bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP193: Knowledge of Stroke in High School & Middle School Students
Authors: Umar Abdullah , Koehler Tracy , Zhang Reian , Gilbert Veronica , Zoetewey Rebecca , Nyenhuis David , Davis Alan
Published: January 2019

Introduction:
We sought to determine the awareness of stroke symptoms and risk factors in middle and high school students at a single institution.

Methods:
An 11 question multiple choice survey was administered to students in grades 7-12 at City High Middle School in Grand Rapids, Michigan. Summary statistics were calculated for the data. Relationships between quantitative variables were assessed using the Pearson correlation coefficient. All analyses were performed using IBM SPSS Statistics, Version 23 (Armonk, NY: IBM Corp).

Results:
Characteristics of the 603 respondents are shown in Table 1. Only 8% of the respondents correctly identified stroke as the 5
th
leading cause of death in the United States. Almost 50% of the students were able to identify that a stroke occurred in the brain. However, only 30.7% of the students correctly identified another name for stroke as “brain attack”. The majority (67.8%) of the respondents, correctly answered ‘false’ for pain being the most common sign of a stroke.

Almost 11% of students correctly identified all 11 stroke risk factors listed. Only 5.1% correctly selected all four correct stroke symptoms (median of two symptoms answered correctly). Almost 65% of students were able to recognize stroke as an immediate medical emergency. Slightly more than half (55.9%) of respondents also knew the acronym FAST (face, arms, speech, time). There was no correlation between BMI and stroke knowledge.

Conclusions:
The majority of students in our study were not aware of all the risk factors and symptoms related to stroke. This study, although very limited as the data were collected only from one school, suggest a need for educating middle and high school students about stroke risk factors, symptoms, and also acute interventions. The recognition of the acronym FAST was most likely due to awareness created by the medical club members during stroke awareness month.
Abstract TP195: Geographic Proximity to Healthy Food Not Associated With Increased Prevalence of Cardiovascular Risk Factors in Stroke Patients
Authors: Izeogu Chigozirim , Idigo Adeniyi J , Howard Alan D , Lyerly Michael J
Published: January 2019

Introduction:
Diets rich in fruits, vegetables, and low-fat dairy reduce the risk of cardiovascular (CV) risk factors. Environmental and socioeconomic barriers prevent people from obtaining these foods. Previously, the association between food deserts (FD) and a higher burden of CV risk factors was attributed to low income rather than food access in the general population. We sought to examine this association in stroke patients who lived in food deserts, low income (LI) and low vehicle access (LV) areas.

Methods:
Medical records of acute ischemic stroke patients at a tertiary center from 10/1/2014 to 9/30/2015 were reviewed. Demographics, address, history of hypertension, diabetes, dyslipidemia, coronary artery disease (CAD), BMI, and clinical diagnosis were extracted. The USDA Food Access Research Atlas was used to determine FD, LI, and LV status. Spearman correlation and adjusted logistic regression were used to examine the relationships between CV risk factors and FD, LI, and LV.

Results:
We identified 353 patients (mean age 69, 45% black, 56% female, 67% Medicare, 56% FD, 52% LI, and 40% LV). Black race correlated with living in a FD (r= 0.16; p-value= 0.003), LI area (r= 0.29; p-value <0.0001), and LV access area (r=0.51 p-value <0.0001). Living in a FD was not associated with having hypertension (OR=0.65, 95% CI=0.32-1.3, p-value=0.23), dyslipidemia (OR=0.95, 95% CI =0.59-1.5, p-value 0.82), CAD (OR=1.1, 95% CI=0.64-1.7, p-value=0.82), diabetes (OR= 0.76, 95% CI= 0.45-1.2, p-value=0.22) or obesity (OR=1.1, 95% CI =0.7-1.8, p-value 0.63). Living in a LI area was found to be associated with hypertension (OR=3.2, 95% CI= 1.4-7.4, p-value=0.007). Food desert (p-value for interaction = 0.05) and LV (p-value for interaction = 0.04) were found to be effect modifiers on the association between LI and diabetes.

Conclusion:
Among ischemic stroke patients, food access as demonstrated by geographical proximity to healthy food source does not have an association with hypertension, diabetes, dyslipidemia, CAD, or obesity as an independent variable. However, FD and LV access modify the association between LI and diabetes. Further studies into food deserts, income, and vehicle access should be conducted to examine this interaction in larger data sets.
Abstract TP196: Utility of
CHADVASC2
Score in Predicting Clinical Outcomes of Patients Undergoing Carotid Angioplasty & Stent Placement
Authors: Memon Muhammad Z , Krementz Nastajjia , Afzal Mohammad R , Saini Vasu , Yavagal Dileep R , Chaturvedi Seemant
Published: January 2019

Background:
CHA2DS2-VASc score is used for stroke risk stratification in atrial fibrillation patients. We considered the possible use of the CHA2DS2Vasc score to predict perioperative stroke and subsequent stroke risk in patients undergoing CAS for symptomatic or asymptomatic atherosclerotic carotid disease.

Methods:
CAS Patients were identified from a prospectively collected neuroendovascular database maintained at our institution. We then collected the demographic information and the elements necessary to calculate the CHA2DS2vasc score. Primary outcomes were stroke within 30 days of the procedure and during follow-up. Mortality due to stroke and all-cause mortality were secondary outcomes. Patients were stratified into three groups based on their CHADVASC score. 0-3 (low risk), 4-6 (moderate risk) and 7-9 (high risk). We then compared the clinical outcomes amongst the three groups and high risk group was used as a reference during multivariate analysis.

