bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 128: Evaluation Of Flat Panel Detector Whole Brain Perfusion Imaging In Acute Stroke Patients: Comparison With Computer Tomography Perfusion Imaging
Authors: Kurmann Christoph , Kaesmacher Johannes , Cooke Daniel L , Psychogios Marios , Weber Johannes , Lopes Demetrius , Albers Greg , Mordasini Pasquale
Published: February 2022

Introduction:
In acute ischemic stroke, perfusion imaging facilitates detection of the occluded vessels, influences decision-making regarding therapy options, and is recommended especially in delayed time windows. In contrast to conventional CT perfusion (CTP), flat panel detector CT perfusion (FD-CTP) can be acquired directly in the angio suite. To evaluate FD-CTP imaging, we assessed clinically important qualitative and quantitative perfusion parameters in correlation to prior acquired conventional CTP using the new RAPID for Angio software.

Methods:
We included patients with ICA-, M1, or M2-occlusions from 6 centers. All patients underwent mechanical thrombectomy (MT) with pre-interventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch volume. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case for conventional CTP and FD-CTP imaging. A blinded reader identified the occlusion site based on visual inspection of the FD-CTP maps.

Results:
We included 77 patients and FD-CTP was technical adequate in 49 patients (63.6%). The final analysis included 20 patients (further reasons for exclusion were n=20 technical inadequate conventional CTP, n=2 reperfusion between scans, n=2 exceeding the time limit between scans, n=2 posterior occlusion and n=3 MRI-perfusion). Conventional rCBF <30% and FD-CTP rCBF <45% showed good correlation (R
2
= 0.84). Conventional CTP Tmax >6s/FD-CTP Tmax >6s and CTP Mismatch/FD-CTP Mismatch showed more variability (R
2
= 0.57, and R
2
= 0.33 respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria in contrast to 18/20 (90%) patients based on conventional CTP. A blinded reader correctly determined the specific vessel occlusions in 34/38 cases (89.5%).

Conclusion:
In our multicenter study, time-resolved whole-brain FD-CTP was technically feasible and qualitative and quantitative perfusion results correlated overall well with conventional CTP. This potentially enables a direct to the angio approach to be established and may increase the chances of good clinical outcome.
Abstract 134: Population-level Trends In Clinal Outcomes And Endovascular Stroke Therapy In Acute Ischemic Stroke
Authors: Abdelkhaleq Rania , Kim Youngran , Salazar-Marioni Sergio , Niktabe Arash , McCullough Louise , Sheth Sunil
Published: February 2022

Intro & Background:
Following the publication of the randomized clinical trials in 2015 and 2018 on endovascular stroke therapy (EVT), procedural utilization has increased. The effect of EVT utilization on clinical outcomes in acute ischemic stroke (AIS) at the population-level, however, remains incompletely characterized.

Methods & Materials:
We performed a retrospective cross-sectional analysis using the Texas Public Use Data File with records from January 2016 through the first quarter of 2020. This dataset includes full sample data on all patients hospital discharged from all state-licensed hospitals. AIS hospitalizations were identified as those with a primary diagnosis of AIS by ICD-10 diagnostic codes. Patients <18 were excluded, as well as patients missing age data. EVT was defined using ICD-10 procedure codes. Excellent clinical outcome was defined as discharge to home. Trends for EVT and percentage of home discharge were assessed by quarter and the correlation between two trends were examined by cross-correlation.

Results:
Among 165,738 AIS cases, 61% were over 65 years old, 51% were female, 51% were White and 25% were Hispanic. Over the course of the study period, EVT utilization increased 0.25% per quarter [95% CI 0.23-0.27, P<0.001]. Excellent clinical outcomes also increased over this time period, with a 0.21% quarterly increase in patients being discharged home [95% CI 0.16-0.25, p<0.001] (Figure). At the population-level, we observed a positive correlation between increasing EVT utilization and excellent clinical outcomes (R=0.64, p< 0.003).

Conclusion:
In this state-wide cohort, increasing usage of EVT was positively correlated with excellent clinical outcomes. These data provide evidence for population-level improvements in AIS care with improving EVT access and utilization.
Abstract 14: Receiver Operating Characteristics Curve Analysis Demonstrates That Quantitative Assessment Of Iodine Contrast Extravasation Post Reperfusion Therapy For Ischemic Stroke Predicts Reperfusion Injury And Discharge Modified Rankin
Authors: Vijayaraghavan Niran , Huynh Tri , Branstetter Hannah , Dickens Rondalyn , De Prey Justin , Simpkins Alexis N ,   on behalf of the Univ of Florida CREST Initiative,*contributed equally
Published: February 2022

Introduction:
We previously demonstrated that the quantitative volumetric assessment of iodinated contrast extravasation (ICE) present on post-intervention imaging was closely associated with the likelihood of an acute ischemic stroke patient having PH-1 or PH-2, and thus ICE may serve as a useful CT biomarker to assess risk of reperfusion injury (hemorrhagic conversion (HC) and blood brain barrier (BBB) disruption). Here we used receiver operator curve (ROC) analysis to compare the efficacy of ICE, infarct volume, and 24hr NIHSS change as a predictor of discharge mRS and HC post-reperfusion therapy.

Method:
Data on ischemic stroke patients treated with reperfusion therapy were obtained from our Institutional Review Board approved database from January 2017 to November 2019 that had evaluable images within 24 hours of admission. Ischemic volume (IV) was measured on diffusion-weighted imaging. ICE was measured on CT head. A freehand 3D region of interest tool on the Visage Imaging PACS System was used to measure volumes. Susceptibility weighted MRI sequences were used to grade HC. Data analysis was conducted with regression modeling and ROC analysis.

