bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P422: Chronic Nicotine Exposure Increases Hematoma Growth Following Intracerebral Hemorrhage in Young Rats of Both Sexes
Authors: Rehni Ashish K , Cho Sunjoo , Navarro Quero Hever , Perez-pinzon Miguel A , Raval Ami P , Dave Kunjan R
Published: March 2021

Spontaneous intracerebral hemorrhage (sICH) is the deadliest stroke subtype. There is strong evidence that tobacco use / smoking increases the risk of sICH, and some epidemiological studies have observed sex differences in sICH outcomes. However, systematic controlled studies on the effect of tobacco / smoking on post-sICH outcomes in both sexes are lacking. Therefore, we determined the effect of nicotine exposure on outcomes following collagenase-induced sICH both sexes. Young animals of both sexes were randomly divided into nicotine (4.5 mg / kg / day b.w.) and vehicle (saline) treatment groups (using osmotic pumps for two to three weeks). sICH in females was induced during the diestrous stage of estrous cycle. sICH was induced by collagenase injection into the right striatum and ~24 hours later, neurological scores were evaluated, rats were euthanized, and brains were sectioned to measure hematoma volume. Hematoma volumes for male rats was 42% higher (p<0.01) in the nicotine-treated group (139 ± 9 mm
3
, n=10) versus vehicle-treated group (98 ± 9 mm
3
, n=10). Hematoma volumes for female rats was 48% higher (p<0.01) in the nicotine-treated group (134 ± 11 mm
3
, n=10) versus vehicle-treated group (90 ± 7 mm
3
, n=10). Hematoma volumes for the vehicle and nicotine-treated male groups were not different from their respective female groups. The neurological score for the nicotine-treated male group (9.3 ± 0.6) was significantly higher (p<0.05) when compared to vehicle group (7.4 ± 0.6). The neurological score for the nicotine-treated female group (10.7 ± 0.2) was significantly higher (p<0.001) than the vehicle group (7.7 ± 0.7). The neurological score for the vehicle-treated male group was not different from its respective female group. However, the neurological score for the nicotine-treated male group was significantly lower than the female group. Our results show that chronic nicotine exposure increases hematoma volume post-sICH in animals of both sexes. Future studies into the mechanism of nicotine-induced increase in hematoma growth following sICH are required.

Support:

James and Esther King Biomedical Research Grant 9JK08
Abstract P423: Race and Ethnicity Influence Perihematomal Edema Volume in Supratentorial Intracerebral Hemorrhage
Authors: Acosta Julian N , Chen Yasheng , Both Cameron , Leasure Audrey C , Testai Fernando , Woo Daniel , Lee Jin-moo , Sheth Kevin N , Dhar Rajat , Falcone Guido J
Published: March 2021

Introduction:
Perihematomal Edema (PHE) is a neuroimaging biomarker of secondary brain injury in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH). There are limited data on racial/ethnic differences in the development of PHE. This dearth of data is partially driven by the time-consuming process of manually segmenting PHE. Leveraging a validated automated pipeline for PHE segmentation, we evaluated whether race and ethnicity influence baseline PHE volume in patients with ICH.

Methods:
The Ethnic/Racial Variations in Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter study of ICH that recruited 1,000 adult participants from each of three racial/ethnic groups (non-Hispanic White, non-Hispanic Black, and Hispanic). We applied a previously validated deep learning algorithm to automatically determine PHE volumes on baseline CTs in these study participants. Quality control procedures were used to include only sufficiently accurate PHE measurements. Linear regression was used to identify factors associated with log-transformed PHE volume and to identify differences across Ethnic/Racial groups.

Results:
Our imaging pipeline provided good quality baseline PHE measurements on 2,008 out of 3,000 ERICH study participants. After excluding infratentorial hemorrhages (273) and those with missing or null baseline ICH volume (49), 1,686 remained for analysis (median age 59 [IQR 51-71], 687 [41%] female sex). Median PHE volume was 12.0 (IQR 4.8-27.1) for whites, 11.9 (IQR 4.5-26.1) for Hispanics and 8.3 (IQR 3.0-19.2) for blacks. Compared to Blacks, Hispanics (beta 0.22; 95%CI 0.11-0.32; p<0.001) and Whites (beta 0.20; 95%CI 0.07-0.33; p=0.003) had higher baseline PHE volumes, in multivariable analysis adjusting for age, sex, ICH location, log-baseline ICH volume, log-baseline intraventricular volume, and systolic blood pressure on admission.

Conclusion:
Race and ethnicity influence the volume of baseline PHE. Further studies are needed to validate our results and investigate the biological underpinnings of this difference.
Abstract P424: Hemorrhage Enlargement in the First Two Hours: A Mobile Stroke Unit Study
Authors: Bowry Ritvij , Parker Stephanie , Bratina Patti , Phan Kenny , Singh Noopur , Wang Mengxi , Yamal Jose-Miguel , Grotta James c
Published: March 2021

Objective:
Hematoma enlargement (HE) occurs after spontaneous intracerebral hemorrhage (ICH) but no studies have evaluated the frequency of HE in first 1-2 h after symptom onset. We evaluated HE in the first 2h after onset using a mobile stroke unit (MSU).

Methods:
Patients with spontaneous ICH within 4.5h were evaluated on the Houston MSU between 5/2014 and 4/2020. Baseline CT scans from the MSU were compared with scans repeated within 1h [median 67min (IQR 57-82 min]. Significant HE was defined as >6 ml if baseline volume was <20 ml and 30% increase if baseline volume >20 ml. Kruskal-Wallis and Wilcoxon rank sum tests evaluated differences in baseline volumes and HE. Intraclass correlation coefficient (ICC) evaluated agreement between two ICH measurement techniques (ABC/2 vs semi-automated).

