bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 56: Changes In Cardiovascular Health Within Midlife And From Midlife To Late-life Associated With MRI Markers Of Cerebral Vascular Disease In Late-life
Authors: Sedaghat Sanaz , Ji Yuekai , Empana Jean-Philippe , Hughes Timothy M , Mosley Thomas , Gottesman Rebecca F , Griswold Michael , Jack Clifford R , Lutsey Pamela L , Van Sloten Thomas
Published: February 2023

Introduction:
Cardiovascular health may be used for prevention of cerebral vascular disease. We evaluated whether improvement of cardiovascular health within midlife and from midlife to late-life were each associated with lower prevalence of MRI markers of cerebral vascular disease at late-life.

Methods:
1,638 participants from the Atherosclerosis Risk in Communities (ARIC) Study took part in two visits at midlife (mean ages 53 at ARIC visit 1 and 59 at visit 3), and a late-life visit (mean age 76). A cardiovascular health Life’s Simple 7 score (range 0-12/0-14, depending on diet availability) including six/seven items was calculated at each visit, with weight assigned to each item as poor (0), intermediate (1), or ideal (2). Participants underwent 3T brain MRI scans in 2011-2013 (late-life visit). Outcomes were white matter hyperintensity volume, microbleeds, and lacunar, subcortical, and cortical infarcts at late-life. Linear and logistic regression models were used to assess the associations of cardiovascular health with MRI markers of cerebral vascular disease.

Results:
Thirty nine percent of participants had high cardiovascular health at midlife visit 1, 32% at midlife visit 3, and 33% at late-life. Improvement of cardiovascular health within midlife and from midlife to late-life were each associated with a lower prevalence of cerebral vascular disease markers. For example, improvement in cardiovascular health (per point) from midlife to late-life was associated with smaller white matter hyperintensity volume (Beta:-0.07 [95%CI:-0.10,-0.04]), and lower odds of microbleeds (OR:0.93 [0.90,0.97]), lacunar (OR:0.93 [0.89,0.97)], subcortical (OR:0.93 [0.89,0.97])], and cortical infarcts (OR:0.92 [0.87,0.97)] (Figure).

Conclusions:
Improving cardiovascular health within midlife and from midlife to late-life may prevent development of cerebral vascular disease.
Abstract 6: Relationship Between Hypoperfusion Intensity Ratio And Ischemic Core Growth Rate Is Similar On CT And MRI For Unselected Acute LVO Patients
Authors: Seners Pierre , Lansberg Maarten G , Heit Jeremy J , Escribano Paredes Jose Bernardo , Carrera Emmanuel , Mlynash Michael , Yuen Nicole , Snyder Sarah , Christensen Soren , Albucher Jean-Francois , Cognard Christophe , Sibon Igor , Obadia Michael , Savatovsky Julien , Olivot Jean-Marc , Albers Gregory W
Published: February 2023

Background:
Predicting infarct growth rate (IGR) in acute stroke with large vessel occlusion (LVO) is important for treatment decision-making. IGR has typically been studied in patients treated with thrombectomy, which likely has underestimated the prevalence of ‘fast progressors’, as large core patients are less frequently treated. We aimed to study IGR in an unselected LVO population and study the association between Hypoperfusion Intensity Ratio (HIR, a surrogate marker of collaterals) and IGR as assessed by both CT and MRI.

Methods:
Retrospective study including ICA/M1 stroke patients with witnessed stroke onset and baseline perfusion imaging (MRI or CT) performed within 24hrs from symptoms onset. To avoid selection bias, patients were selected from (1) the registries of 3 centers with systematic use of MRI- or CT-perfusion and including both MT-treated and untreated patients, and (2) one trial where thrombectomy decisions were performed blinded from perfusion MRI results. IGR was defined as core volume/onset-to-imaging time, and fast progressors as IGR≥10mL/hr. HIR was defined as the proportion of Tmax>6s volume with Tmax>10s.

Results:
Overall, 423 and 215 patients were included in the MRI and CT cohorts. Median IGR was 6.4mL/hr (IQR 2.2-21.3) and 5.2mL/hr (0-25.2) in the MRI and CT cohorts, and median HIR was 0.44 (0.27-0.59) and 0.45 (0.25-0.60). 174 (41%) MRI patients and 86 (40%) CT patients were fast progressors. IGR was increasing with increase of HIR quartiles in both cohorts (
P
<0.001, Figure). IGR≥10mL was found in 7%, 17%, 58%, and 83% of patients within respective increasing HIR quartiles in the MRI cohort (
P
<0.001), and in 2%, 21%, 60% and 80% in the CT cohort (
P
<0.001).

Conclusion:
In this unselected LVO population, 40% of patients were fast progressors regardless of imaging modality. HIR was a strong predictor of IGR in both CT and MRI-assessed patients, and may help for patient triage,
e.g
. for transfer decision from an outside hospital for thrombectomy.
Abstract 67: Endovascular Thrombectomy In Patients With Acute Ischemic Stroke And Recent Use Of Oral Vitamin K-Antagonists: The Get With The Guidelines-Stroke Program
Authors: Mac Grory Brian C , Holmes DaJuanicia , Shah Shreyansh , Hernandez Adrian F , Matsouaka Roland , Fonarow Gregg C , Saver Jeffrey L , Bhatt Deepak , Smith Eric E , Schwamm Lee H , Reeves Mathew J , Unverdorben Martin , Birmingham Mary , Peterson Eric D , Xian Ying
Published: February 2023

Introduction:
Emergent endovascular thrombectomy (EVT) is effective in improving outcomes in patients with stroke caused by large vessel occlusion. However, there are limited data on the use of EVT in patients taking an oral vitamin K antagonist (VKA), constraining guideline development around EVT use in this vulnerable population.

