bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP88: Impact of Tandem Vertebrobasilar Occlusion on Outcome of Mechanical Thrombectomy for Basilar Artery Occlusion
Authors: Cunningham Conor , Elawady Sameh Samir , Matsukawa Hidetoshi , Lee Nawabi Noah , Sowlat Mohammad-Mahdi , Zandpazandi Sara , Uchida Kazutaka , Orscelik Atakan , Maier Ilko , Al Kasab Sami , Jabbour Pascal M , Kim Joon-Tae , Quintero Stacey C , rai ansaar , Starke Robert , Psychogios Marios , Shaban Amir , Arthur Adam S , Yoshimura Shinichi , Cuellar Hugo , Grossberg Jonathan A , Alawieh Ali M , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles C , Park Min S , Levitt Michael , Brinjikji Waleed , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade A , Chowdhry Shakeel A , Ezzeldin Mohamad , Spiotta Alejandro M
Published: February 2024

Introduction:
The efficacy of mechanical thrombectomy (MT) for tandem vertebrobasilar occlusion (tVBO) is not well established in patients with basilar artery occlusion (BAO).

Objective:
To investigate the treatment outcomes of MT in tVBO.

Method:
This international, multicenter, retrospective cohort included patients with MT for tVBO and isolated BAO from 2013 to 2023. The primary outcome was the 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included complete recanalization (modified Thrombolysis in Cerebral Ischemia [mTICI] ≥ 2C) and 90-day mortality rate. These outcomes were compared between tVBO and isolated BAO groups. Adjustment factors were age, sex, admission National Institutes of Health Stroke Scale (NIHSS), pre-morbid mRS, onset to groin duration, and intravenous tissue plasminogen activator.

Results:
Among 10,229 patients, 689 had BAO. Of those, 61 (9.7%) had a tVBO. Median age was 61 [IQR 53-74] years and 29 (47.5%) patients were female. Compared to isolated BAO, tVBO group had lower age (61 [53-74] versus 68 [58-79], P<0.001) and lower admission NIHSS (15 [7 - 22] versus 17 [9-26], P≤0.05). There was no significant difference in the rate of complete recanalization between the two groups (adjusted odds ratio [aOR]: 0.83; 95% CI: 0.39-1.79; P=0.60) However, the tVBO group had significantly lower odds of a favorable outcome compared to the isolated BAO group (aOR: 0.35; 95% CI: 0.13-0.83; P=0.023) and higher odds of 90-day mortality (aOR: 3.51; 95% CI: 1.59-7.85; P=0.002). Binary regression analysis revealed that age (OR 0.98; 95% CI 0.96 - 1.00; P=0.019), admission NIHSS (OR 0.90; 95% CI 0.87-0.93; P<0.001), premorbid mRS (OR 0.71; 95% CI 0.53-0.93; P=0.016), successful recanalization (OR 2.94; 95% CI 1.71-5.15; P<0.001), and tVBO (OR 0.33; 95% CI 0.11-0.86; P=0.031) were significant predictors of 90-day favorable outcome.

Conclusion:
tVBO was associated with poor outcomes. Further efforts should be aimed at improving outcomes for this subpopulation.
Abstract TMP9: Flair Vascular Hyperintensities as Imaging Biomarker in Pediatric Arterial Ischemic Stroke
Authors: Ullman Natalie , Vossough Arastoo , Beslow Lauren A , Ichord Rebecca N , Shih Evelyn K
Published: February 2024

Background:
FLAIR vascular hyperintensities (FVH) are high signal intensities on MRI resulting from sluggish flow through collateral vessels in patients with acute arterial ischemic stroke (AIS). Data from adults suggest they may be a marker of penumbra. In this first investigation of FVH in children, I measured the prevalence and identified risk factors for FVH in pediatric patients with AIS.

Methods:
Retrospective review of patients prospectively enrolled in the CHOP Stroke Registry from 2006-2022. Patients with AIS age 29 days to 18 years with MRI within 72 hours of last known well were included. Children with pre-existing strokes, vasculopathy, prior brain surgery, radiation, or vascular compression from intracranial mass were excluded. MRIs were assessed by a blinded reviewer and adjudicated by a neuroradiologist for presence of LVO, FVH score, modASPECTS score, and AIS lesion volume. Clinical data were abstracted from chart review. Independent sample t-test compared FVH score and LVO presence. Pearson's correlation assessed the relationship between total FVH score and age, stroke size, modASPECTS, and pedNIHSS scores. Multivariable logistic regression evaluated predictors of significant FVH (score >= 3) and included time to MRI, large vessel occlusion, modASPECTS, pedNIHSS, stroke size, and age as independent variables.

Results:
83 patients met inclusion criteria. Median time to MRI was 26 hours (95% CI 26-33). FVH were present in 45 patients (54%). Mean FVH score was higher in patients with LVO (5.22 ± 0.64) compared to those without (1.21 ± 0.24;
p
= 0.00). There was a positive correlation between total FVH score and age (p < 0.05), stroke size (p < 0.0001), modASPECTS (p < 0.0000), and pedNIHSS (p < 0.0002). In the multivariate logistic regression, only older age (OR 1.50, 95% CI 1.12-2.01, p < 0.006) and presence of LVO (OR 0.002, 95% CI 4.85x10
-5
-0.08, p<0.001) were associated with significantly increased odds of high FVH burden.

Conclusions:
FVH are prevalent in children with AIS, with higher burden in older children. Similar to adults, large vessel occlusion and larger infarct size are associated with higher FVH burden. Further study is needed on whether FVH could be used to identify patients who would benefit from reperfusion therapies.
Abstract TMP90: Extension of Subarachnoid Hemorrhage Following Mechanical Thrombectomy is Associated With Clinical Outcomes: A Subgroup Analysis of CLEAR Trial
Authors: Dohiem Mohamed , Ulm Arthur , Nogueira Raul G
Published: February 2024

Introduction:
Subarachnoid hemorrhage (SAH) following mechanical thrombectomy (MT) is not uncommon. The prognostic implication for these patients remains unclear and may be affected by the extension of SAH.

