bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP79: Magnetic Resonance Imaging Elements Predict Incident Intracerebral Hemorrhage
Authors: Lyons John P , Germroth Matthew , Logue Lawson , Moore Shawn , Wasserman Bruce A , Graff-Radford Jonathan , Rosamond Wayne D , Sen Souvik
Published: February 2024

Introduction:
Incident intracerebral hemorrhage (ICH) is an uncommon medical event that can lead to devastating outcomes, including death. Small vessel disease (SVD), as measured by cerebral microbleeds (CMBs) and white matter hyperintensities (WMH), has been associated with risk factors and might be a predictor of incident ICH. CMBs result from irregularities in brain vessel structure due to chronic hypertension and cerebral amyloid angiopathy. These microhemorrhages are a possible risk factor for ICH.

Methods:
A cohort of ARIC (Atherosclerosis Risk in Communities) participants underwent 3T MRI at visit 5 (2011-2013). CMBs were assessed using a T2* gradient echo. CMBs are homogenous hypointense lesions ≤10 mm in diameter. WMH volumes were derived from FLAIR images using an automated program to measure the volumetric burden of leukoaraiosis. During 10 years of follow-up, incident ICH was noted in 7 (0.4%) out of 1,656 participants were dichotomized based on the presence of CMB and the median of WMH volume.

Results:
ARIC subjects (n=1656, mean age=76±5 years; 40% men; 26% African American race) underwent MRI. CMBs were present in 385 (23.25%) patients out of 1656. ICH occurred in 0.16% and 1.30% of patients without CMBs and with CMBs, respectively. Kaplan Meier (KM) survival analysis between CMBs and ICH was significant (logrank p=0.002). Cox Regression yielded a significant crude hazards ratio (HR 8.7, 95% CI 1.7-44.7, p=0.010). Adjustment for age, gender, race, and hypertension was also significant (HR 9.9, 95% CI 1.9-52.0, p=0.07). KM survival analysis between WMH median (11.68 cm
3
) and ICH was significant (logrank p=0.006). Figure 1 displays the KM curves of those with and without CMBs and the incidence of ICH as well as those below and above WMH median and incidence of ICH.

Conclusion:
CMBs and WMH detected by MRI appear to be an important predictor for the occurrence of incident ICH. Further research is needed to observe if MRI could be used to screen subjects at high-risk for elevated risk of incident ICH.
Abstract TMP89: Thrombus Cellular Composition Predicts Unexpected Early Intracranial Reocclusion After Successful Mechanical Thrombectomy
Authors: Juega Jesus , Palacio Carlos , Requena Manuel , Rodriguez Maite , Rubiera Marta , Garcia-Tornel Alvaro , Rodriguez-Villatoro Noelia , Rodriguez-Luna David , Olive MArta , Muchada Marian , Rizzo Federica , Hernandez Morales David , de Dios Lascuevas Marta , Maria Hernandez , Dorado Laura , Quesada Helena , Cardona Pedro , Carolina DE la Torre , Ramon y Cajal Santiago , tomasello alejandro , Ribo Marc , Molina Carlos , Pagola Jorge
Published: February 2024

Introduction:
Our objective is to identify thrombus composition and related factors associated with unexpected early intracranial reoclussion ( EIR) after successful mechanical thrombectomy ( MT).

Methods:
Endovascular treatments of patients with acute intracranial or extracranial stenting were excluded. A total of 206 patients with successful reperfusion ( mTICI ≥ 2b) were included . Each intracranial thrombi obtained by MT were analyzed by Flow Cytometry analysis to provide proportion of main leukocyte composition: granulocytes, monocytes and lymphocyte populations. Thrombi analysis, antithrombotic treatment, etiology , reperfusion treatment features, neuroimaging and other baseline variables were analyzed to identify predictors of early reoclussion in the first 48 hours after thrombectomy .

Results:
EIT were observed in 5.8 %( 12/206) of successfully reperfused strokes. Patients with EIR were younger [ 67 years ( 47-80) vs. 76 years ( 66-84) ; p = 0.046] with lower basal NIHSS [ 17 ( 10-21) vs. 18 ( 11-21) ; p = 0.022]. Thrombi from patients with EIR had higher proportion of lymphocytes B [1.41 % ( 0.48-2.42) vs. 0.44 %(0.16-1.19) ;p = 0.018] in comparison to cases without reoclussion. Basilar artery occlusion ( BAO) [ 2 (15.4%) vs. 8 (4,3%) ; p 0.081 ] and active smoking [ 4( 30.8%) vs. 24 (12.4%) p =0.062] presented a positive trend with EIR cases . In the logistic regression analysis adjusted by age, previous use of intravenous fibrinolysis, number of endovascular passes , proportion of Lymphocytes B, BAO and active smoking , the independent predictor of early reoclussion was the proportion of Lymphocyte B in intracranial thrombus ( aOR 1.363 , 95% CI 1.060- 1.753).

Conclusions:
Rich B-Lymphocyte- Thrombus predicts unexpected early intracranial reoclusion after successful mechanical thrombectomy
Abstract TMP94: Association of Acute Carotid Stenting With Functional Outcome Mediated by Excellent Reperfusion in Tandem Lesions: Analysis of a Multicenter Registry
Authors: Rodriguez-Calienes Aaron , Galecio Castillo Milagros , Farooqui Mudassir , Hassan Ameer E , Jumaa Mouhammad A , Divani Afshin A , Ribo Marc , Abraham Michael G , Petersen Nils H , Johanna Fifi , Guerrero Waldo R , Malik Amer M , Siegler James E , Nguyen Thanh , Sheth Sunil , Yoo Albert J , Linares Guillermo , Janjua Nazli A , Quispe-Orozco Darko , Lu Yujing , Vivanco-Suarez Juan , Mokin Maxim , Yavagal Dileep R , Ortega-Gutierrez Santiago
Published: February 2024

Introduction:
Current evidence suggests that acute carotid artery stenting (CAS) for cervical lesions is associated with better functional outcomes in patients with acute stroke with tandem lesions (TLs) treated with endovascular treatment (EVT). However, a gap in understanding persists regarding the underlying causal pathophysiological mechanism of this relationship when compared to angioplasty alone. We aimed to determine whether, and to what degree, excellent reperfusion (mTICI 2c-3) mediates the relationship between acute CAS and functional outcome in patients with TLs.