Results:
From January 2010 to June 2018, 210 patients underwent CAS at our institution but after excluding patients with tandem lesions and radiation induced carotid stenosis,161 patients were included in the analysis [mean age 67 ± 25 years, 52 (32 %) were women]. Among the patients, 26 (16%) patients had CHA2DS2Vasc-score 0-3, 100 (62 %) in 4-6 group and 35 (22 %) in 7-9 group. A total of 10 (6.2%) had perioperative stroke and 4 (2.5 %) patients had perioperative death. Mean follow-up time was 17 months (range 0-96). Higher number perioperative strokes were observed in the patients with CHADVASC score 7-9 compared to moderate and low risk groups [(14% versus 3% versus 11.5 %) respectively; p-value 0.016]. Similarly recurrent stroke rate was significantly higher in high risk group compared to the other two [31.4% vs 4% vs 3.8% respectively); p-value <0.001]. After adjusting for age and gender, low risk patients (OR 0.011; p-value 0.03)] and moderate risk patients (OR 0.08, p-value 0.001)] had significantly less recurrent strokes when compared to high risk patients.

Conclusion:
In this analysis of CAS patients, higher CHA2DS2Vasc-Score predicted the increased perioperative and recurrent stroke risk. This should be validated further in large registries and trials of CAS patients.
Abstract TP198: Urban Versus Rural Stroke Death Rates From 2005-2015 in the United States
Authors: de Havenon Adam , Meyer Chelsea , Ruff Jerdan , Wong Ka-Ho , Majersik Jennifer J , Tirschwell David
Published: January 2019

Introduction:
After 4 decades of decline in the stroke death rate in the United States, from 2013-2015 the rate increased 2.5% per year.

Hypothesis:
Given that the stroke death rate has historically been higher in rural than urban populations, we propose that the increase in the stroke death rate will be more prominent in rural than urban populations.

Methods:
This is an analysis of CDC surveillance data. We examined stroke death rates for US residents aged 0-84 years, divided into “urban” (metropolitan) versus “rural” (nonmetropolitan). The stroke death rate was defined as: 1) incidence (# of stroke deaths/total population) and 2) potentially excessive stroke death, which is the percentage of stroke deaths in excess of expected, which is defined yearly by the CDC.

Results:
There were 853,892 stroke deaths from 2005-15, of which 682,318 were urban and 171,574 were rural. Comparing 2005-12 to 2013-15, while there was not a statistical difference in the increase in urban versus rural stroke death, there were 3 states with an increase in the urban incidence of stroke death versus 11 states with a rural increase (Figure 1); and 30 states with an increase in urban excess stroke death versus 34 states with a rural increase (Figure 2).

Conclusion:
The increase in the United States stroke death rate may be happening in more states’ rural than urban populations, which is concerning given the existing higher stroke death rate in rural populations and the implications for future trends.
Abstract TP199: Incidence, Characteristics and Outcomes in Patients With Embolic Stroke of Undetermined Source: A Population-based Study
Authors: Tsivgoulis Georgios , Kargiotis Odysseas , Katsanos Aristeidis H , Patousi Athanasia , Mavridis Dimitris , Tsokani Sofia , Pikilidou Maria , Birbilis Theodosis , Mantatzis Michael , Zompola Christina , Triantafyllou Sokratis , Papanas Nikolaos , Skendros Panagiotis , Terzoudi Aikaterini , Georgiadis George S , Maltezos Efstratios , Piperidou Charitomeni , Tsioufis Konstantinos , Heliopoulos Ioannis , Vadikolias Konstantinos
Published: January 2019

Introduction:
Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS.

Methods:
Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period.

Results:
We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10-25) and 16.6 (95%CI: 10-24) per 100,000 person-years. Patients with ESUS were younger [median age 68 years (IQR:61-75) vs. 79 years (IQR:73-83); p<0.001] and had lower median admission NIHSS-scores [4 points (IQR:2-8) vs. 8 points (IQR:5-16); p<0.001]. Functional outcomes were more favorable in ESUS at 28 [median mRS-score: 2 (IQR:1-3) vs. 4 (IQR:3-6)], 90 [median mRS-score: 1 (IQR:0-2) vs. 4 (IQR:2-6)] and 365 days [median mRS-score: 1 (IQR:0-2) vs. 5 (IQR:2-6)]. ESUS was independently (p=0.033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, -3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence (HR: 0.22, 95%CI: 0.01-4.06), mortality (HR: 0.25, 95%CI: 0.02-4.36) and functional improvement (1-point shift in mRS-scores; cOR: 1.47, 95%CI: 0.59-3.70) on multivariable analyses.

Conclusions:
ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.
Abstract TP202: Risk of Incident Stroke and Dementia in Cadasil : A 6-Year Follow-Up of 85 Korean Patients
Authors: Ko Keun Hyuk , Choi Jay Chol , Kim Joong Goo
Published: January 2019

Background:
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is the most common hereditary cerebrovascular disease. The most frequent clinical manifestation is an ischemic stroke, and the risk of incident stroke was very high in Caucasian CADASIL patients. Also, two-thirds of patients with CADASIL developed dementia by age 65 in Caucasian. Although clinical manifestations of the Asian CADASIL patients have been reported to be different from those of Caucasian, little is known for clinical course and long-term prognosis. This study aimed to investigate the risk of incident stroke and dementia in Korean CADASIL patients.

Methods:
We retrospectively reviewed the medical records of patients who were diagnosed with CADASIL at our institution from March 2012 to February 2015. The patients were selected by the following criteria; (1) aged ≥18 years, (2) diagnosis of CADASIL by a NOTCH3 gene mutation, (3) followed for at least 36 months. Primary outcomes were (1) any stroke (ischemic or hemorrhagic), (2) dementia, and (3) death of any cause.

