bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP36: Detection of Early Ischemic Changes in non-contrast Head CT improved by utilization of Standardized “Acute Stroke” Windowing of Images
Authors: Mainali Shraddha , Wahba Mervat , Elijovich Lucas
Published: March 2022

INTRODUCTION:
Non-contrast head CT (NCCT) is the standard radiologic test performed in the emergency department (ED) for patients presenting with symptoms of acute stroke. Early ischemic changes (EIC) in NCCT are often missed by ED physicians and on-call radiologists. We assessed the hypothesis that detection of EIC can be improved by a standardized method of image evaluation.

METHODS:
Retrospective chart review was performed of the University of Tennessee Health Science Center prospective database of acute ischemic stroke from January - July 2012. Patients treated with IV TPA who had NCCT as the initial neuroimaging exam were identified and additional baseline characteristics were noted. EIC was defined as findings consistent with: 1) Hyperdense MCA/basilar artery sign 2) Sulcal effacement 3) Basal ganglia/subcortical hypodensity and 4) Loss of cortical gray-white differentiation. Initial NCCT was reviewed by a blinded neurology resident (except presenting complaints). First, images were reviewed with standard window settings of center and width level of 40 and 100 Hounsfield units (HU). Then, all images were interpreted with ”stroke windows” of center 35 and width of 30 HU. This was compared with the radiologists’ final report. Final interpretations based on "stroke windows" were compared with follow up imaging studies to assess accuracy. Fisher’s exact test was used for statistical analysis.

RESULTS:
NCCTs of 50 patients (42% females) with an average age 75.4 years and mean NIHSS of 13.4 were reviewed. The mean time to CT from symptom onset was 97.7 minutes. Out of 50 patients, radiologists detected EIC in 9 patients while authors detected EIC in 35 patients (18% vs. 70% with 100% accuracy; p < 0.0001). Hyperdense MCA sign although most commonly reported by radiologists, was better appreciated with "stroke windows" (14% and 56%; p <0.0198). Similarly, detection of the remaining EIC also improved with "stroke windows" (6% and 46%, P<0.0001)

CONCLUSIONS:
EIC although common in acute ischemic stroke are often missed by the interpreting radiologists. We conclude that the rates of detection can be significantly improved with standardized “Stroke Windows”. This has important implications in regards to rapid diagnosis and treatment of acute ischemic stroke.
Abstract WP367: Factors Related To High Plasma Homocysteine Level At One Year Post-stroke In Korean Patients With Ischemic Stroke
Authors: Choi Seung-hye , Kim Jong S. , Park Jinyoung , Kim So-hyun , Choi-Kwon Smi
Published: March 2022

Background :
Despite reports of correlation between homocysteine(Hcy) and 2ndary stroke incidence, many stroke patients still have elevated plasma Hcy post-stroke. This study investigates the changes of Hcy over one year and the related factors to high Hcy including nutrient intakes in stroke patients.

Methods:
A total of 203 patients with ischemic stroke admitted to the Asan Medical Center were enrolled. Blood samples were collected for Hcy and other biochemical measurements at admission and 1 year post stroke. Personal interview was performed to obtain socio-demographic data. Nutritional status was determined by mini nutritional assessment (MNA). Dietary intakes of the subjects were obtained by 24 hour dietary recall method and were analyzed with CAN pro (3.0 version).

Results:
The patients with high Hcy (> 15μmol/L) at admission and one year post-stroke were 47(23.2%) and 59(29.1%), respectively. Among the patients with normal Hcy at admission, 36 (23.1%) patients had high Hcy one year post-stroke. The factors related to high plasma Hcy level at admission were male (p=0.048). The factors related to high Hcy one year post-stroke were low plasma folate level (p=0.002), and Vit B
12
level (p=0.011), old age (p=0.025), male (p=0.006), and poor nutritional status (p=0.045). Administration of Vitamin and folate (1mg per day) were not related to Hcy level. The patients with elevated Hcy as compared to the patients with normal Hcy one year post- stroke although they all had normal Hcy at admission had low plasma Vit B
12
(p=0.009), folate level(p=0.003), and poor nutritional status(p=0.031). And old age (p=0.049), male (p=0.021), and dietary Vit B
6
intake (p=.032) were also significantly related to high Hcy one year post-stroke. However, administration of folate (1mg per day), smoking, and exercise were not related to high Hcy.

Conclusions:
Hyperhomocysteinemia is common in Korean stroke patients 1 year after stroke. Many patients with high Hcy at admission still have elevated Hcy regardless of folate administration. The strategies to decrease Hcy after stroke should include nutritional modifications, particularly so in the male patients with old age.
Abstract WP368: Differences In Antioxidant Capacity, Oxidative Stress, And Nutrient Intake Patterns Between Male And Female Stroke Patients.
Authors: Choi-Kwon Smi , Choi Seung-hye , Kwak Chung-Sil , Park Jin-young , Kim So-hyun , Suh Min-hee , Kim Jong S.
Published: March 2022

Background and aims:
Oxidative stress may be related to the pathogenesis of stroke. It has been suggested that there is a gender difference in oxidative stress and antioxidant capacity. The present study was conducted to elucidate differences in antioxidant capacity and related factors to antioxidant capacity between the male and female patients one year post-stroke.

Methods:
A total of 189 ischemic stroke patients who were admitted to Asan Medical Center were screened. Blood samples were collected for ferric reducing ability of plasma (FRAP) for antioxidant capacity, thibarbituric acid reactive substance (TBARS) for oxidative stress at one year post stroke. Anthropometric measurements were also obtained to determine nutritional status. Dietary intakes of the patients were obtained for 2 days by 24 hour dietary recall method and were analyzed with CAN pro (3.0 version). National institutes of health stroke scale (NIHSS), barthel index (BI), and the presence of depression (Beck Depression Inventory, BDI) were also investigated.

