bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP301: Timing of Occurrence of MRI DWI Abnormalities in Patients with Spontaneous Intracerebral Hemorrhages: A Subgroup Analysis from The SHRINC Trial
Authors: Kawano-Castillo Jorge , Sangha Navdeep , Choi Ellie Eun Ju , Martinez Rebecca , Kauffman Teslyn , Pandurengan Renganayaki , Peng Hui , Rahbar Mohammad H , Aronowski Jarek (Jaroslaw) , Grotta James C , Gonzales Nicole R
Published: July 2021

BACKGROUND
MRI DWI abnormalities have been reported in 22-35% of patients with intracerebral hemorrhage (ICH). The mechanism underlying these changes is unknown. The timing of development of DWI changes has not been well described. We evaluated the time at which DWI changes occurred in a prospective database of patients with spontaneous ICH in the Safety of Pioglitazone for Hematoma Resolution In Intracerebral Hemorrhage trial (SHRINC). We also sought to examine if clinical features might predict the time at which DWI changes occurred.

METHODS
SHRINC is an ongoing prospective, randomized study evaluating the safety of pioglitazone versus placebo in patients with ICH. Patients undergo serial MRI on Day (D)1, D2, D7/14, D28, and D42. We captured the occurrence of DWI lesions on MRI and categorized patients into 4 groups according to the time of onset of DWI lesions: observed on admission (hyperacute), D2 (acute), D7 or 14 (subacute) or >28 days (chronic). Patients were excluded if they did not have an MRI for comparison on the selected days. Baseline characteristics were collected prospectively on admission and compared between groups.

RESULTS:
Thirty patients had complete imaging; 17 (56.67%) had DWI abnormalities in total. Characteristics are included in Table 1. Seven patients (23.33%) had DWI abnormalities remote from the ICH. There were no differences in the baseline characteristics between the groups except INR was significantly lower in the hyperacute group compared to the chronic group (p<0.05).

CONCLUSION:
Our data demonstrate that DWI lesions are more frequently seen at the time of initial ICH. The occurrence of DWI lesions at later time points suggests there may be different mechanisms accounting for these changes. Our study is limited by the small sample size and blinded nature of treatment allocation. Further study is needed to understand the underlying mechanisms of these DWI changes and their clinical relevance.
Abstract WP305: Impact of Potential Systolic Blood Pressure Treatment Thresholds on Hematoma Growth in Acute Intracerebral Hemorrhage
Authors: Rodriguez-Luna David , Rubiera Marta , Muchada Marian , Coscojuela Pilar , Ribo Marc , Pagola Jorge , Flores Alan , Ibarra Bernardo , Meler Pilar , Sanjuan Estela , Hernandez-Guillamon Mar , Alvarez-Sabin Jose , Montaner Joan , Molina Carlos A
Published: July 2021

Background:
Although the current AHA guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg in acute intracerebral hemorrhage (ICH), little is known about the relationships between different therapeutic target thresholds and hematoma growth (HG). Therefore, we aimed to investigate the impact of potential SBP treatment thresholds on HG in patients with acute ICH.

Methods:
This study was a secondary analysis of data prospectively collected during a previously reported study of the impact of blood pressure (BP) on HG in 106 patients with acute (<6 hours) supratentorial ICH. Patients underwent baseline and 24-hour computed tomography scans, and noninvasive BP monitoring at 15 minutes interval over first 24 hours. SBP loads were defined as the percentage of 24-hour SBP monitoring values exceeding 140, 150, 160, 170, 180, 190, and 200 mmHg. HG was defined as a relative enlargement greater than 33% or an absolute expansion more than 6 mL at 24 hours.

Results:
Patients who experienced HG (34%) presented higher SBP loads in all thresholds, reaching statistical significance in 170, 180, and 190 thresholds, but not in the others (Figure). Whilst SBP load thresholds were correlated neither with baseline nor 24-hour ICH volumes, highest (170 to 200) but not lowest (140 to 160) SBP load thresholds were significantly correlated with the amount of both relative and absolute hematoma enlargement at 24 hours (p<0.05). In multivariate analyses, both SBP 170-load (OR 1.034, 95% CI 1.001-1.070, p=0.048) and 180-load (OR 1.052, 95% CI 1.010-1.097, p=0.016) were independently related to HG.

Conclusions:
In patients with acute supratentorial ICH, those who experience HG present higher SBP load from 140 to 200 mmHg thresholds. More intensive SBP-lowering treatment than guidelines recommendations is needed, at least below 170 mmHg, in order to minimize the deleterious effect of higher SBP on HG.
Abstract WP315: A 3 Month Follow-up Of A Client-centred Activity Of Daily Living Intervention After Stroke: A Multicenter Randomized Controlled Trial
Authors: Ranner Maria , Bertilsson Ann-Sofie , Guidetti Susanne , Johansson Ulla , Eriksson Gunilla , Ytterberg Charlotte , Ekstam Lisa , Andersson Magnus , Tham Kerstin , von Koch Lena
Published: July 2021

A goal for rehabilitation after stroke is to regain the ability to manage activities of daily living (ADL). The Swedish health care legislation recognizes that individuals bring unique sets of needs and preferences to encounters with the health care system, which should impact the services delivered. Consequently rehabilitation needs to be designed to meet each individual’s concern i.e., be client-centered. This implies interventions tailored to the client’s ability and perceived needs, services that take the client’s unique life-world experiences as the point of departure for goals and collaboration during the rehabilitation. However, studies on such services are scarce. Thus the aim was to compare a client-centered ADL intervention (CADL) to usual ADL training (UADL) regarding perceived participation, independence in ADL and life satisfaction at 3 months after inclusion.

