bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP107: B cells Migrate to Remote Areas Supporting Functional Recovery After Stroke
Authors: Torres Vanessa O , Ortega Sterling B , Ramirez Denise M , Plautz Erik J , Ingle Laura , Kong Xiangmei , Stowe Ann M
Published: October 2018

Background:
Neuronal networks in the post-stroke CNS undergo significant reorganization and plasticity to compensate for loss of function in stroke-injured tissue. Studies in our lab show that B cell-depleted mice exhibit impaired neurogenesis, increased anxiety, and spatial memory deficits after stroke. These post-stroke deficits generally occur in areas outside of the ischemic infarct. Therefore,
we hypothesized that B cells migrate into CNS regions outside the ischemic penumbra to promote post-stroke neuroplasticity and functional recovery.

Methods:
Donor B cells were isolated from spleens of adult 6-8 week old male C57Bl/6J (B6; Jackson Labs) mice 10 days after receiving a 60-minute transient middle cerebral artery occlusion (tMCAo). B cells were labeled with a fluorescent proliferation dye (e450; eBioscience). Recipient mice expressing YFP in cortical neurons (B6 background; Jackson labs) received B cells (0.2-5X10
6
B cells) in the contralesional ventricle 2 days post-tMCAo. B cell migration was assessed 4 days after intraventricular injection using 3D serial two-photon microscopy (TissueCyte 1000 microscope, TissueVision, Cambridge, MA). Peripheral migration of B cells into spleen and cervical lymph nodes was assessed using flow cytometry.

Results:
3D brain reconstruction showed infarcted regions characterized by a loss of neuronal YFP and diffuse blue fluorescence. B cells, identified with punctate blue labeling, exhibited CNS regional-specific migration after stroke. This included B cell populations in bilateral hippocampus, amygdala, and brain stem nuclei; all areas outside the identified infarct region. Furthermore, migration of B cells into peripheral organs was also detected 4 days post stroke following intraventricular injection.

Conclusions:
Our
in vivo
migration studies highlight the migration of B cells to regions outside the ischemic penumbra, coinciding with our preliminary behavioral studies in B cell-depleted mice. We also observed an outward migration of B cells from the CNS to the periphery, which may have local implications that need to be further investigated. These results are the first to indicate the potential for neurotrophic B cell support in remote cortical regions following ischemia.
Abstract TP111: Tibia Fracture Caused Long-lasting Cognitive Impairment of Stroke Mice Accompanied With Microglia Accumulation in the Hippocampal Stratum Lacunosum Moleculare
Authors: Li Zhengxi , Wei Meng , Zhang Meng , Wong Aaron , Wang Sen , Su Hua
Published: October 2018

Background and purpose:
Accumulation of macrophages and microglia is evidenced in the lesions of human and mouse brain arteriovenous malformations (bAVMs) with or without hemorrhage, suggesting that these cells play an active role in bAVM pathogenesis. We hypothesize that transient depletion of microglia reduces bAVM severity.

Methods:
Brain AVM was induced in adult mice that have activin-like kinase 1 (
Alk1,
an AVM causative gene) gene exons 4-6 floxed by co-injection of an adenoviral vectors expressing Cre-recombinase and an adeno-associated viral vectors expressing vascular endothelial growth factor into the basal ganglia. Brain microglia were depleted transiently by administration of an inhibitor of colony stimulating factor receptor (PLX5622 (Plexxikon Inc.), 1200 PPM chow) for 7 days starting 1- (when angiogenesis occurred) or 8-weeks (when bAVMs had formed) after model induction. Brain AVM severity was analyzed through quantification of abnormal vessels, macrophage/microglia and hemorrhage (Prussian blue staining) in the lesion (n=6).

Results:
Administration of PLX5622 to wild-type mice for 7 days depleted 93% of microglia in their brains. PLX5622 treatment starting at 1-week after model induction inhibited bAVM formation. There were less abnormal vessels in the treated group (14±0.9 vessels/mm
2
) compared to that in the control group (23±0.9 vessels/mm
2
,
P
=0.001) at 8 weeks after model induction. Administration of PLX5622 starting 8-weeks after the model induction when bAVMs were fully formed also reduced the number of abnormal vessels (control: 25±1.4 vessels/mm2 vs. treated: 14.±0.8 vessels/mm2,
P
<0.001) analyzed at 9-weeks after model induction when the treatment stopped. PLX5622 treatment has also reduced the number of microglia in bAVM lesion (
P
=0.03 for 1-week-group and
P
=0.003 for 8-week-group), which was correlated with the reduction of abnormal vessels (

R
2

=0.63,
P
=0.0001) and hemorrhage.

Conclusion:
Transient depletion of microglia could be developed into a new therapy for reduction of bAVM severity.
Abstract TP113: Elevated Coated-Platelets and SSRI Use Are Associated with Silent Brain Infarction in Asymptomatic Carotid Artery Stenosis
Authors: Kirkpatrick Angelia , Vincent Andrea S , Stoner Julie A , Mathews Eleanor , Dale George L , Prodan Calin I
Published: October 2018

Background:
Silent brain infarction (SBI) is a marker of stroke risk in asymptomatic carotid stenosis. Increased SBI burden downstream of stenosis has not been consistently shown, emphasizing that mechanisms of SBI formation in carotid stenosis remain unclear. Coated-platelets are a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, and elevated levels are associated with TIA/stroke in asymptomatic carotid stenosis. We now examine if coated-platelet levels are associated with SBI in asymptomatic carotid stenosis.

