bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP6: Patient Outcomes in a Comprehensive Stroke System Transitioning from Alteplase to Tenecteplase
Authors: Bhavsar Riya , Nisar Tariq , Piacenti Amber , Vahidy Farhaan , McCane David , Dinh Thao Nguyen , Chiu David , Gadhia Rajan
Published: January 2025

Introduction:
Many centers have opted to make the transition from alteplase to tenecteplase over the past three years. Making major treatment changes in a healthcare setting has its challenges. This transition period gave us a unique opportunity to assess patient outcomes comparing both drugs with the same healthcare system with similar patient populations.

Hypothesis:
Patients who received tenecteplase will have shorter door-to-needle (DTN) times and better outcomes as measured by 90-day Modified Rankin Scores (mRS) with no significant increase in symptomatic ICH (sICH) when compared to patients who received alteplase.

Methods:
Differences between continuous variables were analyzed using the student’s t-test and Wilcoxon rank test, and the chi-squared test for categorical variables. The primary independent variable was the binary group (tenecteplase vs. alteplase). A generalized linear model was built for the outcome DTN and logistic regression model for the binary outcome (mRS ≤2 as good, >2 as poor) controlling for demographics, comorbidities, NIHSS, LKW time and ICH admission. Odds ratios (OR) and 95% confidence intervals (CI) were reported, with all analyses performed in R v4.4.1.

Results:
The dataset was extracted from the HDSA (with a HOPES registry subgroup), including 574 patients—323 in the alteplase group and 251 in the tenecteplase group. The mean age was similar between groups (66.06 vs. 65.9 years; P=0.88), as was the mean DTN (46.9 vs. 48.9 minutes; P=0.11). A multivariable generalized linear model, adjusted for demographics and comorbidities, showed no significant difference in DTN between the groups (Δβ = -3.04 [95% CI -8.33 to 2.25]; P=0.26). However, in a subgroup analysis looking at the HOPES registry from a single center, a multivariable logistic regression, also adjusted for demographics and comorbidities, indicated that patients in tenecteplase had lower odds of poor functional outcomes at 90 days compared to alteplase (OR = 0.11 [95% CI 0.01–0.84]; P=0.03).

Conclusion:
While DTN times did not improve with the transition to tenecteplase, we do see that patients who received tenecteplase were less likely to have poor outcomes as defined by an mRS of 3-6 based on our subgroup analysis. The rate of sICH was also comparable between the two groups. Additional post-implementation studies should be considered to assess trends in mRS outcomes as more stroke centers transition to use of tenecteplase in acute ischemic stroke.
Abstract WMP66: Oxygen Extraction Fraction on Baseline MRI Predicts Infarction Growth in Successfully Recanalized Patients
Authors: Asghariahmadabad Mona , Metanat Pouya , Tavakkol Elham , Ismail Ameera , Bahr-Hosseini Mersedeh , Szeder Viktor , Colby Geoffrey , Saver Jeffrey , Liebeskind David , Yedavalli Vivek , Wade Smith , Kim Anthony , Halabi Cathra , Savastano Luis , Cooke Daniel , Hetts Steven , Amans Matthew , Narsinh Kazim , Josephson Andy , Hess Christopher , Nael Kambiz
Published: January 2025

Background:
Despite recent advances in endovascular treatment for acute ischemic stroke (AIS), continued infarct growth and poor functional outcome has been reported in 20-50% of patients despite successful reperfusion. Oxygen extraction fraction (OEF) has shown promise as a method to evaluate ischemic tissue viability and can now be quantified from dynamic-susceptibility-contrast (DSC) perfusion MRI. We aimed to determine the association of OEF alterations on pretreatment DSC perfusion MRI with infarct growth among stroke patients that achieved successful reperfusion.

Methods:
In this retrospective study, we included patients with anterior circulation LVO, who achieved successful reperfusion (TICI ≥ 2b), and had pretreatment DSC perfusion and posttreatment MRI within 48 hours from reperfusion. DSC perfusion was analyzed using the Cercare Medical Neurosuite (Cercare Medical). OEF values were quantified from the segmented ischemic core (ADC ≤620 ×10
-6
mm
2
/s) and penumbra tissue (Tmax >6 sec) on pretreatment MRI and normalized to the contralateral hemisphere (rOEF). Infarct growth was determined if the final infarct volume was ≥ 10 mL larger than baseline ischemic core volume. The association between rOEF in conjunction with demographic, clinical, other imaging variables and infarct growth were evaluated by univariate and multivariate analysis.

Results:
Among 94 patients who achieved successful reperfusion, 30 (32%) patients had infarct growth ≥ 10 mL. While there was no significant difference in rOEF values measured in the ischemic core between patients with and without infarct growth, the OEF values were significantly (p=0.004) higher in penumbral tissue of patients without infarction growth. ROC analysis showed an AUC: 0.70, sensitivity of 62.1% and specificity of 70.5% for penumbra-rOEF values at threshold of ≥ 1.8. Multivariate logistic regression analysis revealed penumbra-rOEF (p= 0.002) as an independent variable for prediction of infarct growth ≥ 10 mL (p=0.002) with Odds ratio of 0.057 (95%CI: 0.010-0.321).

