bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T P286: Comparison of Neuro-QOL Physical Function and modified Rankin Scale in Stroke
Authors: Sangha Rajbeer S , Corado Carlos , Bergman Deborah , Curran Yvonne , Bernstein Richard , Cella David , Naidech Andrew , Prabhakaran Shyam
Published: July 2021

Introduction:
The modified Rankin scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL provide validated measures of patient-reported outcomes. We compared changes in physical function QOL scores with transitions in mRS scores after ischemic stroke or transient ischemic attack (TIA).

Methods:
From a single-center prospective cohort study, we identified ischemic stroke and TIA patients admitted between August 2012 and April 2013 who survived to 3-month follow-up and underwent mRS and Neuro-QOL outcomes assessments at 1 and 3 months. The mRS was assessed by structured telephone interviews and Neuro-QOL scores using short forms of upper extremity (UE) and lower extremity (LE) function. We used Pearson's coefficient to compare mRS and Neuro-QOL scores and assessed mean changes in Neuro-QOL T-scores across mRS strata and between 1 and 3 months.

Results:
Three-hundred twelve patients met study criteria (mean age 65.2 years; initial NIHSS score 4; 77.2% ischemic stroke). Strong correlations were noted between mRS and physical function QOL scores at 3-months: mRS-LE: r = -0.74; mRS-UE: r = -0.74. UE and LE QOL scores were 6.1 and 7.1 points lower, respectively, in those with mRS of 1 compared with 0. Within individual patients, a 1 point decrease (improvement) in mRS was associated with increase in UE and LE QOL by 5.6 and 3.3 points while a 1 point increase (worsening) in mRS was associated with a decrease in UE and LE QOL by 4.0 and 7.5 points, respectively. By mRS, 7.5% of patients had worsening by at least 1 point between 1 and 3 months while the proportion with at least 1 standard deviation (10 points) decrease in UE or LE QOL scores was 12.1% and 14.4%, respectively.

Conclusions:
The mRS correlates well with patient-reported scores of physical function using Neuro-QOL. However, Neuro-QOL offers a complementary tool for assessment of neurological function and may help identify finer grades of functional change over time. Using a continuous measurement of function from the patient perspective may also be more valuable to patients and improve statistical power in clinical trials.
Abstract T P290: Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores
Authors: Kenmuir Cynthia , Hammer Maxim , Jovin Tudor , Reddy Vivek , Wechsler Lawrence , Jadhav Ashutosh
Published: July 2021

Objective:
Although NIHSS is a known predictor of outcome in acute ischemic stroke, there are other factors like age, ambulatory status and ability to swallow that may be predictors of outcome, but are not assessed by the traditional NIHSS. The aim of this retrospective review was to identify predictors of outcome in mild ischemic stroke.

METHODS:
Discharge outcomes from patients who presented to our large academic stroke center with acute ischemic stroke from 2005-2013 were retrospectively reviewed. Of 7189 patients reviewed, 2597 had initial NIHSS <5. At the time of abstract submission data was available for 971 patients. Outcome measures were modified rankin score (MRS) and discharge to home.

RESULTS:
In this retrospective review, 64% of patients with NIHSS 0-4 were discharged directly home independent of treatment. The mean age of patients discharged to home was 62 and of those not being discharged to home was 70. Of those patients discharged to home, 99% were able to ambulate independently and 98% passed their dysphagia screen. Of patients unable to be discharged directly to home, 6% were not ambulating independently and 17% did not pass their dysphagia screen. Univariate analysis of variance revealed a significant effect of dysphagia screen (p < 0.001), ability to ambulate independently (p < 0.001), and age (p < 0.001) on both discharge to home and MRS 0-1. Multivariate analysis of variance revealed no significant interaction between ability to ambulate, dysphagia and age on discharge to home or MRS 0-1 (p > 0.05).

CONCLUSIONS:
In patients with mild stroke scale scores defined as NIHSS 0-4, several factors including age, ambulatory status, and ability to swallow may be independent predictors of functional outcome. These data support the development of a modified grading system for assessing functional outcome in mild stroke that considers these factors.
Abstract T P302: Analysis of Publicly Available CMS Data on Hospital Charges and Reimbursements for Stroke Care
Authors: Unia Roople , Kelly Adam , Holloway Robert
Published: July 2021

Background/ Purpose:
The Centers for Medicare & Medicaid Services recently made 2011 hospital charge (i.e., list price) and total payment data (CMS reimbursement data and co-payments by patient) publicly available for common Diagnosis-Related Groups, including cerebral infarction/intracranial hemorrhage, at www.cms.gov. We provide descriptive statistics of the data and begin to explore the association of these data with the quality of stroke care hospital’s provide.

Methods:
We report the median, mean and extreme hospital charge and reimbursement data for cerebral infarction or intracranial hemorrhage without complications or comorbidity (CC) or major complications and comorbidities (MCC), with CC and with MCC. We report the correlation between charges and reimbursement as well as charge, reimbursement and hospital stroke volumes using a Spearman correlation coefficient. We also report median charge and reimbursement data by state for pooled stroke DRGs.