Methods:
Consecutive asymptomatic ≥50% carotid stenosis patients were enrolled and coated-platelets assayed. Brain MRI or CT scans within 12 months of enrollment were reviewed by a blinded neurologist for SBI, defined as a focal, ≥ 3mm, cavitary lesion with T1 hypointensity and T2 hyperintensity features on MRI or hypodense on CT. Demographics, medications and comorbidities were recorded. The optimal coated-platelet cutoff was determined by ROC analysis. Logistic regression analysis included variables having significant (p<.05) bivariate correlations with SBI as potential predictors. Variables with p<0.05 were retained in the final model.

Results:
Brain imaging was available for 64 subjects. The optimal coated-platelet cutoff for predicting SBI was 52.7% (p=0.0002) by ROC analysis. Both elevated coated-platelets (OR=10.4, p=0.043) and SSRI use (OR=3.8, p=0.027) were associated with increased odds of SBI (p=0.005). Stenosis ≥70% was associated with presence (p=0.0005) and number (p<0.0001) of downstream SBI on bivariate analysis, but was no longer significant in the multivariate model (p=0.14).

Conclusions:
Elevated coated-platelets and SSRI use were associated with SBI in this asymptomatic carotid stenosis cohort. Interestingly, presence of ≥70% stenosis was no longer significantly associated with SBI after accounting for coated-platelet levels and SSRI use by multivariate analysis. SSRI use has been linked to recurrent stroke previously, although results have varied. Our findings are the first showing a strong association between platelet procoagulant potential and SBI and warrant further study to confirm our results and explore mechanisms involved.
Abstract TP115: Atherosclerotic Plaque Rupture and Intraplaque Hemorrhage Do Not Correlate With Symptoms in Severe Carotid Artery Stenosis
Authors: Parodi Juan Carlos , Beigelman Ricardo , Zurru Maria C , Milei José
Published: October 2018

Background:
In asymptomatic patients there is no correlation between the degree of stenosis and the benefit of carotid endarterectomy. In these patients, the risk of ischemic stroke (IS) or transient ischemic attack (TIA) decreased significantly in the last 10 years associated with improvement of the medical treatment. The aim of this study was to analyze the relation between the histopathological findings of the carotid plaques and the presence of symptoms.

Methods:
A prospective and descriptive study of the histopathological and immunohistochemical characteristics of the carotid plaques of patients treated with carotid endarterectomy. The study population included patients with more than 70% of carotid stenosis. For the analysis, they were classified as symptomatic because they presented a TIA or IS and asymptomatic. Demographic variables, vascular risk factors and histological characteristics were compared in both groups.

Results:
We analyzed 308 carotid plaques corresponding to 294 patients. The mean age was 68 ± 8 years, 73% (225) were men. There were no differences in the vascular risk factors profile and histopathological plaque characteristics between symptomatic and asymptomatic patients.Seventy-two % (222) presented a complicated plaque and 28% (86) an uncomplicated plaque. Plaques complicated by intraplaque hemorrhage, rupture and / or thrombosis showed mononuclear infiltrate (macrophages and lymphocytes) at the periphery, shoulders and bases in 137 of 220 cases.In contrast, only 22 of 86 of the uncomplicated plaques presented infiltrates (OR 6, 95% CI, 2.6 to 8.3 p <0.00001). In complicated plaques, neovascularization was detected en 148 of 222 cases, being only 42 of 86 cases in the uncomplicated plaques (OR 2.09 95% CI, 1.25 to 3.5 p <0.003). Mononuclear infiltrate was observed in 103 of 133 surgical specimens that presented rupture vs. 56 of 175 with preserved fibrous cap (OR 7.2, 95% CI, 7 to 13 p <0.00001).

Conclusions:
No association between signs of vulnerable plaque and development of symptoms was found. The rupture of plaque was strongly associated with the existence of inflammatory infiltrates at the level of the fibrous cap. Intraplaque hemorrhage was related to the rupture of neoformed vessels.
Abstract TP118: The Topography and Predictors of Blood Brain Barrier Disruption After Carotid Artery Stenting
Authors: Kaplan Berkan , Gocmen Rahsan , Peker Ahmet , Oguz Kader K , Arat Anil , Topcuoglu Mehmet A , Arsava Ethem M
Published: October 2018

Background:
One major issue related to carotid artery revascularization procedures is their potential for inducing disturbances in blood brain barrier (BBB) permeability, which is considered to play a critical role in the pathophysiology of hyperperfusion syndrome. In this study, our aim was to evaluate the predictors of impaired BBB permeability and its topographic distribution among patients undergoing carotid artery stenting.

Methods:
Clinical information (including demographic data, cardiovascular risk factors, degree of stenosis, indication and timing of the procedure), together with pre- and immediate post- (<24 hours) procedural magnetic resonance imaging (MRI) data was prospectively collected in a consecutive series of patients. BBB integrity was specifically evaluated on post-contrast FLAIR sequences. Regions of contrast extravasation were semi-automatically outlined and co-registered to a standard template in order to determine the topography of BBB disruption.

Results:
Evidence for BBB disruption was observed in 11 out of 43 patients (26%) prior to stenting, a feature that was solely related to a recent history of ischemic stroke (<30 days) in multivariate analysis (p=0.033). New-onset or increased BBB disruption following the procedure was seen in 22 patients (51%); increased permeability was primarily observed in the ipsilateral cortical watershed territories (Figure) and was inversely related to the duration elapsed between carotid revascularization and MRI (p=0.036). Hyperperfusion syndrome developed in 7% of our patients, all of whom also having evidence of increased BBB permeability on post-stenting MRI.

