bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP279: Predictive Modeling of Major Adverse Cardiovascular Events (MACE) in Patients with Migraine: Differential Performance for Ischemic and Hemorrhagic Stroke Outcomes
Authors: Tariq Amara , Dumkrieger Gina , Dumitrascu Oana , Schwedt Todd , Chong Catherine , Banerjee Imon
Published: January 2025

Introduction:
Prior data suggest that migraine increases the risk of stroke. However, there is a lack of understanding whether specific migraine features like white matter hyperintensities (WMH) commonly found on brain magnetic resonance (MR) imaging in migraine patients and migraine medications might contribute to Major Adverse Cardiovascular Event (MACE) outcomes including ischemic and hemorrhagic stroke. We assess MACE risk estimation model stratified by event types using Mayo Clinic Electronic Health Record (EHR) data.

Methods:
Case and control sets, based on MACE occurrence among migraine patients at Mayo Clinic Neurology Department, were propensity matched on age, sex, and MACE risk-factors (atrial fibrillation, diabetes, hyperlipidemia, hypertension, tobacco use) to capture migraine-specific predictors (
Figure 1)
. Migraine medications were categorized into 9 classes; Triptans, Ditans, Gepants, Ergots, calcitonin gen-related peptide targeting medications (CGRPs), Beta-blockers, Topiramate, Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs). Demographics (age and sex), migraine characteristics (chronic migraine, migraine with aura), and presence of WMH on MR imaging were curated. To model non-linear relationship between predictors, two comparative Random Forest (RF) models were evaluated for MACE prediction; i) Model-1: using demographics, migraine characteristics and WMH, ii) Model-2: medications, demographics, migraine characteristics and WMH (
Table 1)
.

Results:
Model-2 outperformed Model-1 indicating combined interaction between medications, WMH, and migraine characteristics for estimating MACE risk. Model-2 achieved AUC of 0.68 for overall MACE, but showed higher performance for ischemic stroke (AUC 0.76). We visualized the effects of input features on ischemic stroke risk for four individual patients using SHAP force plots (
Figure 2
). The model often considered use of betablockers, chronic migraine, and presence of WMH as factors for increasing ischemic stroke risk.

Discussion:
Our experiments show that medications, migraine features, WMH and demographics are more effective estimators for ischemic risk stroke risk compared to overall MACE risk, indicating stronger predictive correlation between ischemic stroke and migraine related clinical features. Interestingly, the model inferred the clinical practice pattern of not prescribing Triptans (TRIPTAN=0) to the patients with high risk of stroke from the data itself.
Abstract TP281:

Prevalence of stroke in individuals with Migraine: A risk analysis accounting for comorbidities using participant information from the All of Us database
Authors: Seah Nick , Dumitrascu Oana , Schwedt Todd , Wu Teresa , Chong Catherine
Published: January 2025

Introduction:
We assess the risk of stroke in individuals with and without a migraine diagnosis, adjusting for demographic variables and stroke risk factors using participant information from the All of Us database.

Method:
Diagnoses of migraine, stroke and comorbidities were identified using ICD9 and ICD10 codes. A multivariable logistic regression analysis was performed to assess the association between migraine and risk of stroke adjusting for comorbidities including hypertension, atrial fibrillation, hyperlipidemia, diabetes, tobacco use, depression and demographics (age, sex at birth, race and ethnicity). To compare the prevalence of stroke between individuals with and without migraine, odds ratios using a 95% confidence interval (CI) were calculated.

Results:
Within the
All of Us
database, 31,444 individuals received a migraine diagnosis (female=25,374/81%, male=5,391/17%, other=679/2%; mean (std) age=54.9 (15.6)) and 379,283 did not have a migraine diagnosis (female=222,104/59%, male=149,182/39%, other=7,997/2%; mean (SD) age=55.9 (17.2)), see Figure 1 for detailed demographics.

The migraine cohort had a greater proportion of women (81% vs 59%, p<0.001), a higher proportion of white individuals (61% vs. 55%, p<0.001) fewer African American individuals (15% vs. 19%, p<0.001) and a lower proportion of individuals who were 61 or older (39% vs 45%, p<0.001) compared to the non-migraine cohort.

Compared to the non-migraine cohort, individuals with migraine had significantly higher rates of comorbidities, including depression (13% vs. 4%, p<0.001), diabetes (16% vs. 7%), tobacco use (23% vs. 9%, p<0.001), hyperlipidemia (48% vs. 22%, p<0.001), hypertension (57% vs. 27%, p<0.001), and atrial fibrillation (7% vs. 4%, p<0.001).

A multivariate regression model adjusted for differences between cohort demographics and comorbidities found that individuals with migraine had 2.14 higher odds of overall stroke compared to the non-migraine cohort (OR 2.14, 95% CI [ 2.04, 2.24].

Discussion:
After adjusting for cohort imbalances in demographics and comorbidities, individuals with migraine had a 2.14 times higher risk of stroke compared to those without a migraine diagnosis. Our analysis, using data from the All of Us database, confirms previous findings and suggests that while comorbidities are more prevalent in those with migraine, they do not fully account for the increased stroke risk.
Abstract TP296: How Often is Nonstenotic Carotid Plaque in Cryptogenic Stroke Causal Versus Incidental?
Authors: Chaisinanunkul Napasri , Saver Jeffrey
Published: January 2025

Introduction:
Nonstenotic carotid plaque is found in some patients with otherwise cryptogenic stroke (CS) but also in normal individuals and patients with stroke of known cause (KS). Clinical management would be aided by estimates of how often nonstenotic carotid plaques in patients with CS are causal versus incidental.