Results:
Of 102 CADASIL patients who were evaluated at baseline, 85 patients met the inclusion criteria (mean age 68.9±12.1 years). The median follow-up was 57 months (interquartile range: 50-68 months). Of the 85 patients, 46 patients (54.1%) had a history of ischemic or hemorrhagic stroke, and 17 patients (20.0%) had dementia at baseline examination. Of the 85 patients, 13 patients (15.3%) experienced a new ischemic stroke. The risk of incident ischemic strokes was significantly greater in patients with a history of stroke than in without (23.9% vs. 5.1%, P=0.016). However, vascular risk factors such as hypertension, diabetes, hyperlipidemia, and smoking were not associated with increased risk of incident stroke. Of 68 patients who had no dementia at baseline, incident dementia developed in 11 patients (16.2%). During follow-up, two patients (2.3%) died due to lung cancer and pneumonia respectively.

Conclusions:
The risk of incident ischemic stroke or dementia seems to be lower than expected in Korean CADASIL patients. These findings suggest that clinical course and prognosis could be rather benign in Korean patients compared with the Caucasian patients with CADASIL.
Abstract TP204: Characteristics of in Flight Stroke in Korea
Authors: Rha Joung-ho , Park Hee Kwon , Yoon Cindy , Oh Dan A
Published: January 2019

Background:
During flight, low humidity, atmospheric pressure drop, and restricted motion occur. These environmental changes can precipitate the stroke occurence. However, description of in-flight stroke case series has been limited. We investigated the clinical characteristics of in-flight stroke cases in Korea.

Method:
Since the opening of Incheon international airport in 2001, which is used by about 50 million people a year, our hospital branch has been set up at the airport and all the emergency stroke patients have been referred to our hospital. We performed retrospective review of the prospectively collected stroke registry and the information about the flight from January 2001 to July 2018.

Results:
During the study period, 24 in-flight stroke cases were identified among total 9782 admitted ischemic stroke patients in our hospital (18 men, 58±12 years old): 22 cerebral infarction, and 2 TIA. One patient was diagnosed as cerebral venous thrombosis. On etiological classification, 15 large artery atherothrombosis, 1 septic embolism, 3 cryptogenic stroke, and 3 cardioembolism were identified. Thirteen patients reported to experience symptom during or immediately before (within 10 minutes) landing. Fifteen patients had flight for six hours or more. Compared to the patients with long flight time (≥6hrs), those with short flight time (<6hrs) had the higher incidence of stroke occurrence around landings (24 vs 85%). Seven patients were found as unconscious state after landing. These patients all had long flight time over 6 hours, and showed very poor outcomes. Among them, mismatch between FLAIR and DWI was observed in five patients. PFO was detected in eight patients and deep vein thrombosis was not found in any patients. Seven patients with clear onset during landing could receive intravenous thrombolysis or mechanical thrombectomy.

Conclusion:
In-flight stroke is uncommon, and can easily be neglected during flight, which result in poor outcome. The stroke risk seems to be relatively high around landing, especially for the passengers with short flight time and the mechanism needs to be investigated. The possibility of paradoxical embolism related to motion restriction seems low for stroke occurrence.
Abstract TP206: Prevalence and Predictors of Cerebral Microbleeds Among Racial Minorities With Ischemic Stroke and Transient Ischemic Attack
Authors: Cajiga-Pena Fe Maria , Petrie Benjamin , Lau Helena , Abbas Saleh , Finn Brandon , Nguyen Thanh N , Greer David M , Aparicio Hugo , Romero Jose R
Published: January 2019

Background:
Cerebral microbleeds (CMB) are associated with dementia and stroke. CMB are attributed to cerebral amyloid angiopathy (lobar CMB), and hypertensive angiopathy (deep CMB). Racial minorities (RM) have a higher prevalence and poorer control of vascular risk factors, thus CMB may differ in prevalence and distribution in RM. We determined the prevalence, burden and vascular risk factors of CMB across racial groups in patients with stroke and transient ischemic attack, and CMB influence in short term outcomes.

Methods:
We included 2001 consecutive (year 2009-2018) patients with a readable T2*gradient-echo MRI sequence. CMB rating followed standardized guidelines and grouped topographically into lobar, deep or infratentorial. Race was self-reported based on U.S. census procedures and categorized as White, Black or Other racial groups (ORG). Univariate analyses were done to compare vascular risk factors between CMB groups, and multivariate logistic regression analyses were used to relate CMB and short term functional (modified Ranking scale score <3 vs. higher) and adverse hospital outcomes (pneumonia, UTI, DVT, death), across racial groups.

Results:
We observed CMB in 679 (34%) patients. The respective distribution in lobar, deep and infratentorial regions were: Whites (n=174; 67.2%, 20.7% and 12%); Blacks (n=374; 53%, 28.4% and 18.5%); ORG (n=131; 45.5%, 25.3% and 29.3%). Blacks and ORG with CMB were younger than Whites (66 and 66 vs 70; p<0.01); and had higher prevalence of diabetes (44% and 41% vs 28%, p<0.01). Blacks had higher prevalence of previous stroke when compared with Whites (36% vs 27%, p<0.05). Patients with 10+ CMB, compared with no CMB and 1-9 CMB, had higher in-hospital pneumonia (8% vs 2.1% and 2.4% respectively; p=0.02) and were less likely to have mRS 0-2 at discharge (44.8% vs 55.3% and 48.7%; p=0.06). No difference was observed in mortality and other hospital adverse events.

