bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T MP72: Mild Cerebral Ischemia Combined With Cerebral Amyloid Angiopathy Significantly Deteriorated Cognitive Impairment via Angiotensin At1 Receptor in a Mouse Model of Alzheimer’S Disease
Authors: Nakagawa Takashi , Hasegawa Yu , Ma Mingjie , Kusaka Hiroaki , Lin Bowen , Sueta Daisuke , Koibuchi Nobutaka , Kim-Mitsuyama Shokei
Published: March 2022

Introduction:
Ischemic stroke is suggested to be potentially associated with cognitive impairment in Alzheimer’s disease. Recent clinical data suggest that treatment with angiotensin receptor blocker (ARB) is associated with less incidence of Alzheimer’s disease than other classes of antihypertensive drugs. However, it is unknown whether cerebral ischemia can indeed trigger cognitive decline in Alzheimer’s disease and whether ARB can exert beneficial effect on ischemia-induced cognitive decline.

Hypothesis:
We hypothesized that mild cerebral ischemia deteriorates cognitive impairment in Alzheimer’s disease, through angiotensin II.

Methods:
We used 5XFAD mouse, a model of Alzheimer’s disease with vascular and cerebral amyloid-β(Aβ) deposition. Mild transient cerebral ischemia of mice was induced by bilateral common carotid artery occlusion (BCCAO) for 15 minutes. The post-treatment with olmesartan, an ARB, or vehicle was started at 24 hours after BCCAO, and was performed for 5 weeks. To evaluate cognitive impairment, we performed Morris Water maze test (reference-/working-memory), Passive avoidance test (learning memory), and Open field test (general locomotor activity and anxiety).

Results and Conclusions:
There were no significant differences in cognitive function between 5XFAD and wild type mice without BCCAO. BCCAO in 5XFAD caused greater escape latency (p<0.05) on Water maze test and greater migration distance (p<0.05) on Open field test than that in wild type mice, indicating that mild cerebral ischemia combined with Aβ deposition enhanced cognitive decline. Post-treatment with olmesartan significantly reduced escape latency (p<0.01) and number of crossing platform (p<0.01) on Water maze test, retention trial latency (p<0.05) on Passive avoidance test, and retention time of outer zone (p<0.01) on Open field test in 5XFAD subjected to BCCAO, indicating the improvement of working memory, learning memory and anxiety by olmesartan. Thus, the deterioration of cognitive impairment by BCCAO in 5XFAD was mediated by AT1 receptor. In conclusion, we first demonstrated that mild cerebral ischemia combined with cerebral amyloid angiopathy markedly deteriorates cognitive impairment, through AT1 receptor.
Abstract T MP76: A Systematic Review of Commercially Available Medical Mobile Applications for Stroke Survivors And Caregivers
Authors: Piran Pirouz , Thomas Jinu , Kunnakkat Saroj , Pandey Abhishek , Tanner Tristan G , Burton Dee , Balucani Clotilde , Jensen Amy , Levine Steven R ,   The Mobile Applications for Stroke (MAPPS) Investigators
Published: March 2022

Background:
Recent studies estimate 55% of Americans own a smartphone. There are over 29,000 medical applications (apps) available in the US iTunes® store. However, no systematic data are available on apps focused on stroke survivors/caregivers.

Objective:
To identify apps (a) designed for stroke survivors/caregivers, (b) dealing with a modifiable stroke risk factor (SRF), or (c) were developed for other purposes but could potentially be used by stroke survivors/caregivers.

Methods:
A systematic review of the medical apps in the US Apple iTunes store was conducted using 16 pre-defined inclusion/exclusion criteria. Apps intended for healthcare professionals were excluded. All eligible apps were entered into a database with features (e.g. description of app by developer, Apple/Android/both, cost, key words) and purpose of each. SRFs considered were: diabetes, hypertension, smoking, obesity, atrial fibrillation, and dyslipidemia.

Results:
Out of 29,262 medical apps available, 812 (2.8%) eligible apps were identified. Of these apps, 67/812 (8%) apps were specifically designed for stroke survivors/caregiver use. The majority of these apps addressed communication with aphasic patients (n=22, 32%), speech therapy (n=19, 28%), and calculating stroke risk (n=11, 16%). There were 471/812 (58%) apps that addressed SRFs. Among the remaining apps, 130 (16%) could be used in rehabilitation; 93 (12%) had the potential to facilitate communication with stroke survivors; 29 (4%) could improve the quality of care in survivors; 32 (4%) had the ability to direct a patient to an emergency room based on their location, and 13 (2%) could assist with spotting an acute stroke. Less than 1% specifically assist the caregiver to better face challenges of stroke patients.

Conclusions:
Over 60 medical apps exist to specifically support stroke survivors/caregivers. The majority of apps relate to stroke primarily targeting SRFs, language, and motor deficits and relatively few specifically support caregivers. Apps encompassing most stroke survivor/caregiver needs could be developed and tested to ensure the issues faced by these populations are being adequately addressed.
Abstract T MP78: Use, Safety, and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Nonagenarians
Authors: Arora Rohan , Salamon Elliott , Katz Jeffery M , Libman Richard B ,   and Get With The Guidelines (Stroke) Investigators
Published: March 2022

Background:
Even though IV tPA is the most proven treatment for AIS, it has not been studied extensively in the oldest old population. We used data from Get With The Guidelines(GWTG) to determine the frequency of use, outcomes, and safety of IV tPA in AIS patients who are 90 and older.