Results:
There were 123 (65.1%) male and 66 (34.9%) female patients. No differences were found in stroke subtype, age, and body mass index (BMI) between the groups, while economic status (p=.014), employment status (p<.001), current smoking (p<.001) and alcohol intakes (p<.001) were higher in male than in female patients. The male also had higher FRAP level (p=.001), lower NIHSS (p=.024), higher BI (p=.031), and lower BDI score (p=.042) than the female whereas no difference was found in TBARS. Regarding dietary intakes, protein (p<.001), lipid (p<.001), dietary fiber (p<.001), Vit. A (p=.011), Vit. B
6
(p<.001), and folate(p=.030) intakes were higher in the male group than the female group. In multivariate analysis, drinking (p=.003) was the predicting factor in the male whereas high BMI(p=.019) was the predicting factor of FRAP in the female group.

Conclusion:
Antioxidant capacity was higher in the male than in the female one year post-stroke. Special attention should be paid to female stroke patients since they have low antioxidant capacity with low intakes of antioxidant nutrients.
Abstract WP374: Racial Disparities in Stroke Mortality in the United States 2000-2009
Authors: Adil Malik M , Akbar Siddique , Chaudhry Saqib A , Hassan Ameer E , Qureshi Adnan I
Published: March 2022

OBJECTIVES:
To test the hypothesis that the racial disparities in stroke mortality have declined in the last decade due to increased awareness and recognition.

DESIGN:
Analysis of the U.S. multiple-cause-of-death files for 2000 to 2009.

PARTICIPANTS:
Decedents with stroke (defined by ICD-10 code I60-I64) as underlying cause of death on the death certificate.

MEASUREMENTS:
Age-adjusted fatal stroke incidence for whites, African Americans, American Indians, and Asian and Pacific Islanders aged 25 and older based on the U.S. Census of 2000. The stroke rate ratio with 95% confidence interval (CI) and average annual percentage change over 10 years was also calculated.

RESULTS:
From 2000-2009, the U.S. age-adjusted annual death rate per 100,000 for stroke was 242 in African Americans and 199 in whites. The difference between rates in African Americans and whites ranged from 2 excessive deaths per 100,000 in persons aged 25-34 years to 82 excessive deaths per 100,000 in persons aged 75-84 years. Compared with whites, the stroke rate ratio was 1.2(95% CI 1.0-1.3) for African Americans, 0.6(95% CI 0.5-0.8) for American Indians, and 0.8(95% CI 0.7-1.0) for Asian and Pacific Islanders. The average annual percentage change over 10 years was -6.1%, -5.3%, -5.2%, and -4.6% Asian and Pacific Islanders, American Indians, whites, and African Americans, respectively.

CONCLUSION:
There has been a similar reduction in stroke related mortality among all racial groups between 2000 and 2009. However, the excessive stroke mortality among African Americans continues and is unlikely to change without primary and secondary preventive strategies targeted towards African Americans.
Abstract WP376: Effects of Organized Stroke Care Capacities on In-hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke. J-ASPECT Study
Authors: Iihara Koji , Nishimura Kunihiro , Kada Akiko , Nakagawara Jyoji , Ogasawara Kuniaki , Ono Junichi , Shiokawa Yoshiaki , Aruga Toru , Miyachi Shigeru , Nagata Izumi , Toyoda Kazunori , Kataoka Hiroharu , Matsuda Shinya ,   J-ASPECT Investigators
Published: March 2022

Background and Purpose
Data on the effectiveness of organized stroke care on mortality of patients with ischemic and hemorrhagic stroke are limited. In this study, we examined whether organized stroke care for all types of stroke influence the stroke in-hospital mortality in the real-world setting.

Methods
Of the 1381 certified training institutions of the Japan Neurosurgical Society and/or the Japan Stroke Society, 751 hospitals responded to a survey with questions regarding organized stroke care capacities. Organized stroke care capacities were assessed by 25 items divided into 7 subcategory score regarding personnel with specific expertise, diagnostic techniques, surgical and interventional therapies, infrastructure and educational components recommended for comprehensive stroke center (Albers et al. Stroke 2005). Among the institutions that responded, data on patients hospitalized due to stroke were obtained from the Japanese Diagnosis Procedure Combination database in 2011. In-hospital mortality was analyzed with the total and subcategory scores using hierarchical logistic regression analysis adjusted for age, sex and institutional difference.

Results
Data of 256 institutions and 53,170 emergency hospitalized patients were analyzed. Mortality rates were 7.8% for cerebral infarction(CI), 16.8% for intracerebral hemorrhage(ICH), and 28.1% for subarachnoid hemorrhage(SAH). Mortality of CI was significantly correlated with total score (OR=0.97, 95%CI=0.96-0.99), subcategory score in personnel (OR=0.93,95%CI=0.88-0.99), infrastructure (OR=0.92, 95%CI=0.87-0.97) and education (OR=0.88, 95%CI=0.81-0.95) adjusted for age and sex. Mortality of ICH was significantly correlated with total score (OR = 0.98, 95% CI: 0.96-1.00), diagnostic technique (OR = 0.93; 95% CI: 0.87-0.99) and education (OR = 0.90; 95% CI: = 0.83-0.98). Mortality of SAH was significantly associated with total score (OR = 0.96; 95% CI: 0.93-0.98), surgical and interventional therapies (OR = 0.84; 95% CI: 0.77-0.92), infrastructure (OR = 0.91, 95% CI: 0.84-0.98) and education (OR = 0.83, 95% CI: 0.75-0.92).

