bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP91: Prediction of Recurrent Embolism and Major Hemorrhage in Patients With Acute Stroke and Atrial Fibrillation by Risk Stratification Schema: The Alessa Score Study
Authors: Paciaroni Maurizio ,   RAF Study Investigators
Published: June 2021

Background:
We aim to derive and validate a score that predicts early ischemic events or major hemorrhage in acute stroke patients with atrial fibrillation (AF).

Methods and results:
The derivation cohort consisted of 854 patients with acute ischemic stroke and AF (mean age 76.3 y, 46.6% M) included between January 2012 and March 2014. Older age (HR 1.06 for each additional year, p=0.0025) and severe atrial enlargement (HR 2.05, p= 0.027) resulted being predictors for recurrent ischemic event (stroke, TIA, systemic embolism) within 90 days from acute stroke. Small infarct size (≤1.5 cm) was inversely correlated with both severe bleeding (HR 0.39, p=0.03) and recurrent ischemic events (HR 0.44, p=0.01). Considering the magnitude of the effect, we assigned 2 points to age ≥80 y; 1 point to 70-79 y; 1 point to presence of ischemic index lesion >1.5 cm; 1 point to severe atrial enlargement (ALESSA score). An increase in this score was associated with recurrent ischemic event but not major hemorrhage. A logistic regression with the ROC graph procedure (C-statistic) showed an area under the curve of 0.697 (0.632-0.763), p=0.0001 for ischemic outcome event and 0.585 (0.493-0.678), p=0.47 for major hemorrhage. On multivariate analysis, ALESSA >2 was associated with recurrent ischemic event (OR: 2.5, 95% CI 1.4-4.4, p=0.001) but not major hemorrhage (OR: 1.1, 95% CI 0.5-2.4, p=0.9). The validation cohort included 994 patients with acute stroke and AF (mean age 75.8 y, 46.0% M) included between April 2014 and June 2016. Also in this cohort, a higher ALESSA score was associated with recurrent ischemic event but not major hemorrhage. Logistic regression with the ROC graph procedure showed an area under the curve of 0.646 (0.529-0.763), p=0.009 for recurrent ischemic event and 0.407 (0.275-0.540), p=0.14 for major hemorrhage. On multivariate analysis, ALESSA >2 barely lacked being significantly correlated with recurrent ischemic event (OR: 2.07, 95% CI 0.93-4.67, p=0.07).

Conclusions:
A higher ALESSA score is associated with a higher risk of recurrent ischemic event but not with major hemorrhage. Therefore, patients with acute stroke and AF and an ALESSA score >2 may be candidates for early anticoagulation treatment. Further validations of this schema need to be performed.
Abstract TP1: The Promising System to Support Rural Area Where No Intervenitionists to Perform Embolectomy for Acute Ischemic Stroke "Drive and Retrieve Method"
Authors: Osanai Toshiya
Published: June 2021

Introduction:
In Japan, endovascular treatment for acute ischemic stroke from large vessel occlusion should be performed by neurointerventionists. However, most hospitals in rural area , that offer treatment for cerebral vascular disease do not have access to a neurointerventionist; the rural areas are especially affected. Thus, Our University has offered support to institutions without a neurointerventionist, to perform endovascular treatment. The neurointerventionists stationed in other hospitals drive to retrieve the resultant clot since the acute ischemic stroke from large vessel occlusion. We called this the “drive and retrieve system” method, and launched the prospective trial to evaluate the validity and efficacy of this method. Herein, we report the initial results of this trial.

Methods:
Nine institutes across our affiliated hospitals within a one-hour drive from Sapporo City took part in this trial. Three of these 9 institutes that have a full-time neurointerventionist were registered as the source. When an episode of acute ischemic stroke requiring intervention occurred in the other 6 hospitals, the available neurointerventionist provided treatment based on the drive and retrieve method. The neurointerventionists’ schedules was updated and distributed to all participating units twice a week, so that the supported hospitals could immediately make contact when required. We analysis the data of 44 cases in this trial from July 2015 to April 2016.

Results:
For 41 out of 44 cases (93%), Neurointerventionaists were able to respond immediately. The median time from door-to-puncture was 90 min (interquartile range [IQR]: 72-125). The median time from puncture to recanalization was also 76 min (IQR: 57.5-99.5). The recanalization rate (TICI 2b/3) was 77 %. mRS 0-2 was 39%.

Conclusion:
The drive and retrieve system has the potential to support rural medical institutes that do not have access to a full-time neurointerventionist.
Abstract TP10: Clinical and Imaging Outcomes of Patients with Acute Ischemic Stroke and Mild Nihss Treated with Endovascular Therapy
Authors: Rebello Leticia C , Bouslama Mehdi , Haussen Diogo C , Grossberg Jonathan A , Belagaje Samir R , Bianchi Nicolas , Rangaraju Srikant , Schindler Kiva , Anderson Aaron , Frankel Michael , Nogueira Raul G
Published: June 2021

Background:
The minimal stroke severity justifying endovascular intervention remains elusive; however, a significant proportion of patients presenting with large vessel occlusions and mild symptoms subsequently decline and have poor outcomes. We evaluated clinical outcomes of patients presenting with mild symptoms (NIHSS≤8) undergoing endovascular therapy.

Methods:
Retrospective analysis of a prospectively collected ET database between September/2010-March/2016. Patients with mild symptoms (baseline NIHSS≤8) were included in the analysis. Primary and secondary efficacy outcomes were defined as the rates of good outcome (90-day mRS 0-2) and successful reperfusion (mTICI 2b-3), respectively. Safety outcome was accessed by rates of any parenchymal hematoma (PH-1 and PH-2) and 90-day mortality.