Conclusion:
Infarct growth occured in about 1/3 of patients despite successful recanalization. Low rOEF values in the penumbra tissue could be predictive of infarct growth while elevation of rOEF ≥1.8 could be protective.
Abstract WMP70: Redefining ESUS Evaluation: The Role of Pelvic MRV – A Scoping Review and Meta-Analysis
Authors: Eswaradass Prasanna Venkatesan , Al-sabbagh Mohammed , Hussain Syed , Camerucci Emanuele , Vetter Elyse , Dukes Rachel , alnuaimi Dina , Asedi Tuqa , Thirunavukkarasu Sibi , Pasya Sai Kumar
Published: January 2025

Background:
There is controversy in the literature regarding the role of pelvic venous abnormalities screening through Magnetic Resonance Venogram (MRV) in patients with Embolic Stroke of Undetermined Source (ESUS) and a Patent Foramen Ovale (PFO). Pelvic DVT is thought to occur uncommonly, however studies have shown that around 20% of patients can have isolated pelvic vein DVTs without evidence of lower extremity DVTs. We aimed to describe diagnostic yield of pelvic MRV in ESUS patients.

Review summary: A systemic search was carried out using PubMed following PRISMA guidelines. We retrieved 6 cross sectional and cohort studies, 2 case series, as well as 9 case reports with a total of 1319 patients and a mean age of 51 years. The diagnostic yield of Pelvic MRV in all included ESUS patients was 10% (95% CI: 8-12). In ESUS patients with a negative lower extremity DVT, the diagnostic yield was 9% (95% CI: 7-10). Patients with ESUS and PFO had significantly higher prevalence of abnormal pelvic MRV findings, OR=3.63 (95% CI: 1.53-8.61, P <0.01). All reviewed studies utilized pelvic MRV, except two reports, which used pelvic CTV.

Conclusion:
Pelvic venous abnormalities are relatively common findings in ESUS patients with a PFO and negative lower extremity DVT. Pelvic MRV should be highly considered in these situations as finding pelvic vein DVT would change the management in these patients as they will need anticoagulation. Future research should strive to provide clear guidance on clinical decision making and cost effectiveness of utilizing this valuable tool using highly controlled, comparative studies.
Abstract WMP78: Dynamic Predictive Model for Gastrostomy Tube Placement after Acute Ischemic Stroke: A Single Center Study
Authors: Dunne Therese , Badillo Goicoechea Elena , Bloom Lisa , Babtain Nada , Baskaran Archit , Jhaveri Aditya , Mansour Ali , Siegler James
Published: January 2025

Background and Purpose:
Dysphagia is a common complication of stroke that can lead to increased aspiration pneumonia and malnutrition, prolonged hospital stay, and can necessitate the placement of a gastrostomy tube. Early identification of these patients may lead to significant reductions in hospital stays. In this single center study, we demonstrate a scoring system to predict the likelihood of a gastrostomy tube.

Methods:
Pooled clinical data of consecutive adult stroke patients from a single center from April - December 2023 were retrospectively collected. Patient baseline characteristics, demographics, imaging findings, and clinical assessments were assessed in regards to gastrostomy tube placement. Using a Lasso procedure, features with an independent association with gastrostomy tubes were found. An XGBoost model was used to predict placement of a gastrostomy tube to derive a final scoring model based on feature importance using Shapley values.

Results:
Of the 635 patients screened, 74 (10.4%) underwent gastrostomy tube placement. Demographic and clinical gastrostomy placement predictors were identified and included Rosenbek scores 4-8, pharyngeal residue rating, oral cavity residue rating, Anterior loss on dysphagia assessment, hemorrhagic infarction type 1 (HT-1), National Institutes of Health Stroke Scale (NIHSS) > 10 after 24 hours, intraventricular or subarachnoid hemorrhage (IVH/SAH), cardioembolic etiology, NIHSS > 10 on presentation, and prior stroke. The comprehensive model unbiased estimated out-of-sample performance, using a 10-fold cross-validated area under the curve (AUC), was 0.81 [0.77-0.85]. The simplified scoring model performed similarly to the comprehensive model, although slightly higher than expected given a lack of an independent out-of-sample testing set due to data availability, with an AUC of 0.88 [0.80, 0.92]. This outperformed the previously published PEG score (0.86 [0.84-0.95]) and PRESS score (0.81 [0.75- 0.88]). However, a completely out-of-sample evaluation of the final scoring model remains necessary.

Conclusions:
This scoring system provides clinically relevant predictive value to identify acute ischemic stroke patients who will ultimately require gastrostomy tubes as opposed to those who experience transient dysphagia and premature gastrostomy tube placement can be avoided. Future studies will be required to determine if this scoring system can result in reductions in hospital stays and other clinical outcomes.
Abstract WMP96: Poor Comprehensive Cerebral Collateral Cascade is Associated with More and Faster Ischemic Core Growth During Inter-Hospital Transfer in Acute Ischemic Stroke Patients with a Large Vessel Occlusion
Authors: Zamarud Aroosa , Seners Pierre , Yuen Nicole , Mlynash Michael , Wouters Anke , Voorst Henk , Kesten Jamie , Lugo Leonel , Faizy Tobias , Albers Gregory , Lansberg Maarten , Heit Jeremy
Published: January 2025

Introduction:
Patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and small ischemic cores have the most favorable outcomes after thrombectomy. Core growth and growth rate during transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) may hinder outcomes. The effect of the CCC's combined arterial, tissue, and venous outflow on core growth remains unclear. We determined if poor CCC profiles before transfer to a CSC predict ischemic core growth in AIS-LVO.

Methods:
AIS-LVO patients in the prospective CRISP2 study with a CT angiogram (CTA) and CT perfusion (CTP) at a PSC and a follow-up CTP or Diffusion-weighted imaging(DWI) after transfer to the CSC were screened for enrollment. CCC was determined on CTA collaterals using the TAN scale(favorable: Tan 2-3), tissue level collaterals on CTP using the hypoperfusion intensity ratio (HIR [Tmax >10s/Tmax>6s volume]; favorable HIR≤0.5), and venous outflow on CTA (favorable cortical venous opacification score 3-6). Patients were grouped into favorable CCC (CCC+; favorable scores at all three levels), unfavorable CCC (CCC-; unfavorable scores at all three levels), or CCCmixed(mixed scores at the levels). Ischemic core was determined on CTP at the PSC and pre-thrombectomy DWI-MRI or CTP at the CSC. Ischemic core growth was assessed using a voxel-based method following co-registration between the PSC and CSC images. The primary outcomes were ischemic core growth volume and rate.

