bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 80: Teaching Students To Teach About Stroke
Authors: Liskay Alice M , Fisher Julie , Lewis Steven , Ardelt Agnieszka A
Published: February 2023

Background:
Inadequate stroke prevention and stroke symptom identification delays contribute to higher stroke incidence and worse outcome in African American patients and those living in disadvantaged communities. It is not known how best to improve community stroke awareness. Studies have shown effectiveness of children teaching parents about stroke. Evidence regarding students teaching other students is lacking.

Primary Objective:
To increase awareness of stroke risk factors and stroke signs/symptoms/call 911 in an urban high school.

Secondary Objectives:
1. Teach students the principles of teaching peers. 2. Assess effectiveness of a creative versus standard teaching method.

Methods:
Prospective, cross-over, community-based study in which 48 sophomore students from an urban high school were taught stroke risk factors and signs/symptoms/call 911. These Student Teachers then taught these topics to peers from the same school using a creative or standard method. Student Learners were blinded to the teaching method. Pre and post-tests were used to measure teaching effectiveness with possible scores ranging from 0 to 39.

Results:
Forty-four Student Learners took at least one of three tests (pre, post and one-month retention). Thirty-three Student Learners took pre and post-tests, while 17 took all three. Improvements in both mean post-test scores (4.8, p < 0.001) and mean retention scores (3.4, p = 0.002), irrespective of teaching method, were observed. Thirteen Student Teachers took the retention test. There was no difference in scores relative to teaching method. Scores of Student Teachers who taught stroke risk factors, compared to those who taught signs/symptoms/call 911, were better (35.4 vs. 31.0, p = 0.049).

Conclusion:
Awareness of stroke risk factors and signs/symptoms/call 911 improved in high school students who were taught by peers regardless of the teaching method. Limitations which impacted the results include attendance, COVID restrictions, and scheduling challenges. We will mitigate limitations in the next phase of the project.
Abstract 88: A Multicentric, Randomized, Controlled Phase III Study With Sovateltide (Tycamzzi™) Improving Outcomes In Patients With Acute Cerebral Ischemic Stroke
Authors: Gulati Anil , Adwani Sikandar , Vijaya Pamidimukkala , Agrawal Nilesh , Ramakrishnan TCR , Hari Rai , Jain Dinesh , Sundarachary Nagarjunakonda , Pandian Jeyaraj D , Sardana Vijay , Sharma Mridul , Sidhu Gursaran , Anand Sidharth , Vibha Deepti , Aralikatte Saroja , Khurana Dheeraj , Joshi Deepika , Karadan Ummer , Siddiqui Mohd. Shafat Imam
Published: February 2023

Sovateltide (Tycamzzi™), a selective endothelin-B receptor agonist, has antiapoptotic activity, protects neural mitochondria, and produces neurogenesis. It showed significant safety and efficacy in preclinical and clinical phase I and II studies. A prospective, multicentric, randomized phase III study was conducted in acute cerebral ischemic stroke (ACIS) patients aged 18 through 78 years. Patients with radiologic confirmation of ischemic stroke could be enrolled if presenting up to 24 hours with NIHSS score of greater than 5. Patients with intracranial hemorrhage and those receiving endovascular therapy were excluded. Sovateltide was administered in three doses, each dose of 0.3 μg/kg, as an intravenous bolus at an interval of 3 hours ± 1 hour on day 1, day 3, and day 6 (total dose/day: 0.9 μg/kg). The primary objectives were to determine the neurological outcome based on the mRS score, NIHSS score, and BI scale score from day 1 through day 90. A total of 158 patients with ACIS were enrolled, of which 137 completed a 90-day follow-up. Patients received saline (n=70, 62% male) or sovateltide (n=67, 66% male) at 16.85 ± 0.74 and 17.40 ± 0.67 hours (mean ± SEM) of stroke onset, respectively. The baseline characteristics and SOC in both cohorts were similar. ASPECTS mean value was similar in the control (7.44) and sovateltide (7.61) groups. A significantly greater number of patients in the sovateltide group had an improvement of mRS of ≥2 points (p=0.004) and NIHSS of ≥6 points (p=0.033) vs. baseline at 90 days of treatment. However, an improvement in BI (change of ≥40 points vs. baseline) missed significance (p=0.063). At 90 days, mRS (p=0.007) and NIHSS (p=0.003) were significantly lower, while BI (p=0.011) and EuroQol-EQ-5D (p=0.0055) were significantly higher in the sovateltide compared to the control group. Sovateltide is safe, well-tolerated, and significantly improved neurological outcomes in ACIS patients and may prove to be a novel, effective agent for its treatment.
Abstract 95: High Proportion Of Granulocytes Form Intracranial Thrombus Is Associated With Increased Stiffness And Resistance To Endovascular Recanalization
Authors: Juega Jesus , Li Jiahui , Palacio Carlos , Rodriguez Maite , Tiberi Ricardo , Pinana Plaza Carlos , Rodriguez-Luna David , Requena Manuel , Garcia-Tornel Garcia Alvaro , Rodriguez-Villatoro Noelia , Rubiera Marta , Muchada Marian , Olive-Gadea Marta , Rizzo Federica , Hernandez Morales David , de Dios Lascuevas Marta , Lozano Prudencio , boned sandra , Hernandez-Perez Maria , Dorado Laura , Quesada Helena , Cardona Pedro , de la Torre Carolina , Gallur LAura , Camacho Jessica , Ramon y Cajal Santiago , Tomasello Alejandro , Ribo Marc , Molina Carlos A , Pagola Jorge
Published: February 2023

Hypothesis:
We aim to identify a profile of intracranial thrombus resistant to recanalization by standard mechanical thrombectomy (MT) in acute stroke treatment.