Methods:
This sub-analysis stems from a multicenter cohort study of patients with anterior circulation TLs who underwent EVT across 16 stroke centers spanning from January 2015 to December 2020. Mediation analysis was conducted to examine the potential causal pathway in which the relationship between acute CAS and favorable functional outcome (90-day mRS 0-2) is mediated by excellent reperfusion.

Results:
A total of 512 patients were included, out of whom 319 (62.3%) underwent acute CAS, and 243 (47.5%) had a favorable functional outcome. Excellent reperfusion was a predictor of favorable functional outcome (adjusted OR [aOR]: 2.27, 95% CI 1.57-3.28,
p
=<0.001). Excellent reperfusion partially mediated the relationship between acute CAS and functional outcome (
Figure
), as acute CAS was still significantly associated with functional outcome after adjustment for excellent reperfusion (aOR: 1.56, 95% CI 1.07-2.28,
p
=0.022). Excellent reperfusion explained 53% (95% CI 24-87) of the relationship between acute CAS and functional outcome.

Conclusions:
In TL patients undergoing EVT, excellent reperfusion predicted favorable functional outcome when CAS was performed as compared to angioplasty alone. A significant proportion (53%) of the treatment effect of acute CAS on functional outcome was found to be mediated through the improvement of excellent reperfusion rates.
Abstract TMP95: Context Matters: Geographic Decision-Making Could Improve Prehospital Stroke Triage
Authors: Brown Grant , Seedorf Jacob , Vivanco-Suarez Juan , Zepeski Anne , Farooqui Mudassir , Perez de la Ossa Natalia , Ribo Marc , Saver Jeffrey L , Ortega-Gutierrez Santiago , Mohr Nicholas
Published: February 2024

Introduction:
Emergency medical services (EMS) play a key role in stroke outcomes, as triage decisions made under diagnostic uncertainty impact availability of time sensitive treatments. Quantifying both time varying effects and uncertainty allows for optimized algorithms to improve destination decisions for stroke patients. We developed a Bayesian model of neurological outcomes and an algorithm for hospital triage based on clinical trials data.

Methods:
We used data from Virtual International Stroke Trials Archive (VISTA), RACECAT, and FAST-MAG. To model prehospital diagnosis, we included patients with any stroke-like illness (ischemic/hemorrhagic stroke, and mimics). Primary outcome was 90-day modified Rankin scale (mRS). Due to variability in reported measures from each trial, model-based Bayesian imputation was used. Our model accepts time-from symptoms, location, and capability of all local hospitals as inputs.

Results:
We included 9048 participants with 8600 (95%) ischemic strokes, 1801 (20%) had large vessel occlusion, and 4064 (45%) had a 90-day mRS of 0-2 (good neurologic outcome). We evaluated the impact of our algorithm using 1,320 stroke events from RACECAT. The estimated median absolute difference in chance of good mRS score between bypass and non local hospital bypass was 2.3% (ranging from 0 to 7.4%) among 1,320 stroke events in the RACECAT data set; covariate-adjusted patient scenarios predicted a preference for local hospital bypass of -2.9% to 7.4%. Destination maps for Catalonia show important patterns of bypass optimality.

Conclusion:
We found that no uniform destination selection approach is likely to be optimal under all circumstances. This finding is important, because it suggests that a personalized approach considering diagnostic uncertainty, patient characteristics, and geospatial factors could outperform simpler approaches. Predicted time-to-treatment targets may be insufficient for appropriate system optimization.
Abstract TMP99: Risk of Stroke Recurrence and Silent Myocardial Infarction
Authors: Ridha Mohamed , McCullough Stephen , viscoli catherine , Kernan Walter N , Zhang Cenai , Kamel Hooman , Merkler Alexander E
Published: February 2024

Background:
Prior data suggest that unrecognized or silent myocardial infarction (MI) detected on routine ECG is associated with first-ever stroke, but the impact on stroke recurrence is unknown. We aimed to determine the association of silent MI with stroke recurrence in patients with recent ischemic stroke.

Methods:
We included all subjects with an index stroke and available baseline ECG enrolled in the Insulin Resistance in Ischemic Stroke (IRIS) trial. Clinical MI was defined as a prior hospitalization for MI. Silent MI was defined as ECG evidence of MI (Q wave or equivalent patterns) without prior hospitalization for MI. The primary outcome was recurrent stroke. Ischemic stroke and ischemic stroke subtype were assessed as secondary outcomes. Multivariate cox regression adjusted for age, sex, race, pioglitazone, and vascular risk factors was performed for analysis.

Results:
Of 2285 participants analyzed, prior clinical and silent MI were identified in 164 (7.2%) and 94 (4.1%) patients respectively. Over an average of 4.5 years, 209 recurrent strokes occurred with 191 classified as ischemic. In the fully adjusted model, silent MI was associated with stroke (HR 2.27, CI 1.33-3.88) and ischemic stroke (HR 2.08, CI 1.17-3.68) recurrence. Clinical MI was associated with stroke and ischemic stroke recurrence in the unadjusted analysis; however, the association was no longer significant after adjustment (all stroke: HR 1.31, CI 0.81-2.11; ischemic stroke: HR 1.42, CI 0.87-2.32). No association between silent MI and stroke subtype was significant.

