bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP205: Development and Validation of a Prediction Model for Outcome in Mechanical Thrombectomy for Large-Vessel Occlusion Anterior Circulation Stroke With Low ASPECTS
Authors: Matsukawa Hidetoshi , Elawady Sameh S , Cunningham Conor , Sowlat Mohammad-Mahdi , Uchida Kazutaka , Maier Ilko , Al Kasab Sami , Jabbour Pascal , Kim Joon-Tae , Quintero Stacey C , Rai Ansaar , Starke Robert , Psychogios Marios , Shaban Amir , Arthur Adam , Cuellar Hugo , Grossberg Jonathan A , Alawieh Ali , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles , Park Min S , Levitt Michael , Brinjikji Waleed , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade , Chowdhry Shakeel A , Ezzeldin Mohamad , Yoshimura Shinichi , Spiotta Alejandro M
Published: February 2024

Introduction:
Recent randomized control trials suggested that mechanical thrombectomy (MT) was associated with good functional outcomes after acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in patients presenting with low Alberta Stroke Program Early CT Score (ASPECTS) (defined as ASPECTS 2-5). The aim of this study is to develop and validate a stroke prediction tool for outcome in MT for AIS patients with low ASPECTS using data from an ongoing international multicenter registry, the Stroke Thrombectomy and Aneurysm Registry (STAR).

Methods:
236 AIS patients with low ASPECTS caused by LVO who undertook MT between January 2010 and December 2022 were retrospectively investigated. Univariate and multivariate logistic regression results were used to screen model predictors and construct nomograms of 90-day modified Rankin Scale scores (mRS) 0-3. The performance of the model was detected by using receiver operating characteristic analysis. The bootstrap resampling method was considered internal validation of the model.

Results:
Age (< 70 years), premorbid status (mRS 0), National Institutes of Health Stroke Scale (NIHSS) (< 20), and recanalization status after the MT (modified Thrombolysis in Cerebral Ischemia [mTICU] ≥2b) were related to 90-day mRS 0-3. Predictive score was calculated by adding 1 point for age (< 70 years), premorbid status (mRS 0), and NIHSS < 20 and 3 points for a mTICI ≥2b (ranging 0-6). 90-day mRS 0-3 was observed in 0% of patients with a score of 0 or 1, 6.3% with a score of 2, 17.7% with a score of 3, 22.2% with a score of 4, 45.7% with a score of 5, and 73.7% with a score of 6. The score showed relatively high performance in predicting 90-day mRS0-3 (area under the curve: 0.79 [95% CI 0.73-0.79] and 0.78 [95% CI 0.78-0.78] for derivation and validation cohorts, respectively).

Conclusions:
This study indicates the STAR score can be calculated with baseline and periprocedural characteristics to predict the 90-day outcome after MT in AIS patients with low ASPECTS.
Abstract WP210: Intensive vs. Conventional Blood Pressure Management After Thrombectomy for Acute Ischemic Stroke: Systemic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Abbasi Mehdi , Asghariahmadabad Mona , Metanat Pouya , Yadollahi Sepideh , Desai Masoom
Published: February 2024

Background:
Optimal Blood pressure management after thrombectomy for acute ischemic stroke and its association with clinical outcomes remains unclear. We performed this study to compare clinical outcomes between intensive systolic blood pressure (SBP) control (<120-140mmHg) and conventional SBP control (< 180mmHg).

Methods:
In September 2023, this registered systematic review (CRD42023464176) was performed using multiple databases for the following keywords: stroke, thrombectomy, and Blood Pressure from 2010 to present. Randomized control studies were included if they had the reported the outcome for adults aged >18 who underwent successful thrombectomy (defined as mTICI 2b or higher) for acute ischemic stroke. The primary outcome of interest was the rate of functional independence, defined as a modified Rankin scale of 0-2 at 90 days. The secondary outcomes of interest included rates of mortality, and symptomatic intracranial hemorrhage (sICH). For all outcome events, corresponding odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects meta-analysis model.

Results:
Four studies comprising 1497 patients were included. Compared to conventional SBP control, intensive SBP control was associated with lower rates of functional independence (OR 0.67, 95% CI 0.51- 0.88 p=0.0). There were comparable rates of sICH (OR 1.12, 95% CI 0.75-1.67; p = 0.56) and mortality (OR 1.21, 95% CI 0.90-1.64; p = 0.19) between intensive and conventional SBP control groups.

Conclusions:
Our findings suggest that intensive blood pressure control does not improve clinical outcomes. More robust data is needed to draw definite conclusions.
Abstract WP215: Number of Passes Matter in Acute Ischemic Stroke Patients Who Underwent Failed Mechanical Thrombectomy
Authors: Elawady Sameh Samir , Cunningham Conor , Matsukawa Hidetoshi , Sowlat Mohammad-Mahdi , Uchida Kazutaka , Zandpazandi Sara , Orscelik Atakan , Maier Ilko , Al Kasab Sami , Jabbour Pascal M , Kim Joon-Tae , Quintero Stacey C , rai ansaar , Starke Robert , Psychogios Marios , Shaban Amir , Arthur Adam S , Yoshimura Shinichi , Cuellar Hugo , Howard Brian , Alawieh Ali M , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles C , Park Min S , Levitt Michael , Brinjikji Waleed , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade A , Chowdhry Shakeel A , Ezzeldin Mohamad , Spiotta Alejandro M
Published: February 2024

Introduction:
Acute ischemic stroke (AIS) patients often require multiple passes during mechanical thrombectomy (MT) to open the vessel. Yet, at times, even numerous passes are unsuccessful. This study aims to investigate the impact of the number of passes on the outcomes of patients who underwent failed MT.

