bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP92: Characteristic Brain MRI Features of Manifesting Heterozygotes With Cerebral Autosomal Recessive Arteriopathy With Subcortical Infarcts and Leukoencephalopathy
Authors: Uemura Masahiro , Nozaki Hiroaki , Sekine Yumi , Mizuta Ikuko , Noda Tomoko , Miyazaki Kazuhide , Kaito Muichi , Nishimoto Yoshinori , Shimoe Yutaka , Shirata Akiko , Yamane Kiyomi , Yanagawa Sohei , Hirayama Mikio , Tamura Masato , Mizuno Toshiki , Nishizawa Masatoyo , Onodera Osamu
Published: June 2021

Introduction:
Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is a cerebral small-vessel disease (CSVD). Mutations in the high-temperature requirement serine peptidase A1 gene (
HTRA1
) cause CARASIL via a decrease in protease activity of HTRA1. Although most of the heterozygotes with the HTRA1 mutation are healthy, manifesting heterozygotes have been reported. We have elucidated that the mutant HTRA1s that develops CSVD in a heterozygote state have a distinct molecular mechanism, resulting in the dominant negative effect. These individuals showed mild phenocopy of CARASIL. However, it is not clear whether brain MRI findings in manifesting heterozygotes are different from those of CARASIL. In this study, we aimed to clarify the characteristic brain MRI features in manifesting heterozygotes by comparing them to those in CARASIL.

Methods:
We have evaluated 19 MRIs in eight manifesting heterozygotes and 21 MRIs in seven CARASIL patients and scored the MRIs by using a semi-quantitative scale for CARASIL, which scored white matter lesions (WMLs) (signal score) and atrophy (atrophy score) (Nozaki
et al.
Neurology 2015). Statistical analysis was conducted using software R 3.2.2. We obtained written informed consent from all individuals.

Results:
Signal score in manifesting heterozygotes was significantly lower than that in CARASIL (Mean ± SD; 14.6 ± 1.9 vs. 23.1 ± 5.0, p < 0.0001), however, there was no difference in atrophy score between the two groups (Mean ± SD; 5.5 ± 2.2 vs. 7.5 ± 5.5, p = 0.20). Atrophy score showed positive correlation with the disease duration in both groups (r
2
= 0.48, p = 0.0014 vs r
2
= 0.41, p = 0.0041), however signal score showed no correlation with the disease duration.

Conclusion:
WMLs is milder in manifesting heterozygote as compared with CARASIL. In contrast, the brain atrophy is not influenced by the HTRA1 mutation status but positively correlated with the disease duration. The rate of carriers for pathogenic HTRA1 mutations are higher than expected. These characteristic findings of brain MRIs might be useful to pick up the candidate for the genetic screening for
HTRA1
.
Abstract TMP94: Outcomes in Hospitalized Stroke and TIA Patients with Dementia - A Population-based Study
Authors: Zerna Charlotte , Lindsay Patrice , Fang Jiming , Swartz Richard H , Smith Eric E
Published: June 2021

Background:
Dementia prevalence is rising, and will double in the next 20 years. This study sought to understand the prevalence of dementia in hospitalized patients with stroke and TIA, differences in characteristics and impact on outcomes.

Methods:
Using the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD), all acute stroke and TIA admissions from April 2003 to March 2015 in Canada (excluding Quebec) were analyzed. Concurrent dementia at time of admission was assessed based on hospital diagnostic codes. Characteristics and in-hospital outcomes were compared in patients with vs. without dementia using chi-square and logistic regression.

Results:
During the observed period 464,741 patients were admitted to hospital for cerebrovascular syndromes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage (SAH) and TIA). Of those, 29,812 (6.4%) had a concurrent diagnosis of dementia, including 8.4% of patients ≥65 years. People with dementia had older median age (84 vs. 75 years; p<0.01), were more often female (59.6% vs. 49.3%; p<0.01) and more often had Charlson-Deyo comorbidity index ≥ 2 (62.1% v. 38.4%; p<0.01). They were less likely admitted with SAH (1.3% vs. 5.3%; p<0.01) and more likely coded as strokes with unidentified subtype (29.4% vs. 20.8%; p<0.01). Median length of stay (13 vs. 7 days; p<0.01) was longer. Patients with dementia were less likely discharged to another acute care facility (7.6% vs. 14.7%; p<0.01), rehabilitation facility (5.4% vs. 12.0%; p<0.01) or home independently (22.9% 48.9%; p<0.01); other outcomes are shown in the Table.

Conclusions:
Approximately 1 in 10 hospitalized stroke and TIA patients age ≥65 has coded dementia. Patients with stroke or TIA and dementia have higher mortality, face significantly more dependence after stroke and utilize greater healthcare resources than stroke patients without dementia. Early care planning and coordination are essential to optimize outcomes.
Abstract TMP99: Farmalarm: App for Mobile Devices Improves Risk Factor Control After Stroke
Authors: Ribo Marc , montiel Estefania , Sanjuan Estela , Sanchis Mireia , Rubiera Marta , Muchada Marian , Boned Sandra , Juega Jesus , Rodriguez Noelia , Rodriguez-Luna David , Pagola Jorge , Molina Carlos
Published: June 2021

Risk factor control and treatment compliance in the following months after stroke are often poor. We aim to validate a digital platform for smartphones designed to raise awareness in patients about the need to perform healthy lifestyle changes, improve communication with medical staff and increase treatment compliance

