bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP91: Baseline Comorbidities and Functional Status Are Associated With Subacute Post-Stroke Aphasia Severity
Authors: Johnson Lorelei P , Hirsch Mark , Jacks Adam , Haley Katarina
Published: February 2024

Speech or language changes are just one of the critical stroke warning signs. While symptoms may resolve with treatment, there are individuals for whom aphasia persists. The purpose of this study was to develop a better understanding of which factors are associated with aphasia status in the first six months after left hemisphere stroke to aid clinicians in discussing prognosis and preparing patients for what to expect in recovery. The sample consisted of a subset of individuals from a large, ongoing, federally funded, observational study of speech and language profiles, for whom an NIH Stroke Scale (NIHSS) total score was available (N=59, 35 female, mean age at stroke= 65 years, range = 38-92). We analyzed the complex interaction between the baseline medical (reperfusion/surgical intervention; comorbid hypertension, atrial fibrillation, high cholesterol, diabetes), functional (NIHSS total score), and demographic (age, sex, race) characteristics associated with the Quick Aphasia Battery (QAB) overall score, a measure of aphasia severity, using multiple linear regression. An additional one-way ANOVA was conducted to examine the relationship between baseline (NIHSS language subtest rating) and subacute aphasia status. The multiple linear model of the relationship between baseline factors and subacute aphasia severity was significant (F(114, 43)=1.956, p=0.047), though it accounted for less than 40% of the variance in aphasia severity scores. Of the factors included in the model, hypertension (F(1, 43)=4.513, p=0.039) and NIHSS total score (F(1, 43), p<0.001) were significant. In our secondary analysis, the one-way ANOVA was significant (F(3, 50)=6.106, p=0.001) with individuals rated as normal having, on average, a 3 point difference (p=.001) in overall QAB score from those rated as mute at baseline. This study examined the association between baseline comorbidities and functional status in adults with subacute post-stroke aphasia. We noted that hypertension and baseline NIHSS total score are significantly related to aphasia severity as measured by the QAB overall score in the subacute phase. Although much variation exists, our results may indicate that those with unimpaired language at baseline tend to perform better later in recovery.
Abstract WMP10: Carotid Floating Thrombus; Medical Management and Outcomes
Authors: Aboul-Nour Hassan O , AlShaer Qasem , khalid Fatima , Osehobo Ehizele , Tarek Mohamed A , Mohammaden Mahmoud H , Dolia Jaydevsinh N , Haussen Diogo C
Published: February 2024

Background:
Carotid free-floating-thrombus(CFT)is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by contrast. Unfortunately, there is no clear consensus among experts on the ideal treatment for CFT.

Methods:
Retrospective analysis of acute ischemic stroke(AIS)patients diagnosed with internal carotid CFT on CTA between January2015-March2023.We aimed to compare two treatment regimens: antiplatelet(APT) and anticoagulation(ACT) in the treatment of CFT. APT regimens included the use of dual or single APT (aspirin, clopidogrel and ticagrelor) and ACT regimens included the use of direct oral anticoagulants, warfarin, heparin or low molecular weight heparin+/-aspirin. Patients that underwent thrombectomy were excluded.

Results:
During study time there were 8252 AIS patients, of which 137(1.6%) patients were diagnosed with CFT. Sixty-six patients were included in our analysis. Patients assigned to APT were older (60.4years
+
12.8;p<0.01)
(Table 1)
.Other demographic variables were similar between groups. Complete CFT resolution by repeat imaging was comparable between groups at 30 days (58.8vs31.6%;p=0.1) and at latest follow-up (70.8vs50%;p=0.1) on ACT vs APT, respectively. There were similar rates of any ICH (13.5vs27.6%;p=0.5), PH1/2, independence at discharge and similar hospital length of stay between APT and ACT groups, respectively (
Table 1
). Patients assigned to APT were more likely to be discharged on their assigned treatment compared to those assigned to ACT (86.5vs55.2%;p<0.001).The rate of recurrent AIS was comparable among APT and ACT at 30 days (0vs3.4%;p=0.1,respectively).Sensitivity analysis comparing DAPT to exclusive ACT lead to similar results.

Conclusion:
Our study showed comparable efficacy and safety outcomes in CFT patients who were exclusively managed with APT vs ACT. Larger prospective studies are needed.
Abstract WMP100: Cardiovascular Outcomes in Adult Patients With Atrial Septal Defect: A Nationwide Population-Based Study
Authors: Jung Jin-Man , Lee Jue Seong , Shin Hong Ju
Published: February 2024

Objective:
It is currently unknown whether closing atrial septal defects (ASDs) could reduce cardiovascular events and mortality in adult patients with ASD. This study aims to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults.

Methods:
We conducted a retrospective analysis of the Korean National Health Insurance Service benefit records spanning from 2002 to 2020. From this dataset, we identified patients aged 20 years or older who received a diagnosis of ASD based on ICD-10 codes between 2004 and 2015. Participants were categorized into three groups: observation, device closure, and surgery closure, based on the method of ASD closure. To mitigate imbalances among the groups, we employed propensity score matching (PSM) in a 2:1:1 ratio, considering variables such as sex, age, comorbidities, and medications. We utilized the Cox proportional hazard model to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), and all-cause death, and each component among the three groups.

Results:
A total of 20,643 ASD patients were initially included in the study. After PSM, 6,636 patients were assigned in the observation group, and 3,318 patients were selected in each of the device and surgery closure groups. Over a 5-year follow-up period, the adjusted hazard ratios (aHRs) for MACE were 0.72 (0.66-0.79) in the surgery group and 0.85 (0.78-0.92) in the device group, using the observation group as the reference. For stroke, the aHRs were 0.46 (0.39-0.56) in the surgery group and 0.47 (0.39-0.57) in the device group. Regarding MI, the effect between the surgery/device closure groups and the observation group was comparable [0.83 (0.64-1.06) and 0.98 (0.77-1.25), respectively]. The aHRs for all-cause death were 0.43 (0.34-0.55) in the surgery group and 0.18 (0.12-0.26) in the device group.

