bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP232: Post-stroke Suppression Of Matrix Metalloproteinase-12 Attenuates The Expression Of M1 And M2 Markers And Prevents The Elevation Of Other Matrix Metalloproteinases
Authors: Challa Siva , Fornal Casimir A. , Schaibley Claire , Sama Vinay , Kashyap Aanan , Klopfenstein Jeffrey D. , Veeravalli Krishna
Published: February 2022

Introduction:
We previously reported a marked elevation of matrix metalloproteinases (MMP-1, MMP-7, MMP-8, MMP-9, MMP-11, MMP-12, and MMP-14) in the ischemic brain on day 3 after ischemic stroke in a rodent model. Also, we showed that MMP-12 suppression after ischemic stroke attenuates blood-brain barrier (BBB) disruption. The aim of the present study was to examine the effects of MMP-12 suppression on the expression of elevated M1 and M2 microglia/macrophage phenotypes and other MMPs in the ischemic brain. We hypothesized that MMP-12 suppression, by attenuating infiltrating leucocytes (especially monocytes), would decrease the expression of both M1 and M2 markers as well as other MMPs, since activated monocytes are the primary source of elevated MMPs in the ischemic brain.

Methods:
Young adult male Sprague-Dawley rats (n=6/group) were subjected to 2-h transient middle cerebral artery occlusion and received either MMP-12 shRNA (M12sh) expressing plasmids (1 mg/kg, i.v.; formulated as nanoparticles) within 30 min of reperfusion or no treatment. M12sh-treated and untreated ischemia-induced rats along with sham surgery rats were euthanized on day 3 after ischemia and brain tissues were collected for quantitative real-time PCR analysis of specific M1/M2 markers and various MMPs.

Results:
In untreated ischemia-induced animals, the expression of both M1 markers (CD16, CD68, IL-1β, IL-6, and TNFα) and M2 markers (CD163, CD206, Arg1, TGFβ, and IL-10) was increased approximately 10-150 fold over sham operated animals. Similarly, the expression of all MMPs studied (MMP-1, MMP-7, MMP-8, MMP-9, MMP-11, and MMP-14) was elevated approximately 10-30 fold in untreated ischemia-induced animals. M12sh treatment reduced the expression of most M1/M2 markers, notably CD68, IL-10, Arg1, and TGFβ, compared to no treatment. M12sh treatment also strongly reduced the elevated levels of MMP-7, MMP-9, MMP-11, and MMP-14.

Conclusions:
Suppression of MMP-12 leads to a general downregulation of M1/M2 markers and MMPs in the ischemic brain. We attribute these effects to reduced monocyte infiltration and subsequent inflammation. Suppression of MMP-12 could prove to be a promising therapy for ischemic stroke.
Abstract TP235: Delayed FGF21 Administration Improves Cerebrovascular Remodeling And White Matter Repair After Focal Stroke In Diabetic Mice
Authors: Jiang Yinghua , Han Jinrui , Li Yadan , Wu Yinga , Liu Ning , Shi Samuel , Lin Li , Jing Yuan , Wang Shusheng , Ning Mingming , Dumont Aaron S , Wang Xiaoying
Published: February 2022

Introduction:
Type 2 diabetes mellitus (T2DM) is a major comorbidity exacerbating ischemic brain injury and impairing post-stroke recovery. Our previous study suggested that recombinant human fibroblast growth factor (rFGF) 21 might be a potent therapeutic targeting multiple aspects of pathophysiology in T2DM stroke. As a continuation of our previous work investigating the therapeutic effects of rFGF21 in T2DM stroke, this study aims to evaluate the potential effects of rFGF21 on cerebrovascular remodeling during a delayed phase after T2DM stroke.

Methods:
Permanent distal middle cerebral artery occlusion was performed in heterozygous non-diabetic db/+ and homozygous diabetic db/db mice. Daily rFGF21 administration was initiated one week after stroke induction and maintained for up to two weeks thereafter. Multiple markers associated with post-stroke recovery, including angiogenesis, oligodendrogenesis, white matter integrity and neurogenesis, were assessed up to three weeks after stroke.

Results:
Our results showed an impairment in post-stroke vascular remodeling under T2DM condition, reflected by the decreased expression of trophic factors in brain microvessels and impairments of angiogenesis. The defected cerebrovascular remodeling was accompanied by the decreased oligodendrogenesis and neurogenesis. However, delayed rFGF21 administration normalized post-stroke hyperglycemia and improved neurological outcomes, which may partially via the promotion of pro-angiogenic trophic factor expression in brain microvessels and cerebrovascular remodeling. The better cerebrovascular remodeling may also contribute to oligodendrogenesis, white matter integrity and neurogenesis after T2DM stroke.

Conclusion:
Delayed rFGF21 administration may improve neurological outcomes in T2DM stroke mice, at least in part by normalizing the metabolic abnormalities and promoting cerebrovascular remodeling and white matter repair.
Abstract TP238: Optogenetic Stimulation Of Cortico-thalamic Circuits Promotes Oligodendrogenesis In The Degenerative Thalamus After Stroke
Authors: Cao Zhijuan , Chiang Terrance , Kim Anika , Cheng Michelle Y , Steinberg Gary K
Published: February 2022

Introduction:
Loss of neuronal activity after stroke can impact many activity-dependent processes including oligodendrocyte maturation and myelination. The cortico-thalamic circuit is particularly disrupted after cortical stroke, resulting in secondary axonal degeneration in the thalamus. This secondary thalamic injury is associated with worsened functional outcomes. Increasing neuronal activity by optogenetic stimulation promotes oligodendrogenesis and myelination in normal conditions. In this study, we use optogenetic stimulation to selectively re-activate the cortico-thalamic circuit after stroke and examine its effects on oligodendrocytes in the degenerative thalamus.

