bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T P129: Depression Differs by Race among Stroke Survivors Receiving Inpatient Rehabilitation
Authors: Harris Gabrielle M , Thomas J. George , Nguyen Vu , Hirsch Mark A , Guerrier Tami , Hamm Deanna , Pugh Terrence , Pereira Carol , Bettger Janet P
Published: July 2021

Background:
Depression is associated with increased mortality and morbidity post-stroke and can adversely impact functional recovery. To-date, studies of depression among stroke survivors receiving inpatient rehabilitation have not examined whether the prevalence differs by race.

Methods:
This retrospective cohort study included patients who received inpatient rehabilitation care after an acute stroke in 2009-2011 at one of three facilities that are part of a comprehensive health system. Presence of depressive symptomology either pre- or post-stroke was identified in the neuropsychological assessment or discharge summary. Absence of documentation of depression, depression symptomology or challenges with adjustment was coded for analyses as “no depression.” Descriptive analyses compared presence of depression by race (White, African American, or Other Race/Ethnicity including American Indian, Alaska Native, Asian, Hispanic/Latino, Native Hawaiian/Other Pacific Islander). Patient characteristics were examined to describe depressed patients of each race.

Results:
Among 1491 stroke survivors (61.2% White, 34.0% African American, 4.8% other race/ethnicity), 29.7% had documentation of depression. Difference by race was significant (p<0.001). Prevalence of depression was highest (34.9%) among Whites (38.0% pre-morbid). Depression was documented among 22.1% of African Americans (33.0% pre-morbid). Only 16.9% of other race/ethnicity patients had depression and all were new onset post-stroke (no pre-morbid depression). Compared to those without depression pre- or post-stroke, it was more common for Whites and African Americans with depression (but not patients of other race/ethnicity) to be younger and female. Differences by stroke type, days since onset, impairment group, medical comorbidities, post-stroke complications and deficits were not statistically significant.

Conclusion:
Depression was documented in almost a third of stroke survivors who received inpatient rehabilitation, and highest among Whites compared with African Americans and patients of other race/ethnicity. Outcomes research by race is needed and exploration of how rehabilitation care can be modified to minimize any negative impact of depression.
Abstract T P130: High Serum Insulin-Like Growth Factor 1 is Associated with Lower Risk of Ischemic Stroke: The Framingham Heart Study
Authors: Saber Hamidreza , Himali Jayandra J , Beiser Alexa , Shoamanesh Ashkan , Pikula Alexandra , Harris Tamara B , Roubenoff Ronenn , Romero Jose Rafael , Kase Carlos S , Wolf Philip A , Vasan Ramachandran S , Seshadri Sudha
Published: July 2021

Background:
Insulin-like growth factor 1 (IGF-1), reduces progression of atherosclerosis and in cross-sectional studies low circulating IGF-1 is associated with increased carotid intima-media thickness. Yet, prospective data linking IGF-1 levels to development of stroke remain sparse and inconsistent. We related circulating IGF-1 levels to risk of incident stroke in a community-dwelling sample.

Methods:
Serum IGF-1 levels were assayed in 757 stroke-free participants (age 79+5 years, 62% women) from the Framingham original cohort (1990-1994), and related to prospectively ascertained, incident all-stroke and ischemic stroke using Cox models.

Results:
During a mean follow-up of 10.2 years in 757 participants, 119 developed stroke including 99 with ischemic stroke. After adjustment for age and sex, higher log-IGF1 levels were associated with a lower risk of incident ischemic stroke [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.63- 0.99, p=0.043]. There was a threshold effect with subjects in the lowest quintile of IGF-1 levels having 2.56-fold higher risk of incident ischemic stroke (95% CI: 1.20, 5.45, p=0.015) compared to all others. We observed significant interaction between diabetes and IGF1 in their relation to ischemic stroke (p=0.016). In pre-specified subgroup analyses the effect was restricted to persons with diabetes and central obesity (waist-to-hip ratio in top quartile) in whom each SD increase in IGF-1 was associated with a 61% (HR: 0.39, 95%CI: 0.20-0.78, p=0.007), and 41% (HR: 0.59, 95%CI: 0.37- 0.95, p=0.031) lower risk of incident ischemic stroke, respectively. Results were similar for all-stroke.

Conclusions:
IGF-1 may have a protective role in the pathogenesis of ischemic stroke among persons with insulin resistance as manifested by diabetes and/or obesity.
Abstract T P137: Cerebral Ischemic Events In Patients With Therapeutic Warfarin Treatment
Authors: Khan Hashim , Qureshi Mushtaq H , Khan Shayaan M , Chughtai Morad , Qureshi Adnan I
Published: July 2021

Background:
Patients on long term warfarin treatment can have cerebral ischemic events despite therapeutic levels. We sought to determine unique patient attributes that result in ischemic events on therapeutic warfarin treatment.

Methods:
We reviewed the medical records and imaging data of consecutive patients with cerebral ischemic events who were on long term warfarin treatment over a 4 year period. We stratified the patients based on international normalized ratio (2.0-3.0 versus <2.0) and compared the demographic and clinical characteristics between the two groups of patients.

