bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP84: Racial Disparities in Demographics, Comorbidities, and Outcomes in Moyamoya Disease-Related Hospitalizations: A 15-Year Inpatient Perspective in the United States
Authors: Desai Rupak , Valaparla Vijaya Lakshmi , Varakantam Vaishnavi Reddy , Patel Pooja , Patel Smit D
Published: June 2021

Introduction:
Despite the rising incidence of MMD in the United States (US), there is a paucity of research on disease phenotype and outcomes across different ethnicities in the US.

Methods:
MMD admissions were identified using the National Inpatient Sample from 2000-2015 among the four racial groups; Caucasian, African-American, Hispanic and Asian-American/Pacific Islander (API). Demographics, comorbidities, rate of extracranial-intracranial (EC-IC) bypass, and in-hospital outcomes were compared. P<0.05 was considered significant.

Results:
30,136 MMD admissions (mean 33 [SD 18] years, 69.6% female) were identified among 4 groups (
Table 1
). Of these, the highest admissions were among Caucasians (44%) and African-Americans (35%). Hispanics constituted the highest juvenile admissions and all-cause mortality (2.9%). Comorbidities like hypertension (42.5%), prior stroke/TIA (24.2%), dyslipidemia (21.3%), paralysis (18.5%), diabetes (17.1%), smoking (16.7%), fluid-electrolyte disorders (16.5%), chronic obstructive pulmonary disease (13.6%) and depression (10.7%) were prevalent across the ethnicities. Caucasians most frequently demonstrated hypertension (47.8%), dyslipidemia (25.8%), smoking (22.2%), depression (13.4%) and atherosclerosis (8.6%). African Americans had the highest cumulative stroke burden (37.2%). API underwent EC-IC procedures (23.9%) more often and experienced the highest mean hospital stay (9 days) and charges (100,706 USD), frequent transfers and least routine discharges.

Conclusion:
African-Americans with MMD had the highest stroke prevalence whereas young-onset presentation and highest all-cause mortality was seen amongst Hispanics. Comorbidity burden was highest in Caucasian & African Americans. API demonstrated the highest resource utilization. These racial disparities warrant further studies to understand the disease phenotype for early screening & improved therapeutic approaches.
Abstract TP100: Post-Transcriptional Inactivation of MMP-12 Immediately After Reperfusion Facilitates Neurological Recovery After Ischemic Stroke
Authors: Nalamolu Koteswara Rao , Challa Siva Reddy , Martin Ryan C , Olson Elsa A , Ujjainwala Amma L , Klopfenstein Jeffrey D , Pinson David M , Kalyanasundaram Ramaswamy , Vemuganti Raghu , Veeravalli Krishna Kumar
Published: June 2021

Introduction:
We recently showed in a rodent model of transient focal cerebral ischemia that matrix metalloproteinase-12 (MMP-12) induction in the ischemic brain promotes post-stroke blood-brain barrier disruption, apoptosis, demyelination, and infarction. The purpose of the present study is to investigate the role of elevated MMP-12 on post-stroke neurological function and to identify the time window of therapeutic opportunity for MMP-12 suppression.

Methods:
Adult male Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion and reperfusion. Cohorts of rats (n =8-15/group) were administered with either MMP-12 shRNA or scrambled shRNA sequence (vehicle control) expressing plasmids (1 mg/Kg; intravenous) formulated as nanoparticles. The differences in sample size of various cohorts were attributed to the exclusion criteria followed, high mortality rate in vehicle control-treated group, and sample size required for statistical analysis. To assess the reflex, balance, sensory, and motor functions, rats from various cohorts were subjected to modified neurological severity scoring (mNSS), adhesive removal test, beam walk test and rotarod test at day 1, 3 and 5 of reperfusion. To assess the time window of therapeutic opportunity, various cohorts of rats were treated at 5 min, 3h, and 6h of reperfusion. Investigators blinded to study groups analyzed all outcome parameters.

Results:
The post-stroke percent survival rate in cohorts treated with MMP12shRNA expressing plasmids range from 82 to 89 as compared to 67 in vehicle control-treated group. The cohort of rats treated at 5 min of reperfusion with MMP-12snRNA expressing plasmids showed significantly better functional recovery as assessed by various neurological tests. However, delayed administration of MMP-12snRNA expressing plasmid (either at 3h or 6h of reperfusion) failed to promote any significant improvement in post-stroke neurological recovery.

Conclusions:
Post-stroke induction of MMP-12 in the ischemic brain contributes to neurological deficits and impedes recovery. MMP-12 targeting treatments immediately after reperfusion could offer substantial therapeutic benefits.
Abstract TP117: Endothelial Progenitor Cells in Acute Stage of Ischemic and Hemorrhagic Stroke
Authors: Wisniewski Adam
Published: June 2021

Introduction:
Endothelial progenitor cells (EPC) play an important role in the regeneration of the nervous tissue, blood-brain barrier stabilization and in neovascularization of blood vessels damaged by stroke. The aim of the study was to assess the level of EPC in patients with acute cerebral stroke due to cerebral microangiopathy and the potential dependence with the clinical condition, radiological image and prognosis, both in the ischemic and the haemorrhagic stroke.

Methods:
66 patients with lacunar ischemic stroke were included in the prospective study, 38 patients with the “loco typico” haemorrhagic stroke and 22 from the control group without acute/chronic cerebral circulatory disorders. The level of EPC was determined using flow cytometry and identified with the immune-phenotype CD45–, CD34+, CD133+ on the 1
st
and 8
th
day of stroke.