Methods:
We included patients with SAH detected on CT after MT from CLEAR Study (The Vesalio NeVa Stent Retriever Study for Treatment of Large Vessel Occlusion Strokes). SAH was further classified according to extension degree into diffuse (> 1 extraparenchymal compartment) and non-diffuse. Unadjusted and adjusted logistic regressions were used to measure the association of both groups with modified Rankin Scale (mRS) (mRS) score at 90 days.

Results:
Among 139 patients, 20 SAH patients qualified for final analysis (10 with diffuse SAH: 10 with non-diffuse SAH). There were no statistically significant differences for sex, thrombolytics administration, pre mRS score, baseline NIHSS score, and procedure access (p >0.1) while there were statistically significant imbalances for age and site of occlusion (p=0.02). At the end of the procedure, there was no statistically significant difference in successful recanalization rates defined as a Modified Treatment in Cerebral Ischemia (mTICI) score of 2b or greater (100% in non-diffuse vs. 90% diffuse, P>0.99). However, non-diffuse SAH group were significantly associated with reduced disability at 90 days in both unadjusted (Common odds ratio [cOR] 11.09, 95% confidence interval [CI] (1.72-71.37), p = 0.01) and adjusted models (cOR 12.32, 95% CI 1.49-102.05, p = 0.02). Additionally, non-diffuse SAH group were significantly associated with significantly improved 90-day good functional outcomes defined as mRS 0-2 in unadjusted analysis (80% vs. 30%, OR 9.33, 95% CI 1.99-72.99, p = 0.03) but not in adjusted analysis (OR 7.84, 95% CI 0.55-109.94, p = 0.13). Median NIHSS at 24 hours was significantly lower in non-diffuse group compared to diffuse group (3 [2-6] vs. 17.5 [12-19], p< 0.001) while mortality was reduced to half but did not reach a statistical significance level (10% vs. 20%, p>0.99).

Conclusions:
Non-diffuse SAH was associated with better clinical outcomes compared to diffuse SAH. These findings may inform adjustable management approaches according to extension degree of SAH.
Abstract TMP98: Pre-Stroke Use of Blood-Brain Barrier Crossing Angiotensin Receptor Blockers in Elderly Patients Mitigates Neurological Severity at the Onset of Acute Stroke
Authors: Mori Takahisa , Yano Tetsundo , Yoshioka Kazuhiro , Miyazaki Yuichi
Published: February 2024

Introduction:
Functional outcomes after acute stroke (AS) are related to the initial neurological severity. Therefore, using neuroprotective agents to prevent or reduce brain damage shows promise as a preventive approach. Blood-brain barrier crossing (BBBc) angiotensin receptor blockers (ARBs) have been reported to reduce the risk of cognitive disorders. Therefore, BBBc ARBs may exert neuroprotective effects on brain damage caused by AS. However, the association between pre-stroke BBBc ARB use and neurological severity at the onset of AS has not been well studied.

Hypothesis:
Pre-stroke BBBc ARBs in elderly patients is linked to mild neurological severity (MNS) at the time of AS onset.

Methods:
We retrospectively included patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined MNS as a score of ≤5 points on the National Institutes of Health Stroke Scale. We conducted logistic regression analysis using variables for pre-stroke BBBc ARBs initiation, calculated propensity scores for pre-stroke BBBc ARBs use, and implemented one-to-one propensity score matching (PSM). The McNemar test assessed whether pre-stroke BBBc ARBs administration significantly affected MNS.

Results:
Out of 4294 patients with AS, 3472 met the inclusion criteria. Following one-to-one PSM, we identified 508 patients each in the BBBc ARBs usage and non-usage groups. The median ages of BBBc ARBs users and non-users were 80 and 81 years, respectively. Among the 508 BBBc ARBs users and the 508 non-users, 325 and 278 patients exhibited MNS, respectively (p=0.0027). Furthermore, the McNemar test revealed an asymmetrical binary matched pairs contingency table of MNS (p=0.0021), indicating a significant association between pre-stroke BBBc ARB use and MNS at the time of AS onset.

Conclusions:
The pre-stroke utilization of BBBc ARBs among elderly patients is associated with MNS at the onset of AS, implying potential neuroprotective effects against AS-induced brain damage. Further prospective studies are warranted to validate our findings and establish the practical application of BBBc ARBs for neuroprotection before AS.
Abstract TP10: Artificial Intelligence Algorithm as a Diagnostic Tool for Aneurysms
Authors: Miller Lauren R , Frank Jacqueline , Lee Jessica D , Campbell Margie L , Wise Lesley , Lukins Douglas , Dornbos David , Pahwa Shivani , Fraser Justin
Published: February 2024

Viz Aneurysm is an artificial intelligence engine created to detect aneurysms from CT-Angiography (CTA) scans. As with any new technology, it should be measured against the current standard of care. Here, we compared Viz.ai ‘flagging’ of an aneurysm against interpretation reports by faculty radiologists in order to understand accuracy and precision of the technology as a diagnostic tool.

In this study, CTA scans were analyzed by Viz Aneurysm from October 2022 to June 2023 at a single Comprehensive Stroke Center. Information regarding each subject was collected through Epic, and the presence of an aneurysm was verified by a radiologist. Although Viz.ai states that the algorithm is limited to detecting aneurysms that are 4 mm in diameter or greater, we have included all aneurysms discovered by radiologists. These ranged in diameter from 0.8 to 22 mm.

