bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP183: Race/ethnic Differences in Social Network Characteristics Among Stroke Survivors
Authors: Goldmann Emily , Parikh Nina S , Southwick Lauren , Boden-Albala Bernadette
Published: July 2021

Family and friends have become increasingly responsible for providing informal care for stroke survivors. Studies have noted race/ethnic variation in caregiving of older adults and those with dementia or cancer, but few have described social networks of stroke survivors and examined network characteristics by race/ethnicity. As part of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial, stroke/TIA patients were asked to identify up to 5 persons (“alters”) with whom they discuss important matters and provide information about each relationship. Network characteristics included median number of alters; having an alter in the same household, someone who talks with the participant every day, or with whom they discuss health concerns; relationship “closeness”; and having a family-only (vs. family and friend) network. Household composition was also recorded. Network characteristics were described overall and by race/ethnicity using frequencies and Wilcoxon rank-sum and Chi-square tests. Of the 500 study participants, most identified at least one alter (86%), 61% had an alter in their household, 88% talked to an alter every day, 82% were extremely/very close with all alters identified, 96% discuss health concerns with an alter, and 74% had a family-only network. Less than 27% lived alone, 21% with a spouse only, 15% with a non-spouse, and 38% with >1 person. NHBs and Hispanics were more likely than NHWs to identify no alters (19% and 16% vs. 8%, p=0.006) but talk to an alter every day (90% and 92% vs. 79%, p=0.007). NHWs were more likely to live in the same household as an alter than NHBs and Hispanics (67% vs. 53% and 59%, p=0.006). Hispanics had greater prevalence of having a family-only network than NHWs and NHBs (83% vs. 71% and 68%, p=0.014). NHWs were more likely to live with a spouse, while NHBs and Hispanics were more likely to live with a non-spouse or with >1 person (p<0.001). Given the importance of social networks in the aftermath of stroke, understanding the structure of different types of networks will help inform targeted interventions to promote vascular risk factor management and reduce race/ethnic disparities in stroke outcomes.
Abstract TP196: Nocturnal Desaturation is a Possible Risk Factor for Wake-up Ischemic Strokes
Authors: Kim Tae Jung , Kim Chi Kyung , Kim Yerim , Jeong Han-Gil , Nam Kiwoong , An Sang Joon , Ko Sang-Bae , Yoon Byung-Woo
Published: July 2021

Introduction:
Wake-up stroke (WUS) may represent a specific subgroup and comprise of a quarter of all ischemic strokes. Nocturnal desaturation secondary due to sleep apnea is an independent risk factor for stroke, however, the association between nocturnal desaturation and WUS remains unclear.

Hypothesis:
We assessed the relationship between the overnight oxygen desaturation index (ODI) and WUS in patients with acute stroke in the stroke unit.

Methods:
A consecutive 225 patients with acute ischemic stroke who were admitted to the stroke unit within 7 days after stroke onset between July 2013 and June 2014 were included for analysis. Physiological variables including pulse oximetry were sampled every 1 minute. The ODI was calculated using pulse oximetry data during 9 hours on the first night (10:00 PM-7:00 AM) of the stroke unit admission and nocturnal oxygen desaturation was defined as an ODI of 5 or greater per hour. We compared the clinical characteristics, nocturnal oxygen desaturation, laboratory findings, and radiologic findings in patients with and without WUS.

Results:
Among the total patients, 26.2% (n=59) patients had WUS. These patients were mostly male (52.4%), with a mean age of 66.8 years. The proportion of nocturnal desaturation was significantly greater in WUS compared to non-WUS (23.7% vs. 8.4%, P = 0.002). The age, gender, vascular risk factors, stroke severity, and stroke lesion locations were similar in the two groups (WUS and non-WUS). After controlling for relevant confounding factors, nocturnal oxygen desaturation in the first night of the stroke unit stay was significantly more common in patients with WUS (Odds ratio, 4.39; 95% confidence interval, 1.76-10.93).

Conclusions:
Nocturnal desaturation was more frequently observed in patients with WUS over the first night stay in the stroke unit. This suggests that nocturnal desaturation is a possible and modifiable risk factor for the occurrence of WUS.
Abstract TP252: Using Hospital Door-to-Needle Times to Individualize Hospital Bypass Times in Order to Minimize Regional Onset-to-Needle Times
Authors: Lee Jin-Moo , Ford Andria , Burns Jo-Ann , Panagos Peter
Published: July 2021

Introduction:
With enhanced treatment options but limited resources, acute stroke care is becoming regionalized. Regional pre-hospital triage plans are being developed to permit bypass of certain hospitals in order to deliver patients to hospitals with higher-level resources for advanced treatment options. One of the most contentious issues in these plans is the “bypass time”_time allowed for EMS to bypass one hospital in order to transport to a hospital with presumed higher level stroke care.

Hypothesis:
Incorporating transport times and individual hospital door-to-needle times (DNTs) into regional pre-hospital triage bypass plans will expedite regional treatment times which may lead to improved patient outcomes at the system level.

Methods:
To minimize onset-to-needle times (ONTs), it is essential not only to find the fastest route to the nearest capable hospital, but to find the nearest capable hospital with the shortest DNTs. We examined specific time components comprising ONT, including Onset-to-Arrival times (OATs) and DNTs using Get-with-the-Guidelines data (GWTG), comparing the hospital with fastest DTN times (Hospital A) with that of the average in the St. Louis metropolitan area.

