bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP121: Early Mobilization Post Acute Stroke Thrombolysis And/or Thrombectomy (EMPATHY) Survey
Authors: Silver Brian , Demers-Peel Meaghan , Alexandrov Anne W , Selim Magdy H , Bernhardt Julie
Published: February 2022

Background:
Traditionally, bed rest after emergency ischemic stroke treatments has been defined as 24 hours hours. The scientific basis for this timeline has not been established and practices may vary. We sought to determine bed rest practices following emergency stroke therapy in centers across the United States.

Methods:
We surveyed hospitals in the StrokeNet system regarding bed rest practices following acute stroke thrombolysis and/or thrombectomy. An anonymous survey (SurveyMonkey®) was sent out by the central coordinating center to all StrokeNet participating centers across the United States. Survey questions included stroke center designation, location of admission, whether a formal bed rest protocol was in place, minimum bed rest period required, which person first mobilized the patient, average duration of bed rest, which factors would alter duration of bed rest.

Results:
48 centers responded to the survey including 45 Comprehensive Stroke Centers and 3 Primary Stroke Centers. Most patients were admitted to a neuro-intensive care unit (69%), and others to a general medical/surgical ICU or stroke ward. 60% of respondents indicated that a formal bed rest policy was in place. Minimum bed rest requirements after thrombolysis alone ranged from 0-24 hours (43% with a 24 hour bed rest protocol, 20% with no minimum, 15% with a 12 hour minimum, 5% with an 8 hour minimum, 5% with a 6 hour minimum, and 12% with an indeterminate response). Similar variations were reported in patients undergoing thrombectomy with ranges from 0-24 hours bed rest. First mobilization was by a nurse 52% of the time and by a physical therapist 48% of the time. Actual mobilizations ranged from 0-36 hours after treatment. The most common factors that altered bed rest duration were: hemodynamic factors (> 90% of respondents depending on the scenario) and NIHSS score (> 65% depending on the scenario).

Conclusion:
Bed rest practices following emergency ischemic stroke treatment vary significantly across stroke centers. Mobilization of patients is performed primarily by nurses and therapists. Major factors that influence bed rest duration include hemodynamic factors and NIHSS score. Further study regarding an optimal approach for bed rest is warranted.
Abstract WP124: Necessity Of Universal Echocardiograms In First-time Stroke: A Retrospective Study
Authors: Harrington Anthony , Sillau Stefan , Poisson Sharon N
Published: February 2022

Background:
Transthoracic echocardiogram (TTE) is a “moderate” recommendation under the 2021 AHA/ASA Guidelines. We aimed to identify in which patients TTE is most likely to reveal a clinically relevant finding that helps guide workup and secondary stroke prevention.

Methods:
We reviewed records of patients at an academic stroke center with primary discharge diagnosis of ischemic stroke between January 1-December 31, 2019 excluding those with prior stroke. Stroke location was classified as cortical, subcortical, brainstem, multiple/multifocal. TTE findings defined as clinically significant included reduced ejection fraction, enlarged left atrial size, patent foramen ovale, vegetations, thrombus, and atrial fibrillation during the procedure. Chi-square and Fisher’s exact association tests were used for two-way tables, relative risk, and logistic regressions.

Results:
Of the 307 identified patients admitted for first time stroke, 181(59.0%) were male, and median age was 63.6+/-14.3 years. Stroke location was cortical in 99(32.2%), subcortical in 41(13.4%), brainstem in 39(12.7%), and multiple/multifocal in 128(41.7%). Clinically significant findings on TTE were found in 150 patients(48.9%). Age predicted clinically significant TTE (risk ratio per 10 year interval 1.11, 95% CI 1.02-1.20). Atrial fibrillation and cortical location predicted clinically significant TTE findings (table). Other locations and risk factors were not associated with clinically significant TTE.

Discussion:
Cortical stroke was the only location associated with clinically significant TTE findings. The lack of association with multifocal strokes was surprising as they are often presumed cardioembolic. This suggests that TTE may be most beneficial in evaluating cortical stroke, but given that nearly half of all stroke patients had TTE findings that would inform further management suggests that continuing universal TTEs.
Abstract WP13: History Of Stroke Doubles The Risk Of Dementia: The Brain Attack Surveillance In Corpus Christi (BASIC)-Cognitive Project
Authors: Becker Christopher J , Chang Wen , Heeringa Steven G , Briceno Emily M , Morgenstern Lewis
Published: February 2022

Background:
We studied the association of stroke history with dementia in a population-based cohort study in Nueces County, Texas, USA, a bi-ethnic community with a large and primarily non-immigrant Mexican American population.

Methods:
Nueces County households were randomly identified and community-dwelling residents aged 65 years or older were recruited using door-to-door case ascertainment. Demographics, educational history, and medical history were obtained, and participants completed the Montreal Cognitive Assessment (MoCA), a screening scale that scores multiple domains of cognitive performance with aggregate scores ranging from 0 to 30 (lower scores worse). Using an inverse propensity weighting methodology, the 2015-2019 American Community Survey (ACS) data for the 65+ population of Nueces County were used to develop a population weight for each case in the analysis sample based on age, sex, race, ethnicity, and education level. A logistic regression model was developed to assess the relationship between stroke and dementia (defined as MoCA <20), controlling for age, ethnicity, education, and history of diabetes.

Results:
A total of 1226 participants completed MoCA screening, of whom 435 scored <20 (35.5%), and 154 (12.6%) reported a history of stroke. Stroke prevalence was higher among those with MoCA <20 than those with MoCA 20-30 (17.8% vs 10.3%; p < 0.001). Table 1 shows the final multivariable model demonstrating a 129% increase in the odds of MoCA <20 for those with stroke history.