Methods:
Sixteen rehabilitation units in Stockholm, Uppsala and Gävleborg, Sweden were randomly assigned to deliver either CADL or UADL to people in need of ADL rehabilitation after stroke. The occupational therapists (OT) who delivered the CADL were specifically trained. At 3 months perceived participation was assessed with the Stroke impact scale (SIS) and the Occupational Gaps questionnaire (OGQ), self-reported dependence in ADL with the Barthel Index (BI) and the Katz Extended ADL Index (KE), and life satisfaction with the LiSat-11. Number of contacts with an OT was collected in the clients’ medical records. Intention-to-treat analysis was applied. The significance level was set to 0.05. ClinicalTrials.gov identifier:
NCT01417585
.

Results:
Two hundred and eighty persons with stroke were included (CADL n=126, UADL n=154). The mean number of OT sessions in the CADL was 19 and 14 in the UADL group. There were no differences regarding SIS (p=0.64), OGQ (p=0.15), BI (p=0.06), KE (p=0.78) or in LiSat-11 (p=0.77).

Conclusion:
Albeit people with stroke who receive CADL tend to be more independent in ADL at 3 months it is likely that differences in perceived participation and life satisfaction will not be present until later. Thus there is a need to evaluate such services in the long term, their impact on significant others and qualitative studies of the clients’ experiences.
Abstract WP321: Somatosensory Stimulation Combined with Moderate Intensity Therapeutic Exercise Significantly Improves Motor Function in Chronic Stroke Survivors
Authors: GOBERT DENISE , Merring Curtis , Dugan Kristin
Published: July 2021

Background:
Somatosensory stimulation using electrical microcurrents (MSOMA) has proven efficacious for treatment of pain and tissue healing however little is known about its use to augment hemiparetic muscle response to therapeutic exercise. The study aimed to investigate functional upper limb control in chronic stroke survivors in response to a standardized combination of MSOMA and moderate intensity therapeutic exercise.

Methods:
18 chronic stroke survivors (M/F = 12 / 6), age 59.68 +/- 18.67 years were assigned to two treatment groups with (n= 10), and without MSOMA (n = 8) in a university outpatient physical therapy clinic. Chronicity of impairment was 3.75 +/- 2.23 years. All groups participated in therapeutic exercise using “forced-use” of impaired limbs including total body reciprocal training and robot-assisted limb activities for 12 weeks. The MSOMA group received electrotherapy during clinic sessions and used the units during a standardized Home Exercise Program prescribed for both treatment groups. All patients were assessed at Baseline, 6-weeks and 12-weeks.

Variables:
Outcomes included Motor Activity Log-28 (MAL), Stroke Impact Scale (SIS), Box & Blocks Test (BBT), grip strength (GRIP) and surface EMG activity in both upper extremities during a “Push Task” simulating the sit-to-stand transfer. EMG outcomes included mean muscle activity (MMA), and relative intra- and inter-limb muscle activity.

Data Analysis:
Statistical data analysis included descriptive statistics and repeated measures ANCOVA with Eta-squared values (η2). Games-Howell Post Hoc analysis with a Bonferroni correction was used at an alpha level of 0.05.

Results:
Results indicate a significant group difference with a low to moderate effect size for BBT (p = 0.086, η2 = 0.041), GRIP (p = 0.010, η2 = 0.384) and MMA values at 12-weeks with a significant Group x Time interaction effect for MAL (p = 0.040, η2 = 0.238) and SIS scores (p = 0.027, η2 = 0.344).

Conclusions:
Results indicate that standardized MSOMA combined with moderate intensity therapeutic exercise is tolerated well by chronic stroke survivors and can significantly improve fine and gross motor function in impaired upper limbs. Further investigation is warranted to explore dosage-specific responses in patients.
Abstract WP330: Hospital and EMS Collaborate to Improve Field Stroke Recognition
Authors: King Shelleen , Jenkins Jason
Published: July 2021

Background:
Comprehensive Stroke Center (CSC) measure DSPR.2 recommends that hospitals collaborate with EMS providers regarding routing and transport plans and educational initiatives. Paramedics have a 61 -66% accuracy in identifying stroke cases with standard training, but this is reported to improve to 86-97% when training includes stroke-specific tools such as the Cincinnati Pre-hospital Stroke Scale (CPSS) or Los Angeles Pre-hospital Stroke Screen.
1
A CPSS-trained EMS team that transports cases to the neuroscience institute requested an assessment of their accuracy in diagnosing stroke in the field as compared to the actual discharge diagnosis.

Method:
Retrospective review of the EMS data for neurological transports and the hospital database between January 2010 and June 2012 to compare hospital discharge diagnosis to EMS field diagnosis using the CPSS.

Result:
Of the 74 cases transported for neurological evaluation, 57(77%) were thought to be strokes using the CPSS. At hospital discharge, 28/57(49%) had a confirmed diagnosis of stroke. Overall, 59/74(80%)were discharged with a neurological diagnosis.