Results:
163 patients had baseline CTs, of whom 60 had repeat 1h CTs (table 1). There was no difference between baseline volume and time of CT from symptom onset {<1h vs 1-2h vs >2h median (IQR) = 14 ml (6-28) vs. 16 ml (7-32) vs. 12 ml (4-24), P=0.42)}. There was also no correlation between time from onset and difference in volume between baseline and 1 h repeat imaging. However, 9/60 patients had significant HE from baseline to 1 h repeat imaging; all of these occurred in patients initially imaged within 2 h of onset (6/24 within 1h, 3/20 within 1-2h) (P=0.03) (figure 1). High reliability was seen between the two methods measuring volumes (ICC = 0.84).

Conclusion:
Significant HE in the next hour occurs in 25% of ICH patients imaged within the first hour after symptom onset, and 17% imaged between 1-2 hours of onset. These patients would be a target for ultra-early hemostatic intervention.
Abstract P425: Influenza-Like Illness as a Risk Factor for Hemorrhagic Stroke
Authors: Lansdale Kelsey N , Kamel Hooman , LeMoss Natalie M , Navi Babak , Murthy Santosh , Parikh Neal S , Zhang Cenai , Merkler Alexander E
Published: March 2021

Introduction:
Influenza-like illness (ILI) is associated with an increased short-term risk of ischemic stroke. Whether ILI is associated with an increased short-term risk of hemorrhagic stroke remains uncertain.

Hypothesis:
We hypothesized that ILI would be associated with a heightened risk of hemorrhagic stroke.

Methods:
We performed a case-crossover analysis utilizing administrative claims data from all emergency department visits and acute care hospitalizations from 2006-2015 in NY and 2005-2015 in FL. We used previously validated International Classification of Disease, Ninth Revision, Clinical Modification codes (ICD-9-CM) to identify patients with ILI and hemorrhagic stroke. Hemorrhagic stroke was defined as the composite of nontraumatic intracranial hemorrhage, nontraumatic subarachnoid hemorrhage, and nontraumatic subdural hemorrhage. We compared the risk of hemorrhagic stroke in successive 30-day periods after ILI versus the corresponding 30-day period one year earlier. We used McNemar test for matched data to calculate the absolute risk increases.

Results:
We identified 2,838,178 patients with ILI. The absolute increase in hemorrhagic stroke risk was 0.02% (95% confidene interval [CI], 0.02-0.03%) in the thirty days post ILI compared with the same period one year earlier (OR, 3.7; 95% CI, 3.2-4.3). The absolute increase in hemorrhagic stroke risk decreased over successive 30-day periods after ILI and was no longer significant after 180 days post ILI (Figure). Our results were similar when we evaluated the risk of hemorrhagic stroke subtypes separately.

Conclusions:
ILI is associated with a heightened short-term risk of hemorrhagic stroke. Further studies are warranted to evaluate mechanisms of how infection and/or inflammation lead to a heightened risk of hemorrhagic stroke.
Abstract P429: Hospital Level Diagnostic Disparities of Cerebral Amyloid Angiopathy in the United States Nationwide Hospitalizations
Authors: Patel Urvish K , Nagaraja Nandakumar
Published: March 2021

Background/Objective:
There is limited knowledge of the nationwide prevalence of cerebral amyloid angiopathy (CAA) diagnosis and disparity amongst US hospitalization. The aim of this study is to assess the prevalence of CAA diagnosis and identify hospital-level disparity in the CAA diagnosis amongst US hospitalizations.

Methods:
A cross-sectional study was performed using the National Inpatient Sample [2016-2017] for adult hospitalizations. We extracted a cohort of patients with a diagnosis of CAA using ICD 10 code. Age was categorized as <50 years, 50-59, 60-69, 70-79, and ≥80 years. Weighted analysis using chi-square and multivariable survey logistic regression was performed to identify the prevalence of CAA and evaluate the diagnostic disparity of CAA amongst USA hospitalization.

Results:
Out of total 60,609,519 US hospitalizations, 16040 (0.027%) had a diagnosis of CAA. Patients with CAA were of higher age 71-80 years (39.9% vs 16.4%), ≥81 years (36.4% vs 14.9%), men (48.1% vs 42.1%), white (71.5% vs 67.5%), and more likely admitted to urban-teaching hospitals (83.9% vs 66.0%), Northeast region hospitals (26.5% vs 18.8%), and hospitals with large bed-size (65.7% vs 51.2%) compared to patients without CAA (p<0.0001). On regression analysis, urban non-teaching (aOR 2.1; 95%CI 1.6-2.9; ref=rural), urban-teaching hospitals [5.4 (4.1-7.2); ref=rural], median size hospital [1.3 (1.1-1.5); ref=small], and large bed size hospitals [2.3 (2-2.7); ref=small] had higher odds of diagnosis of CAA. Compared to the Northeast region, Midwest [0.8 (0.7-0.97)] and South [0.7 (0.6-0.8)] region hospitals had lower odds of a diagnosis of CAA.

Conclusion:
CAA was present in 0.03% of hospitalized patients in 2016-17. It was more commonly diagnosed in urban teaching, urban non-teaching, large and medium bed size hospitals compared to rural and small bed size hospitals. Lack of awareness of CAA diagnosis in rural and small hospitals could be a potential factor for these disparities.
Abstract P431: White-Matter Disease Burden and Cerebral Microbleeds After Extracorporeal Membrane Oxygenation Support
Authors: Topiwala Karan , Mehta Tapan , Tore Huseyin , Jagadeesan Bharati
Published: March 2021

Introduction:
Cerebral microbleeds (CMBs) have been increasingly reported in patients receiving extracorporeal membrane oxygenation (ECMO) support. Both, CMBs and cerebral white-matter disease (WMD) are thought to be a result of microvascular lipo-hyalinosis; as commonly seen in an aging brain. The pathogenesis of microbleeds after ECMO, has not yet been definitively established. We sought to examine the relationship between cerebral WMD burden and microbleeds after ECMO-support at a single tertiary referral academic hospital with high volumes of ECMO patients.

