bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract NS27: Effects of a Theory Based Stroke Prevention Program in Korean Americans: A Pilot Study
Authors: An Minjeong , Nahm Eun-Shim , Shaughnessy Marianne , Storr Carla , Han Haera , Lee JuHee
Published: March 2022

Background:
Stroke is the fourth leading cause of death, and nonfatal stroke is a leading cause of long-term functional disability in the United States. Stroke can be prevented by managing risk factors and improving stroke knowledge. Although many health education programs have been shown to be effective for stroke prevention, those programs may not reach minority populations with a language barrier, such as older Korean Americans (KAs). The purposes of this study were to develop an 8-week theory-based stroke prevention (TBSP) program for older KAs and test its preliminary impact on stroke knowledge, healthy eating, and physical activity behaviors among KAs.

Methods:
A two-group, pretest-posttest, randomized controlled trial was employed. Using a convenience sampling method, participants were recruited from two senior centers (n = 73, age ≥ 55). Data were collected at baseline and at 8 weeks. The TBSP program included face-to-face lectures and discussion sessions. Descriptive statistics were performed on the sample and variables. A general linear model and logistic regression analysis were used to test the main hypotheses.

Results:
The majority of participants (n = 54, 74.0%) were female (mean age, 71.49 ± 6.25 years), and 65.8% were married. Thirty-two participants (43.8%) completed greaterthan high school. More than half of participants (n = 40, 55.0%) were engaged in low levels of physical activity (< 600 MET-minutes/wk). Total fat intake was adequate (50.25 ± 22.10 g/day), and sodium intake was high (3861.80 ± 1891.19 mg/day). The intervention group showed greater improvement in stroke knowledge (F = 6.88, p = .011) and physical activity (OR = 11.79, 95% CI = 1.94 - 71.65) and a reduction in total fat intake (F = 8.93, p = .004). There were no significant differences between the two groups for sodium and cholesterol intake or self-efficacy and outcome expectations for physical activity and healthy eating.

Conclusion:
The findings demonstrated some improvement in stroke knowledge and healthy behaviors after the TBSP program. High sodium intake in this population needs further intervention. More studies are needed with larger, more diverse older KA samples to improve generalizability.
Abstract NS8: Improving Acute Ischemic Stroke Improving Acute Ischemic Stroke Treatment Rates: Improving Acute Ischemic Stroke Treatment Rates: Can a Non-Traditional Stroke Response Team Measure Up?
Authors: Dusenbury Wendy , Alexandrov Anne , Taylor Scott
Published: March 2022

Background:
Emergent response to stroke requires internal hospital resources and manpower to ensure delivery of rapid protocolized care. We compared the safety, effectiveness, and efficiency of an innovative Acute Stroke Response Team (I-ASRT) consisting of nurse practitioners, physician assistants, and critical care physicians, compared to a traditional neurologist (T)-ASRT model.

Methods:
A retrospective descriptive study was conducted to examine the effect of an I-ASRT on IV-tPA treatment rates, safety, and door-to-needle (DTN) times, compared to a T-ASRT at a tertiary Stroke Center in the Midwestern U.S. Stroke registry data from April 2007 to October 2013 were analyzed. Stroke mimic syndromes, hemorrhagic stroke, or drip and ship transfers were excluded. Safety was defined by rate of IV-tPA associated sICH defined as ≥ 4 point change of NIHSS in combination with PH-2 hemorrhage on CT.

Results:
1278 ASRT patients were included; 340 (27%) of cases were managed by the T-ASRT and 938 were managed by the I-ASRT. Overall, the sample was 84% White non-Hispanic, 5% White Hispanic, 9% African American, 0.5% Asian, 0.5% Native American, 0.5% mixed race, and 0.5% unknown. Overall median admission NIHSS was 4. Stroke patients were most commonly female, and those managed by the T-ASRT had significantly worse neurologic disability on NIHSS (9.6+/-7.4 vs. 5.8+/-7.1, <.0001), and longer LOS (4.6+/-3.3 vs. 3.7+/-4.9 days, <.0001) compared to those managed by I-ASRT. IV-tPA rates were similar between groups (T-ASRT=16%; I-ASRT=15%; p=ns). Door-to-needle times were statistically similar, although a clinically important 31 minute reduction was achieved by the I-ASRT (I-ASRT=52 +/- 23 minutes vs. T-ASRT=83 +/- 21 minutes; p=ns). T-ASRT sICH rate was 10% vs. a clinically important, but non-significant sICH rate of 5% in I-ASRT patients.

Conclusions:
Our findings are consistent with other studies demonstrating safe expansion of nurse practitioner and physician assistant roles to include IV-tPA decision making following completion of neurovascular fellowship training.
Abstract NS9: A Successful Fall Prevention Program In A Mixed Nursing Unit Does Not Translate To Decreased Fall Rates For Stroke Patients
Authors: Rosete Jane , Neil William , Button Jenny , Buccigrossi David , Forde Kerry , Mallett Karin
Published: March 2022

Background:
Patients with stroke are at high risk for falls, and it is a known medical complication after stroke. It is recorded that approximately 5% of ischemic stroke patients fall at least once in the acute hospitalization. In August 2011, a fall prevention program was implemented in a mixed nursing unit that was successful in reducing falls for hospitalized patients.

Purpose:
The aim of this retrospective sub-group analysis is to examine the fall rate and percentage of falls for stroke and TIA patients after the implementation of a successful fall prevention program in a nursing unit within a community hospital.

Methods:
The fall prevention program, entitled “No One Walks Alone (NIWA)” was implemented August 2011 in an area where the majority of stroke patients were hospitalized. NIWA included the use of routine bed alarms, identifying all patients as a fall risk, routine rounding, and a team approach, which involved the unit desk clerk, primary nurse, patient, and/or family. Stroke records for 3/2011-12/2011 was retrospectively retrieved and the percentage and rate of post-stroke falls compared.