Methods:
Through systematic search, we identified all cohort studies applying identical carotid artery imaging modalities to both CS and KS patients. We performed a random-effects meta-analysis across these studies to determine the best estimate of the differential frequency of nonstenotic carotid plaque in CS and KS patients. We then applied Bayes’ theorem (method of Alsheikh-Ali et al, Stroke 2009) to determine the probability that nonstenotic carotid plaque is causal or incidental.

Results:
The systematic search identified 6 cohort studies enrolling 1551 patients (761 CS, 790 KS). Methods of vessel imaging were carotid duplex ultrasound, CTA, and MRA. Overall, nonstenotic carotid stenosis ipsilateral to ischemic stroke was found in 33.5% (255/761) CS patients vs 19.2% (152/790) KS patients. In formal meta-analysis, the summary risk ratio for nonstenotic carotid plaque in CS vs KS patients was 1.54 (95%CI 1.15-2.05) (Figure). With application of Bayes theorem, the corresponding probabilities indicated that, when present, nonstenotic carotid plaque in CS patients is causal in 52.7% and incidental in 47.3%. Given the prevalence of nonstenotic carotid plaque, these findings indicate that nonstenotic carotid plaque is the cause of 17.7% of all anterior circulation ischemic strokes in the cryptogenic stroke population.

Conclusions:
In patients with cryptogenic stroke, when nonstenotic carotid plaque is found, it is likely causal in about half of patients, who may benefit from intensified anti-atherosclerotic therapy, and likely incidental in about half of patients. Nonstenotic carotid plaque is a common cause of cryptogenic stroke in the anterior circulation, accounting for about 1 of every 6 cases.
Abstract TP301: Prevalence and In-Hospital Characteristics of Patients with Acute Ischemic Stroke and CADASIL
Authors: Molligoda Brandon , Ellsworth Patrick , Szekely Anna , Nene Yash , Falcone Guido , Sharma Richa
Published: January 2025

Background:
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the most common hereditary stroke disorder due to pathogenic variants in the NOTCH3 gene on chromosome 19. Characteristics of CADASIL patients hospitalized with acute ischemic stroke (AIS) have not been widely reported.

Methods:
We identified all adult hospitalizations in the National Inpatient Sample (NIS) from 2018-2020 with diagnosis codes for acute ischemic stroke (ICD-10 I63) and the newly available code as of October 2018 for CADASIL (I67.850) using weighted sampling. Descriptive statistics evaluated demographic and clinical characteristics among AIS patients with and without CADASIL.

Results:
Of a total 1,918,920 weighted AIS hospitalizations, there were 300 patients with CADASIL. The prevalence of CADASIL among AIS patients increased from 0.2% in 2018 to 2.8% in 2020. AIS patients with CADASIL were similar in sex and more likely to be younger (55.8 ± 25.2 vs 69.7 ± 31.4 years, p<0.001), White (70.0% vs 65.4%, p=0.03), and Asian/Pacific Islander (6.7% vs 3.1%, p<0.001) compared to those without CADASIL. CADASIL patients had lower rates of hypertension, diabetes, and coronary artery disease (55.0% vs 82.4%, p<0.001; 21.7% vs 38.9%, p<0.001; 3.3% vs 10.6%, p=0.004). There was no difference in the rate of dyslipidemia (43.3% vs 49.8%, p=0.31), obesity (15.0% vs 8.9%, p=0.19) and smoking (23.3% vs 18.5%, p=0.38) in patients with CADASIL vs those without. There was no difference in the rate of administration of IV thrombolysis (5.0% vs 8.3%, p=0.25), however CADASIL patients were less likely to undergo endovascular thrombectomy (EVT) (0.0% vs 4.1%, p<0.001). CADASIL patients had lower rates of in-hospital mortality and were more likely to be discharged home (0.0% vs 6.5%, 53.3% vs 33.3%, all p-values <0.001).

Conclusions:
CADASIL was rare in our NIS population with a prevalence of 2.8% in 2020. Patients with CADASIL, in general, carried a lower burden of vascular risk factors. They received IV thrombolysis at an equal rate but EVT at a lower rate, likely due to the small vessel pathology of CADASIL. While less likely to experience in-hospital mortality, nearly two-thirds were not independent enough to be discharged home. Our findings highlight the need for targeted therapies addressing the pathophysiology of CADASIL to prevent AIS in these patients with an otherwise low burden of vascular risk factors.
Abstract TP314: Health and Coverage: How Co-Morbidities and Insurance Status Affect Post-Stroke Blood Pressure Control
Authors: Williams Jasmin , Forman Rachel , Wu Qifan , Sharma Richa , Sheth Kevin , de Havenon Adam , Lu Yuan
Published: January 2025

Introduction:
Blood pressure (BP) control after a stroke is crucial in lowering the risk of stroke recurrence. Our prior work found that over 60% of patients recently discharged from a regional health system with stroke did not achieve BP control according to current guidelines. Less is known about the impact of insurance type and co-morbidities on post-stroke BP control.

Objective:
To analyze the relationship between insurance type, comorbidities and post-stroke BP control among patients within a regional health system.

Methods:
This report is an observational cohort study. Patients were admitted between 2013-2021 for ischemic and hemorrhagic stroke and had seen a PCP/PCAPP (primary care physician/primary care advance practice provider) in a regional health system or affiliated outpatient clinics using the EPIC electronic health record. We excluded patients who died during hospitalization, were lost to follow-up, or were on dialysis.

