bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 29: Neuroprotective Potential of Nitroglycerin (GTN) in Ischemic Stroke: Insights Into Glucose Metabolism and ER Stress Inhibition Through NO-CGMP-PKG Signaling
Authors: Jiang Shangqian , Geng Xiaokun , Ding Yuchuan
Published: February 2024

Background:
While Nitroglycerin (GTN) is predominantly recognized as a vasodilator for ischemic heart disease, its potential neuroprotective properties in acute ischemic stroke (AIS) remain under exploration. This investigation sought to discover the therapeutic advantages of GTN post-recanalization in AIS and underlying mechanisms.

Methods:
Adult male Sprague Dawley rats were categorized into sham, MCAO with or without GTN treatment, and MCAO treated with both GTN and KT5823, an inhibitor of cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG). AIS was induced by MCAO for 2 hours followed by 6 or 24 hours of reperfusion (tMCAO). A 28-hour MCAO without reperfusion was defined as the permanent MCAO group (pMCAO). The study assessed infarct volumes, neurological impairments, glucose metabolism metrics (lactate and ROS levels), nitric oxide (NO) and cGMP levels (via ELISA). mRNA and protein expressions of hyperglycolysis (GLUT1, GLUT3, PFK, LDH), gluconeogenesis (PCK1, PCK2), ER stress (BIP, PERK, EIF2α, ATF4, CHOP) as well as signaling molecules (PKG, AMPK), were measured with RT-PCR and Western blotting. Apoptotic cell death was evaluated using TUNEL.

Results:
GTN significantly reduced cerebral infarct volumes, neurological deficits, apoptotic cell death, lactate and ROS levels and decreased the expression of NO and cGMP levels and key glucose metabolism and ER stress-related genes and proteins, including GLUT1, GLUT3, PFK1, LDH, PCK1, PCK2, BIP, PERK, EIF2α, ATF4, CHOP and phosphorylated AMPK, while boosting PKG expression only in tMCAO. The coadministration of GTN and KT5823 reversed the observed GTN benefits.

Conclusion:
Our findings illuminate that GTN showcases neuroprotective properties in tMCAO (but not pMCAO) by enhancing glucose metabolism (hyperglycolysis and gluconeogenesis), controlling ER stress, and working through the NO-CGMP-PKG signaling cascade to inhibit AMPK phosphorylation.
Abstract 31: Let Me Be Your Guide: The Impact of Stroke Navigators on Post-Acute Stroke Follow Up
Authors: SINGER ANDREA , Richardson Alicia M , Reichwein Raymond K , Cekovich Erin
Published: February 2024

Introduction:
Stroke patients often require complex post-discharge management in an outpatient setting. At this Comprehensive Stroke Center, stroke patients are to receive a 30-day, 90 day, and 1 year follow up with the stroke clinic. Post-acute follow up appointments are typically established after discharge, leading to scheduling delays for the 30-day appointment, patients lost to follow up, or no showing to appointments. Stroke Navigators are an emerging role that can bridge the gap between acute and post-acute care settings and integral to ensuring stroke patients receive optimal follow up care.

Methods:
In 2022, a Stroke Navigator was added to the care team and collaborated with the Stroke Clinic to project volume of clinic slots needed for ischemic and TIA hospital discharges. The Stroke Navigator implemented follow up scheduling with patient/family prior to discharge and emphasized the importance of the 30-day appointment. Pre and postintervention data was then collected and analyzed from Q2 2022 to Q1 2023 regarding timeliness of scheduling, appointment type, and rate of no shows for all ischemic stroke/TIA patients.

Results:
The pre-intervention scheduling process resulted in an average wait time of 19 days to schedule appointments. Post intervention, no wait time identified as appointments were scheduled prior to discharge. Pre-intervention data on 30-day appointments showed only 23% of patients were scheduled and attended their provider visit, while post-intervention data showed 60% (Table 1). The clinic no show rate went from 19%, down to 10% in the post intervention phase.

Conclusion:
The Stroke Navigator has made a significant impact on the number of patients with 30-day visits, eliminated the wait time for appointments due to scheduling prior to discharge, and decreased the no show rate for patients at 30 days. Further financial analysis will be critical to validate the impact of a Stroke Navigator, as they are critical to closing the gap in post-acute care.
Abstract 37: The Brain Care Score and Neuroimaging Markers in Asymptomatic Individuals in the UK Biobank
Authors: Rivier Cyprien , Singh Sanjula D , Senff Jasper , Marini Sandro , Oreskovic Tin , Carr Sinclair , Papier Keren , Conroy Megan , Chemali Zeina , Gutierrez Leidys , Mallick Akashleena , Parodi Livia , Mayerhofer Ernst , Kourkoulis Christina , Clocchiatti-Tuozzo Santiago , Nunley Courtney , Payabvash Sam , Newhouse Amy , Ouyang An , Lazar Ronald M , Westover Michael B , Pikula Aleksandra , Ibrahim Sarah , Brouwers Bart , Howard Virginia J , Howard George , Yechoor Nirupama , van Duijn Cornelia , Littlejohns Thomas , Tanzi Rudolph , Fricchione Gregory , Sheth Kevin N , Rosand Jonathan , Anderson Christopher D , Falcone Guido J
Published: February 2024

The 21-point Brain Care Score (BCS) is a novel tool designed to motivate individuals and care providers to take action to reduce the risk of stroke and dementia by motivating lifestyle changes (Fig 1). In this study we aimed to assess if the BCS is also associated with brain changes on MRI in people who have not yet developed dementia or stroke.