Methods:
C57BL6 male mice (6-8 weeks old) were injected AAV1-CaMKIIa-hChR2 virus in the ipsilesional somatosensory cortex and implanted an optic fiber in the ipsilesional thalamus. After six weeks, the left middle cerebral artery was permanently occluded to generate infarct in iS1. Stimulated mice were given daily optogenetic stimulations between Post-stroke Day (PD) 4 to 14. Brain sections were immunostained to detect primary cortical injury and secondary thalamic injury (NeuN), and neuroinflammation (CD68) and oligodendrogenesis (Olig2 and CC1) in the thalamus.

Results:
ChR2 is specifically expressed in the somatosensory cortico-thalamic tract. Neuronal loss and robust neuroinflammation were observed in iTH after stroke, but there was no significant difference between non-stimulated and stimulated mice. However, stimulated mice exhibited 5.5 times increase in the numbers of mature oligodendrocytes (Olig2
+
CC1
+
, p=0.02, n=5/group), and 5.4 times increase in the numbers of oligodendrocyte progenitor cells (Olig2
+
, p=0.03) in the degenerative thalamus.

Conclusion:
Our data demonstrate that selective re-activation of the cortical-thalamic circuits promoted oligodendrogenesis in the secondary degenerative thalamus after stroke. As the secondary thalamic injury allows an extended treatment window, targeting secondary injury is a promising approach to improve stroke recovery. Current studies are testing the effects of cortico-thalamic circuit stimulation in myelination in the degenerative thalamus and functional outcome after stroke.
Abstract TP239: Cholesterol And LXR Signaling In The Macrophage Response To Intracerebral Hemorrhage-relevant Stimulation
Authors: Delong Jonathan H , Velazquez Sofia , Sun Leonardo S , Landreneau Margaret J , Sansing Lauren H
Published: February 2022

Introduction:
In the acute phase of intracerebral hemorrhage (ICH), blood-derived macrophages contribute to an inflammatory response that increases neuronal death and worsens patient outcome. A better understanding of the endogenous signals that control this response would aid in development of therapeutics to suppress it. Uptake of free cholesterol limits the macrophage response to microbial ligands, in part through activation of the transcription factor LXR. During ICH, blood-derived macrophages in the hematoma are not exposed to microbes but are exposed to the endogenous inflammatory molecule S100A9 as well as cholesterol in the form of myelin and cell debris.

Methods and Results:
Murine bone marrow-derived macrophages were treated with cholesterol before stimulation with S100A9 or LPS, which are both TLR4 ligands. The inflammatory response was measured by production of the cytokines/chemokines TNF, IL-6, CCL2, and IL-10 by multiplex ELISA and/or qPCR at 3 and 6 hours after stimulation. Activation of LXR was measured by expression of the LXR target genes
Abca1
and
Abcg1
by qPCR. Cholesterol limited inflammatory cytokine production in response to LPS but not to S100A9. Treatment with the LXR agonist T0901317 activated
Abca1
and
Abcg1
more strongly than cholesterol but was not as effective at suppressing cytokine production. Treatment with the LXR antagonist GSK2033 suppressed cholesterol-mediated expression of
Abca1
and
Abcg1
but did not block all suppressive effects of cholesterol on cytokine production.

Conclusions:
Cholesterol limits the macrophage response to LPS. This is partially through activation of LXR, but LXR-independent mechanisms are involved as well. Cholesterol does not limit the initial inflammatory response to the ICH-relevant molecule S100A9, which may help explain the robust acute inflammatory response that develops during acute ICH in the presence of abundant cholesterol.
Abstract TP250: N-3 Fatty Acid Diglyceride Emulsions As A Novel Acute Treatment For Ischemic Brain Injury
Authors: Zirpoli Hylde , Kollareth Manual Denny Joseph , Sosunov Sergey A , Rashid Sundas , Ng Jesse , Huang Nasi , Lralovec Jaroslav , Mayurasakorn Korapat , Hamilton James A , Ten Vadim S , Deckelbaum Richard J
Published: February 2022

Introduction:
Omega-3 (n-3) fatty acids (FAs), specifically docohexaenoic acid (DHA) and eicosapentaenoic acid (EPA), act as bioactive unsaturated lipids with pleiotropic effects, affording neuroprotection in ischemic brain injury.

Hypothesis:
We reported that n-3 FAs injected acutely as triglyceride (TG) emulsions provide neuroprotection after ischemic brain injury. We now questioned whether novel lipid emulsions made from n-3 diglycerides (DG) would improve the delivery and effectiveness of n-3 FAs in brain after injury.

Methods:
We evaluated
in vitro
interactions of DG (DG-DHA) vs TG (TG-DHA) in phosphatidylcholine (PC) bilayer liposomes, as a model membrane system, by NMR spectroscopy. We compared the
in vitro
kinetics of DG vs TG hydrolysis by lipoprotein lipase. We investigated the neuroprotective effects of DG emulsions in a Vannucci murine model of hypoxic-ischemic (HI) brain injury.

Results:
NMR spectra of PC liposomes incubated with DG-DHA showed an additional peak, adjacent to the phospholipid carbonyl region, indicating a higher incorporation into PC bilayers and a narrower peak at almost the same position in a more fluid phase. In contrast, spectra of liposomes incubated with TG-DHA showed narrow peaks well-separated from PC resonances, representing phase-separated oil droplets. In lipolysis assays, DG emulsions had more efficient hydrolysis than TGs. Neonatal mice treated with DG-EPA, DG-DHA, or the combination of both (DG-DHA+EPA) after HI injury showed up to 3X better reduction in infarct volumes compared to TGs (p<0.05).

