bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 91: Small Perivascular Spaces as Vascular Risk Factors
Authors: Gutierrez Jose , Dong Chuanhui , Cespedes Sandino , Rundek Tatjana , Sacco Ralph , Elkind Mitchell S , Wright Clinton
Published: July 2021

Introduction:
Small perivascular spaces (SPVS) are gaining momentum as imaging biomarkers of cerebrovascular health.

Hypothesis:
SPVS confer vascular risks and the coexistence of SPVS with lacunar infarcts (LI) heightens these risks.

Methods:
Stroke-free participants in the population-based Northern Manhattan Study were followed for incident stroke (ischemic and hemorrhagic), MI, all death, vascular death, and any vascular event. Lesions with diameter of 3 mm or less and absence of FLAIR rim were classified as SPVS on a semi-quantitative scale (range 0 to 28). We defined “high SPVS burden” as the upper quintile and compared the rate of vascular events in this group to individuals in the lower 4 quintiles combined. LI were defined as lesions greater than 3 mm with associated FLAIR rim, round shape, and typical location. Cox models were used to calculate risks of outcomes after adjusting for confounders.

Results:
This analysis includes 1208 NOMAS participants (40% male, 65% Hispanic; mean age 71 ± 9 years at time of MRI) followed a mean of 6 ± 2 years. SPVS were present in 91% of the sample (median SPVS scale score 5). Compared to participants with a lesser burden of SPVS, participants with a high SPVS burden had a higher incidence rate per 1000 person-years of death (48 vs 34), vascular death (20 vs 11), ischemic stroke (12 vs 7) and any vascular event (37 vs 24). After adjusting for demographics and vascular risk factors, participants with a high burden of SPVS had a higher risk of death (HR 1.35, 1.00-1.78), vascular death (HR 1.55, 0.96-2.51), any stroke (HR 1.53, 0.91-2.57), MI (HR 1.29, 0.69-2.41), and any vascular event (HR 1.50, 1.07-2.11). The presence of lacunar infarcts was an effect modifier such that those with LI and a high SPVS burden had a greater risk of vascular death (B=0.63, P=0.03), any stroke (B=0.72, P=0.03) and any vascular event (B=0.54, P=0.02) compared to those without LI.

Conclusions:
In this multi-ethnic, population-based study, participants with a high burden of SPVS had increased incidence rates of vascular events. Furthermore, the joint presence of SPVS and LI heighten the risk of vascular death, any stroke and any vascular event. The presence of SPVS may help select subjects for randomized trials to assess intervention strategies.
Abstract 98: Bilateral Carotid Intraplaque Hemorrhage Association With Simultaneous Bilateral Stroke
Authors: McLaughlin Michael , Kim Seong-Eun , Treiman Gerald , Parker Dennis , McNally Joseph S
Published: July 2021

Introduction:
Bilateral ischemic strokes are often attributed to central or cardiac embolic sources, especially in the absence of severe bilateral carotid stenosis. Carotid MRI detects carotid intraplaque hemorrhage (IPH), a marker of stroke risk independent of stenosis.

Hypothesis:
MRI-detected carotid IPH better identifies bilateral carotid source strokes compared to stenosis alone.

Methods:
In this retrospective cross sectional study, patients undergoing stroke workup were imaged with carotid and brain MRI. Stroke was determined by the AHA definition of CNS infarction. Patients with non-carotid stroke sources (e.g. cardiac sources), occluded or near-occluded carotids were excluded. A total of 425 patients were analyzed. Carotid imaging findings were recorded, including IPH and NASCET stenosis along with clinical cerebrovascular risk factors and medications. Receiver operating characteristic (ROC) analysis was performed to determine the predictive value (area under the curve, AUC) of carotid imaging findings.

Results:
Carotid IPH was present in 89/425 of cases, and was bilateral in 24/89 (27.0%). Bilateral carotid IPH was a good predictor of bilateral stroke (AUC=.808), performing better than bilateral stenosis with ≥50%, ≥60% or ≥70% cutoffs (AUC=.565 p=.001, AUC=.550 p<.001, AUC=.523 p<.001, respectively) but not significantly better than average bilateral stenosis (AUC=.800 p=.90). The combined predictive value of bilateral IPH and average bilateral stenosis was excellent (AUC=.891) and performed better than bilateral IPH alone (p=.07) or average bilateral stenosis alone (p=.002).

Conclusions:
Bilateral carotid IPH is associated with bilateral stroke, and adds significant discrimination of bilateral carotid stroke sources compared to stenosis. In the setting of bilateral stroke, carotid MRI may help uncover potential stroke sources undetected by lumen imaging alone.
Abstract TMP102: Do Statins Decrease Mortality and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage? - Results from a Meta-Analysis
Authors: Sengodan Prasanna , Jadaun Pushkal , Kistangari Gaurav
Published: July 2021

Background:
Aneurysmal subarachnoid hemorrhage (aSAH) induced cerebral vasospasm and delayed cerebral ischemia (DCI) are the major causes of morbidity and mortality in patients with aSAH. Recently, there has been growing interest in the use of statins, which raises cerebral endothelial nitric oxide synthase expression, improves endothelial function, increases cerebral blood flow and has been shown to protect against ischemia. However, the effect of statins use for patients with aSAH remain controversial with mixed results, with a latest meta-analysis demonstrating that statins have a potential benefit with regards to mortality and DCI.