Conclusions:
The favorable cardiovascular outcomes observed after ASD closure (surgery or device) were sustained even in adult ASD patients when compared to the observation group. Moreover, the preventive effect on each cardiovascular outcome after ASD closure varied depending on the treatment approach.
Abstract WMP12: Acid-Formulated Malonate Improves Neuroprotection Ischemia-Selective in a Mouse Model of Ischemic Stroke
Authors: Lee Jordan , Prag Hiran , Mottahedin Amin , Murphy Mike , Krieg Thomas
Published: February 2024

Background:
Malonate, a competitive inhibitor of succinate dehydrogenase, has shown much promise in ameliorating ischemia/reperfusion injury (IRI) in various diseases, including ischemic stroke. Its uptake via the monocarboxylate transporter 1 (MCT1) is enhanced by a decrease in local pH, enabling it to be preferentially taken up by ischemic tissue. We investigated whether an acid-formulated malonate could enhance uptake of malonate and, consequently, protection against stroke IRI.

Methods:
C57BL/6J mice were treated intravenously with either saline or malonate (640/320 mg/kg) at physiological (7.4) or low pH (6.0). Brain malonate levels were assessed by liquid chromatography-tandem mass spectrometry LC-MS/MS. For the transient middle cerebral artery occlusion (tMCAO) stroke model, mice were subjected to 30 mins ischaemia followed by either 2 hour reperfusion. Brain infarct size was assessed by TTC (2,3,5-triphenyl-2H-tetrazolium chloride) staining.

Results:
Malonate was acutely protective against stroke IRI with a reduction in brain infarct size from 21.98% to 6.57% after 2 hours of reperfusion. Malonate uptake into the brain
in vivo
dramatically increased when infused at pH 6 compared to neutral malonate. Furthermore, acid-formulation greatly enhanced the neuroprotective potency of malonate, enabling protection at a much lower dose compared to its non-acidic counterpart.

Conclusions:
Malonate is neuroprotective against stroke IRI. Its uptake via MCT1 and, ultimately its neuroprotective potency can be enhanced by acid formulation of the drug.
Abstract WMP15: Do Changes in Blood Brain Barrier Permeability Mediate the Association Between White Matter Hyperintensities and Post-Stroke Clinical Outcome?
Authors: Okine Derrick , Kern Kyle , Egle Marco , Luby Marie L , Latour Lawrence , Gottesman Rebecca F
Published: February 2024

Introduction:
White matter hyperintensities (WMH) are associated with worse clinical outcomes after stroke. Our objective was to test whether blood brain barrier (BBB) permeability mediates the association between WMH and clinical outcome.

Methods:
In acute ischemic stroke patients who received tPA but not EVT, we quantified WMH volume on baseline FLAIR MRI scans using a deep learning algorithm and calculated WMH fraction (WMH volume/total intracranial volume). Hyperintense acute reperfusion injury marker (HARM) was evaluated for presence and severity at 24 hours on post-gadolinium FLAIR. Using logistic regression, we tested the associations between WMH fraction, presence and severity of HARM, and clinical outcomes. Finally, we used structural equation models to evaluate whether severe HARM mediated the relationship between WMH fraction and clinical outcomes including early neurological improvement (ENI), hemorrhagic transformation (HT), discharge NIHSS (dNIHSS), and 90-day modified Rankin Scale (mRS)).

Results:
Of 264 patients included in this study, (mean age 68 years, 44% female) 26% had severe HARM at 24 hours post-stroke and 25% had any HT (<5% with PH2). WMH fraction was associated with a higher risk of severe HARM (OR: 1.35, 95% CI: 1.03-1.78) after adjusting for demographics, vascular risk factors, plus NIHSS and infarct volume. WMH fraction was associated with dNIHSS, HT, and 90-day mRS in minimally adjusted models. In a mediation analysis, severe HARM explained a significant portion of the associations between WMH fraction and dNIHSS (35% mediation), 90-day mRS (28% mediation), or HT (40% mediation), each, in our demographics-adjusted models.

Conclusions:
Severe HARM partially mediates a significant portion of WMH’s effects on post-stroke clinical outcomes. Future studies should evaluate the mechanism behind this association and how the longitudinal effects of WMH on the BBB may be prevented.
Abstract WMP3: Effect of Ginkgo Diterpene Lactone Meglumineonthe Quality of Lifein Patients With Acute Ischemic Stroke
Authors: Zhang Qian , Wang Anxin , Xu Qin , Xia Xue , Tian Xue , Zhang Yijun , Zhang Yijun , Meng Xia , Zhao Xianquan
Published: February 2024

Objective:
To explore the effect of ginkgo diterpene lactone meglumine on the quality of life in patients with acute ischemic stroke.

Methods:
This was a randomized, double-blind, placebo parallel-controlled, multicenter clinical trial. Patients with acute ischemic stroke within 48 hours of onset were enrolled. Patients received ginkgo diterpene lactone meglumined injection or placebo for 14 days. The ginkgo diterpene lactone meglumine group was treated with ginkgo diterpene lactone glucamine, and the placebo control group was treated with mimic ginkgo diterpene lactone glucamine injection. The outcomes were the change of EuroQol-visual analogue scales (EQ-VAS) total score at day 14 and day 90 after randomization and the different dimension score of EuroQol-5 Dimensions.