Results:
A total of 163 patients (mean age±SD; 77.3 ± 11.2) on long term warfarin treatment were admitted with cerebral ischemic events (97 ischemic strokes and 40 transient ischemic attacks). The mean age was not different between patients who were sub therapeutic and therapeutic on warfarin (78.2 ±11.6 versus 77.5±10.5, p=0.7). The proportion of patients with hypertension (87.2% versus 84.0%, p=0.6), diabetes mellitus (44.2% versus 50.0 %, p=0.5), and cigarette smoking (7.0% versus 6.0%, p=0.8), was similar between the two groups. Patients who were therapeutic on warfarin were more likely to have large vessel atherosclerosis (8.0% versus 2.3 %, p=0.1) and small vessel disease (2.0% versus 1.2 %, p=0.6) and less likely to have atrial fibrillation (66.0% versus 77.5%, p=0.2) as the underlying etiologies for ischemic events. IV alteplase was used in 5 and none of patients who were sub therapeutic and therapeutic on warfarin, respectively.

Conclusions:
Patients who have concurrent predisposing factors appear to be at risk for cerebral ischemic events despite therapeutic warfarin treatment and concomitant preventive strategies should be evaluated.
Abstract T P139: Prevalence and Predictors of Mood Disorders among a National Sample of Individuals with Stroke or Transient Ischemic Attack
Authors: Razmara Ali , Cen Steven , Jin Diana L , Sanossian Nerses , Towfighi Amytis
Published: July 2021

Intro:
Depression is an independent stroke risk factor, yet little is known about comorbid mood disorders prevalence in stroke survivors. Data regarding association between mood disorders and transient ischemic attack (TIA) are scarce. Objective: To determine prevalence and predictors of comorbid mood disorders among individuals hospitalized with TIA, ischemic stroke, and hemorrhagic stroke in a national US sample. Methods: Using Nationwide Inpatient Sample (NIS) data (2000-2010), we identified individuals discharged with a primary diagnosis of acute ischemic stroke, hemorrhagic stroke, or TIA. We determined the weighted proportion of stroke hospitalizations with comorbid mood disorders (bipolar affective disorder, depression, anxiety disorders). We used survey weighted Poisson regression to estimate risk ratios. The first multivariable model adjusted for sociodemographic and hospital factors. The second model also adjusted for comorbid conditions. Results: Among 2,057,799 hospital discharges for stroke or TIA (corresponding to 10.1 million individuals in US), 83,705 (4.07%) had mood disorders. Compared to those without mood disorders, individuals with mood disorders were younger and more likely to be female, White, and had higher income and private insurance. Individuals 84 years (RR 3.61, 95% CI 3.50-3.72) after adjustment for sociodemographic and hospital factors. Further adjustment for comorbidities slightly attenuated the association (RR 3.30, 95% CL 3.19-3.40). Women were twice as likely to have mood disorders (RR 1.94, 95% CI 1.91-1.97), after adjusting for sociodemographic and hospital factors. Further adjustment for comorbidities did not affect the association. Compared to Whites, all other races were less likely to have mood disorders. Conclusions: In this national sample of individuals admitted with stroke or TIA, 4% had mood disorders. This is likely an underestimate, given lack of systematic screening for comorbid psychiatric disease. Women, younger individuals, and Whites appear to be a population at risk; however, further studies are needed to determine the true prevalence of mood disorders among individuals with TIA/stroke, to determine impact on stroke recovery and optimal treatment options.
Abstract T P143: Addressing Stroke Disparities through Exploring Health Information-Seeking Behaviors among Young Adult African Americans
Authors: Allen Shauntice , Safford Monika M , Howard Virginia J
Published: July 2021

Introduction:
Health information-seeking behaviors (HISB) are complex, varying by age, race and socioeconomic status. Examination of the process of HISB is critical in addressing the disproportionally high stroke risk in African Americans (AAs), especially in young adults where the stroke risk is greatest. We developed a survey to understand HISB related to stroke knowledge, beliefs, and attitudes, targeted to young AA professionals aged 21-45. Methods: Phase 1 consisted of focus groups in four states, followed by Phase 2: development, pretesting and pilot survey administration of an online survey. AA members of the southern region of the National Urban League Young Professionals (NULYP) network, a 24-chapter consortium across 11 states, were recruited for participation. Results: Phase 1 consisted of 20 AAs, 15 women, ages 26-42. Five themes emerged: 1) health concerns, 2) preventive actions, 3) preventive awareness, 4) stroke knowledge, and 5) trust in information source. Health information was primarily obtained online, and respondents cited credible information sources as researchers, healthcare providers, and government health sources (i.e., CDC or NIH). Personal contacts such as family, close friends and civic organizations were also viewed as trusted sources. The pilot survey in Phase 2 consisted of a 42-item instrument: 10 demographic questions, 8 sets of items comprising 5 scales and 2 dichotomous questions. After pretesting, 89 surveys were completed (75% women, 89% college-educated, employed). Cronbach alpha reliability coefficients ranged from 0.68 to 0.85 across all survey items. Respondents did not perceive themselves at risk for stroke and would not approach their healthcare provider for stroke risk reduction information. Relevance of knowing and monitoring one’s blood pressure did not emerge as a strong belief across either phase. Conclusion: Results from this developmental work show professional AA adults aged 26-42 identify and understand stroke risk factors; however awareness and beliefs regarding personal susceptibility can impose a facilitatory or inhibitory behavior when seeking general health information.
Abstract T P144: Rural Stroke System Development and Patterns of Arrival
Authors: Torner James C , Rindels Erin , Overton Angela , Leira Enrique , Mueller Michael , Nugent Meg , Spear Brent ,   Iowa Stroke Registry Hosps
Published: July 2021