Results:
Hospital A had a mean DNT that was 20 min faster than the average St. Louis DNT (31 min vs. 51 min, p<.0.001), while OATs were not different. This 20 min advantage might be translated into a longer bypass time specifically for hospital A, to provide equivalent or faster ONTs for patients in the region.

Conclusion:
The incorporation of hospital DNTs into regional pre-hospital triage plans can individualize bypass times for each hospital. This practice may accelerate treatment times throughout a region, and could be trialed with the aid of web-based smartphone application that could provide EMS with important information that could minimize both transport times and DNTs.
Abstract TP313: Virtual Stroke Patient Simulation Training for Residents and Medical Students Improves Knowledge, Skill Sets and Confidence in Acute Stroke Care
Authors: Gangadhara Shreyas , Craig David , Burgin William Scott , Gooch Clifton L , Bozeman Andrea , Telford Britany , Brannick Michael , Rose David Z
Published: July 2021

Introduction:
At most teaching hospitals, first- and second-year residents respond to a “Stroke Alert” where “Time is Brain.” Interpreting neurologic signs and symptoms and acute management of stroke is complex. In many medical specialties, simulated instruction improves performance and addresses patient safety needs without harm to, or practice upon, a real-live patient. Thus, we designed a virtual stroke patient simulation training course: to boost knowledge, skill sets, and confidence in managing hyperacute stroke scenarios with this new first-responder audience in mind.

Hypothesis:
We hypothesize that performance outcomes, as measured by Declarative and Procedural (Skill Sets) Knowledge and Confidence will improve over the 1.5-day period of a virtual stroke patient simulated training course.

Methodology:
Incoming Neurology residents and medical students with minimal exposure to stroke care underwent the aforementioned stroke simulation course at the Center for Advance Medical Learning and Simulation (CAMLS) in Tampa, Florida, USA. It included 3 lectures on acute stroke care by USF faculty and 10 simulated scenarios of “Stroke Alerts” using standardized actors and electronic patient simulators. After each scenario, debriefing reviewed participants’ performance in Declarative and Procedural (Skill Set) Knowledge and Confidence. Results were analyzed using Likert scale on data collected prior to, and after, the course.

Results:
A repeated measures ANOVA demonstrated that, compared to pre-testing, post-testing data for Declarative and Procedural (Skill Set) Knowledge (F=14.05, p=.002) and Confidence (F=33.37, p<.001) of Acute Stroke management improved significantly for both residents and medical students alike.

Conclusion:
In conclusion, simulation training for acute stroke management is statistically and significantly effective for neurology residents and medical students. Simulation training addresses patient safety needs without harm to, or practice upon, real-live patients. Neurology residency programs across the country should consider designing similar programs or utilizing ours at CAMLS for optimal stroke care among beginning residents at the front line of stroke patient care.
Abstract TP35: Eptifibatide is Safe and May Improve Outcomes in Stroke Patients Undergoing Thrombectomy After Receiving IVtPA
Authors: Mehta Siddhart , Moussavi Mohammad , Korya Daniel , Brar Jaskiran , Chahal Harina , Kondapalli Swathi , Samaan Mena , Shaikh Azka , Kalola Rushil , Song Yong-Bum , Kirmani Jawad
Published: July 2021

Introduction:
Recent trials have shown significant improvement in outcome for patients suffering from acute ischemic stroke (AIS) when mechanical thrombectomy is added to the standard of care of IV tPA. In addition to the acute anti-platelet properties eptifibatide may also reduce acute inflammatory response following neurovascular intervention. Our goal was to evaluate the potential benefit of adding IV eptifibatide to mechanical thrombectomy and IV tPA.

Methods:
Patients who presented to a community based university affiliated comprehensive stroke center from 2012-2015 with AIS over a 2 year period were included in the study. Only patients who received thrombectomy after IV tPA were included. A subgroup of those patients also received IV eptifibatide as a continuous drip during and after the procedure. Details of bolus dosing and duration of treatment were documented. The initial NIH Stroke Score (NIHSS) and 24-hour NIHSS were compared between the two groups with paired samples t-test using SPSS Version 22.

Results:
A total of 866 patients were evaluated, and 139 met the study criteria. All patients received mechanical thrombectomy after IV tPA, but 70 also received a bolus dose of 135 mcg/kg of eptifibatide followed by 0.5 mcg/kg/min continuous drip. The mean duration of the drip was 23.8 minutes (SD 14.13). There were no significant differences in complication or hemorrhage rates between groups. The mean initial minus 24-hour NIHSS (Initial-24) for the patients receiving only IV tPA/thrombectomy was 1.6. Patients who also received eptifibatide had a mean Initial-24 of 3.6. The paired mean difference was 2 (95% CI .19-3.8; p=.03), favoring the addition of eptifibatide.

Conclusion:
The addition of eptifibatide bolus followed by a continuous drip for a mean of 24-hours to IV tPA/thrombectomy was associated with a significantly better 24-hour post-procedure outcome. The mechanism of action may be related to the suppression of inflammation and potential prevention of rethrombosis after treatment. No additional complications were noted with eptifibatide and patients tolerated it well. A larger prospective trial is warranted to corroborate our findings.
Abstract TP37: Cervical Vascular Findings and Clinical Correlates in Takayasu Arteritis
Authors: Chancellor Bree , Shaikh Gibran , Davis Adam , Rosenthal Pam , Ishida Koto
Published: July 2021

Though luminal changes in Takayasu arteritis (TA) are well seen with conventional angiography, mural changes can be best seen with CTA. Cervical vasculature is affected in over 75% of patients. Cervical vessel findings on CTA and clinical correlates have not been fully described.