Methods:
Farmalarm is an app for smartphones designed to increase stroke awareness by: medication visual alerts and compliance control, chat communication with medical staff, sharing didactic video files, exercise monitoring... Stroke patients discharged home were screened for participation and divided in two groups: to follow the FARMALARM program during 3-4 weeks or standard of care follow-up. We determined risk factor control goals at 90 days in all patients

Results:
During 16 months, from the 457 patients discharged home, 126 (27.6%) were included in the study: Farmalarm n=74; age 57±12, Control n=52, age 59±10. There were no significant differences in baseline characteristics between groups. Patients in Farmalarm group followed the program for 23±6 days after discharge. In Farmalarm group, mean number alarms due to medication intake failure dropped from 68.5% in the first week to 44.6% in the third week (p=0.03). At 90 days, achievement of risk factor control was higher in the FARMALARM group (table). The rate of patients with 4/4 risk factors under control was higher in the FARMALARM group (45.3% Vs 22.5%; p=0.02) (graph) and less patients dropped all medications at 3 months in the Farmalarm group (1.5% Vs 8.16%:p=0.05). A regression model adjusted for age and gender showed that the only variable independently associated with all risk factors under control at 90 days was the use of Farmalarm (OR: 4.7; 95% CI:1.1-6.9;p=0.03).

Conclusion:
In stroke patients discharged home the use of mobile applications to monitor medication compliance and increase stroke awareness is feasible and seems to improve the control of vascular risk factors.
Abstract TP104: Thyroid Hormone Neuroprotection After Stroke and Fatty Acid Oxidation
Authors: Sifuentes Mikaela , Lechleiter James
Published: June 2021

Thyroid hormone (TH) has long been known to decrease lesion volume in mammals after stroke, yet its mechanism of action remains elusive. Our lab previously reported that TH stimulates fatty acid oxidation (FAO), a mitochondrial process that provides substrates for cellular ATP production. During ischemic stroke, glucose is unable to support the normal mechanisms of cellular metabolism, making FAO a critical source of energy. In this study, we assess the role of brain FAO in TH neuroprotection and we investigate the upstream mechanisms of astrocyte FAO regulation. Using an
in vivo
model of stroke, we observe that by reducing FAO in the adult brain we block the protective effect of TH. In addition, we find that pre-treatment with L-NAME, an inhibitor of nitric oxide synthases, blocks the TH-stimulated increase in FAO, suggesting a possible upstream mechanism involving nitric oxide signaling. Lastly, our experiments showed that TH increases expression of GLAST, a glutamate transporter, and that this response is not seen in astrocytes lacking FAO. Altogether, our data indicate that the oxidation of fatty acids is an essential step in TH-mediated neuroprotection from stroke, and that this metabolic stimulation is regulated by nitric oxide synthase activity. During ischemia, this pathway may lead to an increased transport of excess glutamate from the extracellular space, accounting for increased neuron survival.
Abstract TP106: Adventitial T Cell Infiltrates Are Related to Brain Atherosclerosis in Hiv-infected Individuals, but Not With Advanced Immunosuppression
Authors: Shenoy Adele , Dwork Andrew , Gutierrez Jose , Morgello Susan
Published: June 2021

Background:
HIV-infected individuals may display chronic brain inflammation. It is unclear whether this inflammation may play a role in brain arterial pathologies that predispose patients with HIV to stroke. We tested the hypothesis that T cell infiltrates would be associated with brain arterial pathology.

Methods:
Large brain arteries from 162 patients (84 with HIV) were used in immunohistochemical analysis to detect CD3, a pan T cell marker. A semi-quantitative score of 0 to 3 (absent, mild, moderate, severe) was created by visually rating CD3+ cells within each arterial layer (intima, media, and adventitia). Arterial stenosis, lumen-to-wall ratio and presence of atherosclerosis were measured in each arterial segment of the circle of Willis using previously reported methods of good to excellent reliability. All models were adjusted for co-dependence between arteries of the same subject as well as for age, sex, ethnicity, vascular risks factors, cocaine use and artery type and location.

Results:
Brain arteries from HIV+ individuals had lower adventitial CD3 scores than HIV- (B = -1.65, p = 0.004). Further stratification demonstrated that the decreased arterial CD3 score was significant only among HIV+ subjects with
premortem
CD4 counts < 200 cells/μl (B = -2.28, p <0.001). Among HIV+ individuals with
premortem
CD4 counts ≥ 200 cells/μl, CD3 arterial scores were associated with brain atherosclerosis (B = 0.74, p=0.04). Independent of HIV status, CD3 score was associated with decreased lumen-to-wall ratio (B = -0.37, p = 0.02) and percentage luminal stenosis (B = 1.99, p = 0.004). Among HIV+ cases, higher CD3 score was noted with higher CD4 count at death (per 50, B=0.43, P=0.001), hypertension (B=7.14, P<0.001), male sex (B=6.29, P=<0.001) and prior opportunistic infections (B=3.24, P=0.008) while a lower CD3 score was noted among diabetics (B=-5.36, P<0.001) and reported use of antiretroviral at death (B=-1.39, P=0.01).

Conclusions:
Among HIV+ individuals with premortem CD4 counts ≥ 200, there exists an association between brain arterial lymphocytic activity with atherosclerosis. These findings may suggest a role for lymphocytic inflammation in HIV-related atherosclerosis in the setting of immune reconstitution.
Abstract TP11: Beyond Large Vessel Occlusion Strokes: Distal Occlusion Thrombectomy
Authors: Grossberg Jonathan A , Rebello Leticia C , Haussen Diogo C , Bouslama Mehdi , Bowen Meredith , Winningham Melanie , Schindler Kiva M , Doppelheuer Shannon , Frankel Michael R , Nogueira Raul G
Published: June 2021

Introduction:
Endovascular therapy is the standard of care for the treatment of proximal large vessel occlusion strokes (LVOS). Its safety and efficacy in the treatment of distal intracranial occlusions has not been well studied.

