matter structure was undertaken using voxel-based segmentation of fluid attenuation inversion recovery sequences to assess white matter lesion volume and diffusion tensor imaging to measure microstructural integrity. Voxel-based analysis of grey matter volumes was performed in T1 weighted sequences with adjustment for skull size. Cardiovascular, obstetric profiles were assessed.

Results:
Thirty-four previously preeclamptic women (aged 42.8 ± 5.1 years, mean ± SD) and 49 controls were included. Previously preeclamptic women had reduced cortical grey matter volume (523.2 ± 30.1 vs 544.4 ± 44.7 ml, p<0.05) and, although both groups displayed frontal white matter damage, changes were more extensive in previously preeclamptic women. They displayed increased temporal lobe white matter disease (lesion volume: 23.2 ± 24.9 vs 10.9 ± 15.0 ml, p<0.05) and altered microstructural integrity (radial diffusivity 538 ± 19 vs. 526 ± 18*10
-6
mm
2
/sec, p<0.01), which also extended to occipital and parietal lobes. The degree of temporal lobe white matter change in previously preeclamptic women was independent of their current cardiovascular risk profile (p<0.05) and increased with time from index pregnancy (Figure).

Conclusions:
A history of preeclampsia is associated with temporal lobe white matter damage and cortical atrophy in young women, which is out of proportion to their classic cardiovascular risk profile and increases with time from pregnancy, consistent with ongoing susceptibility and cumulative brain damage.
Abstract TMP57: Cerebral Oxygen Metabolism as a Biomarker to Stratify Stroke Risk in Young Adults with Sickle Cell Disease
Authors: Ford Andria L , Guilliams Kristin P , Fields Melanie E , Ragan Dustin K , Eldeniz Cihat , Binkley Michael M , Blinder Morey , Chen Yasheng , Hulbert Monica L , An Hongyu
Published: June 2021

Background:
While imaging biomarkers guide stroke prevention strategies in children with sickle cell (SC) disease, none have been adequately studied in adults. High oxygen extraction (OEF) predicts stroke in non-SC adults with carotid occlusion, while low oxygen metabolism (CMRO
2
) predicts tissue at imminent risk in acute ischemic stroke. We hypothesized that metrics of cerebral metabolism: (1) differ between SC adults with and without stroke and (2) correlate with infarct burden.

Methods:
A prospective MRI study enrolled 37 adults (28 ± 8 yr) from SC clinic into 4 groups: (1) 9 age/race matched healthy controls, (2) 6 SC adults without infarcts, (3) 15 SC adults with infarcts (infarct volume 7.4 ± 17.5 ml), and (4) 7 SC adults on chronic transfusions (Tx) (infarct volume 3.6 ± 6.6 ml). Arterial spin labelling and asymmetric spin echo measured voxel-wise cerebral blood flow (CBF) and OEF. CMRO
2
= CBF x OEF x blood oxygen content. Infarcts were delineated on FLAIR. OEF, CBF, and CMRO
2
(excluding infarcted tissue) were compared: between groups 1-3 (Kruskal-Wallis) and in group 4 between pre- and post-tx scans (Signed Rank). An ROI defined by high OEF within the deep white matter (a region at high stroke risk in SC) was applied to group 3. OEF, CBF, and CMRO
2
within the ROI were correlated with hemispheric infarct volume (IV) (Spearman’s
ρ
).

Results:
Whole brain OEF showed a stepwise increase from controls, to SC adults without stroke, to SC adults with stroke (P<.001). SC adults on chronic Tx had intermediate OEF, with lowering of OEF post-Tx (Fig A). CBF and CMRO
2
were similar for SC adults with and without stroke (Fig B, C). High OEF and low CBF/CMRO
2
in the ROI correlated with hemispheric infarct burden: IV vs. OEF (
ρ
=.40, P=.043); IV vs. CBF (
ρ
=-.61, P=.002); and IV vs. CMRO
2
(
ρ
=-.50, P=.016).