Methods:
Thirteen patients with TA were identified by ICD-9 diagnosis code at two urban hospitals. Diagnosis was confirmed based on American College of Rheumatology criteria for TA.

Results:
Of 4 male, 9 female (mean age, 37; 5 Latin Am.; 3 Asian; 3 African; 2 North Am.) patients, 10 (77%) had dedicated cervical imaging (CTA/MRA). Ten had neurologic symptoms; visual (46%); weakness/numbness (31%); syncope/dizziness (23%). Nine (69%) had active disease at time of imaging. Twelve (92%) had cervical vessel lesions; 11 (85%) with wall thickening; 11 with vessel stenosis. On average 3 vessels were affected, most commonly L subclavian (69%), L common carotid (54%). Of the 6 patients (46%) with occlusions, all had collateral flow; in 4, wall enhancement, intimal vessel hyperplasia was seen. Three patients imaged before aorto-carotid bypass grafting had an average of 7 diseased cervical vessels. All had strokes soon after bypass, two ischemic with hemorrhagic conversion, a third with IPH/IVH. Two patients had cerebrovascular symptom exacerbation during menses; one was successfully treated with hysterectomy. Findings on cervical imaging directly changed surgical or medical management in 9 (77%) cases.

Conclusion:
Cervical vessel involvement is pervasive in TA. Wall thickening, a common finding in early and active TA, is not part of current diagnostic criteria and may warrant inclusion. Given the prevalence of cervical vessel disease and its clinical implications, cervical vascular imaging should be considered in all TA patients, particularly those with neurologic symptoms. Combining chest/cervical CTA into a single protocol may be beneficial.
Abstract TP382: Improving Door To Needle Time Using A Lean Transformation Rapid Improvement Process
Authors: MacDonald Gregg , Mienel Patricia , Grennes Cheryl , Beller Lesta , Liebscher Julia , Isaacs Larry , Heller Adam , Muller Holly
Published: July 2021

Problem statement and background:
Early initiation of thrombolysis is the key factor to improving quality of life in ischemic stroke patients. The facility has an internal goal of 100 percent. DTN < 60 minutes was not being met. The purpose of this project was to streamline the DTN time using the Lean Rapid Improvement Process (RI).

Methods:
In January 2013, a Lean Transformation RI team was created and involved a collaboration of key frontline stakeholders. The team observed the current procedure, created an event map that detailed each step, and non-value added steps. The current process was analyzed to identify barriers to flow, and excessive lead times. The inter-disciplinary team clearly defined all stakeholder roles and streamlined process was created.

Results:
The average DTN time in 2012 was 76 minutes with 40 percent less than 60 minutes (n=71). After the RI event, average minutes decreased from 68 minutes (n=39) in 2013 to 48 minutes (n=60) in 2014 and 39 minutes (n=49) through June 2015. Overall, the percentage increased from 54 percent in 2013, to 84 percent in 2014 and 94 percent in 2015. The greatest change in performance improvement was seen after the initiation of the RI process in 2015. This resulted in an average improvement of 36 minutes and 54% from 2012 to 2015. The fastest DTN time was 19 minutes.

Conclusion:
The inter-disciplinary team collaborated to streamline the DTN process resulting in a significant reduction in time to tPA administration. The new process rapidly expedited the stroke alert procedure by facilitating timely movement, assessment and treatment of stroke victims. The streamlined procedure will be continued with the goal of ensuring that our performance continues to exceed the Target Stroke Phase II initiative of DTN < 45 minutes. The outcome of this improvement is optimizing the quality of life, patient satisfaction and enhanced team engagement.
Abstract TP416: Does Hands-on tPA Education Really Improve Nurses' Knowledge Retention?
Authors: Montgomery Kelly , Louttit Megan , Fussner Julie
Published: July 2021

University Hospitals Comprehensive Stroke and Cerebrovascular Center (UHCSCC) Registered Nurses (RNs) in the Neurological Intermediate Unit (NIU) often care for patients after Intravenous (IV) tissue plasminogen activator (tPA) has been initiated. IV tPA is a high-alert medication that has potential bleeding risks. Due to the limited opportunity for initiating IV tPA, we identified the need for enhanced education among this group of RNs. Currently, NIU RNs complete an annual competency via an online learning management system (LMS). Our goal is to identify the best teaching method to heighten the ability for the RNs to retain and apply information. This project is to evaluate if an individualized hands-on educational approach improves the RN’s knowledge of IV tPA administration. In 2015, 36 NIU RNs were given a 20 question pretest that assessed their baseline knowledge on dosing, administration, monitoring, and complications of IV tPA. Each RN then completed the annual LMS competency. Eighteen RNs from this group were randomly selected to participate in an additional 30 minute one-on-one instructional session that included both verbal information and hands-on practice. Approximately 2 weeks later, all 36 RNs completed a 20 question post test to assess knowledge retention. All of the 36 NIU RNs had some education on IV tPA prior to this study. The years of experience working as an RN varied from 6 months to 20 years. Group 1 consisting of 18 RNs that solely received LMS education averaged 50.8% on the pretest and averaged 83.3% on the post test. Group 2 consisting of 18 RNs that had the additional hands-on educational session averaged a 42.2% on the pretest and averaged 95.8% on the post test. The data was analyzed using paired
t
-tests, and the difference in scores were significant for both groups (P=0.000). Additionally, a 2-sample
t
-test found significant difference (P=0.004) in the score changes from pre to post when comparing hands-on instruction to the LMS training. Both methods of education were associated with significant increased scores on the post test. Our data suggests that the hands-on approach along with our current practice improves knowledge retention. Further research would be useful to assess retention several months post education.
Abstract TP454: Hemostatic Biomarkers Succeed While Inflammatory Biomarkers Fail To Differentiate Vascular Dementia From Alzheimer’S Disease
Authors: Vishnu Venugopalan Y , Modi Manish , Garg Vivek K , Mohanty Manju , Goyal Manoj K , Khurana Dheeraj , Mittal Bhagwant R , Lal Vivek , Prabhakar Sudesh
Published: July 2021