Results:
A total of 300 hospitalized patients with stroke (mean age 73.1, 54.7% male, 73.4% ischemic, 17% TIA, 9.6% hemorrhagic) were reviewed during the study period, and there was a total of 6 falls. Prior to NIWA, there were 165 stroke patients, with an incidence of 3 falls (1.8%) compared to 135 stroke patients with 3 falls (2.2%, p>0.05). The fall rate for stroke patients prior to NIWA was 6.2 falls per 1000 patient days compared to 9.6 falls per 1000 patient days (p>0.05).

Conclusion:
Although there was no significant difference between the fall percentage and rate for stroke patients with the implementation of a successful fall prevention program, our analysis supports the importance of fall prevention during the acute hospitalization. When compared to the 5% of stroke patients who fall during the acute hospitalization, our hospital continued to demonstrate a lower percentage of falls in this sub-group of patients. Further study is warranted in obtaining a larger cohort, with further analysis to identify risk factors and unique characteristics specific to our patient population to identify those at risk and prevent further post-stroke falls.
Abstract T MP10: Arterial Reocclusion And Distal Embolization During Endovascular Treatment Using New Generation Stent Retrievers In Acute Ischemic Stroke Patients
Authors: Herial Nabeel , Qureshi Mushtaq H , Khan Asif A , Jahangir Nauman , Khan Hashim , Janjua Nazli , Suri Fareed K , Qureshi Adnan I
Published: March 2022

BACKGROUND AND PURPOSE:
Arterial reocclusion and distal embolization have been identified in previous studies of endovascular treatment in patients with acute ischemic stroke. We determined the rates of reocclusion and distal embolization during endovascular treatment using new generation stent retrievers.

MATERIALS AND METHODS:
Acute ischemic stroke patients underwent mechanical thrombectomy using new generation stent retrievers without intra-procedural heparin or proximal flow arrest for angiographically demonstrated arterial occlusion. "Distal embolization" was defined qualitatively as appearance of an occlusion on a downstream vessel. "Arterial reocclusion" was defined as subsequent reocclusion of the target vessel after initial recanalization had been achieved. The rates were compared with data from 4 previous prospective acute stroke protocols prior to availability of stent retrievers.

RESULTS:
The median initial National Institutes of Health Scale Score (NIHSS) for these patients was 14 (range 34-0); mean time from symptom onset to treatment was 5.2 +/- 2.6 hr. Arterial reocclusion occurred in 2.3% of these patients, whereas distal embolization occurred in 24% of the 86 patients. The rates of arterial reocclusion (3.0% versus 1.9%) and distal fragmentation (21.2% versus 30.8%) were similar in patients who did or did not receive IV alteplase prior to thrombectomy. Arterial reocclusion, but not distal embolization, was associated with a lower likelihood of favorable outcome at 1-3 months (P = .05; odds ratio, 3.9; 95% confidence interval, 0.01-0.98) after adjusting for age, initial NIHSS, sex, time to treatment, initial angiographic grade, symptomatic intracranial hemorrhage, and final recanalization. The rates of arterial reocclusion (2.1% versus 2.6% of 86 patients, p=0.8) and distal embolization (35.4% versus 18.4% of 86 patients, p=0.8) were not similar in patients treated with and without stent retrievers.

CONCLUSIONS:
Arterial reocclusion and distal embolization occur in 16%-18% of acute ischemic stroke patients undergoing mechanical thrombectomy with new stent retrievers without IV heparin or proximal flow arrest. The rates are no higher than those observed in cohorts treated without stent retrievers.
Abstract T MP101: Development and Introduction of a Performance Improvement Tool to Enhance Door-To-CT-Times for the Acute Stroke Patient
Authors: Benvenuto Deborah B , DeFronzo Justine
Published: March 2022

Purpose/Background:
The purpose of this abstract is to demonstrate rapid change improvement in SCORE quality measures specifically,
Door-to-CT-times
, for patients presenting to the Emergency Department with signs and symptoms of stroke.This change was implemented subsequent to review of data which revealed less than optimal
Door-to-CT-times
sustained over the course of several quarters.

Objectives:

1. To visually demonstrate the algorithm developed to model the care pathway of the acute stroke patient from Registration to initiation of the CT radiographic exam.

2. To exhibit an educational pathway that resulted in rapid change and improvement of
Door-to-CT-times
as well as an unintentional favorable trend for the
CT-to-Result
measure.

3. To compare
Door-to-CT-times
pre- and post-implementation of multidisciplinary education on the stroke pathway and goal of
Door-to-CT
in less than 20 minutes.

Results:
Prior to implementation of education utilizing the stroke pathway algorithm, results were consistently inconsistent ranging from 22% compliance to 63% compliance month over month. In January 2014 we had a 47% success rate and February 33% success rate for door to CT within 20 minutes. The educational program was implemented in February of 2014. Clearly, the visual depiction of patient flow thru the ED to CT greatly enhanced the educational process. We exceeded our goal of attaining 50% compliance and stretch goal of 70% compliance to 89% compliance in Door-to-CT times in the first month (March 2014) following implementation of the process improvement initiative. Data reveals sustained improvements through Q2 as follows: April 90%, May 68%, and June 73%. Due to the significant improvement in our Door-to-CT compliance, we also noted a comparably significant enhancement in our Door-To-Results times.