Methods:
To address this knowledge gap, we performed a retrospective, observational, cohort study based on a population-based sample of stroke admissions in the US (the AHAs “Get With The Guidelines-Stroke" Program) between October 2015 and March 2020. We aimed to determine whether use of VKA was associated with the risk of symptomatic intracranial hemorrhage (sICH) and functional outcomes in patients undergoing EVT within 6 hours of time last known well after adjusting for pre-specified confounders.

Results:
Of 32,715 patients (median age 72 years; 50.7% female), 3,087 were taking a VKA and 29,628 were not on an OAC prior to stroke. Patients taking VKAs were older (median age 78 vs. 71 years) but stroke severity was similar between the groups (median NIHSS 18 vs. 17). Of patients taking a VKA, 211 (6.8%) suffered a sICH whereas 1,904 (6.4%) patients not on OAC developed a sICH. VKA was not associated with sICH (adjusted odds ratio 1.20, 95% CI: 0.96-1.49). VKA use was associated with a higher risk of life-threatening systemic hemorrhage (1.2% vs. 1.02%; aOR 1.93 (1.17-3.19)) but not with mortality/discharge to hospice (27.1% vs. 20.6%; aOR 1.02 (0.90-1.14)). Patients taking a VKA prior to EVT were more likely to be able to be ambulatory at discharge (aOR 1.24 [1.11-1.39]) and to have an mRS of 0-2 (aOR 1.23 [1.07-1.42]).

Conclusions:
Among patients with acute ischemic stroke on VKA, EVT appears to be well tolerated without prohibitive risks of sICH. Our results provide support for the deployment of this critical, disability-reducing therapy in this population of patients with a large vessel occlusion presenting within 6 hours of time last known well.
Abstract 7: Prediction Of Post-stroke Motor Recovery Benefits From Measures Of Sub-acute Widespread Network Damages
Authors: Rivier Cyprien A , Preti Maria G , Nicolo Pierre , Van De Ville Dimitri , Guggisberg Adrian G , Pirondini Elvira
Published: February 2023

Background:
Following an acute ischemic stroke, some patients recover almost completely, while others barely recover. It is known that lesion volume, initial motor impairment, and cortico-spinal tract asymmetry (benchmark features) significantly impact motor changes over time. However, accurate prediction models of patients’ recovery are still missing. Recent work suggested that disabilities arise not only from focal structural changes, but also from widespread alterations in inter-regional connectivity. Here, we built on this hypothesis to develop a more accurate post-stroke motor recovery prediction model.

Methods:
We evaluated a dataset of 37 patients (17 women) with upper extremity motor strokes. Their impairment was assessed at 2 weeks (baseline) and 3 months after the stroke using the Fugl-Meyer-Assessment. 18 graph measures of global structural connectivity were obtained using the patients’ T2 lesion mask to virtually reproduce the lesions in 60 healthy streamline tractography connectomes. We added these indirect measures to the benchmark features, and we used a ridge regression regularization in a leave-one-out cross-validation framework to predict motor recovery at 3 months post-injury.

Results:
Accuracy in prediction significantly increased when using brain connectivity measures (R
2
=0.68, 95% CI: 0.64-0.74) as compared to benchmark features alone (R
2
=0.38, 95% CI: 0.31-0.51).

Conclusion:
We reported that global measures of brain connectivity estimated by introducing virtual lesions in healthy structural connectomes significantly increase the accuracy of motor recovery prediction in stroke patients compared to focal and clinical measures used until now. This indirect estimation of the stroke impact on the whole brain connectome is more readily available than direct measures of structural connectivity obtained with magnetic resonance imaging (MRI) and would, therefore, have a more substantial clinical impact.
Abstract 89: Mechanical Thrombectomy Or Medical Management Alone For Isolated Posterior Cerebral Artery Occlusion. An International Multicentric Observational Study.
Authors: Sabben Candice , Charbonneau Frederique , Delvoye François , Mazighi Mikael , TURC Guillaume , Seners Pierre ,   ACAPULCO investigators
Published: February 2023

Introduction:
Whether endovascular therapy (EVT) added on best medical management (BMM, including intravenous thrombolysis [IVT] if indicated), as compared to BMM alone, is beneficial in acute ischemic stroke (AIS) with isolated posterior cerebral artery occlusion is unknown.

Methods:
We conducted a multicenter international observational study of consecutive AIS patients admitted within 6hrs from last seen well in 26 stroke centers in France, Switzerland and USA with isolated proximal posterior cerebral artery strokes (P1 or P2 occlusions) and treated either with EVT+BMM or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin score [mRS] 0-2). Secondary outcomes were excellent functional outcome (mRS 0-1) and symptomatic intracranial hemorrhage (sICH) at 24hrs. We searched for an interaction between treatment group and (1) occlusion site (P1
vs
. P2), (2) NIHSS score (<10
vs.
≥10), and (3) IVT use.