Results:
72 patients with baseline NIHSS≤8 we included in the analysis. Mean age in the overall cohort was 63.3 years (range, 56-69) and 39 patients were men (54%). The mean baseline NIHSS, CTP core volumes, and ASPECTS were 6.3±1.5, 7.5±16.1cc, and 8.5±1.3 respectively. A total of 28 patients (38%) received intravenous tPA. The occlusions were located as follows: proximal MCA-M1 in 29 (40%), MCA-M2 in 20 (27%), ICA terminus in 6 (8%) and vertebrobasilar in 9 patients (12%). Tandem occlusion was documented in 7 patients (9%). Successful reperfusion (TICI 2b-3) was achieved in 67 patients (93%) and 90-day good outcome in 52 (72%). The mean final infarct volume was 32.2±59.9 cc. Any parenchymal hematoma occurred in 4 patients (5%). The 90-day mortality was 9% (n=7). Logistic regression showed that only successful reperfusion (OR 27.7; 95%CI [1.1-655.5]; p=0.04) was an independent predictor of good outcomes.

Conclusion:
Our findings demonstrate a good safety profile for endovascular therapy in patients presenting with low NIHSS and proximal arterial occlusions. Future prospective controlled studies are warranted.
Abstract TP107: Timing of Stroke Risk Following Cervical Artery Dissection
Authors: Morris Nicholas A , Merkler Alexander E , Gialdini Gino , Kamel Hooman
Published: June 2021

Introduction:
Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection remains uncertain.

Methods:
We performed a crossover-cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005-2011 in California, 2006-2013 in New York, and 2005-2013 in Florida. Using previously validated
ICD-9-CM
codes, we identified patients with a cervical artery dissection and no prior or concurrent stroke diagnosis. Previously validated diagnosis codes were used to identify the primary outcome of ischemic stroke. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risks increases were calculated using a Mantel-Haenszel estimator for matched data. In a sensitivity analysis, we limited our population to only patients that presented with typical symptoms of cervical artery dissection in order to ensure we identified patients with acute dissection.

Results:
We identified 2,791 patients with dissection. The absolute increase in stroke risk was 1.25% (95% CI, 0.84-1.67%) in the first 2 weeks after dissection compared to the same time period 1 year later. The absolute risk increase was 0.18% (95% CI 0.02-0.34%) during weeks 3-4, and was no longer significant during the remainder of the 12 week post-dissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection.

Conclusions:
The increased risk of stroke following cervical artery dissection appears to be limited to the first 2 weeks.
Abstract TP111: Primary Angiitis of Central Nervous System . Clinical Profile and Outcome of Forty Seven Patients
Authors: Sylaja Pn , Sundaram Soumya , Menon Deepak , Sreedharan Sapna , ER Jayadevan , Sarma Sankara
Published: June 2021

Introduction:
Primary angiitis of central nervous system (PACNS) is a rare and serious disorder of uncertain cause, with significant morbidity and mortality.

Objective:
To determine the clinical profile, response to treatment and outcome in patients with PACNS.

Methodology:
This is retrospective study of 47 patients from January 2000 to Dec 2015 with either angiographically or biopsy proven PACNS. Outcome at 6 months was considered poor, if modified rankin scale was > 2. Relapse was defined as occurrence of new neurological deficits after clinical improvement, progression of existing disability or radiological worsening.

Results:
The median age at diagnosis was 36 years (IQR 17) and 33 (70.2%) were males. Twenty-nine patients (61.7%) had angiography positive, 14 patients (38.3%) had biopsy confirmed and 4 patients (8.5%) had both angiography and biopsy positive PACNS .Stroke was the initial presentation in 33 patients (70.2%) followed by rapidly progressive dementia in 11 patients (23.4%) and myelopathy in 3 patients (6.4%). After a median follow-up of 2.8 years (range 0.5-15) , poor 6 month outcome was observed in 12 (25.5%), relapse in 24 (51.1%) and mortality in 3 (6.4%) patients. The median delay from onset of symptoms to start of immunosuppressive medication was 3.5 months (0.5- 63).More number of patients in the delayed treatment group had relapse compared to the early treatment group (59.1% vs 52.2%, p= 0.76). Among the 34 patients who received steroids as the initial treatment, 61.8% had relapse, whereas in patients on steroid with cyclophosphamide, only 38.5% had relapse (p=0.176). Of the 25 patients with abnormal CSF, 16 (64%) had relapse (p=0.209) and of the 18 patients with abnormal meningocortical biopsy, 15 patients (83.3%) had relapse. The NIHSS at admission > 5 (p=0.046), and presence of severe small vessel ischemic changes in MRI (p= 0.04) were predictors of relapse.

Conclusion:
PACNS is a rare disease with delayed diagnosis. Severity of neurological deficit at presentation and presence of severe small vessel ischemic changes in MRI were predictors of future relapse.
Abstract TP113: Intracranial Atherosclerotic Stenosis Prevalence in a North American Stroke Population
Authors: Li Yongkun , Malhotra Konark , Woolf Graham W , Hinman Jason D , Raychev Radoslav , Sharma Latisha K , Kim Doojin , Rao Neal M , Saver Jeffrey L , Scalzo Fabien , Liebeskind David S
Published: June 2021

Background and Purpose:
Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke especially in Asia, but little is known about its prevalence in ischemic stroke patients in North America. We studied the prevalence of ICAS in a single comprehensive stroke center leveraging the routine acquisition of MRI and MR angiography (MRA).