Conclusion:
Our findings highlight that BBB disruption in the peri-stenting setting is a frequently common observation, with specific spatial and temporal characteristics. Its predictive utility for predicting hyperperfusion syndrome and unfavorable clinical course, on the other hand, is fairly low.
Abstract TP123: Differential Impact of Age on the Relationship Between Cervicocephalic Artery Atherosclerotic Burden and Presence of Complex Aortic Plaque
Authors: Ma Xin , Kong Qi , Wang Chen , Ji Xunming , Feng Wuwei , Ovbiagele Bruce , Du Xiangying
Published: October 2018

Background:
Complex aortic plaque (CAP) is an embolic source and an atherosclerotic marker, for which older age is one of the strongest risk factors. Whether relationship of CAP with cervicocephalic atherosclerotic burden is consistent in different age ranges remains unclear in acute ischemic cerebrovascular disease (AICVD) patients.

Methods:
AICVD patients ≥45 years old admitted from November 2015 to May 2016 were consecutively enrolled and underwent CT angiography of both cervicocephalic artery and thoracic aorta. CAP was defined as atherosclerotic plaque in the aortic arch proximal to the ostium of the left subclavian with ≥4 mm thickness, ulceration, or mobile components. The burden of cervicocephalic atherosclerosis was determined on atherosclerotic degree (0 to 5) in 7 different arterial segments, measuring both severity and extent. Difference was assessed between CAP group and non-CAP group.

Results:
In 285 included AICVD patients, 32.6% had CAP, who tended to be ≥65 and have higher atherosclerotic burden scores. The interaction between age ranges (45~64 and ≥65) and cervicocephalic atherosclerotic burden scores were statistically significant (p≤0.001). Among the middle-aged (45~64, n=178), there was no significant difference in traditional risk factors between CAP group and non-CAP group, while extracranial cervicocephalic atherosclerotic burden score was independently related to existence of CAP. Among the elderly (≥65, n=107), triglycerides level was higher (median 1.35mmol/L vs 1.02mmol/L, p=0.025) in CAP group, but atherosclerotic burden scores were not significantly different in univariate and multivariate analysis.

Conclusions:
Cervicocephalic atherosclerotic burden is significantly associated with presence of CAP in middle-aged, but not elderly AICVD patients. Assessment of the aortic arch in middle-aged AICVD patients may better help identify the precise cause of their stroke and delineate their overall vascular risk.
Abstract TP126: Carotid Webs in Cryptogenic Ischemic Strokes
Authors: Kim Song J , Allen Jason W , Nahab Fadi , Frankel Michael , Nogueira Raul G , Barreira Clara , Haussen Diogo C
Published: October 2018

Introduction:
Carotid web is an intraluminal projection in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. It may serve as a source of thrombus formation leading to embolic strokes and has been poorly described. We aim to study the prevalence of carotid webs among patients with cryptogenic ischemic strokes (CIS).

Methods:
This was a retrospective analysis of patients aged 18-60 years who presented to two comprehensive stroke centers with CIS (TOAST criteria) and underwent neck CTA, from January 2016 to May 2017. Carotid web was defined as a shelf-like projection with linear/smooth filling on the posterior bulb without superimposed atherosclerosis (defined as adjacent calcifications or wall thickness >3mm). CTAs were reviewed by a neurointerventionist blinded to clinical and other radiological studies. CIS patients with carotid webs (with strokes within the vascular territory) were then compared to the remaining CIS patients.

Results:
Of 162 CIS patients within the study period, 43 patients met the inclusion criteria. Thirteen patients had carotid webs (29.5%), 10 of whom had a stroke in the same vascular territory as the web (22.7%). Median length of the intraluminal web projection was 1.6[1.5-2.0]mm. Age, gender and comorbidities were similar between the patients with stroke within the carotid web territory (n=10) and the remainder of the CIS patients (n=33)(
Table
). None of the patients with ischemic stroke in the carotid web territory were white, while 90% were black (compared to 18% and 74% of the 43 CIS patients, respectively). The NIHSS in the carotid web group was 14.2 [7.9-20.5] as compared to the other CIS arm 10.1 [3.3-16.9]; p=0.09.

Conclusion:
Carotid webs are an under-recognized etiology in CIS affecting the young. Routine and careful vascular imaging analysis of the carotid bulb in young CIS patients is indicated. Further studies are needed.
Abstract TP13: Predicting Outcomes After Successful Endovascular Thrombectomy: Damage Control
Authors: Ermak David , Deturk Nathan , Niazi Muhammad , Reichwein Raymond , Richardson Alicia , Morrison Kathy , Brinkley Amy , Cockroft Kevin
Published: October 2018

Introduction:
Endovascular Therapy (ET) has become the new standard of care for treating acute ischemic stroke (AIS) patients with Emergent Large Vessel Occlusion (ELVO). There are numerous tools that predict outcomes of ischemic stroke patients including those given IV tPA, however, there are no published tools for predicting outcomes after ET.

Methods:
From January 2015-March 2017, 109 AIS patients received ET. Patients with unsuccessful ET (TICI 0-2a) or with incomplete 90 day follow-up data were excluded, leaving 42 for final analysis. Primary outcome was defined as MRS at 90 days (good outcome MRS <=3, bad outcome MRS >3). Of the variables analyzed, 90 day outcomes correlated with age, diabetes, thrombolytic use, onset to groin time, and NIHSS scores. Numerical values were assigned to each variable based on OR analysis and the resulting score (range 0-8) was plotted against 90 day MRS and ROC analysis defined a cutoff value.

Results:
The relative score for each non-binary variable was approximated based on the corresponding OR identified during ROC analysis. Using the DamAGE cONTrol scoring tool (figure 1), a cut off of 4 points yielded
Sn 0.82, Sp 0.95, p <0.001, & AUC 0.94
.