Results:
Of the 82 patients, median age was 73 (interquartile range (IQR) 61- 77, 49% were women, admission NIHSS was 12 (IQR 7 - 21), 24hr NIHSS change was 4 (IQR 0 -13), IV was 50.6 +/- 7.1 mL, 48% were treated with thrombectomy, 7% had PH-1 or PH-2 identified on MRI, median systolic blood pressure was 154 (IQR 137-175), 56% were MCA territory strokes, and 37% had a discharge mRS of 0-2. ICE volume was 2.6 +/- 1.0 mL. ICE increased the likelihood of PH-1 or PH-2 HC (odds ratio (OR) 14.34, 95% confidence interval (CI) 5.74 - 22.94) and decreased the likelihood of discharge with mRS of 0-2, OR of 0.09 (CI 0.008-0.972). IV was a better predictor of 0-2 mRS (ROC area under the curve (AUC) 0.832) than ICE (AUC 0.640) and 24hr NIHSS change (AUC 0.557), but ICE was a better predictor of PH-1 or PH-2 (AUC 0.942) than IV (AUC 0.667) and 24hr NIHSS change (AUC 0.447).

Conclusion:
ICE may predict reperfusion injury and functional outcome, but it is a better predictor of hemorrhagic conversion in patients treated with reperfusion therapy.
Abstract 141: Atrial Cardiopathy And Left Ventricular Dysfunction In Patients With ESUS: Findings From The Arcadia Trial
Authors: Ibeh Chinwe , Meinzer Caitlyn , Elkind Mitchell S , Kamel Hooman , Longstreth W T , Tirschwell David L , Aragon Garcia Rebeca , Plummer Pam , Broderick Joe , Di Tullio Marco
Published: February 2022

Background:
Recent data suggest biomarkers of atrial cardiopathy (ACP) can potentially identify a subset of patients with cryptogenic stroke who may benefit from anticoagulation. However, the specificity of these markers for atrial disease and their independence from measures of more global cardiac dysfunction remain unclear. We hypothesized that biomarkers of ACP collectively reflect left atrial pathology and are not strongly affected by coexisting left ventricular dysfunction.

Methods:
ARCADIA is an ongoing multicenter trial comparing standard dose apixaban to aspirin therapy in patients with Embolic Stroke of Undetermined Source (ESUS) with ACP, defined as either N-terminal pro-brain natriuretic peptide [NT-proBNP] > 250 pg/mL; P wave terminal force velocity on ECG lead V1 [PTFV1] > 5000 μV*ms; or echocardiographic left atrial diameter index [LADI] ≥ 3 cm/m
2
. Pearson correlation coefficients and descriptive statistics were used to examine the relationship between left ventricular ejection fraction (LVEF) and ACP biomarkers.

Results:
Among 2,616 ESUS patients screened, 1,046 met ≥ 1 ACP criterion (665 BNP, 531 PTFV1, 14 LADI). Patients with ACP were older (68 ± 11 vs 64 ± 10 years) and 54.5% were women. The great majority (84%) of subjects with ACP had normal LVEF (≥55%). Among them there was no correlation between LVEF and NT-proBNP (r= -0.01, P= 0.5) or PTFV1 (r=0.002, P=0.9). In patients with abnormal LVEF, there was a strong inverse correlation of LVEF with NT-proBNP (r=-0.4, P<0.001), but no correlation with PTFV1 (r=0.11, P=0.16). The LADI criterion was only met in a few patients, precluding further analyses. Among patients with NT-proBNP >250 pg/mL and measured LVEF (n=435), only 19% had abnormal LVEF. Compared to patients with abnormal NT-proBNP alone, those with both abnormal NT-proBNP and abnormal LVEF were younger (66.4 ± 11.0 vs. 71.6 ± 11.0, P<0.001), more often African American (29.6% vs. 11.5%, P<0.001), and more often male (56% vs. 40%, P=0.01).

Conclusion:
Left ventricular dysfunction (EF ≤ 55%) is uncommon in patients with ACP as defined in ARCADIA. These findings suggest that, among patients with ESUS, atrial cardiopathy may represent a separate entity from LV dysfunction.
Abstract 149: Differences In Self-reported Health Status Among Underrepresented Populations In Stroke Survivors Enrolled In
All Of Us
Authors: Demarais Zachariah , Conlon Carolyn , Acosta Julian , Falcone Guido J
Published: February 2022

Background:
Self-reported outcomes in stroke survivors remain understudied. Mounting evidence indicate that the burden of stroke is disproportionately high in underrepresented groups. We investigated differences in self-perceived health status in stroke survivors across broadly defined underrepresented minorities.

Methods:
We analyzed data from stroke survivors enrolled in
All of Us.
Ischemic and hemorrhagic stroke were defined using validated ICD10 codes. Self-perceived health status was evaluated using 5 domains (quality of life, physical health, mental health, social activities and overall health), each with 5 answers (excellent, very good, good, fair and poor). Each domain was dichotomized as favorable (excellent, very good or good) or unfavorable (fair/poor). We used multivariate logistic regression to model the odds of favorable self-perceived health status in underrepresented groups defined by race/ethnicity, education, income and insurance type.

Results:
6,977 stroke survivors were included (mean age 64, female sex 58%), including 1,623 (23.3%) Blacks, 856 (12.3%) Hispanics/Latinos, 654 (9.4%) with less than a high school degree, 2,679 (38.4%) with income <U$S 35k, 3,091 (44.3%) with Medicare/Medicaid and 13 (0.18%) uninsured. A number of underrepresented groups had significantly different self-perceived health status after stroke (Table): low income, limited education and Medicare/Medicaid insurance were associated with self-perceived unfavorable health status in all 5 domains (all results with 95%CI <1).

Conclusion:
Among stroke survivors, underrepresented groups defined by income, education and health insurance were more likely to perceive their health status as unfavorable. Evaluation of underrepresented groups defined by factors other than race/ethnicity was important to identify these differences. Further research should evaluate whether these differences correlate with objectively measured outcome measures.
Abstract 157: Ischemic Strokes In Patients With Atrial Fibrillation On Oral Anticoagulant: The Neuro-AFib Study
Authors: Gurol Edip M , Das Alvin S , Daoud Nader , Gokcal Elif , Horn Mitchell , Abramovitz Avia , Mendel Rom , Smith Eric E , Yaghi Shadi ,   on behalf of The Neuro-AFib Study Group
Published: February 2022

Background:
Ischemic stroke (IS) admissions in patients with atrial fibrillation (AF) using either direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) are commonly seen in stroke units but data on their prevalence and causes are scarce. Understanding the frequency/causes of failures of current FDA-approved preventive methods in patients with AF is important to reduce stroke risk and related death/disability.