Methods:
All randomized, placebo-controlled trials studying the effect of statins on vasospasm, DCI, poor neurological outcomes and death in aSAH were included. Search was done primarily using Medline (PubMed), where a total of 140 studies were identified using the search terms ‘statins’ and ‘subarachnoid hemorrhage’. The search was then narrowed down to 47 items, from which 7 studies were included for the final analysis. Statistical analysis was performed using the comprehensive meta-analysis software RevMan version 5.3 to obtain the odds ratio (risk ratio) estimates and also the forest plot comparisons.

Results:
In 7 studies, a total of 1052 patients were analyzed, 515 in the ‘statins’ group and 537 in the ‘placebo’ group were compared. There were no statistically significant differences between the two groups with regards to vasospasm observed with transcranial doppler (Odds ratio, 0.69 [95% CI, 0.68to 1.24]), poor neurological outcomes ( OR 0.97, [95% CI, 0.74-1.27]), and death (OR 0.74 [95% CI, 0.49-1.12])(Fig.4). A trend towards decreased risk of DCI was seen with the use of statins (OR, 0.79 [95% CI, 0.57-1.09) (Figures 1-4). The mean follow up was about 6 months.

Conclusion:
Statins have no benefit in terms of mortality, cerebral ischemia, DCI or poor neurological outcomes when compared to placebo in patients with aSAH. The current study does not support the routine use of statins for all patients with aSAH.
Abstract TMP106: Early Elevation of D-dimer Values Is Associated With Neurological Deterioration in Acute Ischemic Stroke due to Cerebral Artery Dissection
Authors: Fukuma Kazuki , Ihara Masafumi , Yamagami Hiroshi , Koga Masatoshi , Toyoda Kazunori , Nagatsuka Kazuyuki
Published: July 2021

Background and Purpose:
Plasma D-dimer is a complementary diagnostic marker in patients with acute aortic dissection. However, it remains unknown whether monitoring of D-dimer is of diagnostic value for in-hospital management of cerebral artery dissection. The aim of this study was to identify the relationship between D-dimer and neurological deterioration in acute ischemic stroke due to cerebral artery dissection.

Methods:
We retrospectively studied 90 consecutive patients (60 men; mean age, 51.0 years) with ischemic stroke due to cerebral or cervical artery dissection who were admitted to our hospital within three weeks after the onset between Jan 2005 and May 2015. Plasma D-dimer values were measured at least on admission and within a week. Neurological deterioration (ND) was defined as an increase of ≥ 3 points in the National Institutes of Health Stroke Scale (NIHSS) score within 3 weeks after admission. D-dimer ratio (DDR, peak D-dimer between the 2nd and 7th hospital day / on admission) was measured as an index of D-dimer elevation at an early phase. Associations between ND and patient characteristics including D-dimer values and acute treatment regimen were examined.

Results:
Eight of the 90 patients (8.9%) presented ND, accompanied by progression of stenosis in cerebral artery dissection. None of them had aortic dissection, severe heart failure and active malignant tumor. Fifty-nine of the 90 patients (65.6%) received anticoagulant therapy, 33 (36.7%) antiplatelet therapy and 5 (5.6%) thrombolysis in the acute phase. The mean D-dimer value was 2.80±1.81 (standard deviation, SD) at the time of progression. In univariate analysis, DDR was higher in ND group (3.93±2.45 SD) than non-ND group (1.46±1.04 SD) (p<0.01), whereas the D-dimer value on admission was similar in 2 groups . Multivariate logistic regression analysis showed DDR was related to ND before [OR: 1.57; 95% CI: 1.15-2.38, p<0.01] and after controlling for thrombolysis, anticoagulant therapy and deep vein thrombosis [OR: 1.63; 95% CI: 1.14-2.62, p<0.01].

Conclusion:
Early elevation of D-dimer values may predict neurological deterioration with progression of stenosis in acute ischemic stroke due to cerebral artery dissection
Abstract TMP22: Histological Characteristics of Intracranial Atherosclerosis: a Post-mortem Study
Authors: Yang Wenjie , Fisher Mark , Niu Chunbo , Zhao Hailu , Wong Kasing , Ng Hokeung , Chen Xiangyan
Published: July 2021

Introduction:
Intracranial atherosclerosis is an important cause of ischemic stroke, but there are few systematic examinations of the pathology of these lesions. In the current study, we examined post-mortem specimens of middle cerebral, vertebral, and basilar arteries to characterize the severity of lesions, and to identify potential differences between anterior versus posterior intracranial vasculature.

Hypothesis:
We hypothesized that intracranial atherosclerosis has distinctive features, and that there are differences between anterior and posterior circulation lesions.

Methods:
We examined the intracranial vasculature of 32 randomly-chosen autopsy cases aged 45 years or older. We used routine and immunostaining of pathologic material, and characterized the pathological features and plaque components of the lesions.

Results:
Atherosclerotic lesions were identified in 122/128 (95.3%) of arteries studied. Features of complicated plaques were infrequently seen: Plaque hemorrhage was encountered in 15/128 (11.7%), neovascularity in 15/128 (11.7%), lumen thrombus in 17/128 (13.3%), macrophage infiltration in 26/128 (20.3%), and calcification in 38/128 (29.7%) of arteries. Posterior circulation arteries, compared to anterior circulation, had more concentric (versus eccentric) plaques, 68.8% (44/64) vs. 28.1% (18/64) (p<0.001), and more lumen thrombi 21.9% (14/64) vs. 4.7% (3/64) (p=0.008).

