bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract HUP4: Feasibility And Acceptability Of A Hospital-Based Educational Training For Caregivers Of Patients With Severe Stroke In LMIC
Authors: Ecos Rosa Lizbeth , Suarez Medina Alicia , Abedini Nauzley , Creutzfeldt Claire , Lazo Maria , Garcia Hugo , Gimbel Sarah , Zunt Joseph
Published: January 2025

Background and Aims:
The burden of stroke and stroke-related disability in Peru – a low- to middle-income country – is nearly 50% higher than the global average. Gaps in post-stroke care in Peru include insufficient rehabilitation and post-acute care, limited caregiver training, and lack of a national palliative care program. To address these gaps, we designed and piloted a hospital-based training intervention to support patients discharging home after severe stroke.

Methods:
Between June 1st, and November 30th, 2023, we randomized caregivers to two intervention arms (online vs in-person), which both included training in nasogastric and Foley tube management, bathing and cleaning, and mobilization. Using a convergent mixed-methods design, we simultaneously collected quantitative and qualitative data from caregivers and stroke nursing staff one-month after discharge). Outcomes informed by Proctor et al and RE-AIM frameworks we used to describe and assess feasibility and acceptability of implementation.

Results:
We recruited 38 caregivers of patients with severe stroke (patient median modified Rankin Score of 5) and randomly assigned 19 to each arm. Feasibility and acceptability, as the percentage greater than 75% to administering two caregivers’ scales and the percentage greater than 50% reporting acceptability to the intervention, respectively, were over 80% for both groups; adoption, as the percentage of caregivers who completed training was 100% for in-person versus 57.9% for virtual arm (p=0.001). Willingness to participate in the training was a facilitating factor; barriers included caregiver burden, stressful family dynamics and limited internet skills (for older caregivers).

Conclusions:
While both in-person and online caregiver trainings were feasible and acceptable, in-person training was both preferred and achieved superior results. More interventions to improve support for caregivers of patients with severe stroke with clear implementation guidance strategies are needed to ensure their effectiveness, impact, and sustainability.
Abstract NS1: Identification of Subarachnoid Hemorrhage: The Impact of a Nurse Led Screening Tool Utilizing the Ottawa Rule
Authors: BROWER CHANDRA , KRUMVIEDA SHANNON
Published: January 2025

Background:
The 2023 American Heart Association/American Stroke Association’s
Guideline for Management of Patients with Aneurysmal Subarachnoid Hemorrhage
(SAH) support use of the Ottawa Rule to screen individuals at risk. Data showed SAH patients who presented to the Emergency Department (ED) with headache (HA) and hypertension frequently had long wait times before evaluation by a provider. The ED lacked a formal triage process for identification of SAH resulting in delayed treatment. This gap could lead to suboptimal patient outcomes.

Purpose:
The goal of this project is to create a nurse-led screening tool for identifying patients at risk for SAH and aid in the decision for computed tomography (CT). Earlier identification, along with order set initiation, supports best practice.

Method:
Patients presenting with nontraumatic HA are assessed by an ED RN to determine if HA reached maximum intensity within one hour of initial onset. If criterion is met, a best practice alert (BPA) triggers within the electronic medical record. The Ottawa Rule displays in the BPA to provide guidelines to determine next steps. If the patient age is 40 or older, or meets criteria of the Ottawa Rule, the ED RN initiates a stat head CT per protocol. Patients with identified SAH are immediately roomed and seen by an ED physician, who consults the stroke team. Guideline-based cares, including blood pressure management are initiated.

Results:
Use of the Ottawa Rule screening tool on patient arrival to the ED leads to earlier identification of patients with SAH, reduction of door to seen by provider time and door to diagnostic times, plus allows for expediated initiation of blood pressure management. A total of nine direct arriving patients were reviewed over a one-year period. The six patients treated before the practice change had a median door to CT of 90 minutes and a median door to stroke provider time of 134 minutes. Following implementation, the door to stroke provider median time was 33 minutes and door to provider time decreased to 52 minutes. This reflects a decrease of 63% of median arrival time to CT and a 61% decrease of median arrival time to stroke provider. Since implementation, 100% of patients with SAH were immediately identified and treatment initiated.

Conclusion:
Nurse driven screening tool utilizing the Ottawa Rule expedited care for ED patients diagnosed with SAH. Faster time to diagnosis allows for targeted BP management and adherence to standard of care.
Abstract NS7: Time is Brain and Team is Brain! A Partnership to Improve Blood Pressure Control for Hemorrhagic Stroke Patients
Authors: Cox Stephanie
Published: January 2025

Background and Purpose:
Intracerebral and subarachnoid hemorrhages comprise roughly 15% of all strokes but have a higher risk of mortality and morbidity than ischemic strokes. Controlling hypertension after a hemorrhage is the primary intervention to limit the risk of hematoma expansion (HE) and the sequelae of secondary injury. Practice guidelines recommend smooth and sustained BP control within the first 60 minutes to limit the risk of HE. Chart reviews revealed median time to BP control was above the 1-hour timeframe and hemorrhage order set use by ED providers was only 65% at baseline. These findings drove efforts to improve the BP control for both non-traumatic ICH and SAH patients within the first hour of ED presentation.

Methods:
A multidisciplinary stakeholder group developed several interventions as part of this QI endeavor. A target SBP was defined as 130-150 mmHg for both ICH and SAH patients for the hyper-acute management phase. After a review of the literature for nicardipine titration practices, the ED hemorrhage order set was updated to allow for potentially faster BP control. An educational campaign was shared with ED nurses, providers, and other staff to broadly communicate project goals and changes made to the ED hemorrhage order sets. Target BP outlier cases were shared with ED and pharmacy leaders and reviewed via the Stroke Program’s quality improvement program meetings.