Methods:
This study was conducted within the MRI substudy of the longitudinal cohort study UK Biobank. The assessed MRI neuroimaging markers included: brain volume, white matter hyperintensities (WMH) volume, fractional anisotropy (FA) and mean diffusivity (MD). FA/MD metrics were calculated as the average across 48 discrete brain regions. We used multivariable linear regression to test for association between the BCS computed using baseline data (2006-2010) and neuroimaging markers, measured both during first (2014+) and repeat (2019+) MRI assessments.

Results:
There were 34,772 study participants with MRIs and available BCS data (mean age 55, 53% female). Every five-point increase in the BCS was associated with an 11% increase in brain volume (Beta 0.11, SE 0.01), a 26% reduction in WMH volume (Beta -0.26, SE 0.01), a 13% increase in average FA (Beta 0.13, SE 0.02), and a 9% decrease in average MD (Beta -0.09, SE 0.01). There were 3,778 study participants with first and repeat MRI (mean age 53, 53% female). Comparing the first and repeat imaging assessments, every five-point increase in baseline BCS was associated with a slower growth in WMH volume (Beta -0.08, SE 0.03) and a slower reduction in average FA (Beta 0.11, SE 0.03).

Discussion:
Among middle-aged adults without dementia or stroke, a higher BCS is strongly associated with better neuroimaging brain health profiles and slower rates of brain health decline. Given that the neuroimaging markers evaluated in our study are recognized risk factors that precede stroke and dementia by many years, our results support the BCS is a promising tool for early intervention to prevent these conditions.
Abstract 47: Estimated Remnant Lipoprotein Particle Cholesterol, Very Low-Density Lipoprotein Cholesterol, and Incident Ischemic Stroke Risk - The Cardiovascular Health Study
Authors: Khan Farrah , Kalani Rizwan , Bartz Traci M , Psaty Bruce M , Tirschwell David L , Elkind Mitchell S , Longstreth W T , Vaisar Tomas
Published: February 2024

Introduction:
Serum remnant lipoprotein particle cholesterol (RLP-C), which includes very-low density lipoproteins (VLDL) and its lipolytic products, contributes to atherosclerotic plaque formation. Novel methods for estimating RLP-C and VLDL-cholesterol (VLDL-C) from a serum fasting lipid profile (FLP) have been proposed (Figure).
1,2,3
We evaluated the relationship of estimated serum RLP-C and VLDL-C with the risk of incident ischemic stroke (IS) in the Cardiovascular Health Study (CHS), a population-based longitudinal cohort of older adults.

Methods:
Eligible CHS participants were free of prevalent stroke and completed an FLP at the 1989-1990 or 1992-1993 baseline study visit. The relationships of a two-fold increase in RLP-C
Varbo
, RLP-C
Sampson
, and VLDL-C estimates with incident total IS were evaluated using Cox proportional hazards regression, adjusting for demographics and IS risk factors, including low-density and high-density lipoprotein cholesterol. Secondary analyses evaluated the relationship with incident cardioembolic IS, non-cardioembolic IS, and large artery atherosclerotic or lacunar IS.

Results:
Of 5,427 eligible participants, mean age was 72.8 (±5.6) years, 57.6% were women, and 15.7% were Black. Over a median follow-up of 12.4 years, 895 participants experienced an incident IS. RLP-C
Varbo
, RLP-C
Sampson
, and VLDL-C were each associated with incident total IS risk, non-cardioembolic IS risk, and large artery atherosclerotic or lacunar IS risk, after adjusting for confounders, but not with cardioembolic IS risk (Table).

Conclusions:
In older adults, RLP-C and VLDL-C are associated with IS risk, especially atherosclerotic IS.
Abstract 5: National Institutes of Health Stroke Scale Reporting in Administrative Claims Data: Incomplete and Biased Reporting in the First Three Years
Authors: Stein Laura K , Ortiz Edwin , Nandwani Jaan , Dhamoon Mandip S
Published: February 2024

Background:
Since 2016, hospitals have been able to document International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for National Institutes of Health Stroke Scale (NIHSS). As of 2023, Center for Medicare & Medicaid Services uses NIHSS as a risk adjustment variable. We assessed associations between patient- and hospital-level variables and contemporary NIHSS reporting using Medicare datasets.

Methods:
Retrospective cross-sectional analysis of acute ischemic stroke (AIS) admissions from October 1, 2016-December 31, 2019 using de-identified, national 100% inpatient Medicare datasets. Index AIS admissions were identified using the ICD-10-CM code of I63.x. Demographic information, medical comorbidities, hospital characteristics, and NIHSS were abstracted. Medicare and Mount Sinai Health System registry data were linked using a matching algorithm. We calculated documentation of NIHSS at the patient and hospital level, predictors of NIHSS documentation, change over time, and concordance with local registry data.

Results:
There were 770104 index AIS admissions. NIHSS was documented in 40.1% of AIS admissions and by 62.5% of hospitals. Hospitals documenting ≥1 NIHSS were more commonly teaching hospitals, in metropolitan areas, stroke certified, higher-volume, and had ICU availability. Adjusted odds of documentation were lower for patients of black race compared to white and with inpatient mortality, increasing Charlson comorbidity score, discharge home, and treatment in non-metropolitan areas. NIHSS was documented for 52.9% of Medicare cases even though it was documented in 93.1% of registry cases, and 74.7% of Medicare NIHSS scores equaled registry admission NIHSS.

Conclusions:
Hospitals face financial implications for risk-standardized mortality rate adjustment, and administrative data play an increasingly important in stroke health services and outcomes research. Yet, missing ICD-10-CM NIHSS data remains widespread three years after introduction of the ICD-10-CM NIHSS code, and there are systematic differences in reporting at the patient and hospital levels.
Abstract 50: Sodium-Glucose Cotransporter 2 Inhibitors Use in Diabetic Patients With Acute Ischemic Stroke is Linked to Favorable Neurological Outcomes
Authors: Yang Wookjin , Kim Jeong-Min , Chung Matthew , Ha Jiyeon , Kang Dong-Wan , Lee Eung-Joon , Jeong Han-Yeong , Jung Keun-Hwa , Paeng Jin Chul , Lee Seung-Hoon
Published: February 2024

Background:
The benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in acute ischemic stroke (AIS) have been demonstrated preclinically. Here, we evaluated the neurological effects of SGLT2i use after stroke in patients with diabetes and AIS.