Conclusion:
Global OEF holds promise to stratify stroke risk in SC disease. Regional metrics of cerebral oxygen metabolism may indicate tissue-specific metabolic stress at imminent risk of infarction.
Abstract TMP60: A Prospective Study of Serum Metabolites and Risk of Ischemic Stroke
Authors: Yu Bing , Gottesman Rebecca F , Mosley Thomas H , Boerwinkle Eric , Fornage Myriam
Published: June 2021

Ischemic stroke (IS) is a leading cause of death and disability worldwide. Identification of novel blood-based biomarkers that aid in the early identification of high-risk patients and in the classification and diagnosis of IS may facilitate patient management and improve the understanding of stroke etiologies. In 3,904 men and women from the Atherosclerosis Risk In Communities study, we investigated the association of 245 serum metabolites measured at the baseline examination via untargeted metabolomic profiling with incident IS. First IS events occurring between the baseline examination and December 31, 2012 were ascertained by annual telephone interview and hospital surveillance, followed case adjudication by a committee of experienced physicians. Cox proportional hazard models were used to estimate the hazard ratio (HR) for IS per standard deviation of the standardized serum level of each metabolites, adjusting for baseline age, sex, race and field center (model 1); and additionally for diabetes, hypertension, current smoking, body mass index, and estimated glomerular filtration rate (model 2). Over a median follow-up of 23 years, 306 incident IS were observed. After correcting for multiple testing, we identified 12 serum metabolites associated with IS in model 1 (P<0.0002). Two long-chain dicarboxylic acids, tetradecanedioate and hexadecanedioate, remained significantly associated with IS in model 2 (HR [95%CI] = 1.13 [1.08-1.18] and 1.15 [1.09-1.20], respectively). Serum levels of these two metabolites were strongly correlated (

r
2

=0.88). Analyses by IS subtypes suggested that this association is specific to cardioembolic stroke. In summary, we identified two long-chain dicarboxylic acids associated with cardioembolic stroke independently of known risk factors. These compounds are metabolic products of fatty acids produced by ω-oxidation, a normally minor catabolic pathway, which becomes more prominent when β-oxidation is defective. These results are consistent with recent metabolomics studies of carotid plaque tissue implicating β-oxidation dysfunction in plaque instability. Further studies are needed to confirm the relationships uncovered here and shed light on possible mechanisms for these associations.
Abstract TMP64: Single Stroke Symptoms Cannot Predict Large Vessel Occlusion in Patients With Acute Ischemic Stroke With a High Reliability
Authors: Schrock Jon , Markowski Ashley
Published: June 2021

Background:
Identification of acute ischemic stroke patients (AIS) with large vessel occlusion (LVO) in the pre-hospital setting is paramount now that endovascular treatment has become the standard of care. Correctly identifying this AIS population will allow transport to appropriate stroke centers with endovascular stroke capabilities.

Objectives:
We choose to evaluate single symptoms which, if present, might signify an ischemic stroke with a LVO. We tested if the following stroke symptoms including hemiplegia, severe dysarthria, neglect, eye deviation were associated with a LVO. Our hypothesis is that the use of these selected single or multiple NIHSS symptoms will not result in a ROC of > 0.9 rendering it effective in LVO diagnosis.

Methods:
A retrospective cohort review was conducted of 551 AIS patients who presented to the emergency department over a 77 month period. Subject demographics clinical symptoms, and other pertinent information were collected from the medical record. The following symptoms at ED presentation were evaluated with univariate and multivariate regression and ROC curve analysis; hemiplegia (of arm and leg), dysarthria (severe), neglect, and eye deviation.

Results:
Out of the 551 patients, 220 (40%) had a moderate stroke (NIHSS >9) while 143 (26%) had a severe stroke (NIHSS>14) and 49% were male. The median NIHSS was 7 (IQR 4-15) and 228 (41%) had LVO on CTA. The odds ratio and area under the ROC curve for hemiplegia, severe dysarthria, neglect, and eye deviation were respectively OR 3.2 (2.2- 4.5), 3.2 (2.2- 4.6), 5.5 (3.4- 8.9), 7.7 (4.6- 13.1) and area under the ROC 0.63, 0.64, 0.63, and 0.64 respectively. The results of multivariate analysis were slightly better with an ROC of 0.72.