Results:
During the data analysis period of November 2023 to July 2024, 66 non-traumatic ICH and SAH patients presented directly to our ED (comfort care in the ED, transferred patients and ICH related to metastasis excluded). Charts were reviewed for time of arrival (door) to time of achieving the target SBP of 130-150 mmHg. There were 54 ICH and 12 SAH patients; 47% were female and median age was 59. Of these 66 patients, 85% had the appropriate order set placed which improved from a baseline of 65% prior to the QI endeavor. BP data analysis for the 34 (51%) patients who presented with an SBP above 130-150, improved from 74 to 53 minutes.

Conclusions:
BP control for ICH and SAH patients is a key intervention to limit rebleeding as well as associated morbidity and mortality. While this was a single center project with a limited number of patients, our QI program resulted in better use of the appropriate ED order set and improved median door-to target BP control times reflecting safe, effective, and evidenced-based care for our patients.
Abstract TMP4: Serum Protein Biomarekrs and Cell Suptypes Linked to Reduced Cerebral Edema in Aneurysmal Subarachnoid Hemorrhage
Authors: Yang Bosco Seong Kyu , Gusdon Aaron , Ren Xuefang , Choi H
Published: January 2025

Introduction:
Early brain injury (EBI), a complex collection of pathophysiological processes occurring within 72 hours aneurysmal subarachnoid hemorrhage (aSAH), is the key link connecting the initial event to the delayed and long-term complications. Cerebral edema is the major constituent of EBI, resulting from the direct toxicity of hemoglobin products and a critical increase in intracranial pressure. This study aims to identify serum protein biomarkers specifically targeting cerebral edema in EBI and cell-specific interventional targets.

Methods:
This study is based on a prospective observational cohort at a single tertiary referral center. Plasma samples collected from three separate groups of aSAH patients were analyzed. Each consisted of 64, 71, and 16 samples collected within 48 hours of rupture. For the first cohort, a proximity extension assay by Olink was used to analyze 184 proteins. For the second corhot, commercially available enzyme linked immunosorbent assay (ELISA) kits were used to determine the plasma concentrations of the candidate proteins. For the last cohort, peripheral blood mononuclear cells were isolated and their single-cell transcriptomic (scRNA) data were extracted using the 10X genomics platform. For each patient, the subarachnoid hemorrhage early brain edema score (SEBES) based on initial scans was dichotomized with severe edema being defined as SEBES > 2.

Results:
Overall, the median age was 52.5 years [IQR:45-63] and 76% were female. 35% had severe edema. Subpopulations divided by the outcome did not differ significantly, except for the Hunt-Hess grade (HH), with 71% and 32% of the patients with and without severe edema showing HH greater than three, respectively (p < 0.05). After adjusting for multiplicity, ten proteins showed overlapping, lowest p-values, and five were chosen as candidates based on their mechanistic relevance. Among the five candidate proteins, ALK1 and LAYN showed statistically different expressions, with patients with milder edema showing higher expression. scRNA analysis showed that ALK1 and LAYN were preferentially expressed in a cell cluster that co-expresses CST3, CLEC10A, and FCER1A but has lower levels of the markers for the known subtypes of type 2 conventional dendritic cells.

Conclusion:
This study suggests ALK1 and LAYN as the serum protein biomarkers and the existence of a specific subtype of dendritic cells, potentially associated with less edema following aSAH.
Abstract TP12: Apixaban for Preventing Recurrence of Ischemic Stroke in Patients with Atrial Cardiopathy: A Systematic Review and Meta-Analysis
Authors: Menegat Ana Luiza Rocha Soares , Menegat Brenda Luana Rocha Soares , Rachas Reis Mariana , Rocha Dantas Clara , de Souza Wagner Pedro , Matheus Gustavo Tadeu , Simões Bárbara , Alves Mylena , Bezerra Ian , Menegaz de Almeida Artur , Kelly Francinny , A de Moraes Francisco Cezar
Published: January 2025

Introduction:
Preventing ischemic strokes in patients with atrial cardiopathy is particularly challenging due to the elevated risks associated with the condition. While numerous studies have established the efficacy of anticoagulants in preventing stroke, their benefits for patients with atrial cardiopathy are not clearly understood. Herein, this systematic review and meta-analysis aims to assess the efficacy of Apixaban in preventing ischemic stroke recurrence in patients with atrial cardiopathy.

Methods:
A database search of published studies at PubMed, Web of Science, Cochrane, and Scopus was performed. Randomized clinical trials and observational studies comparing the administration of Apixaban with a placebo in adult patients were included. Risk ratio (RR) was used for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I
2
statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.

Results:
5 studies and 2593 patients were included. Among them, 1401 (54%) were allocated to receive Apixaban and 1192 (46%) were allocated to receive a placebo. The number of female and male patients was similar, with 1331 (51,3%) women and 1262 (48,7%) men. The recurrence of ischemic stroke (RR 0.89; 95% CI 0.64 to 1.23; P=0.479406; I
2
=0%) did not present a statistically significant difference between groups. Similarly, mortality (RR 1.36; 95% CI 0.92 to 2.02; P=0.121981; I
2
=0%) and recurrent fatal stroke (RR 0.31; 95% CI 0.07 to 1.38; P=0.123799; I
2
=0%) also showed no statistical significant difference between Apixaban and control group.

