bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP101: Defining Ischemic Core In Acute Ischemic Stroke Using CT Perfusion: A Multi-center Validation Study
Authors: Shahrouki Puja , Fifi Johanna T , Bauer Adam , Vagal Achala , Khatri Pooja , Srinivasan Ashok , Arango-Lievano Margarita , Mitulescu Anca , Campana-Tremblay Sophie , Bucciarelli Brianna , SAYRE JAMES , Shoirah Hazem , Mocco J D , Nael Kambiz
Published: February 2022

Background:
Estimation of infarction based on computed tomographic perfusion (CTP) remains challenging, mainly due to noise associated with CTP data and variability in reported thresholds ischemic core esstimation. Commercial software companies have attempted to establish CTP thresholds; for example, a relative cerebral blood flow (rCBF) of <30% for RAPID™ (iSchemaView). In this retrospective multi-center study, we sought to establish and validate CTP threshold values for estimation of ischemic core using Olea Sphere® software (Olea Medical Solutions).

Methods:
Under an approved multi-institutional protocol, patients with acute ischemic stroke of the anterior circulation from three comprehensive stroke centers were included if they met the following criteria: baseline CTP, recanalization achieved (Thrombolysis in cerebral infarction scale ≥ IIb), and follow up MRI (DWI) performed. Perfusion maps were generated from the CTP data by the Bayesian probabilistic model and oscillation singular value decomposition (oSVD). CTP parameters, including time to peak (TTP), rCBF, time to max (Tmax), and Delay (equivalent of Tmax in Bayesian model) were generated. Brain was extracted from CTP and coregistered with the follow up MRI. An infarction mask and non-infarcted masks were drawn on MRI. We used a robust logistic regression to assess the binary outcome of our voxel-based analysis (infarcted vs non-infarcted) by adjusting for intra-subject correlations.

Results:
Eighty-one patients (42 Male; mean age 67.4 ±17.3) were included. All CTP parameters for the Bayesian and oSVD methods showed significant differences between infarcted and non-infarcted areas (p < 0.001). In the Bayesian model, a combination of rCBF at threshold of <45% and delay at threshold of 0.82 sec provided the highest diagnostic accuracy; AUC/sensitivity/specificity (0.79/0.69/0.79). In the oSVD method, a combination of rCBF at threshold of <16% and Tmax at threshold of 4.00 sec provided the highest diagnostic accuracy; AUC/sensitivity/specificity (0.71/0.64/0.73).

Conclusion:
Using heterogenous CTP data from three stroke centers, we established thresholds for estimation of ischemic core for Olea software that can be used for both Bayesian and oSVD postprocessing models.
Abstract TP105: Optimizing The Utilization Of Cardiac Magnetic Resonance Imaging Among Patients With Ischemic Stroke
Authors: Kerani Danish , Patel Himanshu A , Zhang Tony J , Lin Andy , Ozel Osman , Vahidy Farhaan S , McCane David , Dinh Thao N , Ling Ken Chyuan , Chiu David , Volpi John J , GADHIA RAJAN R , Shah Dipan J , Chamsi-Pasha Mohammed , Garg Tanu
Published: February 2022

Background:
The current AHA guidelines recommend (class IIb) advanced cardiac imaging in an embolic stroke of unknown source (ESUS). We aim to better characterize the role of cardiac MRI (cMRI) in the evaluation of stroke patients and determine patient characteristics that may increase the positive predictive value of cMRI.

Method:
A retrospective review of stroke patients at a comprehensive stroke center, who had cMRI between 12/2016 and 11/2020 was conducted using institutional registries. Ischemic stroke patients with ESUS, cryptogenic (with ESUS as a competing etiology), and cardioembolic etiologies were included. Cases with TIA, large vessel, small vessel, or hemodynamic etiologies were excluded. Cardioembolic etiology was defined as newly diagnosed Afib patients with TTE abnormalities including wall motion abnormalities and/or reduced LVEF <50%, stroke while compliant with anticoagulation for known Afib, or among whom the timing of restarting anticoagulation was in question. TTE and cMRI results from all cases were reviewed for remarkable findings, most notably intracardiac thrombus, and analyzed if a change in anti-thrombotic therapy was directly attributable to cMRI results.

Results:
As per our criteria, 250 cases (Female 44.4%, Black 29.6%, Age mean: 65.2 years) were included, of whom 146 (58.4%) were ESUS, 86 (34.4%) were cryptogenic, and 18 (7.2%) were cardioembolic. Sixteen (6.4%) revealed intracardiac thrombus, of which 10 had LV thrombus, 5 had LA thrombus, and 1 had RA thrombus along with questionable PFO on cMRI. Of these, 14 (87.5%) had an escalation of anti-thrombotic therapy. For the other 2 cases, despite cMRI obtained due to low LVEF and revealing LA thrombus, antithrombotic regimen was not changed. Eight (3.2%) additional patients were placed on anticoagulation secondary to incidental findings.

Conclusion:
In this large retrospective analysis of 250 select stroke cases, escalation of anti-thrombotic therapy from anti-platelets to full dose anti-coagulation was indicated in 14 patients (5.6%) with addition of cMRI. Further analysis of data is in process to determine the subset of stroke patients who would benefit the most from cMRI.
Abstract TP117: NLR Does Not Predict The Development Of Delirium In AIS Stroke Patients With Higher Rates Of Reperfusion Therapies.
Authors: Chen Herbert , Anjum Sahar , Kumar Aditya , Sebaugh Jacob , Joseph Michele , Williams Bethany , Zha Alicia
Published: February 2022

Introduction:
Stroke patients who develop delirium after their stroke can have worse cognitive and functional outcomes. Prior studies suggest that admission Neutrophil Lymphocyte ratio (NLR) is associated with the development of delirium in both ischemic (AIS) and hemorrhagic stroke geriatric patients. In this study we examine AIS patients for laboratory predictors of delirium.