Results:
The analysis included 2,750 patients. Six months after hospital discharge, the insurance coverage among stroke survivors with uncontrolled BP (
>
130/80 mm Hg) was 61.1% for public, 35.8% for private, 1.9% for other/unknown, and 1.3% for self-pay. In comparison, among those with controlled BP (<130/80 mm Hg), the coverage was 63.0% for public, 33.6% for private, 1.9% for other/unknown, and 1.6% for self-pay; a chi-square test showed a non-statistically significant difference (p=0.6026). The comorbidities with a statistically significant difference for BP control were hypertension for the uncontrolled BP group (p=0.0000027) and cancer for the controlled BP group (p=0.00065).

Conclusions:
We found that type of insurance is not associated with post-stroke BP control as we did not find a statistically significant difference in the proportion of stroke survivors with uncontrolled versus controlled BP for insurance types. There is a strong association between hypertension and uncontrolled BP suggesting that patients with hypertension are significantly more likely to have uncontrolled BP. Additionally, there is a significant association between cancer and BP control indicating that patients with cancer are more likely to have controlled BP. To the best of our knowledge, this study is the first to analyze insurance type and co-morbidities affecting post-stroke BP control from a regional health system that is not solely self-insured or operating under a global budget.
Abstract TP318: Comparison of Lipid-Lowering Therapies Regimens and LDL-C Profiles in Patients with Asymptomatic versus Acute Symptomatic Atherosclerotic Carotid Stenosis
Authors: Vlachos Dimitrios , Dittrich Tolga , Toebak Anna , Pereppadan Sruthy , Frenger Johannes , Jeker Benjamin , Farah Ioannis , Bruelisauer Shania , Inauen Corinne , Katan Mira , de Bresser Carolijn , de Borst Gert Jan , Wegener Susanne , De Marchis Gian Marco
Published: January 2025

Introduction:
Elevated Low-Density-Lipoprotein Cholesterol (LDL-C) blood levels are a risk factor for atherosclerosis. Lipid-lowering therapies mitigate the risk of atherothrombotic events. Among patients with atherosclerotic carotid stenosis, we aimed to compare asymptomatic to acute symptomatic patients in terms of LDL-C levels and lipid-lowering therapies.

Methods:
Analysis of the ongoing prospective multicenter AtheroGEnic LipoprotEinS in Ischemic Stroke study (AGELESS; NCT05090878) investigating the influence of atherogenic lipoproteins on the risk of first-ever stroke in patients with asymptomatic and acute symptomatic atherosclerotic carotid stenosis, NASCET degree 30%-99%. For this study, acute symptomatic was defined as hemispheric ischemic stroke or retinal ischemia ipsilateral to the carotid stenosis, with symptom onset within 24 hours of admission. High-intensity lipid-lowering therapy was defined as high-potency statin (atorvastatin ≥40mg/d or rosuvastatin ≥20mg/d) or any combination of ≥2 lipid-lowering therapies.

Results:
We included 296 patients with atherosclerotic carotid stenosis – median age 77 years (interquartile range [IQR] 70-82) – of which 59.8% were asymptomatic and 40.2% acute symptomatic. At enrolment, high-intensity lipid-lowering therapy was reported among 63.8% of patients with asymptomatic and 37.8% among acute symptomatic ones, p<0.001. Median LDL-C levels were 63 mg/dl (IQR 49-85 mg/dl) in asymptomatic and 101 mg/dl (IQR 73-134) in acute symptomatic patients, p<0.001. After adjusting for confounders including diabetes and coronary heart disease, high-intensity lipid-lowering therapy was not associated with symptomatic carotid stenosis, but LDL-C was: for every LDL-C increase by 39 mg/dl, the odds for a patient with carotid stenosis to be classified as symptomatic were 2.49 higher (95%CI of OR 1.82–3.42).

Conclusions:
Among patients with atherosclerotic carotid stenosis of 30-99%, both lower proportions of high-intensity lipid-lowering therapy and higher LDL-C levels were associated with acute symptomatic carotid stenosis. After adjusting for confounders, only LDL-C levels were associated with the acute symptomatic status of carotid stenosis. Although causation cannot be established due to the cohort study design, the findings suggest that having or maintaining low LDL-C levels might prevent atherosclerotic carotid stenosis from becoming symptomatic.
Abstract TP32: Tooth Loss is Associated with Post-Stroke Cognitive Impairment
Authors: VerKuilen Haley , Parrish Michael , Wood Stefanie , Fleming Phil , Canupp Krystal , Sen Souvik
Published: January 2025

Background:
Periodontal disease and dental caries are a leading cause of tooth loss which has been correlated with stroke in the REGARDS study. We investigated the correlation between tooth loss and post-stroke cognitive impairment (PSCI) assessed by Montreal Cognitive Assessment (MoCA).

Methods:
The MoCA was conducted in consecutive ischemic stroke and TIA patients (N=280) enrolled in PREMIERS trial (ClinicalTrials.gov NCT#02541032) based on presence of moderately severe periodontal disease. These patients were categorized as having normal/mild cognitive impairment (MoCA>19) or severe cognitive impairment (MoCA ≤19). Regarding tooth loss, patients were categorized into two separate groups based on the number of teeth lost as noted during initial assessment. The groups were categorized into those reporting significant tooth loss (≥8) and no significant tooth loss of <7. We tested the association between tooth loss to the MoCA assessment in post-stroke/TIA patients. In addition to the clinical cofounders' patients were assessed for periventricular and deep white matter hyperintensity using axial FLAIR images. They were graded on a 3-point Fazekas scale; none/mild disease = Fazekas grades 0-1 and moderate/severe disease = Fazekas grades 2-3. Univariate and multivariable logistic regression analysis were conducted to calculate crude and adjusted Odds Ratio (OR) respectively.

