bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W P109: Nitrosative Stress Preconditioning Ameliorated Neurovascular Injury in Stroke
Authors: Tao Rongrong , Wang Huan , Jiang Quan , Lu Yingmei , Han Feng
Published: March 2022

Objective:
Ischemic preconditioning (IPC) serves as a protective role in improving ischemic tolerance to subsequent severe stroke. Understanding the mechanisms underlying IPC-induced neuroprotection is essential to reveal potential therapeutic targets of ischemia attack. Here, we tested the hypothesis that moderate level flux of nitrosative stress contributes to IPC-associated neurovascular protection in mice subjected to ischemia-reperfusion injury.
Methods:
IPC was modeled in WT or
eNOS
-/-
mice with two cycles of 5-min ischemia and 30-min reperfusion. 24h-reperfusion later, mice were subjected to 2h-transient middle cerebral artery occlusion (tMCAO) and neurological deficits, infarct volume, blood-brain barrier (BBB) permeability as well as neurovascular damage-related protein expression were evaluated 24 h later. Peroxynitrite donor SIN-1 preconditioning in brain and knockout of
eNOS
were further performed to determine the role of nitrosative stress during ischemic preconditioning.
Results:
IPC treatment ameliorated neurological dysfunction after cerebral ischemia compared to the tMCAO group without IPC, which was accompanied by a reduction of infract volume, evans blue leakage from BBB and MMP9 activation. In contract, inhibition of nitrosative stress by eNOS deficiency blocked the benefits of IPC on neurovascular protection during ischemic stroke. SIN-1 preconditioning at 0.5 mM significantly decreased neurological deficit scores and infarct volume after ischemic stroke. While both of 0.1 mM and 2 mM SIN-1 failed to active cell survival programs against ischemic injury.
Conclusion:
Nitrosative stress at moderate level is a key mediator of IPC-associated cell survival response and neurovascular protection during ischemic insult, thus implicating a novel therapeutic approach that selectively targeting nitrosative stress to active cell survival response during adaptive phase and ameliorate prolonged ischemic damage during later phase in stroke.
Abstract W P110: ABCA1 Partially Mediates D-4F Protection of White Matter After Stroke
Authors: Cui Xu , Chopp Michael , Zacharek Alex , Ning Ruizhuo , Cui Yisheng , Roberts Synthia , Chen Jieli
Published: March 2022

Introduction:
White matter (WM) damage is associated with neurological deficits after stroke. Neuroinflammation increases WM damage. The ATP-binding cassette transporter A 1 (ABCA1) mediates the efflux of cholesterol to ApoA-1 and ApoE and is antiinflammatory and promotes axonal remodeling. D-4F is an ApoA-I mimetic peptide. We tested the hypothesis that D-4F treatment of stroke regulates WM damage and improves neurological functional outcome.

Methods:
C57BL/6 white type mice were subjected to permanent middle cerebral artery occlusion (MCAo) and were orally administered different doses of D-4F (2, 4, 8, 16 or 32mg/kg) starting at 2h after MCAo and daily for 7 days. Functional outcomes, blood biochemistry, BBB leakage, infarct volume, and WM and axonal changes were evaluated.

Results:
D-4F treatment did not alter the blood levels of HDL and total cholesterol, infarction volume and BBB leakage compared to control group. Treatment of stroke with D-4F 16mg/kg 1) significant improved neurological functional outcome (mNSS: 5.2±0.9 vs control 3.9±0.6; Left-foot-fault: 26.7±2.5 vs control 21.4±1.6); 2) did not change the number of oligodendrocyte progenitor cells (OPCs) and oligodendrocytes in the ischemic boundary zone (IBZ) of the striatum; 3) significant increased the density of axons (30.1±1.8% vs control: 19.9±1.7%), phosphorelated neurofilament (39.4±3.5 vs control: 25.3±2.7) and myelin (40.4±2.4 vs control: 25.2±3.6) in the WM bundles in the IBZ of the striatum; 4) increased ABCA1 and decreased TNFα expression in the ischemic brain (n=11/group). In vitro, neurite outgrowth in primary cultured neurons (PCNs) derived from brain specific ABCA1 deficient (ABCA1-B/-B) mice were significantly decreased after hypoxic ischemia compared with PCNs derived from floxed-control (ABCA1fl/fl) mice; D-4F (200ng/ml) treatment significantly increased neurite outgrowth in the ABCA1fl/fl-PCNs, but failed in ABCA1-B/-B-PCNs; D-4F treatment did not increase OPC proliferation, but decreased OPC death of cultured OPCs.

Conclusions:
D-4F treatment initiated 2h after MCAo decreases WM damage and improves functional outcome after stroke. Increasing ABCA1 expression in the ischemic brain may contribute to D-4F induced WM and axonal protection after stroke.
Abstract W P112: Effects of Acute versus Post-acute Systemic Delivery of Neural Progenitor Cells on Neurological Recovery and Brain Remodeling After Focal Cerebral Ischemia in Mice
Authors: Doeppner Thorsten R , Kaltwasser Britta , Theli Mahesh K , Bretschneider Eva , Bähr Mathias , Hermann Dirk M
Published: March 2022

Intravenous transplantation of neural progenitor cells (NPCs) induces functional recovery after stroke, albeit grafted cells are not integrated into residing neural networks. However, a systematic analysis of intravenous NPC delivery at acute and post-acute time points and their long-term consequences does not exist. Male C57BL6 mice were exposed to cerebral ischemia, and NPCs were intravenously grafted on day 0, on day 1 or on day 28. Animals were allowed to survive for up to 84 days. Mice and tissues were used for immunohistochemical analysis, flow cytometry, ELISA and behavioral tests.