Methods:
All patients receiving venovenous (vv) and venoarterial (va) ECMO between January 2013 to January 2018 were retrospectively examined. The distribution of white matter hyperintensities was quantified using the Walhund age-related white matter changes (ARWMC) scale and correlated with the presence of cerebral microbleeds on brain MRI studies with Susceptibility Weighted Imaging (SWI) performed shortly after cessation of ECMO.

Results:
A total of 307 ECMO patients were reviewed, among whom 44 patients (vv:va= 13:31; male:female= 29:15) received at-least one MRI-brain study with SWI sequences after ECMO decannulation. The median duration of ECMO support was 4 days (range 1-25 days), with median duration from decannulation-to-MRI being 11.5 days (range 3-724 days). Microbleeds were present in 77.3% (n=34) patients, with 38.2% (n=13), 14.7% (n=5), and 47.1% (n=16) having mild (<10), moderate (10-30) and severe (>30) CMBs respectively. The median Walhund ARWMC score was 1 (range 0-22). Age and sex adjusted Walhund scores were not found predictive of CMB presence (p=0.578 [0.90-1.19]). Of 44 patients with at-least one post-ECMO MRI, 10 patients had a follow-up MRI scan at a median duration of 4 months (range 0.22-55 months); all of whom had unchanged CMB burden. At 10-month median clinical follow-up (range 0-76 months), none of the 34 patients with CMBs on initial MRI-study had presented with an intracranial hemorrhage.

Conclusion:
Development of CMBs after ECMO support is independent of microvascular lipo-hyalinosis, as estimated from cerebral white-matter disease burden. This requires further study in a larger sample-size.
Abstract P437: Trends in Outcomes, and Length and Costs of Hospitalization in Patients With Intracerebral Hemorrhage in United States
Authors: Chaudhry Mohammad Rauf A , Gill Hussan , Chaudhry Saqib , Singh Baljinder , Bandaru Harathi , Vellipuram Anantha Ramana , Maud Alberto , Rodriguez Gustavo J , Cruz-Flores Salvador , Qureshi Adnan I
Published: March 2021

Background:
It remains unclear whether there is any improvement in outcomes of patients with intracerebral hemorrhage over the last decade.

Objective:
To determine trends pertaining in-hospital outcomes in patients with intracerebral hemorrhage using nationally representative data.

Methods:
We determined the national estimates of intracerebral hemorrhage admissions from 2005 to 2014 and associated in-hospital outcomes, length of stay, mortality, and cost incurred using the Nationwide Inpatient Survey (NIS) data. The NIS is the largest all-payer inpatient care database in the US and contains data from 986 hospitals approximating a 20% stratified sample of US hospitals. Outcome was classified as none to minimal disability, moderate to severe disability, and death based on discharge destination.

Results:
In the 10-year period, there were 70,637 admissions for intracerebral hemorrhage (annual estimate 80804 in 2005 to 109930 in 2014). There was a significant reduction in in-hospital mortality in patients with intracerebral hemorrhage from 30% to 23% (trend test, p < 0.0001). There was a trend towards increase in proportion of patients with moderate to severe disability (trend test, p < 0.097). The mean length of hospitalization increased from 8.58 days to 9.23 days (trend test, p < 0.0001) and cost of hospitalization increased from $50532.1 to $110932.1 (trend test, p < 0.0001).

Conclusions:
The mortality in patients with intracerebral hemorrhage has decreased but there is increased rates of moderate to severe disability, length of hospitalization, and hospitalization cost over the last decade.
Abstract P439: Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors
Authors: Parasram Melvin , Parikh Neal S , Merkler Alexander E , Falcone Guido J , Sheth Kevin N , Navi Babak B , Kamel Hooman , Zhang Cenai , Murthy Santosh
Published: March 2021

Background and Purpose:
Emerging data suggest an increased risk of arterial ischemic events after intracerebral hemorrhage (ICH), but their impact on ICH outcomes is unclear. This study aimed to evaluate the risk of death among ICH survivors with and without an incident arterial ischemic event.

Methods:
We performed a retrospective cohort study using claims data from Medicare beneficiaries with a non-traumatic ICH from January 2008 to October 2015. Our exposure was an arterial ischemic event, defined as a composite of acute ischemic stroke or myocardial infarction (MI), identified using validated ICD-9-CM diagnosis codes. The outcome was death. After excluding ischemic events and deaths in the first 30 days after ICH discharge to prevent carryover of diagnosis codes from the initial hospitalization, we used marginal structural models to analyze the risk of death among ICH patients with and without an arterial ischemic event, after adjusting for demographics and vascular comorbidities as time-varying covariates. In secondary analyses, we studied the mortality risk separately after an ischemic stroke and MI.

Results:
Among 8,222 Medicare beneficiaries with an ICH, 2,371 (28.8%) had an arterial ischemic event. During a median follow up time of 2.0 years (interquartile range, 0.8-3.8), the cumulative mortality rate was 7.0% (95% confidence interval [CI], 6.5-7.5%) in patients with an arterial ischemic event and 4.0% (95% CI, 3.8-4.2%) in patients without an arterial ischemic event. In the marginal structural model, the occurrence of an arterial ischemic event was associated with an increased risk of death (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.5- 1.7). In secondary analyses, the mortality risk was elevated after both an ischemic stroke (HR, 1.5; 95% CI, 1.4-1.6), and a MI (HR, 2.6; 95% CI, 2.1-3.2).

Conclusions:
In a large population-based cohort, we found that elderly patients who survived an ICH had an increased risk of death after a subsequent ischemic stroke or MI. Careful exploration of secondary cardiovascular and stroke prevention strategies may be warranted in these patients.
Abstract P44: Final Outcomes in Patients With Ruptured Aneurysms From the SMART Registry
Authors: Spiotta Alejandro , De Leacy Reade A , Bohnstedt Bradley N , Fiorella David , Schirmer Clemens M , Bellon Richard J , Simon Scott , Sunenshine Peter J , Yoo Albert
Published: March 2021

Introduction:
We report the durability of treatment with SMART COIL System at one-year in patients with ruptured aneurysms enrolled in the SMART registry.