Conclusion:
DamAGE cONTrol represents a novel scoring tool which uses pre-intervention characteristics to predict outcome after successful ET. This type of tool may facilitate more informed discussions regarding the value of performing ET, as well as control unnecessary transfers.
Abstract TP138: The Clinical Features and the Long-Term Outcomes of Carotid Symptomatic Low-Grade Stenosis
Authors: Kurosaki Yoshitaka , Kinosada Masanori , Ishibashi Ryota , Handa Akira , Chin Masaki , Yamagata Sen
Published: October 2018

Background:
Ischemic events caused by carotid artery stenosis are affected not only by stenosis but also by the instability of plaque. In symptomatic low-grade stenosis cases medical treatment is generally performed, but there are cases with repeated recurrence. The purpose of this study is to clarify the clinical features and long-term outcomes in cases of symptomatic low-grade stenosis.

Methods:
We included seventy-one symptomatic patients with carotid low-grade stenosis (<NASCET 50%) who were admitted to our hospital from 2005 to 2016. The relative plaque signal intensity (rSI) with reference to muscle and expansive remodeling rate (ERR) were measured using carotid MRI. Antiplatelet therapy and treatment for atherosclerosis risk factors were administered in all cases. Carotid endarterectomy (CEA) was performed when ischemic symptoms appeared or the stenosis rate progressed despite medical treatment.

Results:
The mean stenosis rate, rSI and ERR on admission were 20.4, 1.75 and 1.96, respectively. Seventy percent of cases involved intraplaque hemorrhage and positive remodeling. During a mean of 52-months follow-up, a recurrence of ischemic events was confirmed in 33 cases (46%), from which the duration until recurrence was within 7 days (33%), 3 months (18%), 1 year (18%), 2 years (21%), and over 2 years (15%). Nine cases had impending stroke, 3 of which were associated with major artery occlusion. CEA was performed in 28 cases (39%) for impending stroke (25%), recurrence of ischemic events (46%), asymptomatic infarction (7%), and stenosis rate progression (11%). During a mean of 47-months follow-up after CEA, 2 cases of death (fetal intracerebral hemorrhage, asphyxia) and one case of brain stem lacunar infarction were observed, but an ipsilateral ischemic event was not observed.

Conclusion:
Most of the symptomatic patients with low-grade stenosis had both intraplaque hemorrhage and positive remodeling. The risk of recurrence and stenosis progression was high. CEA might have had a preventive effect against ischemic events in low-grade stenosis.
Abstract TP14: Duration of Anesthesia Negatively Affects Functional Outcome After Endovascular Therapy for Acute Ischemic Stroke
Authors: Raming Lorenz , Barlinn Jessica , Abramyuk Andrij , Siepmann Timo , Haedrich Kevin , Pallesen Lars-Peder , Prakapenia Alexandra , Theilen Hermann , Reichmann Heinz , Linn Jennifer , Puetz Volker , Barlinn Kristian
Published: October 2018

Introduction:
While three randomized trials recently showed no difference in clinical outcomes between general anesthesia and conscious sedation in stroke patients undergoing endovascular therapy (EVT) for acute ischemic stroke, preliminary data suggest that anesthesia duration itself might adversely affect stroke outcomes. Therefore, we aimed to explore the impact of general anesthesia duration on functional outcome in stroke patients undergoing EVT for large vessel occlusion (LVO).

Methods:
We analyzed prospectively collected data from consecutive ischemic stroke patients who underwent EVT for LVO in the anterior circulation from 01/2016 to 06/2017. To investigate the sole effect of anesthesia, we excluded patients whose anesthesia lasted >= 72 hours (e.g., due to perceived course of malignant infarction) or was prolonged due to medical reasons (e.g., symptomatic intracranial bleeding, malignant infarction). Multivariate linear regression model adjusted for covariates was employed to evaluate whether modified Rankin Scale (mRS) scores at 3 months could be predicted by duration of anesthesia.

Results:
Of 155 ischemic stroke patients undergoing EVT for LVO during the study period, 82 received general anesthesia initiated prior to or during the procedure. Of these patients, 68 fulfilled our inclusion criteria: median age 75 years (IQR, 16); 46% men; median NIHSS score 18 (6); median ASPECT score 7 (2). The median duration of general anesthesia was 440 (1015) minutes and of ventilation/intubation 590 (2150) minutes. Multivariate linear regression analysis revealed that each minute increment in general anesthesia independently predicted mRS scores at 3 months (r
2
=0.368, F=5.13, p<0.0001), adjusted for age, baseline NIHSS, baseline ASPECTS, intravenous tPA, onset-to-groin puncture time and complete reperfusion post-EVT.

Conclusions:
Prolonged anesthesia might negatively affect functional outcome after endovascular therapy in acute ischemic stroke patients undergoing endovascular therapy for large vessel occlusion.
Abstract TP142: Younger Age and Lower Stroke Severity at 24 Hours Predict Return to Driving After Ischemic Stroke
Authors: Dakay Katarina , Chang Andrew D , Hemendinger Morgan , McTaggart Ryan A , Jayaraman Mahesh V , Furie Karen L , Yaghi Shadi , Cutting Shawna M
Published: October 2018

Background:
Driving is a privilege which carries significant emotional and social value to patients, enabling increased independence. After ischemic stroke, residual deficits may prevent patients from driving. We aimed to identify factors predictive of return to driving after stroke.