Results:
A total of 3452 patients from 100 centers were randomized, of which 3219 patients with complete data on EQ-5D at baseline, day 14, and day 90 were included in the analysis, with 1615 patients received ginkgo diterpene lactone meglumine injection and 1604 patients received placebo.The EQ-VAS scores of the two groups increased after treatment, the average change of EQ-VAS scores at Day 14 and Day 90 in ginkgo diterpene lactone meglumine group was 18.16 [95% confidence interval (CI), 17.51-18.81] and 26.30 (95% CI, 25.64-26.95), respectively, which was significantly higher than that in the placebo control group (
P
<0.05). EQ-5D subentry analysis showed that the scores of each dimension were significantly higher than those in the placebo control group (
P
<0.05).

Conclusions:
Ginkgo diterpene lactone meglumine can effectively improve the quality of life for patients with acute ischemic stroke.
Abstract WMP31: Lifetime Trauma Exposure Types Are Linked to Stroke Recovery: Findings From the STRONG Study
Authors: Holman Alison , Cramer Steven C ,   The STRONG Study
Published: February 2024

Introduction:
The STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study has documented the role of cumulative lifetime stress/trauma exposure (LSE) in stroke recovery. Understanding the types of trauma most closely linked with functional outcomes may identify specific risk factors for stroke recovery. We examined specific types of life stress linked with functional and cognitive disability at 1-year post-stroke.

Methods:
Adults with a new stroke enrolled at 28 US sites were assessed 4 times over 1 year. Assessments included LSE 90 days post-stroke, and Stroke Impact Scale (SIS), modified Rankin Scale (mRS), & Telephone Montreal Cognitive Assessment (tMOCA) at 1-year post-stroke. Bivariate and multivariate analyses examined relationships among LSE and outcomes.

Results:
The 763 enrollees had age 63.1±14.9 yrs; initial NIHSS score 4 [2-9]; 41.2% Female; 69.4% White. Controlling for age, gender, race, and 3-mo NIHSS score, lifetime exposure to being raped was associated with worse SIS-ADL, mRS, and tMOCA scores 12-mo post-stroke. Several other LSE were also independently associated with worse 12-mo SIS-ADL scores: witnessing a family member be injured or killed, divorce, and emotional abuse. Having a loved one be seriously ill was associated with better 12-mo t-MOCA scores. These findings were robust when early post-stroke acute stress levels were also included in the model. Women were significantly more likely to report being raped, experiencing emotional abuse, and having a seriously ill loved one. Demographics were not significantly associated with divorce or witnessing a family member injured or killed.

Conclusions:
Assessing specific types of exposure to LSE early in the post-stroke period may help identify at-risk patients who might benefit from additional post-stroke support to enhance their long-term functional and cognitive abilities.
Abstract WMP37: Neighborhood Socioeconomic Status, Race and Prehospital Emergency Care and Time to Presentation for Stroke
Authors: Royan Regina , Stamm Brian , Lin Timmy , Baird Janette , Becker Christopher , Karb Rebecca , Burton Tina M , Kleindorfer Dawn O , Prabhakaran Shyam , Madsen Tracy E
Published: February 2024

Introduction:
It is unclear how neighborhood socioeconomic status (nSES) affects the pre-hospital recognition and care of acute stroke at the national level.

Methods:
Patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the Get With the Guidelines-Stroke registry, presenting from July 2015 to December 2019, with symptom onset <24 hours were included. Social deprivation index (SDI) at the county level approximated nSES. Logistic and quantile regressions evaluated the impact of SDI on EMS use, EMS prenotification, and time of symptom onset to emergency department (ED) arrival. Sequential models were adjusted for patient age, gender, race, vascular risk factors, arrival mode, stroke severity (NIHSS), and insurance status.

Results:
634,823 patients met inclusion criteria. Patients were 51.2% Male, 67.1% White, with median NIHSS of 4 (IQR: 2-10), and median SDI of 51 (IQR: 27-75). Median symptom onset to arrival time was 176 mins (IQR: 63-565). SDI was not associated with differences in EMS use, but was associated with lower odds of EMS prenotification (upper SDI tercile vs lowest, OR 0.87, 95% CI 0.86-0.89). SDI was also significantly associated with stroke symptom onset to ED arrival time (upper SDI tercile vs lowest +2.72 mins, 95% CI 0.68-4.77); however, this association became nonsignificant when insurance was added to the model. By contrast, Black race was significantly associated with prolonged symptom onset to ED arrival time (+28.7 mins, 95% CI 26.0-31.5), and decreased odds of EMS prenotification OR 0.76 (95% CI 0.74-0.77).

Conclusions:
Higher SDI was associated with reduced odds of EMS prenotification, despite similar odds of EMS use across SDI levels. Race had a greater effect, with prolonged prehospital times and decreased odds of EMS pre-notification. Efforts to reduce place-based disparities in stroke care must address significant race-based inequities which exist in pre-hospital recognition and care of stroke.
Abstract WMP38: Access to Acute Stroke Care: Global Perspective From Registry of Stroke Care Quality (RES-Q)
Authors: Mikulik Robert , Sedani Rupal , Asif Kaiz S , Bornstein Natan M , Hill Michael D , Lavados Pablo , Martins Sheila C , Middleton Sandy , Sohn Sung-il , Suwanwela Nijasri , Sylaja PN , Nguyen Huy Thang , Tsivgoulis Georgios K , Van Der Worp H B
Published: February 2024

Introduction:
Disparities in access to acute stroke care represents a major global challenge. Addressing such challenges requires a comprehensive understanding of the variations in stroke care quality between nations.