Conclusions:
The accuracy of EMS diagnosis of stroke in the field fell far below their expectations based on the literature. This result led to an action plan for our hospital to partner with the EMS team to increase their accuracy by providing a higher level of education for stroke assessment. This presentation will discuss the performance improvement initiative undertaken by the hospital outreach team with the EMS providers. Based on quarterly case review results, this process may be expanded to include other local and regional EMS systems.
Abstract WP342: Clinical Practice Guidelines supported through Interdisciplinary Stroke Rounds
Authors: Krokoski Brenda
Published: July 2021

Purpose:
Interdisciplinary stroke rounds were created as a communication forum for staff working with the stroke survivor and family in our hospital stroke unit. The interdisciplinary team discusses patient specific needs in addition to met and unmet clinical practice guidelines.

Methods:
Interdisciplinary stroke rounds are scheduled daily at a set time in the stroke unit conference room. The team is comprised of the following members and disciplines: RN Unit Manager, RN charge nurse, RN caregiver for the patient, Stroke program Nurse Coordinator, Physician Director of the Stroke Program, rehabilitation specialists: speech, occupational therapy, physical therapy, registered dietician, chaplain, casemanager, liaison RN for admission to acute rehabilitation, skilled nursing or outpatient rehabilitation. A precise discussion is coordinated by the RN charge nurse or the Stroke Nurse Coordinator using a stroke performance measure template accessible to the team.

The interdisciplinary team provides input related to their expertise. Eight of the standard stroke performance measures are discussed and addressed for compliance. Compliant staff documentation and patient education opportunities are discussed and interdisciplinary care plans are activated.

The interdisciplinary team summarizes the needs identified in stroke rounds and each member is responsible for completion before the end of their shift.

Results:
Our hospital has earned the Stroke Get with the Guidelines (GWTG) gold plus award for multiple consecutive years. Compliance with the national standards for stroke reflected within our GWTG data is largely due to our interdisciplinary stroke rounds and staff accountability.

Conclusions:
Utilizing a specific stroke performance measure tool during interdisciplionary stroke rounds enables our team to review all stroke performance measures, ensure documentation is complete and allows an interchange of ideas among disciplines to provide the best care to the stroke survivor and family..
Abstract WP395: Classification of Periventricular White Matter Disease (WMD) in Clinical Radiology Reports vs. Direct Film Review in Ischemic Stroke Patients
Authors: Hancher Jonathan , Eilerman Jane , Alwell Kathleen , Sucharew Heidi , Moomaw Charles J , Woo Daniel , Flaherty Matthew L , Khatri Pooja , Adeoye Opeolu , Ferioli Simona , Martini Sharyl , de los Rios la Rosa Felipe , Kleindorfer Dawn , Kissela Brett M
Published: July 2021

Background:
Severe WMD is associated with post-stroke mortality, recurrent stroke risk, cognitive decline, and poor functional outcomes. We have previously reported that “severe” WMD grade is likely when the clinical radiology report includes the words “severe, extensive, advanced, or diffuse”. We examined whether terms consistent with the Fazekas WMD grading scale (none, mild, moderate, or severe) in clinical radiology reports can be used to categorize WMD severity in epidemiologic stroke studies, and sought to repeat our factor analysis with descriptive terms.

Methods:
Clinical reports from 688 ischemic stroke subjects with MRI or CT films from 2010 were reviewed by physician investigators, who recorded whether WMD was described and whether the Fazekas terms or similar descriptors (such as diffuse, patchy, extensive, etc.) were used. A stroke neurologist and a research assistant independently evaluated available neuroimaging studies and categorized WMD severity according to the Fazekas grades. WMD was preferentially graded on MRI scans; CT scans were assessed if MRIs were unavailable or not performed. Kappa statistic was used to compare the grade mentioned in the report with our direct review; factor analysis was applied to the descriptor terms and logistic regression performed to examine predictive value of descriptor terms with WMD grade from direct review.

Results:
Of the 688, 276 had WMD radiologist grades available, 222 had no grades and no descriptors, and 190 had no grades but had descriptors. For all films with grades available, the weighted kappa score was 0.30, indicating poor agreement between the radiologist’s WMD grade and the reviewer’s WMD grade. Examining only the 231 MRI studies with WMD grades did not improve the weighted kappa score (0.34). Factor analysis found clusters of descriptors that were significantly associated with WMD grades: “scattered, minimal, tiny, punctate, spotty” with mild (p=0.0001); “multiple, patchy, diffuse” with moderate (p=0.01); and “advanced, confluent, extensive” with severe (p = 0.002).

Discussion:
Fazekas terms in clinical radiology reports do not seem to be useful by themselves, but descriptors used in clinical radiology reports may be utilized to approximate PVWMD severity.
Abstract WP405: Sex Differences in Post-Stroke Functional Outcomes
Authors: Lisabeth Lynda , Reeves Mathew J , Baek Jonggyu , Sanchez Brisa N , Skolarus Lesli E , Brown Devin L , Morgenstern Lewis B
Published: July 2021

Background:
Studies consistently show that women have less favorable functional outcomes after stroke than men but the causes are uncertain. Our objective was to assess sex differences in functional outcomes measured 90-days post event in a population-based stroke study and to identify which pre-stroke factors and clinical stroke characteristics explain sex differences.

Methods:
Ischemic stroke patients (n=398) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2008-2011). Data were ascertained from in-person patient or proxy interviews (baseline and 90 days post-stroke) and medical records. Functional outcome at 90 days was measured as total ADL/IADL score (range 22-88, higher scores indicate poorer function). Tobit regression was used to estimate sex differences in outcome. To identify clinically important confounding factors, individual variables were added to age-adjusted models to determine if the sex difference changed by ≥ 5%. A final multivariable model was run including sex, age, ethnicity, and identified confounders.