Density of grafted NPCs within the ischemic hemisphere was increased when cells were transplanted on day 28 as compared to transplantation on days 0 or 1. Likewise, transplantation on day 28 yielded enhanced neuronal differentiation rates of grafted cells. Post-ischemic brain injury, however, was only reduced when NPCs were grafted at acute time points. On the contrary, reduced post-ischemic functional deficits due to NPC delivery were independent of transplantation paradigms. NPC-induced neuroprotection after acute cell delivery was due to stabilization of the blood-brain-barrier (BBB), reduction of microglial activation and modulation of both peripheral and central immune responses. On the other hand, post-acute NPC transplantation stimulated post-ischemic regeneration via enhanced angioneurogenesis and increased axonal plasticity.

Acute NPC delivery yields long-term neuroprotection via enhanced BBB integrity and modulation of post-ischemic immune responses, whereas post-acute NPC delivery increases post-ischemic angioneurogenesis and axonal plasticity. Post-ischemic functional recovery, however, is independent of NPC delivery timing, which offers a broad therapeutic time window for stroke treatment.
Abstract W P118: Constriction of Outer Diameter in the Involved Arteries in Moyamoya Disease - Proposal of Novel Diagnosis Criteria
Authors: Kuroda Satoshi , Kashiwazaki Daina , Akioka Naoki , Kuwayama Naoya
Published: March 2022

Background and Purpose:
Moyamoya disease is an uncommon cerebrovascular disease that is characterized by progressive occlusion of terminal portion of the internal carotid artery and its main branches within the circle of Willis. However, it is often difficult to distinguish non-moyamoya disease from moyamoya disease in a certain subgroup of adult patients on conventional modalities such as cerebral angiography. Therefore, this study was aimed to determine the outer diameter of the involved arteries in moyamoya disease, using 3-dimensional (3D) constructive interference in steady state (CISS).

Patients and Methods:
This prospective study included 65 patients with moyamoya disease. There were 25 males and 40 females. There were 13 children and 52 adults. As the control, 8 patients with middle cerebral artery (MCA) stenosis and 17 healthy subjects were also included. Using 3D-CISS, the outer diameters of the internal carotid artery (C1), middle cerebral artery (M1), anterior cerebral artery (A1), and basilar artery (BA) were quantified in all patients. The involved carotid fork was directly observed during surgical revascularization in 3 adult patients with moyamoya disease.

Results:
In patients with moyamoya disease, the outer diameters of C1, M1, and A1 segments were significantly smaller in the involved side than those in the non-involved side (P<0.01). As the disease stage progressed, the C1 and M1 segments decreased in outer diameter (P<0.05). The outer diameters of C1 and M1 segments were also significantly smaller in moyamoya disease than those in MCA stenosis and those in healthy subjects (P<0.01). There was no significant difference in the outer diameter of BA among moyamoya disease, MCA stenosis, and healthy subjects. Direct observations of the carotid fork revealed a marked decrease in the outer diameter, supporting the findings on 3D-CISS.

Conclusion:
These findings strongly suggest that the involved arteries themselves are constricted in moyamoya disease. Their constriction may be pathognomonic in moyamoya disease, which would provide essential information to distinguish moyamoya disease from non-moyamoya disease. Diagnosis guideline should be renewed in future, based on the information on the outer diameter of the involved arteries.
Abstract W P119: High Resolution MRI Characteristics of Unclassified Intracranial Stenosis Under Age 50
Authors: Cerejo Russell , Strohm Tamara , Mathew Jason , Hui Ferdinand , Katzan Irene , Jones Stephen , Uchino Ken
Published: March 2022

Introduction:
Intracranial stenoses in the young have various underlying pathologies, including early atherosclerosis, infectious and inflammatory vasculitis, and Moyamoya disease, but specific diagnosis is challenging in clinical practice. We set out to characterize the unclassified intracranial stenoses and probable atherosclerosis in the young using high-resolution MRI (HR-MR) vessel wall imaging techniques.

Methods:
We reviewed the HR-MR database at our hospital with criteria of patients under 50 years with intracranial stenosis. Patients with primary / secondary CNS vasculitis, infectious vasculitis, Moyamoya disease, dissection or cardio embolic strokes were excluded. Imaging protocol included black-blood gadolinium contrast -enhanced T1-weighted sequence with fat suppression and time-of-flight MRA of the circle of willis with 3-Tesla MRI.

Results:
Twenty-five patients (9 males, median age 41) met the inclusion criteria. Hyperlipidemia hypertension, history of smoking and diabetes mellitus were noted in 24, 20, 16, and 9 patients respectively. Seventeen had 3 or more vascular risk factors. Twenty-one patients (84 %) had isolated anterior circulation involvement, while 13 patients (52%) had single vessel stenosis. Median time interval between ischemic event and HR-MR was 78 days. Concentric vessel wall enhancement of the culprit stenosis was noted in 18 patients (72%). None had eccentric wall thickening and eccentric enhancement. Vessel wall enhancement was associated with the presence of diabetes (p=0.026) but not associated with other vascular risk factors. Having a risk factor burden of 3 or more (p=0.15), multifocal stenosis (p=0.3), or shorter time to MRI imaging (p=0.6) were not associated with vessel wall enhancement. On follow-up HR-MR imaging after median of 6 months, all 5 patients with early vessel wall enhancement had unchanged findings.