Conclusions:
Our data demonstrate that DG molecules incorporate in membrane bilayers more efficiently than TG. We postulate that the faster hydrolysis of DGs contributes to higher neuroprotection compared with TGs. Our findings indicate that n-3 DG emulsions represent a novel and much more efficient modality than n-3 TG for improving ischemic brain injury outcomes.
Abstract TP253: Early Intense Rehabilitation Does Not Reduce Impairment After Intra-striatal Hemorrhagic Stroke In Rats
Authors: Fedor Britt A , Kalisvaart Anna C , Ralhan Shivani , Kung Tiffany F , MacLaren Maxwell , Colbourne Fred
Published: February 2022

Intracerebral hemorrhage (ICH) causes rapid mechanical damage and initiates secondary injury mechanisms, such as from toxic by-products of blood degradation, that cause extended cell death. Experimentally, several rehabilitative treatments (rehab) can mitigate late cell death, and one recent study suggests it is by accelerating hematoma clearance, thereby minimizing neurotoxicity. Here, we assessed whether early, intense, enriched rehab (ER) enhances functional benefit and reduces ICH injury.

Methods:
In experiment 1, rats (n=56) were randomly assigned to groups following collagenase-induced striatal ICH: ER-Dark, ER-Light, CONTROL-Dark, or CONTROL-Light. ER rats completed four reach training sessions and six hours of environmental enrichment daily for 10d (d5-14 after ICH), in either the dark or light phase of their housing cycle. Rats were euthanized on d14 and hematoma volume was assessed. In experiment 2 (n=72), rats were randomized to: ER-10, ER-20, or CONTROL. Using the same ER protocol, rats in ER-10 and ER-20 completed 10d (d5-14) or 20d (d5-14 and 19-28) of ER during the dark phase of their housing cycle. Rats were euthanized on d60, and brains were fixed for histological processing. In both experiments, rats completed behavioural assessments prior to ICH, pre-treatment (d4 post-ICH) and post treatment (experiment 1, d13-14; experiment 2, d16-17 and d30-31).

Results:
In experiment 1 there was no significant difference in reaching intensity between ER completed in light vs. dark (p=0.3318), and both groups reached extensively (3912±947 reaches). ER resulted in slightly better reaching success between d4 and d14 (p=0.0272) but did not significantly alter residual hematoma volume (p=0.9653). In experiment 2, ER duration did not significantly impact reaching success between d4 and d31 (p=0.0587) or reduce lesion size (p=0.6401).

Conclusion:
While similar rehab methods have been beneficial in other work, these findings suggest that slight variations in protocols (rehab initiation, intensity, time in enrichment) have a large impact on treatment efficacy. Additionally, these results underscore the importance of studying rehabilitation after ICH, as the use of comparable treatments appear to be far more efficacious for ischemic injury.
Abstract TP258: Assessing Post-stroke Motor Impairments Using Staircase Reaching Test
Authors: Kim Anika , Chiang Terrance , Cao Zhijuan , Cheng Michelle Y , Steinberg Gary
Published: February 2022

Background:
Behavior tests that assess side-specific motor impairments after unilateral lesion such as focal ischemic stroke have translational applications, as 8 out of 10 stroke survivors suffer from hemiparesis. Accurate measurements of neurological functions are therefore important for assessing the effectiveness of various treatment strategies. Here, we demonstrate the feasibility of the staircase test to objectively evaluate lateralized deficits in coordinated paw reaching in adult mice after experimental stroke.

Methods:
A cohort of adult male C57BL/6J mice (12-14 weeks of age) were subjected to a 14-day training period, where they were kept on a 21-hour food deprivation regime and at 85-90% of their original body weight. They were then subjected to permanent distal middle cerebral artery occlusion (dMCAO, n=10). The number of steps reached and pellets grasped/eaten were evaluated at pre-stroke baseline and post-stroke days (PD) 7-8 and 14-15; behavior data from PD7-8 and PD14-15 were averaged between the two days. Brains were collected at PD16 and sections immunostained with antibodies targeting neurons (MAP2) and/or activated microglia/macrophage (CD68).

Results:
Mice attained a stable baseline for reaching steps and consuming pellets after a 14-day training period. At PD7-8, stroked mice showed a significant decrease in their ability to grasp/consume pellets on the affected side (right limb) compared to pre-stroke baseline (p=0.001). At PD14-15, stroked mice exhibited a significant decline in their ability to reach longer distances on the affected side (right limb), attaining only 65% of their baseline performance (p=0.006). No significant deficit was shown on the non-affected side (left limb).

Conclusions:
Our results show that the staircase test can detect side-specific motor deficits up to PD15 in a dMCAO model. Ongoing studies with a larger cohort are evaluating longer-term deficits up to one-month post-stroke and assessing the effects of optogenetic cortico-thalamic circuit stimulations on grasping behavior using the staircase test.
Abstract TP33: Stroke Navigators: Closing Patient Educational Gaps
Authors: Leutbecker Jacqueline , Hill Erica R
Published: February 2022

Background:
A critical component in preventing Cerebral Vascular Accidents (CVA) and Transient Ischemic Attacks (TIAs) is knowledge of risk factors and, signs and symptoms of a stroke, and follow-up care with a neurologist and primary care provider. To prevent readmission to the hospital for a second CVA, a large hospital system outside the District of Columbia has implemented a Nurse-led Stroke Education program.