Results:
The study included 175 patients; 24.6% were CCC+, 8% were CCC-, and 67.4% were CCCmixed. No differences in baseline demographic or clinical characteristics were found between the groups. CCC- patients had larger baseline ischemic core volumes (median 17.1 ml [IQR: 10.5-56.3]; P<0.001) and penumbra volume (median 115.5 ml [IQR: 62-158;P<0.001). CCC- experienced a higher core growth rate (median 17.9 ml/h [IQR: 10-27.1] vs 2.4 ml/h [IQR: 0.3-7.1] in CCC+, and 3.3 ml/hr [IQR: 0.6-7]; P<0.001) and core growth (median 41.9 ml [IQR: 25.6-64.6] vs 6 ml [IQR:1.2-15.8] in CCC+ and 11.1 mL [IQR:2-25.8]; P<0.001). On regression analysis, CCC- and baseline ischemic core were independently associated with core growth, 95% CI,0.79-3.61, and growth rate, 95% CI,0.48-3.65.

Conclusions:
In AIS-LVO patients, CCC- before transfer to a CSC is associated with more core growth and faster growth rates. These results have implications for neuroprotection trial design and informing triage decisions at PSC.
Abstract WP11: Efficacy and Safety Outcomes of thrombolysis for stroke in Low- and Middle-Income countries: Systematic Review and Metanalysis
Authors: Carbajal Galarza Meiling Milagros , Chinchihualpa Paredes Nathaly , Váscones-Román Fritz Fidel , Vera Daniel , ABANTO PEREZ SERGIO ALEJANDRO , Calisaya-Madariaga Irving , Pacheco Niels , Guerrero Yrene Miriam Lizeth , Retiz Maria , Abanto Carlos
Published: January 2025

Introduction:
Stroke is a leading cause of disability and mortality worldwide, with thrombolysis as a critical treatment. Patients in Low- and Middle- Income countries (LMIC) are disproportionately affected, however, the effectiveness and outcomes of thrombolysis in these regions have been less explored.

Objective:
To assess the safety and efficacy of thrombolysis in patients with ischemic stroke in LMIC.

Design/Methods:
A systematic search was performed in PubMed, Embase, SCOPUS, WOS and Global Index Medicus for studies conducted up to April 2024. Studies aiming to assess the outcomes of thrombolysis after ischemic stroke in LMIC were selected. Outcomes of interest included functional independence (90-day mRS 0-2), symptomatic intracerebral hemorrhage (sICH) and all-cause mortality at 90 days. Quality assessment was performed using Cochrane Risk of bias 2 tool for randomized trials and NewCastle-Ottawa scale for observational studies. A single-arm and a random effects model meta-analysis of proportions were conducted, using the I2 statistics to measure the statistical heterogeneity.

Results:
A total of 1,865 studies were screened, of which 96 studies met the inclusion criteria, representing 849,280 patients who received thrombolysis for ischemic stroke. Seven randomized controlled trials (RCTs) were included and analyzed independently. The majority of the studies used Alteplase as the thrombolytic agent, followed by Tenecteplase, Recombinant human prourokinase and Reteplase. Eight studies evaluated low dose compared to the standard dose of alteplase. For the meta analysis, articles that included the administration of standard dose of 0.9 mg/kg alteplase within a 4.5-hour time window, were considered. The pool proportion of patients with functional independence at 90 days was 58% CI 95% [51%, 64%]. Pooled proportions for sICH (ECASS III definition) and 90-day mortality were 5% CI 95% [4%,6%] and 10% CI 95% [8%,12%], respectively. However, results show high heterogeneity. Quality assessment showed low to medium risk of bias.

Conclusions:
Thrombolysis in LMIC may have similar safety and effectiveness outcomes when used with standard dose and treatment within 4.5 hours.
Abstract WP113: An evaluation of a visual arts-based intervention for promoting psychosocial functioning of community-dwelling stroke survivors: A randomized controlled trial
Authors: Chan Mimi Wai Man , Lo Suzanne , Sit Janet
Published: January 2025

Introduction:
Growing evidence suggested that visual arts-based interventions contributed to improvements in psychosocial functioning among stroke survivors. However, such interventions examining in previous evidence were mainly conducted in the in-patient settings. This might limit access by community-dwelling stroke survivors.

Purpose:
This study aimed to evaluate the feasibility and impact of a visual arts-based intervention on promoting psychosocial functioning of community-dwelling stroke survivors.

Methods:
A two-arm randomized controlled trial was conducted. Adults with stroke were recruited from community centers and support groups. Participants in the intervention group received the visual arts-based intervention grounded on Bandura’s principles of self-efficacy, involving a four-week, face-to-face, 90-mintue weekly group session, led by a trained registered nurse. A workbook with four sources of enhancing self-efficacy and successful stroke recovery experience shared by peers with stroke was also provided. Targeted outcomes, with general self-efficacy as the primary outcome, along with the secondary outcomes, including psychological distress, social participation, and health-related quality of life, were assessed immediately and one-month after completing the intervention. The generalized estimating equations model was adopted to compare the differences in outcomes between the intervention and control groups across time points relative to baseline.