Conclusion:
In this cohort, while the risk factor burden suggests “accelerated atherosclerosis,” the vessel wall enhancement patterns are unlike atherosclerotic plaques that have been previously described with HR-MR. The nature of these stenoses needs further investigation.
Abstract W P122: Comparison Of Clinical And Radiological Outcomes Between Distal And Proximal Protections Performed During Carotid Artery Stent Interventions
Authors: Jeong Hye Seon , Lee Junsik , Song Hee-Jung , Lee Jae-Hwan , Choi Si-Wan , Kim Jei
Published: March 2022

Background & objective:
We evaluated the differences of the clinical deteriorations, distal migration of emboli, and approximation of stent to vessel between the patients who received distal or proximal protections to prevent distal migration of emboli during carotid artery stent interventions (CAS).
Methods:
We retrospectively analyzed clinical and radiological data of 70 patients (Distal-Protection Group), who underwent CAS using distal protection (FilterWire EZ
TM
, Boston Scientific), and 65 patients (Proximal-Protection Group), who using proximal protection (MO.MA® Ultra, Medtronic). The frequency of transient ischemic attacks (TIA) during CAS, the number and frequency of new lesions on post-CAS diffusion weighted image (DWI), and the ratio of the remained-area from outer stent wall to inner vessel wall measured by post-CAS carotid sonogrphy was compared between two groups.
Results:
Proximal-Protection Group showed significantly higher TIA occurrences during CAS (Distal-, 5 [7%]; Proximal- Protection Group, 19 patients [31%], p<0.001). On post-CAS DWI evaluation, total number (Distal-, 4.8±4.6; Proximal-Protection Group, 4.3±5.6, p=0.712) and incidence (Distal-, 29 [40%]; Proximal-Protection Group, 18 patients [29%], p=0.207) of the new DWI lesions were similar between the two groups. Major infarctions (Distal-, 5 [7%]; Proximal-Protection Group, 2 patients [3%], p=0.278) observed on ipsilateral cortex or internal borderzone area were more frequent on Distal- than Proximal-Protection Group without statistical significance. Both groups showed similar ratio of the remained-area from stent to vessel on post-CAS sonography (Distal, 0.33±0.18; Proximal-Protection Group, 0.28±0.15, p=0.072).
Conclusions:
The present differences in clinical and radiological parameters between different protection methods should be the factors to choose appropriate protection device during CAS.
Abstract W P134: Inpatient Rehabilitation Facility Admission Outcomes Specific for Patients with Stroke Predict Community Discharge
Authors: Rosario Emily R , Kaplan Stephanie
Published: March 2022

Objective:
To use IRF admission outcomes specific for patients with stroke to predict community discharge.

Design:
Retrospective study

Setting:
Inpatient Rehabilitation Hospital

Participants:
Patients hospitalized for a stroke

Interventions:
N/A

Main Outcomes Measures:
Admission data from the Functional Independence Measure (FIM) and Stroke Rehabilitation Assessment of Movement (STREAM) were used to determine predictive factors for a community discharge and FIM walk / wheelchair score of 5 or above. A discriminant analysis, logistic regression, and chi-square analysis were used to identify admission variables.

Results:
296 subjects were included in this retrospective analysis; 24% of subjects did not have a community discharge and 54% did not discharge with a FIM walk / wheelchair score of 5 or above. Five admission factors were identified as predictive for a community discharge or a walk / wheelchair FIM score of 5 or above; the Stream, Motor FIM, Total FIM, FIM Bladder control, and FIM social interaction. The sensitivity for each variable ranged from 61% - 94% while the specificity was between 40% and 65%. When all five variables were combined 83% of non-community discharges were identified (77% of patients with a walk wheelchair score of below 5).

Conclusions:
By using admission outcomes, community discharge can be predicted with significant sensitivity. Patients identified as at risk for a non-community discharge may be targeted for specialized interventions. Prospective evaluation of the predictive ability of the above-identified factors is warranted.
Abstract W P137: Inflammatory Biomarkers Predict Disability Independently of Vascular Events: The Northern Manhattan Study
Authors: Dhamoon Mandip S , Cheung Ken , Gervasi-Franklin Palma , Wright Clinton B , Sacco Ralph L , Elkind Mitchell S
Published: March 2022

Background:
Inflammatory biomarkers have been previously associated with stroke and mortality, but inflammation may also have detrimental effects beyond acute events. The association of these biomarkers with functional status is not well defined. We hypothesized that serum levels of high-sensitivity C-reactive protein (CRP), lipoprotein-associated phospholipase A2 (LpPLA2), and tumor necrosis factor receptor-1 (TNFR1) predict long-term functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up.

Methods:
In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged >=40 years had annual assessments of disability with the Barthel index (BI), for a median of 13 years. BI was analyzed as a continuous variable (range 0-100). Baseline demographics, risk factors, and laboratory studies were collected, including CRP (n=2240), LpPLA2 activity (n=1912), and TNFR1 (n=1863). Separate generalized estimating equation models estimated standardized associations between each biomarker and 1) baseline functional status and 2) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up.

Results:
Mean age was 69 (SD 10) years, 36% were male, 54% Hispanic, 74% had hypertension, 22% diabetes; 337 MIs and 369 first strokes occurred during follow-up. CRP (-0.41, 95% CI -0.82 to 0.002) and LpPLA2 (-0.40, 95% CI -0.75 to -0.04) were associated with baseline BI but not change over time. TNFR1 was associated with baseline BI (-0.93, 95% CI -1.59 to -0.26) and change over time (-0.36 BI points per year, 95% CI -0.69 to -0.03).

Conclusions:
In this large population-based study, higher serum inflammatory biomarker levels were associated with disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Elevated TNFR1 predicted greater disability over time, suggesting that systemic inflammation may contribute to long-term functional decline and disability.
Abstract W P139: Normal Fasting Blood Sugar Level and K-Modified Barthel Index at 6 Months after Stroke: A Prospective Multicenter Study
Authors: Jang Shin Yi , Kim Yun-Hee , Sohn Min Kyun , Lee Jongmin , Kim Deog Young , Lee Sam-Gyu , Shin Yong-Il , Oh Gyung-Jae , Lee Yang-Soo , Joo Min Cheol , Han Eun Young , Lim Young Shil , Chang Won Hyuk , Lee Ahee , Kim Jeong Hyun
Published: March 2022

Introduction:
Few studies investigated the relationship between the normal fasting blood sugar (FBS) level at onset and functional outcome (K-Modified Barthel Index; KMBI) at 6 months after stroke.