Methods:
The population consisted of 39,759 patients from 1178 sites who were eligible for IV tPA. who received IV tPA within 3 hours of symptom onset from January 2009 April 2013. Of these, 3,407 patients were 90 years and older. The patients who had contraindications to IV tPA were excluded and advanced age alone was not considered a sufficient contraindication for this study. The primary outcomes of interest were: in hospital mortality, discharge disposition, independent ambulation at discharge, sICH and complications related to IV tPA.The differences in baseline these characteristics were compared using chi-square tests for categorical row variables and Wilcoxon Rank-Sum tests for continuous row variables.Factors associated with tPA use in older patients were assessed using logistic regression with generalized estimating equations to account for within hospital correlations. Outcomes among patients receiving IV-tPA were also compared between old patients (90+) and the three younger age groups.

Results:
With 90 and above as the reference group, the odds ratio for mortality adjusted to patient characteristics was 0.90 (CI- 0.78, 1.04) in the age group of 80-89. However, the adjusted OR for age group of 65-79 was 0.68 (CI 0.5, 0.79) and for 18-64 was 0.48 (0.40, 0.58)As compared to 90 and above, the patients in age group of 80-89 had 2.25 times the odds to be discharged to home or rehab and this trend was more pronounced in the lower age groups (5.5 times for age 65-79 and 14.7 times for age 18-64). The rates of sICH were 6.8 % in age group 80-89 and 6.1 % amongst the 90 and older, which, however, was significantly lower in age groups less than 65 (2.9%) and 65-79 (5.1%).

Conclusion:
Advanced Age increases the likelihood of sICH but the rates of sICH were are still comparable to younger cohorts. The knowledge of high risk of mortality in this population may help real time bedside decision making while treating patients 90 and above.
Abstract T MP85: Comparison Of Carotid Endarterectomy And Carotid Artery Stenting On Asymptomatic Internal Carotid Artery Stenosis Of Japanese Male: A Propensity Score Matched Analysis
Authors: Nishimura Kunihiro , Nishimura Ataru , Kurogi Ryota , Kamitani Satoru , Kada Akiko , Sayama Tetsuro , Iihara Koji
Published: March 2022

Objective:
The nation-wide mortality and morbidity of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on asymptomatic internal carotid artery stenosis in Japanese have not been clear. We thus examined the comparison of CEA and CAS from a nationwide survey in Japan.

Methods:
Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to asymptomatic internal carotid artery stenosis (ICS) for male patients were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I65). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, and postoperative complications who underwent CEA and CAS based on propensity score matching. A propensity-matched cohort was constructed with CEA group and CAS group matched on a 1:1 basis by a nearest neighbor matching method within a caliper 0.05 SD of the propensity score for age, Charlson score, BMI and admission conscious level.

Result:
We identified 2216 patients with asymptomatic ICS (1381 CAS and 835 CAS cases). After propensity matching, Patient characteristics (age, hypertension, DM , hyperlipidemia, smoking and Charlson score) were well balanced between two groups. Patients who underwent CAS had a significantly lower number of complications than patients who underwent CEA (delta= -9.74; P < 0.001).Length of hospital stay was significantly shorter for CAS group. (delta= -9.90; P < 0.001). 30 day mortality and mRS at discharge were not significantly different between two groups.

Conclusions:
Our results estimate the baseline national rates of outcomes in patients with asymptomatic ICS that were treated with CAS or CEA in Japan. CAS treated group showed lower complication rates compared to CEA treated group.
Abstract T MP87: Information Framing And Decision-making After Malignant Middle Cerebral Artery Stroke
Authors: Sulakvelidze Nika , Kelly Adam G , Ton Thanh G , Becker Kyra J , Creutzfeldt Claire J
Published: March 2022

Background and Objective:
In patients with malignant infarction of the middle cerebral artery (MCA), decompressive hemicraniectomy (DHC) reduces mortality and improves outcome but leaves many survivors severely disabled. In deciding whether to undergo this surgery, patients and surrogates look to providers for relevant prognostic information to help make treatment decisions based on their personal values. The goal of this study is to explore whether the way treatment information is framed influences decision-making regarding DHC.

Methods:
Ambulatory patients and their family members in hospital outpatient waiting rooms were recruited for this voluntary survey. Subjects were randomized to 1 of 5 different videos of a physician discussing treatment options for their loved one with a hypothetical acute malignant MCA ischemic stroke, each video with a different presentation format (positive or negative framing, reporting results in absolute or relative proportions, graphical display). Subjects were then asked to indicate their treatment decisions and to provide basic demographic data.

Results:
Fifty-three subjects were enrolled in the study, the majority of whom were insured (47; 88.7%), white (40; 78.4%) and independent (33; 64.7%). Half were 51 years or older (27; 50.9%) and had an income less than $50,000 annually (50.9%). Randomization arms did not differ according to age (p=0.5), functional status (p=0.3), income (p=0.9), insurance type (p=0.4) or race (p=0.8). Marital status differed slightly between arms (p=0.06). Controlling for marital status, subjects were most likely to choose surgery for their loved one (OR 6.9, 95% CI: 0.6, 77.8) after viewing video B (positive framing, relative risk reduction) and least likely (OR 0.8, 95% CI: 0.1-5.5) after viewing video C (negative framing, relative risk reduction) compared to those in the graphical group.