Purpose:
Introduction of a full-time Stroke Navigator will improve patient education for Ischemic and TIA patients, through a nurse-led Stroke Education program.

Methods:
Phase 1: The Stroke Navigator in conjunction with the bedside RN will provide personalized stroke education to patients who suffer from a CVA or TIA. Phase II: The Stroke Navigator will conduct a follow-up phone call of patients discharged with a diagnosis of stroke or TIA within seven days. The phone call will assess patient’s knowledge of their risk factors, the symptoms and symptoms associated with a stroke, medication compliance, and follow-up medical appointment compliance with a Primary Care Provider (PCP) and Neurologist.

Results:
Data was reviewed from January –May 2021(n=87) prior to the implementation of the stroke navigator role, and from June –July 2021(n=57) after integration of the role. Patients’ follow-up compliance with their PCP increased from 34% to 68%. Follow-up with a neurologist increased from 8% to 44%. Medication Compliance decreased from 99% to 89%. Patients’ knowledge of signs and symptoms of stroke increased from 8% to 18%. Patients’ knowledge of their personal risk factors for stroke decreased from 45% to 35%.

Conclusion:
Data surrounding implementation of a full time Stroke Navigator has made a positive impact on patient’s post-stroke knowledge and care surrounding follow-up with providers and knowledge of signs/symptoms of stroke. The Stroke Coordinator and Stroke Navigator will continue to measure quality outcomes over time to determine if the stroke education program is continuing to positively impact post-discharge patient care.
Abstract TP34: Cerebrovascular Nursing Voice Is Critical, Information-Technology Listened, And Posterior Stroke Signs And Care Documentation Improved
Authors: Ayanbadejo Michael O , Ayanbadejo Michael O , Dodda Nick , Babu Krishnan , Guterman Lee , Stoll Nancy M , Foley Alexandria , Scarpello Shannon
Published: February 2022

Introduction:
The impact of EMR workflow template on the capture of signs of posterior circulation stroke is not well understood. The previous Stroke Unit’s EMR-workflow template at Catholic Health System had no protocol in gauging stroke clinician input in EMR-workflow sheet. In November 2020, a new EMR workflow template with protocol in gauging stroke clinician input in EMR-workflow sheet replaced the old one. We conducted a pilot study to determine the ability of the new EMR stroke template capturing signs of posterior stroke. In parallel, elbow support education and training using the new-EMR template was provided to stroke clinicians.

Methods:
We conducted a retrospective chart review and a comparative analysis of patients with a CT/MRI diagnosis of posterior circulation strokes captured with the old-EMR (stroke nurses not involved in design) vs the new-EMR (stroke nurses involved) to see what EMR captured vision and balance problems. From the old EMR, we randomly selected 24 charts from June 2020 to October 2020. From the new EMR, we randomly selected 24 charts from December 2020 to April 2021 (We allowed elbow support and a learning curve of 4 weeks for the new EMR) at our comprehensive stroke center. An audit pass or fail based was assigned on the ability of the EMRs to capture vision and balance symptoms prior and after patient received stroke care. Age, sex, visual and balance symptoms of patients were documented. Data was stored in Excel and analysis was performed with Statistical Package for the Social Sciences (SPSS) version 23 for descriptive and inferential statistics.

Result:
Approximately 56.3% (n=27) were male. Patients’ ages ranged between 18-95 years with the mean age of 66.5 years (95% CI [61.9, 71.1]).Old-EMR stroke template captured visual 62.5% (n=15) and balance 4.2% (n=1) symptoms out of 24 charts reviewed. New-EMR template captured vision 91.6% (n=22) and balance 75% (n=18) as posterior stroke symptoms out of 24 chart reviewed. New EMR stroke template differed from old by audit pass rate (75% vs 4.2%,
p
< 0.00001).

Conclusion:
This study might suggest a relationship between nursing inputs in stroke EMR workflow design and improve documentation. We propose to carry out our study on a larger number of patients to further understand the relationships.
Abstract TP36: Stroke Prevention Community Outreach Education During A Pandemic
Authors: Colbert Charlotte
Published: February 2022

Background:
During the 2020/2021 pandemic Integris Health’s Stroke Awareness Community Education Goals continued. Educating our communities about the early warning signs of stroke and emergency steps to initiate when someone experiences stroke symptoms saves lives. With community closings during the pandemic, locating our community partners and developing creative ways to continue to educate became a challenging and rewarding project.

Purpose:
The purpose of our “new” pandemic community stroke awareness program was to continue our mission goals to teach as many people as possible; a) the short, simple way to recognize a possible stroke, b) learn what to do and what NOT to do if a stroke is suspected, and c) to secure emergency help immediately. The processes to meet these goals were successfully modified permitting our program to continue.

Methods:
Prior to the 2020 pandemic the stroke community educator utilized an in-person teaching/learning strategy. Guided by new pandemic teaching/learning methods such as remote lunch & learns, electronic communication platform learning, vaccine clinic education, drive by health fairs and educating at staff huddles community education continued. Creative ways to distribute promotional stroke awareness items were also developed and distributed.

Results:
Significant community education during the pandemic continued with more than 3000 participants receiving stroke awareness education. Prior to our modification processes our community outreach programs were not providing education to any community contacts. Modifying a Community Stroke Awareness Program during a pandemic can be a successful way to continue this valuable educational platform.