Discussion:
Among patients with a recent ischemic stroke, silent MI is associated with stroke recurrence. Tailored secondary stroke prevention strategies in this population require future investigation.
Abstract TP104: Functional Prognostication of Patients Receiving Thrombolytics in Acute Ischemic Stroke With Machine Learning
Authors: Silva Luis , Khan Shayan , Ramezani Solmaz , Stalin Karen , Annam Saketh , Roberts Rebecca , Jagtap Pramit , Zheng Cynthia , Novy Savannah , Ikramuddin Salman , Streib Christopher D
Published: February 2024

Introduction:
Accurate outcome prognostication in acute ischemic stroke (AIS) informs essential medical decision-making for clinicians, patients, and families. Neuronal Networks (NN) is a machine learning ML algorithm modeled on the workings of human neurons that has been shown to be useful for prediction tasks in the healthcare setting. We tested whether an NN algorithm could accurately predict long-term neurological outcomes for AIS patients receiving intravenous thrombolysis using common clinical variables.

Methods:
Patients with AIS treated with intravenous thrombolysis in our health system between July 1, 2020-June 28, 2022 were included in model creation and internal validation. Cases with a modified Rankin scale (mRS) of 0-2 at 90 days (i.e. independence) were classified as “good” outcomes and mRS 3-6 (non-independent) as “poor” outcomes. An NN prediction tool was trained using clinical and interventional variables collected in the first 24 hours of the hospitalization, such as age, gender, and thrombectomy status. Imputation was used for missing values. The final network had a size of 10 layers and a 0.5 decay. The evaluation was made with 10-fold cross-validation. Report followed the TRIPOD statement.

Results:
We identified 547 AIS patients who received intravenous thrombolysis. Median Age was 70 (IQR: 58-81), and 254 (46.4%) were classified as Female. A total of 115 (20.1%) underwent thrombectomy. Good outcomes were achieved in 354 (64.7%) patients at 90 days. Following the optimization of prediction thresholds through the best informedness values, our final model had a sensitivity of 0.81 and a specificity of 0.78 for detecting good outcomes. The corresponding Area Under the Receiver Operator Curve (AUC-ROC) is 0.85.

Conclusion:
In conclusion, we developed a prognostic algorithm to predict good outcomes in AIS patients receiving thrombolysis with excellent AUC-ROC performance. External validation of our findings is necessary. NN can potentially improve prognostication of post-stroke functional outcomes, aiding individualized medical decision-making.
Abstract TP107: Quantifying Hospital Opportunities to Increase Thrombolysis
Authors: Skolarus Lesli E , Lin Chun Chi , Bi Ran , Burke James F
Published: February 2024

Introduction:
Emergency-department-based implementation strategies to increase thrombolysis are promising. We sought to quantify the number of hospitals with opportunities to increase thrombolysis under various tPA treatment thresholds.

Methods:
We used data from the 2018 State Inpatient Databases (SID) from 17 states. The study population was limited to ischemic stroke patients admitted to the hospital. The primary outcome was the sum of patients receiving stroke thrombolysis (tPA) at each facility (DRG 61-63, ICD-10 procedure code 3E03317, ICD-10 diagnosis code Z92.82). The primary exposure was hospital stroke volume categorized into quartiles (1
st
Quartile [Low]: 1-7, 2
nd
Quartile: 8-53, 3
rd
Quartile: 54-178, 4
th
Quartile [High]: 179-1431). To estimate the number of additional patients treated if hospitals improve their thrombolysis rates across various thresholds, we calculated the expected number of thrombolysis treatments (tPA thresholds multiplied by hospital stroke volume and subtracted by the number of patients receiving tPA at each facility).

Results:
We identified 203,843 hospital admissions with a primary ischemic stroke diagnosis from 1608 hospitals. On average, 13.3% of patients received tPA. The proportion of stroke patients receiving tPA was higher in higher stroke volume hospitals (Table 1). Black people were more likely to receive care at high-stroke volume hospitals. Among 1608 hospitals, 1131 (70%) had tPA rates below 10%. If these 1131 hospitals improve their tPA rates to 10%, 2655 (2.3 patients/hospital/year) additional stroke patients would be treated with tPA.

Conclusions:
Low stroke volume hospitals have the lowest thrombolytic treatment rates, but interventions at these hospitals will have limited population benefits and may not be an efficient use of hospital resources. Intervening at high-volume, low-performing hospitals offers the largest opportunity to increase thrombolysis and will promote stroke racial equity.
Abstract TP117: Improving Thrombolysis Door-to-Needle Time With a Multi-Pronged Approach
Authors: Paolucci Gino , Harmon Melissa , Souza Stephanie , Karb Rebecca , Perelstein Elizabeth , Furie Karen L , Thornsbury Alyssa , Yaghi Shadi
Published: February 2024

Introduction:
Reducing door-to-needle (DTN) times lead to improved patient outcomes in acute ischemic stroke. We sought to use innovative methods to continuously reduce the DTN time, with the specific goal of consistently achieving a median DTN time < 30 minutes.

Methods:
At an academic Comprehensive Stroke Center, we implemented these strategies to reduce the DTN time: 1) Addition of a virtual DTN timer in the Electronic Medical Record (EMR) to display elapsed time since arrival.2) Creation of a multidisciplinary Thrombolysis Focus Group to analyze data and improve processes. Additional monthly quality improvement meetings were held to discuss all thrombolysis cases with times over our median. 3) Reduction of EMR barriers to recognize metric exclusion criteria and document accordingly. 4) Review of each thrombolysis case with direct provider feedback and an opportunity to appropriately document and clarify delays. 5) Addition of Specialized Neurovascular APPs responding to every Code Stroke with Neurology resident physicians.6) Creation of a “Golden Needle” award to recognize providers who achieved the fastest DTN time in the year.

Results:
The median DTN time steadily decreased over 3 academic years. The median DTN time was 40 minutes in 2020, 39 in 2021, 38 in 2022 and 36 in year-to-date 2023. Additionally, the percentage of thrombolysis cases meeting the institutional goal of < 30 minutes improved from 21.5% in 2020, to 31.9% in 2021, to 59.6% in 2022, to 88.6% in year-to-date 2023 (figure).