Conclusions:
History of stroke was associated with more than double the odds of dementia after controlling for other factors. Aggressive stroke prevention is needed to reduce cognitive impairment.
Abstract WP130: Fibroblast-derived Laminin Promotes Blood-brain Barrier Repair After Stroke Not Through Integrinβ1 Receptors
Authors: Xu Lingling , Yao Yao
Published: February 2022

Blood-brain barrier (BBB) breakdown has been observed in various neurological disorders, including stroke. More importantly, BBB disruption positively correlates with stroke outcome. Laminin, an extracellular matrix protein, plays an important role in the formation and maintenance of blood brain barrier (BBB) integrity under both homeostatic and pathological conditions. Fibroblasts, mainly located in the meninges and around large blood vessels, also secrete laminin. The function of fibroblast-derived laminin in BBB maintenance, however, remains unknown. Here we generated mutant mice with lamininγ1 deficiency in fibroblast-like cells using the Col1a1-Cre line (γ1FKO). These mutants were born at expected Mendelian ratio and failed to show obvious abnormalities, indicating a dispensable role of fibroblast-derived laminin under homeostatic conditions. Next, we examined BBB integrity in these mutants in a collagenase induced hemorrhagic stroke model. Compared to the controls, the mutant mice exhibited aggravated BBB damage and brain injury, including enhanced BBB permeability, elevated inflammatory cell infiltration, reduced tight junction coverage, reduced PDGFRβ coverage, larger hematoma size, worse neurological dysfunction, and increased neuronal cell death. These results suggest that fibroblast-derived laminin exerts a beneficial role in stroke pathogenesis possibly via repairing damaged BBB. Using γ1FKO:Ai14 and Col1α1-Cre+:Ai14 (control) mice, we found significantly reduced fibroblast density in the peri-hematoma region γ1FKO:Ai14 at day7 after injury. Additionally, laminin γ1 knockout in fibroblast cells by CRISPR Cas9 results in reduced fibroblast migration ability. These results suggest that fibroblast-derived laminin play important roles on fibroblast migration. Classical laminin receptors include integrin-α3β1, -α6β1, -α7β1 and -α6β4. To study the receptor regulating laminin- mediated fibroblasts function, we generated integrin β1 mutant mice using Col1a1-Cre line. In these mutants we did not see difference in terms of stoke outcomes as we saw in γ1FKO mice, indicating that integrin β1 is not the receptor regulating laminin- mediated fibroblasts function.
Abstract WP134: Association Between Hyperacute Blood Pressure Variability And Hematoma Expansion In Patients With Intracerebral Hemorrhage: Secondary Analysis Of The Field Administration Of Stroke Therapy - Magnesium Database
Authors: Oh Daniel , Shkirkova Kristina , Poblete Roy , Chung Pil-wook , Sanossian Nerses
Published: February 2022

Background:
Blood pressure variability (BPV) has emerged as a significant factor associated with clinical outcomes after intracerebral hemorrhage (ICH). While hematoma expansion (HE) is also associated with clinical outcomes, the relationship between BPV and HE has not been established. In this secondary database analysis, we aim to describe the association between BPV and HE. We hypothesized that BPV was positively associated with HE.

Methods:
Among 1,690 enrolled in the NIH-funded Field Administration of Stroke Therapy - Magnesium (FAST-MAG) study, 268 patients sustained ICH and received repeat CT or MRI head imaging within 6 to 48 hours of arrival. BPV was calculated by standard deviation (SD) and coefficient of variation (CV) of the hyperacute, prehospital data using the systolic blood pressure (SBP) measurements taken on ED arrival, 15min-post maintenance infusion start, 1-hour post maintenance infusion start, 4-hours after ED arrival. HE was defined by hematoma volume expansion greater than 6ml. Multivariate logistic regression was used for presence of HE in quintiles of SD and CV of SBP.

Results:
Of the 268 patients from the FAST-MAG study who had follow up head imaging, 116 (43%) had HE. Proportions of patients with HE was not statistically significant in the higher quintiles of the SD and CV of SBP for either hyperacute or acute period.

Conclusions:
HE was not found to be associated with higher quintiles of BPV using SD and CV of SBP in the hyperacute or the acute period. Expanded inclusion criteria or new statistical markers for BPV incorporating temporality for SBP could help in future studies.
Abstract WP135: Impact Of End Stage Renal Disease On Outcomes After Intracerebral Hemorrhage - A Nationwide Analysis
Authors: Lui Aiden , Weber Harli , Salazar Marco , Sebastian Adonai , Naftchi Alexandria , Henson Theresa , Al-Mufti Fawaz , Mayer Stephan
Published: February 2022

Introduction:
Intracerebral hemorrhage (ICH) is a devastating form of stroke that is usually related to chronic hypertension. End stage renal disease (ESRD) requiring renal replacement therapy (RRT) often leads to chronic hypotension, and fluid shifts during dialysis might increase the severity of brain edema. We sought to better understand the impact of ESRD on outcomes after ICH, with a focus of the presence of hypertension or hypotension during hospitalization.

Methods:
We analyzed the National Inpatient Sample (NIS) database and extracted all cases of ICH (ICD-9 431 or ICD-10 I61) between 2012 and 2017. Patients were classified as requiring RRT (ICD9: V56, V4511, 5856; ICD 10: N186, Z49, Z992) or not. We also noted the presence of codes for hypertension, hypotension, or cerebral herniation. The main outcome measure was death at discharge. Logistic regression was used to calculate odds ratios for mortality with adjustment for ICH severity using a compilation of codes for common complications.