Methods:
We used Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to August 2023. Patients who underwent MT for ICA, M1, or M2 with unsuccessful recanalization (modified Thrombolysis in Cerebral Infarction ≤ 2a) were included. Primary outcome was 90- day modified Rankin Scale (mRS) 0-2. Secondary outcomes included any intracranial hemorrhage (ICH) and symptomatic ICH (sICH). Outcomes were compared among patients who received ≤ 2, 3, 4, and ≥ 5 MT passes.

Results:
736 patients met inclusion criteria. 90-day mRS 0-2 was found to decrease with number of passes (Figure 1). Multivariate logistic regression analysis revealed that 3 passes (OR: 0.48, 95% CI: 0.23 -0.96, P-value: 0.04), 4 passes (OR: 0.46, 95% CI: 0.19 -1.03, P-value: 0.07), and ≥ 5 passes (OR: 0.22, 95% CI: 0.08 -0.50, P-value: <0.001) were associated with lower odds of mRS 0-2 compared to ≤ 2 passes. However, there were no significant differences between groups in ICH, sICH, or 90-day mortality.

Conclusion:
The number of passes affects functional outcomes among stroke patients who underwent failed MT.
Abstract WP221: Vein of Galen Malformations: Twenty Years Later
Authors: Devarajan Alex , Shigematsu Tomoyoshi , Philbrick Brandon D , Hardigan Trevor , Bonet Jessica M , Giovanni Brian , Morgenstern Peter F , Sorscher Michelle , Molofsky Walter , Ghatan Saadi , Berenstein Alejandro , Fifi Johanna T
Published: February 2024

Introduction:
Vein of Galen Malformations (VOGM) are congenital arteriovenous malformations which carry a mortality of 76.7% in untreated patients. Outcomes have improved over time with advances in endovascular embolization. As endovascular management of VOGM has begun to favor more aggressive treatment strategies, there is scarce literature examining long-term functional and neurological outcomes and whether patients may have benefited from a more or less aggressive approach to treatment.

Methods:
A single-center retrospective review identified all patients with VOGM over the age of 18 with complete clinical data from January 1982 to May 2005. Patients were stratified based on radiographic outcomes: cured before the age of 18 (“pediatric-cured group”), cured after the age of 18, or not cured. Patients cured after the age of 18 and patients who were never cured were grouped together (“adult-cured group”). Long-term functional outcomes were assessed using the modified Rankin Scale (mRS). Statistical analyses were conducted in R version 4.2.1.

Results:
Forty-three adult patients were identified: 26 in the pediatric-cured group and 17 in the adult-cured group. The median current age of the pediatric-cured group was less than the adult-cured group (21 vs. 28, p<0.01). On initial presentation, the groups did not differ in their clinical or radiographic symptoms, comorbidities, or developmental delays. No significant differences were present in treatment courses. The pediatric-cured group demonstrated lower risk of intraprocedural or postprocedural hemorrhagic complications (p=0.03). On long-term follow-up, adult-cured patients presented with worse mRS (p<0.01), a higher rate of neurological symptoms (p<0.01), persistent fine motor delays (p<0.03), persistent cognitive or learning deficits (p=0.04), and persistent hydrogenous disorder (p<0.01).

Conclusion:
This is the first study to analyze long-term outcomes of adult patients managed for VOGM during the pediatric period. Patients cured in the pediatric period demonstrated reduced risk of hemorrhagic complications and improved long-term functional and neurological outcomes. Pursuing early cure in patients with VOGM may provide long-term benefit and reduce risk in later treatment.
Abstract WP226: Perioperative Stroke and Cardiac Anomalies Associated With Posterior Cerebral Artery Stenosis in Children With Moyamoya
Authors: Singh Nikita , Rangwala Shivani , Mosher Amanda , Papadakis Joanna , Kappel Ari , See Alfred Pokmeng , Orbach Darren , Smith Edward R , Lehman Laura L
Published: February 2024

Introduction:
Moyamoya is a progressive steno-occlusive arteriopathy of the intracranial circulation affecting the anterior circulation and less often the posterior circulation. Risk factors and severity of disease progression in children with moyamoya and posterior cerebral artery (PCA) stenosis have not been well described in the literature. Previous research has shown an association between PCA stenosis and increased risk of post-operative stroke. We wanted to further explore this relationship in children with moyamoya and delineate the associated risk factors.

Methods:
Children with moyamoya who underwent surgical revascularization at our institution between December 2015 and December 2022 were reviewed for presence of PCA stenosis. Clinical and radiographic features were compared between children with moyamoya with and without PCA involvement. Categorical variables were compared using Fisher's exact test and continuous variables using Wilcoxon rank-sum. Associations between perioperative stroke and PCA stenosis were analyzes using a multivariate logistic regression.

Results:
In our cohort of 160 children with moyamoya, 45 (28%) had PCA stenosis; 26 of these 45 (57%) had PCA stenosis at time of diagnosis. Of the 19 children who did not have PCA stenosis at time of diagnosis but developed it during follow up, the median time to development of PCA stenosis was 1.0 years. Children with moyamoya and PCA stenosis had significant more cardiac anomalies than those without (p=0.02). Other associated disorders were found in 13 (28%) including trisomy 21 (6, 13%), cranial radiation (2,4%) and NF1 (3,7%). Interestingly, we found no significant difference in age, sex or prevalence of bilateral disease between the groups. Children with moyamoya and PCA stenosis had a 3.5 higher odds of having a stroke within 2 weeks of surgery (p=0.049).