Materials and Methods:
The SMART Registry is a prospective, multi-center registry study. Procedures must employ ≥75% of the SMART, PC400, or POD coils to meet registry criteria. Patients with ruptured aneurysms presenting prior to the procedure were included in this analysis. SMART Registry endpoints include retreatment rates at one year, procedural device-related serious adverse events (SAE), and the ability to achieve adequate occlusion at immediate post-procedure.

Results:
Of the 905 enrolled patients with aneurysms, 31.8% (288/905) of patients had ruptured aneurysms (74.0% female; mean age 58.0 ± 13.5 years). Ruptured aneurysms were small (<4 mm) in 16.7% (48/288), medium (≥4mm to 10mm) in 68.4% (197/288), large (>10 to 25 mm) in 14.6% (42/288), giant (>25) in 0.3% (1/288), and the mean size was 6.9 mm (SD 3.5 ). Hunt and Hess grade ≥3 was reported in 43.8% (123/281) of patients. The anterior cerebral artery had 33.7% (97/288) of all ruptured aneurysms and the internal carotid artery had 30.6% (88/288). Stent-assisted coiling and balloon-assisted coiling were performed in 7.6% (22/288) and 31.3% (90/288) of patients, respectively. Mean packing density for ruptured aneurysms was 33.4% (SD 20.9). In patients with ruptured aneurysms, retreatment rate at one year was 16.5% (33/200). Procedural device-related SAEs were observed in 3.1% subjects (9/288). Raymond Class I or II was observed in 84.6% (242/286) at immediate post-procedure and in 84.3% (161/191) at one year. The multivariate analysis showed that neck width ≥4 mm (OR 2.56, 95% CI 1.21-5.44, P=0.0144) and male gender (OR 2.17 95% CI 1.05-4.49, P=0.0376) were predictors of Raymond Class III or retreatment at one year.

Conclusion:
This analysis suggests that the SMART COIL System achieves adequate embolization and retreatment rates in ruptured aneurysms at one year.
Abstract P443: Identification of Traumatic and Non-Traumatic Intracranial Bleeding Subtypes in Patients With Non-Valvular Atrial Fibrillation Receiving Oral Anticoagulant Therapy Using Primary Care Data From the United Kingdom
Authors: Garcia Rodriguez Luis A , González Pérez Antonio , Saéz Goñi Maria , Vora Pareen , Roberts Luke , Fatoba Samuel , Brobert Gunnar
Published: March 2021

Introduction:
Classification of intracranial bleeding (ICB) by trauma status is important in research relating to anticoagulant therapy. We evaluated trauma status of ICB subtypes - intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) - in a large population of patients with non-valvular atrial fibrillation (NVAF) receiving oral anticoagulant (OAC) therapy.

Methods:
Using the IQVIA Medical Research Data UK primary care database, we followed 45,164 patients with NVAF newly prescribed OAC therapy to identify incident ICB cases, and categorized them as ICH, SAH or SDH based on the coded description. We identified cases with a code suggesting the event was traumatic (e.g. head injury) or non-traumatic within 90 days either side of the ICB event, and manually reviewed the patient records for cases without such a code to identify other entries indicating trauma in the time period. ICH and SAH cases without a trauma/non-trauma code were classed as non-traumatic and SDH cases without a trauma/non-trauma code were classed as traumatic.

Results:
A total of 286 ICB cases were identified: 45.5% ICH, 41.9% SDH, 12.6% SAH. Classification of cases is shown in the Table. Most traumatic cases were SDH (77.3%, 85/110); most non-traumatic cases were ICH (66.5%, 117/176). Classification by the presence of a trauma/non-trauma code was 82.5% for SDH, 33.3% for SAH and 10.8% for ICH. Classification of all but one non-traumatic ICH case and all non-traumatic SAH cases were by the absence of a trauma/non-trauma code. For SDH, 75.3% of traumatic SDH cases were based on a trauma code, and 100% of non-traumatic SDH cases were based on a non-trauma code.

Conclusion:
Among patients with NVAF receiving OAC therapy, the majority of incident ICB cases were non-traumatic. Classification of SDH was predominantly made from trauma/non-trauma codes; cases of ICH and SAH were mostly based on the absence of trauma/non-trauma codes using non-trauma as the default category.
Abstract P444: Myocardial Infarction and Subarachnoid Hemorrhage. Frequency and Impact on Outcome
Authors: Chaudhry Mohammad Rauf , Gill Hussan , Chaudhry Saqib , Singh Baljinder , Bandaru Harathi , Vellipuram Anantha Ramana , Piriyawat Paisith , Maud Alberto , Rodriguez Gustavo , Cruz-Flores Salvador
Published: March 2021

Introduction/background:
Subarachnoid hemorrhage is known to be associated with systemic complications including neurogenic pulmonary edema and Talkotsubo cardiomyopathy. We set to establish the frequency of myocardial infarction (MI) and its impact on outcome among patients with subarachnoid hemorrhage (SAH)

Methods:
We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all subarachnoid hemorrhage (ICH) patients. Myocardial infraction (MI) was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, moderate to severe disability at dischagre, length of stay and in-hospital charges) were compared between the two groups.