Results:
It has been shown a significantly higher level of EPC on the 1
st
day of stroke (regardless of aetiology) compared to the control group (med. 17,75 cells/ul (0-488 cells/ul) vs 5,24 cells/ul (0-95 cells/ul); p=0.0006). The level of EPC on day 1 and 8 was correlated with the subgroup of patients with haemorrhagic stroke. A significant correlation was found between the volume of the haemorrhagic focus on the 1
st
day and the level of EPC (R= -0.3378, p=0.0471) and the degree of regression of the haemorrhagic focus and the level of EPC (R=-0.3896, p=0.0367).

Conclusions:
The study showed that endothelial progenitor cells are an early marker of cerebral vascular damage, both in ischemic and haemorrhagic stroke. The research highlights, for the first time, the relationship between the level of EPC and the degree of regression of a haemorrhagic focus. However the prognostic value of EPC for clinical condition and prognosis of stroke patients was not found in the study.
Abstract TP123: Baseline Differences in Risk Factor Control Between CREST-2 and SAMMPRIS
Authors: Turan Tanya N , Voeks Jenifer H , Barrett Kevin M , Brown Robert D , Chaturvedi Seemant , Chimowitz Marc , Demaerschalk Bart , Emmady Prabhu , Howard George , Howard Virginia J , Huston John , Jones Michael , Lal Brajesh K , Lazar Ronald M , Moore Wesley , Moy Claudia S , Roldan Ana M , Roubin Gary S , Sangha Navdeep , Brott Thomas G , Meschia James F
Published: June 2021

Baseline Differences in Risk Factor Control and Medication Use Between 2 Trials Employing Intensive Medical Management (SAMMPRIS & CREST2)

Background:
The CREST2 trial Intensive Medical Management (IMM) protocol was adapted from the SAMMPRIS trial. However, since the 2011 publication of initial results of SAMMPRIS, there has been a greater appreciation for the importance of risk factor control in patients at risk of stroke associated with atherosclerosis. Therefore, we sought to determine differences in baseline risk factor control and medication use between SAMMPRIS and CREST2.

Methods:
Baseline risk factor and medication use data from 451 patients enrolled in SAMMPRIS (2008-2011) with severe symptomatic intracranial atherosclerosis and 1473 patients enrolled in CREST2 (2014-2019) with severe asymptomatic carotid stenosis were compared using the Chi-square test and t-test.

Results:
The Table shows baseline risk factor values and medications. SAMMPRIS patients were younger but had significantly worse risk factor control than CREST2 patients for all measures. There was no significant difference in statin use at baseline, but the mean SAMMPRIS subjects’ LDL was 16.1 mg/dL higher than in CREST2. CREST2 patients had higher rates of use of angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and thiazides, but lower rates of use of angiotensin converting enzyme (ACE) inhibitors.

Conclusions:
Despite being older, CREST2 patients have significantly better baseline risk factor profiles than SAMMPRIS patients. This could be due to greater appreciation of the importance of risk factor control and healthy lifestyle habits for stroke prevention or more aggressive treatment targets in guideline recommendations. Although risk factor control appears to be improving since SAMMPRIS, many CREST2 patients are still not meeting recommended risk factor goals at baseline and may benefit from IMM protocols.
Abstract TP133: Assessment of Hemodynamic Compromise by Neuro-Parenchymal Blood-Volume System: Comparison With Acetazolamide Challenged Single Photon Emission Computed Tomography
Authors: Kataoka Yuko , Kunieda Takenobu , Iwata Ryoichi , Nakayama Kentaro , Kaneko Satoshi , Asai Akio , Kusaka Hirofumi
Published: June 2021

Objective:
To investigate whether Neuro-parenchymal blood-volume (PBV) measurements could be used instead of acetazolamide (ACZ)-challenged single-photon emission computed tomography (SPECT) to evaluate hemodynamic compromise in patients with cerebrovascular steno-occlusive disease.

Methods:
Thirteen patients with unilateral carotid artery steno-occlusive disease were enrolled from April 2018 to June 2019, and the severity of hemodynamic compromise was assessed by Neuro PBV system (syngo Neuro PBV IR, Siemens Medical Solutions, Erlangen, Germany) and acetazolamide-challenged SPECT of the brain. Cerebral blood volume (CBV) was measured using a C-arm flat detector angiographic system. The asymmetry ratio of CBV in the middle cerebral artery (MCA) territory (CBV
AR
) was defined as the (CBV on the ipsilateral side / CBV on the contralateral side) х 100 (%). Cerebral blood flow (CBF) was quantified by SPECT using the quantitative SPECT/dual-table autoradiography method. Cerebrovascular reserve (CVR) in the MCA territory was defined as (CBF after ACZ challenge – CBF at rest) / CBF at rest х 100 (%) and classified as reduced (<18.4%) or non-reduced (≥18.4%).

Results:
Five patients showed reduced CVR. The CBV
AR
was significantly lower in the reduced CVR group than in the non-reduced CVR group (71.6% vs. 110.0%, P = 0.003). The cut-off value of CBV
AR
for predicting reduced CVR obtained from analysis of the receiver operating characteristic curve was 99.0% (sensitivity 100% and specificity 87.5%), and the area under the curve was 0.975 (95% confidence interval: 0.906-1).

