bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP4: Higher Pretreatment Computed Tomography Angiography Source Image (CTA-SI) ASPECTS Score Predicts Better Outcome After Intra-arterial Therapy
Authors: George Pravin , Wisco Dolora , Man Shu-mei , Uchino Ken , Cheng Ching Esteban , Rasmussen Peter , Tateishi Yohei , Aoki Junya , Hussain Muhammad S
Published: July 2021

Introduction:
Intra-arterial (IA) therapies are becoming prevalent in acute stroke management. Despite greater success rates of recanalization and newer IA therapies, outcomes have shown mixed improvements. Patient selection remains a key element in targeting those who are more likely to benefit from therapy. The Alberta Stroke Program Early CT Score (ASPECTS) is a 10-point quantitative topographic computed tomography (CT) scan score that has been used to estimate the size of cerebral infarction. The relationship between CTA-SI ASPECTS on IA therapy outcomes in acute stroke patients has not been reported.

Hypothesis:
Higher CTA-SI ASPECTS scoring in IA therapy patients will yield favorable 30-day outcomes.

Methods:
All patients with acute stroke who underwent CT, CTA and IA therapy between July 2006 and June 2012 were included in this study. Demographic, radiological and clinical data including admission NIHSS and 30 day modified rankin score (mRS) was collected. 30-day data was pooled into an mRS of 1-3 marking favorable outcome and 4-6 marking unfavorable outcome. CTA-SI ASPECT scores were binned into one of three scoring groups: 8-10, 5-7 and 1-4. Data were analyzed by t-test and chi-square.

Results:
Eighty one (41 females, mean age 69.1 +/- 15 years) patients underwent CT, CTA and IA therapy and had a 30-day mRS assessment. Mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 15.6 (+/- 6.7). 10 patients had a CTA-SI ASPECT score of 1-4, 32 had a score of 5-7 and 39 had a score of 8-10. All 10 with a CTA-SI ASPECT score of 1-4 had an unfavorable outcome after IA therapy. 3 patients (9.38%) with a score of 5-7 and 13 patients (33.33%) with a score of 8-10 had a favorable outcome after IA therapy. Patients with higher CTA-SI scores were more likely to have a better outcome at 30 days after IA therapy (LR 10.95, p< .004).

Conclusions:
This study suggests that patients with higher CTA-SI ASPECT scores have more favorable outcomes after IA therapy. Further studies are needed to assess the clinical benefit of using CTA-SI ASPECTS as a selection tool for IA therapy.
Abstract TMP55: Circulating MicroRNA Expression Pattern in Acute Stroke
Authors: Moon Jangsup , Kim Jeong Min , Jung Keun-Hwa , Chu Kon , Lee Soon-Tae , Ban Jae-Jun , Huh Ji-Young , Roh Jae-Kyu
Published: July 2021

Background:
MicroRNAs (miRNA) are short sequenced non-coding RNAs that control gene expression by post-transcriptional RNA silencing. Recent studies reported that circulating miRNA can be detected in various disease models such as cancer and myocardial infarction. In this study we examined the expression level of circulating miRNA in acute ischemic stroke patients.

Methods:
Between August 1st 2011 and March 31st 2012, those patients who admitted due to acute cerebral infarction were included. We determined to measure five miRNA candidates including miR-17, 21, 106a, 126, and 200b, which are related with atherosclerosis and vascular injury from previous studies. We obtained 5 ml of venous sample from each patient after informed consent and reviewed clinical variable and laboratory data. The expression level of miRNA was calculated by quantitative real-time PCR. The patients without acute stroke were compared as control.

Results:
Total of 108 patients was included in the study and 75 patients were diagnosed as acute ischemic stroke. Acute stroke patients showed higher level of circulating miR-17 level than control patients, which was confirmed by multiple logistic regression analysis including age, gender, systolic blood pressure, diabetes mellitus, and white blood cell count (p=0.018, odds ratio=2.149, confidence interval=1.142-4.046). The level of miR-126 was correlated with the degree of atherosclerosis on brain MR angiography (r=0.319, p=0.001). Among the stroke subtypes, cardioembolic stroke patients had lower level of miR-126 than non-cardioembolic patients (p=0.015).

Conclusion:
This study shows that circulating miR-17 was increased after acute ischemic stroke and miR-126 level was related to atherosclerosis. These miRNAs might serve as potential markers of cerebral infarction pathogenesis and warrants further investigation.
Abstract TMP58: A Simple Score to Assess the Risk of Paroxysmal Atrial Fibirillation in Acute Ischemic Stroke Patients
Authors: Yoshioka Kotaro , Watanabe Kosuke , Hidume Masaki , Kanazawa Toshiro , Ishibashi Satoru , Tanaka Hiroaki
Published: July 2021

Introduction:
Paroxysmal atrial fibrillation (PAF) is an important risk factor for ischemic stroke and has similar risk to permanent atrial fibrillation (AF), but detecting PAF is challenging. Holter ECG has a low sensitivity. Continuous ECG monitoring and implanted event recorders are high cost and inconvenient for elderly patients. Identifying patients at a particularly high risk of PAF by using scores may represent a reasonable alternative. We aimed to elucidate a clinical profile of patients with PAF including those risk factors by multiple variable analysis and create a score to detect patients with PAF.

Methods:
Consecutive patients with acute ischemic strokes from 2010 to 2011 were prospectively analyzed. We excluded patients with permanent AF. All patients without permanent AF had 24-hour Holter ECG and ECG monitoring on the ward within 7 days. Collected data included demographic data, clinical data including history of irregular rhythm or antiarrhythmic agent and transthoracic echocardiography data. PAF was documented by review of medical history, baseline ECG, ECG monitoring and Holter ECG.