Results:
Data were available for 5735 hospitals. The minimum, median, mean, and maximum charge data were as follows: without CC or MCC: $5392, $19976, $23593, $117831; with CC: $5223, $25151, $29492, $162923; with MCC: $9539, $40953, $48522, $234913. The minimum, median, mean, and maximum reimbursement data were as follows: without CC or MCC: $3916, $5326, $5714, $14744; with CC: $5369, $7280, $7922, $26510; with MCC: $8174, $12084, $13263, $50882. There was modest correlation between hospital charges and reimbursement (without CC or MCC ρ= 0.28; with CC ρ= 0.38, with MCC ρ= 0.46.) There was less correlation between discharge volume and charges or reimbursements (ρ =0.15 and 0.12 respectively). By state, pooled median charges ranged from $10,150 (Maryland) to $58,032 (New Jersey). Pooled median reimbursements ranged from $6,306 (Alabama) to $11,529 (Alaska).

Conclusions:
The variability in the amount hospitals charge for stroke admissions is enormous and currently inexplicable. Much more research is needed to understand the reason for this variation and if there is any association to the quality of care provided; otherwise, this information may have unintended consequences for patients and providers.
Abstract T P304: Disordered Attention May Persist After Resolution of Post-Stroke Delirium
Authors: Liotta Eric M , Corado Carlos , Bergman Deborah L , Bernstein Richard A , Caprio Fan Z , Curran Yvonne , Guth James C , Maas Matthew B , Naidech Andrew M , Prabhakaran Shyam
Published: July 2021

Introduction:
Delirium after acute stroke has been associated with worse outcomes but the effect on domain specific health-related quality of life (QOL) is less well-defined. We hypothesized that post-stroke delirium is associated with worse QOL.

Methods:
A prospective cohort of acute ischemic stroke patients was screened for post-stroke delirium. Delirium was diagnosed using the Confusion Assessment Method. Patient variables were prospectively recorded including initial NIHSS score and medical complications. Six QOL domains were assessed at three months post-stroke using Neuro-QOL (a validated patient-reported outcome tool that calculates T scores with means of 50 and standard deviations of 10): upper and lower extremity function, social roles satisfaction, fatigue, executive function (planning, calculating, and learning), and general cognitive concerns ([GCC] perceived attention, memory, and decision difficulties). Functional outcomes at 3 months were also obtained using the modified Rankin Scale (mRS, a validated outcome measure from 0, no symptoms, to 6, death). Univariate associations between delirium and QOL domains were identified and linear regression models were developed for domains with significant associations.

Results:
Over 10 months 246 patients (56% male, mean 65 years) met inclusion criteria. Delirium occurred in 30 (12%) patients. Three month follow up exceeded 90%. Of the Neuro-QOL domains, only GCC was significantly different between those with delirium and those without (T-scores 48.6 vs. 53.4, p=0.03). The mRS outcomes did not differ between those with delirium and those without (median [interquartile range], 1 [0-3] vs 1 [0-2]; p=0.59). Delirium (Beta -3.8, p=0.02) and initial NIHSS (Beta -0.25, p=0.006) were associated with worse GCC after correction for covariates.

Conclusion:
Our finding that post-stroke delirium is independently associated with worse measures of cognition at three months suggests that the disordered attention of delirium may persist long term. Delirium may impair recovery after stroke or may represent a separate mechanism of neurologic injury not well characterized by global outcome scales like the mRS.
Abstract T P316: Are AHA/ASA Stroke Guidelines Evident Enough?
Authors: Pawar Swaroop A , Boan Andrea , Athar M. Kamran , Turan Tanya
Published: July 2021

Background and Purpose:
Professional society statements and practice guidelines are commonly used in clinical decision-making and to establish benchmarks for quality of care. However a small percentage of recommendations are based on high levels of evidence. We sought to determine temporal trends in the strength of guideline recommendations by comparing the current Level of Evidence and Class of Recommendation assigned to recommendations in current vs. previous American Stroke Association (ASA) Flagship Guidelines.

Methods:
We assessed 3 current (2011-2013) ASA practice guidelines for acute stroke, primary prevention and secondary prevention and the prior version (2006-2007) of each guideline. Class (I, IIa, IIb, III) and Level of Evidence (A, B, C) for all recommendations (total of 503) were abstracted. The percentages of recommendations in each of the categories for each guideline were compared between the recent and prior guidelines using a chi-square test.

Results:
Comparisons between the Class and Level of Evidence categories for the 3 current and previous flagship guidelines are shown in the table. For the acute stroke guidelines, the number of Class IIb (mostly level B and C) recommendations increased from 2007 to 2013, with a decrease in III recommendations. There were no significant changes in the Class or Level for the primary prevention guidelines from 2007 to 2011. For the secondary prevention guidelines, there was a trend toward an increase in the number of Class I recommendations from 2006 to 2011 and an increase in the number of level B recommendations.

Conclusion:
Many of the recommendations in the current stroke guidelines are based on Level B and C Evidence. However, there has been some improvement in the Level of Evidence for secondary prevention guidelines compared to prior versions. Continued assessment of areas of low evidence may help focus future research strategies.
Abstract T P324: Sex Differences in Ischemic Outcomes and Inflammatory Responses in Neonatal Stroke
Authors: Mirza Mehwish A , Bentivegna Kathryn , Ritzel Rodney , Hajdarovic Kaitlyn H , McCullough Louise D , Liu Fudong
Published: July 2021

Background and Purpose:
Neonatal arterial ischemic stroke (NAIS) is an important cause of motor and cognitive impairment in children. Clinically, male infants are more vulnerable to ischemic insult and suffer more long-term deficits than female infants though the mechanisms remain elusive. Inflammatory processes are fundamental in the pathophysiology of ischemia as microglial activation initiates the inflammatory response after ischemia. Recent studies report a sexual dimorphism in microglia numbers and expression of activation markers in neonatal brains under normal conditions. How these basal sex differences in microglia affect NAIS remains largely unexplored. This study investigated sex differences in stroke phenotypes and inflammation triggered by NAIS. We hypothesize that ischemia induces sex-specific tissue injury in male and female neonates, which is related to differences in microglial activation and inflammatory responses.

