bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP120: Elevated Lipoprotein-Associated Phospholipase A2 is Differentially Associated With Symptomatic Intracranial Atherosclerosis
Authors: Wang Yuan , Song Haiqing , Meng Ran , Feng Wuwei , Ovbiagele Bruce , Sun Yongxin , Ji Xunming
Published: October 2018

Background and Objective:
Intracranial atherosclerotic disease (ICAD) is a common etiology of stroke in China. Lipoprotein-associated phospholipaseA2 (Lp-PLA2), an inflammatory enzyme expressed in atherosclerotic plaques, has been linked to an increased risk of ischemic stroke. Relatively few studies have explored the relationship between Lp-PLA2 and various ischemic stroke subtypes. We aimed to determine the association between the serum Lp-PLA2 mass and the main types of symptomatic large vessel atherosclerosis.

Methods:
In this cross-sectional study, we reviewed data on 126 eligible acute ischemic stroke patients consecutively admitted to a single medical center in China from March 2014 to February 2016. Clinical symptoms, signs and traditional risk factors of cerebrovascular diseases were recorded. The level of serum lipids, homocysteine and glucose etc. were collected. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were measured. According to the results of CT angiography, patients were divided into four different groups: 1) no artery stenosis (N), 2) both intracranial and extracranial artery stenosis (B), 3) intracranial artery stenosis (I), 4) extracranial artery stenosis (E). The association of serum Lp-PLA2 and other inflammatory markers to ICAD were analyzed with Pearson correlation test.

Results:
Lp-PLA2 expression in the ICAD group was higher than other three groups (I vs. N vs. B vs. E: 112.22±66.79 ug/l vs. 81.70±38.50 ug/l vs.89.25±52.15 ug/l vs. 106.11± 57.76 ug/l, p=0.025). When Lp-PLA2 was above the median level, the presence of ICAD was higher than other three groups (Q3: 16[50.0%] vs. 1[3.1%] vs. 9[28.1%] vs. 6[18.8%], P=0.002; Q4: 15[48.4%] vs. 5[16.1%] vs. 8[25.8%] vs. 3[9.7%], P=0.014). In ICAD group, Lp-PLA2 mass was positively correlated with hs-CRP (r=0.899, P <0.001), and inversely correlated with total cholesterol (r=-0.307, P =0.028) and apoliprotein B (r=-0.320, P =0.022).

Conclusions:
Lp-PLA2 is differentially associated with ICAD compared to extracranial artery stenosis or no stenosis, which suggests that inflammation may play a greater role in the pathophysiology of ICAD versus these other symptomatic stroke categories.
Abstract TP124: Development of a Novel Mouse Surgical Model for Moyamoya Syndrome
Authors: Roberts Jill , Maniskas Michael , Bix Gregory , Fraser Justin
Published: October 2018

Introduction:
Moyamoya is characterized by progressive stenosis and occlusion of the intracranial internal carotid arteries (ICA) and their major branches. Vascular stenosis is accompanied by formation of abnormal vascular networks, with major symptoms including ischemia and hemorrhage. Current treatments are limited to antiplatelet therapy and surgical bypass. While research has recently discovered a susceptibility gene (RNF213) for idiopathic moyamoya disease, there is still no animal model which mimics the acquired vasculopathy of moyamoya syndrome, which is often associated with autoimmune diseases. We report here a novel surgical model of moyamoya that employs microcoils placed on the ICA of mice.

Methods:
Male C57Bl/6 mice (4 months old) underwent surgery for the unilateral placement of a microcoil (0.16 mm) onto the proximal ICA, referred to as internal carotid artery stenosis (ICAS). After 28 days, the blood vessels were examined for changes in diameter and number of anastomoses using a fluorescent dye called Di I. Cresyl violet and Prussian blue were used to assess ischemia and hemorrhage, while PCR was used to examine biomarkers typically altered in moyamoya patients.

Results:
We observed a significant narrowing of the distal ICA and anterior cerebral artery (ACA) in the Circle of Willis, as well as a decreased number of anastomoses between the middle cerebral artery (MCA) and the ACA in the watershed region of the cortex in ICAS-treated mice. Histological examination also showed changes in brain cellular morphology and alterations in VEGF and MMP9 gene expression.

Conclusions:
We report for the first time the development of an animal model with moyamoya-like vasculopathies as observed in humans. While further characterization is needed, it may provide a crucial model for development of therapies for moyamoya syndrome.
Abstract TP125: Blood Biomarkers of Systemic Inflammation in Individuals With Brain Arterial Dilatation and Dolichoectasia
Authors: Gutierrez Jose , Katan Mira , Cespedes Sandino , Alperin Noam , Bagci Ahmet , Rundek Tatjana , Wright CLinton , Sacco Ralph , Elkind Mitchell
Published: October 2018

Background:
Brain arterial dilatation is a core feature of dolichoectasia, and is associated with higher risk of stroke and vascular events. The role of systemic inflammation in brain arterial dilatation is uncertain.

Methods:
We measured blood levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), high-sensitivity C-reactive protein (hsCRP), and procalcitonin (PCT) in 538 NOMAS participants (mean age 71±8, 42% men, 60% Hispanic) who underwent brain time-of-flight MRA. Brain arterial diameters were normalized and averaged to obtain a global, anterior and posterior circulations measures of dilation. The concentration of each inflammatory biomarker was normalized to facilitate comparison, and to create an inflammation score consisting of the average of the four biomarkers. Generalized linear models were used to assess for main effects and statistical interactions by sex given known differences in arterial size.