Conclusion:
Racial minorities had higher proportion of CMB in non-lobar regions, suggesting that RM are more likely to have hypertensive angiopathy. RM with CMB were younger and differed in several risk factors compared to Whites. High CMB burden affected adversely outcomes. Further studies are needed to better characterize the clinical impact of CMB in RM.
Abstract TP207: Do Women Have Lower Odds of In-hospital Mortality Compared to Men After Mechanical Thrombectomy for Acute Ischemic Stroke?
Authors: Wabnitz Ashley , Lekoubou Looti Alain , Bishu Kinfe , Ovbiagele Bruce
Published: January 2019

Introduction:
Published studies show a greater clinical benefit for intravenous thrombolysis for acute ischemic stroke (AIS) among women compared to men. It is not clear whether there are any sex differences in clinical outcomes following mechanical thrombectomy (MT) for AIS. Using a nationally representative database, we examined the influence of sex on outcomes after MT.

Methods:
We used the Nationwide Inpatient Sample from 2006-2014, a nationally representative data set of US hospital admissions, to identify patients with ischemic stroke. In-hospital mortality was compared between men and women using a logistic regression model that accounted for extraneous factors.

Results:
A total of 6,049 (weighted =30,137) patients with ischemic stroke and MT were included in this analysis. There was no significant difference in baseline characteristics between men and women except for older age among women. In a multivariable logistic regression model, women had statistically and significantly lower odds of in-hospital mortality (OR=0.846; 95% CI: 0.721- 0.996) after ischemic stroke and MT.

Discussion:
Women in the United States had 16% lower odds of dying in the hospital following MT for AIS. While this sex benefit corresponds to that that seen with IV thrombolysis, further investigation into its underlying mechanisms, especially in the era after the pivotal thrombectomy trials is warranted.
Abstract TP208: Feasibility of a "Psychologically Smart" Community Pharmacy Intervention to Improve Patient Recognition and Response Time in Stroke
Authors: Malcolm Elizabeth , Spokoyny Ilana , Safaeinili Nadia , Tai Amy , Govindarajan Prasanthi , Donelson Sarah , Door Tom , Fotuhi Omid , Wu Winnie , Cohen Geoffrey
Published: January 2019

Background:
Evaluations of public health campaigns demonstrate that stroke symptom knowledge is necessary but not sufficient for timely patient activation of emergency services in acute stroke. Incorporating behavioral and psychological factors into stroke preparedness interventions may reduce pre-hospital delay.

Methods:
We developed and tested the feasibility of patient-based educational interventions “Control Stroke” (CS) and CS plus self-affirmation, in two pharmacies. The interventions drew on theory and methods in psychology and behavioral science, including self-affirmation and self-regulation theories. We enrolled 50 higher risk subjects, defined as age
>
50 and having prescriptions for at least two drugs across 7 stroke-associated conditions. Consecutive patients were randomized to receive the (CS) intervention or CS plus self -affirmation, a strategy that reduces defensive message processing. Using a survey, we measured satisfaction with the intervention, openness to its message, self-efficacy, and knowledge of stroke symptoms immediately post-intervention and at 1 month.

Results:
We recruited 28 female and 22 male subjects over eight weeks. 86% of participants completed the 1-month survey. 45% of subjects were over 75 years old. CS took 10-15 minutes to complete. Satisfaction with the intervention was high: mean net promoter score was 8.9 (of 10) (CI 8.4,9.5); 96% (CI 86,99) were satisfied or completely satisfied with the program; 96% (CI 86,99) felt the session was useful, and 100% reported the information was clear and easy to understand. Stroke symptom knowledge on the validated Stroke Action Test was comparable to other stroke education studies. There was a trend towards persistence of some program benefits in the one month follow up in the CS + self-affirmation group.

Conclusion:
It was feasible to recruit community pharmacy subjects to participate in a brief educational intervention for stroke. Participants reported high likelihood to recommend, easy to understand content, and symptom knowledge comparable to other studies. Self-affirmation showed evidence of prolonging some benefits. Future work will validate this in a larger population intervention and measure impact in simulated stroke scenarios.
Abstract TP21: Did evolution of Evidence Based Stroke Thrombectomy treatment change Efficiency across Stroke Systems of Care?
Authors: Kulhari Ashish , Panezai Spozhmy , Strauss Sara , Arango Audrey , Patel Hemal , Mehta Siddhart , Kirmani Jawad F
Published: January 2019

Background:
Negative thrombectomy trials (IMSIII, MRRESCUE, Synsthesis expansion) resulted in very cautious selection of patients who underwent thrombectomy which probably caused delay in deciding neurointervention. With the positive results of the Big Five trials, mechanical thrombectomy within 6 hours became standard of care. DAWN broadened the horizon of mechanical thrombectomy to 24 hours of last known normal. To expedite mechanical thrombectomy at our community hospital we have implemented Code Neurointervention in addition to Code Stroke. Our purpose in this study is to analyse the effect of positive trials on code neurointervention time.

Methods:
All patients who received mechanical thrombectomy at our university affiliated community comprehensive stroke center from January 2014 till July 2018 were analyzed. Patients were divided in three groups: A)Pre Big Five Trials era (Jan 2014 -Dec 2014), B) Post Big five trials to pre DAWN trial (Jan 2015 - May 2017) and C) Post DAWN trial era (Jun 2017 - July 2018). We compared the time interval between Code stroke and Code Neurointervention (in minutes) among these three groups. Code stroke: time when any patient with acute neurological change within last 24 hours is encountered. Code Neurointervention: time when Vascular Neurologist and Neurointerventionalist decide to pursue endovascular therapy.