Methods:
Using a prospective stroke registry, we reviewed consecutive diabetic patients with AIS. Patients with and without SGLT2i use were 1:4 propensity score-matched for clinical variables. Clinical outcomes, including early neurological deterioration (END) during admission, National Institutes of Health Stroke Scale (NIHSS) score at discharge, and modified Rankin Scale (mRS) scores at discharge and at 3 months, were compared. The impact of SGLT2i on metabolic activity of various organs was examined in another cohort using
18
F-fluorodeoxyglucose positron emission tomography post-stroke.

Results:
Among the 820 eligible patients, 90 (11.0%) were prescribed SGLT2i on admission, and 76 continued the prescription at discharge. Seventy-four patients with and 266 patients without SGLT2i use were propensity score-matched and analyzed. SGLT2i did not increase the END risk (adjusted odds ratio [aOR] 0.48, 95% confidence interval [CI] 0.20-1.19). There was no significant difference in clinical outcomes at discharge between the two groups (NIHSS: B [standard error] -1.321 [0.952], p=0.17; mRS: aOR for favorable mRS 1.47, 95% CI 0.93-2.32). SGLT2i demonstrated significant improvement in the 3-month mRS (aOR 1.73, 95% CI 1.10-2.74). The positron emission tomography cohort showed that SGLT2i prescription was associated with elevated brown and subcutaneous adipose tissue metabolism.

Conclusions:
SGLT2i may be a priority for diabetic patients with AIS because of its potential benefits on long-term outcomes.
Abstract 52: Predictors of Mortality in Patients With Various Rheumatological Conditions Admitted for Stroke: Findings From National Inpatient Sample 2020
Authors: Gandhi Shreena Kamlesh , Akkawi Abdul Rahman R , Kotia Samvid
Published: February 2024

Background/Purpose:
Stroke imposes a substantial healthcare burden, with ischemic stroke (IS) mortality rising from 2.04 million (1990) to 3.29 million (2019) and projected to reach 4.90 million by 2030 according to the Global Burden of Disease Study. Autoimmune diseases are increasingly associated with chronic conditions and may modify risks by altering underlying pathophysiology. We aimed to compare in-hospital mortality and predictors in stroke patients with secondary rheumatological conditions.

Methods:
Using the National Inpatient Sample (NIS), we identified patients ≥18 admitted for stroke (Jan 2019 - Dec 2020), stratified into RA, SLE, scleroderma, or vasculitides groups using ICD-10-CM codes. We compared demographics, hospital traits, comorbidities, and outcomes. In-hospital mortality, our primary outcome, was analyzed through multivariate logistic regression using STATA 18.

Results:
Incorporating a cohort of 32,180 stroke patients, consisting of 23,439 with rheumatoid arthritis (RA), 7,080 with systemic lupus erythematosus (SLE), 960 with scleroderma, and 700 with vasculitides, the main findings are as follows: Mortality rates were 5.73% (n=1345) for RA, 6.28% (n=445) for SLE, 9.37% (n=90) for scleroderma, and 10.71% (n=75) for vasculitides, with no significant disparity between the latter three and RA. Age emerged as a significant mortality predictor (OR 1.01, p <0.01, CI 1.00 to 1.02), while no associations were observed for gender, race, insurance, or hospital traits. Regarding comorbidities, congestive heart failure (OR 1.73, p <0.01, CI 1.32 to 2.26) and liver disease (OR 2.20, p < 0.01, CI 1.27 to 3.79) exhibited connections to higher mortality, while no significant associations were detected for hypertension, dyslipidemia, chronic obstructive pulmonary disease, kidney disease, coronary artery disease, diabetes, obesity, or peripheral vascular disease.

Conclusions:
Rheumatological diseases, inducing cytokine-mediated systemic inflammation, potentially modify risks in stroke-admitted patients. This study uniquely compares stroke mortality and predictors across distinct rheumatological diseases, revealing age, congestive heart failure, and liver disease as significant mortality predictors.
Abstract 58: Socioeconomically Driven Reversal of Mortality Trends Among Patients With Primary Intracerebral Hemorrhage During the COVID-19 Pandemic: An Analysis of Nationally Representative Data
Authors: Bako Abdulaziz T , Potter Thomas B , Pan Alan P , Borei Karim , Prince Taya , Britz Gavin W , Vahidy Farhaan
Published: February 2024

Background:
Nationwide data demonstrating the impact of the COVID-19 pandemic on hemorrhagic stroke outcomes are lacking.

Methods:
We used the National Inpatient Sample (2016-2020) to identify adults (>=18 years) with primary intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH). We fit segmented logistic regression models to evaluate the differences in the rates of in-hospital mortality between the pre-pandemic (January 2016-February 2020) and pandemic periods (March 2020-December 2020). Multivariable logistic models were used to evaluate the differences in mortality between patients admitted from April to December 2020, with and without COVID-19, and those admitted during a similar period in 2019. Stratified analyses were conducted among patients residing in low and high-income zip codes and among patients with extreme loss of function (E-LoF) and those with minor to major loss of function (MM-LoF).

