bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP84: Switching Thrombectomy Technique After Failed First Pass Improves Reperfusion Success: A Multi-Center Cohort Study Using SVIN Registry
Authors: Bajaj Ritesh , Stimming Tucker , Le Ngoc Mai , Ballekere Anjan Nagesh , Azeem Hussain , Iyyangar Ananya , Lee Eunyoung , Ebirim Emmanuel , Sheth Sunil
Published: January 2025

Introduction:
Complete reperfusion (TICI 2c/3) with the fewest number of passes remains the target for EVT techniques, but at present, rates remain relatively low. Prior studies have demonstrated that switching techniques between passes may improve rates of reperfusion. Here we assess the efficacy of technique switching after the first pass failed reperfusion in a large multi-center cohort.

Methods:
All consecutive patients treated with EVT from 12 centers across the US were prospectively collected between 10/2018 – 12/2021 (SVIN Registry). Patients were included if they underwent EVT for occlusion of the M1 or ICA-T. Exclusion criteria included incomplete data. EVT technique was categorized as Stent-Retriever (SR), Contact Aspiration (CA), or a Combined Technique (CT). The primary outcome was the likelihood of achieving TICI 2c/3 with or without switching the thrombectomy technique and was determined using multivariable logistic regression adjusted for the use of balloon guide catheter, occlusion location, age, and co-morbid medical conditions.

Results:
Among 2,891 patients in the SVIN registry included in this analysis, the median age was 69 years [IQR, 58-80], 49.9% were female and median NIHSS was 17 [IQR, 12-22]. Occlusion location was ICA-T in 18.4% and M1 in 81.6%. As shown in Figure 1a, for patients with ICA-T occlusions, first-pass TICI 2c/3 occurred in 32.7% with SR, 23% with CA, and 31.2% with CT. As shown in Figure 1b, for patients with M1 occlusions, first-pass TICI 2c/3 occurred in 37.7% with SR, 35.9% with CA, and 35.4% with CT. Switching from CA to SR or CT for the 2nd pass was associated with increased point estimates of 2nd pass TICI 2c/3 for patients with ICA-T occlusions (27% vs 12%, second pass SR vs. second pass CA, p=0.06). In multivariable logistic regression, odds of TICI 2c/3 were significantly greater (OR 3.7, CI 95% [1.1 – 12.4]) after switching to SR or CT after a failed first pass with CA in patients with ICA-T occlusion.

Conclusions:
Switching from CA to SR-based techniques was associated with improvement in TICI 2c/3 reperfusion rates among patients with Internal Carotid Artery Terminus occlusions.
Abstract TMP89: Predictive Model of Ischemic Event Recurrence in Pediatric Moyamoya
Authors: Kaseka Matsanga Leyila , Johara Fatema Tuj , Pulcine Elizabeth , Moharir Mahendranath , Pullenayegum Eleanor , Dlamini Nomazulu
Published: January 2025

Background:
Moyamoya is a progressive cerebral arteriopathy and one of the leading causes of stroke recurrence in children. Clinical severity scores have been developed for adult patients given the multifaceted pathophysiology of moyamoya. However, these scores were not designed to assess the risk of ischemic event recurrence, and they have not been validated in children.

Objective:
To develop a predictive model of ischemic event recurrence adapted to pediatric moyamoya.

Methods:
We retrospectively reviewed a single-center cohort of moyamoya patients, extracting demographic, clinical, and radiographic data. A binary logit mixed-effects regression was applied to predict ischemic event recurrence or disease progression based on this data. Variables were selected based on current literature. The model was validated using three approaches: validation, leave-one-out cross-validation (LOOCV), and 10-fold cross-validation, assessing performance via area under the curve (AUC), prediction accuracy, and binary classification entropy (BCE).

Results:
Two-hundred and twenty hemispheres were analyzed. Sixty-six hemispheres showed evidence of ischemic event recurrence or disease progression over a mean follow-up period of 6.23 ± 4.19 years. The median time to event was 21 months. Age at presentation (β=-0.036; p=0.48), Asian ancestry (β=1.74; p=0.002), asymptomatic presentation (β=1.084; p=0.207)), ischemic symptoms at presentation (β=2.15; p=0.011), evidence of infarction on initial brain MRI (β=-0.79; p=0.155), presence of an ivy sign (β=-0.2; p=0.67), unilateral disease (β=-0.97; p=0.077) with an intercept at β=-2.02 (p=0.052) were the variables included in the model. Computed model included LOOCV and 10-fold produced highest prediction accuracy (0.77 and 0.773 respectively), whereas 10-fold cross-validation had the smallest BCE value along with AUC=0.736.

Conclusions:
We present a pediatric-specific predictive model for the recurrence of ischemic events in moyamoya patients, demonstrating good accuracy. Our performance metrics indicate that 10-fold cross-validation is the preferred method for predicting moyamoya recurrence. This model provides a framework for developing a scoring scale that can be used in clinical practice to quantify risk and guide treatment decisions.
Abstract TMP91: Acute Stroke Characteristics, Treatment and Outcomes in Children on Mechanical Circulatory Support
Authors: Cheronis Chrisoula , Jackson Karla , Mayne Elizabeth , Teeyagura Prathyusha , Lee Sarah
Published: January 2025

Introduction:
Mechanical circulatory support (MCS) carries a high risk of neurologic complications, with estimates of arterial ischemic stroke (AIS) to be between 5 and 30%. We report our cohort of children on Ventricular Assist Device (VAD) or Extracorporeal Membrane Oxygenation (ECMO) support who suffered AIS, and describe stroke treatment and outcomes in this high-risk population.