Conclusions/Implications for Practice:
By developing an ongoing educational process with demonstrable improvements in care for the acute stroke patient, Emergency Department staff appreciated improved outcomes for this particular patient population. This is a single institution study, results may not be applicable to other institutions.
Abstract T MP104: Stroke Transition of Care: Preventing a Second Event
Authors: Valdez Krystal
Published: March 2022

Background:
In the United States stroke is the leading cause of long-term disability leaving over six million stroke survivors. In 2009, the indirect and direct cost in the U.S. was $38.6 billion dollars. If modifiable risk factors were controlled, up to 80% of strokes could be prevented. There is no current recommended transition of care approach or algorithm to track and follow-up on acute ischemic stroke or transient ischemic attack patients post discharge from the hospital for secondary stroke prevention.

Purpose:
The purpose of this exploration is to perform a gap analysis of programs/trials for transition of care in order to prevent a secondary stroke event.

Methods:
Eight secondary stroke prevention program/trials were evaluated to provide hospitals with evidence-based tools to start to address the wide gap in post-discharge transition of care.

Results:
Several areas were identified as potential starting points for a healthcare organizations transition of care program. They include an educator/coordinator role, follow-up time frames, and validated tools for assessment pre/post discharge. Significant gaps exist for those who are unable to be discharged to the community; this population is largely excluded in transition of care programs.

Conclusion:
There is not a program/trial with a holistic approach regardless of discharge disposition. Future studies are needed to centralize the qualities found in this review that are ideal for any program: Pre-set physician appointments, follow up phone calls pre/post doctor appointments, series of classes in-hospital with topics on nutrition, exercise regimen, cardiac and neurologic event education and prevention, psychological support with referral, caregiver and community licensed personnel education/training, algorithms with evidence based literature regarding follow up and secondary prevention provided to primary physicians, and social worker community resources. The utilization of the advanced practice nurse and the holistic approach of the Roy Adaptation Model and theory as an assessment and intervention conduit can begin to bring current evidence for transition of care.
Abstract T MP106: Nursing Acceptance of a Novel Care Coordination Application to Reduce Time to Thrombolysis in Patients with Acute Ischemic Stroke: A Pilot Study
Authors: Courville Katheryn A , Dickson Robert
Published: March 2022

Background:
STOP STROKE© is a novel medical application (app) developed to improve care coordination in acute ischemic stroke and was previously demonstrated to improve door to thrombolytic times. The app captures stroke benchmarking data in real time for quality assurance/improvement. Current literature reports that successful adoption of new health care technologies is not decided by hospital administration, but determined on the work floor. Purpose: We seek to determine the feasibility of an instrument used to measure end users’ intent to use, perceived usefulness, and perceived ease of use of STOP STROKE© and to capture the determinants of these constructs. Methods: We administered a 74-question, on-line survey to a convenience sample of 16 end users involved in acute stroke care after STOP STROKE© was instituted at our level II trauma center with annual emergency department volumes of 90,000. The Technology Acceptance Model (TAM) employs constructs including: perceived usefulness, ease of use, self-efficacy, external control, enjoyment, subjective norm, computer anxiety, voluntariness, image, job relevance, output quality, result demonstrability, and intent to use. Participants included emergency department charge nurses, cardiac catheterization lab nurses, house supervisors, and stroke coordinator. Data analysis included descriptive statistics and crosstabs. Results: Our sample consisted of 62% women, mean age 41 with an average of 10 years in their current role. Respondents had an average 4.8 years experience using smart phone technology. Overwhelmingly, nurses indicated they intended to use the app (93%), that it had usefulness (81.3%) and was easy to use (87.5%). Additionally, when comparing the app to the traditional stroke activation system, nurses felt that the app improved patient outcomes (86.7%), fit with current protocols and practice (93.3%), and that positive results were demonstrable (100%). Determinants were congruent with TAM theory. Conclusions: The use of TAM can measure acceptance and intent to use the app. Our findings will allow a fully-developed instrument to identify pre-implementation concerns and then measure intervention success in post-implementation surveys.
Abstract T MP109: Leptomeningeal Collaterals, Ageing and Metabolic Syndrome in Development of White Matter Hyperintensities
Authors: Volny Ondrej , Nambiar Vivek , Sohn Sung I , Faber James E , Welsh Donald G , Sajobi Toloupe , Mikulik Robert , Demchuk Andrew M , Menon Bijoy K
Published: March 2022

Background:
Ageing and metabolic syndrome are associated with poor leptomeningeal collateral status. Animal studies suggest that collateral rarefaction and consequent decrease in vascular efficiency may result in increase in white matter hyperintensities. Using mediational analysis, we test if the known effect of ageing and metabolic syndrome on development of white matter hyperintensities is mediated through collateral status.

Methods:
Data are from the Keimyung Stroke Registry. Consecutive patients with M1 segment middle cerebral artery (MCA) ± intracranial internal carotid artery (ICA) occlusions on baseline CT-angiography (CTA) and brain MRI done within 90 minutes after admission CT/CTA, from May 2004 to July 2009, were included. Baseline and follow-up imaging was analyzed blinded to all clinical information. Two raters assessed leptomeningeal collaterals on baseline CTA by consensus, using previously validated regional leptomeningeal score (rLMC). FLAIR volume of white matter hyperintensities (ml) was measured in the unaffected hemisphere using Quantomo® software. The template of Baron and Kenney along with two tests (Sobel’s and Aroian’s) was used to test for the presence of mediation.