Results:
116,812 ICH patients were identified, 3,329 (2.8%) of whom received RRT. Mortality in the non-RRT group was 18% as opposed to 32% in the RRT group (severity adjusted odds ratio 2.1, 95% CI 2.0–2.3, P<0.001). Hypertension was common (67%) and hypotension uncommon (1.7%) in the non-RRT group. Hypotension was associated with much higher mortality (32%) than patients who were hypertensive (18%) or normotensive (23%) in non-RRT patients. By contrast, hypertension in the RRT group occurred much less frequently (21%) and hypotension was slightly more common in the RRT group (2.1%). There was no significant relationship between extremes of blood pressure and mortality in the RRT group. Compared to normotensive patients, herniation occurred more frequently in hypotensive non-RRT patients (28% vs 14%, OR 1.5, 95% CI 1.5–1.7, P<0.001). No relationship between BP and herniation was identified in patients with ESRD.

Conclusion:
ESRD requiring RRT is associated with a 78% relative increase in mortality after ICH. Whereas hypotension increases the risk of death in ICH patients with preserved renal function, hypotension is much more common in ESRD patients and does not confer the same hazard. Further research is needed to understand how ESRD increases mortality after ICH.
Abstract WP138: Delirium Is Associated With Higher Rates Of 90-day Hospital Readmission Among Patients With Primary Intracerebral Hemorrhage
Authors: Potter Thomas , Meeks Jennifer , Bako Abdulaziz T , Pan Alan , Tannous Jonika , Johnson Carnayla , Baig Eman , Ahmed Wamda , Misra Vivek , Vahidy Farhaan S
Published: February 2022

Background:
Delirium in-hospital (DIH) results in poor in-patient outcomes. However, it’s longer-term effects among intracerebral hemorrhage (ICH) patients are not well characterized. We sought to evaluate the association between DIH and 90-day readmission (RA) among primary ICH patients.

Method:
Clinical, imaging and outcomes data, from May 2016 to June 2021, were obtained from the
Neurological Outcomes Registry for ICH (NEURO-RICH)
; an informatics pipeline across 7 comprehensive and primary stroke centers which implement protocolized delirium assessments via 4AT / CAM-ICU scales. Demographic (age, sex, race, ethnicity, marital status), Glasgow Coma Scale (GCS), systolic and diastolic blood pressure (S/DBP), sepsis, systemic inflammatory response syndrome, and comorbidity data were analyzed. Survival analysis for time-to-90-Day RA was performed with death modeled as a competing risk. Sub hazard ratios (SHR) and 95% confidence intervals (CI) are reported. Subgroup with imaging data (ICH score and cerebral small vessel disease) was analyzed.

Results:
Final analyses included 1,434 ICH patients (mean age: 66.0 years, 47.2% female, 24.8% non-Hispanic Black, 19.9% Hispanic, median GCS: 13.2, SBP: 163 mmHg). In the fully adjusted model, DIH was significantly associated with higher rates of 90-Day RA (SHR, CI: 2.24, 1.04 - 4.81) (Figure 1A). Anticoagulant therapy (1.36, 1.03 - 1.80), hypertension (1.95, 1.38 - 2.74), diabetes (1.13, 1.09 - 1.17), and Charlson Comorbidity Index (1.08, 1.04 - 1.13) were also independently associated with 90-Day RA (SHR, CI reported). In the imaging subgroup of 523 patients, DIH retained independent association with 90-Day RA (SHR: 3.94 [1.37 - 11.36]) (Figure 1B).

Discussion:
In addition to traditional predictors of poor outcomes among ICH patients, DIH demonstrated strong and independent association with 90-day RA. Screening, identification, and active management of DIH is critical to reduce long-term disease burden of ICH.
Abstract WP139: Association Of Antiplatelet Use And Outcomes In Aneurysmal Subarachnoid Hemorrhage
Authors: Persaud Bianca H , Joudi Kareem , Stretz Christoph , Potter Nicholas S , Cutting Shawna M , Wendell Linda C , Thompson Bradford , Furie Karen L , Reznik Michael , Mahta Ali
Published: February 2022

Introduction:
Antiplatelet agents are commonly used after endovascular repair of ruptured aneurysms in patients with subarachnoid hemorrhage (SAH). Recent evidence suggests post-treatment antiplatelets may reduce risk of delayed cerebral ischemia (DCI) and worse outcome. We sought to determine potential risks and benefits of antiplatelets in our patients’ population

Methods:
This is a retrospective cohort study of consecutive patients with aneurysmal SAH who were admitted to an academic referral center from 2016 to 2021. We used multivariable logistic regression analysis, propensity score matching and multiple linear regression to test the association of antiplatelets use and functional outcome (modified Rankin Scale at 3 months), DCI, any intracranial hemorrhagic complications including EVD tract hemorrhage and ICU length of stay (continuous variable).

Results:
Of the confirmed aneurysmal SAH patients (n=315), mean age was 57 years (SD 13.6) and majority of patients were female (62%) and white (70%). Thirty-nine percent of patients received antiplatelets (26% single agent; 13% dual agents) with no differences in demographics. Of the patients in the cohort, 85% received endovascular treatments (including 59% coil, 12% pipeline and stent assisted coil, 14 other endovascular treatments) and 15% underwent surgical clipping. Antiplatelets were used more in aneurysms originating from posterior circulation compared to anterior circulation (54% vs 35%, p=0.012). There was no difference in functional outcome (modified Rankin Scale at 3 months), DCI, or any intracranial hemorrhagic complications including EVD tract hemorrhage. ICU length of stay was longer in patients who received antiplatelets (3.32 additional days, 95% CI 0.4-6.3; p=0.02) and this association was independent of Hunt and Hess grades, modified Fisher scales, aneurysm treatment modality, age, comorbidities, and hospital complications.