Methods:
We retrospectively reviewed patients with ischemic stroke and transient ischemic attack who were admitted within seven days of onset from Jan 2014 to July 2016. Patients we excluded: 1) Age <18 years; 2) without intracranial angiography; 3) overt cardiogenic occlusion or risk factors. Data were retrieved including demographics, vascular risk factors, brain imaging including MRA, CTA, and /or DSA, and prior medical prevention of stroke. ICAS was defined as the proximal atherosclerotic stenosis or occlusion ≥50% in diameter. We estimated the prevalence of ICAS at this single stroke center.

Results:
685 included patients were aged 20 to 101 years, 384(56.1%) were men, 520 (75.9%) were white, and 74(10.8%) were black. ICAS was prevalent in 41.6% of

all included patients. Univariate analysis indicated that the prevalence of ICAS was significantly increased along with age, it was 39.3% for 41-60 years, and 43.8% for 61-80 years (P=0.034). But no significant difference was found between different races, it was 40.8% in Whites, and 40.5% in Blacks, and other races were 47.3%. Patients with ICAS had more severe stroke (NIHSS>3 vs NIHSS≤3: OR 2.729; 95%CI: 1.748-4.260; P<0.001). Higher levels of high-density lipoprotein cholesterol were associated with decreased odds of ICAS (OR 0.981; 95% CI: 0.968-0.995; P<0.006). Our data did not show hypertension, dyslipidemia and body mass index and smoking were associated with ICAS.

Conclusions:
The prevalence of ICAS in North America may be much higher than previous estimates. The impact of this common cause of recurrent stroke warrants further study, even in populations were cardiogenic embolic risk is common.
Abstract TP118: Recanalization After Extracranial Dissection Stratified by Medical Treatment: Antiplatelets versus Anticoagulation
Authors: Ramchand Preethi , Mullen Michael T , Bress Aaron , Messe Steven R
Published: June 2021

Objective:
Dissection is a leading cause of stroke in young adults, though optimal antithrombotic management with either anticoagulation or antiplatelet therapy remains controversial. Existing data have focused on recurrent stroke but these studies have been underpowered. We aimed to assess recanalization rates for patients treated with anticoagulants compared to those treated with antiplatelet agents and to identify factors associated with vessel recanalization.

Methods:
We performed a retrospective, single center, cohort study, identifying patients with extracranial carotid or vertebral dissection, with acute and follow up imaging, over a 15 year period. Vessel stenosis was measured using NASCET methodology. Anticoagulation was defined as treatment with therapeutic Heparin or warfarin for greater than 50% of the first month. Univariable and multivariable analyses were performed to determine clinical, demographic, and radiographic factors associated with ≥ 50% relative recanalization at follow up.

Results:
We identified 75 patients with 84 dissections, mean age 47± SD 15, 43% female, 39% non-white. The rate of recurrent strokes was 2.7% in the entire cohort, which was not significantly different between treatment arms (p=0.35). Median time from symptom onset to first vessel imaging was 1 day (interquartile range [IQR] 0-6) and median time to follow up imaging was 4 months (IQR 3-7) after symptoms. Patients with higher percent stenosis at baseline were more likely to be treated with anticoagulation (median 99% vs. 50%, p=0.02). Comparing anticoagulation to antiplatelet therapy, there was no difference in the rates of ≥50% relative recanalization (50% vs 48%, p=0.84), nor in the absolute change (median 16% vs 7%, p=0.34) nor relative change (median 48% vs 43%, p=0.92) from baseline. In a multivariable model, antithrombotic therapy was not significantly associated with ≥ 50% recanalization. Hypertension was the only significant variable and was negatively associated with the outcome (OR 0.26, 95% confidence interval 0.09 - 0.72, p=0.009).

Conclusions:
Use of anticoagulation did not result in higher rates of recanalization, suggesting antiplatelet therapy is sufficient for the majority of patients with acute extracranial dissection.
Abstract TP12: Comparison of 3D Stent Retriever to Solitaire in Patients with Small Ischemic Cores: An Analysis of the Penumbra 3D Trial
Authors: Siddiqui Adnan , Frei Donald , Yoo Albert J , Soulimani Ghita , Buell Hope , Kuo Sophia S , Mualem Elan , Barraza Leticia , Bose Arani , Sit Siu Po , Nogueira Raul ,   for the Penumbra 3D Investigators
Published: June 2021

Introduction:
A recent meta-analysis of four randomized controlled trials (RCTs) concluded that mechanical thrombectomy using Solitaire for large vessel ischemic stroke was effective with significantly reduced disability.

Hypothesis:
Our hypothesis was that treatment with the Penumbra Aspiration System and the novel 3D Stent Retriever would demonstrate similar angiographic and functional outcomes compared to use of Solitaire.

Methods:
The 3D trial was a RCT to compare the safety and effectiveness of the 3D Stent Retriever when used with the Penumbra Aspiration System (3D/PS) compared to the PS alone. Inclusion criteria for the 3D RCT included presentation with NIH Stroke Scale ≥ 8 and refractory to or not eligible for IV rtPA. Analysis compared reperfusion to mTICI 2b or 3 and functional independence (mRS 0-2 at 90 days) in a 3D Trial cohort with ASPECTS 8-10 vs the meta-analysis data reported by Campbell et al (
Stroke
2016).

Results:
One hundred four (104) of 198 patients met analysis criteria. Baseline ASPECTS (median [IQR]) were similar between the 3D Trial ASPECTS 8-10 cohort (3D/PS, PS, combined: 9 [8,10]) and Campbell group (9 [7,10]). Substantial reperfusion (mTICI 2b or 3) was experienced in 84.6% (44/52) of 3D/PS and 75.0% (39/52) of PS alone cases, similar to the Campbell group (76.6%). When both arms were pooled, results (79.8%) were also similar to Campbell. With regards to functional independence, both 3D cohorts and pooled trial results showed similar rates compared with Campbell (Figure).