Results:
Out of 2423 ischemic stroke patients, 262 received endovascular therapy. Group A (n=38, males =18 (47%), mean age=72 years); group B (n=137, males=67 (77%), mean age=68 years); group C (n=87, males= 47 (54%), mean age=71 years). It took about about 110 minutes to decide neurointervention in group A (SD=70; 95 CI= 88 -133), 72 minutes in group B (SD= 50; 95 CI= 67-81) and 64 minutes in group C (SD=40; 95 CI =54 -73). All intergroup differences were statistically significant (p value < 0.05).

Conclusion:
Accumulation of recent evidence based data has progressively and significantly reduced the time to decision for neurointervention. Improvement in time efficiency is probably multifactorial. Larger trials are required to corroborate our findings.
Abstract TP210: Temporal Trends of Comorbidities From 2009 to 2013 Among U.S. Elderly With Ischemic Stroke
Authors: Man Shumei , Schold Jesse , Uchino Ken
Published: January 2019

Background:
Comorbid diseases affect stroke incidence and outcomes. We aimed to examine the trend over time of comorbidities among U.S. elderly under Medicare who were hospitalized for acute ischemic stroke between 2009 and 2013.

Methods:
We examined the prevalence of some comorbidities in Medicare beneficiaries aged 65 years and greater who were hospitalized between January 2009 and December 2013 with a primary discharge diagnosis of acute ischemic stroke. Patient population and comorbidities were identified using the ICD-9 CM codes. The data were obtained from the Medicare Provider Analysis and Review file.

Results:
There were 1,070,574 Medicare beneficiaries hospitalized for ischemic stroke between 2009 and 2013. The prevalence of hypertension increased from 45.7% in 2009 to 54.9% in 2013, atrial fibrillation increased from 24.9% to 29.7% (p<0.001), diabetes increased from 23.5% to 28.4% (p<0.001), congestive heart failure increased from 16.3% to 17.4% (p<0.001), smoking increased from 9.3% to 20% (p<0.001), myocardial infarction increased from 6.6% to 8.5%, and peripheral vascular disease increased from 7.4% to 10.1% (p<0.001). The prevalence of malignancy, liver disease and dementia remained stable in this population during the study period.

Conclusion:
The prevalence of cardiovascular comorbidities has been increasing from 2009 to 2013 among the U.S. elderly hospitalized with acute ischemic stroke. The increase might be due to true increase in prevalence but might reflect increased documentation.
Abstract TP211: Outcomes and Predictors of Postoperative Atrial Fibrillation in Patients With Left Ventricular Assist Devices
Authors: Kim Mary , Lamba Harveen K , Chou Brendan , Civitello Andrew B , Delgado Reynolds M , Simpson Leo , Oberton Selby , Nair Ajith P , Taimeh Ziad A , Rosengart Todd K , Frazier O. H , Morgan Jeffrey A
Published: January 2019

Introduction:
Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery and is especially hazardous in elderly patients and those with left ventricular dysfunction. Therefore, we sought to find the associated risk factors and predictors for the development of POAF in patients undergoing left ventricular assist device (LVAD) implantation.

Materials and methods:
We retrospectively reviewed 109 patients with no prior history of atrial fibrillation undergoing continuous flow LVAD implantation at a single center institution from 2013-2017.

Results:
POAF lasting 24 hours or greater occurred in 29 of 109 patients (26.6%). Early 30-day mortality was higher in POAF patients compared to non-POAF (6.9% vs 0%, p=0.02) (Figure). Patients with POAF had higher rates of pump exchange although this did not reach statistical significance (17.2% vs 6.3%, p=0.08). However, POAF was not associated with stroke (10.3% vs 23.8%, p=0.24) or long-term mortality (27.6% vs 31.3%, p=0.8). The only independent risk factor for POAF was elevated pre-operative creatinine (OR: 2.5 95% CI: 1.3-4.6, p=0.004). Higher mean preoperative CHADS
2
(3.0 +/- 0.01 vs 2.4 +/- 0.5, p=0.01) and mean preoperative R
2
CHADS
2
(5.0 +/- 0.01 vs 4.4 +/- 0.5, p=0.01) scores were associated with POAF as compared to non-POAF.

Conclusion:
In patients undergoing continuous-flow left ventricular assist device implantation, postoperative atrial fibrillation was associated with higher rates of early mortality but not postoperative stroke or long-term mortality. Furthermore, higher preoperative CHADS
2
and R
2
CHADS
2
scores were associated with postoperative atrial fibrillation. However, the only independent predictor of post-operative atrial fibrillation in this small cohort was elevated preoperative creatinine.
Abstract TP212: Stroke Risk Following Takotsubo Cardiomyopathy
Authors: Morris Nicholas A , Adejumo Oluwayemisi L , Desai Masoom , Chen Monica , Murthy Santosh B , Kamel Hooman , Merkler Alexander E
Published: January 2019

Introduction:
Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is an increasingly recognized cause of left ventricular dysfunction after acute brain injury. Previously considered a benign disease, recent small, single-center case series suggest that Takotusubo cardiomyopathy may be a risk factor for ischemic stroke. The strength and temporal profile of this association remain uncertain.

Methods:
We performed a cohort-crossover study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005-2015 in California New York, and Florida. We identified patients with Takotsubo cardiomyopathy using a previously validated
International Classification of Diseases, Ninth Revision, Clinical Modification
diagnosis code. We excluded patients with a prior or concomitant stroke diagnosis. We compared the risk of ischemic stroke in the first year after Takotsubo cardiomyopathy to the risk of ischemic stroke in the second year after. The absolute risk increase and odds ratio (OR) were calculated using McNemar’s test for matched data.