Conclusions:
Intracranial atherosclerotic plaques were commonly present in this population, but the lesions generally lacked features of complicated plaques. Posterior circulation lesions had some identifiable differences compared to anterior circulation lesions. Further studies are needed to determine whether these characteristics indicate a distinctive atherosclerotic phenotype for the intracranial vasculature.
Abstract TMP44: Contrast Enhanced Ultrasound Can Detect Small Disruption of Carotid Plaques Related to Symptomatic Internal Carotid Artery Stenosis
Authors: Abe Soichiro , Saito Kozue , Ishibashi-Ueda Hatsue , Tonomura Shuichi , Mori Kota , Motoyama Rie , Yamagami Hiroshi , Kataoka Hiroharu , Takahashi Jun C , Iihara Koji , Toyoda Kazunori , Nagatsuka Kazuyuki
Published: July 2021

Background:
The ulcerated atheroma of the carotid artery is a risk factor of ipsilateral ischemic stroke. Contrast-enhanced ultrasound (CEUS) is a novel noninvasive technique useful for evaluating the morphology of carotid plaques, and can detect small disruptions on plaque surface. However, it remains unclear whether the disrupted carotid plaque detected by CEUS is related to the symptomatic internal carotid artery stenosis (ICS).

Methods:
A total of 79 ICS patients who underwent carotid endarterectomy (CEA) were enrolled from July 2010 to July 2015. Before operation, ICA lesions were examined by color Doppler ultrasound (CDUS) and CEUS using perflubutane. The ulceration was diagnosed when both of the color Doppler signal on CDUS and the pooling of microbubbles on CEUS were observed within the plaque. The disruption was diagnosed only by CEUS when microbubbles pooled through the fissured surface, unlike the linear delineation of neovessels. We validated findings on ultrasound compared with the histopathological findings of ulceration and present/recent plaque rupture. The associations between ulceration/disruption on ultrasound and symptomatic ICS (with a history of ipsilateral transient ischemic attack and/or ischemic stroke) were investigated.

Results:
Of 79 subjects (mean age 71.2±6.8 years old, 78 men), 55 had symptomatic ICS. The ulceration by CEUS and CDUS was recognized in 20 patients (25%), and the disruption on plaque surface was seen by CEUS solitary in 26 patients (33%). The sensitivity and specificity of detecting plaque ulceration or disruption using CEUS compared with histopathological findings were 0.57 (45/66) and 1.00 (13/13), respectively. The detection rate of ulceration or disruption using CEUS was higher in symptomatic ICS than in asymptomatic ICS (66% vs 42%, P=0.049). Compared to plaques without ulceration/disruption on ultrasound, prevalence of symptomatic ICS was higher in plaques with the disruption (88% vs 58%, P=0.01), whereas it was similar in plaques with the ulceration (65% vs 58%, P=0.77)

Conclusion:
Small disruptions on carotid plaque surface detected by CEUS were significantly related to symptomatic ICS and this results may help the detailed assessment of plaque vulnerability.
Abstract TMP68: Vulnerability to Health Disparities and Secondary Stroke Prevention: The REGARDS Study
Authors: Rhodes James. D , Oikeh Asikhame , Gamboa Chris , Fadairo Abimbola , Judd Suzanne , Howard Virginia , Safford Monika
Published: July 2021

There are few studies on the effect of multiple vulnerabilities to health disparities identified in the AHRQ 2012 report on secondary stroke prevention. We examined the effects of 5 vulnerability domains (race, age, region, health insurance and income) on the prescription of secondary stroke prevention medications at discharge following hospitalization for an acute ischemic stroke (AIS) in a large, national cohort of patients admitted to unselected hospitals.

Methods:
We conducted a retrospective review of admissions for AIS between 2003-2012 within the REGARDS cohort. Discharge medications, insurance status, and age at time of stroke event were obtained from hospital records. Race, region and income < $20,000 were obtained from REGARDS baseline data. We constructed a vulnerability score (v score) range from 0-5, with 0 indicating no vulnerability. We examined the prevalence of each discharge medication by each vulnerability domain, score category, and by overall score using Poisson regression with a robust variance estimator.

Results:
664 participants met the inclusion criteria. 132 (20%) of the study participants had ≥ 3 vulnerabilities (v score of 3-5). Participants with ≥ 3 vulnerabilities were more likely to be black (80.3%), > 75 years old (63.6%), and to report income < $20,000 (67.4%). The prevalence of receiving antithrombotic prescriptions at discharge was significantly lower in participants with ≥ 3 vulnerability domains (PR: 0.90 [95% CI: 0.82, 0.99]). The prevalence of receiving antithrombotic prescriptions was also inversely associated with a per point increase of the v score (PR: 0.96 [95% CI: 0.93, 0.99]), as were lipid- lowering prescriptions at discharge (PR: 0.95 [CI: 0.90, 0.99]). There was a non-statistically significant inverse association between ACEi/ARB prescriptions at discharge and having multiple vulnerabilities, including for 2 vulnerabilities (PR: 0.93 [CI: 0.80, 1.09]) and for ≥ 3 vulnerabilities (PR: 0.84 [CI: 0.69, 1.01]).