A total of 963 scans were analyzed, with 70 aneurysms detected total. Approximately 51.10% scans were performed on male patients, and our population ranged in age from 23 to 94 years. The algorithm performed well in flagging scans containing definite aneurysms, with a specificity of 96.78% (95% CI 0.95-0.98) and a negative predictive value of 97.23% (95% CI 0.96-0.98). It was less accurate in excluding scans without aneurysms, showing a sensitivity of 63.64% (95% CI 0.51-0.75) and a positive predictive value of 60.00% (95% CI 0.50-0.69). When aneurysms smaller than 4 mm were excluded, the sensitivity and specificity increased to 81.25% (95% CI 0.64-0.93) and 96.90% (95% CI 0.96-0.98), respectively. The algorithm was successful in identifying all cases (n = 5) of ruptured aneurysms. In several cases (n = 27), radiologists were unable to definitively diagnose an aneurysm, frequently citing the possibility of an infundibulum. It should be noted that there was one case where the algorithm detected an aneurysm, but the patient was diagnosed with a 23-mm pituitary macroadenoma. This suggests that the algorithm may be susceptible to neuroanatomical mimics.

We have shown that Viz Aneurysm is a highly specific diagnostic tool that may help medical professionals to identify definite aneurysms. More studies of this nature should be conducted in a variety of populations to confirm these results.
Abstract TP101: Disposition Disparities: Differences in Discharge and Rehabilitation Post-Stroke Between Racial and Ethnic Groups
Authors: Romano Madison , Dombroski Allison , Dunoyer de Segonzac Beatriz , Weiss Kayla , Sturn Michael , Coughlin Emily , Burgin William S
Published: February 2024

Background and Purpose:
Racial and ethnic disparities affect stroke treatment, altering patient outcomes. Previous studies have shown that white patients often arrive at the Emergency Department more quickly and use Emergency Medical Services more than minority patients. They also receive specific treatments more frequently, including tPA. Our study investigates whether these disparities continue in post-stroke care in Florida.

Methods:
We conducted a retrospective review using our comprehensive Get with the Guidelines database. We categorized patients by stroke type, risk factors, and stroke severity. The focus was comparing discharge dispositions and rehabilitation plans across racial and ethnic groups.

Results:
Data gathered from Get with the Guidelines database, including 6,426 records between 2012-present. Discharge disposition disparities were observed across racial and ethnic groups with comparable stroke severity (p<0.001). Black people were more frequently discharged home compared to White people (p=0.029), and Asian people more often went to hospice, especially inpatient (p<0.001). Asian people and White people had the highest in-hospital death rates (p<0.001), while Hispanic people had lower in-hospital deaths(p=0.26) and were more likely discharged home (p=0.001). Black people received the greatest in-patient rehabilitation services (p<0.001), whereas Asian people were least likely to get in-patient or outpatient rehabilitation (p=0.016). Hispanic people had higher inpatient rehabilitation rates than non-Hispanic people (p=0.007).

Conclusions:
Our study highlights post-stroke disparities across racial and ethnic groups. Recognizing and addressing these disparities may improve outcomes in these populations, increasing stroke management equity. Elucidating the causes of these findings is the next step in this research.
Abstract TP108: Clinical Utility of the Alberta Stroke Program Early CT Score: A Survey Comparing Comprehensive Stroke Centers
Authors: Tombo Tasha , Rashba Gabriel , Xu Lora , Taylor Will , Schneck Michael J
Published: February 2024

Introduction:
The Alberta Stroke Program Early CT Score (ASPECTS) is often used in considering whether patients are appropriate for thrombolysis and/or thrombectomy after acute ischemic stroke (AIS). We hypothesized that while clinical guidelines recommend ASPECTS evaluations in AIS, ASPECTS use is low in practice. We also explored differences in ASPECTS use between high and low volume comprehensive stroke centers (CSC).

Methods:
We surveyed United States CSC from 2021-2022 regarding ASPECTS utilization in evaluating eligibility for thrombolysis and/or thrombectomy in patients with suspected or confirmed large vessel occlusion. We asked whether ASPECTS was routinely used, if it was the preferred primary modality for final decision making, and whether an ASPECTS
<
6 excluded a patient from thrombectomy consideration. Survey responses were divided between large (Annual volumes of ischemic strokes >600) and small CSC (
<
600). Chi square analysis was performed on this data.

Results:
Thirty-nine CSC completed the survey. Of these, 21 were large CSC and 18 were small CSC. Of all CSC, 31% did not use ASPECTS at all. Seventy-four percent preferred automated mismatch software over ASPECTS as the primary modality in final decision making. Thirty six percent of CSC noted that an ASPECTS
<
6 would exclude a patient from consideration for thrombectomy. There was no relationship between CSC size and ASPECTS use [X
2
(1, N = 39) = 0.71, p < .05]. There was also no relationship between CSC size and whether ASPECTS was the preferred primary final decision making modality [X
2
(1, N = 39) = 0.23, p < .05]. Additionally, there was no relationship between CSC size and whether ASPECTS
<
6 excluded patients from thrombectomy consideration [X
2
(1, N = 39) = 0.73, p < .05].

Conclusion:
In practice, the clinical utility of ASPECTS for AIS evaluation is low. Case volume experience also has no apparent impact on ASPECTS utilization. Our preliminary survey reveals low use of ASPECTS, and a preference for mismatch software in choosing AIS candidates for intervention. This discrepancy suggests significant differences between clinical guidelines and actual practice.
Abstract TP132: Optimal CT Perfusion Post-Processing Method in Posterior Circulation Stroke
Authors: Edwards Leon , Cappelen-Smith Cecilia , Cordato Dennis , Bivard Andrew , Parsons Mark W
Published: February 2024

Objective:
CT-perfusion (CTP) has revolutionised stroke care by improving diagnostic accuracy and expanding eligibility to acute therapies. Software packages utilise various mathematical techniques to transform raw perfusion data into measures of infarct core and ischaemic penumbra. These techniques have been derived from studies of anterior-circulation stroke and not yet validated in posterior circulation stroke (PCS). We examined the optimal CTP thresholds for acute PCS.