Conclusions:
Information framing may influence surrogate decision-making for DHC after malignant MCA ischemic stroke. Clinicians should consider this influence when counseling patients; formal decision aids or other methods to present results in a more standardized fashion may help mitigate these effects.
Abstract T MP88: Computerized In-hospital Alert System Reduces Time Delay to Reperfusion Therapy for In-hospital Stroke Patients
Authors: Yoo Joonsang , Song Dongbeom , Lee Kijeong , Kim Young Dae , Yang Jae Hoon , Jung Yo-han , Cho Han-Jin , Nam Hyo Suk , Heo Ji Hoe
Published: March 2022

Introduction:
Stroke may occur while patients are being admitted (in-hospital stroke [IHS]). Although patients with IHS are potentially good candidates for fast reperfusion therapy, many patients are often not treated rapidly as are expected.

Hypothesis:
A code stroke program using computerized physician order entry (CPOE) will be effective in reducing time delay to reperfusion therapy in patients with IHS.

Methods:
We developed a code stroke program for IHS, based on CPOE. The program included protocols for stroke recognition, activation and notification, imaging, preparation of tissue-type plasminogen activator (tPA), and regular education of medical staffs. We implemented this program for cardiology and cardiovascular surgery wards because in our previous study, about one-half of all IHS occurred in them. We compared time intervals from symptom onset to evaluations and reperfusion treatment before and after the program implementation in patients with IHS that developed inside or outside the program.

Results:
The program launched at November 2008. All consecutive patients who received reperfusion therapy due to IHS that developed outside the neurology department from July 2002 to June 2014 were included for this study. Among total 59 IHS patients enrolled, 20 patients were treated before and 39 patients after implementation of the program (24 patients inside the program [cardiology/cardiovascular surgery wards], 15 patients outside the program). In cases treated inside the program, time intervals from symptom onset to brain image (98.5 min vs 37 min; P<0.001), symptom recognition to neurology notification (29.5 min vs 15 min; P=0.008), and symptom onset to IV tPA (130 min vs 65 min; P<0.001) or to arterial puncture (270 min vs 165 min; P<0.001) were reduced significantly after the program implementation. However, in cases treated outside the program. time intervals from symptom onset to evaluation, notification, and IV tPA, except symptom onset to arterial puncture (270 vs 207.5 min, P=0.025), were not reduced.

Conclusions:
The computerized in-hospital alert system, which was developed for IHS, was effective to reduce time delay to evaluation and reperfusion treatment. More widespread implementation of the program for patients with IHS is warranted.
Abstract T MP96: Factors Associated with Neurological Worsening in Hospitalized Patients with Cerebral Venous Thrombosis
Authors: Chiquete Erwin , Cantú-Brito Carlos , Barboza Miguel , Quiroz Alejandro , Jonathan Colín , Merlos Marlon , Arauz Antonio
Published: March 2022

Background and purpose:
A significant proportion of patients with cerebral venous thrombosis (CVT) present neurological deterioration within the following days after arriving to hospital without significant altered consciousness. This has been a poorly studied issue. We aimed to determine factors associated with neurological worsening in hospitalized patients with CVT.

Methods:
We analyzed a collaborative database on patients with autopsy or neuroimaging confirmed CVT who were hospitalized from 1980 to 2014 in two third-level referral hospitals. For the present analysis we excluded cases arriving to hospital with profound altered consciousness. Neurological worsening was defined as the progression to stupor or coma in patients initially presenting alert or with somnolence. Bivariate analyses were performed to identify variables associated with neurological worsening. A multivariate analysis by logistic regression was performed to determine independent variables associated with this study outcome.

Results:
A total of 426 patients were here analyzed (94% aseptic CVT, 81.2% women, median age: 29 years, interquartile range: 22-38 years), of whom 51 (12%) presented neurological worsening at least 24 h after hospital arrival (median time to deterioration: 8 days, interquartile range: 5-13 days). Among patients with neurological worsening, 28 (54.9%) deteriorated after the first week upon arrival, 21 (41.2%) died during their hospital stay, and 36 (70.6%) attained a modified Rankin scale >3 at hospital discharge. Independent predictors of neurological worsening were age >40 years (OR: 5.79, 95% CI: 2.53-13.24), parenchymal lesion >6 cm in its greater diameter (OR: 11.27, 95% CI: 5.00-25.41) and bilateral pyramidal syndrome at arrival (OR: 15.40, 95% CI: 6.90-34.40). Etiological factors, anticoagulant vs antiplatelet therapy, seizures, presence of extracranial venous thrombosis or CVT topography were not independent predictors for neurological worsening after adjustment.

Conclusion:
Worsening in CVT patients arriving stable is not uncommon. More than half of cases of neurological deterioration occur after the first week of hospitalization, nonetheless, its determinants can be easily anticipated upon hospital arrival.
Abstract T MP98: Stroke Coordinator Boot Camp: Training the Troops
Authors: Block Starr , Censullo Eileen , Dentel Steve , Jackson Tawny , Loechler Abigail
Published: March 2022

Background and Issues:
The role of a Stroke Coordinator is multifaceted; demanding expertise in a number of areas including clinical competence, administrative aptitude, collaboration, team management, enhanced education skills, quality improvement, and data analysis proficiency. Few nurses possess all of these skills, and without them, are often frustrated and at risk to fail. Finding appropriate educational opportunities for professional development in this unique role is quite challenging.