Introduction:
The Iowa Stroke Registry (ISR) is one of the Paul Coverdell Registries of the Centers for Disease Control. Its goal is to assess the performance of the Iowa Stroke System and to conduct system improvement to improve stroke care and outcomes. One of the major challenges in rural state is acute intervention in a geographically dispersed population and transport to definitive care.

Methods:
The Iowa Stroke Registry was established in 2007 with data collection from 32 comprehensive, primary and stroke capable hospitals in Iowa beginning in 2009. To date over 10,000 patients have been enrolled.

Arrival to the ISR was characterized as via EMS, private vehicle or transfer from another facility. Factors related to stroke symptoms and presentation and time to arrival from last known well were examined by arrival mode.

Categorical analysis was done using a Chi-Square Test with an alpha of 0.05.

Results:
To date 39% of patients with stroke came directly by ambulance, 35% by private vehicle and 25% transferred from local hospitals. Of EMS transported patients were 94% were admitted through the ER; 13% of private vehicle and 32% of transfer patients were directly admitted to inpatient beds. Admission symptoms were similar regardless of transport mode with 64% of patients with weakness, 10% speech difficulties, 3% vision abnormalities and 28% with aphasia. Ambulation with assistance or unable to ambulate was highest in private vehicle patients (8.6%)(p<.05). Transfer (median=347 minutes) and private vehicle (median=408) were significantly longer than EMS arrivals (median=222). As the system developed, the percentage of transfer patients significantly increased over time.

Conclusions:
With nearly one-third of patients still arriving by private vehicle there is a need for further public education. Increase in transfers demonstrate the effect of stroke system development. These data from the ISR provide information for a wide-ranging stroke education program by the Coverdell Registry and Stroke Task Force committees and stakeholders in Iowa.
Abstract T P15: Final Infarct Volume as Predictor of Clinical Outcomes Following Intra-Arterial Stroke Treatment
Authors: Espinosa Aixa , Chen Michael , Ogami Kyle , Korsnack Andrea , Zaidi Syed , Jumaa Mouhammad
Published: July 2021

OBJECTIVE:
Previous studies have shown age and recanalization as principal variables influencing clinical outcome following intra-arterial stroke treatment (IAT). We sought to study the impact of final DWI infarct volume on patient outcomes following IAT.

METHODS:
We reviewed records of stroke patients who underwent IAT at our center from Jul 2012 – Jul 2014. Patients demographics, risk factors, admission clinical and neuroimaging findings, treatment times and methods, procedure related complications and modified Rankin score (mRS) at 90 days were analyzed. For patients who are not yet at 90 days post-treatment, mRS at hospital discharge was used in the final analysis. A favorable outcome was defined as mRS 2 or less at 90 days. Infarct volume was calculated using the MIM Maestro automated software on post IAT MR DWI sequences.

RESULTS:
Overall, 144 consecutively treated patients were identified. Eighty-eight subjects underwent post treatment MRI and are included in this analysis. Patients who achieved successful recanalization (TICI 2b &3) had lower mean infarct burden (53.2 mL) than the cohort with persistent occlusion (95.1 mL), p=0.01. Also, patients with favorable outcomes had significantly lower mean infarct volumes (see table). Multivariate logistic regression model identified lower final DWI infarct volume (OR 0.97, 95% CI 0.95-0.99, p<0.01) and low presentation NIHSS (OR 0.85, 95% CI 0.73-0.99, p=0.04) as predictors of favorable outcome.

CONCLUSION:
Our study results indicate that final DWI infarct volume is an independent predictor of outcome in patients undergoing IAT. Infarct volume may be utilized as a surrogate for clinical outcome. Larger prospective studies are warranted to corroborate these findings.
Abstract T P153: APOE e4 Increases Risk of Recurrent Non-lobar Hemorrhage
Authors: Raffeld Miriam R , Anderson Christopher D , Battey Thomas W , Ayers Alison M , Schwab Kristin , Viswanathan Anand , Greenberg Steven M , Rosand Jonathan , Biffi Alessandro
Published: July 2021

Introduction:
Genetic variants ε2 / ε4 within the APOE gene are established risk factors for lobar intracerebral Hemorrhage (ICH) and its recurrence. Data from a large case-control meta-analysis suggest a potential but not yet replicated role for APOE ε4 in risk of non-lobar ICH.

Hypothesis:
APOE ε4 increases risk of recurrent non-lobar ICH and, replicating prior results, increases risk of initial non-lobar ICH.

Methods:
Among consecutive non-lobar ICH cases from our single center series (n=468), 363 survivors were followed for recurrence. All subjects had clinical and demographic data, and APOE genotype determined at the time of index ICH. In a separate case-control analysis, 156 non-lobar ICH cases and 152 ICH-free controls, ascertained subsequent to all prior publications, were analyzed as replication of previously published case-control findings. These case-control results were then meta-analyzed with previously published data.