Conclusion:
The presence of multiple vulnerabilities was associated with lower adherence by healthcare providers to secondary stroke prevention recommendations for discharge prescriptions.
Abstract TMP81: Stroke Systems of Care: EMS Partnerships and Feedback
Authors: VonCannon Shellie , Porcelli Thomas
Published: July 2021

Background and Purpose:
In 2014, Novant Health Presbyterian Medical Center (NHPMC) and Mecklenburg EMS Agency (MEDIC) launched a collaborative project to improve stroke care in our community. The goals of the project were to: Improve the efficiency of the Code Stroke process Determine the accuracy of priority one stroke calls from EMS to the Emergency Department Identify areas of the community with greatest numbers of stroke calls Provide individual case feedback to EMS colleagues

Method:
MEDIC crews call in priority one suspected acute stroke patients prior to emergency arrival. Unless stabilization is required, MEDIC takes the patient directly to the CT scanner, located in the emergency room, and assists with transferring the patient to the scanner. The accuracy of priority one calls is shared monthly and quarterly with MEDIC and the NHPMC Stroke Best Practice Team.If the patient receives t-PA, the NHPMC Clinical Analyst sends the MEDIC Quality Specialist a feedback sheet within 24-48 hours which includes dispatch to arrival and dispatch to drug time parameters and initial patient outcomes. The feedback sheets are sent via the supervisors, who also send a letter of commendation to the responding crew members.

Results:
In 2013 the door to CT report time averaged 27 minutes, 2014 average was 20 minutes or a 26% reduction. In 2014, NHPMC received 80 priority one stroke calls from MEDIC crews. Of these 80 patients, 71 were coded at discharge as either strokes or stroke mimics. This number reflects 89% stroke identification accuracy. Ischemic stroke patients who received t-PA at NHPMC had a median door to drug time of 40 minutes and a median dispatch to drug time of 68.5 minutes. Density of stroke calls assisted in identification of target areas and populations for community awareness education.

Conclusion:
Having a strong collaborative relationships with EMS agencies, together both EMS and hospitals can positively impact the quality of stroke care within a community. As first responders, EMS crews have a unique perspective that can improve processes and decrease time to treatment. Providing feedback information to our EMS partners helps them understand their impact on stroke patient outcomes.
Abstract TMP90: Limited Use of Oral Anticoagulant Therapy in Patients with Atrial Fibrillation After Ischemic Stroke
Authors: McGrath Emer R , Go Alan S , Chang Yuchiao , Borowsky Leila , Fang Margaret C , Reynolds Kristi , Singer Daniel E
Published: July 2021

Introduction:
Oral anticoagulants (OAC) prevent stroke in patients with atrial fibrillation (AF) yet many are not prescribed OAC. Exploring barriers to OAC among AF patients at high stroke risk might identify opportunities to intervene.

Hypothesis:
Old age, fall risk, and comorbidity will be strong barriers to use of OAC even among survivors of acute ischemic stroke (IS).

Methods:
Inpatient and 1-year follow-up of patients sustaining an acute IS within the ATRIA and ATRIA-CVRN community-based AF cohorts (1996-2009; n=46,806). MD chart reviewers recorded use of OAC (warfarin) at discharge (96% complete), reasons for non-use, and modified Rankin disability score at discharge. Logistic regression identified patient features associated with non-use of OAC. Follow-up recorded 1-year mortality and recurrent IS.

Results:
Of 1,405 AF patients discharged alive after IS, 44% (619) were not prescribed OAC despite a median CHA2DS2-VASc score of 5. The most frequent (non-mutually exclusive) reasons for non-use of OAC included risk of falls (26.7%), poor prognosis (19.3%), bleeding history (17.1%), patient/family refusal (14.9%), older age (11.0%) and dementia (9.4%). Logistic regression identified older age (OR 9.0, 95% CI 5.0-16.0 for age ≥85 vs. <65 yrs) and increased disability on discharge (OR 12.6, 95% CI 5.8-27.2 for severe deficit vs. no deficit) as the strongest independent clinical features associated with non-use of OAC at discharge. One-year mortality for those not receiving OAC at discharge was 43%--far higher than risk of recurrent IS (7.7%).

Conclusions:
Despite very high stroke risk, >40% of AF/IS patients were not discharged on OAC. The dominant reasons for non-use of OAC were fall risk, poor prognosis, bleeding history, patient refusal, older age, and dementia. The high 1-year mortality rate confirmed these patients’ high comorbidity burden. Effective mitigation of fall risk or the improved safety profiles of newer anticoagulants might increase use of OACs. However, despite the substantial stroke protection benefit from OACs, understandable obstacles to OAC remain for many older and complex AF patients.
Abstract TP102: Modulation of Neuroinflammation by Haptoglobin Reduces Oxidative Stress and Improves ICH Outcomes
Authors: Leclerc Jenna , Dang Alex , Santiago-Moreno Juan , Dore Sylvain
Published: July 2021