Conclusion:
Children with moyamoya and PCA stenosis had a 3 fold higher odds of perioperative stroke compared to those without PCA stenosis. Genetic evaluations may be warranted given association of PCA stenosis and cardiac anomalies.
Abstract WP230: Global Burden of Stroke and Its Attributable Risk Factors in High Income North America From 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019
Authors: Dadhania Khush , Chhayani Hiren , AKULA Sai bhavani , Pranathi Royal Naradasu , patel Anandkumar , Bollu Sashank Sai , Anne Sai Nitya Tejaswi , Sajeev Krishna , Patel Sneh , Thota Anjani Kumar , Patel Tirath , Gadamidi Vinay Kumar , Desai Hardik Dineshbhai
Published: February 2024

Background:
Stroke ranks as the 2
nd
leading cause of mortality, following ischemic heart disease, within the spectrum of cardiovascular-related deaths.

Method:
Employing the Global Burden of Disease tool, Stroke prevalence, incidence, mortality, and Disability-Adjusted Life Years (DALYs) by age, sex, and year across the High-Income North America (HINA) countries from 1990-2019.

Result:
The overall prevalence of stroke increased from 4,796,172 (with a 95%UI:4,289,092-5,345,234) in 1990 to 7,703,036 (95% UI: 6,967,262-8,537,862) in 2019. The annual percentage of change (APC) demonstrated an increment of 22% in incidence, 21% in DALYs, and 23% in mortality from 1990-2019. Notably, the most substantial APC in mortality was observed in Mexico, at 74% from 1990-2019, whereas the lowest increase was seen in the United States at 23% during the same period. Notably, all countries exhibited a significant reduction in the burden of stroke from 1990-2019. Within the age groups, the highest number of deaths, 37,559, occurred among individuals aged 85-89, whereas the highest incidence, 64,422, was noted in the 70-74 age group. In terms of DALYs, the 75-79 age group accounted for 516,753 in 2019. Throughout the assessed period, males bore a greater burden than females. High blood pressure emerged as the leading attributable cause of stroke-related deaths, contributing to 89,009 fatalities in 2019.

Conclusion:
The burden of stroke within High-Income North America embodies intricate dimensions spanning health, economics, and society. This study underscores the imperative for targeted interventions that address the distinctive challenges posed by stroke within this specific region.
Abstract WP231: The Incidence of Intracranial Hemorrhage in Patients Anticoagulated With Factor Xa Inhibitors (FXai): A Multi-Country Observational Study (AXIOM ICH)
Authors: Cohen Alexander T , Welsh Robert C , Leentjens Jenneke , Canbay Ali , Coleman Craig I , Choudhuri Satarupa , Er Chaozer , Chai-Adisaksopha Chatree , Dover Douglas , Hoveling Liza , Smits Lisa , Mamza Jil Billy , Gao He , Randhawa Arsh , Babak Elena , Beekman Wendy , Houthuizen Noortje , Scherg Felix , Kopke Katarina , Winter Julia , Godfrey George , Lang Eddy , Arenillas Juan F ,   On behalf of the AXIOM Rsch Group
Published: February 2024

Background:
Intracranial haemorrhage (ICH) is associated with significant long-term morbidity, high healthcare costs and mortality. There is a paucity of accurate national incidence rate data on ICH, fatal ICH and ICH sub-types in patients on FXai anticoagulants (e.g. rivaroxaban and apixaban).

Aim:
To describe patient characteristics and incidence of ICH following the initial use of FXai in an ongoing multi-country study.

Methods:
A retrospective observational cohort analysis of electronic health records from new users of FXai in the UK and Canada. Individuals with FXai prescriptions for a therapeutic indication such as venous thromboembolism, atrial fibrillation (AF), and/or non-mechanical cardiac-valve replacement, were included. Demographic and clinical data were summarised using descriptive statistics, and incidence rates for ICH events were reported per 100 person-years with 95% confidence intervals. Subgroups have been analysed.

Results:
In the UK and Canada, there were a total of 383,433 new users of FXai; average age 69 years, 54% male, average BMI 29 kg/m
2
and 88% of patients used an oral FXai. The most common indication was AF (73%). 1650 and 438 ICH events were reported in the UK and Canada, with 1-year incidence rates of 0.56 and 0.72 per 100 person-years, 27% and 26% were fatal (Table), respectively. Event rates remain elevated in the years following FXai initiation.

Conclusions:
Findings indicate incidence rates of ICH in patients treated with FXai were consistent over time, approximately 0.64 per 100 person-years or 1:160 patients per year throughout the course of treatment. Case fatality rates are high, around 27%, remaining elevated in the years following FXai initiation.
Abstract WP240: Long Term Impact of the Los Angeles Barbershop Blood Pressure Study on Stroke/TIA and Cognitive Impairment
Authors: Katti Abhinav , Harris Jennifer , Conley Patrick , Pacheco Jeannette , Sati Pascal , Bello Natalie A
Published: February 2024

Background:
Individuals with poorly controlled blood pressure (BP) have a heightened risk of stroke and vascular cognitive impairment. BP reduction has been associated with reduced risk of future stroke and cognitive impairment. Black Americans are disproportionately affected by hypertension and neurologic-target organ damage. Interventions targeted to reduce these disparities are greatly needed. From 2/2015 - 7/2017, 307 Black men were enrolled into a cluster randomised, pharmacist-led BP reduction intervention at 52 Black-owned barbershops in Los Angeles, CA [the Los Angeles Barbershop BP Study (LABBPS)] which demonstrated significant improvement in BP control sustained over a 12-month period. The current study evaluates the long-term impact of the intervention on incident stroke/TIA and prevalent mild cognitive impairment (MCI).