Methods:
First extracted clot of each MT were analyzed by Flow Cytometry obtaining composition of main leukocyte populations: granulocytes, monocytes and lymphocytes. Demographics, reperfusion treatment and grade of recanalization were registered. MT Failure ( MTF) was defined as final Thrombolysis in Cerebral Infarction score IIa or lower and/ or need of permanent intracranial stenting as a rescue therapy after standard MT. In other cohort of cases, unconfined compression tests were performed to explore stiffness of retrieved clots . We looked for correlation between mechanical characterization tests and clot composition.

Results:
Among 225 patients, there were 13 % of MTF that were significantly associated to atherosclerosis etiology ( 33.3% vs. 15.9% ; p 0.021) , more passes ( 3 vs. 2; p <0.001), higher proportion of clot granulocytes ( 82.46% vs. 68.90% ; p <0.001) and lower proportion of clot monocytes ( 9.18% vs.17.34% ; p<0.001). The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained as an independent marker of MTF. Among Thirty eight clots tested by unconfined compression median clot stiffness was 30.2 (IQR, 18.9-42.7) kPa. There was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r=0.35, p=0.032).

Conclusions:
There is a positive correlation between granulocyte proportion and thrombi stiffness that may explain endovascular resistance to recanalization. Influence of granulocytes within thrombus may be a target for future reperfusion treatments.
Abstract HUP11: Alliance Of Young Neurologists To Examine And Resolve Stroke Disparities In Latin America
Authors: Orjuela Karen D , Barboza Miguel A , Amaya Pablo F , De Souza Ana C , Cano-Nigenda Vanessa , NAVIA GONZALEZ VICTOR HUGO , Guerrero Rodrigo , Alet Matias , Jimenez-Monsalve Claudio A , Carbonera Leonardo , Corredor Angel B , rosales julieta s ,   ALATAC (Alianza joven LATinoamericana contra el ACv)
Published: February 2023

Background:
Reducing the burden stroke in Latin America (LATAM) is imperative. Stroke remains the first or second leading cause of death in LATAM. The Declaration of Gramado crafted in 2018 established priorities for stroke care in the region. Understanding the design and implementation of acute stroke systems of care at a local level is critical to guide health policy, clinical research, and education resources. Young neurologists are at the forefront of these efforts. ALATAC (Alianza joven LATinoamericana contra el ACv) is an organization of young neurologists in LATAM that uses innovative online communication strategies (social media and instant messaging) to examine and resolve disparities in stroke care in the region.

Methods:
An 11-question survey was sent to 76 members of ALATAC via email and instant messaging (WhatsApp). The survey queried demographic, geographic information, acute stroke treatment and availability of stroke unit data.

Results:
76 young neurologists from LATAM and Spain were surveyed. 54 neurologists from 13 countries took the survey (71% response rate) (see graph). 16 (29.6%) identified as woman and 38 (70.4%) as man. 43 (79.6%) are between 31-40 years of age. 31 (57.4%) practice in more than 1 hospital and 21 (38.9%) do not have a stroke unit in their hospitals. Each neurologist sees a mean of 10 stroke patients per week (range 0-40); the majority had access to intravenous thrombolytics 53 (98.1%), but 12 (22.2%) do not have mechanical thrombectomy available at their hospitals.

Conclusions:
ALATAC is professional movement designed to examine and resolve stroke disparities via new communication technologies enabling real time collaboration. Future ALATAC efforts will develop peer to peer mentorship, networking, clinical research, and implementation of evidence-based medicine aiming to reduce stroke burden in LATAM. This study provides introductory, baseline data to better define the stroke care in LATAM
Abstract HUP12: Promoting Scholarly Activity Of Trainees In Vascular Neurology And Bridging Gender Gaps In Stroke Publications Through Team Science
Authors: Ahmadi* Sabrena , Kincaid* Keith , Simpkins Alexis ,   On Behalf of the CREST Initiative. *authors contributed equally as co-first authors
Published: February 2023

Introduction:
Scholarly activity is important to achieving academic and clinical proficiency during residency and fellowship and an ACGME requirement. Team science is known to propel research productivity, but we found few programs within neurology using team science to promote scholarly productivity. Also, studies report that women are often under-represented as first or co-authors within publications. CREST is a team-science initiative developed and implemented in 2018 that is based on research-supported determinants shown to improve scholarly activity and involvement among trainees within vascular neurology. Here we assessed whether implementing the CREST Initiative improved involvement in scholarly activity amongst neurology residents and fellows in the field of vascular neurology by assessing the number of publications residents and fellows co-authored within the field of vascular neurology and the representation of women as first or co-authors of those publications following the introduction of CREST.

Methods:
This study used PubMed as a search engine for publications. Articles were included in data analysis if published between 2015-2021 by a Vascular Neurology faculty member, and authorship included at least one neurology resident or stroke fellow. Linear regression with Graph Pad was used for statistical analysis.