Methods:
The Neuro-AFib study is a multicenter effort geared toward elucidating the causes and consequences of IS and hemorrhagic stroke in a contemporary AF cohort. Detailed clinical, laboratory and multimodal neuro- and cardiac imaging data from known AF patients consecutively admitted to 22 US academic stroke centers with an IS between 1/2018-12/2019 were used to compare characteristics of IS on vs off oral anticoagulants.

Results:
Out of 6443 IS patients with AF, 4898 (76%) had known AF prior to the acute stroke. Among these patients with known AF, 2204 (45%) were using oral anticoagulants [OAC= DOAC (59.3%) or VKA (40.7%)]. Patients who had IS on OAC were younger (76.8
+
11 vs 78
+
12, p=0.001), had higher mean CHA
2
DS
2
-VASc scores (4.17
+
1.5 vs 3.9
+
1.5, p<0.0001), and more likely to have a past history of IS/TIA when compared to non-OAC group (35% vs 23%, p<0.0001). In a multivariable logistic regression model, history of IS/TIA, diabetes, hyperlipidemia, heart failure, prosthetic heart valve, sleep apnea, permanent atrial fibrillation, left atrial dilation and ischemic arterial disease were all independently associated with IS on OAC (all p<0.05). Imaging data were complete in 15% of the cohort and IS on OAC group had more acute lacunar infarcts, and extracranial and intracranial atherosclerotic disease causing 50% or more ipsilateral stenosis compared to patients with IS off OAC (all p<0.05).

Conclusions:
Based on a large multicenter contemporary cohort of IS patients with known AF, the numbers of patients who failed OACs (and especially DOACs) are high. These patients have severe vascular risk factor loads, concurrent etiologies, and they are more likely to have recurrent ischemic events. Further detailed data focused on imaging and IS mechanisms from this contemporary cohort will be ready to be presented during ISC 2022.
Abstract 159: Recurrent Ischemic Stroke And Cigarette Smoking: A Secondary Analysis Of The POINT Trial
Authors: Lang Adam , Mac Grory Brian , de Havenon Adam H , Henninger Nils , Furie Karen L , Easton J D , Kim Anthony S , Johnston S C , Yaghi Shadi
Published: February 2022

Background:
Recent data suggest that in patients with acute myocardial infarction (MI), the effect of clopidogrel on risk reduction of cardiovascular outcomes is more pronounced in smokers. The aim of this study was to determine the effect of smoking status on subsequent stroke risk in patients with minor ischemic stroke or TIA and determine whether smoking improves the effect of clopidogrel treatment on subsequent stroke risk reduction.

Methods:
This was a post-hoc analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. The POINT trial compared clopidogrel plus aspirin (DAPT) to aspirin alone for prevention of recurrent stroke, myocardial infarction, or vascular death within 3 months of a high-risk TIA or minor ischemic stroke. We used multivariable cox-regression models to determine the effect of smoking on the risk of subsequent ischemic stroke. We also performed interaction analyses to determine whether the effect of clopidogrel on subsequent ischemic stroke differed with respect to smoking status.

Results:
Data from 4,877 participants enrolled in the POINT trial were analyzed. Among these, 1,004 were current smokers and 3,873 were non-smokers. Smoking was associated with a non-significantly increased risk of recurrent ischemic stroke during follow up (hazard ratio, 1.31 [95% CI, 0.97 - 1.78], P=0.076). The effect of clopidogrel on ischemic stroke was not significantly different in non-smokers (hazard ratio, 0.74 [95% CI, 0.56 - 0.98], P=0.03) compared to smokers (adjusted hazard ratio, 0.63 [95% CI, 0.37 - 1.05], P=0.078), P for interaction = 0.572. In addition, the effect of clopidogrel on major hemorrhage was not significantly different in current smokers (hazard ratio, 2.59 [95% CI, 1.08 - 6.21], P=0.032) compared to non-smokers (hazard ratio, 1.67 [95% CI, 0.40 - 7.00], P=0.481), P for interaction = 0.613.

Conclusions:
Cigarette smoking was associated with a non-significantly higher risk of subsequent ischemic stroke and smoking did not modify the effect of clopidogrel-based dual antiplatelet therapy on subsequent ischemic stroke risk reduction. Every effort should be made to encourage tobacco dependence treatment and cessation in patients with minor ischemic stroke and TIA.
Abstract 163: Potential Therapeutic Effects Of Angiopoietin-2 Inhibition On Rescuing Hereditary Hemorrhagic Telangiectasia Associated Cerebrovascular Defects
Authors: Zhou Xingyan , Meadows Stryder
Published: February 2022

Introduction:
Hereditary Hemorrhagic Telangiectasia (HHT) is a vascular disease characterized by arteriovenous malformations (AVMs), which are abnormal, enlarged connections between arteries and veins that are prone to hemorrhage. AVMs often form in the brain and can lead to stroke. Mutations in endoglin (Eng), activin receptor-like kinase 1 (Alk1) or smad-related protein 4 (Smad4) cause HHT. Endothelial cell (EC) specific knock out of Alk1, Eng, or Smad4 in mice mimics HHT vascular defects, including AVM formation. We showed that Smad4 directly repressed transcription of the critical pro-angiogenic factor Angiopoietin-2 (Ang2) in ECs and that in Smad4-HHT mice,
Ang2
/ANG2 levels are robustly and ectopically increased in ECs. By inhibiting Ang2, we prevented and rescued AVMs and normalized retinal vasculature. Since Smad4 is a central transcription factor in the TGF-β signaling pathway and a downstream effector of the Eng and Alk1 co-receptors, we
hypothesized
that Ang2 inhibition may universally normalize HHT vascular phenotypes.