Methods:
The Stanford Pediatric Stroke Registry retrospectively and prospectively enrolled children aged 30 days-22years admitted to our quaternary care pediatric hospital between 2007-2024 with confirmed AIS on neuroimaging. Demographic, clinical, radiographic, treatment and outcome data were collected via chart review and entered into a secure, HIPAA-compliant RedCAP database. Children on MCS at the time of stroke were compared with non-MCS patients and analyzed using descriptive statistics.

Results:
A total of 35/207 (16.9%) patients were identified as having an AIS while on MCS; demographics and clinical characteristics are shown in Table 1. Overall, MCS patients were younger and were more likely to have congenital or acquired heart disease than non-MCS patients. Stroke presentation, treatment and outcomes are shown in Table 2. Stroke symptoms were detected upon weaning sedation in the majority of MCS patients (37.1%), and clinical exam was confounded by paralysis or sedation in 82.9%. Over half of MCS patients had peri-procedural strokes, and stroke was detected within 24 hours in 45.8%. Large Vessel Occlusion (LVO) was detected in over half of MCS patients; however, less than a third underwent vessel imaging as part of their initial stroke neuroimaging. Intravenous thrombolysis was contraindicated in all MCS patients. Thrombectomy was performed on 2 MCS patients after ECMO decannulation and was not pursued for most MCS-LVO patients primarily due to large core or completed stroke (Figure 1). Mortality and morbidity were high in the MCS cohort, with 45.5% of MCS patients having an mRS of 5-6 on discharge, compared to 14.4% of non-MCS patients.

Conclusions:
Pediatric AIS on MCS carries a high risk of morbidity and mortality and can be challenging to recognize acutely, with the post-procedural period being particularly high-risk. Advanced neuroimaging and neuromonitoring may play an important role in earlier detection of stroke and eligibility for thrombectomy in this population.
Abstract TMP99: Characterization of Large Vessel Occlusion Stroke in Head and Neck Cancer Survivors treated with Endovascular Therapy
Authors: Al-Qudah Abdullah , Doheim Mohamed , Bhatt Nirav , Rios Rocha Lucas , Khalifa Moustafa , Starr Matthew , Nilsen Marci , Lang Michael , Gross Bradley , Johnson Jonas , Al-Bayati Alhamza , Nogueira Raul , Rocha Marcelo
Published: January 2025

Background:
Head and neck cancer (HNC) survivors have more than double the risk of ischemic stroke relative to the general population, attributed to radiation-induced carotid vasculopathy. Yet the characteristics of large vessel occlusion (LVO) stroke in HNC survivors is undefined. This study aimed to characterize LVO strokes among HNC survivors who received endovascular therapy (EVT).

Methods:
Retrospective analysis of a single-center prospective stroke registry of EVT patients from January 2021 to January 2024. Patients were divided into three groups: HNC, other cancer (other-CA) and no cancer (non-CA). Demographic data, clinical characteristics, and procedural variables were compared between groups. Primary outcomes were functional independence (modified Rankin Scale [mRS] 0-2) and mortality at 90 days. Multivariable binary and multinominal logistic analyses were performed to adjust for baseline imbalances.

Results:
Among 1004 patients undergoing EVT in this cohort, 884 (88.0%) were non-CA, 110 (11.0%) had other-CA, and 10 (1.0%) had HNC status post neck radiation therapy. The median [IQR] age of HNC patients were significantly younger (63.5 years [IQR: 61.3–69]), compared to both non-CA and other-CA groups (72 years [IQR: 61–80] and 73.5 years [IQR: 65–82], respectively), p = 0.02. The prevalence of tandem carotid occlusion requiring angioplasty or stenting was 90% in the HNC group, whereas it was 15.3% in non-CA and 10.8% in other-CA groups (adjusted odd ratio (aOR) 48.7, 95% CI [8.1 – 830], p=<0.001). HNC patients were less likely to achieve complete reperfusion compared to the other 2 groups (40.0 % vs 48.5 % vs 61.8 %; aOR 1.6, 95% CI [1.09 – 2.4], p=0.01). The rate of mRS 0-2 at 90 days was 55.5% in the HNC group, compared to the 33.4% in non-CA or 32.2% in other-CA, which did not reach statistical significance (p = 0.4). There was no statistically significant difference in the age-adjusted mortality rate at 90 days among the 3 groups.

Conclusion:
HNC survivors with LVO stroke referred for EVT were younger but had extremely high prevalence of tandem carotid occlusion requiring angioplasty and stenting. They experienced comparable rates of functional outcomes and mortality, despite lower rates of complete reperfusion relative to non-HNC groups. The findings support the need for early monitoring and prevention for accelerated carotid vasculopathy in this population.
Abstract TP104: Bridging the Education Gap: Strengthening Stroke Rehabilitation in the Midwest
Authors: Pawloski Madeline , Pietrzak Janna , Picou Kylie , McWeeny Patrick , Schmidt Joelle , Schweers Amy , Spenner Mindy , Zevenbergen Kelci , Malina Beth
Published: January 2025

Introduction:
Post-acute care (PAC) facilities across Iowa, Montana, Nebraska, and North Dakota are engaged in the American Heart Association’s Mission: Lifeline Stroke PAC Initiative, a quality improvement initiative focused on enhancing stroke rehabilitation through evidence-based practice. Participants across these states collaborate to improve patient care, identify gaps in current practices, and enhance stroke specific education.