Conclusion
Organized stroke care was associated with in-hospital mortality rates depending on the stroke types.
Abstract WP379: “Defect-Free” Stroke Care Improves Outcomes in Patients with Acute Ischemic Stroke
Authors: Dong Li , Probst Daniel , Nelson Nancy , Call Kevin
Published: March 2022

Background:
Studies showed that adherence to a standardized care process model (CPM) during hospitalization can improve clinical outcomes in numerous patient populations.AHA/ASA guidelines encourage this model to improve “Defect-Free” stroke care. It is unknown if “Defect-Free” care improves clinical outcomes in acute ischemic stroke (AIS) patients. In 2011, Intermountain Healthcare (IH) implemented a quality improvement initiative to improve compliance with 5 stroke care measures for AIS patients.

Hypothesis:
Implementation of a systematic quality improvement program will increase “Defect-Free” stroke care performance and improve clinical outcomes in AIS patients.

Methods:
A retrospective cohort study of AIS patients 18 years or older was conducted at 6 stroke receiving hospitals within IH. Defect-free care was defined as compliance with 5 care measures: ED arrival to head CT <25 minutes, ED arrival to rtPA <60 minutes, discharge on an anti-platelet, anticoagulation for patients with atrial fibrillation, and statin medication at discharge. All patients who met eligibility criteria for any measure were included. The primary outcome was hospital discharge disposition. Multivariate logistic regression (MLR) controlling for Charlson Comorbidity Index Score (CCIS) assessed the association of “Defect-Free” care with clinical outcomes.

Results:
Among 817 patients in the study, 707 received “Defect-free” care and 110 did not. The results indicates the compliance rate was increased from 78.1% in 2010 to 86.5% in 2011 (p<0.0001). Additionally, the percentage of patients discharged to home or rehabilitation facilities in “Defect-Free” care and “Non Defect-Free” care groups were 77.6% and 67.3%, respectively. MLR showed that patients who received “Defect-free" care were more likely to be discharged to home or a rehabilitation facility (OR=1.808, 95% CI: 1.155- 2.830) than those who did not get “Defect-free” care after adjusting for CCIS.

Conclusion:
Improving “Defect-free” stroke care by following a discreet CPM across an integrated healthcare system is achievable and results in improved clinical outcomes in AIS patients.
Abstract WP381: Hospital Participation and Performance in Stroke Systems of Care: Results from The NorthEast Cerebrovascular Consortium (NECC) Region
Authors: Wira Charles R , Magdon-Ismail Zainab , Melluzzo Shannon , Day David , McCullough Louise D , Stein Joel , Schwamm Lee H , Gropen Toby ,   on behalf of The NorthEast Cerebrovascular Consortium
Published: March 2022

INTRODUCTION:
The NorthEast Cerebrovascular Consortium (NECC) was created in 2006 to unite health care providers, public health officials and advocacy organizations in an 8-state region to implement a Stroke Systems of Care Model.

Hypothesis:
Implementation of The NECC has been associated with increased participation in Get With the Guidelines - Stroke (GWTG-S) and higher performance ratings of acute care hospitals (ACH) and critical access centers (CAC).

Methods:
A two-tiered analysis of all ACH/CACs in The NECC region compared (1): GWTG-S participation and award trends over time in the pre (2005) and post (2006-11) NECC time periods, and (2) The NECC region compared to all other US regions from 2005-11. Analysis used US census data regions stratified as The NECC (CT, MA, ME, NH, NJ, NY, RI, VT) and Non-NECC regions (PA, South, Midwest, West). ACH/CACs were obtained from CMS. GWTG-S data were used for GWTG-S participation and awards (silver or higher for >1 year indicated sustained performance).

Results:
Over the study time period (2005-11) the ACH/CACs per year in The NECC and non-NECC regions were 442.1 + 8.2 and 3958.7 + 204.4. In The NECC region GWTG-S participation increased over time from 22.8% in 2005 to 60.7% in 2011 compared to 10.1% in 2005 to 31.0% in 2011 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend test). GWTG-S awards increased over time in The NECC from 0.5% in 2005 to 33.4% in 2011 compared to 0.1% in 2005 to 12.0% in 2011 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend test). After adjusting for year, significantly more NECC ACH/CACs participated in GWTG-S and received GWTG-S awards than non-NECC ACH/CACs (both analyses p<0.0001, Cochran-Mantel-Haenszel test). Among ACHs only, the trends for increased GWTG-S participation and awards over time as well as the differences between NECC vs. non-NECC regions remained significant (P<0.0001, Cochran Armitage Trend tests; p<0.0001, Cochran-Mantel-Haenszel tests).

Conclusions:
There has been more rapid growth of ACH/CAC participation and achievement in GWTG-S in the Northeast from 2006-11 compared to other regions. The NECC may complement and enhance existing regulatory and advocacy initiatives. Further investigation is merited evaluating regional networks.
Abstract WP389: Lack of Relationship Between Joint Commission Stroke Performance Measures and Functional Outcome in Ischemic Stroke
Authors: Adelman Eric E , Lisabeth Lynda D , Baek Jonggyu , Sanchez Brisa N , Burke James F , Skolarus Lesli E , Smith Melinda A , Morgenstern Lewis B
Published: March 2022

Background
Performance measures are used to encourage quality improvement, but there is little data that show performance measures improve post-stroke functional outcome. We sought to determine if adherence to Joint Commission (JC) performance measures is associated with a better functional outcome after ischemic stroke.