Results:
We studied 197 stroke patients and excluded 45 (23%) patients with permanent AF. Thirty-five (23%) of 152 patients had PAF. Univariate analyses revealed that older age (p = 0.008), arrhythmia history (p <0.0001), higher brain natriuretic peptide (BNP) (p <0.0001) and left atrial dilatation (p = 0.007) were significantly associated with documented PAF more than without documented AF. Arrhythmia history (OR 11.4, 95% CI 2.4-54.0), BNP ≥ 85 pg/ml (OR 24.2, 95% CI 6.8-86.1) and left atraial (LA) diameter ≥ 40 mm (OR 3.3, 95% CI 1.1-9.5) were significantly independent predictive factors of PAF by logistic regression analysis. We calculated a score (BNP [≥ 150 pg/ml:3 point, 149-85 pg/ml:2], arrhythmia history[yes:2] and dilatation of LA [≥ 40 mm:1]. The area under the ROC curve for the documented PAF group was 0.908 and a total score ≥ 3 had a sensitivity of 83% and a specificity of 87%.

Conclusions:
In acute ischemic stroke patients without permanent AF, patients with documented PAF had significantly more history of arrhythmia, higher BNP and LA dilatation than those without documented AF. The new score can be useful to identify individuals at high risk of PAF.
Abstract TMP63: Accuracy of Remote Video Cellphone Evaluation of Stroke Deficits Using California Brief Stroke Scale
Authors: Ali Latisha K , Starkman Sidney , Avila Gilda , Rao Neal M , Fiaz Rana , Smith Hannah , Saver Jeffrey L
Published: July 2021

Background:
Availability of 4G cellular network and video cellphone handsets may allow mobile videophone assessment to be employed in prehospital stroke care. The California Brief Stroke Scale (CABSS) is a 4 item scale designed as a mobile videophone test to evaluate a prehospital telemedicine instrument to rate stroke severity. Potential uses include identifying patients who are likely harboring persisting large vessel occlusions and to characterize baseline deficits prior to enrollment in prehospital trials.

Methods:
One bedside and one remote CABSS score were independently obtained on 15 ischemic stroke patients with persistent neurologic deficits. The bedside examination was performed by a stroke neurologist. The remote examination was performed by a second stroke neurologist through mobile video phone. A CABSS score of 1 or higher (scale 0-7) was an index of global stroke deficit severity. Kappa coefficients were calculated for concordance between bedside and remote scores.

Results:
The median National Institutes of Health Stroke Scale score was 6 (interquartile range IQR 4-10). On average the CABSS score evaluation took 25 seconds to perform. The median video CABSS was 2, (IQR1-3) and median bedside CABSS was 3, (IQR 1-3). Based on weighted K coefficients, cortical findings (aphasia, gaze deviation/hemineglect) displayed excellent agreement κ=1 (95% CI 1.0) and non-cortical findings (facial droop, arm drift) displayed substantial agreement κ =0.7 (95% CI 0.4-1.0). There was substantial agreement between bedside and remote methods for the total CABSS κ 0.68 (95% CI 0.44-0.92). The CABSS scores obtained by bedside and remote methods were strongly correlated (r= 0.85, P<0.0001).

Conclusion:
Our prospective study found that mobile videocell phone evaluation using CABSS is a feasible and reliable means of examining hyperacute stroke patients in the field. A physician can rapidly perform an audiovideo examination to increase the accuracy of prehospital identification of patients harboring persisting large vessel occlusions and characterize baseline deficits prior to enrollment in prehospital clinical trials to a clinically important degree.
Abstract TMP8: Post-thrombolysis Changes in DWI Lesion Volume and Correlation with Good Clinical Outcome
Authors: Luby Marie , Warach Steven , Merino José G ,   on behalf of the LESION investigators
Published: July 2021

Objectives and Hypothesis:
Studies investigating the change of the DWI volume after thrombolysis have not demonstrated a consistent correlation with clinical outcome. Our objective was to quantify the DWI change at 2 hours and compare to the change in NIHSS in a large homogeneous stroke patient population. Our hypothesis is that patients with a decrease in DWI volume at 2 hours have a better clinical outcome compared to patients with no decrease.

Methods:
Patients were selected from the Lesion Evolution of Stroke and Ischemia On Neuroimaging (LESION) Project if they: had a pre-treatment MRI with evaluable DWI, were treated with standard IV-tPA, and had post-treatment MRI with evaluable DWI at 2 and 24 hours. A reader measured the DWI volumes using a validated technique. A vascular neurologist scored the NIHSS at pre-treatment, 2 and 24 hours and the mRS at discharge, 5, 30 and 90 days. The Chi-Squared, independent samples median and Mann-Whitney U tests were used to demonstrate differences between groups.

Results:
Seventy-one patients met the study criteria with a mean (±SD) age of 71.6 (±16.4) years, 58% women (n=41), median baseline NIHSS of 9 (IQR25-75: 4-18), median onset of 45 minutes (30-65) and median first MRI to start of thrombolysis of 47 minutes (39-59). The median pre-treatment and 2 hour DWI volumes were 8.4 ml (2.1-51.5) and 11.4 (3.6-54.7). Sixteen patients (23%) had a decrease in DWI volume > 2 ml at 2 hours versus 55 (77%) had an increase or no change at 2 hours (p=0.000). Of the 16 patients with a decrease in DWI volume > 2 ml at 2 hours, 10 (63%) had a mRS=0 or 1, while 20 (36%) of the 55 patients with no decrease had a mRS=0 or 1 (p=0.192). Limiting the analysis to the 43 patients with a pre-treatment DWI lesion ≥ 5 ml, there was a significant difference in mRS between the 15 patients with a decrease in DWI volume > 2 ml at 2 hours versus the 28 patients with no decrease, median of 1 versus 4, (p=0.014). There was also a significant difference in mRS distribution between these groups, (0-3 versus 2-6, p=0.008).