Results:
A total of 144 stroke survivors (mean age: 68.41, SD: 11.64) were recruited and randomly allocated to intervention (n=72) and control (n=72) groups (attrition rate: 10.42%). The mean duration of the group session was 82.46 minutes (SD: 15.75). The generalized estimating equations analysis showed that participants in the intervention group had greater improvements in general self-efficacy, social participation, and health-related quality of life, as well as decrease in psychological distress in both follow-up assessments compared with the control group. Participants were satisfied with their involvement in the intervention, which rated the aspects of content, usefulness, material, facilitator, and arrangement of the intervention with a mean score exceeding 3.3 out of 5 for each item.

Conclusion:
The results showed the benefits of visual arts-based intervention for stroke recovery. It is worthwhile to further explore its longer-term effects as a community program for community-dwelling stroke survivors.
Abstract WP114: Impact of Readmission on the Continuity of Rehabilitation Care Among Acute Stroke Patients Discharged to Inpatient Rehabilitation and Skilled Nursing Facilities
Authors: Hailat Raed , Thompson Mike , Nickles Adrienne , Oostema John , de los Campos Gustavo , Reeves Mathew
Published: January 2025

Introduction:
Two-thirds of US stroke patients undergo rehabilitation post-discharge with about 20% and 25% receiving care at an inpatient rehabilitation facility (IRF) and skilled nursing facility (SNF), respectively. Total rehabilitation time for stroke patients discharged to SNF are about twice as long as those of IRF, but the effect of hospital readmission (to acute care) on the continuity of rehabilitation care in either setting is not known.

Methods:
We probabilistically linked data from Michigan’s Coverdell Stroke Program and Michigan Value Collaborative claims database for Medicare FFS beneficiaries following acute stroke (ICD-10 I61-I63) between 2016-2020. Patients admitted to IRF or SNF after hospital discharge were confirmed using claims data. We followed patients for 30 days post-discharge and compared the all-cause readmission rate, initial rehabilitation length of stay, 30-day total rehabilitation length of stay (in the same setting), and number of admissions to the same rehabilitation setting between IRF and SNF patients.

Results:
From an initial cohort of 14,316 patients, we identified 2,995 (20.9%) and 2,948 (20.6%) directly admitted to IRF or SNF following stroke hospitalization, respectively. Compared to SNF patients, IRF patients were younger, and more likely to be male, have minor strokes (NIHSS 1-4), and be able to ambulate at hospital discharge. Over 30 days of follow up, 12.6% (n=376) of IRF and 19.6% (n=577) of SNF patients were readmitted at least once to an acute hospital setting (Table). Of the patients who experienced readmission, SNF patients were more likely to be readmitted to a SNF rehabilitation setting compared to IRF patients being readmitted to an IRF setting (mean number of SNF admissions = 2.1 vs mean number of IRF admissions = 1.3). The mean length of stay of the initial IRF and SNF care settings were 14.6 (SD=8.0) and 11.5 (SD=8.2) days, respectively. However, the mean cumulative length of stay in the same rehabilitation setting over the 30-day period increased slightly to 15.3 (SD=8.1) days for IRF patients but increased substantially to 26.4 (SD=21.3) days for SNF patients.

Conclusions:
Readmission to the acute hospital has a disrupting effect on the continuity of rehabilitation care especially for SNF patients who are less likely to complete their initial rehabilitation stay. However, because most SNF patients return to SNF, the cumulative amount of rehabilitation care is close to the theoretical 30 day maximum.
Abstract WP12: Intravenous Thrombolysis in Unknown time of Symptom Onset: Real World Data from the K-NET Registry
Authors: Yamamoto Ryoo , Amano Yu , Kamimura Naoya , Amari Kazumitsu , Tanaka Fumiaki , TAKEUCHI MASATAKA , MORIMOTO MASAFUMI , Tsuboi Yoshifumi , SHOGO KAKU , Ayabe Junichi , Akiyama Takekazu , Ito Hidemichi , Onodera Hidetaka , Takaishi Satoshi , Hasegawa Yasuhiro , Ueda Toshihiro , Johkura Ken
Published: January 2025

Introduction:
Following the results of the WAKE-UP trial, the AHA and Japanese guidelines were revised in 2019 to recommend IV rt-PA for ischemic stroke patients who have unclear time of onset >4.5 hours from last known well, when MRI DWI-FLAIR mismatch is identified. Here, we investigated the actual implementation rate, efficacy, and safety of IV rt-PA in patients with unclear onset time ischemic stroke in an area with extremely high MRI prevalence.

Methods:
Using data from the K-NET Registry, a multi-center stroke registry in Kanagawa Japan, we investigated 2,021 patients who underwent IV rt-PA between January 2018 and December 2021. The patients included were divided into two groups: those with unclear onset time and >4.5 hours from last known well (UO) and those with clear onset time (CO), and their clinical backgrounds, treatment outcomes, and complications were compared.

Results:
The UO group consisted of 88 patients, which accounted for 4.4% of the included patients, while the CO group 1,933 patients. The UO group patients were significantly older (median age 81 vs 77 years, p<0.001). However, there were no significant differences in comorbidities (HT/DM/HL/af), pre-stroke mRS, NIHSS at admission, or stroke subtype. The door-to-needle time (DTN) was significantly longer in the UO group (60.5 minutes vs 53 minutes, p<0.01). Mechanical thrombectomy was performed in 62% of patients in both groups, with similar successful reperfusion (TICI 2b/3) rates (89.1% vs 92.0%). The rate of symptomatic intracerebral hemorrhage (sICH) was comparable between the groups (2.3% vs 2.6%). The rate of favorable outcome (mRS 0-1 at 3 months) was significantly lower in the UO group (28.4% vs 39.8%, p<0.05), though there was no difference in mortality between the groups (mRS 6 at 3 months) (6.8% vs 6.9%).