Introduction:
A reliable plasma biomarker in differentiating between Alzheimer’s disease (AD) and Vascular dementia (VaD) is the need of the hour, in most memory clinics.

Hypothesis:
We assessed the hypothesis that plasma inflammatory [Interleukin 6 (IL 6) and C-Reactive Protein (CRP)] and hemostatic (Fibrinogen and D dimer) biomarkers can aid in differentiating between AD and VaD.

Methods:
Neuropsychological assessment, MRI brain, FDG-PET brain and CSF biomarkers of AD (Aβ42 and total tau) were used for establishing the diagnosis of Mild Cognitive Impairment (MCI), AD or VaD. ELISA analyses for IL6, Fibrinogen, D dimer and CRP were performed according to the manufacturers’ protocols.

Results:
During the study period (January 2013-April 2014), 68 diagnosed patients of AD/MCI/VaD were included. FDG PET brain, plasma fibrinogen, D dimer, IL6 and CRP were done in all 68 patients while 48 patients underwent CSF biomarker analysis. Sixteen patients had MCI, of which 11 were MCI-AD and 5 were MCI-VaSC. There were 41 patients with AD (Mild AD- 9, Mod AD -23, Severe AD- 9) and 11 patients with VaD. The Alzheimer group (MCI-AD and AD) and Vascular group (MCI VaSC & VaD) consisted of 52 and 16 patients respectively. Table 1 depicts biomarker levels. Alzheimer and Vascular groups did not exhibit significant difference in IL6 and CRP levels. Plasma fibrinogen levels were significantly higher in VaD and vascular group as compared to Alzheimer group. But MCI-VaSC was not significantly different from MCI-AD. Plasma D dimer levels were significantly higher in all vascular subgroups compared to Alzheimer subgroups except between MCI-VaSC and MCI-AD.

Conclusion:
In conclusion, hemostatic biomarkers (Plasma Fibrinogen and D dimer) succeed, whereas inflammatory biomarkers (IL6 and CRP) fail in differentiating VaD from AD.
Abstract TP462: Cognitive Profile of Non-demented Cerebral Amlyoid Angiopathy Patients
Authors: Xiong Li , Davidsdottir Sigurros , Duangnapa Roongpiboonsopit , Thanprasertsuk Sekh , Fotiadis Panagiotis , Charidimou Andreas , M Ayres Alison , Reijmer Yael , Shoamanesh Ashkan , Martinez-Ramirez Sergi , Edip Gurol Mahmut , Blacker Deborah , Greenberg Steven , Viswanathan Anand
Published: July 2021

Objective:
To characterize the neuropsychological profile of sporadic cerebral amyloid angiopathy (CAA) patients without dementia and to determine the association between cognitive performance in different domains and neuroimaging lesions characteristic of CAA.

Methods:
Forty-eight CAA patients were compared to 138 cognitively normal subjects (CN) using a standard neuropsychological test battery designed to assess the cognitive profile in CAA patients without dementia. Total brain volume (TBV), white matter hyperintensities (WMH), number of cerebral microbleeds (CMBs), hippocampal volume (HV) and the presence of cerebral superficial siderosis (cSS) of all CAA patients were measured. The association between these neuroimaging markers and neuropsychological performance in different cognitive domains in the CAA group were analyzed.

Results:
Patients with CAA had significantly worse performance on all individual neuropsychological domain tested when compared to the CN group. The cognitive decline of CAA patients was most noticeable in tests for processing speed (Z score -1.84±1.50), then followed by executive function (Z score -1.03±1.04), semantic fluency (Z score -0.71±1.07), episodic memory (Z score -0.68±1.08), and attention (Z score -0.48±1.00). Total brain volume of the CAA patients was correlated with processing speed (β=0.358, P=0.034) and executive function (β=0.507, P=0.002).

Conclusion:
Non-demented patients with CAA had cognitive deficits in multiple areas. Lower total brain volume was related to slower processing speed and worse executive function.
Abstract TP81: Faster Start of IV tPA Does not Decrease the Need for Endovascular Thrombectomy in Acute Ischemic Stroke
Authors: Chhabra Arun , Shkirkova Kristina , Alfonso Rodel , Buitrago Blanco Manuel , Vespa Paul , Starkman Sidney , Yoo Bryan , Jahan Reza , Szeder Viktor , Kim Doojin , Ali Latisha , Rao Neal , Hinman Jason , Liebeskind David , Saver Jeffrey
Published: July 2021

Background:
Recent patient series have shown IV tPA to more often lyse cerebral thrombi when started sooner after symptom onset in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). This association has been attributed to less fibrin-cross-linking and less compaction of thrombi. We sought to determine if this phenomenon would make endovascular thrombectomy less often needed among AIS-LVO patients treated hyperacutely with IV tPA.

