bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP92: High Nationwide Incidence and Decline Trend of Subarachnoid Hemorrhage From Register-based Study in Japan
Authors: Ikawa Fusao , Morita Akio , Nakayama Takeo , Kurisu Kaoru
Published: June 2021

Background and Purpose:
There has never been a report of the nationwide incidence rate and the recent trend of subarachnoid hemorrhage (SAH) in Japan. This study aimed to clarify the age-standardized nationwide incidence rate and recent trend of SAH in Japan and reasons for recent changes in this trend.

Methods:
We compiled data from the Japan Neurosurgical Society and records from the Ministry of Health, Labor, and Welfare in Japan. We reviewed the age-standardized mortality rate and estimated crude incidence rate of SAH including the 95% confidence interval (CI) from 2002 to 2017. The trend in treatment numbers of unruptured cerebral aneurysms (UCAs), ruptured cerebral aneurysms, the estimated treatment rate of UCAs with 95% CI, and the prevalence of hypertension, current smoking and use of cholesterol-lowering drugs were assessed.

Results:
Based on the 2010 population as a reference, the age-standardized nationwide SAH mortality rate significantly declined from 13.91 (95%CI:13.90-13.91) to 8.12 (8.12-8.13) by 41.7% per 100,000 person-years from 2002 through 2017. The estimated crude incidence rate of SAH excluding conservative survivors per 100,000 also showed a significant decline from 25.41 (25.40-25.42) to 21.35 (21.34-21.36) by 16.0 % and from 23.89 (23.88-23.89) to 20.05 (20.04-20.05) by 16.1% , if the in-hospital mortality was 10% and 20%, respectively. The prevalence of hypertension and current smoking declined significantly (p<0.05) and use of cholesterol-lowering drugs increased significantly (p<0.05) during the same period.

Conclusions:
The nationwide incidence rate of SAH in Japan was higher than in other countries. However, the declining trend of SAH was shown in this study. Improving lifestyle might contribute to reducing the incidence of SAH in Japan.
Abstract WMP95: Sociodemographic Factors Associated With Retention of Minorities: Findings From the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) Trial
Authors: Kuo Grace , Vickrey Barbara , Barry Frances , Ayala-Rivera Monica , McCreath Heather , Cheng Eric , Sanossian Nerses , Mehta Bijal , Dutta Tara , Razmara Ali , Song Shlee , Bryg Robert , Moreno Lilian , Garcia Diamond , Fernandez Maura , Lopez Enrique , Valdez Sarah , Martinez Beatrice , Towfighi Amytis
Published: June 2021

Background:
Minority and socioeconomically disadvantaged individuals are underrepresented in secondary stroke prevention trials. Little is known about factors associated with study retention in these populations.

Objective:
To evaluate the impact of sociodemographic characteristics on retention in the Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED) trial.

Methods:
487 participants ≥40 years with stroke/TIA were recruited from 4 safety-net hospitals and 1 stroke center serving low income zip codes. Strategies for boosting retention included: having bilingual research assistants from similar cultures establish rapport and follow participants; culturally and linguistically tailoring materials; arranging visits around participants’ schedules; offering transportation, and conducting assessments in the home and community. We compared sociodemographic characteristics among those retained at 12 months (n=412) vs. those not retained (n=75) using t-test, Chi Square, and Fisher exact tests. Independent factors associated with retention were determined using logistic regression.

Results:
Average age was 57 years, 18% were black, 71% were Hispanic, 58% were Spanish-speaking, and 72% were born outside the US. 12-month retention was 85%. On bivariate analysis, factors associated with retention were: Spanish-speaking, Hispanic ethnicity, younger age, born outside the US, and married status (all p<0.05). After multivariate analysis, study site, younger age (<64 vs ≥65 years OR 2.2, 95% CI 1.1,4.4), married status (OR 2.0, 1.0,4.2), government insurance (vs uninsured OR 25.1, 1.2,5.1), private insurance (vs uninsured, OR 4.6, 1.3,16.4), and inability to afford medical care (OR 2.9, 1.3,6.7) were associated with retention.

Discussion:
In this secondary prevention trial of stroke survivors from predominantly minority backgrounds, younger age, marriage, and insurance were associated with retention, suggesting that addressing barriers in the elderly, and those without insurance or spousal support may be beneficial. Financial constraints were associated with retention suggesting that study participation appealed to more socioeconomically vulnerable individuals.
Abstract WMP96: Industry Payments to Vascular Neurologists, a Six-Year Analysis of the Open Payments Program From 2013 to 2018
Authors: Sheng Sen , Nalleballe Krishna , Brown Aliza , Ali Syed , Sharma Rohan , Kapoor Nidhi , Kamran Mudassar , Patrice Kelly-Ann , Onteddu Sanjeeva
Published: June 2021

Objective:
To analyze and characterize industry payment to vascular neurologists from 2013 to 2018 using open Payments Database.

Methods:
This is a retrospective analysis of open payments database, which is available publicly. We calculated the percentage of vascular neurologists in the United States receiving payments and payment characteristics. We have analyzed the top 1% payment to vascular neurologist with detailed payment category analysis, payment regional trends, and sponsors each year. The number of board-certified vascular neurologists is available from the database of the American Board of Psychiatry and Neurology.

Results:
From Jan 2013 to Dec 2018, industry payments to vascular neurologists have increased significantly each year, while a relatively stable fraction (17%) of US vascular neurologists received industry payments totaling $ 3,782,222 (6 years combined). The median payment per physician ranges from $ 115 to $ 241, while 90th percentile payments vary from $1,766 to $ 4,988 with a maximum payment up to $190,551. Nine payment categories are available and the highest amounts were paid for "Consulting Fee". The payment proportion from top 10 sponsors consists of 75% of the total amount since 2013. The payment to the south region has a steady growth rate among the other regions and has the highest payment amount of $ 470,551 in 2018. Top 1% vascular neurologists received more than 60% of the total payment. Among the top 1% vascular neurologists, 73% are likely to be key leaders in the field. Among the top 1%, 42% are specialized in neuro-intervention and less than 15% have Authored AHA/ASA guideline papers.