Conclusion:
This is the first report to evaluate the correlation between CBV
AR
measured using the Neuro PBV system and CVR assessed by SPECT. CBV
AR
is useful indicator for evaluating reduced CVR in the MCA territory, as an alternative to ACZ-challenged SPECT.
Abstract TP140: Automated Individualized Evaluation of Hemodynamics in Intracranial Atherosclerotic Disease With Dual-
Venc
4D Flow MRI
Authors: Ma Yue , Vali Alireza , Aristova Maria , Abdalla Ramez , Ansari Sameer , Prabhakaran Shyam , Ragin Ann , Schnell Susanne
Published: June 2021

Introduction:
Hemodynamic alterations of intracranial atherosclerotic disease (ICAD) patients may be associated with increased risk of stroke. Dual-
venc
4D Flow MRI can provide time-resolved 3D hemodynamics with large velocity dynamic range, but clinical utility is limited by labor intensive analysis. We developed an automated tool to simplify analysis, rapidly extract and visualize hemodynamic parameters, bringing 4D Flow MRI closer to clinical practice.

Purpose:
To demonstrate clinical feasibility of a new automated tool for extracting hemodynamic parameters based on 4D Flow MRI, and evaluate intracranial hemodynamics in individual ICAD patients relative to normative reference values.

Methods:
Intracranial dual-
venc
4D Flow MRI was acquired in 59 healthy subjects (32M, 48±15Y) and 16 ICAD patients (12M, 62±14Y). An in-house Matlab tool was used to quantify velocity and flow in each Circle of Willis vessel. Hemodynamic measures from the controls were used to derive normative parameter estimates using polynomial fit as a function of age. A hemodynamic profile for each patient included computing percent difference of peak velocity (PV) and flow rate (FR) in each vessel compared to reference values (Fig.1a-c), and showing results in a diagram (Fig.1d).

Results:
Fig.1e shows results for ICAD patients. 93.8% of stenotic vessels showed normal FR suggesting intracranial hemodynamic compensation. 62.5% of stenotic vessels showed abnormal PV and 75% of patients showed increased PV in at least one vessel in affected hemisphere. Among 3 patients with compensatory collateral circulation, 2 patients had more than 3 vessels with increased PV. This suggests PV is a more sensitive marker of stenosis than FR.

Conclusions:
We demonstrate the feasibility of an automated tool used with 4D Flow MRI to interrogate intracranial hemodynamics in ICAD patients. It has considerable promise for identifying new noninvasive biomarkers for individualized stroke risk stratification.
Abstract TP144: The Relationship Between Gait Speed and Self-Reported Quality of Life in Stroke Survivors After Treatment With a Therapeutic Gait Device
Authors: Darcy Brianne , Rashford Lauren , Lundin Elizabeth , Medas Ryan , Shultz Stephen T , Dubose Elizabeth , Huizenga David , Reed Kyle B
Published: June 2021

Introduction:
In stroke survivors, variables associated with lower quality of life (QOL) include hemiplegia, lower functional status, degree of walking ability, speed of gait, and overall walking dysfunction. The iStride
TM
Gait Solution, a home-use gait treatment device, has been shown to improve gait speed and other functional parameters in stroke survivors. This analysis discusses the relationship found between gait speed parameters and self-reported QOL after treatment with the iStride
TM
Gait Solution.

Methods:
Nineteen subjects were treated with the iStride
TM
device in their home environment for a targeted 12 sessions over four weeks. QOL was measured using the Stroke Specific Quality of Life Scale (SS-QOL) and gait speed was measured using the 10 Meter Walk Test (10MWT) at comfortable pace. Outcome measures were assessed at baseline and one-week post-treatment.

Results:
Results showed a statistically significant improvement from baseline to one-week follow-up for 10MWT (p=0.0001) and SS-QOL (p=0.007). The relationship between these variables appeared to be more dependent on the % improvement of gait speed and the ending gait speed being above the mean baseline speed (0.575 m/s) than the absolute improvement in gait speed. For example, subjects starting below the mean gait speed improved 23 points (14.8%) on SS-QOL (gait speed improvement = 0.22m/s) compared to 11.7 points (8%) on SS-QOL (gait speed improvement = 0.33 m/s). In addition, subjects that improved from the home ambulator category to limited community ambulator improved an average of 15.3 points (10.2%) on SS-QOL while subjects improving from limited community ambulator to full community ambulator improved only 4.8 points (4.6%) SS-QOL, despite a 0.16 m/s larger gait speed improvement.

Conclusions:
The results of this analysis indicate that larger gains in QOL may be achieved by focusing on patients reaching a gait speed above approximately 0.575 m/s. Our findings also support the importance of helping home ambulator stroke survivors achieve limited community ambulator status. These findings may guide clinicians who desire to improve the QOL of their patients to select effective treatment methods targeting gait speed improvement.
Abstract TP155: Predictive Values of Glasgow Coma Scale and National Institutes of Health Stroke Scale Scores in Determining 3-Month Outcomes of Patients With Intracerebral Hemorrhage
Authors: Lobanova Iryna , Huang Wei , Qureshi Adnan I
Published: June 2021

Background:
Intracerebral hemorrhage (ICH) is associated, with high rates of mortality, and long-term disability. We investigated the predictive values of the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) in the prognosis of mortality and functional outcome in patients with ICH.

Methods:
A total of 1000 patients recruited in a clinical trial with acute were assessed using GCS and NIHSS at admission. Then, the receiver operating characteristic (ROC) curves were established, and the area under the curves of these 2 scoring systems was compared. The primary outcome was death or disability (modified Rankin scale (mRS) score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments.