Purpose:
To validate that new, as well as seasoned, stroke coordinators benefit from an intensive boot camp style conference geared to their diverse role. Conference content was designed to enhance programmatic skills, role development, provide best practices for improving their stroke organization, and promote networking with fellow professionals.

Methods:
Established a volunteer committee of national experts from the five state region with expertise in stroke program management and implementation:

•

Developed a pre-event survey to assess educational needs

•

Conducted an educational gap analysis

•

Conceptualized:
& designed a comprehensive educational experience

•

Conducted a one-day intensive boot camp-style program at 3 different locations with following presentations: o

ISC

2014 Hot Topics o

Traditional and emerging role of the stroke coordinator o

Quality:
improvement/data analysis o

Validating the stroke coordinator role o

CMS, Affordable

Care Act, Meaningful Use

Results:
Boot camp attendees were asked to complete a ten question post-event survey with six possible responses: No change, Strongly Disagree, Disagree, Agree, Strongly Agree, and N/A. Of the 325 attendees an impressive 74% response rate (240) was achieved. Our success was measured by those with a score of Agree or Strongly Agree. Overall for the 10 topics, we had a success rate of 95.56%. Attendees requested that this be repeated annually.

Conclusions:
The role of the stroke coordinator continues to evolve. It is imperative that those individuals not only have the clinical skills to perform those roles but also the key components described above in order to effectively lead quality stroke programs. This educational format was successful and can be replicated in other parts of the country.
Abstract T MP99: Your Role as Stroke Coordinator, from Surviving to Thriving
Authors: Graves Alexandra , Blakie Julie , Casper Christy , Chapman Stephanie , DeLuna Larissa , Lorenz Heather , Mazabob Janine , Motz Deb , Ochoa Sonya , Whaley Michelle , Zimmermann Mary Beth
Published: March 2022

Background:
Stroke coordinators are essential to stroke programs. An international survey demonstrates lack of formal guidance and role expectations. The ASA Southwest Affiliate observed high turnover of stroke coordinators and lack of general knowledge of their role. Additionally, there were few local experts available to individually mentor new coordinators. ASA staff teamed with experienced stroke coordinators to host the first conference of this kind in the region.

Purpose:
The purpose of this conference was to impact practice and longevity by offering content focused on successful stroke program development and key stroke coordinator responsibilities.

Methods:
ASA staff recruited successful stroke coordinators from the SW Affiliate to plan a 2 day conference with a keynote, 2 hours of breakout sessions and 8.5 hours of CE. Topics included: stroke coordinator role, certification preparation, team leadership, resources, and PI. Sponsors and vendors participated, and registrants paid $150. To encourage attendance, the committee chose an upscale Denver hotel with reasonable room prices, identified the theme of Survivor and the tagline “From Surviving to Thriving”. Mirroring the TV show, team challenges reinforced important concepts and encouraged networking.

Results:
45% of attendees came from GWTG Stroke hospitals in the SWA. Sixty-nine online evaluations indicated 77% were in the role less than 2 years. Only 5% reported a structured orientation plan and 39% answered “no, I made it up as I went along.” At the conclusion of the conference, 90% stated they could define key responsibilities of the stroke coordinator and 90% indicated they could articulate the important role evidenced-based guidelines play in the care of the stroke patient.

Conclusion:
Stroke programs success depend greatly on the competency and ability of the stroke coordinator. The ASA’s support of programs that spotlight the stroke coordinator’s responsibilities offer a unique venue to gather colleagues and discuss the evolution of the position as it pertains to the stroke continuum of care. The SW Affiliate will host the 2
nd
event in May 2015 in Houston. A long term goal of this SW Affiliate group is to offer this conference annually.
Abstract T P101: Incidence of Dissection and Vasospasm Related to Distal Embolic Protection Devices During Elective Carotid Artery Stenting: 5 Year Retrospective Review
Authors: Satti Sudhakar R , Traylor Katie , Anzilotti Kert
Published: March 2022

Hypothesis:
•We assessed the hypothesis that the Abbott Vascular Nav6 DEP, was associated with the lowest risk of dissection and vasospasm.

•Identify the overall incidence of vasospasm and dissection associated with distal embolic protection device during elective carotid artery stenting

BACKGROUND:
•Carotid angioplasty and stenting has been show to have an increased risk of embolic stroke compared to carotid endarterectomy. To minimize this risk, distal embolic protection devices are considered the standard of care for all carotid stenting procedures.

• At Christiana Care Health System over 225 carotid stents have been placed in the last 5 years.

• No prior study has compared distal embolic protection devices to determine which were associated with lower complication rates.

Methods:
•Electronic query of all carotid stenting procedures was performed between 1/2/2009 and 12/30/13; total of 244 patients included

Results:
• Distal embolic protection devices were associated with angiographic vasospasm in 31% and dissection in less than 1% of patients.

The Nav 6 device was found to associated with the lowest incidence of vasospasm and no dissections.

Discussion:
• Research that improves equipment or techniques during carotid artery stenting should be aggressively pursued to further improve clinical outcomes and reduce the risk of procedural complications.

Conclusion:
On the basis of this single center retrospective five year analysis, the Abbott Vascular Nav 6 distal embolic device was associated with the lowest incidences of vasospasm.

Clinical Implications:
• More research and study of complications associated with distal embolic protection devices is warranted. This may lead to a lower complication rate in elective carotid artery stenting
Abstract T P140: Predictors of Optimal Post-Stroke Hypertension Control
Authors: Sico Jason J , Myers Laura J , Concato John , Williams Linda S , Bravata Dawn M
Published: March 2022

Introduction:
Significant patient- and facility-level predictors of optimal post-stroke hypertension (HTN) control have not been identified; their identification may inform future intervention studies.