Methods:
We retrospectively reviewed a prospectively collected endovascular database (September 2010-December 2015, n=898) for all patients with distal intracranial occlusions treated with endovascular therapy. Distal occlusions were defined as any occlusion of the anterior cerebral artery (ACA), any occlusion of the posterior cerebral artery (PCA), or any occlusion at or distal to the middle cerebral artery (MCA)-M3 opercular segment.

Results:
Distal occlusions were treated in 70 patients. The mean age was 66+/-14 and 57% of the patients were male. Thirty-one (44%) of the patients received IV-tPA. The median pre-procedure NIHSS was 19 (IQR, 13-23). The distal occlusion was the primary treatment location in 54 patients and in 16 patients the distal occlusion was treated as a rescue strategy after successful treatment of a proximal LVOS. The locations of the primary cases were MCA-M3 (n=21), ACA with a concomitant MCA-M1 or MCA-M2 (n=16), ACA alone (n=9), PCA (n=6), and ACA with a concomitant MCA-M3 (n=2). The locations of the rescue cases were MCA-M3 (n=8), ACA (n=7), and both MCA-M3 and ACA (n=1). The most common treatment modalities employed were intra-arterial tPA (n=37, 52%), small (3mm) stent-retrievers (n=24, 33%), and thromboaspiration (n=30, 42%). Near or complete reperfusion (mTICI 2b-3) was achieved in 56 cases (80%). Overall, there were 5 (7%) cases of any parenchymal hematoma (PH). However, two of the PHs were in patients with both a MCA-M1 and an ACA occlusion, and both of these hemorrhages were in the MCA territory. Thus only 3 PHs (4.3%) occurred in the territory of the treated distal occlusion with two of these patients also receiving IV tPA. At 90 days, 24 patients (40%) had a mRS of 0-2 and 13 (21%) had died.

Conclusions:
Distal intracranial occlusions can be treated safely and successfully with endovascular therapy. Although promising our results need to be corroborated by larger prospective controlled studies.
Abstract TP114: Cognition Independently Affects Quality of Life in Carotid Occlusive Disease
Authors: Pavol Marykay , Sundheim Kathryn M , Festa Joanne R , Cheung Y. K , Slane Kevin , Lazar Ronald M , Marshall Randolph S
Published: June 2021

Objective:
To determine whether cognition among those with carotid occlusive disease independently affects Quality of Life (QoL).

Introduction:
Carotid occlusion may result in stroke, TIA, and reduction in cognition. QoL has been studied in stroke patients but less is known about QoL in patients with carotid occlusive disease without stroke or significant depression.

Methods:
Subjects, selected from an NIH study of carotid occlusive treatment, included those with with history of TIA or a remote history of minor stroke, and excluded those with a history of stroke within 4 months prior, major deficits in ADL’s, and dementia. Because the relationship between depression and OoL is well-established, we excluded with moderate-severe depression. Patients underwent cognitive examination (memory, language, motor, executive function skills), completed depression and QOL questionnaires (Center for Epidemiological Studies-Depression (CES-D), Stroke Specific Quality of Life (SSQOL), and were rated for stroke severity (NIHSS). Age-corrected Z-scores for cognitive tests were calculated and averaged into a composite cognitive Z-score (Cog-Z). The SSQOL scores were averaged across subgroup domains. Correlation analyses were performed to determine univariate relationships between the variables, with significant values put into in a regression model to predict SSQOL.

Results:
Among 24 subjects (mean age=58.38 (2.01); 10 women), mean Cog-Z was –1.06 SD (Low Average range), mean CES-D score was 10.77 (normal range), mean NIHSS was 0.46 (normal range), and the mean SSQOL score was 3.92 (needing “a little help”). The correlations between NIHSS, history of prior stroke, and SSQOL were nonsignificant. In a regression model including Cog-Z and CES-D, Cog-Z was an independent predictor of SSQOL (Beta=.389, p=.038).

Conclusions:
In patients with carotid occlusive disease without major stroke, cognitive scores were independently associated with QOL. Even minor reductions in cognition influenced QoL and were distinct from the influence of depression. These data further establish the clinical relevance of cognitive decline among patients with cerebrovascular conditions.
Abstract TP116: Perioperative Assessment of Cerebral Perfusion Territories Through Arterial Spin Labeling Magnetic Resonance Imaging in Carotid Stenosis
Authors: Hosoda Kohkichi , Yamamoto Daisuke , Uchihashi Yoshito , Tanaka Jun , Yamamoto Yusuke , Kohta Masaaki , Fujita Atsushi , Sasayama Takashi , Kohmura Eji
Published: June 2021

Backgroud:
Territorial arterial spin labeling (TASL) is a MRI technique that permits independent labeling of major individual feeding vessels and noninvasive visualization of their perfusion territories.

Objective:
The objectives of this study were to use TASL to assess perioperative changes in the perfusion territories of the internal carotid arteries (ICAs) in carotid stenosis patients and to investigate the usefulness of this technique.