Conclusion:
In this systematic review and meta-analysis, we analyzed patients with ischemic stroke and evidence of atrial cardiopathy. Apixaban did not present significant reduction in recurrent stroke risk, recurrent fatal stroke incidence or mortality when compared with a placebo. Despite this, potential efficacy of early initiation of Apixaban should be clarified from new larger randomized clinical trials.
Abstract TP18: Hyperbaric oxygen treatment improves visual outcome in patients with non-arteritic central retinal artery occlusion: an observational retrospective study
Authors: Min Jiangyong , Orwig Drue , Naser Haj Aissa , Hovingh Majesta , Packard Laurel , Ahrar Asad , Miller Malgorzata , Khan Nadeem , Wees Nabil , Kooistra Joshua
Published: January 2025

Background and Objectives:
Central retinal artery occlusion (CRAO) is a rare form of acute ischemic stroke that causes severe visual loss, which is a relatively rare emergency but devastating eye condition. There is currently no guideline-endorsed treatment for CRAO. Data on hyperbaric oxygen therapy (HBOT) for CRAO is minimal. We aim to investigate the benefit of HBOT in patients with CRAO compared to conservative management.

Methods:
We conducted a retrospective single-center study that recruited patients with diagnosed non-arteritic CRAO from January 2019 to May 2024. HBOT was offered to CRAO patients who presented to the emergency room within 24 hours from symptom onset. Eight patients underwent a full course of HBOT (twice a day for five days with a total of 10 HBO treatments). Twelve CRAO patients received partial HBOT (from 1 to 7 treatments); HBOT was discontinued per patients' request, either due to anxiety or no noted visual improvement. Twenty-seven CRAO patients did not undergo HBOT due to being outside of the treatment window or HBOT was declined by patients. The primary outcome was visual improvement at the time of discharge. Student's T-test and Chi-square test were used to compare the change in LogMAR best-corrected visual acuity (BCVA) in patients before and after HBOT.

Results:
There was no statistical difference among the three groups in patient demographic and clinical characteristics (vascular risk factors). In the HBOT group, patients who received an entire course of HBOT (twice a day for five days) revealed significant visual improvement at discharge evaluation with LogMAR BCVA compared to the partial HBOT and the control group (Table 1). Only one patient developed an episode of seizure while receiving HBOT; no complications occurred in the rest of the patients.

Conclusions:
HBOT improves visual outcomes in CRAO patients who receive a full course of therapy. The benefit from HBOT does not appear to improve the visual outcome of patients who receive partial HBOT or no treatment. Our result suggests that HBOT is safe and should be offered to CRAO patients who present to the hospital within 24 hours of symptom onset as part of the standard of care. A large-scale prospective study is surely needed to validate our retrospective result.
Abstract TP189: Statin Therapy and Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis of Mortality Risk
Authors: Alhatemi Ahmed Qasim Mohammed , Hashim Hashim Talib , Khalaf Assad Abbas , Ahmed Shahzaib , Akhtar Muhammad Tanzeel , Al-Ghuraibawi Mohammedbaqer Ali , Sulaiman Fatimah Abdullah , Saab Omar
Published: January 2025

Objective:
To determine the association between intracerebral hemorrhage mortality and statin therapy, aiming to provide effective methods to prevent intracerebral hemorrhage and reduce the mortality rate.

Background:
Intracerebral hemorrhage (ICH) poses significant challenges due to its high mortality and disability rates, especially among Asian populations. Contributing factors such as hypocholesterolemia and hypertension amplify the risk of ICH and subsequent hematoma expansion, underscoring the urgent need for effective interventions. Despite the lack of established pharmacological treatments for ICH, statins have emerged as promising candidates for neuroprotection, attributed to their pleiotropic effects beyond lipid-lowering properties.

Methods:
This study meticulously conducted a systematic search of various databases until February 2024 to identify relevant literature on statin therapy following ICH. The inclusion criteria encompassed randomized controlled trials (RCTs) and observational cohort studies, ensuring a comprehensive analysis of the available evidence. Data extraction was performed rigorously, involving screening, extraction, and cross-checking by two independent investigators utilizing a predefined table. Quality assessment was carried out using the Newcastle-Ottawa Scale, a recognized tool for evaluating observational studies.

Results:
The analysis of 14 studies comprising 86,838 patients revealed a substantial reduction in mortality associated with statin therapy post-ICH, with an odds ratio (OR) of 0.37 and a 95% confidence interval (CI) of 0.25-0.57 (p < 0.00001). However, heterogeneity was observed in studies assessing outcomes such as intraventricular hemorrhage and Glasgow Coma Scale (GCS), indicating variability in populations or methodologies.

Conclusion:
One of the significant life-threatening condicions is ICH, and patients are associated with poor prognosis. There is no effective pharmacological treatment to decrease ICH mortality, While statin therapy demonstrates promising potential in mitigating post-ICH mortality, this study underscores the necessity for further research to elucidate optimal treatment duration and address existing heterogeneity. Standardized studies are imperative to inform evidence-based clinical decisions and improve outcomes for individuals afflicted with intracranial hemorrhage.
Abstract TP19: Intravenous thrombolysis before inter-facility transfer for thrombectomy
Authors: Seners Pierre , ter Schiphorst Adrien , Wouters Anke , Mlynash Michael , Yuen Nicole , Arquizan Caroline , Heit Jeremy , COSTALAT VINCENT , Lansberg Maarten , Albers Greg
Published: January 2025

Background:
Patients with acute ischemic stroke and a large vessel occlusion (LVO) admitted to primary stroke centers (PSC) often require inter-facility transfer for thrombectomy. We aimed to study the efficacy and safety of intravenous thrombolysis (IVT) use before transfer.