Conclusions:
Unlike previous reports, the rate of favorable outcome was lower in the UO group in this study. This study also showed that UO group patients were significantly older and had a significantly longer DTN; age bias, in addition to the additional time required for ischemia evaluation, may be responsible for the difference in outcomes. The similar rates of mechanical thrombectomy (including its success rate) and sICH complications may suggest that IV rt-PA itself worked well in the UO group.
Abstract WP137: 10-Year Trends in Last Known Well to Arrival Time in Acute Ischemic Stroke Patients: 2014-2023
Authors: Ferrone Nicholas , Sanmartin Maria , O'Hara Joseph , Jimenez Jean , Ferrone Sophia , Wang Jason , Katz Jeffrey , Sanelli Pina
Published: January 2025

Introduction:
Many national initiatives have focused on increasing public awareness of acute ischemic stroke (AIS) symptoms because earlier treatment is associated with improved outcomes. Our purpose was to evaluate the 10-year trends in the last known well to arrival (LKWA) time in AIS patients and assess disparities.

Methods:
A retrospective study of consecutive AIS patients admitted to a large integrated healthcare system was performed over a 10-year period from 2014-2023. LKWA time was categorized according to treatment eligibility as 0-4.5, >4.5-24, and >24 hours. Demographic and clinical characteristics, treatment utilization, and modified Rankin Score (mRS) at discharge were extracted from the electronic health records. Trend, bivariate, and multivariable logistic regression analyses were conducted.

Results:
A total of 11,563 AIS patients were included with 53% (6,163) in LKWA0-4.5, 34% (3,988) in LKWA>4.5-24, and 12% (1,412) in LKWA>24 groups. From 2014-2023, there was a downward trend in the early LKWA0-4.5 from 61% to 46% (
Figure 1, Table 1
). Concurrently, there was an upward trend in the later LKWA>4.5-24 (31% to 42%) and LKWA>24 (8% to 11%) groups.
Table 2
describes the study cohort characteristics. Compared to LKWA0-4.5, the LKWA>4.5-24 group was less likely to receive endovascular thrombectomy (EVT) and more likely to have worse outcomes (mRS2-5). The AIS patients in the LKWA>4.5 groups were more likely to be older >80 years (Odds Ratio=1.18 [95% Confidence Intervals:1.03-1.32]), males (1.10 [1.03-1.17]), Black (1.20 [1.08-1.33]), Asian (1.20 [1.04-1.39]), Medicaid insurance (1.16 [1.06-1.27]), lower income <$80,000 (1.43 [1.24-1.66]), and comorbidities of diabetes (1.29 [1.18-1.41]), hypertension (1.15 [1.05-1.25]), and current smoker (1.31 [1.12-1.52]).

Conclusion:
In the past decade, there was a downward trend in AIS patients in the early LKWA0-4.5 group with a concurrent upward trend in the later LKWA>4.5-24 group. During the peak of the COVID pandemic (2020), these trends were further exaggerated and did not return to pre-pandemic levels in 2021-2023. The LKWA>4.5 groups were more likely to be older, males, Black or Asian race, Medicaid insurance, lower income, and more comorbidities. Furthermore, the LKWA>4.5-24 group was less likely to receive EVT and more likely to have worse outcomes. These findings highlight the need of implementing targeted efforts towards the late LKWA groups to improve disparities in stroke treatment and outcomes.
Abstract WP141: Cardiac Troponin is Infrequently Tested in Emergency Department Patients with Suspected Stroke
Authors: Kolludra Kleona , Navi Babak , Merkler Alexander , Kamel Hooman , Liberman Ava
Published: January 2025

Background:
A recent prospective study reported that myocardial infarction (MI) was present in nearly half of ischemic stroke patients with substantially elevated troponin, with 1 in 5 having a type 1 MI. The proportion of stroke patients in whom cardiac troponin, a key component of diagnosing MI, is checked at Emergency Department (ED) presentation is unknown. We therefore used population-level data to report the frequency of cardiac troponin assessments among U.S. patients presenting emergently with stroke symptoms and to identify factors associated with cardiac troponin testing.

Methods:
Using the National Hospital Ambulatory Medical Care Survey (NHAMCS), which provides data from a nationally representative sample of EDs in the U.S., we analyzed patients presenting from 2016 to 2021 with an initial diagnosis of stroke, defined by ICD-10 codes in any diagnostic position as abstracted from free text responses by ED staff. The study exposure was cardiac troponin testing, which is a collected variable in NHAMCS. We applied survey weights to calculate national estimates and 95% confidence intervals (CI). Survey-weighted tests of comparison were used to compare demographics and clinical features between visits in which troponin was tested versus not. We constructed a multivariable conditional logistic regression model to evaluate potential associations between demographic and clinical factors and troponin testing in the ED.

Results:
An estimated 5.8 ([95% CI, 4.8-5.7) million patients or 0.69% (95% CI, 0.58-0.80%) of all ED visits during the study period were for suspected stroke. Mean age was 67.8 (95% CI, 66.5-69.2) years and 53.1% (95% CI, 48.2-57.9) were women. In suspected stroke patients, 26.1% (95% CI, 20.9-32.2%) had troponin tested in the ED. In unadjusted analysis, factors significantly associated with troponin testing were a triage complaint of chest pain, older age, higher mean systolic BP, hypertension, diabetes, obesity, stroke or TIA, congestive heart failure, or coronary disease. In a multivariable model, only elevated systolic blood pressure was significantly associated with having cardiac troponin tested in the ED (p= 0.02).