Methods:
Male and female C57BL6 mice were subjected to 60-minute Rice-Vanucci Modeling at post-natal day 10 (P10) to induce NAIS. Stroke outcomes were measured at 24 hours, 72 hours and 7 days after stroke. Microglial activation and inflammatory responses were evaluated by flow cytometry, immunohistochemistry, and multiplex cytokine analysis.

Results:
At 24 hours no difference in infarct volumes (total infarct: male vs. female 46.6±7.2% vs. 43.2±9.3%, n=6/gp) and in Iba-1 staining of the ischemic brain were seen between male and female neonates. However, at 72 hours female neonates exhibited significantly smaller infarct size and improved behavior outcomes compared to males (total infarct: male vs. female 43.1±9.9% vs. 27.1±8.8%, n=6/gp,
p
<.05). Male animals demonstrated increased microglial activation and up-regulated inflammatory response compared to females at 72 hours. This male-specific phenotype was also seen at 7 days after injury. There was no difference in hormone levels at any of the three time points after stroke.

Conclusions:
Acute ischemia leads to an equivalent primary brain injury in male and female P10 mice. However, infarct damage worsens in males at sub-acute time points vs. females, as does the immune response. This sex difference independent of hormone levels exists in NAIS.
Abstract T P34: Residual Contrast Enhancement of Middle Cerebral Artery on Non-contrast Ct (ncct) After Endovascular Treatment in Ischemic Stroke Patients
Authors: Payabvash Seyedmehdi , Qureshi Mushtaq H , Majidi Shahram , Qureshi Adnan I
Published: July 2021

Background:
Residual contrast enhancement of cerebral arteries is frequently visualized on follow up non-contrast CT (NCCT) after endovascular treatment in acute ischemic stroke and may represent distal microvascular no-reflow phenomenon.

Objective:
To evaluated the prevalence of and correlation between post- endovascular treatment residual contrast enhancement of middle cerebral artery (MCA) on follow up NCCT with clinical and imaging outcomes in patients with acute ischemic stroke.

Methods:
We analyzed clinical and radiographic data from all patients with acute MCA occlusion who underwent endovascular treatment at two centers over a 6-year period. The M1 segment of affected MCA was selected with free-hand region of interest on the first post-angiography NCCT; and the average attenuation was determined in Hounsfield units (HU). Bivariate correlation between the MCA contrast enhancement and clinical/imaging outcome was determined.

Results:
A total of 89 patients (mean age ± SD, 66.4 ± 15.5 years) with MCA occlusion were included. The median time interval between the first follow up NCCT and the time of catheterization, and the time of recanalization (if successful) were 1.7 h (interquartile range: 1.2 - 2.4), and 0.8 h (interquartile range: 0.5 - 1.6), respectively. MCA contrast enhancement with an average attenuation of >40 HU was seen in 74 of 89 patients. There was no significant correlation between the average attenuation of the affected MCA on post- endovascular treatment NCCT and post- endovascular treatment “Thrombolysis in Cerebral Infarction” (TICI) score (p=0.43), Qureshi score (p=0.61), discharge National Institutes of Health Stroke Scale (NIHSS) score (p=0.34), or 3-month modified Rankin score (p=0.51). However, the MCA contrast enhancement was inversely correlated with time interval between NCCT and catheterization (p<0.001) and angiographic recanalization (p<0.001).

Conclusion:
In patients with acute ischemic stroke, the residual contrast enhancement of the affected MCA on NCCT post- endovascular treatment does not correlate with status of recanalization or clinical outcome.
Abstract T P348: Successful Resolution of the Cardiac Thrombus Using Novel Oral Anticoagulants
Authors: Okata Takuya , Toyoda Kazunori , Okamoto Akira , Miyata Toshiyuki , Takasugi Junji , Koga Masatoshi , Nagatsuka Kazuyuki , Minematsu Kazuo
Published: July 2021

Objective:
We aimed to determine therapeutic effects of novel oral anticoagulants (NOACs) on cardiac thrombi in acute stroke.

Methods:
We studied consecutive acute ischemic stroke/TIA patients with non-valvular atrial fibrillation who started to take rivaroxaban or dabigatran and was diagnosed as having cardiac thrombi on transesophageal echocardiography (TEE) within 10 days after the admission between July 2012 and July 2013. All continued to take NOACs without additional antithrombotic agents. Plasma concentrations for rivaroxaban were calibrated based on anti-Xa chromogenic assay for rivaroxaban (Stago®) and thrombin clotting time assay for dabigatran (Hemoclot®) just before (trough) and 4h after medication (peak) at steady state.