Results:
From 2015 to 2022, the number of stroke publications per academic year, including residents or fellows as authors or co-authors, increased from 0 per year to 9 per year, which linear regression demonstrated was a significant increase (βo 2.726, [Confidence Interval 2.130 - 3.283], R2 0.8854). Similarly, linear regression demonstrated that the number of women included as co-authors or first authors in publications increased from 0 in 2015 to 5 in 2022(βo 18.30, [Confidence Interval 15.56 - 21.04], R2 0.9722). Inpatient clinical service weeks did not change significantly over time (p-value 0.9485).

Conclusion:
Results of this study highlight the significance of initiatives geared toward career development and research in successfully promoting scholarly activity in post-graduate education.
Abstract HUP15: Investigating Racial Disparities In Acute Stroke Management At An Academic Comprehensive Stroke Center
Authors: Sosa Crystal , Guzik Amy K , Datar Sudhir
Published: February 2023

Introduction:
In the U.S. racial disparities in age of diagnosis and outcome of ischemic stroke remain despite advances in preventive, acute and chronic management. Social determinants of health, implicit bias and lack of diversity in healthcare which are resultant of systems of oppression have been identified as root causes. It is currently understood that primordial factors such as relatively higher risk of vascular disease, limited access and low stroke literacy contribute to these discrepancies. The role of delivery of care in the acute stroke setting has, however, not yet been investigated.

Objectives:
In this retrospective study we sought to elucidate if significant delays in acute stroke care exist in non-white (NW) compared to white (W) patients at Wake Forest Baptist.

Methods:
Data from EPIC of patients hospitalized from January 2018 to December 2019 were pulled via the Comprehensive Stroke Center and Get with the Guidelines databases. Standard descriptive statistical analyses were used.

Results:
We found that time to activation of acute stroke protocol, time to IV thrombolytic administration (NW 42.5 min, W 44.0 min, p= 0.82) and proportion of Individuals with a 90-day modified Rankin Scale score of 0 to 3 (NW 71.4%, W 60.0%, p= 0.24) were comparable. Interestingly and though not statistically significant, we did find that white patients underwent EVT sooner (NW 98 min, W 88 min, p= 0.54) and were more likely to achieve near-complete reperfusion when compared to their non-white counterparts (NW 80.0%, W 92.3%, p= 0.30).

Discussion:
Within our institution there are no differences in outcome between races of the patients who receive standard acute stroke care, suggesting that the protocolization of this emergent clinical practice may potentially play a role in mitigating racial disparities.
Abstract HUP17: Thrombectomy Outcomes In Relation To Socioeconomic Status By Utilizing Income And Area Deprivation Index Data
Authors: Sari Murat , Dwairi Vanessa , Jain Rishabh , Rocha Marcelo
Published: February 2023

Introduction:
Socioeconomic status has been shown to affect the outcome of patients in different patient populations. In this study we looked at how stroke patients are affected by using ADI (Area Deprivation Index,) and median income. Higher scores of ADI represent poorer conditions. We hypothesize that patients with higher ADI scores and lower median income will show worse stroke outcomes.

Methods:
Our data includes patients who were admitted to University of Pittsburgh Medical Center between March 2020 and March 2022. Our variables include demographics, medical background and COVID-19 status, socioeconomics. Last known well, hospital arrival and recanalization times are used with outcomes measures of TICI grade, hemorrhagic conversion, discharge NIHSS, discharge and mRS.

Results:
TICI score and NIHSS on discharge showed significant correlation with median income. mRS 3 months of discharge was correlated with age, COVID19, hypertension, diabetes, hyperlipidemia, smoking, median income, TICI, NIHSS on discharge. In regression analysis, median income showed a significant impact onLKW-to-arrival time and TICI score. However, there can be many omitted variables on its effects on LKW-to-arrival time. Median income, LKW-to-arrival time, and age significantly affect NIHSS on discharge. Median Income, age, and hyperlipidemia have significant impact on death/mortality (mRS=6). Median Income and ADI have significant impact on mRS 3 m on regression without the covariates. After adding the covariates and age is significantly affecting the mRS 3 m.

Conclusions:
Median income has significant impacts on stroke patients’ time of treatment and functional outcomes. These patients have less resources to get treatment for stroke and stroke risk factors due to several reasons and less chance for rehabilitation following strokes. ADI data did not show a clear relation with outcome variables despite it is a good indicator of socioeconomic status. With less than 10% of total population, COVID-19 patients were not included in final analysis.
Abstract HUP7: Contemporary Nationwide Estimates For Outcomes Associated With Craniotomy Among Patients With Intracerebral Hemorrhage
Authors: Bako Abdulaziz T , Potter Thomas B , Pan Alan P , Tannous Jonika , Britz Gavin W , Hanley Daniel F , Vahidy Farhaan S
Published: February 2023

Introduction:
Contemporary nationwide estimates of outcomes associated with craniotomy procedures (CP) among patients with primary intracerebral hemorrhage (ICH) are lacking.

Methods:
From the nationwide inpatient sample (2016 - 2019), we identified adults discharged with primary ICH diagnosis and those who received CP. We fit a series of multivariable logistic regression models to report the adjusted odds ratios (aOR) and 95% confidence interval (CI) for factors associated with receiving CP and the association of CP with in-hospital mortality, home discharge, and development of major complication (MCC): brain abscess, sepsis, deep vein thrombosis, urinary tract infection, and pneumonia. We also fit generalized linear model (γ family) to report the adjusted mean ratio (aMR) and CI for the association of craniotomy with length of stay (LOS) and cost of care.