Results:
Of the 325923 patients with SAH, 12720 (3.90%) had in-hospital myocardial infraction. SAH patients with MI were older (64.6 years versus 59.0 years, P <.0001) compared to SAH patients without MI but there was no difference in-term of proportion of females between the two groups. The in-hospital mortality was also higher (49.8% versus 23.9%, p≤.0001) among patients with MI in both univariate and multivariate analysis (OR = 1.75 (1.59 -1.93), P<.0001) after adjusting for potential confounders. SAH patients with MI had higher (68.5% versus 40.9%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (13.2 days versus 11.8 days, P <.0001) and mean hospital charges ($188845 versus $150062, P <.0001) were also higher in SAH patients with MI

Conclusions:
While MI was reported in only 3.9% of SAH cases it had a significant impact on outcome with a one fold increase in morality and about 75% increase risk of severe disability.
Abstract P445: Implications of Associated Infection in Intracranial Hemorrhages During Left Ventricular Assist Device Support
Authors: Shoskes Aaron , Hassett Catherine , Cho Sung-min , Estep Jerry , Starling Randall C , Uchino Ken
Published: March 2021

Background:
Intracranial hemorrhage (ICH) is a devastating complication in patients with an implanted left ventricular assist device (LVAD) for advanced heart failure. Blood stream infection is associated with LVAD-associated ICH. We compared infectious and non-infectious ICH among LVAD recipients.

Methods:
Records of patients who had LVAD implantation at a tertiary care center were retrospectively reviewed. All LVAD-associated ICH were analyzed, including intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH). Hemorrhages were categorized into infectious and non-infectious by presence or absence of concurrent bacteremia or driveline infection.

Results:
Of 683 patients with an LVAD, 74 ICHs occurred in 73 patients (10.7%). IPH was most prevalent (72%), followed by SAH (27%), and SDH (23%). Multiple concurrent subtypes of hemorrhage were present in 22% of events. ICH occurred at median 188 days after implant, and was associated with a 54% in-hospital mortality. Twenty-three ICHs occurred in the setting of infection. While 20% of overall ICH occurred within 30 days of LVAD implantation, only 1 infectious ICH occurred within 30 days of implantation (4.5%). IPH without associated infection was larger (median 41 ml, interquartile range [IQR] 11-70) than without infection (median 9 ml, IQR 2-65, p= 0.04), but in hospital mortality did not differ between infectious and non-infectious ICH (52% vs 59%) or IPH (58% vs 68%).

Conclusion:
While timing and volume of infectious and non-infectious ICH differ, in-hospital mortality is similarly high in both groups. Further research is necessary to better understand hemorrhagic complications in LVAD patients.
Abstract P447: Intracranial Pressure and Cerebral Perfusion Pressure Monitoring in Spontaneous Intracranial Hemorrhage: A Secondary Analysis of the Mistie III Trial
Authors: Al-Kawaz Mais , Avadhani Radhika , Awad Issam A , Hanley Daniel F , Ziai Wendy C
Published: March 2021

Introduction:
Intracerebral hemorrhage (ICH) management guidelines recommend maintaining intracranial pressure (ICP) <20 and cerebral perfusion pressure (CPP) between 50-70 mmHg. We did subgroup analyses of MISTIE III trial to explore whether minimally invasive surgery (MIS) improves ICP or CPP and whether thresholds are associated with long term outcomes.

Methods:
MISTIE III was a randomized clinical trial including 499 patients with spontaneous ICH randomized to MIS+Alteplase or standard medical care (SMC). Primary outcomes were any threshold event of ICP >20 and CPP <60/70 mmHg. Secondary outcomes were poor modified Rankin Scale at one year and mortality at 30/365 days. We used multivariable models to investigate factors associated with ICP/CPP events and outcomes.

Results:
Of 72 patients with ICP monitored for median 92 (72-96) hours, 31 (43.1%) had at least one ICP reading >20 and 52/35 (72.2/34.7%) had at least one CPP reading <70/60 mmHg. Lower intraventricular hemorrhage volume and SMC group were associated with having any ICP threshold event >20 and CPP event <70 mmHg whereas CPP<60 mmHg was associated with end of treatment (EOT) ICH volume, hydrocephalus on diagnostic CT and no prior antiplatelet agent use. On adjusted analyses, percentage of ICP readings >20 were significantly less likely in patients undergoing MIS vs SMC (Coefficient -0.79, 95% Confidence Interval [CI] [(-)1.46-(-)0.11]; p=0.02). Percentage of CPP readings <70 were significantly less frequent in MIS group (Coefficient -1.59 [(-)2.58-(-)0.59]; p=0.002). Patients who underwent successful MIS with EOT ICH volume <15mL also had significantly lower percentage of readings at ICP<20 (p=0.02), and CPP<70 (p=0.05). Lower percentage of CPP readings <60 mmHg was independently associated with lower mortality at 30 and 365 days (p=0.02 and 0.04) and CPP <70 was associated with lower one-year mortality (p=0.04). There were no significant associations with one-year functional outcome.

Conclusion:
Elevated ICP and inadequate CPP are not infrequent during ICP monitoring for large ICH. Burden of low CPP events predict higher short and long term mortality, but not functional outcomes. CPP may be more significant than ICP. MIS appears to mitigate ICP and CPP threshold events.
Abstract P449: The Impact of Race and Social Determinants of Health on Imaging Biomarkers in Intracerebral Hemorrhage
Authors: Bauman Kristie , Agarwal Shashank , Yaghi Shadi , Lewis Ariane , Lord Aaron , Ishida Koto , Zhang Cen , Czeisler Barry , Torres Jose L , Melmed Kara R
Published: March 2021

Introduction:
The association between race and white matter hyperintensities (WMH) and cerebral microbleeds in patients with intracerebral hemorrhage (ICH) is controversial. We examined the relationship between race and social determinants of health with WMH and microbleeds in ICH.

Methods:
We performed a retrospective study of patients at a tertiary care hospital between 2013 and 2020 who presented with ICH and underwent MRI of the brain. MRIs were evaluated for the presence of microbleeds and WMH severity (defined by the Fazekas scale; severe WMH defined as Fazekas 3). We assessed for an association of sex, race, ethnicity, employment status, median household income by zip code, education level, and insurance status with the severity of WMH or presence of microbleeds.