Methods:
We retrospectively analyzed data from two prospective cohorts of acute stroke patients with an anterior circulation LVO transferred for thrombectomy from a PSC, regardless of whether thrombectomy was eventually attempted in the endovascular-capable center. The primary efficacy outcome was good 3-month functional outcome, defined as a modified Rankin scale (mRS) 0-2. Secondary efficacy outcomes were excellent 3-month functional outcome (mRS 0-1) and arterial recanalization during transfer. Safety outcomes were any intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) at 24-36hrs. We used propensity score with overlap weighting to reduce baseline differences between patients treated with IVT vs those without.

Results:
A total of 521 patients were included, of whom 260 (50%) received IVT before transfer. The main reasons for withholding IVT were being outside the 4.5hr time-window (56%) and anticoagulants use (21%). Median age was 72 years, 55% were men, median baseline NIHSS was 15 and occlusion site was intracranial carotid in 21%, M1 in 61% and M2 in 18%. Good functional outcome occurred in 37% of patients. After propensity score with overlap weighting, all baseline variables were well balanced between the two groups. Compared with patients not treated with IVT, those receiving IVT more frequently had good functional outcome (OR=2.31; 95%CI 1.52-3.51; P<0.01), excellent functional outcome (OR=1.99; 1.21-3.27; P<0.01), and inter-facility recanalization (OR=5.64; 2.91-10.92; P<0.01). There were no significant between-groups differences for any ICH (OR=1.16; 0.78-1.73; P=0.47) and sICH (OR=0.65; 0.31-1.38; P=0.26).

Conclusion:
IVT before inter-facility transfer for thrombectomy is associated with improved functional outcome, without safety concerns. Broadening IVT indications in PSCs may improve clinical recovery.
Abstract TP196: CCL11 is a pivotal player in the brain-lung axis that mediates stroke outcomes in aged mice with intracerebral hemorrhage.
Authors: Ozaki Dan , Kitamura Yuki , Bautista-Garrido Jesus , Sun Guanghua , Kim Gab Seok , Aronowski Jaroslaw , Jung Joo Eun
Published: January 2025

Stroke, especially in the aged population, affects the lung health of stroke patients, and this influences the stroke outcome. Blood circulating CC-motif chemokine 11 (CCL11) increases in rodents and humans with age. Under aging-related pathological stress, the lung-modified neutrophils (PMNs) can acquire a ‘damaging’ phenotype. Lungs can release these PMNs into the bloodstream, and these PMNs potentially exacerbate severity upon entering the ICH-affected brains of aged mice. Microglia (MG) are essential for hematoma clearance and brain repair; however, MG exacerbates tissue injury if polarized to a ‘damaging’ type. The aging elevated CCL11 can robustly alter MG function in the aged mouse brains, impacting ICH outcomes.

Methods:
Autologous blood injection was used for the mouse ICH model. To simulate aging with an increase of circulating CCL11 level, we intraperitoneally administered the CCL11 once every 4d for 1mo into the middle-aged mice. To examine the effect of lung-targeted delivery of CCL11 on stroke outcome in the young ICH mice, the CCL11 was administered via oropharyngeal injection to the young mice before the ICH onset. To prevent the effect of circulating CCL11 in the aged ICH mice, a CCL11-neutralizing antibody was intraperitoneally administered to the aged mice before ICH onset. Neurological deficit scores (NDS) were measured with a postural reflex test.

Results:
We found that chronic exposure to CCL11 in middle-aged mice increased the PMN population in lung tissue and polarized these PMNs to a ‘damaging’ type (n=4-5, p<0.05). We also found that CCL11 infused directly into the lungs of young ICH mice increased PMNs in the lung and aggravated neurological deficits (n=10, p<0.05 on d-7). Moreover, systemic delivery of a CCL11-neutralizing antibody into aged ICH mice reduced NDS (n=13, p<0.01 on d-21) and PMN influx to the ICH-affected brain. In the cultured MG, we found that CCL11 decreased MnSOD expression and phagocytic function by downregulating PPARγ and its target genes, signifying a pro-inflammatory phenotype (n=4, p<0.05).

Conclusions:
These data suggest a new target for ICH treatment in elderly people, based on understanding the pathological role of CCL11 through lung-localized polarization of PMNs to a ‘damaging’ phenotype before their transmigration to the brain and augmentation of the injury and through disruption of MG homeostasis.
Abstract TP204: Perspectives of Patients, Proxies, and Clinicians on the Use of Machine Learning and Artificial Intelligence in the Management of Stroke: A Mixed-Methods Study
Authors: ABAHUJE Egide , Houskamp Ethan , Silva Pinheiro do Nascimento Juliana , Agha Elaf , Thompson William , Michelson Kelly , Naidech Andrew
Published: January 2025

Background:
Machine learning and artificial intelligence (ML/AI) are rapidly spreading in clinical medicine. Few data describe the perspectives of patients, proxies (e.g., patients’ spouses), and clinicians. In this mixed-methods study, we qualitatively characterized perspectives regarding ML/AI use and quantitatively explore sentiment towards ML/AI from acute neurology patients, proxies, and clinicians.

Methods:
We conducted semi-structured interviews with survivors of intracranial hemorrhage, proxies, and clinicians. We analyzed interview transcripts using framework analysis, organizing data within the domains of the Theoretical Framework of Acceptability, adding domains identified with input from all co-authors. We quantitatively analyzed the sentiment scores of responses from positive to negative using a transformer-based model, the same technology that underlies large language models. Sentiment scores were compared with Kruskal-Wallis H, and multiple comparisons adjusted using Dunn’s test.