Results:
Median age was 69 (IQR: 57, 79) and 52% were women. In crude and age-adjusted models women scored 11.2 points (p<0.001) and 8.7 points (p<0.001) higher on the ADL/IADL score respectively. After accounting for age, stroke severity, pre-stroke functional and cognitive status, pre-stroke comorbidity index, nursing home residence, history of stroke/TIA, BMI and marital status were all clinically important confounders of the sex difference. In the final multivariable model, a sex difference in functional outcome remained, with women scoring 6.2 points higher on the ADL/IADL score than men (p<0.01).

Conclusions:
Women had poorer functional outcomes post stroke even after accounting for differences in age, pre-stroke confounding factors and stroke severity. Age, pre-stroke factors and stroke severity explained about half of the total observed sex difference. Further research is needed to identify the reasons why women have poorer outcomes in order to design interventions aimed at reducing stroke disability in women.
Abstract WP430: Utility of Prolonged Transcranial Doppler Monitoring in the Detection of Vasospasm and Stroke after Subarachnoid Hemorrhage: Is 10 days enough?
Authors: Kass-Hout Tareq , Kass-hout Omar , Winningham Melanie , Bishara Nawar , Mailyan Eugene , Webb Adam , Martin Kathleen , Samuels Owen , Nahab Fadi
Published: July 2021

Background:
Transcranial Doppler (TCD) monitoring is commonly used to identify cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) though its utility after day 10 has been questioned. The objective of our study was to determine the frequency of vasospasm by TCD in SAH patients who underwent prolonged monitoring (beyond day 10).

Methods:
We retrospectively identified all SAH patients seen at Emory University Hospital in 2011 who underwent TCD monitoring beyond 10 days. Outcomes of interest included cerebral vasospasm on TCD and delayed ischemic neurological deficit (DIND) beyond day 10.

Results:
Of 93 patients who met inclusion criteria, 66 (71%) experienced vasospasm and 28 (31%) developed DIND beyond day 10; of patients with DIND, TCD identified vasospasm in 24 (86%). Vasospasm on TCD was a predictor of DIND in univariate analysis (OR 3.29; 95% CI 1.015 to 10.63) but was not significant in multivariable analysis when adjusted for admission Hunt and Hess score.

Conclusion:
Prolonged TCD monitoring (beyond day 10) identified a high frequency of cerebral vasospasm in our subset of patients though was not a significant predictor of DIND in multivariable analysis. Prolonged TCD monitoring needs to be evaluated in a prospective study to determine its utility as a predictor of DIND.
Abstract WP445: Age Differences in the Impact of Sleep Apnea on Cognition and Quality of Life
Authors: Addison-Brown Kristin J , Letter Abraham J , Yaggi Henry K , McClure Leslie A , Unverzagt Frederick W , Howard Virginia J , Lichtman Judith H , Wadley Virginia G
Published: July 2021

Introduction:
Using a subsample from the national REasons for Geographic And Racial Differences in Stroke (REGARDS) study, we examined the associations of obstructive sleep apnea (OSA) with cognition and quality of life and whether these associations vary with age while controlling for other demographic factors and comorbid medical conditions.

Methods:
Stroke-free participants with complete data on OSA risk, cognition, and quality of life as of October 2010 were included (N =2,925; ages 47-93, 43% men, 35% black, 65% white). OSA risk was defined as high or low based on responses to the Berlin Sleep Questionnaire (BSQ). Cognitive function was assessed with three validated fluency and recall measures; quality of life was assessed with the 4-item Center for Epidemiological Studies-Depression (CESD-4) scale and the Medical Outcomes Study Short Form-12 (SF-12). MANCOVA statistics were applied to the cognitive and quality of life outcomes separately while accounting for potential confounders (age, sex, race, education, diabetes and dyslipidemia). Body mass index and hypertension were taken into account as part of the BSQ definition of OSA risk.

Results:
In fully adjusted models, those at high risk for OSA had significantly lower cognitive scores (p < .05) and lower quality of life (depressive symptoms and SF-12) (p < .0001) than those at low risk. Some of the associations were age-dependent, such that younger participants with high OSA risk had worse cognitive and quality of life scores than both younger participants with low OSA risk and older participants with high OSA risk.

Discussion:
Lower cognitive function and lower quality of life in those at high risk for sleep apnea remained after accounting for potentially confounding factors in a population-based sample. These relationships were more pronounced during middle age, with attenuated effects after age 70. It may be of particular importance to detect and treat OSA in younger adults.
Abstract WP45: Comparison of Automated Whole Brain CT Perfusion Analysis with Perfusion-Diffusion MRI in Ischemic Stroke
Authors: Campbell Bruce C , Christensen Søren , Yassi Nawaf , Sharma Gagan , Bivard Andrew , Lin LongTin , Levi Christopher R , Desmond Patricia M , Donnan Geoffrey A , Straka Matus , Lansberg Maarten G , Bammer Roland , Albers Gregory W , Davis Stephen M , Parsons Mark W
Published: July 2021

Background and purpose:
CT perfusion (CTP) provides rapid and accessible imaging of ischemic stroke pathophysiology. Studies with limited brain coverage CTP have suggested that relative cerebral blood flow (relCBF) is the optimal CTP parameter to define irreversible infarction. We analyzed patients with whole brain CT perfusion and contemporaneous MR perfusion-diffusion imaging to confirm the optimal CTP parameter for infarct core and compare mismatch classification between MR and CT.