Results:
Baseline characteristics (n=120): mean age 67.4±11.4 years, male (53.3%), median baseline NIHSS 14 (IQR 11-20), and median stroke symptom onset to CTA 166 minutes (IQR 96-262). Poor collateral status at baseline (rLMC score 0-10) was seen in 42/120 (35%). Mean periventricular hyperintensity (PVH) volume was 6.5 ml (SD=6.0) while mean white matter hyperintensity (WMH-total) volume was 8.6 ml (SD=8.0). Higher age was associated with increased PVH and WMH-total (p<0.01) while metabolic syndrome was associated with increased PVH only (p=0.03). We did not find statistical evidence of leptomeningeal collaterals mediating the association between ageing and PVH/WMH-total or between metabolic syndrome and PVH (Sobel’s and Aroian’s test p>0.05).

Conclusion:
The effect of ageing and metabolic syndrome on development of white matter hyperintensities is independent of an effect mediated through the poor collateral status.
Abstract T MP111: Cerebral Amyloid Angiopathy Is Associated With Arteriolar Sclerosis And Microinfarcts, But Not Overt Ischemic Stroke Or Hemorrhage In A Large Autopsy Series
Authors: Lee Jessica D , Rose Danny R , Jicha Gregory A , Murphy Richard R
Published: March 2022

Introduction:
Cerebral amyloid angiopathy (CAA) has been associated with various types of cerebrovascular pathology independent of Alzheimer’s disease (AD), including atherosclerosis, arteriosclerosis, ischemic and hemorrhagic infarction. Available studies have frequently produced conflicting results in regards to specific cerebrovascular associations, likely due to confounds of subject selection biases, small sample sizes, and incomplete pathologic analyses. The present study represents one of the largest and most comprehensive clinical-pathologic series to date focused on examining clinical, genetic, and pathologic associations in CAA.

Hypothesis:
As CAA represents a vasculopathy of the small arterioles and capillaries, we hypothesized that cerebrovascular associations with CAA would include small vessel pathologies and microinfarcts rather than large or medium vessel pathologies.

Methods:
Cases were derived from the University of Kentucky brain bank (n=741). Vascular pathology was graded on semiquantitative scale or as present/absent. Cases were grouped by presence (n=414) or absence of CAA (n=327). Standard descriptive and comparative statistics were used for the analysis.

Results:
ApoE status (p<0.001), but not age, was associated with CAA. Cases with and without CAA did not differ in regards to large vessel or lacunar ischemic stroke, hemorrhagic stroke, hippocampal sclerosis, or circle of Willis atherosclerosis. A significant increase in arteriolar sclerosis (p<0.001) and microinfarct burden (p<0.01) was seen in the CAA-positive group.

Conclusions:
CAA across the cognitive continuum, appears independent of age, and is a significant contributor to small vessel ischemic changes that may have a profound effect on brain health, including risk for stroke and cognitive impairment. Comprehensive treatment strategies for small vessel ischemic disease need to acknowledge and potentially address the role of CAA as therapeutic treatments for this unique vasculopathy become available in the future.
Abstract T MP120: Platelet Reactivity Monitoring In Neuro-endovascular Treatment -The PLANET Multicenter Study-
Authors: Yamagami Hiroshi , Sakai Nobuyuki , Matsumoto Yasushi , Yoshimura Shinichi , Enomoto Yukiko , Ishii Akira , Sakai Chiaki , Matsumaru Yuji , Hayakwa Mikito , Takada Tatsuro
Published: March 2022

Background and Purpose:
Antiplatelet therapy is essential for preventing thrombotic complications in neuro-endovascular treatment (NET). However, it has been clarified that there are poor responders of antiplatelet drugs. The present study was conducted to evaluate the usefulness of platelet reactivity monitoring for predicting thrombotic or hemorrhagic event in patients underwent NET.

Methods:
Between May 2010 and Mar 2013, we enrolled 617 patients who were planning to undergo elective carotid artery stenting or aneurysmal coil embolization in 7 Japanese centers. Antiplatelet therapy was started at least two days before, and platelet reactivity was measured with Verify Now system at beginning of the procedure. Patients were followed for 1 year. Thrombotic events (ischemic stroke, myocardial infarction, or systemic embolization) and hemorrhagic events (intracranial or major systemic hemorrhage) were examined. We evaluated the relationships between platelet reactivity and occurrences of thrombotic/hemorrhagic events.

Results:
A total of 595 patients (270 men, 63.7±11.9 years old) with sufficient data were analyzed. Thrombotic and hemorrhagic events were observed in 38 (6.4%) and 19 (3.2%) patients within 30 days, and additionally observed in 4 (0.6%) and 10 (1.7%) patients between 31 days and 1 year after the procedure. With receiver operating characteristic analysis, optimal cut-off values for predicting thrombotic events were P2Y12 reaction units (PRU) >225 (area under the curve: 0.57). Higher platelet reactivity was related to higher incidence of thrombotic events within 1 year (10.0% vs 4.3%, Log rank P225 (HR 2.55, 95% CI 1.24-4.87, P=0.01) and prior cerebrovascular disease (HR 2.83, 95% CI 1.48-5.40, P<0.01) were the predictors of thrombotic events within 1 year after the procedure. Low platelet reactivity on P2Y12 was not associated with hemorrhagic events.

Conclusion:
High platelet reactivity on P2Y12 (PRU>225) can predict thrombotic events after NET. Safer drugs or tailored strategies may be needed to reduce the complications in patients with cerebrovascular diseases.
Abstract T MP13: Tak1 Knockdown In Myeloid Lineage Protects Against Transient Focal Cerebral Ischemia In Mice
Authors: Chauhan Anjali , Hudobenko Jacob , DiMauro Sharon , McCullough Louise
Published: March 2022

Introduction:
Stroke is 4
th
cause of death and one of the leading causes of disability in United States. Transforming growth factor β activated kinase-1 (TAK1) is a major contributor in the progression of injury post stroke. Pharmacological inhibition of TAK1 is neuroprotective after stroke, but the cell type responsible for these effects is unknown. Myeloid cells play a key role in inflammation after stroke and selective deletion of TAK1 in myeloid cells reduced neuro-inflammation in models of multiple sclerosis. Therefore, we hypothesized that the detrimental effects of TAK1 activation after ischemic injury were mediated by myeloid-specific activation of TAK1.

