bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP189: Is A Low Ankle-brachial Index A Predictive Factor For Poor Recovery From Acute Ischemic Stroke?
Authors: Neshige Shuichiro , Ohtsuki Toshiho , Hara Naoyuki , Takeshima Shinichi , Himemo Takahiro , Fukushima Tomoko , Takamatsu Kazuhiro , Ota Taisei , Kuriyama Masaru , Matsumoto Masayasu
Published: March 2022

Background:
The ankle-brachial index (ABI) is widely used as a marker of peripheral arterial disease, and it reflects the severity of systemic atherosclerosis. Lower limb hypoperfusion or ischemia may inhibit recovery from neurological impairment. Whether a low ABI is associated with poor functional outcome after ischemic stroke was examined.

Methods:
926 acute ischemic stroke patients (598 males; mean age, 71.1±10.8 years; median age, 72.0 years) who did not undergo t-PA or surgical treatment were enrolled. All provided informed consent and underwent ABI measurement during hospitalization. Baseline characteristics and NIHSS scores at admission were noted, and modified Rankin scale (mRS) scores 3 months after stroke were evaluated. The patients were categorized into normal (≥0.9) and decreased (<0.9) ABI groups, and into fair-outcome (mRS score, 0-2) and poor-outcome (mRS score, 3-6) groups.

Results:
ABI was decreased in 42 (5.9%) of 713 fair-outcome patients and 31 (14.6%) of 213 poor-outcome patients. The poor-outcome group had a higher average NIHSS score, a higher proportion of patients that were female, underweight, had a stroke history, and aged >75 years, and a lower proportion of patients who had dyslipidemia, a smoking history, and a drinking history. Logistic regression analysis including the above factors showed a relationship with poor outcome. Decreased ABI was negatively related to fair outcome (OR=0.569, 95%CI=0.324-0.999, p=0.050).

Comments:
Decreased ABI was an independent risk factor correlated with poor outcome 3 months after acute ischemic stroke, suggesting that lower limb and general atherosclerosis may delay or hamper recovery from stroke.
Abstract TP191: The Relationship Between Intracranial Atherosclerosis Assessed By Transcranial Doppler And Body Composition In Apparently Healthy Korean Adults
Authors: Rhee Eun-Jung , Oh Hyung-Geun
Published: March 2022

Background:
Intracranial atherosclerosis is the cause for ischemic stroke and other cerebrovascular diseases. Transcranial Doppler (TCD) is a diagnostic modality that could be noninvasively used for the diagnosis of ischemic cerebral arteries. Body composition affects metabolic status and subsequently atherosclerosis. In this study, we analyzed the relationship between the intracranial atherosclerosis assessed by TCD and body composition in apparently healthy Korean adults.

Methods:
TCD was performed to assess the status of cerebral arteries as a part of a health screening program. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis trial methods was used to diagnose intracranial atherosclerosis with TCD. Body composition was assessed by bioelectrical impedance analysis method. Analyses were performed in 78 subjects with abnormal TCD finding and 150 age- and body mass index (BMI)-matched control subjects.

Results:
Mean age of the participants was 49 years old. Mean BMI of the participants was 22.6 kg/m
2
. Although the age and BMI were matched in two groups, mean values of fasting glucose and systolic blood pressure were higher in abnormal group (94.5±14.5 vs. 99.3±18.3 mg/dL, 113.3±12.3 vs. 119.0±15.7 mmHg, P<0.05). When the components of body composition were compared between the two groups, abnormal group showed higher body fat ratio, lower lean body mass and higher waist-hip ratio (WHR) assessed by BIA method. When all the participants were analyzed divided in three groups according to the components of body composition, the proportion of subjects with intracranial atherosclerosis increased as the body fat ratio and WHR increased from 1
st
to 3
rd
tertile groups, and decreased as the lean body mass increased from 1
st
to 3
rd
tertile groups.

Conclusions:
Subjects with intracranial atherosclerosis showed higher body fat and lower lean body mass. Subjects with high body fat and low lean body mass showed higher proportion of subjects with intracranial atherosclerosis.
Abstract TP192: Comparison of Stroke Subtype and Admission Rate between Beijing, China and Ontario, Canada - A Population-Based Approach
Authors: Fang Jiming , Liu Gaifen , Wang Yilong , Zhao Xingquan , Wang Chunxue , Zhou Yong , Pan Yuesong , Xie Xueqin , Silver Frank L , Wang Yongjun , Kapral Moira K
Published: March 2022

Objective:
Previous studies suggested Chinese were more likely to experience hemorrhagic stroke than Caucasian, however most of those studies were hospital-based and were performed more than a decade ago. We conducted a population-based study to investigate stroke subtypes and admissions rates in Beijing, China and Ontario, Canada from 2007 to 2009.

Methods:
We identified all admissions for stroke or transient ischemic attack (TIA) in Beijing from the Discharge Abstract Database maintained by Beijing Public Health Information Center, and in Ontario from the Discharge Abstract Database maintained by the Canadian Institute for Health Information, using ICD-10 codes I63 and I64 (ischemic stroke), I60 (subarachnoid hemorrhage) and I61 (intracerebral hemorrhage) and G45 (TIA). Patients with medical history of stroke, age under 20 years were excluded. If patient had multiple hospitalizations, only the first one was included. We adjusted the world population in 2007 as the standard to calculate the gender/age standardized admission rates.