Results:
We compared those with significant tooth loss (N=201) with non-significant tooth loss group (N=79). Those that scored severe on the MoCA assessment were only slightly older than those who scored normal/mild (age 61± 12 vs. 59 ± 12, respectively), slightly less likely to be male (63% vs. 64%, respectively), and more likely to be African American (83% vs. 68%, respectively). Significant tooth loss was associated with severe PSCI (Crude OR=3.25, 95% CI.; 1.65-6.41). The association remained significant after adjustment for age, sex, race, level of education, hypertension, diabetes, white matter hyperintensity assessed by Fazeka scale (Adjusted OR=2.60, 95% CI; 1.20-5.61).

Conclusion:
In summary, the results showed a significant independent association between significant tooth loss and PSCI in a patient population with moderate to severe periodontal disease. Further study is needed to see if modifying tooth loss by aggressive management of periodontal disease and dental caries could alleviate PSCI.
Abstract TP320: The Kynurenine pathway and its metabolites in stroke: A systematic review and meta-analysis of clinical studies
Authors: Liu Mi , Xie Haihua , Jiang Jia , Cao Sihui , Ding Changsong
Published: January 2025

Background:
The kynurenine (KYN) pathway serves as the primary route for tryptophan (TRP) metabolism and plays a crucial role in the occurrence and development of several nervous diseases. The alterations in this pathway have been confirmed in psychiatric disorders, but their role in stroke remains unclear. This review aims to investigate whether metabolites in the TRP-KYN pathway change in patients with stroke.

Methods:
We searched PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases for studies that compare the levels of KYN pathway metabolites between stroke and healthy volunteers. The primary outcome of this study was KYN, and the secondary outcome were TRP, kynurenine/tryptophan ratio (KYN/TRP), and kynurenic acid (KYNA). The Stata software was utilized for data synthesis.

Results:
Seven full-length articles with a total of 1080 participants (767 with stroke and 313 healthy volunteers) were included. The results indicated that compared to the control group, stroke patients had significantly lower levels of TRP (standardized mean difference (SMD)=-1.64; 95% CI [-2.36, -0.93];
P
<0.0001) and significantly higher levels of the KYN/TRP (SMD=0.69; 95% CI [0.32, 1.07];
P
<0.0001). There was also a marginal significance in the levels of KYNA, with the stroke group showing slightly lower levels (SMD=-0.46; 95% CI [-0.99, 0.07];
P
=0.09<0.1). In contrast, there was no significant difference in KYN levels between the two groups (SMD=-0.07; 95% CI [-0.32, 0.28];
P
=0.59), but the studies inherently exhibited high heterogeneity (

I
2

=63.97%,
P
=0.01). Further subgroup analysis revealed significant differences between ischemic stroke and hemorrhagic stroke subgroups (
P
=0.03).

Conclusions:
These findings indicate that significant alterations in metabolites of the TRP-KYN pathway of patients with stroke, particularly TRP, KYN/TRP, and KA. Moreover, variations in KYN exhibit significant differences among different stroke types, with more pronounced changes observed in hemorrhagic stroke. Future studies with larger sample sizes are needed to determine whether these biomarkers can be utilized for the identification, diagnosis, and management of stroke.

Keywords:
Kynurenine; stroke; tryptophan; kynurenic acid; biomarkers.
Abstract TP327: Prevalence of healthcare access measures among stroke survivors aged 18-64, Behavioral Risk Factor Surveillance System, United States, 2011–2022
Authors: Imoisili Omoye , Pankowska Magdalena , Loustalot Fleetwood
Published: January 2025

Self-reported stroke prevalence has increased among US adults aged 18-64 over the past decade and is projected to rise. As younger stroke survivors live longer, access to healthcare is essential for the detection, treatment, and monitoring of cardiovascular disease (CVD) risk factors to prevent recurrent stroke or other acute CVD events. Adults aged <65 years may face more challenges accessing healthcare compared to older adults, who have access to Medicare. This study examined the prevalence of healthcare access among US adults aged 18-64 years who reported surviving a stroke.

Data from the Behavioral Risk Factor Surveillance System (2011-2022) included 78,857 self-reported stroke survivors. Data were stratified by age group, sex, race and ethnicity, and education. Those with missing demographics, CVD risk factors, and healthcare access information were excluded. Adjusted Wald-F chi-square tests assessed associations between sociodemographic characteristic and measures of healthcare access (having health insurance coverage,
>
1 personal healthcare provider, the ability to afford to see a doctor in the past year, and a routine checkup within the past year).

Most stroke survivors reported healthcare access: 86.3% (95% CI 85.7 – 86.8 had insurance coverage and
>
1 personal healthcare provider); 26.6% (95% CI 25.9 – 27.3) couldn’t afford a doctor in the past year; and 81.2% (95% CI 80.6 – 81.1) had a routine checkup in the past year. Statistically significant differences (p < 0.05) were found across all sociodemographic groups. Younger adults (aged 18-29 and 30-44), men, and those with lower education reported less healthcare access. Varying measures of access were reported across racial/ethnic groups.

Overall, most stroke survivors reported access to healthcare, although opportunities exist to improve access for younger adults, men, different racial/ethnic minorities, and those with lower education. Prior access to healthcare might have contributed to stroke survival for some individuals. Continued and improved healthcare access could help prevent recurrent stroke or other acute CVD event among stroke survivors.
Abstract TP37: Brain Activity During Cognitive-motor Balance Dual-tasking Among Healthy Older Adults and People With Subcortical Stroke: A Cross-sectional Study
Authors: LI Xun , OUYANG Huixi , PANG Marco Yiu Chung
Published: January 2025

Introduction:
Prefrontal cortex (PFC) has long been thought to be involved in dual-tasking, and is also found to be associated with areas involved in motor control (supplementary motor area (SMA), premotor cortex). Functional near-infrared spectroscopy (fNIRS), a non-invasive neuroimaging technology, allows measurement of cortical activity during dual-tasking. This study aimed to compare cognitive-motor interference and brain activity between people with subcortical stroke and their healthy counterparts.