Methods
Ischemic stroke patients were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project between Nov. 2008 and June 2011. Data were abstracted from the medical records for the following performance measures (using 2008 JC criteria): DVT prophylaxis at 48 hours, discharged on antithrombotic therapy, anticoagulation for patients with atrial fibrillation, thrombolytic therapy administered, antithrombotic by hospital day 2, discharged on cholesterol reducing medication, and assessed for rehabilitation. Adherence to quality measures was defined by a either a binary defect free score indicating receipt of all of the measures a patient was eligible for or an opportunity score indicating the proportion of eligible measures received. Functional outcome was ascertained by patient or proxy interview as a total ADL/IADL score at 90 days post-stroke, with higher scores indicating poorer function (range 22-88). Tobit regression was used to estimate the effects of adherence to quality measures on functional outcome with adjustment for age, gender, pre-stroke functional and cognitive status, ethnicity, stroke severity, medical comorbidities, education, and clustering of patients within hospital.

Results
At total of 379 ischemic stroke patients were included. The median age was 68 and 52% of patients were women. 33.8% of patients had defect free care and the median opportunity score was 0.8 (IQR: 0.67-1). In the final multivariable models, defect free care (B -1.04, SE 2.24, p=0.66) and the opportunity score (B 1.80, SE 5.38, p=0.74) were not associated with functional outcome.

Conclusions
In this population, meeting JC performance measures was not associated with improvement in post-stroke functional outcome. While process based measures are important and improve adherence to guideline recommended care, these measures may not lead to improved functional outcome, a measure that patients and families value.
Abstract WP39: Perfusion Angiography in TREVO2: Quantitative Reperfusion After Endovascular Therapy in Acute Stroke
Authors: Liebeskind David S , Scalzo Fabien , Sanossian Nerses , Gupta Rishi , Jovin Tudor G , Walker Gary A , Albers Gregory W , Lutsep Helmi L , Smith Wade S , Nogueira Raul G ,   for the TREVO2 Investigators
Published: March 2022

Background:
Effective reperfusion is the ultimate therapeutic strategy for acute ischemic stroke, yet endovascular trials have been limited by the use of categorical scales for angiographic outcomes. Semi-automated perfusion angiography (PA) software can objectively quantify reperfusion from routine angiography. We studied feasibility and performance of PA software to evaluate angiographic and associated clinical outcomes in the multicenter TREVO2 trial.

Methods:
Core lab angiography DICOM data in TREVO2 was retrospectively used to identify anterior circulation cases with adequate temporal resolution at both baseline and after revascularization with mechanical thrombectomy. CBF was computed by deconvolution of contrast-intensity data up to 3 sec to correlate with TICI and avoid collaterals. Regions of interest (ROI) outlined areas of hypoperfusion on baseline AP and lateral angiography to map reperfusion onto identical post-procedure angiography runs. A nonlinear cross-validation model was used to map output from the ROI to a single reperfusion metric (PA CBF
3
).

Results:
148/178 (83%) patients with anterior circulation stroke in TREVO2 had DICOM angiography data with complete temporal information on serial runs at baseline and post-procedure that could be processed with the software. Core lab TICI scores in this dataset ranged from 0-3 (0, n=6; 1, n=7; 2a, n=40; 2b, n=83; 3, n=12). The continuous PA CBF
3
metric or reperfusion score ranged from 0-8.6 (mean 3.7±1.2), capturing hyperperfusion and heterogeneity.

Overall, PA CBF
3
closely correlated with TICI (ρ=0.69, p<0.001), yet provided a continuous measure that better discriminated angiographic outcomes. Software performance and PA CBF
3
results were equivalent in ICA, M1 and M2 occlusions treated in TREVO2.

Conclusions:
PA can objectively quantify heterogeneity of reperfusion in a multicenter trial, providing a continuous metric that discriminates angiographic outcomes better than TICI.
Abstract WP390: Stroke Severity Threshold For Acute Stroke Trials
Authors: Mishra Nishant K , Albers Gregory W , Lees Kennedy R ,   on behalf of the VISTA Collaboration.
Published: March 2022

Introduction:
The planning of a thrombolysis trial presents a typical clinical research problem: what lower threshold of baseline stroke severity will identify an informative population? Applying representative trial entry criteria for patients lodged within Virtual International Stroke Trials Archive (VISTA), we undertook to identify a lower threshold for baseline (b)NIHSS at which thrombolysis was associated with improved outcomes in all patients, and in patients with left or right hemisphere stroke.

Methods:
We selected patients with an age-range of 18-85 and baseline (b)NIHSS 4-24. Outcomes were defined as mRS 0-1 (Excellent Functional Outcome), mRS 0-2 (Good Functional Outcome) and either NIHSS improvement of 8 points, or NIHSS of 0-1, or both, on day 90 (Neurological Outcome). We undertook age-adjusted comparison of outcomes between thrombolysed and non-thrombolysed patients that belonged to each bNIHSS level.

Results:
Functional and neurological outcome data were available for 7811 patients and 7696 patients respectively. Thrombolysed patients were younger than non-thrombolysed patients (66.7 ± 12.4 vs. 68.7 ± 11.5, p<0.001, N=7811). bNIHSS was greater among thrombolysed patients compared to non-thrombolysed patients (median 13 vs.12, p<0.0001, N=7811). OR for outcomes after thrombolysis were >1 for b-NIHSS ≥8 in all patients, and in patients with right and left hemisphere stroke. Stroke laterality significantly interacted with b-NIHSS, and with thrombolysis, in a prediction model of functional outcomes (p<0.05), and OR for all outcome measures were greater for left hemisphere stroke (p<0.05).

Conclusions:
Outcomes were consistently improved among patients whose bNIHSS was ≥8, with inconsistency or neutral findings at lower NIHSS scores.
Abstract WP401: Influence of Hospital-Level Practices on Readmission after Ischemic Stroke
Authors: Burke James F , Adelman Eric E , Skolarus Lesli E , Brown Devin L
Published: March 2022

Introduction:
The Center for Medicare and Medicaid Services intends to publicly report hospital-level readmission rates after ischemic stroke to enable comparisons of hospital quality. The influence of hospitals and hospital-level practices on readmission rates is unknown.