Conclusion:
Using population-level data, we found that only 1 in 4 patients with a suspected stroke had troponin tested in the ED. There appears to be an opportunity to improve MI detection among stroke patients in the U.S.
Abstract WP149: Empowering Stroke Survivors Through Digital Health Based Navigation: Qualitative Analysis of the Kandu Health Pilot Study
Authors: Gidner Bree , Misterka Justin , Wertheimer Jeffrey , Tsai Nancey Trevanian , Sheehan Lauren
Published: January 2025

Introduction:
Stroke imposes a significant burden on individuals, families, and healthcare systems, with high readmission rates and healthcare utilization. It disproportionately affects racial/ethnic minorities, exacerbating healthcare disparities. There is a critical need for tailored, patient-centered interventions, particularly for minority populations.

Objectives:
This research identifies key themes in stroke survivors' and care partners' perspectives post-stroke, and examines the demographic and social determinants of health impacting outcomes. The study focuses on how these factors influence survivors' experiences with a digital health platform offering personalized support through remote clinical guidance and curated educational content.

Methods:
A mixed-methods, exploratory design was employed with 50 participants, including 36 unique stroke survivors (52.7% female, 47.2% male) and 13 care partners (84.6% female, 15.3% male), followed for 90 days for comprehensive post-stroke care via Principal Illness Navigation (PIN). The average age of participants was 59 years, with close to 60% being non-white. Participants provided feedback through focus groups conducted via video-conferencing between December 2022 and March 2024. These sessions included up to 3 participants, a facilitator, a Kandu representative, and lasted no more than 60 minutes.

Results:
Participants were highly engaged, with an average of 12 navigator touchpoints over 12 weeks, totaling 7.65 hours of one-on-one navigator time. The cohort identified an average of 3.1 social determinants of health (SDOH) needs, with mental health (43.9%), financial strain (34.1%), and family/community support (31.7%) being the most common. Focus group themes included: (1) Multi-faceted Therapeutic Support, (2) Educational Content&Services, (3) Triaging/Clinical Care Guidance, (4) Behavioral Health Support, (5) Connectivity/Community, (6) Programmatic Value, and (7) Constructive Feedback/Future Opportunities.

Conclusion:
This study offers insights into the effectiveness of a digital health and clinical navigation platform in enhancing stroke recovery and person-centered care. The program addressed core themes impacting patient and care partner experiences, such as access to educational resources, real-time clinical guidance, intervention compliance, and behavioral health needs. These findings can inform future interventions aimed at providing post-acute stroke navigation and reducing healthcare disparities.
Abstract WP15: Intravenous Thrombolysis in Cervical Artery Dissection-Related Stroke: A Nationwide Study
Authors: Shu Liqi , Lee Elizabeth , Field Thalia , Guo Xiaofan , Henninger Nils , Keser Zafer , Khan Muhib , Mistry Eva , Nguyen Thanh , Siegler James , Strelecky Lukas , Mandel Daniel , Stretz Christoph , Khan Farhan , Furie Karen , Yaghi Shadi
Published: January 2025

Introduction:
The safety and efficacy of intravenous thrombolysis (IVT) in cervical artery dissection-related acute ischemic stroke (CeAD-AIS) remains unclear. We performed a retrospective study of data from the National Inpatient Sample investigating outcomes in CeAD-AIS patients treated with and without IVT.

Methods:
We included adult patients with CeAD-AIS hospitalized between 2016 to 2019. CeAD-AIS was defined by concurrent CeAD and AIS diagnoses, identified with ICD-10 codes. The primary outcome was home discharge. The safety outcomes were inpatient death and intracerebral hemorrhage (ICH). We used survey-weighted multivariable adjusted logistic regressions comparing the groups (IVT versus no IVT), followed by interaction analyses to examine for effect modifications based on age, medical history, stroke severity, and endovascular treatment.

Results:
Between 2016-2019, 1,360 (12.1%) of 11,285 CeAD-AIS patients received IVT. Patients treated with IVT- had higher NIH Stroke Scale (NIHSS) scores (median 8 [4-17] versus 3 [1-11];
p
< 0.001). In adjusted analyses, treatment with IVT was associated with a greater odds of home discharge (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] 1.09-2.05,
p
= 0.014), but not ICH (aOR 0.90, 95% CI 0.43-1.86,
p
= 0.773) or inpatient death (aOR 1.22, 95% CI 0.72-2.06,
p
= 0.454). In interaction analyses, stroke severity significantly interacted with IVT (
p
for interaction = 0.001), where IVT was significantly associated with increased likelihood of home discharge in patients with moderate to severe strokes (NIHSS > 4) (aOR 2.28, 95% CI 1.59-3.26,
p
< 0.001) but not in those with mild stroke (NIHSS 0-4) (aOR 1.03 95% CI 0.62-1.70,
p
= 0.922).

Conclusion:
IVT improved the likelihood of home discharge in patients with CeAD-AIS without increasing the risk of inpatient death or ICH.
Abstract WP152: Associations between measures of structural racism and receipt of acute ischemic stroke interventions in the US
Authors: Mehta Amol , Polineni Sai , Polineni Praneet , Dhamoon Mandip
Published: January 2025

Background:
Structural racism and disparities between rural and urban healthcare systems significantly impact stroke care delivery in the United States. This study explores the interaction between structural racism, urbanity, and the administration of acute ischemic stroke (AIS) interventions—specifically, intravenous thrombolysis (TPA) and endovascular thrombectomy (ET).

Methods:
This retrospective analysis utilized complete, de-identified inpatient Medicare data from January 1, 2016, to December 31, 2019. We included Medicare beneficiaries aged ≥65 years with incident AIS admissions in large metropolitan and non-urban settings. Structural racism was assessed using county-level validated metrics, including segregation, housing, employment, education, and income indices, and a composite structural racism score. We used multilevel logistic models adjusted for age, sex, and race (Black vs. White) to estimate the odds ratios (ORs) for TPA and ET receipt, with data clustered at the county level.