Methods:
People with subcortical chronic stroke and their healthy counterparts (N=25/group; aged ≥ 50 years old, Montreal Cognitive Assessment score ≥ 22 points, Mini Balance Evaluation Systems Test score ≥16 points) were included. Each participant performed tasks in random order including: (1) single-task maintaining balance in standing position under vibration disturbance, (2) single-task serial-7-subtractions/clock test (while standing), and (3) dual-task maintaining balance in standing position in conjunction with a serial-7-subtractions/clock test. Participants were instructed to maintain balance as fast as they could safely while generating as many correct answers as possible during dual-task balance maintenance. Oxyhemoglobin (HbO) changes in bilateral PFC and SMA were measured with 46 channels of a continuous-wave system in fNIRS (ETG-4000, Hitachi). Path length of center of gravity was monitored by DynSTABLE system for postural sway. For both HbO and postural sway, dual-task cost was calculated as (dual-task performance-single-task performance) × 100%) / (single-task performance).

Results:
People with subcortical stroke had greater dual-task cost for postural sway during dual-task serial-7-subtractions than their healthy counterparts (
P
<0.001). However, the dual-task cost for HbO changes was not significantly different between the two groups. There was moderate correlation of changes in oxyhemoglobin (HbO) in non-lesion hemisphere of PFC and postural sway during dual-task serial-7-subtractions among people with subcortical stroke (r = 0.538,
P
= 0.005).

Conclusions:
PFC plays an important role in dual-task balance tests. People with subcortical stroke have similar brain activation compared to healthy older adults, but with worse dual-task performance. Dual-task serial-7-subtractions may serve as a better assessment to discriminate dual-task performance between people with subcortical stroke and their healthy counterparts compared to dual-task clock test.
Abstract TP4: Characterization of Acute Ischemic Stroke (AIS) patients excluded from thrombolysis due to recent NOAC use.
Authors: Mok Kent , Palmisano Caitlin , McArdle Patrick , Mehndiratta Prachi , Chaturvedi Seemant
Published: January 2025

Introduction:
Current guidelines exclude patients with recent NOAC use from thrombolysis, even if they present during the 4.5hr timeframe. Emerging data suggest there may not be an increased risk of hemorrhagic conversion for patients who receive thrombolysis despite recent NOAC use. At a large urban Joint Commission certified comprehensive stroke center, a retrospective analysis was conducted to identify characteristics of patients excluded from thrombolytic due to NOAC use.

Methods:
The GWTG database was queried for patients with acute ischemic stroke presenting (time frame) within 4.5 of last known well. A total of 1,933 AIS patients were identified). A total of 5.0 % (n=96) of these patients were excluded due to recent NOAC use. A chi-squared analysis was performed to determine if there was a significant difference based on sex, race, age, history of heart disease and statin use. A pooled T-test analysis was also performed to determine if a significant difference exists between the mRS and NIHSS at baseline and at discharge within the excluded patients group.

Results:
Patients excluded from IVT due to recent NOAC use were more likely to take cholesterol reducer (67.1% vs 45.6%). The NOAC exclusion group were more likely to have medical co-morbidities including Afib/Aflutter, prosthetic heart valves, CAD/prior MI, heart failure, prior DVT/PE and sleep apnea (Table 1). Both groups had an equal probability of having a history of a previous stroke. There was no statistically significant difference in patient demographics (race, sex,etc.) between the two groups.

Among the patients excluded from IVT due to recent NOAC use: 54.2% (n=52) had a normal EF, 10.8 % (n=10) had a thrombus visualized on TTE, 49.0 % (n=47) had a L.MCA stroke. 80.2% (n=77) had plans to restart their AC on discharge: Apixaban 45.8% (n=44), Rivaroxaban 11.5% (n=11) and Dabigatran 2.1 % (n=11). The median mRS at baseline was 1 and at discharge was 4.

Conclusion:
Patients excluded from IVT due to recent NOAC use were more likely to have cardiovascular co-morbidities. If NOAC exclusion is removed in the future, 1 in 20 patients could potentially become eligible for IVT, and MRS worsening due to stroke can potentially be avoided.
Abstract TP46: Longitudinal Effects of Diet on Cognitive Function and Fecal Metabolites in Two Genetically Diverse Wild-type Rat Strains
Authors: Solch-Ottaiano Rebecca , Prats Madison , Subramanian Malaika , Prus Nicholas , Yu Irene , Engler-Chiurazzi Elizabeth , Bix Gregory , Maraganore Demetrius
Published: January 2025

Background:
Modifiable lifestyle factors such as diet and genetic predisposition influence cognitive aging. The Mediterranean diet (MeDi) is associated with healthy brain aging while the Western diet (WD) is associated with cognitive impairment. Genetics may interact with dietary patterns to further impact cognitive function through the gut-brain axis. The objective of this study was to determine the effect of the MeDi on cognition and fecal metabolites relative to the WD as animals age in genetically distinct wild-type strains.

Methods:
Ten-week-old Male Fischer344 (F344; in-bred) and Sprague Dawley (SD; out-bred) rats were randomized to a MeDi or WD (n=8/group/strain). Y-maze and Morris water maze (MWM) were completed at 3.5, 9.5, and 15.5 months of diet to test spatial reference memory. Fecal samples for metabolomics were collected prior to behavioral assessment at 3.5 and 15.5 months. Data were analyzed using a Student’s t-test with false discovery rate of 0.1 or Two-Way Repeated Measures ANOVA, where appropriate.