Conclusion:
Novel multifaceted measures surrounding acute stroke thrombolysis can positively impact both the door-to-needle time and percent of cases within the institutional DTN time goal.

Figure: Percentage of Thrombolysis Cases with DTN < 30 Minutes
Abstract TP122: Variables Associated With Post-Stroke PTSD; a Systematic Review and Narrative Synthesis
Authors: Gray Shannon , Brennan Ciara , Gallagher Pamela , Slattery Brian
Published: February 2024

Background:
Stroke is often a sudden, traumatic, and potentially catastrophic event for those who experience it, leading to many stroke survivors experiencing post-stroke post-traumatic stress disorder (sPTSD). The development of sPTSD may impede patients' rehabilitation and negatively affect their long-term physical and psychological outcomes.

Aim:
This review aims to identify and provide a narrative synthesis of the factors associated with sPTSD onset.

Methods:
Six databases (Web of Science, social sciences citation index, Embase, Pubmed, PsychInfo, Cinahl and PTSDPubs) were searched for studies that included samples of people who were 18 years of age or over, had had a stroke that was clinically recorded and who had a clinical diagnosis of PTSD post-stroke.

Results:
A total of 21 studies were included in the review, with prevalence rates of stroke varying between 6.5% - 31%, and the PDS and PCL being the most frequent method of assessing PTSD. The most common factors found to be associated with the onset of PTSD were depression, younger age, symptoms of anxiety and lifetime history of psychiatric comorbidity.

Conclusion:
Following a stroke, patients are at an increased risk for developing sPTSD. Preliminary analyses would suggest certain factors such as gender, age, and marital status impact the development of sPTSD. However, an agreed-upon, standardised practice in measuring and reporting SPTSD is necessary to ensure findings can be readily contextualised against previous research in a sensible and meaningful way.
Abstract TP14: SocialBit: A Novel Smartwatch Sensor to Detect Social Interaction Frequency in Stroke Survivors
Authors: Adeboye Oluwamayomikun , Cooke Grace , White Kelly , Tate Samuel , Zafonte Ross , Narayanan Shrikanth , Mehl Matthias , Shin Min , Dhand Amar
Published: February 2024

Introduction:
Stroke survivors experience high levels of social isolation which hinder their rehabilitation and well-being. A gap in the field that impedes intervention development is a lack of real-time social interaction measurement tailored for this population. In response, we developed SocialBit, a smartwatch-based machine learning algorithm to discreetly and passively detect social interactions through privacy-preserving acoustic analysis. In this observational study, we estimated the accuracy of SocialBit to detect social interactions compared to human observers in stroke survivors.

Methods:
SocialBit was built as a neural network machine learning algorithm using features from YAMNet and a Transformer classifier. It was then trained and tested in stroke survivors for up to 8 days in hospital. Independently, human observers tallied the presence or absence of social interactions every minute to establish the ground truth. SocialBit performance of detecting social interactions was compared against the ground truth.

Results:
We analyzed 1137.7 hours of ambient audio data in 90 patients within 14 days of stroke onset. 16% of patients had aphasia, 25% reported symptoms of clinical depression, and 28% reported moderate to severe loneliness. SocialBit had an accuracy of 0.83 (SD = 0.2), sensitivity of 0.86 (SD = 0.2), specificity of 0.81 (SD = 0.02), and an area under the curve (AUC) of 0.90 (SD = 0.2) (Figure 1).

Conclusion:
SocialBit accurately detected the frequency of social interactions in stroke survivors in a hospital setting. These results will drive future planned studies to examine SocialBit's performance in patients’ home communities. SocialBit shows the potential to be the first real-time social sensor to quantify social interactions and social isolation in stroke survivors.
Abstract TP140: Effect of MR-Guided Perfusion Imaging Mismatch Profiles Within 6 Hours on Endovascular Thrombectomy Outcomes
Authors: Li Xiaohui , Deng Qiwen , Zhou Junshan
Published: February 2024

Background:
The treatment of acute ischemic stroke (AIS) aims to achieve early vascular recanalization and reperfusion of the penumbra. However, the effect of early penumbral imaging within 6 hours on clinical outcomes remains unclear.

Objective:
The objective of this study was to determine the effect of magnetic resonance-guided (MR-guided) perfusion imaging within 6 hours after symptom onset on endovascular thrombectomy outcomes in AIS patients.

Methods:
We prospectively collected the clinical information of consecutive AIS patients undergoing endovascular thrombectomy based on MR-guided perfusion imaging within 6 hours after symptom onset from AISRNA and EVTRNA studies. The primary outcome was defined as the poor outcome (mRS > 2 within 90 days). The perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch was assessed by an automated software.

Results:
We enrolled 84 patients (25 in the mismatch ≤ 1.8 group and 59 in the mismatch > 1.8 group). Significant difference was found between the mismatch>1.8 group and the mismatch≤1.8 group for the incidence of disabling stroke (mRS > 2) within 90 days (40.7% vs. 68.0%, OR: 3.099, 95% CI: 1.154-8.323, P =0.025). Intracranial hemorrhage occurred in 8 patients (13.6%) in the mismatch > 1.8 group and 10 patients in the mismatch ≤ 1.8 group (40.0%) (P = 0.010). The risk of severe cerebral edema was 2/59 (3.4%) vs. 7/25 (28.0%) (P = 0.004). These findings remained stable after adjustment.

Conclusion:
MR-guided perfusion imaging mismatch profiles within 6 hours after symptom onset may be feasible to improve clinical outcomes and reduce clinically ineffective reperfusion after endovascular thrombectomy.
Abstract TP156: The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) Technique for Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation: A Pilot Study
Authors: Hou Yan , Li Ya-Huei , Elsayed Sherif , Casciani Samantha , Kureshi Inam U
Published: February 2024

Introduction:
Spontaneous intracerebral hemorrhages (ICH) remains the most devastating form of stroke. Only approximately 20% survivors achieve functional independence at six months after ICH. Up to today, there are no medical or surgical treatments with proven functional benefits for this population. The Stereotactic ICH Underwater Blood Aspiration (SCUBA) allows minimally invasive endoscopic hematoma evacuation in basal ganglia. In this pilot study, we tested that early hematoma evacuation by SCUBA may improve functional outcome.