Methods:
Young male ovary-intact and ovariectomized female [litter mates TAK
fl/fl
and TAK
fl/fl
LysM
cre
(mTAK-/-)], (8-12 weeks) were randomly divided into sham and stroke group and subjected to 90 minutes of right middle artery occlusion. Neurobehavioral assessments were performed after 24 hours and brains were taken for analysis.

Results:
In sham males, there was a significant increase in the percentage of circulating macrophages and neutrophils in mTAK-/- (62.48 ± 2.43 and 33.33 ± 3.01 respectively) compared to TAK
fl/fl
(35.38 ± 3.09 and 17.04 ± 3.26) (p<0.05) mice. After stroke, a significant decrease in macrophages and neutrophils was observed in mTAK-/- (22.60 ± 1.23 and 17.57 ± 2.60, respectively) compared to TAK
fl/fl
(72.90 ± 4.63 and 57.78 ± 5.9, respectively) (p<0.05). There was a significant improvement in neurological deficit score (NDS) in mTAK-/- (1.9 ± 0.4) compared to WT littermates (3 ± 0.7) (p<0.05). An increase in total TAK1 expression was seen in mTAK-/- mice after stroke but there was no difference in levels of phosphorylated TAK1 (p<0.05). In females, there was a significant improvement in the NDS and corner test in ovx mTAK-/-females (2.2 ± 0.4 and 0.7 ± 0.1) as compared to ovx TAK
fl/fl
females (3.0 ± 0.6and 0.9 ± 0.2) (p<0.05) respectively. Ovary intact mTAK-/- and TAK
fl/fl
females had similar infarct suggesting a role for estrogen in TAK signaling or post stroke inflammation.

Conclusion:
TAK1 deletion in myeloid cells leads to neuroprotection against ischemic injury. Further studies will be performed to determine the contribution of different cell types in the TAK1 signaling.
Abstract T MP31: Imaging of 68Ga-PRGD2 PET/CT for αvβ3-integrin in Severe Intracranial Atherosclerotic Stenosis Patients
Authors: Shu Shi , Zhu Zhaohui , Zhu Yicheng , Li Fang , Cui Liying , Peng Bin
Published: March 2022

Background:
Angiogenesis has been demonstrated in acute cerebral infarct lesion. Intracranial atherosclerotic stenosis(ICAS)is usually associated with chronic cerebral ischemia. It is uncertain whether angiogenesis exist in such circumstance. αvβ3-integrin is expressed by angiogenic endothelial cells and serve as a biomarker of angiogenesis. 68Ga-PRGD2 which is a PET tracer specifically binding to toαvβ3-integrin was used for imaging angiogenesis.

Objective:
To evaluate the status of angiogenesis in patients with severe ICAS.

Method:
For the pilot study, patients with unilateral ICAS were recruited. 68Ga-PRGD2 PET/CT, 13N-Amonia PET/CT and 18F-FDG PET/CT scans were performed. The procedures were done at least 45 days after index ischemic event in symptomatic ICAS patients. The PET images were evaluated by semi-quantitative analysis. Peak standardized uptake value (pSUV)were calculated. pSUV was compared between hemisphere supplied by ICAS and opposite side. Correlation analysis were applied between pSUV of 68Ga-PRGD2, and 13N-Amonia. Informed consent were obtained.

Results:
Nine patients were studied, 6 with symptomatic (45 days to 19 years post ischemic event) and 3 asymptomatic ICAS. Among them, there were 3 ICA occlusion, 3 MCA occlusion and 3 MCA stenosis (unilateral ≥70%). 68Ga-PRGD PET/CT showed significantly higher pSUV in lesion sides (0.22 vs 0.08, P<0.02 ). There are no significant difference between SUV of 13N-Amonia (3.59 vs 3.90,p=0.489) and 18F-FDG(12.42 vs 13.86,p=0.34). pSUV of 13N-Amonia in lesion sides significantly correlates with pSUV of 68Ga-PRGD2 (r=-0.77, P=0.015).

Conclusion:
68Ga -PRGD2 uptake was observed beyond acute phase in patient with severe ICAS. Chronic cerebral ischemic might induce angiogenesis in addition to acute ischemic event. Further study to explore the mechanism was warranted.

Fig.1 Images of a TIA patient 45 days after onset. C. Obvious uptake of 68Ga -PRGD2 (arrow). D. Lightly low uptake of 18F-FDG .
Abstract T MP37: Incidence of New or Worsening Renal Insufficiency (RI) Among Stroke Patients Receiving IV Contrast Dye: A Population-Based Study
Authors: Demel Stacie L , Moomaw Charles J , Khoury Jane S , Alwell Kathleen A , Kissela Brett M , Grossman Aaron G , Woo Daniel , Flaherty Matthew L , Ferioli Simona , Mackey Jason , De Los Rios la Rosa Felipe , Adeoye Ope , Kleindorfer Dawn , Martini Sharyl
Published: March 2022

Background:
CT angiography (CTA) and conventional angiogram provide timely vascular anatomical information in stroke patients. However, the iodinated contrast dye may cause renal injury. Within a large, biracial population, we examined in-hospital incidence of new or worsening RI in stroke patients and its association with administration of intravenous (IV) dye.