Purpose:
In a 2023 survey of healthcare professionals (HCPs) in Iowa, 48% (n=120) of respondents identified professional education as a missing resource that could help them provide rehabilitation care to stroke survivors. Through the initiative, education was developed to address this identified need.

Methods:
A variety of free educational opportunities were offered throughout the Mission: Lifeline Stroke Initiatives. These included in-person stroke conferences and workshops, virtual learning modules, online courses, and discipline specific rehabilitation certifications. 760 HCPs participated in 12 different educational offerings across Midwest states. Attendees were surveyed to assess the perceived benefits of the offerings, utility to their current role, and improvements in knowledge and confidence providing rehabilitation care to stroke patients.

Results:
Following the completion of the educational offerings, 93 attendees completed a post-survey. The large majority of respondents reported they were extremely or mostly confident in identifying signs of a stroke (95%), describing common deficits after a stroke (96%), and implementing evidenced-based practices to address these deficits (90%). Most respondents agreed the trainings improved their knowledge of the relationship between treatment and stroke rehab patient outcomes (91%) and their understanding about key issues related to working with stroke rehab patients (91%). Overall, 78% of respondents reported they always or often use the knowledge and skills learned from the trainings and 95% were satisfied with the content of the trainings. Respondents also identified additional educational needs for cognitive rehabilitation strategies, aphasia interventions, caregiver education, community integration, and general stroke rehabilitation.

Conclusions:
Mission: Lifeline Stroke educational offerings benefitted HCPs by improving their knowledge and confidence to provide care to stroke patients. Education on additional stroke specific topics were also identified.
Abstract TP119: What do participants want in a consent form? A systematic review
Authors: Seeger Rena , Palacek Katerina , Cummings Emma , Dewar Brian , Shamy Michel
Published: January 2025

Introduction:
Informed consent is a cornerstone of modern clinical research, though ensuring consent has long been recognized as problematic. This is especially true for acute stroke trials, where the time-sensitive nature of treatment challenges traditional consent practices. The era of platform adaptive trials will likely add further complexity to acute stroke consent. Therefore, we sought to survey the literature for any empirical studies documenting research participants’ preferences around what content is most important to include in consent forms.

Methods:
We conducted a systematic review of the literature to identify empirical studies reporting patients’ opinions about what content is most important to include in consent forms for research participation. Eligible studies included surveys, focus groups, or interviews. Based on a review of consent form templates, we identified 18 elements that commonly appear in consent forms, and used these to guide our extraction of potential content.

Results:
Of the 1,444 studies screened by title and abstract, 35 were sent to full text review, and data were extracted from 17 studies. To determine the ubiquity of the importance of these topics, we counted if each of these topics appeared in the 17 papers. The most commonly mentioned items included risks (65%, 11/17 studies), potential benefits (53%, 9/17 studies), study procedures e.g. blood draws and imaging (47%, 8/17 studies), confidentiality (47%, 8/17 studies), study rationale (41%, 7/17 studies), and voluntariness (41%, 7/17 studies). The least important elements included information about the condition and investigator conflicts of interest.

Conclusion:
In the era of adaptive platform trials for acute stroke, there is the potential for consent forms to become incredibly lengthy and complex. This is the first systematic review of which we are aware that seeks to identify what information is most important to be included in consent forms to participate in research studies. Unfortunately, data are limited but they suggest that consent form optimization is possible. Only risks and potential benefits were identified as important in a majority of studies.
Abstract TP124: Perception of health status in stroke patients through Patient-Reported Outcome Measures depending on who collects them
Authors: Guirao Cristina , Rizzo Federica , Sanchez Ester , Paredes Carolina Kina , Baladas Maria , Montiel Estefania , Cano David , Ribo Marc , Molina Carlos , Rubiera Marta
Published: January 2025

Value-based medicine places the patient and their health status at the center of the intervention through the use of Patient-Reported Outcome Measures (PROMs). The ideal would be that these outcome measurements were answered directly by the patient but in many cases it is a caregiver or a healthcare professional who collects the person's health status perception. This reason could lead to a bias in the results.

Our aim was to compare whether there were differences in the perception of health status depending on who answered these questionnaires.

Stroke patients discharged from six European hospitals were included in a 1-year follow-up program based on a holistic communication tool (web platform for professionals and app for patients/caregivers) called NORA. PROMs at 7-90 days were collected through NORA-app. In case that the patient or caregiver didn't have access to a smartphone, the data collection was carried out by a professional healthcare who contacted them to manage PROMs by a phone call.

Main outcome measures include: HAD-depression and HAD-anxiety (defined as pathological by a score ≥10 points in each of the subscales) and PROMIS-10 (cut-offs raws values of normality were defined as: Physical-PROMIS>13 and Mental-PROMIS>11). Median scores per collector were compared. In addition, a social questionnaire was collected from app-users'.

Over two years, 5116 stroke patients were included in Harmonics project, 60% were men with a mean age of 70.2 years and median mRS of 2(1- 3) at hospital discharge. From them, 2432 were actively monitored and 1498 reported PROMs (428 patients (28.6%), 376 (25.1%) caregivers and 694 (46.3%) professionals). P-value < 0.05 was considered significant for all tests at 90 days. Median PROMs results are shown in Table-1.