Results:
We analyzed 21 interviews (14 patients, 1 proxy, and 6 clinicians), by which point there was thematic saturation. Help with clinical decision-making was cited as the key potential advantage of ML/AI. Participants noted the importance of considering ML/AI as an adjunct to clinical care, not as a replacement for clinicians. Over-reliance on recommendations potentially leading to diminution of clinician skill, incorrect ML/AI recommendations, potential liability, and bias were cited as challenges. Clinician and patient education were noted as potential burdens that impose opportunity costs, but are important for self-efficacy. Median sentiment scores ranged from 0.0 (neutral) to 0.3 (positive). Sentiment varied with question type (P < 0.001). Questions about clinicians’ using ML/AI for patient care had the highest sentiment score.

Conclusion:
Patients, caregivers, and clinicians expressed mixed views about ML/AI. Concerns related to potential burdens and opportunity costs were noted and should be considered as ML/AI is introduced. Future directions include how best to incorporate ML/AI into education and obviate potential burdens as ML/AI is integrated into clinical care.
Abstract TP214: New Discoveries in Amyloid-Related Imaging Abnormalities with Hemorrhage (ARIA-H) and Anti-Amyloid Beta Monoclonal Antibodies
Authors: An Dinghao , Xu Yun
Published: January 2025

Background:
Amyloid-related Imaging Abnormalities (ARIA) are adverse effects that occur during amyloid beta monoclonal antibody treatment for Alzheimer's disease, including edema-type ARIA and hemorrhage-type ARIA. Few retrospective analysis have compared ARIA-H incidence among individual monoclonal antibodies, and a comprehensive comparison is currently lacking. After the approval of these antibodies, research has mainly focused on dosing frequency and drug dosage, leaving it unclear whether ARIA-H is associated with the specific characteristics of different monoclonal antibodies.

Methods:
1. For monoclonal antibodies targeting Aβ clearance, we selected seven: Aducanumab, Bapineuzumab, Crenezumab, Donanemab, Gantenerumab, Lecanemab, and Solanezumab. Our data is derived from systematic reviews and meta-analyses of Phase III clinical trials for these seven monoclonal antibodies. Data from Jeremic D et al. include six monoclonal antibodies (mAbs), while data from Qiao Y et al. include four mAbs. 2. For the evaluation variables, we selected the following factors: the form of monoclonal antibody binding to Aβ protein, binding affinity, binding epitope, Fc subtype of the monoclonal antibody, and the Aβ clearance rate. ARIA-H occurrence was used as a categorical variable for differential analysis. The odds ratio (OR) was utilized for data assessment, with an OR not equal to 1 and a 95% confidence interval excluding 1 used as the criterion for statistical significance. 3. We standardized the data for the seven monoclonal antibodies (mAbs). We compared the ARIA-H occurrence rates for the mAbs, taking into account other dimensional variables.

Results:
The risk of ARIA-H, from highest to lowest, is as follows: Donanemab, Aducanumab, Bapineuzumab, Lecanemab, Gantenerumab, Crenezumab, Solanezumab. Besides, ARIA-H is associated with the characteristics of mAb. (1)More mature Aβ clearance is associated with a higher risk of ARIA-H.(2)Lower clearance of Aβ oligomers is associated with a higher risk of ARIA-H.(3)Aβ clearance closer to the N-terminus is associated with a higher risk of ARIA-H.(4)mAb with an IgG4 structure are more likely to cause ARIA-H than those with an IgG1 structure.(5)Faster achievement of Aβ clearance thresholds is associated with a higher risk of ARIA-H.

Conclusion:
This research enhances our understanding of ARIA-H and may guide future monoclonal antibody drug development, which may improve the cognition and overall prognosis of Alzheimer's disease patients.
Abstract TP22: Risk of Intracerebral Hemorrhage from Adjunct Intra-arterial Thrombolysis in Acute Ischemic Stroke Patients Undergoing Thrombectomy
Authors: Qureshi Adnan , Huang Yilun , Bhatti Ibrahim , Gomez Camilo , Hanley Daniel , Ford Daniel , Hassan Ameer , Nguyen Thanh , Spiotta Alejandro , Veznedaroglu Erol , Budzik Ronald , Gupta Rishi , Nogueira Raul , Krajina Antonin , Bartolini Bruno , English Joey , Baxter Blaise , Liebeskind David
Published: January 2025

Background and Purpose:
Intra-arterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intra-arterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.

Methods:
We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans. We determined the risk of ICH in subgroups defined by clinical characteristics, and use of intravenous (IV) thrombolysis.

Results:
A total of 146 (7.5%) patients received intra-thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intra-arterial thrombolysis (p=0.006). Among patients who received IV thrombolysis (n=1042), the proportion of patients who developed ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intra-arterial thrombolysis (p=0.028). The risk was not different in strata defined by age, gender, location of occlusion, pre-procedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT score, systolic blood pressure, and serum glucose concentrations.