Intracerebral hemorrhage (ICH) is a stroke subtype associated with high morbidity and mortality. With breakdown of the blood-brain barrier and entry of toxic blood components and metabolites within the brain, a highly oxidative environment ensues and leads to a toxic neuroinflammatory cascade. A major cause of the debilitation following brain hemorrhage is due to the direct toxicity of blood components, notably hemoglobin (Hb), the most upstream precipitating factor in the cascade. The acute phase plasma protein haptoglobin (Hp) binds Hb and inhibits its cytotoxic, pro-oxidative, and pro-inflammatory properties. In this study, we investigated whether the local and specific overexpression of Hp would aid in the safe detoxification and clearance of free Hb, thereby protecting the neuropil from Hb-mediated oxidative stress and improving ICH outcomes. Hp was overexpressed locally within the brain using uniquely designed adeno-associated viral vectors and ICH was induced using the intrastriatal autologous whole blood injection model. Functional outcomes were assessed by a 24-point neurological deficit score. At 72h post-hemorrhage, mice were sacrificed and brains collected for histological staining. Hp-overexpressing mice demonstrated smaller lesion volumes (p<0.05) with less blood accumulation (p<0.05) and improve neurologic status after ICH (p<0.05) when compared to an identically treated control group (n=11-13/group). Histological staining for Iba-1, GFAP, heme oxygenase-1, 4-hydroxynonenal, ferric iron, and myeloperoxidase was performed and revealed: 1) significantly less heme oxygenase-1 expression and lipid peroxidation, 2) a trend towards reduced peripheral neutrophil infiltration, 3) significantly increased cortical microgliosis and cortical and striatal astrogliosis, and 4) no changes in ferric iron content or striatal microgliosis. In conclusion, Hp overexpression in the brain reduces ICH-induced brain injury and improves functional outcomes. Locally modulating brain Hp levels could represent an important clinically relevant strategy for the treatment of ICH.
Abstract TP136: Four-dimensionally Guided Three-dimensional Color-doppler Ultrasonography Quantifies Carotid Artery Stenoses With Equally High Reproducibility and Accuracy Compared to Catheter Angiography
Authors: Macharzina Roland Richard , Kocher Sascha , Messé Steven R , Hoffmann Fabian , Rutkowski Thomas , Vach Werner , Fan Nian , Reuter Björn , Neumann Franz-Josef , Zeller Thomas
Published: July 2021

Introduction:
Clinical stratification in patients with ICAS largely depends on symptomatic status and stenosis grading. The purpose was to analyze the agreement and binary accuracy for the degree of internal carotid artery stenoses (ICAS) as determined by four-dimensional (4D) real-time guided three-dimensional color-Doppler (3DC) ultrasonography (4D/3DC-US) compared to catheter angiography (CA).

Hypothesis:
We hypothesized that 4D/3DC-US is non inferior to CA in grading ICAS in selected patients.

Methods:
Screening with 4D/3DC-US was performed in 93 patients (122 ICAS) admitted to our vascular center.Main exclusion criteria were insufficient image quality, previous revascularization and contraindications to CA. Eighty patients were prospectively examined in optimal planes with 4D-US assisted static 3DC-US color-Doppler (10MHz) followed by blinded multiplanar off-line rendering to determine %-NASCET stenosis. Multiplane selective CA of the same ICAS were quantified with dedicated software in a blinded fashion.

Results:
Quantitative CA of 103 stenoses with a mean degree of 65 ± 17% were compared to 4D/3DC-US resulting in a Pearson correlation coefficient of 0.89 and a standard deviation of differences (SDD) of 8.1% at a bias of +1.7%. Binary 50, 60 and 70%-stenosis detection with 3DC-US revealed an accuracy of 96, 89, 85%, a sensitivity of 97, 92, 87% and a specificity of 92, 83 and 84%. Interobserver SDD for CA of 52 stenoses (7.2%) did not differ from SDD between 3DC-US and CA (P = 0.274).

Conclusions:
4D/3DC-US allowed good metric stenosis quantification and accurate binary classification with high reproducibility in a selected cohort.
Abstract TP142: Factors Influencing Post-stroke Discharge to Institutional Rehabilitation Settings versus Home
Authors: Reeves Sarah , Baek Jonggyu , Wing Jeffrey , Skolarus Lesli , Morgenstern Lewis , Lisabeth Lynda
Published: July 2021

Introduction:
We assessed relative impacts of sociodemographic, clinical, and geographic factors on discharge to rehabilitation or home in a population-based stroke study.

Methods:
Stroke survivors were identified from 2011-2013 in the Brain Attack Surveillance in Corpus Christi (BASIC) Project (death<30 days or nursing home residence excluded). Sociodemographic factors (age, sex, ethnicity, insurance type), clinical factors (risk factors, comorbidities, NIH Stroke Scale), and discharge location (inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), home) were collected from medical records and interviews. Geographic factors were distance to nearest IRF/SNF and number of IRF/SNFs within 5 miles of the survivor’s home. Multinomial logistic regression models were used to calculate probabilities of discharge to IRF, SNF, and home for each factor set, fixing the other two factors at their means. High vs low probabilities (25 vs 75 percentile) of discharge to IRF, SNF, and home were compared to show the impact of each factor set.

Results:
Discharge location was available for 796/942 (85%) survivors; 15% were discharged to IRF, 26% SNF, and 59% home. Median age was 68 (IQR 58-79); 64% were Mexican American and 36% non-Hispanic white. High/low probabilities of discharge to IRF differed by 2% for sociodemographic factor variation, 7% for clinical factors, and 9% for geographic factors; probabilities of discharge to SNF differed by 22% for sociodemographic factor variation, 14% for clinical factors, and 6% for geographic factors; and probabilities of discharge home differed by 25% for sociodemographic factor variation, 24% for clinical factors, and 6% for geographic factors.