Conclusion:
Payments to vascular neurologists is highly skewed with the top 1% receiving around one-third of all payments, less than 15% of these vascular neurologists have authored AHA/ASA guidelines. The industry is known to target key leaders in the field whether this is translating to changes in clinical practice should be looked into more thoroughly.
Abstract WMP97: Haptoglobin is Associated With Increased Early Perihematoma Edema Progression in Spontaneous Intracranial Hemorrhage
Authors: Halstead Micheal , Mould William , Sheth Kevin , Rosand Jonathan , Thompson Richard , Levy Andrew , Hanley Danial , Goldstien Joshua , Nyquist Paul A
Published: June 2021

Introduction:
Perihematomal edema in intracranial hemorrhage (ICH) is influenced by free hemoglobin clearance and inflammation. Serum Haptoglobin (Hp) binds free hemoglobin, affecting clearance as well as free radical production, resulting in inflammation. Of the three phenotypes of Haptoglobin, Hp 1-1 has the greatest effect on free hemoglobin clearance. We hypothesized that individuals with the Hp 1-1 phenotype have different rates of early perihematomal edema formation as compared to those with Hp 2-1 and Hp 2-2.

Methods:
We determined Hp phenotype, ICH volume, and rate of early change in perihematomal volume (ePHE) in participants from three prospectively collected ICH cohorts; Johns Hopkins University hospital (JHH), Massachusetts General Hospital (MGH), and the MISTIE III trial. The association of Hp phenotypes 1-1, 2-1, 2-2, with ePHE, while controlling for key clinical characteristics was analyzed using a multivariate model. Findings: 166 participants, 57 from JHH, 30 from MGH, and 79 from the MISTIE III trial were included: 73 (44%) female, 41(25%) African Americans, 34 (20%) diabetics, 133 (80%) with hypertension, and 75 (45%) active smokers. There were 15 subjects with Hp phenotype 1-1, 86 with 2-1 and 65 with 2-2. In the adjusted analysis, controlling for race, diabetes, hypertension, smoking status, and change in intracranial hemorrhage volume over time (cc/hr), Hp 1-1 had a significantly increased estimated mean rate of ePHE at 1·15, (95% CI 0·58-1·71) as compared to all other Hp 2-1 or Hp 2-2 containing phenotypes (0·30, 95% CI 0·06-0·54; 0.29 95% CI 0·02-0·56). Neither mortality nor discharge mRS differed between Hp phenotypes.

Interpretation:
Haptoglobin phenotype is associated with ePHE. Hp 1-1 significantly increased mean rate of ePHE suggests that haptoglobin phenotype may be a key player in understanding the multiphasic progression of PHE in sICH, which may help identify windows for targeted interventions to improve clinical outcomes.

Conclusion:
In our adjusted models, patients with the Haptoglobin 1-1 phenotype had an increased rate of ePHE formation within the first 96 hours. The Hp 1-1 phenotype may increase perihematomal progression in sICH. A larger prospective observational study is warranted.
Abstract WMP99: Alpha2-Antiplasmin Inactivation Reduces Hemorrhagic Transformation and Ischemic Brain Injury After Tissue Plasminogen Activator Therapy and Mechanical Reperfusion
Authors: Saleem Sofiyan , Reed Guy L
Published: June 2021

Tissue plasminogen activator (r-tPA) therapy followed by thrombectomy-mediated, mechanical reperfusion profoundly reduces neurologic disability in appropriately selected patients. Nevertheless, a high proportion of these patients (20-37%) develop brain hemorrhage. We examined the contribution of α2-antiplasmin, a fast-acting plasmin inhibitor, to brain hemorrhage and ischemic injury following r-tPA treatment and mechanical reperfusion.

Methods:
Mice (C57Bl6) underwent 1 to 4 h of middle cerebral artery occlusion followed by treatment with r-tPA alone (10 mg/kg), r-tPA (10 mg/kg) plus an α2AP inhibitor (α2AP-I, 10 mg/kg) antibody or saline, followed by reperfusion. Mice were assessed by neurobehavioral measures (Bederson score and corner test) and histology 24 h post-ischemic stroke. Analyses were performed in a blinded fashion. Time course studies in r-tPA-treated mice showed that intracerebral hemorrhage (p<0.05), brain infarct volume (p<0.001) and brain swelling (p<0.01) increased progressively with ischemic time, with a plateau at 3 h of ischemia, as compared to saline treated controls. Mice treated at 3 h with r r-tPA + α2AP-I showed significantly (p<0.05) reduced brain hemorrhage, brain infarct volume (p<0.01) and brain swelling (p<0.05). Treatment with r-tPA + α2AP-I also significantly improved neurobehavioral deficits (p<0.01) and sensory motor dysfunction (p<0.01) at 24h of reperfusion.

Conclusion:
α2AP contributes to the increased brain hemorrhage and ischemic brain injury associated with r-tPA treatment followed by mechanical reperfusion. Targeting a2AP appears beneficial, because specific, monoclonal antibody-mediated inhibition of α2AP markedly reduced brain hemorrhage, infarction, swelling and neurobehavioral disability.
Abstract WP101: Remote Ischemic Perconditioning Among Acute Ischemic Stroke Patients in Catalonia: Remote-Cat Project
Authors: Purroy Francisco , Arque Gloria , García Cristina , Torres Coral , Abilleira Sonia , Cardona Pere , López-Gomariz Alfonso , Mauri Gerard , Vicente-Pascual Mikel , Pagola Jorge , Portero-Otin Manel , Rodríguez-Campello Ana , Rovira Álex , Martí-Fàbregas Joan
Published: June 2021

Rationale:
Remote ischemic perconditioning (RIPerC), consisting of brief episodes of transient limb ischemia, represents a new paradigm in neuroprotection with interesting results in ischemic heart disease patients.