Results:
The area under the curve of GCS and NIHSS was 0.660 (95% confidence interval: 0.593-0.727) and 0.708 (95% confidence interval: 0.640-0.755), respectively, for predicting disability among survivors. The area under the curve was 0.655 (95% confidence interval: 0.621-0.688) and 0.788 (95% confidence interval: 0.759-0.817), respectively for prediction of 3-months death or disability among all patients with ICH. The GCS predicted 3-month disability among survivors with a sensitivity of 68.7% and a specificity of 57.7%, and the NIHSS predicted 3-month disability with a sensitivity of 74.6% and a specificity of 62.3%. The GCS predicted 3-month death or disability among all patients with a sensitivity of 60.5% and a specificity of 66.5%, and the NIHSS predicted 3-month death or disability with a sensitivity of 80.1% and a specificity of 66.8%. NIHSS (P<0.0001) and GCS (P=0.0002) scores had a statistically significant predictive value for the presence of intracerebral hemorrhage among survivors. Among all patients, NIHSS (P<0.0001) and GCS (P<0.0001) scores also had statistically significant predictive value for identifying patients at risk for death or disability at three months.

Conclusions:
GCS and NIHSS scales have good predictive values for the prognosis of patients with ICH as regards of mortality and disability. The NIHSS is more accurate than the GCS in predicting death or disability in patients with ICH.
Abstract TP161: Sexual Dysfunction in Mild Stroke
Authors: Blum Jennifer , Wisialowski Caroline , Taboada Susan , Clark Sarah , Staff Ilene , Nouh Amre
Published: June 2021

Background:
Stroke impacts several aspects of patients’ lives and sexual dysfunction post stroke has been reported in 40%-50% of patients. Current investigations have revealed links to depression, however this has not been examined specifically in mild stroke.

Objective:
To determine prevalence and factors associated with sexual dysfunction after mild stroke

Design/methods:
A retrospective study was conducted on a self-report questionnaire completed by a convenience sample of patients during a hospital follow-up appointment in the stroke clinic. Patients were asked about sexual dysfunction after stroke and if yes, to specify the cause: safety concern, physical limitation, consequence or change in libido. In addition, patients completed a PHQ-9 to measure depression, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). A thorough review of clinical history including NIHSS, mRS and demographics was completed by researchers. Descriptive statistics were used to identify and understand the patient population. Mild stroke was defined as NIHSS ≤ 5.

Results:
In our study of 135 patients, 21 (16%) did not respond to the sexual dysfunction question. Of the 114 who responded, only 11 (9.6%) reported sexual dysfunction and 9 (81%) attributed their sexual dysfunction to physical limitations. Descriptive statistics of the respondent subgroup indicate that the cohort was 59% male with a median (IQR) age of 64 (57,75) and that 52% were living with someone at the time. The mean NIHSS on discharge was 1 (IQR 0-3) and 77% were ischemic strokes. Few patients experienced post stroke depression (21.9%, N=25), and the cohort reported low levels of fatigue (median FAS=19). Low incidence and response rates precluded an analysis of specific predictors in this cohort.

Conclusion:
Physical limitations are reported to be the main cause of post stroke sexual dysfunction. Roughly 1 in 10 patients with mild stroke reported experiencing sexual dysfunction, however twice as many did not respond to the question. Therefore, the true incidence is unclear, prompting the need for further investigation on post stroke sexual dysfunction in mild stroke.
Abstract TP180: Outcomes in the Elderly Post-Endovascular Therapy in a Community Setting
Authors: Nguyen-huynh Mai N , Alexander Janet , Lee Catherine , Meighan Melissa , Flint Alexander , Klingman Jeffrey
Published: June 2021

Background:
Risks and benefits of thrombectomy in elderly stroke patients remained unclear. We evaluated outcomes in the elderly who underwent endovascular therapy (EST) in a large integrated healthcare system.

Methods:
In 2016, our integrated healthcare system launched a new standardized acute telestroke care workflow for all 21 stroke centers. It included immediate evaluation by a stroke neurologist via video, expedited IV alteplase treatment, rapid CT angiographic investigation, and expedited transfer and EST for patients with large vessel occlusion (LVO). From January 2016 through December 2018, our study cohort included adult members who had EST within our care system. We compared patient characteristics, door-to-needle (DTN) times, door-to-groin (DTG) times, inpatient and 90-day mortality between those treated with EST aged <80 to those ≥80 years. Multivariable logistic regression model was used to assess whether being ≥80 years was associated with a higher 90-day mortality adjusting for demographics, co-morbidities, and DTG time.

Results:
There were 291 acute stroke patients who underwent EST [Table]. The older subgroup had a higher percentage of female and higher rates of atrial fibrillation. They were more likely to arrive by EMS, to have a higher initial NIHSS and to have a faster DTN time. Average DTG times and inpatient mortality rates were not different between groups. The elderly had a higher rate of 90-day mortality. In multivariate model, being elderly was associated with higher 90-day mortality (OR=2.56, 95% CI 1.29-5.09, p=0.007).

Conclusions:
For those who underwent EST in a large community setting with a standardized approach to acute stroke treatment, being elderly was associated with a higher risk of 90-day mortality. Further data analyses are being carried out with additional co-morbidities, inpatient complications, and 90-day functional outcome to better understand outcomes in older patients undergoing EST.
Abstract TP195: Pre-Stroke Cognitive Impairment is Associated With Poor Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy
Authors: Kanamaru Takuya , Suda Satoshi , Aoki Junya , Suzuki Kentaro , Sakamoto Yuki , Katano Takehiro , Numao Shinichiro , Nishiyama Yasuhiro , Kimura Kazumi
Published: June 2021

Background:
It is reported that pre-stroke cognitive impairment is associated with poor functional outcome after stroke associated with small vessel disease. However, it is not clear that pre-stroke cognitive impairment is associated with poor outcome in patients treated with mechanical thrombectomy.

Method:
We enrolled 127 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke from December 2016 to November 2018. Pre-stroke cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We retrospectively compared poor outcome (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=75) with good outcome (a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=52) and examined that IQCODE could be the predictor of PO.