Results:
We observed 29 non-lobar-ICH recurrences among 363 survivors. APOE ε4 was associated with non-lobar-ICH recurrence (HR = 1.31, 95% CI =1.02 - 2.69, p = 0.038) after adjustment for age / gender / ethnicity and cardiovascular risk factors.

Case-control analyses of newly ascertained subjects replicated the APOE ε4 association with risk of non-lobar ICH (OR = 1.31, 95% CI = 1.02-1.68, p = 0.035). Meta-analysis of these with published case-control data returned an association between ε4 and non-lobar ICH (OR = 1.21, 95% CI = 1.11-1.32, p = 1.5 x 10
-5
).

No associations were identified between APOE ε2 and non-lobar ICH risk or recurrence.

Conclusions:
APOE ε4, but not ε2 is associated with risk and recurrence of non-lobar ICH. Whether APOE’s role in non-lobar ICH involves beta-amyloid pathology, its presumed mechanism in lobar ICH, requires further study.
Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study
Authors: Matsuki Takayuki , Koga Masatoshi , Arihiro Shoji , Todo Kenichi , Yamagami Hiroshi , Furui Eisuke , Shiokawa Yoshiaki , Okuda Satoshi , Mochizuki Hiroshi , Okada Yasushi , Kameda Tomoaki , Terasaki Tadashi , Takizawa Shunya , Nagakane Yoshinari , Ito Yasuhiro , Hasegawa Yasuhiro , Kimura Kazumi , Kamiyama Kenji , Nakashima Takahiro , Takamatsu Kazuhiro , Nishiyama Kazutoshi , Homma Kazunari , Kinoshita Naoto , Kario Kazuomi , Toyoda Kazunori
Published: July 2021

Background and purpose:
The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF).

Methods:
From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months).

Results:
Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either.

Conclusion:
High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.
Abstract T P163: Inpatient Stroke Mortality Has Been Declining in Japan: Japanese Stroke Databank
Authors: Takano Daiki , Fujimaki Yumi , Yamazaki Takashi , Nakase Taizen , Maeda Tetsuya , Satoh Yuichi , Nagata Ken , Kobayashi Shotai
Published: July 2021

Background and Purpose:
Although thrombolytic therapy, novel oral anticoagulants and neuroendovascular therapy became available in this decade, the stroke victims are facing the increasing risk of death including the comorbidity such as pneumonia due to rapid aging in Japan. As a part of the Japan Standard Stroke Registry Study (JSSRS) which is a multi-center registration study of acute stroke cases in Japan, we analyzed the trends in the inpatient stroke mortality in relation to the demographic data and stroke subtypes.

Subjects and Methods:
The present study was based on 101,160 acute stroke cases including 59,493 men (58.8%) and 41,667 women (41.2%) who were registered to the JSSRS databank between 1999 and 2012. Among them, 72,774 cases (71.9%) were diagnosed as having cerebral infarction (CI), 17,723 cases (17.5%) as intracerebral hemorrhage (ICH), 5,343 (5.3%) as subarachnoid hemorrhage (SAH), and 5,320 cases (5.3%) as transient ischemic attack (TIA).

Results:
There were 7,651 deceased cases and the overall mortality rate (MR) was 7.6%. The MR was greater in women (9.2%) than in men (6.4%), and greater in those who were 75 years or older (10.2%) than in younger age categories. The MR was greater for SAH (23.5%) and ICH (15.1%) than for CI (5.1%), and greater for cardiogenic embolism (11.7%) than for atherothrombotic infarction (3.8%) and lacunar infarction (0.6%). Among the deceased cases, 53.7% died in the acute stage whereas 26.0% died in the subacute stage and 20.3% died in the chronic stage. 23% of the in-hospital death was due to SAH in women, whereas that was only 9% in men. The overall MR was 9.2 % and the MR was 6.8% for CI and 15.6% for ICH in 2000, whereas the overall MR was 6.3% and the MR was 3.9% for CI and 13.3% for ICH in 2012. The MR for SAH was 21.4% in 2000 and 21.8% in 2012.

Conclusions:
The greater stroke MR in women was considered to be due to the greater MR for SAH. Our data revealed the stroke MR decreased significantly in last 12 years. This decline can be partly explained by the improved outcome in cerebral infarction in the acute phase.
Abstract T P165: Women Had Worse Stroke Outcome
Authors: Alonzo Claudia , Zurru Maria C , Brescacin Laura , Pigretti Santiago , Colla Machado Pedro , Luzzi Ariel , Waisman Gabriel , Camera Luis , Cristiano Edgardo
Published: July 2021

Background:
women who have ischemic strokes are on average older than men.Several studies, however, show that stroke outcomes are worse in women even after adjusting for age, and the specific conditions that contribute to this outcome are poorly known. Our objective was to evaluate post-stroke disability and mortality after ischemic stroke in women.

Methods:
acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic records; disability (modified Rankin scale) were evaluated one month after stroke.

