bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP102: Exploring the Role of Podcasts in Stroke Recovery and Prevention
Authors: Hart Rosa
Published: January 2025

The recovery process for stroke patients requires ongoing reinforcement of critical health information. Traditional education methods of written handouts often fail to adequately meet patient needs, particularly for those with limited literacy, or busy lifestyles. Podcasts are emerging as a powerful tool in patient education, offering a flexible, accessible, and engaging format that can be accessed anytime, anywhere.

The hypothesis was that by prescribing podcasts, we could ensure patients have continuous access to vital information, allowing for repeated exposure and improved retention of key concepts. Studies have shown that podcasts can significantly enhance knowledge retention and listener engagement, even when listeners are engaged in other activities, as verified by EEG. This makes podcasts a practical solution for reinforcing key health messages and catering to diverse learning preferences, offering an alternative for patients who may struggle with written materials. Since neurological patients struggle to retain complex medical information provided during brief consultations, this can lead to gaps in understanding, and consequently suboptimal outcomes.

Putting this hypothesis to the test, our method was to create a podcast with episode topics selected by a multidisciplinary stroke team, focusing on the frequently asked questions posed by stroke survivors and caregivers. Each podcast episode features interviews with expert guests or stroke survivors who discuss strategies and resources relevant to the topic. To enhance accessibility, links to printable information and specialist directories are provided in the show notes of each episode.

The results demonstrate global demand for access to such specialized information, with regular listeners in 56 countries, all 50 of the United States and over 1600 downloads in outlying US territories. Each new episode consistently averages 300 audio downloads or video views in the first week they are released.

In conclusion, neurology providers are encouraged to incorporate podcasts as a standard component of their stroke patient education strategy. Also, future research should focus on developing specialized neurological podcasts tailored to community needs, providing insight into how to aid them to better understand and manage their conditions, ultimately contributing to improved adherence to treatment plans and better quality of life.
Abstract TP103: Exploring the experience of engaging in a visual arts-based intervention on promoting psychosocial functioning among community-dwelling stroke survivors: Qualitative insights from a randomized controlled trial
Authors: Chan Mimi Wai Man , Lo Suzanne , Sit Janet
Published: January 2025

Introduction:
A visual arts-based intervention was developed and implemented for community-dwelling stroke survivors.

Purpose:
This study aimed to explore the participants’ experience of engaging in a visual arts-based intervention.

Methods:
Stroke survivors were recruited and randomly allocated to receive visual arts-based intervention or usual stroke care in the community settings. This intervention is a four-week group intervention with six activities guided by Bandura’ principles of self-efficacy, including warm-up activity, art-making activity, break, discussion, workbook review, and end-up activity. Semi-structured interviews were conducted with the participants after completing the intervention. Participants were invited to share their experience of engaging in the intervention, including comments, primary concerns, and difficulties encountered. Interview data were audio-recorded and transcribed as well as analyzed by thematic analysis.

Results:
Sixty-one participants (age range: 49 to 93) were interviewed. The results showed that most participants were satisfied with the intervention and appreciated the facilitator’s encouraging attitude. They appreciated the theme of each session, all of which enabled them to recall their memories to draw on meaningful values from their stroke recovery journey. Furthermore, over half of participants acknowledged that the intervention addressed their psychosocial concerns, which added values to address gaps in the traditional stroke rehabilitation. Specifically, they considered the creative approach in art-making activities and discussions enhanced their verbal and non-verbal expression, explored and expressed their inner emotions, and encouraged them to engage in group interactions. However, participation in the intervention was challenging for some participants. They pointed out some stroke-related barriers, such as blurred vision, slow reaction, lack of imagination, and limitation in hand movement, affecting their performances in group. Additionally, a lack of familiarity with art-making activity and tool for drawing also contributed to their difficulties in engaging in the intervention. To ensure the intervention implementation, participants suggested modifying the intervention to minimize barriers that hinder participants and establishing a more inclusive intervention environment in future.

Conclusion:
The qualitative results provided valuable insights of the impact of the visual arts-based intervention for stroke recovery.
Abstract TP105: Non-invasive Brain Stimulation Alters Resting-State Brain Activity in Ischemic Stroke
Authors: Williamson Jordan , James Shirley , Li Sheng , Sidorov Evgeny , Yang Yuan
Published: January 2025