Aims:
The aim of this study is to investigate whether normal FBS level predicts 6-Month KBMI after adjustment for cardiovascular disease risk factors socioeconomic position and health behavior factors in Korean stroke patients.

Methods:
This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 816 ischemic stroke patients aged 18-92 years. KBMI score was assessed at 6 months after stroke onset. We divided subjects into three FBS levels according to FBS tertile: lower (70 ≤ FBS < 104 mg/dl), medium (104 ≤ FBS < 118 mg/dl), and higher (118 ≤ FBS < 140 mg/dl).

Results:
The mean age of subjects was 63.2 (±13.6) years. The mean of discharge KBMI and 6-month KBMI was 73.9 (±29.5) and 85.2 (±28.9), respectively. The mean of discharge KBMI for patients with lower, medium, and higher FBS level at onset was 77.7 (±26.8), 72.6 (±29.8), and 72.6 (±29.8), respectively (p<0.05); the mean of 6-Month KBMI 88.5 (±25.7), 84.9 (±29.5), and 82.2 (±31.1), respectively (p<0.05). The 6-Month KBMI significantly decreased in patients with higher FBS levels compared to lower FBS levels after adjustment for confounding factors (p<0.05).

Conclusions:
These hospital-based cohort study showed that higher FBS level at onset may predict poor functional outcome at 6 months after stroke (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).
Abstract W P147: Apixaban Versus Warfarin in Patients with Atrial Fibrillation: Patient Characteristics of the Latin America Cohort from a Multinational Clinical Trial
Authors: Avezum Alvaro , Bahit Cecilia M , Gonzalez Hermosillo Antonio , Lanas Zanetti Fernando , Isaza- Restrepo Daniel , Juarez-Garcia Ariadna , Vulcano Cristina , Cubillos Luz Angela , K Donato Bonnie
Published: March 2022

Introduction:
Apixaban, a novel oral direct factor Xa inhibitor has clearly demonstrated clinical benefit in stroke or systemic embolism (SE) reduction without impacting the risk of major bleeding or intracranial hemorrhage in patients with atrial fibrillation (AF). Here we present the patient characteristics of the Latin American cohort (patients from Argentina, Brazil, Chile, Colombia, Mexico, Peru and Puerto Rico) relative to the overall clinical trial population. Methods: Patients with AF who also had at least one risk factor for stroke were randomized to receive apixaban (at a dose of 5 mg twice daily) or warfarin (target international normalized ratio, 2.0 to 3.0) in a double blind clinical trial. The study recruited from 39 countries from December 2006 through April 2010. Of the 36 countries seven were from the Latin America region: Argentina, Brazil, Chile, Colombia, Mexico, Peru, and Puerto Rico. Patient characteristics from the Latin American (LA) cohort, is presented relative to the patient characteristics of the overall trial population. Results: There were 18,201 patients in the study, of which 3,468 were from Latin America which comprised approximately 19% of the trial population. The median age was similar between the LA cohort and the total study population, 71 (IQR 64-77) and 70 (IQR 63-76) respectively. The majority of patients were male, 60.2 and 64.7% for the LA and total study populations respectively. At enrollment, 14% of the LA cohort had a previous stroke, transient ischemic attack, or systemic embolism and 19% in the overall trial population. Mean CHADS2 score at enrollment for the LA cohort was 2.1±1.1, which is the same as the overall population. When region subgroup analysis was performed, there was no statistically significant (p> 01.0) interactions between treatment effects and geographic region. Conclusions: Baseline demographic and disease characteristics data from the LA cohort are relatively similar to that of the clinical trial population for the LA cohort. Results, in terms of safety and efficacy, given the total population trial, are expected to be consistent since interaction between treatment effects and geography was not significant.
Abstract W P159: Impact of Body Mass Index on 1-year Outcome After Acute Ischemic Stroke
Authors: Sun Weiping , Zhu Sainan , Liu Ran , Li Fan , Sun Wei , Huang Yining
Published: March 2022

Introduction:
Debates exist in the impact of overweight and obesity on the outcome after stroke. Our study is aimed to investigate the relation between body mass index(BMI) and stroke outcome in a broad range of hospitalized patients with acute ischemic stroke in China.

Methods:
Data are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study, a multi-centre, prospective, 62-hospital registry in China during 2006-07. Patients were categorized as underweight(BMI<18.5), normal(BMI 18.5 to <25), overweight(BMI 25 to <30) and obesity(BMI≥30). The primary endpoint was all-cause mortality at 12 months. The secondary endpoint was the proportion of death or dependency (modified Rankin Scale score 3-5) at 12 months.

Results:
There were 4782 patients with acute ischemic stroke enrolled in ChinaQUEST registry study. According to BMI, 282(5.9%) patients were of underweight, 2889(60.4%) were of normal weight, 1408(29.4%) were of overweight, and 203(4.2%) were obese. Outcome measures at 12 months were available in 4645 patients. The mortality was 21.3%(58/272) for underweight group, 10.6%(299/2810) for normal weight group, 8.5%(116/1365) for overweight group and 9.1%(18/198) for obesity group. The corresponding proportion of death or dependency was 45.6%(124/272), 30.9%(867/2810), 28.1%(384/1365) and 29.3%(58/198), respectively. After adjustment for all confounders, compared with patients of normal weight, odds ratio(95% confidence interval) of death at 12 months was 1.985(1.373-2.868) for underweight group, 0.952(0.738-1.229) for overweight group and 0.844(0.468-1.522) for obesity group. The corresponding odds ratio(95% confidence interval) of death or dependency at 12 months was 1.541(1.155-2.054), 1.004(0.853-1.181) and 0.837(0.578-1.211), respectively.