Results:
Overall, 810 AIS patients were included (180 and 630 in the EVT+BMM and BMM alone groups, respectively). Median age was 74yo (IQR 63-83), 352 (44%) were female, median NIHSS was 6 (IQR 4-10), 594 (73%) received IVT, and occlusion site was P1 in 205 (25%) and P2 in 605 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity-score weighting. EVT was not associated with good (adjusted OR=0.86; 95%CI: 0.67-1.09;
P
=0.21) or excellent (adjusted OR=1.10; 95%CI: 0.87-1.39;
P
=0.42) functional outcome but was associated with higher risk of sICH (OR=2.71; 95%CI: 1.41-5.21;
P
=0.003). No interaction was found between EVT effect and (1) NIHSS score, (2) occlusion site, or (3) IVT use for either outcome.

Conclusion:
In our population of AIS patients with isolated P1 or P2 occlusion, EVT was not associated with higher rates of good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of sICH. Randomized trials are warranted.
Abstract 97: Association Between Use Of A Flying Intervention Team Versus Patient Interhospital Transfer And Longterm Clinical Outcome Among Patients With Acute Ischemic Stroke And Large Vessel Occlusion In Non-urban Germany
Authors: Hubert Nikolai , Herdegen Sophie , Maegerlein Christian , Kraus Frank , Wiestler Hanni , Hohenbichler Katharina , Witton-Davies Thomas , Heinrich Isabel , Jarsch Iris , Wehrle Bernadette , Bath Philip M , Haberl Roman , Audebert Heinrich J , Hubert Gordian J
Published: February 2023

Background and Aims:
Use of a Flying Intervention Team has shown to significantly reduce time to endovascular thrombectomy compared to interhospital transfer. Aim of this study is to determine whether this new system of care is also associated with improved long-term outcome.

Methods:
This is a non-randomized controlled intervention study comparing two systems of care in alternating weeks. Thirteen telemedicine assisted primary stroke centers in a non-urban region in Germany participated. Acute ischemic stroke patients for whom the decision to pursue thrombectomy had been made, were either treated by a Flying Intervention Team (an interventionist and a nurse flown by a dedicated helicopter to the primary stroke center to perform thrombectomy on site), or were transferred to the closest referral center. Enrollment was between 2018-02-01 and 2019-10-24. In this secondary analysis, results of the modified Rankin Scale (mRS), Barthel Index, and mortality rate after 12 months were compared between groups.

Results:
Among 146 patients included, 70 received flying team care and 76 were transferred. Functional outcome (ordinal mRS) after 12 months was significantly improved in the FIT group (acOR, 1.96; 95% CI [1.05-3.69]; p = 0.036). No significant differences were found for Barthel Index in surviving patients and mortality rate.

Conclusion:
Deployment of a Flying Intervention Team was associated with significantly improved functional outcome at 12 months. FIT should be considered as a system of care for primary stroke centers with adequate infrastructure and sufficient experience in stroke management onsite.
Abstract HUP18: The Diversity, Inclusion, And Equity Lessons Learned From Developing A Culturally Competent Community Stroke Education Program For Asian American Minorities In West Michigan
Authors: Anderson Taylor R , Ngo Vincent , Park Sojung , Antonio Aileen , Farooq Muhammad U , Koehler Tracy , Gorelick Philip B
Published: February 2023

Introduction:
Asian Americans in the United States have well-documented healthcare disparities. The presence of multiple subgroups with distinct cultures and languages adds to the complexity of caring for these patients. We describe our journey in expanding diversity, equity, and inclusion (DEI) practices through the process of developing a stroke education program for Asian American minorities in West Michigan are discussed here.

Methods:
Educational materials were tailored towards specific Asian American minorities. These were developed with the assistance of community navigators familiar with each targeted language and culture to ensure cultural competency of materials. Regular meetings with patient navigators helped us understand the culture and needs of each target population. The use of written language was limited to avoid misinterpretation and to be inclusive of illiterate participants. Graphics were simplified to allow for better understanding. Frequent debriefing sessions were held throughout the planning and implementation phases to reflect on DEI insights learned during the process.

Results:
The educational materials have been used in 2 different sessions with Vietnamese and Chinese groups. A total of 35 non-English speaking participants have been involved in educational sessions to date. Feedback from participants included difficulty in navigating Emergency Medical Services, and strategies were suggested to empower participants so they may receive the highest standard of stroke care. Participants also requested further education regarding stroke risk factors, which was provided. Misconceptions regarding stroke care were discussed and clarified.

Conclusions:
DEI insights learned during the process of developing stroke education sessions for Asian Americans stress the importance of this education during medical training so that healthcare professionals can deliver equitable healthcare.
Abstract HUP3: Addressing Social Determinants Of Health In An Urban Safety Net Hospital A Quality Improvement Initiative
Authors: Onuigbo Chiamaka , Patel Harsh , Porrey Kelly , Frankel Michael R , Navalkele Digvijaya
Published: February 2023

Introduction:
Over 10% of stroke survivors have a recurrent stroke, and studies indicate that Black people have a higher risk of stroke recurrence. Social Determinants of Health (SDoH) are associated with a high incidence of stroke, and there is emerging data on recurrence. Grady Memorial Hospital serves this vulnerable urban population at high risk of first and recurrent stroke. We sought to determine the prevalence of SDoH in our clinic population and address these unmet needs to reduce disparities.

Methods:
We implemented SDoH screening in the stroke clinic by training two medical assistants to fill out the SDoH questionnaire during patient check-in. Screening results were checked by the fellows/attending during the clinic visit. Social worker consultation was sought for unmet social needs. Data was collected in a prospectively maintained stroke clinic registry.