Conclusions:
In patients undergoing mechanical thrombectomy, the risk of any ICH and sICH was not increased with intra-arterial thrombolysis, including in those who had already received IV thrombolytics.
Abstract TP225: Larger Basilar Arterial Diameters Correlate with Reduced Blood Flow Velocities in Ischemic Stroke Patients
Authors: Lombardi Jorge , Sur Nicole , Gutierrez Jose , Cabrera Yosdely , Koch Sebastian , Romano Jose , Del Brutto Victor
Published: January 2025

Background:
Dolichoectasia (DE) is characterized by the abnormal dilation and elongation of brain arteries, leading to high morbidity and mortality, commonly presenting as ischemic stroke. However, the mechanisms underlying brain ischemia in DE are not well understood. Here, we explore the relationship between basilar artery (BA) diameters and blood flow velocities using transcranial doppler (TCD) in stroke patients to evaluate whether TCD is a viable method for evaluating the hemodynamic impact of DE.

Methods:
Using a cross-sectional design, we analyzed consecutive ischemic stroke patients admitted to a comprehensive stroke center from October 2017 to January 2018, who had completed both intracranial arterial imaging (CTA or MRA) and TCD during admission. Diameter of the BA was measured using semiautomatic vessel segmentation, and DE was defined as a BA diameter greater than the 95th percentile stratified by sex. TCD-derived blood flow velocities were recorded through the transforaminal window (depth 80-100mm). Linear regression models adjusted for age and sex were used to assess the association between BA diameter and averaged mean flow velocity (MFV). Subgroup analysis excluding cases with BA stenosis and fetal posterior cerebral artery (fPCA) was also performed.

Results:
Among 211 ischemic stroke patients, 44 had vessel imaging and TCD. The mean age was 64 ± 13 years, 66% were male, 36% had posterior circulation stroke, 11.4% had BA DE, 21% had BA stenosis, and 16% and 11% had unilateral and bilateral fPCA, respectively. The mean BA diameter was 3.7 ± 2.1 mm, and the mean averaged MFV was 40 ± 21 cm/s. A weak negative correlation was found between BA diameter and MFV (r = -0.37, p = 0.01). The linear regression model adjusted for age and sex showed an independent negative correlation (β per mm = -3.33 [95% CI -6.2 to -0.5]). In the subgroup without BA stenosis and fPCA (n = 25), the negative correlation between BA diameter and MFV was stronger (r = -0.65, p < 0.01), with β per mm of -4.44 (95% CI -7.0 to -1.9; figure).

Conclusion:
In ischemic stroke patients, larger BA diameters correlated with reduced TCD-derived blood flow velocities, particularly after excluding cases with fPCA and BA stenosis. Reduced blood flow velocities can lead to blood stagnation, thromboembolism, and hypoperfusion, suggesting that TCD may be useful for grading DE severity and assessing stroke risk.
Abstract TP235: Outcomes after Mechanical Thrombectomy in Cancer patients with Acute Ischemic Stroke: A Nationwide Analysis
Authors: Anil Peethambar Gowri , Joseph Varughese Vivek , JAYARAJ RANJINI NIVED , Mummadisetty Anvitha , Hasan Mohamed , Mehta Tapan , Sen Souvik , Manjila Sunil
Published: January 2025

Aim:
To analyze outcomes in AIS patients with history of cancer after Mechanical thrombectomy

Introduction:
Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion.. The impact of MT in AIS patients with cancer is underexplored, with some research indicating higher mortality rates in cancer patients compared to those without cancer. This study aims to evaluate outcomes after MT in AIS patients with knnow history of cancer.

Methods:
A retrospective cohort study was conducted using the National Inpatient Sample 2019 to identify AIS patients who underwent MT. A total of 5279 MT cases were reported during admission. Out of those, 155 MT cases were reported in patients with a primary diagnosis of cancer, and 114 MT cases were reported in patients with metastatic cancer. A binomial logistic regression was done, using smoking and age as independent variables due to their significant association with lung cancer and MT outcomes.

Results:
The study found that the overall mortality rate among AIS patients undergoing MT was 8.33% (6.80% - 10.16%). However, mortality was higher in stroke patients with cancer, reaching 12.90% (4.72% - 30.67%), and significantly higher in those with metastatic malignancy, at 26.08% (11.64% - 48.58%). The odds of mortality in AIS patients after MT were significantly lower (OR: 0.6698, 95% CI: 0.5199 - 0.8630). However, the presence of metastatic cancer was associated with a significant increase in mortality risk (OR: 2.955, 95% CI: 1.157 - 7.546, p < 0.05), which persisted even after adjusting for confounders like age, sex, and median quartile income (OR: 2.845, 95% CI: 1.107 - 7.307, p < 0.05). Patient with lung cancer was found to increased risk of mortality post-MT (OR: 5.0017, 95% CI: 1.1901 - 21.1019, p = 0.028), and the association remained significant with binomial logistic regression, accounting for smoking and age (OR: 5.43, 95% CI: 1.327 - 23.991, p = 0.019).

Conclusion:
This study demonstrates that mortality risk is higher after MT in AIS patients with known diagnosis of cancer, particularly in those with metastatic disease. Metastatic cancer was significantly associated with higher mortality risk after MT. Additionally, patient's with lung cancer had significantly increased mortality risk after MT. These findings emphasize the importance of carefully considering the status of cancer, especially whether metastatic or not, in AIS patients undergoing MT.
Abstract TP238: Sequential cardiac and brain 4D Flow MRI in healthy individuals show positive correlation between aortic blood flow and cerebral blood flow pulsatility in internal carotid arteries and basilar artery
Authors: Chien Aichi , Boyle Noel , Finn Paul , Salamon Noriko , Colby Geoffrey , Joy Ajin , Thomas Michael Albert , VINUELA FERNANDO
Published: January 2025

Introduction:
Cerebral blood flow (CBF) is a major determinant of when and where within the brain stroke occurs. The brain’s demand for oxygen and nutrients makes it sensitive to pulsatility propagating from the heart. The contribution of cardiac flow to CBF is poorly understood. We present a pilot study using 4D flow MRI to sequentially measure both aortic blood flow and CBF in the same individual and our initial findings comparing blood pressure (BP), cardiac flow, and CBF in healthy volunteers.