Conclusion:
In ischemic stroke patients, a J-shaped relationship between BMI and stroke outcome was observed. Underweight was associated with the highest risk for unfavorable outcome. No benefit of overweight and obesity on the survival or functional outcome over normal weight was found.
Abstract W P167: Obstructive Sleep Apnea in Wake-Up Stroke
Authors: Koo Brian B , Yaggi Henry K , Qin Li , Tobias Lauren , Bravata Dawn
Published: March 2022

Introduction:
Stroke that occurs during sleep or wake-up stroke (WUS) accounts for nearly 30% of all ischemic strokes. Little is known about the characteristics of WUS and whether this stroke presentation is associated with obstructive sleep apnea (OSA).

Methods:
Patients with ischemic stroke were divided into WUS and non-WUS groups. Excluded were patients with iatrogenic, hemorrhagic, and dissection/aneurysmal strokes. Participants underwent polysomnography and ambulatory blood pressure monitoring. Collected data included: demographic, medical, anthropomorphic, ambulatory blood pressure, infarct location and mechanism, cholesterol, and polysomnographic (apnea-hypopnea index (AHI) and oxygen desaturation index).

Results:
Among 165 participants, 30.3% had WUS. There was no difference in age or race between WUS and non-WUS groups, but there was a trend for the WUS group to have more men (74.0% vs. 59.6%; p=0.08). Cardiovascular risk factor profiles did not differ between the two groups including: history of stroke, HTN, DM, dyslipidemia, or atrial fibrillation. WUS was less likely than non-WUS to occur by cryptogenic mechanism (14.3% vs. 27.7%; p=0.05). There was a trend for WUS to occur less in the posterior circulation (22.0% vs. 36.0%; p=0.08). LDL cholesterol was significantly higher in the WUS group (114.5±36.3 vs. 101.4±37.6; p=0.04). SBP did not differ between the two groups, but DBP was significantly greater in the WUS group (82.4±7.8 vs. 78.3±9.7; p=0.03). Percentage of those with non-dipping blood pressure (<10% drop in MAP) did not differ between WUS and non-WUS groups (70.0% vs. 83.6%; p=0.12; n=103). Neither AHI (22.5±18.6 vs. 19.7±18.9; p=0.46) nor the frequency of OSA differed between groups (81.5% vs. 79.6%; p=0.84). There was a trend toward higher oxygen desaturation index in the WUS group (49.5±57.3 vs. 33.9±28.3 [events per hour sleep]; p=0.13). Stroke severity did not differ according to NIH stroke scale or modified Rankin scale.

Conclusion:
WUS compared to non-WUS is associated with significantly higher diastolic blood pressure and LDL cholesterol. WUS does not appear more strongly associated with OSA or non-dipping BP than is non-WUS; however, there was a trend toward more frequent oxygen desaturation in WUS.
Abstract W P175: Stroke Etiology and the Risk of Post-stroke Seizure: A Long-term Population-based Cohort Study
Authors: Klaas James , Kramer Neha , Sedova Petra , Mandrekar Jay , Brown Robert
Published: March 2022

Background:
Seizures are a known complication of ischemic stroke. Some studies have reported a higher risk of post-stroke seizure with cardioembolic strokes, whereas others have not. The risk of post-stroke seizure for different stroke mechanisms is unclear.

Objective:
To compare different stroke etiologies and the risk of post-stroke seizure in a population-based study.

Methods:
Utilizing the Rochester Epidemiology Project medical records linkage system, we ascertained all first ischemic strokes occurring among Rochester, MN residents from 1990-1994, and followed the patients in the comprehensive medical record through March 2014 for occurrence of seizure. TOAST stroke subtype classification was determined by a consensus of cerebrovascular neurologists. New post-stroke seizure was identified by physician diagnosis and/or EEG report. Patients with a seizure before the index stroke were not included. Pre-morbid stroke risk factors were recorded. Associations between seizure after index ischemic stroke as outcome and other variables of interest were assessed using univariate logistic regression.

Results:
A total of 490 patients met inclusion criteria, with median follow-up of 6.5 years. Out of 490 patients, 35 had new onset seizures (7.1%). Median age was significantly lower at index stroke for patients with seizures (73 v. 77 years, p=0.017). The most common TOAST stroke subtype was cryptogenic (46.8%) followed by cardioembolic (24.9%). There was no significant difference in TOAST stroke subtypes between patients with post-stroke seizure and those without (p=0.35). There was also no difference between the two groups when comparing combined cardioembolic and large-vessel to small-vessel (p=0.28) or cryptogenic to small-vessel (p=0.9) mechanisms. There was also no difference in pre-morbid stroke risk factors between the two groups, including hypertension (p=0.22), total cholesterol (p=0.95), type 2 diabetes mellitus (p=0.13), tobacco use (p=0.27), atrial fibrillation (p=0.9), or previous myocardial infarction (p=0.67).

Conclusion:
This study suggests that the long-term risk of post-stroke seizures does not differ by ischemic stroke etiology.
Abstract W P184: Echocardiographic Left Ventricular Hypertrophy is Associated with Severity of Cerebral White Matter Hyperintensities in Acute Ischemic Stroke
Authors: Lee Jun , Noh Hyun-Du , Kim Na-Young , Kwon Jung-Im
Published: March 2022

BACKGROUND & OBJECTIVE:
White matter hyperintensities (WMH) indicate an increased risk of cerebrovascular events. Echocardiographic left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular morbidity. We aimed to investigate the association between higher left ventricular mass index (LVMI) and severity of WMH in acute ischemic stroke.