Methods:
This was a secondary analysis of a retrospective cohort study that included 3965 Veterans who were admitted with ischemic stroke at 131 Veterans Health Administration (VHA) facilities (fiscal year 2007). Blood pressure (BP) values at 6-month post-stroke were used to define optimal (<140/90 mmHg) and suboptimal (≥140/90 mmHg) control among patients with a history of HTN. Among facilities that admitted at least 25 stroke patients annually, we used multivariate logistic regression with backward elimination to identify patient- (e.g., stroke severity) and facility-level (e.g., hospital level complexity) characteristics that independently predicted optimal BP control 6-months post-stroke while adjusting for age, race, marital status, and post-stroke follow-up care.

Results:
A total of 2541 (64.1%) patients had a history of HTN, with 33.4% of patients achieving goal BP at 6-months. A past medical history of congestive heart failure (CHF; adjusted OR [aOR]: 2.5, 95% CI: 1.02 to 6.26; p=0.046) and being discharged on a lipid lowering agent (aOR: 2.5, 95% CI: 1.26 to 5.03) were associated with optimal BP control 6-months post-stroke. Admission stroke severity (aOR: 0.998, 95% CI: 0.996-1.110), Charlson comorbidity score (aOR: 0.875, 95% CI: 0.59-1.30), past history of ischemic stroke (aOR: 1.41, 95% CI: 0.74-2.67), and medical record documentation of a post-discharge plan for HTN management (aOR: 1.00, 95% CI: 0.99-1.02; p=0.47) were not predictive of optimal BP control. Facility-level characteristics, including hospital level complexity (aOR: 0.998, 95% CI: 0.992-1.005; p=0.16) and the number of stroke patients seen annually at a facility (aOR 0.997, 95% CI: 0.993-1.001; p=0.17) were also not associated with optimal post-stroke BP control.

Conclusions:
Future work should seek to understand why current approaches to improving post-stroke BP control are inadequate for a majority of patients and whether lessons might be learned from the care of patients with stroke and CHF that could be applied to the general post-stroke population.
Abstract T P142: Association between Left Atrial Abnormality on ECG and Vascular Brain Injury on MRI in the Cardiovascular Health Study
Authors: Kamel Hooman , Bartz Traci , Longstreth W.T. , Okin Peter , Thacker Evan , Patton Kristen , Stein Phyllis , Gottesman Rebecca , Heckbert Susan , Kronmal Richard , Elkind Mitchell , Soliman Elsayed
Published: March 2022

Background:
Atrial fibrillation (AF) has long been recognized as a risk factor for vascular brain injury. Emerging evidence suggests that atrial disease is associated with vascular brain injury even in the absence of AF.

Methods:
The Cardiovascular Health Study prospectively enrolled community-dwelling adults ≥65 years of age. Among participants who underwent MRI, we examined associations of left atrial abnormality on a 12-lead electrocardiogram (ECG) with MRI-defined brain infarcts and leukoaraiosis. P-wave terminal force--the product of the duration and depth of the terminal component of the P-wave--in lead V1 (PTFV1) is the most consistently used ECG measure of left atrial abnormality and was our primary predictor; P-wave area and duration were secondary predictors. We excluded participants with AF on their index ECG or a diagnosis of AF prior to the index ECG. Primary outcomes were incident infarcts and worsening leukoaraiosis from initial to follow-up scan approximately 5 years later. Secondary outcomes were prevalent infarcts and degree of leukoaraiosis on initial MRI. Non-lacunar infarcts were separately examined in a secondary analysis. We performed relative risk and linear regression analyses adjusting for vascular risk factors.

Results:
Among 3,129 participants with at least one scan, each 1-SD increase in PTFV1 (2160 μV*ms) was associated with a 0.05-point (95% CI, 0.0003-0.10) higher baseline white matter grade on a 10-point scale. PTFV1 was also associated with prevalent infarcts of any type (RR per SD, 1.09; 95% CI, 1.04-1.16), and in particular with prevalent non-lacunar infarcts (RR per SD, 1.22; 95% CI, 1.08-1.38). Among 1,839 participants with two scans, PTFV1 was associated with worsening leukoaraiosis (RR per SD, 1.09; 95% CI, 1.01-1.18), but not incident infarcts (RR per SD, 1.06; 95% CI, 0.93-1.20). Similar results were seen in sensitivity analyses accounting for incident AF diagnosed after the ECG and before the MRI under analysis. P-wave area and duration were not associated with our outcomes.

Conclusions:
ECG left atrial abnormality is associated with vascular brain injury even in the absence of AF.
Abstract T P147: Estimating the Effect of Antidepressant Use on Stroke Risk in the Presence of Competing Risks: A Simulation Study
Authors: Mayeda Elizabeth R , Glymour Maria
Published: March 2022

Introduction:
Research on determinants of stroke must account for competing risks (events, such as death, that preclude subsequent stroke). Fine and Gray competing risk regression models are increasingly used in place of traditional Cox proportional hazards models to account for competing risks, but may not always provide clinically relevant estimates.

Hypothesis:
Even when antidepressant use has no effect on stroke risk, both Fine and Gray and Cox models can yield spurious associations if antidepressants affect mortality.