Methods:
The Study included 10 ICH patients (age 18-85 years, pre-morbid mRS 0-1, hematoma volume 30-90ml) who underwent SCUBA from 2019 to 2022. SCUBA patient was matched with control ICH patient who received standard medical treatment at 1:1 ratio by variables (hematoma volume and laterality, intraventricular hemorrhage [IVH] with hydrocephalus, age, NIHSS, GCS). The comparison between SCUBA and Controls were carried out by T-test, Mann-Whitney U Test or Fisher's Exact Test as appropriate.

Results:
Of the 10-paired SCUBA patients and controls, the mean age was 66 years, 45.0% were females, pre-op median NIHSS of 18, 45.0% were intubated, and 30.0% had IVH with hydrocephalus and EVD placed. Among SCUBA patients, the median hematoma volume is 34.0 ml; 90.0% of hematoma was located in basal ganglia. The median time from the last known well to SCUBA initiation was 22.3 hours. Hematoma volume reduction by 80% was achieved in 70.0% of SCUBA patients and 100.0% patients with residual hematoma volume less than 15 ml. SCUBA patients had shorter median NeuroICU stay than controls (SCUBA 5 vs. Control 11 days, p=0.029). SCUBA patients tended to have lower hospital mortality rate (SCUBA 10% vs. Control 20%), and a higher proportion of SCUBA patients were discharged to acute rehab (SCUBA 50% vs. Control 10%). At three months of follow-up, none of the patients were functionally independent, but more SCUBA patients achieved mRS 3 (SCUBA 37.5% vs. Control 16.7%).

Conclusions:
Our pilot study suggests that early SCUBA can efficiently evacuate deep hematoma with potential of improving functional outcome. Further study requires more patients and longer follow-up.
Abstract TP164: Predisposing Factors and Outcomes of Primary Intracerebral Hemorrhage in Patients Presenting With Hyponatremia
Authors: Gilotra Kevin , Basem Jade , Janssen Melissa , Mani Racheed M , Razzaq Bayan , Faraji Farshid , Dashti Reza
Published: February 2024

Background:
Hyponatremia is the most common electrolyte abnormality seen in intracerebral hemorrhage (ICH) and is associated with a nearly doubled mortality rate and more severe presentations. However, the current literature has not addressed what factors might predispose ICH patients to presenting with hyponatremia or developing it during their hospital stay. The aim of this study was to evaluate the characteristics, comorbidities, and inpatient outcomes prevalent amongst ICH patients with hyponatremia.

Methods:
A retrospective study was performed for 814 adult patients admitted from January 2011-December 2022 with primary ICH at Stony Brook University Hospital. We recorded sodium and serum chemistry levels throughout admission, medical history, radiographic hematoma volumes, and Modified Rankin Scale (MRS) and Glasgow Coma Scale (GCS) up to 1-year follow-up.

Results:
Hyponatremia on admission was seen in 79 (9.8%) patients. Another 311 patients (38.3%) developed hyponatremia during their hospital stay. Pre-existing hyponatremia was correlated with a history of diabetes while hyponatremia during stay was correlated with diabetes, liver disease, heavy drinking, and prior valve replacement. Complications such as pneumonia, UTI, or a bloodstream infection were more prevalent in patients with hyponatremia. They also had a longer hospital stay and higher inpatient mortality (χ2(1)=5.176, p=0.023). Patients with hyponatremia had significantly lower GCS values on discharge. A multivariate regression analysis of age, admission MRS, diabetes, liver disease, ICH score, volume, and minimum Na was statistically significant (
R
2=0.255, F(7,704)=34.46, p<0.001). Minimum Na reliably predicted death in this model (β=0.007, p=0.023).

Conclusions:
Several factors can predispose ICH patients to hyponatremia on presentation or be associated with developing hyponatremia during their hospital stay. This study showed that developing hyponatremia during the hospital stay was associated with worse outcomes at discharge. In addition, hyponatremia can significantly predict inpatient mortality when controlling for ICH severity and common aggravating factors.
Abstract TP173: Differential Outcomes and Treatment in Vertebral versus Carotid Artery Dissections: A National Inpatient Sample Study
Authors: Lee Elizabeth , Shu Liqi , Salehi Omran Setareh , Goldstein Eric D , Nguyen Thanh N , Siegler James E , Khan Farhan , Stretz Christoph , Furie Karen L , Yaghi Shadi
Published: February 2024

Introduction:
Cervical artery dissection (CAD) involves the carotid (CCAD) or vertebral artery (VCAD). However, limited studies have compared their clinical features and outcomes. Our study utilized a comprehensive nationwide database to discern these differences.

Method:
We examined non-traumatic CAD-diagnosed patients from the U.S. National Inpatient Sample (2005-2019) using ICD-9 and ICD-10 codes. The evaluation included patient demographics, comorbidities, in-hospital complications, treatment, and costs. Differences between CCAD and VCAD were assessed using survey-weighted stepwise backward logistic regression, followed by propensity score matched adjusted regressions for outcomes.