Conclusions:
Singular stroke symptoms do not have the diagnostic power to predict which patient with AIS will have a LVO. While they have positive odds ratios, the ROC analysis suggests that individually or in combination, they are not accurate enough to determine the presence of LVO.
Abstract TMP66: Safety of Urgent Computed Tomographic Angiography in the Evaluation of Patients with Acute Stroke
Authors: Aziz Rami A , Panjwani Sharjeel , Jumaa Mouhammad A , Shawver Julie , Zaidi Syed F
Published: June 2021

Objective:
Computed Tomography Angiography ( CTA) is the standard of care test for ischemic stroke patients with suspected large vessel occlusion. When establishing emergency room stroke pathways, concerns for contrast induced nephropathy (CIN), which occurs in 11% of the general population could influence the time efficiency for CTA. Our aim is to report the incidence of CIN in our suspected severe stroke population.

Method:
With Institutional Review board approval, we maintained a prospective database on patients who were identified to have a high pre-hospital Rapid Arterial occlusion Evaluation ( RACE) between July 2015 and June of 2016. Per protocol, RACE alert patients go directly to the CT scanner to obtain a CT head and a CTA unless the test is cancelled by the stroke team. Labs are typically not available when CTA is performed. Our data included patient demographics, pre-morbid risk factors, baseline serum Creatinine level (Cr), peak Cr level during admission and at discharge. Incidence of renal consults and need for Hemodialysis was also monitored.

Results:
A total of 150 RACE alert patients were included in the analysis. Median age of patients was 73 and 12 patients had pre-morbid chronic renal failure. CTA was not performed in 21 of patients, due to low probabability of stroke determined by stroke team onsite.. Transient CIN occurred in 9(6%) of patients, renal consult was obtained in 4(3%) patients and 2(1) patients had a diagnosis of acute kidney injury on discharge.

Conclusion:
Emergent CTA resulted in a low number of transient CIN in our RACE alert patients. No cases of chronic renal Failure or need for HD were reported in our prospective cohort. A larger prospective registry may be needed to confirm the safety of this approach.
Abstract TMP68: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar
Authors: Prabhakaran Shyam , Sednew Renee M , O’Neill Kathleen
Published: June 2021

Background:
There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients.

Methods:
All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data.

Results:
In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2.

Conclusions:
Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.
Abstract TMP70: The Emergency Department Screen is Associated with Lower Rates of Pneumonia in Acute Hemorrhagic Stroke Patients
Authors: Schrock Jon , Ball Benjamin
Published: June 2021

Introduction:
Dysphagia is a common problem in acute hemorrhagic stroke (AHS) patients, predisposing them to pneumonia and leading to poor outcomes. The Joint Commission mandated that dysphagia screening be performed at hospital presentation, which for most patients with AHS is the Emergency Department (ED). No evidence exists to demonstrate if the use of an ED dysphagia screen is associated with lower rates of pneumonia.

Hypothesis:
We assessed the hypothesis that the use of our ED dysphagia screen would not be associated with lower rates of pneumonia in AHS patients.

Methods:
We performed a pre-post cohort study evaluating the rates of pneumonia in AHS patients presenting to our ED before and after instituting dysphagia screening in 2010. Our pre group were AHS patients presenting from 2005-2009 and our post group from 2011-2015. The presence of pneumonia was pre-defined as new pulmonary infiltrate treated with antibiotics. We collected demographic and clinical data including rates of dysphagia and stroke severity. Data are presented as frequencies and medians with interquartile ranges (IQR) where appropriate. Rates of pneumonia were compared using the t-test.

Results:
We evaluated 469 pre screen and 462 post screen AHS patients. Both groups were 53% male. The rates of parenchymal bleed in the pre and post groups were 78% and 82%, respectively, with the remainder comprising subarachnoid hemorrhages or combination bleeds. Mean ICH scores were similar, pre 2.0 (SD 1.5) post 1.7 (SD 1.4). Dysphagia was present in 65% of the pre group and 63% of the post group. Incidence of pneumonia in the post group (13%) was significantly lower than the pre group (19%, P<0.001).

Conclusion:
The use of an ED dysphagia screen is associated with a lower rate of pneumonia in AHS patients. This study was not designed to prove causation. Other factors not measured may have contributed to the reduction in rates of pneumonia. With the very high rates of dysphagia seen in this population, early dysphagia screening at ED presentation seems appropriate.
Abstract TMP71: Increasing Prevalence of Secondary Intracerebral Hemorrhage in Acute Ischemic Stroke
Authors: Otite Fadar O , Tipirneni Anita , Khandelwal Priyank , Malik Amer M , O’phelan Kristine
Published: June 2021

Background:
Temporal data on secondary intracerebral hemorrhage (SICH) risk in acute ischemic stroke (AIS) patients (pts) is sparse since implementation of current measures to lessen times to intravenous thrombolysis (tPA) and/or endovascular reperfusion.