Conclusions:
The novel 3D Stent Retriever + Penumbra System and the Penumbra Aspiration System alone showed similar reperfusion and functional outcomes compared to Solitaire.
Abstract TP120: A Novel Potential Therapy in Severe Stroke: Neuroprotective Chlorpromazine/Promethazine Combination in Transient and Permanent Ischemia
Authors: Rastogi Radhika , Geng Xiaokun , Ding Yuchuan
Published: June 2021

Background and Purpose:
Previous studies have demonstrated depressive or hibernation-like roles of phenothiazine neuroleptics [combined chlorpromazine and promethazine (C+P)] in brain activity. This ischemic stroke study aimed to establish neuroprotection by reducing oxidative stress and improving brain metabolism through post-ischemic C+P administration.

Methods:
Sprague-Dawley rats (n=272) were subjected to transient (2 or 4 h) middle cerebral artery occlusion (MCAO) followed by 6 or 24 h reperfusion, or permanent (28 h) MCAO without reperfusion. At 2 h after ischemic onset, rats received either an intraperitoneal (IP) injection of saline or two doses of C+P. Body temperatures, brain infarct volumes, and neurological deficits were examined. Oxidative metabolism and stress were determined by levels of ATP, NADH, and reactive oxygen species (ROS). Protein kinase C-δ (PKC-δ) and Akt expression were determined by Western blotting.

Results:
In both transient and permanent ischemia models, C+P administration significantly induced a dose-dependent reduction in body temperature and neuroprotection within as early as 5 min and lasting up to 12 h. Body temperature reduction either only slightly or did not enhance C+P-induced neuroprotection, as determined by infarct volumes and neurological deficits post-stroke. C+P therapy improved brain metabolism as determined by increased ATP levels and NADH activity, as well as diminished ROS production. These therapeutic effects were associated with alterations in PKC-δ and Akt protein expression.

Conclusions:
C+P treatments conferred neuroprotection in severe stroke models by suppressing the damaging cascade of metabolic events, most likely independent of drug-induced hypothermia. These findings may direct us towards the development of an efficacious, practical, and accessible neuroprotective therapy in stroke patients.
Abstract TP131: Use of Fixed-Dose Heparin Protocol for Carotid Angioplasty and Stenting in Patients with Symptomatic Carotid Stenosis
Authors: Suri,MD M. Fareed K. , Miran,MD Muhammad Shah , Riaz,MD Ahmed , Afzal, MD Mohammad Rauf , Lobanova, MD Iryna , Qureshi,MD Adnan I
Published: June 2021

Introduction:
Appropriate dosing of anticoagulation during carotid angioplasty and stenting remains unstudied. Although 70 units /kg is a commonly used dose, in patients with acute stroke, this dose may increase the risk of hemorrhagic transformation. We report safety of a novel low fixed-dose protocol in patients treated with CAS after recent ischemic event.

Methods:
All patients who underwent carotid angioplasty and stenting after or during a recent admission with acute ischemic stroke, at a tertiary care hospital, from Jun 2012 to August 2015 were retrospectively identified from a prospectively maintained database. A dose of 25 u/kg was used if patient had a recent infarct on imaging, or in case imaging cannot rule out an acute infarct, a recent clinical stroke. In other patients a dose of 50 u/kg was used. Activated clotting time (ACT) was checked in all patients at the time of stent deployment.

Results:
CAS was performed in 59 patients (mean age 71.3+/-13.3, 68% men) as per fixed-dose heparin protocol. Procedure was performed within 48 hours, 48 hours to 7 days, and after 7 days of the event in 18, 15 and 26 patients, respectively. Clinical characteristics of patients in three groups are shown in table. Only 2 patients suffered transient ischemic event and 1 patient suffered minor stroke during hospitalization. No patients suffered any hemorrhagic complication or death.

Conclusion:
A fixed low dose heparin protocol during carotid angioplasty and stenting ay be safe and effective, especially in patients with recent ischemic stroke.
Abstract TP133: Interactive Development of Direct and Indirect Bypass After Combined Revascularization for Moyamoya Disease: The Significance of Indirect Bypass
Authors: Tokairin Kikutaro , Uchino Haruto , Kazumata Ken , Ito Masaki , Nakayama Naoki , Houkin Kiyohiro
Published: June 2021

Background & Purpose:
The additional effects of indirect bypass on combined revascularization surgery in moyamoya disease (MMD) remain unclear. Our purpose in this study is to evaluate how direct and indirect bypass in combined revascularization change through long term follow up and to analyze the clinical factors or hemodynamic parameters involved in these changes.

Methods:
A retrospective survey was conducted with a sample size of 97 hemispheres from 69 consecutive patients (43 adults and 26 children) with MMD treated by combined revascularization. We used magnetic resonance angiography (MRA) to evaluate bypass development with the diameters of superior temporal artery (STA) for the direct bypass and middle meningeal artery (MMA) and deep temporal artery (DTA) for the indirect bypass. A multivariate logistic regression analysis was used to study the related multiple variables on bypass development.

Results:
Good indirect bypass indicated by MMA development was seen 78% of the adult hemispheres and 95% of the pediatric ones. Dual development of direct and indirect bypasses was most frequently observed (47% and 56% of the adult and pediatric hemispheres, respectively). When indirect bypasses developed, 28% of the STAs reduced in diameter reciprocally from the acute to the chronic phases after surgery. The development of indirect bypass was significantly better in the adult hemispheres at Suzuki stage 4 or greater (
P
=0.02; odds ratio 7.4, 95% confidence interval, 1.4-39.4). The disease onset type and the hemodynamic parameters were not associated with the development of surgical revascularization.