Results:
Overall, 309,965 ICH patients (mean age [SD]: 68[14.8], 47% female, 56% low-income) and 112,210 SAH patients (mean age [SD]: 60.2[15.4], 62% female, 55% low-income) were analyzed. Pre-pandemic, ICH mortality was decreasing by ≈1% per month (adjusted odds ratio, 95% confidence interval: 0.99, 0.99-1.00). However, during the pandemic, the overall ICH mortality increased by ≈2% per month (1.02, 1.00-1.02), and by ≈4% per month among low-income patients (1.04, 1.01-1.07). However, there was no change in trend among high-income patients during the pandemic (1.00, 0.97-1.03). Comorbid COVID-19 was significantly associated with higher odds of mortality, overall (ICH: 1.83, 1.33-2.51; SAH: 2.76, 1.68-4.54), and among patients with MM-LoF (ICH: 2.15, 1.12-4.16; SAH: 5.77, 1.57-21.17). Patients with E-LoF and comorbid COVID-19 had similar mortality rates with the 2019 cohort.

Conclusion:
Sustained efforts are needed to address socioeconomic disparities in healthcare access, quality, and outcomes during public health emergencies.
Abstract 64: Biomarkers of Atrial Cardiopathy and Outcomes After Cryptogenic Stroke: The ARCADIA Trial
Authors: Elkind Mitchell S , Kronmal Richard , Longstreth W T , Tirschwell David L , Marshall Randolph , Gladstone David J , Healey Jeff S , Chaturvedi Seemant , Aragon Garcia Rebeca , Plummer Pamela , Di Tullio Marco , Soliman Elsayed Z , Elm Jordan J , Broderick Joseph P , Kamel Hooman
Published: February 2024

Background:
Atrial cardiopathy is associated with incident ischemic stroke in the absence of clinical atrial fibrillation in prospective cohorts. Whether biomarkers of atrial cardiopathy predict recurrent stroke is less clear.

Methods:
In the ARCADIA trial, a multicenter randomized trial of apixaban versus aspirin in patients with cryptogenic stroke and evidence of atrial cardiopathy, we explored whether the biomarkers P-wave terminal force in ECG lead V
1
(PTFV1), N-terminal pro-Brain natriuretic peptide (NT-proBNP), or left atrial diameter index (LADI) predicted primary and secondary trial outcomes: (1) recurrent stroke of any type; (2) recurrent ischemic stroke or systemic embolism; and (3) recurrent stroke of any type or death. We analyzed the full cohort using Cox proportional hazard models , sequentially adjusting for treatment effect, demographic factors, and clinical risk factors. NT-proBNP concentrations were log-transformed.

Results:
With 1,015 of the target 1,100 participants enrolled (mean age 68 years, 54.3% female, 21.1% Black, and 8.1% Hispanic) and mean follow-up of 1.8 years, the trial was stopped for futility. Recurrent stroke occurred in 80 patients (annualized rate, 4.4%) and death in 54 patients. NT-proBNP significantly predicted recurrent stroke; recurrent ischemic stroke or systemic embolism; and recurrent stroke or death after adjusting for other risk factors, while PTFV1 and LADI did not (Table). NT-proBNP predicted recurrent stroke and death most strongly and with little change after adjusting for other risk factors. Treatment effect was not significant in any of the models.

Conclusions:
In this population of patients with cryptogenic stroke and evidence of atrial cardiopathy, NT-proBNP is a predictor of recurrent stroke and, with greater magnitude, of a composite of stroke or death. The role of NT-proBNP measurement in management after stroke deserves further study.
Abstract 65: Automated Detection of Facial Droop: Ml/AI Based Tool for Early Detection of Stroke
Authors: McGuffey Connor J , Singh Ishmeet , Yilmaz Alper , Gulati Deepak
Published: February 2024

Introduction:
Facial droop (FD) is a common symptom (45-60%) of stroke so early detection is critical for timely treatment. FD is a part of almost all stroke scales. Our study is to develop a machine learning (ML)/AI based tool that uses an automated detection of FD as one of the components. Our approach uses a normalized value of minor facial expressions called a blendshape.

Methods:
Google’s Mediapipe was used to create 52 different blendshape values (e.g., left eyebrow raised, right mouth lowered, etc.) from an input image, which were then used as inputs for a simple deep neural network (DNN). We trained this DNN using the blendshapes from 872 images of people with symptoms of facial palsy (FP) and 872 images of people without symptoms exhibiting multiple emotions (neutral, smiling, frowning, etc.).

Results:
The proposed approach was evaluated on a dataset of facial images of patients with FD and strokes. Our model showed promising results with over 91% test accuracy. This result suggests that the proposed approach is a promising new method for the early detection of FP with high accuracy. The approach is integrated in our ML/AI based tool to replicate different stroke scales.

Conclusions:
Our model shows that the use of Blendshapes as features in a ML classifier can produce great results in the detection of FP. For greater accuracy, a better dataset with higher quality images as well as unilateral facial expressions (winking, smirks, etc.) should be used. In a future study, a ML model that uses Blendshapes as inputs could be used to classify FP on a scale.
Abstract 67: Risk and Time-Course of Post-Stroke Dementia: A Population-Wide Cohort Study, 2002-2022
Authors: Joundi Raed A , Fang Jiming , Yu Amy Y , Austin Peter , Smith Eric E , Ganesh Aravind , Sposato Luciano , Hachinski Vladimir , Sharma Mukul , Kapral Moira K
Published: February 2024

Background:
People with acute stroke are at high risk of dementia. Population-wide data on the risk and time-course of dementia after stroke are lacking.

Methods:
We conducted a population-wide analysis of over 15 million people in Ontario, Canada between 2002-2022. Using linked administrative databases, we compared all 90-day survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH) to controls in the general population and with acute myocardial infarction (AMI) by matching 1:1 on age, sex, rural residence, neighborhood marginalization, and vascular comorbidities, and excluded people with prior dementia. We evaluated the rate of dementia per 100 person-years using a validated definition which included hospitalization, physician claims, and medications, and calculated cause-specific hazard ratios overall and across follow-up time.