Results:
Greater levels of MPO were associated with global and anterior circulation dilatation whereas greater levels of PCT were associated with posterior circulation dilatation (table 1). A higher inflammation score was associated with global and posterior circulation, but not anterior circulation, dilatation. There was a statistical interaction between MPO and sex (P=0.06). In a stratified model, the association between MPO and global arterial dilatation was significant in men (B=0.164±0.057, P=0.004) but not in women (B=0.053±0.054, P=0.33). There were no sex-based interactions for any of the other three inflammatory biomarkers.

Conclusion:
The inflammation markers MPO and PCT were associated with global and regional measures of brain arterial dilatation. The strength of the associations with MPO was greatest in men while the association with PCT was greatest for the posterior circulation. Understanding the physiopathology of these associations may uncover novel therapeutic targets for dolichoectasia.
Abstract TP127: Morphology of Acute Symptomatic Intracranial Atherosclerotic Plaques
Authors: Leng Xinyi , Wang Li , Zou Xinying , Soo Yannie O , Chan Anne Y , Ip Vincent H , Fan Florence , Mok Vincent C , Wong Lawrence K , Yu Simon C , Leung Thomas W
Published: October 2018

Introduction:
Intracranial atherosclerotic disease (ICAD) is an important subtype of ischemic stroke worldwide. Understanding the morphologic features of acutely symptomatic plaques may help identify vulnerable lesions and guide treatment.

Methods:
We prospectively recruited 170 patients (median age = 60.5 years) with acute ischemic stroke attributed to ICAD (≥60% stenosis) confirmed by 3-dimensional rotational angiography (3DRA) from May 2007 to Feb 2017. We evaluated the morphology of the index atherosclerotic plaques in 3DRA. We categorized plaques with irregular or ulcerated surface as complicated plaques. We compared the morphological features of smooth and complicated plaques.

Results:
The median interval between symptom onset and 3DRA exam was 22 days. The median severity of luminal stenosis was 75%. The median maximum plaque thickness was 1.3mm and lesion length was 8.8mm. The plaque surface was smooth, irregular, or ulcerated in 50 (29.4%), 90 (52.9%), and 27 (15.9%) cases, respectively. The point of maximum stenosis was located in the distal end of the lesions in 88 (51.8%) cases. A majority (85.3%) of the plaques were eccentric. The median angulation between the upstream plaque shoulder and an imagined “normal” vessel wall (assuming there were no plaque) was 33.4°. Overall, complicated plaques led to more severe luminal stenosis (medians 77.0 vs 73.0%; p=0.032); the lesions were longer (medians 10.0 vs 6.9 mm; p<0.001), and the upstream shoulders were steeper (median angles 34.3 vs 28.0°; p=0.048) than smooth plaques.

Conclusions:
We identified the morphologic pattern of symptomatic high-grade intracranial atherosclerotic plaques during the acute phase that are significantly different between smooth and complicated plaques. The current findings warrant a comparison with silent ICAD lesions for validation.
Abstract TP132: Vascular HDAC9 Modulates Atherogenic Processes and Enhances NF-kB Activation
Authors: Bokov Yury , Asare Yaw , Yu Lydia Luya , Megens Remco , Prestel Matthias , Azhghandi Sepiede , Haffner Christof , Bernhagen Jürgen , Dichgans Martin
Published: October 2018

Background:
Genome-wide association studies (GWAS) identified the histone deacytelase 9 (HDAC9) gene region as the leading risk locus for large artery atherosclerotic stroke.
Hdac9
deficiency was shown to attenuate atheroprogression in
Apoe

-/-

and

Ldlr
-/-

mice, however the mechanisms linking HDAC9 to atherosclerosis remain elusive.

Objective:
We aimed to determine HDAC9-related pro-inflammatory and pro-atherogenic responses in vitro and employed an early-stage atherosclerosis model to study these effects in vivo.

Methods and Results:
Human endothelial (ECs) and smooth muscle cells (SMCs) were cultured and transfected with
HDAC9
siRNA or scrambled RNA (control) and stimulated with 20 ng/ml human TNF-α.
HDAC9
depletion resulted in reduced adhesion molecule (VCAM-1, ICAM-1) and cytokine (CCL2, IL-8) expression as determined by RT-PCR, ELISA and Western Blot.

Hdac9
+/+
Apoe
-/-

and

Hdac9
-/-
Apoe

-/-

mice were fed a western-type diet for 2 weeks.
Hdac9
-deficient mice showed reduced circulating levels of Ccl2 and reduced levels of Vcam-1 and Icam-1 in whole aorta. Two-photon imaging of whole-mount carotid arteries further revealed a significant reduction of Vcam-1 expression. Motivated by the pattern of pro-inflammatory and pro-atherogenic responses, we investigated the effects of HDAC9 on NF-κB signaling. HDAC9 promoted NF-κB luciferase activity, facilitated p65 nuclear translocation, and enhanced p65 phosphorylation as determined by luciferase gene reporter assay, Western Blot and confocal microscopy.

Conclusion:
We demonstrate that HDAC9 promotes pro-inflammatory and pro-atherogenic responses in vascular cells and identify an activating effect of HDAC9 on NF-kB signalling. Our findings identify HDAC9 as a promising target for therapeutic interventions.
Abstract TP134: HDAC9 Polymorphisms Alter Blood Gene Expression in Patients With Large Vessel Atherosclerotic Stroke
Authors: Shroff Natasha , Jickling Glen C , Ander Bradley P , Sharp Frank R
Published: October 2018

Background and Purpose:
HDAC9 polymorphisms rs2107595 and rs11984041 are associated with large vessel atherosclerotic stroke. HDAC9 regulates gene expression and is expressed in circulating leukocytes involved in atherosclerosis. In this study, we sought to determine whether HDAC9 single nucleotide polymorphisms (SNPs) rs2107595 or rs11984041 influence gene expression in blood of patients with large vessel atherosclerotic stroke (LVAS).