Methods:
Living participants from the LABBPS were contacted via telephone for interval health history inquiring about the development of symptoms consistent with stroke/TIA since trial end and via telephone interview for Cognitive Status (TICS-M); whereby a score ≤34 was considered positive for possible amnestic MCI. Rates of stroke/TIA were compared using a Pearson’s Chi-squared test.

Results:
Out of 288 participants, 115 men (50%) with mean (SD) age 62 (9) years, were successfully contacted a median of 6 years after trial end. The distribution of TICS-M scores was similar between groups with 71% and 70% having an abnormal result in the intervention and control groups respectively. Self-reported stroke/TIA occurred in 4 men in the intervention group and 9 in the control group (p = 0.13).

Conclusion:
Barbershop-based interventions have proven effective in lowering BP in Black men, a group at disparate risk for neurovascular complications. The preliminary results of our follow-up study do not show a significant difference in possible MCI between treatment arms, though there was a trend towards lower incident stroke/TIA seen in the intervention group. Limitations include a lack of interval BP values, unknown durability of the intervention beyond 12 months, and disproportionate impact of COVID-19 pandemic on the health of African American communities which is not accounted for in this analysis.
Abstract WP247: Potential Predictors for Progression of Adult Moyamoya Disease: A Study From Multicenter Registry
Authors: Heo Sung Hyuk , Woo Ho G , Chang Dae-il , Noh Kyung Chul , Choi Hye-Yeon , Kim Young Seo , Kim Hyun Young , Kwon Hyuk Sung , Koh Seong-Ho
Published: February 2024

Background and aims:
Moyamoya disease refers to a chronic progressive steno-occlusive disease at the distal portion of the internal carotid arteries (ICAs) and compensatory abnormal collateral vessel formation. However, the incidence of progression and its’ related factors in adult moyamoya disease has not been well known. Our study was to investigate the prevalence of progression of steno-occlusion of intracranial vessels and clinical outcome in the patients with adult moyamoya disease.

Methods:
From Jan 2001 to Jun 2021, we included the patients who was diagnosed with symptomatic or asymptomatic moyamoya disease from moyamoya registries of 4 hospitals in Korea. We excluded patients who did not have any follow-up angiography more than 1 year after baseline angiography [digital subtraction angiography (DSA) or magnetic resonance angiography (MRA)]. We adopted Suzuki’s angiographic staging and MRA score for the analysis.

Results:
A total of 293 moyamoya patients were included, and mean follow-up period was 92.7 ±52.8 months. Among them, progression of vessel stenosis in DSA and/or MRA was found in 110 patients (37.5%). Recurrent stroke occurred in 39/183 (21.3%) in non-progression group and 40/110 (36.4%) in progression group. Clinical characteristics were not significantly different between two groups. However, previous ischemic stroke history is independently associated with angiographic progression (odds ratio, 3.384 [95% CI, 1.521-7.531]) in multivariable logistic regression analysis.

Conclusions:
Occlusive arterial status worsened in one-third of the patients with adult moyamoya disease during approximately 8 years of follow-up. Careful neurological and radiological follow-up would be essential to prevent additional stroke occurrence, especially in patients with a history of cerebral infarction.
Abstract WP255: Association Between Asymptomatic Intracranial Large Artery Stenosis and Neurofilament Light Chain: The Northern Manhattan Study
Authors: R. Barreto Brenno , Guzman Vanessa A , Khasiyev Farid , Spagnolo-Allende Antonio , Elkind Mitchell , Rundek Tatjana , Gutierrez Jose
Published: February 2024

Introduction:
The Neurofilament light chain (NfL) is a neuronal cytoplasmic protein and a reliable biomarker for assessing axonal damage in neurological diseases and traumatic brain injury. Asymptomatic intracranial large artery stenosis (ILAS) has been associated with higher risk of stroke and dementia. Although widely studied in the last few years, the role of NfL concentrations in ILAS is not well understood.

Methods:
We leveraged data from stroke-free participants in the population-based cohort Northern Manhattan Study (NOMAS) for a pilot study. Arterial stenosis was measured on magnetic resonance angiography in 11 intracranial large arteries and graded as 0 = no stenosis, 1 ≤ 50%, 2 = 50-69%, 3 ≥ 70% stenosis and 4 = flow gap. An asymptomatic Intracranial Large Artery Stenosis (ILAS) score was then developed to reflect the global stenotic burden, with a range of 0 to 44. We also dichotomized the ILAS score into any stenosis > 50% versus none to reflect a more clinically relevant definition of ILAS. NfL concentrations were measured in plasma using Quanterix Simoa™ platform. We conducted generalized linear models adjusting for demographic and vascular risk factors and Wald Chi-Square test to analyze the association between NfL and ILAS score.

Results:
We included 79 stroke-free NOMAS participants (66% women, 77% Hispanic/Latino, and 75% with hypertension). The mean concentration of NFL was 0.19±0.10 pg/mL with a mean intra-assay coefficient of variation equal to 8.2%. In a model adjusted for age, sex, race/ethnicity, hypertension, diabetes, dyslipidemia and smoking, a higher ILAS score was associated with increased levels of NfL (B=0.01 ± 0.004, p=0.007). In an adjusted model, any stenosis >50% was also associated with increased levels of NfL (B=0.11 ± 0.03, p<0.001).