Methods:
Data were analysed from 331-patients diagnosed with a PCS enrolled in the International-stroke-perfusion-registry (INSPIRE). Twenty-seven-patients with baseline multimodal-CT with occlusion of a large posterior-circulation (PC) artery and follow up diffusion-weighted-MRI at 24-48 hours were included. CTP parametric maps were generated using five different post-processing methods. Receiver-operating-curve analysis was used to determine the optimal perfusion parameter and thresholds.

Results:
Partial deconvolution was the optimal post-processing method for characterisation of ischaemic penumbra and infarct core. Mean transit time (MTT) at a threshold of >165% and >195% most accurately defined ischaemic core (AUC=0.73) and penumbra (AUC=0.78) respectively. Post-processing technique influenced accuracy of core (AUC range=0.54-0.73) and penumbra (AUC range=0.72-0.79) estimates. MTT was consistently the most accurate parameter at distinguishing core and penumbra across all post-processing methods.

Conclusion:
CTP has significant diagnostic utility in PCS. Accuracy of CTP varies considerably by post-processing method. The underlying post-processing technique employed by individual software packages should be considered when interpreting the accuracy of ischemic core and penumbra estimates.
Abstract TP141: Understanding Potential Limitations of CTP Imaging in Early Window Large Vessel Anterior Circulation Strokes
Authors: Miller Ethan A , Balabhadra Anvesh , Varon Alberto , Li Ya-Huei , Emmerson Danison , Patel Smit D , Sussman Eric S , Tunguturi Ajay , Mehta Tapan
Published: February 2024

Background:
Computerized tomography perfusion (CTP) imaging serves as a valuable modality for the assessment of individuals with a large vessel anterior circulation stroke. Current literature proposes that employing CTP imaging in patients within the initial time frame of less than 8 hours, may lead to an overestimation of the projected infarct core, specifically when utilizing cerebral blood flow (CBF) less than 30%. The hypoperfusion intensity ratio (HIR) may result in overestimation. We sought to further investigate the interplay of CTP parameters in patients presenting within 8 hours of symptom onset of stroke, to assess the accuracy of core infarct estimation.

Methods:
A retrospective cohort study analyzing patients with large vessel anterior occlusion (LVAO) who underwent CTP and mechanical thrombectomy within 24 hours of symptom onset between January 2017 to December 2022. RAPID software estimates the infarct core using CBF <30%. DWI-MRI determined final infarct volume. A multivariate logistic regression model was employed to assess the impact of HIR and reperfusion success on outcomes.

Results:
Ninety-seven patients were identified within an 8-hour time window. CBF<30% overestimated core infarct volume (mL) in 22 patients (22.6%) with a mean of 15.72 (range 4.4-37.7) and a median of 22.85. Of these, 2 patients experienced poor reperfusion (9%) while 20 had successful reperfusion (91%). Of the patients who did have successful reperfusion, an average of 13.57mL core was overpredicted compared to the DWI volumes. A multivariate logistic regression model adjusting for degree of reperfusion, administration of thrombolytic, and time from symptom onset showed that HIR strongly predicted the probability of core estimation with an odds ratio of 148.6, 95% CI [21.0-1048.8], (p<0.001).

Conclusion:
HIR exceeding 0.4 demonstrates a predictive capacity for core overestimation in early-window LVAO patients. Our study affirms this observation with statistical significance. The integration of HIR as a parameter for early-window LVAO core computation shows promise, and has potential ramifications for patient selection for thrombectomy. In this context, utilization of further databases is imperative for validation and broader application of HIR.
Abstract TP142: Perfusion Profiles to Identify Acute Extracranial Internal Carotid Artery Atherosclerosis-Related Stroke Prior to Endovascular Therapy
Authors: Quispe-Orozco Darko , Galecio Castillo Milagros , Farooqui Mudassir , Vivanco-Suarez Juan , Rodriguez Aaron , Dibas Mahmoud , Ortega-Gutierrez Santiago
Published: February 2024

Introduction:
Perfusion imaging has been used to assess collateral status in patients with acute ischemic stroke secondary to anterior large-vessel occlusion. We aimed to evaluate the hypoperfusion intensity ratio (HIR), a surrogate of collateral status, in acute stroke secondary to extracranial atherosclerosis disease (AD) compared with extracranial non-AD etiologies prior to EVT.

Methods:
We retrospectively reviewed the data of consecutive EVT stroke patients in our prospectively collected registry from January 2019 to December 2022. Inclusion criteria: patients with anterior circulation stroke with concomitant extracranial internal carotid artery (ICA) disease with 70-100% stenosis per NASCET criteria and patients who underwent computed tomography perfusion (CTP) before EVT. Patients were divided into those with extracranial AD and non-AD based on clinical and radiological characteristics. HIR was calculated as the volume of ischemic brain tissue with a Tmax>10s divided by a Tmax>6s. A relative CBF<30% was also obtained. Multivariable regression was used to identify the HIR independently associated with extracranial ICA AD-related stroke; adjusted odds ratio with 95%CIs were calculated using the non-AD group as a reference.

Results:
Among all 624 EVT patients, 79 met inclusion criteria. Of these patients (21 women [36.2%]; median age 67 [60-75] years), 58 (72.5%) had extracranial ICA AD. Patients in the AD group had significantly lower CBF<30% (median 8ml [0-17] vs 19ml [9-36]), lower Tmax>10s (median 29ml [11-69] vs 68ml [38-117]), and lower HIR (median 0.27 [0.13-0.45] vs 0.49 [0.42-0.59]). There was no significant difference in time from last know well to CTP between groups. Lower HIR was independently associated with AD after adjusting for variables related to AD (Figure1).