Conclusion:
The probability of discharge to IRF is most affected by variation in clinical factors; discharge to SNF by sociodemographic factors; and discharge home by sociodemographic and clinical factors. Geographic factors do not substantially affect discharge location.
Abstract TP147: Prior Stroke Predicts Posttraumatic Stress Disorder and Depression in a Multi-ethnic Cohort of Stroke Survivors
Authors: Goldmann Emily , Parikh Nina S , Boden-Albala Bernadette
Published: July 2021

Posttraumatic stress disorder (PTSD) and depression are common after stroke and associated with poor outcomes in stroke survivors. Although prior traumatic event experience has been linked to elevated risk of PTSD from a subsequent event, few studies have examined the influence of prior stroke experience on mental health conditions following a subsequent stroke. We hypothesized that prior stroke/TIA experience would be associated with PTSD and depression independently of PTSD following stroke. As part of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, a multi-ethnic group of mild/moderate stroke/TIA patients were enrolled in a behavioral intervention to reduce vascular risk. Symptoms of partial or full PTSD and depression were assessed in a six month follow-up survey in 134 patients using the PTSD Checklist and Center for Epidemiologic Studies - Depression scale (CES-D), respectively. PTSD was defined as meeting any DSM-IV criterion B-D, and depression as those with CES-D scores ≥ 8. Patients were categorized as having: 1) no depression or PTSD, 2) depression only, or 3) PTSD (with or without depression). Chi-square tests and multinomial logistic regression were used to examine the association between prior stroke/TIA experience and depression/PTSD. One-third (33.1%) of patients had experienced a prior stroke or TIA. At follow-up, 9.0% and 34.3% of patients met criteria for PTSD and depression without PTSD, respectively. Patients with prior stroke/TIA had 3.6 times greater odds of developing PTSD from the index stroke (95% CI: 1.0-13.3) and 2.7 times the odds of depression only (95% CI: 1.2-6.3) after controlling for age and race/ethnicity. Stroke/TIA patients who had experienced a previous stroke/TIA had significantly greater odds of developing not only PTSD but also depression than those who had not had a previous stroke/TIA. Given the high rate of recurrent stroke and the negative mental health consequences highlighted in this study, interventions that focus on prevention of recurrent stroke are crucial for promoting both physical and psychological well-being among stroke survivors.
Abstract TP160: Degree of Functional Independence After an Ischemic Stroke Affects Quality of Life Similarly in Men and Women
Authors: Demel Stacie L , Khoury Jane , Moomaw Charles J , Sucharew Heidi , Alwell Kathleen , Kissela Brett M , Khatri Pooja , Woo Daniel , Flaherty Matthew L , Ferioli Simona , Mackey Jason , De Los Rios la Rosa Felipe , Martini Sharyl , Adeoye Ope , Kleindorfer Dawn
Published: July 2021

Background:
Women have worse quality of life (QoL) after an ischemic stroke (IS) compared with men for unclear reasons. We hypothesized that men and women may value functional independence differently. We assessed the association between sex, functional outcome, and quality of life within a large prospective cohort of ischemic stroke patients.

Methods:
Within the Greater Cincinnati/Northern Kentucky catchment area of 1.3 million we prospectively screened local hospital stroke admission diagnoses in 2005 and 2010. A subset of physician-confirmed IS patients were interviewed at baseline and followed longitudinally. Medical history and stroke-related data were collected through standardized retrospective chart review. Pre-stroke and 3-month modified Rankin Scale (mRS) was assessed, and European Quality of Life (EQ-5D) was administered at 3 months. Multiple regression analysis was used to compare QoL between men and women across mRS categories, adjusted for age, race, baseline mRS, stroke severity history of depression, diabetes, and use of proxy responses.

Results:
The GCNK follow-up cohorts from 2005 and 2010 included 964 adult IS patients, of which 797 were interviewed at 3 months post stroke. Women comprised 50% of the cohort and were older than men on average (68.4 ± 14.2 vs. 65.2 ± 13, p<.001) years at the time of their stroke. Women had worse functional outcomes (median mRS 3 vs. 2, p=.02) and quality of life (EQ-5D 0.55 vs. 0.65, p=.03), even after adjustment for the covariates listed above. The EQ-5D index was no different in men and women for each point on the mRS spectrum (i.e., there was no interaction between sex and 3-month mRS; Figure).

Conclusion:
In this cohort study, we confirmed worse functional outcome and worse quality of life in women after stroke. However, at each level on the mRS spectrum, men and women valued their quality of life similarly. Further research is needed on the reasons for worse outcomes in women than men.
Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes
Authors: Rumalla Kavelin , Reddy Adithi Y , Letchuman Vijay , Berger Paul A , Mittal Manoj K
Published: July 2021

Introduction:
The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported.

Methods:
We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes.

Results:
We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p<0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p<0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p<0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p<0.0001).

Conclusion:
Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.
Abstract TP168: Risk of Stroke and Hemorrhage in Patients Treated With Warfarin Versus Dabigatran Requiring Surgery
Authors: Dandapat Sudeepta , Leira Enrique C , Adams Harold P , Miller Jeffrey C , Vaughan-Sarrazin Mary S
Published: July 2021

Introduction:
Patients with atrial fibrillation (AF) cease anticoagulants prior to surgery to minimize bleeding risk. Patients requiring emergency surgery may be particularly vulnerable to bleeding if anticoagulants remain in the blood. This may be especially problematic with dabigatran (DAB) use given its lack of reversal agent.

Objective:
This study compares stroke or bleeding risk in patients with AF taking DAB or warfarin (WARF) that undergo elective, urgent, or emergent inpatient surgery.