Conclusions:
The increased levels of plasma NfL associated with asymptomatic ILAS suggest neuronal injury that may implicate development of neurodegeneration. Confirming these results in a larger sample and longitudinal evaluation of NfL may advance the understanding of the mechanisms by which ILAS may increase the risk of dementia.
Abstract WP262: Enhancing Stroke Knowledge Among Youth: Insights from
Stroke Busters
Authors: Chang Wayne W , Parker Ranisha L , Stevens Lynn , Blood Justin , Nystrom Karin , Forman Rachel
Published: February 2024

Introduction:
Educating youth about stroke can improve stroke knowledge in communities.
Stroke Buster
s, a 5-day program for high school students, consists of interactive stroke lectures, a mock stroke code simulation, and a hands-on thrombectomy demonstration. In 2022, we found that the program was efficacious in improving stroke knowledge using pre/post-tests. In 2023 we designed a consolidated 1-day program, and also repeated the annual 5-day summer program. We assessed pre/post-test knowledge for each workshop, long-term retention, and if teaching the program improved knowledge for prior participants. The optimal duration and format of stroke education for youth is not known.

Methods:
Students from three cohorts of the Yale University Pathways to Science program participated in Stroke Busters: 13 students from Summer 2022 (5-day, 90 min/day), 14 from Spring 2023 (1-day, 90 min), and 15 from Summer 2023 (5-day, 90 min/day). Student demographics of the overall Pathways to Science program were 31% White, 29% Black, 28% Hispanic, 12% Asian and <1% other. 8-question pre/post tests were administered at the beginning and conclusion of each session, as well as 8 months following the summer 2022 program.

Results:
Scores were similar for both summer (5-day) programs, increasing from 36.3% (pre-test) to 66.3% (post-test) in 2022 and from 41.7% to 62.5% in 2023. For the 1-day program, the scores increased from 35.7% to 62.5%. Post-test scores were similar for both the 5-day program and the 1-day consolidated program. Five students from the 2022 summer program replied to the 8-month follow up survey, resulting in an average test score of 65%, which was similar to their immediate post-test score of 66.3%. Two students from Summer 2022 (5-day) returned to teach the Spring 2023 (1-day) program, and their average test score after teaching was 87.5%.

Conclusion:
Stroke Busters
is efficacious in promoting long-term retention of stroke knowledge among high school students; students who taught the course retain knowledge even better. The equivalence of post-test scores between the 5-day and 1-day programs offers valuable insights for resource optimization without compromising education quality.
Abstract WP264: Identifying Gaps in Discharge Statin Prescription Within a Stroke Clinical Network
Authors: Palmisano Caitlin , Goff Lindsay M , Gonzalez Karen L , Leonard Nicole , Maloney Theresa , Miskell April , Schrier Chad , STINE SHELLEE , Ross Jeffrey , Chaturvedi Seemant
Published: February 2024

Introduction:
Statins are recommended in national guidelines for secondary prevention following acute ischemic stroke (AIS). Studies have reported patients not taking statins after AIS have increased mortality. The purpose of this retrospective quality improvement initiative was to determine if there is a difference in prescription of statin medications at discharge for patients with AIS within a Stroke Clinical Network (SCN), consisting of one comprehensive stroke center (CSC) and eight primary stroke centers (PSC).

Methods:
The Get with The Guidelines registry was queried for AIS patients admitted to the SCN between 2017-2022 to evaluate discharge practices for statins. Information was collected to include age, gender, race, history of CAD, DM, HTN, and if discharging facility was a PSC or a CSC. Patients were excluded if they died, discharged to hospice, or if a reason for no statin at discharge was documented. A Chi-square and a multivariable regression were performed to examine the relationships between demographic and medical variables and if a statin was prescribed at discharge.

Results:
A total of 15,606 AIS patients were identified. Mean age was 68 years (SD +/- 14.2), 50% male (7798/15606), and 38.8% Black (6061/15606). Of the 15,606, a total of 13,319 (85.3%) were prescribed a statin at discharge. Compared to patients with the following risk factors, there was a significant difference in the odds of being discharged without a statin for patients who did not have HTN (OR 1.52, 95% CI [1.36-1.69]), DM (OR 1.65, 95% CI [1.48-1.83]) or CAD (OR 1.34, 95% [1.18-1.53]). Patients who are < 70, white, female, and discharged from a PSC are also at higher risk for non-statin use.

Conclusions:
In a large SCN, those without well-known vascular risk factors, those under the age of 70, white patients and women were at higher risk of not being prescribed statins at discharge. Further studies should be done to address these disparities and to optimize secondary stroke prevention.
Abstract WP272: Insulin Resistance Estimated by Estimated Glucose Disposal Rate Predicts Outcomes in Acute Ischemic Stroke Patients
Authors: Lu Zhengzhao , Xiong Yunyun , Feng Xueyan , Gu Hongqiu , Wang Yongjun
Published: February 2024

Background:
Estimated glucose disposal rate (eGDR), a simple and noninvasive measure of insulin resistance, has been proven to be an independent risk factor for first-time stroke and all-cause mortality. In this study, we aimed to investigate the associations between eGDR and the stroke outcome in patients with first-time acute ischemic stroke (AIS).

Methods:
We included first-time AIS patients with available data on eGDR in the China National Stroke Registry III (CNSR-III), and divided the subjects into lower eGDR group (eGDR ≤6 mg/kg/min) and higher eGDR group (eGDR >6 mg/kg/min). The primary outcome was excellent functional outcome (modified Rankin Scale score 0-1) at 3 months. Secondary outcomes included stroke recurrence and favorable functional outcome (modified Rankin Scale score 0-2) at 3 months, and functional outcome and combined vascular event at one year. Univariate and multivariate analyses were performed to evaluate the association between eGDR and outcomes.