Results:
Among 5,283 patients with Takotsubo cardiomyopathy (mean age, 67 years; 92% female), we identified 49 ischemic strokes during the year after Takotsubo cardiomyopathy versus 19 ischemic strokes in the control period 2 years later. The risk of stroke was significantly higher in the year after Takotsubo cardiomyopathy (absolute increase, 0.6%; 95% CI, 0.2%-0.9%) (OR, 2.6; 95% CI, 1.5-4.6) as compared to the control period.

Conclusion:
We found a heightened risk of ischemic stroke in the year after a diagnosis of Takotsubo cardiomyopathy, although the absolute risk increase was small.
Abstract TP213: Associations Between Risk Factors and Stroke Mechanisms in Young Adults
Authors: Michaels Elena M , Leung Lester Y
Published: January 2019

Background:
Atherosclerotic stroke risk factors are prevalent among young adults with stroke. However, it is not certain if these risk factors are contributors to the majority of index mechanisms of stroke in young adults.

Methods:
This retrospective cohort study included young adults age 18-50 with a primary stroke diagnosis (ischemic stroke, IS, transient ischemic attack, TIA, intracerebral hemorrhage, ICH, subarachnoid hemorrhage, SAH) evaluated in inpatient or outpatient settings at a tertiary care academic medical center between 1/2016-12/2017. Covariates included demographics, medical history, stroke subtype, and stroke mechanism. Comparisons were made using the Chi-square, Fisher exact, and
t
tests.

Results:
This study included 263 patients (128 women, 135 men). Atherosclerotic risk factors were common among young adults: hypertension (38%), hyperlipidemia (25%), diabetes (20%), tobacco use (47%). Women were more likely to have migraine (34% vs 16%, p=0.001), and men were more likely to be tobacco users (39% vs 54%, p=0.01). Women had more aneurysmal SAH (62% vs 23% hemorrhagic strokes, p<0.001). Men had more hypertensive ICH (3% vs 23% hemorrhagic strokes, p=0.02). When comparing the frequency of atherosclerotic risk factors between young adults with stroke mechanisms commonly implicated with atherosclerosis (e.g. large artery atherosclerosis, LAA, small vessel occlusions, SVO) and unrelated stroke mechanisms, these risk factors were not more frequent in patients with LAA and SVO.

Conclusion:
Despite a high prevalence of atherosclerotic risk factors among young adults with stroke in this cohort, only a small proportion of young adults had stroke mechanisms pathogenically related to these risk factors. This observation should prompt further research on risk factors related to non-atherosclerotic mechanisms of stroke in young adults and modification of patient counseling about the role of atherosclerotic risk factors to their index strokes.
Abstract TP215: Clinical Phenotypes of Obstructive Sleep Apnea in Stroke Patients: A Cluster Analysis
Authors: Schütz Sonja G , Shafie-Khorassani Fatema , Case Erin , Sanchez Brisa N , Lisabeth Lynda D , Brown Devin L
Published: January 2019

Introduction:
Obstructive sleep apnea (OSA) is highly prevalent in stroke survivors. Untreated OSA is associated with an increased risk of adverse cardiovascular outcomes and OSA treatment may improve neurological recovery in stroke survivors, yet OSA in stroke patients remains poorly characterized. To our knowledge, this is the first study aiming to identify OSA phenotypes in stroke survivors.

Methods:
Patients (n=451) with ischemic strokes and OSA (apnea-hypopnea index (AHI) ≥ 10 using a cardiopulmonary screening device (ApneaLink Plus)) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Latent class analysis was performed based on the following variables: age, sex, race/ethnicity, AHI, pre-stroke snoring, pre-stroke tiredness/fatigue, pre-stroke sleep duration, prior stroke history, initial NIHSS, BMI, hypertension, diabetes, atrial fibrillation, coronary artery disease, and congestive heart failure.

Results:
A model with 3 phenotype clusters provided the best fit. Cluster 1 (n=55, 12%) was defined by higher NIHSS scores and high prevalence of snoring. Patients in cluster 2 (n=253, 56%) were younger and had relatively low NIHSS scores. Cluster 3 (n=143, 32%) included patients with severe OSA and higher prevalence of medical comorbidities.

Conclusion:
Ischemic stroke survivors with OSA can be categorized into three clinical phenotype clusters characterized by differences in stroke severity, OSA severity, patient age and medical comorbidities. This highlights the heterogeneity of post-stroke OSA. Awareness of the different faces of OSA in patients with ischemic stroke may help clinicians identify OSA in their patients, and informs research concerning the pathophysiology and prognostication of post-stroke OSA.
Abstract TP217: Longitudinal Study of Young Patients With Embolic Stroke of Undetermined Source (ESUS)
Authors: Lee Sarah , MacLellan Adam , Ameriso Sebastian F , Arauz Antonio , Häusler Karl G , Arnold Marcel , Birnbaum Lee A , Martí-Fàbregas Joan , Olavarría Verónica V , Taylor Amanda , Perera Kanjana S
Published: January 2019

Introduction:
Stroke in young adults is not rare, and can have a devastating, lasting impact. Up to 20% of patients with Embolic Stroke of Undetermined Source (ESUS) are under 50 years of age; thus, determining potential causes and outcomes in this younger cohort may significantly impact clinical practice. We aim to describe clinical, laboratory and imaging characteristics of patients between 21 and 50 years of age with ESUS; determine rates of new-onset atrial fibrillation; and investigate predictors of recurrent stroke in this unique population.

Methods:
This is an ongoing multi-center, international registry, which plans to prospectively enroll 500 patients between the ages of 21-50 years with ESUS
1
within 60 days. Clinical, laboratory and imaging data are documented at enrollment. Patients will be followed prospectively at 6, 12 and 18 months post-stroke via telephone interview to determine treatment and outcomes. End of enrollment is anticipated in mid-2019.