Conclusion:
Use of antiplatelets may not reduce risk of DCI and worse outcome but can be associated with longer ICU length of stay. Further studies are required to identify appropriate candidates who may benefit from antiplatelets.
Abstract WP14: Association Of Vascular Properties With The Periventricular And Deep White Matter Hyperintensity In Middle-age Population
Authors: Hannawi Yousef , Vaidya Dhananjay , Yanek Lisa R , Johansen Michelle C , Kral Brian G , Becker Lewis C , Becker Diane M , Nyquist Paul A
Published: February 2022

Introduction:
The periventricular white matter is more sensitive to alterations in the hemodynamics of the systemic circulation than the deep white matter due to differences in its vascular supply and relationship to systemic circulation. We hypothesize that periventricular white matter hyperintensity volume (PVWMH) shows greater association than deep white matter hyperintensity (DWMH) volume with vascular property measures of arterial stiffness (AS) and cardiovascular remodeling, important indicators of the systemic circulation.

Methods:
Participants in the Genetic Study of Atherosclerosis Risk ≥ 50 years of age with brain MRI were selected. Vascular property measures included pulse pressure (PP), hypertension response to exercise (HRE), diastolic brachial artery (BA) diameter, diastolic common carotid artery (CCA) diameter, CCA distensibility coefficient, and left ventricular function. PVWMH and DWMH were measured using semi-automated segmentation approach. The relative associations of these parameters with PVWMH and DWMH volumes as multiple measures within the same individual further nested within families were determined using multilevel linear models. We also determined if differences between PVWMH and DWMH associations were modified by age.

Results:
426 participants (age 59.0±6.1 years, 57.5% females, and 39.7% African American) were included. Within the same subject, PVWMH volume showed greater association than DWMH volume with PP (P=0.002), HRE (p=0.04), diastolic BA diameter (p=0.012), and diastolic CCA diameter (p=0.04) independent of age and cardiovascular risk factors. This difference in PVWMH versus DWMH association with vascular properties did not differ at any age threshold.

Conclusions:
We show for the first time that PVWMH volume has greater association than DWMH volume, independent of age, with vascular property measurements of AS and cardiovascular remodeling. Our findings suggest that changes in the systemic circulation may affect PVWMH and DWMH differently adding to a growing body of literature that PVWMH and DWMH may represent different phenotypes of cerebral small vessel disease.
Abstract WP142: T Cells Aggravate Intracerebral Hemorrhage Injury
Authors: Shi Samuel X , Xiu Yuwen , Shi Kaibin , Glosser Logan , Jiang Yinghua , Liu Ning , Liu Qiang , Wang Xiaoying , Jin Weina
Published: February 2022

Intracerebral hemorrhage (ICH), a devastating form of stroke, has a mortality of 40% and no available treatment. Inflammation contributes to the genesis and expansion of perihematomal edema (PHE) in ICH, thus driving secondary injury and subsequent neurological deterioration. This study was carried out to elucidate contributions of lymphocytes, specifically CD4
+
cells in the formation of PHE and ICH-induced neural injury. Upon examination of brain sections of ICH patients, we observed abundant CD4
+
T cells among the PHE-infiltrating immune cells as early as 24 hours post-ictus. Analogous findings in ICH mouse model induced with autologous blood or collagenase injection confirmed the phenomenon. Using anti-CD4 antibody to deplete CD4
+
T cells, we find that brain-infiltrating CD4
+
T cells exacerbates acute ICH injury in mice by reducing BBB integrity and promoting leukocytes recruitment with early and time-dependent CD4
+
T cells activation. Brain infiltrating CD4
+
T cells exhibit activated transcriptome signatures, promoting local inflammation via IL-17. In the hemorrhagic brain, CD4
+
T cells induces CD31
+
endothelial cell apoptosis via death receptor-ligands TRAIL-DR5 pathway; specific ablation of CD4
+
T cells with depleting antibody results in reduced PHE volume and improved long-term neurological outcome. In all, these data sheds new lights on T cell-mediated immune responses contributing to PHE and brain injury in ICH.
Abstract WP144: Safety Of Eptifibatide Use In Ischemic Stroke Patients Undergoing Endovascular Thrombectomy: A Matched Cohort Analysis
Authors: Rana Ameena , Yu Si , Reid-Herrera Savina , Hunter Krystal , Shaikh Hamza , Jovin Tudor , Patel Parth , Kamen Scott , Siegler James E , Thon Jesse
Published: February 2022

Introduction:
Small studies have suggested that eptifibatide (EPT) may be safe in acute ischemic stroke (AIS) following IV thrombolysis (tPA) or during endovascular therapy (EVT) for large vessel occlusion (LVO), however larger studies are called upon to evaluate the safety of EPT use in this setting.

Methods:
A stroke center registry (09/2015-12/2020) of consecutive adults who had undergone EVT for LVO was queried. Patients treated with EPT were matched with 3 control groups based on known factors associated with intracranial hemorrhage (ICH) risk - age, early infarct size (Alberta Stroke Program Computed Tomography Scale [ASPECTS] score), and number of thrombectomy passes. ICH, parenchymal hematoma (PH-2), symptomatic ICH (sICH), and 90-day modified Rankin Scale (mRS) score were compared between matched groups.

Results:
A total of 236 patients were included, 59 of whom (25%) received EPT. IV tPA was non-significantly more utilized in EPT patients (41%, p=0.22). Rate of any ICH was similar between groups (p=0.23), while PH-2 was significantly more frequent with EPT (21% v. 7% v. 3% v. 0%; p= 0.0001). There were no significant differences in sICH (7% EPT v. 7% v. 5% v. 2%; p=0.57), 90-day mRS (p=0.84), or 90-day mortality (p=0.92) between EPT and control groups.