Results:
We identified 105 patients (median age 65.5 (IQR 53-76); 51% females; 13.2% Black) with ICH who had an MRI of the brain. Median ICH score was 1 [IQR 0-2] and median hematoma size was 15.9 ml (SD 19.7). High school graduation was the highest education level in 13.2%, and 57.5% had private insurance. Median income by zip code was $87,667 (IQR $65,900-$117,923). Severe WMH was observed in 19.8% and 52.8% of patients had microbleeds. There was no significant difference in sex, insurance status or median income for patients with or without severe WMH nor those with or without microbleeds. Severe WMH was more common among older patients (p=0.001), Black patients (p=0.03), patients with hypertension (p=0.03), and those with lower levels of education (p=0.03). In multivariable analyses, Black race was associated with severe WMH when adjusting for age and history of hypertension (OR 6.13 95% CI 1.14-25.98, p=0.01) but the effect size attenuated and the association disappears when adding education level to the model (OR 3.38 95% CI 0.48-23.76, p = 0.2). Age and history of hypertension were associated with presence of microbleeds (p<0.01 for both), but there was no association between presence of microbleeds and Black race or education level.

Conclusion:
Although Black race was associated with severe WMH, this association did not remain after adjusting for level of education. Our findings suggest that social determinants of health can modify the association between race and imaging biomarkers of ICH.
Abstract P450: Serum Arachidonic Acid Levels in Relation With Outcome of Acute Intracerebral Hemorrhage
Authors: Takahashi Junichiro , Sakai Kenichiro , Kitagawa Tomomichi , Sato Takeo , Takatsu Hiroki , Komatsu Teppei , Mitsumura Hidetaka , Iguchi Yasuyuki
Published: March 2021

Introduction:
The correlation between serum polyunsaturated fatty acids (PUFAs) such as Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), Arachidonic Acid (AA) and Dihomogammalinolenic Acid (DHLA) levels and clinical outcomes of cardiovascular disease are previously reported. The aim was to investigate serum PUFAs including AA levels to clinical outcome in intracerebral hemorrhage (ICH) patients.

Method:
From Nov 2012 to Nov 2019, ICH patients within 24 hours from the onset were enrolled. All patients underwent radiological investigations and laboratory examinations including measurement of serum PUFAs levels on admission. We divided patients into two groups, favorable outcome group (mRS at 3 months 0-3) and poor outcome group (mRS at 3 months 4-6). We compared baseline variables including serum PUFAs levels between two groups.

Result:
We enrolled 142patients (87 male, median age 60 years old, median NIHSS score 8). Of them, 113 patients (80%) were favorable outcome group and 29 patients (20%) were poor outcome group. Higher NIHSS score and larger size of hematoma on admission were found in poor outcome group (median NIHSS score 6 of favorable outcome vs. 14 of poor outcome, p<0.001, and median hematoma size, 7.5ml vs. 13.5ml, p=0.048). In serum PUFAs levels, only serum AA levels was significantly lower in poor outcome group (median interval 213μg/ml vs. 179μg/ml, p=0.002) though there were no difference of DHLA, EPA and DHA levels between two groups. In multivariate logistic regression analysis, lower serum AA levels was independently associated with poor outcome (OR 0.987, 95%CI 0.978-0.996, p=0.007, Figure).

Conclusion:
Serum AA levels may play an important role in predicting the outcome in ICH.
Abstract P451: Clinical Characteristics of Coagulopathic Intracranial Hemorrhages
Authors: Hassouneh Zakariya J , Lau H Lee , Shah Nayna , Field Thalia S , Koch Sebastian
Published: March 2021

Introduction:
Acute non-traumatic intracerebral hemorrhage (ICH) is the second-most common subtype of stroke and has a 40% mortality rate at one month. Non-iatrogenic coagulopathies comprise less than 20% of ICH and few studies have investigated characteristics of these groups. We compared baseline characteristics of individuals with ICH with and without non-iatrogenic coagulopathy.

Methods:
A retrospective study of 392 consecutive patients with ICHs between 2017 and 2019 were analyzed by the absence of coagulopathy, presence of anticoagulation and non-iatrogenic coagulopathy. Non-iatrogenic coagulopathy was defined as a prior documented coagulopathy (such as liver/kidney disease or cancer), platelets <100K, INR >2.0 or aPTT >60 seconds. Location(s) and size of abnormalities on prior imaging and presenting ICH were recorded. A two-tailed type 1 Student’s
t
-test (continuous variables), chi-squared test (categorical variables), Bonferroni corrections and Cramer’s V were used for statistical analyses.

Preliminary Results:
Of 392 patients with ICH, 28 (7.1%) were anti-coagulated and 29 (7.4%) had non-iatrogenic coagulopathy. There were lower/comparable rates of hypertension (83%, p=0.02 and p=0.25) and higher rates of alcohol use (28%, p=0.01 and p<0.01) and chronic kidney disease (38%, p<0.01 and p<0.01) in the non-iatrogenic coagulopathy compared to non-coagulopathic and anticoagulated groups, respectively. Highest baseline blood pressure was lower in the non-iatrogenic coagulopathy (systolic p=0.09, diastolic p=0.04) and anticoagulated groups (systolic p=0.02, diastolic p=0.22) compared to non-coagulopathic ICH.

Conclusion:
Our preliminary findings suggest that individuals with non-iatrogenic coagulopathy are as common as anticoagulated patients in our ICH cohort and have distinct clinical characteristics. Future directions, such as neuroimaging anaysis and assessment of functional outcomes, will determine if there are risk factors that would warrant distinct treatments beyond standard supportive management.
Abstract P456: Myocardial Infarction in Patients With Intracerebral Hemorrhage. Prevalence and Impact on Outcome
Authors: Chaudhry Mohammad Rauf , Gill Hussan , Chaudhry Saqib , Singh Baljinder , Bandaru Harathi , Vellipuram Anantha Ramana , Piriyawat Paisith , Maud Alberto , Rodriguez Gustavo J , Cruz-Flores Salvador
Published: March 2021

Introduction/background:
Comorbidities can potentially affect outcome of patients with intracerebral hemorrhage (ICH). It is unclear what the prevalence of acute myocardial infarction (AMI) and its impact on outcome are in patients with intracerebral hemorrhage.