Aim:
We aim to conduct a multicentre study of pre-hospital RIPerC application in acute ischemic stroke (AIS) patients.Sample size estimates: To detect a treatment difference of 14% in the outcome, 286 patients will be included for 5% significance and 80% power.

Methods:
A total of 572 adult patients diagnosed of suspected clinical stroke within 8 hours of symptom onset and clinical deficit >0 according to prehospital RACE scale will be randomized, in blocks of size 4, to RIC or sham. Patients will be stratified by RACE score scale. RIC will be started in the ambulance before hospital admission. RIPerC will consist of five cycles of electronic tourniquet inflation and deflation (5 min each). Study outcomes: The primary outcome will be the difference in clinical benefit measured by the modified Rankin Scale (mRS) score <3 at 90 days. Secondary outcomes to be monitored will include early neurological improvement rate, treatment related serious adverse event rates, size of the infarct volume, symptomatic intracranial hemorrhage, and metabolomic and lipidomic response to RIPerC.

Discussion:
Neuroprotective therapies could not only increase the benefits of available reperfusion therapies among AIS patients but also provide an option for patients who are not candidates for these treatments. REMOTE-CAT will investigate the clinical benefit of RIC as a new neuroprotective strategy in AIS. Clinicaltrials.gov number: NCT03375762. Status: Active
Abstract WP110: Intravenous Thrombolysis in Acute Ischemic Stroke Patients With Large Vessel Occlusion and Mild Stroke Severity
Authors: Tsivgoulis Georgios , Goyal Nitin , Katsanos Aristeidis H , Malhotra Konark , Frohler Michael T , Spiotta Alejandro M , Anadani Mohammad , Psychogios Marios , Maus Volker , Siddiqui Adnan , Waqas Muhammad , Schellinger Peter D , Groen Marcel , Krogias Christos , Saqqur Maher , Garcia-Bermejo Pablo , Mokin Maxim , Leker Ronen , Cohen Jose E , Magoufis Georgios , Psychogios Klearchos , Lioutas Vasileios-Arsenios , VanNostrand Meg , Sharma Vijay K , Paciaroni Maurizio , Rentzos Alexandros , Shoirah Hazem , Mocco J , Nickele Christopher , Mitsias Panayiotis D , Inoa Violiza , Hoit Daniel , Elijovich Lucas , Arthur Adam S , Alexandrov Andrei V
Published: June 2021

Introduction:
We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) and mild neurological deficits defined as National Institutes of Health Stroke Scale scores <6 points (mELVO).

Methods:
The primary efficacy outcome was three-month functional independence (FI; mRS-scores of 0-2) that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included three-month favorable functional outcome (FFO; mRS-scores of 0-1) and mRS-scores distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding.

Results:
We evaluated 336 AIS patients with mELVO (mean age: 63±15 years, 45% women). Patients treated with IVT (n=162) had higher FI (85.6% vs. 74.8%, p=0.027) with lower mRS scores at hospital discharge (p=0.034) compared to the rest. Three-month mRS-scores tended to be lower in the IVT group (p=0.069). No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality (p>0.1). IVT was associated with higher likelihood of 3-month FI (OR=2.19, 95%CI: 1.09-4.42), 3-month FFO (OR=1.99, 95%CI: 1.10-3.57) and functional improvement at discharge [cOR (per 1-point decrease in mRS-score)=2.94, 95%CI: 1.67-5.26] and at 3 months (cOR=1.72, 95%CI: 1.06-2.86) on multivariable logistic regression models adjusting for potential confounders including mechanical thrombectomy.

Conclusion:
IVT is independently associated with higher odds of improved discharge and three-month functional outcomes in AIS patients with mELVO. IVT does not increase the risk of systemic or intracranial bleeding.
Abstract WP111: The Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke With Large Vessel Occlusion
Authors: Ooi Yinn Cher , Mukarram Faisal , Tristan Honda , Kaneko Naoki , Nour May , Colby Geoffrey , Tateshima Satoshi , Jahan Reza , Duckwiler Gary , Liebeskind David , Saver Jeffrey , Szeder Viktor
Published: June 2021

Introduction:
Current guidelines recommend administration of intravenous tissue plasminogen activator (IVT) for all eligible patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO). Recent observational data question the safety and efficacy of IVT in AIS patients with LVO undergoing mechanical thrombectomy (MT).

Methods:
Retrospective analysis using prospectively collected database on all AIS patients with LVO treated at our institution over 3 consecutive years. Stroke outcomes and adverse events were compared between patients who underwent IVT+MT versus MT only. Stroke outcomes were adjusted for known comorbidities, last know well time and core volume on pretreatment imaging.

Results:
158 AIS patients with LVO were treated. 69 patients had treatment strategy of IVT+MT, 89 patients MT only. 7 (10%) patients treated with IVT had successful reperfusion before MT. IVT+MT, compared with MT alone, was associated with reduced 90day mortality (22.4% vs 40.8%, p:0.03) and reduced 90day severe disability or death (mRS 4-6: 48% vs 67%, p:0.03). Door-to-puncture time (DTP) was longer with IVT. IVT was not associated with increased intracranial hemorrhage but was associated with increased access site hematomas (16.9% vs 5.7%, p:0.03). Both groups showed similar proportion of patients ≥TICI2c (IVT+MT: 48% vs MT: 47%), however IVT+MT patients had greater proportion of TICI2c than TICI3. (IVT+MT TICI2c:30.4% vs MT TICI2c:17%)