Methods:
We simulated data (50 simulations) on 3000 individuals followed for up to ten years with biennial assessments of stroke status. We considered two scenarios. In both scenarios, we set antidepressant use to have no effect on stroke risk. In Scenario 1, we set antidepressant use to increase mortality (HR (hazard ratio)=2.00). In Scenario 2, we set antidepressant use to decrease mortality (HR=0.50).

Results:
In Scenario 1, the average stroke incidence rate was 16.5/1,000 person years and the average mortality rate was 33.9/1,000 person years. Even though antidepressants had no effect on stroke in the simulations, both Fine and Gray (average HR=0.69) and Cox (average HR=0.83) models estimated protective effects of antidepressants on stroke. Fine and Gray models incorrectly rejected the null hypothesis in 22% of simulations and Cox models incorrectly rejected the null hypothesis in 10% of simulations. In Scenario 2, the average incidence rate was 16.9/1,000 person years and the average mortality rate was 31.3/1,000 person years. Even though antidepressants had no effect on stroke in the simulations, both Fine and Gray (average HR=1.22) and Cox (average HR=1.09) models estimated protective effects of antidepressants on stroke. Fine and Gray models incorrectly rejected the null hypothesis in 20% of simulations and Cox models incorrectly rejected the null hypothesis in 8% of simulations.

Conclusions:
For exposures that affect mortality, both Cox models and Fine and Gray corrections can yield misleading results regarding effects on stroke risk. This is important for interpreting findings on controversial topics, such as the effect of antidepressants on stroke.
Abstract T P148: Level of Education is Inversely Proportional to ABCD2 Score in Patients with TIA
Authors: Litao Miguel , Sanger Matthew , Ishida Koto , Roberts Eric , Lord Aaron , Boden-Albala Bernadette
Published: March 2022

Background:
Racial and socioeconomic disparities in stroke care have been reported including decreased recognition of stroke symptoms, delay to presentation, severity of stroke at presentation, and inpatient management of stroke in minority and disadvantaged populations. However, similar racial disparities in patients presenting with transient ischemic attacks (TIAs) has not been investigated. Since TIA represents a critical opportunity for prevention of major disability in these high risk groups, we sought to determine if there were racial or socioeconomic differences in ABCD2 scores on presentation with TIA.

Methods:
ABCD2 scores for patients presenting to the emergency department with suspected TIA (symptom duration <24 hours) were retrospectively calculated from the Stroke Warning Information and Faster Treatment Study (SWIFT). Ethnic and racial information were redacted during calculation. Independent t-test and One-way ANOVA were used for comparison.

Results:
ABCD2 scores were calculated for 129 TIA patients. Among these, 31 patients identified as white, 19 as black, 71 as Hispanic, 8 as other race. Mean age was 67 years and 57% were female. 63% of patients had a prior history of hypertension. Mean total ABCD2 score varied among the different racial groups as follows: 4 for white, 4.05 for black, 4.4 for Hispanic, and 3.4 for other (p= 0.25). There was a trend towards higher ABCD2 scores at presentation among Hispanics (4.4) as compared with non-Hispanics (4.03) although this did not reach statistical significance (p=0.08). There were no sex differences in ABCD2 score, with mean scores of 4.3 for females and 4.08 for males (p=0.41). Education status was inversely proportional to ABCD2 score at presentation with mean score of 4.64 for those not completing high school, 4.11 for those completing high school, and 3.82 for those with education beyond high school (p=0.03).

Conclusion:
Although there was a trend toward higher ABCD2 scores at presentation in the Hispanic population, this difference was not significant. Level of education was inversely proportional to ABCD2 score at presentation suggesting that education may have a greater impact on TIA presentation than race or ethnic background alone.
Abstract T P154: Association Between Intracranial Artery Calcification and Body Mass in Patients with Ischemic Stroke
Authors: Park Moo-seok , Shin Dong Woo , Kim Jeong-Min , Park Kwang-Yeol
Published: March 2022

Introduction:
Arterial calcification is known to be related with atherosclerosis burden and future vascular event. Obesity has been suggested as a risk factor of coronary artery calcification. In this study we investigated association between intracranial arterial calcification and body mass among stroke population.

Subject and Method:
Between January 2008 and December 2013 acute cerebral infarction patients who were hospitalized in Chung-Ang University Hospital were eligible to be included. The patients with brain computed tomographic angiography were included, and intracranial arterial calcification was examined from cavernous portion of internal carotid artery. Underweight, normal, overweight and obesity groups were divided according to body mass index (BMI). Univariable and multivariable analysis was conducted to examine association between body mass and intracranial arterial calcification.

Results:
A total of 1231 patients was included (mean age, 67.4 years old; percentage of male gender, 57.8%; mean BMI, 23.7kg/m2), with 4.9% of underweight, 37.6% normal weight, 26.3% overweight and 31.2% obese patients. Advanced arterial calcification, defined as calcification involving at least 1 cm length or more of both intracranial internal carotid arteries was found in 281 patients (22.8%). The association between obesity and advanced arterial calcification was not significant [odds ratio (OR) 0.76, 95% confidence interval (CI) 0.56-1.02, p=0.064]. However, the underweight group had significantly more advanced arterial calcification compared to normal group (OR 2.95, 95% CI 1.74 - 5.01, p<0.001). Multinomial logistic regression analysis including age, hypertension, ischemic heart disease and BMI proved that underweight is an independent risk factor of advanced arterial calcification (OR 1.94, 95% CI 1.03-3.63, p=0.021).