Conclusions:
Indirect bypass developed effectively in both adult and pediatric patients, even in the presence of direct bypass. The universal application of indirect bypass is considered an optimal surgical strategy to maximize revascularization in MMD.
Abstract TP145: Anodal 2mA Transcranial Direct Current Stimulation Over Affected Parietal-Insular-vestibular Cortex Shows No Effect on Lateropulsion Following Strokei
Authors: Babyar Suzanne , Santos-Pontelli Taiza , Will-Lemos Tenysson , Mazin Suleimy , Edwards Dylan , Reding Michael
Published: June 2021

Objective:
To assess the effects of 2mA transcranial Direct Current Stimulation (tDCS) over the affected Parietal-Insular-Vestibular Cortex (PIVC) on seated posture of patients with lateropulsion following stroke. We hypothesized that bilateral electrode placement over PIVC (vs active control) would produce a change in seated posture.

Background:
Lateropulsion following stroke (Pusher Syndrome) is characterized by lateral displacement of subjective postural vertical toward the weak side. It is caused by lesions affecting vestibular projections to the Ventral Lateral Thalamus (VLT) or projections from the VLT to the Parietal-Insular-Vestibular Cortex (PIVC).

Methods:
Seventeen subjects with Burke Lateropulsion Scale scores ≥ 2 within 30 days of an ischemic stroke signed an IRB-approved consent. They received 2mA tDCS delivered using 25cm
2
saline soaked sponge electrodes via one of two montages: Test (anode over the affected PIVC and cathode opposite PIVC) versus Active Control (anode over the affected PIVC and cathode over the opposite supra-orbital region). PIVC was defined using EEG 10/20 coordinates. Seated medial-lateral center of pressure (COP-X) was measured using a custom-designed chair mounted on an AMTI™ analog-to-digital forceplate. An inclinometer strapped to the chest and aligned with the sternum measured lateral trunk tilt. Data were collected prior to, then at 5, 10, and 15 minutes during tDCS and 5 min following tDCS.

Results:
Repeated Measures Analysis of Variance rejected the hypothesis of an interaction between Montage and Time for: mean COP-X displacement (in) (Wilks’ λ
F
= 0.647
df
=(4, 13),
P
= 0.639); mean speed of COP-X (in/s) (Wilks’ λ
F
= 0.740
df
=(4, 13),
P
=0.581); mean inclinometer tilt (degrees) (Wilks’ λ
F
= 0.740
df
=(4, 13),
P
=0.581).

Conclusion:
Neither tDCS montage showed improvement in COP-X displacement, COP-X movement velocity or inclinometer readings. These negative results are important to encourage the development of alternative tDCS stimulation parameters or identification of alternative cortical or vestibular tDCS targets for the treatment of Lateropulsion Following Stroke.
Abstract TP148: Characteristics and Estimated Rehabilitation Costs for Stroke Survivors Treated in a Community-Based Interdisciplinary Outpatient Rehabilitation Program Who Return to Work
Authors: Breen Joan , Andrusin Jeanne , Ferlito Tom , Hobbs Samantha
Published: June 2021

Background:
Return to work is a motivating goal for many stroke survivors. Little is known about the cost, length of treatment, and characteristics of patients returning to work.

Methods:
Prospective observational study of stroke patients treated between 12/2014-6/2016 in an interdisciplinary outpatient rehabilitation program addressing physical, psychosocial, cognitive, communicative, driving, and vocational issues. The estimated average cost of treatment was calculated from reimbursement amounts received for skilled PT, OT, ST, and Nurse Practitioner services, including services received after patients returned to work.

Results:
Of 96 consecutive patients, 48% were working prior to their stroke. Of these, 9% of patients were work capable and 44% returned to work (n=20) by rehabilitation discharge (mean program length was 8 months, maximum of 34 months). Returning workers were 70% men, mean age of 56 years, 75% ischemic strokes (4 Left, 4 Right, 3 Bi-lateral hemisphere, 4 posterior circulation), and on program admit had an average NIHSS score of 3.4 (range 0-9), 40% were aphasic, 65% needed ADL assistance (55% mRS=3, 10% mRS=4). All patients working prior to their stroke were also driving and 90% of those who returned to work also returned to driving. All patients demonstrated improvements in multiple standardized rehab outcome measures. Mean treatment cost for patients who returned to work was $17,730 (60% had costs less than $7,500; 25% had costs from $7,501-$21,000; 15% had costs from $50,000-$92,000). Services continued for 75% of patients after returning to work for an average of 3.7 months(included in mean program length of 8 months). Almost half of these patients (47%) were aphasic. Mean treatment cost for patients not returning to work was $22,561, with mean program length of 6.5 months.

Conclusions:
These findings demonstrate that interdisciplinary, outpatient rehabilitation programs can promote successful return to work at a reasonable cost, with 60% of patients who returned to work costing less than $7500. Aphasic patients needed longer treatment, but were able to successfully return to work. Additional outcomes research is needed to understand mechanisms supporting stroke patients’ return to work and other patient-centered goals.
Abstract TP15: A Case for the Chase? A Case Series of Mechanical Thrombectomy of M2 Occlusions
Authors: Salahuddin Hisham , Shawver Julie , Tietjen Gretchen , Zaidi Syed , Jumaa Mouhammad
Published: June 2021

Introduction:
Randomized clinical trials have demonstrated an improvement in outcomes with endovascular treatment of large vessel occlusions, however studies evaluating the effectiveness of endovascular treatment of smaller vessels of the anterior circulation are lacking. We present initial data from two tertiary care centers with a focus on outcomes of patients with isolated middle cerebral artery (MCA) M2 occlusions.