Results:
fifty seven percent of the 1194 ischemic stroke patients prospectively included between December 2006 and December 2013 were women. They were older, more probably hypertensive, dislipidemic and diabetic, and had higher incidence of atrial fibrillation, while men had higher prevalence of obesity, metabolic syndrome, smoking, and history of coronary heart disease and peripheral artery disease. Pre-stroke vascular risk factor control and management are shown in table 1. Women had worst outcome than men: mRankin >1 (66% women vs 52% men, p 0.0001), 30-day mortality (4% women vs 2% men, p 0.04), composite disability + mortality (52% women vs 36% men, p 0.0001). After adjusting by age women still had higher risk of disability and mortality: m-Rankin >1 (OR 1.40, 95%CI 1.05-1.87; p 0.02); mortality (OR 1.64, 95%CI 0,98-2,74), and composite disability + mortality (OR 1.59, 95%CI 1.22-2.07; p 0.004).

Conclusion:
in our cohort women have worst post-stroke outcome, even though they have higher burden of vascular risk factors they have lower prevalence of vascular disease in other vascular beds previous to stroke. This difference persists after adjusting by age, raising the possibility of specific gender risk factors influencing on ischemic stroke outcomes.
Abstract T P171: Clinical and Imaging Features Associated with Intracranial Internal Carotid Artery Calcifications in Patients with Ischemic Stroke
Authors: Yilmaz Arda , Akpinar Erhan , Topcuoglu Mehmet A , Arsava Ethem M
Published: July 2021

Background:
Intracranial internal carotid artery calcifications (ICAC), a radiologic feature frequently detected on imaging studies, have been shown to be associated with future stroke risk in population-based studies. The clinical significance of this observation among patients with ischemic stroke is, on the other hand, less clear. In this study we sought to identify features associated with ICAC burden in a consecutive series of ischemic stroke patients.

Methods:
The burden of ICAC was determined separately on non-contrast CT and CT-angiography by semi-quantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype and calcification burden in other craniocervical arteries were assessed among patients with no ICAC, mild-moderate ICAC and severe ICAC.

Results:
Of the 319 patients included into the study, 28% had no ICAC, 35% had mild-moderate ICAC and 37% hade severe ICAC on CT-angiography source images. The corresponding figures were 22%, 38% and 41%, respectively, when the ratings were performed on non-contrast CT. Overall non-contrast CT and CT-angiography based ratings were highly correlated (r=0.90, p<0.001). ICAC burden was significantly associated with older age, history of hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation, higher prevalence of large artery atherosclerosis and cardio-aortic embolism as the underlying stroke subtype and presence of calcifications in other craniocervical vessels. Multivariate analyses revealed age, history of diabetes mellitus and coronary artery disease, together with a stroke etiology of large artery atherosclerosis, as factors independently associated with ICAC burden.

Conclusion:
ICAC burden as determined either by non-contrast CT or CT-angiography reflects a continuum of atherosclerotic disease involving the carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with large artery atherosclerosis related stroke and might thereby guide the clinician for therapeutic management and etiologic work-up during the acute period.
Abstract T P179: Guideline Adherence in Testing for Drugs of Abuse in Intracerebral Hemorrhage
Authors: Mackey Jason , Tormoehlen Laura M , Blatsioris Ashley D , Moser Elizabeth A , Carter Ravan J , Reagan Secrest Angie , Hulin Abigail L , O'Neill Darren P , Cohen-Gadol Aaron A , Williams Linda S
Published: July 2021

Introduction:
Sympathomimetic drugs have been associated with poorer outcomes in intracerebral hemorrhage (ICH). The ICH guidelines recommend screening young and middle-aged patients for drugs of abuse but guideline adherence data are scarce, particularly outside of academic centers. We sought to characterize the pattern of testing for drugs of abuse in a cohort of primary ICH patients at a large academic referral center.

Methods:
We performed a retrospective study of primary ICH occurring in 2009. Cases were identified by ICD-9 code and verified by physician review. Demographic data, vascular risk factors, imaging characteristics, processes of care, and short-term outcomes were ascertained. We analyzed performance of urine drug screen (UDS) by race, sex, age, and hospital presentation (outside hospital [OSH] vs. academic center).

Results:
We identified 131 patients with primary ICH in 2009; 100 (76.3%) were initially evaluated at an OSH. Cohort characteristics are in the Table. Overall, 19 (14.5%) patients had UDS performed at either the OSH or the academic center, with no positive screens for either cocaine or amphetamine. There was no difference in testing between men and women (10/67 vs. 9/64, p=0.89). Of patients <55, only 9/28 (32.1%) were tested. There was no difference in testing between white and black patients <55 (6/22 vs. 3/6, p=0.35). The proportion of patients <55 tested at the OSH was 3/21 (14.3%) and at the academic center 3/7 (42.9%). Only 3/18 (16.7%) patients <55 not tested at OSH were tested after transfer.