Results:
Among 271 840 ICH hospitalizations (mean age [SD] 68.2 [14.9] years; 48% females), 15.3% received CP. Utilization of CP increased from 14.6% in 2016 to 15.8% in 2019 (aOR, CI: 1.10, 1.00 -1.21). Factors independently associated with lower odds of receiving CP (aOR, CI) are older age (0.97, 0.97 - 0.97); Hispanic ethnicity (0.87, 0.78 - 0.97) and Asian race (0.84, 0.73 - 0.96) (vs. Non-Hispanic White); congestive heart failure (0.86, 0.79 - 0.95); diabetes (0.79, 0.72 - 0.87) and renal failure (0.68, 0.62 - 0.74). Private (vs. Medicare) insurance (1.23, 1.13 - 1.34); and residence in large metropolitan (vs. non-metropolitan) counties (1.14, 1.03 - 1.25) is associated with higher odds of receiving a CP. CP is associated with significantly lower odds of in-hospital mortality (aOR, CI: 0.66, 0.61 - 0.72) and home discharge (0.51, 0.45 - 0.57). However, CP ICH patients had longer LOS (aMR, CI: 1.79. 1.75 - 1.84) and higher cost of care (1.82, 1.79 - 1.85). CP is not associated with MCC (aOR, CI: 0.99, 0.92 - 1.07).

Conclusions:
Modern-day craniotomy procedures likely improve ICH in-patient survival and are not associated with major complications. Large, pragmatic clinical trials for ICH patients are needed to evaluate effectiveness of craniotomy, particularly minimally invasive procedures, on longer term mortality and functional outcomes.
Abstract NS2: Intracerebral Hemorrhage Patients Actively Involved In Post-acute Care With Nurse Navigators Experienced Reduced Readmission Rates And Better Outcomes
Authors: Dellostretto Nicole , Hackett Chris , Pope Leslie , Noah Patty , Cerejo Russell
Published: February 2023

Objective:
To evaluate whether the level of engagement of hemorrhagic patients with nurse navigators affected readmissions and outcomes.

Methods:
Retrospective multicenter study of hemorrhagic stroke patients from seven hospitals between January 2021 and April 2022. Patients who died or discharged to hospice were excluded. Navigators contacted patients at scheduled intervals to review care, medications, confirm appointments and provide education. Engagement was defined as a phone or virtual encounter with patient: low (< 5 encounters) or high (≥ 5 encounters) during 90-day epoch. The primary outcome examined readmission within 90 days using a binomial logistic regression. Secondary outcomes included: attendance of neurology visit; new or worsening symptoms and 90 day modified Rankin Scale (mRS) analyzed with binomial logistic and ordinal regressions. Sensitivity analysis examined outcomes in patients discharged to inpatient rehabilitation or skilled nursing. Multivariable analyses were adjusted for potential confounding variables.

Results:
We enrolled 368 hemorrhagic stroke patients, of which, 281 were included; 217 (77.2%) intracerebral hemorrhage and 64 (22.8%) subarachnoid hemorrhage. There were 144 (51.2%) less engaged and 137 (48.8%) highly engaged patients. Highly engaged patients were less likely to be readmitted compared to less engaged patients (23% vs. 42%), adjusted odds ratio (aOR) = 0.49 [95%CI, 0.28 - 0.87], p= 0.02. There was no difference in engagement and attendance of appointments, aOR = 1.73 [95%CI, 0.96 - 3.11], p = 0.07 or new neurologic events, aOR = 0.52 [95%CI, 0.25 - 1.08], p = 0.08. Highly engaged patients had less disability at 90 days compared to less engaged patients, median mRS = 2 (IQR, 1 - 3) versus 3 (IQR, 2 - 5), aOR = 0.49 [95% CI, 0.30 - 0.81], p = 0.006. Highly engaged patients discharged to a health care facility were also less likely to be readmitted and had less disability at 90 days compared to less engaged patients, all p< 0.05.

Conclusions:
Patients were found to have lower readmission rates and less disability at 90 days if they had a high level of engagement with the nurse navigators.
Abstract NS3: Are You Ready For Your Pediatric Stroke Patient?
Authors: Zimmermann Susan ,   Pediatric Stroke Workgroup
Published: February 2023

Background:
Our Comprehensive Stroke Center (CSC) located in Atlanta, had a pediatric patient present with stroke symptoms to our ED. We did not have a plan except to transfer to the closest Children’s Hospital approximately 15 miles away which In Atlanta, can be a 45-minute travel time. Our seasoned CSC treats over 2000 adult stroke patients annually however was not prepared for our pediatric patient population. After the patient was successfully enroute to Children's Hospital, a team quickly assembled to debrief and discuss a plan to treat. Since our hospital does not have a Pediatric Intensive Care, a "Drip and Ship" model would be the focus of care. Our hospital is a level 2 trauma center therefore keeping within the age range of >14 through the 18th birthday.

Purpose:
Develop a "Drip and Ship" model for pediatric stroke patients using best practice for stroke treatment inside ages 14- <18 years of age. This model utilizes our available Pediatric Emergency and Neurology teams while keeping the patient and family at the center of our care.