Results:
There was no difference for Y-maze by Diet for F344 or SD rats. For MWM, there was no difference in latency to reach the platform by Diet for either strain at 3.5 or 9.5 months. However, at 15.5 months of diet, the F344 MeDi rats had a shorter latency compared to the F344 WD rats. Latency for SD rats did not differ by Diet. At 3.5 months, fecal metabolomics demonstrated 6 and 5 differing metabolites by Diet for F344 or SD rats, respectively. This increased to 202 and 139 at 15.5 months by diet for F344 or SD rats, respectively. There were 99 metabolites that overlapped by strain including an increase in deconjugated bile acids with the MeDi relative to the WD. Interestingly, the F344 had an additional 103 metabolites that were different between diets, including pathways related to glycolysis, tryptophan metabolism, and hormone production such as lower cortisol with the MeDi relative to the WD.

Conclusion:
Duration of diet and strain is an important factor in cognitive function and fecal metabolomics. The effect of diet on cognition was only evident at 15.5 months with the MeDi demonstrating better cognitive function relative to a WD within the F344 strain. Fecal metabolite differences increased with diet duration with greater differences found by diet in the F344 rats at 15.5 months. These metabolic and inflammatory pathway differences may be an indicator of related mechanisms contributing to the cognitive differences in F344 rats.
Abstract TP6: Thymosin alpha 1 promotes neuron survival by enhancing mitophagy after AIS
Authors: Kang xinmei , Wang Shisi , Cai Wei , Lu Zhengqi
Published: January 2025

Background:
Thymosin alpha 1 (Tα1) had been used in kinds of inflammatory and immunodeficiency diseases as an immunomodulator. According to our clinic observation, patients with acute ischemic stroke (AIS) treated with Tα1 to prevent/cure post-stroke infection display favorable stroke outcome. Whether Tα1 exerts direct neuronal protection besides immunomodulation remains elusive.

Aim:
To explore the effect of Tα1 on neuronal protection after AIS and unveil the underlying mechanisms.

Method:
In vivo
: 8-10 weeks old male Wild type (WT) mice were subjected to 60 minutes middle cerebral artery occlusion (tMCAO) and administrated Tα-1 by intraperitoneal injection.
Ex vivo
: Primary mouse neuron is subjected to 60 min oxygen and glucose deprivation (OGD), followed by Tα-1 treatment.

Results:
Compared with untreated group, Tα1 treatment displayed decreased infarct volume, limited neuronal loss, attenuated white matter injury，restricted neuroinflammation and improved neurological functions. Treatment of antibiotics or glucocorticoid failed to substitute the therapeutic effects of Tα1, indicating extra protection of Tα1 treatment besides anti-infection and immunomodulation. As for primary mouse neuron, Tα1 treatment showed fewer neuron death and higher cell viability upon OGD stimulation. Both
in vivo
and
ex vivo
experiments revealed that Tα1 directly inhibited ischemia-induced neuronal death. Mechanistically, Tα1 enhanced mitophagy by down-regulating Drp1, thus promoted mitochondrial renewal and supported neuronal viability.

Conclusions:
Our results identified that Tα1 possessed direct neuronal protection and improved prognosis of AIS. Given the multi-functions of Tα1 including anti-infection, immunomodulation and neuronal protection, we propose that Tα1 is a promising therapy against AIS.
Abstract WMP107: Carotid Artery Assessment via Blood Acoustic Signatures Captured by a Wearable Seismometer Patch
Authors: Sang Brian , Desai Nia , Park Jin-Woo , Junek Greg , Wen Haoran , Fonseca Michael , Kvantaliani Nino , Nahab Fadi , Ayazi Farrokh
Published: January 2025

Background:
Early detection of carotid artery (CA) conditions such as atherosclerosis and dissection are important as they represent major preventable causes of stroke. While medical imaging equipment can track calcification and dissection, they are bulky, time-consuming and unsuitable for remote or continuous monitoring. In this study, we sought to analyze if a wearable, microchip seismometer patch can capture significant differences in the systolic and diastolic blood acoustic vibrational signature from the carotid arteries across various conditions.

Methods:
The multi-head StethX seismometer patches were placed on 63 patients seen at the Emory Stroke Clinic via medical tape near the left and right CA and the pulmonic region of the heart to capture the CA blood acoustic and heart sound vibrations. These patients had varying CA conditions (atherosclerosis, dissection, normal, etc.) confirmed by magnetic resonance angiography (MRA), computer tomography angiography (CTA) or carotid ultrasound within the past year and had their blood acoustic vibration signatures recorded for one minute. The signals were then converted into time-frequency representations (TFR) with color scale used as magnitude of signal using continuous wavelet transform to distinguish between healthy and unhealthy carotid arteries.

Results:
The TFR of the blood acoustic vibrations captured by the seismometer showed significant differences of as a function of varying CA conditions. For CA with less than 50% stenosis, two distinct peaks representing systolic and diastolic are present, with systolic being lower frequency than diastolic, as shown in the Figure. For CA stenosis of greater than 50%, specifically 70-99%, the diastolic peaks are in a lower frequency range compared to less than 50% stenosis. For CA dissection, the systolic and diastolic peaks both show a higher frequency range compared to patients with less than 50% stenosis.