Results:
There were 131 patients seen between October 2021 and February 2022 in the stroke clinic. Of those, 108 patients (82%) were screened for unmet SDoH needs (financial, transportation, and food insecurity). Of the screened, 81% were black, the mean age was 55 years, 51% were male, and 59% were from economically at-risk or distressed communities. The mean duration from stroke onset to clinic visit was 12 months. Fifty-eight of the screened patients had at least one unmet need (54%), 30 had none (28%), and 20 were unknown (19%). Eighty-one percent (47/58) of patients with unmet needs had BP ≥130/80 (Odds ratio 2.47 CI 0.91-6.66, p =0.07). Most patients had financial insecurity (74%), followed by transportation needs (55%) and food insecurity (50%). Of the patients with unmet needs, 59% (n=34/58) reside in economically at-risk or distressed communities. 55% (32/58) of patients received resources to address these needs during the clinic visit.

Conclusions:
We found a high prevalence of unmet social needs in our stroke population, and the needs persisted for at least a year post-stroke. Screening and addressing unmet social needs should be incorporated as a routine follow-up post-stroke care. Systematic ways of assessing SDoH to address their effects on stroke recurrence and recovery should be done in larger studies.
Abstract HUP4: Svin Mt2020 + Global Mechanical Thrombectomy Access Barrier Score
Authors: Zevallos Mau Cynthia , Aroor Sushanth , Asif Kaiz S , Potter-Vig Jennifer , Menon Bijoy K , Inoa Violiza , Al-Mufti Fawaz , Herial Nabeel A , Urrutia Victor C , Yavagal Dileep , Ortega-Gutierrez Santiago
Published: February 2023

Introduction:
Mechanical thrombectomy (MT) is a highly safe and effective standard of care for acute ischemic strokes with large vessel occlusion. However, timely access to MT is extremely limited on a global scale, with vast disparities in access between countries. MT2020+, a global non-profit initiative of SVIN, aimed to create a semi-quantitative global MT access barrier score (MTABS) to objectively measure the barriers impeding the implementation of treatment worldwide.

Methods:
Four independent investigators performed an in-depth systematic literature review using the peer review of electronic search strategies. Barriers to access were identified and categorized into 3 groups: information and diagnostic, physical, and financial. An international expert panel was created and scored each attribute using a modified Delphi process with the assistance of consultants from the University of Calgary W21C. A 1-9-point scale was used, with 1 being not at all important and 9 being extremely important. A meeting was held for the attributes that require deliberation. After an agreement, a list of attributes for access was elaborated. Next, a ranking of importance and individual weighting was done. We assigned a presence of or lack of an attribute a numerical value (1 for yes, 0 for no) and multiply by its weight to determine a final score.

Results:
After an initial screening of 2864 abstracts, 121 studies were included in the final systematic review. A total of 34 possible attributes that are barriers to access were identified. After the modified Delphi process, 26 individual attributes were selected. The MTABS was made with possible results from 0-62 points, with higher scores meaning higher barriers to access to MT.

Conclusions:
The global MTABS represents the first tool to quantify barriers to MT access worldwide. Its implementation will objectively measure the magnitude and identify key barriers to guide regional public health interventions to improve MT workflow and access.
Abstract NS8: Predictors Of Complete Oral Feeding Resumption After Stroke Based On The Modified Volume-viscosity Swallow Test In A Rehabilitation Hospital
Authors: Ye Ting , Wenmin Wan , Zhou Huijun , Wei Hui , Fu Xiaolei , Ding Hongyan
Published: February 2023

Objective:
Although the importance of early tube feeding after stroke has been established, many risks and problems such as negative impacts on swallow function, respiratory infections and feeling uncomfortable, also warrant attention. The trajectory of swallowing function recovery may be related to each patient’s characteristics. There is still no systematic predictors for clinical decision-making regarding oral feeding resumption. The aim is to explore predictors of complete oral feeding resumption after feeding tube with stroke based on the modified V-VST.

Methods:
A total of 86 stroke patients with tube feeding were enrolled after admission in rehabilitation hospital from 2020 to 2021. The swallowing function was screened with modified V-VST. If a patient complete every viscosity more than 5ml, feeding tube will be removed. Oral feeding was begun using mechanical soft diet and thickener to ensure every meal safe. 55 patients(63.95%) resumed complete oral intake, while 31 patients(36.05%) presented a more permanent way of tube feeding. We compared the baseline and clinical characteristics between the groups. To analyze oral feeding resumption probability, the Kaplan-Meier method was used.

Results:
The days of onset to rehabilitation hospital admission was significantly shorter in the complete oral resumption group(20.89±11.27 vs 37.16±27.37; P<0.001). The group was also measured better performance in activities of daily living (Barthel Index). Patients in the tube feeding group have high rate of previous stroke. Kaplan-Meier estimated oral feeding resumption rates, patients with longer days(>21days) tolerated tube feeding longer.(P<0.001).

Conclusion:
Days of onset to rehabilitation hospital was the strongest predictor of complete oral feeding resumption. Patients might benefit from early recovery in rehabilitation hospital and start oral intake as early as possible.
Abstract NS9: When STK-OP-1 Surprises You... And So Does Your Large Vessel Occlusion Screening Tool!
Authors: Werner Amanda
Published: February 2023

Background:
STK-OP-1 is a relatively new measure that captures the transfer times for all patients transferring out of their presenting facility. The measure encompasses all reasons for transfer and is broken into sub-categories to highlight each patient population that requires care elsewhere. While it has been established that timely and rapid transfer for acute stroke intervention is essential and improves outcomes, the STK-OP-1 measure may be misleading without detailed case review.