Result:
IQCODE was significantly higher in poor outcome group than in good outcome group (89 vs. 82, P=0.0012). Moreover, age (77.2 years old vs. 71.6 years old, P= 0.0009), the percentage of female (42.7% vs. 17.3%, P= 0.0021), complication of hypertension (HT, 68.0% vs. 44.2%, P=0.0076), National Institutes of Health Stroke Scale (NIHSS) at admission (20 vs. 11, P<0.0001), the percentage of postoperative intracerebral hemorrhage (ICH, 33.3% vs. 15.4%, P=0.0233) were higher in poor outcome group than in good outcome group, too. However, there was no significant difference between poor outcome and good outcome groups in occlusion site (P= 0.1229), DWI-ASPECTS (P= 0.2839), the duration from onset to recanalization (P=0.4871) and other risk factors. Multivariable logistic regression analysis demonstrated that IQCODE, HT and NIHSS at admission were associated with poor outcome (P= 0.0128, P=0.0061 and P<0.0001, respectively).

Conclusion:
Cognitive impairment could be associated with poor outcome in patients treated with mechanical thrombectomy.
Abstract TP218: Black-Blood MRI; Efficacy in the Diagnosis of Cerebral Arterial Dissection and Changes Over Time
Authors: Iwanaga Taeshi , Okada Hiroshi , Inoue Takeshi , Yamashita Shinji , Oota Masahiro , Uemura Junnichi , Yagita Yoshiki
Published: June 2021

Background:
Cerebral arterial dissection is considered a rare disease, but recent advances in diagnostic imaging have increased the likelihood of its diagnosis. In particular, Black-Blood (BB) MRI T1 weighted imaging (BB-MRI) enables the diagnosis of cerebral arterial dissection by reducing the signal in the vascular lumen and detecting a high signal from the hematoma in the false lumen. However, the changes in the hematoma over time are still unknown. In this study, these changes were investigated retrospectively.

Methods:
This study included patients who were admitted to the Stroke Department of the Japanese Red Cross Okayama Hospital from April 2015 to May 2019 and diagnosed with cerebral arterial dissection at discharge based on the imaging criteria of the spontaneous cervicocephalic arterial dissections study-Japan (SCADS-J). The ratios of the signal intensity from the arterial dissection sites to the signal intensity from the normal blood vessel walls (BB-ratio = dissected vessel wall T1 value/normal vessel wall T1 value) were calculated based on when the B-MRI images were taken. The period from the onset of the disease was analyzed.

Results:
During this study, 646 acute stroke patients were hospitalized, and cerebral arterial dissection was confirmed at discharge in 16 patients (mean age, 57 years; 14 men) based on the diagnostic imaging criteria of the SCADS-J. For the 12 patients who underwent BB-MRI within 1 week of onset, the BB-ratio increased over the first week and peaked at a median of 10.5 days (1st IQR 8.75-3rd 15.25), with a mean BB-ratio of 3.35 (SD 1.00).

Discussion:
The signal intensity of the BB-MRI T1 weighted images for intramural hematoma increased 1 week after the onset of cerebral arterial dissection. Therefore, diagnoses must account for the length of time elapsed since disease onset.
Abstract TP219: Hyperintense Vessels on FLAIR MRI Suggest Dissection and Large-Artery Atherosclerosis but Do Not Predict Outcome in Acute Posterior Circulation Infarct
Authors: Takahashi Maki , Sato Takeo , Maku Takahiro , Motegi Haruhiko , Takatsu Hiroki , Komatsu Teppei , Sakuta Kenichi , Sakai Kenichiro , Umehara Tadash , Omoto Shusaku , Murakami Hidetomo , Mitsumura Hidetaka , Iguchi Yasuyuki
Published: June 2021

Background and Purpose:
Hyperintense vessel sign on FLAIR (HVS) has been described in hyperacute stroke patients with arterial occlusion. It’s a surrogate marker for stroke severity in patients with acute ischemic stroke of the anterior circulation. We aimed to reveal the clinical significance of HVS in patients with acute posterior circulation infarction.

Methods:
This observational study is based on a single-center prospective registry study. Inclusion criteria were: symptomatic ischemic stroke patients who have lesions only in posterior circulation; and taken initial MRI within 14 days from onset.An unfavorable outcome was defined as mRS score of 2 to 6 at 3 months from the onset. First investigation is to estimate whether HVS could be related to the subtype of acute ischemic stroke (cohort A). Second, the correlation between HVS and mRS at 3 months was evaluated (cohort B).

Results:
From October 2012 to May 2019, consecutive 1,079 ischemic stroke subjects were screened, including 277 in cohort A (191 male, median age 64 years) and 240 in cohort B (165 male, median age 66 years, Figure A). In cohort A, HVS was independently associated with intracranial artery dissection (OR 5.228; 95% CI 2.270-12.039;
p
= 0.001) and large-artery atherosclerosis (OR 3.582; 95% CI 1.244-10.317;
p
= 0.018, Figure B). In cohort B, HVS was not a factor independently associated with unfavorable outcome (OR 2.925; 95% CI 0.881-9.714;
p
= 0.080).

Conclusions:
HVS in patients with posterior circulation infarct suggests intracranial artery dissection or large-artery atherosclerosis, but does not have impact on their clinical courses.
Abstract TP23: Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy: A Systematic Review and Meta-Analysis
Authors: Tsivgoulis Georgios , Katsanos Aristeidis H , Malhotra Konark , Goyal Nitin , Palaiodimou Lina , Schellinger Peter D , Caso Valeria , Cordonnier Charlotte , Turc Guillaume , Magoufis Georgios , Arthur Adam , Alexandrov Andrei V
Published: June 2021

Introduction:
Recent randomized-controlled clinical trials (RCTs) have provided solid evidence that mechanical thrombectomy (MT) coupled with best medical therapy (BMT) improve functional outcomes of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) compared to BMT alone. However, they provided inconclusive evidence on the benefit of MT on mortality.