Results:
During the study period, Beijing and Ontario had similar population size (~10 million) and age structure. In total, 140,574 patients in Beijing and 41,477 patients in Ontario had a first admission for stroke or TIA. Overall age/sex standardized admission rates were higher in Beijing than in Ontario (357 vs. 100 per 100,000). Of these patients, those in Beijing were younger than those in Ontario (Median of age in years: 66 vs. 76, p<0.001), and more likely to be male (58% vs. 49%, p<0.001), and to be TIA (22% vs. 17%, p<0.001), and less likely to have hypertension (68% vs. 75%, p<0.001) and diabetes (25% vs. 32%, p<0.001). Of these stroke patients in Beijing and Ontario, they were similar in subtype, ischemic stroke (84% vs. 82%) and hemorrhagic stroke (16% vs. 18%). The median length of hospital stay was much longer in Beijing than in Ontario (median 15 vs. 7 days, p<0.001).

Conclusion:
There were substantial differences in baseline patient characteristics, admission rates and length of stay, but similar stroke subtypes between Beijing and Ontario. These findings suggest that enhanced stroke primary prevention efforts are needed to reduce the burden of stroke in China.
Abstract TP194: Internet-based Control Recruitment for a Case-Control Study of Major Risk Factors for Stroke in Korea: A Failure and Lessons Learned from the Experience
Authors: Park Jong-Moo , Cho Yong-Jin , Lee Kyung Bok , Park Tai Hwan , Lee Soo Joo , Han Moon-Ku , Ko Youngchai , Lee Jun , Cha Jae-Kwan , Lee Byung-Chul , Yu Kyung-Ho , Oh Mi-Sun , Lee Ji Sung , Lee Juneyoung , Bae Hee-Joon
Published: March 2022

This study aimed to estimate the population attributable risks (PARs) of major risk factors for stroke in Korea through an internet-based case-control study and test the feasibility and validity of this approach.

Control subjects were recruited by a web-based questionnaire from April 2008 to September 2009. Cases were consecutive stroke patients hospitalized to during the same period. Each control was matched with 2 cases for age and sex. The presence of hypertension, diabetes, hypercholesterolemia, smoking, atrial fibrillation, coronary heart disease, history of stroke, family history of stroke and obesity were investigated. Age-standardized prevalence, adjusted odd ratios (ORs) and PARs for 9 risk factors for stroke were calculated.

One thousand forty one control subjects were matched with 2,082 cases. Adjusted ORs for stroke were 2.80 for hypertension, 3.56 for diabetes, 3.65 for smoking, 3.95 for history of stroke, and 1.25 for obesity. Risk of atrial fibrillation, coronary heart disease, and family history of stroke were not significant, while hypercholesterolemia showed inverse correlation. PARs for stroke were 16.3% for hypertension, 9.4% for diabetes, 23.6% for smoking, 5.84% for stroke history, and 4.18% for obesity. Comparisons of education level and religion between the control group and the national census data for validating its representativeness revealed significant discrepancy.

In conclusion, internet-based control recruitment for a case-control study of stroke risk factors may be feasible; however, careful approaches for reducing selection and reporting biases are essential.
Abstract TP197: Racial Differences in Comorbidities after Stroke
Authors: McCarthy Michael J , Sucharew Heidi J , Alwell Kathleen , Moomaw Charles J , Kissela Brett M , Woo Daniel , Flaherty Mathew L , Khatri Pooja , Ferioli Simona , Kleindorfer Dawn O
Published: March 2022

Introduction:
Blacks report more risk factors and more frequent strokes than whites. However, little is known about racial differences in comorbidities after stroke. Examining racial differences in post-stroke comorbidities is important for identifying individuals who may be at particular risk and, ultimately, for promoting better quality of life, fewer secondary strokes, and increased longevity. We assessed the hypothesis that blacks would experience more comorbidities following stroke than whites.

Methods:
In 2005, the population-based Greater Cincinnati/Northern Kentucky Stroke Study enrolled a cohort of 460 ischemic stroke patients using hot-pursuit methods. Medical and psychiatric comorbidities were assessed at the 3-month follow-up interview by medical record and self-report. Data from 324 survivors of black or white race were analyzed. Of the 136 not included, 5 were excluded for race, 32 died within 3 months, 20 were lost to follow-up, 14 refused, and 65 did not provide comorbidity data. Comorbidity rates were compared by race using logistic regression.

Results:
Black (n=83) and white (n=241) survivors were similar in rates of medical comorbidities after ischemic stroke. There was a significant difference in rates of psychiatric comorbidity (i.e., anxiety, confusion, agitation, depression, hallucinations), with 69% of blacks experiencing psychiatric comorbidities compared with 54% of whites (p < .05). In the unadjusted logistic model, blacks were almost twice as likely to experience psychiatric comorbidities as whites (OR=1.90, 95% CI 1.12-3.23). However, this difference became nonsignificant (OR=1.56, 95% CI 0.88-2.76) after controlling for gender, age, stroke severity, and degree of disability at hospital discharge. In the final model (c statistic=0.69), younger survivors (OR=0.98, 95% CI 0.96-0.99) and those with greater disability (OR=1.58, 95% CI 1.25-1.99) were more likely to experience psychiatric comorbidities, irrespective of race.

Conclusion:
Racial differences in comorbidities after stroke appear to be less pronounced than in other areas of disparities research. Age and degree of disability may be more relevant factors than race in determining survivors’ risk for post stroke comorbidities.
Abstract TP199: Association between Metabolic Syndrome and Carotid Atherosclerosis: a Community-based Study in Hong Kong
Authors: Leng Xinyi , Chen Xiangyan , Chook Ping , Xiong Li , Lin Wenhua , Liu Jingyi , Tomlinson Brian , Thomas G Neil , Lam Tai Hing , Lam Karen , Cheung Bernard , Wong Ka Sing
Published: March 2022

Background and Purpose—
Carotid atherosclerosis is not neglectable as a cause for stroke in China, despite of low prevalence. This study was performed to evaluate the association between its ultrasonographic markers with metabolic syndrome (MetS).