Methods:
In a prospectively maintained registry, we identified patients receiving IV tPA at 2 academic medical centers from March 2005 - May 2015. Inclusion criteria were: 1) LVO seen on CTA or MRA before (or early during) infusion of IV tPA and 2) follow-up vessel imaging within 6h of IV tPA initiation, using CT, MR or catheter angiogram. Degree of thrombus lysis with IV tPA alone was rated using the arterial occlusive lesion (AOL) Scale.

Results:
Among the 166 patients, average age was 72.4 (±13.4), 52.4% were female and pretreatment NIHSS was 13.9 (±8.4). Onset to needle time (OTN) was median 105 min (IQR 79-129) and door to needle time 44 min (27-65). Initial vessel imaging modality was MRA in 68.7% and CTA in 31.3%. Early post-tPA vessel imaging modality was catheter angiogram in 63.8%, MRA in 33.7% and CTA in 2.4%. Time from tPA initiation to recanalization assessment was faster when post-tPA vessel imaging was catheter angiogram vs MRA/CTA, 72 min (45.5-116.5) vs 232 min (185-283), p<0.001. In cases assessed with early post-treatment catheter angiogram, IV tPA yielded complete recanalization in 17%, partial in 6.6%, and none in 76.4%. In cases assessed with MRA/CTA, IV tPA yielded complete recanalization in 30%, partial in 35%, and none in 35%. Recanalization within the 6h window was visualized more often when imaged with later CTA/MRA than with earlier catheter angiogram (p<0.001). Among patients going directly to catheter angiography, OTN for IV tPA was not different between recanalizers and non-recanalizers, 106 vs 98 min, p = 0.53.

Discussion:
Among large vessel acute ischemic stroke patients, the rate of complete recanalization with IV tPA alone is only 1 in 6, and faster OTN time is not associated with increased recanalization. All AIS-LVO patients should proceed to thrombectomy as swiftly as possible.
Abstract TP84: Predictors of Outcomes From Carotid Endarterectomy and Implications of SAPPHIRE Risk Criteria for the 30 day MACCE Endpoint - a Prospective Evaluation
Authors: Macharzina Roland Richard , Müller Carolin , Vogt Matthias , Messé Steven R , Vach Werner , Reinhard Matthias , Winker Thomas , Hetzel Andreas , Neumann Franz-Josef , Siepe Matthias , Beyersdorf Friedhelm , Zeller Thomas
Published: July 2021

Introduction:
Identifying factors associated with short term outcome following carotid endarterectomy (CEA) is important to improve patient selection. There are limited data assessing 30-day major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction (MI) and death) in clinical practice.

Hypothesis:
We hypothesized that patients fulfilling SAPPHIRE high risk (SHR) or exclusion (SEC) criteria contribute to worse outcomes in a real-life cohort.

Methods:
Patients undergoing CEA at 2 centers between 1998 and 2010 were prospectively entered into a database. Baseline characteristics, comorbidities, SHR and SEC were assessed using Cox regression to determine predictors for the MACCE 30-day endpoint.

Results:
The analysis included 748 operations, 262 (35%) asymptomatic , 211 (28%) with previous strokes, and 278 (37%) with transient ischemic attacks (TIA). The overall MACCE rate was 6.7%, 5.0% of asymptomatic and 7.6% in symptomatic patients. SEC patients (n=137) had a MACCE rate of 14.7%; after exclusion, the MACCE rate of the remainder dropped to 4.9% (3.5% in asymptomatic and 5.4% in symptomatic patients). Hazard ratio (HR) for SEC was 3.605 (p=0.0001) after adjustment for symptomatic status. SHR patients did not show a significantly increased event rate (HR 1.714, p=0.16). In multivariate analysis diabetes (HR 2.019, p=0.02), symptomatic status (HR 2.015, p=0.049) and prior MI (HR 1.957, p=0.03) showed an independent influence on MACCE.

Conclusion:
High risk clinical characteristics, as defined by the SAPPHIRE study were not independently associated with 30-day increased risk of MACCE, although exclusion criteria from that study, diabetes, symptomatic status and prior MI were associated with outcomes.
Abstract WMP110: Improvement in Cortical Versus Subcortical Perfusion After Superficial Temporal Artery- Middle Cerebral Artery (MCA) Bypass in Patients With Severe Stenosis of Intracranial Carotid and MCA
Authors: Sharma Vijay K , Bolem Nagarjun , Chow Ning , Wong Lily Y , Teoh Hock-Luen , Chan Bernard P , Yeo Tseng-Tsai , Seet Raymond , Sinha Arvind K
Published: July 2021

Background and Objective:
The role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We have recently reported the improvement in clinical and various cerebral hemodynamic parameters after STA-MCA bypass surgery for severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR). Using acetazolamide challenged hexamethylpropyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT), we evaluated the differential improvement in metabolic perfusion in cortical and subcortical structures after STA-MCA bypass surgery.

Methods:
Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) for CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged SPECT and STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent SPECT at 4±1 months. Using automated image analyzer, we evaluated differences in metabolic perfusion in cortical and subcortical regions.