Methods:
We evaluated the association of MT+BMT compared to BMT with the risk of three-month mortality using aggregate data from all available RCTs. We also sought to identify potential predictors on the mortality risk and performed univariate meta-regression analyses.

Results:
Our literature search identified 11 eligible RCTs, including a total of 2,460 patients. The pooled rates of 3-month mortality were 15% (95%CI:12-19%) and 19% (95%CI:16-23%), respectively, in the MT+BMT and BMT groups. In the overall analysis MT+BMT was associated with a significantly lower risk for 3-month mortality compared to BMT (Risk Ratio=0.83, 95% confidence interval:0.69-0.99; p=0.04), without heterogeneity across included studies (I
2
=3%,p for Cochran Q=0.41). No evidence of publication bias was present in funnel plot inspection and Egger’s statistical test (p=0.762). In meta-regression analyses no moderating effect on the aforementioned association was detected with patient age (p=0.254), gender (p=0.702), admission systolic blood pressure (p=0.601), admission glucose (p=0.277), onset-to-groin puncture time (p=0.985), administration of intravenous alteplase prior to MT (p=0.804), MT under general anesthesia (p=0.735) and successful reperfusion following MT (p=0.663).

Conclusion:
Our meta-analysis provides evidence that MT+BMT reduce the risk of three-month mortality compared to BMT alone. This association appears not to be moderated by individual patient or procedural characteristics.
Abstract TP230: Ischemic Strokes in Anti-Coagulated Patients - Treatment Failure or Alternate Etiology?
Authors: Khan Alina , Gallegos Patrick , Mullen Chanda , Patel Jay , Nasseri Irvin , Itrat Ahmed
Published: June 2021

Background:
Patients experiencing ischemic strokes while already on therapeutic anti-coagulation are often considered anti-coagulant failures if they are compliant with treatment, and pose a management challenge. Stroke etiology in such patients is also often overlooked and they are routinely switched to alternate anticoagulant or combined with an anti-platelet therapy, although evidence is lacking if doing so prevents future ischemic strokes.

Objective:
To identify determinants and mechanisms of strokes in patients who experience ‘breakthrough ischemic strokes’ while already on therapeutic anticoagulation.

Methods:
We conducted a retrospective case-cohort study of patients presenting to Cleveland Clinic Akron General between January 2013 - December 2017. Patients were included if they had an ischemic stroke diagnosis on admission and were already on therapeutic anticoagulation at the time, who were then compared against a matched cohort from the same time period. Treatment compliance was determined using manual chart review. Stroke etiology was determined and dichotomized into embolic stroke (ES) vs Non-embolic stroke (NES) etiology based on their history, imaging and ancillary findings.

Results:
We identified 64 patients who were true breakthrough strokes with complete data and compared them to 119 matched controls. Both groups were similar in age (72±13 years among cases vs 72±16 among cohorts, p=0.795) and sex (Females 69 (58%) among cases vs 30 (47%) among cohorts, p=0.150). History of auto-immune disease was the only co-morbid condition not dependent on anticoagulation status which was significantly higher among cases (9(14%) vs 4(3%), p=0.013). Stroke etiology was similar among both groups, with the anti-coagulated group not necessarily showing a trend towards higher incidence of ES (49 (77%) in cases vs. 83 (70%) in cohort, p=0.327).

Conclusion:
Ischemic strokes among patients on therapeutic anticoagulation do not necessarily differ in stroke mechanisms compared to routine ischemic strokes, and require a thorough, individualized approach to prevent future stroke risks.
Abstract TP231: Predictors of Early Neurological Deterioration in Acute Minor Ischemic Stroke
Authors: Sung Sang Min , Kang Yoon Jung , Jang Sung Hwan , Kim Nae Ri , Lee Suk Min
Published: June 2021

Introduction:
Early neurological deterioration is one of the critical determinants of functional outcomes in patients with minor ischemic stroke. The purpose of this study was to identify predictors of early neurological deterioration in patients with acute minor ischemic stroke.

Methods:
A total of 739 patients with acute minor ischemic stroke who are admitted within 24 hours after onset of stroke symptom between January 2014 and December 2018 were enrolled in this study. We analyzed demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, neuroimaging parameters, and relevant arterial steno-occlusive lesions. Early neurological deterioration was defined as any worsening of neurological deficits within 3 days after admission. Logistic regression was used to determine independent predictors of early neurological deterioration.

Results:
Seventy-eight of 739 (10.5%) patients had early neurological deterioration. Among 78 patients with early neurological deterioration, 61 (78.2%) had poor functional outcomes at 90 days after stroke onset. By contrast, 131 of 661 (19.8%) patients without early neurological deterioration had poor functional outcomes. Multivariate analysis identified hemorrhagic transformation (OR, 3.8; 95% CI, 1.4-10.5; P=0.010), higher score of NIHSS on admission (OR, 1.4; 95% CI, 1.1-1.7; P=0.003), relevant arterial stenosis (OR, 2.0; 95% CI, 1.2-3.5; p=0.014) and occlusion (OR, 2.6; 95% CI, 1.4-4.8; p=0.004) were the factors associated with early neurological deterioration.