Methods:
In 155 patients (43 LVAS and 112 vascular risk factor control) HDAC9 was genotyped for SNPs rs2107595 and rs11984041. RNA was isolated from whole blood and gene expression differences between HDAC9 risk allele positive and risk allele negative LVAS and control patients identified using human transcriptome microarrays. Pathway analysis was performed to identify canonical pathways and molecular functions associated with HDAC9 SNPs in LVAS.

Results:
In rs2107595 risk allele positive LVAS patients there were 155 genes differentially expressed compared to SNP negative patients (fold change > |1.2|, p<0.05). Over represented pathways corresponded to IL6 signaling, cholesterol efflux and platelet aggregation. In rs11984041 risk allele positive LVAS patients there were 419 genes differentially expressed genes compared to risk allele negative patients (fold change > |1.2|, p<0.05). Over represented pathways included NF-?B signaling, T cell response and macrophage activation.

Conclusions:
Polymorphisms in HDAC9 are associated with differences in gene expression in blood cells of patients with LVAS. The risk alleles in HDAC9 may contribute to functional differences in peripheral immune cells involved in stroke related atherosclerosis, plaque stability, and inflammation.
Abstract TP136: Dual versus Mono Antiplatelet Therapy in Acute Ischemic Stroke Patients Due to Large Artery Atherosclerosis
Authors: Kim Dohoung , Park Jong-Moo , Cho Yong-Jin , Lee Kyung Bok , Park Tai Hwan , Lee Soo Joo , Kim Beom Joon , Lee Jun , Cha Jae-Kwan , Kim Dong-Eog , Kim Joon-Tae , Choi Jay Chol , Lee Byung-Chul , Kim Wook-Joo , Shin Dong-Ick , Sohn Sung Il , Lee Ji Sung , Lee Juneyoung , Bae Hee-Joon ,   Clinical Rsch Collaboration for Stroke in Korea (CRCS-K) Investigators
Published: October 2018

Background:
Although dual antiplatelet treatment with aspirin and clopidogrel is widely used in stroke patients due to large artery atherosclerosis (LAA), there are limited data to justify this.

Methods:
We used a multicenter, prospective stroke registry database (CRCS-K) to analyze acute ischemic stroke patients due to LAA who were treated with aspirin alone or combination of aspirin and clopidogrel from May, 2008 to May 2015. Results were analyzed by intention-to-treat (ITT), as-treated (AT), and per-protocol (PP) method. Primary endpoint was the 1-year composite outcome of stroke recurrence, myocardial infarction (MI), and all-cause death. To balance the differences between groups, a frailty model with inverse probability of treatment weighting was used.

Results:
A total of 5,934 patients due to LAA were treated either aspirin alone (n=3,031, 51%) or combination of aspirin and clopidogrel (n=2,903, 49%). Primary outcome was 14% (n=410) in aspirin alone group and 12% (n=353) in aspirin plus clopidogrel group. In ITT analysis, compared to aspirin alone, aspirin plus clopidogrel did not decrease the hazards of primary outcome (adjusted hazards ratio, 0.86; 95% confidence intervals, 0.74-1.01; p=0.06), but decreased all-cause mortality significantly (0.80; 0.66-0.98; p=0.03). Stroke recurrence and a composite of stroke recurrence, MI, and vascular death were not reduced by aspirin plus clopidogrel. Results of AT and PP analyses are shown in the table below.

Conclusion:
Addition of clopidogrel to aspirin may decrease all-cause death and perhaps the composite of stroke recurrence, MI and all-cause death in patients with large artery atherosclerotic stroke.
Abstract TP140: The Beneficial Effects of Sequential Combination of Cognitive Training and Aerobic Exercise in Stroke Patients With Cognitive Decline
Authors: Wu Ching-yi , Yeh Ting-ting , Hu Yu-tzu , Chang Ku-chou
Published: October 2018

Introduction:
Post-stroke cognitive decline is a major problem that affects up to 70% of stroke survivors. Combination of aerobic exercise and cognitive training has been found to be effective for improving cognitive functions in individuals with dementia and community-dwelling elderly. However, the training effects of combined training on stroke survivors with cognitive decline require further investigation.

Hypothesis:
A sequential combination of aerobic exercise and cognitive training would be effective than control training on cognitive function, physical activity, and quality of life in stroke survivors with cognitive decline.

Methods:
Stroke survivors with cognitive decline were recruited and separated into sequential (SEQ) and control groups (CON). Participants in the SEQ group (N=15) first received 30-minute aerobic exercise followed by 30-minute computerized cognitive training; participants in the CON group (N=15) received non-aerobic exercise and unstructured cognitive training for 60 minutes. All participants received trainings for three days per week for 12 weeks. The cognitive function outcomes included Montreal Cognitive Assessment (MoCA) and double decision (i.e., visual spatial processing). Six-minute walk test (6MWT) and International Physical Activity Questionnaire (IPAQ) were used to evaluate physical activity. Quality of life was assessed by Stroke Impact Scale (SIS). We used paired sample t-test to examine the within group training effect and analysis of covariance to determine the between groups training effect.