Conclusion:
In this single center analysis, EPT during EVT was associated with a higher rate of PH-2 grade hemorrhages but not with differences in sICH, 90-day mRS, or 90-day mortality. Larger prospective studies are needed to confirm these findings.
Abstract WP146: Five-year Outcome After Endovascular Treatment For Large Vessel Occlusion In Acute Ischemic Stroke
Authors: Li fengli , Zi Wenjie , huang jia cheng , Yang Qingwu
Published: February 2022

Background:
Endovascular treatment (EVT) has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke. However, results on long-term clinical outcomes are lacking.

Objective:
We sought to assess the 5-year functional outcome of patients with acute LVO in anterior circulation undergoing EVT.

Methold
This study was an observational, nationwide registry of consecutive patients aged 18 years or older who received EVT for acute LVO in anterior circulation in 27 comprehensive stroke centers across 12 provinces in China. The primary outcome was the proportion of good functional outcome defined as modified Rankin Scale scores (mRS) of 2 or less at 5 years. Secondary outcomes included the proportion of patients with excellent clinical outcome (mRs0-1), all-cause mortality and risk of stroke recurrence at 5 years.

Results:
A total of 807 patients were recruited into the study. Of these, 642 patients (79.6%) had 5-year follow-up data. Both the proportions of good outcome (40.7% VS 43.2%, P=0.321).and excellent outcome (29.6% VS 27.0%, P=0.278) at 5 years were similar to the proportions at 90 days after stroke; The cumulative 5-year mortality (47.0% VS 24.7%, P<0.001) and stroke recurrence rate (19.9% VS 1.6%, P<0.001) were significantly higher than rates at 90 days, and 66.4% of the stroke recurrent patients died at 5 years. Multivariate analyses identified increasing age, residual disability at 90 days and stroke recurrence were predictors for good functional outcome and the increased mortality risk at 5 years.
Abstract WP151: Outcome Of Endovascular Treatment For Acute Basilar Artery Occlusion With Moderate Deficit
Authors: huang jia cheng , kong weilin , Qiu Zhongming , Song Jiaxing , Li Fengli , Zi Wenjie , Yang Qingwu
Published: February 2022

Background and Purpose:
This study aimed to investigate the efficacy and safety of endovascular treatment (EVT) in patients with acute basilar artery occlusion and moderate deficit (National Institutes of Health Stroke Scale [NIHSS] score 10 to 20) versus standard medication treatment (SMT) alone.

Methods:
Patients from a nationwide prospective registry termed BASILAR (the Endovascular Treatment for Acute Basilar Artery Occlusion Study) were divided into three kinds of population according to NIHSS, including patients with mild deficit (NIHSS score <10), moderate deficit (NIHSS score 10-20) and severe deficit (NIHSS score>20). Then patients with moderate deficit were identified and divided into two groups for analysis: EVT group or SMT-alone group. The primary efficacy outcome was a favorable functional outcome (modified Rankin Scale score 0-3) at 90 days and safety outcomes were symptomatic intracerebral hemorrhage and mortality at 90 days.

Results:
A total of 194 patients had moderate deficit of which 47 patients treated with SMT-alone and 147 patients treated with EVT. Compared with patients in the SMT-alone group, patients undergoing EVT were associated with significant higher proportion of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 3.36 [95%CI, 1.14-9.92];
P
= .028) but no statistically significant difference was found in 90-day mortality (adjusted odds ratio, 0.53 [95% CI, 0.25-1.14];
P
= .10) despite a higher rate of symptomatic intracerebral hemorrhage (4 of 146 patients [2.7%] vs 0 of 47 patients [0%]).

Conclusions:
This study suggests that EVT in acute basilar artery occlusion patients with moderate deficit may be associated with better functional outcomes. More randomized clinical trials were in need to explore the management of these patients.
Abstract WP153: Abnormal Cerebral Blood Flow Determined By Transcranial Doppler In Patients With Anterior Circulation Large-vessel Occlusion Stroke And Successful Endovascular Recanalization
Authors: Sambursky Jacob A , Krementz Nastajjia , Gondal Faisal , Saleh Velez Faddi G , Koch Sebastian , Del Brutto Victor J
Published: February 2022

Background:
Almost half of large-vessel occlusion (LVO) stroke patients have unfavorable outcomes despite successful endovascular revascularization. We aim to characterize post-revascularization cerebral blood flow (CBF) determined by transcranial Doppler (TCD) and explore whether abnormal CBF associates with in-hospital outcomes in this population.

Methods:
We analyzed 105 stroke patients with anterior circulation LVO who had successful endovascular revascularization (Thrombolysis in Cerebral Infarction 2b-3) and CBF assessment by TCD within 48 hours of recanalization. TCD parameters recorded at the ipsilateral middle cerebral artery included mean flow velocity, peak systolic velocity, pulsatility index (PI), and resistance index (RI). CBF was classified according to the Thrombolysis in Brain Ischemia (TIBI) score into dampened flow (score of 3), stenotic flow (score of 4), and normal flow (score of 5). We explored unadjusted associations between post-revascularization CBF and hospitalization outcomes including reduced disability at discharge (modified Rankin Score [mRS] 0-2), home disposition, and in-hospital mortality.

Results:
Table 1 summarizes study population characteristics. Overall, 62 (59.1%) individuals had normal CBF, 29 (27.6%) had stenotic flow, and 14 (13.3%) had dampened flow. Patients with abnormal CBF showed a trend towards lower likelihood of mRS 0-2 at discharge (32.1% vs. 44.2%; p=0.20) and home disposition (28.1% vs. 46.6%; p=0.08). TCD parameters were not associated with disability at discharge or home disposition. However, in-hospital mortality was significantly associated with elevated PI (1.3 ± 0.4 vs. 1.1 ± 0.5; p<0.01) and RI (0.7 ± 0.1 vs. 0.6 ± 0.1; p<0.01).