Methods:
Medicare inpatient claims were used to identify patients with AF who underwent elective (n=20,535) and urgent or emergent (n=24,665) surgery from 11/2010 -12/2012, and had received DAB or WARF within 90 days prior to admission. Outcomes included stroke and major bleeding within 30 days of surgery, and blood units used during the admission. Other patient characteristics included demographics, operation type, and comorbid conditions. Risk adjusted differences in outcomes between patients taking DAB or WARF were estimated within admission category using multivariable regression.

Results:
DAB was used by 5,495 (12%) of patients prior to admission. Overall, 1.0% of patients had stroke within 30 days of surgery, 1.2% had a major bleeding event, and patients received an average 0.12 units of blood. Stroke and bleeding rates did not differ for patients taking WARF or DAB, overall or within admission category. Among elective admissions, blood units used also did not differ between WARF or DAB patients. Among urgent and emergent admissions, patients taking DAB used significantly fewer blood units than patients taking WARF (0.09 vs 0.18, respectively; p<.001). Results were consistent after controlling for other patient factors in multivariable models.

Conclusions:
Stroke and bleeding risk in patients taking either DAB or WARF were comparable, while patients taking DAB required significantly fewer blood units than patients taking WARF when undergoing emergency surgery. The lack of a reversal agent for DAB does not appear to increase the risk of complications even for emergency surgery.
Abstract TP173: Delay In Presentation To The Hospital For Young Adults With Ischemic Stroke
Authors: Leung Lester Y , Caplan Louis R
Published: July 2021

Introduction:
Young adults with ischemic stroke may present late to medical care, and the reasons for these delays are unknown.

Hypothesis:
We hypothesized that some medical conditions, social factors, and low stroke severity would be associated with delayed presentations to medical attention.

Methods:
We performed a retrospective cohort study of adults ages 18 to 50 admitted to a single academic medical center between 2007-2012.

Results:
61% of 141 young adults with ischemic stroke presented more than 4.5 hours after stroke onset. Diabetes was associated with delays in presentation (p = 0.03), whereas systemic cancer was associated with early presentations (p = 0.03). Individuals who were single were more likely to present late than those who were married or living with a partner (p = 0.005). Age (dichotomized by 18-35 and 36-50), race, employment or schooling status, home medications, other medical conditions (including common stroke mimics such as migraine, seizure, and psychiatric disease), and stroke subtype were not determinants of delay in presentation, although there was a non-significant trend towards delayed presentations in women (p = 0.08) and with low stroke severity (dichotomized by NIHSS ≤ 5 and NIHSS > 5, p = 0.06).

Conclusions:
A majority of young adults with ischemic stroke presented outside the time window for intravenous fibrinolysis. Diabetes and single status were associated with a greater risk of delayed presentation.
Abstract TP175: Intensification of Statin Treatment is Associated With Improved Mortality Among Patients With TIA and Ischemic Stroke
Authors: Sico Jason J , Ofner Susan , Baye Fitsum , Concato John , Zillich Alan J , Reeves Mat , Cheng Eric , Phipps Michael S , Arling Greg , Johanning Jason , Chaturvedi Seemant , Williams Linda S , Bravata Dawn M
Published: July 2021

Introduction:
Current guidelines for hyperlipidemia among patients with cerebrovascular disease recommend prescribing moderate/high potency statins rather than intensifying (low/moderate) treatment, but whether this treatment approach confers mortality benefits is unclear.

Hypothesis:
Intensification of statin therapy will be associated with improved outcomes within a given potency strata.

Methods:
Administrative data were analyzed from a sample of 11,306 Veterans admitted to 134 Veterans Health Administration (VHA) facilities with a TIA or ischemic stroke in fiscal year 2011. Patients who: were transferred to another non-VHA acute care facility or hospice, died in the emergency room/hospital, left against medical advice, had a documented statin allergy were excluded (n=1538). Treatment intensification was defined as an increase in potency class within 7-days of discharge. Multivariable logistic regression models were used to determine whether treatment intensification (vs. none) was associated with differences in 30-day and 1-year mortality.

Results:
Among 9,768 eligible patients, 66.5 % (n=6494) were prescribed statins at discharge; a majority (90.4%) were prescribed moderate/high potency statins. Treatment intensification occurred among 51.7% and 57.1% of patients in the moderate/high potency and low potency strata, respectively. Compared with patients receiving moderate/high potency statins without intensification, intensification was associated with lower 1-year (odds ratio [OR]=0.51; confidence Interval [CI]
95
:0.33, 0.80) but not 30-day (OR=2.10; CI
95
:0.66, 6.68) mortality. Compared with patients receiving low potency statins without intensification, intensification was associated with lower 1-year (OR=0.79 CI
95
:0.67, 0.93) and thirty-day (OR=0.72; CI
95
:0.52, 0.99) mortality.

Conclusion:
Treatment intensification for patients receiving moderate/high or low potency statins was associated with improved mortality after a cerebrovascular event, with potential implications for future treatment guidelines.
Abstract TP180: Ankle-brachial Index and Recurrent Stroke Risk: a Meta-analysis
Authors: Liman Thomas , Hong Ja Bin , Leonards Christopher , Siegerink Bob , Endres Matthias
Published: July 2021

Background and Purpose:
The ankle-brachial index (ABI) is a fast, cheap, non-invasive indicator of atherosclerotic burden that may also be indicative of stroke recurrence. In this systematic review and meta-analysis, we sought to explore ABI’s merit as a marker for stroke recurrence and vascular risk by synthesizing the data currently available in the stroke literature.