Conclusions:
Low HIR values was a predictor of stroke secondary to extracranial ICA AD and could be helpful to differentiate from other non-AD etiologies prior to EVT.
Abstract TP144: Deep Learning on Pre-Procedural CT and Clinical Data Predicts Outcome Following Stroke Thrombectomy
Authors: Diprose James , Diprose William , Chien Tuan-Yow , Wang Michael , McFetridge Andrew , Tarr Gregory P , Ghate Kaustubha , Beharry James , Hong Jae Beom , Wu Teddy Y , Barber P A
Published: February 2024

Background:
Deep learning using clinical and imaging data may improve pre-treatment prognostication in ischemic stroke patients undergoing endovascular thrombectomy (EVT).

Methods:
Deep learning models were trained and tested on pre-treatment clinical and imaging (CT head and CT angiography) data to predict 3-month functional outcomes in ischemic stroke patients who underwent EVT. Logistic regression models were constructed to compare their performance with the deep learning models. An external validation dataset was used to validate the models. The MR PREDICTS prognostic tool was tested on the external validation set, and its performance was compared with the deep learning and logistic regression models.

Results:
There were a total of 975 patients (550 men; mean±SD age 67.5±15.1 years), including 778 patients from the model development cohort, and 197 patients in the external validation cohort. The deep learning model trained on CT head and clinical data, and the logistic regression model (clinical data alone) demonstrated the strongest discriminative abilities for 3-month functional outcome and were comparable (AUC 0.811 versus 0.817, Q=0.82). Both models exhibited superior prognostic performance than the other deep learning (CT head alone, CT angiography alone) and MR PREDICTS models (all Q<0.05).

Conclusions:
The discriminative performance of deep learning for predicting functional outcome following EVT was comparable to logistic regression. Future studies should focus on whether incorporating procedural and post-procedural data significantly improves model performance.
Abstract TP15: Association Between Prevalent Cardiovascular Disease Plus Atrial Fibrillation and Global Cerebral Small Vessel Disease- The Framingham Heart Study
Authors: Ekenze Oluchi , Pinheiro Adlin , Beiser Alexa , Lioutas Vasileios , Benjamin Emelia J , Vasan Ramachandran , De Carli Charles , Seshadri Sudha , Demissie Serkalem , Romero Jose R
Published: February 2024

Background:
Cardiovascular diseases (CVD) contribute to stroke and dementia, which can be due to cerebral small vessel disease (CSVD) detectable on brain MRI.

Aim:
To determine the association between prevalent CVD and atrial fibrillation (AF) with CSVD.

Methods:
We assessed a composite of CVD including coronary heart disease, intermittent claudication, congestive heart failure (CHF) and AF, as well as the individual components. A multi-marker CSVD score was used to reflect increasing CSVD burden (cerebral microbleeds, high burden perivascular spaces, extensive white matter hyperintensity, or covert brain infarcts were assigned 1 point each, range 0-4). We related prevalent CVD or the individual components to the CSVD score using logistic regression analyses adjusted for age, sex, FHS cohort, time between MRI-clinic exam (model-1), and vascular risk factors (model-2).

Results:
In 3413 participants (mean age 59±14 years, 46.6% males), 8.4% had prevalent CVD, 4.1% had AF and 10.9% had both. One CSVD marker was seen in 22.7% participants, two in 7.1% and ≥3 in 1.82%. In multivariable-adjusted analyses prevalent CVD was associated with presence of one CSVD marker (OR 1.40, 95% confidence interval [CI] 1.07-1.84). The association with 2 or ≥3 markers did not reach statistical significance. The strongest association with subtype of CVD was between CHF and ≥3 CSVD markers (OR 5.67, 95% CI 1.90-16.9). Stratified analyses in subgroups by hypertension status, APOE- ε4 presence, and age < 65 years were limited by smaller number of events, with no significant differences.

Interpretation:
Prevalent CVD (including AF) is associated with presence of CSVD in community dwelling middle-aged adults free of stroke and dementia, with stronger associations with CHF.
Abstract TP155: Predictive Value of Plasma Matrix Metalloproteinase-9 Concentrations for Hemorrhagic Transformation in Acute Ischemic Stroke: A Systematic Review and Diagnostic Accuracy Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , Faraj Hazem Abdelkarem A , Msherghi Ahmed
Published: February 2024

Background:
Hemorrhagic transformation (HT) is a critical sequela of acute ischemic stroke (AIS). Matrix metalloproteinase-9 (MMP-9) has been implicated in the pathophysiology of hemorrhagic transformation (HT) post-acute ischemic stroke (AIS). However, the diagnostic accuracy of plasma MMP-9 concentrations as a predictive marker for HT remains inconsistent across studies.

Aim:
This study aims to determine the potential of plasma MMP-9 concentrations as an indicator for HT in AIS patients.

Methods:
Systematic reviews of leading databases such as PubMed, Embase, and the Cochrane Library were performed until March 2023. Studies were included assessing the diagnostic accuracy of plasma MMP-9 concentrations in predicting HT after AIS. Statistical analyses were conducted using R software (version 4.0.3) and the mada package. This analytical method enabled the pooling of sensitivity, specificity, false-positive rates, diagnostic odds ratio, as well, as both positive and negative Likelihood Ratios. Outcomes are reported within a 95% Confidence Interval (CI).

Results:
Our analysis included 4 studies with a total of 378 patients, of whom 79 developed hemorrhagic transformation. Plasma MMP-9 displayed notable predictive capabilities with a pooled sensitivity of 92.4% (95% CI: 77-97.8%, I
2
=0%), highlighting its proficiency in detecting HT cases. Its specificity was 78.3% (95% CI: 73.2-82.6%, I
2
=0%), emphasizing its accuracy in distinguishing non-HT cases. However, there was a false-positive rate of 21.7% (95% CI: 17.4-26.8%). The positive Likelihood Ratio was 4.25 (95% CI: 3.36-5.38), and the notably low negative Likelihood Ratio was 0.09 (95% CI: 0.03-0.32). The diagnostic odds ratio, suggesting strong discriminative power, was 43.72 (95% CI: 11.73-162.91).