Conclusions:
In patients with a substantial pre-treatment DWI lesion volume, the decrease of DWI volume at 2 hours post-thrombolysis is a significant predictor of good clinical outcome.
Abstract TMP82: Increased Intracerebral Hemorrhage During Acute and Chronic Hypertension in Alzheimer's Transgenic Mice
Authors: Cribbs David H , Passos Giselle , Vasilevko Vitaly
Published: July 2021

Hypertension is a major risk factor for intracerebral hemorrhage (ICH), and the accumulation of amyloid-beta (Aβ) in the cerebrovascular system, cerebral amyloid angiopathy (CAA), is also a significant risk factor for intracerebral hemorrhage ICH. Currently, there are no animal studies demonstrating a direct involvement of hypertension in the accumulation of Alzheimer’s disease-like pathology. To address this issue we have developed several mouse models that combine hypertension protocols with amyloid precursor protein (APP) transgenic mice (Tg2576), which accumulate significant CAA in the large cerebral vessels and the meninges by 18 months of age. The goal of this study was to determine the effect of acute and chronic hypertension on ICH in wildtype and a transgenic mouse model overexpressing a mutant human amyloid precursor protein (Tg2576 mice) associated with early onset AD and CAA. Fifteen-month-old Tg2576 mice and non-transgenic (nTg) littermates were treated with an angiotensin II (AngII) infusion (1000 ng/kg/min) and L-NAME (100 mg/kg/day) in drinking water to produce chronic hypertension. One week later, transient acute hypertension was induced by daily AngII injections (0.5 μg/g, s.c., twice daily) to produce ICH. A similar increase in mean blood pressure was observed in Tg2576 and nTg mice when evaluated 2 weeks after initiation of treatment. However Tg2576 mice had a higher incidence of signs of stroke compared with nTg littermates (P > 0.05). These data suggest that the accumulation of Aβ in the brain has an important role in development of ICH. Moreover, there was robust glial activation and increase in CAA in the gray matter of Tg2576 mice showing that hypertension may affect gray as well as white matter in the brain. Further studies may provide insights into the hypertension-induced changes in the cerebral vascular system that initiated the increase in CAA. The accumulation of Aβ in the cerebrovascular system is a significant risk factor for intracerebral hemorrhage (ICH), and has been linked to endothelial transport failure and blockage of perivascular drainage. While management of hypertension and atherosclerosis can reduce the incidence of ICH, there are currently no approved therapies for attenuating CAA.
Abstract TP103: Brain Protection Effect By Exposure To Hydrogen Sulphide In Cerebral Infarct In Rat
Authors: Henriques Isabel , Gutiérrez-Fernández María , Rodríguez-Frutos Berta , Ramos-Cejudo Jaime , Ferro José , Díez-Tejedor Exuperio
Published: July 2021

Introduction:
Hydrogen sulphide (H2S) can regulate oxygen consumption by competing with O2 in binding to cytochrome C oxydase. At micro molar concentrations H2S interferes with antinecrotic and antiapoptotic mechanisms, including up regulation of cytoprotective genes. We studied the effect of H2S exposure on lesion and functional recovery after permanent middle cerebral artery occlusion (pMCAO) in rats.

Methods:
Young adult male and female Sprague- Dawley rats distributed into three groups: 1- Sham (control for craniotomy); 2-Control: Surgery + permanent MCAO; 3- Treated: Surgery + permanent MCAO + inhalation of 40 ppM hydrogen sulphide. We analyzed functional outcome (Rogers modified scale), lesion volume by MRI at 24h and 14 day and by hematoxyline-eosin, cell death by TUNEL, repair markers implicated in brain plasticity (cellular proliferation by BrdU, GFAP (glial fibrillar acis protein), VEGF (vascular endothelial growth factor), Synaptophysine) by western-blot and immunofluorescence at 14 days. Rats were sacrificed at day 14th.

Results:
Treated animals showed a benefit in functional outcome both at 24h (p = 0,004445) and sacrifice day (p = 0,000942). We observed a decrease in infarct size at day 14th on MRI (p= 0,0383 ) and in Hematoxyline Eosine infarct areas (p= 0.026672 ). At 24 hours there was no statistical difference on MRI (p= 0,380644). TUNEL analysis showed a decrease in the expression of marked cells in the perinfarct zone of treated animals (p= 0,048877). We did not observe significant differences in cellular proliferation (BrdU), GFAP, VEGF and synapthophysin levels between control and treated groups.

Conclusions:
Exposure to hydrogen sulphide in rats with cerebral infarct was effective in functional recovery associated to brain protection mechanisms with reduction in size volume and cell death and may be associated with reperfusion increased but not in repair effects.
Abstract TP119: Recurrent Thromboembolic Events After Ischemic Stroke in Patients with Cancer
Authors: Merkler Alexander , Singer Samuel , Cheng Natalie T , Stone Jacqueline B , Kamel Hooman , DeAngelis Lisa M , Navi Babak B
Published: July 2021

Background:
Cancer often causes hypercoagulability, leading to venous and arterial thromboembolic events such as stroke. The rate and type of recurrent thromboembolic events (RTE) in cancer patients after stroke is unknown.

Methods:
We retrospectively identified consecutive patients with active cancer diagnosed with acute ischemic stroke by MRI at Memorial Sloan-Kettering Hospital from 2008 to 2010. Study neurologists collected demographic and clinical data using a standardized abstraction tool, and reviewed all electronic records after patients’ index stroke for the primary composite outcome of RTE, defined as any recurrent ischemic stroke, TIA, MI, systemic artery thrombosis, DVT, or PE. Kaplan-Meier statistics were used to calculate the cumulative rate of RTE and recurrent ischemic stroke; follow-up was censored when patients experienced an outcome or died. In an exploratory analysis, bivariate Cox proportional hazard analysis was used to compare rates of RTE on anticoagulation compared with antiplatelet agents.