Methods:
Blue latex dye perfusion methods were used to visualize and characterize cerebrovascular defects in HHT mouse models (n=5~7). RNA-seq was performed on isolated brain ECs (iBECs) to further define molecular phenotypic characteristics (n=5). In situ hybridization on brain slices (n=3) and ELISA on whole brain lysate (n=3~9) were performed to confirm elevated Ang2 RNA and protein levels. Ang2 inhibitor was delivered via intraperitoneal injection, followed by cerebrovascular assessments (n=5~9).

Results:
We found that brain AVMs are present in Smad4-, Alk1-, and Eng-HHT mutants, with all models displaying elevated Ang2 levels. RNA-seq of iBECs in Smad4-, Alk1-, and Eng-HHT models reveals 5502, 5307, and 1659 differentially expressed genes in respective mutants compared to controls. Data set comparisons revealed common, increased pro-angiogenic genes, which helped to define the HHT-specific angiogenic profile. Moreover, Ang2 inhibition decreased Smad4-HHT’s brain vessel diameter and Alk1-HHT’s brain vessel density, and prevented brain AVM formation in Eng-HHT mice.
In conclusion,
Ang2 inhibition partially normalized cerebrovascular defects in Smad4- and Alk1-HHT mice, and completely in Eng-HHT mice.
Abstract 36: Endovascular Thrombectomy Beyond 24 Hours From Last Known Well:
A Pooled Multicenter International Cohort
Authors: Sarraj Amrou , Hassan Ameer E , Abraham Michael G , Cardona Portela Pere , Manning Nathan W , Cordato Dennis , Kleinig Timothy J , Goyal Nitin , Blackburn Spiros , McCullough-Hicks Margy E , Ribo Marc , Wu Teddy Y , Blasco Jordi , Sangha Navdeep , Arenillas Juan F , Wallace Adam , Pujara Deep K , Shaker Faris , de Lera Alfonso Mercedes , Renu Arturo , Olivé Gadea Marta , Gibson Daniel , Lechtenberg Colleen G , Maali Laith N , Abdulrazzak Mohammad A , Almaghrabi Tareq S , Beharry James , Krishnaiah Balaji , Miller Megan , Khalil Najwa , Sharma Gagan J , Katsanos Aristeidis H , Fadhil Ali , Duncan Kelsey R , Hu Yin , sitton clark W , Martin-schild Sheryl B , Tsivgoulis Georgios K , Mitchell Peter J , Arthur Adam S , Parsons Mark , Grotta James C , Campbell Bruce C , Albers Gregory W
Published: February 2022

Background:
Limited data are available on endovascular thrombectomy (EVT) efficacy and safety in large vessel occlusion (LVO) patients presenting >24hr from last known well (LKW). We compared outcomes between patients receiving EVT and best medical management (MM) in a multicenter international cohort.

Methods:
Consecutive patients with anterior circulation LVO presenting >24h after LKW from 13 centers from 7/2012-4/2021 were analyzed. Multivariable models for 90d mRS distribution and symptomatic ICH were adjusted for age, NIHSS, glucose, IV tPA, transfer status, clot location, time from LKW, CT ASPECTS and ischemic core (rCBF<30%) and Tmax >6s volumes.

Results:
Of 240 patients with a median (IQR) LKW to presentation 28.3h (24.9-38.2), 153 (64%) received EVT. Baseline characteristics were similar except for NIHSS (EVT: 13 (8-20) vs MM: 17 (10-22), p=0.005), CT ASPECTS (EVT: 8(6-9) vs MM: 4(3-6), p<0.001) and ischemic core 2.5(0-13) vs 15(0-71) mL, p<0.001. EVT was associated with a better shift in 90d mRS (acOR: 2.45, 95% CI=1.42-4.22, p=0.001), higher functional independence (42% vs 10%, aOR: 4.84, 95% CI=2.02-11.64, p<0.001) and numerically lower mortality (22% vs 42%, aOR: 0.50, 95% CI=0.23-1.06, p=0.071), Fig 1A. However, EVT was associated with numerically higher sICH (5.5% vs 0%, p=0.10). Following EVT, 82% achieved successful reperfusion (mTICI 2b-3), which was associated with better shift in 90d mRS (acOR: 5.82, 95% CI: 1.77-19.10, p=0.004), higher functional independence (44% vs 22%, aOR: 5.03, 95% CI: 0.87-29.12, p=0.07) and lower mortality (20% vs 52%, aOR: 0.08, 95% CI: 0.01-0.57, p=0.01), Fig 1B.

Conclusions:
EVT may be associated with better functional outcomes, despite numerically increased risk of sICH in patients presenting with anterior circulation LVO beyond 24 hours. Further prospective studies are warranted.
Abstract 53: Covid-19 Spike-protein Causes Cerebrovascular Rarefaction And Deteriorates Cognitive Functions In A Mouse Model Of Humanized ACE2
Authors: Al Jabi Muhammed Subhi , Akram Zubair , Bolduc Deanna , Coucha Maha , Abdelsaid Mohammed
Published: February 2022

COVID-19 pandemic has affected our health and economy. Clinical trials confirmed multiple neurological symptoms due to COVID-19, ranging from headaches, insomnia to stroke, and encephalopathy. More studies are required to unravel the cellular and molecular mechanisms to find a cure for these neurological symptoms. Here, we investigate the effect of COVID-19 spike protein (S-protein) on the cerebrovasculature and cognitive functions in two mouse models that express humanized ACE-2 (h ACE2), a receptor essential for cellular infection and COVID-19 internalization. We hypothesize that COVID-19 S-protein causes cognitive dysfunction via the deterioration of cerebrovascular functions.