Methods:
We used data from the global Registry of Stroke Care Quality (RES-Q). RES-Q is web-based quality monitoring platform for the management of stroke care. Key quality metrics on patients with acute ischemic stroke admitted in 2022 were calculated: patients percentage arriving by Emergency Medical Services (EMS); patients percentage admitted to the Stroke Unit/Intensive Care Unit (ICU); Door-to-Imaging Time (DIT), Door-to-Needle Time (DNT) for intravenous thrombolysis.

Results:
Of 153 181 patients across 912 hospitals in 67 countries enrolled in the register, 125 390 had acute ischemic stroke. After excluding secondary transfers (n=26 648), missing or erroneous data (n=45 526), and countries with <200 cases (n=1 410), a total of 51,806 patients from 696 hospitals and in 30 countries were analyzed. The percentage of patients arriving at healthcare facilities by EMS varied from 3% to 98% (median 51%; IQR 26-87) and admitted to the Stroke Units/ICUs from 25% to 99% (median 78%; IQR 47-89). The median DIT was 32; IQR 21-39, with range 10-60 minutes. The median DNT was 44; IQR 31-52, with range 20-71 minutes. Median DNT of patients admitted directly to the CT scanner was 24 minutes (IQR 15-38), and, if admitted to the emergency department, DNT was 39 minutes (IQR 25-55). Data by quartiles (best is blue, worst is red) from each country are presented in a detailed Table below.

Conclusion:
Our study underscores the critical role of the global registry in enabling cross-national comparative analyses of acute stroke care quality. The findings highlight disparities and variations in critical aspects of acute stroke care, paving the way for targeted interventions, policy reforms, and enhanced collaboration among stakeholders to improve stroke care globally.
Abstract WMP42: Trends of In-Hospital Strokes Over Time: Results From the Greater Cincinnati and Northern Kentucky Stroke Study
Authors: Nobel Lisa , Chulluncy Rivas Roberto , Robinson David , Stanton Robert J , Kissela Brett M , Ferioli Simona , Alwell Kathleen , Sucharew Heidi , Khatri Pooja , Adeoye Opeolu M , Broderick Joseph P , Mackey Jason , Woo Daniel , Flaherty Matthew , Martini Sharyl , DeLosRiosLa Rosa Felipe , Demel Stacie , Madsen Tracy , Star Michael , Coleman Elisheva R , Walsh Kyle , Slavin Sabreena , Jasne Adam S , Mistry Eva , Haverbusch Mary , Kleindorfer Dawn O
Published: February 2024

Background:
Prior studies have shown that individuals who have an in-hospital stroke are less likely to receive thrombolysis. Few studies have investigated the trends of in-hospital strokes over time, and many large databases do not include in-hospital strokes. We aimed to determine how in-hospital strokes compared to out-of-hospital stroke over time in terms of number of strokes, treatment, and 30-day mortality.

Methods:
Within the Greater Cincinnati Northern Kentucky area, all incident strokes among adult residents were ascertained at all hospitals during July 1993-June 94, calendar years 1999, 2005, 2010, 2015. Data for all potential cases were adjudicated by study physicians. We defined in-hospital strokes as all physician adjudicated strokes that happened when the patient had already been admitted for a condition aside from stroke. Out of hospital strokes were patients who were not admitted to the hospital when their stroke symptoms. We used national death index data to determine death at 30 days post-discharge.

Results:
Among 13134 strokes from 1993-2015, 1152 (9%) occurred in the hospital. The percentage of in-hospital strokes over time stayed similar (Figure 1). Overall, in-hospital strokes were more likely to be hemorrhagic in 2015 than in 1993/94; 12 % in 2015 vs. 3.6% in1993/94 (p=0.003). For both in-hospital and out-of-hospital strokes the percentage of ischemic strokes given thrombolysis increased over time (2% vs. 3% in 1993 compared to 12% vs. 10% in 2015 for in-hospital and out-of-hospital strokes respectively). 30-day mortality rate was higher for in-hospital strokes compared to out of hospital strokes throughout all study years (30.1% for in-hospital strokes and 13.4% for out of hospital strokes; p<0.001).

Conclusions:
We found in this population-based study that although the rate of thrombolysis is increasing for in-hospital strokes; 30-day mortality outcomes are still much worse.
Abstract WMP46: Rurality Affects Access to Mechanical Thrombectomy for Large Vessel Occlusion Stroke on a Global Scale
Authors: Asif Kaiz S , Otite Fadar , Desai Shashvat , Herial Nabeel A , Al-Mufti Fawaz , Toth Gabor , Atchaneeyasakul Kunakorn , Limaye Kaustubh , Urrutia Victor C , Szeder Viktor , Ortega-Gutierrez Santiago , Yavagal Dileep R
Published: February 2024

Introduction:
Global mechanical thrombectomy access (MTA) for large vessel occlusion (LVO) stroke is extremely low. Rural patients are less likely to receive initial care at a thrombectomy-capable hospital. While regional studies have suggested rurality as a barrier to MTA, the magnitude and variability of this effect across countries is unknown. The aim of this study is to evaluate the association of country-level % of the rural population with access to mechanical thrombectomy.

Methods:
We conducted an online survey of 75 countries through the Mission Thrombectomy 2020+ (MT2020+) global professional peer network between November 22, 2020, and February 28, 2021. Questions included country-level availability of MT centers, operators, procedures, reimbursement, emergency medical services, cultural barriers, and other factors affecting systems of stroke care. MTA was defined as the estimated proportion of patients with thrombectomy-eligible LVOs receiving MT in each region annually. We used the World Bank data to obtain the income class based on per capita GNI of a country and the proportion of rural population expressed as % of total population of each country. In the final analysis, 60 countries were included. We used multivariable-adjusted generalized linear models with logit link to evaluate the association of rural population % with MT access.