METHODS:
We evaluated 868 consecutive acute ischemic stroke or transient ischemic attack (TIA) patients who were admitted within 7 days after onset of stroke and underwent magnetic resonance imaging (MRI) and transthoracic echocardiography. LVH was defined as a left ventricular mass index (LVMI) of > 115 g/m2 for men and > 95 g/m2 for women. Periventricular and deep white matter hyperintensities were systematically analyzed and rated according to the modified Fazekas scale (grade 0, 1, 2, and 3) on the baseline MRI.

RESULTS:
A total of 841 patients were included in this analysis. Numbers of WMH patients are 66 (7%) in grade 0, 546 (65%) in grade 1, 159 (20%) in grade 2, and 70 (8%) in grade 3. Mean LVMIs in each grade of WMH are 86 (SD 18) in grade 0, 95 (SD 22) in grade I, 104 (SD 29) in grade 2, and 100 (SD 28) in grade 3. LVH and 4th quartile of LVMI were associated with grade 2 (OR 2.3, 95% CI 1.1 to 5.0 and OR 3.2, 95% CI 1.4 to 7.2) and grade 3 (OR 2.5, 95% CI 1.1 to 5.9 and OR 2.7, 95% CI 1.1 to 6.6). Binary logistic regression analysis (WMH grade 0-1 versus grade 2-3) showed that age per year (OR 1.09, 95% CI 1.07 to 1.12, p<0.001), hypertension (OR 1.8, 95% CI 1.2 to 2.7, p=0.004), previous stroke or TIA history (OR 2.3, 95% CI 1.5 to 3.4, p<0.001) and increased LVMI per 10 g/m2 (OR 1.15; 95% CI 1.06 to 1.24, p<0.001) were independently associated with grade 2-3 WMH.

CONCLUSIONS:
Our results demonstrate that higher LVMI or LVH are independently associated with moderate to severe WMH in acute ischemic stroke and TIA patients even after adjusting of established cardiovascular risk factors. Further studies to evaluate whether regression of LVH slows the progression of WMH will be needed.
Abstract W P198: Older Stroke Patients Get Fewer Diagnostic Tests
Authors: Siegler James E , Vanassche Thomas , Giruparajah Mohana , Kasner Scott
Published: March 2022

Introduction:
Embolic stroke of undetermined source (ESUS), or non-lacunar cryptogenic stroke, accounts for up to one-third of all strokes. As it is a diagnosis of exclusion of other stroke etiologies, an incomplete evaluation of stroke may result in an unclear diagnosis.

Hypothesis:
Our objective was to determine if older patients are at risk for receiving incomplete diagnostic evaluations in an international cohort study.

Methods:
The ESUS Global Registry was a retrospective cohort of consecutive stroke patients evaluated at 20 stroke centers in 20 countries. Diagnostic evaluation was considered complete if the patient had, at a minimum, brain CT or MRI, carotid imaging, ECG, ≥24 hours of cardiac rhythm monitoring, and echocardiography. Patients were classified as having experienced an ESUS if brain imaging confirmed a non-lacunar infarction and no stroke etiology was determined after complete evaluation. Completeness of evaluation was compared between patients ≥75 vs. <75 years old.

Results:
The registry included 2,090 patients with recent ischemic stroke during 2013-2014. Forty-three percent of patients ≥75 years old had a complete evaluation compared to 51% of patients <75 years (p<0.001). Fewer patients ≥75 underwent echocardiography (64% vs. 74%, p<0.001) and carotid imaging (85% vs. 91%, p<0.001). Three hundred seventy-eight patients (18%) had a complete evaluation and were diagnosed with ESUS. Among ESUS patients, those ≥75 were more likely to have only transthoracic echocardiography (84% vs. 65%, p<0.001), only carotid ultrasound rather than any other carotid imaging modality (55% vs. 37%, p<0.001), and no intracranial vessel imaging (22% vs. 12%, p=0.011).

Conclusions:
Older patients in this international cohort were more likely to have an incomplete etiologic evaluation for stroke, despite advanced age being well established as an independent risk factor for recurrent stroke. Further investigations are warranted to explore the potential bias in age-associated stroke evaluation completeness.
Abstract W P199: Time Needed To Find - A New Metric For Evaluating Screening Strategies For Atrial Fibrillation In Stroke Patients
Authors: Wachter Rolf , Weber-Krüger Mark , Liman Jan , Hamann Gerhard F , Klimpe Sven , Kermer Pawel , Grond Martin , Gröschel Klaus
Published: March 2022

Background:
Numerous observational and two published multicenter randomized controlled studies have evaluated different screening strategies and modalities for finding undiagnosed atrial fibrillation (AF) in stroke. Usually, the number needed to screen (i. e. how many patients have to undergo a certain screening strategy to find one case of AF) has been used to describe the efficiency of a single screening strategies. However, screening is often confined to small subgroups (e. g. elderly patients, patients with cryptogenic stroke), but this is not accounted for in the number needed to screen.

Methods:
We searched MEDLINE and available meta-analyses for multicenter observational and randomized trials that analysed screening strategies. We defined time needed to find (TNF) as the ratio of number needed to screen (NNS) to average recruitment rate per month and per study site. Only AF episodes lasting > 30 seconds were included into the analysis.

Results:
Five trials fulfilled the inclusion criteria (3 randomised, 2 observational). Details on the trials and on NNS and TNF are shown in the table.