Methods:
Acute ischemic stroke patients <6hr after onset had whole brain CTP (320slice) closely followed by perfusion-diffusion MRI. Maps of CBF, CBV and time-to-peak of the deconvolved tissue residue function (Tmax) were generated by RAPID automated perfusion analysis software (Stanford University) using delay insensitive deconvolution. The optimal CTP map to identify infarct core was selected by maximizing the average Dice co-efficient across the same threshold range for all patients using co-registered diffusion lesion (manually outlined to its maximal visual extent) as reference region. Mismatch classification agreement between CT and MRI was then assessed using 2 definitions: mismatch ratio a) >1.2 or b) >1.8, absolute mismatch a) >10mL or b) >15mL, infarct core<70mL.

Results:
In 28 patients imaged <6hr from stroke onset (median age 69, median onset to CT 180min, median CT to MR 69min), relCBF provided the most accurate estimate for infarct core, significantly better than absolute or relative CBV (both p<0.001). Using relCBF to generate acute CTP infarct core volumes, the median magnitude of volume difference versus diffusion MR was 6.9mL, interquartile range 1.6-27.4mL. CTP mismatch between relCBF core and Tmax>6sec perfusion lesion was assessed in 25 patients (3/28 had no MR perfusion). CTP and MR perfusion-diffusion mismatch classification agreed in 23/25 (92%) patients (kappa 0.84) using either definition.

Conclusions:
This study using whole brain CTP confirms the greater accuracy of CBF over CBV for estimation of the infarct core. The >90% agreement in mismatch classification between CTP and MRI supports the concept that both modalities can identify similar patient populations for clinical trials of reperfusion therapies.
Abstract WP75: Dual Antiplatelet Therapy in Addition to Post-Operative Heparin and Dextran Reduces Clinically Symptomatic Thromboembolic Events During Elective Aneurysm Coiling
Authors: Wilson TJ , Davis Matthew , Pandey Aditya S , Stetler William , Chaudhary Neeraj , Gemmete Joseph , Thompson B. Gregory
Published: July 2021

BACKGROUND:
Thromboembolism is a feared complication of coiling a cerebral aneurysm. The purpose of this study was to compare the thromboembolic events between cerebral aneurysms coiled with an anti-thromboembolic regimen versus those with no regimen.

METHODS:
This retrospective cohort study included all adult patients who underwent elective coiling of an intracranial aneurysm between January 1, 2005 and February 1, 2012. All aneurysms were treated with conventional coiling. Patients were started on aspirin and clopidogrel for seven days prior to treatment with aspirin continued indefinitely and clopidogrel for 4 weeks post-coiling. During the coiling procedure patients were given heparin to maintain an activated clotting time 2.5x baseline. Additionally, dextran-40 and heparin were infused for 24 hours post coil placement. The primary endpoint was the presence of a clinically significant thromboembolic event as determine by physical exam and/or MRI diffusion weighted imaging. Each variable was analyzed for its independent association with the occurrence of an embolic event.

RESULTS:
312 aneurysms were electively treated. 261 of 312 aneurysms received our anti-thromboembolic regimen versus 51 who did not. There were a total of 6 (1.9%) embolic events. Patients who received the anti-thromboembolic regimen had 3 (1.1%) embolic events versus 3 (5.9%) in those not receiving the regimen (
p
= 0.024). Patients receiving the anti-thromboembolic regimen had significantly more active tobacco use but the two groups did not differ in age, sex, or the presence of obesity, diabetes, or hypercoagulable state. There was no difference in the occurrence of central nervous system or systemic hemorrhages between the two groups. In univariate analysis, the presence of a hypercoagulable state (
p
= 0.014) and the lack of anti-embolic regimen (
p
= 0.043) were associated with the occurrence of an embolic event. Both remained significant in multivariate analysis (
p
= 0.016 and
p
= 0.048, respectively).

CONCLUSION:
An anti-thromboembolic regimen consisting of dual antiplatelet therapy plus post-operative heparin and dextran reduced the risk of embolic events during elective aneurysm coiling. This regimen was safe, with no observed increase in hemorrhagic complications.
Abstract WP95: Delayed Progesterone Treatment Attenuates Infarct and Behavioral Deficits Induced by Permanent Middle Cerebral Artery Occlusion (pMCAO) in Middle-Aged Rats: Therapeutic Time Window Study
Authors: Wali Bushra , Sayeed Iqbal , Ishrat Tauheed , Yousuf Seema , Won Soonmi , Stein Donald G
Published: July 2021

BACKGROUND:
Previously we carried out a dose response study and reported 8 mg/kg PROG to be the optimal therapeutic dose following in pMCAO. A systematic preclinical progesterone (PROG) therapeutic time window study is lacking. In the present study we used a clinically relevant middle-aged rat and long-term sensory, motor, and cognitive outcome measures to determine the effects of delayed PROG treatment.

METHODS:
Male Sprague-Dawley rats (12 months old) underwent pMCAO by electrocoagulation or sham operation. Beginning 3, 6, or 24 h post-occlusion, rats were given IP injections of 8 mg/kg of PROG or vehicle, followed by SC injections at 5 h after the first IP injection and then every 24 h for 7 days. The dose was tapered over the final 2 treatments. Behavioral recovery was evaluated at repeated intervals on sensory, motor, and cognitive tasks. Rats were killed at 22 days post-stroke and brains perfused for infarct evaluation.