Results:
From pre to post training, the SEQ group improved cognitive function (MoCA,
p
<0.001; double decision,
p
=0.006), physical function (6MWT,
p
=0.038; IPAQ,
p
=0.052) but not quality of life (SIS,
p
=0.47). The CON group, however, had no significant changes across all variables (all
p
’s>0.05). Compared to the CON group, the SEQ group improved cognitive function (MoCA,
p
=0.03) and physical activity (6MWT,
p
=0.025), but no group difference was found in double decision, IPAQ and SIS. (all
p
’s>0.05).

Conclusions:
A sequential combination of aerobic exercise and cognitive training approach is favored to facilitate cognitive function and physical activity in stroke survivors with cognitive decline.
Abstract TP148: Care Partner Program improves Discharge to Community and Functional Gains in Stroke Patients at Acute Inpatient Rehabilitation Facility
Authors: Schroder Michael , Hummel Wesley , Reichwein Raymond K
Published: October 2018

Introduction/Hypothesis:
Caregiver training and education plays an important role throughout the post-stroke recovery continuum. The comfort level and competence of these caregivers in providing the support and assistance necessary is often the determining factor for a stroke survivor’s ability to return to their community dwelling. In this study, we hypothesized that a comprehensive, multidisciplinary caregiver education and training (Care Partner) program would improve functional outcomes and discharge to community outcomes of stroke patients at an acute inpatient rehabilitation facility (IRF).

Methods:
The Care Partner program was established as a comprehensive multidisciplinary training and education program for stroke patients and their caregivers at an IRF. Data was collected for patient’s discharge destination, case mix index (CMI), and functional improvements according to the FIM (Functional Independence Measure) and compared to facility, regional, and national benchmarks.

Results:
In 2016, 41 out of 252 total stroke patients participated in the Care Partner program. The participant discharge to community rate was 87%, which is higher than facility (67.8%), regional (60.4%), and national (64.6%) levels of stroke patient populations. Additionally, the FIM change per stay for participants was 33.04 as compared to facility (27.65), regional (24.73) and national (23.84). The participant FIM change per stay is significantly higher, which equates to a higher functional level upon discharge. The CMI for participants was 2.02 as compared to the facility (1.64), regional (1.63), and national (1.54), which denotes a much greater burden of care. However, even with a greater care burden, the participants in the PSHR Care Partner program had better quality outcomes when compared to the non-participants.

Conclusion:
The Care Partner program improves a stroke survivor’s ability to return to their community dwelling with greater functional independence when being discharged from an IRF.
Abstract TP154: A Qualitative Study on a Telehealth System for Home-Based Stroke Rehabilitation
Authors: Chen Yu , Chen Yunan , Zheng Kai , Dodakian Lucy , See Jill , Zhou Robert , Chiu Nina , Augsburger Renee , McKenzie Alison , CRAMER Steven C
Published: October 2018

Purpose:
This abstract reports a qualitative study on a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education at the patient’s home. Therapists examine patients then establish regular videoconferences with them via the system to discuss their progress, provide feedback, and adjust treatment. The aims of this study were to investigate patients’ general impressions about the benefits of and barriers to using the telerehabilitation system at home.

Methods:
We used a qualitative study design that involved in-depth semi-structured interviews with 10 participants who had completed a 6-week intervention using the telerehabilitation system. Thematic analysis was conducted using the grounded theory approach.

Results:
Participants mostly reported positive experiences with the telerehabilitation system. Benefits included observed improvements in limb functions and provision of an outlet for mental tension and anxiety. They mainly valued the following four merits of the system: engaging game experience, flexibility in time and location in using the system, having the therapists accountable, and having less burden on caregivers. In particular, all participants rated highly their experience using the videoconference capability, which provided a channel for therapists to observe, correct, and provide feedback and encouragement to patients. Most patients expressed that they established a personal connection with the therapist through use of the telerehabilitation system. By doing so, they felt less isolated and more positive and connected. Finally, communicating with therapists three times a week also held patients accountable for completing the exercises. Barriers to system use were all logistics-related, such as the lack of physical space at home, which impeded effective use, and poor internet connection at home.

Conclusions:
The telerehabilitation system studied provides patients with home-based access to games, exercises, education, and therapists. Based on participants’ qualitative feedback, it is a promising tool to deliver stroke rehabilitation therapies effectively and remotely to patients at home.
Abstract TP158: Neural Function and Injury Combined Best Predict Behavioral Gains During Inpatient Stroke Rehabilitation
Authors: Cassidy Jessica M , Srinivasan Ramesh , Aziz Zainab , Yang Derek Z , O’Brien Connor , CRAMER Steven C
Published: October 2018

Background:
A better understanding of the mechanisms of recovery during rehabilitation could inform treatment decision-making. We tested two hypotheses: [1] a combination of neural function and injury measures is better than either measure alone for predicting motor gains during inpatient rehabilitation facility (IRF) admission; and [2] performance of prediction measures varies according to severity of baseline impairment.

Methods:
Fifteen patients with subacute stroke (56±12 yr, 16 days post-stroke) admitted to an IRF underwent EEG [3-min, resting-state, dense-array (256-lead)] and MRI [anatomical and diffusion tensor] at IRF admission; and serial behavioral testing. Neural function was assessed using EEG measures of coherence and power from electrodes overlying ipsilesional (M1
i
) and contralesional (M1
c
) primary motor cortex, in the Delta (1-3 Hz) and high Beta (20-30 Hz) frequency bands. Neural injury was assessed as integrity of white matter in corpus callosum (CC). Change in arm Fugl-Meyer (FM) and Functional Independent Measurement motor (FIM-m) scores served as primary and secondary behavioral recovery metrics, respectively.