Conclusions:
Our new creative community education program demonstrated that community education can continue in a pandemic. Finding creative ways to reach closed communities were successful and our stroke education/stroke prevention mission continued.
Abstract TP44: A Novel Emergency Medical Services Protocol To Improve Treatment Time For Large Vessel Occlusion Strokes
Authors: Glober Nancy , Supples Michael , Persaud Sarah , Kim David , Liao Mark , Glidden Michele , O'Donnell Daniel , Tainter Christopher , Boustani Malaz , Alexander Andreia
Published: February 2022

Objective:
In many systems, patients with large vessel occlusion (LVO) strokes experience delays in transport to thrombectomy-capable centers. This pilot study examined use of a novel emergency medical services (EMS) protocol to expedite transfer of patients with LVOs to a comprehensive stroke center (CSC).

Methods:
From October 1, 2020 to February 22, 2021, one large urban EMS agency piloted a protocol, in which paramedics, after transporting a patient with a possible stroke remained at the patient’s bedside until released by the emergency department or neurology physician. In patients with possible LVO, EMS providers remained at the bedside until the clinical assessment and CT angiography (CTA) were complete. If indicated, the paramedics at bedside transferred the patient, via the same ambulance, to a nearby thrombectomy-capable CSC with which an automatic transfer agreement had been arranged. This five-month pilot assessed use of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergent transfers via conventional interfacility transfer agencies. EMS providers, and emergency department physicians and neurologists at both sending and receiving institutions, completed e-mail surveys on the process, and offered suggestions for process improvement. Responses were coded with an inductive content analysis approach.

Results:
The protocol was used 42 times during the study period; four patients were found to have LVOs and were transferred to the CSC. There were no adverse events. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes (IQR 24.5-29.0), compared to 314.5 minutes (IQR 204.0-459.3) for acute non-stroke transfers during the same period. Major themes of provider impressions included: incomplete awareness of the protocol, smooth process, challenges when a stroke alert was activated after EMS left the hospital, greater involvement of EMS in patient care, and comments on communication and efficiency.

Conclusion:
This pilot study demonstrated the feasibility, safety, and efficiency of a novel approach to expedite endovascular therapy for patients with LVOs.
Abstract TP49: Visual Review Of Neuroimaging Prior To Transfer Acceptance Is Significantly Associated With Higher Rates Of Endovascular Therapy
Authors: Thatikunta Prateek , McCullough-Hicks Margy E , Mlynash Michael , Albers Gregory W , Mijalski Sells Christina M
Published: February 2022

Background:
With the advent of extended window endovascular therapy (EVT) for acute ischemic stroke (AIS), interhospital transfer is increasingly frequent. However, not all patients who are transferred undergo EVT. To use resources judiciously, stroke centers need to identify which patients are most likely to benefit from EVT prior to transfer.

Methods:
We performed a retrospective study of AIS patients transferred for potential EVT at our neurovascular center between 2015 and 2018. We noted whether pre-acceptance imaging was available for visual review on LifeImage, RAPID perfusion software, or Telestroke PACS. The primary outcome was EVT on arrival.

Results:
530 AIS patients were included. 270 underwent EVT (50.9%); 156 (29.4%) had pre-acceptance imaging reviewed; 275 (51.9%) received IVtPA. Of all patients who were transferred, performance of pre-transfer CTA was significantly associated with EVT (57% vs 40%, p<0.001). Review of any pre-acceptance imaging was significantly associated with EVT in patients who did not recanalize by the time of arrival (67% vs 53%, p=0.006) and in those who did not receive tPA before transfer (68% vs 49%, p=0.003). Review of imaging via perfusion software was significantly associated with EVT in patients who did not recanalize prior to arrival (69% vs 54%, p=0.009) and in those who did not receive tPA (72% vs 50%, p=0.002).

Conclusions:
Pre-acceptance visual review of imaging by accepting team, in particular via perfusion software, was significantly associated with likelihood of EVT in patients who did not receive IVtPA and/or who did not recanalize by time of arrival. Performance of CTA at outside hospital prior to transfer (regardless of imaging review) was associated with likelihood of EVT. Type of imaging performed and ability for accepting team to review imaging prior to transfer acceptance may help improve interhospital transfer resource utilization.
Abstract TP67: Rehabilitation Of Cognitive Deficits Post-stroke: Systematic Review And Meta-analysis Of Randomised Controlled Trials Of Non-pharmacological Interventions
Authors: O Donoghue Mairead , Leahy Siobhan , Boland Pauline , McManus John , galvin rose , Hayes Sara
Published: February 2022

Background and Purpose:
Stroke is among the leading causes of death and disability worldwide. Despite the prevalence of cognitive impairment post-stroke, there is uncertainty regarding the optimal type of rehabilitation intervention to improve cognitive functioning in people post-stroke. This systematic review and meta-analysis evaluates the effectiveness of rehabilitation interventions across multiple domains of cognitive function, namely, memory, attention, executive function, perception, apraxia and neglect, as well as general cognitive functioning.

Methods:
Five databases were searched from inception to August 2019. Eligible studies included randomised controlled trials (RCTs) of rehabilitation interventions for people with stroke when compared to other active interventions or standard care where cognitive function was an outcome.

Results:
Sixty-four RCTs (n= 4,005 participants) were included. Multiple component interventions improved general cognitive functioning (MD:1.56, 95% CI 0.69 to 2.43) and memory (SMD:0.49, 95% CI 0.27 to 0.72) compared to standard care. Physical activity interventions improved neglect (MD:13.99, 95% CI 12.67 to 15.32) and balance (MD:2.97 to 95% CI 0.71, 5.23) compared to active controls. Non-invasive brain stimulation (NIBS) impacted neglect (MD:20.79, 95% CI 14.53 to 27.04) and function (MD:14.02, 95% CI 8.41 to 19.62) compared to active controls. Neither cognitive rehabilitation (MD:0.37, 95% CI -0.94 to 1.69) or occupational-based interventions (MD:0.45, 95% CI -1.33 to 2.23) had a significant effect on cognitive function compared to standard care.