Results:
Majority of patients are male (63.7%), and males had a higher median age at stroke than females (43 versus 41 years, range 21-50). Figure 1 shows the geographical breakdown of recruited patients. Intravenous recombinant tissue plasminogen activator (tPA) was given to 26/146 (17.8%). Median modified Rankin Score at time of stroke was 1.0 (range 0-5.0). Table 1 contains baseline characteristics and diagnostic workup of 146/187 patients enrolled thus far.

Conclusion:
Demographics, stroke risk factors and recurrence rates may differ for younger patients with ESUS; thus, findings of this study could potentially shape clinical practice and ultimately improve outcomes for this at-risk population.
Abstract TP219: Two-Year Recurrence After First-Ever Stroke in a General Population of 1.4 Million Japanese: Shiga Stroke Registry
Authors: Takashima Naoyuki , Arima Hisatomi , Kita Yoshikuni , Fujii Takako , Tanaka Sachiko , Shitara Satoshi , Kitamura Akihiro , Miura Katsuyuki , Nozaki Kazuhiko
Published: January 2019

Introduction:
Despite many effective strategies for the secondary prevention of stroke, individuals who survived an initial stroke have been shown to be at high risk of recurrent stroke. The aim of the present analysis is to investigate the current status of stroke recurrence after first-ever stroke using data from a large-scale population-based stroke registry in Japan.

Methods:
Shiga Stroke Registry is an ongoing population-based registry of stroke, which covers approximately 1.4 million residents of the Shiga prefecture in central Japan (located central part of Honshu Island). There is an integrated surveillance system involving the registration of cases among a network of all acute care hospitals with neurology/neurosurgery facilities and smaller hospitals with rehabilitation facilities. A total of 2,176 first-ever stroke cases (1,398 cerebral infarction, 551 intracerebral hemorrhage, 227 others), who were registered in 2011, were followed up till December 2013. We defined recurrence as any type of stroke after 28days from the onset of index event. The 2-year cumulative recurrence rates were estimated using Kaplan-Meier method for total stroke cases and according to gender or subtypes of index stroke. The study has been approved by the Institutional Review Board of Shiga University of Medical Science.

Results:
During a 2-year follow up period, 57 patients experienced recurrent stroke and 646 patients died without recurrence. One-year and two-year crude cumulative recurrence rates after first-ever stroke were 1.8% and 3.4%, respectively. Two-year crude cumulative recurrence rates were similar for men and women (3.4% vs 3.5%). Two-year crude cumulative recurrence rate was higher in patients with prior cerebral infarction (4.3%) than that in those with prior intracerebral hemorrhage (2.0%).

Conclusions:
In the present population-based stroke registry with real-world setting in Japan, 2-year cumulative recurrence rate after first-ever stroke is still high, particularly among patients with a history of cerebral infarction. More intensive secondary prevention strategies are required for these high-risk individuals.
Abstract TP220: Volume of White Matter Disease Prior to Ischemic Stroke may Predict Outcome
Authors: Andere Ariana J , Yaghi Shadi , Chang Andrew D , Collins Scott , Merck Derek , Jayaraman Mahesh V , McTaggart Ryan , Burton Tina , MacGrory Brian , Furie Karen , Cutting Shawna
Published: January 2019

Background:
White matter disease (WMD) and microhemorrhages (MH) present at the time of stroke have been linked to outcome, yet few have investigated changes in the time leading up to stroke. Magnetic Resonance Imaging (MRI) characteristics before a stroke may shed light on the severity of outcomes following stroke.

Methods:
We retrospectively identified patients admitted to our institution for ischemic stroke between 5/16-12/17 who had an MRI in the 1-24 months prior to their stroke. After collecting clinical and demographic data, automatic segmentations of gray and white matter volumes and manual segmentation of WMD and MH (size<10mm) were completed using 3D Slicer 4.5 and 4.9, respectively. Groups were created based on modified Rankin Scale score (mRS) at 90 days; an mRS of 3-6 was considered a poor outcome. Univariate analyses and multivariate regression models were performed to determine factors associated with poor outcome.

Results:
Among the 48 patients in our study (mean age 68, 50% female), 29 patients (60%) had poor outcome. Poor outcome was associated with pre-existing WMD volume (21.9+/-23.6 vs 6.1+/-5.7mL, p= 0.002), and WMD volume at time of stroke (26.4+/-24.9 vs 8.8+/-6.0mL, p=0.001). There was a trend towards poor outcome in older patients (p=0.073), women (p=0.075), higher NIHSS score (p=0.066), and need for thrombectomy (p=0.065). History of prior stroke was not associated with poor outcome (p=0.74), larger pre-existing WMD volumes (14.3+/-19.3 vs 19.5+/-22.6mL, p=0.47) or larger WMD volumes at time of stroke (18.7±22.5 vs 21.5±18.8mL, p=0.67). After adjusting for confounders, pre-existing WMD volume showed a trend to predict poor outcome (adjusted OR 1.086 per one point increase, 95% CI 0.987-1.195, p=0.09), as did WMD volume at the time of stroke (adjusted OR 1.103 per one point increase, 95% CI 0.992-1.226, p=0.07).