Methods—
This was a community-based cross-sectional study. Demographics, common vascular risk factors, and results of fasting blood analysis were collected at baseline. MetS was defined as ≥3 following conditions or receiving specific treatment: abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima-media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4th quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of >1.5 mm.

Results—
A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. MetS was found in 188 (28.8%) subjects (30.8% in male and 27.0% in female). Mean CIMT was 0.74±0.12 mm. Increased CIMT and carotid plaques were detected in 163 (25.0%) and 95 (14.5%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of MetS components (P<0.001). In multivariate logistic regression, MetS was independently associated with increased CIMT (OR 1.17; 95% CI 1.11-2.64; P=0.014) but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108).

Conclusion—
MetS may be independently associated with early stage but not later and advanced stages of carotid atherosclerosis in community residents in China.
Abstract TP201: Delayed Increase In Blood Glucose Fluctuation And Neurological Outcome After Acute Stroke
Authors: Neshige Shuichiro , Ohtsuki Toshiho , Hara Naoyuki , Takeshima Shinichi , Himemo Takahiro , Fukushima Tomoko , Takamatsu Kazuhiro , Ota Taisei , Kuriyama Masaru , Matsumoto Masayasu
Published: March 2022

Introduction:
Hyperglycemia leads to a poor prognosis in acute stroke. We previously reported that neurological deterioration was related to larger variation of daily fasting blood glucose levels a week after acute stroke. In the present study, neurological worsening after stroke was correlated with delayed large fluctuation of glucose levels in the late half of week after admission.

Methods:
After excluding patients who underwent tPA or surgical treatment and had an NIHSS score at acute stroke admission exceeding 23, a total of 811 diabetic patients (267 females; mean age, 70.4±10.1 years; median age, 71 years) was enrolled. Blood glucose (BG) levels were measured three times a day at 6 AM, noon, and 6 PM for 7 days after admission. For the blood glucose levels, the average and successive variation (SV=[1/(n-1)*sigma{(BG

i

+1
-BG

i

)^2}]^0.5 while
i
denotes
i
th measurement of blood glucose), as an indicator of variation of BG levels, were calculated from two admission period, the early half (days 1 to 3, i=1 to 9) and the late half of week (days 4 to 7, i=10 to 21), respectively. Differences in BG and SV between the early and late half of week were evaluated. Patients whose NIHSS scores increased by ≥4 points from admission to discharge were classified into the exacerbation group.

Results:
The exacerbation group included 30 (3.7%) patients. The exacerbation group had a higher proportion of female and elderly patients and higher NIHSS scores on admission than the non-exacerbation group. From the early to late half of week, mean BG declines were 2.0±35.1 mg/dL in the exacerbation group and 7.9±24.4 mg/dL in the non-exacerbation group (p=0.287). While SV did not change (0.9±23.1) in the non-exacerbation group, it increased by 10.5±30.2 in the exacerbation group (p=0.017). Logistic regression analysis showed that a larger increase in SV difference was related to neurological exacerbation (HR=1.016, 95%CI=1.000-1.032, p=0.050).

Conclusion:
An increase in fluctuation of blood glucose levels a week after stroke, rather than its absolute reduction, was an independent risk factor of neurological deterioration in diabetic patients. These findings may suggest a vicious association between impaired glucose metabolism and symptom progression.
Abstract TP206: The Prevalence of Patent Foramen Ovale in Ischemic Stroke Patients in Korea - An Observational Study
Authors: Lee Si Baek , Koo Jaseong
Published: March 2022

Objective:
To find the prevalnece of Right to left shunt in stroke patients and general population in Korea.

Methods:
We assessed RLS by TCD from middle cerebral artery(MCA) of the stroke patients from whom MCA could be detected through temporal bone window. We tried to find microembolic signal(MES) at the middle cerebral artery for 90 seconds after injection air agitated saline (9ml saline with 1ml of air) in the right antecubital vein. This procedure was performed 2 times in one of the middle cerebral artery with and without Valsalva maneuver.

Results:
Seven hundred and fifty five stroke patients (430 male, mean age of 66.7 12.1) were enrolled. We also performed TCD monitoring in 1347 contorls (patient with other than stroke with or without headache, 915 male, mean age of 51.2 .2) for the comparison of the detection rate of RLS in stroke patients and general population. RLS was detected in 59 stroke patients, while in control group 170 cases (7.8% vs. 12.6%, p=0.001). In stroke patients, the mean age of those with RLS was significantly different from those without RLS (62.3 11.3 vs. 67.0 12.1, P=0.004). And RLS was more frequent among male(8.1%) than female(7.4%). There were no significant differences in the prevalence of PFO among stroke subtypes by TOAST classification (large artery atherosclerosis, 7.3%; small arterial occlusion, 7.9%; cardioembolic, 7%; undetermined cause, 8.3%).

Conclusion:
The frequency of RLS in general population is about 11%, but decreased in stroke patients compared to controls. And the prevelance of RLS is slightly increased in stroke patients with undetermined cause without significant difference from those of stroke patients with other etiology.
Abstract TP210: Short-Term Changes in Ambient Temperature and Risk of Ischemic Stroke Onset
Authors: Mostofsky Elizabeth , Wellenius Gregory A , Wilker Elissa H , Zanobetti Antonella , Gold Diane R , Mittleman Murray A
Published: March 2022

Background:
Despite consistent evidence of a higher short-term risk of cardiovascular mortality associated with ambient temperature, there have been discrepant findings on the association between temperature and ischemic stroke hospitalization. Moreover, few prior studies have considered potential confounding by ambient fine particulate matter air pollution <2.5 μm in diameter (PM
2.5
).