Conclusions:
StethX’s wearable microchip seismometer patch captured distinct acoustic vibration patterns as shown via TFR in patients with varying CA conditions, including moderate to severe atherosclerotic stenosis and dissection, when compared to less than 50% CA stenosis. This enables the application of machine learning models that use the CA blood acoustics along with possibly pulse transit time using a third patch located on the heart pulmonic region as inputs to classify severity of carotid artery stenosis as a digital health screening solution.
Abstract WMP17: The Role of Intracranial Arterial Calcifications in Neurodegeneration and Alzheimer’s Disease Pathology
Authors: Barreto Brenno , Garzon Nicolas , Hassett James Stokes , Dohmen Tren , Sole Guardia Gemma , Kozii Khrystyna , Zambrano Maria , Ramaswamy Srinath , Cadena-Tejada Angel J , Spagnolo-Allende Antonio , Flaherty Delany , Orlando Quiiroles Lucas , Chou Lindsey , Bueno Pedro , Yang Dixon , Kiliaan Amanda , Bos Daniel , Schneider Julie , Teich Andrew , Gutierrez Jose
Published: January 2025

Introduction:
Intracranial arterial calcifications (IAC) are considered a surrogate for intracranial large artery atherosclerosis but IAC can also represent non-atherosclerotic arterial aging. People with IAC have an increased risk of dementia. Nonetheless, the interplay between IAC, atherosclerosis, luminal stenosis and arterial stiffness as determinants of neurodegeneration remains unclear.

Methods:
We analyzed 161 brain autopsy cases from the Brain Arterial Remodeling Study. We dissected each of the components of the circle of Willis and stained all arterial segments with H&E, elastic van-Gieson (to semi-quantify elastin content) and trichrome (to semi-quantify collagen content) stains. We rated calcification using H&E as present or absent and classified calcifications as scattered, media calcifications, coalescent or a combination of the above. We obtained ipsilateral brain cuts and stained with H&E to measure the arteriolar wall thickness and lumen. We used immunohistochemistry to stain for beta amyloid, phospho-tau and Iba1, a measure of activated microglia. Each stained slide was processed automatically to quantify the number of amyloid plaques and microglial (Iba1+) cells per 100u
2
and percentage of tissue area stained positive by phospho-tau. We related calcification in the circle of Willis to parenchymal measure of neurodegeneration using mixed hierarchical models, adjusting for age, demographics and vascular risks.

Results:
Among 161 cases (mean age 81±16 years), 52% were female, 78% non-Hispanic white, 52% had hypertension, 11% diabetes, and 54% died with diagnosed dementia. Presence of any calcification was associated with increased number of Aβ plaques per 100 µ
2
, greater percentage of tissue area stained by phospho-tau, higher number of microglial cells and higher lumen to wall ratio (Table 1). The results were most consistent for IAC that had combined scattered and coalescent calcifications. The association between IAC and neurodegeneration markers attenuated after adjusting for elastin loss and collagenosis, both markers of arterial stiffness, but not after adjusting for atherosclerosis or luminal stenosis.

Conclusion:
IAC are associated with pathology markers of neurodegeneration, specifically Alzheimer’s disease. The association was independent of atherosclerosis and luminal stenosis, but attenuated partially after adjusting for markers of arterial stiffness. Hemodynamic studies in living persons are needed to replicate these associations.
Abstract WMP18: The Association between Cerebral Microbleed Patterns and Incident Dementia: The ARIC-Neurocognitive Study
Authors: Vuong Richard , Morrill Valerie , Graff-Radford Jonathan , Knopman David , Mosley Thomas , Johansen Michelle , Walker Keenan , Jack Clifford , Pike James , Schneider Andrea , Gottesman Rebecca
Published: January 2025

Background:
Cerebral microbleeds (CMBs) are associated with incident dementia, but the impact of specific CMB patterns is unclear. CMBs in lobar regions suggest cerebral amyloid angiopathy (CAA), which is sometimes accompanied by superficial siderosis (SS), while subcortical CMBs indicate hypertensive origins. This study investigates the association between CMB patterns and dementia risk in the community-based longitudinal Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).

Methods:
All ARIC-NCS participants with a 3T research MRI at visit 5 (2011-13; aged 67-90) without intracerebral hemorrhage or dementia were included. CMB and SS presence and location were coded from T2* GRE sequences. Individuals were classified into one of four patterns: no CMBs, only subcortical, mixed (lobar and/or SS + subcortical), and only lobar and/or SS. Incident dementia diagnoses were defined by cognitive testing (in-person and telephone), informant interviews, and hospital discharge codes or death certificates. Cox proportional-hazards models assessed the association between the presence, patterns, and frequency of CMBs (0,1,2,3+), presence of SS, and incident dementia from visit 5 through 2020. Model covariates included demographics, vascular risk factors, and imaging markers of small vessel disease.

Results:
Among 1609 participants, 364 had CMBs (Table 1). Participants with CMBs tended to be older and female compared to those without CMBs. Compared to individuals with no CMBs, presence of any CMBs was associated with an increased risk of dementia (Table 2). Compared to individuals without CMBs, individuals with only lobar CMBs and/or SS had an increased risk of incident dementia, as did individuals with mixed CMBs, but individuals with subcortical-only did not. Participants with ≥3 CMBs of any variant had an increased risk of incident dementia vs no CMBs. Although SS was infrequent, its presence (vs no SS) was associated with an elevated risk of dementia.