Methods:
Between September 2019 and June 2021, patients diagnosed with AIS, within 48 hrs of last seen normal or time of onset and had expected mortality >1 month were prospectively evaluated for delirium using the Confusion Assessment Method (CAM)-ICU daily for the first 8 days of their hospital stay and at discharge. NLR ratio was derived from patients’ admission blood panel and were both evaluated as continuous variables and in quartiles.

Results:
During the study period, 213 patients were screened for delirium. Of these, 18 patients could not be evaluated by the CAM-ICU at any point during the first eight days and 99(50.5%) screened positive for delirium. Our patient population was younger and had higher rates of endovascular and thrombolytic therapy than prior studies. Similar to other studies, patients with delirium had more severe NIHSS score (Table 1), longer lengths of stay, were more likely to be discharged to inpatient rehab than home, and trended to higher inpatient mortality. However, there was no apparent association between NLR and the development of delirium.

Conclusion:
In our patient population of younger patients who were more likely to receive reperfusion therapies, we did not find that NLR is associated with delirium. These results warrant additional study, specifically if reperfusion therapies such as thrombectomy and thrombolysis change how the nature of delirium and its predictive variables.
Abstract TP119: Celecoxib In Aneurysmal Subarachnoid Hemorrhage: A Single Center Experience
Authors: Teitcher Michael , Azevedo Jessica , Kolli Avi , Serrone Joseph , Reynolds Matthew , Gill Rick , Garg Ravi
Published: February 2022

Introduction:
Inflammation may play a central role in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Prostaglandins are inflammatory mediators that are elevated in aSAH and are synthesized by cyclooxygenase-2 (Cox-2). Celecoxib is a selective Cox-2 inhibitor with anti-inflammatory effects and good central nervous system penetration. In a mouse model of SAH, Cox-2 gene expression was found to be up-regulated in brain endothelial cells and celecoxib was found to limit Cox-2 up-regulation. We sought to evaluate the safety of celecoxib in patients with aSAH for future clinical studies.

Methods:
We used a matched case-control study to evaluate safety of celecoxib in aSAH patients. Our prospectively collected aSAH database (N=230) was retrospectively reviewed from 1/2010 - 2/2020. Celecoxib cases (N=13) and controls (N=217) were matched by closest Euclidean distance based on age and Glasgow Coma Scale (Figure 1). Each case was matched with 4 controls to maximize power based on closest Euclidean distance. Baseline characteristics for cases and controls were compared using a t-test or signed rank test for pairs. Categorical variables were compared using McNemar’s test for discordant pairs. A p value ≤.05 was considered significant for all univariate testing. Results are listed in Table 1.

Discussion:
No adverse events were associated with celecoxib use. At our center, celecoxib was primarily used in high grade aSAH for fever or headache. Maximum and mean temperature are statistically higher in the celecoxib group, consistent with the treatment indication. There were no differences in vasospasm prevalence, although our analysis is limited by sample size. Given the favorable safety profile, ease of drug availability, and plausible mechanism of therapeutic effect, celecoxib warrants further study in aSAH.
Abstract TP121: Examination Of Initial NIHSS And Discharge Disposition In Patients Hospitalized With Acute Ischemic Stroke
Authors: Davila Claire , Meyer Dawn M , Shifflett Ben , Meyer Brett C , Agrawal Kunal
Published: February 2022

Introduction:
Acute ischemic stroke (AIS) patients require post-acute care (PAC) rehabilitation that is consistent with degree of stroke deficit. Appropriate PAC disposition for AIS patients varies widely. We examine the relationship between initial National Institutes of Health Stroke Scale (NIHSS) and discharge disposition to determine if stroke severity is associated with disposition.

Methods:
In our IRB-approved database, consecutive Emergency Department stroke code activations with confirmed diagnosis of AIS were retrospectively analyzed from January 2004-May 2021 at UC San Diego. Patients were grouped into mild (NIHSS 0-5), moderate (NIHSS 6-14), and severe (NIHSS >14) stroke. Outcome variables were PAC disposition: Home, Inpatient Rehab Facility (IRF), Skilled Nursing Facility (SNF), Expired, and Other. Chi-squared and Kruskal-Wallis followed by pairwise proportion tests were used for analysis. Analyses were adjusted for age, sex, baseline modified Rankin score (mRS), and acute stroke treatment.

Results:
Total 2316 patients were included for analysis. There was a difference between initial stroke severity and discharge disposition overall (p<0.001). (Table 1). Mild stroke patients had less discharges to IRF, SNF, Expired, or Other compared to moderate (p<0.001) and severe (p<0.001) strokes. There was no difference between moderate and severe stroke patients discharged to IRF (p=0.44) or SNF (p=0.48). Age, baseline mRS, and receiving acute stroke treatment were independent predictors for discharge to home, IRF, and SNF. Baseline mRS was an independent predictor for Expired patients.