Methods:
Thirty-two patients underwent TASL and SPECT before and after carotid endarterectomy (CEA) or carotid artery stenting (CAS). ICA perfusion volume was calculated using TASL images. ICA flow was measured during CEA, both before and after reconstruction, using electromagnetic flow meter.

Results:
In most cases, preoperative asymmetry (
Fig. A
) of ICA perfusion volume improved postoperatively (
Fig B
) (red, rt ICA; green, lt ICA; blue, VA-BA). We classified patients into the following two groups: (1) an elevated CBF group (CBF increase after surgery ≥50%, n=4) and (2) a stable CBF group (CBF increase after surgery <50%, n=28). ICA perfusion volume increased significantly after surgery in the stable CBF group (291.1±89.0cm
3
versus 396.4±40.9cm
3
, p<0.0001) but did not increase significantly in the elevated CBF group (246.4±103.2cm
3
versus 268.7±107.7cm
3
) (
Fig. C
). However, ICA flow increased significantly after reconstruction in both the elevated CBF group (54.0±58.2ml/min → 177.7±25.4ml/min) and the stable CBF group (85.7±50.0ml/min → 171.8±56.1ml/min) (p<0.0001) (
Fig. D
).

Conclusion:
TASL clearly demonstrated that CEA and CAS elicited increases in the perfusion volumes of stenotic ICAs, which resulted in equalization of the perfusion volumes of the left and right ICA. In the elevated CBF group, however, ICA perfusion volume increased slightly, despite marked increase in ICA flow. These findings suggest that an imbalance between these parameters plays an important role in the pathophysiology of hyperperfusion.
Abstract TP119: Credentialing of Interventionists in a Large Randomized Trial
Authors: Roubin Gary S , Heck Donald V , White Christopher J , Rosenfield Kenneth , Dabus Guilherme , Jovin Tudor G , Jankowitz Brian T , Katzen Barry T , Gray William A , Matsumura Jon S , Hopkins Leo N , Gamble Dale M , Voeks Jenifer H , Luke Sothear M , Lal Brajesh K , Meschia James F , Brott Thomas G
Published: June 2021

Introduction:
Outcomes from endovascular procedures are highly dependent on the experience and skill of the operating physician. The multi-disciplinary CREST-2 Interventional Management Committee (IMC) was charged with credentialing a cohort of skilled interventionists with adequate contemporary case volumes.

Methods:
Applicants were required to submit 25 consecutive cases completed within 5 years as primary operator out of a required total experience of ≥ 50 cases (≥ 20 for operators completing training). Interventionists not approved on initial review were asked to submit additional cases (with procedural angiograms), the number depending on quality and recent-quantity of the cases.

Results:
The IMC has had 102 meetings, and 283 interventionists have been evaluated: 104 (37%) interventionists were cardiologists, 64 (23%) vascular surgeons, 42 (15%) neurosurgeons, 32 (11%) neuroradiologists, 26 (9%) neurologists, 9 (3%) interventional radiologists, and 6 (2%) other. The mean total experience among the 226 interventionists with available information was 220±263 carotid stent cases (median 135; range 10-2500). A total of 7037 cases have been reviewed by the IMC, dating from August 2001 to April 2016, with 3366 symptomatic, 3541 asymptomatic and 130 undetermined. The range of cases reviewed per interventionist was 5 to 50. Of the 251 interventionists with sufficient periprocedural follow-up data, no stroke events were reported by 152 (60.5%), and at least one or more stroke events were reported by 99 (39.5%). The IMC has approved 115 interventionists, 29 at the first review and 86 subsequently, based upon submission and review of 631 additional contemporary cases (mean=7 cases per interventionist); 122 have approval pending submission of additional cases; 33 have been denied; 8 have been deferred; 4 have been approved for the CREST-2 Companion Registry only; and 1 is pending decision.

Discussion:
Rigorous evaluation and credentialing of carotid stenters in CREST-2 has been demanding, for the candidates and for the evaluators. Yet the cohort of interventionists so selected should be able to provide the high-quality stenting outcomes necessary for acceptance of the trial results.
Abstract TP121: National Patterns of Carotid Revascularization in the Pre- and Post- Crest Era
Authors: Otite Fadar O , Khandelwal Priyank , Malik Amer M , Chaturvedi Seemant
Published: June 2021

Background:
The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients (pts) <70 yo and endarterectomy (CEA) in >70 yo. The aim of this study was to evaluate national patterns in CAS performance in pts >70yo in the pre- (2007-2010) and post-CREST (2011-2013) era.

Methods:
Adults requiring CAS or CEA were identified from the 2007-2013 Nationwide Inpatient Sample (NIS) using International Classification of Disease (ICD-9) codes. We estimated the proportion of CAS performed in all age groups and used multivariate models adjusted for clinical and hospital factors to compare odds of receiving CAS in the pre- to post-CREST era.

Results:
We identified 839,357 weighted cases of CAS and CEA from the NIS. 15.7% of CAS and 8.4% of CEA were performed in symptomatic pts. CAS increased in all age groups over time (figure 1). Proportion of >70yo receiving CAS increased from 11.9% in the pre- to 13.9% in the post-CREST era (p=0.004). In multivariate models, odds of receiving CAS as opposed to CEA increased by 15% in all pts >70yo in the post-CREST compared to the pre-CREST period (OR 1.15, 95%CI 1.10-1.19, p<0.001) including asymptomatic women (OR 1.10, 1.03-1.18). Congestive heart failure (OR 1.50, 95%CI 1.41-1.60), peripheral vascular disease (OR 1.41, 95%CI 1.34-1.48) and hospitalization in the Western region as opposed to the Northeast (OR 1.25, 95%CI 1.16-1.34) were associated with higher odds of CAS in pts>70yo, while female sex (OR 0.92, 95%CI =0.89-0.97), smoking (OR 0.84, 95%CI 0.79-0.90) and weekend admission (OR 0.78, 95%CI 0.70-0.86) were negatively associated with odds of CAS.