Results:
Acute ischemic stroke was diagnosed in 119 patients with active cancer (mean age 66 [SD 13]; 49% women) during the study period. Patients’ underlying cancer was usually a carcinoma (83%) and was advanced (systemic metastases in 74%). Using TOAST criteria, stroke mechanisms were classified as 16% large artery atherosclerosis, 21% cardioembolism, 6% small vessel, 4% of other determined cause, and 53% of undetermined etiology. Despite a very short median survival in these patients (85 days [IQR 24-495 days]), RTE were diagnosed in 37 (31%), consisting of 16 DVTs, 12 recurrent ischemic strokes, 3 PEs, 2 MIs, and 2 systemic artery thromboses. Kaplan-Meier cumulative rates of RTE were 20% at 1 month, 29% at 3 months, and 31% at 6 months, while cumulative rates of recurrent ischemic stroke were 7% at 1 month, 15% at 3 months, and 15% at 6 months. There was no significant difference in event rates on anticoagulation compared with antiplatelet agents (HR=1.2, 95% CI 0.5-2.8).

Conclusions:
The short-term risk of RTE and recurrent ischemic stroke in patients with active cancer and ischemic stroke is substantial.
Abstract TP146: Impaired Acute Collateral Flow Dynamics Experimental Stroke In Type 2 Diabetic Mice
Authors: Akamatsu Yosuke , Lee Chih C , Wang Ruikang K , Liu Jialing
Published: July 2021

Introduction:
Type 2 diabetes mellitus (T2DM) is a major risk factor for stroke, yet it is unclear whether T2DM associated-poor outcome after stroke is related to unfavorable cerebral blood flow dynamics. The current study aimed to investigate the effect of T2DM on acute blood flow dynamics and stroke outcome.

Methood:
Adult male db/db and db/+ mice (8-9 weeks of age) were subjected to permanent distal middle cerebral artery occlusion (pMCAo). Neurologic deficit was assessed with a 5-point scoring system (0 to 4) and infarction volume was determined at 48 hours after pMCAo by TTC staining. Hemodynamics was evaluated by laser doppler flowmetry. The number of connecting collateral vessels, functional microvascular network morphology, and vessel area density of the ischemic hemisphere were determined by DiI-labeling, and optical coherence tomography (OCT), respectively.

Results:
db/db mice had a higher baseline blood glucose level (341±39.7 vs. 172±26.5 mg/dl,
p
<0.01) and a larger infarct volume after pMCAO compared to db/+ mice (69.5±5.4 vs. 51.0±3.1 mm
3
,
p
<0.01). Neurologic deficit did not differ between groups at 2 hours after pMCAO, but was significantly worse in the db/db at 24 hours after pMCAo compared to db/+ mice (1.9±0.1 vs. 1.4±0.2,
p
<0.05), correlated with lower rCBF in the core of the MCA territory at 24 and 48 hours (10.9%±1.1 vs. 14.4%±0.8,
p
<0.05 and 9.5%±1.0 vs. 14.1%±1.2,
p
=0.01). Ipsilateral functional microvascular density as detected by OCT did not differ between groups at one hour after occlusion but was significantly lower in the db/db mice at 24 hr after pMCAo (
p
<0.05). However, we did not observe a significant difference in the number of connecting collateral arteries between groups at 48 hours after pMCAo in this age group.

Conclusion:
Our results demonstrate that T2DM is associated with lower rCBF and lower density of functional blood vessels during the acute phase of pMCAo, which might in part, contribute to the observed worse outcome in the db/db mice. Ongoing experiments will investigate whether T2DM affects the flow dynamics in individual collateral following MCA occlusion and outward remodeling of the collateral vessels.
Abstract TP149: Moyamoya Disease in Pregnancy: Protective Effect of Cerebral Revascularization via Pial Synangiosis
Authors: Lin Ning , Donoho Daniel A , Yecies Derek , Scott R. Michael , Smith Edward R
Published: July 2021

Introduction:
Pregnancy, labor and delivery may lead to hemodynamic changes that could cause neurologic complications in patients with moyamoya disease (MMD). We reviewed an operative series of moyamoya patients treated by pial synangiosis from 1985 to 2012 to identify those patients who became pregnant in an attempt to determine the safety of pregnancy in this group of patients.

Methods:
Clinical and radiographic records of all adult moyamoya patients treated at a single institution from 1985 to 2012 were retrospectively reviewed.

Results:
From 1985-2012, 8 pial synangiosis surgeries were performed on 5 women with moyamoya disease before or during pregnancy. The mean age at surgery was 16.2. Four patients presented with stroke and one with transient ischemic attacks. Pre-operative Suzuki grade was III or higher in all treated hemispheres. Post-operative angiogram was available in 3 patients (5 treated hemispheres), and all demonstrated good collateral formation (Matsushima grade A or B). Clinical follow-up was available for an average of 13.0 years (range 1-22.0 years). The mean duration from surgery to delivery was 9.4 years; one patient was diagnosed with MMD during pregnancy and was operated at 4 months gestation. All women experienced successful pregnancy outcome: three had normal vaginal delivery and two underwent Caesarean section. Post-pregnancy stroke occurred on the contralateral hemisphere in one patient originally treated with unilateral moyamoya. This patient was found to have developed MMD on the other hemisphere and underwent additional revascularization. No other complications were observed during the follow-up period.

Conclusions:
Women with moyamoya disease can go through pregnancy safely and successfully after adequate cerebral revascularization.
Abstract TP161: Evaluation Of On-treatment Platelet Reactivity During Carotid Artery Stenting Using The VerifyNow System
Authors: Maruyama Daisuke , Takagi Toshinori , Takada Shigeki , kanamaru Hideki , Ishii Daizo , Kobayashi Norikata , Itho Kaname , Morita Kenichi , Satow Tetsu , Kataoka Hiroharu , Iihara Koji
Published: July 2021

OBJECTIVE:
We evaluated the correlation between point-of-care measurement of on-treatment platelet reactivity and postoperative thromboembolic events in patients undergoing carotid artery stenting (CAS) for atherosclerotic carotid artery stenosis.