Methods:
Phase I included a interdisciplinary planning committee to review current literature, treatment parameters, medications, and dosing for the pediatric population related to acute stroke treatment. Risk assessment to ensure patient safety was a top priority for each step of the process. Clinical Practice Guidelines supports the rationale behind treating the pediatric stroke patient and transport to the Children’s Hospital. Phase II will include Neuro Endovascular evaluation for potential treatment with thrombectomy and subsequent admission to our Neuro ICU.

Results:
A “Drip and Ship” protocol was developed using evidence-based literature to guide emergent brain imaging, immediate consultation with Pediatric Neurologist and dosing guidelines for IV Alteplase. The team identified parameters and treatment for hypertension, angioedema and hemorrhagic conversion included in the newly developed pediatric stroke order set and Alaris pump build. Finally, a family centered brochure explaining the treatment for stroke along with directions to the Children’s Hospital completed this phase.
Abstract TMP11: Cerebral Venous Sinus Thrombosis After Covid-19 Vaccination In Korea: A Nationwide Cohort Study
Authors: An Sang Joon , Lee Joongyub , Park Heekwon , Rha Joung-Ho
Published: February 2023

Introduction:
Covid-19 vaccination is reported to relate with cerebral venous sinus thrombosis (CVST). This study aims to evaluate the association between CVST and Covid-19 vaccination in Korea.

Methods:
Hospitalized patients with incident CVST during January 2021 to January 2022 were extracted from nationwide health insurance claim data, and the history of vaccination was investigated. We used modified self-controlled case series (SCCS) analysis comparing the occurrence of CVST between risk period (within 28 days of covid-19 inoculation) and control period (excluding the risk period) and calculated the incidence rate ratio (IRR) for CVST in risk period compared to control period. Sensitivity analysis with extended risk period up to 5 weeks was also performed.

Results:
A total of 373 CVST cases were recruited in this SCCS study. The IRR for CVST in risk period was 1·41 (95% CI 1·01-1.95) compare with a control period. Subgroup analysis according to demographic profile revealed IRR of 1.86(1.01-3.42) and 2.53(1.40-4.58) in the age of 30-49 and 50-64 respectively, and also significantly higher IRR of 1.84(1.14-26.96) in women. CVST without thrombocytopenia group showed similar IRR of 1.45 (1.04-2.01). In the sensitivity analysis with risk period extended to 5 weeks, the IRR was 1.55 (1.13-2.13), which was not significantly different to 4 weeks risk period.

Conclusions:
A significant increase in the risk of cerebral venous thrombosis after COVID-19 vaccination is suggested from this study. The risk was higher in the old age and women. Because our data is health insurance claim data, the risk might be overestimated, and the validation of diagnostic accuracy is scheduled. Also nationwide registry of confirmed CVST cases will be presented and compared. Despite these limitation, this study heralds that CVST could follow after Covid-19 vaccination.

Funding:
This study was funded by research grant from Korean Center for Disease Conttrol, National Academy of Medicine in Korea, and Korean Stroke Society.
Abstract TMP117: Housing Light Cycle Impacts Metabolic Profile, Stroke Survival, And Cognitive Outcomes In Diabetic Rats
Authors: Li Weiguo , Edgerton-Fulton Mia , Jamil Sarah , Li Alice A , Abdul Yasir , Ergul Adviye
Published: February 2023

Diabetes worsens stroke outcomes and cognitive function, but the underlying reasons are not understood. Long-term experimental studies had been limited by greater mortality in diabetic cohorts. Recent studies suggested circadian rhythms may modulate brain ischemia and hence mortality/recovery. The goal of this study was to determine the impact of stroke timing and housing light cycle conditions on survival and cognitive outcomes in control and diabetic rats.

Methods:
Control (C) and diabetic (D) male rats (n=7/group) were randomly grouped into normal light cycle (NLC 6 am/6 pm) or reverse light cycle (RLC 12 am/12 pm) starting at 4 w of age. At 12 w of age, rats were subjected to 60 min middle cerebral artery occlusion (MCAO, night stroke in NLC and morning stroke in RLC). A battery of behavioral tests was performed up to W8 post-stroke to assess motor, cognitive, and psychosocial status.

Results:
(Table). RLC conditions improved stroke surgery mortality and long-term survival in diabetic animals. Pre- and post-stroke body weight gain was affected only in the NLC/D group. High mortality in the NLC/D prevented 2x2 comparisons at W8 but suggested the worst performance the in NLC/D cohort. Comparisons of C and D rats in RLC showed a decline in recognition memory in both groups over time with trends for worse performance in diabetic animals. There was no difference in aversive learning or anxiety status.

Conclusions:
These results suggest that the light cycle and timing of MCAO affect the circadian rhythm, overall health state, and cognitive outcomes, especially in diabetes. RLC experiments may refine and improve the long-term studies in comorbid disease models.
Abstract TMP15: Transcriptomic Signatures Of Individual Cell Types In Cavernous Angioma
Authors: Li Ying , Girard Romuald , Srinath Abhinav , Ciszewski Cezary , Chen Chang , Lightle Rhonda , Romanos Sharbel , Moore Thom , Debiasse Dorothy , Antonopoulos Mira , Bindal Akash , Ali Heba , Stadnik Agnieszka , Lee Justine , Lopez-Ramirez Miguel A , Shi Changbin , Awad Issam A
Published: February 2023

Introduction:
Cavernous Angiomas (CAs) are vascular malformations characterized by clusters of blood-filled capillary spaces lined by “leaky” endothelium. While mutations in endothelial cells have long been recognized as necessary for lesion genesis, there is evidence of inflammation, response to hypoxia, and non-endothelial autonomous cell effects driving pathogenesis. Disrupted gene expression in the CA neurovascular unit (NVU) has been described but the contribution of each cell type has not been previously investigated.