Methods:
S-protein was either injected intravenously or directly into the hippocampus of K-18 (h ACE2 in epithelial cells) or global h-ACE2 knock-in (h ACE2 KI) mice or wild-type mice. Cognitive functions were assessed by Y-maze and Barnes maze. Cerebrovascular density was determined using confocal 3-D image reconstruction. Human brain microvascular endothelial cells (HBMVEC) were treated with S-protein and assessed for apoptosis and inflammatory markers using immunoblotting and RT-PCR. K-18 and h-ACE2 KI mice received intraocular injections of S-protein; retinas were evaluated for vascular cell death and inflammation.

Results:
S-protein injections caused significant deterioration in memory and learning function of K-18 and h-ACE2 KI mice but not in the wild-type mice (P<0.05). S-protein significantly increased inflammatory mediators, cytokine production, and apoptosis in the brains and HBMVECs (P<0.05). Significant cerebrovascular rarefaction was detected only in K-18 and h-ACE2 KI mice compared to wild-type mice (P<0.05). Retinal vascular cell death and inflammation were significantly increased after S-protein injection. (P<0.05)

Conclusions:
COVID-19 spike protein decreases cognitive function via increased endothelial cell inflammation, apoptosis, and cerebrovascular rarefaction. Humanized ACE2 animal models are excellent and reliable for investigating the neurological symptoms of COVID-19.
Abstract 58: Adherence To Discharge Rehabilitation Recommendations May Decrease Unplanned Care And Improve Patient Outcomes
Authors: Noah Patty , Pope Leslie , dellostretto nicole , Buchinsky Kelly , Hackett Chris
Published: February 2022

Adherence to Discharge Rehabilitation Recommendations May Decrease Unplanned Care and Improve Patient Outcomes Introduction Unplanned episodes of care result in increased cost to patients and institutions. Minimal data exist correlating discharge recommendation by rehabilitation specialists to patient outcomes. We aimed to evaluate the discharge recommendation of rehabilitation team (physiatry, occupational and physical therapies) versus actual discharge location and their relationship of unplanned episodes of care and ninety day outcomes.

Method:
A single center retrospective analysis of Acute Ischemic Stroke (AIS) patients discharged from January to September 2020. We excluded those that were discharged to hospice and expired during the initial encounter. Our primary outcome was to examine unplanned care episodes in comparison to the adherence of the rehabilitation team’s discharge recommendation. The secondary outcome examined the 90 day modified Rankin Score in comparison to the discharge recommendations. Stepwise logistic regression and ordinal regression models were utilized to analyze primary and secondary outcomes.

Results:
A total of 544 patients were evaluated. After exclusions we included 385 patients; 301 (78.2%) followed the discharge recommendation. Agreement on discharge location between physiatry and therapy modalities was 85.7%. When physiatrist final recommendations were unavailable, agreement between occupational and physical therapy decreased to 83.9%. Patients who adhered to rehabilitation recommendations were less likely to experience unplanned care compared to patients who did not (23.7% vs. 28.6%), although the difference was not statistically significant; adjusted odds ratio (aOR) = 0.63 [95%CI, 0.36 - 1.10], p = 0.10. Similarly, patients adhering to recommendations experienced less disability at 90 days compared to those who did not, although the difference was not statistically significant; aOR = 0.64 [95%CI, 0.39 - 1.06], p = 0.08.

Conclusion:
When the patients followed the recommendations of the rehabilitation team, a trend was found towards a decrease in unplanned care and better outcomes. Findings suggest additional research is warranted.
Abstract 60: Diverging Time Trends Of Gender-specific Ischemic Stroke Incidence - 10-year-analysis Of A State-wide Registry In Germany
Authors: Schaefer Jan , Bohmann Ferdinand O , Misselwitz Björn , Foerch Christian
Published: February 2022

Introduction:
The incidence of ischemic stroke (IS) was previously expected to rise among countries with an ageing population. Lately, several studies from developed countries have reported a decline in certain cohorts. Whether this applies to all genders, however, is uncertain along with limited data on the temporal development in incidence, treatment, and recovery.

Methods:
We analyzed a prospective stroke inpatient quality assurance registry of the federal state of Hesse, Germany. Recruitment of all patients with a final diagnosis of ischemic stroke at hospital discharge (ICD10: I63) is mandatory by law. Stroke incidence rates were calculated based on census data of all inhabitants and stratified according to age.

Results:
Between 2010 and 2019 141,277 patients were included, 73,770 (52.2%) male and 67.507 (47.8%) female. Overall, the incidence of IS was 228/100,000 in 2010 and 226/100,000 in 2019 (OR 0.99; 95%-CI 0.96 to 1.02; p=0.50). For men, the incidence increased continuously from 236/100,000 to 245/100,000, in women it decreased from 220/100,000 to 208/100,000. After adjusting for age, the odds ratio for IS between men and women was 1.40 in 2010 (95%-CI 1.35 to 1.44; p<0.01) and 1.48 in 2019 (95%-CI 1.43 to 1.53; p<0.01). This trend was most pronounced in men aged 45 to 59 years with an increase from 151/100,000 to 176/100,000. In this age group, men had higher rates of prior strokes (16.3% vs. 14.3%; p<0.01), arterial hypertension (67.3% vs. 61.2%; p<0.01) and diabetes (20.6% vs. 17.9%; p<0.01) than women. Atrial fibrillation was more common in women (30.8% vs. 22.6%; p<0.01). The modified Rankin Scale (mRS) on hospital discharge has generally improved from 2010 to 2019 (median 2 vs. 2; Mann-Whitney-U-test p<0.01) with a more favorable outcome in men (mRS 0-2: OR 1.29; 95%-CI 1.26 to 1.32; p<0.01).