Results:
We identified 180,940 people with acute stroke, of which 33,765 (18.7%) developed dementia over mean follow-up of 5.5 years (max 20y). The rate of dementia per 100 person-years was highest after acute stroke compared to the general population (3.40 vs. 1.88) and compared to AMI (3.23 vs. 1.81). The overall risk of dementia was higher in those with acute stroke compared to the general population (HR 1.79, 95% CI 1.76-1.82; Figure 1A), and particularly after ICH (HR 2.43, 2.31-2.57). The results were similar when compared to AMI (HR 1.77, 1.74-1.80; Figure 1C). There was an almost 3-fold elevation of dementia risk in the first year after stroke, decreasing to 1.5-fold by 5 years and remaining elevated even 20 years after (Figure 1B/1D).

Conclusion:
In this large, population-wide study almost one fifth of people developed dementia after stroke, with an 80% higher risk of developing dementia compared to matched controls. The risk was highest early after stroke but remained elevated 20 years after, raising the urgency of developing interventions for dementia prevention in acute and chronic survivors of stroke.
Abstract 86: Outcomes of Endovascular Therapy for Late Large Vessel Occlusion in Patients With Pre-Stroke Disability
Authors: Tanaka Kanta , Yamagami Hiroshi , Qureshi Muhammad , Uchida Kazutaka , Siegler James E , Nogueira Raul G , Yoshimura Shinichi , Sakai Nobuyuki , Strbian Daniel , Nagel Simon , Demeestere Jelle , Puetz Volker , Haussen Diogo C , AbdalKader Mohamad , Olive-Gadea Marta , Mohammaden Mahmoud , Marto João Pedro , Dusart Anne , Winzer Simon M , Tomppo Liisa , Caparros Francois , Henon Hilde , Bellante Flavio , Ramos João Nuno , Ortega-Gutierrez Santiago , Sheth Sunil , Nannoni Stefania , Kaesmacher Johannes , Vandewalle Lieselotte , Martinez-Majander Nicolas , Salazar-Marioni Sergio , Farooqui Mudassir , Virtanen Pekka , Ventura Rita , Zaidi Syed F , Castonguay Alicia , Puri Ajit S , Farzin Behzad , Masoud Hesham , Klein Piers , Strambo Davide , Möhlenbruch Markus , Ringleb Peter , Zaidat Osama , Raymond Jean , Lemmens Robin , Ribo Marc , Michel Patrik , Nguyen Thanh
Published: February 2024

Background:
There is a paucity of research to develop evidence-based recommendations for endovascular management in the extended time window (>6 hours after time last seen well [TLSW]) for large vessel occlusion (LVO) patients with pre-stroke disability.

Methods:
We analyzed data from a multinational cohort (66 sites, 10 countries from 2014 to 2022) of acute ischemic stroke patients with pre-stroke modified Rankin Scale (mRS) 0-4 and anterior or posterior circulation LVO who received endovascular therapy 6-24 hours after TLSW. The primary outcome was the composite of functional independence (FI, mRS 0-2) or return to pre-stroke mRS (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS 2-4) vs those without (mRS 0-1).

Results:
There were 2231 patients (median age 77 years; median NIH Stroke Scale 16) included in the present study, of whom 564 (25.3%) had pre-stroke disability. The primary outcome (FI or ROR) was seen in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR 30.7%), compared with 44.1% of those without (FI, 44.1%; RoR 13.0%) (
P
<0.0001,
Figure 1
). In both multivariable logistic regression and inverse probability of treatment weighting analysis, pre-stroke disability was not associated with a lower odds of achieving FI or RoR (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.50-1.15 and aOR 0.73, 95% CI 0.43-1.25, respectively). FI or ROR was achieved at a higher percentage with reperfusion with mTICI ≥2b than with mTICI 0-2a, both in patients with pre-stroke disability (34.8% vs 10.8%,
P
<0.0001) and in those without (49.2% vs 12.1%,
P
<0.0001). Symptomatic intracranial hemorrhage occurred in 6.3% in both groups (
P
=0.995).

Conclusions:
A substantial proportion of late LVO patients with pre-stroke disability regained pre-stroke mRS after EVT and did not have a worse functional prognosis than patients without pre-stroke disability when their pre-stroke mRS was considered.
Abstract 87: Predictive Scoring System for Pre-Thrombectomy Diagnosis of Intracranial Atherosclerotic Disease LVOS
Authors: Tarek Mohamed A , Monteiro Mateus D , Mohammaden Mahmoud H , Martins Pedro N , Dolia Jaydevsinh N , Pabany Aqueel , Grossberg Jonathan A , Nahhas Michael , De La Garza Carlos A , Marioni Sergio A , Sheth Sunil , RANGARAJU Srikant , Nogueira Raul G , Haussen Diogo C
Published: February 2024

Introduction:
Early identification of intracranial atherosclerotic disease (ICAD) underlying large vessel occlusion strokes (LVOS) may allow for mechanical thrombectomy (MT) optimization. We sought to create a pre-procedural scoring system to predict ICAD.

Methods:
Retrospective analysis of prospectively collected MT databases from 2 comprehensive stroke centers (derivation and validation) including patients with anterior circulation LVOS. ICAD cases were matched for age / sex (1:1) to non-ICAD controls and stepwise logistic regression utilized for various clinical and radiological (NCCT, CTA and CTP) variables. Calibration slope / intercept as well as the area under curve (auROC) were assessed.