Conclusion:
Our analysis underscores the promising role of plasma matrix metalloproteinase-9 concentrations in predicting hemorrhagic transformation following an acute ischemic stroke. However, the broad adoption in clinical settings mandates further confirmatory studies and validation across heterogeneous populations.
Abstract TP157: Utility of CT Angiography in Patients With Intracerebral Hemorrhage
Authors: Schneck Michael , Lippman Haley , Wesolwoski Michawel
Published: February 2024

Introduction:
Patients with intracerebral hemorrhage (ICH) often undergo CT and CT angiography with the latter being done to identify vascular abnormalities for ICH etiology. It is unclear whether CTA yields are high enough to warrant routine use particularly for subcortical ICH, however.

Methods:
Retrospective chart review was done on the Loyola Stroke Database of ICH patients over the last 10 years. Data from CT, CTA (and other imaging modalities) regarding ICH size and location, as well as vascular abnormalities, were collected. Demographics, comorbidities, and clinical outcomes were also recorded. Frequencies and percentages are reported to describe overall sample and bivariate associations. Univariate logistic regression estimated unadjusted effects of ICH type, age, hypertension (HTN), and other predictors on the logit of vascular abnormalities. Chi square values are reported for overall interaction effects. Stratified odds ratios (OR) are reported with 95% confidence intervals and p-values. Multivariable binary logistic regression estimated adjusted effects of ICH type on the logit of vascular abnormalities, after adjusting for covariates; OR are reported for adjusted effects.

Results:
Of 744 ICH cases analyzed, 376 were subcortical (50.54%) and 368 cortical (49.46%). Eighty-one had vascular abnormalities (10.89%); 46 of those being lesion-related (6.18%). Unadjusted odds of lesion-related vascular abnormalities were higher for cortical versus subcortical ICH (OR: 7.04; 95% CI: 3.09, 16.04; p < 0.01). Two-way interaction was non-significant for effects of ICH type and age (p = 0.76), ICH type and HTN (p = 0.68), age and hypertension (p = 0.09), and ICH type and ICH size (p = 0.93) on the logit of lesion-related vascular abnormalities. Thus, these effects did not co-vary significantly with respect to lesion-related vascular abnormalities. Odds of lesion-related vascular abnormalities are significantly higher for cortical versus subcortical ICH, after adjusting for age, HTN ICH size, and CTA (OR: 6.91; 95% CI: 2.93, 16.30; p < 0.01).

Conclusion:
Our analysis suggests there is decreased utility for CTA in subcortical compared to cortical ICH and CTA should probably not be performed routinely on subcortical ICH.
Abstract TP161: Social Isolation Increases Liver Inflammation and Alters Hepatocyte Morphology in Cerebral Amyloid Angiopathy
Authors: Garg Shivi , Jiang Danye , Khan Romeesa
Published: February 2024

Introduction:
Social isolation (SI) is a growing yet understudied public health concern. Accumulating evidence suggests that SI has critical psychological implications and can also lead to considerable negative physiological outcomes, as in the case of cerebral amyloid angiopathy (CAA). CAA is characterized by the accumulation of amyloid-beta (Aβ) in the leptomeningeal vessels, which compromises the integrity of cerebral vasculature, thus increasing risk of intracerebral hemorrhages. Our preliminary data suggests SI induces metabolic changes including average weight gain in CAA mice compared to pair-housed (PH) counterparts (30g vs 25g, respectively; p<0.01). Hence, it is imperative to investigate the effects of social isolation on liver physiology and energy metabolism in the context of CAA.

Hypothesis:
We hypothesize that SI leads to decreased Aβ clearance by the liver, and increased immune cell infiltration into the liver.

Methods:
3-month-old C57BL/6 (WT, n=21) and TgSwDI mice (n=21) were either pair-housed (PH) or socially-isolated (SI) for 9 months. We assessed Aβ deposition, hepatocyte morphology, vascular structure, and liver immune cell composition through immunohistochemistry. We additionally quantified ALT/AST levels and LRP-1 levels as a measure of liver dysfunction and Aβ clearance, respectively. Neurobehavioral performance was measured by nesting and tail-suspension test.

Results:
Our findings show that socially isolated CAA mice exhibit sustained affective and cognitive impairments when compared to the PH group. Average nesting scores are significantly lower for male CAA SI mice compared to PH mice (1.67 vs 3.5, respectively; p<0.01). SI CAA mice have larger hepatocytes and increased immune cell infiltration when compared to the PH counterparts and WT controls. Furthermore, Aβ signals were found to colocalize with liver-resident macrophages, implying a role of amyloid clearance by these cells.