Results:
Of the 126 patients (80 male, mean age 56yrs; range 23-78yrs) that fulfilled our inclusion criteria, 84 (67%) showed impaired CVR on SPECT. Fifty (60%) of them underwent STA-MCA bypass surgery. HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in all cases. Significantly better improvement (14.5%) in cerebral perfusion was noted in the cortical regions as compared to the subcortical regions (4.5%, p<0.005).

Conclusion:
STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in cerebral perfusion, especially in the cortical regions.
Abstract WMP117: Conservative versus Surgical Treatment for Brainstem Cavernous Malformation.
Authors: Patino Hernan M , Chavarria-Medina Monica , Becerril Mayra , Longo Gabriel M , Nathal Edgar , Arauz Antonio
Published: July 2021

Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main objective of our series was to evaluate the long-term functional outcome and recurrence in patients with BCM treated with conservative or surgical treatments.

Hypothesis:
We assessed the hypothesis that surgical and conservative treatments are associated with different functional outcome and re-hemorrhage rate in long-term follow-up.

Methods:
In this non-randomized, clinical series, we compared the clinical and radiological findings of patients with their first hemorrhage secondary to confirmed BCM, treated in a tertiary neurological center, during a twenty five- year period. Treatment of each patient was selected by the attending physician and consisted of either conservative or surgical evacuation of BCM. The primary end-points were recurrent hemorrhage and functional outcome. Favorable prognosis was defined as modified Rankin scale (mRs) of 0 to 2.

Results:
From January of 1990 to July of 2015; 99 patients with BCM hemorrhage were treated (59 [59,6%] female; mean age 37± 13 years). 37 patients (37,4%) were surgically treated and 62 (62,6%) received conservative treatment. During the follow-up; 20 patients in the medical group (median time of recurrence: 34,5 months; IQR: 13,75-93) and 4 patients in the surgical group (median time of recurrence: 22 months; IQR: 9-46,5) had a recurrence (OR: 0,255; 95% IC: 0,079-0,817), with a cumulative incidence of 5,1 per 100 years-person and 3,96 per 100 years-person respectively. Because of rebleeding, 11 patients of the conservative group were taken to surgery and 3 of the surgical group were to required re-intervention. At the end of follow-up (median: 51 months; IQR: 19-104) 51 patients remained in the conservative group and 28 (54,9%) had a favorable mRs. 48 patients remained in the surgical group and 27 (56,2%) had a favorable mRs (OR:0,94 95% IC: 0,42-2,09).

Conclusion:
Despite a significant high recurrent hemorrhage rate was observed in conservative treated patients, we did not found difference in clinical outcome between both groups of patients with BCM.
Abstract WMP119: 4d Digital Subtraction Angiography (4d-dsa) for Pre-treatment Evaluation of Cerebrovascular Diseases
Authors: Yuki Ichiro , Hataoka Shunsuke , Ishibashi Toshihiro , Dahmani Chihebeddine , Abe Yukiko , Ikemura Ayako , Kambayashi Yukinao , Kan Issei , Kaku Shougo , Nishimura Kengo , Murayama Yuichi
Published: July 2021

Purpose:
4D Digital Subtraction Angiography (4D-DSA) is a new imaging technology that provides both high spatial resolution and temporal resolution in one acquisition. It is a special new reconstruction algorithm that made this technology possible. Patients with various types of cerebrovascular diseases were evaluated with 4D-DSA, and its efficacy and limitations were assessed.

Methods:
The 4D-DSA images of patients with different types of vascular malformations were evaluated. 6 seconds acquisitions were used for the evaluation of arterial phase dynamics and 12 seconds acquisitions for assessing the entire arterial-venous phase. The amount of contrast material and radiation dose used in each acquisition was compared with the conventional rotational 3D-DSA. The unique findings observed in the 4D-DSA in each type of vascular malformation were described, and whether or not the findings are useful for the pre-treatment planning was discussed.

Results:
The 4D-DSA images of a total of 57 patients were evaluated. 33 aneurysm patients, 6 arteriovenous malformation (AVM) patients, 8 dural arteriovenous fistula (AVF) patients, as well as 4 spinal vascular malformation patients, and 6 others were included. The amount of contrast and radiation dose required for the 4D-DSA (6 seconds acquisition) was similar to the conventional 3D-DSA, whereas 12 seconds acquisitions required almost double the dose. Especially for the vascular malformations with arterio-venous shunting, the 4D-DSA helped understand the detailed vascular anatomy by breaking down the complex vascular structures into the different phases of contrast filling. Motion artifact due to the longer acquisition time, and metal artifact from deployed coils were observed.

Conclusions:
The temporal information provided by 4D-DSA helps us understand the complex vascular structures and flow dynamics. 4D-DSA can be an effective assessment tool for the pre-treatment planning of brain vascular malformations.
Abstract WMP42: Astrocyte Specific rAAV-mediated Insulin-Like Growth Factor-1 Expression in Aging Female Rats Increases Post-Stroke Survival and Sensory Motor Performance
Authors: Okoreeh Andre K , Bake Shameena , Sohrabji Farida
Published: July 2021

Background and Purpose:
Our previous work shows that middle aged female rats sustain larger strokes as compared to younger female rats. With age, circulating and brain parenchymal levels of IGF-1 are reduced. Exogenous IGF-1 treatment improves infarct volume in aging females. Our recent studies show that astrocytes from aging females synthesize less IGF-1. Here we tested the hypothesis that elevation of astrocyte derived IGF-1 would improve stroke impairment in older female rats.