Methods:
We acquired both 4D flow brain MRI and 4D flow cardiac MRI in a single session using a Siemens 3T Magnetom Vida scanner in 5 volunteers (4 male, 1 female) 31.2 ± 10.4 years old. Using a compressed sensing protocol (R=7.7) each 4D flow scan was acquired in under 15 minutes. Brain and cardiac MRI respectively used a 1.4 mm
3
and 2.1 mm
3
voxel size; velocity was encoded in 3D at 120 cm/s and 200 cm/s, with 15-25 cardiac phases. 4D flow brain coverage included the ICA, BA, MCA, ACA, and PCA (Fig 1). 4D flow cardiac coverage included the ascending and descending thoracic aorta (Fig 2). 4D flow data were reconstructed using Tempus Pixel (Tempus, IL) and regions of interest were defined to measure volumetric flow rate (Q). Blood flow pulsatility over the cardiac cycle was quantified using pulsatility index (PI). Pearson’s correlation coefficient (r) was calculated for statistical analysis.

Results:
Aorta Q correlated strongly with cerebral Q, in the ICA and BA (r=0.90), in the MCA, ACA, and PCA (r=0.70). Aorta Q correlated with PI in both the ICA and BA (r=0.81), but not within the MCA, ACA, and PCA (r=0.12). Aorta PI was moderately anticorrelated with PI throughout the cerebral arteries (r=-0.52). Brachial systolic and diastolic BP both correlated with cerebral PI (r=0.68, 0.99, respectively), while moderately anticorrelated with aorta PI (-0.66, -0.52). Pulse pressure correlated strongly with cerebral Q (r=0.85), and less with aorta Q (r=0.59). Heart rate was strongly anti-correlated with aorta PI (r=-0.82) and moderately correlated with cerebral PI (r=0.61).

Conclusion:
These initial findings demonstrate that flow characteristics Q and PI are similar between the aorta and major arteries feeding the brain (ICA, BA), but the effects of BP and heart rate appear to invert at more distal vessels (MCA, ACA, PCA). We plan to expand this technique to investigate the connection between cardiac and cerebral flow in patients with neurovascular disease.
Abstract TP26: Early Cerebral Blood Flow Deficits in 5xFAD Mouse Model of Alzheimer’s Disease.
Authors: Mughal Amreen , Hennig Grant , Hand Lilian , Purvee Caleb , Barry Jeremy , Liu Yanling , Nelson Mark
Published: January 2025

Early deficits in cerebral blood flow (CBF) precede age-related neurodegeneration in Alzheimer’s disease (AD). We previously showed CBF deficits in 12-month 5xFAD mice, a familiar model of AD
(Mughal et al., Function 2021)
. However, these mice already have neurodegeneration at 12-months age. We hypothesized that impaired neurovascular coupling begins at an early age (<= 3-months-old) and contributes to cognitive decline later in life in 5xFAD mice. We performed
in-vivo
imaging using laser doppler flowmetry, two-photon and wide-field microscopy in craniotomy fitted mice, and active avoidance behavioral testing to study neurovascular dynamics and cognitive functions. Using cerebral hemodynamic with laser doppler flowmetry in 3-month-old 5xFAD mice, we showed a significant reduction in functional hyperemia responses to whisker stimulation due to an impairment in inward rectifying K+ (Kir2.1) channels activity. Ca
2+
signals in cortical vascular endothelial cells studied
in vivo
using the genetic encoded Ca
2+
indicator GCaMP8 were also significantly reduced in 3-month-old 5xFAD mice. The early loss in CBF in 5xFAD mice linked with reduced cortical neuronal Ca
2+
activity in 5xFAD mice compared to age matched controls measured using wide-field imaging
in vivo
. However, CBF deficits present in 5xFAD mice did not affect performance in spatial learning and memory tests compared to controls at 3-months age, suggesting that functional deficits in CBF precede, and may contribute to neuronal and later cognitive impairment.
Abstract TP265: Early risk prediction model for stroke–heart syndrome following endovascular therapy
Authors: Wang Lanjing , Huang Shuangfeng , Wang Yongle , Ren Changhong , Zhao Wenbo , Ji Xunming , Li Sijie
Published: January 2025

Objective:
Stroke–heart syndrome (SHS) leads to poorer prognosis in patients with acute ischemic stroke (AIS), which makes early identification and prevention of SHS crucial. Therefore, the primary objective of this study was to establish a nomogram-based risk prediction model for SHS following endovascular therapy (EVT) in anterior circulation stroke.

Methods:
This retrospective observational study recruited consecutive AIS patients undergoing EVT between January 2014 and June 2021. Utilizing the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis, we screened for variables that demonstrated strong associations with SHS. Significant variables were included to construct risk prediction model and visualized with nomogram. Multiple methods were employed to comprehensively assess the accuracy and calibration of the prediction model. The modified Rankin Scale (mRS) score was utilized to assess the prognosis of patients at 3 months.