RESULTS:
Three weeks post-pMCAO, PROG treatment delayed by 3 h improved grip strength by 64.48%, rotarod stability by 94.29%, sensory neglect by 94.48%, and long-term memory deficits by 60.56%. PROG treatment delayed by 6 h improved grip strength by 82.62%, rotarod stability by 75.89%, sensory neglect by 60.14%, and long-term memory deficits by 60.16%. Automated, computer-assisted gait assessment showed that PROG treatments significantly improved motor deficits in the affected limb on parameters like stride length, paw print and swing speed. When PROG treatment was compared to non-treated group, a significant reduction of 49.59 and 58.06% in infarct size was observed with 3- (
F
(1,14)
= 8.25,
p
<0.01) and 6-h delay of treatment (
F
(1,13)
= 4.44,
p
<0.05), respectively.

CONCLUSION:
The therapeutic dose of 8 mg/kg PROG was found to be effective within a large therapeutic time window. After both 3- and 6-h delays, PROG was effective in improving motor, sensory and memory function deficit. A 24-h treatment delay did not produce significant improvement in most of the outcome measures. PROG shows pre-clinical promise and should be examined for safety and efficacy in a clinical trial for ischemic stroke.
Abstract 101: Educational Level, Emergency Medical Services Activation and Hospital Arrival in Acute Stroke
Authors: Silva Gisele S , Andrade Viana Georgiana , Borges Machado Cícera , Fortunato Cardoso dos Santos Bento , Bueno Alves Monique , Carolina Acre Nunes Miranda Renata , Cendoroglo Neto Miguel , Freitas de Carvalho João José
Published: July 2021

Background:
Several studies report that certain factors such as socioeconomic status, living alone or being alone at onset of symptoms play a role in late arrival at hospitals thereby decreasing the ultimate success of medical interventions for stroke patients. There is little research about the influence of educational level upon early arrival in patients with acute stroke. We hypothesized that higher educational level is associated with early arrivals in patients with acute stroke.

Methods:
We conducted a prospective cohort study to evaluate consecutive patients admitted with a new stroke in 19 hospitals in Fortaleza, Brazil, from April 2009 to April 2012. Educational attainment was categorized into 5 levels: no school attendance, less than secondary school graduation, secondary school graduation, bachelor's degree and master's or doctorate degree. Multiple logistic regressions were used to investigate the influence of epidemiologic and clinical data on the frequency of early arrival (defined as hospital arrival within 4.5 hours from symptoms onset).

Results:
We evaluated 4679 patients (48% males, mean age: 67.67± 14.48). Ischemic stroke was the most frequent subtype (74.9%) followed by intraparenchymal hemorrhage (14.5%), subarachnoid hemorrhage (5.1%), transient ischemic attack (2.8%), and undetermined stroke (2.7%). A total of 1128 (24.1%) patients arrived within 4.5 hours from symptoms onset. Higher educational level was a predictor of early hospital arrival (p= 0.01). Other univariate predictors of early hospital arrival included having a decreased level of consciousness at presentation OR 1.36 [1.17-1.58], p<0.01, having a hemorrhagic stroke OR 1.46 [1.19-1.79] p<0.01, having a transient ischemic attack OR 2.2 [1.50-3.49] and arriving by emergency medical services (EMS) OR 0.37 [0.31-0.44]. In the multivariate logistic regression analysis, educational level just remains as an independent predictor of early hospital arrival if arriving by EMS is not included in the model.

Conclusions:
Educational level is associated with early hospital arrival in patients with acute stroke. The association between educational level and early hospital arrival seems to be mediated by activation of the EMS.
Abstract 105: Geographic Disparities in Emergency Medical Services Calls for Stroke in Chicago
Authors: Prabhakaran Shyam , Schuble Todd , Beck Eric , Richards Christopher , Stein-Spencer Leslee , Aggarwal Neelum , Choucair Bechara , O'Neill Kathleen
Published: July 2021

Introduction:
Geographic Information Systems (GIS) is a methodology for matching clinical and spatial metrics to inform public health intervention and policy development. We evaluated statistical hot spots for emergency medical services (EMS) calls for stroke and compared these with stroke admission rates in Chicago.

Methods:
In a retrospective review, we compared stroke hospitalizations (ICD-9 code 430-436) for residents of Chicago using Illinois Hospital Association CompData to EMS stroke calls between May 15, 2012 and November 30, 2012. EMS stroke calls were identified through the patient tracking system of the Chicago Fire Department which also captured the scene coordinates (latitude and longitude). Using the Getis-Ord Gi* method, we identified hot spots for EMS stroke calls. Statistical hot spots are defined as areas where there is <1% chance of the case clusters occurring by chance. We then calculated a ratio of EMS calls to stroke admissions for each zip code in Chicago to identify areas where EMS usage was disproportionately low.

Results:
During the study period, there were 4,135 stroke admissions and 919 EMS stroke calls. Stroke admissions were more frequent in the south, west, and northwest sides of Chicago. While hot spot data for EMS stroke calls overlapped with areas of greatest stroke density and mortality, there were some areas with disproportionately low rates of EMS calls (figure). In particular, the regions in the northwest area of the city and downtown/south loop of Chicago appear to have low (4-11%) rates of EMS calls per stroke admissions.