Results:
Eight patients (7 men, 52-83 years old) were studied. Their BW ranged 41.0-88.8 kg, CHADS2 ranged 2-5, and NIHSS ranged 2-18. NOACs were initiated at median 3 days and TEE was performed at median 3 days after admission. As a NOAC, one patient took 15 mg o. d. of rivaroxaban, 5 took 10 mg o.d. of rivaroxaban (officially approved dose in Japan) and the other 2 took 110 mg b.i.d. of dabigatran. For all the patients, the thrombus was identified in the left atrial appendage with median size of 14.7 mm; two of them were hyperechoic, being judged as already-organized. In follow-up TEE examinations median 19 days after admission , 5 thrombi disappeared (rivaroxaban in 3, dabigatran in 2), 1 diminished in size (rivaroxaban), and the other 2, all being initially hyperechoic, did not change (rivaroxaban for both). For 6 patients with absolute/partial dissolution of the thrombi, median peak/trough concentrations of rivaroxaban were 69 (19-255)/10 (range10-20) ng/ml, and those of dabigatran were 100 (40-160)/40 (20-60) ng/ml, median peak/trough aPTT was 42/34.5 s in rivaroxaban users and 45/37 s in dabigatran users, and median peak/trough PT was 20.2/12.9 s and 15.3/13.3 s, respectively.

Conclusion:
Rivaroxaban and dabigatran have potential to resolve non-organized cardiac thrombi. Monotherapy using NOACs may be enough for early prevention of recurrent stroke in patients with cardioembolic stroke/TIA.
Abstract T P39: Leptomeningeal Collaterals in Patients with Proximal Middle Cerebral Artery Occlusion are Associated with Milder Stroke and Better Functional Outcome after Fibrinolysis
Authors: Trampedach Charlotte R , Ovesen Christian , Christensen Anders F , Christensen Hanne K
Published: July 2021

Background:
Proximal middle cerebral artery occlusions (M1 occlusion) are often but not always associated with severe stroke and poor outcome. The presence of leptomeningeal collaterals can potentially reduce the acute ischemia and thus reduce stroke severity. Occlusions and collaterals can be assessed using computed tomography angiography (CTA). Collaterals were scored according to the amount of collateral supply filling the occluded middle cerebral artery territory. We assessed the hypothesis that leptomeningeal collaterals covariates with National Institutes of Health Stroke Scale (NIHSS) at time of admission and with three month outcome after acute ischaemic stroke.

Method:
Fifty-eight patients - subsequently diagnosed with a M1 occlusion on CTA - were admitted within 4.5 hours after symptom onset between May 2009 and December 2011. All patients were scored according to NIHSS at time of admittance by a stroke-neurologist. Occlusions and leptomeningeal collaterals were evaluated on the nonenhanced CT and CTA. All patients received fibrinolysis. Outcome was assessed by modified Rankin Scale (mRS) at 3 months.

Results:
Fifty-eight patients with a M1 occlusion were included into the analysis (57% female, 43% male, mean age 70 years, range 42-93 years). There was no correlation between age and collateral score. Median NIHSS at time of admittance was 15 (range 3-25), which correlated to the collateral score (r= -0.422, p=0.001). Median mRS at 3 months was 3 (range 0-6) and a correlation with the collateral score was present (r=-0.361, p=0.007).

Conclusion:
Leptomeningeal collaterals on CT angiography in patients with a proximal middle cerebral artery occlusion relate to lower NIHSS on admission as well as less handicap three months after fibrinolysis treatment.
Abstract T P52: Technique for Measurement of Traumatic Aneurysms of the Cervical Internal Carotid Artery and Assessment of Reproducibility
Authors: Griessenauer Christoph , Foreman Paul , Shoja Mohammadali , Kicielinski Kimberly , Deveikis John , Harrigan Mark
Published: July 2021

Background:
Traumatic aneurysms occur in 10-20% of blunt traumatic extracranial carotid artery injuries. There is currently no standardized method for characterization of traumatic aneurysms. This study presents a systematic method for aneurysm characterization on both digital subtraction angiography (DSA) and CT angiography (CTA).

Methods:
Four raters, including one vascular neurosurgeon, one neuroradiologist, and two senior neurosurgical residents independently reviewed 15 CTAs and 13 DSAs obtained at the time of diagnosis of the traumatic aneurysm. Raters were asked to categorize the aneurysms as either ‘saccular’ or ‘fusiform’ and obtain measurements. Saccular aneurysm size was defined as the greatest linear distance between the expected location of the normal artery wall and the outer edge of the aneurysm lumen (‘depth’). Fusiform aneurysm size was defined as the depth and longitudinal extent (‘length’) parallel to the normal artery. The size of the aneurysm (‘aneurysm plus parent artery’) in relationship to the normal artery (‘parent artery’) was assessed as well. Assessments of five scans of each imaging modality were repeated for measurement of intra-rater reliability. Fleiss's free-marginal multi-rater kappa (κ), Cohen’s kappa (κ), and interclass correlation coefficient (ICC) were applied to determine inter- and intra-rater reliability.

Results:
Inter-rater agreement on aneurysm shape, ‘saccular’ versus ‘fusiform’, was almost perfect for CTA (κ = 0.82) and DSA (κ = 0.897). Agreement on aneurysm ‘depth’, ‘length’, ‘aneurysm plus parent artery’, and ‘parent artery’ for CTA and DSA were excellent (ICC > 0.75). Intra-rater agreement on aneurysm shape was substantial to almost perfect (κ > 0.6) in all four raters.