Purpose:
What each facility does with the data from STK-OP-1 is dependent upon the patient population being reviewed and workflows that impact that population. The STK-OP-1d and STK-OP-1g measures focus on patients eligible for mechanical thrombectomy who need to transfer to a facility offering that service. In a center that does not offer thrombectomy, use of a large vessel occlusion (LVO) tool may not only increase the number of patients identified but also improve transfer times.

Methods:
STK-OP-1d and STK-OP-1g cases from two Primary Stroke Centers and their licensed freestanding emergency departments were reviewed following LVO tool implementation in 2019. Updates to use of the LVO tool in 2020 included early activation of the region’s rotor crew with positive LVO findings. Transfer times for thrombectomy eligible patients and volumes of identified LVO patients were compared from 2019 through 2022.

Results:
Review of transfer times reflected marked improvement in times for those patients meeting criteria for STK-OP-1d and STK-OP-1g. Following the 2020 workflow updates, the volumes of patients identified also improved. In 2019, there were 7 LVO patients with a median transfer time of 117 minutes. In 2020, there were 9 LVO patients with a median transfer time of 98 minutes. In 2021, there were 17 LVO patients and median transfer time was 93 minutes. For 2022, it is projected there will be 24 transfers with a median transfer time of 95 minutes.

Conclusions:
In conclusion, further differentiating the STK-OP-1 measure by treatment eligibility highlights those patients that require time sensitive interventions. Implementation of an LVO tool in centers with thrombectomy capabilities can improve the number of LVO patients identified and also support more expeditious transport.
Abstract TMP101: Post-stroke Cognitive Impairment And The Risk Of Recurrent Stroke And Death: Systematic Review And Meta-analysis
Authors: Dowling N. Maritza , Johnson Skylar , Power Melinda , Nadareishvili Zurab
Published: February 2023

Post-stroke cognitive impairment (PSCI) occurs in 20-40% of patients 3-6 months after stroke. However, the question regarding risks of recurrent stroke and death in patients with PSCI remains controversial. The goal of this study was to conduct meta-analysis of published literature to estimate the risks of stroke recurrence and death associated with PSCI, as well as to assess the quality of these studies, and to identify sources of variation. Electronic databases (PubMed, EMbase, Google Scholar, Cochrane Library, and Scopus) were screened for eligible studies published from 1992 to 2019. Study quality was assessed using the Newcastle Ottawa Scale. Risk of bias in non-randomized and randomized studies was assessed using ROBINS-E and RoB 2 tools, respectively. Funnel plots and selection models were used for evaluating publication bias. Heterogeneity was assessed using a combination of statistics:

I
2

,
Q
-statistic, and Kendall

τ
2
.

Estimates were obtained using a random effects model and restricted maximum likelihood estimation. Pooled estimates for the two outcomes of interest were calculated as hazard ratios (HR) with 95% confidence intervals (CIs). We included eight studies examining the effect of PSCI on risk of stroke recurrence. We found no evidence of potential publication bias among the included studies in stroke recurrence (χ
2
=3.440, p=0.487) and mortality (χ
2
=3.797, p=0.150). Pooled data from the eight studies involving n=1,840 PSCI and n=5,824 non-PSCI showed that the hazard of recurrent stroke risk was significantly higher in individuals with PSCI compared to non-PSCI participants (HR = 1.71; 95% CI: 1.45 - 2.01;

I
2

= 0%). Seventeen studies were included examining the impact of PSCI on mortality risk. The pooled data from these studies comprised n=7,591 PSCI and n=22,328 non-PSCI study participants. The pooled hazard of mortality was significantly higher in the PSCI group relative to the non-PSCI group (HR = 1.98; 95% CI: 1.64 - 2.40;

I
2

= 82.95%). This meta-analysis shows an increased risk of mortality and recurrent stroke in patients with PSCI. Post-stroke cognitive testing may identify patients at a higher risk of stroke recurrence and death who may require more aggressive interventions for secondary prevention.
Abstract TMP107: Detection Of Cerebral Artery Vasospasm In Transcranial Doppler Using Artificial Intelligence Based On Convolutional Neural Network
Authors: Kim Yong-Jae , Go DongWoon , Kim Ilwoong , Kim Joohwan , Park Yosub
Published: February 2023

Purpose:
Detection of cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (SAH) is imperative as this is one of the main determinants of delayed cerebral ischemia and poor neurological outcome. A transcranial Doppler (TCD) is a noninvasive device that can effectively detect CV. However, accurate interpretation of a TCD-based CV is time-consuming and demands expertise, and thus is underused in clinical practice. Artificial Intelligence (AI) models can assist in interpretation, reducing subjectivity, and speeding up the detection of CV.

Methods:
We conducted an automated method using neural networks to detect CV from TCD audio signal, obtained as short sequences of 3-5 seconds. A convolutional layer-based neural network is constructed that receives preprocessed two-dimensional data and estimates the peak systolic, end-diastolic, and mean blood flow velocity. Data were classified into three categories: normal, CV, and hyperemia.