Conclusions:
We found suboptimal guideline adherence for drugs of abuse testing in our ICH cohort. Systematic efforts to improve guideline adherence in a variety of acute care settings are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and could influence both therapeutic decision-making and prognosis counseling.
Abstract T P182: Peripheral Immune Protein Profiles Can Differentiate Ischemic Stroke from Transient Ischemic Attack and are Correlated with Stroke Severity
Authors: Petrone Ashley B , VanGilder Reyna L , Regier Michael , Simpkins James W , Barr Taura L
Published: July 2021

Introduction:
Inflammatory signals released from ischemic brain tissue recruits peripheral immune cells to the brain following ischemic stroke (IS). The mechanisms behind this crosstalk between the brain and periphery are not well understood. Studies suggest that excessive T-cell activation and migration into the brain may contribute to a greater infarct volume and increased stroke severity. The goal of the project was to evaluate the protein expression of a variety of T cell related cytokines in the peripheral blood to determine their differential expression in ischemic stroke (IS) and transient ischemic attack (TIA).

Methods:
Blood was drawn from IS and TIA patients within 24 hours of last known normal. Serum was processed from whole blood centrifuged within one hour of collection then frozen at -80C until analysis. Serum cytokine concentrations of 35 analytes were quantified using a Multi-Analyte Profiling Kit (R&D Systems®) on the Luminex® 100 platform. Random forest methodology and logistic regression were used to identify cytokines and demographic characteristics that distinguish stroke from TIA. Univariate analyses were performed to describe relationships between cytokine levels and NIHSS.

Results:
We analyzed data from n=17 IS and n=12 TIA patients, with an average age of 69 years and a median NIHSS of 3. Age, NIHSS, dyslipidemia, CD40, and CD27 were identified as important predictors of stroke versus TIA (Error rate = 0.233, sensitivity =0.765, specificity = 0.769). In IS patients CD27 and CD40 were significantly correlated with NIHSS (r=0.823, p=0.006; r=0.66; p=0.03 respectively).

Conclusion:
The peripheral blood protein expression of CD27 and CD40 correlates with stroke severity, and in combination with demographic data may be used to differentiate IS from TIA in the acute care setting. Future studies are needed to assess the functional role of CD27 and CD40 following stroke for potential therapeutic applications.
Abstract T P184: The Importance of Blood Biomarkers in Penetrating Artery Territory Infarction; A Prospective Multicenter Observational Study
Authors: Kawano Tomohiro , Miyashita Kotaro , Takeuchi Mariko , Metoki Norifumi , Akaiwa Yasuhisa , Yamamoto Yasumasa , Manabe Yasuhiro , Toyoda Kazunori , Nagatuka Kazuyuki
Published: July 2021

Objective:
Neurological deterioration in penetrating artery territory infarction (PATI) is unpredictable and associated with a worse clinical outcome. This study aimed to determine the importance of blood biomarkers to predict neurological deterioration and long-term clinical outcome.

Methods:
From November 2012 to December 2013, we performed a prospective multicenter observational study of PATI patients presenting within 2 days of stroke onset. Blood samples were obtained within 24h after admission (1st point) and on a day between 6th and 8th hospitalization (2nd point) for several biomarkers. Symptomatic progression (SP) was defined as the increase of at least one point on the National Institutes of Health Stroke Scale. Favorable outcome was defined as modified Rankin Scale score≤2 at 90 days after ictus.

Results:
25 patients (28%) showed SP in evaluated 90 patients (35 men with a mean age of 70.4 years). The patients with SP were significantly (p<0.05) more elderly, hypertensive, clinically severed than those without SP on admission.

At 1st point, the patients with SP had significantly higher serum IL-6 and lower CD34 levels as compared to those without SP (IL-6: 4.8 [2.3-7.95] vs 2.4[1.3-4.1] pg/ml (p=0.007) and CD34: 0.5 [0.31-0.88] vs 0.8[0.49-1.08] /μL (p=0.002)).

Moreover, the patients with poor outcome at 90 days had significantly higher serum IL-6 levels, higher TNF-alpha levels and lower CD34 levels as compared to those with favorable outcome. At 2nd point, the patients with poor outcome had significantly higher serum IL-6 levels, higher TNF-alpha levels, higher pro-adrenomedullin levels, and lower ADAMTS13 levels compared to those with favorable outcome .

Comparing the change of biomarker levels between two-point measurements, the significant increases of pro-adrenomedullin and oxidized LDL receptor-1, and decrease of ADAMTS13 were correlated with SP.

Conclusions:
Blood biomarkers of inflammatory and endothelial function might be valuable to predict symptomatic progression and poor long-term outcome in PATI, meaning the surrogate markers for treatment evaluation in future stroke trials.
Abstract T P185: Amnesic Strokes and TIAs Are Rare and Frequently Missed: A 12.5 Year Single Center Experience
Authors: Eskioglou Elissavet , Beaud Valerie , Maeder Philippe , Demonet Jean-François , Michel Patrik
Published: July 2021

Aims:
To describe the frequency and characteristics of acute ischemic strokes (AIS) and transient ischemic attacks (TIAs) presenting predominantly with amnesia, and to identify clinical clues for differentiating them from similar conditions like transient global amnesia (TGA).

Methods:
Over a 12.5 year period, we retrospectively identified in our stroke center patients with DWI-MRI-confirmed AIS and TIAs whose main presenting symptom was acute antero- and retrograde amnesia. We excluded patients with important focal or cognitive symptoms, absence of significant amnesia or absence of a witness (for patients with self-reported transient amnesia).