Conclusions:
This study demonstrates a clinically oriented, standardized method to characterize traumatic aneurysms with remarkable inter- and intra-rater reliability. This approach may help to define this disease entity more clearly and better understand the natural history. While certain characteristics of traumatic aneurysms may be associated with low risk and treatment with antithrombotic therapy may be sufficient, other characteristics may carry increased risk warranting endovascular repair.
Abstract T P74: Metabolomic Analysis Reveals Novel Small Molecule Plasma Markers of Hyperacute Ischemic Stroke
Authors: Deng Wenjun , Beecher Chris , Burant Charles , De Jong Felice , Lopez Mary , Wickham Thomas , Elia Mikaela , Feeney Kathleen , McMullin David , Buonanno Ferdinando S , Lo Eng H , Ning MingMing
Published: July 2021

Background:
As we conduct proteomic screening for blood biomarkers of acute ischemic injury, we find many accompanying small molecules and peptides to be better markers for hyperacute ischemic injury. Since these small metabolites can cross the blood-brain barrier more easily than larger proteins, brain-derived markers may potentially be better detected in blood as small molecules. Here we used a targeted approach to identify small molecule biomarkers in acute ischemic stroke patients.

Methods:
Target small molecule (537) profiles of acute ischemic stroke (<6hr post stroke onset) and control blood were analysed by LC-MS followed by multivariate analysis.

Results:
Principal component analysis (PCA) shows stroke and controls can be very well distinguished by their composite metabolic profiles (Figure 1A). One-way ANOVA identified metabolites differentially expressed in plasma between stroke vs controls. Stroke patients had significantly reduced relative concentration (expressed as peak area) of citrate (control-c: 7.39 ± 0.08; stroke-s: 7.17 ± 0.12; p=0.0057), and elevated glutamate (Glu) (c: 4.28 ± 0.27; s: 5.12 ± 0.33; p=0.006), and plasma lactate (PLA) (c: 5.40 ± 0.19; s: 5.69 ± 0.10, p=0.0029) (Figure 1B-D). Other novel mediators were also identified (not shown due to space).

Conclusions:
Utilizing targeted metabolomic analysis, we found increased Glu and PLA and decreased citrate levels in acute ischemic stroke patients within 6 hours of stroke onset. Glu, an excitatory neurotransmitter, and PLA, a known apoptotic marker, are both found in CSF and in the peri-infarct ischemic zone. Citrate is not only important in energy metabolism (TCA cycle), but also binds calcium to prevent clot formation. Building on previous studies, this proof-of-concept analysis helps to understand the early metabolic landscape of hyperacute ischemic stroke in peripheral plasma. Further studies of sources, time profiles, and metabolomic-proteomic interactions are needed.
Abstract T P79: Molecular Disorganization of Axons Adjacent to Subcortical Stroke in Hereditary Endotheliopathy With Retinopathy, Nephropathy, and Stroke; an Imaging to Molecular Neuropathology Correlation
Authors: Hinman Jason D , Lee Monica D , Tung Spencer , Jen Joanna C , Vinters Harry V , Carmichael S. Thomas
Published: July 2021

White matter stroke secondary to microvascular injury is common yet the molecular changes that accompany ischemic damage to white matter are poorly understood. MRI imaging studies suggest that abnormalities exist within the white matter adjacent to lacunar infarcts and this may lead to infarct progression through a functional disruption of adjacent axons. Hereditary subcortical stroke syndromes provide a unique opportunity to study the molecular mechanisms of cerebral microvascular disease and its effect on white matter. Here, we examined two autopsy cases of hereditary endotheliopathy with retinopathy, nephropathy and stroke (HERNS) syndrome with severe microvascular ischemic disease in the cerebral white matter to determine the molecular organization of myelin and axons within the cerebral white matter adjacent to lacunar infarcts in these patients. MRI imaging was used to identify regions of prior lacunar infarction or FLAIR hyperintensity. Serial paraffin-embedded sections within these regions were immunolabeled for markers of nodes of Ranvier and paranodes as well as neurofilaments and myelin basic protein and compared to normal-appearing white matter and non-diseased controls. Compared to controls, HERNS cases demonstrate lengthening of paranodes and disrupted nodal staining patterns consistent with a loss of normal axon-oligodendrocyte molecular interactions. These abnormalities of axonal microdomains are present beyond the region of infarction suggested by MRI and H&E sections and occur in areas of FLAIR hyperintensity without frank lacunar infarction. These results indicate there is a peri-infarct in white matter stroke marked by molecular disruption of axons surrounding the infarct that may serve as a new therapeutic target for this currently untreatable form of ischemic stroke.
Abstract T P86: Lipid Profiling Reveals Galatosylceramide Increasing in Plasma of Atherosclerotic Stroke
Authors: Huang Yining
Published: July 2021

The development and innovation of new technique in metabonomics research and its application in medicine provides important resolution in screening biomarkers and targets for further investigation. The metabonomics research has unique advantages of facility, objection and reliability compared with other -omics studies.

Lipidomics research was development based on metabonomics and has supreme merits in study of lipids related disease.

Method:
The carotid arthrosclerosis patients with stroke suffered before were recruited in this research. The items of lipid related laboratory examinations of these patients are normal because of well controlling under drug-taken. The peripheral blood of these patients was drawn and the plasma was isolated after centrifugation. The lipids from plasma were extracted by the standard Folch method. Then the lipids samples were injected for lipid profile analysis by 2D QoF LC/MS. The qualitative differentiations of these lipids were based on their m/z value, characteristic of the compounds fragmentation, direct and relative retention time of each lipid class. On the establishment of the lipids identification, we validated this newly 2D QoF LC/MS method following these measurements including its calibration equations, low of the detection and relative standard deviation.

Result:
Compared with native subjects, 518 different types of lipids molecular from 17 classes were identified from plasma of atherosclerosis patients by the method of 2D QoF LC/MS; The galactosylceramide and glucoceramide were identified separately although they were same of molecular weight; We proved that the levels of galactosylceramide, rather than glucoceramide were increasing in atherosclerotic stroke patients.