Methods:
We abstracted data from our ischemic stroke database and included all patients with ischemic stroke from April 1
st
, 2016 to March 31
st
2017 who were reported to have been driving prior to their stroke. Formal driving evaluations were performed, if deemed necessary by the treating physician. Follow-up information was obtained at 90 days and included whether patients had returned to driving. Patients were divided into two groups - those who returned to driving at 90 days vs. not driving at 90 days. We compared baseline demographics including age, vascular risk factors, NIHSS score, acute stroke treatment (mechanical thrombectomy and IV thrombolysis), stroke subtype determined based on ESUS criteria, and hospital acquired-infections, hospital readmission rate.

Results:
We identified 282 patients with ischemic stroke who were driving prior to their stroke; 149 patients (52.8%) returned to driving at 90 days. On univariate analyses, patients who returned to driving were more likely to be younger (62.5 ± 15.1 years vs 70.6 ± 13.5 years; p <0.001), have a lower admission NIHSS score (3 vs 7; p<0.001) and 24-hour NIHSS (1 vs 5; p<0.001), less likely to have diabetes (22.9% vs 36.1%; p 0.016), coronary artery disease (11.9% vs 21.7%; p 0.03), large vessel occlusion (36.1% vs 51.5%; p 0.022), and hospital-acquired infections (3.6% vs 13.9%; p 0.004). On regression models, only age (adjusted OR 0.97; 95% CI 0.94-0.99, p 0.014) and NIHSS at 24 hours (adjusted OR 0.79; 95% CI 0.7-0.89; p <0.001) were predictive of ability to return to driving at 90 days. Among NIHSS items, absence of motor arm and language deficits predicted ability to drive at 90 days.

Conclusion:
In patients with ischemic stroke, younger age and lower 24-hour NIHSS predict return to driving after ischemic stroke. Larger studies are needed to confirm our findings.
Abstract TP143: Evaluation of Knee Extensor Muscle Strength and Femoral Artery Blood Flow in Subacute Stroke Patients Admitted to Inpatient Rehabilitation - a Feasibility Study
Authors: Durand Matthew J , Nguyen Jennifer N , Wright Michael T , Raab Stephanie C , Gutterman David D , Schmit Brian D , Hyngstrom Allison S
Published: October 2018

Introduction:
Weakness of the contralateral leg muscles commonly occurs following unilateral stroke. We and others have also shown that the femoral artery is atrophied in the paretic (P) limb of chronic stroke subjects (>6 months post-stroke) compared to the non-paretic (NP) limb, and that both resting and hyperemic blood flow to the exercising muscle are dramatically reduced. Further, the hyperemic response positively correlates with leg strength and clinical measures of leg function. It is unknown if these changes in femoral artery diameter and peripheral blood flow are present in the subacute phase of stroke (<30 days post-stroke).

Hypothesis:
Femoral artery diameter is smaller, and resting and hyperemic blood flow to exercising muscle is reduced in the P limb in subjects in the subacute phase of stroke admitted to inpatient rehabilitation.

Methods:
Stroke patients were tested within three days of admission to inpatient rehabilitation in a hospital setting. Isometric knee extensor maximal voluntary contractions (MVCs) were measured in both legs using a Biodex dynamometer. Superficial femoral artery diameter and blood flow were measured at rest and immediately following MVCs using Doppler ultrasound.

Results:
A pilot group of four subjects (1 male, 3 female) aged 68 ± 4 years (range 56-75 years) completed all study procedures on average 13 ± 5 days post ischemic stroke (range 7-24 days). All subjects had infarcts of the middle cerebral artery (3 right, 1 left). P leg knee extensor MVCs were lower compared to the NP leg (93.8 ± 25.5 Nm vs. 160.4 ± 33.2 Nm, respectively; p<0.05). Superficial femoral artery diameter was smaller in the P leg compared to the NP leg (5.7 ± 0.4 mm vs. 6.0 ± 0.5 mm, respectively; p=0.06), and resting blood flow was reduced (172 ± 46 ml/min vs. 206 ± 54 ml/min, respectively; p<0.05). Hyperemic blood flow in response to knee extensor MVCs was also lower in the P limb compared to the NP limb (239 ± 62 ml/min vs. 435 ± 67 ml/min, respectively; p<0.05).

Conclusions:
We show feasibility of testing knee extensor muscle strength and peripheral blood flow in subacute stroke inpatients. Our preliminary data indicates that femoral artery atrophy has occurred in the P leg and that both resting and hyperemic blood flow to the P muscle are reduced.
Abstract TP145: Evolution of Language Network Plasticity Post Stroke Based on Graph Theory
Authors: Mazrooyisebdani Mohsen , A. Nair Veena , Garcia-ramos Camille , Prabhakaran Vivek
Published: October 2018

Introduction:
Modeling the human brain as a large-scale network has been shown to provide systematic understanding of reorganizational evolvement secondary to stroke. To investigate these changes in the language network, we applied graph theory methods to resting-state fMRI data acquired from left hemisphere stroke patients at 2 time points and also compared them with healthy controls.Materials &

Methods:
Eyes-closed resting-state fMRI scans were collected along with a T-1 weighted anatomical scan from 12 left hemisphere stroke patients (11 right-handed) at two time points (visit 1 (V1) at one week and visit 2 (V2) approximately 6 months from stroke onset) and 34 age-gender matched healthy controls with 3T GE scanner. 23 defined language regions were used to derive Pearson correlation coefficient matrices from each subject’s R-S fMRI using AFNI. By using minimum spanning tree (to guarantee connectedness) combined with proportional thresholding on these matrices, Binary undirected connection matrices for each subject was obtained and it then were used to study networks’ measurements. We evaluated changes at the whole-network level, individual regions level using graph theoretic measures, and functional connectivity(FC) level using the Network Based Statistic approach.