Conclusions:
The results of this study suggest that hemorrhagic transformation, higher NIHSS score on admission, relevant arterial steno-occlusive lesions are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.
Abstract TP234: "Last Known Normal" Accuracy Among Initial Responders: An Update
Authors: Bautista Alyssa , Saavedra-Chavez Christian , Chiang Chia-Chun , Duda Julian , Meyer Dawn , Modir Royya , Agrawal Kunal , Hemmen Thomas , Meyer Brett C
Published: June 2021

Background:
Because acute treatment in stroke is time-based for inclusion, efficacy and safety, obtaining an accurate Last Known Normal (LKN) is of critical importance in stroke codes. We sought to assess with a larger sample if the assessment of 1st documented LKN times has improved since our prior 2013 data.

Methods:
Data was obtained from an IRB approved stroke registry in a single center from July 2013 to December 2018, for LKN time documented by a neurologist (“LKN2”). Chart review was done to document 1st reported LKN time as documented by EMS (or ED if no runsheets available) (“LKN1”). Inpatient stroke codes and hospital transfers were excluded. Differences in LKN1 and LKN2 were computed and stratified into Groups A (LKN1 is earlier in time than LKN2), B (LKN1 is the same as LKN2), and C (LKN1 is later in time than LKN2). Baseline characteristics, thrombolysis rates, stroke code time interval metrics, 90-day disability and death, discharge disposition, and symptomatic ICH rates, were compared between groups.

Results:
Of 990 stroke codes, 397 or 40.1% had agreeable LKN1 and LKN2 times (Group B) (increased from a historic 26.4%;p=<.001), while 593 or 59.9% had a discrepancy in LKN1 and LKN2 times. Of 593, 177 (29.8%) had an LKN1 earlier than LKN2 (Group A), 416 (70.2%) had LKN1 later than LKN2 (Group C). The mean age in Groups A, B, and C were 63.5, 63.4, and 66.1, respectively (p=0.04). Discharge disposition to home/self-care was seen more in Group C (n=284, 69.4%;A n=117, 63.2%;B n=255, 66.2%;p=0.03). There were no other differences in baseline characteristics, r-tPA rates, 90-day disability and death, or sICH rates. Among Group C patients who were excluded from IV-tPA based on time, 55.6% would have been treated outside of stroke guidelines had LKN1 been used (55.6% vs. prior report of 69.7%;p=0.2).

Conclusion:
Though initial LKN times obtained by EMS and ED responders have improved over time, there remains a significant discrepancy with 60% incorrect initial reports. Caution should be used when considering rt-PA treatments based on these LKN1 reports as 56% of cases could have been treated outside of current guidelines and evidence. This study highlights the need for continuous training in obtaining accurate LKN times and caution about using initial estimates of time.
Abstract TP239: Cross-Training In-Hospital Operating Staff Significantly Improves Door-to-Puncture Time in Thrombectomy Patients
Authors: Callahan Angela M , Rosengart Axel , Graham Karissa , Capone Kellie , Wright Kathryn , Beckett Lisa , Dicristina Heather , Doucoure Samantha , Wagner Thomas , Griessenauer Christoph , Dalal Shamsher , Weiner Gregory , Goren Oded , Schirmer Clemens M
Published: June 2021

Objective:
Delay in endovascular reperfusion in patients with acute large-vessel cerebral occlusion decreases the likelihood of functional independence. Given the large contribution of the pre-puncture, in-hospital time period to the overall speed of reperfusion therapy we evaluated the benefits and impediments of utilizing an immediately available OR team to reduce door-to-puncture time compared to a traditional model of an on-call team.

Methods:
Prospectively collected data were retrospectively analyzed to compare the readiness strategies of 2 comprehensive stroke centers of the Geisinger Health System serving stroke patients in rural and suburban Pennsylvania with different hospital level characteristics: Center A with an in-hospital available operating room team cross-trained in both operating and neuroendovascular procedures and center B with a dedicated on-call neuroendovascular team. Data compared included patient demographics and presentation characteristics, stroke severity, door-to-puncture time, and successful reperfusion (
t
test, Fisher exact test, Chi square test).

Results:
There was no significant difference in the baseline stroke patient characteristics at center A (n=31) and center B (n= 45): 61% vs. 62% females; mean age 72 (range 47 to 93) vs. 69 (range 28 to 96) (p=0.35); admission NIHSS 17 vs 17, respectively. Successful reperfusion (TICI 2b-3) was achieved in 98% and 97% of cases in center A and B, respectively (p=0.79) but door-to-puncture time differed significantly between 50 in center A compared to 121 minutes in center B (58% reduction, p<0.02).

Conclusion:
Crossed-training in-hospital operating room staff in neuroendovascular procedures significantly reduces door-to-puncture time in thrombectomy patients when compared to a traditional on-call neuroendovascular call team. Based on existing data, this achievement in earlier reperfusion is expected to translate directly to improve clinical outcome.
Abstract TP24: Radiological and Symptomatic Hemorrhagic Transformation Post Endovascular Thrombectomy for Both Anterior and Posterior Large Vessel Occlusion Ischemic Stroke - Insights From STAR Collaboration
Authors: Saini Vasu , Chalhoub Reda M , McCarthy David J , Alawieh Ali M , Chen Stephanie H , Luther Evan M , Kan Peter , Keyrouz Salah , De Leacy Reade , Arthur Adam , Kim Joon-Tae , Psychogios Marios , Rai Ansaar , Fargen Kyle , Dumont Travis , Maier Ilko , Peterson Eric C , Yavagal Dileep R , Spiotta Alejandro , Starke Robert M
Published: June 2021

Introduction:
Radiological hemorrhagic transformation (rHT) and symptomatic intracranial hemorrhage (sICH) remain a major complication of mechanical thrombectomy (MT) in acute stroke. Our aim is to identify independent predictors of rHT and sICH.