Conclusion:
This study presents the association of weight and calcification of intracranial vessels in stroke population, and underweight defined as BMI less than 18.5kg/ m2 is related to advanced arterial calcification. Future studies are warranted to evaluate pathophysiological mechanism of intracranial arterial calcification and lean body mass.
Abstract T P157: The Effect of Paroxysmal Atrial Fibrillation on Stroke Outcomes Among Ischemic Stroke/TIA Patients: An Eight Year Cohort Study
Authors: Jain Ash , Van Houten Douglas , Sheikh Lamiya
Published: March 2022

Background:
Paroxysmal atrial fibrillation (PAF) is more prevalent than chronic AF in the general population. It may also be more prevalent in ischemic/TIA patients. It is difficult to diagnose PAF prior to event and most studies focus on chronic AF (CAF). In this study we evaluate the effect of PAF on stroke outcomes and highlight the need to focus on this treatable condition to ensure appropriate care.

Methods:
• The study population included ischemic/TIA cases with AF status known from July, 2006-July, 2014 (n=2951). AF status (n=573) was classified as paroxysmal (31.4%) or chronic (68.6%). o PAF was diagnosed with telemetry during hospitalization.

• Outcomes included discharge disposition (alive/expired) and neurological impairment at discharge, quantified using the National Institutes of Health Stroke Scale (NIHSS). CHADS2 score was evaluated as a continuous variable.

• Patient demographics and co-morbidities including diabetes, hypertension, smoking and dyslipidemia were considered as confounders in logistic regression.

• Analysis was done using R-based statistical tools. Bi-variate analysis included t-tests for continuous variables and chi-square tests for categorical variables. Multivariable analysis was done using logistic regression. Results were determined to be statistically significant within a 95% confidence interval.

Results:
• PAF patients were more likely to be female (61.3%) than CAF (56.7%), although not significantly more likely, p=0.38. PAF patients were mean age of 76 (± 12.4) years.

• PAF patients were two times as likely as non-AF patients and three times as likely CAF patients to expire (R.R. 2.2, 95% C.I. 1.17-10.9; R.R. 3.1, 95% C.I. 0.55-17.97).

• There were no significant differences in recurrent stroke rate between PAF and CAF patients or PAF patients and non-AF patients.

• Admission NIHSS and CHADS2 for PAF patients were higher than for non-AF patients (p<0.0001 for both). There were no significant differences between PAF and CAF patients.

Conclusion:
• PAF patients had a significantly higher mortality rates compared to CAF patients, despite no significant differences in CHADS2 or admissions NIHSS.

• Careful evaluation is important for PAF patients since they are higher risk of poor outcomes.
Abstract T P173: Cerebral Oxygen Extraction Fraction MRI to Assess Metabolic Changes in Acute Ischemic Stroke
Authors: Ali Latisha K , Alger Jeffry R , Johnson Mark S , Yoo Bryan , Scalzo Fabien , Liebeskind David S
Published: March 2022

Background:
In acute cerebral ischemia, there is an imbalance between oxygen tissue consumption and delivery and oxygen extraction fraction (OEF) from the circulation increases to maintain normal oxygen metabolism and neuronal function. Detecting such metabolic changes may provide important data to inform decisions on therapeutic interventions such as patient selection for reperfusion or identification of futile therapeutic situations. We used serial OEF MRI to assess metabolic changes in brain tissue associated with reperfusion interventions.

Methods:
Serial OEF acquired in 10 consecutive cases of acute anterior circulation ischemic stroke at a single center during a 12 month period. Transverse relaxation and static magnetic field inhomogeneity driven relaxation was mapped using multislice gradient echo planar imaging. Data are fitted on a voxel-by-voxel basis to the Yablonskiy and Haacke model to map deoxyhemoglobin concentration and cerebral blood volume.

Results:
10 cases (median age 72 years (IQR 62-77), 5 women) were studied. Median NIHSS score 15.5 (IQR 9-25). 3 patients received no intervention as last known well time exceeded a treatment window. 3 patients received intravenous thrombolysis (IV), 3 patients received IV and mechanical thrombectomy (MT), and 1 patient received MT only. In the IV treated patients, median time to therapy 110. 5 minutes (IQR 80-132). In the MT treated patients, median time to therapy 257 minutes (IQR 234-331). In the untreated patients, the OEF was elevated in the ischemic territory and this appeared to persist at 24 hours. In the treated patients, those who had at least partial recanalization, demonstrated improved OEF in the ischemic territory at 24 hours.

Conclusions:
OEF provides a novel method for non-invasive detection of tissue with impaired oxygen delivery in acute stroke patients and is a novel tool for imaging metabolic changes in pathophysiology and disclosing therapeutic opportunities.
Abstract T P198: The Importance of Formal Training in Telemedicine During Stroke Fellowship
Authors: Jia Judy , Savitz Sean , Sarraj Amrou , Wu Tzu-Ching
Published: March 2022

Objective:
Telemedicine (TM) consultation for evaluating acute stroke patients improves access to vascular neurologists. However, TM training and its application to clinical practice has not been formally addressed . We surveyed the graduates of our stroke fellowship training program regarding TM training and the educational value of TM exposure during their fellowship.