Result:
From 2005 to 2019, we identified 157,086 CAD admissions, of which 79.9% (125,477) were spontaneous CADs, with CCAD outnumbering VCAD (67,671 vs. 57,806). Compared to VCAD, CCAD was significantly associated with older age (54 [44-66] vs. 49 [37-62]), Black race (12.6% vs. 8.7%), atrial fibrillation (6.1% vs. 3.7%), hypertension (58.0% vs. 53.9%), fewer concurrent acute ischemic strokes (AIS) (22.1% vs. 24.7%), higher NIHSS (mean NIHSS 7 [2-16] vs. 2 [0-5]), extended stays (4 days [2-8] vs. 4 days [2-7]) and increased hospitalization charges ($52,005 [$25,759-$118,806] vs. $43,199 [$24,116-$85,701]); all P<0.05. Within the concurrent AIS group, the CCAD group also exhibited an increased likelihood for IV thrombolysis (10.7% vs. 5.7%) and mechanical thrombectomy (14.9% vs. 3.7%). After propensity score matching for NIHSS and age, the CCAD group was associated with less death (adjusted odds ratio [aOR] 0.41, 95% CI 0.26-0.65, P<0.001) but a similar home discharge rate (aOR 1.15, 95% CI 0.78-1.69, P=0.480) (Figure).

Conclusion:
Our study underscores distinct comorbidity profiles and treatment patterns between CCAD and VCAD groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.
Abstract TP178: Impact of Fetal PCA on Ipsilateral Carotid Artery Stiffness: Results From Northern Manhattan Stroke Study (NOMAS)
Authors: Khasiyev Farid , Liu Minghua , Elkind Mitchell S , Rundek Tatjana , Gutierrez Jose
Published: February 2024

Introduction:
The wall stress is the major contributor of arterial stiffness, which is well-known risk factor for cardiovascular diseases. The interindividual variability of the Circle of Willis affects blood flow redistribution intracranially. The fetal posterior cerebral artery (fPCA) is associated with larger carotid arteries due to increased brain territory supplied by the anterior circulation. Thus, an fPCA increases blood flow in the ipsilateral carotid artery and could plausibly increase ipsilateral carotid artery stiffness.

Methods:
We included participants from the multi-ethnic community-based Northern Manhattan Stroke Study (NOMAS) cohort with available time-of-flight MRA. High-resolution B-mode ultrasound of the right common carotid artery (CCA) evaluated markers of arterial stiffness, including diastolic diameter (DD), strain (systolic diameter - DD/DD), cIMT (carotid intima-media thickness), and stiffness (systolic blood pressure - diastolic blood pressure/strain). We used multivariable regression analyses to calculate odds ratios and beta values, examining the association of fPCA and markers of stiffness.

Results:
Among 1,210 NOMAS (mean age 70 ± 9 years, 61% women, 66% Hispanic) participants with available MRA, 151 (12.5%) participants had a right fPCA, and 129 (10.7%) had a left fPCA. In models adjusted for demographics, vascular risk factors, and height, right fPCA was associated with a higher ipsilateral CCA diastolic diameter (B = 0.31, p=0.001) and strain (B=0.04, p=0.02). Notably, no similar association was found between the left fPCA and contralateral carotid measures (Table 1).

Conclusion:
A fetal PCA associated with ipsilateral markers of cervical carotid stiffness. This research provides valuable insight into the changes in demands resulting from the variability of the circle of Willis and the extracranial correspondence of such demand.
Abstract TP182: Vessel Wall MRI in Diagnosis and Prognosis of Intracranial Vasculopathy
Authors: Hao Qing , Belani Puneet , Robson Philip , Sharma Shivangi , Fayad Zahi A , Nael Kambiz
Published: February 2024

Introduction:
High resolution vessel wall MRI (VWMRI) has been increasingly used in stroke patients to evaluate the arterial pathologies and underlying cause of stroke. We aimed to explore VWMRI features of intracranial vasculopathies in ischemic stroke patients and assess their associations with stroke mechanism and with clinical outcome.

Methods:
Ischemic stroke or TIA patients with intracranial vasculopathy as the potential cause of stroke were included if they underwent VWMRI (3D T1-weighted, pre- & post- contrast, resolution isotropic 0.625 mm). The VWMRI features including the number of arterial lesions with thickened wall, presence of T1 hyperintensity, degree of enhancement [absent (0), mild (1), significant (2 =similar to infundibulum)], pattern of enhancement [eccentric, concentric, and mixed (both)] were evaluated by board certified neuroradiologists. Primary outcome was defined as recurrent stroke or other cardiovascular events. The association between clinical characteristic VWMRI features & clinical outcome were examined.

Results:
A total of 46 patients [29 (63%) males; mean age (SD) 55.7 (15) years] were included. Among 41 patients (89%) had at least one lesion with thickened wall, 21 patients (51.2%) had multiple lesions, 28 (68.3%) had T1 hyperintensity, 39 (95%) had contrast enhancement (eccentric n=24, concentric n=10, mixed n=5 ) and 27 (66%) had significant enhancement. Overall, VWMRI suggested a different pathological mechanism of stroke in 16 patients comparing with the original impression. Higher creatinine and lower HDL levels were significantly (p<0.05) associated with presence of multiple vs single lesion on VWMRI. LDL was significantly (p=0.04) higher in those with eccentric vs concentric enhancement. The median follow-up was 28.4 (IQR 13- 47) months, and primary outcome occurred in 6 (13.3%) patients. VWMRI features were not associated with the primary outcome.

Conclusions:
Presence of some degree of enhancement is common (95%) in patients with ischemic stroke attributed to intracranial vasculopathies. The VWMRI features were not associated with the primary clinical outcome. VWMRI may help to clarify the etiology of the stroke mechanisms. These findings warrant further evaluation in larger studies.
Abstract TP19: Predictors of Outcome in Subarachnoid Hemorrhage in the Pediatric Population
Authors: Patel Smit D , Balabhadra Anvesh , Otite Fadar , Miller Ethan A , Jaffa Matthew N , Tunguturi Ajay , Sussman Eric , Ollenschleger Martin , Alberts Mark J , Mehta Tapan
Published: February 2024

Background:
Studies describing outcomes of subarachnoid hemorrhage (SAH) in children are sparse. This study aims to describe outcomes and determinants of outcomes in pediatric patients with SAH.