Conclusion:
the increasing levels of galactosylceramide in plasma of atherosclerosis patients hint that the immune effects induced by lipids play an important role in atherosclerosis.
Abstract T P99: Elevated Fasting Glucose as a Potential Predictor for Asymptomatic Cerebral Stenosis: A Cross-Sectional Study in Chinese Adults
Authors: Wang Jing , Wu Jianwei , Wang Chunxue , Wu Shouling , Zhao Xingquan
Published: July 2021

Purpose:
Cerebral Stenosis is known as an important cause of stroke, and elevated fasting glucose level is traditionally supposed as a risk factor for stroke; however, it is doubtful whether elevated fasting glucose is associated with cerebral stenosis, especially with asymptomatic cerebral stenosis .

Methods:
5,309 participants with age of 40 years or older, free of stroke, transient ischemic attack, and coronary disease, were enrolled in this study from 2010 to 2011. Information of potential risk factors for cardiovascular disease were collected and cerebral stenosis was assessed by Doppler ultrasound. Participants were classified into four subtypes: non-cerebral steosis (NCS), intracranial artery stenosis (ICAS), extracranial carotid stenosis (ECCS) and combined intracranial and extracranial carotid stenosis (IECS). Fasting blood glucose (FBG) was also stratified into normal fasting glucose (FBG<5.60mmol/L), impaired fasting glucose (IFG) (FBG: 5.60-6.99mmol/L) and diabetes (FBG>6.99mmol/L) groups. The IFG group was further divided into IFG1 and IFG2 at cutpoint of 6.10mmol/L. A multivariate logistic regression was used to examine the association between FBG and cerebral stenosis.

Results:
FBG levels were significantly higher in ICAS and IECS groups than the other two groups. In multiple regression analysis, IFG2 level was the risk factor for ICAS (OR 1.50, 95%CI 1.10-2.06), and diabetes level was a powerful predictor for ICAS (OR 1.82, 95%CI 1.43-2.31) and IECS (OR 2.22, 95%CI 1.36-3.62). However, the paper finds fasting glucose level was not a risk factors for ECCS.

Conclusions:
The results suggest that elevated fasting glucose level is associated with asymptomatic cerebral stenosis, especially with ICAS and IECS, which suggesting the importance of fasting glucose control in the prevention of asymptomatic cerebral stenosis.
Abstract W MP104: Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals
Authors: Sanossian Nerses , Kim-Tenser May A , Liebeskind David S , Breen Justina , Hamilton Scott , Conwit Robin , Stratton Samuel , Eckstein Marc , Pratt Franklin D , Starkman Sidney , Saver Jeffrey L ,   FAST-MAG Investigators and Coordinators
Published: July 2021

Background:
Primary Stroke Centers (PSC) provide better acute stroke care than non-PSC hospitals, including faster times to imaging and lytic treatment, and higher rates of lytic delivery. Nationwide less than 1 in 3 hospital has achieved this designation. We aimed to determine the extent to which the better performance at PSC is driven by improvements within hospitals after PSC designation versus better baseline hospital care among facilities seeking PSC certification.

Methods:
From 2005 to 2012, the NIH Field Administration of Stroke Therapy -Magnesium (FAST-MAG) Phase 3 clinical trial enrolled subjects with likely stroke within 2 hours of onset in a study of prehospital start of a neuroprotective agent. Subjects were routed to 59 community and academic centers in Los Angeles and Orange Counties. Of the original 59 centers, 39 eventually achieved PSC status during the study period. Each subject was classified as enrolled at a PSC before certification (pre-PSC), at a PSC post certification (post-PSC), or at a hospital that never achieved PSC (non-PSC).

Results:
Of 1700 cases, 529 (31%) were enrolled at pre-PSC, 856 (50%) at post-PSC, and 315 (19%) at non-PSC hospitals. Mean time in minutes from ED arrival to first scan was 33 minutes at post-PSC, 47 minutes at pre-PSC and 49 at non-PSCs [p<0.001 by Mann-Whitney]. Among cases of cerebral ischemia (CI) [N=1223], rates of TPA utilization were 43% at post-PSC, 27% at pre-PSC and 28% at non-PSC hospitals [p<0.001 by X2]. Time in minutes from ED arrival to thrombolysis in treated cases was 71 at post-PSC, 98 at pre-PSC, and 95 at non-PSC hospitals [p<0.001 by Mann-Whitney]. Hospitals that achieved PSC showed improvements in pre-PSC and post-PSC performance on door to imaging time, from 47 to 33 minutes [p=0.014]; percent TPA use in CI, from 27% to 43% [p<0.001], and reduced door-to-needle times, from 98 to 71 minutes [p=0.003]. There was no difference in time to imaging [47 vs. 49 minutes], time to thrombolysis [98 vs. 95 minutes] and percent TPA use [27% vs. 28%] between pre-PSC hospitals and non-PSC hospitals.

Conclusions:
Better performance of Primary Stroke Centers on acute care quality metrics is primarily driven by a beneficial impact of the PSC-certification process, and not better performance prior to seeking PSC status.
Abstract W MP120: Hemorrhage Rates from Brain Arteriovenous Malformations in HHT Patients
Authors: Kim Helen , Nelson Jeffrey , Krings Timo , ter Brugge Karel , Young William L , Faughnan Marie E ,   HHT Brain Vascular Malformation Consortium (BVMC)
Published: July 2021

Introduction:
Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disease caused by mutations in transforming growth factor-beta signaling genes (ENG, ALK1, or SMAD4), and is characterized by mucocutaneous telangiectasia and arteriovenous malformations (AVM) primarily in brain, lung and liver. In contrast to sporadic brain AVM, HHT brain AVMs are often multiple though small series to date have suggested that they may have a lower risk of intracranial hemorrhage (ICH). We sought to describe ICH rates and characteristics in HHT patients with brain arteriovenous malformations (HHT-BAVM).