Methods:
Adult subjects were entered into this cohort study when hospitalized for ischemic stroke (principal ICD-9-CM 433.x1, 434.x1, 436) in 6 states from 2003-2009 from the State Inpatient Databases. The primary outcome was any non-procedural readmission within 30 days. 26 hospital level practices of interest (utilization of diagnostic testing, procedures, ICU, tPA, and therapeutic modalities) were identified using a combination of ICD-9 procedure codes, diagnosis-related groups (DRGs) and Health Cost and Utilization Project utilization flags. Multilevel logistic regression was used to estimate the association between mean hospital-level practices and readmission after accounting for demographics, vascular risk factors, comorbidities, socioeconomic status and whether a practice was implemented in an individual patient.

Results:
Hospitals accounted for 3.7% of the variance in the probability of readmission, intraclass correlation coefficient 0.037 (95% CI 0.031-0.043). Only three practices were associated with readmission: higher use of occupational therapy and acceptance of transfers were associated with lower readmission rates, while higher use of hospice was associated with higher readmission rates. (Table)

Conclusions:
Hospitals are responsible for a small proportion of readmission variance. These findings suggest ways that readmission rates may be reduced and illustrate potential susceptibility of a publicly-reported readmission measure to manipulation.
Abstract WP402: Randomised Controlled Trial Of Motivational Interviewing Early After Acute Stroke - The Effect Of Using Different Cut-Points For Mood
Authors: Lightbody C E , Leathley Michael J , Auton Malcolm F , Dickinson Hazel , Forshaw Denise , McAdam Joanna , Sutton Christopher J , Watkins Caroline L
Published: March 2022

Background:
Mood problems are detrimental to recovery post-stroke. Of the different approaches to treating mood disorders, Motivational Interviewing (MI) - a patient-centred talk-based therapy - has been shown to have a beneficial effect at 3- and 12-months post-stroke in a single-centre randomized controlled trial (RCT). Mood was assessed by the General Health Questionnaire-28 (GHQ-28) using a cut-point 4/5. The purpose of this study was to explore the association between the effect of MI on mood and different recommended cut-points on the GHQ-28.

Methods:
In the RCT, consecutive patients on a hospital stroke register who met the inclusion criteria were randomised, balanced on age, sex, function, and location, to either usual stroke care (USC) or USC plus MI. Patients in the MI group received four weekly sessions of MI starting 2- to 4-weeks post-stroke. Logistic regression modelling was used to explore the effects of MI on mood when cut-points 5/6 and 11/12 were used.

Results:
Four hundred eleven patients were randomized: 207 to USC (mean age 69, female 41%); 204 to MI (mean age 69, female 42%). At 3-months post-stroke, the different cut-points produced varying results. For the trial cut-point (4/5), 81 (39%) USC patients and 100 (49%) MI patients had a good outcome, which was significant [p<0.04; OR=1.60, 95%CI=1.04-2.46]. A cut-point of 5/6 meant that 98 (47%) USC and 114 (56%) MI patients had a good outcome [p=0.08; OR=1.47, 95%CI=0.96-2.27]. A cut-point of 11/12, meant that 151 (73%) USC and 155 (75%) MI patients had a good outcome [p=0.49; OR=1.19, 95%CI=0.73-1.94].

Similarly, at 12-months the cut-point of 4/5 showed a significant benefit of MI over USC, while the cut-points of 5/6 and 11/12 showed a non-significant effect.

Conclusion:
The RCT showed a significant benefit of MI over USC on mood using the cut-point of 4/5: the power of the original trial was based on this cut-point. Post-hoc analysis showed this effect was not seen using other recommended cut-points. This analysis demonstrates the importance of identifying a valid cut-point to power a trial, the need to be consistent in its use when analysing and interpreting the data, and that caution is needed in performing and interpreting post-hoc analyses.
Abstract WP403: A New Risk Index for Predicting Outcomes Among Patients Undergoing Carotid Endarterectomy in Large Administrative Datasets.
Authors: Chaudhry Saqib A , Hussain Syed I , Afzal Mohammmad R , Hassan Ameer E , Adil Malik M , Qureshi Adnan I
Published: March 2022

Background:
Administrative datasetsare used frequently without risk adjustment to determine regional and national level characteristics pertaining to performance of carotid endarterectomy (CEA). We developed and validated a new index to provide risk adjustment and to predict patient mortality or other outcomes in the hospital in patients undergoing CEA.

Methods:
The primary end point was occurrence of stroke, cardiac complications, or death during the post procedural period of CEA derived from the Nationwide Inpatient Sample (NIS) which is representative of all admissions in the United States. Multivariate logistic regression was performed to identify the effect of clinical and demographic factors associated with the composite (stroke, death, or cardiac event) end point. Data from 2005-2006 (study period 1) was used to derive the risk index score (weights used to define risk adjustment were identified from the logistic regression model) while data from 2007-2009 (study period 2) was used for validation of the risk index.

Results:
A total 120,633 patients with mean age in yrs [±SD] of 71.1 [±9.5] and 42.4% females underwent CEA during the study period. The composite endpoint during study period 1 was 3.02%; cardiac event 1.77%, stroke 0.99% and in-hopital mortality 0.47%. Predictors of the composite endpoint were (odds ratio [OR], P value) as follows: age≥70 years (1.15, 0.013), atrial fibrillation (3.18, <.0001), CHF (1.81, <.0001), cigarette smoking (1.64, <.0001), symptomatic status (1.87, <.001) and chronic renal failure (1.64, <.0001). The receiver operating curve (ROC) of the risk index was 80% [±SE 5%] when applied to the validation set. Patients with scores 2-3 had higher composite rates of composite endpoint (OR 2.5, 95% confidence interval [CI] 2.3- 2.7), scores 3-4 (OR 4.8, 95% C.I. 4.3- 5.4) and scores of ≥5 (OR 7.4, 95% C.I. 6.4- 8.5) as compared to scores ≤1.