Conclusion:
The evidence regarding the effects of rehabilitation interventions for improving cognitive deficits post-stroke is uncertain. Finings must be considered in the context of moderate and high risk of bias across various methodological domains. There is some evidence to support multiple component interventions, physical activity interventions and NIBS protocols. However, findings must be interpreted with caution given the heterogeneity of interventions and outcome measures used across studies.
Abstract TP71: Characteristics And Demographics Of Patients Using Emergency Medical Services For Suspected Acute Stroke And Its Impact On Long-term Outcomes In A Multi Ethnic Population
Authors: Bhutta Zain A , AKHTAR NAVEED , Pathan Sameer A , Puolakka Tuukka , Harris Tim , Ganesan Gowrii Saswathy S , Kamran Saadat , Thomas Stephen H , Cameron Peter , Castren Maaret K
Published: February 2022

Introduction:
Acute ischemic stroke (IS) patients who receive IV thrombolysis are more likely to have good long-term prognosis. Unfortunately, more than two-third of IS patients present outside the therapeutic window. The use of emergency medical services (EMS) can reduce pre-hospital delay and increase likelihood of treatment with t-PA. We aim to determine the characteristic variations amongst the suspected acute stroke patients using EMS.

Methods:
In this retrospective observational study, all suspected acute stroke patients admitted to Hamad General Hospital from April 30, 2014 to September 15, 2020 were included. We evaluated demographics, clinical features, impact on treatment and associated factors in EMS versus non-EMS group.

Results:
During the study period, 11892 patients presented as suspected acute stroke. Of these, 65.1% used EMS (EMS-group). Mean age in EMS group was 53.4
+
14.1 versus 52.6
+
14.0 in non-EMS group (p = 0.003). Male to female ratio in both groups was 3:1. The proportion of patients who used EMS were higher in the Asian (66.8%), African (66.8%) and Caucasian (66.6%) population as compared to Arabs (61.9%). EMS use in Qatari population (59.2%) was relatively low. Intracerebral hemorrhage patients (82.4%) had a significantly higher EMS use followed by IS (65.7%) and cerebral venous thrombosis (64.7%); p<0.001. Symptom onset time of less than 4.5 hours at presentation was reported by 41% in EMS-group versus 24.3% in Non-EMS group. Patients with prior stroke (65.5%) and transient ischemic attack (58.4%) preferred EMS as compared to Non-EMS group (34.5% and 41.5%). Patients with unilateral weakness (66.4%) aphasia (78.2%), neglect (78.2%), dysarthria (68.4%), loss of consciousness (83.3%) and seizures (83.9%) had a higher use of EMS versus non-EMS group. The thrombolysis rate in EMS group was high vs non-EMS (82.4% vs 17.6%; p<0.001) with a door-to-needle time significantly lower in the EMS group (56.4
+
38.2 vs 75.7
+
43.8; p<0.001).

Conclusion:
EMS use facilitate rapid transfer, timely stroke evaluation and management of patients who need time-critical care. Patient characteristics and demographics, clinical symptoms and stroke type are associated with early stroke recognition and EMS use leading to higher recanalization rate.
Abstract TP75: LVO Screening Saves Lives
Authors: Janjua Nazli A , Tse-chang Karen , Jones Kimberly A , Rulloda Raquel , Woolfolk Katrina J , Keasler Debbie , POPALZAI Adeel
Published: February 2022

Background:
Since publication of the landmark endovascular thrombectomy trials for large vessel occlusion (LVO) ischemic stroke patients, many clinical tools to identify these patients have been developed. In the real world, resource constraints may limit these early activation strategies. Definitive guidelines by the American Heart Association recommending LVO screening tools await studies proving their impact on outcome. We therefore aimed to evaluate the implementation of our LVO screening tool in our hospital on both time and clinical metrics.

Methods:
Our previously validated “SNO” scale (expressive aphasia/speech, neglect, ocular deviation), has acceptable balance of user ease, sensitivity and specificity. October 2020 we began an LVO alert for patients presenting with at least 1 of the 3 above signs, and collected their data including baseline National Institutes of Health Stroke scale scores (NIHSSS), time metrics, and mortality rates and compared them between LVO activation and non activation groups using t-test and chi square.

Results:
Since 10/2020, 93 (22 endovascularly treated) LVO alerts were called compared with 55 (23 treated) patients in the same time epoch who fulfilled criteria but not LVO activated (1219 stroke alerts called in 2020). Mean age was 71 vs 74 years and NIHSSS were 21 vs 18. There was a trend towards earlier minutes from door to puncture (94 vs 110), device placement (113 vs 129), and recanalization (146 vs 152) between them. The most significant difference was in door to thrombolysis times (33 vs 49 minutes, p<0.03). Both groups had over 90% rate of successful recanalization. Discharge NIHSSS were not significantly different: 11 vs 9. There were more than twice the number of mortalities among the latter group (2 vs 5, p>0.05).

Discussion:
Although LVO activation using SNO criteria has shortened times to intervention in our hospital, clinical improvements may be dampened by ongoing issues limiting full adoption. But, those treatment modalities that require no additional resources, regardless of LVO (IV TPA) were expedited.