Stroke is the leading cause of serious long-term disability in the United States. Stroke recovery is greatly varied since the long term effect is determined by the site and size of the initial lesion. Specifically, post stroke motor impairments occur due to damage to the corticospinal tract and maladaptive upregulation of the cortico-reticulospinal tract. Transcranial direct current stimulation (tDCS) may be an effective treatment for stroke rehabilitation. However, conventional tDCS is limited by spatial resolution to precisely target a specific brain region. To improve its spatial resolution, this study used targeted high-definition tDCS (HD-tDCS) navigated by paired-pulse transcranial magnetic stimulation. In a double-blind randomized crossover study, stroke participants (n=12) had three visits 1) anodal HD-tDCS stimulation of the arm region of the primary motor cortex (M1) to improve function of the corticospinal tract in the lesioned hemisphere, 2) cathodal stimulation of the arm region of the dorsal premotor (PM) cortex to inhibit maladaptive use of the cortico-reticulospinal tract in the contralesional hemisphere, and 3) sham. The effect was measured by quantitative electroencephalogram (qEEG) metrics delta alpha ratio (DAR) and delta theta alpha beta ratio (DTABR), calculated from a pre and post 3-minute EEG. Acute changes in brain activity of these power bands have been associated with the severity of motor impairment post stroke. The results demonstrate that anodal (p=0.026) and cathodal (p=0.0108) stimulation significantly decreased the DAR compared to the sham. The reducation of DAR value is associated with the improvement of Fugl-Meyer Upper Extremity score. However, there were no significant differences found in the DTABR. These results indicate that both anodal and cathodal HD-tDCS may improve brain function following stimulation. However, future work is required on the use of qEEG metrics and its use as a marker of stroke recovery. This work is important as qEEG could be used as a more objective method, compared to clinical assessments, to track stroke rehabilitation.
Abstract TP109: Safety and Feasibility of Paired Upper Extremity Gamified Rehabilitation and Vagus Nerve Stimulation in Patients with Chronic Stroke
Authors: Amin Megha , Polizzi Jessica , Parada Iraheta Wilber , Rozanski Gabriela , Kypros Michael , Kellner Christopher , panov fedor , Nitzberg Emily , Putrino David , Tosto Jenna
Published: January 2025

Introduction:
Upper extremity motor impairment and hemiparesis are prevalent following stroke, and can impact independence, ability to perform activities of daily living and overall quality of life.1 While the majority of motor recovery post stroke occurs within the initial 3 months, gains can continue through chronic stages.2 Evidence has identified vagus nerve stimulation (VNS) paired with intensive rehabilitation as an effective intervention for improving upper extremity (UE) function in persons with chronic stroke.3 Utilization of gaming-based stroke rehabilitation has been shown to increase engagement and improve UE motor function.4–6 This work reports on a cohort of patients with chronic stroke who participated in gamified UE rehabilitation paired with VNS.

Methods:
Data from 6 patients with UE motor impairment due to chronic stroke (> 1 year) were included. Following surgical vagus nerve stimulator implantation, patients participated in UE therapy sessions 3 times a week for 6 weeks. Intervention included gamified rehabilitation with VNS triggered upon each movement attempt. Between sessions, patients were provided with a magnet to activate VNS while performing an UE home activity program up to 8 times per day. Each self-initiated stimulator activation delivered 30 minutes of VNS. At the conclusion of 6 weeks, patients were encouraged to continue their VNS home program. Safety was assessed using adverse event reporting. Feasibility was assessed using time on task reported by the gamified rehabilitation software. Exploratory clinical outcomes included the Action Research Arm Test (ARAT) and Fugl Meyer Assessment (FMA) at baseline following implantation, upon completion of 6 weeks of therapy, and at 4 months post intervention.

Results:
Patients participated in 64.1 ± 14.9 mins of gamified rehabilitation per session with 29.9 ±8.6 of those minutes being active time on task. No adverse events were reported. FMA-UE motor subscale and ARAT scores increased from baseline to the end of 6 weeks by an average of 9.3±3.6 and 7±7.4 respectively. Average increases from baseline to 4 month follow up for FMA-UE motor subscale and ARAT score were 14±6.3 and 10±8.2 respectively.

Conclusion:
These findings suggest that VNS paired with gamified rehabilitation is a safe and feasible intervention for UE motor impairment post stroke. Future work will investigate short- and long-term feasibility and efficacy of the intervention in patients with chronic stroke.
Abstract TP138: Life's Essential 8 Among Stroke Survivors
Authors: Lian Kendra , Scott Lisa , Markovic Daniela , Towfighi Amytis
Published: January 2025

Background:
The AHA uses “Life’s Essential 8 (LE8)” to quantify cardiovascular health (CVH). These metrics assess eight essential components of nicotine exposure, sleep duration, physical activity, diet, body mass index, lipid levels, blood glucose, and blood pressure to calculate a CVH score. However, little is known about LE8 scores in patients with history of stroke compared to the general population.