Conclusion:
Rates of CAS increased in the post- compared to pre-CREST era in pts >70yo including asymptomatic women. Despite the concerns of higher periprocedural complications with CAS in elderly pts, the results of CREST have not influenced clinical revascularization practice in pts >70yo.
Abstract TP135: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: Role of Infarct Growth
Authors: Kamran Saadat , Akhtar Naveed , Salam Abdul , Alboudi Aymen , Kamran Kainat , Ahmed Arsalan , Bhutta Zain A , Irfan Furqan B , Shuaib Ashfaq
Published: June 2021

Objective:
The purpose of this multi-institutional pooled data analyses from three countries was to determine the impact of DHC timing on the functional outcomes in patients operated beyond 48 hours in comparison with DHC under 48 hours. In addition factors leading to early or late DHC were also identified.

Methods:
Retrospective, multicenter cross-sectional study to measure outcome following DHC <48 or >48 hours using the modified Rankin Scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4, at three months.

Results:
In total 137 patients underwent DHC. There was no significant difference in the functional outcome [P=0.140] and mortality [P=0.975] but with a trend towards better outcome in patients operated over 48 hours. Multivariate analysis showed age ≥ 55, MCA with additional infarction, septum pellucidum deviation ≥1cm, and uncal herniation was independent predictor of poor functional outcome at three months. In the ‘‘best’’ multivariate model IGR >7.5ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] [DHC<48 hours, 15.2± 8.1ml/hr vs. >48 hours, 7.1 ± 5.03ml/hr] [P<0.001] and second infarct growth rate [IGR2] [DHC 48 13.64 ±8.76 ml/hr, > 48 hours 7.15 ±6.23 ml/hr [P<0.001] were nearly double in patients with early surgery [<48 hours].

Conclusions:
There was no significant difference in the functional outcome and mortality in patients operated >48 hours of stroke onset compared to early [<48 hours]. Time to surgery had no impact on functional outcome. Our data identifies IGR, temporal lobe involvement and MCA with additional infarct were independent predictors of early surgery.
Abstract TP14: Predictors of Good Outcome after Endovascular Therapy for Acute Posterior Circulation Stroke
Authors: Bouslama Mehdi , Jadhav Ashutosh , Haussen Diogo C , Aghaebrahim Amin , Rebello Leticia C , Starr Matthew T , Grossberg Jonathan A , Ranginani Manasa , Nogueira Raul , Jovin Tudor
Published: June 2021

Background and Purpose:
Endovascular therapy (ET) is increasingly utilized in acute ischemic stroke treatment and is now considered the gold standard approach for select patient populations. Prior studies have demonstrated that eventual patient outcome depend on both patient specific factors as well as procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome after ET for acute posterior circulation stroke

Methods:
We reviewed our prospectively collected endovascular databases at two tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015. Baseline characteristics, procedural data and outcomes were evaluated. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and procedural parameters and functional outcome was assessed.

Results:
A total of 214 qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score (NIHSS), anesthesia modality (conscious sedation vs general anesthesia), procedural length and reperfusion status were significantly associated with outcomes in the univariate analysis Multivariate logistic regression indicated that only smoking (odds ratio, 2.49; 95% confidence interval 1.16-5.36; P=0.019), low NIHSS (odds ratio, 0.92; 95% confidence interval 0.88-0.96; P<0.001), and successful reperfusion (mTICI 2b-3) (odds ratio, 13.65; 95% confidence interval 1.71-108.76; P=0.014), were independent predictors of good outcomes.

Conclusion:
Our study suggests that baseline NIHSS, smoking and reperfusion status are independent predictors of good outcomes after ET for acute posterior circulation stroke.
Abstract TP143: Sensor-based Assistive Technology to Aid Arm Recovery in Stroke and Its Effectiveness: A Systematic Review
Authors: Maheshwari Aneel Kumar , van Vliet Paulette , Hudson Irene , Welsh James
Published: June 2021

Background:
Improving upper limb function is a core element of stroke rehabilitation, needed to maximise recovery and reduce disability. There is an increasing number of medical devices available to improve motor control of the upper limb following stroke, but yet there is no systematic review combining information about these devices and to evaluate the effectiveness in improving upper limb motor control.

Objective:
(1) identify all existing sensor-based assistive technology targeted at improving motor control of the upper limb following stroke, and (2) investigate the effectiveness of current sensor-based assistive technology for improving the motor control of the upper limb following stroke.

Search Methods:
The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE; EMBASE; CINAHL; AMED; IEEE Explorer; ProQuest Dissertations and Theses (International), ISI Proceedings (Conference) databases, and occupational therapy (OT Seeker) and physiotherapy (PEDRO) databases.

Data collection and analysis:
Following exclusion of irrelevant titles by one review author, two review authors independently screened abstracts according to inclusion and exclusion criteria. The quality of evidence was determined independently by two authors using the Pedro levels of evidence scale. We systematically tabulated data and performed meta-analysis where studies used the same outcome measures.