Results:
At the whole-network level, Global efficiency was significantly increased in Patients’ V2 compared with patients’ V1 at different thresholds which is an indication of more efficient communication in network after recovery. At the regional level, sum of strengths over all right hemisphere regions increased significantly in patients’ V2 compared with V1 due to increased FC in this hemisphere post stroke and local efficiency in the right cerebellum increased significantly(p<0.001) in V2 compare to V1. At FC level, there were significant proportions of newly formed inter-hemispheric connections such as between the right cerebellum and key left hemisphere language areas.

Conclusion:
Results showed that during recovery process of patients with stroke in left hemisphere, significant neuroplastic changes lead to strengthening of connections mostly in the right hemisphere to increase functional efficiency of the language network.
Abstract TP147: Factors Influencing Home Discharge Preference of Inpatients With Acute Cerebral Infarction: A Retrospective Cohort Study
Authors: Itaya Takahiro , Murakami Yusuke , Ota Akiko , Nomura Eiichi , Fukushima Tomoko , Nishigaki Masakazu
Published: October 2018

Background and Purpose:
Many previous studies explained clinical predictors of discharge planning for inpatients with acute cerebral infarction, while the factors that influence inpatients and their family’s preference for discharge destination are not often investigated. The purpose of this study was to clarify the relationship between home discharge preference of inpatients with acute cerebral infarction and socio-demographic factors or clinical characteristics.

Methods:
We surveyed the electronic medical records of 2,495 (mean age 73.5+ years, 62% were male) acute cerebral infarction patients who were admitted to a stroke center in Japan between January 1, 2011 and December 31, 2015. The main outcome variable was the home discharge preference within 5 days after hospitalization. The explanatory variables were socio-demographic and clinical factors. Multiple logistic regression analysis with backward variable selection was performed to investigate relationships between home discharge preference and these factors.

Results:
In all, 1,056 (42%) patients showed their preference for discharge to their homes. Multiple logistic regression analysis identified relationships between discharge preference to home and five variables. Patients exhibiting the following characteristics tend to show the preference for discharge to their home: higher age, paresis, cancer, cohabitating, and higher functional independence measure motor (FIM-M) score on admission (13-91 points). The odds ratio of these factors for home discharge preference were 1.02 per a year (95% confidence interval[95%CI] 1.00-1.03), 3.68 (vs. without paresis, 95%CI 1.83-7.38), 2.35 (vs without cancer, 95%CI 1.11-4.94), 3.04 (vs. living alone, 95%CI 2.03-4.56), 1.06 (vs lower FIM-M score, 95% 1.05-1.07), respectively. The model showed an area under the curve equal to 0.83 (95%CI 0.80-0.86).

Conclusion:
Patients’ preference for home discharge is influenced largely by physical impairments and support availability. Additionally, patients with comorbidity such as cancer tend to choose facility care rather than home care. These results showed that development of a family support system for elder patients in multimorbid situations facilitated their decision for home discharge.
Abstract TP149: A Prospective Study of Use of a Topical Anesthetic Cream (EMLA) to Reduce Pain During Femoral Artery Catheterization for Diagnostic and Interventional Neurovascular Procedures in Awake Patients
Authors: Qureshi Adnan I , Saleem Muhammad A , Naseem Nishath , Aytac Emrah , Wallery Shawn S
Published: October 2018

Objectives:
To test the effectiveness of EMLA cream (lidocaine 2.5% and prilocaine 2.5%) for pain control during femoral artery catheterization for diagnostic and interventional neurovascular procedures in awake patients.

Methods:
Topical EMLA cream was applied in the femoral region under occlusive dressing prior to lidocaine infiltration and femoral artery catheterization. The body habitus overflying the femoral arterial pulsation was graded as: (1) Pubic symphysis and iliac crest bone protuberance visualized; (2) Pubic symphysis and iliac crest bone protuberances not seen but easily palpable; (3) Pubic symphysis and iliac crest bone protuberance palpable with considerable difficulty; (4) Abdominal layers fold over the femoral region. The severity of pain at femoral artery catheterization was classified using a visual analog scale (VAS) rating from 0-10. Ease of cannulation was scored using a four-point scale, ranging from insertion at first attempt (1), a number of minor adjustments needed (2), a second attempt required (3), or failure of 2 or more attempts (4). The primary endpoints were the proportion of patients with good (VAS score of <3) and excellent (VAS score of ≤1) pain control, and failed pain control (VAS score of ≥8).

Results:
A total of 164 patients (mean age ±SD, 60.8±16.1) were included in the registry. The mean (±SD) and median VAS scores were 2.2±2.6 and 1, respectively. The ease of cannulation was rated as 1 (n=49), 2 (n=82), 3 (n=20, and 4 (n=13). The proportions of patients with good, excellent, and failed pain control were 69.4%, 51.5%, and 4.4%, respectively. The primary endpoints were significantly different according to strata defined by body habitus as follows (Table 1):

Conclusions:
Topical EMLA cream as an adjunct to local lidocaine infiltration was associated with high rates of good and excellent pain control during femoral artery catheterization in this cohort of patients despite a relatively high rate of unfavorable body habitus.
Abstract TP15: Systolic Blood Pressure on Initial Presentation: A Predictor of Infarct Size in Large Vessel Anterior Circulation Stroke Treated With Endovascular Therapy
Authors: Mehta Tapan , Rath Subhendu , Mirtchev Dimitre , Hussain Mohammed , Spiegel Gary , McCullough Louise , Ollenschleger Martin
Published: October 2018

Background:
Endovascular treatment (EVT) of large vessel anterior circulation stroke has become standard of care. Emerging clinical trials have shown effectiveness of EVT for anterior circulation strokes beyond 6 hours after stroke onset. In addition to imaging criteria, it is important to understand clinical and demographic predictors of poor outcomes in this subgroup.