Conclusion:
CMBs, particularly in a mixed or lobar and/or SS-only pattern, are linked to an increased risk of incident dementia. The number of recurrent CMBs and any SS also showed an increased dementia risk. These data support that dementia risk is high in individuals with a CAA-type CMB pattern, but also emphasize that a mixed pattern, not typical of CAA alone, is associated with a high risk of dementia. Further studies should evaluate mechanisms by which these different patterns contribute to dementia.
Abstract WMP3: A retrospective analysis of Tenecteplase vs Alteplase for the treatment of central retinal artery occlusion
Authors: Vo Alexander , Khrlobyan Manya , Han SeungYong , Modjtahedi Bobeck , Taleb Shayandokht , Cheng Pamela , Ajani Zahra , Le Duy , Ly An , Rho Howard , Sangha Navi
Published: January 2025

Introduction:
There is no established acute intervention for central retinal artery occlusion (CRAO) which often results in poor visual outcomes. Intravenous Alteplase (tPA) has emerged as a promising acute treatment for CRAO. Intravenous Tenecteplase (TNK) is non-inferior to tPA in the acute treatment of ischemic stroke. However, there is limited data on its use for CRAO.

Methods:
Retrospective data of patients from January 2016 to February 2024 with CRAO who received TNK or tPA and a medical management (MM) matched cohort were collected, including demographics, suspected etiology of CRAO, presenting and final central visual acuity, symptomatic intracranial hemorrhage (sICH), vitreous hemorrhage, and neovascularization. In cases where the presenting central visual acuity was not quantified, it was assigned a value by the investigator based on qualitative descriptions. Visual acuity was converted to LogMAR units to enable quantitative comparison, where the ability to count fingers was assigned a value of 1.85, hand motions 2.28, light perception 2.70, and no light perception 3.00. Functional visual recovery was defined as a final visual acuity of 20/100 or better. Patients without a documented final central visual acuity were excluded from the analysis. T-test, chi-square, and ANOVA were used for statistical analysis.

Results:
A total of 15 TNK, 19 tPA, and 31 MM patients were included. MM patients were older than the thrombolytic patients (74.5±8.8 vs. 68.2±14.4 yrs) p=0.04. More patients had diabetes in tPA (52.6%) vs TNK (13.3%) vs MM (29.0%) p=0.04. There was no difference in suspected etiologies of CRAO. Functional visual recovery trended toward improvement in TNK (33.3%) vs. tPA (5.3%) vs. MM (16.1%) p=0.09. Quantitative assessment of final visual acuity by LogMAR trended toward improvement in TNK (1.45±1.03) vs. tPA (1.97±0.55) vs. MM (2.04±0.86) p=0.07. Fewer patients were legally blind in TNK (60.0%) vs. tPA (94.7%) vs. MM (83.9%) p=0.03. There was no difference in sICH, vitreous hemorrhage, or neovascularization.

Conclusions:
This is the first case series comparing CRAO treated with TNK, tPA, and MM. There were fewer patients who were legally blind and there was a trend toward improved final visual acuity in the TNK group. There was no difference in sICH, vitreous hemorrhage, or neovascularization. This study adds to the growing body of evidence that TNK can be an effective and safe treatment for CRAO.
Abstract WMP54: Outcomes of acute ischemic stroke patients in primary stroke centers versus comprehensive stroke centers: a pre-specified analysis of the Alteplase compared to Tenecteplase trial
Authors: Gutierrez Diego , Ignacio Katrina , Tkach Aleksander , Manosalva Alzate Herbert , Bala Fouzi , Horn MacKenzie , Khosravani Houman , Shankar Jai , Tarek Mohamed , Hunter Gary , Ademola Ayoola , Dowlatshahi Dar , Swartz Richard , Catanese Luciana , Buck Brian , Ganesh Aravind , Sajobi Tolulope , Menon Bijoy , Almekhlafi Mohammed , Singh Nishita
Published: January 2025

Background and Objectives:
Transportation to comprehensive stroke centers (CSCs) from primary stroke centers (PSCs) is key to achieving fast reperfusion in endovascular treatment (EVT)-eligible patients. We aimed to evaluate outcomes and workflow times of patients treated PSCs vs CSCs and additional key metrics for those transported from PSCs to CSCs for EVT.

Methods:
We performed a pre-specified analysis of the Alteplase compared to Tenecteplase (AcT) multicenter, randomized, controlled, trial in patients with acute ischemic stroke within 4.5 hours of onset. We compared baseline characteristics, workflow times, and clinical outcomes at 90 days between PSCs and CSCs. Mixed effects regression analyses were performed adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), location of intracranial occlusion, IVT drug and door-to-needle-time as fixed effects; and study site as a random effect.

Results:
Of 1,577 patients enrolled in the trial, 99 (6.27%) were treated in PSCs while 1,478 (93.72%) were treated in CSCs. Patients in both groups had similar age (median 72 [64 - 82] vs 74 [63 - 83] years), proportion of females (42.42% vs 48.24%), baseline stroke severity (median NIHSS 9 [6 - 16] vs 10 [6 - 16.5]), presence of large vessel occlusion (24.24% vs 24.70%; p=0.919) and EVT utilization (24.24% vs 32.61%). Patients treated in PSCs had longer onset-to-needle (median, 139 [100 - 190] vs 128 [94 - 185] minutes) and door-to-needle times (median, 56.5 [42 - 70] vs 35 [27 - 47] minutes) compared to those treated at CSCs. For patients transferred from PSCs to CSCs, patients who received tenecteplase had shorter needle-to-puncture times than those who received alteplase (median, 35.5 [21 - 58] vs 52 [18 - 74] minutes, p<0.001). The proportion of patients achieving excellent functional outcome (mRS 0-1) at 90 days was higher at PSCs compared to CSCs (48.48% vs 35.01%, adjusted IRR, 1.42 [CI 95%, 1.04 - 1.95]).

Conclusions:
Despite less efficient workflows for IVT administration and similarities in baseline characteristics, the proportion of patients receiving initial treatment in PSCs who had excellent functional outcomes was higher compared to CSCs. Among those who received tenecteplase prior to CSC transfer, more efficient time metrics were noted.