Methods:
This is a descriptive study, using an anonymous 23-question online survey distributed to the 30 stroke fellows who have graduated in the past 10 years from our institution. The fellows had different amounts of TM exposure due rotational variability but provided coverage in a 14-spoke TM network during their assigned time. We gathered information about prior training, current practice, and opinions regarding formalized TM training. Answers to specific questions were based on a 1-5 scale (1-strongly disagree, 2-disagree, 3- neural, 4-agree, 5-strongly agree). Responses were analyzed using descriptive statistics.

Results:
We received surveys from 21 prior fellows, of which 16 graduated in the past 5 years, and 5 in the past 6 to10 years. 14 (67%) are currently practicing in an academic environment and all are either providing care to stroke patients or a combination of stroke and general neurology. 19 (92%) performed TM during fellowship and 13 (62%) are currently using TM. Most, 17 (81%), thought TM training is necessary in a 1 year stroke fellowship and recommended approximately a 4 week rotation. Responses to the 5-point scale questions are summarized in Figure 1.

Conclusion:
According to our graduates, TM training is important and should become a formalized component of fellowship. TM education needs to be emphasized with specific guidelines implemented by accrediting educational bodies given the increasing application of TM in clinical practice. A larger survey is planned of recent graduates of fellowship programs.
Abstract T P207: TeleStroke Systems Preclude Access to Endovascular Procedures in Acute Stroke Patients
Authors: Ribo Marc , Perez de la Ossa Natalia , Cardona Pere , Abilleira Sonia , Molina Carlos A ,   Catalan Stroke Code and Reperfusion Consortium
Published: March 2022

Telestroke systems as we know them today imply transfer of acute stroke codes to Community Hospitals (CommH) that cannot offer endovascular procedures (EVT). The aimed benefit of this policy relies on the fact that 1) iv-tPA may be offered earlier and 2) unnecessary transfers to Comprehensive stroke centers (CSC) can be avoided. On the other hand this strategy may generate a time delay in potential candidates for endovascular procedures. We aimed to quantify these potential benefits and disadvantages.

Methods:
From march 2013 to march 2014, 533 teleconsults were centrally attended by a stroke neurologist in the Catalan telestroke system that covers 8 centers with no endovascular facilities. Mean distance from CommH to referral CSC was 60 km. We defined criteria to identify potential candidates for EVT in the field (<81 years & NIHSS>8 & <8 hours from symptom onset) or in the ComH after teleconsultation (excluding ICH, ASPECTS<7, lacunar syndroms).

Results:
From the 533 patients, 84 (17%) could be identified on-field before arrival to Community Hospital as potential candidates for EVT. Once at the CommH, from these 84 patients, 60 (71%) were still potential candidates for EVT after CT-scan and teleconsultation.Of these 84 patients, only 27 (32%) received iv-TPA in the CommH, however 68 (80%) were still transferred to the CSC, where only 15 (18%) were finally treated with EVT. The median time from ComH-door to groin puncture was 216 min Vs door-to-groin 152 min for primary admissions at the CSC (p<0.01).

Conclusions:
Telestroke systems as we know them today offer safe and timely iv-tPA treatment to eligible patients but may induce a considerable time loss in most EVT candidates. Only one third of the on-field potential EVT candidates benefit from admission in a CommH by being treated with iv-tPA while more than ¾ will still be transferred to the CSC. New technologies allowing on the field telestroke triage could identify those patients suitable for primary transfer to CSC.
Abstract T P21: Complex Internal Carotid Artery T Occlusion By Computed Tomographic Angiography Is A Very Malignant Subtype With Massive Infarcts And Poor Outcomes Despite Revascularization Treatment
Authors: Lee Kyu Sun , Hong Ji Man , Suh Hong-Il , Lee Sun-Uk , Han Miran , Choi Jin Wook , Demchuk Andrew M , Lee Jin Soo , Lee Jin Soo
Published: March 2022

Background:
ICA T/L occlusions appear to have a particular poor prognosis due to low recanalization with intravenous tissue plasminogen activator alone. What is not known however is whether all ICA T/L occlusions remain as good candidates for endovascular treatment. We divided ICA T/L occlusions into distinct types according to Willisian collaterals and compared infarct core volumes and clinical outcomes in the two groups as well as other anterior circulation occlusion sites.

Methods:
We enrolled patients with acute ischemic stroke in anterior circulation whose CT angiography showed major intracranial artery occlusion. Patients were included if their MRI was taken just after CT scan and within 6 hours from onset. We classified patients into Complex ICA T, Simple ICA T/L, MCA M1, MCA M2, and extracranial to intracranial tandem groups. Among patients with ICA T/L occlusion, patients were classified into simple ICA T/L occlusion group if ACA A2 and PCA P2 segments are patent whereas those into complex ICA T group if A2, P2 or their distal branches were occluded, or contralateral occlusion was seen in ICA or contralesional A1 absent or hypoplastic. Other occlusion types were excluded in this study.

Results:
Table shows comparisons among groups. Age, sex and vascular risk factors did not differ among groups. Initial NIHSS score was different among groups. Pretreatment infarct core volume with ADC value threshold of 600 x 10-5 mm2/s was significantly different according to cerebral artery occlusion types. Clinical outcome significantly differed among groups regarding NIHSS score at discharge, frequency of good outcome (mRS 0-2 at 3 months), and frequency of 3-month mortality.

Conclusion:
We describe a subtype of carotid occlusions we have named as complex ICA T occlusions in which Willisian collateral flow is limited. This group is associated with very large infarct core volumes and poor 3-month outcomes despite acute revascularization treatment.