Discussion:
Over the last decade, the overall incidence of IS has declined predominantly in the female population. Contrarily, for men the incidence has risen by about 4% with a steeper increase of 17% in males aged 45-59 years. This finding could be explained by higher rates of prior strokes, arterial hypertension and diabetes in men compared to women. Notably, the high rate of recurrent strokes in men provides a cautionary tale for effective secondary prevention.
Abstract 63: Recanalization Treatments In Pediatric Stroke: Safety And Efficacy Data Issued From The French KidClot Study
Authors: Kossorotoff Manoelle , denier christian , Husson Beatrice , Ozanne Augustin , Bellesme Celine , Kerleroux Basile , NAGGARA OLIVIER ,   KidClot Group
Published: February 2022

Background:
Safety and efficacy of recanalization treatments,
i.e.
intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT), have to be refined in pediatric stroke.

Methods:
The French KIDCLOT multisourcing nationwide retrospective study (NCT03887143) collected data of consecutive children aged >28 days and <18 years old with acute arterial ischemic stroke who had a recanalization treatment, during a 41 month-period.

Results:
68 patients, 44 boys (64.7%), median age at stroke onset 11.5 years old, were included. Pre-stroke mRS was 0 for 89.7%. Main stroke etiologies were cardio-embolic (30.9%), focal cerebral arteriopathy (FCA, 25%), cervical (carotid/vertebral) arteriopathy (13.2%), and thrombotic (11.8%). 70 pediatric procedures were recorded: IVT alone (n=31), MT alone (n=23), combined IVT and MT (n=14), and DSA without recanalization treatment (n=4). Median stroke onset to first recanalization treatment delay was shorter in adult stroke units than in pediatric wards (188 vs. 264 minutes respectively, p=0.0087). An early complication was reported for 6 procedures, including two significant intracranial hemorrhages. After MT, cardio-embolic stroke patients achieved good arterial recanalization more frequently than FCA patients (88.9% vs 33.3%). Although high initial severity markers (median NIHSScore=13.5, decreased consciousness in 52.2%, decompressive craniectomy in 17.1%), outcome was relatively good in the 65/68 survivors (median mRS=1 and PSOM=1.2 at 12 month-follow-up).

Conclusions:
This study provides encouraging safety data despite severe stroke presentations. It suggests potential ways to improve recanalization treatments efficacy in children: reducing management delays in pediatric wards and optimizing etiological orientation since the hyperacute phase, as cardio-embolic strokes seem to display a better recanalization rate profile.
Abstract 64: Diffusion Tensor Imaging Suggests Decreased Axonal Myelination In Children With Moyamoya Without Stroke
Authors: Ahtam Banu , Feldman Henry A , Solti Marina , O'Donnell Lauren J , Zhang Fan , Vyas Rutvi , Rathi Yogesh , Doo Justin , Grant Patricia , Lehman Laura L
Published: February 2022

Introduction:
Moyamoya is a progressive cerebrovascular disease leading to arterial stenosis of the circle of Willis. Using diffusion tensor imaging (DTI), adults with moyamoya have significantly decreased white matter fractional anisotropy (FA) compared to controls even when conventional imaging is normal. This raises concern for under recognized white matter injury. Children with moyamoya have been shown to have significantly increased whole brain apparent diffusion coefficient (ADC) values. However, to our knowledge the involvement of specific white matter tracts in children with moyamoya, relevant to specific cognitive domains, has not been evaluated.

Methods:
We present a cohort of 16 children with moyamoya with 25 affected hemispheres without stroke compared to 25 children controls. We analyzed DTI data using unscented Kalman filter (UKF) tractography and extracted major white matter pathways with a fiber clustering method. We compared the FA, ADC, AD, and RD globally as well as within each white matter tract using ANOVA.

Results:
Age and sex were not significantly different between children with moyamoya and controls. For all white matter tracts, children with moyamoya had significantly lower FA (-7.0%, p=0.04) as well as higher ADC (5.7%, p=0.002) and RD (9.5%, p=0.002). AD was also higher but not significant (2.3%, p=0.21). Specific white matter tracts that were significantly affected included: inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus and thalamo-frontal tract (Table 1).

Discussion:
Lower FA with higher ADC and RD is consistent with decreased axonal myelination. Tracts in watershed regions were especially affected in children with moyamoya. These findings are also consistent with concerns that children with moyamoya are chronically hypoperfused. In conclusion, future research is needed to determine whether these findings are reversible.
Abstract 75: Association Between Speed From Hospital Arrival To Endovascular Thrombectomy And Health-Related Quality Of Life In Patients With Acute Ischemic Stroke
Authors: Joundi Raed A , Ganesh Aravind , Smith Eric E , GOYAL MAYANK , Hill Michael D ,   ESCAPE-NA1 Investigators
Published: February 2022

Background:
Faster treatment with endovascular thrombectomy (EVT) in patients with acute ischemic stroke is associated with better functional outcome at 90 days on the modified Rankin Scale. Whether speed of treatment is associated with improvements in patient-reported outcomes such as health-related quality of life is not well known.

Methods:
We used data from the ESCAPE-NA1 randomized trial which tested the effect of nerinetide in patients with large vessel occlusion undergoing EVT. We calculated EuroQol 5-dimension 5-level (EQ-5D-5L) index scores at 90 days using country-specific value sets. Using quantile regression, we evaluated the association between time from hospital arrival to EVT groin puncture (door-to-puncture) and EQ-5D-5L index score and visual analogue scale (EQ-VAS), adjusting for age, sex, stroke severity, ASPECTS, alteplase treatment, and nerinetide treatment. Using logistic regression, we determined the association between door-to-puncture time and reporting no/slight symptoms in each domain (mobility, self-care, usual activities, pain, and anxiety/depression) or all domains concurrently.

Results:
There were 1045 patients receiving EVT with EQ-5D values at 90 days. Median door-to-puncture time was 59 minutes (interquartile range 42-84). There was a strong association between faster door-to-puncture time and higher EQ-5D index score and EQ-VAS (Figure A-C). Faster time was also associated with higher probability of no/slight problems in each of five domains and all domains concurrently, with approximately 10% increase in probability for each hour of faster treatment (Figure D-I).