Conclusion:
Patients with mild strokes are discharged home more than moderate and severe strokes, but there was no difference between moderate and severe stroke patients discharged to either IRF or SNF. This suggests PAC disposition is not consistent with stroke severity and further studies are needed to investigate other factors related to final disposition.
Abstract TP126: The Therapeutic Window Of Red Cell Microparticles In Limiting Intracerebral Hemorrhage-induced Hematoma Growth In Nicotine-exposed Rats.
Authors: Rehni Ashish K , Cho Sunjoo , Raval Ami P , Perez-pinzon Miguel A , Jy Wenche , Dave Kunjan R
Published: February 2022

Spontaneous intracerebral hemorrhage (sICH) is a subtype of hemorrhagic stroke with enormous mortality and morbidity, and tobacco use is one of the major risk factors for sICH. We have shown that red cell microparticle (RMP) treatment limits hematoma growth following sICH in nicotine-exposed rats. Presently, we determined the therapeutic time window of RMP efficacy. RMPs were generated from RBCs using high pressure extrusion. Rats were treated for a period of 2-3 weeks with nicotine (4.5 mg / kg b.w./ day, s.c.) using osmotic pumps. sICH was induced using intra-striatal collagenase administration. Rats of either sex were randomized between saline (vehicle) or RMP treatment groups (n=10 each for 4.5 h and 6 h RMP treatment time points, n=15 each for pooled vehicle time points). Males treated at 4.5 h and females treated at both timepoints received ~1.34х10
11
particles/ kg b.w., i.v. over 2 h period. While males treated at 6 h received ~ 1.58х10
11
particles/ kg b.w., i.v. over 2 h duration. After ~24 hours, functional deficit was assessed using neurological scores, and hematoma volume was measured in a blinded manner. The hematoma volume of male rats treated with RMPs 4.5 h post-sICH (94±3 mm
3
) was significantly lower (p<0.05) than the controls (119±7 mm
3
). Moreover, the neurological score of male rats treated with RMPs 4.5 h post-sICH (8.9±0.5) was significantly lower (p<0.005) than the controls (10.9±0.2). However, the hematoma volume (103±12 mm
3
) and neurological score (10.1±0.6) of the 6 h post-sICH RMP treatment male group were not different from the controls. The hematoma volume observed in female rats treated with RMPs 4.5 h post-sICH (60±6 mm
3
) was significantly lower (p<0.01) than the controls (99±2 mm
3
). Further, neurological score of the rats treated with RMPs 4.5 h post-sICH (7.7±0.6) was significantly lower (p<0.001) than the controls (10.1±0.2). However, the hematoma volume (96±8 mm
3
) and neurological score (10.4±0.3) in female rats treated with RMPs 6 h post-sICH were not different from the controls. Our results show that RMPs limit hematoma growth in nicotine-exposed rats when administrated 4.5 h post-sICH induction. Thus, RMPs may lower hematoma growth in sICH patients following tobacco use. Support: James Esther King Biomedical Research Grant 9JK08.
Abstract TP132: Associations Of N-acetyl-aspartyl-glutamate With Intracerebral Hemorrhage Characteristics And Functional Outcomes: A Pilot Study
Authors: Laws Lindsay H , Budhathoki Chakra , Zink Elizabeth K , Hanley Daniel F , Le Anne , Ziai Wendy C
Published: February 2022

Introduction:
N-acetyl-aspartyl-glutamate (NAAG) is a peptide-based neurotransmitter that has been extensively studied in many neurological diseases. N-acetylaspartate (NAA) and NAAG are markers of neuronal integrity. Decreased NAA on MR-spectroscopy is associated with neuronal damage in ischemic and hemorrhagic stroke. We investigated serial plasma concentrations of NAA and NAAG in patients with ICH to examine correlations with ICH severity.

Methods:
Plasma from 38 consecutive patients with ICH was collected up to 8 days post-ictus. Days 1 and 2 were defined as time point 1 (T1), days 3 and 4 as T2, etc. Five patients underwent surgery and were analyzed separately. NAA and NAAG concentrations were assessed using mass spectrometry. ICH, intraventricular hemorrhage (IVH) and perihematomal edema (PHE) volumes were analyzed from CT scans using computerized volumetrics. Modified Rankin Scale (mRS) was collected at 90 days. Spearman rank correlations (r
s
) were used to describe associations between changes in metabolite values and continuous measures.

Results:
Mean age was 63 ± 13 years, 58% male, and median [IQR] initial ICH and IVH volumes were 16 [7-35] and 0 [0-5.2] mL respectively. Mean NAA/NAAG levels at T1 were 114k ± 112k and 18k ± 30k ion counts respectively. Mean levels of NAA were stable and NAAG decreased over time. T1 levels of NAAG were higher in males than females (25k vs. 6k ion counts; p=0.02), negatively correlated with admission GCS (r
s
= -0.5), and positively correlated with IVH volume (r
s
= 0.7). T1 levels of NAA/NAAG did not correlate with ICH or PHE volume or admission NIHSS. Increases (percent change) in NAAG from T1 to T3 correlated with higher 90-day mRS (r
s
= 0.5), and correlated negatively with IVH volume (r
s
= -0.6 for both T1-T3 and T1-T2). Percent change in NAAG from T1 to T4 correlated positively with both ICH and PHE volume (r
s
= 0.98 and 0.9). These correlations were not significant for percent change in NAA. In patients who had hematoma evacuation, median level of NAAG 1-2 days post-op was lower than pre-surgery (18k vs. 16k; p > 0.05).

Conclusions:
Admission NAAG levels were associated with IVH volume, lower GCS, and male sex. Elevation of plasma NAAG following ICH correlated with worse 90-day outcomes and with higher ICH and PHE volumes.
Abstract TP138: Prevalence And Risk Factors Associated With Cerebral Microbleeds In Patients With Acute Respiratory Distress Syndrome
Authors: gedansky aron , Huang Merry , Hassett Catherine , Shoskes Aaron , Cho Sung-Min C , Buletko Andrew , George Pravin , Duggal Abhijit , Uchino Ken
Published: February 2022

Introduction:
Acute respiratory distress syndrome (ARDS) is associated with pulmonary vascular endothelial injury. Cerebral microbleeds (CMB) have been reported in patients with critical illness such as ARDS, particularly involving the splenium of the corpus callosum and immediate subcortical white matter. We aimed to examine the prevalence and risk factors of CMB in ARDS.