Methods:
We searched Embase, MEDLINE, and Pubmed databases for prospective cohort studies that included consecutive stroke and/or transient ischemic attack (TIA) patients, measured ABI at baseline, and performed a follow-up assessment at least 12 months following initial stroke/TIA. The following endpoints were chosen for our analysis: (1) recurrent stroke and (2) combined vascular endpoint (recurrent vascular event or vascular death). Crude risk ratios and adjusted Cox proportional hazard ratios (HRs) were combined separately using the random-effects model. Study level characteristics (e.g. percent of cohort with a history of hypertension, average cohort age, and mean follow-up duration) were included as meta-regression covariates.

Results:
We included 11 studies (5374 patients). Low ABI was associated with an increased risk of recurrent stroke (pooled estimated HR 1.70, 95% CI 1.10-2.64) and vascular events or vascular death, following stroke (pooled estimated HR 2.22, 95% CI 1.67-2.97). No significant heterogeneity was observed in the meta-analysis.

Conclusion:
Our results confirm the prognostic value of ABI for the recurrence of stroke. It is likely that the inclusion of ABI in risk calculation models will help in improving accuracy of existing models.
Abstract TP185: Stroke Symptom Recognition is Associated With Everyday Linguistic Style and not With Acculturation in Hispanic Americans
Authors: Froeschke Laura L , Nelson Nickola W , Lagerwey Mary , Campbell Evvy H
Published: July 2021

Background and Purpose:
Prompt recognition and emergency response toward acute stroke has been related in prior literature to reduced delays to treatment. Among Hispanics, disproportionate delays to acute treatment have been related to disparities of knowledge and reduced likelihood to activate 911. Prior research has supported the hypothesis that knowledge of stroke for Hispanics may vary in accordance with non-traditional risk factors including acculturation. The Stroke Action Test (STAT) is an instrument designed to assess stroke knowledge in English speakers based on intended behavioral response, with symptoms phrased in medical and everyday language. The purpose of this study was to assess stroke knowledge in a community sample of Hispanics using a pilot Spanish translation of the STAT. A second objective was to assess the hypothesis that stroke knowledge varies according to acculturation level. Finally, the study assessed the degree to which language style (everyday/medical) was associated with stroke knowledge.

Methods:
A pilot sample of 94 Hispanics completed interviews including demographics, the Short Acculturation Scale for Hispanics (SASH), and STAT. Data were analyzed using Pearson correlations, independent and dependent t-testing. Internal consistency for the Spanish STAT was assessed with Cronbach’s alpha.

Results:
Data from this pilot sample of a Spanish STAT indicated that stroke knowledge was low (32%), though similar to a general population sample. Internal consistency of the Spanish STAT was good (α=0.83). No relationship was found between acculturation (SASH) and STAT ( r = 0.08, p = 0.44). A significant relationship was found between language style and stroke knowledge in Spanish speakers ( p = .006, r=.32 ), with everyday language relating to greater symptom recognition.

Discussion/Conclusion:
Although results are preliminary, these pilot data suggest that language style may play an important role in understanding of stroke symptoms and likelihood of emergency response among Hispanics. The finding that everyday language was associated with more frequent 911 responses may warrant further investigation into the finer linguistic constituents of everyday style and its relationship to urgent behavioral responses.
Abstract TP195: The Association of Body Mass Index With Post-stroke Mortality: a Systematic Review
Authors: Leung Doris Y , Sit Janet W , Ching Raina
Published: July 2021

Background:
Previous studies have documented an obesity-stroke paradox, suggesting stroke patients who are overweight or obese (measured by body mass index, BMI) have a lower risk of post-stroke mortality as comparing those with normal (or lean) BMI.

Purpose:
This systematic review aims to synthesis the evidence regarding the association of BMI with mortality in stroke patients.

Method:
A search was conducted using databases MEDLINE, EMBASE, Ovid Nursing Database and CINAHL Plus from conception to July 2015. In addition, a hand search was done of the references of the eligible studies. Two reviewers independently evaluated the methodological quality of the studies reviewed.

Result:
Eleven studies met the inclusion criteria: eight cohort studies and four experimental studies. Seven studies examined both ischemic and hemorrhagic stroke while 5 examined ischemic stroke only. Ten studies examined all-cause mortality, and one study examined recurrence of stroke plus stroke and vascular-related mortality. Mean age of the participants ranged from 64 to 78.8. One study recruited postmenopausal women and another study used US-Japanese born men. Sample sizes per study ranged between 304 to 21,884 stroke survivors. Mortality follow-up ranged between 14 days to 16 years. Findings from four studies reported obese patients had a significantly lower risk of mortality compared to normal/lean patients; while four studies found non-significant results. However, the remaining three studies found that a significantly higher risk of mortality was reported in obese patients. In addition, five of the seven studies that had an underweight category reported that the underweight group had a significantly higher risk of mortality than normal weight patients.

Conclusion:
There is not enough evidence at present to support the association of lower all-cause mortality in overweight or obese stroke patients. Based on BMI measures in the existing literature, our findings suggest that obesity is not a protective factor for stroke survivors. Our review also highlights the importance of cautious interpretation of the association between BMI and all-cause mortality, while also taking into account potential etiologies of unintentional weight loss among stroke patients.