METHODS:
Thirty patients receiving dual antiplatelet treatment, including clopidogrel, before CAS were prospectively enrolled. On-treatment platelet reactivity was measured within 24 h before CAS using both the VerifyNow P2Y12 and aspirin assays and light transmittance aggregometry (LTA) with ADP (LTA-ADP) and collagen (LTA-collagen) as the agonists. The endpoint was defined as the detection of acute ipsilateral ischemia on diffusion-weighted imaging (DWI) within 72 h after CAS. Cut-off values for high on-treatment platelet reactivity were established by receiver operating characteristic curve analysis.

RESULTS:
A significant correlation was observed between VerifyNow P2Y12 reaction units (PRUs) and LTA-ADP and between VerifyNow aspirin reaction units (ARUs) and LTA-collagen. Small abnormalities were observed on DWI in 9 patients (30.0%), and transient ischemic attack was found in 2 (6.67%). Patients with ischemic events had significantly higher mean pre-CAS PRU values (286.42 ± 85.95 vs. 195.28 ± 90.05; p = 0.027) and lower mean pre-CAS PRU percent inhibition (11.71 ± 12.40 vs. 41.52 ± 22.51; p = 0.0027) than those without ischemic events. In the univariate analysis of the endpoint, 4th quartile PRU values (risk ratio [RR]: 3.0; 95% confidence interval [CI]: 1.00-8.92; p = 0.0533), 1st quartile PRU percent inhibition (RR: 6.33; 95% CI: 1.57-25.42; p = 0.0021), and 4th quartile LTA-ADP (RR: 3.06; 95% CI: 1.17-8.00; p = 0.0341) were found to increase the risk of abnormality detection on postprocedural DWI. The optimal cut-offs for high on-treatment platelet reactivity were 264 for pre-CAS PRU values (area under the curve [AUC]: 0.82; 95% CI: 0.65-0.99), 29 for PRU percent inhibition (AUC: 0.89; 95% CI: 0.77-1.01), and 38 for LTA-ADP (AUC: 0.80, 95% CI: 0.67-0.98).

CONCLUSION:
This study indicates that the new point-of-care VerifyNow P2Y12 assay might help identify patients who are at higher risk for thromboembolic events after CAS.
Abstract TP172: Analysis of Stroke Risk and Risk Factor Awareness in Samoa
Authors: Trupe Lydia A , Lameko Viali
Published: July 2021

Background:
The prevalence of stroke in Samoa is extremely high due to high rates of risk factors such as obesity, hypertension, and diabetes. Stroke remains the leading cause of death in Samoa. We hypothesized that poor knowledge of stroke risk factors and warning signs contributes to high stroke prevalence in Samoa, such that widespread dissemination of information might induce lifestyle changes (e.g. diet and exercise) and cause more people to seek treatment for stroke.

Methods:
We enrolled a series of English-speaking Samoan adults age 25- 65 (mean=45) on the Tupua Tamasese Meaole Hospital inpatient service from January to April, 2012. Because they were inpatients, they tended to be at a higher stroke risk than the general population. Detailed interviews were conducted regarding knowledge of stroke risk factors and warning signs and assessment of personal stroke risk. Participants’ cerebrovascular risk was categorized as high, moderate or low based on their risk factors. Participants were informed of their stroke risk, ways to reduce stroke risk, warning signs and what to do in the event of stroke.

Results:
Of 19 adults interviewed, 8 were categorized as “high risk”, 3 as “moderate risk” and 8 as “low risk.” Participants were able to name a mean of 0.74 risk factors for stroke and mean of 1.2 warning signs. 21% incorrectly named stress as a common risk factor. The most common risk factors correctly named were obesity/unhealthy diet (23.8%) and diabetes (15.8%). There was no association between stroke risk classification and participant’s belief that they were at risk of stroke (chi square=1.6; ns); 50% of high-risk participants and 25% of low risk patients believed they were at risk of having a stroke. High-risk participants, compared to low-risk participants, had a slightly higher knowledge of both stroke risk factors (mean=1 vs. 0.25) and warning signs (2 vs. 0.63).

Conclusion:
In Samoa, knowledge of stroke risk factors and warning signs is very low. It is likely that many Samoans receive health information after developing medical conditions; thus, high-risk individuals tend to have slightly higher knowledge. We aim to conduct a larger study with follow-up interviews to determine the impact of education.
Abstract TP178: Walk Score and Risk of Ischemic Stroke Among Town Residents
Authors: Adil Malik M , Suri Mariam , Rahim Basit , Gilani Sarwat I , Qureshi Adnan I
Published: July 2021

BACKGROUND:
Regular physical activities, including light-to-moderate activities, such as walking, have well-established benefits for reducing the risk of ischemic stroke. It remains unknown whether certain area characteristics can influence the risk of stroke through promoting such activities.

OBJECTIVES:
We tested the hypothesis that how walkable an area is will be negatively associated with the risk of ischemic stroke in persons residing in the area.

METHODS:
We calculated the age- adjusted annual incidence rates of ischemic stroke among residents in each of the 63 cities in Minnesota between 2007 and 2011. The walk score, an online database, provides a numerical walkability score for any location within the United States, ranging between 0 and 100 that is computed by using exclusive algorithms. The route to amenities is sorted into nine different categories: grocery, restaurants, shopping, coffee, banks, parks, schools, books, and entertainment, which are weighed according to their prominence.

RESULTS:
There are 2,901,389 persons residing in 63 cities in Minnesota (average population per town is 46053). The average walk score of the 63 towns in Minnesota was 37, ranging from 14 to 69. The average median age of residents was similar in tertiles of towns based on walk score as follows: ≤25 (n=9) 36 years; 26-50(n=46) 36 years; and 51-100(n=8) 34 years. The age adjusted incidence of ischemic stroke was similar in tertiles of towns based on walk score as follows: ≤25 (n=9) 2157 per 100,000; 26-50(n=46) 1924 per 100,000; and 51-100(n=8) 2856 per 100,000 residents. The correlation between age adjusted ischemic stroke incidence and walk score was low (R2=0.32) within Minnesota.