The social questionnaire (Figure-1) showed significant differences between male and female patients. From the total, 26.6% women and 11.7% men leave alone (p-value = 0.005).

At the patients group 77.9% women considered they can take care of their basic needs’ vs 85.9% men (p-value= 0.036).

Significant differences were found between the three groups of collectors, with professionals being the ones who perceive a better state of patient health through the collected PROMs collected. Among patients and caregivers groups, worse outcomes were reported by the last one.

When using PROMs the collector should avoid bias in reporting the results and direct patient response should be encouraged.
Abstract TP126: The association of patient outcomes with caregiver mental health and strain in a community-based study.
Authors: Kelley Libby , Kwicklis Madeline , Lisabeth Lynda , Morgenstern Lewis
Published: January 2025

Background:
Stroke survivors face functional changes that may alter their quality of life. Although these changes are significant for the stroke survivor, they are consequential for the caregiver of the stroke patient as well. Psychological burden of stroke caregivers has been investigated, but its association with level of disability and quality of life of the stroke patient has been less studied.

Objective:
To determine if worse 90-day patient stroke outcomes result in greater caregiver strain and worse caregiver mental health in a multiethnic sample.

Methods:
Using data from the Brain Attack Surveillance in Corpus Christi project, we prospectively determined 90-day ischemic and hemorrhagic stroke outcome from 2019-2023. Patient function based on ADLs/IADLs (higher scores worse) along with patient quality of life based on SS-QOL (higher scores better) were used to measure patient outcome. Stroke caregivers' depression was measured using the PHQ-8 (higher scores worse) and strain was measured by mCSI (higher scores worse). Generalized propensity scores (GPS) were calculated for the main exposures using caregiver and patient demographics, dyad characteristics, and clinical variables as predictors. Caregiver outcomes were modeled with linear regression, with caregiver depression and strain as main outcomes, unadjusted and adjusted for GPS.

Results:
During this time period, 339 strokes were identified and their caregivers subsequently interviewed. The median age of interviewed caregivers was 55, with 46% being the sole informal caregiver. A majority of the caregivers interviewed were either the spouse of the stroke patient (42.2%) or the child of the stroke patient (38.1%). In adjusted analyses, functional status for stroke patients was not associated with caregiver depression (p=0.12), higher stroke patient quality of life was strongly associated with lower odds of any depression symptoms among caregivers (p<0.001), and worse patient functional status (continuous ADL/IADL) and lower patient quality of life were strongly associated with higher caregiver strain (p<0.001, p<0.001, respectively).

Conclusion:
Worse stroke patient outcome has a negative association with caregiver mental health and caregiver strain. Interventions targeting caregivers of stroke patients are necessary to improve and protect caregiver mental health and strain.
Abstract TP127: Isolation and Stroke: A Retrospective Analysis of Outcomes Amidst Solitude
Authors: Austin Hannah , Sharma Sameer
Published: January 2025

Introduction:
Stroke is the leading cause of long-term disability and fifth leading cause of death in the United States. Social isolation (SI) and loneliness are known risk factors for stroke and may be linked to worse functional outcomes. Previous animal studies have demonstrated enhanced outcomes associated with socialization. The impact of SI following stroke may be clinically relevant for therapeutic intervention.

Hypothesis:
Stroke patients experiencing social isolation will exhibit worse outcomes compared to those with social support networks.

Aim:
This retrospective analysis aims to compare stroke outcomes during the COVID-19 visitation restrictions with outcomes during the preceding years when visitation was permitted.

Methods:
Data were collected from the Patient Cohort Explorer, a de-identified database within our institution’s Research Data Warehouse. Patients were divided into two groups based on date: the isolation group and the control group. The control group included patients admitted from December 1, 2018, to January 1, 2019, during normal visitation policies, while the isolation group comprised patients admitted from December 1, 2020, to January 1, 2021, during visitation restrictions. Two-proportion Z-tests were conducted to analyze differences in demographic data, and two-sample T-tests were used to assess outcomes, including length of stay and discharge disposition.

Results:
A total of 725 unique patients met the inclusion criteria, with demographic characteristics such as sex and race well-matched between the isolated and control groups, except for a notable age difference (p-value .011). Significant differences in mortality rates were observed, with the control group showing a higher likelihood of returning home (p-value < .001) and the isolation group having a greater proportion of deaths (p-value .003). Additionally, there was a statistically significant difference in hospital stay length, with the control group able to discharge earlier (p-value .001).

Conclusion:
Social isolation can result in longer hospital stays, poorer outcomes, and increased mortality for patients with acute infarcts. Since the data was gathered during the COVID-19 pandemic, it's challenging to eliminate the virus as a confounding factor in these outcomes. However, the findings suggest that patients lacking social support may face worse functional recovery and different recovery trajectories compared to those with support.
Abstract TP132: Safety-net Hospitals in the U.S. Have Worse Outcomes than Non-safety Net Hospitals for Ischemic Stroke
Authors: Zhan Michelle , Man Shumei
Published: January 2025

Background:
Safety-net hospitals (SNHs) are crucial in serving uninsured, underinsured, and socioeconomically disadvantaged populations, who often face financial limitations and resource shortages compared to their counterparts. We hypothesized that patients with ischemic stroke treated at SNHs would have inferior outcomes compared to non-SNHs, which may be related to the patient's socioeconomic status and care allocation.