Methods:
We collected data from the first 134 HHT-BAVM patients with follow-up enrolled in the BVMC HHT Project, including age, sex, race, HHT gene mutation, and ICH at diagnosis. We performed Kaplan-Meier survival analysis to estimate ICH rates after diagnosis censoring at date of first treatment, death or last follow-up, out to 15 years.

Results:
The majority of patients were female (57%) and Caucasian (93%). HHT gene mutation status was known in 57%, of which 74% had ENG mutations, 23% ALK1, and 3% SMAD4. The mean age at BAVM diagnosis was 30±19 years (range: 0-70), with over half of cases diagnosed based on asymptomatic screening (54%). Among symptomatic cases, 32% presented initially with ICH. During 482 person-years of follow-up, there were 5 ICH events corresponding to a rate of 1.04% per year (95% CI: 0.43 - 2.49%). ICH-free survival differed significantly by ICH presentation (P=0.003); ruptured cases had a higher rate (5.23%, 95% CI: 1.31 - 20.89%) than unruptured cases (0.51%, 95% CI: 0.13 - 2.04%). ICH-free survival did not differ by gender (P=0.285).

Conclusions:
HHT-BAVM patients who present with hemorrhage are at a higher risk for rehemorrhage compared to BAVMs detected presymptomatically in HHT patients. Correlation with unruptured sporadic BAVM cases will however need a larger sample and number of events in the HHT BAVM cohort. Ongoing recruitment of HHT-BAVM patients into the BVMC study will increase precision of ICH estimates and ability to examine additional risk factors such as angiographic features that may differ from sporadic BAVM.
Abstract W MP15: A Novel Magnetic Resonance Imaging Approach for Collateral Flow Imaging in Ischemic Stroke
Authors: Kim Suk Jae , Son Jeong Pyo , Ryoo Sookyung , Yoon Chang Hyo , Cha Jihoon , Kim Gyeong-Moon , Chung Chin-Sang , Lee Kwang Ho , Bang Oh Young
Published: July 2021

Background:
Assessing the status of collateral circulation is important in acute ischemic stroke. However, digital subtraction angiography(DSA) which is considered as the gold standard for evaluation of collaterals is invasive and has a risk of thrombotic complications. Dedicated MRI sequences for evaluation of collateral flow can be generated using perfusion-weighted imaging(PWI) source data. We compared a novel collateral flow imaging technique with DSA for determining collateral circulation in the setting of acute stroke.

Methods:
Consecutive patients who were eligible for recanalization therapy underwent MRI and DSA for acute MCA infarction at a university medical center. A collateral flow map derived from PWI source data was generated by manual or semi-automatic post-processing. Collateral grading based on collateral flow map was performed and compared with DSA (Figure).

Results:
Of 68 patients, 42(61.8%) had M1 occlusion and 26(38.2%) had ICA occlusion. The time interval between MRI scanning and the start of DSA was 50.8±28.6 minutes. Both the collateral flow map and DSA showed good inter-observer agreement of collateral grade(weighted κ-coefficients=0.817 for collateral flow map and 0.757 for DSA). There was good correlation between MRI- and DSA-based collateral grades: 68% had the same grade in the same patient(weighted κ-coefficient=0.653). In most patients who had mismatches between the two modalities, the collateral grade was higher in MRI-based vs. DSA-based assessment.

Conclusion:
MRI techniques for assessment of collaterals are rapidly being developed, which may provide insight on collateral perfusion in patients who are not otherwise candidates for conventional angiography and may potentially replace it in the future.

Figure
. Typical examples of collateral flow map- (left panel) and digital subtraction angiography (right panel)-based collateral grade.

All DSAs show proximal MCA occlusions (white arrows).
Abstract W MP17: Basilar Plaque on High Resolution Mri Predicts Early Neurologic Deterioration After Pontine Infarction
Authors: Kim Hyun Young , Kim Young Seo , Lee Kyu-Yong , Koh Seong-Ho , Heo Sung Hyuk , Chang Dae-Il , Lee Yeong-Bae
Published: July 2021

Background:
The association between early neurologic deterioration (END) in pontine infarction and basilar stenosis remains unclear. Recently, it has been reported that evaluation of the basilar artery using high-resolution MRI (HRMRI) could provide more accurate information about intracranial artery stenosis than MR angiography (MRA). We aimed this study to identify the relationship between basilar plaque assessed by HRMRI and END after pontine infarction.

Methods:
Ninety consecutive patients with unilateral pontine infarction within 24 hours of stroke onset were included. All patients underwent diffusion weighted MRI, MRA and HRMRI within 24 hours after admission. Basilar stenosis was assessed with MRA and HRMRI. Basilar plaque on HRMRI was classified as 1) "no plaque" when the wall of the basilar artery was clear; 2) "minimal plaque" when the basilar wall was irregular without clear crescentic thickening; and 3) "apparent plaque" when a typical lesion with a crescentic thickening of the wall could be seen. END was defined as increased NIHSS score by ≥2 during admission. Factors potentially associated with END were validated by multivariate analyses.