Methods:
We reviewed all pediatric admissions with the primary diagnosis of SAH from the 2016-2020 National Inpatient Sample using International Classification of Disease Codes. Baseline characteristics of patients (age, gender, and associated comorbidities) were computed using descriptive statistics. Multivariable-adjusted logistic regression determined predictors of in-hospital mortality for children with SAH.

Results:
1,310 weighted hospitalizations for SAH were identified during the 5-year study period. The median age was 11.8 years (95% CI, 11.0-12.5), 54.6% were male. Seizures (34.6%), intraparenchymal hematoma (21.7%), acute ischemic stroke (6.4%), brain tumors (0.7%), and arteriovenous (AV) malformations (6.1%) were identified as the most common associated neurologic disorders during index hospitalization. 320 patients (24.4%) were treated endovascularly and 480 (36.6%) were treated via open surgical approach to treat vascular pathologies (AV malformations, dural AV fistulas, and aneurysms). Median length of hospitalization was 9.7 days (95% CI, 8.2-11.2. A total of 61.8% were discharged home, 29.3% were discharged to a rehabilitation facility, and in-hospital mortality was 8.8%. Patient-level variables associated with higher odds of mortality were age (Odds Ratio [OR] 1.01, [95% CI 1.01-1.02], p<0.001), higher NIS-Subarachnoid Hemorrhage Severity Score (NIS-SSS) (12.64 [4.21-37.95], p<0.001), coagulopathy (5.72, [1.40-23.29], p=0.01), and liver dysfunction (69.02 [2.65 - >999], p=0.01).

Conclusion:
Six of ten pediatric patients with SAH are discharged with excellent outcome with a 10% index hospitalization mortality. Underlying coagulopathy and liver dysfunction are the strongest risk factors for mortality
Abstract TP199: Prominent Laterality of the Posterior Cerebral Artery on MR Angiography Before Mechanical Thrombectomy in Patients With the Middle Cerebral Artery Occlusion Predicts Long-Term Functional Outcome
Authors: Shoda Sotaro , Sakamoto Yuki , Shioda Jun , nishi yuji , Yoshimura Junki , Numao Shinichiro , Katano Takehiro , Suzuki Kentaro , Kanamaru Takuya , Saito Tomonari , Nishiyama Yasuhiro , Kimura Kazumi
Published: February 2024

Background and Purpose:
Well-developed collateral flow is reported to be associated with a reduction of infarct volume, successful reperfusion, and better functional outcome in acute ischemic stroke (AIS). Relatively increased visualization of posterior cerebral artery (PCA) ipsilateral to the ischemic lesion on MR angiography (MRA), a sign of prominent PCA laterality (PCAL), represents the development of collateral flow from PCA to middle cerebral artery (MCA) territory. However, the prognostic value of PCAL on functional outcome in AIS patients having MCA occlusion and undergoing mechanical thrombectomy, is not well known.

Methods:
We retrospectively reviewed initial MRA scans of pre-morbidly independent patients treated with mechanical thrombectomy for M1-segment occlusion from September 2017 to May 2022. PCAL was defined as better visualization of ipsilateral PCA, compared to contralateral PCA, by one or more segments on MRA. We divided patients into two groups, those presenting PCAL and not, and compared the background characteristics, in-hospital management, and functional outcome between the two groups. Factors associated with favorable outcome (mRS score 0-2) at 3 months after onset were assessed using multivariate logistic regression analysis.

Results:
In total, 172 patients (76 female [44%], median age 77 [IQR 74.5-78.0] years, median NIHSS score 16 [15-18]) were included. Of these, 86 patients (50%) presented PCAL on initial MRA. There is no significant difference between the two groups in age, sex, major vascular risk factors, NIHSS on admission, DWI-ASPECTS, onset-to-recanalization time (OTR), and preclinical modified Rankin scale. Multivariate logistic regression analysis showed an adjusted odds ratio of 2.11 for a favorable outcome in patients with PCAL (95% CI: 0.986 to 4.53, P=0.054). When focused on the cases with OTR >6 hours (n=53), PCAL was independently associated with favorable outcome (OR 5.77, 95% CI: 1.28 to 26.0, P=0.022).

Conclusion:
PCAL on initial MRA in patients with M1-segment occlusion predicts favorable long-term functional outcome after mechanical thrombectomy, especially in the case taking longer time from onset to recanalization.
Abstract TP200: Anticoagulation Use and Endovascular Thrombectomy in Patients With Large Core Stroke - A Secondary Analysis of SELECT2 Trial
Authors: Pujara Deep , Shaker Faris , Abraham Michael G , Chen Michael , Kasner Scott , Ortega-Gutierrez Santiago , Hussain M. Shazam , churilov leonid , Sundararajan Sophia , Hu Yin , De Georgia Michael A , Opaskar Amanda , Al-Shaibi Faisal , Duncan Kelsey R , Moussa Rami , Abdulrazzak Mohammad Ammar A , Johns Hannah Tabitha , Sila Cathy A , Furlan Anthony J , Mendes Pereira Vitor , Hill Michael D , Grotta James C , Ribo Marc , Hassan Ameer E , Campbell Bruce , Sarraj Amrou
Published: February 2024

Introduction:
Anticoagulation (AC) use is common in patients presenting with acute ischemic stroke and is known to pose challenges to acute reperfusion therapy. However, evidence about association of AC use prior to stroke with endovascular thrombectomy outcomes and post-procedure hemorrhages, especially in those with large strokes is limited.

Methods:
From SELECT2, patients were stratified based on AC medication use and prior to stroke. Functional outcomes at 90day follow-up and hemorrhagic transformation on follow-up imaging were compared between patients with and without AC in adjusted regression models.