Methods:
With institutional review board approval, we retrospectively reviewed medical records of patients who underwent mechanical thrombectomy (MT) between September 2013 and June 2016. The following data was collected: demographics, stroke risk factors, intravenous tPA use, MT treatment times, grade of recanalization, complications, and 3 month modified Rankin Scores. A favorable clinical outcome was defined as a modified Rankin Scale (mRS) 0-2 at 90 days.

Results:
A total of 50 patients were included in this analysis with 19 (38%) women and 31 (62%) men, with a mean age of 70 (63-80) years. One patient had an occlusion of both superior and inferior divisions of the middle cerebral artery (MCA) artery, 20 had occlusion of the inferior M2 artery, and the remaining 29 had occlusion of the superior division of the MCA. Baseline characteristics are summarized below. Average door to groin time was 75 (46-112) minutes, mean procedure time was 30 (25-47) minutes, and mean onset of symptoms to recanalization time was 220 (156-305) minutes. Of the cohort, 22 patients had a change of mRS of 3 or more at the time of discharge, 25 (50%) patients had a favorable outcome at 3 months, and 4 (8%) patients were lost to follow up. Ten (20%) patients developed hemorrhagic infarction and five (10%) developed parenchymal hematoma.

Conclusions:
Our data on MT targeting M2 occlusions demonstrates reasonable safety, recanalization rates, complications, and functional outcomes. Randomized studies are needed to confirm the benefit of pursuing MCA M2 occlusions with MT.
Abstract TP158: Adductor Pollicis Muscle Thickness Alone or in Combination with Obesity is Associated with Poor Outcome 90 Days After Stroke
Authors: Souza Juli T , Braga Gabriel P , Ribeiro Priscila W , Luvizutto Gustavo J , Polegato Bertha F , Minicucci Marcos F , Zornoff Leonardo A , Paiva Sérgio A , Bazan Silméia G , Bazan Rodrigo , Azevedo Paula S
Published: June 2021

Background:
The nutritional status at the time of stroke, may influence the functional capacity after the event. There are controversial data indicating that obesity may be related to better prognosis. It is possible that some obese individuals present reduced fat-free mass.

Objective:
To identify if bedside evaluation of body composition by the body mass index (BMI), muscle mass measured by adductor pollicis muscle thickness (APMT), arm muscle area (AMA) and the combination of low APMT or AMA with obesity are associated with poor functional status and mortality, 90 days after stroke.

Methodology:
Were evaluated 120 patients hospitalized at Stroke Unit. Data was expressed by average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass was estimated by the APMT, which is the only directly measured muscle, and AMA. Roc curve and multivariate logistic regression analysis were used to measure whether the APMT and obesity were associated with RANKIN ≥3 (greater dependence and death), after 90 days of the event. The data were adjusted by the NIHSS, sex, age, type of stroke and thrombolysis. Significance level was 5%.

Results:
Of 120 patients, 54 (45.0%) were women and 66 (55.0%) men; age 66.6 ± 13.2 years; 109 patients (90.8%) had ischemic stroke and 11 (9.16%) hemorrhagic; NIHSS 4 (2-10). Among patients with ischemic stroke, 18 (16.5%) were thrombolized. Considering RANKIN ≥3, Roc curve analysis showed that the value of the cutoff for APMT was <12.5 mm, with sensitivity 0.84, specificity 0.58, area under the curve 0.75 ( 0,6629 - 0,8440) (p = 0.<0,001). In multivariate analysis adjusted by the above factors, the increase in each 1 mm of APTM reduce 31% the chance of disability (OR 0.764, 95% CI: 0.613 to 0.951) (p = 0.016). In addition, the intersection of obesity with APMT<12,5 mm, increased in 37 folds the risk of disability. AMA was not associated with RANKIN≥3.

Conclusion:
Lower APMT alone or in combination with obesity was associated with poor functional status. The body composition assessment was performed at bedside, in the setting of Stroke Unit, with simple methods that may be feasible and useful to predict Stroke prognosis.
Abstract TP166: The Topmost Modifiable Risk Factors for Stroke Among People of African Ancestry
Authors: Owolabi Mayowa O , Sarfo Fred S , Akpa Onoja , Gebregziabher Mulugeta , Akinyemi Rufus , Armstrong Kevin , Akpalu Albert , Tiwari Hemant , Arnett Donna , Obiako Reginald , Owolabi Lukman , Wahab Kolawole , Melikam Ezinne S , Saulsom Raelle , Lackland Dan , Jenkins Carolyn , Arulogun Omoyisola , Ovbiagele Bruce ,   SIREN
Published: June 2021

Background:
Regional and geographical variations exist in stroke burden and risk factor distribution. The unique and dominant risk factors for stroke among people of African ancestry where the burden of stroke is escalating, are poorly understood. Such information is crucial in prioritizing tailor-made interventions to tackle the menace of stroke in developing countries.

Purpose:
We aimed to identify and quantify the contributions of the topmost modifiable risk factors for stroke occurrence in people of African ancestry within the context of the Stroke Investigative Research and Educational Network (SIREN), the largest study of stroke in Africa.

Methods:
The SIREN study is an ongoing, multicenter, case-control study involving several sites in Nigeria and Ghana. Cases included adults aged >18 years with first clinical stroke within 8 days of current symptom onset with CT scan confirmation. Controls were stroke-free adults, mostly from the communities in the catchment areas of the SIREN hospitals where cases were recruited. A systematic evaluation of traditional vascular risk factors as well as lifestyle and behavioral factors were assessed for cases and controls.