Methods:
We reviewed patient data from an ARDS registry at a tertiary medical center from January 2010 to October 2018. Patients were excluded if MRI imaging was motion degraded or did not include susceptibility weighted imaging (SWI) or T2*weighted gradient echo sequences. CMB were defined as hypointense SWI or T2* lesions <5 mm. Microbleeds were labeled as diffuse if there were ≥10 present in a region. ARDS rescue therapies included extracorporeal membrane oxygenation, inhaled vasodilators, recruitment maneuvers, high frequency oscillatory ventilation, neuromuscular blockade, and proning. Univariate analysis was performed to examine association with CMB.

Results:
Of the 678 patients with ARDS, 61 had MRI’s meeting inclusion criteria. CMB were present in 12 patients, with median age 62.5 years. Ten patients had lobar CMB, of which 4 were diffuse and also involved the cerebellum. There were 3 patients with CMB in the corpus callosum, all involving the splenium, of which 2 were diffuse among patients who had diffuse lobar involvement. Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment scores did not differ between those with and without CMB, but ARDS rescue therapies were more commonly used in patients with CMB (66.7% vs 22.4%, p=.003). CMB was associated with acute cerebral ischemia on MRI (41.7% with CMB vs 10.2% without CMB, p=.008).

Conclusions:
CMB are common in ARDS, mostly involving the cerebral lobes and cerebellum. CMB might be associated with ARDS rescue therapies and higher risk for ischemic infarcts.
Abstract TP147: Endovascular Therapy Versus Medical Therapy Alone For Basilar Artery Stroke: A Systematic Review And Meta-analysis Through Nested Knowledge
Authors: Adusumilli Gautam , Pederson John , Hardy Nicole , Kallmes Kevin , Hutchinson Kristen , Kobeissi Hassan , Heiferman Daniel , Kallmes David F , Brinjikji Waleed , Albers Gregory W , Heit Jeremy J
Published: February 2022

Background and Purpose:
Endovascular thrombectomy (EVT) is an effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion of the anterior circulation (AC-LVO). Randomized trials of posterior circulation large vessel occlusion (PC-LVO) patients have failed to show a benefit of EVT over medical therapy (MEDT). We performed a systematic review and meta-analysis to understand better whether EVT is beneficial for PC-LVO.

Methods:
Using the Nested Knowledge AutoLit living review platform, we identified randomized control trials and prospective studies that reported functional outcomes in patients with PC-LVO treated with EVT versus MEDT. The primary outcome variable was 90-day modified Rankin Scale (mRS) 0-3, and secondary outcome variables included 90-day mRS 0-2, 90-day mortality, and rate of symptomatic intracranial hemorrhage (sICH). A separate random effects model was fit for each outcome measure to calculate pooled odds ratios.

Results:
Three studies with 1,248 patients, 860 in the EVT arm and 388 in the MEDT arm, were included in the meta-analysis. The favorable outcome rate (mRS 0-3) in EVT patients was 39.9% (95% CI: 30.6-50.1%) versus 24.5% in MEDT patients (95% CI: 9.6-49.8%). EVT patients had higher mRS 0-2 rates (31.8% [95% CI: 25.7-38.5%] versus 19.7% [95% CI: 7.4-42.7%]) and lower mortality (42.1% [95% CI: 35.9-48.6%] versus 52.8% [95% CI: 33.3-71.5%]) compared to MEDT patients, but neither result was statistically significant. EVT patients were more likely to develop sICH (OR=10.36; 95% CI: 3.92-27.40).

Conclusions:
EVT treatment of PC-LVO trended toward superior functional outcomes and reduced mortality compared to MEDT despite a trend toward increased sICH in EVT patients. Existing randomized and prospective studies are insufficiently powered to demonstrate a benefit of EVT over MEDT in PC-LVO patients.
Abstract TP149: Association Of 24-hour Blood Pressure Parameters Post-thrombectomy With Functional Outcomes According To Collateral Status
Authors: Nisar Taha , Abu-hadid Osama , Lebioda Konrad , Tofade Toluwalase , Khandelwal Priyank
Published: February 2022

Introduction:
Higher blood pressure (BP) most post mechanical thrombectomy (MT) can influence perfusion in the ischemic brain tissue depending on collateral status. We aim to determine the association of 24 hour post MT BP parameters with the functional outcome depending on the pre MT collateral status.

Methods:
We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into two groups (good versus bad) depending on collateral status. A board certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Mass ≥3 and modified-Tan>50% to designate good collaterals on the pre MT CT Angiogram. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, time to thrombectomy, LDL, Hemoglobin A1C, intravenous alteplase, with the 24 hour post MT BP parameters as the predictors. The outcomes were good functional outcome (90 day mRS≤2) and mortality.

Results:
220 patients met the inclusion criteria. Lower 24 hour BP parameters of standard deviation (SD) SBP (OR,1.16; 95% CI,1.01-1.33; P 0.047) and maximum DBP (OR,1.05; 95% CI,1.01-1.09; P 0.036) were associated with good functional outcome, while higher values of SD SBP (OR,1.15; 95% CI,1.01-1.31; P 0.045), coefficient variation (CV) SBP (OR,1.19; 95% CI,1.01-1.41; P 0.043), SBP range (OR,1.04; 95% CI,1.01-1.07; P 0.046), maximum DBP (OR,0.95; 95% CI,0.91-0.99; P 0.016), pulse pressure (OR,1.09; 95% CI,1.02-1.16; P 0.022) and SBP≥140 (OR,5.85; 95% CI,1.11-30.85; P 0.038) were associated with mortality in patients with good collaterals according to Mass grading. Higher values of BP parameters of SD SBP (OR,1.13; 95% CI,1.04-1.24; P 0.007), CV SBP (OR,1.18; 95% CI,1.05-1.32; P 0.006), SBP range (OR,1.04; 95% CI,1.01-1.06; P 0.008) and maximum DBP (OR,0.97; 95% CI,0.94-1; P 0.02) were associated with mortality in patients with good collaterals according to modified-Tan grading. There was no such association in patients with bad collaterals.