Conclusion:
A noteworthy fraction of anterior circulation LVO stroke patients had TCD-defined abnormal CBF despite successful revascularization. Abnormal CBF and increased vascular resistance may relate to unfavorable outcomes in this population.
Abstract WP159: Effect Of Multiple Passes During Mechanical Thrombectomy On Clinical Outcomes
Authors: Hassan Ameer E , Fifi Johanna T , Zaidat Osama O
Published: February 2022

Introduction:
Reperfusion with mechanical thrombectomy improves outcomes in patients with Large Vessel Occlusion Acute Ischemic Stroke (LVO-AIS). The technical goal of thrombectomy is reperfusion to a modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b. Here we investigate if procedures requiring multiple passes to achieve complete reperfusion (MP mTICI 3) result in better outcomes compared to procedures stopped after achieving mTICI 2b-2c on the first pass (FP mTICI 2b-2c).

Methods:
Using data from the COMPLETE registry (a global prospective study of LVO-AIS patients who underwent mechanical thrombectomy using the Penumbra System), we grouped patients into MP mTICI 3 and FP mTICI 2b-2c. Functional independence (mRS 0-2) at 90 days, all-cause mortality at 90 days, device-related serious adverse events (SAE) ≤ 24 hours, procedure-related SAEs ≤ 24 hours, embolization to new or previously uninvolved territories (ENT), symptomatic intracranial hemorrhage (sICH) ≤ 24 hours, vessel perforation, vessel dissection, and length of stay were compared.

Results:
Of the 650 patients in the COMPLETE registry, 215 were included in this subgroup analysis; 111 were categorized as MP mTICI 3, and 104 as FP mTICI 2b-2c. The MP mTICI 3 group has fewer M1 occlusions (48% vs 67%, p = 0.004) and more ICA-T occlusions (19% vs. 9%, p = 0.032). The groups were otherwise well matched with respect to age, sex, medical history, pre-procedure ASPECTS, NIHSS, IV tPA use, onset-to-puncture time, and occlusion etiology. Outcomes are shown in table 1.

Conclusions:
In this exploratory subgroup analysis, we found that procedures requiring multiple passes to achieve complete revascularization were not associated with improved outcomes compared to procedures stopping after achieving mTICI 2b-2c on the first pass.
Abstract WP160: First-Pass Effect Modification In Proximal Vs Distal M1 Occlusion Thrombectomy
Authors: Rao Rahul , Salahuddin Hisham , Prologo-Richardson Paige , Khalid Fatima , Afreen Ehad , Burgess Richard , Zaidi Syed F , Jumaa Mouhammad A
Published: February 2022

Modified first pass effect (mFPE) of TICI 2B or greater is an independent predictor of clinical outcome in patients who undergo mechanical thrombectomy (MT). Location of the occlusion in the M1 segment may affect the mFPE and may influence clinical outcomes. A comparison of mFPE between occlusions of the proximal and distal (sparing lenticulostriate branches) M1 segments of the MCA has yet to be performed. We aim to examine the interaction between first pass effect and clinical outcomes in proximal versus distal M1 occlusions. We performed retrospective analysis of patients who underwent MT between 2014 and 2020. Patients were included if they were treated for M1 occlusion within 24 hours from last seen normal, and achieved successful recanalization (TICI2b or greater). Patients were excluded if they were not successfully recanalized, or if they had other intracranial or multifocal occlusions. A total of 264 patients were included in this analysis. Ninety two patients had proximal M1 occlusions and 172 had distal M1 occlusions. Patients with proximal M1 occlusions had higher NIHSS (median 18 vs. 16, p=0.003), lower ASPECTS (mean 8.5 vs 9, p=0.02), and were less likely to be females (44.6% vs. 62.8%, p=0.006). Modified first pass effect was achieved in 45.3% of distal M1 occlusions compared to 31.9% of proximal (p=0.047). Excellent clinical outcome, defined as mRS of 0-1 at 90 days was higher in distal occlusion group (38.8% vs. 24.7%, p=0.03). Additionally, the proximal occlusion group was more likely to experience any grade of hemorrhagic transformation (HT) (37.4 vs. 23.3, p=0.02). Other baseline characteristics and time metrics did not differ between the two groups. In a multivariate analysis of predictors of excellent outcome in the overall cohort, ASPECTS (OR=1.39, p
=
0.026) and proximal occlusion site (OR=0.485, p=0.037) were the only two independent predictors. Therefore, mFPE was not a predictor of excellent outcome when adjusted for exact location of occlusion.
Abstract WP164: Prediction Of 90 Day Home Time Among Patients With Low Baseline Aspects Score Undergoing Endovascular Thrombectomy
Authors: Singh Nishita , Holodinsky Jessalyn K , Kashani Nima , McDonough Rosalie , Bala Fouzi , Horn MacKenzie , Stang Jillian , Demchuk Andrew M , Hill Michael D , Almekhlafi Mohammed
Published: February 2022

Background:
The outcome in stroke patients with ASPECTS of ≤5 who undergo Endovascular Thrombectomy(EVT) in Large Vessel Occlusion (LVO) is uncertain. We used machine learning models to predict 90-day home-time in these patients.

Methods:
We used the QuICR provincial stroke registry and administrative data from Southern Alberta to identify patients who underwent EVT from Jan 2015-Dec 2019. Imaging data were scored by 2-physician consensus. The primary outcome was the predicted 90-day home-time(number of days a patient is back at their premorbid living situation without an increase in level of care within 90 days of the stroke) using generalized boosting machine model with Gaussian distribution. Covariate contribution to hometime was determined using partial dependence plots.