Results:
1,638 cases and 1,653 controls with mean ages of 58.52 and 57.76 years respectively were recruited. Ischemic and hemorrhagic stroke types constituted 62.4% and 36.1% of stroke respectively. Among ischemic stroke subjects, 45.7%, 36.3%, 13.6%, 1.0% and 3.4% had small-vessel, large-artery atherosclerosis, cardio-embolic, others and unknown subtypes according to the TOAST classification. Leading vascular risk factors identified among stroke subjects compared with controls were hypertension- 79.3% vs 34.6%, p<0.001; Dyslipidemia 20.8% vs 6.6%, p<0.001; Diabetes mellitus- 24.4% vs 12.8% and history of cardiac diseases 15.4% vs 7.9%, p<0.001. Adjusted ORs (95% CI) for hypertension, dyslipidemia, cardiac disease and diabetes among stroke subjects compared with controls were 6.43 (5.84-7.54), 2.08 (1.61-2.69), 1.48 (1.15-1.91) and 1.29 (1.05-1.60) respectively.

Conclusion:
Implementation of interventions towards mitigating the impact of vascular risk factors at the population level would be essential in curtailing the growing burden of stroke in Africans.
Abstract TP169: Neuroprotective Effect of Pre-stroke Statin Therapy
Authors: Zurrú Maria C , Alonzo Claudia , Brescacín Laura , Linares Geraldina , Balian Natalia , Luzzi Ariel , Cámera Luis , Waisman Gabriel , Cristiano Edgardo
Published: June 2021

Background and purpose:
In observational studies, patients under statin therapy at the time of stroke onset have lower likelihoods of mortality and poor functional outcome. This neuroprotective effect could be related to anti-inflammatory and antiplatelet actions of statins. Our objective was to evaluate early functional outcome in a cohort of ischemic stroke patients.

Design and Method:
stroke patients were included in PROTEGE-ACV, a multidisciplinary secondary prevention program aimed to improve adherence to clinical practice guidelines. Vascular risk factor (VRF) profile and control, and statin treatment in the year before stroke were collected, and functionality one-month after discharge was evaluated using modified Rankin scale.

Results:
1981 ischemic stroke patients (20% TIA) were included between December 2006 and December 2015; mean age was 76±11 years with 57% females. Patients receiving statins (n 713, 38%) had a significant higher prevalence of hypertension, diabetes, dislipidemia, obesity, metabolic syndrome, coronary heart disease, peripheral artery disease, chronic renal failure and previous stroke. Both groups had similar blood pressure, and patients under statins had lower total cholesterol (182±42 vs 200±40 mg/dL, p 0.00001), LDL-c (106±36 vs 128±47, p 0.00001) with similar levels of HDL-c and triglycerides; these patients also had lower GFR (62±23 vs 67±31 mL/min, 0.0003) and higher fasting glucose levels (103±26 vs 99±21 mg/mL; p 0.0003). Predictors of bad outcome in the multivariate analysis adjusted by age and VRF are shown in the table.

Conclusion:
Even though patients under statin treatment before stroke had higher prevalence of vascular diseases, they have better functional outcomes one-month after the event. In our cohort, previous statin use seems to have neuroprotective effect, which could be related to modulation of inflammatory response, platelet aggregation, fibrinolysis and nitric oxide production.
Abstract TP170: Age and Race Disparities of Cardioembolic and Cryptogenic Strokes Over Time
Authors: Demel Stacie L , Khoury Jane C , Moomaw Charles J , Alwell Kathleen , Kissela Brett M , Khatri Pooja , Woo Daniel , Flaherty Matthew L , Ferioli Simona , Mackey Jason , De Los Rios la Rosa Felipe , Martini Sharyl , Adeoye Opeolu , Broderick Joseph P , Kleindorfer Dawn O
Published: June 2021

Introduction:
Cardioembolic (CE) stroke etiology has been increasing over time. How incidence rates of CE strokes within subgroups of the population have been changing is not known. We sought to determine if strokes of CE etiology have been changing similarly between races and between older versus younger populations over a recent 17-year period.

Methods:
Within the Greater Cincinnati/Northern Kentucky (GCNK) catchment area of 1.3 million, all strokes were ascertained in the population from July 1993 to June 1994 and in 1999, 2005 and 2010 using ICD-9 codes 430-436. Stroke subtypes were determined by retrospective physician review and were then examined by age (< 50 or ≥ 50) and race (black or white). The proportions of incident stroke subtypes with 95% confidence intervals were calculated for each study period.

Results:
There was an increase in the proportion of ischemic stokes identified as having CE etiology over time (p = 0.0002). The Table shows the percentage of CE and cryptogenic strokes by both race and age for each study period. Whites had a higher percentage of CE strokes compared with blacks, with the largest difference in 2010. The percentage of CE strokes in patients ≥50 years increased in 2010 but remained relatively stable in patients < 50 years old. Examination by race showed just over 10% reduction in cryptogenic strokes over time in both blacks and whites. The proportion of cryptogenic strokes decreased in both those ≥50 years and in those <50 years over time.

Conclusions:
In our population, there was an increase in the proportion of CE strokes in whites only, most significantly between the two most recent study periods. Conversely, the percentage of cryptogenic strokes has decreased steadily over the study periods and equally in blacks and whites. Future studies are needed to explore the rates of longer-term cardiac monitoring to evaluate if this fully explains changes seen in CE stroke.
Abstract TP176: Carotid Arterial Diameters as an Effect Modifier of Pulsatile Hemodynamics and Brain Perivascular Spaces
Authors: Gutierrez Jose , Dong Chuanhui , Elkind Mitchell , Alperin Noam , Bagci Ahmet , Mora McLaughlin Consuelo , Sacco Ralph L , Wright Clinton B , Rundek Tatjana
Published: June 2021

Introduction:
Brain perivascular spaces (PVS) are associated with higher pulse pressures and may be imaging biomarkers of systemic arterial stiffness. We hypothesized that larger proximal arterial diameters act as effect modifiers between downstream PVS and surrogate measures of arterial stiffness.