Methods:
A hospital based stroke registry was used for retrospective analysis of 225 consecutive cases of large vessel anterior circulation strokes. Poor outcome was defined as >1/3 middle cerebral artery territory infarct (MCAI) on MRI diffusion weighted imaging or on CT scan performed approximately 24 hours from treatment. Multivariate logistic regression model was used to identify demographic and clinical predictors of poor outcome. IBM - SPSS version 24 was used for data analysis.

Results:
In the study cohort, 31.25% patients had <1/3 MCAI. Group of patients with >1/3 MCAI had higher admission NIHSS (National Institute of Health Stroke Scale) (19.37 Vs 15.52, p<0.001) and admission systolic blood pressure (SBP) (153.28 Vs.138.54, p<0.001) compared to <1/3 MCAI group. There was no statistically significant difference noted in time from symptom onset to re-canalization (335.11 Vs 306.04, p=0.24), admission diastolic blood pressure (DBP) (80.19 Vs 80.81, p=0.83) SBP at 24 hour (132.00 Vs.132.61, p=0.84), and DBP at 24 hours 66.97 Vs 64.71, p=0.28). Higher admission SBP [Odds ratio (OR) 1.028; 95% CI (Confidence Interval) 1.002- 1.056, p=0.007) and NIHSS [OR 1.26; 95% CI 1.13 - 1.41, p<0.001) independently predicted >1/3 MCAI after controlling for clinical and demographic variables in multivariate logistic regression analysis.

Conclusion:
SBP on initial presentation predicted >1/3 MCAI in large vessel anterior circulation strokes treated with EVT. This finding was in a setting of non-significant difference in DBP on initial presentation, SBP and DBP at 24 hours in >1/3 MCAI versus <1/3 MCAI groups. In addition to the understanding of tissue at risk based on imaging, optimal hemodynamic parameter goals need to be investigated in post thrombectomy care to minimize tissue injury.
Abstract TP151: Higher Than Expected Fatigue Among Mild Stroke and TIA Survivors
Authors: Taboada Susan B , Taboada Isabelle , Maran Ilaraasy , Grenier Laura , Staff Ilene , Ferrante Francesca , Nouh Amre
Published: October 2018

Background:
A growing body of research indicates that fatigue is a common and debilitating sequel of both ischemic and hemorrhagic stroke affecting roughly half of all survivors. However, in patients with minimal to no residual symptoms (mild stroke and TIA) the prevalence and impact is unknown.

Objective:
To evaluate the prevalence and functional impact of fatigue among patients with mild stroke and TIA.

Design/methods:
A retrospective observational cohort questionnaire-based study from July 2016-July 2017 was conducted on patients presenting to stroke clinic for the first-time after hospital discharge and completed during the visit. A total of 72 patients (58 ischemic, 5 ICH and 9 TIA) were analyzed. Chart review of clinical data including demographics, stroke type, NIHSS, mRS, level of education, work status, living situation, vascular risk factors, and history of depression was completed. The Fatigue Assessment Scale (FAS) was utilized to determine level of fatigue. A score of 22 or higher indicated fatigue. Statistical significance was calculated using Pearson’s Chi-square and Fisher’s exact testing.

Result:
Among all patients, median age was 62.5 years 64% were men and 70.8% Caucasian. The median discharge NIH score was 1.5 and 90% were evaluated within the first 12 weeks of hospital discharge. Approximately 42% of patients reported fatigue (n=30) and 19% (n=14) reported new fatigue since their event. Concomitant depression was observed in 45% of fatigued patients (n=13). Fatigue was most commonly observed among patients with an ischemic MCA territory infarction (p=.007). Patients with fatigue were less likely to drive a car (p=.04) and a trend towards being less likely to have returned to work was observed (p=.053).

Conclusions:
A higher than expected proportion of patients with mild stroke or TIA report fatigue and roughly 1 in 5 reported new fatigue since their event despite only half of patients experiencing depression. Continued research is needed to better understand predictors of fatigue and its long term impact among these patients.
Abstract TP152: Use of Acupuncture to Reduce Hemiplegic Shoulder Pain is Feasible and Acceptable among Community-Dwelling Stroke Survivors
Authors: Chau Janita Pak Chun , Lo Suzanne Hoi Shan , Lau Alexander Yuk Lun , Wu Justin Che Yuen , Cheung William Hoi Ngai , Ching Jessica Yuet Ling , Choi Kai Chow , Lee Vivian Wing Yan , Sit Janet Wing Hung , Thompson David R.
Published: October 2018