Conclusion:
LVO activation based on SNO criteria has shortened time to treatment. NIHSSS at discharge did not notably improve among the LVO activation group, but in house mortality was halved.
Abstract TP79: Palliative Care After Stroke In Patients With Left Ventricular Assist Devices: A Nationwide Analysis
Authors: Ibeh Chinwe , Tirschwell David L , Creutzfeldt Claire J
Published: February 2022

Background:
Stroke is a common cause of death in patients with left ventricular assist devices (LVADs) and there is wide variation around end-of-life care. Palliative care encounters (PCEs) are associated with 6% of all stroke-related hospitalizations in the US but little is known about the palliative care needs or practices of PCE after LVAD-related stroke. We sought to better understand current practices around PCE after LVAD-related stroke and its association with outcomes.

Methods:
Using the National Inpatient Sample (2012 - 2018) we identified all LVAD-related acute ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) hospitalizations. Demographics, clinical variables, utilization of life-prolonging interventions (LPIs; e.g., percutaneous endoscopic gastrostomy and tracheostomy) and outcomes were compared using multivariable regression.

Results:
952 LVAD-related strokes were identified (58% IS, 22% ICH, and 19% SAH); 30% occurred perioperatively. PCE was associated with 16.9% of strokes (in 11% of IS, 24% of ICH and 28% of SAH), a rate that remained stable over time (P=0.112 for trend). Women made up a smaller proportion of those receiving PCE (17% vs 25%, P = 0.05). PCE was associated with 6% of non-fatal strokes and 46% of strokes resulting in in-hospital death. Among patients who died, SAH had the highest rate of PCE (54%), followed by IS (44%), and ICH (40%). Among decedents, PCE was associated with less frequent use of LPIs in ICH and SAH but did not effect length of stay (Figure).

Conclusion:
Although PCE is utilized more frequently in LVAD-related stroke compared to rates in the general stroke population, many LVAD stroke patients die without PCE intervention. PCE is not consistently associated with less aggressive care or early death in LVAD patients dying of stroke. Further work is needed to increase patient and family awareness of PCE services aimed at directing goal-concordant care after devastating neurologic injuries.
Abstract TP80: Innovative Use Of A Large Real-world Database For Identifying Stroke Survivors And Access To Rehabilitation In Primary Care In Brazil
Authors: Machline Carrion Julia , Marton Pereira Pedro , Nathan Girotto Alysson N , Nieri Josue , Serafini Peter , Serafini Peter
Published: February 2022

Background:
As the impact of stroke continues, the number of people who require rehabilitation close to their homes will also increase. Primary health care will continue to be a critical platform for the identification and referral of stroke survivors who need long-term rehabilitation

Purpose:
We aimed at identifying stroke survivors assisted by community health workers (CHW) in Brazil as they relate to rehabilitation facilities locations.

Methods:
We used de-identified data from a real-world database generated by a free data collection app used by CHW from May 2015 to January 2021 in Brazil to identify stroke survivors, and to assess demographics and clinical characteristics. We used data from a public database,
Cadastro Nacional de Estabelecimentos de Saúde
(CNES), for identifying rehabilitation facilities. Locations were obtained by a Geocoding API (Google Maps Platform), distances were measured in kilometers (km) and travel time in minutes (min). Continuous variables were measured by mean (SD) and, categorical data in frequencies and percentages.

Results:
Among 2,397,764 individuals assisted by CHW that used the free app, 21,785 were stroke survivors, representing a 0.9% prevalence. Among this subgroup, the majority were from the Northeast region (50.3%), and 77.7% in urban areas. Most individuals (52.8%) were women, the mean age was 66.5 years (SD 14.7) and 4313 reported physical disability. A total of 348 re-habilitation facilities were identified, mostly located in the Southeast region (40.8%). The mean distance from stroke survivor to facility was 79.13 km and, mean travel time 81.16 min. The southern region has the largest mean distance (175.58 km) and travel time (144.48 min). Among patients that reported physical disability, the mean distance from stroke survivor to facility was 83.26 km and, mean travel time 85.29 min.

Conclusions:
We observed that stroke survivors’ distributions as they relate to rehabilitation facilities varies widely in Brazil. As a means of evaluating improvement of the clinical pathway and resources allocation for long term care, the use of large real-world databases and adequate analysis may assist in real needs assessments and policy changes.
Abstract TP84: Bias In Ordering Toxicology Screens In Stroke Patients
Authors: Mousa-Ibrahim Fady M , Pecoraro Alexandria , Kubicki Konrad , Richardson Christopher
Published: February 2022

Background:
Current guidelines for the management of acute ischemic stroke (IS) in 2021, and intracerebral hemorrhage (ICH) in 2015 recommend toxicology (TOX) screens to detect cocaine and other sympathomimetic drugs of abuse without discrimination by race/ethnicity or socioeconomic status. Retrospective studies have demonstrated bias, however, on drug screening of young African-American ICH patients despite current guidelines. We sought to explore our current screens use for both IS and ICH patients to discover if there was any bias in our clinical practices.