Conclusion:
Discrete areas within Chicago were identified as hot spots for EMS-treated stroke which correspond generally with regions of greatest stroke density and stroke mortality. GIS mapping of EMS stroke calls may be valuable for targeted neighborhood educational outreach, operational deployment of EMS resources, and monitoring performance improvement initiatives.
Abstract 106: Low Cognitive Scores in Domains of Learning, Memory or Executive Function Predict Incident Stroke: The REGARDS Study
Authors: Wadley Virginia G , Thacker Evan L , Letter Abraham J , Unverzagt Frederick W , Moy Claudia S , Clark David G , McClure Leslie A , Howard Virginia J , Cushman Mary , Levine Deborah A , Kelley Brendan J , Kleindorfer Dawn , Kissela Brett , Howard George
Published: July 2021

Objective:
Low scores on tests of learning, memory, and executive function have been associated with subclinical cerebrovascular pathology in the absence of stroke. In a population-based, stroke-free cohort, we hypothesized that lower performance in these cognitive domains would predict incident stroke.

Methods:
From 2003-2007, REGARDS enrolled black and white adults aged ≥45 throughout the U.S. Participants are followed by phone twice a year for stroke events and biennially for longitudinal cognitive assessments. Word list learning and recall tasks are used to measure learning and memory, and semantic and letter fluency tasks to measure executive function. Included participants were stroke-free at enrollment and remained so prior to their cognitive assessments. We assessed incident stroke risk through September 1, 2012 using standard survival analyses adjusted for age, education, race, and geographic region.

Results:
Sample sizes up to 20,422 varied by cognitive task, and follow-up time ranged up to 7 years. Adjusted hazard ratios (95% CI) for stroke associated with the lowest versus highest quintiles of pre-stroke cognitive scores were 1.90 (1.24, 2.93) for learning, 2.23 (1.45, 3.42) for memory, and 1.69 (1.10, 2.61) and 1.98 (1.12, 3.52) for executive function as assessed by semantic and letter fluency, respectively (Figure).

Conclusions:
In a stroke-free, population-based cohort, lower baseline function in each cognitive domain was associated with increased risk of incident stroke. Low scores may signal the progression and severity of stroke risk factors.
Abstract 122: Intra-aneurysmal Flow Disruption: A New Approach for the Endovascular Treatment of Intracranial Aneurysms. Clinical Experience in a Multicenter Series of 66 Patients with 68 Aneurysms.
Authors: Pierot Laurent , Januel Anne-Christine , Spelle Laurent , Papagiannaki Chrysanthi , Raoult Hélène , Desal Hubert , Brreau Xavier , Velasco Stéphane , Courtheoux Patrick , Costalat Vincent , Macchi Paolo , Turjman Francis , Kadziolka Krzysztof , Bonafé Alain , Gauvrit Jean-Yves , Moret Jacques , Herbreteau Denis , Cognard Christophe
Published: July 2021

Purpose:
Standard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalizations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Clinical experience with this new technique is analyzed in a series collected in 11 French centers.

Materials and Methods:
The WEB (Sequent, Aliso Viejo, CA) is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal. 66 patients (49F/17M, age: 36-75 years) harbouring 68 aneurysms (ruptured: 5, unruptured: 57 or recanalized: 6) were treated between June 2011 and July 2013. Aneurysm location was middle cerebral artery (39 aneurysms), basilar artery (16), anterior communicating artery (7), and internal carotid artery (6).

Results:
The device was successfully deployed in all but 4 cases (failure rate: 5.9%). Additional coiling was performed in 6 aneurysms, remodeling in 2 cases, and stenting in 1 case. One intraoperative rupture was observed in a ruptured aneurysm (1.5%). Six thromboembolic events (8.8%) were observed with transient clinical worsening and good clinical outcome in 5 cases (mRS ≤2). No delayed rupture or remote hematoma was observed. Finally mortality was 0.0% and morbidity 1.5% (in a patient who both had intraoperative rupture and thromboembolic complication).

Anatomical follow-up was obtained in 32 patients 3 to 15 months after the treatment. Total occlusion was obtained in 15/32 aneurysms (46.9%), neck remnant in 14/32 aneurysms (43.8%), and aneurysm remnant in 3/32 aneurysms (9.4%).

Conclusion:
In the present series reporting the initial clinical experience with intra-saccular flow disruption using WEB in 11 French centers, the feasibility of treatment is high, the safety profile similar to coiling, and anatomical results are quite satisfactory knowing that some neck remnants are in fact just opacification of the proximal recess of the device.
Abstract 125: Treatment of Intracranial Aneurysms With the LUNA AES Updated
Authors: SOUROUR NADER , Piotin Michel , Blanc Raphael , Biondi Alessandra , Mounayer Charbel , Andersson Tommy , Mangiafico Salvatore , Jaworski Maciej , Anxionnat René
Published: July 2021

Purpose:
The LUNA Aneurysm Embolization System (AES) is a new self-expanding ovoid device that serves as an intra saccular flow diverter as well as a scaffold for endothelization across the neck. The objective of this prospective clinical study aiming to include a total of 63 patients was to evaluate the ability of the AES to occlude intracranial aneurysms while maintaining patency of the parent artery.

Materials and Methods:
Immediate post-implantation occlusion grade (complete (complete obliteration of the aneurysm including the neck), near-complete (persistence of any portion of the original defect of the arterial wall), or incomplete (any opacification of the sac) compared to baseline), and parent vessel compromise were evaluated. Patients underwent neurological testing with the Modified Rankin Scale and the National Institute of Health Stroke Scale (NIHSS) at baseline and time of discharge. Follow-up included clinical assessment at one, 3, 6, 9 and 12 months, and angiographic follow-up at 6 and 12 months.