Results:
The median country-level % of rural population among 60 countries was 30.5% (IQR 16.1-45.7%). In univariable generalized linear models, each 5% increase in country-level % of rural population was associated with 22% lower odds of MT access (OR 0.78, 95%CI 0.70-0.86, p<0.001). After adjustment for differences in country-level % of GDP spent on healthcare, reimbursement for MT, country’s income class, prehospital emergency services (EMS) system availability, training, and triage systems, each 5% increase in % of rural population was associated with 6% lower odds of MT access (OR 0.94, 95%CI 0.90-0.99, p=0.013).

Conclusion:
The % of rural population of countries is a significant independent negative predictor of access to mechanical thrombectomy. The % of rural populations and its distribution within countries needs to be carefully studied, as policies to improve access are created and implemented.
Abstract WMP49: Outcomes of Patients With Cerebral Venous Thrombosiswith and Without COVID-19 Infection
Authors: Arora Rohan , Srinivasan Pavitra , Omprakash Omina , Ballur Narayana Reddy Varalakshmi , Nagaraja Nandakumar
Published: February 2024

Introduction:
COVID-19 infection has thus emerged to be a new risk factor for Cerebral Venous Thrombosis (CVT). Our study aimed to compare outcomes of patients diagnosed with CVT within 2 weeks of COVID infection compared to those without COVID-19.

Methods:
Adult patients with CVT diagnosis from 2020-2022 in TriNetX COVID research network were included in the study. Patients diagnosed with COVID within 2 weeks of CVT diagnosis were defined as CVT with COVID. CVT without COVID group included those without COVID diagnosis any time before and up to three months after diagnosis of CVT. All-cause mortality was the primary outcome. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), epilepsy, deep vein thrombosis and pulmonary embolism were secondary outcomes. 1:1 propensity score matching was performed to control for age, sex, race, ethnicity, obesity, malignancy and medications. The two groups were compared with cox proportional hazard analysis and reported as hazard ratio (HR) and 95% confidence interval (CI).

Results:
A total of 424 patients with CVT and COVID-19 and 8,969 patients with CVT without COVID met the study criteria. After 1:1 propensity score matching, 422 patients were included in both cohorts. The group CVT with COVID-19 infection within two weeks of diagnosis of CVT had two times higher risk of all-cause mortality at one month [31 (7.3%) vs 16 (3.8%); HR=1.94; 95% CI=1.06-3.55] and three months [43 (10.2%) vs 17 (4.0%); HR=2.57; 95% CI=1.46-4.50] compared to CVT without COVID. CVT patients with COVID were two times more likely to have complications of ICH [1 month: 11.6% vs 5.5%; HR=2.16; 95% CI=1.23-3.64 and three months: 11.6% vs 6.3%; HR=1.90; 95% CI=1.15-3.13] and SAH [1 month: 8.3% vs 4.2%; HR=2.00; 95% CI=1.11-3.59 and three months: 8.3% vs 4.5%; HR=1.89; 95% CI=1.07-3.36]. CVT with COVID patients were more likely to develop deep vein thrombosis at one month (19.8% vs 13.6%; HR=1.51; 95% CI=1.04-2.20) but not at three months. There was no difference in diagnosis of AIS, epilepsy and pulmonary embolism at one and three months in the two groups.

Conclusion:
CVT patients with COVID-19 infection in the prior two weeks are two times more likely to die and have complications of ICH and SAH compared to CVT without COVID-19.
Abstract WMP50: Disparities of Interhospital Transfer for Mechanical Thrombectomy in Acute Stroke in US
Authors: Choudhury Faisal , Saber Hamidreza
Published: February 2024

Introduction:
A large proportion of mechanical thrombectomies (MT) in acute stroke include patients transferred from an outside hospital to thrombectomy capable centers. However, patient characteristics associated with the odds of transfer is unknown. We explored the US national claims database to explore predictors of interfacility transfer in MT hospitalizations using a nationally representative sample.

Methods:
National Inpatient Sample database was retrospectively explored from 2016 to 2020 for stroke hospitalizations with EVT. The primary outcome was transfer status from the presenting emergency department of MT-capable hospital. Multivariable logistic regression models with multiple robustness checks were performed to determine patient characteristics with the odds of transfer.

Results:
This study included 100,865 patients with MT, of whom 32,685 patients (32.4%) were transferred (median [IQR] age, 71 [60-81] years; 16775 women [51.2%]; 23090 White individuals [74.9%]; 3715 Black individuals [12.1%]; 1875 Hispanic individuals [6.1%]; 895 Asian individuals [2.9%]). White race, higher baseline NIHSS, hospital size and status (urban teaching vs rural), and hospital location were independent predictors of interfacility transfer for MT.

Conclusion:
Nearly one in 3 MTs in the US is performed in patients presenting following transfer from another acute care hospital. Analysis of population level data utilizing the National Inpatient Sample database shows disparities in the transfer of patients with minority backgrounds (Black, Hispanic, Asian) for MT. Urban teaching centers, larger hospitals, higher baseline NIHSS, and hospital location (northeast and midwest) were more likely to receive Interhospital MT transfers regardless of race.
Abstract WMP55: Advance Care Planning and Decision Regret Among Stroke Surrogate Decision Makers
Authors: Zahuranec Darin B , Becker Christopher , Ortiz Carmen , Lank Rebecca , Zhang Guanghao , He Kevin , CASE Erin , Morgenstern Lewis
Published: February 2024

Introduction:
There has been limited study of outcomes among surrogate decision makers who make decisions on life-sustaining treatments after severe stroke. We investigated surrogate reports of decision regret after stroke and investigated whether prior advance directives were associated with decision regret.