Results:
Among 951,914 AIS patients, those treated in rural hospitals had lower ICU capacity (27.5% vs. 88.6%), stroke certification (5.3% vs. 38.4%), and lower rates of TPA (1.6% vs. 12.3%) and ET (<1% vs. 3.8%) compared to urban hospitals. Structural racism metrics, particularly higher dissimilarity (OR: 1.06 for TPA, 1.27 for ET) and isolation indices (OR: 1.10 for TPA, 1.33 for ET), as well as a composite structural racism score (OR: 1.47 for TPA, 4.15 for ET), were associated with increased odds of receiving these interventions in urban areas. Despite better access to care in urban settings, Black patients were significantly less likely to receive TPA (OR: 0.70) and ET (OR: 0.63) compared to White patients.

Conclusions:
This analysis underscores the persistent disparities in stroke care access and outcomes influenced by structural racism and the rural-urban divide. These findings suggest a need for targeted interventions to address these inequities in stroke treatment
Abstract WP170: Association of Workflow Metrics with Functional Outcomes in the SELECT2 trial
Authors: Jabbour Pascal , Al-Mufti Fawaz , Hassan Ameer , Abraham Michael , Hussain Shazam , Ortega-Gutierrez Santiago , Chen Michael , Pujara Deep , Johns Hannah Tabitha , sitton clark , churilov leonid , Hill Michael , Ribo Marc , Campbell Bruce , Gandhi Chirag , Tjoumakaris Stavropoula , Sarraj Amrou
Published: January 2025

Introduction:
Faster reperfusion from initial presentation was associated with improved outcomes after endovascular thrombectomy(EVT) in patients with small core strokes. However, the relationship between time and different workflow metrics with outcomes in not well-established in patients with large strokes. We aimed to analyze the clinical workflow and time measures and their effect on overall procedure and functional outcomes from SELECT2 trial.

Methods:
Patients enrolled in SELECT2 trial were stratified based on treatment arm and transfer status and various workflow metrics, both in-hospital and outside (limited to transferred patients) were compared and their effect on clinical outcomes were evaluated.

Results:
Of 352 enrolled, 141 patients (72 EVT, 69 MM) presented directly to EVT-capable centers, whereas 211(106 EVT, 105 MM) were transferred from referral centers. Among patients presenting directly, no difference was observed between time from LKW to arrival(EVT:376.5(119.5-638)min vs MM:435(118-802)min,p=0.50), arrival to imaging acquisition(EVT:14(10-21)min vs MM:16.5(11-25)min,p=0.21) or time from imaging to randomization(EVT:55(40.5-72.5)min vs MM:64(44-84)min,p=0.083)-Fig1a. For patients transferred to EVT-capable centers, no difference was observed between treatment arms in time from LKW to arrival - EVT:418(63-757)min vs MM:313(87.5-713)min,p=0.77; time from arrival to imaging – EVT:12(3.5-24)min vs MM:13.5(10-20)min,p=0.12; time from imaging to departure – EVT:123.5(82-195)min vs MM:128.5(85-197.5)min,p=0.95; transit time to EVT center – EVT:39(21.5-67)min vs MM:38.5(25.5-67.5)min,p=0.73); time from imaging to randomization – EVT:43(21-70)min vs MM:39(21-68)min,p=0.96)-Fig1b. Longer procedure time was associated with worse mRS (aGenOR:0.92, 95%CI:0.87-0.96,p-value:0.001 for every 10min). Longer time from perfusion imaging to reperfusion was associated with worse mRS in both direct(aGenOR:0.99(0.99-1.00),p=0.003 for every 10min) and transferred patients(aGenOR:0.98(0.95-1.00),p=0.038 for every 10min) fig2, but Interfacility transfer times or other time metrics were not significantly associated with functional outcomes.

Conclusion:
In large ischemic core infarct patients randomized in the SELECT2 trial, longer times from imaging to reperfusion and procedure time were associated with worse clinical outcomes after thrombectomy. Expedited and efficient workflow protocols at thrombectomy centers are vital to optimize outcomes in large core patients.
Abstract WP173: The Influence of Social Isolation on SSQOL in a Community-Based Study
Authors: Martins-Caulfield Joshua , Zhang Guanghao , Lisabeth Lynda , Morgenstern Lewis
Published: January 2025

Introduction:
Quality of Life (QOL) is a critical patient-centered indicator for evaluating recovery in individuals who have experienced life-altering illnesses such as stroke. Social isolation and family structure may affect a stroke survivor’s QOL and could be influenced by depression, potentially intensifying its impact on an individual’s recovery from stroke. We studied how social isolation impacts Stroke-Specific QOL (SSQOL) in a community-based study.

Hypothesis:
Stroke survivors who are more socially isolated will have worse SSQOL.

Methods:
Participants in the Brain Attack Surveillance in Corpus Christi (BASIC) project in Nueces County, Texas, were interviewed 90 days after stroke between October 2019 and June 2023 to determine QOL using the SSQOL scale (higher scores better), social isolation using the Patient-Reported Outcomes Measurement Information System (PROMIS) scale (higher scores more isolation), family structure using marital status, family size, and whether an adult child lived within 10 miles and covariates. Patients with ICH or ischemic stroke who survived 90 days were the target population. We analyzed the relationship between social isolation scores and SSQOL by applying four weighted linear regression models. Model 1 included social isolation score and demographic variables. Model 2 added clinical variables to Model 1 and Model 3 further included socioeconomic variables with Model 2. The fully adjusted Model 4 added familial variables to Model 3.