Results:
In subjects with moderate or severe impairment (FM <55, N=11), neither neural function (M1
i
-M1
c
Delta coherence) nor neural injury (CC integrity) alone significantly predicted FIM-m score change. However, when combined into a single model, these measures did significantly predicted FIM-m score change (R
2
= 0.85, p=0.024); note that baseline behavior was not a significant predictor. An identical neural injury+function model approached significance at predicting FM score change (R
2
= 0.72 p=0.08). These models failed, however, when applied to all 15 patients (R
2
= 0.06, p=0.81).

Conclusions:
Results thus far in this ongoing study suggest that recovery during inpatient rehabilitation is best predicted by combining neural function and injury measures, and not by behavioral assessments. Performance of recovery predictors varies according to severity of baseline deficits, as adding mild strokes to moderate/severe strokes increased the sample size but diluted the model. These findings could potentially inform patient selection, treatment decisions, and discharge planning in an IRF setting.
Abstract TP159: Beta Blockers Do Not Increase the Risk of Post-Stroke Depression in a Predominantly Afro-Caribbean Population
Authors: McCuaig Elizabeth , Balucani Clotilde , Weedon Jeremy , Gilles Nadege , Tsui Cindy L , Tan Lucy , Singer Jonathan , Law Susan W , Levine Steven R
Published: October 2018

Background:
Depression is one of the most common neuropsychiatric disorders among ischemic stroke survivors, affecting up to 50%. Beta-blockers (BB) are commonly prescribed for stroke patients and the evidence for an association between BB use and depression is mixed. We explored this relationship in an urban, predominantly Afro-Caribbean stroke cohort.

Hypothesis:
The use of BB will be associated with an increase in frequency and severity of post-stroke depression.

Methods:
Observational, cross-sectional, prospective study of eligible non-demented patients with ischemic stroke in the past 3 years and without a history of major depression. Subjects were recruited from the inpatient stroke unit, outpatient stroke clinics (including at Kings County Hospital), and inpatient rehabilitation unit at SUNY Downstate Medical Center. Demographics, medical history, and current medications were recorded from medical records and patient interviews. Depression was assessed using Beck’s Depression Inventory (BDI). For bivariate analysis, the Mann-Whitney test was used to associate BB usage with BDI score. For multiple regression analysis, a general linear model was constructed, with square-root (BDI score) as the dependent variable. Covariates were history of myocardial infarction and/or coronary artery disease, NIH Stroke Scale, and age.

Results:
Of 83 subjects enrolled, 76 (91%) were Afro-Caribbean, 47 (56%) were female, and mean age was 66.9 (SD±12.7) yrs. Median (Q1,Q3) BDI score was 7 (3,10) for BB users (N=37), 5 (3,9) for no BB use (N=46) (
p
=0.275). Controlling for covariates (sample n=83), the difference remained non-significant (
p
=0.909). There were 10 patients with BDI scores over 13, indicating their depression was worse than minimal, and of these, 6 were on BB.

Conclusion:
BB use was not associated with a significant increase in the severity or frequency of depression in this urban, predominantly Afro-Caribbean post-stroke population.
Abstract TP161: The Cerebrovascular Disease Knowledge Portal: an Open Access Data Resource to Accelerate Genomic Discoveries in Stroke
Authors: Crawford Katherine , Kourkoulis Christina , Miyares Laura , Burtt Noel , Flannick Jason , Hall Jennifer L , Rosand Jonathan , Falcone Guido
Published: October 2018

Introduction:
High throughput genotyping technologies and large collaborative consortia have revolutionized the field of medical genetics. Open data access is the final barrier capitalizing fully on the opportunities available in stroke genetics research. The International Stroke Genetics Consortium (ISGC) has created the Cerebrovascular Disease Knowledge Portal (CDKP), a platform to explore and access genetic data related to cerebrovascular diseases.

Methods:
Funded by the NIH, the CDKP has been developed by the ISGC and the American Heart Association (AHA) Institute for Precision Cardiovascular Medicine. The CDKP seeks to democratize access to genomic data and potentiate stroke genomics research by providing open access to genetic, phenotypic and imaging data on patients with stroke. Within the CDKP, data are aggregated, integrated, and harmonized according to a pre-specified standardized pipeline. Any institution or investigator working with stroke genomic data is welcome to deposit their data or use available data.

Results:
The CDKP houses two types of data, for different regulatory and analytical needs: summary level data and individual level data. The CDKP offers three main features: (1) a web-based graphical user interphase that allows the exploration of genomic information through a wide menu of integrated tools for analysis and data visualization; (2) a repository of full sets of genome-wide summary statistics produced by published landmark studies in the field; and (3) a repository of individual level data, accessible through a secure cloud working space provided by the AHA Platform for Precision Medicine. The CDKP can be accessed at
www.cerebrovascularportal.org
.

Conclusion:
The CDKP advances the ISGC’s goal of liberal data sharing in stroke genomics and other areas of cardiovascular research that may benefit from genomic analyses. In the future, phenotypic datasets can be added to further enrich sharing of non-genetic data as well.
Abstract TP17: The Smoking-Thrombolysis Paradox: a Matched Case-Control Study
Authors: Bouslama Mehdi , Rebello Letícia C , Haussen Diogo C , Grossberg Jonathan A , Barreira Clara M , Doppelheuer Shannon , Anderson Aaron M , Belagaje Samir R , Frankel Michael R , Nogueira Raul G
Published: October 2018

Background and Purpose:
Smoking is a well-established risk factor for stroke. However, several studies have shown that smokers with stroke have better outcomes after thrombolysis, a phenomenon commonly known as the smoking-thrombolysis paradox. We investigated whether clinical and procedural outcomes differ between smokers and non-smokers with large vessel occlusion stroke after endovascular therapy.