Methods:
Six CA and four control brain samples were collected and frozen during surgical resection. The endothelial cells, pericytes, and neuroglia (astrocytes and neurons) were sorted, and the RNA was extracted and sequenced. The differentially expressed genes (DEGs) were identified (
p
<0.05, FDR corrected) for each cell type. Enrichment pathway analyses were performed through Ingenuity Pathway Analyses (IPA, Qiagen;
p
<0.05, FDR corrected), Gene Ontology (GO;
p
<0.1, FDR corrected) and Kyoto Encyclopedia of Genes and Genomes (KEGG;
p
<0.1, FDR corrected).

Results:
In endothelial cells, 362 DEGs were identified contributing to 54 enriched IPA pathways. In addition, 484 DEGs were found in pericytes and 50 IPA pathways were identified. The common functions between these two cell types were related to angiogenesis, extracellular matrix organization, cell adhesion, and platelet activation, while the function related to response to hypoxia was only shown in pericytes. Finally, 242 DEGs and 52 IPA pathways were identified in neuroglia cells. The associated pathway functions were related to inflammatory response and cell adhesion. The IPA results were further confirmed by the GO term and KEGG pathway analyses.

Conclusion:
We confirm that disrupted genes related to angiogenesis, blood-brain barrier integrity, cell adhesion and platelet activation in the CA lesion involve endothelial cells and pericytes primarily. Pericytes are particularly associated with disrupted genes related to response to hypoxia, while neuroglia is associated with greater gene disruptions related to inflammation. These results motivate novel mechanistic hypotheses regarding non-endothelial cell contributions to lesion pathobiology.
Abstract TMP28: Prevalence Of Dementia In Stroke And Its Effect On Prognosis: A National Database Analysis
Authors: Hussain Bilal , Vasudevan Viswanath , Ayala-Rodriguez Cesar , Reddy Sarath , Paul Timir K
Published: February 2023

Background:
Stroke has been extensively studied to cause vascular dementia leading to cognitive dysfunction. However, Alzheimer’s dementia and dementia with Lewy bodies (DLB) need to be further explored. Our goal was to describe the prevalence and prognosis of different dementias in stroke.

Methods:
A retrospective analysis was conducted with National Inpatient Sample 2016-2019. Prevalence and demographics of dementia in stroke were characterized and prognosis was studied in terms of mortality. Independent predictors of mortality were also described. Multivariate logistic regression analysis was used.

Results:
3,412,614 patients were diagnosed with stroke within the population of 142,420,122 patients, establishing a prevalence of 2.4%. Among these patients with stroke, 398,685 patients had concomitant diagnosis of dementia (prevalence 11.7%). Stratified analysis illustrated that within this stroke population, Alzheimer’s dementia had the highest prevalence (2.4%, 81,234 patients), followed by vascular dementia (prevalence 1.65%, 56,195 patients) and DLB (prevalence 0.14%, 4770 patients). Mean age for patients with stroke and dementia was 81.4 years, 59% were females, 41% were males, and 70% were white. In terms of prognosis, dementia is associated with 129% increase in mortality (OR 2.29), vascular dementia with 67% increased odds of mortality (OR 1.67), Alzheimer’s dementia with 100% (OR 2.0) and DLB with 86% increased mortality (OR 1.86). Among patients with stroke and dementia, independent predictors of mortality are heart failure (OR 1.15), ischemic heart disease (OR 1.08), atrial fibrillation (OR 1.32), pulmonary embolism (OR 1.95) and pneumonia (OR 2.19). African-American ethnicity was independently associated with decreased mortality (OR 0.8, p=0.00).

Conclusions:
11.7% stroke patients had dementia. Alzheimer’s dementia has the highest prevalence in stroke followed by vascular dementia and DLB. Heart failure, ischemic heart disease, atrial fibrillation, pulmonary embolism and pneumonia are independently associated with higher mortality in this patient population.
Abstract TMP42: 911 Continuation Of Care Protocol Reduces Door In, Door Out Time For Transfer Patients With Emergent Large Vessel Occlusion
Authors: Shaw Robin , Rho Howard J , Sangha Navdeep S , Saver Jeffrey L , Modzelewski Michael , Fleming Cherryl , Kern Kristin , Rojas Abigail , Guerra Marcos , Faskell Paxton , gutierrez loreen , Duke Leslie A , Liang Conrad
Published: February 2023

Background:
Rapid reperfusion with mechanical thrombectomy (MT) for large vessel occlusion leads to an improvement functional independence. Prolonged transfers from non-interventional to interventional hospitals are a major cause of delay in reperfusion times. The use of the 911 EMS system has accelerated myocardial infarction transfers and potentially could accelerate stroke transfers, but their effect on stroke transfer times have not been well delineated.