Results:
Of 352 patients, 29/180 (16%, VKA - 15, DOACs 14) EVT patients and 18/172 (10%, VKA - 3, DOACs 15) MM patients were receiving anticoagulants at baseline. AC patients were older (72 (62-79) y vs 66 (58-75) y), with higher cardiac morbidity (Congestive Heart Failure: 28% vs 10%, Atrial Fibrillation: 70% vs 17%), but had similar NIHSS [20 (16-24) vs 18 (15-23)], time to randomization [511 (350-909) vs 586 (326-920) minutes], CT ASPECTS [4 (3-5) vs 4 (3-5)] and ischemic core estimates [91 (71 -110) vs 103 (71-139) ml, AC vs nonAC respectively]. Within AC patients, EVT did not improve outcomes (Shift: 6 (4-6) vs 5 (4-6), aGenOR: 0.89 (0.53-1.50), mRS 0-3: 11% vs 14%, aRR: 1.27 (0.40-4.05), mRS 5-6: 69% vs 67%, aRR: 1.05 (0.73-1.50)]. Furthermore, EVT patients on AC reported numerically higher rates of any intracerebral hemorrhage [85.7% vs 70.2%, aRR: 1.18, 95% CI: 0.98-1.43], but no sICH or parenchymal hemorrhage and demonstrated worse outcome [median mRS: 6 (4-6) vs 4 (3-6), aGenOR: 0.49(0.32-0.74)], mRS 0-3: 14% vs 43%, aRR: 0.36 (0.15-0.86)], and mRS 5-6: 69% vs 43%, aRR: at 90 day follow-up and numerically lower functional independence (mRS 0-2) [3.4% vs 23.3%, aRR: 0.18(0.03-1.21)], AC vs nonAC respectively. Consistent results were observed in patients achieving successful reperfusion.

Conclusion:
Almost 1/7
th
of patients presenting with large stroke in SELECT2 trial demonstrated AC use at baseline, with higher cardiac morbidity. These patients were more likely to have hemorrhagic outcomes and worse clinical outcomes after EVT and successful reperfusion.

Clinicaltrials.gov registration:
NCT03876457
Abstract TP204: Performance of Rapidai NCCT Stroke Software in Colombia's Early Stroke System: Preliminary Results
Authors: Granja Manuel F , Ramirez Karen , Espinel Laura , Salazar Antonio J , Mejia Juan A , Torres Oscar , Morillo Anibal , Bermudez Sonia , Useche Nicolas , Albers Gregory W
Published: February 2024

Background:
Automated stroke solutions in developing countries have the potential to reduce healthcare gaps. This study assesses the performance of the RAPID NCCT Stroke module compared to local neuroradiologists’ evaluation of acute stroke.

Methods:
Rapid NCCT stroke is a new multi-module AI tool that simultaneously evaluates non-contrast CT scans (NCCT) for ICH (any subtype, volume >0.4 ml), the ASPECT score, and suspicion of LVO (i.e., intracranial ICA or horizontal segment of the MCA). The software determines suspicion of LVO based on an algorithm that evaluates the hyperdense MCA sign and early ischemic changes in the MCA territory. Consensus readings were defined by three blinded neuroradiologists based on a subset of Non-contrast CTs obtained between January 2013 to December 2018 at Fundacion Santa Fe De Bogota University Hospital. The overall diagnostic performance of the RAPID NCCT was compared to the assessments made by the neuroradiologists.

Results:
179 total stroke cases with technically adequate NCCT scans were identified. Based on the consensus of the neuroradiologists, these cases included 151 ischemic strokes, 27 ICHs >0.4 ml, 1 ICH <0.4 ml, and 28 LVO cases (verified by CT angiography). The Rapid NCCT Stroke module demonstrated high specificity (96%), NPV (98%), and accuracy (95%) for the detection of ICH. For determining the ASPECT score, the software had a specificity of 93% and an NPV of 76%. Seventy percent of the CTA-verified LVOs were detected from NCCT alone with a specificity and NPV of 82%.

Conclusions:
The RAPID NCCT Stroke software displayed promising results for the early identification of ICH and characterization of ischemic strokes. The software identified 70% of the LVOs from NCCT alone. This tool can potentially enhance patient outcomes by bridging healthcare gaps in evolving stroke systems. Multicenter studies in additional Latin American countries are needed for further validation.
Abstract TP221: Progression of Intracranial Artery Stenosis and Cerebral Small Vessel Disease and Associations Between the Two Entities: A Prospective Community-Based Cohort Study
Authors: Pan Ziang , Han Fei , Zhu Yicheng
Published: February 2024

Background:
Both intracranial artery stenosis (ICAS) and cerebral small vessel disease (CSVD) can cause heavy socioeconomic burdens. However, their longitudinal changes remain controversial. To investigate the risk factors for ICAS and CSVD progression and their associations in a community population.

Methods:
This longitudinal analysis included 756 participants who underwent both baseline and follow-up brain magnetic resonance imaging (MRI) and magnetic resonance angiography from Shunyi cohort. The follow-up duration was 5.58±0.49 years. Incident ICAS was defined as new stenosis occurring in at least one artery or increased severity of the original artery stenosis. CSVD markers included lacunes, cerebral microbleeds (CMB), and white matter hyperintensities (WMH).

Results:
Of the 756 participants (aged 53.7±8.0 years, 34.9% men), 8.5% had incident ICAS. Body mass index (BMI) and diabetes mellitus are independent risk factors for ICAS. Hypertension is an independent risk factor for incident lacunes and CMB, whereas WMH progression is primarily affected by BMI. Higher LDL cholesterol level independently protects against WMH progression. Baseline ICAS burden predicted an increased risk of incident lacunes (odds ratio [OR] = 2.17, 95% confidence interval [CI] = 1.10-4.29, p = 0.025) after adjusting for age, sex, follow-up time, vascular risk factors, and baseline lacunes burden. Incident ICAS was also significantly associated with incident lacunes (OR = 3.29, 95% CI = 1.61-6.72, p = 0.001). No significant correlation was identified between ICAS and CMB or WMH.

Conclusions:
Patients with ICAS and CSVD progression had different modifiable risk factor profiles. The disparate association between ICAS and progressions of different MRI markers of CSVD imply vital differences of their underline mechanism.