Results:
Of 659 EVT patients, 82(12%) had baseline ASPECTS ≤5(mean age 69.8y, 44.6% females, 93% good-moderate collaterals, M1 occlusion(64.1%). Overall, patients with low ASPECTS had lower median predicted home-time by 2.8d. Holding other covariates constant, factors predicting lower 90d-home-time were diabetes mellitus(-14d), hypertension(-7d), and symptomatic intracerebral hemorrhage (sICH) on follow up scan(-14d). Home-time decreased with increasing age in both low and non-low ASPECTS groups, but the difference was larger in older age groups (Figure). There was no meaningful difference in predicted 90d-home-time by sex, atrial fibrillation, baseline NIHSS, occlusion site, tandem lesion, thrombolysis, or successful reperfusion.

Conclusions:
Among patients with low ASPECTS who underwent EVT, hypertension, diabetes and sICH predicted lower 90-d home-time. .
Abstract WP169: The Utility Of Transesophageal Echocardiogram In Embolic Strokes Of Undetermined Source Not Associated With Patent Foramen Ovale
Authors: Thakur Gaurav , Schlick Konrad H , Figueroa Sonia , Rinsky Brenda
Published: February 2022

Introduction:
Transesophageal echocardiography (TEE) is frequently utilized in the diagnosis of embolic stroke of undetermined significance (ESUS), with a patent foramen ovale (PFO) being the most common finding. Transcranial doppler (TCD) is comparable to TEE in diagnosing a right-to-left shunt, while being less invasive. Our aim is to evaluate the diagnostic yield of TEE excluding the diagnosis of PFO, in patients with ischemic stroke satisfying ESUS criteria.

Methods:
We retrospectively evaluated patients at our institution with acute ischemic stroke fulfilling ESUS criteria who underwent TEE examination during a 50-month period (May 2017 to July 2021). In these patients, we also evaluated whether TCD bubble study was done. We assessed whether non-PFO TEE findings altered management course.

Results:
We identified 113 patients with ESUS who underwent investigation with TEE (mean age 65 ± 13.5 years, 62% men, 38% women, median NIH Stroke Scale = 4 points [interquartile range: 2-9]). TEE revealed a PFO in 23.4% (95% CI: 19%-28.8%). TCD was performed in 55.6% of the patients with a PFO found on TEE, and revealed a right-to-left shunt in 80% of them. Excluding the finding of PFO, TEE revealed additional findings in 27 (23.9% [95% CI: 15.9%-31.2%]) patients. This changed management (anticoagulation therapy or surgical evaluation) in 3 (2.7% [95% CI: 0%-5.6%]) patients. The surgical evaluation was due to marantic valve endocarditis. No patients required IV antibiotic therapy due to TEE findings.

Conclusions:
Abnormal TEE findings only rarely affect the management in ESUS. TCD may be sufficient to screen for PFO in ESUS patients.
Abstract WP170: Hospital Course And Clinical Outcomes In Internal Carotid Versus Vertebral Artery Dissections
Authors: Garg Aayushi , Leira Enrique C. C , Shaban Amir
Published: February 2022

Background:
Data regarding the differential clinical features of internal carotid artery dissection (CAD) versus vertebral artery dissection (VAD) are limited. We, therefore, aimed to evaluate the clinical course of cervical artery dissections (CeAD) presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA), according to the location of the dissection.

Method:
Hospitalizations with discharge diagnoses of CeAD and AIS/TIA were identified from the Nationwide Readmissions Database 2016-2018. Logistic regression analysis was used to compare the risk factors, interventions, and clinical outcomes of CAD and both CAD/VAD in reference to VAD alone. Survival analysis was used to study the risk of recurrent ischemic events after discharge.

Results:
There were 21402 hospitalizations with ischemic events due to CeAD (mean±SD age: 54.8±17.2 years, female: 40.7%). Of these, 10250 (47.9%) had VAD (reference group), 10813 (50.5%) had CAD, and 339 (1.6%) had both CAD/VAD. Patients with CAD were older, more likely to be female, more likely to have comorbidities like hypertension, atrial fibrillation, coronary artery disease, heart failure, tobacco use, head/neck vessel atherosclerosis, and previous stroke, and less likely to have migraines. Whereas patients with both CAD/VAD were younger, less likely to have hypertension, hyperlipidemia, and diabetes, and more likely to have Ehlers Danlos syndrome. Patients with CAD were more likely to receive intravenous thrombolysis and mechanical thrombectomy. Both groups had higher risk for intraparenchymal hemorrhage and in-hospital mortality and patients with CAD were less likely to discharge home as compared to those with VAD alone. Of 17925 patients with survival to discharge and known discharge disposition, 746 (4.2%) were readmitted due to recurrent ischemic events within 1 year of discharge (mean±SD time to readmission: 55.5±71.0 days). The risk of readmission did not vary by the location of dissection during the initial hospitalization.

Conclusion:
Carotid and vertebral artery dissections have different risk factor profiles. Although patients with CAD are more likely to get acute stroke interventions, they remain at a higher risk of worse clinical outcomes as compared to those with VAD.
Abstract WP174: Incidence Of Pediatric And Neonatal Cerebral Venous Sinus Thrombosis In The United States (US)
Authors: Zhou Lily , Reiter Stephanie , Field Thalia S , Lee Sarah
Published: February 2022

Background:
Prior pediatric CVT incidence estimates range from 0.4-0.7 per 100,000 per year but no US specific incidence has previously been reported. We examined incidence of CVT hospitalization within a large US pediatric database.

Methods:
We evaluated incidence of neonatal and childhood CVT using the 2012 and 2016 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID), a large-scale administrative dataset providing estimates of US hospital inpatient stays for children. Patients under 20 years of age were examined to match US census population data. All children with discharge diagnoses of CVT were queried using ICD-9 (2012) and ICD-10 (2016) codes. Survey weights were applied to estimate total national discharges adjusting for KID’s sampling technique. Population incidence was calculated from 2012 and 2016 US vital statistics data for live births for neonates and census data for other ages.