Aims:
(1) Evaluate trends in SICH prevalence in AIS pts in the United States from 2004-2013 and to compare SICH risk following tPA and mechanical thrombectomy (MT) from 2011-2013 to risk in earlier periods. (2) Assess the magnitude of the current association of SICH with in-hospital morbidities and mortality in AIS.

Methods:
All adults with a primary diagnosis of AIS (n=4,355,140) were identified from the 2004-2013 Nationwide Inpatient Sample. We computed weighted risk of SICH in AIS according to age, sex and intervention received (tPA, MT or no-intervention). Multivariate models were used to compare SICH risks in the period 2004-2007 to periods 2008-2010 and 2011-2013, respectively, and to evaluate association of SICH with in-hospital morbidity, mortality, length-of-stay (LOS) and cost.

Results:
SICH risk increased over the study period but most of the increase occurred after 2010 (figure 1). From the period 2004-2007 to period 2011-2013, SICH risk increased by 75% in IV tPA pts (4.8%-8.4%), 164% in MT pts (8.1%-21.4%) and by 367.8% in no-intervention pts (0.5%-2.3%). Risks increased with age but only in tPA pts and did not vary by sex in both tPA and MT pts after multivariate adjustment. SICH was associated with >200% increased odds of ventilator use, pneumonia, sepsis, acute renal failure, deep venous thrombosis, pulmonary embolism and 67% reduced odds of home disposition compared to non-SICH. Mortality in SICH decreased from 26% to 18.3% compared to 6.1% to 4.0% in the non-SICH patients over the entire period. SICH was associated with >$8,000 increase in cost and >3-day increase in mean LOS.

Conclusion:
The burden of SICH in AIS is growing. Innovative strategies are needed to prevent SICH and/or alleviate its sequelae.
Abstract TMP75: Recanalization Therapy is Associated with Lower Odds of 30-Day Readmission: An Analysis of the Nationwide Readmission Database
Authors: Vahidy Farhaan , Donnelly John , McCoullough Louise , Miller Charles , Tyson Jon , Savitz Sean , Albright Karen
Published: June 2021

Introduction:
Readmission for acute ischemic stroke (AIS) is an important quality of care metric, and has been tied to reimbursement penalties. We aimed to describe nationwide readmission for AIS patients, and the potential impact of IV-tPA and Intra Arterial Treatment (IAT) on 30-day readmission.

Methods:
We analyzed the 2013 Nationwide Readmission Database, a nationally representative, weighted probability sample of ~ 36 million discharges from short-term hospitals. We used ICD-9 codes to identify patients with diagnosis of AIS (434.x1, 434.x1, 439), and patients receiving IV-tPA (99.1) or IAT (39.74). We excluded repeat, pediatric, and same-day events, and discharges in December. We defined readmissions as any admission within 30-days of index hospitalization discharge. Using published methods, we classified events as planned or unplanned, and identified readmissions attributable to potentially preventable ambulatory care-sensitive conditions. Logistic regression, using survey design variables, was performed to report nationally-weighted estimates of odds ratios (OR) and 95% CIs for factors associated with readmission.

Results:
A total of 319,317 index cases were identified with a primary diagnosis of AIS. Figure 1 illustrates the overall and therapy specific proportions for 30-day readmissions. Overall 12.1% (95% CI: 11.9 -12.3) of AIS patients were readmitted during 30-day post index hospitalization discharge. After adjustment, both IV-tPA and IAT were significantly associated with lower odds of 30-day readmission. For patients receiving either IV-tPA or undergoing IAT, the OR for 30-day readmission was 0.71 (CI: 0.66 - 0.77). Subgroup analyses for patients older than 65, and reasons for readmission will be presented.

Conclusion:
Recanalization therapy for AIS is associated with 23-34% lower odds of readmission. Analyses are limited by lack of survival data; however, thrombolysis has not shown to increase mortality in clinical trials.