Results:
50 patients (9 men) with 47 unruptured and 4 ruptured saccular aneurysms (38 bifurcation, 13 sidewall, sizes from 3.9 to 10.1 mm) were enrolled to date in the study. In all but 2 aneurysms (2 failed procedure converted in coiling) 1 LUNA AES was deployed per aneurysm. In 5 cases, the LUNA AES placement was carried out with balloon microcatheter assistance. In one case, the LUNA AES placement was carried out with a stent. Clinical follow up was uneventful in all but 2 patients (one sustained SAH from a contralateral MCA aneurysm, one had GI bleeding). Immediate complete/near complete occlusion was obtained in 26.5% (13/49). At 6 month follow-up, complete/near complete occlusion was obtained in 70.8% (34/48). There was no parent artery occlusion. None of the treated aneurysm (re)bled during follow-up. 4 aneurysms treated with the LUNA needed retreatment (2 incomplete deployment of the LUNA into the sac, 2 angiographic recurrences).

Conclusion:
Preliminary results demonstrate good safety profile. Angiographic follow up are promising.
Abstract 134: Effect of Warfarin Adherence on the Mortality After Ischemic Stroke: A Nationwide Multicenter Cohort Study
Authors: Kim Chi K , Ryu Wi-Sun , Jung Seunguk , Kim Yerim , Kim Tae Jung , Kim Jun Yup , Ko Sang-Bae , Lee Seung-Hoon , Bae Hee-Joon , Yu Kyung-Ho , Lee Byung-Chul , Yoon Byung-Woo
Published: July 2021

Background and purpose:
Warfarin is one of the most important prevention drugs against ischemic stroke. Factors influencing on warfarin adherence in patients with atrial fibrillation have been investigated. However, few studies have elaborated on the significance and related factors of warfarin adherence in patients with ischemic stroke or transient ischemic attack (TIA).

Methods:
A total of 46,219 patients with ischemic stroke or TIA were enrolled from October 2007 through December 2011 in Clinical Research Center for Stroke as a nationwide project in Korea. The morality information of all patients was based on computerized searches of death certificate data from the “Statistics Korea” of the Korean National Statistical Office, and the whole drug information was obtained from the Health Insurance Review Assessment and Review Service in Korea. Among them, warfarin was prescribed for 5,660 patients over 6 months. Warfarin adherence was defined as % adherence = (n of days’ supply) / (actual n of days to refill) х 100. Nonadherence was defined as < 80% adherence. We censored the mortality data on 31 December 2012.

Results:
From 5,660 patients using warfarin over 6 months, 801 patients (14.2%) were included in nonadherence group. The factors related to nonadherence for warfarin ware theses: old age, increased stroke severity, and the presence of diabetes or hyperlipidemia. Based on Cox regression analysis, compared with good adherence group, the adjusted hazard ratio (HR) of the nonadherence group for all-cause of mortality were 1.46 (95% confidence interval, 1.24 – 1.72) after controlling old age, stroke severity, and the presence of diabetes, hypertension, hyperlipidemia, and smoking. The presence of diabetes also predicted all-cause death after stroke independently in patients using warfarin over 6 months (adjusted HR, 1.28 ; 95% confidence interval, 1.10 – 1.49).

Conclusion:
Our study demonstrated that nonadherence for warfarin is independent predictor of all-cause death after ischemic stroke or TIA from nationwide multicenter follow-up study. The related factors to nonadherence for warfarin were old age, increased stroke severity, and the presence of diabetes or hyperlipidemia.
Abstract 151: Selection of Post-Acute Rehabilitation Facilities in the Northeast: A Survey of Discharge Planners
Authors: Sicklick Alyse , Stein Joel , Hedeman Robin , Prvu-Bettger Janet , Magdon-Ismail Zainab , Martin Lila
Published: July 2021

Introduction:
The process of determining the level and type of post-acute care for stroke patients has not been adequately studied. We surveyed stroke discharge planners regarding this process, and examined the factors perceived to influence the selection of post-acute care.

Methods:
Requests were sent to 471 acute care hospitals within the eight states in the Northeast Cerebrovascular Consortium (NY, NJ, MA, CT, RI, ME, VT, NH) for a discharge planner responsible for the care of stroke patients to complete an anonymous on-line survey. Respondents were asked to indicate the factors impacting the selection of post-acute care. The influence of patients/families and members of the health care team on the discharge process were rated on a 1-10 scale, and compared via a Mann-Whitney test.

Results:
Experienced nurses and social workers responded (82% and 18% respectively, with 73% reporting ≥20 years healthcare experience) from 71 hospitals. Discharge planners, patients/families and physical therapists were identified as having the greatest influence in determining discharge location, with physicians rated as less influential (p<0.001). Multiple factors were perceived to influence decision planning for post-acute facility type; however, insurance was identified by 48% as the single greatest barrier in referring stroke patients to the most
appropriate level
of post acute care. With regard to referring patients to the most
appropriate specific facility
for post-acute care, the most significant barriers were insurance (27%), bed availability (18%), and facility location (8%). More than half reported “the speed with which you are able to discharge a stroke patient” impacts patients’ final destination “frequently”, “very frequently” or “always”.

Discussion:
Discharge planners in this sample perceive insurance as a major barrier, and physicians to have a less influential role in determining post-acute level, type and setting for care. The pressure to discharge patients rapidly often influences the selection of post-acute care. Findings suggest non-clinical factors may disproportionately affect post-acute care decision making for stroke survivors.