Methods:
We reviewed our prospectively collected endovascular database at a tertiary care academic institution between Sep 2010-Dec 2016. All patients that underwent endovascular therapy for anterior circulation large vessel occlusion acute ischemic stroke were included and categorized into two groups: (1) current smokers and (2) non-smokers. The 2 groups were then matched for age, baseline NIHSS and glucose levels using a weighted Euclidian distance method. Baseline, procedural, and radiological characteristics, as well as outcome parameters were compared.

Results:
A total of 326 (163 matched pairs) qualified for the study. Smokers had higher rates of dyslipidemia (48.5% vs 28.8%, p<0.001), lower body mass index (26.7[23.5-31.3] vs 28.4[24.9-32.6], p=0.03) and shorter procedures (63[45-82] vs 73.5[46-116], p=0.03). Other baseline characteristics including baseline NIHSS, ASPECT scores, CT Perfusion parameters (ischemic core and penumbra volumes) and median time to treatment were well balanced. When compared with non-smokers, smokers also had similar rates of good outcomes at 90 days (mRS 0-2) (58.2% vs 52.4%, p=0.33), successful reperfusion (mTICI 2b-3) (92% vs 89.6%, p=0.44), parenchymal hematomas (7.4% vs 6.7%, p=0.83) and mortality at 90 days (14.9% vs 15.6%, p=0.86). On multivariate analysis, age (OR 0.97 95%CI [0.94-0.99], p=0.006), pretreatment glucose (OR 0.99 95%CI [0.98-0.99], p=0.02), baseline NIHSS (OR 0.92 95%CI [0.87-0.97], p=0.002) and successful reperfusion (OR 6.98 95%CI [2.19-22.25] were associated with good outcome.

Conclusion:
Our data shows that smoking is not associated with outcomes in patients with large vessel occlusion stroke treated with mechanical thrombectomy.
Abstract TP171: Liver Cirrhosis is Associated With an Increased Risk of Aneurysmal Subarachnoid Hemorrhage
Authors: Parikh Neal S , Merkler Alexander E , Jesudian Arun , Kamel Hooman
Published: October 2018

Introduction:
Cirrhosis has been associated with non-traumatic subarachnoid hemorrhage (SAH). Additionally, cirrhosis appears to contribute to the development of pulmonary vascular abnormalities. We therefore sought to investigate whether cirrhosis is associated specifically with aneurysmal SAH.

Methods:
We performed a retrospective cohort study using 2009-2015 inpatient and outpatient claims data from a 5% sample of Medicare beneficiaries ≥66 years of age. Our exposure was cirrhosis as defined by a previously validated algorithm using inpatient and outpatient
ICD-9-
CM
diagnosis codes. The outcome of aneurysmal SAH was identified using a validated approach requiring an inpatient
ICD-9-CM
diagnosis code for non-traumatic subarachnoid hemorrhage, without concomitant diagnosis codes for trauma or rehabilitation. Additionally, to further ensure we were identifying aneurysmal SAH, we required the presence of an
ICD-9-CM
procedure code reflecting endovascular or surgical treatment of a cerebral aneurysm during the same hospitalization. Patients were censored at the time of death or end of Medicare coverage or on September 30, 2015. We used survival statistics to calculate incidence rates and Cox proportional hazards models to evaluate the association between cirrhosis and aneurysmal SAH after adjustment for demographics, established SAH risk factors, and Charlson comorbidities.

Results:
We identified 10,658 (0.6%) patients with cirrhosis from among the 1,778,604 beneficiaries in our sample. The mean age of patients with cirrhosis was 73.2 (±6.5) years, and 48% were female. Over a mean of 4.7 (±2.1) years of follow-up, 4,272 patients were hospitalized with aneurysmal SAH. The annual incidence of aneurysmal SAH in patients with cirrhosis was 0.11% (95% confidence interval [CI], 0.08-0.17%) compared to 0.05% (95% CI, 0.05-0.05%) in patients without cirrhosis. After adjustment for demographics, risk factors, and comorbidities, cirrhosis was independently associated with an increased risk of aneurysmal SAH (hazard ratio, 2.3; 95% CI, 1.5-3.4).

Conclusions:
We found that cirrhosis was associated with aneurysmal SAH among Medicare beneficiaries. Liver cirrhosis may be an independent risk factor for aneurysmal SAH.
Abstract TP182: Coronary Calcium Score Improves Predictability of Asymptomatic Coronary Artery Disease in Non-embolic Ischemic Stroke Patients
Authors: Choi Hye-Yeon , Shin Soo Jung , Yoo Joonsang , Lee Kijeong , Song Dongbeom , Kim Young Dae , Cho Han-Jin , Nam Hyo Suk , Lee Kyung Yul , Lee Hye Sun , Heo Ji Hoe
Published: October 2018

Background and purpose:
Many patients with ischemic stroke have concomitant coronary artery disease (CAD). Coronary screening is recommended in patients with high risks for CAD. It remains uncertain which group of stroke patients need evaluation for asymptomatic CAD, and which evaluation tool is appropriate for stroke patients. We investigated whether the coronary artery calcium (CAC) scores could predict significant CAD in patients with acute stroke and which stroke patients need a screening test for significant CAD.

Methods:
Among consecutive stroke patients between September 2011 and August 2013, a total of 1143 patients who underwent multiple detector CT coronary angiography and cerebral angiography were included. Atherosclerotic stenosis ≥ 50% or obstruction was classified as significant stenosis in coronary and cerebral arteries. Patients were grouped into four subgroups on the basis of CAC score: 0, 0.1-99.9, 100-399.9, and ≥ 400. Presence of hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking were considered as risk factors.