Conclusion:
Various higher 24 hour BP parameters post MT are associated with a bad functional outcome or mortality in patients with good collaterals, unlike in patients with bad collaterals.
Abstract TP153: First Pass Effect In Middle Cerebral Artery M1 Occlusions
Authors: Salahuddin Hisham , Rao Rahul , Khalid Fatima , Prologo-Richardson Paige , Castonguay Alicia , Burgess Richard , Zaidi Syed , Jumaa Mouhammad A
Published: February 2022

Introduction:
First pass effect (FPE) defined as TICI 3 recanalization or greater is an independent predictor of clinical outcome in patients who undergo mechanical thrombectomy (MT). The first pass effect may be impacted by device-related factors, thrombus composition, or collateral circulation flow dynamics. In this study, we aim to examine the impact of first pass effect on clinical outcomes in patients with MCA M1 occlusions.

Methods:
A retrospective analysis of all patients with MCA M1 occlusion who underwent successful mechanical thrombectomy (TICI 2b or greater) between 2014-2020 at two thrombectomy stroke centers was performed. Location of occlusion was recorded as proximal MCA (involvement of the lenticulostriate vessels) or distal. Patients were excluded if they were not successfully recanalized or if they had multifocal intracranial occlusions. Patient characteristics, time metrics, procedural data, and 90 day clinical outcomes were collected. The primary outcome of interest was first pass effect, defined as TICI 3 after a single pass.

Results:
A total of 261 patients achieved successful recanalization of MCA occlusions in our cohort, with 70 (26.8%) patients achieving a first pass effect. Baseline demographics, rates of IV-tPA administration, and time metrics were similar between the FPE and non-FPE group. Proportion of proximal MCA and distal MCA occlusions were similar between groups as well (38.2% vs. 25.7%; p=0.08). Rates of excellent clinical outcomes were significantly higher in the FPE group compared to the non-FPE group (46.3% vs. 29.9%; p=0.02). In a multivariate analysis, proximal MCA occlusion was a significant predictor of first pass effect.

Conclusion:
First pass effect in middle cerebral artery M1 occlusions is a significant predictor of an excellent clinical outcome. Patients with a proximal MCA M1 occlusion are more likely to achieve a first pass effect compared to patients with a distal MCA occlusion.
Abstract TP154: Impact Of Non-English Primary Language On Mechanical Thrombectomy Outcomes
Authors: Karim Nurose , Stone Suzanne , Salter Amber , Johnson Mark , Jones Erica
Published: February 2022

Background:
Delays in acute treatment of ischemic stroke have been associated with worse outcomes. Ischemic stroke patients with non-English primary language have not been shown to have delay in receiving thrombolytic therapy. We assessed whether non-English primary language was associated with functional outcomes in patients receiving mechanical thrombectomy (MT).

Method:
This is a retrospective study of our MT database from two comprehensive stroke centers from January 2016 to May 2021. Primary endpoints were discharge and 90-day modified Rankin Scale (mRS) 0-2. Descriptive statistics were used to summarize the demographic and clinical characteristics, means and standard deviation or median and the 25th and 75th percentiles for continuous variables and frequency and percentages for categorical variables. Differences between primary English speaking (ES) and primary non-English speaking (nES) patients were evaluated using an analysis of variance (ANOVA), Kruskal-Wallis and chi square test. Multivariable logistic regression was used to evaluate ES vs nES patients adjusted for age, hemoglobin A1c, tPA treatment, and TICI 2B/3 reperfusion which were selected a priori. The significance level was set at 0.05.

Result:
We identified 276 patients receiving MT with 83% ES and 17% nES patients. nES patients had higher mean hemoglobin A1c, were less likely to have insurance, and more likely to have symptomatic intracranial hemorrhage compared to ES patients (Table). No differences were observed in discharge or 90-day mRS in the univariate and multivariable logistic regression. We observed a nominally longer median ED arrival to groin puncture time in the nES group.

Conclusion:
There was no difference between nES and ES in good functional outcome rates in patients treated with MT. The trend toward longer ED length of stay in non-English language patients warrants additional study to identify specific causes of delay that may be targeted for intervention.
Abstract TP156: Balloon Angioplasty For Symptomatic Intracranial Artery Stenosis
Authors: Sun Xuan , Miao Zhongrong
Published: February 2022

Background:
Intracranial atherosclerotic disease is the most common cause of ischemical cerebrovascular events. The risk of stroke recurrence or death of ICAD patients remains very high. Previous nonrandomized studies have showed that stroke and death rate of angioplasty for ICAD patients with severe stenosis of intracranial artery is lower than that of aggressive medication.

Methods:
The trial is a multicenter, prospective, randomized, parallel controlled study, with the primary idea to determine whether intracranial balloon angioplasty combined with aggressive medical therapy is superior to aggressive medical treatment alone in patients with cerebral ischemic stroke due to neurovascular stenosis (≥70%) for preventing the primary endpoint: 1.Stroke (including hemorrhagic and ischemic stroke) and all-cause mortality within 30 days after enrollment. 2. Ischemic stroke attributed to the offending vessel from 31 days to 12 months after enrollment. Aggressive medical treatment is identical in both arms, which consists of aspirin 100 mg per day during the entire follow-up and clopidogrel 75mg per day for the first 90 days after enrollment. Management of primary risk factors (blood pressure 130-140 / 90-100 mmHg and LDL < 70 mg/dl) and secondary risk factors is also required in both arms.