Conclusion:
Faster door-to-puncture EVT time is strongly associated with greater health-related quality of life across all domains in patients with large vessel occlusion. These results support the beneficial impact of speed of EVT on patient-reported outcomes and encourage efforts to improve quality of life in patients by optimizing workflows.
Abstract 76: Stroke Imaging Selection For Endovascular Therapy In The Extended Window: Systematic Review And Meta-analysis.
Authors: Sequeiros Chirinos Joel M
Published: February 2022

Introduction:
The best stroke imaging modality to select patients for endovascular therapy (EVT) beyond 6 hours (extended window) is not well established.

Objective:
To assess the value of additional advanced imaging.

Methods:
A meta-analysis in accordance with PRISMA guidelines was conducted. We searched on MEDLINE/Pubmed, SCOPUS, EMBASE, CENTRAL, and reference lists until July 22, 2021, including randomized clinical trials (RCT) and observational studies describing 90 days outcomes in anterior circulation large vessel occlusion (LVO) ischemic stroke. Our primary outcome was functional independence, defined as modified Rankin Scale score (mRS): 0-2. Secondary outcomes were mortality and symptomatic intracranial hemorrhage (sICH). We used fixed effects model to estimate the pooled mRS for all patients and the proportion of patients with each outcome, both for all studies and by imaging modality.

Results:
Four RCTs (n=236) and 19 observational studies (n=1495) that met the inclusion criteria were included for meta-analysis. Patients selected by advanced imaging had a pooled estimate of functional independence in 45% (95% confidence interval [CI], 40% to 50% I2=62%), and 51% (95%CI, 43% to 60% I2=68.2%) without additional imaging. [Low certainty of evidence] Pooled mortality rate was 13% (95%CI,9% to 17%, I2=57.5%) vs 16% (95%CI,10% to 23%, I2=63.9), symptomatic intracranial hemorrhage (sICH) was 5% (95%CI,2% to 8% I2=33.6%) vs 4% (95%CI,2% to 7%, I2=66.4%) in both groups respectively [Low certainty] The overall pooled estimate of functional independence was 47% (95%CI, 43% to 52%, I2=65.2%) [Low certainty], with mean mRS of 2.88 (95%IC, 2.36 to 3.4) [moderate certainty] in all included patients indistinctly of the imaging modality.

Limitations:
substantial heterogenicity and not direct comparison of imaging modalities in most of the studies.

Conclusion:
This meta-analysis suggests that functional independence in patients with stroke who underwent EVT on the extended window can be achieved in a high proportion of patients despite the use or not of additional advanced imaging. Both groups also presented similar mortality and sICH.
Abstract 80: Hospital Cost Of Direct To Angiography Suite Compared To Emergency Department Transfers For Large Vessel Occlusions Undergoing Mechanical Thrombectomy: A Propensity Adjusted Analysis
Authors: Catapano Joshua , Ducruet Andrew F , Albuquerque Felipe C , Jadhav Ashutosh P
Published: February 2022

Introduction:
Direct-to-angiography-suite (DTAS) transfer for patients with large vessel occlusions (LVOs) undergoing mechanical thrombectomy is associated with decreased workflow times and improved neurological outcomes. Herein, we sought to demonstrate a decrease in hospital cost associated with DTAS compared to emergency department (ED) transfers for patient undergoing mechanical thrombectomy for an LVO.

Methods:
A retrospective analysis was performed on all patients who underwent mechanical thrombectomy for an LVO at a single comprehensive stroke center from 2017 to 2021. All patients who were transferred DTAS or ED were included. Total hospital cost (sum of overhead, professional, diagnostic, and room charges throughout the entire index patient admission) was obtained from the hospital financial department for the index admission. A propensity adjusted (matched for age, sex, vessel occluded, co-morbidities, BMI, admission NIHSS, access site, and use of a stent retriever) was implemented. Mean difference in hospital cost was the primary outcome.

Results:
During the study period, 341 patients underwent mechanical thrombectomy for an LVO. Of these patients, 140 (41%) were transferred DTAS and 96 (28%) to the ED. There were no significant differences between cohorts in terms of age, sex, vessel occluded, admission NIHSS, co-morbidities, number of passes, TICI score, access site, stent retriever, major complications, or in-hospital mortality. The DTAS cohort ($33,061, sD $17,258) had a significantly lower hospital cost compared to ED transferred patients ($38,030, sD $18,572) (p=0.04). There was no significant difference between the ED (12.2, sD 11.8) and DTAS (11.6, sD 11.1) cohorts in discharge NIHSS. Following propensity score adjustment, linear regression analysis found DTAS (compared to ED transfer) to be significantly associated with a decrease in hospital cost ($-6,344; 95% CI: $-11,067 to $-1,623; p=0.009).

Conclusion:
DTAS transfer for patients undergoing an acute mechanical thrombectomy for a LVO was associated with a greater than $6,000 decrease total hospital cost compared to patients first transferred to the ED. The present study further supports DTAS transfer for patients undergoing mechanical thrombectomy for LVO.
Abstract 85: Genetic Deficiency Of MiRNA-15a/16-1 Confers Resistance To Neuropathological Damages And Cognitive Dysfunction In Experimental Vascular Cognitive Impairment And Dementia
Authors: Zhou Chao , Sun Ping , Chen Yuang , Hamblin Milton H , Hitchens T. Kevin , LI Song , Yin Kejie
Published: February 2022

Introduction:
Chronic cerebral hypoperfusion-derived brain damage contributes to the progression of vascular cognitive impairment and dementia (VCID). Cumulative evidence has shown that microRNAs (miRs) are emerging as novel therapeutic targets for CNS disorders. We have previously demonstrated that genetic manipulation of miR-15a/16-1 regulates neurovascular injury and functional outcomes in ischemic stroke. In this study, we sought to determine the role of miR-15a/16-1 in VCID.

Hypothesis:
Genetic deficiency of miR-15a/16-1 protects against white matter/grey matter injury and long-term neurobehavioral dysfunctions in VCID.