Results:
Of 1143 patients, significant stenosis was detected in 164 patients (14.3%) in the internal carotid artery (ICA), 279 (24.4%) in the vertebrobasilar artery (VBA), and 81 (7.1%) in the both ICA and VBA. Significant coronary artery stenosis in at least one coronary artery was detected in the 398 patients (34.8%). Two or more risk factors and one or more significant stenosis in the ICA or VBA were considered as screening criteria for choosing potential CAD patients according to AUC analysis. As the CAC score increased, odd ratio for significant CAD remarkably increased (2.1678, CI 1.0152 to 4.6290 for CAC score 0, 5.7193 ,CI 2.9192 to 11.2051 for 0 <CAC score < 100 , 15.6351 ,CI 7.8537 to 31.1262 for 100≤CAC score < 400, and 72.2925, CI 33.8979 to 154.1746 for CAC score≥400, respectively, P <0.05 for all).

Conclusion:
Two or more risk factors and one or more significant stenosis in the ICA or VBA can be used to choose patients with stroke who need to perform a screening test predicting significant CAD. CAC score also can be used as a screening to perform coronary artery evaluation even in the patients without documented cerebral atherosclerosis.
Abstract TP184: Liver Transplantation is Associated With a Reduced Risk of Hemorrhagic Stroke Among Patients With Liver Cirrhosis
Authors: Parikh Neal S , Sharma Rajani , Jesudian Arun , Kamel Hooman
Published: October 2018

Introduction:
Cirrhosis is associated with an increased risk of hemorrhagic stroke. We sought to determine whether liver transplantation is associated with a subsequently reduced risk of hemorrhagic stroke.

Methods:
We performed a retrospective cohort study using administrative claims data on hospitalizations and emergency department visits in CA, FL, and NY from 2005-2013. Patients with cirrhosis awaiting liver transplantation were identified by previously validated
ICD-9-CM
diagnosis codes for cirrhosis in combination with code V49.83 for “awaiting organ transplant” status. The exposure variable was liver transplantation, ascertained using
CPT
and
ICD-9-CM
procedure codes. The primary outcome was a composite of intracerebral hemorrhage and subarachnoid hemorrhage, identified using a previously validated algorithm. Patients were censored at the time of death or last available data. Hemorrhagic stroke incidence was calculated using survival statistics, and Cox proportional hazards modeling was used to examine the association between liver transplantation and hemorrhagic stroke. To minimize immortal time bias, we modeled liver transplantation as a time-varying covariate. We adjusted for demographics, established stroke risk factors, Elixhauser comorbidities, as well as hemodialysis and hepatocellular carcinoma, two factors which significantly increase patients’ priority status for liver transplantation.

Results:
We identified 11,250 patients with cirrhosis awaiting liver transplant, of whom 2,925 (26%) underwent transplantation. The mean age (54.7 years) did not differ between groups. Patients who underwent transplantation were more often male and less frequently had vascular comorbidities. Over a mean follow-up of 2.6 (±2.3) years, 154 hemorrhagic strokes were identified. The annual incidence of hemorrhagic stroke was 0.24% (95% CI, 0.15-0.36%) after liver transplantation compared with 0.66% (95% CI, 0.56-0.79%) among patients awaiting transplant. After adjustment for potential confounders, liver transplantation was associated with a lower risk of hemorrhagic stroke (HR, 0.6; 95% CI, 0.3-0.9).

Conclusions:
Liver transplantation was associated with a reduced risk of hemorrhagic stroke among patients with cirrhosis.
Abstract TP19: Impact of Revascularization Therapy on Patient Outcome by the Severity of Acute Ischemic Stroke
Authors: Nomura Eiichi , Takemaru Makoto , Kono Ryuhei , Himeno Takahiro , Ando Hitoshi , Nishigaki Masakazu , Ota Shinzo
Published: October 2018

Background and Purpose:
It has not fully investigated whether the benefit from revascularization therapy for patients with mild acute ischemic stroke (AIS) can overweigh the risk. The aim of this study was to investigate the impact of revascularization therapy on patient outcome as related to the severity of the stroke.

Methods:
From our hospital’s stroke database from January 2006 to March 2017, we extracted data for patients with AIS. Eligible criteria for the patients were: modified Rankin Scale (mRS) of 0 or 1 before onset, admitted less than 24 hours after onset, and followed up for at least 3 months. Revascularization therapy included intravenous tissue plasminogen activator; endovascular therapy (intra-arterial urokinase infusion, percutaneous transluminal angioplasty, emergent carotid artery stenting, and thrombectomy); and carotid endarterectomy performed within 14 days from onset.

Patients were divided into 4 groups based on the severity using the National Institutes of Health Stroke Scale (NIHSS) on admission : Group 1 = 0-4, Group 2 = 5-9, Group 3 = 10-19, and Group 4=20-. We defined a good outcome as mRS score of 0-1 at 3 months after onset. The odds ratio of a good outcome was computed among 4 groups, adjusting for age and sex.