Result:
We postulate that balloon angioplasty with submaximal balloon is safe enough and effective enough, not increasing ischemic/hemorrhagic stroke rate within 30 days. Moreover, we expect primary angioplasty combined with optimal medical management can reduce a relatively 50% risk of recurrent ischemic stroke due to attributed artery with estimated rate of 15% at 1 year in the control group and 7% in the treatment group in 1-year follow-up.

Conclusion:
BASIS is the first randomized trial comparing primary angioplasty combined with optimal medical regime with optimal medical regime alone. With enough evidence, we believe the risk of major hemorrhage can also be maximal minimized by using submaximal balloon during the procedure and probably shorter-term dual antiplatelet treatment after procedure. With the result of BASIS, we hope primary angioplasty can serve as an independent or alternative treatment in patients with severe intracranial atherosclerotic stenosis
Abstract TP163: Effect Of Renal Impairment On Clinical Outcomes Among Acute Ischemic Stroke Patients Treated With Endovascular Therapy- A Bi-center Study.
Authors: Ravelo Aaron , Hackett Chris , Mittal Aditya , Desai Shashvat , Jadhav Ashutosh , Malhotra Konark
Published: February 2022

Objective:
To investigate the effect of renal impairment on clinical outcomes among acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT).

Methods:
We performed a retrospective analysis from January to December 2020 involving AIS patients with CKD and premorbid modified Rankin Scale (mRS) ≤2, undergoing EVT in two large academic comprehensive stroke centers. Our primary efficacy outcome of interest was mRS at 90 days. Secondary outcomes included: inpatient mortality, length of hospitalization and reperfusion status based on Thrombolysis in Cerebral Infarction (TICI) score. CKD was defined as estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60-89 mL/min), moderate (eGFR 30-59 mL/min) or severe (eGFR 15-29 mL/min). We performed ordinal regression, multinomial logistic regression and binomial logistic regression analyses. In our subgroup analysis, we compared outcomes among AIS patients diagnosed with mild, moderate and severe CKD. We additionally performed a sensitivity analysis comparing patients with treated with combined intravenous thrombolysis (IVT) and EVT vs EVT only.

Results:
A total of 484 AIS patients underwent EVT at both stroke centers during the study period. After excluding patients for missing data and baseline mRS >2, total of 300 AIS patients who underwent EVT (176 CKD and 124 patients with normal renal function) were included. Patients with CKD was associated with worse clinical outcomes [4 (2-6) vs 3 (1-6)]; adjusted odds ratio [aOR] 1.70, 95% confidence interval [CI] 1.10 - 2.61,
p
=0.02] based on 90-day mRS shift analysis and increased odds of in-hospital mortality (aOR 2.63, 95% CI; 1.08-6.38,
p
=0.03). Rates of TICI 2b/3 reperfusion (
p
=0.84) and length of stay (
p
=0.42) were similar between the two groups. Subgroup analyses found no difference between CKD and normal renal function groups for primary and secondary outcomes (all
p
>0.05). Similarly, sensitivity analyses demonstrated no difference in clinical outcomes between patients receiving combined IVT and EVT compared to EVT only (all
p
>0.05).

Conclusion:
Among AIS patients undergoing EVT, renal impairment was independently associated with worsening functional outcomes at 90 days and a higher rate of inpatient mortality.
Abstract TP165: Preventing Ophthalmic Complications By Coiling The Orbital Anastomosis Prior To Middle Meningeal Artery Embolization
Authors: Moussavi Kiana , Moussavi Mohammad
Published: February 2022

Background:
Embolization of the Middle Meningeal Artery (MMA) is a minimally invasive procedure used as an alternative or adjunctive treatment of chronic subdural hematoma (cSDH). The benefits of MMA embolization have been attributed to targeting of the pathophysiology of cSDH which currently favors a process of increasing inflammatory response causing immature and leaky neovascularization. The major dural arteries and hazards associated with their embolization have been thoroughly described in past literature. The unintended embolization of orbital arteries leading to blindness is the most significant hazard associated with MMA embolization.

Purpose:
The purpose of this study is to present 5 cases demonstrating the success of our technique in the treatment of cSDH while preventing the possibility of blindness by coiling the anastomotic vessel between MMA and Ophthalmic Artery (OA) branches prior to particle embolization.

Methods:
After doing an Internal Carotid Artery (ICA) run and ensuring the origination of the OA from the ICA and observing retinal blush, we routinely infused 10-20μg of Nitroglycerine into the main trunk of MMA through a microcatheter to dilate and better visualize the MMA branches including anastomosis. If the meningeo-ophthalmic collaterals were visualized during the follow-up microcatheter run, we coil embolized the proximal segment of those collaterals through the same microcatheter. We then infused 100-300μm particles through the main branches of the MMA supplying the dura.

Results:
Of the 39 patients who underwent MMA embolization for cSDH, 5 received MMA/OA collateral variants coil embolization followed by successful particle embolization of all MMA branches supplying the dura without complication.