CONCLUSIONS:
The ready availability of indices such as walk score makes it an attractive option but currently such indices lack the sensitivity to measure the magnitude and health benefits of light-to-moderate activities performed within a town.
Abstract TP180: Markedly Elevated High-sensitive C-reactive protein (hsCRP) Predicts Early Mortality Among Stroke Patients
Authors: Itrat Ahmed , Alam Shazia , Walker Esteban , Katzan Irene
Published: July 2021

Background:
High-sensitive C-Reactive Protein (hsCRP) levels are correlated with risk of vascular disease and cardiovascular mortality. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood as they are often excluded from studies.

Objective:
To determine the association of very high admission hsCRP levels (> 10mg/L) on all-cause mortality in patients with acute stroke

Methods:
We performed a retrospective cohort study of patients admitted to our institution with acute stroke (8/2003- 11/2011) who had at least one hsCRP assay drawn < 7 days of stroke diagnosis. Mortality data was obtained using Social Security Death Index. Differences in survival were determined using Kaplan-Meier curves. Cox proportional analysis was used to determine hazard ratios of death among patients with hsCRP values > 10 mg/L after adjusting for age, sex, race and the following co-morbid conditions: cancer, atrial fibrillation, diabetes, hypertension, myocardial infarction

Results:
There were 293 stroke patients identified with hsCRP levels drawn < 7 days of stroke admission. Median age was 65.7 years (SD 15.3), and 55% were male. All-cause mortality was 18% (n=53) with a median follow-up of 2.2 years. Median hsCRP level was 5.5 mg/L, [IQR 1.8 - 14.6] with 31.7% patients having hsCRP > 10 mg/L. Patients with hsCRP > 10 mg/L had a 2.7 times higher risk of mortality than those with hsCRP < 10 mg/L (p=0.004). The increased risk was steepest in the first months after stroke (Figure). The only other significant variable affecting hazard for death was age; each year increased the hazard ratio by 3.3%. Of the cases in which cause of death was known (n=31), stroke was the most common cause (71%)

Conclusion:
Very high level of hsCRP (>10 mg/L) at the time of admission is associated with increased early mortality among patients presenting with acute strokes. This finding may help stratify risk of death in stroke.
Abstract TP196: New Zealand Workforce Stroke Incidence: Urban and Rural Risk Factor Evaluation
Authors: Buell Hope E , Metcalf Patricia , Exeter Daniel
Published: July 2021

This analysis aims to assess the impact of urban and rural risk factors on a model of stroke incidence in a New Zealand workforce population.

The New Zealand study consisted of 4,926 subjects prospectively enrolled at 46 worksites. The subjects were aged 40-78 years at baseline and had no prior history of stroke. This prospective study defines stroke events experienced by the study subjects during follow-up between 1988 and 2012 based on hospital admission coding. Proportional hazards regression models were fit using baseline characteristics. The difference in stroke outcomes for urban and rural worksites was also evaluated.

Results demonstrate that baseline demographic, physical exam, and behavioural measures impact stroke outcomes. While the baseline distribution of stroke risk factors such as Pacific Island ethnicity, smoking status, and increased blood pressure indicates a potentially higher risk of stroke in the rural population, the proportional hazards model does not identify increased stroke risk for rural workers. Additional analysis of the diet, exercise and Quality of Life measures for these subjects may provide further information into the stroke risk profiles of individuals working in different locales.
Abstract TP198: Combined Diet and Aerobic Exercise Reduces non-HDL-C in Adults: A Meta-Analysis of Randomized Controlled Trials
Authors: Kelley George A , Kelley Kristi S
Published: July 2021

BACKGROUND AND PURPOSE:
Non-high-density lipoprotein cholesterol (non-HDL-C) is associated with an increased risk for cerebrovascular disease. However, the effects of three community-deliverable lifestyle interventions [diet (D), aerobic exercise (E), or both (DE)] on non-HDL-C in adults are not known. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap.

METHODS:
A priori
study eligibility included randomized controlled trials >4 weeks that included a D, E, DE and control (C) group in adults >18 years of age in which data for total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were available for calculating non-HDL-C. Studies were retrieved by searching nine electronic databases, cross-referencing and expert review. Dual data selection and extraction were conducted. A mixed effects model was employed whereby a random-effects approach was used to combine effect size (ES) results within each subgroup while a fixed-effect approach was used to compare subgroups (Q
b
). Heterogeneity was examined using the Q and

I
2

statistics and 95% confidence intervals (CI) were also calculated. Statistical significance was set at
p
< 0.05 while a trend for statistical significance was set between
p
>0.05 to < 0.10.

RESULTS:
Overall, a statistically significant exercise minus control group decrease in non-HDL-C was found for DE (7 ESs, 389 participants, mean, -11.1 mg/dl, 95% CI, -21.7 to -0.6,
p
=0.04, Q=2.4,
p
=0.88,

I
2

=0%), a trend for the D group (7 ESs, 402 participants, mean, -8.5 mg/dl, 95% CI, -18.6 to 1.6,
p
=0.10, Q=0.76,
p
=0.99,

I
2

=0%) and no change for the E group (7 ESs, 387 participants, mean, 3.0 mg/dl, 95% CI, -7.1 to 13.1,
p
=0.56, Q=0.78,
p
=0.99,

I
2

=0%). Relative changes were -6.5%, -5.6%, and 0.8% respectively, for DE, D and E groups. Overall, no statistically significant between-group differences were found (Q
b
= 4.1,
p
= 0.12). There was a trend for decreases in non-HDL-C to be greater in the DE versus E group (Q
b
= 3.6,
p
= 0.06) with no statistically significant differences between D and E (Q
b
= 2.5,
p
= 0.12) or DE and D (Q
b
= 0.1,
p
= 0.72) groups.