Methods:
We reviewed the medical records of 1,705 Boston area patients hospitalized with neurologist-confirmed ischemic stroke and abstracted data on the time of symptom onset and clinical characteristics. We obtained hourly meteorological data from the National Weather Service station at Boston’s Logan airport and calculated mean apparent temperature as an index of perceived discomfort due to heat and humidity. Hourly PM
2.5
was obtained from the Harvard ambient monitoring station. We used the time-stratified case-crossover study design to assess the association between the risk of ischemic stroke onset and apparent temperature in the hours and days preceding each event, after accounting for PM
2.5
, patient characteristics, season, and long-term time trends.

Results:
We found a 20% (95% confidence interval 3% to 33%) higher risk of ischemic stroke associated with a 10
0
C decrease in mean apparent temperature in the 4 days preceding symptom onset. The higher risk associated with cooler temperatures was observed within 14 to 24 hours. Results were similar in analyses stratified by season.

Conclusions:
Lower temperatures are associated with a higher risk of ischemic stroke onset in both warm and cool seasons. Additional work is necessary to examine the potential mechanisms underlying these observations and to examine whether other environmental factors may account for this association.
Abstract TP212: Basilar Artery Diameter Is an Independent Predictor Of Incident Cardiovascular Disease
Authors: Tanaka Makiko , Sakaguchi Manabu , Miwa Kaori , Okazaki Shuhei , Furukado Shigetaka , Fukunaga Ryuzo , Kitagawa Kazuo
Published: March 2022

Background and purpose:
Basilar arterial dolichoectasia, is extreme dilatation and elongation of the basilar artery (BA), is associated with intracranial bleeding, stroke mortality, and cardiovascular death. However, the association between moderate dilatation of the BA and subsequent cardiovascular events remains unclear. The study aims to clarify whether the BA diameter is an independent predictor of incident cardiovascular events.

Methods:
The study subjects comprised 493 outpatients aged 50 years or older with atherosclerotic risk factors, who underwent brain magnetic resonance imaging (MRI). The short axis of the BA diameter, cerebral infarcts, hemorrhagic lesions, the severity of deep white matter hyperintensities (DWMH), and intracranial steno-occlusive lesions were assessed with MRI and MR angiography. We prospectively evaluated the association between BA diameter and incident cardiovascular events such as cerebrovascular events, coronary heart events, and peripheral arterial events. The Kaplan-Meier method was used to analyze survival, and Cox regression models were used to examine prognostic variables.

Results:
The BA diameter ranged from 1.1 to 5.2 mm, and only 0.8% of the total patients had dolichoectasia. In the mean follow-up of 6.0 years, 91 patients developed cardiovascular events. BA diameter was independently associated with the cardiovascular events after adjusting for risk factors, stroke lesions, intracranial arterial steno-occlusion, and DWMH. Patients with large BA diameter (>2.7 mm) developed more cardiovascular events compared with those with small BA diameter (≤2.7 mm) (log-rank test; p <0.001). Among the cardiovascular events, BA diameter was most strongly associated with coronary heart events; however, it was not independently associated with cerebrovascular events.

Conclusion:
BA diameter is independently associated with incident cardiovascular events in high-risk patients. BA diameter could be a new predictive marker of cardiovascular events.
Abstract TP215: Leukocyte RNA Expression Is Altered Prior To Hemorrhagic Transformation In Ischemic Stroke
Authors: Jickling Glen C , Stamova Boryana , Ander Bradley P , Zhan Xinhua , Liu DaZhi , Verro Piero , Khoury Jane , Jauch Edward C , Pancioli Arthur , Broderick Joseph P , Sharp Frank R
Published: March 2022

Background:
Hemorrhagic transformation (HT) is a major complication of ischemic stroke that worsens outcomes and increases mortality. In ischemic stroke circulating leukocytes may contribute to blood brain barrier disruption, which is an important component of HT. In this study we sought to determine whether leukocytes express RNA differently in ischemic strokes that latter develop HT, and thus identify molecules and pathways important for the pathogenesis of HT in human stroke.

Methods:
Blood samples were collected within 3 hours of ischemic stroke onset prior to thrombolytic therapy. No subjects had HT prior to sample collection. RNA from circulating leukocytes was isolated and processed on Affymetrix U133 Plus2.0 microarrays. Ischemic strokes that developed HT (n=11) were compared to matched ischemic strokes without HT (n=33) and controls (n=14). Genes with a Benjamini Hochberg corrected p-value <0.05 and fold change >
Abstract TP216: Cardio-Ankle Vascular Index (CAVI) Is A Novel Parameter To Predict Aortic Arch Plaque Causing Atherothrombotic Stroke
Authors: Sasaki Shintaro , Nishiyama Satoshi , Watanabe Tetsu , Tamura Harutoshi , Wanezaki Masahiro , Sato Chika , Kubota Isao
Published: March 2022

Aortic arch plaque is an important cause of atherothrombotic stroke. The cardio-ankle vascular index (CAVI) has been reported as a novel parameter for aortic stiffness, and high CAVI implies progression of carotid and coronary arteriosclerosis. However, it remains to be determined whether CAVI is associated with arch plaques.

We performed CAVI and transesophageal echocardiography in 290 subjects (197 males, 65 ± 12 years), including 29 patients with the history of atherothrombotic stroke. We defined arch plaque as wall thickness ≥ 4 mm and the presence of ulceration or mobile plaque in aortic arch.