Methods:
In our 14- hospital system, transfers from non-interventional facilities to intrasystem or intersystem interventional capable facilities typically utilize a centralized group of nurses who arrange for contracted ambulance pickup (CAP). However, in San Bernardino County (CA), 911 EMS continuation of care (COC) is an alternative method available for transferring MT patients. Under the COC process, the sending hospital calls 911 and the nearest EMS ambulance responds to transport the patient to the thrombectomy center. We compared Door In, Door Out (DIDO) times between the COC vs CAP protocol between January 1, 2021 and January 30, 2022. Demographic and clinical variables were compared using t-test for continuous variables and chi-square for categorical variables.

Results:
Among 112 patients, 26 (23%) were transferred by COC and 86 (77%) by CAP. COC and CAP patients did not significantly differ in age (
Mdn
71 {IQR:22} vs
Mdn
72 {IQR:20.5}, p = 0.81), sex (46% vs 36% female, p = 0.92), or presenting NIHSS (
Mdn
14 {IQR:12} vs
Mdn 13
{IQR:14}, p = 0.62). Rates of thrombolytic started at the sending hospital were 54% (14/26) in COC patients and 48% (41/86) in ETAP patients (p = 0.58). DIDO time was faster in the COC group, (
Mdn
58 minutes {IQR 44-73} vs
Mdn
94 minutes {IQR 79-142}, p<0.01). In contrast, there was a significant difference in DIDO time between intrasystem transfers by COC (
Mdn
69.5 min. {IQR: 48.5-115.5} and transfers out of system by COC (
Mdn
66 min.{IQR: 53-88}, p=0.20), suggesting that there was no special advantage for intrasystem transfers over intersystem transfers.

Conclusion:
Using the 911 EMS system for interfacility transport of patients eligible for MT reduced DIDO time at the sending hospital by over 40 minutes, which may contribute to improved functional outcome.
Abstract TMP43: 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 R , 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 TMP50: Increased Pre-stroke Emergency Department Visits And Post-stroke Readmissions For Mexican-Americans Compared To Non-hispanic Whites In The Brain Attack Surveillance In Corpus Christi (BASIC) Study
Authors: Lin Chun Chieh , Burke James F , Cox Melinda , CASE Erin , Morgenstern Lewis , Lisabeth Lynda D
Published: February 2023

Introduction:
Mexican Americans (MAs) use less preventative healthcare than NHWs and this may result in in more emergency department (ED) visits or readmissions. We sought to explore ethnic differences in ED and hospital utilization immediately before and after stroke.

Methods:
BASIC is a stroke epidemiologic study in Corpus Christi TX. We performed probabilistic matching to identify hospital claims for all BASIC-identified index strokes (ischemic or ICH) from 2010-2020 continuously enrolled in Medicare fee-for-service (FFS). Matching was performed using demographics (including date of birth), stroke admission/discharge dates, vascular risk factors, comorbidities, and in-hospital procedures. All emergency department (ED) visits and hospital readmissions within 90 days before and after the index stroke were identified using Medicare claims. Logistic regression models were used to determine the association of MA ethnicity (compared to NHWs) with prior ED/inpatient visits and cox regression models were used to estimate the associations with subsequent ED visits/readmissions (censoring at death), adjusting for patient age, sex, stroke severity, and stroke type.

Results:
We identified 1,180 incident BASIC strokes that could be matched with Medicare FFS inpatient claims: 84% with ischemic stroke, 46.2% NHWs vs 45.7% MAs, mean age 76.4, median (IQR) NIHSS 5 (2-13). Both ED visits and hospitalizations were relatively common before and after stroke (Table). Compared to NHWs, MAs were more likely to have ED visits before stroke than NHWs (OR 1.5, 95%CI [1.1-2.1]) and hospitalizations after stroke (HR 1.3, [1.1-1.7], but no ethinc differences were observed in pre-stroke hospitalizations or post-stroke ED visits. (
Table
)

Conclusion:
The increased rate of pre-stroke ED visits in MAs suggests the potential for missed opportunities to prevent stroke may exist and merits further scrutiny.
Abstract TMP53: Prediction Of Acute Cerebrovascular Events Based On Patient Reported Symptoms
Authors: Khatri Ishaani , Fraser Hamish , Bacher Ian , Madsen Tracy
Published: February 2023

Introduction:
Many patients fail to recognize the initial symptoms of TIA or stroke and delay seeking urgent medical care. Algorithms based on patient reported symptoms have the potential to improve patient decision making and care seeking behavior. Though machine learning (ML) based on clinical and imaging data has been used to predict stroke, little work has been done to create ML methods based on patient symptom data. We aimed to evaluate the efficacy of ML algorithms for prediction of stroke or TIA from data collected at presentation among patients admitted to an emergency department TIA/Stroke observational unit (ED-OU).

Methods:
Patients in a large, urban, academic ED admitted to the ED-OU for suspected TIA from 3/2013 - 2/2020 were included. A full medical workup, including blood work, EKG, vessel imaging, DWI MRI, and neurology consultation was performed. The outcome was a discharge diagnosis of stroke or TIA. Demographic data, symptomatology, past medical and surgical history, and relevant medication data was utilized to predict a stroke or TIA. After applying recursive feature selection (RFE), we utilized logistic regression (LR) to predict stroke/TIA diagnosis. Model performance was evaluated using accuracy, precision, and AUROC.