Conclusion:
Time needed to find (TNF) is a new metric to describe how many patients can be found with different screening strategies in a single study center per month. We propose to use this parameter when evaluating diagnostic modalities and strategies for finding undiagnosed AF in stroke patients.
Abstract W P2: Timeline of Blood Pressure Changes After Intra-arterial Therapy For Acute Ischemic Stroke Based on Recanalization Status
Authors: John Seby , Hazaa Walaa , Uchino Ken , Wisco Dolora , Hui Ferdinand , Toth Gabor , Stecker Margaret , Buttrick Maureen , Hussain Muhammad S
Published: March 2022

Introduction:
Arterial recanalization with intravenous thrombolysis early for acute ischemic stroke (AIS) has been reported to be associated with spontaneous blood pressure (BP) reduction compared to those without recanalization. We investigated the course of BP after intra-arterial therapy (IAT) for AIS.

Methods:
Retrospective study from 1/08-12/12 of AIS patients who underwent IAT for ICA/M1 occlusions with TICI 0 flow was conducted. Cases under general anesthesia were excluded. BP recorded before, and at hourly intervals for 36 hours post procedure was collected. The average hourly BP, and the difference in hourly BP from pre-procedure baseline was calculated and compared by recanalization status. Successful recanalization was defined as TICI2b-3.

Results:
Sixty-two patients consisting of 37 (59.7%) with TICI2b-3 (Group R) and 25 with TICI 0-2a (Group NR) recanlization were included. Baseline characteristics were similar except for greater frequency of IV tPA administration in group R (51.3% vs. 20.8%, p 0.017). Average systolic BP (SBP) pre-procedure was similar in both both groups (R 158 vs NR 154 mm Hg, p 0.521). SBP decreased significantly at the end of procedure in both groups (Fig a,b), but without inter-group difference (Fig c). With time however, there was significantly lower average SBP, and greater SBP drop from baseline in the R group compared to NR group, but this persisted only till hour 12. (Fig 1c,d) Similar trend was observed with the mean arterial BP.

Conclusions:
BP after IAT differed significantly based on recanalization status and the difference was early. Endogenous drive to increase BP to maintain cerebral perfusion may account for the findings. This may have implications for BP management post IAT.
Abstract W P217: Improvement of Door to Needle Times and IV rt-PA Utilization with the Application of TARGET:STROKE Recommendations to an Urban Integrated Tele-Medicine System
Authors: Sangha Navdeep S , Diep Elizabeth H , Premsrirath Tonya , Burton Naomi M , Mauban Elisa T , Rho Howard J , Tu Grace M , Mirsaidi Zohreh , Watrous Catherine M , Farman Shirin , Marcos Lisa L , Rosete Jane , Warren Noelani C , Uhle Jill K , Neil William P , Sharp Adam L , Sauser Kori L , Manthena Prasanth , Guzman-Marin Ruben , Ajani Zahra A
Published: March 2022

Background and Objectives:
Tele-medicine (TM) has been proven to provide quality acute stroke care. The type of consultation and services provided by TM vendors vary. None seem to provide a comprehensive service to the receiving center that includes methods on how to improve door to needle times (DTN). We hypothesized that creating a comprehensive TM solution in an integrated medical system using TARGET: STROKE (TS) principles would improve DTN times and IV rt-PA utilization.

Methods:
Five urban Joint Commission certified primary stroke center community hospitals in a Southern California integrated healthcare system participated. Prior to initiation of TM services, each hospital had two separate meetings with the TM provider (two vascular neurologists). The first meeting was with emergency room physicians, explaining the need to have a low threshold to call a tele-code stroke within 4.5 hours of last seen normal regardless of inclusion/exclusion criteria and prior to obtaining the head CT. The second meeting included a multi-disciplinary group to outline the TS principles and organize a stroke team with a focused goal to improve DTN. The 10 TARGET: STROKE best practice strategies were implemented. Data regarding the key time interval goals were gathered and reviewed with each hospital on a bi-weekly basis. The TM providers worked with each hospital to improve specific time intervals where necessary by providing proven strategies, and assisting in their implementation. Data were analyzed using a parallel time period at each hospital comparing pre-TM to post-TM, the longest period being 11 months.

Results:
Twenty-eight patients were given rt-PA pre-TM compared to 50 patients post-TM. The percent of patients who received rt-PA ≤ 60 minutes (min) pre-TM was14% vs. 42% post-TM (p=0.02). The median pre-TM DTN was 78 min (IQR 68-116) compared to a post-TM DTN of 67 min (IQR 56-78), an absolute difference of 11 min (p=0.007).

Conclusion:
Application of TARGET: STROKE guidelines can be implemented successfully via an integrated TM system of stroke care to improve DTN and rt-PA utilization.
Abstract W P22: Examining the Effects of Intra-Arterial Therapy in Acute Posterior Circulation Occlusions
Authors: Sarraj Amrou , Martin-Schild Sheryl , Boehme Amelia K , Sun Chung-Huan J , Sitton Clark W , Supsupin Emilio P , Jagolino Amanda L , Bajgur Suhas S , Datta Proleta , Wu Tzu-Ching , Friedman Elliot , Barreto Andrew D , Dannenbaum Mark J , Chen Peng R , Gupta Rishi , Grotta James C , Savitz Sean I
Published: March 2022

Background:
Recent trials have failed to show benefit of intra-arterial therapy (IAT) in acute ischemic stroke (AIS) patients. Patients with posterior circulation occlusions, however, were vastly underrepresented (only 4 patients in IMS3, MR-RESCUE and SYNTHESIS combined). IAT is often pursued, due to the inherent poor outcome associated with brainstem infarction. We sought to evaluate potential benefit with IAT in this population.

Methods:
A US multicenter retrospective cohort of 106 patients with AIS and LAO in the vertebrobasilar distribution presenting 01/05-3/14 within 12 hours from stroke onset was examined. Patients were divided into two groups (IAT vs No IAT). Logistic regression with good and poor (discharge mRS 0-2 and 4-6) outcome was performed. Univariate and multivariate analyses evaluated independent predictors of good outcome after IAT.