Results:
A total of 6,271 patients with AIS were included in this study. The median values of eGDR in lower and higher eGDR group were 5.0mg/kg/min (interquartile range, 4.2-5.6) and 7.6mg/kg/min (interquartile range, 6.8-9.6), respectively. Patients with higher eGDR were significantly associated with higher incidence of excellent functional outcome (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.45; P<0.01) at 3 months and favorable (adjusted odds ratio, 1.55; 95% confidence interval, 1.24-1.93; P<0.01) and excellent (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51; P<0.01) functional outcome at one year. However, there was no significant difference in stroke recurrence between these two groups at 3 months (adjusted odds ratio, 0.81; 95% confidence interval, 0.61-1.06; P=0.12) and one year (adjusted odds ratio, 0.91; 95% confidence interval, 0.73-1.14; P=0.41).

Conclusion:
eGDR is a predictor of functional outcome in patients with AIS, independent of traditional cardiovascular predictors.
Abstract WP273: The Association of Social Determinants of Health on Functional Outcome After Intracerebral Hemorrhage
Authors: McVeigh Taylor , Rist Pamela , Mallick Akashleena , Mora Samantha , Kourkoulis Christina , Anderson Christopher D , Rosand Jonathan , Yechoor Nirupama
Published: February 2024

Background:
It remains unknown which social determinants of health (SDOH) are impactful or when disparities begin to emerge in intracerebral hemorrhage (ICH). This study aimed to investigate the association between pre-stroke SDOH and post-stroke functional outcome.

Methods:
Data from the Massachusetts General Hospital (MGH) ICH cohort was used and included age, sex, ICH severity, history of hypertension, tobacco use, diabetes, coronary artery disease, atrial fibrillation, liver disease, history of dementia, and history of prior ICH. SDOH exposures included income bracket, educational attainment, marital status, race, and religion. The primary outcome was the modified Rankin Score (mRS) measured at 12 months. Baseline characteristics, past medical history, and SDOH among those with mild stroke versus severe stroke were compared using the Wilcoxon Rank Sum test and chi-square tests. Factors from the univariate analysis which were associated with stroke severity (p<0.05) were included in a logistic regression model.

Results:
Of the 315 patients with available 12-month mRS, 180 (57%) had mRS scores <3 or relatively good functional outcomes, and 135 (43%) had mRS scores >=3 or relatively poor functional outcomes. The median age of those with low mRS was 69 compared to 76 for those with high mRS. Those with high mRS were more likely to have high school-only education or a diagnosis of dementia on admission compared to those with low mRS. Those with high school-only education were 2.94 times more likely than college diplomates to have high mRS (OR 2.94, 95% CI 1.57-5.53). Similarly, those with a diagnosis of dementia on admission, were 6.22 times more likely than those without a diagnosis of dementia to have high mRS (OR 6.22, 95% CI 1.70-22.75).

Discussion:
In addition to clinical determinants of age, ICH severity, and underlying dementia, educational attainment was an independent predictor of poor functional outcome after ICH. We recognize the impact of survival bias in our study design; however, we found differences in recovery despite this bias. Our findings suggest that disparities in outcomes exist even in relatively homogenous patient populations and that SDOH prior to an ICH still have associations with functional outcomes after stroke.
Abstract WP274: Clinical Outcomes of Vasospasms in Non-Traumatic Subarachnoid Hemorrhage and Racial Disparity in the United States: A 20-year Analysis of the National Inpatient Sample From 2000-2019
Authors: Shigematsu Tomoyoshi , Hardigan Trevor , Kellner Christopher P , Fifi Johanna T , Mocco J D , Majidi Shahram
Published: February 2024

Background:
Cerebral vasospasm in non-traumatic subarachnoid hemorrhage (SAH) is associated with a high rate of morbidity and mortality. We aimed to analyze the clinical outcome of the cerebral vasospasms and characterize the racial disparities in patients with vasospasms over a 20 year period.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with cerebral vasospasm (ICD-9 435.9, ICD-10 I67.84) in non-traumatic SAH (ICD-9 430, ICD-10 I60). Demographics, comorbidities, and outcomes were identified. Functional outcome was categorized in Excellent, Good and Poor. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
Among a total of 67,670 SAH patients, 34,091 (50.3%) with vasospasms were identified. Mean Age was 53.4±13.5 years. Patients with vasospasms had higher Elixhauser Comorbidity Score (8.47 ± 7.86 vs. 7.70 ± 7.77; p<0.001). Patients with seizures were more likely to be White or Hispanic, and to have systemic inflammatory disease, hyperlipidemia and hypertension (all p<0.001). After propensity matching, vasospasm patients were less likely to experience in-hospital mortality (AOR 0.53; 95%CI: 0.47-0.59), likely to have longer hospital stay (3.55 days, 95%CI:3.03-4.07), and had increased hospital charges ($114,108; 95%CI: $102,527-125,688)(all p<0.001). The vasospasm patients were 62.2% White, 15.4% Black, 13.2% Hispanic, and 3.7% Asian. The Hispanic patients had more likelihood to have an excellent outcome (P=0.003).

Conclusions:
Approximately 50% of patients with non-traumatic SAH experienced vasospasms while hospitalized. Vasospasm is more likely to occur in hypertension and hyperlipidemia patients and is associated with longer hospital stay but less in-hospital mortality. The Hispanic race may have better odds of having an excellent outcome.
Abstract WP282: Association of Very Short Interval Blood Pressure Variability With Stroke
Authors: Tantisattamo Ekamol , Rochanaroon Voramol , Thiravetyan Ben , Puchongmart Chanokporn , Tribuddharat Narisara , Wanichwecharungruang Nisha , Suenghataiphorn Thanathip , Kulthamrongsri Narathorn , Srikulmontri Thitiphan , Chuenchaem Urairat , Noree Wanprapit , Naunsil Piengpich , Vutthikraivit Possawat , Tanariyakul Manasawee , Wattanachayakul Phuuwadith
Published: February 2024

Background:
While blood pressure variability (BPV) is associated with poor cardiovascular outcomes, the relationship between BPV obtained in a very short interval and stroke is unknown. We aim to examine the association between very short interval BPV and a history of stroke.