CONCLUSIONS:
Combined DE reduces non-HDL-C in adults.
Abstract TP20: Longer Procedural Times Are Independently Associated with Symptomatic Intracranial Hemorrhage in Large Vessels Occlusion Stroke Patients Undergoing Thrombectomy
Authors: Kass-Hout Omar , Kass-Hout Tareq , Frankel Michael R. , Nahab Fadi , Belagaje Samir R. , Anderson Aaron A. , Yepes Manuel , Gershon Rafael , Sun Chung-Juan Johnny , Isakov Alex , Glenn Brenda A. , Tong Frank , Dion jacques , Nogueira Raul G. , Gupta Rishi
Published: July 2021

Background and Purpose:
Time to reperfusion is an essential factor in determination of outcomes in (AIS). We sought to establish the effect of the procedural time on the clinical and radiographic outcomes of AIS patients undergoing intra-arterial therapy.

Methods:
Retrospective review of a prospectively collected database of endovascularly treated large vessel AIS in a large academic center. Data from all consecutive patients who underwent mechanical thrombectomy from September 2010 to July 2012 were analyzed. The variable of interest was procedural time (defined as time from groin puncture to end of procedure). Outcome measures included the rates of symptomatic intracebral hemorrhage (sICH, defined as any parenchymal hematoma e.g. PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale, mRS 0-2) at 90 days.

Results:
The entire cohort included 242 patients with a mean age of 65.5+/- 14.2 and median baseline NIHSS 20. Of the patients 49.38% were females. The median ASPECTS score was 8. The mean procedure time was significantly shorter in patients with good outcome (86.73 vs. 73.13 respectively, P-value: 0.0228). However, after controlling for ASPECTS score, type of retrieval device, TICI score, volume of infarct, interval from symptoms onset to puncture, and co-morbidities, this association did not prove to be significant (P-value = 0.7101). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.65 vs. 104.5 respectively; P-value: 0.0319) which remained significant when controlling to the previous factors (OR = 0.974 with a 95 % CI of (0.957, 0.991). There was no correlation between the volume of infarction and the procedure time (r = 0.10996, P-value: 0.0984). There was no association between procedure time and 90-day mortality (77.8 vs. 88.2 minutes in survivals vs. deaths respectively; P-value: 0.0958).

Conclusion:
Our data support an association between the risk of SICH and a longer procedure time while no definite association between procedural times and the final infarction volume or long-term functional outcomes was found after adjustment for multiple imbalances.
Abstract TP200: Independent Contribution of HbA1c, Systolic Blood Pressure, and LDL Cholesterol Control to Risk of Ischemic Stroke Hospitalizations in Type 2 Diabetes
Authors: Nichols Gregory A , Parasuraman Shreekant , Joshua-Gotlib Sandra
Published: July 2021

Risk of ischemic stroke is approximately doubled in patients with diabetes. To reduce risk, managing diabetes includes optimizing glycemic, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) control. We studied which risk factors alone or in combination were most strongly associated with stroke hospitalizations.

We identified 26,924 Kaiser Permanente Northwest members with type 2 diabetes and no known prior cardiovascular disease hospitalization. Beginning in 2002, we identified the earliest point patients had glycosolated hemoglobin (HbA1c), systolic BP (SBP), and LDL-C measurements within 6 months of each other and followed them until they died, disenrolled, or 31 December 2011. Outcome was hospitalization with primary diagnosis of ischemic stroke. Using mean HbA1c, SBP, and LDL-C between baseline and end of follow-up, we identified dichotomous categories of control of HbA1c (<7%), SBP (<130 mm Hg) and LDL-C (<100 mg/dL) and estimated the relative risk of stroke hospitalization independently associated with all combinations of risk factors controlling for age, sex, diabetes duration, comorbidities, body mass index, smoking, and pharmacotherapy.

Mean (SD) age of patients was 59 (12) years; 50% were men. Over mean (SD) follow-up of 6.2 (2.8) years, 606 (2.3%) patients were hospitalized for ischemic stroke. Compared with patients with all 3 risk factors in control, patients who had no risk factors controlled or only HbA1c controlled had >2-fold increased risk of ischemic stroke. Patients who controlled both SBP and LDL-C had significantly lower risk relative to control of all 3 risk factors.

In this observational study, maintaining control of SBP over 6.2 years was essential to reduction of ischemic stroke risk. Simultaneous control of LDL-C further reduced risk, but HbA1c control <7% did not mitigate stroke risk beyond SBP and LDL-C control. Further research is needed to evaluate the relationship between HbA1c control and stroke risk.
Abstract TP203: New Onset Atrial Fibrillation Post Stroke
Authors: Sadighi Arezou , Cherin Samantha , Klutch Rochelle , Craig Sharon , Chatfield Fiona , Liebeskind David , Kim May , Ali Latisha , Valdes-Suerias Miguel , Conwit Robin , Hamilton Scott , Eckstein Marc , Pratt Frank , Stratton Samuel , Sanossian Nerses , Restrepo Lucas , Starkman Sidney , Saver Jeffrey ,   for the FAST-MAG Investigators and Coordinators
Published: July 2021

Background:
Atrial fibrillation (AF) makes a person five times more likely to experience a stroke. According to the National Stroke Association, atrial fibrillation accounts for about 15 percent of stroke. Many of these patients do not have any previous history of AF, and are diagnosed with this condition post-stroke. We sought to characterize the frequency and features of AF in stroke patients hospitalized after acute presentation, focusing on new diagnoses.

Methods:
All subjects were enrolled in the Field Administration of Stroke Therapy- Magnesium (FAST-MAG) clinical trial, a phase 3 NIH-funded study of pre-hospital Magnesium Sulfate vs. placebo for patients with symptom onset <2hours. General demographic information, past medical history, first electrocardiogram (ECG) in the emergency department (ED), and final diagnosis data were collected on consecutive subjects.