CAVI showed a good correlation with age, systolic blood pressure, fibrinogen, von Willebrand factor, carotid plaque score and arch wall thickness. CAVI was higher in subjects with following risk factors than in those without; hypertension, diabetes mellitus, and dyslipidemia. CAVI was higher in subjects with ulceration or mobile plaques than in those without. CAVI was higher in subjects with atherothrombotic stroke than in those without (10.5 vs. 8.6, P<0.001). The subjects with CAVI ≥ 9 had higher risk for atherothrombotic stroke compared with those with CAVI < 9 in univariate logistic regression analysis (odds ratio 5.07, 95% confidence interval 2.16-11.91). Multivariate logistic regression analysis revealed that CAVI was an independent risk factor for atherothrombotic stroke.

In conclusion, CAVI is a novel parameter predicting aortic arch plaques, which cause atherothrombotic stroke.
Abstract TP220: Utility of Transthoracic Echocardiography in the Evaluation of Acute Stroke and TIA
Authors: Dham Bhavpreet , Velazquez-Rodriquez Yadira , Mirsen Thomas
Published: March 2022

Background:
Transthoracic echocardiography (TTE) is widely employed in the evaluation of acute ischemic stroke (AIS) and transient ischemic attack (TIA). However, there is no consensus on its utility. We aim to determine the diagnostic and therapeutic value of TTE in AIS and TIA.

Methods:
We retrospectively reviewed 359 charts of patients with a diagnosis of AIS or TIA. TTE was performed on 322/359 patients. The results were separated into 3 categories: 1) no major abnormality; 2) findings with no definitive intervention required: ejection fraction <40% , left atrial size >4.0 cm, patent foramen ovale with or without atrial septal defect, left ventricular thrombus or enlarged left atrium with mitral valve disease; 3) findings necessitating intervention: left atrial thrombus, left atrial myxoma, or valvular vegetations. Interventions were defined as initiation of anticoagulation, antibiotics or valvular surgery for myxomas.

Results:
Of 359 patients, 251 had AIS and 108 had TIA. TTE was performed in 229/251 patients with AIS and 93/108 patients with TIA. The frequencies of category 1, 2 and 3 findings were 63/93 (67.7%), 29/93 (31.2%), 1/93 (1.1%), respectively in TIA group and 109/229 (47.6%), 117/229 (51.1%), 3/229 (1.3%), respectively in AIS group. In the AIS cohort, 3/3 patients (100%) with category 3 findings (2 cases of valvular vegetations and 1 case of cardiac myxoma) and only 7/117 (6.0%) patients with category 2 findings had a change in management. In the TIA cohort, 2/29 (6.9%) patients with category 2 findings (1 case of left ventricular thrombus and 1 case of low ejection fraction) had a change in management and the single patient with category 3 finding had a left atrial appendage thrombus who was inadequately anticoagulated, thus no new therapy was begun.

Conclusion:
TTE has a modest yield in acute cerebrovascular disease. While it provides useful information, it seldom (in only 1.7% of cases) provides data that unequivocally necessitates a therapeutic intervention in patients with AIS. Given low yield of TTE among TIA patients, it may be reasonable to obtain TTE after hospital discharge. In summary, a better mechanism is needed to identify, prior to the performance of TTE, a cohort of AIS and TIA patients in whom the TTE findings will definitively alter care.
Abstract TP225: A New Chemokine (CCL23) Is Useful As A Brain Damage Marker And Reflects The Time After Stroke Onset Serving As A Biological Clock.
Authors: Montaner Joan , Penalba Anna , Garcia-Berrocoso Teresa , Flores Alan , Rubiera Marta , Ribo Marc , Molina Carlos , Alvarez-Sabin Jose
Published: March 2022

Cardiologists use several blood biomarkers to assess acute myocardial infarction diagnosis and onset, which would be also of great value in the stroke field; specially in the case of patients that show brain damage due to an ischemic stroke and who reach the hospital unconscious or with inability to communicate, or wake-up strokes in which we may not determine precisely when symptoms began.

Methods:
To identify such markers a first screening step [1] was performed exploring around 200 candidate proteins (multiplex Searchlight technology) among a small number of stroke patients that identified a protein, chemokine CCL23, significantly elevated in blood with respect to healthy individuals. Next step [2] included a large replication study among patients with stroke suspicion who came to the ED with acute neurological symptoms initiated <24h before admission. Following step [3] evaluated time profiles and kinetics of CCL23 level in strokes who received t-PA. Serum CCL23 was determined in duplicate by two ELISA-type commercial immunoassays (Aushon Biosystems and RayBiotech).

Results:
Healthy controls had CCL23 blood levels lower (p<0.001) than patients with ischemic stroke (n=146), and lower than patients with other stroke mimics (n=58). CCL23 was found higher in patients with brain damage caused by a structural injury (TBI or brain tumors) than in those with the same neurological symptoms but without structural brain injuries (simulators, primary headaches, etc). CCL23 increased progressively in the acute stage of ischemic stroke as shown in the Figure (dashed-line=healthy control′s range). Lower CCL23 levels, between 2-3.5 hours were observed in patients who improved at 48h.