Methods:
The National Inpatient Sample Database was queried to identify adult patients (≥18 years) who were hospitalized for ischemic stroke from 2016 to 2019. Patients with safety-net features were those with Medicaid or no insurance. Hospitals were ranked based on the percentage of patients with safety-net features. Hospitals in the top quartile were defined as SNHs, and the remaining hospitals were defined as non-SNHs. The characteristics and outcomes of the patients with or without safety-net features treated at SNHs vs non-SNHs were compared after adjusting for patient and hospital characteristics. A composite overall outcome variable was also generated to include in-hospital mortality, acute renal failure, tracheostomy, and sepsis.

Results:
We identified a weighted total of 1,823,985 patients, including 501,345 treated at SNHs and 1,550,100 at non-SNHs. The patients treated at SNHs were more likely to be non-white, had lower socioeconomic status but higher neurological severity, and more frequently required endovascular thrombectomy. They were associated with higher in-hospital mortality (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.09-1.19, p<0.001) and composite outcome (aOR 1.17, 95% CI 1.14-1.19), and longer hospital length of stay (5.6±7.7 vs 4.5±5.4 days, p<0.001) (Figure 1). Patients without safety-net features who were cared at SNHs had higher neurological acuity and worse outcomes compared to those treated at non-SNHs including in-hospital mortality (aOR 1.14, 95% CI 1.09-1.19), acute respiratory failure (aOR 1.24, 95% CI 1.20-1.29), tracheostomy (aOR 1.45, 95% CI 1.30-1.63), acute renal failure (aOR 1.16, 95% CI 1.13-1.19), and sepsis (OR 1.42, 95% CI 1.33-1.51) (Figure 2).

Conclusions:
Patients treated for ischemic stroke at SNHs, regardless of their socioeconomic status and safety-net features, have higher in-hospital mortality and an increased risk for composite adverse outcomes. These findings support changes in resource allocation and efforts to improve the care of ischemic stroke in SNHs.
Abstract TP133: Who's Ready to Change? Factors Influencing Stroke Risk Activation Among High-Risk Patients
Authors: Groves Christine , Damush Teresa , Perkins Anthony , Daggy Joanne , Williams Linda
Published: January 2025

Introduction:
We recently completed an intervention study (n=3,843) demonstrating that a monetarily incentivized mailing is associated with patient activation, defined as calling a stroke coordinator to discuss risk reduction. This study was carried out in two diverse healthcare systems: Eskenazi Health System (EHS) and the Richard L. Roudebush Veterans’ Administration Medical Center (VA). The purpose of this secondary analysis was to identify factors associated with readiness to change stroke risk behaviors among patients who called the coordinator.

Methods:
Patients who responded to a mailed stroke risk message participated in a standardized interview assessing their perceptions of stroke risk, possible risk reduction behaviors, and readiness to change. The stroke coordinator rated patients’ readiness to change based on the Transtheoretical Model stages of change: pre-contemplation, contemplation, preparation, action, or maintenance. Readiness (yes/no) was defined as being in the action or maintenance stage. Additional data collected included demographics, stroke risk factors, Framingham Stroke Risk Score, Charlson Comorbidity Index, and median income/percent poverty by zip code. We used Fisher’s exact test for categorical variables and either a two-sample T-test or Wilcoxon rank-sum test for continuous variables to analyze differences between readiness to change by site. Logistic regression was conducted with readiness to change as the outcome, adjusting for site and significant variables from bivariate associations.

Results:
238 EHS and 387 VA patients called the coordinator. 87 (37%) EHS and 172 (44%) VA patients were categorized as ready to change. Self-reported excellent/very good health was associated with readiness to change (OR 2.30, 1.40-3.77, p=0.001), as was having personally made significant health changes or knowing someone who had (OR 1.74, 1.24-2.44, p=0.001). Smoking was negatively associated with readiness to change (OR 0.46, 0.29-0.73, p=0.001). Site, gender, race, and income/poverty were not associated with readiness to change.

Conclusions:
Less than half of high-risk patients who called a stroke coordinator were ready to change stroke risk-related behaviors. Behavioral modification interventions may benefit from focusing on modifying self-perceptions of health and on making small health changes to improve patients’ readiness to change modifiable stroke risk factors.
Abstract TP148: The Need for Standardized Stroke Care: Assessing Global Provider Training and Institutional Disparities
Authors: Owens Cameron , Bonin Pinto Camila , Heldner Mirjam , Carbonera Leonardo , De Souza Ana , Tunkl Christine , Matuja Sarah , Orjuela Karen , Guerrero Rodrigo , Alet Matias , Vasquez Sebastian , Cano-Nigenda Vanessa , Roa Wandurraga Luis , Lagos-Servellon Javier Alfredo , Saposnik Gustavo , Rosales Julieta , Saleh Velez Faddi
Published: January 2025