Results:
2,292 audio files, from 173 test data of 19 patients in the SAH registry were analyzed. Of these, the training dataset was comprised of 1,727 doppler wave files, the remaining 565 files were evaluated for validation using the proposed classifier. The ground truth was vascular neurologist’s previously reported TCD diagnosis. The accuracy for CV was 0.91, the precision was 0.90 and the sensitivity was 0.95. The area under the curve of CV discrimination was 0.97 and the f1 score was 0.93.

Conclusion:
The results show that the deep learning method can be used for accurate analysis and interpretation of CV based on audio signal analysis of TCD spectra. This novel AI-assisted interpretation may facilitate the diagnostic accuracy of TCD for the detection of CV.
Abstract TMP110: Elezanumab Decreases Neuronal Damage And Improves Functional Recovery In A Rabbit Model Of Permanent Middle Cerebral Artery Occlusion
Authors: Smith Elaine , Dreher Ingeborg , Droescher Mathias , Hooker Bradley A , Mollon Jennifer , Zhang Xiaomeng , Jacobson Peer B
Published: February 2023

Introduction:
Current acute interventions for ischemic stroke aim to restore perfusion of affected tissue. There is an unmet need for therapies that protect neurons from ischemic damage and/or enhance natural repair processes to restore function. In humans, the neuronal growth and survival inhibitor RGMa (repulsive guidance molecule A) is upregulated following ischemic stroke. Elezanumab is a novel, humanized monoclonal antibody targeting RGMa. Preclinical evidence in traumatic and ischemic models of CNS damage suggest a protective and regenerative mechanisms for elezanumab following CNS damage.

Methods:
Elezanumab was evaluated in a rabbit permanent middle cerebral artery occlusion (MCAO) model of acute ischemic stroke by injection of an autologous blood clot. In replicate experiments, elezanumab (1, 10 and 40 mg/kg) or IgG control was administered 6 hours post occlusion or 24 hours post occlusion (10 mg/kg). Animals were dosed weekly through 28 days. Functional ability was assessed using the Neuromotor Score, a composite of sensorimotor performance tasks. Ex vivo MRI, histology, and fluid biomarker analyses were performed.

Results:
MCAO consistently reduced cerebral blood flow by ~60% and resulted in neuromotor dysfunction. All doses of elezanumab demonstrated statistically significantly improved neuromotor function and recovery rate versus controls when dosed 6 hours post occlusion. The 10 mg/kg group dosed 24 hours post occlusion did not show a statistically significant functional improvement versus controls. Infarct volumes, plasma neurofilament light chain levels, and histological evidence of microglial proliferation were all significantly reduced with elezanumab treatment versus controls, including in the delayed elezanumab treatment group.

Conclusions:
Elezanumab treatment was associated with improved functional recovery and reduced markers of neuronal damage. Collectively, these data support a neuroprotective role for elezanumab in this translational model of acute ischemic stroke. Elezanumab is now being tested in a Phase 2a clinical trial for acute ischemic stroke.
Abstract TMP114: Modulation Of P75ntr Improves Neuroprotection Following Ischemic Stroke
Authors: Mirzahosseini Golnoush , Ismael Saifudeen , Salman Mohd , Ishrat Tauheed
Published: February 2023

Background:
Stroke is a serious cause of mortality in the United States. Tissue plasminogen activator (tPA) is the only effective drug. However, it increases the risk of cerebral hemorrhage due to its narrow therapeutic window. Previous studies have shown the role of neurotrophins in several brain diseases. P75
NTR
which is the receptor of tumor necrosis family is highly expressed in stroke and associated with neuronal apoptosis. Downregulation of p75
NTR
attenuates brain injury. This study aims to find the role of p75
NTR
in the outcome of stroke.

Methods:
Two different sets of experiments were performed.
1.
Young adult C57BL/6 mice were subjected to ischemic stroke using intraluminal suture model. P75
NTR
modulator (LM11A-31) was administered following stroke. Brain samples were collected 24 hours after injury.
2.
Young adult C57BL/6 and p75 heterozygous mice were subjected to stroke using Rose Bengal photothrombotic method. Mice were tested for neurobehavioral analysis and samples were collected 72h after stroke.

Results:
We found that administration of LM11A-31 significantly reduced infarction volume, edema, and hemorrhagic transformation 24h after stroke in mice. Also, LM11A-31 reduced several inflammatory markers including tumor necrosis factor- alpha (TNF-α), nuclear factor kappa-light-chain (p-NFκb/t-NFκb), and c- Jun N-terminal kinases (p-JNK/t-JNK), and significantly increased the expression of several anti-inflammatory signaling, including protein kinase B (p-Akt/t-Akt) and extracellular signal-regulated kinase ½ (p-ERK1/2/t-ERK1/2) after stroke. Furthermore, we found that p75
NTR
heterozygous mice remarkably demonstrated less infarction, edema, and hemorrhagic transformation than wild-type mice after stroke. Moreover, p75
NTR
heterozygous significantly showed better motor function.

Conclusion:
This study suggests that p75
NTR
modulation can be a potential pharmacological target for improving the outcome of ischemic stroke.
Abstract TMP115: Inhibition Of S-nitrosoglutathione Reductase Mitigates The Acute Injury In A Mouse Model Of Stroke
Authors: Singh Inderjit , Khan Mushfiquddin , Qiao Fei
Published: February 2023

Background:
This project aims to evaluate the potential beneficial effects of a selective S-nitrosoglutathione reductase (GSNOR) inhibitor on post-acute stroke outcomes. Nitric oxide (NO) metabolome plays a critical role in stroke towards maintaining the crucial levels of deleterious peroxynitrite (ONOOO
-
) vs. beneficial S-nitrosoglutahione (GSNO). The homeostasis of endogenously-produced-GSNO following stroke is altered due to aberrantly increased activity of GSNO-degrading enzyme GSNOR. GSNO’s role in the context of stroke is recognized as anti-inflammatory, neuroprotective and neurorestorative. Therefore, we investigated the efficacy of a new and orally bioavailable GSNOR inhibitor N91115 (cavosonstat) in a mouse model of transient cerebral ischemia and reperfusion (IR).