Conclusion:
A new risk index is developed to assist in risk adjustment in the logistic regression model and is meant to be used with large administrative data sets to provide appropriate adjustment for comparative studies.
Abstract WP404: The Supplementary Motor Scale Of The Nihss: A Valid And Efficient Tool For Multidisciplinary Recovery Trials
Authors: Leira Enrique , Coffey Christopher , Jorge Ricardo , Morton Susanne , Froehler Michael , Davis Patricia , Adams Jr. Harold
Published: March 2022

Background and Purpose:
There is a growing interest in therapies that may augment motor recovery that could be initiated in the acute stroke unit and maintained through the rehabilitation period. Homogenization of the currently fragmented stroke clinicometrics is necessary before such multidisciplinary trials can be conducted. The supplementary motor scale of the NIH stroke scale (SMS-NIHSS) is a simple and reliable scale for assessing proximal and distal motor function in the upper and lower extremities. We hypothesized that the SMS-NIHSS is a valid tool for assessing motor recovery with prognosticative value.

Methods:
We performed an analysis of SMS-NIHSS scores recorded in 1281 patients enrolled in trial of ORG 10172 in Acute Stroke Treatment (TOAST).

Results:
The mean SMS-NIHSS scores were 8.18 at baseline, and 4.68 at 3 months. The SMS-NIHSS baseline score was an independent predictor of favorable outcome at 3 months (OR=0.86; 95% CI 0.84-0.87; p<0.0001) after adjusting for confounders. The degree of improvement in the SMS-NIHSS scores from baseline to three months (ΔSMS-NIHSS) was also independently associated with a favorable outcome (p<0.0001). At three months, SMS-NIHSS scores showed a strong correlation with Barthel Index (r=-0.70, p<0.0001) and Glasgow Outcome Score (r=+0.73, p<0.0001).

Conclusion:
The SMS-NIHSS is a valid scale for assessing recovery with prognosticative value, and may be sensitive to changes during recovery. Given that the SMS-NIHSS is an extension of the widely accepted NIHSS, it could be easily implemented in trials conducted in a variety of clinical research settings including acute stroke hospitals and rehabilitation units.
Abstract WP410: Comparison of Transcranial Doppler Ultrasound with Intracardiac Echocardiography in the Detection of Cardiac Right-to-Left shunt in Children and Young Adults
Authors: Barreto Andrew D , Doan David T , Fulep Eva , Bui Thanh-Tung , Burkholder Henry L , Butler Ian J , Numan Mohammed T
Published: March 2022

Background and Objectives:
Right to left shunts (RLS) found with patent foramen ovale are implicated in the pathophysiology of cryptogenic stroke, migraine headaches as well as decompression illness. Our dysautonomia clinic has described a syndrome of neurocardiogenic syncope, stroke, migraine headaches and positive tilt table testing associated with atrial septal defects (ASD). All patients underwent transcranial Doppler ultrasound (TCD) and intracardiac echocardiogram (ICE) testing.

Methods:
We performed a restrospective analysis of a prospectively obtained registry of patients that underwent shunt testing ± endovascular ASD closure. All patients had previously undergone a transthoracic echocardiogram bubble study (TTE) to confirm a RLS. Patients underwent general anesthesia and bilateral TCD monitoring of the middle cerebral artery. Valsalva was produced by the anesthesiologist (40mm Hg). Simultaneous assessment of RLS was performed using ICE and TCD monitoring after injection of agitated saline into the femoral vein sheath. If negative, a direct right atrial injection was performed. The size of ASD was measured by ICE independent of TCD results.

Results:
Between 9/2010 and 7/2012, 112 patients underwent testing. Patient characteristics are displayed in the table. RLS was found in 82.1, 81.1, and 71.4% by TTE, ICE and TCD, respectively. After peripheral injection (n=85), when compared to ICE, TCD had a sensitivity, specificity, PPV, NPV and accuracy of 96, 100, 100, 64 and 95%, respectively. Combined peripheral and intracardiac injections (N=112) when compared to ICE, TCD had a sensitivity, specificity, PPV, NPV and accuracy of 89, 100, 100, 66 and 90%, respectively.

Conclusion:
Transcranial Doppler ultrasound detection of right to left shunts remains a highly accurate, non-invasive tool. If closure of cardiac shunts is proven to prevent stroke, migraines or treat neurocardiogenic syncope, TCD might be considered the preferred screening method.
Abstract WP412: Anticoagulant Therapy in Head Injury-associated Cerebral Sinovenous Thrombosis in Children
Authors: Xavier Frederico , Komvilaisak Patcharee , Williams Suzan , deVeber Gabrielle , Moharir Mahendranath D
Published: March 2022

Background
- Head injury is a rare risk factor associated with cerebral sinovenous thrombosis (CSVT). Literature concerning head injury-associated CSVT (HIA-CSVT) is scarce. There is emerging data to support the safety and efficacy of anti-coagulant therapy (ACT) in childhood CSVT. However, intracranial hemorrhage (ICH), which is seen frequently in children with HIA-CSVT at diagnosis, makes initiation of ACT controversial due to the fear of extension of pre-existing ICH.

boldMethods
- We conducted a retrospective review of a consecutive cohort of children with HIA-CSVT from 1998-2009.