Results:
Table 1 summarizes CVT-related discharges by sex and age group. Overall annual incidence for CVT related hospitalization was 4.37 (95% CI 3.72-5.02) and 5.51 (95% CI 4.78-6.24) per 100 000 births for neonates in 2012 and 2016 respectively and 1.18 (95% CI 1.11-1.26) and 1.58 (95% CI 1.49-1.66) per 100 000 other children under 20 years old in 2012 and 2016. Mortality was 3.4% and 3.53% for all CVT discharges compared to 0.34% and 0.36% for all US pediatric discharges in 2012 and 2016. The overall incidence of CVT related hospitalization was higher in 2016 than 2012 for all age groups and was higher for males until the 15-19 age group in both years.

Conclusion:
Higher incidence of CVT hospitalizations in 2016 versus 2012 is similar to trends seen in adults. Unlike adults, more CVT hospitalizations occurred among males until the 15-19 age group. The current analysis is limited by inability of available national data to differentiate between hospitalizations due to new CVT presentation and re-admission.
Abstract WP175: A National, Population Based Study Of Neonatal Hemorrhagic And Ischemic Stroke
Authors: Fraser Stuart M , Levy Samantha , Talebi Yashar , Savitz Sean I , Wu Hulin
Published: February 2022

Background:
Neonatal stroke occurs in an estimated 1 in 3000 live births and is the most common cause of hemiplegic cerebral palsy in term infants. Most population based studies on neonatal stroke in the past have been single center or regional, focused only on ischemic stroke, and with less than 100 cases. Large administrative datasets can provide information on comorbid perinatal conditions in neonatal stroke.

Methods:
Data for patients aged 0-28 days with a diagnosis of either ischemic or hemorrhagic stroke (either subarachnoid or intracerebral hemorrhage) were extracted from the Cerner Health Facts EMR database from 2000-2018. Incidence of birth demographics, perinatal complications, anti-epileptic use, and aspirin use was assessed. Odds ratios were calculated against a cohort of neonates without stroke.

Results:
Among 1,591,104 neonates in the Cerner EMR database, 452 (59%) neonates were identified with ischemic stroke and 311 (41%) with hemorrhagic stroke. The most common comorbidities for ischemic stroke were neonatal sepsis (16%, OR=13.1), head and scalp birth injury (13%, OR=7.1) and hypoxic injury (12%, OR=38.7). The most common comorbidities for hemorrhagic stroke were head and scalp birth injury (30%, OR=19.5), prematurity (26%, OR=4.2) and neonatal sepsis (23%, OR=13.1). Procedure codes for intubation, neonatal resuscitation, and epinephrine use were prominent in both hemorrhagic (15.1%, OR=35) and ischemic stroke (8.9%, OR=19.1). The proportion of hemorrhagic and ischemic stroke patients receiving antiepileptics was 23% and 27%, respectively. The proportion of ischemic stroke patients who received aspirin was 16.4%.

Conclusion:
This population based study of neonatal stroke, the largest of its kind, demonstrated a wide variety of comorbid conditions with ischemic and hemorrhagic stroke. Antiepileptic use is common in neonatal ischemic stroke, though in our population-based study of both academic and non-academic centers the prevalence is less than prior estimates. Sepsis, head and scalp injuries, prematurity, and hypoxic injury are associated with neonatal hemorrhagic and ischemic stroke, though prevalence varies between types. More study is needed on specific risk factors and pathogenesis in neonatal stroke.
Abstract WP176: Compared To Catheter Angiogram MRA Is A Moderate Predictor Of Suzuki Grade In Children With Moyamoya
Authors: Lehman Laura L , Kaseka Matsanga Leyila , ARMSTRONG DEREK , Shroff Manohar , Dirks Peter , Moharir Mahendranath D , Muthusami Prakash , MacGregor Daune , Deveber Gabrielle A , Dlamini Nomazulu
Published: February 2022

Introduction:
Moyamoya is a progressive cerebral arteriopathy affecting the arteries in the circle of Willis. Suzuki grade for moyamoya using catheter angiogram has been gold standard for the evaluation of moyamoya both in children and adults. Suzuki grade evaluates the amount of stenosis and collateral formation in the cerebral arteries. Magnetic resonance angiography (MRA) non-luminal imaging can overestimate stenosis and underestimate collaterals. With greater use of MRA for diagnosis and follow-up, it is important to understand MRA staging is truly comparable to catheter angiogram.

Methods:
Study neurologist and interventional radiologist reviewed both catheter angiograms and MRAs without clinical information. The modified Suzuki stage was used to evaluate the MRA. Median time from MRA to catheter angiogram was calculated. Cohen’s Kappa was used to compare modalities of Suzuki grade based on catheter angiogram to modified Suzuki grade by MRA on the same patients.

Results:
A total of 29 patients with moyamoya were reviewed. Median time between MRA and catheter angiogram was 2.4 months with interquartile range from 0.6-5.3 months. Unweighted Cohen’s Kappa was 0.34 (p<0.0001) which is considered fair correlation. When we calculated a weighted Cohen’s Kappa it improved but only to 0.49 (p<0.0001) which is moderate correlation.

Conclusion:
Using Cohen’s kappa to compare two methods of evaluating cerebral artery stenosis in children with moyamoya, we demonstrated that there is only moderate correlation between catheter angiogram Suzuki staging compared to modified Suzuki staging with MRA. In conclusion, we suggest caution in the reliance of MRA for diagnosis and follow-up of children with moyamoya. We recommend consideration catheter angiograms at time of diagnosis and with surgical planning.