Methods:
A single center retrospective review of electronic medical records between January 1
st
2018-Dec 31
st
2019. With the following diagnosis; IS, transient ischemic attack (TIA), ICH, and subarachnoid hemorrhage We recorded demographic data; age, gender, race/ethnicity, insurance status, cardiovascular comorbidities, drug and alcohol screen. We present data with descriptive statistics with plans for covariant analyses

Results:
We reviewed 725 patient charts. There were 406 (56%) white, 161 (23%) African American, 90 (12%)Hispanic and 66 (9%)other race/ethnicities. There was 146/725 (20%) tox screens ordered. Distributed by race; 61/408(15%) white, 56/161 (35%), African-Americans 20/90 (23%) Hispanic and 8/166 (12%) others had tox screens. Tox was ordered in 75/373 (20%) males and 71/352 (20%) females. By insurance status, patients with tox screens had predominantly Medicaid (44%) or no-insurance (30%). Tox screens was ordered on 31% of those <55 yo and tox screen was ordered on 17% >55 yo. There was 483/725 (66%) IS or TIA and 242/725 (33%) ICH. Tox screen was ordered on 82/483 (17%) IS and 65/242 (27%) ICH

Conclusion:
At our center, there appears to be unintended ethnic and/or economic bias in ordering toxicology screens both for ICH and IS. Awareness of implicit bias and better standardization in care processes for evaluation of drug and alcohol use in ischemic and hemorrhagic stroke patients is essential.
Abstract TP90: Challenges Implementing An Innovative Home Health Evaluations And Active Living Program
Authors: Johnson Keri , Chapman Sherita , Aldridge Chad , Madden Thomas , Shields Irene , Howe Savannah , Motuz Danica , Schneider Brett , Gladney Leslie , Turner Heather
Published: February 2022

Introduction:
Approximately 50% of stroke patients are discharged to home from the hospital. Post stroke transitional care is fragmented and unorganized leading to poor patient outcomes, hospital readmissions, decreased functional status, and increased caregiver burden. We discuss our experience implementing a multidisciplinary team-based post stroke transitional telehealth program.

Methods:
Acute stroke patients discharged home were invited to participate in a 90-day telehealth program, iHEAL, upon discharge. Inclusion criteria included 2 or more uncontrolled risk factors requiring medication management, two or more therapy needs, WiFi at home, knowledge of technology, and agreement to follow up with iHEAL program providers. Patients were discharged with remote monitoring devices (blood pressure monitor, medication adherence device) and an iPad for telehealth visits with the stroke NP and both the neurology pharmacist and therapists. Surveys were completed by participants during and after completion of the program.

Results:
Of approximately 167 patients discharged home within the initial 9 months, 6 patients enrolled in iHEAL. The most common reasons for ineligibility were lack of two therapy needs and lack of two risk factors in need of medication adjustment excluding 69% of patients when combined in addition to limited internet access in the home. There have been no readmissions. Medications were scanned 50% of the time. Blood pressure readings were maintained or decreased for all patients. Telehealth visit completion: 50% NP, 40% Pharmacist
,
40% PT, 20% OT and 40% SLP. Most reported feeling comfortable using the iHEAL equipment (80%) and 100% reported satisfaction with the program and would recommend to others.

Conclusion:
Enrollment in iHEAL has been unexpectedly difficult due to overly stringent enrollment criteria and limited broadband internet access in Central Virginia and surrounding regions. These difficulties led to changing criteria in Month 10 to one therapy need and removing the requirement for medication management of the two identified risk factors. Follow up data to be included in final presentation.
Abstract TP99: Hemorrhagic Conversion Of Ischemic Stroke Is Associated With Hematoma Expansion
Authors: Palaychuk Natalie , Changa Abhinav , Dogra Siddhant , Wei Jason , Lewis Ariane , Lord Aaron , Ishida Koto , Zhang Cen , Czeisler Barry M , Torres Jose L , Frontera Jennifer , Dehkharghani Seena , Melmed Kara R
Published: February 2022

Objectives:
Hemorrhagic conversion of ischemic stroke (HCIS) is a common complication of cerebral ischemia and is associated with worse stroke outcomes. Differentiation between HCIS and other causes of intracerebral hemorrhage (ICH) can be challenging in practice. We sought to determine whether imaging features of hematoma expansion (HE) can be used to discriminate HCIS from other etiologies of ICH.

Materials and Methods:
We performed a retrospective review of patients admitted to two large urban hospitals between 2015-2020 with non-traumatic ICH and at least two head CTs within the initial 24 hours and brain MRI prior to discharge to assist with etiology identification. ICH etiology was determined by expert consensus. HE was defined as ≥6 mL and/or ≥33% growth between the first and second scan. Clinical and imaging covariates were studied using univariable and multivariable regression to assess the relationship between cause of intracerebral hemorrhage and HE. We evaluated whether HE was associated with functional status on discharge.

Results:
258 patients (median age 66 [51-76], 43% female) met our inclusion criteria including 37 (14%) with HCIS as the presumed cause of hemorrhage. Etiology for ICH was hypertensive in 29%, vascular in 27%, and cerebral amyloid angiopathy in 13%. HE occurred in 11/37 (30%) patients with HCIS, and in 33/221(15%) patients with other causes (p= 0.04). History of anticoagulation use was more frequent in patients with HCIS (24% vs 11%, p= 0.04), although there was no significant difference in admission INR or platelet count. There was no difference in age, admission systolic blood pressure, admission hematoma size or ICH score between groups. HCIS was significantly associated with HE (OR 2.4, CI 1.08-5.34, p=0.03) on univariable analysis. When controlling for hematoma size and anticoagulant use, the relationship between HCIS and HE remained significant (aOR 2.68, CI 1.17-6.13, p=0.02). Patients with HCIS had a higher modified Rankin scale on discharge when compared to those with ICH due to other causes ((mRS 5 [4-5.5] vs. mRS 4 [2-4], p<0.001).

Conclusion:
HE within the first 24 hours is more common in HCIS than in other etiologies of ICH. Imaging signatures of HE may be contributory towards determining ICH etiology.