Results:
Of 2870 MTs within the study period, 174 anterior circulation ICAD (6.6%) were matched with 174 controls (n=348) in the derivation cohort. Multivariable analysis β coefficients lead to a 20 point-scale: absence of AF (5), vascular risk factor burden (1 for each: hypertension, diabetes, smoking, hyperlipidemia), CTA multifocal ICAD (3), absence of cortical infarcts (3), presence of borderzone infarct (3), calcium at the siphon (2). The validation cohort comprised 75 ICAD patients (6.9% of 1359 MTs) and 75 controls. AuROC for the derivation cohort was 0.88(0.84-0.91) while for the validation cohort 0.82(0.73-0.89). Calibration slope and intercept showed a good fit for the development cohort although with overestimated risk for the validation cohort. After intercept adjustment, the overestimation was corrected (intercept 0; 95%CI -0.5-0.5 / slope 0.8 95%CI 0.5-1.1). In the full cohort (n=498), ≥ 11 points showed the best performance for distinguishing ICAD from non-ICAD patients, with a sensitivity 0.71 (0.65-0.78) and specificity 0.82 (0.77-0.87), a positive likelihood ratio of 3.92 (2.92, 5.28) and a negative LR of 0.35 (0.28, 0.44). Scores ≥ 12 showed 90% specificity, although sensitivity of 63% (55%-69%).

Conclusion:
We developed a predictive scoring system for pre-procedural diagnosis of ICAD LVOS with satisfactory discrimination and calibration based on clinical and non-invasive radiological data.
Abstract 94: Sex Disparities in a Telestroke Network: From Treatment Times to Outcomes
Authors: Hanna McKay , Sam Henry , Gregoski Mathew , Wabnitz Ashley M , Al Kasab Sami , Larson Katharine , Holmstedt Christine A , Grewal Parneet
Published: February 2024

Background:
The structure of the stroke care delivery system in rural South Carolina has been changed by the Medical University of South Carolina tele-stroke program with >40 spoke sites with improved treatment times and outcomes overall. Disparities at the level of primary stroke centers and acute stroke ready hospitals have not been well studied. The aim of this study is to retrospectively analyze data from the tele-stroke network for sex differences in stroke care processes at spoke sites to identify disparities in treatment times and outcomes between men and women.

Methods:
Data was collected and analyzed for 21,549 patients between 1/1/2012 and 12/31/2022 for whom a telestroke was paged out. Statistical analysis was completed using SPSS version 28 (IBM corporation, Armonk, NY). Variables with continuous outcomes were assessed using independent samples median tests and categorical variables were assessed using X
2
.

Results:
Of 10,713 (49.7%) males and 10,836 (50.3%) females, females were older (68.29±15.5 vs 66.09±13.7, p<0.01) and more likely to be to be African American (20.4% vs16.8%, p<0.05) as compared to males. Females were more likely to get thrombolytic therapy (29.06% vs 27.2%, p<0.05) but there was no difference in endovascular therapy between both sexes. Treatment times showed that door-to-registration timing (F: 18±27 vs M: 17±26, p<0.05) and door to telestroke page timing (F: 22±27 vs M: 20±26, p<0.05) was significantly higher in females compared to males with ultimately door to needle time having the expected disparity between men and women (F: 59±36 vs M: 55±35, p<0.05). Women also had significantly higher mean discharge NIHSS (M: 4.17±6.20 vs F: 4.61±6.70 (p<0.001) and mRS score (M:2.24±1.93 vs F:2.43±1.95 (p<0.001)). More males were discharged home (62.4% vs 60.4%, (p<0.001) and more females were discharged to nursing home (8.1% vs 6.2%, p<0.001) and hospice (3.9% vs 2.9%, p<0.001) post admission.

Conclusions:
Females are older at the time of stroke onset, have longer times to treatment and poorer outcomes and discharge dispositions. Our findings highlight the opportunities to ameliorate sex disparities in developing telestroke networks in the United States. Future studies should target these disparities to improve outcomes.
Abstract 96: Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke: The Florida Stroke Registry
Authors: Shoskes Aaron , Zhou Lili , Ying Hao , Gardener Hannah , Alkhachroum Ayham , Gordon Perue Gillian L , Bustillo Antonio , Koch Sebastian , Marulanda-Londono Erika , Gutierrez Carolina M , Rundek Tatjana , Romano Jose G , Asdaghi Negar
Published: February 2024

Introduction:
While ischemic stroke (IS) in the young (18-55) is thought to have different etiologies than in older patients, a rise in vascular risk factors (VRFs) among young adults may translate to an IS risk profile similar to the older population. We aimed to examine the prevalence of VRFs and temporal trends in VRF burden among young patients presenting with IS.

Methods:
Data was prospectively collected by Get With the Guidelines-Stroke® hospitals participating in the Florida Stroke Registry between January 2010 and December 2022. Patients aged 18-55 with a diagnosis of IS were included and separated into two age groups: 18-35 and 36-55. VRFs included hypertension, dyslipidemia, obesity, smoking, atrial fibrillation, coronary artery disease, heart failure, diabetes, and sleep apnea. Multimorbidity was defined as having ≥4 VRFs.

Results:
47,792 patients with IS were included (43% female, median age 49, 51% white), comprising 4,275 patients aged 18-35 (8.9%) and 43,517 aged 36-55 (91.1%). The prevalence of each VRF was higher among patients aged 36-55 vs 18-35 (all p values <0.001), and only 15.3% of patients aged 36-55 and 40.0% of patients aged 18-35 had 0 VRFs. African American patients with IS had a significantly higher prevalence of multimorbidity than white or non-white Hispanic patients; specifically in those aged 18-35 (6.1% vs 3.5% vs 3.5%, p <0.001), while those aged 36-55 demonstrated a smaller difference (17.6% vs 17.2% vs 15.4% p <0.001).VRF burden worsened across the study period, with an increase in multimorbidity from 11.2% to 21.7% in patients 36-55 (p<0.0001) and from 1.3% to 6.6% in patients 18-35 (p= 0.0006).