Results:
Patients in the IAT group (n=57) had more severe strokes (NIHSS 24 vs 12) than the medical management group (n=49); otherwise the two groups were comparable (Table 1). IAT was not associated with improved odds of good outcome (OR 0.76, 95%CI 0.27-2.14, p=0.60), even after adjusting for admission NIHSS, recanalization, and time to IAT start (OR 1.35, 95%CI 0.39-4.68, p=0.63). The subgroup with basilar occlusions also did not benefit from IAT. Stroke severity predicted treatment with IAT; each additional point in NIHSS was associated with 5% increased chances of IAT (P 0.07). There were more deaths in the IAT group (Figure 1); 73% of these, however, were associated with care withdrawal decisions.

Conclusion:
While vascular neurologists intervene more often on severe posterior circulation strokes, our results suggest poor outcome was not averted, even after adjusting for stroke severity. While our results are affected by the inherited limitations of a retrospective cohort and selection bias of a non- randomized design, it addressed an underrepresented stroke population. RCTs are needed to validate these results.
Abstract W P220: Use Of A Prehospital Stroke Scale Increases Accuracy Of Emergency Medical Services Stroke Recognition
Authors: Oostema John A , Nasiri Mojdeh , Chassee Todd , Reeves Mathew J
Published: March 2022

Background:
Prehospital activation of in-hospital stroke response depends on accurate Emergency Medical Services (EMS) provider stroke recognition. While screening tools such as the Cincinnati Prehospital Stroke Scale (CPSS) have been validated, their real world impact is less clear. We determined the accuracy of prehospital stroke recognition and its relationship to CPSS documentation in a cohort of EMS transported suspect and confirmed stroke patients.

Methods:
We identified a prospective cohort of all suspected or confirmed ischemic stroke or transient ischemic attack (TIA) patients transported by EMS to a large primary stroke center. Data on prehospital and hospital care were abstracted from medical records. The sensitivity and positive predictive value (PPV) of EMS stroke recognition were calculated using the final hospital discharge diagnosis of ischemic stroke or TIA as the gold standard. We compared the sensitivity and PPV of EMS recognition among cases with and without a documented CPSS using chi square tests. We performed multivariable logistic regression analysis to determine the independent relationship between CPSS use and the odds of EMS stroke recognition among confirmed stroke and TIA cases.

Results:
Over a 12 month period, 434 EMS transported patients met inclusion criteria. The median age was 78 and 60% were female. EMS transported 371 (85.5%) patients as suspect strokes and documented a CPSS in 343 (79.0%). A total of 246 cases (56.7%) were confirmed ischemic strokes (n=186) or TIA (n=60). The sensitivity of EMS stroke recognition was 74.4% (95% CI 68.9 to 79.8) and PPV was 49.3% (95% CI 44.2 to 54.4). Sensitivity was higher among cases with CPSS documentation than without (85.9% vs. 25.5% p<0.0001) as was the PPV (54.3% vs. 21.4%, p<0.0001). After adjustment for age, sex, stroke severity, dispatch reason, and time from symptom onset, CPSS use was associated with substantially higher odds of EMS stroke recognition (OR 19.04, 95% CI: 7.95 to 45.59).

Conclusion:
EMS providers recognized three quarters of all stroke or TIA admissions, while EMS suspicion of stroke was correct only half of the time. Documentation of a CPSS was associated with substantially higher EMS stroke recognition.
Abstract W P226: Pre-Notification of Stroke Symptoms Reduces Decision Times in Acute Stroke
Authors: Olson-Mack Lindsay , Berger Lynn , Dullnig Brooke , Suarez Randi , Afshar Katherine , Perry Sandy , Ludwig Jon , Tafreshi Gilda , Kelley Barbara
Published: March 2022

Introduction:
Both the American Heart and American Stroke Associations recommend pre-notification of potential stroke patients to receiving facilities. Although Emergency Medical Services (EMS) may identify stroke symptoms in the field, initiation of the stroke code process is often postponed until after the patient arrives in the Emergency Department (ED). This could lead to unnecessary delays in assessment and intervention during an acute stroke.

Hypothesis:
We hypothesized that initiating a stroke code based on advanced notification of stroke symptoms via EMS and a Stroke Code Pit Stop (SCPS) would lead to decreased time of assessment, diagnosticssitics and IV tPA initiation.

Methods:
A pre- and post-intervention study of 733 patients presenting to 2 EDs in a 5 campus hospital system. Both EDs initiated a SCPS, with pre-notification of stroke symptoms via EMS and stroke code activation prior to patient arrival. Data were reviewed from January 2013-April 2014, comparing code stroke metrics pre- and post SCPS initiation. Inclusion criteria: patients with stroke code initiations in the ED. Exclusion criteria: patients with stroke code initiations after hospitalization.

Results:
668 patients metpatients met inclusion and exclusion criteria. Assessment times decreased in all metrics post SCPS initiation. Median time of arrival to time of stroke code initiation decreased from 7 minutes to -11 minutes (39%). Median time from patient arrival to CT imaging and laboratory results both decreased by 12 minutes, from 23 to 11 (48%) and from 41 to 29 (71%) respectively. Median door to IV tPA initiation decreased by 24 minutes, from 73 to 49 (67%). Of the 368 patients in the post intervention time period, 192 patients (52%) arrived to the ED through the SCPS. IV tPA was initiated in 30 patients (16%) arriving to the ED through SCPS, versus 13 patients (7%) arriving to the ED without EMS pre-notification.

Conclusions:
ED pre-notification of stroke symptoms via EMS and a Stroke Code Pit Stop leads to more rapid assessment, CT imaging, laboratory results , and increased IV tPA usage.