Results:
After exclusion of 6 amnestic DWI-positive stroke patients not fulfilling all inclusion criteria, we identified 10 amnestic strokes and TIAs, representing 0.2% of all patients admitted during the observation period. Half of the events could not be distinguished clinically from TGA (no “red flags”). When compared with 3’250 AIS from our registry (ASTRAL), the initial stroke diagnosis was significantly more often uncertain in amnestic patients (80% vs. 2.4%), involved more frequently the posterior circulation (90% vs. 27.2%) and/or multiple territories (40% vs. 1.4%, all p< 0.01 in univariate analysis). Most events were cardioembolic (n=5), and affected at least one structure in the limbic system (n=9). Acute CT was negative in all patients where it was performed. Clinical clues for an ischemic origin of the amnestic syndrome were higher age (median 70 years vs. 60 for TGA in the literature), minor focal neurological signs (n=3), circumstances such as interruption of antithrombotic treatment (n=3) and multiple cerebrovascular risk factors (n=5); 5 patients had none of these clues. Three months after the event, all patients were living independently at home despite persistent memory deficits in 3, and none had stroke recurrence.

Conclusion:
Predominant amnesia as the main symptom of acute ischemic cerebral events is rare, often transient, and is easily be missed or mistaken as TGA. Although associated mild localizing signs and circumstances increase the likelihood of an ischemic amnestic event, the threshold for performing direct DWI imaging in patients with acute transient amnesia should be low.
Abstract T P188: High Prevalence Of Igm Anti-phosphatidylserine-prothrombin Complex Antibodies And Lupus Anticoagulant In Patients With Non-lacunar Ischemic Stroke Without A Determined Cause
Authors: Furui Eisuke , Itabashi Ryo , Yazawa Yukako , Yamazaki Masahide , Fujiwara Satoru
Published: July 2021

Background and Purpose:
The cause of ischemic stroke remains undetermined in about 25% of patients even after appropriate studies. Antiphospholipid syndrome (APS) is an autoimmune disease in which vascular thrombosis occurs in patients with antiphospholipid (aPL) antibodies. Anti-phosphatidylserine-prothrombin complex (aPS/PT) antibodies are reported to be associated with symptoms of APS and lupus anticoagulant (LAC) activity. Correlations between ischemic stroke and IgM aPS/PT antibodies have not been well investigated. We tried to explore possible correlations between non-lacunar ischemic stroke without a determined cause and aPL antibodies.

Methods:
Diagnostic studies consisted of brain MRI/CT, extracranial and intracranial MRA, carotid ultrasonography, 12-lead ECG, 24-hour ECG, transthoracic echo cardiography, transesophageal echo cardiography and venous ultrasonography. After excluding lacunar stroke, proximal arterial stenosis and caridoembolic sources with all these diagnositc studies, we selected 22 non-lacunalr ischemic stroke patients without a determined cause (age 48.5 +/- 14.4 years; 9 woman). We preliminarily measured IgG and IgM anticardiolipin (aCL) antibodies, IgG and IgM aPS/PT antibodies, anti-beta2-glycoprotein I-dependent cardiolipin (anti-beta2 GPI/CL) antibodies and LAC. aCL, aPS/PT, and anti-beta2 GPI/CL antibodies were measured by enzyme-linked immunosorbent assay. LAC was determined according to the Subcommittee on Lupus Anticoagulant/Phospholipid Dependent Antibody guidelines.

Results:
IgM aPS/PT antibodies, LAC, and both of them were detected in 10, 7, and 3 patients, respectively. Neither aCL nor anti-beta2 GPI/CL antibodies were identified in all patients.

Conclusion:
Our data demonstrate a high prevalence of IgM aPS/PT antibodies and LAC in patients with non-lacunar ischemic stroke without a determined cause. IgM aPS/PT antibodies and LAC might play some role in the development of ischemic stroke of these patients.
Abstract T P19: Higher HDL Levels Increase the Risk of Intracranial Hemorrhage After Endovascular Treatment for Ischemic Stroke
Authors: Moussavi Mohammad , Korya Daniel , Sajjan Shanker Raj , Isaac Ifeoma , Uhegwu Nnamdi , Ahmad Javaad , Mehta Siddhart , Galea Bernard , Chaudhry Saqib , Kirmani Jawad F
Published: July 2021

Background and Objectives:
Recent evidence has highlighted an inverse relationship between lipids (HDL/LDL) and ischemic versus hemorrhagic stroke. Select patients presenting with ischemic stroke within the 4.5-hour time window should receive IV tPA, and depending on symptom severity or neuroimaging, they may be treated with intra-arterial (IA) tPA or endovascular therapy. Evidence has shown elevated LDL to be a risk factor for ischemic stroke, but once a patient has an ischemic stroke elevated HDL levels may put them at risk for hemorrhagic stroke. Our objective was to determine if serum lipids had a role in increasing the risk of large intracranial hemorrhage after treatment with IV tPA and IA therapy.

Methods:
Patients receiving IV tPA for ischemic stroke at a major university affiliated comprehensive stroke center were evaluated from 2011-2013. The procedure notes of patients who underwent IA after IV tPA were reviewed for complications. SPSS software version 22 was used to determine Spearman’s rho correlations between serum lipids and likelihood of complications as well as other baseline parameters, and descriptive statistics with standard deviations to determine the population characteristics.