Conclusion:
Chemokine CCL23 level is useful as a diagnostic marker of pathologies associated with neurological damage. This allows rapid diagnosis of stroke patients and determining stroke onset regarding CCL23 blood level, that might allow starting safely and sooner reperfusion therapies.
Abstract TP235: Higher Urine Albumin-Creatinine Ratio is an Independent Predictor of Outcome among Critically Ill Acute Stroke Patients
Authors: Lee Meng , Huang Ying-Chih , Wu Yi-Ling , Lee Ming-Hsueh , Lee Jiann-Der , Wu Chih-Ying , Huang Yen-Chu , Hsu Huan-Lin , Lin Ya-Hui , Yang Jen-Tsung , Ovbiagele Bruce
Published: March 2022

Background:
Albuminuria [urine albumin-creatinine ratio (UACR) ≥ 30 mg/g] and low estimated glomerular filtration rate (eGFR < 60 ml/min per 1.73 m
2
) have been separately associated with poor short-intermediate term outcomes after an index stroke. However, few studies have assessed the impact of both these indices of kidney dysfunction in the same acute stroke patient population; and especially not among critically ill stroke patients. We investigated the role of baseline UACR and eGFR as prognosticators for stroke patients admitted to the intensive care unit (ICU).

Methods:
We enrolled consecutive stroke patients admitted to a hospital ICU in Taiwan from September 2007 to August 2010 and followed-up for 1 year. UACR and eGFR were recorded at baseline. The primary outcome was poor functional outcome (mRS 3-6) at 1 year. Additional analyses subcategorized UACR into 30-299 and ≥ 300 mg/g, eGFR into 45-59 and < 45 ml/min per 1.73 m
2
, and stroke into ischemic and hemorrhagic stroke. Multivariable modeling adjusted for confounders.

Results:
There were 188 patients met entry criteria. Compared to patients with normal kidney function, patients with higher UACR had poorer 1-year functional outcomes whether they had normal eGFR (OR 2.76, 1.03-7.44, p=0.044) or low eGFR (OR 8.49, 2.84-25.39, p<0.001). Patients with low eGFR but normal UACR did not have poorer functional outcomes (OR 0.73, 0.19 to 2.90, p=0.685) (Table). Additional analyses showed that poor functional outcome was driven by baseline macroalbuminuria (OR 16.66, 2.58 to 107.64, p=0.003) vs. microalbuminuria (OR 2.01, 0.64 to 6.30, p=0.233). Separate analyses for ischemic and hemorrhagic stroke were similar to the overall findings.

Conclusions:
Higher baseline UACR, especially in the macroalbuminuric range, is an independent predictor of poor 1-year functional outcome among critically ill acute stroke patients regardless of stroke type. Baseline low eGFR does not appear to be a prognosticator in these patients.
Abstract TP237: Simulation: A Novel Modality for Improving Physician Knowledge and Confidence with recombinant tissue-type Plasminogen Activator for Acute Ischemic Stroke
Authors: Stork Rachel , Frank Jeffrey , Kharasch Morris , Wang Ernest , Aitchison Pam , Goldenberg Fernando , McKoy Cedric
Published: March 2022

Background:
Intravenous recombinant tissue-type plasminogen activator (rtPA) is the only FDA approved non-invasive medical treatment for restoring brain perfusion in acute ischemic stroke (AIS) patients, however many neurology residents will graduate with little or no experience in its use. rtPA for AIS is underutilized, in part, due to lack of physician experience and training. Inappropriate use of rtPA leads to more frequent, potentially deadly complications. Simulation is an ideal educational modality for increasing physician knowledge, skill, and experience with the management of AIS without risk to patients.

Methods:
23 physicians (13 neurology, 10 emergency medicine) were interviewed to identify and prioritize learning objectives for AIS management with respect to intravenous rtPA use. A comprehensive curriculum consisting of case discussions, a standardized patient encounter, and both high and low fidelity simulated patient scenarios were designed around these objectives in the format of a half-day simulation workshop. A pilot workshop was used to refine the curriculum. Entrance and exit surveys were administered to measure changes in knowledge, skills, and attitudes. The use of rtPA for AIS was tracked before and after the intervention.

Results:
To date, 17 neurology and emergency medicine residents have completed the workshop. All trainees reported significantly increased confidence in AIS patient selection and management with rtPA, including its potential complications. Intravenous
rtPA use increased by 75% in the 7 months after residents began participating in the workshop (no protocol violations). This increase has persisted at 13 months after the initial simulation.

Conclusions:
Medical simulation is an effective educational modality for the training of physicians in management of AIS and shows great promise to favorably impact physician practice and AIS patient outcome.
Abstract TP246: Emergency Medical Service Transportation Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke
Authors: Heidari Khosrow , Sen Souvik , Jauch Edward C , Finney Chris , Chen Er , Brooks Joy , Kowalczyk Hannah , Brown Jordan
Published: March 2022

Background:
Emergency medical services (EMS) transportation of a potential stroke patient may provide a means of reducing evaluation and treatment times and improve fibrinolytic treatment rates; yet, state-level data have not been linked to diagnosis at discharge and clinical outcomes.

Objectives:
To link the South Carolina (SC) statewide EMS database with hospital discharge diagnosis and evaluate the impact of EMS transportation in improving identification and treatment of acute stroke.

Methods:
A retrospective analysis was conducted of the statewide EMS database linked with statewide hospital discharge records stored at SC Department of Health and Environmental Control, for the calendar year 2010. Patients with a discharge diagnosis of stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, transportation time, location/ type of destination hospital and treatment with intravenous tissue plasminogen activator (tPA).

Results:
In the year 2010, 18,962 hospitalized patients in SC were assigned a primary discharge diagnosis of stroke. Of these, 36% (6,824) were transported via EMS. The average time from 911 call to hospital arrival was 44.6 minutes. Time from 911 calls to EMS on scene was on average of 1.2 minutes longer for patients residing in rural areas than those in urban areas. About 48% of all stroke cases were treated in primary stroke centers (PSCs) and 4.3% of all ischemic cases received thrombolytic therapy. EMS identification of stroke signs and symptoms was associated with shorter transfer times and a higher transfer rate to a PSC than cases whose symptoms were not identified as stroke by EMS (50% vs. 43% for all strokes, P<0.001; 50% vs. 41% for ischemic strokes, P<0.001). For patients with ischemic stroke, EMS identification of stroke resulted in a markedly higher tPA treatment rate (10.9%) than cases whose symptoms were not identified as stroke by EMS (3.6%) and cases arriving by private vehicles (3.5%, P<0.001).