Conclusions:
IVT before MT in AIS with LVO, results in reperfusion prior to thrombectomy in 10% of patients, and is associated with reduced mortality and severe disability at 90days. However, IVT+MT is associated with more access site hematomas and increased TICI 2C vs TICI 3 reperfusion, suggesting increased distal embolization due to thrombus fragmentation. The use of balloon guide for proximal flow arrest and aspiration during thrombectomy should be considered.
Abstract WP118: Laboratory Examinations - Lessons Learned From 120 Cases Treated With Idarucizumab in Germany
Authors: Kermer Pawel , Eschenfelder Christoph C , Grond Martin , Diener Hans-Christoph
Published: June 2021

Recently we have shown that idarucizumab application in acute stroke patients treated with dabigatran improves clinical outcome parameters. In this retrospective series of 120 cases positive effects of dabigatran reversal could be documented regarding mortality and modified Rankin scale in patients with acute hemorrhagic stroke (ICH). At the same time, individuals with acute ischemic stroke (IS) regained eligibiliy for intravenous thrombolysis, thereby improving substantially in NIHSS. Here, we report results on medication and blood parameters from this case series. In acute ICH, 15 of 40 patients were on dabigatran 150mg bid, while 25 took 110mg bid. CrCl was above 50ml/min in all cases while TT upon admission was elevated substantially in almost all cases examined. aPTT was normal in 79.5%. In acute IS, 32 patients received 150 mg, 48 received 110 mg dabigatran bid. The vast majority of patients with ischemic stroke had a CrCl above 50 ml/min. TT was prolonged above 35 seconds in 91.4% of cases while aPTT values were normal in 48.1% of patients. These data underline the necessity to prescribe the appropriate dosage recommended in the prescription protocol to all patients since ICH and IS incidence seems to be dose-independent. Furthermore, global hemostasis parameters like aPTT again prove to be not useful for therapeutic decisions. Finally, inclusion of TT values into emergency laboratory examination in patients with acute stroke under dabigatran is helpful to identify patients with impaired hemostasis potentially benefitting from idarucizumab application.
Abstract WP133: The Clinical Impact of Neutrophil/Lymphocyte Ratio in Patient With Cerebral Aneurysm
Authors: Lee Kee Ook , Lee Cheol-Young , Lee Kyung-Yul , Oh Seung-Hun , Heo Ji Hoe , Na Sang-Jun , Chung Darda , Woo Min-Hee , Choi Jung-Won , Hong Jun Yeong
Published: June 2021

Introduction:
Increased neutrophils, and stress-induced low lymphocyte levels both indicate changes in the immune system. Blood neutrophil/lymphocyte ratio (NLR) is shown to be a simple, reliable and inexpensive inflammatory indicator that can provide important information on many conditions. Recently, NLR has been proposed as a useful biomarker to predict cardiovascular risk. However, little is known about the role of NLR in patients with intracranial aneurysm (IA).

Hypothesis:
The purpose of present study was to investigate whether NLR values differ in patients with IA.

Methods:
The study group consisted of patients with IA who had been admitted to the neurology department from January 2008 to December 2016. A total of 406 patients including 198 patients with unruptured IA, 208 patient with ruptured IA were enrolled in this study. The control group consisted of 420 age, sex-matched healthy adults who had not harbor IA by CTA, MRA, DSA. The baseline NLR was calculated as the ratio of neutrophil count to lymphocyte count. WBC count>12.000 cells per μL or <4.000 cells per μL and high body temperature>38 ° are excluded from the study.

Results:
The Mean NLR was significantly higher among persons with cerebral aneurysm compared with controls (P < 0.001). The level of NLR in ruptured IA group were found higher compared to unruptured IA and control group (6.1 ± 4.3 vs 2.7 ± 1.5 vs 1.8 ± 1.1, P < 0.001). Other comorbid conditions were balanced between these three groups.

Conclusions:
We demonstrated that the NLR is an independent predictor of IA patients. In addition, higher NLR is associated with ruptured IA. Unlike many other inflammatory markers and bioassays, NLR are inexpensive and readily available biomarkers that may be useful for risk stratification in patients with cerebral aneurysm. The clinical implications of NLR on IA remain to be established by future investigations. A long term prospective study is needed to clarify this matter.
Abstract WP144: Cerebral Amyloid Angiopathy Pathology Worsens Stroke Outcome and Has a Detrimental Effect on the Gut Microbiome in Mice
Authors: Blixt Frank W , Maniskas Michael , Chauhan Anjali , Miranda-Sohrabji Darius F , Blasco Conesa Maria P , Honarpisheh Pedram , Bryan Robert M , McCullough Louise D , Ganesh Bhanu P
Published: June 2021

Background:
Cerebral amyloid angiopathy (CAA) is associated with both ischemic and hemorrhagic stroke, is a known cause of vascular cognitive impairment (VCI), and predicts worsened outcome after stroke. A growing body of literature has highlighted the importance of the gut microbiome in stroke outcome and neurodegenerative diseases such as Alzheimerz’s. However, little is known about how changes in the microbiome can affect CAA progression. The gut-brain axis is highly involved in the systemic inflammatory response following stroke. Furthermore, the gut is a primary source of bacterial translocation resulting in cerebral inflammation which further may contribute to vascular pathology. Therefore, the cross talk between CAA, stroke, and gut function could be key in our understanding and treatment of stroke in patients with CAA.

Methods:
Symptomatic male Tg-SwDI (4 mths old) and C57BL/6 wild type (WT) mice underwent a 60 minute transient MCAO. Stroke was confirmed with cresyl violet staining and presence of amyloid β (Aβ) plaques were demonstrated with thioflavin. Post-stroke motor function was assessed at day 4 with open field-testing and results were compared to pre-stroke baseline and WT values and cognitive assessment was performed with the Y-maze test. Furthermore, PCR was used to identify the presence of Firmicutes and Bacteroidetes ratio (F:B) in both brain tissue and gut content.