The development of vascular neurology as the primary specialty for stroke evaluation and treatment is a relatively recent advancement. Vascular neurology is well-established in the United States, ensuring most stroke patients receive specialized care, but many stroke patients globally are managed by physicians without specialized training in cerebrovascular and neurological medicine that is partly manifested by the availability of institutions that incorporate dedicated stroke training. Our goal is to evaluate the training of stroke providers worldwide to identify who is leading stroke care in different regions, and to assess the availability of dedicated stroke education within these regions. This evaluation aims to highlight disparities and ultimately work towards the global standardization of stroke care. We distributed an international survey to assess level of training of physicians treating stroke, if dedicated stroke training (e.g., fellowships) is available at their institution and location where they practice. Preliminary results from our ongoing survey show the average age of 83 respondents was 38.29 ± 7.72 and no difference in proportion of males (n=44) and females (n=39, p=0.0025). Physicians who treat the hyperacute phase of stroke indicated their level of training (Vascular Neurologist n=19, Other n=40, p=0.0045) (
Figure 1
). A subset analysis of non-vascular neurologists revealed that most ‘Other’ physicians worked in areas where no vascular neurology training was available (vascular neurology training available n=11, not available n=24, p=0.0410) (
Figure 2
). Distribution of vascular neurologist’s vs other physicians treating stroke indicate countries where there is increased proportion (i.e UK, Switzerland, Czech Republic, Argentina, USA) and decreased proportion of dedicated vascular neurology training (Honduras, Colombia, Nepal, Kenya, Papua New Guinea, Tanzania, Bolivia, Hungary) (
Figure 3
). While the availability of vascular neurology is growing internationally, our preliminary results from this ongoing survey indicate there is still a disparity amongst currently practicing physicians who are taking care of acute and subacute patients. Accordingly, this disparity in training may affect patient outcomes; hence, these preliminary data serve to bolster stroke care internationally by identifying areas of training and institutional disparity, all with the goal of improving outcomes in stroke patients through global standardization of care.
Abstract TP151: Optimizing Acute Stroke Care Through a Hub-and-Spoke Telestroke Network: Insights from a Large Cohort Analysis
Authors: Musmar Basel , Roy Joanna , El Naamani Kareem , Herial Nabeel , Abbas Rawad , Sioutas Georgios S , Amllay Abdelaziz , Munoz Alfredo , Sweid Ahmad , Morse Charles E , Moylan Daniel , Joffe Daniel , Knapp Michael , Tjoumakaris Stavropoula , Gooch M. Reid , Rosenwasser Robert , Jabbour Pascal
Published: January 2025

Background:
Efficient management of acute ischemic stroke is critical to reducing disability and mortality. The hub-and-spoke telestroke model has been developed to extend specialized stroke care to regions with limited resources, ensuring timely diagnosis and treatment.

Objective:
To evaluate the effectiveness of a large-scale hub-and-spoke telestroke network in delivering acute stroke care, focusing on the rates of thrombolysis and mechanical thrombectomy, treatment timelines, and patient outcomes.

Methods:
We conducted a retrospective analysis of 9,702 patients treated within a 38-hospital telestroke network from December 2014 to January 2018. Data collected included patient demographics, stroke characteristics, treatment interventions, and outcomes. Key measures included the proportion of patients receiving intravenous tissue plasminogen activator (IV tPA), mechanical thrombectomy, time from stroke onset to treatment, and rates of complications and discharge outcomes.

Results:
Of the 9,702 patients included, 83.1% were diagnosed with a true stroke, and the mean NIHSS score on admission was 6.2. IV tPA was recommended for 16.3% of patients, with 61.7% receiving the treatment. Mechanical thrombectomy was performed in 2.3% of cases, with an average procedure duration of 46.2 minutes. The median time from stroke onset to IV tPA administration was 114.2 minutes. Hemorrhagic transformation occurred in 19.4% of patients who received thrombolysis, and the overall mortality rate was 17.4%. The average NIHSS score at discharge improved to 4.4, with 54.9% of patients discharged home.

Conclusion:
The hub-and-spoke telestroke network demonstrated significant efficacy in delivering timely, specialized stroke care across a large and diverse patient cohort. By reducing treatment delays and optimizing access to advanced interventions, this model has the potential to transform stroke care in underserved regions, reducing both mortality and long-term disability.
Abstract TP156: Stroke Survivor and Caregiver Perspectives on Seeking Acute Care: A Qualitative Study
Authors: Stewart Lindsay , Johnson Emma , Pinapaka Mahesh , Jauch Edward , Brice Jane , Patel Mehul
Published: January 2025

Introduction:
Early recognition of acute stroke and activation of emergency medical services (EMS) is a critical first step in the stroke care continuum. Failure to call 9-1-1 and other delays in seeking care contribute to prolonged prehospital delays, often limiting access to time-sensitive treatment. To identify challenges in early initiation of EMS, we sought to understand stroke survivor and caregiver perspectives on seeking acute stroke care.

Methods:
We conducted individual, semi-structured interviews with a convenience sample of adult stroke survivors and caregivers for patients with acute stroke that occurred in central North Carolina. In virtual interviews, participants were asked about stroke signs and symptoms experienced, their response, and care received from EMS and in the ED and hospital. Interviews were recorded, transcribed, and analyzed by two individual coders. Deductive coding and rapid thematic analysis focused on care-seeking behaviors and perspectives.

Results:
Of 16 interviews conducted thus far, 10 were with stroke survivors and 6 were with accompanying caregivers (14 Non-Hispanic White; 13 used EMS). Stroke onset was promptly recognized when the patient/caregiver had prior experience with stroke, exposure to stroke education, or access to healthcare professionals among their personal circles. Early stroke recognition prompted over half of the caregivers or other bystanders (spouses, adult children, or neighbors) to call 9-1-1 right away. Symptoms perceived by the patient/caregiver as a non-stroke issue (e.g., migraine, seizure) or not severe enough led a third of the participants/caregivers to delay or fail to call 9-1-1. Some participants reported being aware of EMS costs; however, none reported delaying care-seeking due to these concerns. Other concerns with calling 9-1-1 included general apprehension of medical professionals and fear of being perceived as “the boy who cried wolf.”