Conclusions:
EMS identification of stroke signs and symptoms was associated with increased rate of transportation to PSCs and fibrinolytic treatment for ischemic stroke.
Abstract TP250: Impact of Emergency Medical Services Acute Stroke Routing Protocols on Primary Stroke Center Certification in California.
Authors: Schuberg Samuel D , Song Sarah , Saver Jeffrey L , Sanossian Nerses
Published: March 2022

Background:
An organized stroke system of care includes the development of Primary Stroke Centers (PSCs) and preferential emergency medical services (EMS) routing to deliver suspected stroke patients to designated PSCs. EMS routing of stroke patients is not nationally governed and in California, EMS routing is decided on the county level. EMS routing policies might provide a financial or competitive incentive for hospitals to invest in PSC accreditation. We sought to evaluate the relationship between the independent adoption of EMS stroke routing protocols and hospital acquisition of PSC designation in California.

Methods:
All dates of California PSC certification were obtained through The Joint Commissions website qualitycheck.org and follow-up call to the stroke coordinator. Starting dates of EMS stroke routing policies were obtained for each county with at least one PSC. We describe the number of hospitals achieving PSCs designation relative to implementation of EMS routing policies, and annual rates of conversion to PSC for each county.

Results:
As of June 2012 there are 127 PSCs in California in 27 counties; 22 of 58 counties have implemented EMS routing policies. The greatest number of PSCs were in Los Angeles County (29) followed by San Diego (11) and Santa Clara (9) counties. Achievement of PSC designation was more frequent in the periods immediately before and after a county’s adoption of EMS routing (48 PSCs,38% of total, designated within one year and 81,64%, within 2 years). In Los Angeles, there were 4 hospitals with PSC certification >1 year in advance of EMS routing, 11 within a year of EMS routing and 13 additional PSC’s >1 year after EMS routing policies. The rate of conversion to stroke center accelerated prior to EMS diversion policy adoption and decelerated in the years following.

Conclusion:
Implementation of EMS routing policies may be an important factor driving PSC certification. National adoption of EMS routing policies for stroke may lead to greater numbers of PSCs, which could positively impact patient care.
Abstract TP26: Enterprise
™
-assisted Recanalization in Acute Ischemic Stroke (ERAIS): First FDA approved prospective trial
Authors: Natarajan Sabareesh , Dumont Travis , Eller Jorge , Kelly William , Seals Kevin , Snyder Kenneth V , Hopkins L. N , Siddiqui Adnan H , Levy Elad I
Published: March 2022

AIM:
The ERAIS study was designed to test the safety of the Enterprise stent as the primary intraarterial device in cerebral revascularization.

METHODS:
Twenty patients with acute ischemic stroke within 8 hours of stroke symptom onset with contraindication to IV thrombolysis or with no clinical improvement 1 hour after administration of IV thrombolysis were prospectively enrolled between July 2010 and June 2012 after consultation with the local IRB and FDA. The Enterprise stent was deployed across the occlusion. Alternatively, the stent was used as a thrombectomy device based on operator preference.

RESULTS:
All patients had major intracranial vessel occlusion (TIMI 0), with an average preoperative NIHSS score of 15.5±1.3. The primary target vessels where the stents were deployed were the MCA in 15 patients, ICA in 2, basilar artery in 2 and tandem ICA-MCA in 1.The stent was deployed in 13 patients and used as a thrombectomy device and thus retrieved in 7 patients. Twenty-four stents were used in 20 patients. The time from start of procedure to TIMI 2/3 recanalization was 43±21 minutes. Recanalization to TIMI 2/3 flow was achieved in 18 (90%) of 20 patients. Three major complications were noted (15%), including 2 MIs and 1 ischemic stroke in a distribution other than the qualifying vessel. Eight minor complications were noted. Seven (35%) patients died within 30 days of revascularization. Ten patients (50%) improved to an mRS score of 0-2 within 30 days post-intervention.

CONCLUSION:
The Enterprise stent is equivalent in efficiency and has comparable acceptable adverse events when compared to previously published results with the Wingspan stent in the SARIS trial and confirms the high recanalization rate achieved with stent-assisted revascularization in selected patients. This is the first reported prospective FDA-approved trial with the Enterprise stent as the primary intraarterial stroke revascularization device.
Abstract TP27: Admission Motor strength Grade Predicts Mortality in Patients with Acute Ischemic Stroke undergoing Thrombectomy.
Authors: SHUSHRUTHA HEDNA VISHNUMURTHY , BODHIT AAKASH , STEAD LATHA , BIDARI SHARATHCHANDRA , FALCHOOK ADAM D , Doré Sylvain , ANSARI SAEED , HEILMAN KENNETH M , HOH BRIAN L , WATERS MICHAEL F
Published: March 2022

Introduction:
The mortality due to mechanical thrombectomy (MT) in the acute treatment of intracranial arterial thromboses can be up to 30%. It is important to determine pre-procedural factors that help predict post-intervention prognosis.

Hypothesis:
To determine which factors on admission may be used to predict mortality after MT.