Results:
We demonstrate a significant decrease in the total distance traveled in both open field and cognitive Y-maze (p<0.05 and p<0.01 respectively) at baseline of Tg-SwDI mice. This was associated with the presence of Aβ plaque in the brain. PCR did not reveal any conclusive evidence for bacterial translocation in the brain at day 4. However, there was a pathogenic shift in the gut F:B ratio following stroke in Tg-SwDI mice compared to sham Tg-SwDI or sham WT controls and this will be confirmed by 16S rRNA gene sequencing.

Conclusion:
Symptomatic CAA mice exhibit decreased motor and cognitive function compared to WT controls. Furthermore, 16S sequencing was performed to look at the bacterial translocation in detail from the gut to the brain. This is the first study to link CAA, stroke, and the gut brain axis, that may be crucial in understanding the complexity of stroke pathology.
Abstract WP155: Delayed Administration of Angiotensin Receptor (AT2-R) Agonist C21 Downregulates Diabetes Induced Pro-Inflammatory Microglia Activation Post-Stroke in Female Rats: Therapeutic Indications for Vascular Cognitive Impairment & Dementia
Authors: Jackson Ladonya , Eldahshan Wael , Dong Guangkuo , Dumanli Selin , Jamil Sarah , Baban Babak , Fagan Susan , Ergul Adviye
Published: June 2021

Post-stroke cognitive impairment (PSCI) occurs in up to 48% of patients, for which there is no therapy. Although 70% of stroke victims present with comorbid diseases such as diabetes and hypertension, the inadequate integration of these comorbidities into experimental studies limited our understanding of the mechanisms involved in the development of PSCI. Based on our recent findings that 1) the increased prevalence of PSCI in male diabetic animals is linked to heightened chronic inflammation and 2) even delayed administration of compound 21 (C21), an angiotensin II Type 2 receptor agonist, effectively reduces PSCI by lowering inflammation in male animals, we hypothesized that a delayed administration of C21 would also lower chronic inflammation post-stroke in female animals.

Methods:
Diabetes was induced by a high fat diet (HFD) and low dose streptozotocin (STZ) combination. Rats were subjected to 1 h middle cerebral artery occlusion (MCAO) or sham surgery. 3 days post-stroke, rats were administered C21 or vehicle in drinking water at a dose of 0.12 mg/kg/day for 4 weeks. The direct effect of C21 on microglia polarization was determined in mouse cells (C8B4) and the mature:pro BDNF ratio was evaluated through western blot. Samples from freshly harvested brains (B-D slice containing the prefrontal cortex through the hippocampus), and from cell culture were analyzed by flow cytometry.

Results:
Delayed administration of C21 starting 3 days post-stroke improved inflammation through modulation of the M1/M2 ratio. Cell culture results indicated that along with decreasing the M1/M2 ratio, it also increased the mature/pro-BDNF ratio.

Conclusion:
Delayed administration of C21 downregulates post-stroke inflammation in both male and female diabetic animals. This study emphasizes the importance of translational disease modeling and suggests that C21 may be a useful therapeutic option to lower inflammation and prevent PSCI in comorbid diseases.
Abstract WP169: Symptomatic Intracranial Atherosclerotic Stenosis: The Associations Between Cerebral Hemodynamics and the Stroke Mechanisms
Authors: Feng Xueyan , Chan Ka Lung , Abrigo Jill , Lan Linda , Xu Yuming , Fang Hui , Soo Yannie , Leung Thomas W , Leng Xinyi
Published: June 2021

Background:
Intracranial atherosclerotic stenosis (ICAS) may cause ischemic stroke by various mechanisms; artery-to-artery (AA) embolism and hypoperfusion often co-exist and bear a high risk of recurrent stroke despite optimal medical treatment. Little is known regarding how ICAS lesions cause ischemic strokes via different mechanisms, while the hemodynamic features of ICAS lesions may play an important role.

Methods:
Patients with acute ischemic stroke attributed to 50-99% ICAS in the anterior circulation confirmed in CT angiography (CTA) were recruited from two teaching hospitals. We classified probable stroke mechanisms as parent artery atherosclerosis occluding penetrating artery (PAO), AA embolism, hypoperfusion, and mixed mechanisms, based on infarct topography and ICAS lesion features. Computational fluid dynamics (CFD) models were built based on CTA to simulate blood flow across culprit ICAS lesions. We calculated translesional pressure ratio (PR), the ratio of pressures distal and proximal to the lesion; and translesional wall shear stress ratio (WSSR), the ratio of WSS at the stenosis throat and at proximal normal vessel segment. We defined PR ≤ median as low PR, indicating larger pressure gradient across the lesion, hence restricted downstream perfusion; and WSSR ≥ 4
th
quartile as high WSSR, indicating higher WSS upon the lesion. We associated PR and WSSR with probable stroke mechanisms.

Results:
Among 99 patients, 44 had AA embolism as a probable stroke mechanism, 13 with AA embolism alone and 31 with coexisting hypoperfusion; 18 and 37 respectively had isolated PAO and isolated hypoperfusion as the probable stroke mechanisms. High WSSR was independently associated with AA embolism (adjusted OR 4.86; p = 0.008). The significant, positive relationship between high WSSR and higher risk of AA embolism remained in those with a low PR (adjusted OR 4.01; p = 0.044), but not in those with a normal PR (p = 0.621).

Conclusions:
High WSS upon ICAS lesions may increase plaque vulnerability, but it may only cause distal arterial embolism when there is impaired cerebral perfusion. Therefore, in secondary prevention of ischemic stroke in ICAS via AA embolism, impaired cerebral perfusion may be an important therapeutic target.
Abstract WP174: A Large-Scale Perfusion Imaging Atlas of Subacute Ischemia in MCA Atherosclerotic Stenosis
Authors: Liebeskind David S , Yaghi Shadi , Honda Tristan , Scalzo Fabien , Hinman Jason D , Raychev Radoslav , Sharma Latisha K , Feldmann Edward , Romano Jose G , Prabhakaran Shyam
Published: June 2021

Background:
Impaired perfusion may be an important determinant of outcomes in intracranial atherosclerotic disease (ICAD). CT and MRI perfusion imaging patterns of stenosis due to MCA ICAD have not been studied in detail. We characterized CT and MRI perfusion imaging measures of subacute ischemia subjects with MCA stenosis to create a novel atlas and define specific blood flow parameters.