Methods:
All residents of the Greater Cincinnati/Northern Kentucky region ≥ 20 years of age with ischemic stroke (IS), subarachnoidhemorrhage (SAH), or intracerebral hemorrhage (ICH) who presented to an emergency department in 2010 and survived at least two days were included. Medical records from the acute hospitalization were retrospectively reviewed, and age, race, sex, stroke risk factors, admission serum creatinine (Cr), vascular imaging, and metformin use were abstracted. Incidence of RI was assessed and stratified by use of IV dye. RI on presentation was defined as history of RI or ESRD or Cr ≥ 1.5 on admission. Development of RI during the hospital stay was defined as renal failure/insufficiency after day 2 of hospitalization or new dialysis documented in the record.

Results:
In 2010, 2350 stroke patients in the region met inclusion criteria (86% IS, 11% ICH, 3% SAH); mean age 69 years (SD 15), 22% black, 54% female. Among these patients, 22% had RI at baseline, 25 (3%) developed new RI, while 11 (2% had worsening RI during hospitalization). Among all 2350 patients, 340 (14%) had IV dye-based vascular imaging.

Table presents demographics and incidence of new or worsening RI stratified by IV dye administration.

Discussion:
Incidence of new or worsening renal insufficiency in stroke patients in this population based study was extremely low (36/2350;

1.5%). One patient had severe enough RI to warrant new dialysis. We did not find an association between IV dye and new or worsening RI. This confirms prior single-center reports that the risk of severe renal complications after contrast dye is extremely low.
Abstract T MP43: Patient Characteristics and Outcomes in Pregnancy-Related Ischemic Stroke
Authors: Leffert Lisa , Clancy Caitlin , Bateman Brian , Cox Margueritte , Schulte Phillip , Smith Eric , Fonarow Gregg , Kuklina Elena , George Mary G , Schwamm Lee
Published: March 2022

Background:
Ischemic Stroke (IS) is a rare but serious event during pregnancy or the postpartum period. We compared the characteristics and outcomes of pregnant vs. non-pregnant women diagnosed with IS in the Get With The Guidelines Stroke Registry.

Methods:
We identified 24641 female patients aged 18-44 with IS, based on medical history or ICD-9 codes, from 2008-2013. Patient and hospital categorical variables were compared by Chi-square and continuous variables by Wilcoxon Rank-Sum. Stratified logistic regression assessed the effect of pregnancy on outcomes conditional on age and adjusted for patient and hospital characteristics.

Results:
There were 338 (1.4%) pregnant IS patients. Compared to non-pregnant patients, pregnant patients had fewer traditional stroke risk factors, were less often black, and were more likely to be insured by Medicaid, in a healthcare setting at stroke onset, and admitted to a stroke center. Both groups had similar initial mild stroke severity and exam findings most notable for weakness (Table). Discharge outcomes of in-hospital death (aOR 0.70, 95% CI 0.33-1.50), discharge to home (aOR 1.04, 95% CI 0.81-1.34), independent ambulation (aOR 1.03, 95% CI 0.79-1.34) or length of stay >4 days (aOR 1.27, 95% CI 0.96-1.68) did not differ between groups. Of the 145 cases where pregnancy stage was coded, 76 (52.4%) occurred postpartum and 65 (44.8%) antepartum, with no difference in discharge outcomes. Women with postpartum compared with antepartum IS were more likely to have hypertension, use antihypertensives pre-stroke, and have higher median initial post-stroke blood pressure.

Conclusions:
Pregnancy-related IS is uncommon and occurs in women with few traditional stroke risk factors, often within 6 weeks postpartum. Despite these differences, short term outcomes after stroke are similar to non-pregnant women. Further research is needed to determine if pregnancy, itself, independently contributes to stroke risk.
Abstract T MP50: Novel TIA Serum Biomarkers Identified by Mass-Spectroscopy Proteomics
Authors: George Paul M , Mlynash Michael , Adams Christopher M , Garcia Madelleine , Kemp Stephanie , Kuo Calvin , Albers Gregory W , Olivot Jean Marc
Published: March 2022

Background:
One of the “holy grails” in vascular neurology is a TIA serum marker. Mass spectrometry-based proteomics, a unique, unbiased method to identify candidate proteins, was used to test the serum of patients with transient neurologic symptoms for biomarkers of cerebral ischemia.

Methods:
Patients with transient neurologic symptoms were prospectively enrolled. Mass spectrometry was performed on the serum samples, and results were searched against the Human Uniport database. Three candidate proteins were found, and serum concentrations of these proteins were measured by ELISA in a second cohort of prospectively enrolled patients. The student’s t-test was used for comparison. The Benjamini-Hochberg false discovery rate controlling procedure for multiple comparison adjustments determined significance for the proteomic screen.

Results:
Patients with TIA (n=20), minor stroke (n=15), and controls (i.e. migraine, seizure, n=12) were enrolled in the first cohort. Ceruloplasmin, complement component C8 gamma (C8γ) and platelet basic protein (PBP) were significantly different between the ischemic samples (TIA and minor stroke) and the controls (p = 0.0001, p=0.00027, p=0.00105 respectively). A second cohort of patients with TIA (n=16), minor stroke (n=20), and controls’ (n=12) serum was tested. PBP serum concentrations were increased in the ischemic samples compared to control (for TIA and stroke, p= 0.04, for TIA alone, p=0.027). Ceruloplasmin trended towards increased concentrations in the ischemic groups (p=0.10), and an insignificant increase in C8γ (p=0.23) was found.