Methods:
Middle-aged (10-12 month old; acyclic) female rats were injected with adeno-associated virus serotype 5 (rAAV5) into the cortex and striatum. rAAV5 was packaged with the coding sequence of the IGF-1 gene downstream of an astrocyte-specific gene (GFAP). The construct contained the mCherry reporter gene. Control rAAV consisted of an identical shuttle vector construct without the IGF-1 gene. In separate experiments, two titers of virus were injected: high dose (5 X 10
12
VP/mL) or low dose (5 X 10
11
VP/mL). Three to four weeks after injection, middle-cerebral artery occlusion via an intraluminal suture for ninety minutes was performed followed by reperfusion. Post-surgery survival was monitored as well as sensory motor function using the vibrissae evoked forelimb placement task.

Results:
Specificity of IGF-1 expression was confirmed by visualization of the mCherry reporter under fluorescent illumination and immunohistochemistry. Post stroke survival was improved in animals that received the high dose rAAV-IGF-1 animals a 5-day period (p<0.001). Low dose rAAV-IGF-1 did not affect post stroke survival, however sensory motor performance was preserved in this group. In low dose control animals, ischemic stroke impaired performance on the vibrissae evoked forelimb placement task. Impairment was seen in the same-side and cross-midline task performance on the limb contralateral to the infarct and cross midline task on the limb ipsilateral to the infarcted side (p<0.05). No significant deficits were seen in the rAAV-IGF-1 low dose treated animals.

Conclusion:
These data support the hypothesis that increasing astrocytic IGF-1 in aging females improves post stroke survival and behavior outcomes.
Abstract WMP73: Interictal Epileptiform Discharges and Periodic Patterns After Acute Ischemic Stroke Are Associated With Poor Prognosis
Authors: Lima Fabricio O , Ricardo João A , Coan Ana C , Soriano Diogo C , Avelar Wagner M , Li Li M
Published: July 2021

Introduction:
Seizures after acute ischemic stroke lead to a worse functional outcome. Interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke increase the risk of seizures. However, their prognostic significance has not been assessed.

Hypothesis:
We sought to test whether IED and PP, detected on standard EEG performed during the acute phase of ischemic stroke are associated with a worse functional outcome.

Methods:
One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 hours from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a board certified neurophysiologist blinded to clinical data. IED and PP (grouped as epileptiform activity - EA) were defined according to proposed guidelines. Univariable and multivariable analysis were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤ 2 vs. ≥ 3) at 3 months.

Results:
In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p=0.001), age (OR 1.03, 95% CI 1.01-1.05, p=0.02) and presence of EA (OR 2.94, 95% CI 1.51-5.88, p=0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p<0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p=0.04) were independently associated with the prognosis.

Conclusion:
The importance of EEG in the prognosis of acute ischemic stroke warrants additional research examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.
Abstract WMP8: Results of Trevo Acute Ischemic Stroke Thrombectomy Registry: Predictors of Clinical Outcome
Authors: Zaidat O O , Castonguay A , Haussen D , English J , Farid H , Veznedaroglu E , Binning M , Puri A S , Hou S Y , Janardhan V , Vora N , Budzik R F , Alshekhlee A , Abraham M G , Edgell R , Taqi A , Lin E , Khoury R , Mokin M , Majjhoo A Q , Kabbani M R , Froehler M T , Finch I , Prabhakaran S , Novakovic R , Nguyen T , Mehta S , Quadri S A , Ramakrishnan P , Nogueira R G
Published: July 2021

Background and Purpose:
Recent randomized clinical trial (RCTs) demonstrated efficacy of mechanical thrombectomy using stent-retrievers in acute ischemic stroke (AIS) patients. The main purpose of TRevo ACute Ischemic StroKe (TRACK) stent-retriever thrombectomy multicenter registry is to demonstrate safety and efficacy in real life clinical practice.

Methods:
The investigator-initiated TRACK multicenter registry recruited 24 sites in north America to submit demographic, clinical, site-adjudicated angiographic, and outcome data on consecutive AIS patients treated with Trevo stent-retriever device as the first treatment option. Standard clinical safety (symptomatic intracranial hemorrhage (sICH), and mortality) and efficacy (revascularization and disability) outcomes and predictors of clinical outcome were analyzed.

Results:
624 patients were enrolled in the TRACK registry. Median age was 68 years (range 16-94, 118 (18.1%) >80), male gender was 51.4%, and 67.7% were white. The median National Institutes of Health Stroke Severity Scale (NIHSS) was 17 (IQR 13-22). Transfer cases were 50.6% with IV-rtPA use in 318 cases (51.3%). Median onset to groin puncture (OTG) time was 283 min (IQR 198.5-443), and groin puncture to revascularization was 66 min (IQR 37.5-103). Anterior circulation occlusion was 86.2% (MCA/M2 in 55.2% followed by ICA in 15.9% and M2 in 12.7%). Use of GA was in 389 cases (62.3%), number of passes were ≤ 3 in 92% of the cases (1: 45.2%, 2:28%, and 3:18.7%), 291 (46.7%) had BGC use. Rescue use was seen in 21.7%. Revascularization of ≥ TIMI 2 was 81.8% and ≥ TICI 2b was 70%. The primary outcome of mRS of ≥ 2 was 48.3% in the full cohort, and 50.6% in TREVO-2 like group. sICH and mortality were 7.2%, and 20.1% in the full cohort vs 6.9% and 17.5% in the TREVO-2 like group, respectively. The independent predictors of clinical outcome were lower baseline NIHSS, younger age, use of BGC, successful recanalization, and no general anesthesia (GA).