Results:
2364 records were screened, and 221 full-text articles were evaluated for eligibility. Finally, 65 studies for objective 1, and 29 randomized controlled trials for objective 2 were included. Studies were divided into 7 groups for objective 2. Results were statistically significant for EMG and Electrical Simulation (standardised mean difference (SMD) 0.46, 95% confidence intervals (CI) -0.03 to 0.96, based on 2 studies with 65 participants). However, results were not statistically significant for the other device groups.

Authors’ Conclusions:
EMG and Electrical Stimulation showed a significant effect in improving upper limb function, but it is unknown whether effects are sustained in the longer term. Further studies are needed to investigate the effectiveness of sensor-based devices to improve upper limb motor control.
Abstract TP146: Vagus Nerve Stimulation Paired With Rehabilitation To Improve Upper Limb Function
Authors: Dawson Jesse , Kimberley Theresa J , Francisco Gerard E , Smith Patricia , Cramer Steven C , Wigginton Jane , Yozbatiran Nuray , Wolf S , Tarver Brent , Pearce David , Engineer Navzer
Published: June 2021

Introduction:
Vagus Nerve Stimulation (VNS) paired with rehabilitation induces movement specific plasticity in rat motor cortex and improves forepaw function in a rat ischemic model compared to rehabilitation alone. A 20 subject first-in-human study in the UK indicated acceptable safety and feasibility of this approach in patients with arm weakness after stroke and showed a significant difference in favour of VNS paired with rehabilitation in the per-protocol analysis (Upper Extremity Fugl Meyer difference of 9.6 points for VNS vs. 3.0 Control; p = 0.038). We conducted a new, double-blind sham controlled study to further assess this technique.

Methods:
Subjects with chronic moderate to severe upper extremity hemiparesis secondary to ischemic stroke (Upper Extremity Fugl Meyer (UEFM) 20-50) were enrolled at four sites (3 US, 1 UK). After baseline assessments subjects were implanted with a vagus nerve stimulation device if all eligibility criteria were met. Following implantation, randomization was made to either paired VNS (1/2 second, 30 Hz., 0.8 mA, 100 uS stimulation with task-specific movement) or sham control (stimulation only on first 5 movements). All received the same intensive and task-specific rehabilitation and had 18 treatment sessions (2-hourly, 3 times a week for 6-weeks, approximately 50 repetitions per task and 300 to 400 repetition movements per session). Outcomes were assessed on the first and 30
th
day following completion of the 6-week therapy course.

Results:
Sixteen patients (8 female) were implanted (8 VNS, 8 Control). Mean age (SD) was 63.2(6.9), with an average (SD) of 21.7 months (12.9) post stroke. One study related serious adverse event was reported (a wound infection that resolved with IV antibiotics). Blinded results (change in UEFM, WMFT, and UEFM responders for both groups) will be available and presented.

Conclusions:
A pivotal study of VNS paired with rehabilitation movements will be justified if preliminary results are confirmed.
Abstract TP151: Association of Splenic Contraction And Development of Systemic Inflammatory Response Syndrome After Acute Ischemic Stroke
Authors: Zha Alicia M , Tippinayani Bhargav , Randhawa Jaskaren , Pariseau Nicole J , Vahidy Farhaan S , Savitz Sean I
Published: June 2021

Background:
Animal models have demonstrated the deleterious contribution that immunocytes from the spleen exert on secondary brain injury after stroke. While previous work has demonstrated that there is splenic contraction (SC) in patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), no clinical studies have connected the systemic inflammatory response syndrome (SIRS) with SC. We aim to associate SIRS and its individual components with SC in acute stroke

Methods:
This is a retrospective analysis of a previous prospective observational study where daily spleen sizes were evaluated in 178 acute stroke patients in a tertiary care center from 2010-2013. Spleen contraction was defined compared to previously established normograms of healthy volunteers from the same study. SIRS was defined as the presence of 2 or more of the following: body temperature <36 or >38C, heart rate >90 beats, respiratory rate >20, and serum white blood cell count >12,000 or <4000 mm3 in the absence of infection. SC was evaluated in patients at 24 and 72 hrs after AIS with SIRS as a primary outcome.

Results:
91 patients had verified AIS without concurrent infection at admission and 70 of these patients remained inpatient at 72 hrs. SIRS was not associated with admission SC at 24hr and 72 hrs. Patients with SIRS at 24 and 72 hrs were more likely to have higher admission NIHSS. SIRS was associated with higher discharge mRS (OR 4.24, 95% CI 1.64-10.9, p=0.0028) and PEG placement (OR 3.70, 95% CI 0.95-15.11, p=0.05). 16 patients (22.9%) developed SIRS by 72hrs, only 5 of whom had SC initially. 28 patients (47%) had SIRS on admission that persisted, 12 of whom had SC. SC was not associated with SIRS at 72 hrs (OR 1.05, 95% CI 0.35-2.79, p = 0.92). 14 patients (15%) developed infections while hospitalized, of which 85% had SIRS on admission.

Conclusion:
Based on our initial evaluation, SC detected within 24 hrs of stroke onset is not associated with SIRS suggesting that the relationship between the two may be more complicated in humans. Consistent with prior studies, however, SIRS is associated with worse outcome. Further studies and additional time points are necessary to further clarify the role of the spleen in the development of SIRS in stroke patients.
Abstract TP155: Weight Loss and Functional Outcomes After Stroke
Authors: Amakiri Nnana , Reding Michael , Dohle Carolin I
Published: June 2021

Introduction:
It is a well described fact that elderly hospitalized patients lose weight, and this weight loss has been attributed to loss of muscle mass. On our acute Inpatient Stroke Rehabilitation Unit, patients with more severe deficits on admission appear to lose more weight than patients who are fairly functional. With this retrospective cohort study, we examined whether weight loss during stroke rehabilitation was associated with stroke severity as measured with the Functional Independence Measure (FIM) Score, and due to poor nutrition due to dysphagia or otherwise decreased food intake (estimated by Percent of Meal Consumed (PoMC)).