Discussion:
Together we show that SI increases body weight and inflammation, and exacerbates cognitive and behavioral deficits. These changes may affect AB clearance, thereby potentially worsening CAA pathology. Further investigation into liver energy metabolism and macrophage-mediated inflammation is warranted.
Abstract TP170: An Explainable Deep Learning Method to Quantitatively Predict Hematoma Progression After Intracerebral Hemorrhage
Authors: Mi Donghua , Chen Siqi
Published: February 2024

In patients with intracerebral hemorrhage (ICH), it is important to quickly and accurately individualize the treatment decision by quantitatively predicting the hematoma progression using medical information collected on admission. Current approaches only qualitatively predict ICH progression trends leveraging anatomical features extracted from non-contrast computed tomography (NCCT) images. However, these approaches do not consider the hemodynamics of the cerebral circulation system, cannot quantitatively predict ICH progression, and lack the needed explainability. To address these technical challenges, in this work, we developed an explainable deep learning method to quantitatively predict hematoma progression after ICH, which quantitatively predicts ICH progression leveraging (i) deep anatomical features (baseline ICH lesion volume) derived from NCCT images, and (ii) deep hemodynamic features focusing veins-of-interest derived from time-resolved CT images collected on admission. A total of 73 patients categorized into the training data set (containing 58 patients) and the test data set (containing 15 patients), with 216 sets of images, were used in the development and validation of the model. For the ICH lesion volume predicted by this model, the mean difference with respect to the reference volume is -0.96 mL, and the agreement limits are [-9.64 mL, +7.71 mL] (Figure 1). In conclusions, by simultaneously leveraging deep anatomical and hemodynamic features, our model can quantitatively predict ICH progression using multimodal CT images collected on admission and hence help individualize the treatment decision during hospitalization.
Abstract TP175: Older Age is Associated With Smaller Ischemic Core Volume and Slower Infarct Progression Despite High Clinical Severity in Anterior Circulation Large Vessel Occlusion Stroke
Authors: Rocha Marcelo , Kayyali Mohammad , Sari Murat , Song Shlee S , Perera Subashan , Nogueira Raul G
Published: February 2024

Background:
Older patients with acute stroke due to anterior circulation large vessel occlusion (ACLVO) experience worse clinical outcomes. Fast progressors typically present early with high stroke severity and larger ischemic core volumes. However, the relationship between aging and early infarct growth rate is unknown. We examined the association between older age, baseline ischemic core volumes and fast or slow infarct growth during ACLVO.

Methods:
Retrospective study of patients with acute ICA or MCA occlusion across two academic centers in 2014-2019. Patients were included if they had baseline CTP or MRI within 24 hours after estimated stroke onset. Infarct growth rate (IGR) was calculated as ischemic core volume (ml) / stroke onset to imaging time (h). Fast or Slow progressor status was defined by IGR ≥ or < 10 ml/h. Univariate comparisons were made across age tertiles. Multivariable linear and logistic regression analysis examined the association of age tertile with ischemic core volume and slow progressor status adjusting for sex, vascular co-morbidities and NIHSS.

Results:
We included 312 patients (57% female; age tertiles [T1-T3]: 33—66, 67—81, and 82—102). Older age was associated with decreasing ischemic core volume (median [range] ml: T1, 29 [0-253]; T2, 12 [0-406]; T3, 6 [0-244]; p<0.001) and lower IGR (median [range] ml/h: T1, 5.8 [0-153]; T2, 2.6 [0-122.5]; T3, 0.6 [0-248]; p<0.001). The frequency of slow progressors increased with age (N (%): T1, 65/107 (61); T2, 76/105 (72); T3, 78/100 (78); p=0.02). However, baseline NIHSS was numerically higher with older age (median [range]: T1, 16 [1-30]; T2, 17 [2-38]; T3, 18 [1-33]; p=0.22). In multivariable models, age tertile (T3 vs T1) and NIHSS were associated with: 1. ischemic core volume (age coefficient [95% CI], -18.9 [-36.1, -1.7], p=0.03; NIHSS coefficient [95% CI], 3.2[2.3, 4.1], p<0.001); and 2. slow progressor status (age OR 2.63 [1.27, 5.43], p=0.009); NIHSS OR 0.91 [0.87, 0.95], p<0.001).

Conclusions:
Older age was paradoxically associated with lower baseline core volumes and slow progressor status, despite high stroke severity during acute ACLVO, suggesting older patients may be more vulnerable to even slow infarct growth. Future studies are needed to confirm and extend the findings.
Abstract TP180: Characteristics and Outcomes of Cerebral Venous Sinus Thrombosis Associated With COVID-19
Authors: Scutelnic Adrian , van de Munckhof Anita , Miaclin Angel , AARON SANJITH , Hameed Sajid , Wasay Muhammad , Grosu Oxana , Krzywicka Katarzyna , Sanchez van Kammen Mayte , Lindgren Erik , Hom Moreira Tiago , Acampora Roberto , Alberto Negro , KARAPANAYIOTIDES Theodoros , Marialuisa Zedde , Yaghi Shadi , Ana Barbera , Cuadrado Godia Elisa , La Spina Paolo , Francesco Grillo , GIamello Fabrizio , Nguyen Thanh , Abdalkader Mohamad , Alina Buture , raposo Nicolas , Tsivogoulis Georgios , Candelaresi Paolo , Kristoffersen Espen Saxhaug , Ciacciarelli Antonio , Mbroh Joshua , Katheryna Antonenko , Kremer Hovinga Johanna A. , Batenkova Tatjana , Scoppettuolo Pasquale , Jood Katarina , Aguiar De Sousa Diana , Poli Sven , Tatlisumak Turgut , Putaala Jukka , Coutinho Jonathan M , Ferro Jose , Arnold Marcel , Heldner Mirjam
Published: February 2024

Background:
Coronavirus disease 2019 (COVID-19) increases the risk of cerebral venous sinus thrombosis (CVST), and previous reports derived from small case series reported a high mortality in these patients, up to 40%. We assessed the clinical characteristics and outcomes in an international cohort of patients with COVID-CVST.

Methods:
This was a registry study of consecutive COVID-CVST patients diagnosed between March 2020 and March 2023. As a comparison, we used data of patients with CVST unrelated to COVID-19,diagnosed between 2017 and 2018 and derived from the International Cerebral Venous Thrombosis Consortium database.