Conclusions:
The real life clinical practice Trevo registry demonstrated good clinical outcome and high rate of recanalization. Younger age, lower baseline NIHSS, use of balloon guide catheter, successful recanalization, and avoiding endotrachaeal GA independent predictors of good clinical outcome.
Abstract WMP95: Cerebral Amyloid Angiopathy Patients With Convexity Subarachnoid Hemorrhage Present Higher Risk of Subsequent Hemorrhage Than Those With Lobar Intracranial Hemorrhage
Authors: Calviere Lionel , Raposo Nicolas , Cazolla Vanessa , Pastoura Sofia , Albucher Jean François , Ruidavets Jean-Bernard , Olivot Jean-Marc , Chollet François , Larrue Vincent , Cognard Christophe , Bonneville Fabrice , Viguier Alain
Published: July 2021

Background:
Acute convexity subarachnoid hemorrhage (cSAH) is increasingly recognized as a marker of cerebral amyloid angiopathy (CAA). Little is known about the risk of subsequent hemorrhage in such CAA presentation, whereas CAA-related lobar intracranial hemorrhage (ICH) is associated with a high risk of recurrence. The aim of this study was to compare clinical outcome among patients with an acute CAA related- cSAH to those with an acute CAA-related lobar ICH.

Hypothesis:
We hypothesized that the risk of subsequent hemorrhage is different between patients with acute cSAH and lobar ICH related to CAA.

Methods:
We retrospectively reviewed the clinical outcomes (death, subsequent transient focal neurological episodes (TFNE), rates of ICH and acute cSAH) of 45 consecutive patients (75 ± 7 years) with an acute cSAH related to probable CAA compared to 70 consecutive patients (78 ± 7 years) with an acute lobar ICH meeting the Boston criteria for probable CAA.

Results:
cSAH-patients presented essentially with TFNE (84.4% vs 0%; p<0.001) whereas ICH-patients had a persistent neurological deficit (98.6% vs 15.6%; p<0.001). Five patients with lobar ICH died in the first days. Thirty nine cSAH-patients and 60 lobar ICH-patients had available follow-up data. The mean time of follow-up (± SD) was 364 ± 358 days. Mortality did not differ between cSAH-patients and ICH-patients who survived (10.2 % vs 16.7%; p = 0.38). Patients with cSAH had a higher rate of TFNE (48.7 % vs 0 %; p<0.001) and acute cSAH recurrence (20.5 % vs 1.7 %; p = 0.002). In the other hand, 20.5 % of cSAH-patients presented a subsequent ICH, not different from patients with acute ICH (15.0 %; p = 0.45).

Conclusions:
In the context of CAA, patients with acute cSAH present more clinical recurrences than lobar ICH-patients, due to higher risk of subsequent TFNE and acute cSAH. Although the clinical presentation of cSAH-patients may appear benign, their outcome regarding the risk of incident ICH and mortality, does not seem different from CAA-related lobar ICH survivors.
Abstract WP107: Molecular Disorganization of Axons Adjacent to Human Cortical Microinfarcts
Authors: Coban Hamza , Tung Spencer , Vinters Harry V , Hinman Jason D
Published: July 2021

Introduction:
Ischemic brain lesions are pathologic hallmarks commonly associated with cognitive and cerebrovascular diseases. In particular, cortical microinfarcts are described as microscopically identified wedge shaped ischemic lesions such as cavitations with few remaining macrophages and fibrillary gliosis. These microscopic lesions are observed with high resolution magnetic resonance imaging in aging brains and in patients with cerebrovascular disease (CVD). Recent studies have suggested that strategically located microinfarcts strongly correlate with cognitive deficits, which can contribute to Alzheimer’s Disease (AD) as well as other forms of dementia.

Hypothesis:
We have recently shown that there is altered axonal molecular organization in white matter areas adjacent to white matter lacunar and microinfarcts. In this study, we hypothesized that similar changes were present in nodal, paranodal, and axon initial segments adjacent to human cortical microinfarcts.

Methods:
Paraffin-embedded sections of autopsy brain tissue from five patients (post mortem interval range= 4 to 45 h) with cortical microinfarcts reported in their clinical neuropathological examination were immunofluorescently labeled for nodal and paranodal markers including beta-IV spectrin, ankyrin-G, and contactin-associated protein (caspr). High magnification images were generated using confocal microscopy.

Results:
Cases ranged in age from 73 to 93 years old. Comorbid neuropathologic diagnoses included AD (n=3) and mixed dementia (n=2). Adjacent to cortical microinfarcts, we observed significant elongation of paranodal segments and shortened axon initial segments adjacent to cortical microinfarcts. In adjacent cortical regions without microinfarcts, paranodal segments were less frequently abnormal and axon initial segment length appeared normal.

Conclusions:
These data indicate that the molecular organization of axons adjacent to human cortical microinfarcts is abnormal providing support for a microinfarct penumbral injury that worsens the effect of these tiny strokes.