Methods:
We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. AMI was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, discharge disposition, length of stay and in-hospital charges) were compared between the two groups.

Results:
Of the 884379 patients with ICH, 27692 (3.13%) had in-hospital myocardial infraction. ICH patients with AMI order had lower proportion of females (47.8% versus 49.7%, P= 0.0028) and were older (69.7 years versus 67.2 years, P <.0001) compared to ICH patients without MI. The in-hospital mortality was higher (40.9% versus 25.5%, p≤.0001) among ICH patients with AMI in both univariate and multivariate analysis (OR = 1.22 (1.14 -1.31), P<.0001) after adjusting for potential confounders. ICH patients with MI had higher (72.4% versus 58.8%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (12.4 days versus 8.94 days, P <.0001) and mean hospital charges ($129328 versus $ 81984.0, P <.0001) were also higher in ICH patients with MI

Conclusions:
While only 3.13% of patients with ICH have an AMI, there is a 22% increase in worse outcome among those patients with AMI and ICH.
Abstract P458: Systemic Inflammatory Response Syndrome is Associated With Hematoma Expansion in Intracerebral Hemorrhage
Authors: Carroll Elizabeth , Lord Aaron , Lewis Ariane , Ishida Koto , Zhang Cen , Torres Jose L , Czeisler Barry , Melmed Kara R
Published: March 2021

Objective:
Systemic inflammatory response syndrome (SIRS) and hematoma expansion are both associated with worse outcomes after intracerebral hemorrhage (ICH), but their relationship remains unclear. We sought to determine the association between SIRS and hematoma expansion after ICH.

Methods:
We performed a retrospective cohort study of patients admitted to our hospital from 2013 to 2020 with primary spontaneous ICH with at least two head CTs within the first 24 hours. Patients were excluded if they had a decompressive craniectomy, intracranial vascular lesions or malignancy, or coagulopathy. Hematoma volume was measured using the ABC/2 method; hematoma expansion was defined as 6mL or 33% growth between the first and second scan. We compared patients with and without SIRS using Pearson’s χ2, students T and Wilcoxon rank sum tests. The relationship between admission SIRS and hematoma expansion was assessed using univariate and multivariate regression analysis.

Results:
Of 187 patients with ICH, 73 (39%; mean age 6617, 40% female) met inclusion criteria. Of those, 38 (52%) had SIRS on admission. Admission systolic blood pressure (SBP) was significantly higher in patients with SIRS compared to those without (169 [IQR 133- 205] vs 152 [125- 179] mm Hg, p= 0.02). There was no difference in mean days to first antibiotic administration (6.3 vs 5.6, p=0.78), admission platelets (227 vs 243, p= 0.38) or initial hematoma volume (23 vs 15, p=0.16). Hematoma expansion occurred in 14 patients, 11 (79%) of whom also had SIRS. A significantly greater percentage of patients with SIRS had mRS 4-6 at discharge (87 vs 67%, p=0.05). SIRS was significantly associated with hematoma expansion (OR 4.35, 95% CI 1.10-17.20, p= 0.04) on univariate analysis. The association remained statistically significant after adjusting for admission SBP, platelets, and initial hematoma volume (OR 4.54, 95% CI 1.01-20.60, p= 0.05).

Conclusion:
Presence of SIRS on admission is associated with hematoma expansion within the first 24 hours. Further research is needed to better understand this association, which may enable us to identify early on and treat those patients at highest risk for decompensation.
Abstract P460: Comparison of Hemorrhagic Posterior Reversible Encephalopathy Syndrome and Hemorrhagic Reversible Cerebral Vasoconstriction Syndrome
Authors: Purohit Meghan , Scarsella Monica , Toljan Karlo , Mullaguri Naresh , Wisco Dolora R , Uchino Ken
Published: March 2021

Introduction:
Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are diagnoses that have a clinical and radiographic overlap. One particular overlap includes the presence of hemorrhage, which we studied in each population to determine its effect on outcomes.

Objective:
To compare characteristics and outcomes of hemorrhagic PRES and hemorrhagic RCVS populations.

Methods:
We conducted a review of the electronic health record at a single tertiary center from January 2008 to December 2018. Inclusion criteria were 18 years or older with clinical and radiographic evidence of PRES or RCVS. Patient demographics, presenting symptoms, imaging findings, and outcomes were compared between PRES and RCVS groups. Poor outcome was defined as discharge to skilled nursing facility or death. Analysis was performed using Pearson’s Chi-Square test.

Results:
Among 281 PRES and 98 RCVS cases, intracranial hemorrhage was seen on imaging in 51 PRES cases (18%) and 34 RCVS cases (35%). Headache was present in all patients with hemorrhagic RCVS but only seen in 40% of hemorrhagic PRES. Use of antidepressants or drugs of abuse was more frequent with hemorrhagic RCVS (53%) as compared to hemorrhagic PRES (7%, p <0.05). Among hemorrhagic PRES, presence of intraparenchymal hemorrhage but not subarachnoid hemorrhage was associated with vasoconstriction on arterial imaging (p<0.05). Length of stay was longer for both hemorrhagic PRES and hemorrhagic RCVS (p<0.001) compared those without hemorrhage. Presence of focal neurological deficits, motor and sensory, was associated with poor outcomes in hemorrhagic RCVS patients (p<0.05). Discharge to a rehabilitation facility was associated with hemorrhagic PRES (p<0.05), no association in those without hemorrhage. There is no evidence that discharge location is significantly different between RCVS hemorrhage and non-hemorrhage groups.