Results:
A final study population of 706 stroke survivors completed the 90 day follow-up interview and were included after removing extreme values (beyond the 1st and 99th percentiles). Mean age of the participants was 65 and 47% identified as women. Mexican Americans comprised 64% of the sample. Social isolation was negatively associated with SSQOL in all models with little change in the strength of association after adjustment for demographics, clinical variables, socioeconomic and family structure. The Table shows the fully adjusted Model 4; social isolation was negatively associated with SSQOL (Beta -0.05 (95% CI -0.06, -.04); p<0.01).

Conclusions:
Social isolation is associated with lower SSQOL among stroke survivors. Recovering from a stroke is a long and challenging process. This study highlights the significance of psychosocial factors, like social isolation, as key elements in that recovery.
Abstract WP174: ANALYSIS OF GUIDELINES IN VASCULAR NEUROLOGY AND STROKE PUBLISHED BETWEEN 2012 AND 2023.
Authors: Martins Hanna , Andrade Joao , Sampaio Gisele , Lopes Renato , Barreto Marcella , Ikeda Raissa , Sanchez Paula , Lopes Carlos Felipe , Mauricio Rebeca , Peixoto Vitoria , de Souza Jorge Luiz , Gomes Gustavo
Published: January 2025

Introduction:
Clinical guidelines have become an essential tool for updating medical professionals. Its use in clinical practice reduces the possibility of medical harm and promotes appropriate medical practices. However, the publication of guidelines in vascular neurology is often inconsistent between medical entities, making access and interpretation of recommendations difficult.

Methods:
Systematic review of guidelines published by the American, Brazilian, and European Academies of Neurology (AAN, ABN, and EAN), and societies endorsed by such academies (American Heart Association/American Stroke Association – AHA/ASA, European Stroke Organization – ESO), from 2012 to 2023 in the area of vascular neurology, selected through the official websites of the respective institutions. Evaluated the number and proportion of recommendations made.

Results:
A total of 61 guidelines were analyzed: 5 published by ABN, 34 by EAN/ESO, and 22 by AAN/AHA/ASA. There were 2,547 recommendations, with 261 published by ABN (10,24%), 548 published by EAN/ESO (21,51%) and 1,738 (68,23%) published by AAN/AHA/ASA. There were 430 recommendations with LOE A (16.88%), 1,003 with LOE B (39.37%), and 785 with LOE C (30.82%). Only EAN/ESO adopted the GRADE system in 31 of its 34 publications, with 20 recommendations rated as high (0.78%), 68 as moderate (2.66%), 95 as low (3.72%), and 145 as very low (5.69%). There were 242 recommendations with level of evidence A/Class I (IA), with 178 (73.55%) published by AAN/AHA/ASA. Recommendations classified as high quality of evidence and strong strength of recommendation (high/strong) totaled 17, all published by EAN/ESO. There have been 27 guidelines published in the last 4 years (2020-2023), which were responsible for 709 recommendations (27,83%). The average number of recommendations per guideline in this period was lower when compared to previous years – 26,25 recommendations per guideline versus 54,05.

Conclusion:
Less than 20% of recommendations in vascular neurology in current guidelines are classified as level A of evidence (LOE A), and less than 1% of the total recommendations receive a high-quality classification in articles that used the GRADE system. New approaches to conducting clinical research are needed to enable the generation of high-quality evidence in a more pragmatic and efficient way.
Abstract WP181: Effect of RapidAI Imaging Software Implementation on Workflow Metrics in Acute Ischemic Stroke Care
Authors: Salim Hamza , Yedavalli Vivek , Lakhani Dhairya , Copeland Karen , Heit Jeremy , Albers Gregory
Published: January 2025

Background:
Timely intervention is crucial for patients with acute ischemic stroke. The RapidAI imaging system (RAPID) was implemented to enhance the speed and efficiency of care delivery. We evaluated the impact of RAPID on various metrics in the patient care pathway.

Methods:
In this retrospective observational study, we analyzed consecutive patients who presented to our hospital ER with acute ischemic stroke and who were treated with Intravenous Thrombolysis (IVT) or mechanical thrombectomy between December 20, 2014, and April 20, 2024. Patients were divided into pre-RAPID (n =186) and post-RAPID (n =264) groups based on the implementation date of the RAPID system (September 1, 2019). We compared Door to Non-contrast CT (NCCT), Door to CT Angiography (CTA) / Perfusion Imaging, Door to IVT, and Door to Puncture / first pass for thrombectomy, between the two groups using Fisher’s exact test.

Results:
For Door to CT, no significant difference was observed between pre-RAPID and post-RAPID groups; 74% of patients in the post-RAPID group and 71% in the pre-RAPID group received NCCT within 45 minutes (
p
= 0.44). Significant improvements were observed in Door to CTA/Perfusion times; 90% of patients received vessel or perfusion imaging within 150 minutes post-RAPID compared to 70% pre-RAPID (
p
= 0.01), and 87% received imaging within 120 minutes post-RAPID compared to 70% pre-RAPID (
p
= 0.031). For Door to IVT, 96% of patients received treatment within 120 minutes post-RAPID compared to 82% pre-RAPID (
p
= 0.015). For thrombectomy, there was a trend toward faster door to puncture post-RAPID; 70% of patients were treated within 150 minutes post-RAPID compared to 62% pre-RAPID (
p
= 0.36), and 90% were treated within 210 minutes post-RAPID compared to 81% pre-RAPID (
p
= 0.12). Similarly, a trend toward faster Door to First Pass times was observed post-RAPID, with 88% treated within 240 minutes compared to 80% pre-RAPID (
p
= 0.20).

Conclusions:
RapidAI Implementation was associated with significant improvements in key workflow metrics, notably in Door to Vessel/Perfusion Imaging and Door to IVT. These findings suggest that RAPID enhances the efficiency of patient care delivery in acute ischemic stroke. Further studies with larger sample sizes are warranted.