Results:
We included 70 patients with COVID-CVST from 23 hospitals in 15 countries and 206controls from 14 hospitals in 13 countries. Median age did not differ between the groups (43 vs 44years,
P
=0.6) but there were fewer women in the COVID-CVST group (50% vs 68%,
P
<0.01). The COVID severity was asymptomatic, mild or moderate in 60/69 (87%). The median thrombus load was higher in COVID-CVST patients (3 [IQR 2-4] vs 2 [1-3],
P
<0.01), as was the frequency of non-hemorrhagic brain lesions (47% vs 33%,
P
=0.03). The length of hospital stay in COVID-CVST patients was longer compared to controls (11 days [IQR 7-20] vs 8 [4-15],
P
=0.02). In-hospital mortality did not differ (5/67 [7%] vs 7/206 [3%], aORsex,age 2.5 [95%CI 0.7-9]), nor did the frequency of favorable clinical outcome (modified Rankin Scale 0-2, 45/56 [80%] vs 161/185 [87%], aORsex,age0.6 [0.2-1.7]) after 6 months.

Conclusion:
Contrary to previous reports, there was no significant difference in in-hospital mortality and long-term outcome in patients with COVID-CVST compared to patients with CVST unrelated toCOVID-19.
Abstract TP189: Outcome Differences Between Endovascular Thrombectomy and Medical Management Based on Underlying Stroke Etiology:
A Secondary Analysis of SELECT2 Trial
Authors: Shaker Faris , Pujara Deep , Abraham Michael G , Chen Michael , Kasner Scott E , Ortega-Gutierrez Santiago , Hussain Muhammad S , Blackburn Spiros , Churilov Leonid , Sundararajan Sophia , Hu Yin , Xiong Wei , DeGeorgia Michael , Opaskar Amanda , Moussa Rami , Abdulrazzak Mohammad , Al-Shaibi Faisal , Duncan Kelsey R , Johns Hannah , Sila Cathy A , Furlan Anthony J , Mendes Pereira Vitor , Hill Michael D , Grotta James C , Ribo Marc , Hassan Ameer E , Campbell Bruce , Sarraj Amrou ,   The SELECT2 Investigators
Published: February 2024

Introduction:
In patients with large core ischemic stroke, potential heterogeneity in EVT treatment effect based on underlying etiology is an important question. We explored differences in clinical outcomes and successful recanalization rates between EVT and MM.

Methods:
From SELECT2 randomized clinical trial, patients were categorized based on Stroke etiology: Large-artery atherosclerosis (LAA), Cardioembolism (CE), Stroke of other determined etiology (SOE), and Stroke of undetermined etiology (SUE). Procedure success, clinical outcomes and EVT treatment effect was compared based on stroke etiology.

Results:
Cardioembolic stroke was most frequently observed etiology across the trial (41%), followed by stroke of undetermined etiology (29%), large artery atherosclerosis (23%) and stroke of other determined etiology (6%). Proportion of patients achieving successful reperfusion (mTICI 2b-3) after EVT differed significantly across the categories (CE: 87%, LAA: 82%, SOE: 73%, SUE: 66%, p=0.040). However, treatment effect estimates favored EVT across categories of stroke etiology without significant heterogeneity - CE (ref): aGenOR: 1.83 (1.30-2.59) vs LAA: aGenOR: 2.04 (1.24-3.37), p-int: 0.87 vs SOE: aGenOR: 2.06 (0.80-5.28), p-int: 0.79 vs SUE: aGenOR: 1.20 (0.77-1.88), p-int: 0.17.

Conclusion:
In patients with large core ischemic stroke, proportion of patients achieving successful reperfusion differed based on stroke etiology. However, EVT was associated with better outcomes without evidence of significant heterogeneity. Further optimization of procedure techniques may help improve successful reperfusion rates and clinical outcomes in patients with SUE.

Clinicaltrials.gov registration:
NCT03876457
Abstract TP201: Impact of Microguide Wire Stiffness on Microcatheter and Aspiration Catheter Navigation in Tortuous Vessels
Authors: Sakuta Kenichi , Hanaoka Yoshiki , Ghovvati Mahsa , Imahori Taichiro , Tateshima Satoshi , Kaneko Naoki
Published: February 2024

Background and Purpose:
Endovascular therapies require devices to access treatment sites safely and efficiently. Vessel tortuosity often complicates this navigation, increasing the risk of microguide wire (MGW) or microcatheter (MC) kickback, which may result in unstable device movements or sudden drop of devices. This study aims to elucidate the effect of MGW stiffness variability on the trackability of MC and aspiration catheters (AC).

Methods:
Using two silicone vascular models, we replicated the M2 segment of the middle cerebral artery (MCA) at an 80-degree branch (MCA model, Fig. A) and a severely tortuous internal carotid artery (ICA model, Fig. B). Experiments were conducted under conditions of 37°C, 60 BPM, and an ICA flow rate of 240 mL/min. In the MCA model, the MC (TrevoTrak21) was advanced from the M1 segment to distal M2 while three MGWs (Synchro SELECT Soft, Standard, Support) were placed at distal M2. In the ICA model, the AC (Zoom 71) was advanced from ICA to M1 with MC and MGW at distal M2. Maximum push force and kickback length were measured while TrevoTrack21 or Zoom71 were advanced at 4 mm/sec for 7 runs per device. One-way ANOVA assessed group differences.

Results:
In the MCA model, when using the Soft MGW, the MC recorded the highest pushing force at 59.3mN and kickback of 29.87mm. Conversely, the Support MGW demonstrated the least pushing force at 38.2mN (P<0.001) and the shortest kickback length at 17.83mm (P<0.001). For the ICA model, differences in forces across the MGW types were less distinct. However, the kickback length with the Soft MGW at 13.78mm was significantly greater than that with the Standard MGW at 6.26mm and the Support MGW at 6.76mm (P=0.026).

Conclusion:
Our findings suggest that MGWs with higher stiffness offer more stable guidance, requiring less force in both MC and AC navigation. Moreover, increased MGW stiffness consistently leads to shorter kickback lengths, emphasizing its importance in stable device navigation.