Conclusion:
Hemorrhage in PRES and RCVS is associated with more clinical deficits at presentation and longer hospital stays. Underlying vasoconstriction is frequent and associated with hemorrhagic PRES.
Abstract P463: Direct to Angio in Transferred Patients is Associated With Faster Reperfusion and Higher Functional Independence Rates Both During Regular and On-Call Hours: A Multi Center Cohort
Authors: Sarraj Amrou , Goyal Nitin , Chen Michael , Blackburn Spiros , Requena Manuel , Kamal Haris , Grotta James C , Abraham Michael G , Elijovich Lucas , Mir Osman , Tekle Wondwossen G , Pujara Deep , Shaker Faris , Reddy Sujan T , Parsha Kaushik N , Alenzi Bader , Hoit Daniel , Martin-schild Sheryl B , Song Sarah , Sitton Clark , Tsivgoulis Georgios K , Alexandrov Andrei V , Arthur Adam S , Day Arthur L , Hassan Ameer E , Ribo Marc
Published: March 2021

Background:
Direct To Angio (DTA) for transferred large vessel occlusions (LVO) lowers time to endovascular thrombectomy (EVT), reperfusion and potentially improves outcomes. Safety and efficacy of DTA in late time window and on-call hours is unknown.

Methods:
Pooled cohort from 6 centers (EU, US) from 1/14-5/20 (ICA, M1, M2) LVO pts transferred for EVT≤24 hrs from LKW. Pts stratified into with repeat imaging (RI) (CT+/- CTA/CTP) and without RI (DTA). We compared time metrics, good outcome (90 day mRS 0-2), safety (sICH, mortality) and assessed the impact of arrival for EVT; regular (M-F, 8am-5pm) vs on-call hrs. Propensity matched analysis was done.

Results:
Of 1178 EVT transfers, 334 (28%) were DTA. DTA pts had more tPA (61% vs 51%, p=0.002), trended to lower NIHSS 17 (12, 20) vs 17 (13, 21), p=0.07 and lower LKW to arrival 268 (190, 430) min vs 280 (190, 518), p=0.097. Groin puncture (GP) was faster with DTA (p<0.001) Fig 1. Good outcomes were higher with DTA overall (53% vs 38%, aOR 1.7, 95%CI 1.3-2.4, p=0.001), regular (54% vs 41%, p=0.07) and on-call hrs (52% vs 36%, p=0.008), mortality was lower overall (17% vs 24%, p=0.04) and all hrs Fig 2 A-C. sICH rates were similar. A 10 min increase arrival to GP with RI correlated to 5% reduction in good outcome odds (aOR 0.95, 95%CI 0.91-0.99, p=0.01). The results did not vary by time window (0-6 hrs vs >6-24, p=0.88 for interaction). In propensity matched 75 pairs, DTA had shorter time to EVT (19 min vs 52, p<0.001) and higher mRS 0-2 (55% vs 32%, aOR 4.8 (1.9-12.4), p=0.001) fig 2D. However, the probability of mRS 0-2 decreased with increasing transfer times in DTA pts (< 3 hrs 59% vs 36% ≥ 3 hrs, p<0.001) but not in RI (36% vs 37%, p=0.88) fig 3.

Conclusion:
In pooled, non-randomized data DTA may result in faster treatment, safe and better functional outcomes, during all hours and treatment windows. Repeat imaging may be reasonable with prolonged transfer times. Optimal EVT workflow in transfers may result in faster, safe reperfusion with higher good outcomes.
Abstract P472: Characterization of Infarct Growth Rate Patterns in Patients With Large-Vessel Occlusion Stroke Undergoing Mechanical Thrombectomy
Authors: Quispe-Orozco Darko , Zevallos Cynthia , Farooqui Mudassir , Dajles Andres , Nguyen Cindy Khanh , Peshwe Krithika , Mendez Ruiz Alan , Kobsa Jessica , Prasad Ayush , Kodali Sreeja , Petersen Nils H , Ortega-Gutierrez Santiago
Published: March 2021

Introduction:
Infarct growth is affected by the collateral blood supply and ischemic tolerance and thus unlikely linear. This study aimed to better characterize infarct growth rates (IGR) after large-vessel occlusion (LVO) stroke.

Methods:
We retrospectively identified patients with anterior LVO stroke who underwent mechanical thrombectomy (MT) at two comprehensive stroke centers. Core infarct volumes at presentation (CBF<30%) were estimated using RAPID software. Final infarct volume (FIV) was measured on post-MT MRI. We estimated IGR during two intervals: IGR 1 defined as CBF<30% (ml) / Time from onset to CTP (hours); and IGR 2 as [FIV - CBF<30% (ml)] / Time from CTP to reperfusion (hours). To calculate IGR 2, we only analyzed patients with successful MT (mTICI ≥ 2b) assuming no significant infarct growth after reperfusion. Functional outcome was assessed using the modified Rankin scale (mRS) at 90 days. We performed the Receiver-operating characteristic (ROC) analysis for each interval to best classify patients into slow and fast progressors.

Results:
Of the 361 patients (age 68 ± 15, 55% female, NIHSS 14 ± 6) included in the analysis, 282 (78.1%) had successful reperfusion, and 150 (41.6%) achieved a good outcome (mRS ≤2). IGR showed an exponential growth pattern (Figure 1). There was no significant difference in the median IGR 1 between the poor and good outcome groups (2.3 vs. 1 ml, p=0.061). The median IGR 2 in patients with poor outcome was significantly higher when compared to those in the good outcome group (IGR 14.1ml/h vs. 4.62ml/h, p<0.0001). IGR 2 ≥ 12.2ml/h had a sensitivity of 0.56 and a specificity of 0.77 (AUC 0.67) for predicting poor outcome.

Conclusions:
We identified an exponential infarct growth pattern after LVO stroke that differs in relation to outcome. High IGR in the interval from CTP to reperfusion is associated with worse outcomes, emphasizing the importance of future research into therapeutic approaches to slow down infarct progression.