Methods:
420 ischemic stroke patients, admitted to the Burke Rehabilitation Hospital Inpatient Stroke Unit between 12/14 and 12/15, were included in this retrospective cohort study. Weight change per admission day, as well as motor, cognitive and total FIM Scores was recorded. Patients who had mechanically altered diet orders or thickened liquid orders were judged to be dysphagic, and nutritional intake was estimated by PoMC.

Results:
Weight change per day during inpatient stroke rehabilitation was not correlated with gains in motor FIM (Pearson correlation 0.07, p=0.89) or cognitive FIM (Pearson Correlation -0.053, p=0.29) scores. Weight change per day was also not correlated with admission cognitive or motor FIM scores, indicating that stroke severity did not predict weight loss during admission. Of note, weight change per day was also not correlated with dysphagia, indicating that patient with swallowing difficulties were able to meet their nutritional needs through dietary modifications.

Conclusion:
Weight changes after stroke do not appear to be correlated to stroke severity and stroke outcomes, as measured by the FIM Score. In our cohort, dysphagia was not an independent risk factor for weight loss. Future prospective trials will be required in order to assess which patients are at risk for weight loss, and whether weight loss is correlated with other measures of impairment.
Abstract TP157: Rates of Spinal Cord Infarction After Repair of Aortic Aneurysm or Dissection
Authors: Gialdini Gino , Merkler Alexander E , Parikh Neal S , Lerario Michael P , Chatterjee Abhinaba , Kamel Hooman
Published: June 2021

Introduction:
The rate of spinal cord infarction associated with repair of an aortic aneurysm or dissection is uncertain.

Methods:
We identified all adult patients discharged from nonfederal acute care hospitals in California, New York, and Florida who underwent surgical or endovascular repair of a thoracic or abdominal aortic aneurysm or dissection between 2005 and 2013. Our outcome was a spinal cord infarction (
ICD9-CM
codes: 336.1 or 344.1-5) occurring during the index hospitalization for aortic repair. Patients with a spinal cord infarction prior to the hospitalization for aortic repair were excluded. Descriptive statistics with exact confidence intervals (CIs) were used to report crude rates of spinal cord infarction in patients with repair of ruptured aortic aneurysm or dissection and in patients with repair of unruptured aneurysm. In a secondary analysis, we evaluated the rate of spinal cord infarction in these groups by treatment approach – surgical versus endovascular.

Results:
We identified 116,892 patients who underwent repair for an aortic aneurysm or dissection, and spinal cord infarction was diagnosed in 658 cases (0.56%, 95% CI, 0.52-0.61%). Patients with spinal cord infarction were more often male and more likely to have vascular risk factors. In patients undergoing repair of a ruptured aneurysm or dissection, the rate of spinal cord infarction was 1.91% (95% CI, 1.70-2.13%), compared to 0.35% (95% CI, 0.32-0.39%) in patients undergoing repair of an unruptured aneurysm. In secondary analysis of patients with repair of ruptured aneurysm or dissection, spinal cord infarction occurred in 1.88% (95% CI, 1.63-2.13%) of those undergoing surgical repair and 2.01% (95% CI, 1.59-2.44%) of those undergoing endovascular repair. For patients with repair of unruptured aneurysm, spinal cord infarction occurred in 0.42% (95% CI, 0.36-0.47%) of those undergoing surgical repair and 0.29% (95% CI, 0.24-0.33%) of those undergoing endovascular repair.

Conclusions:
Clinically apparent spinal cord infarction results from approximately 1 in 50 procedures to repair an aortic dissection or ruptured aneurysm and 1 in 300 procedures to repair an unruptured aortic aneurysm.
Abstract TP159: Risk of Ischemic Stroke in Patients with Atrial Flutter
Authors: Al-Kawaz Mais , Salehi Omran Setareh , Parikh Neal S , Elkind Mitchell S , Soliman Elsayed Z , Kamel Hooman
Published: June 2021

Introduction:
Guidelines advise anticoagulation for patients with both atrial fibrillation (AF) and flutter (AFL). However, the risk of stroke associated with these two conditions has not been robustly compared.

Methods:
Using inpatient and outpatient Medicare administrative claims data from 2008-2014 for a 5% sample of all beneficiaries ≥66 years of age, we identified all patients diagnosed with AFL or AF. Patients with prior stroke were excluded. The primary outcome was ischemic stroke. Predictors and the outcome were ascertained by validated
ICD-9-CM
diagnosis codes. Patients were censored at the time of ischemic stroke, death, or last available follow-up. In the primary analysis, patients with AFL were censored upon diagnosis of AF. Survival statistics were used to compare stroke incidence in patients with AF versus AFL. We used Cox proportional hazards analysis to compare the associations of AFL and AF with ischemic stroke after adjustment for demographics and risk factors. In a secondary analysis, patients with AFL were not censored upon diagnosis of AF because the natural history of AFL frequently features the development of AF.