Methods:
A retrospective multicenter international study across the US and Europe included 2499 patients, 18 years or older, who underwent EVT for acute stroke from 2015-2019. rHT is defined as any intracranial hemorrhage post MT and subgrouped per ECASS II as petechial (HI), parenchymal hematoma without (PH1) and with mass effect (PH2) and subarachnoid hemorrhage (SAH). sICH was defined as presence of PH2 or SAH. Functional outcomes were described using the 90-day modified Rankin score (mRS) as “good” 0-2 or “poor” 3-6. Multivariable logistic regression model was used to identify predictors of rHT and sICH.

Results:
600 (24%) had rHT and 145 (5.8%) had sICH. On multivariable regression model, independent predictors for both rHT and sICH were higher admission NIHSS (OR 1.03, p<.001 vs. OR 1.04, p<.001), lower ASPECTS (OR .82, p<.001 vs. OR .83, p<.001) and higher number of thrombectomy attempts (OR 1.08, p.013 vs. OR 1.08, p .014). Patients with hyperlipidemia (OR .77, p .03 vs. OR .75, p.02) or posterior circulation strokes (OR .59, p .013 vs. OR .58, p .01) had significantly lower rates of rHT and sICH. Both rHT and sICH are independently associated with poor functional outcomes (OR .5, p<.001; OR .29, p .006).

Conclusion:
Compared to posterior circulation, anterior circulation strokes have higher rates of rHT and sICH. Baseline hyperlipidemia is protective for rHT or sICH post MT and this association needs further study. Clinical severity of stroke, poor ASPECTS on admission and higher thrombectomy attempts are associated with higher rates of rHT or sICH. Both rHT and sICH are independently associated with poor functional outcomes.
Abstract TP247: A Comparison of Time to Treatment Between an Emergency Department-Focused Stroke Protocol and Mobile Stroke Units
Authors: Mangasarian Paul H , Keenan Kevin J , Hemphill J C , Kim Anthony S , Madhok Debbie Y
Published: June 2021

Background:
San Francisco is a relatively compact city with a population of 884,000 and nine stroke centers within a 47 square mile area. Emergency medical services (EMS) transport distances and times are short and there are currently no mobile stroke units (MSUs).

Methods:
We evaluated EMS activation to CT (EMS-CT) and EMS activation to thrombolysis (EMS-TPA) times for acute stroke in the first two years after implementation of an emergency department (ED)-focused, direct EMS-to-CT protocol entitled “Mission Protocol” (MP) at a safety net hospital in San Francisco and compared our performance to published reports from MSUs. EMS times were abstracted from ambulance records. Geometric means were calculated for MP data and pooled means were similarly calculated from published MSU data.

Results:
From July 2017 through June 2019, a total of 423 patients with suspected stroke were evaluated under the MP, and 166 of these patients were ultimately diagnosed with ischemic stroke. EMS and treatment time data were available for 129 of these patients with 60 patients (47%) receiving IV-tPA with mean EMS-CT and EMS-TPA times of 41 minutes (95% CI 39-43) and 64 minutes (95% CI 58-70), respectively. The pooled estimates for MSUs suggested a mean EMS-CT time of 35 minutes (95% CI 27-45) and a mean EMS-TPA time of 48 minutes (95% CI 39-60). MSUs achieved faster EMS-CT and EMS-TPA times (p<0.0001 for both).

Conclusions:
In moderate-sized, urban settings with high population densities, our protocol was able to achieve EMS activation to treatment times that were comparable but ultimately slightly slower than published performance data from MSUs.
Abstract TP254: A Comparison of Models for Evaluation and Transfer of Patients With Suspected Large Vessel Occlusions
Authors: Jauch Edward C , Bhuva Parita , Schneider Alexander T , Thurman Jason , Tooley Ameran , Lewis Joshua , McCarthy Kathryn , Philpot Debra , Jones Robin , Yoo Albert , Frei Donald
Published: June 2021

Introduction:
Mechanisms for the hospital identification of patients with suspected large vessel occlusions (LVO) vary widely based on referring and receiving stroke center resources. We compared processes for identifying patients with suspected LVO who may be candidates for endovascular therapy (EVT) at non-EVT hospitals and the criteria for interfacility transport to Comprehensive Stroke Centers (CSC) for potential EVT.

Methods:
Data were obtained from 4 CSC which serve distinct geographic regions, ranging from rural to urban environments, over a continuous 12 month period of time beginning year 2018. Patients transferred from all referring hospitals to these facilities were considered regardless of hospital affiliations (n=2213). Geographic description, imaging modalities and form of emergent neurologic consultation available and utilized, rates of stroke transfers for EVT, and rates of final EVT were recorded.

Results:
The process for identifying a patient with a likely LVO appropriate for interfacility transfer varied greatly by referring and receiving hospital (table). The intensity of referring hospital evaluation ranged from complete multimodal CT imaging and either onsite or video telestroke consultation with access to neuroimaging to simple noncontrast CT and telephone consultation. Rates of transfer and eventual EVT varied across the centers. Further details of the form of stroke expertise, penumbral imaging criteria, unique geographic variances, criteria for transfer, and final utilization of EVT will be presented.

Conclusions:
Optimal interfacility transfer procedures are essential to ensure patients with LVO are considered in a timely fashion, and that over triage does not overwhelm receiving CSC. We found significant process variations in identifying EVT candidates for interfacility transfer. Providing examples of multiple best practices allows for other centers to identify potential solutions for their unique circumstances.