Hemiplegic shoulder pain (HSP) limits stroke survivors’ physical function, which in turn impairs their capabilities in participating in activities and compromises their quality of life (QoL). Systematic reviews report acupuncture is potentially beneficial in reducing HSP and improving physical function. A study was conducted to investigate the feasibility and acceptance of a 6-week acupuncture treatment among community-dwelling survivors. It was hypothesized that there would be no significant problems in recruiting participants, conducting the true and sham treatment, and measuring clinical outcomes. Fifteen survivors with HSP were recruited and assigned randomly to a true acupuncture, sham acupuncture, or control group in a 1:1:1 ratio. Participants in the true acupuncture group received an acupuncture treatment regimen developed by a panel of experts in Chinese and Western medicine. Acupuncture devices with needles that retract into the handle were used in the sham group. Participants in the control group received usual rehabilitative care. Outcomes including HSP, upper extremity function, depressive symptoms, social participation, and QoL were collected at baseline and 1 week after completion of the treatment for the true and sham groups: participants were asked to comment on the acceptability and satisfaction of the treatment within 1 week after the 6-week treatment. Data were collected at baseline and at 7 weeks for the control group. The participants’ mean age was 62.67 years. The mean duration post-stroke was 6.33 years. Eighty percent had an ischemic stroke and 66.7% a left-sided weakness. A total of 7-15 acupoints were used for the true and sham groups. Overall, participants found the traditional Chinese Medicine practitioners helpful and attentive to their health concerns. No adverse events were reported throughout the study. More participants in the true acupuncture group reported reduced HSP after the treatment. They expressed that they were willing to participate in the treatment again. In conclusion, the high level of user satisfaction indicated the feasibility of conducting a large-scale randomized controlled trial to evaluate the effects of the proposed acupuncture treatment on survivors’ post-stroke HSP and health outcomes.
Abstract TP155: Cognitive Impairment in Mild Stroke
Authors: Maran Ilavarasy , Taboada Susan , Ferrante Francesca , Grenier Laura , Staff Ilene , Taboada Isabelle , Nouh Amre
Published: October 2018

Background:
Cognitive symptoms are easily overlooked despite its effect on quality of life after stroke. In patients with minimal physical residual symptoms, the true burden of cognitive impairment is unknown.

Objective:
To evaluate the risk factors and burden associated with cognitive impairment after mild stroke.

Methods:
A retrospective observational cohort study of 56 patients (51 ischemic, 5 hemorrhagic) evaluated at the stroke clinic between July 2016 and June 2017 was performed. Patients completed a questionnaire including demographics and history including previously known cognitive impairment. Cognition was evaluated with the Montreal Cognitive Assessment Score (MOCA).

Results:
The median age of the group studied was 61.5 years. Sixty-six percent (66.1%) patients were men and 76.8% Caucasian. The median discharge NIH score was 1. This study group did not have a previous diagnosis of dementia. About 4% (n=2) of patients presented to clinic <6 weeks, 71.4% (n=40) 6-12 weeks, 17.9% (n=10) 12-24weeks and 7.1% (n=4) >24 weeks from discharge. Cognitive assessment at the stroke clinic after discharge identified 19.6% patients with mild impairment, 16.1% with moderate impairment and 14.3% with dementia. MOCA scores were lower in those greater than 65 years of age (
p
=0.022), living in facilities post-stroke (
p
=0.007), have history of stroke and diabetes mellitus (
p
=0.011, 0.019). Education level did not show significant difference in MOCA scores (
p
=0.283). Those who were employed prior to their stroke have a higher MOCA score compared to those who were unemployed (
p
=0.001). Of those previously working, 50% were able to return to work and this group had higher MOCA scores (
p
=0.011). Of those who stopped driving, 19.6% was due to cognitive concerns.

Conclusion:
In our study, about 50% of the mild stroke patients were found to have some degree of cognitive impairment. Factors that may suggest a higher risk for cognitive impairment after stroke include those age greater than 65, history of stroke and diabetes, unemployment and living in a facility. Post-stroke cognitive impairment was found to be associated with inability to return to work and drive. Since cognitive impairment can impact life quality, screening even in mild stroke could be beneficial.
Abstract TP157: Patient and Physical Therapy/Occupational Therapy Characteristics Associated With Functional Mobility Outcomes After Mechanical Thrombectomy
Authors: Burch Danielle , Drake Andrea , Steuber Traci , Nihart Jayma , Abner Erin , Stafford W Lane , Fraser Justin
Published: October 2018

Background and Purpose:
Mechanical thrombectomy is now a standard of care therapy for large vessel stroke; however, patients often demonstrate variable outcomes, and do not return to independent function. Physical Therapy (PT) and Occupational Therapy (OT) after thrombectomy may play a vital role in maximizing patient recovery. The goal of this study was to examine the relationships between PT/OT and patient characteristics on mobility outcome in patients who have undergone thrombectomy after a stroke. The primary hypothesis was that earlier PT/OT evaluation would be associated with higher scores on the Kansas University Hospital Physical Therapy Acute Care Functional Outcomes Tool.

Methods:
A retrospective review was performed of 127 patients diagnosed with stroke who underwent mechanical thrombectomy at a Comprehensive Stroke Center 07/2011-02/2017. Collected data included demographics, National Institute of Health Stroke Scale (NIHSS), ICU/hospital length of stay, functional status (Kansas score), timing of PT/OT evaluation, and number of PT/OT sessions. To account for the collinearity of the covariates, the least absolute shrinkage and selection operator (LASSO) method was used to identify the best subset of predictors of change in Kansas score.

Results:
Median length of stay was four days in the ICU and eight days overall. Mean NIHSS at discharge was higher among those not receiving a PT/OT evaluation than among those who did (22.1 vs 8.8, respective, p<0.0001). This was likely explained by the fact that 97% of those who did not receive PT/OT were discharged to hospice or died during hospitalization. Despite this limitation, higher Kansas scores were significantly associated with shorter time to recanalization (β=-0.16 [0.07], p=0.03), earlier initial PT/OT evaluation (β=-0.45 [0.17], p=0.01), and lower Kansas score at initial evaluation (β=-0.19 [0.05], p<0.001).

Conclusion:
The data demonstrated that early recanalization time correlated to improved Kansas score. However, this study also demonstrated a significant relationship between earlier PT/OT evaluations and higher Kansas scores. Therefore, for patients who have undergone thrombectomy, earlier PT/OT evaluations could have significant impact on clinical outcomes.