Conclusions:
PBP has been identified as potential serum biomarker for TIA. Larger sample size may find that ceruloplasmin is an additional candidate. Ultimately, a panel of proteins may be required. Larger studies are needed to determine the validity of these proteins in clinical use.
Abstract T MP56: Immediate Post-operative Serum Blood Urea Nitrogen is Strongly Associated with Early Post-surgical Stroke Risk in Cardiac Surgical Patients
Authors: Arnan Martinson K , Hsieh Tyken , Yeboah Joseph , Bertoni Alain , Burke Gregory , Bahrainwala Zainab , Grega Maura , Baumgartner William , Gottesman Rebecca
Published: March 2022

Objective:
To identify perioperative risk factors that are associated with post-operative stroke risk after all cardiac surgical procedures at a large tertiary hospital.

Methods:
Among 5498 adults aged 18-90 years who underwent cardiac surgery at Johns Hopkins Hospital from 2005-2010, we identified 180 cases who suffered a stroke within 10 days post-operatively. An equal number of controls were randomly selected and frequency-matched for sex and age-band to cases. Univariate and multivariate logistic regression analyses were performed to ascertain risk factors for post-operative stroke.

Results:
Emergent surgery (OR 3.04, 95% CI 1.80- 5.10), current smoking (OR 1.97, 95% CI 1.29- 3.00), peripheral vascular disease (OR 2.80, 95% CI 1.41-5.53), and previous stroke with residual paralysis (OR 4.27 95% CI 1.18-15.38) were associated with increased stroke risk. Pre-operative blood pressures were higher in cases than in controls (p <0.0001). Log of immediate
post-operative
BUN was higher in cases than in controls (p< 0.0001). In multivariable logistic regression (adjusted for pre-operative hematocrit, post-operative creatinine, acute myocardial infarction and low ejection fraction), post-operative BUN was associated with increased odds of stroke (OR 2.4 per 25% increase in BUN, p <0.0001). Postoperative stroke risk was also predicted by emergent surgical status (OR=2.7, p=0.014), current smoking (OR= 2.8, p=0.002) and pre-operative diastolic blood pressure (OR: 1.8 for every 10-point increase in DBP, p<0.0001). ROC curves indicated that post-operative BUN (AUC = 0.855) largely explained the increased post-operative stroke risk. AUC for the adjusted final model was 0.896 and the ROC curve that excluded post-operative BUN only yielded an AUC of 0.700.

Conclusion:
In these analyses we have identified factors that are associated with post-operative stroke for all types of cardiac surgery. Awareness of these exposures may improve stroke risk assessment.
Abstract T MP59: Symptomatic and Silent Cerebral Infarct following Combined Bypass for Moyamoya Disease evaluated with Diffusion-Weighted Image: A Multivariate Analysis
Authors: Tokairin Kikutaro , Ito Masaki , Kazumata Ken , Kaneko Sadao , Houkin Kiyohiro
Published: March 2022

Background:
The clinical features of cerebral infarct detected by diffusion-weighted image (DWI) following combined direct and indirect bypass for moyamoya disease (MMD) is still not fully understood. This study aims to study the incidence and risk correlates of symptomatic and silent cerebral infarct following combined bypass in MMD.

Methods:
A retrospective survey was conducted with a sample size of 95 consecutive patients with MMD treated by combined bypass in Hokkaido University since 2002. DWI that was evaluated within 2 weeks after surgery was available in 111 of 131 surgeries (85%). Demographics, preoperative radiological findings, procedure-related data and postoperative symptomatic hyperperfusion were assessed. A multivariate logistic regression analysis was used to study the related variables on postoperative cerebral infarct on DWI.

Results:
Postoperative DWI detected a total of 21 instances (18.9%/surgery) of cerebral infarct, with no significant difference between generations (21.9 and 13.2%/surgery in adults and pediatrics, respectively). Symptomatic and silent cerebral infarct was occurred more frequently when surgery was performed following the ischemic events within 6 months prior to the surgery (recent ischemic events) compared to when performed without the recent ones (15.3 and 3.6%/surgery, respectively, P = 0.0078). Preemptive antiplatelet use and procedure-related variables, including craniotomy size and the number of direct bypass did not have any relationships with cerebral infarct. After adjustment of above-mentioned variables, symptomatic and silent cerebral infarct was found to associate significantly with recent ischemic events (P = 0.032; OR = 5.5; 95%CI 1.2-26) and preoperative FLAIR ivy sign (P = 0.047; OR = 5.9; 95%CI 1.02-33.9). Cerebral infarct detected by DWI was likely to be observed beyond the area covered by combined bypass.

Conclusions:
Symptomatic and silent cerebral infarct occurred in 18.9% of combined bypasses for MMD. It may be associated with recent ischemic events and preoperative FLAIR ivy sign. Surgical management to avoid postoperative infarct after the combined bypass beyond the bypassed area would be essential to further improve the outcome of ischemic type of MMD.
Abstract T MP6: The Effect of Proximal Arterial Stenosis on Outcomes Following Interventional Therapy for Acute Ischemic Stroke in the IMS-III Trial
Authors: Gogela Steven L , Abruzzo Todd , Gozal Yair , Ringer Andrew , Khatri Pooja , Broderick Joseph , Jovin Tudor , Tomsick Thomas
Published: March 2022

Introduction:
In patients undergoing interventional treatment for acute ischemic stroke (AIS), arterial stenosis proximal to the intracranial arterial occlusive lesion (AOL) may decrease the probability of technical success and result in worse outcomes. We examined the impact of proximal arterial stenosis in the Interventional Management of Stroke (IMS)-III trial.

Hypothesis:
Arterial stenosis proximal to the intracranial AOL impedes successful interventional therapy for AIS resulting in worse outcomes.

Methods:
A total of 369 patients receiving combination intra-arterial (IA) and intravenous (IV) therapy for anterior circulation AIS in the IMS-III trial were categorized according to the degree of Internal Carotid Artery (ICA) stenosis proximal to the index AOL, as determined by immediate pretreatment digital subtraction angiography. Patients with severe stenosis or occlusion (≥70%, n=37) were compared to patients without severe stenosis (<70%, n=332). Modified Rankin scores (mRS) at 90 days, 24-hour mean infarct volumes, time to reperfusion, and symptomatic intracerebral hemorrhage (sICH) rates were evaluated.