Methods:
To determine the neuroprotective efficacy of GSNOR, a wild-type mouse model of middle cerebral artery occlusion (60 min) and reperfusion was used. N91115 (1 mg/kg body weight) was administered orally initially at 2 h after the reperfusion and the same treatment dose was repeated once a day for 3 consecutive days. The animals were evaluated for brain infarctions, neurological deficits, nitroxidative stress and the activity/expression of GSNOR. The study was validated in a GSNOR knock-out (KO) mouse model of IR.

Results:
The post-injury treatment with N91115 reduced brain infarctions and edema and improved survival and functional outcomes. The treatment also decreased the IR-induced GSNOR activity and the levels of injurious peroxynitrite. The significance of GSNOR inhibition-based mechanisms in neuroprotection was supported by a GSNOR KO mice study, showing significantly reduced brain infarctions and decreased neurological deficits following stroke.

Conclusion:
The study shows the neuroprotective and functional recovery potential of orally administered N91115 through the inhibition of GSNOR. Based on the safety profile in humans, favorable pharmacokinetics and neuroprotective efficacy in an animal model of stroke, N91115 seems to be an ideal small molecule drug to be investigated in stroke patients.
Abstract TMP120: Transcriptomic Analysis Reveals Common Age Independent Immunomodulatory Proteins As A Mode Of Neuroprotection In P2X4R KO Mice After Ischemic Stroke
Authors: Gamiotea Turro Daylin , Cronin Chunxia , Liang Bruce T , Verma Rajkumar
Published: February 2023

Background and Purpose:
Identification of a new potential drug target protein and their plausible mechanism for stroke treatment is critically needed. We earlier showed that genetic deletion as well as short term pharmacological inhibition of P2X4R, a purinergic receptor for adenosine triphosphate ATP, provides acute neuroprotection and thus can be potential drug targets to treat ischemic stroke. However, potential mechanisms remain unknown. Therefore, in this study, we employed RNA-seq technology to identify the gene expression profiles, pathways analysis and qPCR validation of differentially expressed genes (DEGs). This analysis will identify role of those DEGs in certain biological processes responsible for P2X4R dependent neuroprotection after stroke.

Methods:
We subjected young (8-12 weeks-old n= 4/group), and aged (12-18-month-old; n=8/group) male and female Global P2X4 KO and littermate WT mice to right middle cerebral artery occlusion MCAo for 60 min followed by 3 day of reperfusion. After 3 days, mice were sacrificed and prefrontal cortex tissue was isolated to extract total RNA using Trizol and used for RNA-seq sample preparations as well as for validation by Nanostring mediated qPCR technique. DESeq2 and Gene Ontology (GO) and /or Ingenuity Pathway Analysis (IPA) were used to identify mRNA transcript expression profiles and biological pathway. qPCR was analyzed with nSolver Data Analysis Support system.

Results:
We found 2246 DEGs in P2X4R KO vs WT tissue after stroke. Out of these DEGs 1920 gene were downregulated and 325 genes were upregulated in KO. GO/IPA analysis of top 300 DEGs suggests an enrichment of ion channel transport system, inflammation and extracellular matrix component genes. QPCR validation of top 30 DEGs revealed down regulation of two common age independent genes: Lnterleukin-6 (
IL-6)
, an inflammatory cytokine and Cytotoxic T Lymphocyte-Associated Protein 2 alpha (
Ctla2a
), an immunosuppressive factor KO group.

Conclusion:
This data suggests P2X4R mediated neuroprotection after stroke is brought by attenuation of immune modulatory pathways in both young and aged mice of both sexes. Future studies will delineate the detailed role of
IL-6
and
Ctla2a
in P2X4R mediated neuroprotection mechanisms after stroke.
Abstract TMP19: Development Of A Pediatric Stroke Dashboard To Assess Pediatric Stroke Metrics Across A Fourteen Hospital Healthcare System In Southern California
Authors: Urbayan Carmen , Rho Howard J , Han Paul , Lewis Keith , Punsalang Lorina , Gaffney Denise , Sangha Navdeep S
Published: February 2023

Background:
Delays in pediatric stroke recognition and treatment are significant factors contributing to the high rate of morbidity and mortality. There is a lack of national standards for pediatric stroke quality measures. We created a dashboard to abstract pediatric stroke data, including patient volume and established quality measures, from our organization’s 14 hospitals.

Methods:
The regional pediatric stroke dashboard was created using the organization’s existing adult stroke dashboard as a template. The monitoring system was designed using PowerBI™ and Microsoft Suite™. Dashboard elements were modified to capture pediatric stroke demographics and quality indicators identified by the region’s multidisciplinary pediatric stroke workgroup. Data were abstracted using the organization’s electronic medical record system.