Conclusions:
Increasingly, young stroke patients have traditional VRFs. The prevalence of multimorbidity disproportionately affects African American patients and has significantly increased over the past 12 years. Efforts targeting VRFs reduction must start as early as possible in light of the rise in VRF burden amongst young IS patients.
Abstract HUP11: Racism, Resilience, and Quality of Life in Black Stroke Survivors
Authors: Love Mary F , Okpala Munachi N , Cox Sonya , Brooks Andrea N , Beamon Emily , Cooksey Gail , Sharrief Anjail Z
Published: February 2024

Introduction:
Stroke impairs stroke survivor (SS) quality of life (QoL). Black SS in the US also endure stress from structural, cultural, and interpersonal racism. Resilience is a dynamic process of maintaining stable functioning after an event such as stroke. This observational study aimed to assess the effects of racism and resilience on Black SS QoL.

Methods:
Participants were community-dwelling SS (age ≥ 18) who identified as African American or Black and experienced a stroke within 8 weeks. Baseline data collection included exposure (discrimination, vigilance, resilience), demographic, clinical, and psychosocial variables. Outcome data for QoL was gathered after 6 months. The effects of exposure variables and covariates on QoL were analyzed with multiple linear regression.

Results:
Participants (n=74) had a mean age of 56.2, 32% were in marital or partner relationships, and 58% were female. Most participants (84%) had ischemic stroke, with no more than mild disability (mRS 0-2 for 80%). Over half of participants had some college (32%) or a college degree (20%). The remaining 46% had a high school education or less. Work status included 32% currently working, 15% not working, 28% retired, and 24% disabled. Half reported an annual household income of < $25,000, with 63% living at ≤ 200% above the US poverty level. Participants reported moderate (64%) to high (8%) perceived stress, and 14% had moderate to moderately severe anxiety. Resilience was correlated with stress (r=-.59, p<.001) and anxiety (r=-.66, p<.01). At 6-month follow-up (n=44), QoL domains were very low for social relations (
M
=36.83, SD=17.76) and environment (
M=
35.04, SD=14.57), and moderately low for physical (
M
=46.49, SD=19.22) and psychological (
M
=54.39, SD=17.23). Higher vigilance and higher disability explained 23.3% of the variance in social relations QoL (F=7.545, p=.002). Higher resilience and higher socioeconomic status explained 25.7% of the variance in psychological QoL (F=5.524, p=.009).

Conclusions:
This sample had significant baseline socioeconomic disadvantage and increased psychosocial stress at baseline, and diminished QoL 6 months post-stroke. Future research with larger samples is warranted.
Abstract HUP2: Brain Health Outcomes in Sexual and Gender Minority Groups
Authors: Huo Shufan , Rivier Cyprien , Clocchiatti-Tuozzo Santiago , Renedo Daniela , Sunmonu N. Abimbola , de Havenon Adam H , Sheth Kevin N , Falcone Guido J
Published: February 2024

Background:
There is mounting evidence that sexual and gender minority (SGM) groups experience health disparities, but research on brain health status of this underrepresented group is limited. We evaluated whether SGM persons are at higher risk of adverse brain health outcomes compared to cisgender heterosexual (non-SGM) individuals.

Methods:
We conducted a cross-sectional study in the All of Us Research Program, a population study focused on health disparities enrolling 1 million Americans. We used baseline questionnaires to identify participants from sexual minorities (non-straight e.g., gay, lesbian, bisexual) and gender minorities (gender identity different from sex assigned at birth). We further divided gender minorities into gender diverse (e.g., non-binary) and transgender. The primary outcome was a composite of stroke, dementia, and late-life depression. In secondary analyses, we analyzed SGM subgroups and diseases separately. We used multivariate logistic regression to assess the link between SGM groups and brain health outcomes.

Results:
We included 393,041 participants (mean age 51, female sex at birth 62%), of whom 39,632 (10%) belonged to SGM groups. Of these, 4,431 (1%) belonged to a gender minority (2,212 [50%] gender diverse and 2,219 [50%] transgender) and 38,528 (10%) to a sexual minority. Full results are shown in the Figure. Compared to non-SGM, SGM individuals had 19% higher odds of the brain health composite outcome (OR 1.19, 95%CI 1.13-1.25). These results were consistent across all SGM subgroups (p<0.05). When assessing individual diseases, all SGM groups had higher odds of late-life depression, all SGM except transgender persons had higher odds of dementia, and gender minority groups had higher odds of stroke.

Conclusion:
In a large US population study, SGM individuals had a higher rate of adverse brain health outcomes. Further research should explore the structural causes of inequity to advance inclusive and diverse neurological care.
Abstract HUP6: Ideal Cardiovascular Health and the Intersectionality of Race/Ethnicity and Sexual Identity
Authors: Rosendale Nicole , Wood Andrew J , Leung Cindy , Kim Anthony S , Caceres Billy A
Published: February 2024

Introduction:
Disparities exist in cardiovascular health (CVH) by sexual identity and race/ethnicity separately, however an understanding of the intersectional effect of these identities has been limited.

Objective:
To evaluate differences in ideal CVH, as captured in the American Heart Association’s Life’s Essential 8 framework, across race/ethnicity and sexual identity.