Hypothesis:
Higher BPV is associated with the likelihood of having a stroke.

Methods:
A cross-sectional study using 2017-2020 NHANES included 3 consecutive BP measurements taken 60 seconds apart. The average real variability (ARV) of systolic and diastolic BP (AVR-SBP and AVR-DBP) was assessed as an average of absolute difference in consecutive BP. The association of AVR-SBP and AVR-DBP and the history of stroke was examined by multiple logistic regression.

Results:
Of 9,693 adult participants, mean±SD age was 50±19 years and 51% were female. Up to 5% (487 patients) had a history of stroke. Mean of the three average SBP and DBP were 120±20 and 72±12 mmHg, respectively. Median (IQR) of ARV-SBP was 3.5 (2, 6) mmHg and of ARV-DBP was 2.4 (1.5, 4) mmHg. Patients with stroke had significantly higher SBP and ARV-SBP, but not DBP and ARV-DBP compared to non-stroke patients (mean difference (95%CI) of SBP 11 (9, 13); ARV-SBP 0.7, (0.4, 1.1); DBP 0.7 (-0.5, 1.9); ARV-DBP 0.1 (-0.2, 0.4)). For every one mmHg increase in ARV-SBP, there was a 4.6% significantly greater odds of stroke (OR (95%CI) 1.05 (1.02, 1.07)), while there were 1.6% greater odds of stroke for every one mmHg increase in ARV-DBP but no statistical significance (OR 1.02 (0.98, 1.05)). After adjusting for age, gender, race, ethnicity, and BMI, the odds of stroke were 2.8% significantly higher for every one mmHg increase in ARV-SBP (OR 1.03 (1.00, 1.05)) and the ARV - stroke association remained non-significant. ARV-SBP was only associated with stroke in patients who were diagnosed with a stroke at an age < 50 years old, while ARV-DBP was not associated with stroke regardless of the age when the stroke was diagnosed.

Conclusions:
ARV-SBP in a very short interval is associated with prior history of stroke in younger than 50 years old. Impaired cerebral vasculatures may affect autoregulation in younger patients with stroke, which possibly manifests as BPV. Longitudinal cohort studies to determine the association between BPV and stroke are required.
Abstract WP290: Stroke 90 Program
Authors: Ashok Twinkle , Okashima Taylor
Published: February 2024

Background:
Despite tremendous scientific advancements in acute stroke care, post-stroke management can be challenging. Information overload and a lack of post-discharge understanding can lead to potential stroke readmissions. Purpose Patients with a history of stroke have a significantly higher risk of readmission. Neuro-telemetry nurses designed Stroke 90 as a follow-up outreach program to reduce the stroke readmission average by 2% over six months and address knowledge gaps. After completing the program, patients will have the education and resources to prevent readmission.

Methods:
Neuro-telemetry nurses call stroke patients three weeks post-discharge to determine baseline knowledge of their stroke. The next six weeks reinforce individualized stroke education and reassess for continued post-discharge needs. The Plan Do Study Act (PDSA) cycle was implemented May 2021 for 11 months and only included acute ischemic or hemorrhagic stroke patients (n=154) discharged home from the Neuro-Telemetry Unit. A second PDSA cycle began in September 2022, including patients (n=356) discharged with a diagnosis of Transient Ischemic Attack, Ischemic, or Hemorrhagic Stroke from the Emergency Department, Intensive Care Unit, and Neuro-Telemetry Unit. Data is collected retrospectively by identifying patients with a final stroke diagnosis 30 days post-discharge. Outpatient visits and procedural admissions were excluded. 90-day readmissions only included inpatient hospital stays with another stroke diagnosis.

Results:
From September 2022 to December 2022, 6.25 patients were readmitted per month with a diagnosis of acute stroke, making the readmission average 16%. From January 2023 to June 2023, 4 stroke patients were readmitted per month, yielding a readmission average of 12%. The program demonstrated a monthly acute stroke patient reduction of 2.25 with a 3-day average length of stay (total savings of 6.75 hospital days).

Conclusion:
Overall, there was a 4% decrease in the readmission average, which exceeded the goal of a 2% decrease. The teach-back method is valuable for addressing knowledge gaps and decreasing post-stroke readmissions. The Stroke 90 Program significantly benefits stroke survivors as they navigate recovery.
Abstract WP292: Sleep Debt Induces Loss of S-Nitrosylation of Cysteine 93 Residue of Beta Chain Hemoglobin (
β
Hb-Cys
93
) to Impair Post-Stroke Brain Tissue Reoxygenation
Authors: Fatima Sumbul , NEMATULLAH MOHAMMAD , Rashid Faraz , Ahmed Mohammad E , Ata Syed M , Hasan Hera , Ahmad Abdullah S , Giri Shailendra , Hoda Nasrul
Published: February 2024

Introduction:
Sleep debt attenuates nitric oxide synthase 3 (NOS3) activity and vasodilation which could diminish brain tissue oxygen (PbtO
2
) after stroke. S-nitrosylated
β
Hb-Cys
93
promotes hypoxic vasodilation to enhance PbtO
2
. But the detection of s-nitrosylated
β
Hb-Cys
93
remain challenging and debated. We report a novel antibody and immunodetection of s-nitrosylated
β
Hb-Cys
93
and relate it to PbtO
2
after stroke.

Hypothesis:
Sleep debt in mice would attenuate erythrocyte-associated NOS3 (
ery
NOS3) activity and
β
Hb-Cys
93
s-nitrosylation resulting in diminished PbtO
2
after stroke.