Results:
The dashboard provides a regionwide, visual representation of this organization’s pediatric stroke data. It is an automated and systematic graphic report describing pediatric stroke volumes and quality metrics. Between 1/2021-6/2022, there were 39 stroke cases: 15% subarachnoid hemorrhage(6/39), 56% intracerebral hemorrhage (22/39), 28% ischemic (11/39). Nine percent of ischemic strokes received a thrombolytic (1/11); 27% had thrombectomy (3/11); 54% were discharged to home (21/39) with no mortalities. The median age was 7.5 years and 66.7% were female. Future dashboard elements will include times for door-to-initial physician evaluation, door-to-Stroke Team notification, door-to-CT or MRI interpretation and door-to-lab results.

Conclusion:
The Pediatric Stroke Dashboard is an important component of the organization’s regional Pediatric Stroke Program. Leveraging this technology to track and trend the patient volumes and performance measures allows for continuous assessment and identification of opportunities for improvement to achieve pediatric stroke care excellence.
Abstract TMP20: Performing The Pediatric National Institutions Of Health Stroke Scale Over Televideo: A Pilot Study
Authors: Pabst Lisa , Chung Melissa G , Murray Thomas , Hutchinson Melissa , Zha Alicia , Lo Warren D
Published: February 2023

Introduction:
Telestroke networks are widely used by stroke neurologists to rapidly assess adults presenting to remote facilities with suspected acute stroke. Televideo assessment of acute neurological deficits in children is potentially useful for children who live in remote areas, but has not been studied. This study tested the feasibility of assessing the pediatric National Institutes of Health stroke scale (PedNIHSS) by televideo in children.

Methods:
Children ages 2-17 years with and without strokes were recruited and examined in the outpatient neurology clinic. The PedNIHSS was performed on each child by separate neurologists; one by televideo and the other at the bedside. The total PedNIHSS, subscores and time to complete each exam were recorded. Intraclass correlation coefficients (ICC) were used to analyze inter-rater reliability.

Results:
Twenty children were recruited with an average range of 9.2 years (range 2-17 years). Six children had chronic stroke. By bedside exam, the total PedNIHSS score ranged from 0-8 with a mean of 1.65. By televideo, the PedNIHSS total score was identical to the bedside examination in 12/20 (60%) of the children and identical or within 1 point in 19/20 children (95%). All total PedNIHSS were scored higher by the bedside vs remote examiner in cases where there was a difference. There was excellent overall inter-rater reliability (ICC=0.92; 95% CI: 0.81, 0.97) for the total PedNIHSS when comparing bedside and video exams. In the subgroup of children less than 6 years of age, ICC was 0.88 (95% CI: 0.44-0.98). The PedNIHSS subscores with lowest reliability between exams were dysarthria, ataxia and sensory change. The average time to complete the bedside and remote examinations were 5 minutes and 7 minutes, respectively.

Conclusions:
It is feasible to perform the full PedNIHSS over televideo with reasonable accuracy and in a similar amount of time as compared to bedside evaluations. Limitations of this study include a small number of patients and overall low burden of neurologic deficits. Future studies focusing on children presenting with focal neurologic deficits in the acute care setting are needed to further determine the reliability of performing the PedNIHSS over televideo.
Abstract TMP22: Exploring The Impact Of Material Deprivation, Clinical, And Radiological Features On Neurological Outcomes Of Neonatal Stroke
Authors: Harris Madeleine Mary Rak , Pai Akshat M , Nichol Daniel , Musaphir Scherazad , Parthasarathy Sujatha , Slim Mahmoud , MacGregor Daune , Bhathal Ishvinder , Moharir Mahendranath D , Deveber Gabrielle A , Dlamini Nomazulu
Published: February 2023

Introduction:
Neonatal arterial ischemic stroke (AIS) is an important cause of neurologic disability in children. No research to date has examined the influence of determinants of health on outcomes in a neonatal AIS population. This study examined whether neighbourhood-level material deprivation was associated with long-term neurological outcomes in neonatal AIS patients, after accounting for the influence of clinical and radiological factors.

Methods:
Patients with neonatal AIS between 2004 and 2019 at a comprehensive stroke centre were included. The Ontario Marginalization Index (ON-Marg) was used to assess neighbourhood-level material deprivation. Participant postal codes were linked to census data and ON-Marg scores were reported. Neurological outcomes were assessed using the Pediatric Stroke Outcome Measure Severity Classification Scale (PSOM-SCS) at latest follow up (median = 49 months, range = 12 to 187 months). A poor outcome was defined as any neurologic deficit (i.e., mild, moderate, or severe). Univariable and multivariable logistic regression models were developed.

Results:
Amongst 154 participants, the majority of scores (66.23%) were within the normal range. Remaining participants demonstrated neurological deficits, including 25.97% mild and 7.79% moderate-to-severe. Predictors of poor outcome in the multivariable model included hemiparesis at stroke presentation (OR = 12.81, p < 0.05) and basal ganglia involvement (OR = 3.68, p < 0.05). Neighbourhood-level material deprivation was not significantly associated with poor outcome.

Conclusions:
Hemiparesis and basal ganglia involvement are important in determining long-term outcomes. Although material deprivation was not associated with poor outcomes in our study, it may be associated with neurological outcomes at later ages. Further research is needed to understand the role of socioeconomic factors in a neonatal stroke population, including the measurement of individual-level indicators and outcomes at later ages post-stroke. While outcomes after neonatal stroke are generally favourable, identifying predictors of poor outcomes may assist clinicians in developing a more precise risk evaluation regarding recovery after stroke.