Methods:
This study used data from the National Health and Nutrition Examination Survey (NHANES, 2007-2016). Non-institutionalized adults (18-59 years) without a history of cardiovascular disease/stroke and who were not pregnant at the time of the interview were included. Self-reported race/ethnicity was categorized as non-Hispanic Black (hereafter Black), Hispanic, non-Hispanic White (hereafter White), and another race. Self-reported sexual identity was categorized as straight and sexual minority (SM), which encompassed those who identified as lesbian, gay, bisexual, or something else. The primary outcome was total CVH score (range 0 -100), which is the unweighted average of 8 CVH components, assessed using questionnaire, dietary, and physical examination data. Sex-stratified regression models were developed for the overall CVH score and CVH components, adjusting for age and study year.

Results:
The sample included 12,256 adults (mean age 39.6 years [SD 11.7]). While Black (ß= -4.9, 95% CI -7.7, -2.0), Hispanic (ß= -4.9, 95% CI -9.6, -0.2), and White (ß = -5.9, 95% CI -8.8, -3.0) SM female adults had lower total CVH scores compared to their straight counterparts, female participants of another race and SM male adults of any race/ethnicity did not. Black SM female individuals had less favorable nicotine (ß= -20.9, 95% CI -32.3, -9.4) and blood pressure (ß= -7.2, 95% CI -13.8, -0.6) scores compared with Black straight females. Hispanic SM female individuals had less favorable body mass index scores (ß= -15.6, 95% CI -28.0, -3.2) compared with Hispanic straight females.

Conclusions:
CVH differed across racial/ethnic identities in SM females but not SM males. Longitudinal studies are needed to identify mechanisms driving CVH disparities in Black and Hispanic SM females.
Abstract TMP106: Use of Net Promoter Score to Quantify the Participant Experience With a Telehealth Lifestyle Management and Cardiovascular Risk Reduction Coaching Program
Authors: Gordon Neil F , Wright Brenda S , Savona Thomas J , Reid Kevin S , Ponnusamy Prabakar , Allen Kim , Queensland Amie , Kridl Terri L , Faircloth George C , Salmon Richard D
Published: February 2024

Introduction:
Improving the patient experience of care is 1 of the 3 dimensions of healthcare’s “Triple Aim.” The net promoter score (NPS) measures willingness to recommend a company’s services and is widely used by Fortune 500 companies as an indicator of customer loyalty/satisfaction. The NPS is increasingly being used to assess patients’ healthcare experience. We sought to quantify the experience of participants in the same telehealth lifestyle management and CVD risk reduction coaching program used in multiple NIH/PCORI-funded stroke-related multi-center RCTs (namely, SAMMPRIS, CREST-2, CAPTIVA and TEAMS-BP) by measuring the NPS in real-world (i.e., non-RCT) program participants.

Methods:
Participants in the coaching program typically have an opportunity to complete a voluntary satisfaction survey after 12 weeks and 1 year of participation and annually thereafter. The survey is conducted online or via telephone. For this analysis the NPS was calculated, from 17,929 consecutive surveys completed by non-RCT program participants, using responses on an 11-point scale (10 = "strongly agree"; 0 = "strongly disagree") to this item: “I would recommend the program to others.” Scores can range from -100 (worst) to +100 (best). In industry, a positive NPS is well regarded, and scores ≥50 are thought to highlight an excellent experience.

Results:
Three categories of responders were identified and classified as ‘promoters’ (rating = 9 or 10; i.e., those who would likely recommend the program = 78% of responses), ‘passives’ (rating = 7 or 8; i.e., those who are satisfied but would probably not actively promote the program = 16% of responses) and ‘detractors’ (rating = ≤6; i.e., those who might actively discourage participation = 6% of responses). The NPS (calculated from the % of promoters minus the % of detractors) was +72, a score comparable to that achieved by the most popular/successful commercial organizations in other industries.

Conclusion:
This is the first study to utilize the NPS to evaluate the participant experience with a telehealth coaching program that has been/is currently being successfully deployed in multiple stroke-related multi-center RCTs. The data show that real-world program participants have an NPS indicative of very high satisfaction.
Abstract TMP118: Aged Maternal Gut Microbiome Impairs Offspring Behavior and Exacerbates Stroke Outcome
Authors: Rebeles Kristen , Blixt Frank , Kim Joshua , McCullough Louise D
Published: February 2024

The microbiome plays a significant role in influencing general health. A disruption of the gut biome homeostasis, dysbiosis, can be both the effect of disease or a precondition. The maternal biome has been shown to play a vital role in offspring brain and immune development by shaping the metabolic environment for the embryo. Therefore, an aged dysbiotic maternal biome may increase stroke risk factors among offspring and additionally, worsen stroke outcome. Young female C57B6 mice 3-month (M) of age had their host gut bacteria cleared via antibiotic treatment prior to recolonization via fecal microbiome transplants from 3M control, and 14M middle aged female mice. After breeding, the subsequent offspring was aged to 14 months, followed by behavioral tests, glucose tolerance, prior to a transient 60-minute middle cerebral artery occlusion (MCAO or sham surgery). The maternal biome had a significant effect on offspring biome at 2M, 6M and 9M of age, shifting the beta-diversity of females significantly (p=<0.01), and males to a lesser extent (p=0.241), extending into adulthood. Additional sex specific changes were observed in adult mouse behavior with decreased motor function and increased anxiety being prevalent in male offspring at 2 months of age (p=0.0338 and 0.0261 respectively) but not in females. At 6 months of age female offspring from dysbiotic mothers exhibited significantly impaired object recognition abilities compared to control (p=>0.01). Once the offspring had been subjected to a 60 min MCAO, a spontaneous recovery was observed in NDS scores in all females and in the control males, but not in males from dysbiotic mothers, suggesting that male stroke outcome is negatively affected by dysbiotic mothers. The maternal microbiome has a significant impact on offspring biome composition and health. Mice from mothers with aged microbiome exhibited sex specific early life motor function and cognitive impairment. Additionally, male offspring from dysbiotic mothers have a worsened stroke outcome.