Methods:
Using click chemistry approach, a KLH-conjugated s-nitrosylated peptide, -SLSELH-C(NO)-DKLHVDPEN- (a conserved domain of
β
Hb in mouse and human carrying Cys
93
), was synthesized. Rabbits were immunized using s-nitrosylated antigen, and polyclonal antibodies were affinity purified. Mice were subjected to progressive sleep deprivation (1-6h) for 3-wks to induce sleep debt. Blood samples were collected to detect s-nitrosylated
β
Hb-Cys
93
using western blot (WB) and FACS. Mice were subjected to transient middle cerebral artery occlusion (tMCAo; 45 minutes) followed by reperfusion. PbtO
2
at 2h post-stroke was recorded in vivo using an O
2
-sensor, followed by assessments of neurologic deficit at 24h and infarction volume at 48h (P<0.05).

Results and Conclusion:
Purities of antigens were confirmed with HPLC and mass spectrometry. Antibody against s-nitrosylated
β
Hb-Cys
93
exclusively detected it but not the non-nitrosylated
β
Hb-Cys
93
. WB and FACS results showed that sleep debt induces loss in
β
Hb-Cys
93
s-nitrosylation via reduced
ery
NOS3 activity. Post-reperfusion restoration of PbtO
2
in mice with sleep debt was significantly attenuated as compared to the non-sleep debt group. Sleep debt augmented the neurologic deficit and infarction volume as compared to the non-sleep debt controls subjected to stroke. In conclusion, immunodetection of
β
Hb-Cys
93
using this novel antibody could be translated as a biomarker to monitor the risk of sub-optimal brain tissue reoxygenation after stroke. Future studies are warranted to test therapies which could enhance the s-nitrosylated
β
Hb-Cys
93
to overcome the detrimental effects of sleep debt in stroke.
Abstract WP3: Serum Glucose Fluctuations is an Independent Predictor of Adverse Outcomes in Patients With Acute Ischemic Stroke Undergoing Endovascular Treatment
Authors: Chaudhry Saqib A , Khan Hamza , Ali Akif , McHugh Ashley , Laleka Maham , Chaudhry Mohammad Rauf A , Khan Muhammad Taimoor , Zaki Abdullah , Fahadan Pouya Tahsili , Altaweel Laith , Qureshi Adnan
Published: February 2024

Background:
Acute hyperglycemia may increase the rate of death or disability among acute ischemic stroke patients undergoing endovascular procedures.

Objective:
To explore the association between serum glucose fluctuation on post treatment symptomatic intracranial hemorrhage (sICH) and mortality.

Methods:
We analyzed consecutive acute ischemic stroke patients who underwent endovascular treatment over 30 months at a comprehensive stroke center. Serum glucose levels within the initial 24 hours were used to calculate the mean and standard deviation (SD). Patients were grouped by the standard deviation [SD] of the mean value of serum glucose, whether above or below 25%. Outcomes included sICH, and inpatient mortality, adjusted for confounders which included age, gender, baseline NIHSS, perfusion grade (TICI) intravenous thrombolysis, history of diabetes and HBA1c.

Results:
A total of 224 patients (mean age was 68.7 years (±14.3); 44.2% were women) underwent endovascular treatment. The proportion of sICH (16.7% vs. 3.28%; p=0.0006) and inpatient mortality (18.6% vs. 7.4%; p=0.0112) were higher in patients with SD exceeding 25. After adjusting for potential confounders, serum glucose SD above 25 was significantly associated with increased rate of sICH (odds ratio [OR] 5.2; 95% confidence interval [CI] 1.5-18.5; p=0.0112) and inpatient mortality (OR 3.5; 95% CI 1.3-9.8; p=0.0154).

Conclusion:
Serum glucose fluctuations within first 24 hours maybe be therapeutic target due to its association with increased risks of sICH and inpatient mortality following endovascular treatment in acute ischemic stroke.
Abstract WP311: Novel Computational Framework for Modelling the Effects of Temperature on Survival Time in Ischemic Stroke
Authors: Carluccio Giuseppe , Dehkharghani Seena , Collins Christopher
Published: February 2024

Introduction:
The detrimental influence of cerebral hyperthermia is well known, with notably deleterious effects in the ischemic brain, where even mild increases (<1°C) may rapidly potentiate ischemic injury. Experimental models of ischemic hyperthermia are undermined by the lack of pragmatic means for temporally- and spatially-resolved, direct cerebral thermometry. Computational models of cerebrovascular ischemia are well-suited to such exploration, and the use of digital phantoms for sophisticated biophysical modeling has been facilitated by emergent hardware, software, and computational solutions. We present a realistic computational environment for the simulation of thermal disturbance in cerebrovascular ischemia, permitting multiscale demonstration of hemodynamic, metabolic, and thermal aberrations in ischemic brain

Methods:
A multi-tissue biophysical numerical model of the human head and brain was extended to incorporate the dynamics of nutritive flow, metabolic need, tissue heating, and cytotoxicity. By restricting perfusion in a region of brain using a rudimentary representation of vascularization, we could quantify tissue heating arising from impaired radiative cooling, and time-dependent cell death. The procedure was iterated with an expected proportionality between temperature and metabolic rate

Results:
Fig 1 demonstrates simulated hypoperfusion affecting one hemisphere with resultant cerebral hyperthermia arising from impaired countercurrent heat exchange. Incorporating the effects of hyperthermia upon metabolic demand, the downward influence of heating on survivability is apparent, with ~30-minute acceleration to cytotoxicity.

Conclusion:
We present a combined model for tissue physiology and survival time following ischemic stroke using a multi-tissue model of whole-head bio-thermodynamics to examine effects of critical temperature disturbance on predicted tissue survival time.