Methods:
Ischemic stroke and intracerebral hemorrhage stroke cases and their surrogate decision makers were enrolled in the Outcomes Among Surrogate Decision Makers in Stroke (OASIS). Surrogates reported the baseline presence of formal written advance care plans and the validated decision regret scale (range 0-100, higher=more regret, analyzed as “any” vs. “none” due to skewed data) in the year after stroke (post-discharge, 3-,6-, and 12-months). The association of advance care planning and decision regret was assessed with multilevel mixed effects logistic regression models, adjusted for pre-specified covariates.

Results:
A total of 317 surrogates for 255 stroke patients were enrolled (4/2016 to 10/2020). Patient characteristics were mean age: 74.6, Female: 51.8%, Mean NIHSS: 14.7, deceased at 3 months: 53.1%. Surrogate characteristics were mean age: 55.8, female: 76.7%, child of patient: 62.1%, and race-ethnicity (Mexican American 62.8%, non-Hispanic White 32.2%, other 5.1%). Overall, 132/317 (41.64%) surrogates reported advance care plans. Decision regret scores tended to be low overall (post-discharge mean score: 11.2, SD: 20.2, 39.1% had regret scores >0). On both unadjusted (OR 0.42, 95% CI 0.22-0.79, p=0.01) and fully adjusted regression analyses (OR 0.46, 95% CI 0.24-0.89, p=0.02, see Table), advance care plans were associated with lower odds of decision regret. Prior surrogate discussion of patient wishes without formal written advance care plans did not affect decision regret (data not shown).

Conclusions:
Advance care plans were protective against decision regret among surrogate decision makers in the year after stroke.
Abstract WMP71: Association Between Functional Network Connectivity, Retina Structure and Microvasculature, and Visual Performance in Patients After Thalamic Stroke: An Exploratory Multi-Modality Study
Authors: Zhang Xuening , Ye Chen , Wu Bo
Published: February 2024

Introduction and Hypothesis:
Neuro-ophthalmologic symptoms and retinal changes have been increasingly observed following thalamic stroke, and there is mounting evidence indicating distinct alterations occurring in the vision-related functional network. However, the intrinsic correlations between these changes are not yet fully understood. Our objective was to explore the altered patterns of functional network connectivity and retina parameters, and their correlations with visual performance in patients with thalamic stroke.

Methods:
We utilized resting-state functional MRI to obtain multi-modular functional connectivity (FC), and optical coherence tomography-angiography to measure various retina parameters such as the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIP), superficial vascular complex (SVC), and deep vascular complex (DVC). Visual acuity (VA) was used as a metric for visual performance.

Results:
We included forty-six patients with first-ever unilateral thalamic stroke (mean age 59.74 ± 10.02 years, 33 males). Significant associations were found between FC of Attention-to-Default Mode and SVC, RNFL, and GCIPL, as well as between FC of Attention-to-Visual and RNFL (p<0.05). Both RNFL and GCIPL exhibited significant associations with FC of Visual-to-Visual (p<0.05). Only GCIPL showed an association with VA (p= 0.038). Stratified analysis based on a disease duration of 6 months revealed distinct and significant linking patterns in multi-modular FC and specific retina parameters, with varying correlations with VA in each subgroup.

Conclusion:
These findings provide valuable insight into the neural basis of the associations between brain network dysfunction and impaired visual performance in patients with thalamic stroke. Our novel findings have the potential to inform future targeted and individualized therapies. However, further comprehensive studies are necessary to validate our results.
Abstract WMP78: Mobile Stroke Units Enable Hyperacute Interventions for Intracerebral Hemorrhage
Authors: Zhang Andrew , Askari Elham , Huang Merry , Koroneos Nicholas , Dang Johnny , Chin Stella , Smith Chelsea , Falcon Orozco Michelle , Buttrick Maureen F , Mathew Jason , Buletko A Blake
Published: February 2024

Introduction:
Mobile stroke units (MSUs) are an evolving means to expedited acute stroke management. Recent landmark trials BEST-MSU and B_PROUD have proven that MSUs facilitate quicker thrombolysis times and improved functional outcomes at 90 days when compared to conventional emergency medical services (EMS) for acute ischemic stroke patients. Despite the growing body of literature surrounding MSUs and acute ischemic stroke, literature describing the intracerebral hemorrhage experience in MSUs has been lacking.

Methods:
Retrospective analysis of consecutive patients with acute intracerebral hemorrhage triaged by MSU or EMS from January 2018 to December 2022 was performed at two tertiary institutions. In the EMS cohort, only patients seen between 8 am to 8 pm, corresponding to the operating hours of the MSU, were included. Goal blood pressure was defined as systolic blood pressure <160. Chi-squared test for categorical variables and t-test for continuous variables were used for statistical analysis.

Results:
A total of 146 MSU patients were compared to 221 EMS patients. Both cohorts had similar baseline demographics. Median initial blood pressure in the MSU was 190/99, which dropped to a median blood pressure of 157/80 upon arrival to the hospital. Initial systolic blood pressure in the hospital was significantly higher for EMS compared to MSU patients (166 vs 157, p=0.011). The majority (77%) of MSU patients received anti-hypertensive medications while in the MSU. Times from door to CT completion (14 vs 33 min, p=0.000), anticoagulation reversal (99 vs 139 min, p=0.013), anti-hypertensive medication administration (21 vs 45 min, p=0.020), and goal blood pressure (35 vs 51 min, p=0.000) were significantly faster in the MSU cohort.