Methods:
Experimental VCID was induced in miR-15a/16-1 knockout (KO) mice and wild-type (WT) controls by asymmetric common carotid artery stenosis (ACAS) for 5 weeks. Neurobehavioral functions were evaluated by rotarod, adhesive tape removal, corner, water maze, and novel objective recognition tests. White matter injury was examined by diffusion tensor imaging, transmission electron microscopy, Luxol fast blue stain, and MBP/SMI32 double immunostaining. Grey matter injury was analyzed by Cresyl violet stain and NeuN immunostaining. The regulatory role of miR-15a/16-1 on AKT3 and IL-10RA were assessed by luciferase assay, qPCR, western blotting, and immunostaining. In addition, AKT3 and/or IL-10RA siRNA-loaded nanoparticles were intranasally delivered to miR-15a/16-1 KO mice with VCID.

Results:
Compared to WT controls, miR-15a/16-1 KO mice exhibited less cognitive and sensorimotor deficits following VCID. Genetic deficiency of miR-15a/16-1 in VCID mice also mitigated myelin degeneration, axonal injury, and neuronal loss. Mechanistically, miR-15a/16-1 binds to the 3’-UTR regions of AKT3 and IL-10RA. Genetic deletion of miR-15a/16-1 increased AKT3 and IL-10RA expression in VCID brains, and intranasal delivery of AKT3 and IL-10RA siRNA-loaded-nanoparticles partially reduced the brain protection and cognitive recovery in miR-15a/16-1 KO mice after VCID.

Conclusions:
MiR-15a/16-1-IL-10RA/AKT3 axis plays a critical role in regulating vascular brain damage and cognitive decline after VCID. Targeting miR-15a/16-1 is a novel miR-based therapeutic approach for the treatment of VCID.
Abstract 89: Nimodipine-induced Blood Pressure Reductions Below Personalized Limits Of Autoregulation Are Associated With Worse Outcomes After Subarachnoid Hemorrhage
Authors: Bartolome David , Begunova Yelyzaveta , Prasad Ayush , Soto Alexandria , Kobsa Jessica , Top Ilayda , Quispe-Orozco Darko , Farooqui Mudassir , Zevallos Cynthia , Kim Jennifer , Gilmore Emily J , Beekman Rachel , de Havenon Adam , Matouk Charles , Sheth Kevin N , Ortega-Gutierrez Santiago , Petersen Nils H
Published: February 2022

Background:
Impairment of cerebral autoregulation after subarachnoid hemorrhage (SAH) makes patients vulnerable to changes in blood pressure (BP). While oral nimodipine is recommended for improving neurological outcomes, its administration is frequently associated with reductions in BP. In this observational study, we examined the effect of nimodipine-induced BP reductions below personalized limits of autoregulation on outcome after aneurysmal SAH.

Methods:
Autoregulatory function was continuously measured by interrogating changes in near-infrared spectroscopy-derived tissue oxygenation (a cerebral blood flow surrogate) in response to changes in mean arterial pressure (MAP). The resulting autoregulatory index was used for trending the BP range at which autoregulation was most preserved. Cerebral hypoperfusion was defined as episodes with at least 30 minutes of MAP reductions below the lower limit of autoregulation (LLA) following nimodipine administration (Fig. 1). Functional outcome was measured with the modified Rankin Scale at 90 days.

Results:
We identified 593 occurrences of nimodipine administration with simultaneous recording of continuous physiologic data for 60 minutes before and after the intervention among 26 SAH patients (mean age 57
+
14, 21 F). Following nimodipine administration, the mean MAP decreased from 103 to 98 mmHg (p<0.001), and the time with MAP below the LLA increased from 9.5 to 21.7% (p<0.001). Moreover, the proportion of episodes with cerebral hypoperfusion was associated with worse 90-day outcomes after adjusting for age and SAH severity (OR for 10% increase 1.5, 95% CI 1.2-2.2, P=0.038).

Conclusions:
Nimodipine-induced BP reductions below the LLA may increase the risk of secondary brain injury and poor functional outcomes. A more personalized treatment approach accounting for cerebral autoregulation status could help identify vulnerable patients and maximize the benefit from current clinical interventions.
Abstract NS2: The Optimal Timing Of Nurse-driven Depression Identification: 7 Vs. 30-45 Days Post Discharge
Authors: Mkrtumyan Alvina , Gaffney Denise , Punsalang Lorina , Sangha Navdeep S , Le Duy , Cheng Pamela , Ajani Zahra
Published: February 2022

Introduction:
Post-stroke depression (PSD) is under-recognized and affects the recovery and rehabilitation of stroke patients. PSD affects one-third of stroke survivors, but there is little known when to screen for depressive symptoms. The purpose of this study is to determine the optimal timing of depression screening at 7 days vs. 30-45 days post discharge.

Methods:
All stroke patients received a phone call from a stroke certified RN (SCRN) to assess depression within 7 days and within 30-45 days post discharge using the Patient Health Questionnaire Screening Tool (PHQ9). Three call attempts were made. Data were analyzed from 2018 to 2020. Based on the PHQ9 scores, patients were referred to different clinical care pathways. Patients who scored 1-9 received lifestyle modification information, 10-19 were referred to depression care management, 20 and above were referred to psychiatry. The number of patients evaluated and the percentage of those who were referred to specific pathways were assessed. Data were analyzed using a t-test.

Results:
Stroke subtype were as follows: 17% ICH, 80% ischemic, 2% SAH. 1001 patients were called: 564 at 7 days, 437 at 30-45 days. 421 (75%) at 7 days and 277 (63%) at 30-45 days were reached. 11 (3%) at 7 days, 30 (11%) (p=0.045) at 30-45 days scored ≥10 on the PHQ9. Of those who scored ≥10 on PHQ9, 28 (68%) were female and more than half were over the age of 65. 91% of patients had NIHSS ≤5.

Conclusion:
A higher percentage of patients with PHQ9 ≥10 was detected within 30-45 days post discharge. The 30-45 day time period is more optimal to detect PSD than the 7-day time period post discharge.