Methods:
Retrospective analysis of 62 patients who underwent MT for acute ischemic stroke with or without concurrent intravenous thrombolysis from an IRB approved stroke database (Jan07-Mar11). Mortality served as an independent primary outcome measure using five baseline variables: medical research council (MRC) motor grade (0-5); modified collateral flow (CS) grading (0-3); age; and acute and chronic co-morbidities in the univariate and multivariate analyses. If upper and lower extremity motor grade differed, the lower score was utilized. Age was analyzed independently as well as dichotomized using 80 as cut-off value. Relevant stroke related acute and chronic co-morbidities were given 1 point each and mean calculated.

Results (table):
In the univariate analysis, low MRC (0-1) motor strength grade (p=0.001) and age (p=0.011) was significantly associated with mortality. The presence of collateral flow or acute and chronic co-morbidities were not significantly associated with mortality. In the multivariate analysis, motor grade retained its statistical significance for mortality (p=0.003) along with chronic co-morbidities (p=0.04). Interestingly, age which was a strong predictor of favorable stroke outcome in previous studies was not statistically significant for predicting mortality (p=0.32).

Conclusions:
In conclusion, admission MRC motor strength grade may serve as a robust predictor of mortality after MT in patients with acute ischemic stroke. Further validation by prospective multivariate analysis using larger sample size is needed.
Abstract TP272: An Association Between Tlr And Jak Signaling Following Cerebral Ischemia: A Translational Approach
Authors: VanGilder Reyna , Rellick Stephanie , Huber Jason , Rosen Charles , Turner Ryan , Barr Taura
Published: March 2022

Objectives:
Toll like receptor (TLR) signaling emerged as a significant pathway in our whole genome peripheral blood study of ischemic stroke patients. In our dataset, TLR signaling is associated with stroke severity, can predict outcome and is influenced by age. The age-mediated effects on TLR expression and kinase signaling in response to cerebral ischemia are not well-characterized. The objective of this project was to confirm and further characterize our clinical findings in a preclinical aged stroke model by analyzing TLR gene expression and the kinase proteome.

Methods:
An SaBiosciences rat TLR PCR array was used to compare brain and blood gene expression in 3 (n=3) and 18 (n=3) month old rats that underwent embolic middle cerebral artery occlusion (MCAO) with tPA reperfusion and sacrificed at 24 hours. Blood samples were collected via femoral artery in Qiagen RNA protect tubes. Rats were perfused and then Brain tissue was collected in RNA later. A Kinetworks Protein Kinase Screen 1.2 was performed on infarcted cortex (n=4). Univariate and multivariate associations between old and young and blood and brain and group differences across sham and treatment were identified by the Mann-whitney U and ANOVA.

Results:
There was an 85% overlap in TLR related genes when comparing blood and brain. Kinase data revealed HPK1 expression was lowest in old MCAO (p=0.005); Jak2 expression was higher in old MCAO (0.03).There was a differential response of Pkc-a expression after MCAO, where it was increased in the young, but decreased in the aged (0.014). PKA expression increased after MCAO, but was lower in the aged (0.014).

Conclusion:
Our findings support the use of peripheral blood as a surrogate to monitor the response to cerebral ischemia and emphasize the clinical relevance of using age in preclinical models of ischemia. This data suggests a novel age-related mechanism of cross talk between TLR and JAK2 signaling that may occur through HPK1 and PKA. Additional clinical and preclinical studies are required to confirm this data and better characterize the kinase cross-talk between TLR and JAK2 signaling.
Abstract TP280: Risk Factors Predicting Progression in Penetrating Artery Territory Infarction; a Retrospective Study
Authors: Yasui Mariko , Miyashita Kotaro , Kada Akiko , Nakagawawra Jyoji , Todo Kenichi , Metoki Norifumi , Manabe Yasuhiro , Akaiwa Yasuhisa , Yamamoto Yaasumasa , Toyoda Kazunori , Nagatsuka Kazuyuki
Published: March 2022

[Background]
The patients with penetrating artery territory infarction (PATI) sometimes show progressive motor deficits during the acute stage with poor prognosis. Although some predicting factors are suggested concerning symptomatic progression (SP), there have been no established predicting indices and medical therapy to suppress SP. In this study, we investigated the clinical factors including medical therapy related with SP in PATI .

[Methods]
We retrospectively examined acute stroke patients with PATI for recent two years in collaborative hospitals. SP was defined as the increase of at least one point on the National Institutes of Health Stroke Scale (NIHSS). The influence of factors including age, sex, medical history, vital signs and laboratory data on admission, and medical therapies, on SP were determined by multivariable logistic regression.

[Result]
Five hundreds and eight patients (320 men with a mean age of 70 years) with PATI were consecutively enrolled. The mean modified Rankin scale (mRS) before the onset was 0, and average NIHSS score on admission (adNIHSS) was 3. Sixty six patients (13%) exhibited SP. On univariable analysis, the following factors were risk factors of SP: adNIHSS, systolic blood presseure on admission (adsBP), BUN, HbA1c, LDL-C. Dual antiplatelet therapy (DAPT) was administered to more patients with SP than to those without SP within 24 hours after admission. Outcome measure using mRS at 3 months after ictus was worse in patients with SP than in those without SP (3 vs 1, p<0.0001), while DAPT appeared to bring about the slight improvement of 3 months prognosis. Multivariable analysis revealed that higher HbA1c (OR 1.36, 95%CI 1.14-1.63), BUN (OR 1.33, 95%CI 1.04-1.38) and adSBP (OR 1.23, 95%CI 1.11-1.38) were independent predictors for SP in PATI.

[Conclusions]
In our retrospective study, more than 10% of patients with PATI showed progressive course in the acute stage with poor prognosis despite the best available therapy. Initial high blood pressure, diabetic and dehydration tendency on admission influenced the early progression in penetrating artery territory cerebral infarction with poor outcome.