Methods:
A retrospective, 5-year, analysis of consecutive ICAD patients evaluated with CT or MRI perfusion imaging for recent TIA or stroke (0-7 days) due to sub-occlusive (50-99%) MCA stenosis was conducted. CT/MRI volumes of core and hypoperfusion (>5 ml) were extracted with RAPID (iSchemaView, Inc.) and analyzed with respect to clinical variables. Descriptive statistics were used to quantify and map patterns of impaired perfusion.

Results:
194 (median age 71, range 30-102 years; 53% women) patients with subacute ischemia were evaluated with MRI (n=161) or CT (n=33) perfusion imaging. Median initial NIHSS was 5 and median inpatient length of stay (LOS) was 4 (1-42) days. Hypoperfusion with Tmax>4s delay volumes (median 66.5 ml, mean 107.5 ml) were noted in 162 (84%) patients, Tmax>6s delay volumes (median 11.0 ml, mean 41.5 ml) in 118 (61%), Tmax>8s delay volumes (median 0 ml, mean 23.4 ml) in 81 (42%) and Tmax>10s delay volumes (median 0 ml, mean 16.9 ml) in 61 (31%). Hypoperfusion intensity ratios (Tmax>10s/Tmax>6s) were median 0.08 and mean 0.24. Ischemic core volumes on MRI (ADC<620) were mean 10.3±33.2 ml and mean 5.6±16.1 ml on CT (rCBF<30%). Mismatch volumes were mean 32.0±79.8 ml and mismatch ratios mean 4.8±9.9 ml. The extent of Tmax>6s hypoperfusion was unrelated to initial NIHSS (r=0.17, p=NS) or LOS (r=0.11, p=NS).

Conclusions:
Hypoperfusion is common in recently symptomatic ICAD patients with MCA stenosis. Tmax delay volumes and hypoperfusion intensity ratios are distinct from acute MCA occlusion. Mapping and understanding these specific patterns of perfusion will be instrumental in planning future ICAD trials.
Abstract WP18: Benefits of M2 Thrombectomy in Arise 2 - Analysis of Revascularization in Ischemic Stroke With Embotrap
Authors: Narata Ana Paula , Amelot Aymeric , Zaidat Osama , Saver Jeffrey , Bozorgchami Hormozd , Mattle Heinrich , Ribo Marc , Andersson Tommy
Published: June 2021

Introduction:
Patients with proximal (M1) and more distal occlusions (M2) of the middle cerebral artery (MCA) from the ARISE II Study were assessed in order to determine risks and efficacy of revascularization with the EmboTrap device, which has a 5 mm diameter, in small vessels.

Methods:
Data from the ARISE II Study concerning MCA occlusions were separated into 2 groups: M1 occlusion and M2 occlusion (proximal, median, distal segment). From the ARISE II Study, inclusion criteria were NIHSS score ≥ 8 and ≤ 25, ASPECT ≥ 6. Comparison of the 2 groups was performed in order to evaluate M2 revascularization with EmboTrap device.

Results:
M1 occlusion was present in 126 patients and M2 occlusions in 57 patients. M2 occlusions were distal in 35.1%. Substantial reperfusion within 3 passes (TICI 2b-3) was similar for both target locations, 79.3% for M1 and 78.9% for M2 (P=0.29). First pass substantial reperfusion was also similar, 43.6% for M1 versus 40.3% for M2 (p=0.75). Symptomatic intracranial hemorrhage was observed in 4.7% of patients in M1 and 3.5% in M2 (p=0.66). Functional independence at 90 days (mRS 0-2) was achieved in 67.5% of patients with M1 occlusions and 70.2% with M2 occlusions (p=0.320).

Conclusions:
Revascularization of the M2 segment of MCA with a 3 or 4 mm-stent retriever was previously evaluated and was considered safe and efficient. In this study, we analyzed patients with M2 occlusions and treated with a 5 mm stent retriever EmboTrap that showed similar efficacy and safety compared to M1 occlusions. Use of the same device for proximal and more distal occlusions can have economic and technical advantages.
Abstract WP181: Preprocedual Carotid Plaque Characterization by Duplex Ultrasonography as a Predictor of in-Stent Intimal Restenosis 6 months After Carotid Stenting
Authors: Takao Naoki , Hagiwara Yuta , Ohtsubo Haruki , Hamada Yuki , Tatsuno Kentaro , Tokuyama Yoshiaki , Yoshie Tomohide , Takaishi Satoshi , Usuki Noriko , Takada Taturou , Ueda Toshihiro , Hasegawa Yasuhiro
Published: June 2021

Background and Purpose:
In-stent intimal restenosis (ISR) caused by neo-intimal hyperplasia generally occurs <24 months after carotid stenting (CAS). Although the real clinical impact of ISR are still unclear, several studies suggested the development of ISR significantly correlated with ipsilateral stroke and death. Also differences in the rate of ISR between open-cell and closed-cell stents have yet to be well evaluated. We aimed to investigate predictors of ISR 6 months after CAS.

Methods:
We examined 133 patients (mean age of 72.1±8.4 years old) received CAS in a single hospital during 2014 and 2018. Preoperative carotid plaque evaluation was performed by carotid angiography, duplex carotid ultrasonography (CUS), and black-blood carotid artery MRI (BB-MRI). Mean stenosis rate (NASCET) was 71.0±12.3% (44%-100%). Follow-up carotid angiography was performed six months after CAS in all patients according to a predefined protocol. ISR was defined as in-stent intimal hyperplasia more than 50% stenosis based on the NASCET method. Selection of stent type was at the discretion of the treating physician. Predictors of ISR were determined by multivariate logistic regression analysis.