Results:
Of 1478 patients, 69 (4.7%) had no previous history of AF but were diagnosed with AF post-stroke onset. There were 274 cases with AF recorded on the ED ECG (274), only 36 (13.1%) had no documented history of AF. Patients in both groups were of similar age (age 81 vs 79 years) and had similar rates of ICH diagnosis (8.7 vs 7.1%). However, newly diagnosed patients had more severe strokes (median NIHSS 14 vs 10, p=0.008) and a lower burden of cardiac disease by history (coronary artery disease 15.9 vs 31.7%, and myocardial infarction 5.8 vs 15.9%). Female gender women (50.7 vs 48.2%) history of prior stroke (10.1 vs 8.8%), hypertension (89.9 vs 89.5%), and hyperlipidemia (56.5 vs 54.1%) were similar in both groups.

Conclusion:
Most new diagnoses of AF after stroke were made based on the ED ECG. Strokes in patients who would go on to have new AF diagnoses were more severe than those where AF diagnosis was already established, likely due to less likelihood of anticoagulation.
Abstract TP207: Baseline Characteristics And Functional Outcomes Of Pontine And Non-pontine Infarcts: On Behalf Of The Secondary Prevention Of Small Subcortical Strokes (SPS3) Investigators
Authors: Field Thalia S , Szychowski Jeff , Kase Carlos , Anderson David , Tapia Jorge , Bazan Carlos , Hart Robert , Benavente Oscar
Published: July 2021

BACKGROUND:
Pontine stroke accounts for 7% of ischemic infarcts and 25% are due to cerebral small vessel disease (CVSD). Risk factors and functional outcomes distinguishing pontine from non-pontine small vessel infarcts are not well-defined.

METHODS:
Data are from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Patients have MRI-proven small vessel infarcts. The analysis compared baseline characteristics, clinical features and functional outcomes of participants with pontine and non-pontine infarcts.

RESULTS:
Of 2871 participants, 634 (22%) had pontine infarcts. Pontine patients were more often male (69% vs 61%, p=0.0009), with history of hypertension (82% vs 73%, p<0.0001) and diabetes (45% vs 34%, p<0.0001). More Hispanics (38% vs 28%), Blacks (20% vs 15%), and fewer Whites (40% vs 54%, p<0.0001) had pontine infarcts. Pontine participants were more likely to have no white matter abnormalities (WMA) on MRI (13% vs 2%, p<0.0001). There was no difference in mean age (64 vs 63), presence of multiple infarcts (39% vs 40%), or rates of intra- (18% vs 16%) or extracranial (2% vs 3%) stenosis. Pontine infarcts had worse functional outcomes (mRS≤2 29% vs 23%, p<0.0001) and higher rates of MI on followup (1.1%/yr vs 0.5%, HR 2.2(1.3-3.7)). There was no significant difference for rates of stroke (2.5%/yr vs 2.6%) or all-cause mortality (2.2%/yr vs 1.6%) on followup. In a multivariable logistic regression model, significant differences persisted for gender (OR 1.4(1.1-1.8)), history of hypertension (1.6(1.2-2.1)) and diabetes (1.4(1.1-1.8)), white vs. black race (0.5(0.4-0.7)), and degree of WMA (moderate vs mild 0.6(0.5-0.9); severe vs mild 0.5(0.4-0.7)).

CONCLUSIONS:
Participants with pontine infarcts had distinct baseline characteristics from those with non-pontine infarcts. These differences suggest that a stroke mechanism distinct from conventional CVSD may be responsible for a majority of pontine infarcts and may help to target future therapeutic strategies.
Abstract TP209: Time Of Stroke Onset Is Not Associated With Risk Of Obstructive Sleep Apnea In Intracerebral Hemorrhage.
Authors: Molano Jennifer Rose V , Koch Sebastian , Langefeld Carl , Woo Daniel
Published: July 2021

Objective:
To test the hypothesis that risk status for obstructive sleep apnea (OSA) is associated with time of onset in intracerebral hemorrhage.

Background:
OSA can affect 30-70% of patients with ischemic strokes, intracerebral hemorrhage and transient ischemic attacks. In normal sleep, blood pressure and heart rate decrease due to increased parasympathetic activity. In OSA, increased sympathetic activity during sleep can lead to a absence of this blood pressure fall. This non-dipping nocturnal blood pressure pattern has been associated with a shift in the timing of sudden cardiac death, from 7am-noon in those without OSA to 12am-6am in those with OSA. Whether this diurnal shift exists in intracerebral hemorrhage cases at high risk for OSA has not been studied.

Method:
A nested case control study within the interviewed case cohort from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study was performed. OSA risk status was categorized as “high-risk” based on a positive score in 2 out of 3 categories on the Berlin questionnaire, which ascertains snoring, daytime fatigue, body mass index and hypertension. Timing of intracerebral hemorrhage was categorized as “Nocturnal” based on a known time of stroke onset from 22:00pm to 06:00am and “Awake” based on a known time of stroke onset from 06:01am to 21:59pm.

Results:
Time of stroke onset was known in 434 subjects. The Berlin questionnaire categorized 54.2% of cases as high-risk for OSA. In comparison with low-risk subjects, high-risk cases tended to be younger (59.1±13.7 vs. 61.8±15.7, p=0.05), male (48% vs 58%, p=0.03), have coronary disease (6% vs 11%, p=0.09), have diabetes (27% vs 18%, p=0.02), and have dyslipidemia (43% vs 30%, p=0.006). There were no ethnic differences in the prevalence of high risk for OSA (P=0.60). Nocturnal strokes were seen in 17% of high- and low-risk OSA cases. There was no statistically significant difference in OSA status and timing of stroke (p=0.98).

Conclusions:
OSA risk status was not associated with timing of hemorrhagic stroke. This finding suggests that a non-dipping nocturnal blood pressure pattern is not seen in intracerebral hemorrhage cases at high-risk for OSA.