Conclusion:
In our cSDH patients, the collaterals from MMA to Ophthalmic or Lacrimal branches were safely coil embolized before complete particle embolization of the MMA dural branches. In a few patients these collaterals became obvious after inducing vasodilatation. None of these patients had major complications. This technique may be safer, more effective and cheaper than wedging, gluing or low pressure infusion. Our literature search did not find a similar technique used in this application.
Abstract TP169: Post-Neonatal Stroke In Children With Critical Congenital Heart Defects
Authors: Ibeh Chinwe , Lewis Matthew , Rosenbaum Marlon S , Argenio Melissa , Mammadli Gular , Miller Eliza C
Published: February 2022

Background:
Critical congenital heart defects (CCHD) are a subset of mostly cyanotic lesions that require intervention within the first days to weeks of life for survival. For children born with CCHD, the neonatal period is considered the time of highest risk for brain injury as abnormalities in fetal circulation can lead to vulnerabilities in cerebral perfusion prior to corrective cardiac procedures. The prevalence and timing of cerebrovascular events associated with CCHD after the neonatal period is less clear.

Methods:
We performed a cross-sectional analysis using the National Inpatient Sample database from 2012-2018. We included all children aged 1-18 years hospitalized with either ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We created multivariable linear and logistic regression models to assess differences in age at stroke onset and mortality after stroke.

Results:
We identified 4,647 pediatric strokes, 162 (3.5%) of which were associated with CCHD. Adjusting for demographic and clinical covariates, the median age at time of stroke was lower in CCHD patients across all stroke subtypes (Figure). Children with CCHD experienced a higher proportion of IS compared to children without CCHD (75.3% vs 49.5%, P<0.001); and a lower proportion of ICH and SAH (10.5% vs 25.7% and 14.2% vs 24.9%; both P = 0.002). In-hospital mortality for the entire sample following stroke was 10.4% for IS, 14.5% for ICH, and 13.4% for SAH. Adjusting for demographics and confounders, presence of CCHD doubled the odds of death following stroke (OR 2.05; 95% CI 1.35-3.11).

Conclusion:
Beyond the first year of life, children with CCHD have earlier age at stroke onset and higher post-stroke mortality compared to children without CCHD. Continued vigilance and monitoring of potential neurological complications is warranted in children with CCHD.
Abstract TP172: Clinical And Neuroimaging Predictors Of Dyskinetic Cerebral Palsy
Authors: Sanvido Liam , Krishnan Pradeep , Domi Trish , Walker Kirstin , Fehlings Darcy , Robertson Amanda , Thapa Ritesh , Dlamini Nomazulu
Published: February 2022

Background:
Dyskinetic cerebral palsy (DCP) is a non-progressive disorder that results from lesions to the developing fetal brain. Neuroimaging patterns and risk factors for DCP in pre-term infants are poorly understood. Furthermore, neuroimaging differences between preterm and term infants with DCP and its relationship to clinical outcomes are not well established.

Objectives:
1) To describe neuroimaging differences between term and preterm infants with DCP. 2) To investigate relationships between neuroimaging patterns and clinical motor outcome of infants with DCP.

Methods:
Patients with DCP were identified through The Cerebral Palsy Network where clinical details and magnetic resonance images (MRI) were collected on children with DCP. To determine lesion volume and location, manual segmentation was performed using ITK-SNAP software by study neuroradiologist. Lesion severity was graded using a semi-quantitative scale for structural MRIs(Laporta-Hoyos et al. 2018) based on the number of lobes and subcortical structures involved. Motor outcomes was assessed with the Gross Motor Function Classification System.

Results:
Twenty-nine patients with DCP were identified. Preterm infants (n=12, [male= 8, female=4]), and term infants (n=16 term, [male= 6, female=10]) differed in mean gestational age (30.5 versus 39.1 weeks respectively, p=.02). The frequency of periventricular leukomalacia in preterm (89%) and term-born (58%) infants differed (p = 0.02). Lesion severity was associated with: the ventral posterior lateral (VPL) thalamus (r=0.574,p =.01), the posterior limb of the internal capsule (PLIC) (r=0.437p = .04) in term infants, and the right (r = 0.504, p = .01) and left putamen r = 0.629, p = .002) in term infants. Significant negative correlations were found between lesion severity and gross motor function in the VPL thalamus (r= -0.624, p = .001), PLIC (r= -0.735, p < .001), right (r= -0.50, p= .016) and left putamen (r= -0.54 p = .008).

Conclusion:
Our results suggest the timing of lesions in term-born and preterm infants with DCP are associated with neuroimaging lesion patterns. Involvement of subcortical structures and lesion severity scores were associated with gross motor function in this cohort of patients with DCP.
Abstract TP185: Cardiac Gadolinium Enhancement And Cerebral Small Vessel Disease
Authors: Navarro Kayla , Garg Gauri , Wolcott Zoe , Muddasani Varsha , Peterson Cecilia , Sheibani Nazanin , Wong Ka-ho , Ibrahim Mark , de Havenon Adam H , Goldstein Eric
Published: February 2022

Background:
Accumulation of cerebral small vessel disease (CSVD) leads to various well described detrimental clinical consequences. Similar to CSVD, the development of coronary microvascular disease (CMD) yields end-organ dysfunction, namely myocardial ischemia and chamber dilation. We aimed to investigate the relationship between cardiac gadolinium enhancements (CGE), a marker for CMD, on CSVD burden on brain MRI.

Methods:
We performed a retrospective cross-sectional analysis of adults between January 2014 and December 2019 who completed a cardiac and brain MRI within one year of each other. The ordinal total small vessel disease score (tSVD) was used to quantify CSVD with two cohorts being created: tSVD 0 to 1 (low CSVD) and tSVD 2 to 4 (high CSVD). Cardiac MRI data was obtained under the guidance of an experienced cardiologist with advanced cardiac imaging training. Chi-squared or Fisher’s, Wilcoxon rank-sum analyses were performed for binary and ordinal variables, respectively. Adjusted multivariate logistic regression models were used to calculate odds ratios. Statistical significance was defined as < 0.05.