Results:
Sixty-six patients (73%) had paramedian pontine infarction (PPI) and 24 patients (27%) had deep pontine infarction (DPI). END was observed in 29 (32%) patients and they all had PPI. Patients with END had more frequent apparent plaque in basilar artery than without it (79% versus 33%, p=0.001). However, basilar stenosis (>30%) assessed by MRA did not show any differences regardless of the presence of END (24% versus 17%, p=0.380). In univariate analysis with the patients with PPI, END was associated with hypertension (p=0.029) and apparent plaque (p=0.002). After adjusting covariates, END was independently associated with hypertension (OR, 6.672; 95% CI, 1.376-32.367) and apparent plaque (OR, 7.260; 95% CI 1.285-41.030).

Conclusion:
Our result suggest that basilar stenosis assessed by HRMRI was associated with END in patients with acute pontine infarction. However, the result was not significant when assessed by MRA. We suggest that since basilar stenosis are underestimated with MRA, HRMRI may be more useful in evaluating basilar artery stenosis and predicting END in pontine infarction.
Abstract W MP22: Hyperdense MCA Sign as a Recanalization and Outcomes Predictor of IA Thrombectomy
Authors: Horev Anat , Romero David G , Jankowitz Brian T , Aghaebrahim Amin , Kenmuir Cynthia L , Jadhav Ashutosh , Jovin Tudor G
Published: July 2021

Background:
The hyperdense MCA sign (HMCAS) is related to poor clinical outcomes and low recanalization rates after IV TPA. We explored the association between presence of HMCAS and clinical /procedural outcomes in patients with M1 MCA occlusion treated at our institution with endovascular therapy within the last five years.

Methods:
We retrospectively collected from our mechanical thrombectomy database a total of 193 patients with M1 occlusion, of which 107 patients were found to have HMCAS (55%). Eligible patients were treated with IV TPA prior to the intra-arterial thrombectomy. A blinded stroke neurologist evaluated baseline head CT done for possible HMCAS and measured the MCA Hounsfield Units (HU). Procedure times and other clinical and radiographic parameters were calculated.

Results:
A positive correlation between presence of HMCAS and procedure duration (mean time with HMCAS 112.3 min versus 89.89 min in the non HMCAS group P<0.05) was found. Intraprocedural perforation was 8% (n=9) in the HMCAS group versus 1% (n=1) in the non HMCAS group (P<0.05).Hounsfield Unit analysis (ratio of ipsilateral side/contralateral side), showed a linear correlation (p<0.05) between this ratio and procedure duration (Graph 1).

Conclusions:
HMCAS is associated with slower recanalization, higher rate of complications and lack of differences in clinical outcomes possibly explained by low power after endovascular therapy. This association may reflect differences in thrombus composition or thrombus burden which should be taken into account when choosing recanalization strategies.Further studies focused on clot analysis and better understanding of clot's structure, may serve a future role in selecting special treatment options for acute stroke patients.
Abstract W MP29: CSF MicroRNA-181b is Associated With Poor 6-Month Outcome Following Subarachnoid Hemorrhage
Authors: Chou Sherry H , Icli Basak , Cahill Meghan , Du Rose , Suh Sarah , Henderson Galen V , Sorond Farzaneh A , Feske Steven K , Lo Eng H , Ning MingMing , Feinberg Mark W
Published: July 2021

Background:
Early brain injury and vasospasm (VSP) in subarachnoid hemorrhage (SAH) are associated with inflammation and release of TNFα, which correlates with poor SAH clinical outcome. TNFα regulates the expression of microRNA (miR) 181b, which mediates NF-κB signaling and is known to exacerbate ischemic stroke in animal models. MiRs have higher stability in biological fluids than peptides and may be candidate clinical biomarkers. We hypothesize that miR-181b is present in SAH CSF and may be associated with SAH outcome.

Methods:
We prospectively enrolled consecutive SAH subjects, banked serial CSF samples, and evaluated their modified Rankin scores (mRS) via telephone follow-up every 3 months. Poor functional outcome was defined as mRS>2. Angiographic VSP was defined as >50% reduction in caliber of any vessel on post-SAH day 7 cerebral angiogram. In 54 SAH subjects, we compared CSF miR-181b and 26a (as control) by quantitative PCR on post-SAH day 3 with respect to VSP and outcome using Student’s t-test after log-transformation of data with non-normal distribution. Associations were measured using Pearson’s or Spearman’s correlation depending on data distribution.

Results:
Twenty-seven subjects (50%) developed VSP and 21 (39%) had poor 6-month outcome. MiRs-181b and 26a were consistently measurable in SAH CSF, and miR levels were not associated with Hunt and Hess or Fisher grades. Elevation of CSF miR-181b was associated with poor 6-month outcome in SAH (p=0.04). CSF miR-181b inversely correlated with blood TNFα (r=0.74, p=0.0001). CSF miR-181b was not associated with VSP. CSF miR-26a was not associated with VSP or with clinical outcome in SAH.

Conclusion:
MiR-181b is present in human CSF after SAH and early elevation of CSF miR-181b is associated with poor 6-month outcome but not with VSP after SAH. Lack of association between control miR-26a and outcome suggests that association between miR-181b and SAH outcome is not due to a non-specific miR surge in more severe cases. Inverse correlation between blood TNFα and CSF miR-181b suggests TNFα may mediate miR-181b release into CSF. Future mechanistic studies on the role of miR-181b in SAH-related brain injury and validation studies in larger cohorts are necessary to understand the role of miR-181b as a SAH biomarker.