Conclusions:
Greater volume of WMD at time of and prior to admission for stroke may be independent predictors of poor outcome. These results should be validated in subsequent studies.
Abstract TP221: Deterioration of Glomerular Filtration Rate is Associated With Greater Cerebral Small Vessel Disease Burden in Ischemic Stroke Patients Aged Below 80 Years
Authors: Balian Natalia R , Alonzo Claudia , Brescacin Laura , Cea Clarisa , Colla Machado Pedro E , Zurru Maria C
Published: January 2019

Introduction:
Cerebral small vessel disease (cSVD) and deterioration of glomerular filtration rate (dGFR) may be part of a systemic small vessel disease, or simply the consequence of vascular risk factors (VRF) and age related vessel changes.

Objective:
to assess the relation of cSVD burden and dGFR in ischemic stroke patients.

Methods:
acute ischemic stroke patients that had a brain MRI performed within 48 hours upon admission were enrrolled. Demographic data and vascular risk factores were analyzed. SVD score (Staals J et al, Neurology. 2014;83:1228-1234) was employed to evaluate cSVD burden in MRI. An univariate analysis was performed, and then a multivariate regression analysis which was adjusted by sex, vascular risk factors, and stratified by age.

Results:
Eight hundred and eight patients were included. Mean age was 77 ± 11 years, and 56% were female. In the univariate analysis (table 1), patients with SVD score ≥2 were older, had greater prevalence of VRF, and greater dGFR. In the unadjusted regression analysis, the global OR for heavier cSVD burden in patients with dGFR was 3 (CI 95% 1.8-3.2). When adjusted for sex, VRF, and stratified by age, the OR was 2.6 (IC 95% 1.88-3.10) in patients aged <65 years, 2.2 (IC 95% 1.77-3) in patients aged 65-79 years, and 0.72 (IC 95% 0.43-1.05) in patients aged over 80 years.

Conclusions:
The relation between dGFR and cSVD was attenuated in patients aged over 80 when adjusted for age and VRF prevalence. In patients aged ≤80 years, dGFR was associated with greater cSVD burden.
Abstract TP222: Silent Brain Infarct (SBI) on MRI, Not White Matter Lesions, is Related to 10-year Stroke Risk Prediction in Middle-aged Healthy Japanese Individuals
Authors: Muraga Kanako , Nishiyama Yasuhiro , Kato Katsuhito , Saiki Yoshiyuki , Otsuka Toshiaki , Kimura Kazumi
Published: January 2019

Background:
Periventricular hyperintensity (PVH), deep and subcortical white matter hyperintensity (DSWMH), and silent brain infarct (SBI) have been proposed as subclinical risk markers for future symptomatic stroke onset. However, the differences between PVH, DSWMH, and SBI as markers for eventual development of symptomatic stroke in middle-aged healthy Japanese individuals has not been adequately explored.

Methods:
We examined 280 Japanese adults (92 female, mean age, 52.9±5 years) with no history of cardio-cerebrovascular disease. PVH, DSWMH, SBI and various vascular risk factors for each subject were assessed, and 10-year stroke risk was predicted using the point-based prediction model provided by the Japan Public Health Center (JPHC) study, which consists of six risk factors that are used to calculated predicted stroke risk, including age, sex, smoking status, body mass index (BMI), blood pressure (BP), and diabetes status.

Results:
The subjects were divided into four groups based on predicted stroke risk: low, <1%; low-medium, 1- <5%; medium-high, 5-<10%; high, ≥10%. According to the JPHC study risk-prediction algorithm, a PVH grading ≥ 2, a DSWMH grading ≥2, and a SBI number ≥1 were positively correlated with an increase in predicted stroke risk. Age, systolic BP, HbA1c levels, eGFR, hypertension, diabetes mellitus, and family history of cardio-cerebrovascular disease (CCVD) were found to be significantly associated with SBI. The odds ratio (OR) for high predicted stroke risk (10-year risk ≥10%) showed significance for SBI ≥1, even after adjusting for potential confounding factors (OR, 12.45: 95% CI, 3.09-50.84), whereas the ORs for PVH and DSWMH were not significant.

Conclusion:
The presence of an SBI, not white matter lesions, was significantly correlated with an increased 10-year stroke risk, suggesting that detection of SBI by MRI may be practical for identifying a high risk of stroke for middle-aged Japanese subjects.
Abstract TP227: Stroke Education in School Age Children
Authors: Smith Angela L , Girtler Bethany L , Borgert Andrew J , Davenport-Fortune Polly A , Vang Choua A , Kabbani Mouhammed R
Published: January 2019

Introduction:
A partnership was formed with the local school district. Stroke education was presented to high school students in the Health Science Academy, who then disseminated stroke education to other students in the district.

Objective:
To determine the effect of formal stroke education among elementary, middle, and high school students in the region.

Methods:
Surveys differentiated for each school level were administered to students prior to and a month after stroke education to assess knowledge of stroke signs and symptoms, risk factors, and behavioral action.

Results:
A total of 3,145 students in elementary, middle, and high school received stroke education. At the elementary level, knowledge of where a stroke occurs significantly increased post education (18.5% vs 37.3%, p<0.0001). There was also an increase in the identification of corrective action to be taken if someone they knew was having a stroke (79.7% vs 85.4%, p=0.0006). The knowledge of signs and symptoms increased significantly in middle (p<0.0001) and high school (p=0.015) students. A small percentage of middle (5% vs 4.3%, p=0.62) and high school students (8.3 % vs 6.4%, p=0.13) were able to recognize all risk factors of a stroke with no significant change in knowledge after stroke education.

Conclusions:
In conclusion, stroke education in school age children can improve awareness of what organ is affected in stroke, signs and symptoms, and the correct actions that should be taken when suspecting stroke symptoms. However, retention of the presented information after one month was suboptimal. Further steps are needed to refine and sustain stroke education within the local school district. Stroke education need to be included in the school curriculum and should probably be provided on yearly basis.