Results:
When compared to those with ≥70% stenosis, patients with <70% stenosis had a lower mean mRS at 90 days (2.9 vs 3.3, p=0.10), greater percentage of mRS 0-2 (43.5 vs 34.3%, p=0.15), smaller mean infarction volume (70.1 vs 87.6mL, p=0.18), shorter mean time to reperfusion (78.7 vs 105.7 minutes, p=0.002), and a higher rate of sICH (7.3 vs 2.7%, p=0.15).

Conclusion:
In patients receiving combined IV/IA treatment for AIS, ipsilateral ICA stenosis of ≥70% is associated with a statistically significant longer time to reperfusion, and trends favoring larger infarct volumes and worse clinical outcomes despite a lower rate of sICH.
Abstract T MP64: Placental Pathology in Neonatal and Presumed Perinatal Arterial Ischemic Stroke
Authors: Bernson-Leung Miya E , Boyd Theonia K , Rivkin Michael J
Published: March 2022

Objectives:
Arterial ischemic stroke (AIS) occurring around birth presents in the neonatal period (NAIS) or manifests later with evidence of remote stroke (presumed perinatal, PPAIS). Both likely result from fetal/neonatal, placental, and maternal risk factors. Few studies have focused upon placental abnormalities in NAIS/PPAIS. We hypothesized that placental pathology would reveal patterns of abnormality in NAIS/PPAIS.

Methods:
We retrospectively reviewed patients with neonatal or presumed perinatal stroke in a large children’s hospital since January 2005. Placental specimens requested for all cases of neonatal stroke were reviewed by one pathologist. Clinical data were collected on maternal and infant risk factors. Stroke type was determined by consensus neuroimaging review.

Results:
We identified 30 cases with placental specimens, including 20 (67%) AIS, 9 (30%) venous infarction, and 1 arterial and venous (both). Four cases were presumed perinatal, all AIS. Of AIS/both cases, 13 (65%) involved the middle cerebral artery territory, 2 (9.5%) involved perforators, and 6 (28%) were multifocal. Clinical risk factors were identified in 17 (57%). Of placental specimens, 28/30 (93%) showed abnormalities including uteroplacental malperfusion, fetal vascular flow restriction or thrombosis, chorioamnionitis, non-specific chronic villitis, and large placenta with chorangiosis. Fourteen cases (47%) had chorioamnionitis, 11 AIS and 3 venous, of which all AIS and 1 venous showed both maternal and fetal inflammation. In 15 cases (50%) meconium was found, including 13 AIS (62%) and 2 venous (22%). Two or more abnormalities appeared in 14 cases (47%). Meconium and chorioamnionitis with fetal-side inflammation were significantly more common in AIS than in venous cases (p = 0.047 and p = 0.003, respectively).

Conclusions:
Placental abnormality was common in NAIS/PPAIS even in the absence of clinical risk factors. Meconium and chorioamnionitis with fetal-side inflammation were especially prevalent in arterial cases. All findings were subacute to chronic and could reflect intrauterine stressors that may predispose to acute ischemic stroke in the perinatal period.
Abstract T MP70: Genetic Deletion of the Prostaglandin E2 EP3 Receptor Improves Outcomes after Experimental Intracerebral Hemorrhage in Young and Old Mice
Authors: Leclerc Jenna L , Diller Matthew , Lampert Andrew , Doré Sylvain
Published: March 2022

Intracerebral hemorrhage (ICH) is a type of hemorrhagic stroke associated with high mortality and morbidity rates. Prolonged and unbalanced inflammatory responses after hemorrhagic stroke may negatively contribute to secondary brain injury. Prostaglandin E2 (PGE
2
) is an important mediator of inflammation and plays a role in several neurologic disorders. PGE
2
has selective high affinity toward its membrane-bound G-protein-coupled receptors EP1, EP2, EP3, and EP4, which together arbitrate its neuromodulatory effects. We have previously shown in a middle cerebral artery occlusion model of ischemia/reperfusion-induced brain injury and a striatal NMDA-induced excitotoxicity model that mice pretreated intracerebroventricularly with a selective EP3 receptor agonist have larger brain lesions when compared to control mice. In the present study, we investigated whether EP3 receptor deletion (EP3
-/-
) would lead to improved anatomical and functional outcomes in young (2-4mo) and aged (22-24mo) C57BL/6 mice after inducing a hemorrhagic stroke using the collagenase model of ICH (n=8-10 for all groups). Neurobehavioral testing, including video-recording of home cage activity and neurological deficit scoring was performed at 24h, 48h, and 72h post-ICH. At 72h, mice were transcardially perfused and brains isolated for Cresyl Violet staining and lesion volume quantification. In both young and aged mice, smaller brain lesion volumes were seen for the EP3
-/-
when compared to age-matched wildtype controls (p<0.05). Further, the aged EP3
-/-
displayed significantly better neurologic recovery at 72h, as identified by both behavioral tests (p<0.01). Interestingly, the aged EP3
-/-
showed significantly reduced ambulatory and stereotypic activity at 24h post-ictus (p<0.005). No significant behavioral differences were seen in the young cohort. Collectively, these results indicate a dynamic role of the EP3 receptor in mediating anatomical and functional outcomes following ICH. Additional studies are needed in order to clarify the mechanisms involved and identify potential therapeutic paradigms for alleviating the initial PGE
2
-EP3 receptor associated toxicity and promoting its later beneficial effects.