Results:
We identified 16,441 patients with AFL and 338,726 with AF. Patients with AFL were less often female (42.4% versus 53.0%), but other baseline characteristics, including mean CHA
2
DS
2
-VASc scores (3.9), were similar between groups. Over 2.4 (±2.0) years, 16,451 ischemic strokes were identified. The annual incidence of ischemic stroke in patients with AFL was 0.60% (95% confidence interval [CI], 0.48-0.75%), whereas it was 2.00% (95% CI, 1.96-2.02%) in patients with AF. After adjustment for demographics and vascular risk factors, AFL was associated with a lower risk of ischemic stroke than AF (hazard ratio [HR], 0.30; 95% CI, 0.24-0.37). Within 1 year, 64.9% (95% CI, 64.1-65.6%) of patients with AFL received a diagnosis of AF. The difference between stroke risk in AFL compared to AF was attenuated (HR, 0.85; 95% CI, 0.79-0.92) when patients with AFL were not censored upon diagnosis of AF.

Conclusions:
Patients with AFL may face a lower risk of ischemic stroke than patients with AF. However, AF often develops in those with AFL, and taking this into account, the difference in stroke risk between the two conditions grows smaller.
Abstract TP160: Predicting Bone Fracture After Stroke—The Fracture Risk After Ischemic Stroke (FRAC-Stroke) Score
Authors: Smith Eric E , Fang Jiming , Alibhai Shabbir M , Cram Peter M , Cheung Angela M , Casaubon Leanne K , Silver Frank L , Austin Peter C , Kapral Moira K
Published: June 2021

Background:
Risk for low trauma fracture is increased by >30% after ischemic stroke. Additionally, in the IRIS trial pioglitazone therapy prevented ischemic stroke but increased fracture risk. We derived a risk score to predict risk of fracture one year after ischemic stroke.

Methods:
The Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score was derived in 20,435 ischemic stroke patients from the Ontario Stroke Registry discharged from 2003-2012, using Fine-Gray competing risk regression. Candidate variables were medical conditions included in the validated World Health Organization FRAX risk score complemented by variables related to stroke severity. Registry patients were linked to population-based Ontario health administrative data to identify low trauma fractures (defined as any fracture of the femur, forearm, humerus, pelvis or vertebrae, excluding fractures resulting from trauma, motor vehicle accidents, falls from a height or in people with active cancer). The score was externally validated in 13,698 other ischemic stroke patients in the population-based Ontario stroke audit (2002-2012).

Results:
Mean age was 72; 42% were women. Low trauma fracture occurred within 1 year of discharge in 741/20435 (3.6%); cumulative incidence increased linearly throughout follow-up. Age, discharge modified Rankin score (mRS), and history of arthritis, osteoporosis, falls and previous fracture contributed significantly to the model. Model discrimination was good (c statistic 0.72). Including discharge mRS significantly improved discrimination (relative integrated discrimination index 8.7%). Fracture risk was highest in patients with mRS 3 and 4 but lowest in bedbound patients (mRS 5). From the lowest to the highest FRAC-Stroke quintile the cumulative incidence of 1-year low trauma fracture increased from 1% to 9%. Predicted and observed rates of fracture were similar in the external validation cohort.

Conclusion:
The FRAC-Stroke score allows the clinician to identify ischemic stroke patients at higher risk of low trauma fracture within one year. This information might be used to target patients for early bone densitometry screening to diagnose and manage osteoporosis, and to estimate baseline risk prior to starting pioglitazone therapy.
Abstract TP190: The Effectiveness of a Person-centered Empowerment-based Self-management Intervention in Reducing Risk of Stroke Among Male Patients With Poorly Controlled Type 2 Diabetes: A Mixed-method Study
Authors: Cheng Li , Sit Janet W , Chair Sek-ying
Published: June 2021

Introduction:
The overall incidence of stroke was higher in men than women. Type 2 diabetes is found to be a risk factor for stroke. Previous prospective studies showed each 1% increase in HbA1c would be associated with 12% increase in the risk of developing a stroke. Identifying effective strategies to optimize the glycemic control of male patients with poorly controlled type 2 diabetes would be valuable for reducing the risk of stroke. This mixed-method study aims to examine how male patients with poorly controlled type 2 diabetes responded to a person-centered empowerment-based self-management intervention.

Methods:
Phase I study was based on a sub-group analysis of 179 male subjects with poorly controlled type 2 diabetes [with Glycated hemoglobin (HbA1c) ≥7.5%] who received a six-week empowerment-based self-management intervention (n= 93) or attentional control (n= 86), respectively. The primary outcome was HbA1c level from baseline to three-month post-intervention. Phase II study was an in-depth individual interview with the purpose to reveal how facilitating factors or barriers become apparent in the implementation of self-management practice. Integration of quantitative and qualitative data was performed to disclose a comprehensive picture of intervention effect and mechanism.

Results:
The pre-post HbA1c change for male subjects in the intervention group was 1.01%, which indicated a clinical significant reduction in the risk of developing stroke. At three-month post-intervention, male participants in the intervention group showed significant improvement in glycemic control (8.99% vs. 9.68%, between-group difference: 0.69±2.64, p= 0.045). Content analysis revealed that setting personally meaningful goals, making a personalized action plan, and reflecting and solution-finding were facilitating factors perceived by male subjects with poorly controlled type 2 diabetes. Two categories for barriers to optimal glycemic control were identified, including collective culture and diabetes fatalism.

Conclusions:
Person-centered empowerment-based intervention could facilitate male subjects with poorly controlled type 2 diabetes to actively engage in self-management activities for stroke prevention.