Results
- Seventeen patients (11 males, mean age 7-years) with HIA-CSVT were identified. Most [16/17 (94%)] had significant ICH at diagnosis. None received ACT at diagnosis. 12/17 (71%) were later treated with ACT due to CSVT persistence (8) and propagation (4) despite ICH in 11. None of the 12 treated patients, including the 11 with pre-existing ICH, had significant worsening of hemorrhage on ACT. Three (25%) of the 12 treated patients had minor extension of their hemorrhage; further ACT was withheld in these patients due to physician preference. No patient died on ACT. No patient experienced CSVT propagation on ACT. Neurological outcome was normal in 3/17 (18%), mildly abnormal in 9/17 (53%) and moderate-severely abnormal in 5/17 (29%). Due to small sample size, influence of ACT on clinical and recanalization outcome could not be measured.

Conclusions
- Anticoagulant therapy is safe in selected children with HIA-CSVT. Head injury is not an absolute contraindication to ACT in children with HIA-CSVT.
Abstract WP413: High Purity Eicosapentaenoic Acid In Addition To A Strong Statin Makes Regression Of Intima-media Thickness In Patients With Asymptomatic Cerebral Infarction.
Authors: Wakita Yoshinori , Wakida Yasushi , Itou Takahumi , Mizuno Rika
Published: March 2022

Background:
JELIS indicated the efficacy of eicosapentaenoic acid (EPA) in addition to statin for coronary events and cerebrovascular events in terms of secondary prevention. However, there are few studies on the efficacy of additional EPA to a strong statin in a manner of randomized controlled study.

Objective:
To evaluate the efficacy of additional EPA to strong statin for carotid plaque using carotid echography and pulse wave velocity (PWV).

Methods:
Forty patients (mean age 70 y.o.) with asymptomatic cerebral infarction and coronary artery disease who were administrated 2mg/day of pitavastatin were randomly assigned to EPA-group (n=20) and non-EPA-group (n=20). The patients in EPA-group were additionally administered 1800mg/day of EPA for more than 6 months. In all patients carotid echography was performed before EPA administration and average 8 months later. At the same timing, PWV was recorded.

Results:
There were no significant changes in lipids profile, PWV and Ankle-Brachial index after randomization between 2 groups. There was significant reduction of intima-media thickness (IMT)in EPA-group compared with non-EPA-group (follow-up IMT - baseline IMT : 015±0.38 vs 0.85±1.2mm,respectively; p<0.05), and there was significant improvement of pulsatility index of carotid echography.(0.94±0.39 vs 1.49 ±0.35; p<0.05). EPA/Arachidonic acid (AA) ratio was increased in EPA-group (0.4±0.3 to 1.2±0.5; p<0.01). The change of IMT during follow-up was significantly associated with the change of EPA/AA ratio (r=0.4, p<0.05).

Conclusion:
EPA reduced IMT even under the strong statin administration in patients with asymptomatic cerebral infarction.
Abstract WP416: Risk Factors for Symmetrical Distribution of Carotid Atherosclerotic High-risk Plaque Determined by Black-blood, High Resolution Magnetic Resonance Imaging
Authors: Mi Donghua , Zhao Xihai , Sui Binbin , Wang Yilong , Wang Yongjun , Yuan Chun , Zhao Xingquan
Published: March 2022

INTRODUCTION:
Control of risk factors that are associated with carotid high-risk plaques will play important role in plaque stabilization and prevention of ischemic events. However, the relationship between traditional risk factors and carotid high-risk plaques is unclear. This study sought to determine the risk factors that are associated with carotid high-risk plaques.

Methods:
Eighty-one patients (mean age 61 years, 60 males) with recent ischemic stroke and carotid plaque on ultrasound underwent MR imaging using multicontrast sequences (T1W, T2W, 3D TOF, and MP-RAGE). The clinical risk factors, such as age, gender, hypertension, diabetes, current smoking, blood pressure, pulse pressure (PP), BMI, and cholesterol levels were collected. The presence/absence and the maximum percentage of carotid lipid-rich necrotic core (LRNC) and intaplaque hemorrhage (IPH) to wall area for each artery were determined. Lesions with either IPH or large LRNC (% LRNC ≥20%) were defined as high-risk. The patients were divided into three groups according to the symmetrical distribution of carotid LRNC or IPH at none, unilateral, and bilateral carotid arteries. The risk factors in three different groups were compared.

Results:
Of 81 patients, 71.6%, 18.5%, and 9.9% had none, unilateral, and bilateral IPH at carotid arteries, respectively. We also found that 54.3%, 27.2%, and 18.5% of patients had none, unilateral, and bilateral large carotid LRNC, respectively. There was significant difference in BMI and PP among three groups of patients with none, unilateral, and bilateral carotid IPH or large LRNC (all P<0.05) (Fig. 1A-B).

Conclusions:
BMI and pulse pressure are associated with symmetrical disrtibution of carotid high-risk plaque indicating that control of these risk factors might be helpful for plaque stabilization.
Abstract WP421: A Peer-led Intervention Improves Stroke Survivors’ Blood Pressure Control
Authors: Horowitz Carol R , Fei Kezhen , Tuhrim Stanley , Negron Rennie , Kronish Ian
Published: March 2022

Background:
Hypertension is a major risk factor for stroke recurrence but it is poorly controlled among stroke survivors, particularly from minority groups. The Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) trial tests whether a community-based, peer-led stroke education intervention improves stroke risk factors, primarily blood pressure control.

Methods:
Using community-based participatory research, clinicians, educators and stroke survivors developed a six-session peer-led workshop to help stroke survivors understand their illness, and identify and manage their recurrent risks, particularly hypertension. We recruited 600 individuals with a history of stroke or TIA within the past 5 years who were randomized to the intervention or a wait-list control group. At baseline, 6 and 12 months, we measured participants’ blood pressures, socio-demographics, beliefs and behaviors. Six-month data collection has been completed.