Results:
We extracted data for 3275 patients with AIS (71.3 years, 65.1% men). Of these, 17.9% received revascularization therapy of any type. This was distributed across the 4 NIHSS groups as follows: 6.1% of Group 1 (n=2193), 27.1% of Group 2 (n=527), 56.4% of Group 3 (n=298), and 55.6% of Group 4 (n=257). The odds ratios (95% confidence interval) of treatment for good outcome in group 1 to 4 were 0.42 (0.29-0.62), 1.15 (0.78-1.72), 2.80 (1.60-4.90), and 4.40 (1.79-10.82), respectively. Group 1 was further divided into 5 subgroups by each NIHSS scores of 0-4. The odds ratios for each subgroup (NIHSS scores 0, 1, 2, 3, and 4) were 0.20 (0.07-0.61), 0.28 (0.11-0.69), 0.27 (0.11-0.69), 0.93 (0.43-2.03), and 0.88 (0.42-1.85), respectively.

Conclusions:
Approximately half of the patients with NIHSS score of ≥10 received revascularization therapy and had significant benefit. However, revascularization therapy for patients with mild AIS (specifically NIHSS scores of 0, 1, or 2) could be rather harmful.
Abstract TP193: Epidemiology of Intracerebral Hemorrhage in Qatar
Authors: Dsouza Atlantic , Shuaib Ashfaq , Kamran Saadat , Akhtar Naveed , El Sotouhy Ahmed , Abbas Salma , Ali Musab , Bourke Paula , Joseph Sujatha , Saqqur Maher
Published: October 2018

Background:
Intracerebral hemorrhage (ICH) accounts for 10 to 30 % of all strokes. However, the clinical outcome is worse than ischemic stroke with 50 % mortality rate at 30 days follow up. Qatar has a unique multi-cultural demography which may make the etiology and mechanism of ICH different from the west. There are no reports on the epidemiology of ICH from Qatar. Our study thus aims to evaluate the main risk factors and etiology based on the age and race of our current population.

Method:
Using our stroke database a retrospective analysis of prospectively collected data of patients with suspected stroke was undertaken . Our study sample included all ICH’s based on head CT imaging and clinical presentation. The etiology of ICH was based on age, risk factors and neurovascular imaging findings. Etiology was classified as: hypertension, CAA, vascular malformation, drug related and others (eg: vasculitis). Baseline characteristics of ICH population were assessed using univariate analysis (χ
2
test, ANOVA & student t test). Multiple logistic regression analysis was performed to define predictors of ICH using SPSS 23 and P value of 0.05 was considered significant.

Result:
Out of 2525 strokes, 518 (20.5%) were ICH. Patients with ICH were younger with a mean age of 51.72±13.1 compared to ischemic strokes 56.12±13.38. (P value 0.68) Due to the population distribution of races, ICH was more common in the South Asians 201/518 (38.8%) followed by Filipino and Far East [FFE] 96/518 (18.5%), then Nepali 76/518 (14.7%) then Qatari and Arabic population 12% and 9.8% (P < 0.001). The main risk factors for ICH were FFE and Nepali race followed by hypertension, obesity and diabetes. Hypertensive ICH remained the main mechanism across the different races. In the multiple logistic regression analysis, the main predictors of ICH were the FFE race (adjOR: 2.297, CI: 1.77-2.97, P-Value: 0.00) and hypertension (adj OR: 1.85 CI: 1.46-2.36, P-Value: 0.00, NIHSS (adjOR: 1.15 CI: 1.13-1.17, P-value: 0.00) and age (adjOR: 0.9, CI: 0.96-0.98, P-value: 0.00)

Conclusion:
The rate of ICH in Qatar is similar to the west. It is substantially low in the Qatari’s compared to the Far Eastern and South Asian population. Across all races the main risk factor and etiology remains uncontrolled hypertension.
Abstract TP202: Vertebrobasilar Insufficiency is an Easy to Ascertain and Important Predictor of Cardiovascular Events in Elderly Population: Analysis of Cardiovascular Health Study
Authors: Qureshi Adnan I , Saeed Omar , Malik Ahmed A
Published: October 2018

Background:
Vertebrobasilar insufficiency is a clinical diagnosis which consists of multiple minor recurrent in the distribution of vertebral or basilar arteries. The value of such clinical symptoms for risk stratification in elderly population remains unknown.

Methods:
We analyzed data from the Cardiovascular Health Study participants aged ≥65 years who underwent a standard clinical evaluation at baseline evaluation. Each participant was inquired regarding symptoms of stroke using baseline neurological history questionnaire. Vertebrobasilar insufficiency was defined when stroke or TIA was localized to vertebral or basilar artery distribution based on location, duration of symptoms and associated factors. Incident cardiovascular events were identified during annual follow-up examinations and at 6-month telephone contact and adjudicated by appropriate central committees. Hazards ratio [HR] for cardiovascular events during follow up were estimated using Cox proportional Hazards analysis.

Results:
Vertebrobasilar insufficiency was observed in 62 (1.1%) of 5,888 study participants (50% women, 24.2% African American; mean baseline age, 73.2 ± 5.4 years) who were followed for incident events for a mean (SD) period of 6.5 (1.8) years. There was a significantly higher proportion of African Americans (24.2 % versus 15.2%, p=0.007) and those with congestive heart failure (14.5 % versus 2.7%, p=<.0001) in patients with vertebrobasilar insufficiency. The rate of any stroke (19.4% versus 9.1%, HR 1.8, 95% confidence interval [CI] 1.0 - 3.3), myocardial infarction (19.4% versus 9.1%, HR 1.8, 95% CI 1.1-3.4),and death (38.7% versus 22.1%, HR 1.5, 95% CI 1.0-2.3) were significantly higher among patients with vertebrobasilar insufficiency after adjusting for age, race, congestive heart failure, and previous myocardial infarction.

Conclusions:
Vertebrobasilar insufficiency is an easy to ascertain and important predictor of cardiovascular events and should be incorporated into routine clinical evaluation.