Methods:
Stroke-free Northern Manhattan Study participants with brain MRI and carotid ultrasound were analyzed. Perivascular spaces were rated semi-quantitatively as ≤ 3 mm voids on axial T1 images without associated FLAIR hyperintensities. Intracranial brain arterial diameters were measured on MRA. The right common carotid artery (CCA) was assessed by high resolution B-mode ultrasound to obtain systolic and diastolic diameters. CCA stiffness was calculated as a ratio between log
n
transformed systolic-diastolic blood pressure and (systolic - diastolic diameter)/diastolic diameter. We created generalized linear models using and pulse pressure (PP) and CCA stiffness as predictors as independent variables and right anterior PVS score as the outcome, adjusting for demographics, risk factors, head size.

Results:
Among 941 participants (N=941, mean age 71 ± 9 year, 60% women, 66% Hispanic), PP was associated with PVS score (B=0.003, P=0.04) in an adjusted model. There was a statistical interaction between PP, right CCA diastolic diameter, and right intracranial arterial diameters as predictors of right anterior PVS score (P=0.03), but this interaction was not significant for posterior fossa PVS score (B=0.015, P=0.191), or when substituting right intracranial arterial diameters with the basilar artery diameter (B=-0.004, P=0.191). The association between PP (P=0.003) or carotid stiffness (P=0.002) with right anterior PVS score was greater among participants with larger right intracranial arterial and larger CCA diameters.

Conclusions:
Arterial stiffness is related to downstream PVS in those with larger proximal arterial diameters. These results suggest a mechanical effect of pulsatility on brain parenchyma and further studies are needed to enhance our understanding of the link between systemic hemodynamics and brain diseases such as dementia and stroke.
Abstract TP177: Long-term Stroke Risk in Patients Diagnosed with Hypertensive Encephalopathy
Authors: Lerario Michael P , Merkler Alexander E , Gialdini Gino , Parikh Neal S , Bernardini Gary L , Kamel Hooman , Navi Babak B
Published: June 2021

Introduction:
The long-term cerebrovascular consequences of hypertensive encephalopathy (HE) are poorly understood. Therefore, we aimed to measure the risk of stroke following HE.

Methods:
We identified all adult patients discharged from nonfederal acute care hospitals between 2005 and 2013 in New York with a primary
ICD-9-CM
discharge diagnosis of HE (437.2). Only patients who underwent magnetic resonance imaging were included to reduce the likelihood of misclassification error. Patients with all other forms of hypertension (401-405), without concomitant codes for HE or cerebrovascular disease (430-438), served as controls. The primary outcome was incident stroke (431, 433.x1, 434.x1, or 436 in the absence of hemorrhage, trauma, or rehabilitation codes). Kaplan-Meier survival analysis was used to calculate cumulative rates of incident stroke and Cox proportional hazards analysis was used to determine the association between HE and incident stroke while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index.

Results:
We identified 1,386 patients with HE and 2,869,873 with hypertension. Over a mean follow-up period of 3.3 (+/-1.8) years, we identified 66,594 ischemic and 12,343 hemorrhagic strokes. After 5 years, the cumulative rate of stroke was 7.8% (95% CI, 6.2-9.9%) in patients with HE and 3.2% (95% CI, 3.2-3.2%; P<0.001 for the log-rank test) in patients with any other hypertensive disease. After adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index, HE was independently associated with incident stroke (hazard ratio, 1.9; 95% CI, 1.5-2.4) as compared to controls. This association was similar when considering ischemic and hemorrhagic stroke separately.

Conclusions:
Patients discharged after HE face a higher long-term risk of subsequent stroke than patients without prior neurological complications of hypertension.
Abstract TP178: Thrombi Occluding the Intracranial Artery Are Larger in Stroke Patients With Atrial Fibrillation in the Presence of Spontaneous Echo Contrast
Authors: Kim Kyoungsub , Yoo Joonsang , Nam Hyo Suk , Kim Young Dae , Hong Geu-Ru , Lee Hye Sun , Heo Ji Hoe
Published: June 2021

Introduction:
Spontaneous echo contrast (SEC) is frequently observed in patients with atrial fibrillation (AF). SEC represents red blood cell aggregates associated with increased thrombogenecity, which may produce larger thrombus formation. This can result in larger infarctions and severe stroke.

Hypothesis:
Thrombus characteristics occluding the intracranial artery may differ between AF patients with concomitant SEC and those without.

Methods:
This was a post hoc analysis of prospective cohort. Acute stroke patients with non-valvular AF who underwent transesophageal echocardiography and thin-section (1 or 1.25 mm) noncontrast CT between January 2008 and December 2014 were considered for this study. The volume and the density of thrombus were measured semi-automatically using three-dimensional image software, and compared between the patients with SEC and those without.

Results:
Among 368 patients considered, thrombus was identified in 135 patients. Of the135 patients, 67 (49.6%) had SEC. The frequency of SEC was not different between patients with identified thrombi and those without (P=0.146). Thrombus volume was larger in the patients with SEC than those without (median [interquartile range], 75.0 mm
3
[46.1-142.9] versus 55.9 mm
3
[30.3-91.8]; P=0.013). As the degree of SEC increased, the thrombus volume increased (P=0.025). On multivariate analysis, the presence of SEC was independently associated with thrombus volume. (P=0.008)
.
Linear regression analysis showed positive association between initial National Institute of Health Stroke Scale scores and thrombus volume (P<0.001). However, thrombus density was not different between patients with SEC and those without (P=0.226).

Conclusions:
This study suggests that increased thromogenecity by SEC in patients with AF might produce larger intracardiac thrombi and embolization, which resulted in larger thrombi occluding the intracranial artery and more severe stroke.