Results:
Follow-up angiography demonstrated ISR in 33 patients (24.8%). In 44 patients, more than 2 stents were deployed. Univariate analyses demonstrated hypoechoic plaque, 1 mobile plaque with jerry fish sign, complete occlusive or pseudo occlusive lesion, closed-cell stent are significantly associated with ISR (>50%), however no association was observed in traditional risk factors, MRI plaque characterization, and implantation of multiple stents. Multivariate analysis demonstrated low echoic plaque in preoperative CUS (OR4.67; 95%CI, 1.85-11.78) and closed-cell stent (OR 0.378; 95%CI, 0.15-0.97) as significant predictors of ISR.

Conclusions:
Preprocedual plaque characterization by CUS but not MRI appeared to be useful to predict ISR 6 months after CAS even after adjustment of stent type.
Abstract WP184: The Road to Recovery Stroke Support Group: A Feasibility Assessment of an Inpatient Multi-Disciplinary Stroke Support Group
Authors: Diaz Jade Ann V , Punsalang Lorina , Mkrtumyan Alvina , Gaffney Denise , Hines Qiana , Le Duy , Cagandahan John , Dhanji Raeesa , Sangha Navdeep S , Ajani Zahra A
Published: June 2021

Background:
Stroke is life changing for both patients and caregivers. Recovery from stroke affects the physical, social and emotional aspects of life. Transitioning to a new normal should begin immediately after stroke, ideally during hospital admission. Most support groups exist outside of the hospital setting and begin weeks to months after the ictus. The Road to Recovery Stroke Support Group (RRSSG) was created to bridge the gap between the inpatient and outpatient setting.

Purpose:
RRSSG aims to provide a weekly platform for stroke survivors and caregivers in an in-hospital setting. During sessions, attendees learn about types of challenges after stroke, rehabilitation services available to them and what to expect after leaving the hospital. Patients can return to the same support group once discharged from the hospital.

Methods:
RRSSG was launched in November 2018. Candidates for the weekly RRSSG meeting were identified by nurses and the stroke case manager. Meetings were facilitated by a stroke survivor volunteer, case management and physical and social medicine. Invitations were extended to patients and their caregivers prior to discharge. Data were collected for 7 months and analyzed for the following: patient demographics, types of stroke and discharge disposition.

Results:
During the 7-month period, 514 patients were discharged with a stroke diagnosis, 24.3% of which attended the RRSSG. The demographics were 53.7% women with a median age of 66 years; 33.1% White/European, 36% Hispanic/Latino, 18.0% African American, 10.8% Asian, and 2.1% other. 61.6% had an ischemic stroke, 30.4% had an intracerebral hemorrhage, 11.2% had a subarachnoid hemorrhage. More patients who attended RRSSG were discharged to an acute rehabilitation hospital (6.5% RRSG vs. 1.8% non-RRSG, p=0.04). There was no difference in those discharged to: home (54.0% RRSSG vs. 55.5% non-RRSSG) and skilled nursing facility (27.3% RRSSG vs. 20.1% non-RRSSG).

Conclusion:
Creating and sustaining an inpatient multi-disciplinary stroke support group on a weekly basis is feasible. The future goals are to assess the impact of the in-hospital support group on stroke knowledge retention, medication compliance, post-stroke depression, recurrent stroke and re-admission rates.
Abstract WP185: How to Design Woke Stroke Tech: The STORIES Project
Authors: Eakin McKenzie , Gian Amanda , Kim Francesca , Muccini Julie , Lansberg Maarten , Flavin Kara
Published: June 2021

Introduction:
There is little foundational evidence describing needs, wants, and concerns of stroke survivors and their carers regarding stroke rehabilitation technology. The aim of the STORIES Project (Stroke Tech- Overviews in Rehabilitation, Insights, and Experiences of Survivors & carers) was to identify, characterize, and prioritize these needs and concerns, as well as differences in characterizations across subgroups, to inform socially inclusive design.

Methods:
Mixed-method, semi-structured interviews were conducted with 29 stroke survivors and 16 carers, including 12 matched patient-carer dyads. Participants used a 1-5 scale to rate confidence and interest in using technologies for stroke rehabilitation and to rate the importance of 41 aspects of rehabilitation technology use. Differences between subgroups were compared via student t-tests. Qualitative data was coded to add depth of understanding to quantitative results.

Results:
Across all participants, aspects rated most important were clear instructions, ability to return a product from home, ease of use, ability to see progress over time, and that technology use did not replace time with a therapist. Human interaction in rehabilitation was deeply important for motivation, effectiveness, and mental health. Compared to carers, patients found the following less important: training carers in rehabilitation technology use (
p
=.006), ability to share progress (
p
=.001), and ability to do exercises with therapists rather than carers (
p
=.001). Non-whites more strongly valued including music in the rehabilitation technology experience (
p
=.001). Medicaid beneficiaries cared more about time & financial risk-minimization strategies (
p
<.000), but not direct cost (
p
=.72). People without a Bachelor’s degree had less technology familiarity and interest (
p
=.003). Finally, patients and carers of patients less than 12 months post-stroke were less interested in stroke rehabilitation technologies (
p
<.000).

Conclusion:
To increase adoption of stroke rehabilitation technologies, development should focus on improving multiple parts of the product experience, including clear instructions, ease of use, progress tracking, music inclusion, free trials, and free returns from home.
Abstract WP192: Severe Trauma in Stroke Survivors --A Matched Control Study
Authors: Shiraishi Atsushi , Otomo Yasuhiro
Published: June 2021

Purpose:
To compare the characteristics and outcomes of severely injured trauma patients with or without preinjury stroke.