Conclusion:
Stroke survivors’ and caregivers’ perspectives highlighted accurate and early stroke recognition as a facilitator of prompt EMS initiation. Conversely, symptoms associated with other neurologic conditions or perceived as mild created delays in seeking care. Further recruitment is in progress until reaching at least 30 participants, focusing on racial and ethnic minority groups and underserved rural populations. Study findings will be used to develop effective solutions to challenges in seeking acute stroke care.
Abstract TP157: Sex Disparities in Stroke Care at Comprehensive Stroke Centers: DiVERT Stroke Study Phase I
Authors: Rose David , Lakkireddy Dhanunjaya , Braklow Jana , Pothineni Krishna , Snavely Josh , Mohanty Bibhu , Hairston Marla , Carta Roberto , Richmond Dalia , Franco Noreli , Neisen Karah , Devlin Thomas
Published: January 2025

Introduction:
Prior studies have shown various sex disparities in stroke care; whether sex disparities exist for cardiac consultation or monitoring post-stroke is unknown.

Methods:
DiVERT (SeconDary Stroke PreVEntion ThRough Pathway ManagemenT) is an ongoing, retrospective, multicenter study evaluating in-hospital care pathways for patients with cryptogenic, large-vessel atherosclerotic disease and small vessel disease stroke subtypes. Phase I included in-person clinician interviews across cardiology and vascular neurology subspecialities, data collection from electronic health records and the American Heart Association Get With the Guidelines (AHA GWTG) registry from 2017 to 2019. Baseline demographics and 6 months post-index stroke discharge data were collected at 5 comprehensive stroke centers (CSC) in the United States and compared between females and males.

Results:
Among 2,699 patients, the majority presented with cryptogenic stroke (70.9%) and females (48.8%) were older than males (68.3, SD=14.6 vs. 65.7, SD=13.3; p<0.001) (Table). Females were less likely to receive cardiology referrals during index hospitalization (12.8% vs. 15.5%, p=0.043), had shorter length of stay (6.8 vs. 7.7 days; p=0.025) and were less likely to receive post-stroke cardiac monitoring (19.9% vs. 23.0%, p=0.048). There were no sex differences for type of cardiac monitoring (external vs. insertable). The rate of atrial fibrillation detected post-stroke was higher for any type of cardiac monitoring vs. non-monitoring, irrespective of sex (7.4% vs. 3.9%, p=0.015 for females and 8.0% vs. 3.5%, p<0.001 for males).

Conclusion:
Among stroke patients admitted to CSC, women had shorter length of stay at index stroke hospitalization, fewer referrals to cardiology and less frequent post-stroke cardiac monitoring than men. These differences could represent sex disparities that impact preventive actions for secondary stroke and long-term outcomes.
Abstract TP161: Machine Learning to Glean Characteristics of Quantitative Susceptibility Maps in Cerebral Cavernous Angiomas with Symptomatic Hemorrhage
Authors: Kinkade Serena , Li Hui , Hage Stephanie , Koskimaki Janne , Stadnik Agnieszka , Lee Justinee , Papaioannou John , Flemming Kelly , Kim Helen , Torbey Michel , Huang Judy , Carroll Timothy , Girard Romuald , Giger Maryellen , Awad Issam
Published: January 2025

Introduction and Hypothesis:
New bleeding in cerebral cavernous malformations (CCM) heralds increased risk of future hemorrhage for several years, yet conventional imaging only detects new bleeding that occurred in the prior weeks. A biomarker of hemorrhage could help identifying high risk lesions. An increase of mean lesional quantitative susceptibility mapping (QSM) ≥6% on MRI has been adjudicated as reflecting new bleeding in CCM during longitudinal follow-up. However, mean lesional QSM from a single acquisition could not diagnose or prognosticate a bleed. We hypothesize that machine learning (ML) may identify diagnostic and prognostic features of bleeding within QSM maps at a single point in time.

Material and Methods:
Two hundred and sixty-five QSM maps of CCM lesions were acquired in 120 patients enrolled in National Institute of Health (NIH) multisite trial readiness project (NCT03652181). Each map was classified (Yes/No) in association with symptomatic hemorrhage (SH) and/or biomarker event with QSM increase ≥6% in the prior (diagnostic association) and subsequent (prognostic association) year. Twenty-eight features were extracted including 14 texture, 5 first-order statistical, as well as 3 size, shape, and morphological. Five-fold cross-validation was conducted on a support-vector machine (SVM) with linear stepwise kernel for both diagnostic and prognostic associations. Performance of individual features and composite classifiers was evaluated using student t-test (
p
<0.05) with Bonferroni-correction and receiver operating characteristic (ROC) analysis, area under the curve (AUC).

Results:
Lesions with SH in the prior year had lower average values for sum variance (AUC=0.79, p<0.001), variance (AUC=0.79, p<0.001), and correlation (AUC=0.71, p=0.004) as compared to lesions without SH. The SVM classification method tasked with distinguishing lesions with mean QSM increase ≥6% in the prior year included recurrent selection of sum average, mean, sphericity and margin sharpness, yielding an AUC of 0.61 (p=0.02). In the prognostic cohort, no individual feature nor any SVM classification model was able to distinguish cases with a subsequent clinical bleed or biomarker event.