Results:
A total of 259 individuals were included with 140 and 119 in the low and high CSVD groups, respectively. Those with low CSVD were significantly lower in age, predominately female and had lower rates of hypertension, hyperlipidemia, diabetes mellitus and congestive heart failure. CGE was more common in those with higher burdens of CSVD (23.2% vs 47.2%, p<0.001). CGE increased the odds of being within the high CSVD group despite adjustment for significant clinical and demographic factors (OR 2.1, 95% CI 1.1 - 4.0).

Discussion:
In those with CMD as identified by CGE, there was a 2 fold increase in being within the high burden of CSVD cohort likely as a result of similar intrinsic pathological processes. Further studies are needed to determine whether CGE predates development of CSVD, its association with development of acute cerebrovascular diseases and its influence on specific subtypes of CSVD.
Abstract TP189: Atrial Fibrillation, Age, And Ischemic Stroke Severity In A Nationally Representative Dataset
Authors: Steinberg Amy , Pankaj Preethy , Marsden Katelyn , de Havenon Adam , Davis Arielle , Kalani Rizwan , Longstreth W T , Tirschwell David L
Published: February 2022

Introduction:
Atrial fibrillation (AF), a well-defined ischemic stroke (IS) risk factor whose prevalence increases with age, is associated with higher stroke severity. We aimed to evaluate stroke severity and hospital mortality in a nationally representative sample of AF-related IS patients.

Methods:
We utilized data from the National (Nationwide) Inpatient Sample databases from 2015 - 2018 using ICD-10 diagnostic codes to identify individuals with IS and comorbid AF. The NIHSS was used to characterize stroke severity in a subset of cases after 10/1/2016. Nonparametric statistics and logistic regression analyses were conducted to evaluate associations between AF and hospital death.

Results:
Of the 382,758 IS cases, 99,566 (26%) had comorbid AF. AF increased linearly with age, reaching at 47% of all hospitalized IS patients 85+ years of age or older (Figure). Higher age, male sex, white race, obesity, and higher median income were associated with comorbid AF, whereas diabetes, hypertension, tobacco use, and hyperlipidemia were associated with reduced odds of comorbid AF. While 5.8% of all IS patients died during hospitalization, mortality was increased nearly two-fold in those with AF (9.0% vs. 4.6%, p<.001). Among in-hospital deaths from IS, comorbid AF increased with age, present in 59% of those 85+ years of age or older (Figure). NIHSS, reported in 21% of patients, was higher in AF patients (mean NIHSS 6 vs. 9, p<.001). High NIHSS was the strongest independent predictor of hospital death.

Conclusion:
The burden of AF in a nationally representative sample of hospitalized IS patients is substantial, present in nearly 50% of the 85+ age group. AF-related IS is more severe and more likely to be fatal. As our population ages, the prevalence of AF will only increase. Understanding the severity and fatality of AF-related IS will have profound implications for health systems and may better facilitate anticipatory guidance and AF treatment.
Abstract TP192: Plasma Mid-regional Pro-adrenomedullin Reflects Ischemic Penumbra In Acute Ischemic Stroke
Authors: Ishiyama Hiroyuki , Tanaka Tomotaka , Saito Satoshi , Koyama Teruhide , Inoue Manabu , Fukushima Naoya , Koga Masatoshi , Toyoda Kazunori , Kuriyama Nagato , Ihara Masafumi
Published: February 2022

Background:
Adrenomedullin (AM), an endogenous peptide, is secreted in response to cerebral ischemia, contributing to neuroprotection by exerting anti-inflammatory and vasodilatory effects. Although previous studies showed elevated levels of mid-regional fragment of pro-AM (MR-proAM), a stable marker of AM, predict unfavorable outcome in acute ischemic stroke (AIS), the role of the biomarker remains to be determined.

Methods:
Firstly, plasma MR-proAM levels were measured in consecutively enrolled patients with AIS within 4.5 hours of the onset and compared with those of healthy controls. Propensity score was used to match the baseline difference. Secondly, variables associated with the increased MR-proAM levels were evaluated in AIS. Finally, it was determined whether MR-proAM levels are associated with a large penumbra which was defined as ICA/M1 occlusion with NIH stroke scale ≥ 6 and ischemic core volume ≤ 50 ml calculated by the RAPID software.

Results:
MR-proAM levels in AIS (n = 122; median age, 77 years; male, 59%; median NIHSS 6.5) were higher (median 0.68 vs. 0.42 nmol/L, p < 0.001) compared with controls (n = 1298; median age, 58 years; male, 33%). The difference remained after matching of baseline (p=0.004). In patients with AIS, MR-proAM levels were correlated with NIHSS (r = 0.367, p < 0.001) and eGFR (r = -0.527, p < 0.001). MR-proAM levels did not correlate with ischemic core volume (r = 0.065, p = 0.478), but significantly increased in AIS patients with cardioembolic stroke (CES) (n = 53) (0.80 vs. 0.59 nmol/L, p < 0.001) and ICA/M1 occlusion (n = 40) (0.78 vs. 0.63 nmol/L, p = 0.048). Interestingly, MR-proAM levels were higher (0.85 vs. 0.62, p < 0.001) in AIS patients with a large penumbra (n = 24) compared to those without (n = 98), and the difference remained after adjustment of baseline factors (OR [95% confidence interval], 1.43 [1.10-2.02], p = 0.004).

Conclusions:
MR-proAM levels increase in patients with AIS, especially in those with large vessel occlusion and clinical imaging mismatch. MR-proAM is a potential biomarker for ischemic penumbra.