Methods:
A retrospective matched cohort study was conducted using data from the Japan Trauma Databank (JTDB), a Japan-nationwide hospital-based trauma registry from the year of 2003 to 2017. Adult (>15 years old) trauma patients were selected from the database and subjected to the within-cluster propensity-score matching. Patients with or without preinjury stroke were matched on 1:1 basis with the balancing of preinjury confounders consisted of fixed effect confounders (age and preinjury comorbidities except for stroke) and random effect confounders (sex, year of injury and hospital). The mechanism, anatomical distribution and severity of injury under the definition of the Abbreviated Injury Scale and hospital mortality was compared across the patients with or without preinjury stroke. Association between prior stroke and hospital mortality was also assessed by the quasi Poisson regression model doubly-adjusted for confounders included in the propensity score estimation and the trauma severity.

Results:
Of 294,274 patients registered in JTDB, 13,532 and 254,670 trauma patients did and did not complicate with preinjury stroke were selected as the study participants, respectively. Within-cluster propensity score matching extracted 13,212 patients each with or without preinjury stroke whose preinjury characteristics were adequately balanced across the groups. Fall on the ground was the most popular mechanism of injury and significantly higher in the group with preinjury stroke (75.9% versus 64.4%, risk ratio [RR] 1.18 95%CI [1.14, 1.21]). The severe injuries in head (34.1% versus 31.4%, RR 1.09 96%CI [1.04, 1.14]) pelvis and lower extremities (42.9% versus 39.8%, RR 1.08 95%CI [1.04, 1.12]) were relatively frequent in the stroke survivors, in contrast, those in chest, abdomen, and spine were relatively infrequent in the stroke survivors. Adjusted hospital mortality was similar in patients with or without prior stroke (RR 1.00 95%CI [0.91, 1.09]).

Conclusion:
Severely injured trauma patients with preinjury stroke were associated with frequent fall and possibly fall-related injuries on the head, hip and lower extremities.
Abstract WP20: Intra-Arterial Chemotherapy for Retinoblastoma in Infants<10 kg: 74 Treated Eyes With 222 IAC Sessions
Authors: Sweid Ahmad , Hammoud Batoul , Texakalidis Pavlos , Xu Vivian , Shivashankar Kavya , Baldassari Michael , Das Somnath , Tjoumakaris Stavropoula , Sheilds Carol , Lezama David , Lim Li-Anne S , Jabbour Pascal M , Dalvin Lauren A
Published: June 2021

Background:
Intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) has dramatically altered the natural history of the disease. The spectacular outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients
<
10 kg of weight.

Objective:
We aim to share our findings and experience in a large series of IAC infusions performed in infants
<
10 kg.

Methods:
A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with IAC as either primary or secondary treatment.

Results:
There were 207 Rb tumors of 207 eyes in 197 consecutive patients. Of these, patient weight was 10 kg in 69 (35.7%) and >10 kg in 133 (67.5%) patients. Of the 69 patients weighing
<
10 kg, 5 patients had bilateral Rb. Thus, a total of 74 eyes of 69 patients weighing
<
10 kg were compared to 133 eyes of 133 patients weighing > 10 kg. Comparison (
<
10 kg vs. >10 kg) revealed the total number of IAC cycles was 222 vs. 436. Periprocedural complications occurred in 2 (0.9%) vs. 2 (0.45%) infusions (
p
=0.49). Aborted procedure occurred in 12 (5.4%) vs. 7 (1.6%) infusions (
p
=0.005). Enucleation following IAC was required in 14 (18.9) vs. 44 (33%) eyes (
p
=0.029). On multivariate analysis, weight
<
10 kg was not an independent predictor of complications, procedure failure, or eye enucleation.

Conclusions:
Our results speak for the safety and efficacy of IAC in patients
<
10 kg.
Abstract WP206: Cognitive Functioning Predicts Engagement in Inpatient Stroke Rehabilitation
Authors: Lowder Ryan , Jaywant Abhishek , O'Dell Michael
Published: June 2021

Introduction:
Patient engagement during inpatient stroke rehabilitation (ISR) is critical to long-term outcomes. Cognitive deficits have demonstrated impact on engagement in rehabilitation. Here, we prospectively investigated the relationship between specific cognitive domains and patient engagement during ISR.

Methods:
Of 423 patients completing ISR, 127 (30%) had complete data with mean age=67.63
+
15.46 years, NIHSS=6.78
+
5.68, and onset from stroke to ISR admission=8.55
+
7.72 days. The sample comprised 55% males and 56.7% had a college education or more. The National Institute of Neurologic Disorders - Canadian Stroke Network (NINDS-CSN) 30-minute cognitive screening battery was administered within 72 hours of ISR admission to assess verbal fluency, executive functioning, and memory. The Hopkins Rehabilitation Engagement Ratings Scale (HRERS; total score 0-30, higher=greater engagement) was completed by treating therapists at ISR discharge. Spearman rank-order correlations (r
s
) examined the relationships between the HRERS total score and the NINDS-CSN total (the mean z-score across subtests) as well as its 8 subtests. Items with correlations p<.10 were entered into a logistic regression (controlling for age, comorbidity, and stroke severity) to predict low (HRERS ≤ 25) versus high engagers (HRERS > 26).

Results:
NINDS-CSN total and 6 subtests assessing verbal fluency and executive function were weakly to moderately correlated with HRERS scores (r
s
=0.23-.38, all p’s <.01). Memory subtests were not associated with HRERS. Higher NINDS-CSN total score and subtests reflecting executive functions modestly increased the odds of being a high engager (Odds Ratios ranged from 1.03-1.08, 95% CIs ranged from 1.013-1.134, all p’s < .01).

Conclusion:
Poor executive functioning may pose a barrier to patient engagement in ISR. Executive functions may impact patients’ ability to shift among activities, maintain attention, and rapidly process information during therapy. Rehabilitation therapists should consider making environmental modifications, providing more frequent guidance and positive reinforcement, and presenting simplified material to increase engagement in stroke patients with executive dysfunction.