Results:
1441 patients were included; (52.4% female; 23.4% non-white; 57.7% diagnosed with stroke/TIA). Average age was 62.5 (SD = 30.2). The most common presenting symptoms were headache, dizziness, slurred speech, visual disturbance, and aphasia.Our classifier predicted the diagnosis of a stroke/TIA with AUROC 0.705, Accuracy 0.717, Precision 0.722, Recall 0.802, NPV 0.709.

Conclusions:
These results show algorithms utilizing patient-reported symptoms and risk factors can predict TIA/stroke. ML-based algorithms could support improved patient decision making in seeking medical care and reduce delays, and such algorithms could be incorporated in symptom checker apps.
Abstract TMP61: Lesion Growth Continues Beyond 24 Hours Following Endovascular Therapy In Some Patients With Successful Recanalization
Authors: Lomahan Carolyn , Hsia Amie W , Davis Rachel , Adil Malik , Kim Yongwoo , Lynch John K , Burton Shannon , Cabatbat Rainier Michael , Craft Veronica , De Vis Jill , Thomas Leila , Uche Victoria , Afzal Mariam , Latour Lawrence , Luby Marie L
Published: February 2023

Introduction:
Lesion volume on MRI or CT provides evidence of tissue response to successful recanalization by endovascular therapy. The most appropriate time to estimate “infarct” volume remains unclear. Largely for convenience, 24-48 hours has been used in clinical trials and registry datasets which may be too early to determine the final infarct volume. The objective of this study was to quantify the comparability of lesion volume using MRI measured at 24 hours versus 5 days in acute stroke patients following successful recanalization.

Methods:
Patients were included if they consented to the prospective GUARDS study between April 2018 through February 2022, had LVO of the anterior circulation, were treated with EVT, achieved complete revascularization defined as TICI 2b/3, and imaged with MRI at 2 hours, 24 hours, and 5 days post EVT. Two independent readers measured lesion volumes using a semi-automated validated approach on DWI at 2 and 24 hours, and FLAIR at 5 days. Statistical comparisons of lesion volumes across time points were performed. Lesion growth was defined as change in lesion volume and percent change compared to lesion volume at 2 hours.

Results:
Sixty-nine patients met all study criteria and were included. Median age was 66 years, 55% female, median admit NIHSS of 18, 62% with M1 LVO, and 46% treated with IV thrombolysis. Post-EVT median lesion volumes were 24mL, 35mL, and 45mL respectively for 2-hour DWI, 24-hour DWI, and 5-day FLAIR. Lesion growth based on median percent change from the 2-hour DWI was 39% [21-96] and 52% [12-145] at 24 hours and 5 days. The difference in lesion growth based on percent change from 24 hours to 5 days was not significant (p=0.17). However, there was a significant difference based on change in lesion volume, 12mL [2-25] at 24 hours and 16mL at 5 days (p=0.029). Fifty-one (74%) patients had DWI volumes at 24 hours that were ≥80% of their FLAIR volumes at 5 days. However, 18 (26%) patients continued to have lesion growth beyond 24 hours, median lesion growth of 18mL,with 11 (61%) of those having lesion growth >20mL.

Conclusions:
Lesion growth >20mL continues in some patients beyond 24 hours, suggesting that infarct volume at 5 days should be used as the imaging outcome when assessing tissue response to recanalization.
Abstract TMP66: Correlation Of Cerebrovascular Reserve Assessed By Acetazolamide-stress Spect With Collaterals On Arterial Spin-labeling MRI In Patients With Carotid Occlusive Disease
Authors: Kang Hyunkoo
Published: February 2023

Introduction:
We investigated the relationship between the level of cerebral collateral circulation on arterial spin-labeling (ASL) magnetic resonance imaging (MRI) and cerebrovascular reserve (CVR) on acetazolamide (ACZ)-stress single photon emission computed tomography (SPECT) brain scans in internal carotid artery (ICA) stenosis.

Methods:
This study enrolled 129 patients with severe ICA stenosis (>70%). Collateral circulation was assessed in pulsed ASL images based on the presence of arterial transit artifact (ATA) that late-arriving flow appears as serpiginous high ASL signal within cortical vessels. CVR based on rest-SPECT and ACZ-stress SPECT with Tc-99m-ECD was calculated. The ASL CBF maps were independently assessed by two neuroradiologists blinded to clinical information. The two neuroradiologists graded on two slices of ASL images corresponding to Alberta Stroke Program Early Computed Tomography Score (ASPECTS) location using a 4-point scale for ASL intensity.

Results:
With ACZ-stress SPECT, the 88/129 (68%) patients showed normal CVR and 41/129 (32%) patients showed decreased CVR. In 73/88 (82%) of the normal CVR group patients, ASL showed ATA in ipsilateral to the stenosis. In 19/41 (46%) of the decreased CVR group patients, ASL showed no evidence of ATA in ipsilateral to the stenosis. Significant positive relationship was observed between the normal CVR group and the ATA showing group in ICA stenosis patients (p = 0.001, chi-square test). The ASL-based ASPECTS scores of brain in the ipsilateral side was lower than the scores in the contralateral side to the ICA stenosis (p < 0.0001, Wilcoxon signed rank test). The ASL-based ASPECTS scores of brain ipsilateral side to the ICA stenosis was lower in the reduced CVR group than normal CVR group (p = 0.005).

Conclusion:
This study demonstrated the statistically significant positive correlation between good collaterals on ASL MRI and intact CVR in patients with ICA stenosis.