Conclusions:
MSUs provide faster medical treatment for patients with acute intracerebral hemorrhage. The target blood pressure goal was met much quicker in the MSU. Faster time metrics convey a hypothetical benefit towards improved patient outcomes.
Abstract WMP80: 20 Year Incidence and Outcomes for Intracerebral Hemorrhage During Pregnancy: A Nationwide Study
Authors: Mehta Amol , Hardigan Trevor , Kellner Christopher P , Johanna Fifi , Mocco J D , Majidi Shahram
Published: February 2024

Introduction:
Pregnant patients are at risk of neurological complications including intracerebral hemorrhage (ICH). We aim to further characterize this risk and its in hospital consequences using a large population based sample over a 20 year study period.

Methods:
Using the Nationwide Inpatient Sample (2000-2019), we selected for patients who had ICH. We compared characteristics between pregnant and non-pregnant patients using t-tests and chi-squared tests. A 1:1 propensity score matched cohort was generated. Variables with standardized mean differences >0.1 were used in multivariable regression to generate adjusted odds ratios (AOR)/beta coefficients to determine the impact of pregnancy on outcomes.

Results:
In our study involving 2,000,675 ICH patients, 5,107 were pregnant (0.26%). We observed an increasing trend of ICH among pregnant individuals. Pregnant patients were notably younger (30.63 vs 63.38, p<0.001) and had fewer comorbidities such as cancer and chronic kidney disease, atrial fibrillation, hypertension, hyperlipidemia. Interestingly, a greater percentage of pregnant ICH patients African American (25.0% vs 16.2%, p<0.001). Pregnant patients experienced lower in-hospital mortality (12.4% vs 24.7%, p<0.001) and were more frequently discharged home or to short-term hospital (53.8% vs 23.2%, p<0.001). After propensity matching, pregnant patients shower lower odds of in-hospital mortality (AOR 0.68, p=0.008), but other outcomes including discharge outcomes and hospital charges remained similar.

Conclusion:
ICH is a rare complication in pregnancy, occurring in 0.26% of cases, and presenting roughly a 14% risk of in-hospital mortality. However, patients they appear to have lower rates of mortality than the overall ICH population. There may be a racial disparity in pregnancy related ICH as well, with African American experiencing this complication at a higher rate than other races.
Abstract WMP83: The Pentose Phosphate Pathway is Crucial for Combating Heme-Induced Ferroptosis in Red Blood Cells After ICH
Authors: Bories Gael , DeLong Jonathan , Sansing Lauren H
Published: February 2024

Intracerebral hemorrhage (ICH) occurs upon blood vessel rupture, allowing blood into brain tissue. Red blood cells (RBCs) make up 99%+ of blood cells. Brain-trapped RBCs undergo phagocytosis; however, many RBCs lyse prior to being phagocytosed due to their abundance. RBC lysis releases hemoglobin and toxic heme, driving oxidative stress especially in lipid-rich plasma membranes (PM), causing tissue damage and ferroptosis. Few studies have explored RBC fate in ICH, but unraveling the factors governing RBC lysis may yield ICH therapies.In in vitro human and murine RBC cultures, we observed RBCs are exquisitely sensitive to heme-induced death with increased oxidized fatty acids (FAs), a ferroptosis marker (Fig 1A-B). The ferroptosis inducer Erastin validated RBC susceptibility to ferroptosis (Fig 1C). Heme-induced cell death was countered by β-mercaptoethanol (β-ME), N-acetylcysteine (NAC), ferrostatin-1 (Fer-1) and Vitamin E (Vit. E), ferroptosis inhibitors, confirming RBC death was due to ferroptosis (Fig 1D-G). Heme and Erastin induced RBC ferroptosis differs from eryptosis, RBC specific programmed cell death, as it isn't Ca++ dependent (Fig1H&I). Unlike other cells, RBCs solely rely on the Pentose Phosphate Pathway (PPP) for NADPH production for oxidation defense. PPP inhibition with Dehydroisoandrosterone (DHEA) and treatment with ThioNa, an NADP+ synthesis inhibitor, both heightened heme-induced RBC ferroptosis (Fig 1J-L). These data support the PPP's role against heme-driven ferroptosis. Heme induced RBC ferroptosis may trigger a chain reaction of RBC lysis and ongoing heme release. Notably, 400 million people face G6PD deficiency, the rate-limiting PPP enzyme, leading to NADPH depletion in RBCs with enhanced susceptibility to oxidation. Hence, in addition to identifying the PPP in RBCs resistance to heme toxicity, our findings could aid in identifying a population that is particularly vulnerable to the devastating effects of ICH.
Abstract WMP84: The Impact of Pre-Morbid Antidepressant Exposure on the Risk of Intracerebral Hemorrhage: The Florida Stroke Registry
Authors: Saleh Velez Faddi , YING HAO , Gardener Hannah , Siddu Mithilesh , Alkhachroum Ayham , Yin Ruijie , Zhou Lili , Gordon Perue Gillian L , Bustillo Antonio , Koch Sebastian , Marulanda Erika T , Gutierrez Carolina M , Rundek Tatjana , Romano Jose G , Asdaghi Negar
Published: February 2024

Antidepressants (AD), particularly selective serotonin reuptake inhibitors (SSRIs), are amongst the most frequently prescribed medications. Concerns have been raised regarding their potential increased risk of bleeding complications including intracerebral hemorrhage (ICH) as they are known to affect platelet function. In the large Florida Stroke Registry (FSR), we sought to determine if pre-morbid use of AD impacted the risk of ICH

Methods:
Data collected from Jan 2010-Jun 2023 in FSR, GWTG statewide stroke registry comprised of 170 hospitals in the state of Florida was used to identify ischemic (IS) and hemorrhagic stroke cases with and without prior use of AD. Multivariate regression with generalized estimating equations, were used to determine whether premorbid-AD use was associated with an increased risk of ICH vs. ischemic stroke