Conclusion:
This proof-of-concept suggests that ML may assist in deriving features on QSM maps acquired at a single timepoint, which reflect prior hemorrhagic activity in CCM. Further investigation is planned in larger cohorts and in conjunction with clinical trials of bleeding in CCM.
Abstract TP164: Feasibility of Randomizing to CT or MRI for Evaluation of First Imaging Modality for Stroke
Authors: Moore Marina , Berstis Karinne , Warach Steven , Goldberg Mark , Olson Daiwai , Savitz Sean , Anderson Jane , Dula Adrienne
Published: January 2025

Background:
Ischemic stroke is a leading causes of death and disability and imaging is essential when determining treatment. Currently, both computed tomography (CT) and magnetic resonance (MR) are accepted as options for first imaging of stroke. Whether MR or CT is more advantageous for first stroke imaging has yet to be determined in a randomized study. The goal of this study was to determine feasibility of randomizing code stroke patients to MR or CT.

Methods:
Multisite, randomized, prospective study of code stroke patients presenting within a 12-week window to 4 certified stroke centers. Hospital-level cluster randomization assigned each site 6 CT-first weeks, and 6 MR-first weeks. Patients ≥18 years presenting with stroke symptoms < 24 hours with active code strokes at time of first imaging were included. Patients transferred from another hospital or who received prior imaging at an outside facility were excluded. Demographics, clinical stroke variables, and workflow metrics were extracted from the local stroke database or patient electronic health records. A univariate logistic regression model was used to evaluate the primary outcome: compliance (i.e. proportion of patients scanned according to assigned imaging). We hypothesized compliance would be comparable to that seen when MR-first was the preferred standard of care, ≥60%, demonstrating feasibility.

Results:
406 patients (199 females; mean age 67 years, range 24 - 103) were included in the analysis (Table 1). Compliance with assignment to CT was 90%, compliance with MR was 66%. Those assigned to MR were significantly less likely to be scanned as assigned (OR: 0.21, 95% CI [0.12-0.36]). Reasons for non-compliance included both process-related (e.g. MR scanner in use) and patient-related reasons (e.g. medically unstable). Most frequently, the reason for non-compliance was not documented.

Conclusion:
This study is the first step in evaluating feasibility for a large-scale randomized clinical trial to determine whether MR or CT is preferable as the first stroke imaging modality. Compliance with assignment (MR or CT) our preset threshold of 60%, with significantly higher compliance when CT was assigned compared to MR. With mitigation of process-related barriers to randomization compliance, these results inform next steps in optimizing a future trial.
Abstract TP165:

Computed-Tomography (CT) Based Imaging Scores in Basilar Artery Occlusions – A Comparison of Predictive Abilities for Functional Outcomes
Authors: Lun Ronda , Shah Parshva , Franco Lia Carolina , cereda carlo , Mlynash Michael , Yuen Nicole , Qureshi Abid , Hinduja Archana , Dehkharghani Seena , Goldman Yassen Adam , Hsieh Kevin Li-Chun , Giurgiutiu Dan-Victor , Gibson Dan , Carrera Emmanuel , Alemseged Fana , Faizy Tobias , Fiehler Jens , Pileggi Marco , Campbell Bruce , Heit Jeremy , Albers Gregory
Published: January 2025

Background:
Posterior circulation (PC) large-vessel occlusion (LVO) strokes have significant morbidity and mortality, but patient selection for acute interventions remains understudied. Multiple computed tomography (CT)-based scores exist, including the CT-perfusion-based CAPS score, CT-angiogram(CTA)-based BATMAN and PC-CTA scores, and CTA source image or non-contrast-CT-based PC-ASPECTS score, but their predictive values for long-term outcomes after thrombectomy have not been directly compared.

Methods:
We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions treated with endovascular thrombectomy. Four CT-based scores were assessed: PC-ASPECTS, BATMAN, PC-CTA, and CAPS. The primary outcome of interest for the study was favourable functional outcome at 3 months (mRS of 0-3). We generated receiver operating characteristic curves measuring area under the curve (AUC) for poor functional outcomes and compared AUCs with non-parametric methods.

Results:
98 patients were included for analysis, with an average age of 64.9±15.6 years.

The median National Institute of Health Stroke Severity Score (NIHSS) was 13.5 (IQR 7.0 – 23.0). AUC values were highest for the CAPS score (AUC 0.72 (95%CI 0.63 – 82)), and lowest for the pc-CTA score (AUC 0.57 (95%CI 0.45 – 0.68)), p=0.019. There was a trend towards the CAPS score outperforming the BATMAN (AUC 0.66 (95%CI 0.55 – 0.77) and PC-ASPECTS scores (AUC 0.63 (95%CI 0.52 – 0.75)), though this difference was not statistically significant (p=0.29 and p=0.23, respectively). However, the CAPS score was the only score with 100% specificity for predicting inability to achieve good functional outcome after thrombectomy: 0/12 patients with CAPS score of 4-6 went on to have a good functional outcome at 3 months after thrombectomy.

Conclusion:
Our analysis demonstrated that the CT-perfusion-based CAPS score outperformed three other imaging-based scores for predicting outcomes after 3 months. The CAPS score could be implemented to inform patient selection for endovascular thrombectomy in basilar artery occlusions.