Results:
A sample of 218 patients was incorporated into the study. The incidence of SHS within two weeks after EVT is 13.8%. After multiple analyses, age (OR 1.060, 95% CI 1.021–1.100, P = 0.002), hyperlipidemia (OR 3.400, 95% CI 1.289–8.968, P = 0.013), creatinine (OR 1.023, 95% CI 1.000–1.046, P = 0.049), and total anterior circulation infarct (TACI, OR 4.875, 95% CI 1.984–11.980, P = 0.001) were included in the risk prediction model. The model has good discriminatory capacity (AUC = 0.812), calibration (Hosmer-Lemeshow test P = 0.855, Brier score = 0.098), and robustness (internal cross-validation AUC = 0.811). SHS independently increased the risk of 3-month unfavorable prognosis (OR 3.267, 95% CI 1.159–9.212, P = 0.025) and mortality (OR 3.484, 95% CI 1.154–10.516, P = 0.027).

Conclusions:
SHS significantly increases unfavorable prognosis risk and mortality in AIS patients with EVT. The prediction model based on age, hyperlipidemia, TACI, and creatinine exert good predictive efficacy for early SHS.
Abstract TP295: Stroke Risk in Cancer Survivors: A Systematic Review and Meta-Analysis
Authors: Silva Anna Lydia , Menegaz de Almeida Artur , Padilha Lucas , Souza Maria Eduarda , Kreuz Michele , Fernandes Lilianne , Rachas Reis Mariana , A de Moraes Francisco Cezar , Kelly Francinny
Published: January 2025

Background:
It is suggested that survivors of different types of cancer may have an increased risk of stroke. Our study aims to evaluate cancer patients and non-cancer controls by analyzing stroke events in each group. Previous studies concluded that certain types of cancer increased stroke risk, however, their results had significant heterogeneity and statistical concerns.

Methods:
Medline, Embase, and Cochrane databases were systematically searched until February 18th, 2024, assessing stroke in cancer survivor patients compared to the global population. Data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I
2
statistics. Review Manager 5.4 was used for statistical analysis.

Results:
A total of 18 studies were included, and stroke was reported in both cancer and non-cancer groups. Breast cancer (HR 1.09; 95% CI 1.02-1.17; p=0.01; I
2
= 0%), Central Nervous System cancers (HR 2.47; 95% CI 1.01-6.01; p=0.05; I
2
= 78%), cervical cancers (HR 1.58; 95% CI 1.19-2.09; p=0.001; I
2
= 0%), head and neck cancers (HR 1.34; 95% CI 1.07-1.68; p=0.01; I
2
= 59%), lung cancers (HR 1.60; 95% CI 1.40-1.83; p<0.00001; I
2
=67%), multiple myeloma (HR 1.58; 95% CI 1.32 -1.89; p<0.00001; I
2
= 49%), nasopharyngeal cancers (HR 1.72; 95% CI 1.28-2.30; p=0.0003; I
2
= 85%), oesophageal cancers (HR 1.33; 95% CI 1.07-1.65; p=0.009; I
2
= 0%), ovarian cancers (HR 1.33; 95% CI 1.07-1.65; p=0.01; I
2
= 38%), pancreatic cancers (HR 2,70; 95% CI 2.34-3.11; p<0.00001; I
2
= 0%) and rectum cancers (HR 1.29; 95% CI 1.01-1.63; p=0.04; I
2
= 0%) showed statistically significant differences between groups in favor of non-cancer controls.

Conclusions:
In this meta-analysis, the stroke risk was increased in all cancers that reached statistical significance. Furthermore, our study brings relevant data to the body of literature concerning this long-term clinical uncertainty.
Abstract TP297: Knowledge, Attitudes, and Practices Regarding Stroke in the Tz’utujil Maya Community of Guatemala
Authors: Fretes Burgos Alana , Valhuerdi Porto Camelia , Valhuerdi Porto Bibiana , Bagnas Jasmine , Shrimali Anamika , Martinez-Kratz Jesse , Yakhkind Aleksandra
Published: January 2025

Stroke is one of the leading causes of death in Guatemala [1]. Previous data has indicated that differences regarding stroke mortality exist depending on geographical location, ethnicity, and educational level within Guatemala [2]. We sought to understand community-level knowledge, attitudes, and practices regarding stroke in the Tz’utujil Maya Community of Guatemala.

A total of 25 interviews were held in Spanish with one or more community members, through a snowball sampling method with the assistance of Tz’utujil interpreters as needed. Interviews were based on a predefined questionnaire based on the Kleinman explanatory model of illness [3]. Through these interviews, we sought to assess community members’ understanding of stroke, its causes, available treatments, and prevention. Demographic data was collected and recorded interviews were transcribed into Spanish and subsequently translated into English. Each interview was analyzed and coded by two reviewers based on a consensus-based coding framework.

Analysis of the collected data revealed several recurring themes. Most interviewees conveyed a belief that stroke is directly caused by psychosocial factors such as stress, negative family dynamics, and overthinking. Some interviewees attribute stroke to spiritual causes including witchcraft. Individuals oftentimes seek out natural remedies provided by traditional healers in addition to, or instead of, prescription medications. Lack of access to healthcare, based on cost and proximity to tertiary care, was independently mentioned by numerous community members. Most individuals reported that a person who suffered a stroke could have prevented his/her symptoms by avoiding stress. The majority of the interviewees did not stigmatize stroke themselves but said that other members of the community do stigmatize stroke. Overwhelmingly, community members enthusiastically said that they would be interested in learning more about how doctors can treat and prevent stroke.

Our research provides valuable insight into the understanding of stroke as well as related attitudes and practices within the Tz’utujil Maya community of Guatemala. Our findings serve as a blueprint for stroke education efforts within this community and can guide similar research in other low-resource settings. We firmly believe that education is essential to primary prevention of stroke as well as improved health outcomes.