Results:
A total of 219,558 stroke cases were identified (mean age 70.26±14.45; 52% male), among those 14% had pre-morbid AD use (age 72.13±13.23, 39% male). Patients on pre-morbid AD (vs no AD) were more likely White (75% vs. 62%) female (61% vs. 46%), with higher rates of vascular risk factors [(HTN (83%), DM (40%), HLD (61%), prior TIA (39%)]. The percentage of ICH was 11% and 14% amongst AD users and non-AD users respectively. In a multivariate model adjusting by multiple covariates, prior use of AD was not associated with an increased likelihood of presenting with ICH as opposed to IS (OR=0.72, 0.42-1.21). In the sensitivity analysis of subgroups of patients with data regarding the class of AD (SSRIs, Non-SSRIs) (n=657) or prior antiplatelet or anticoagulant therapies (n=740) premorbid SSRI use (vs no AD use) was not associated with increase ICH risk (OR=1.39, 95%CI 0.81-2.38 and OR=0.84, 0.64-1.10)

Discussion
In this large registry-based study we did not find an association between prior use of AD and increased risk of ICH as opposed to IS. Additionally, our findings were consistent among stroke patients with prior use of either antiplatelet or anticoagulants. These findings challenge the prevailing literature notion that AD, particularly SSRIs are linked to an increased risk of hemorrhages of all type. However, clinicians should consider individual patient's presentation, comorbidities and preferences when prescribing AD
Abstract WMP85: Outcomes in Transitioning From First-Line Conscious Sedation to General Anesthesia for Endovascular Thrombectomy
Authors: Charles Jude H , Castello Juan Pablo , Larinde Oluwagbemiga , Torolira Daniel , Lundy Neva , Peterson Eric , Starke Robert , Yavagal Dileep , Saini Vasu
Published: February 2024

Background:
Endovascular thrombectomy (EVT) is the standard of care for patients with large vessel occlusion stroke with salvageable penumbra. Recent meta-analysis of randomized clinical trials showed general anesthesia (GA) improved successful recanalization by 9% and functional independence by 8.4%.(1) In our comprehensive stroke center we transitioned from first-line conscious sedation (CS) to GA in q4 2017.

Methods:
Retrospective analysis of 505 patients undergoing EVT from January 2015 to May 2020 was performed. Demographics, procedural variables, and modified Rankin scale (mRS) at discharge were collected for each year. We appropriately used ANOVA and Chi-square tests to compare the variables for each year.

Results:
Median age was 72[61-82], 258(51%) male and median NIHSS was 17[10-20]. Average door-to-puncture (DTP) time was 104.2±28 minutes and procedure time was 44±28.7 minutes. Median ICU length of stay was 3[1-5] days. There was no difference in age, initial NIHSS, and DTP over the years. Average procedure time increased over the years, with 30.1min in 2015, 34min in 2016, 44.9min in 2017, 52.3min in 2018, 45.9min in 2019, and 50.4min in 2020[F (5, 499)=7.7, p<0.001]. Tukey's HSD indicated that the time was significantly higher when comparing years of CS(2015-2017) versus GA(2018-2020) (p< 0.001). Figure1 shows the distribution of cases, proportion of patients undergoing GA, successful recanalization (TICI 2c-3), and mRS 0-2 at discharge over the years. Successful recanalization was achieved in 129/218 (58%) patients with CS versus 198/287(69%) with GA(OR 0.7, CI 95%[0.5-0.9], P=0.02). MRS 0-2 at discharge was achieved in 71/218(33%) patients with CS versus 118/287(41%) with GA (OR 0.6, CI 95%[0.4-0.9], p=0.04).

Conclusion:
Overall, the rate of successful recanalization and mRS 0-2 at discharge significantly improved after the transition to GA. Though procedure time increased over the years, this did not affect outcomes.
Abstract WMP97: Stroke Risk After Emergency Department Treat-and-Release Visit for Fall
Authors: Kaiser Jed H , Zhang Cenai , Parikh Neal S , Kamel Hooman , Navi Babak B , Liberman Ava L
Published: February 2024

Introduction:
Previous cohort studies of hospitalized patients with a delayed diagnosis of ischemic stroke have found that these patients often had an initial admitting diagnosis of fall from the ED. We sought to evaluate whether ED visits resulting in discharge to home (i.e., treat-and-release) after a fall were associated with increased short-term stroke risk.

Methods:
A case-crossover design was used to compare ED visits for falls during case periods (0-15, 16-30, 31-90, 91-180, and 181-365 days prior to stroke) and control periods (equivalent time periods exactly 1 year prior to stroke) using administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across New York and Florida from 2016-2018. To identify ED treat-and-release visits for falls, we used previously validated
ICD-10-CM
injury codes. To identify patients hospitalized for ischemic stroke, we used previously validated
ICD-10-CM
codes. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression.

Results:
We identified 62,849 hospitalized ischemic stroke patients, of whom 4,693 (7.5%) had an ED treat-and-release visit for fall one year prior to their stroke. Patients with an ED treat-and-release visit for fall were older (mean age 77 years [SD 14] vs 71 years [SD 15]), more often female (63% vs 49%), and had similar prevalence of vascular comorbidities as other stroke patients. ED treat-and-release visits for fall were significantly more common in the 15 days before stroke compared to the 15-day control period 1 year earlier (OR, 4.5; 95% CI, 3.8-5.5; P= 0.008). The association between stroke and a preceding ED visit for fall decreased in magnitude with increasing temporal distance from stroke but remained significantly elevated in all case periods compared to control periods as well as during the entire year prior to stroke hospitalization (0-365 days) (OR, 3.3; 95% CI, 3.1-3.6; P=0.049).

Conclusion:
ED treat-and-release visits for falls are associated with significantly increased stroke risk.