Results:
Participants have a mean of 63 years, the majority are female (60%), Black or Latino (81%) and live in poverty (56%). At baseline, 31% in both groups had uncontrolled blood pressure (<140/90 mmHg). At six months, the intervention group demonstrated better blood pressure control when compared to the control group, 76% vs. 65% (p=0.01). The intervention group also had a significant blood pressure reduction of 3.6/2.0mmHg (p=0.005/p=0.04) compared to the control group (+0.5/-0.5mmHg).

Conclusions:
A peer-led educational program developed through a community-academic partnership was successful in improving blood pressure control at 6 months. While 12-month data will confirm the longevity of this impact, PRAISE is simple, culturally appropriate and inexpensive, and may represent an important and sustainable secondary stroke prevention strategy.
Abstract WP423: Final Results of Cilostazol-Aspirin Therapy Against Recurrent Stroke with Intracranial Artery Stenosis (CATHARSIS)
Authors: Uchiyama Shinichiro , Sakai Nobuyuki , Toi Sono , Ezura Masayuki , Okada Yasushi , Takagi Makoto , Nagai Yoji , Miyakoda Keiko , Minematsu Kazuo , Suzuki Norihiro , Tanahashi Norio , Taki Waro , Nagata Izumi , Matsumoto Masayasu ,   CATHARSIS Study Group
Published: March 2022

Background:
The Cilostazol-Aspirin Against Recurrent Stroke with Intracranial Artery Stenosis (CATHARSIS) (Clinicaltrials.gov identifier: NCT 00333164) was a randomized controlled trial to compare cilostazol plus aspirin with aspirin alone in patients with symptomatic intracranial artery stenosis (IAS). We presented final results of CATHARSIS.

Methods:
Subjects were patients at age of 45-85 years with ischemic stroke after two weeks to six months from onset and >50% stenosis in responsible intracranial arteries on MRA. They were randomly allocated either group of cilostazol 200 mg/day plus aspirin 100 mg/day (CA group) or aspirin 100 mg/day alone (A group), who were followed up for two years. Primary endpoint was progression of IAS after two years. Secondary endopoints included ischemic stroke, all strokes, all vascular events (ischemic stroke, MI, and other vascular events) and new silent brain infarcts.

Results:
A total of 165 patients (109 males, average 68 years) were randomized. Male (77.1% vs 53.8%), hypertension (83.1% vs 68.8%), and diabetes (48.2% vs 25.0%) were more frequent in CA than A group. There was no difference in the progression of IAS between both groups (9.6% [95 CI 3.9-18.8%] in CA group and 7.6% [95% CI 3.8-13.2%] in A group, p = 0.5326). Stroke recurrence occurred in 2.4%/year in CA group (ischemic 4, hemorrhagic 0) and 5.5%/year in A group (ischemic 6, hemorrhagic 2). Rate of stroke recurrence tended to be lower in CA than C group (adjusted HR 0.439, 95% CI 0.112-1.497, p = 0.191). Rate of vascular events also tended to be lower in CA than A group (adjusted HR 0.390, 95% CI 0.118-1.136, p = 0.085). New silent brain infarcts were observed in 4.8% in CA group and 10.0% in A group at two years (p = 0.2445).

Conclusion:
Rates of IAS progression and recurrent stroke were unexpectedly low in both treatment groups, which could be due to excellent medical management and have reduced statistical power. There was no difference in the progression of IAS between two groups. Rates of stroke recurrence, vascular events, and new silent brain infarcts tended to be lower in CA than A group.
Abstract WP433: Haemostatic and Neuroprotective Effects of Xe-loaded Echogenic Liposomes in a Subarachnoid Hemorrhagic Stroke Model
Authors: Miao Yi-Feng , Peng Tao , Geng Yong-Jian , Britton George L , Moody Melanie R , Kim Hyunggun , McPherson David D , Huang Shao-Ling
Published: March 2022

Background:
We have developed Xe-containing echogenic liposomes (Xe-ELIP). Using this delivery agent, we have demonstrated neuroprotective effects in an ischemic stroke model. Given the common mediators of cellular injury in ischemic and early-stage hemorrhagic stroke, the goal of this study was to evaluate the neuroprotective effects of Xe-ELIP on early brain injury after subarachnoid hemorrhage (SAH).

Methods:
Xe-ELIP was prepared by a pressurization-freeze method. The neuroprotective effects of Xe-ELIP on cultured brain astrocytes and microglia were evaluated by a lactate dehydrogenase (LDH) assay. For in vivo evaluation, rats (n=35) were randomly divided into sham, SAH, SAH with Xe-ELIP, ELIP treatment, and Xe saturated saline treatment groups. SAH was induced by an endovascular puncture method. Treatments were administrated intravenously in combination with ultrasound application over the common carotid artery to trigger Xe release from circulating Xe-ELIP at 30 minutes after SAH. Mortality assessments, neurological evaluations, and behavioral tests were conducted for three days following surgery. Brain tissue was harvested for SAH grading, H&E staining, TUNEL staining, and brain water content measurement on the third day after surgery.

Results:
Treatment with Xe-ELIP protected brain astroacytes and microglia against H
2
O
2
(10 mM) induced cytotoxicity. SAH grading revealed effective reduction of bleeding in association with decreased mortality. Moreover, Xe-ELIP significantly reduced apoptotic neuronal death and improved both general neurological and motor function.

Conclusions:
Xe-ELIP alleviates early SAH brain injury by inhibiting neuronal death and bleeding. This novel delivery approach, using Xe-ELIP with ultrasound-controlled cerebral drug release, provides a relatively noninvasive strategy for therapeutic gas delivery in SAH.