Results:
A total of 1,565 patients with ischemic stroke were evaluated, and 188 (mean age 74.3, 55% men) patients received IV tPA, 68 also underwent intra-arterial (IA) treatment with either IA tPA or thrombectomy and met study criteria. There were 31 males and 37 females with a mean age of 73.4 (SD=14.8). The mean NIHSS was 15.9 at admission and 7.7 at discharge (SD= 6.4 and 5.5, respectively). There were 6 instances of large intracranial hemorrhages (3 symptomatic). Patients with large ICH were significantly more likely to have higher levels of total cholesterol, HDL and LDL (r=.373, r=.323 and r=347, respectively; p<.01).

Conclusion:
As expected, patients with elevated LDL were more likely to have severe strokes requiring endovascular treatment. However, Our data suggests that ischemic stroke patients with elevated HDL are not protected and are at increased risk of hemorrhage after intra-arterial therapy. Larger, prospective trials need to be conducted for more definite conclusions.
Abstract T P196: Tissue Plasminogen Activator is Safe When Administered by Neurovascular Fellows via Telemedicine
Authors: Jagolino Amanda , Gildersleeve Kasey , Indupuru Hari Kishan , Cai Chunyan , Rahbar Mohammad , Sarraj Amrou , Savitz Sean I , Wu Tzu-Ching
Published: July 2021

Objective:
Telemedicine (TM) has increased the use of intravenous (IV) tissue plasminogen activator (tPA) for management of acute ischemic stroke. Despite its known safety in guiding tPA treatment, TM has not been formally embedded into stroke fellowship training. We compared the safety of tPA administration via TM consultation by neurovascular fellows (NVFs) versus neurovascular attendings (NVAs).

Methods:
In a retrospective chart review from 4/12 to 4/13, we identified 137 patients who were given IV-tPA at the advice of a NVA or NVF in our 14 spoke TM network. We abstracted baseline characteristics and clinical variables. We compared outcomes in patients treated by NVFs versus NVAs. Logistic regression was performed to compare rates of symptomatic intracranial hemorrhage (sICH), neurological worsening (an increase in NIHSS of ≥2 regardless of etiology), angioedema, and death. Median time between symptom onset and tPA administration was also compared between NVFs and NVAs.

Results:
Table 1 illustrates baseline characteristics. Of 137 consecutive patients given IV-tPA via TM, fellows treated 48 patients (35%). The sICH rates between patients treated by NVFs and those by NVAs were not significantly different (2.1% vs 1.1%, p=1.00) (Table 2). Neurologic worsening occurred in 6.3% of cases treated by NVFs and 6.7% by NVAs (p=1.00). The rates of angioedema between patients treated by NVFs and those by NVAs were not significantly different (0% vs 1.1%) (Table 2). While death rate was higher in patients treated by NVAs (4.5% vs 0%), this increment was not significant (Table 2). The median minutes between symptom onset and tPA administration was 10.5 more for NVFs than NVAs (143 vs 132.5, p<0.05) (Table 2).

Conclusion:
Although NVFs took more time to give tPA compared to NVAs, administration of IV tPA via telemedicine was safe when advised by NVFs compared with NVAs. This finding supports the feasibility of formally integrating telemedicine exposure into fellowship training.
Abstract T P197: Early Improvement In NIHSS Is Common During Inter-hospital Transfer And Is Associated With Lower In-hospital Mortality
Authors: Siddiqui Khawja A , Cohen Abigail S , Ali Syed F , Schwamm Lee H
Published: July 2021

Introduction:
A significant number of patients are transferred from outside referral hospitals (OSH) to larger tertiary care centers for specialized care or post-tPA management. As efforts to risk adjust stroke mortality and patient outcomes increase, better understanding of early changes in stroke severity are needed, especially changes in stroke severity that occur during interhospital transfer. We evaluated the percentage of patients with significant early improvement after transfer and associated patient characteristics and outcomes.

Method:
Using our Get with the Guidelines-Stroke registry, we identified 302 acute ischemic stroke transfer patients with documented initial NIHSS at the OSH from 12/10 - 12/13. Patients with early improvement after interhospital transfer (≥ 4 points improvement in NIHSS between initial NIHSS at receiving hospital minus initial at OSH) were compared to those without (< 4 points improvement or worsening). Baseline clinical characteristics, tPA treatment and outcomes were compared with Chi-square test and student's t-test.

Results:
There were 76/302 (25.2%) patients with ≥ 4 points improvement in NIHSS. Compared to those without early improvement, those with early improvement were less likely to have history of hyperlipidemia and carotid stenosis, presented with altered level of consciousness less often, and had higher median initial NIHSS at OSH. They had substantially lower inhospital mortality (3.9% vs. 12.4%).

Discussion:
Early improvement in stroke severity during interhospital transfer is common, and is not confined to patients receiving thrombolysis. These early improvement patients have very low mortality, and it is substantially lower than in those without early improvement, despite higher initial NIHSS. This has important implications for assessing the safety and efficacy of drip and ship thrombolysis or other pre-transfer interventions. Further research is warranted.