Methods:
Data was included on individuals aged 18 and older who participated in the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2018. A LE8 score ranging from 0 (lowest) to 100 (highest) was calculated for all participants. Subscores of 0 to 100 points were also calculated for each of the metrics. The total LE and individual metric scores of participants with a self-reported history of stroke were compared to those who did not. The characteristics of all participants were stratified across age, gender, race/ethnicity, poverty/income ratio (PIR), education level, insurance status, alcohol consumption, high cholesterol, high high density lipoprotein, and histories of hypertension, diabetes, and/or myocardial infarction.

Results:
1,019 participants self-reported a history of stroke of 27,670 total participants. When adjusted for age, sex, race/ethnicity, education and PIR, the mean LE8 score was significantly lower in those who reported a history of stroke at (59.2, 95% CI, 57.8-60.5) compared to those who did not (63.8, 95% CI, 63.4-64.2) in those who did not. Stroke survivors had significantly lower mean subscores in 6 of 8 metrics on nicotine exposure (range 66.2-71.5), blood glucose (range 70.8-74.7), physical activity (range 30.8-36.9), diet (range 35.3-40.1), sleep duration (range 73.3-77.7), and blood pressure (range 58-62.4) compared to other participants (p<.001). Conversely, stroke survivors had higher mean lipid subscore (range 66.8-71.6) compared to other participants (range 63.0-64.3). In contrast to general participants who showed improvements over time in smoking, lipid levels, and sleep subscores, stroke survivors did not exhibit significant changes over time in any of these scores.

Conclusions:
Stroke survivors have inferior overall cardiovascular health and lower total LE8 scores compared to the general population. More intensive and tailored secondary stroke interventions are necessary to ensure improvement in overall cardiovascular health among stroke survivors.
Abstract TP143: Improving CT imaging in Non-Fatal strangulation Domestic Violence Victims
Authors: Donegal Kereisha , Hiana James , Law Susan , Kang Derrek , Soh James
Published: January 2025

Introduction:
The incidence of domestic violence (DV) can vary from 2 to 4 million in a year. Domestic violence can be broad in definition and not limited to physical assault. The role of the medical provider in caring for these patients can be difficult; studies suggest that less than 10% of these cases are diagnosed correctly in the emergency room.

In collaboration with Brooklyn District Attorney office, we examined and designed a quality improvement study to look at the performance of CT imaging in non-fatal strangulation DV in the emergency department from 8/1/2021 to 3/31/2024 of all NYC Health and Hospitals System (NYCHH). The timely identification of arterial dissection can potentially lead to a decrease risk of stroke.

Methods:
We developed a non-fatal strangulation pathway in the emergency department for DV patients. We examined the use of CT head and CTA head and neck. The utilization of CT was monitored every quartile. Cases were abstracted with diagnoses of DV and asphyxiation. Strategies were employed to encourage and improve the utilization of pathway.

Results:
In total, 2163 domestic violence cases were abstracted from electronic medical records.

63% (n=1363) female

5.2% (113) male

31.7% (n=687) did not select for sex (NOA)

The percentage of CT performance during 8/1/2021 through 3/31/2024 was 5.5% (116/2163). Upon further evaluation, the percentage of female cases imaged was 5.5% (75/116); by contrast, male cases were imaged at 24.8% (28/116), and NOA 1.9% (13/116).

The odds ratio of CT performances in noted cases was 4.5 [95% CI 2.8016-7.2381], 13.0946 [6.5861-26.0349], 2.9 [1.6024-5.277], Male to female cases, male to NOA, and Female to NOA, respectively.

Discussion:
The literature on domestic violence range in incidence from 2 million to 4 million in a year. The identification of stroke risk factors from a domestic violence incident is a novel approach and has not been fully elucidated.

Non-fatal strangulation is known to decrease cerebral perfusion; the risk of developing an arterial dissection is known. Arterial dissection is an independent risk factor for ischemic stroke. In this study, we have observed a low utilization of imaging to rule out dissection; there is a suggestion of disparity among the sexes in diagnosis.

Conclusion:
The observation from this study involving all hospitals in the NYCHH system reveals a need to better educate and improve diagnosis of domestic violence. This can lead to prompt intervention and medical stabilization.
Abstract TP144: Telemedicine Appointments early after Acute Ischemic Stroke may Reduce 30-day Emergency Department Visits
Authors: Jumah Ammar , Owens Javacia , Ma Tianwen , Wu Yunong , Ro Jennifer , Starnes Danielle , Christopher Hannah , Blanke Debra , Henriquez Laura , Belagaje Samir , Kvantaliani Nino , Cabral Jacqueline , Walczak Teri , Collier Judy , Mack Kourtni , Nahab Fadi
Published: January 2025

Introduction:
Limiting the rate of unplanned emergency department (ED) revisits for patients with acute ischemic stroke is an important aspect of secondary stroke prevention. This is influenced by patients’ demographics, comorbidities, stroke severity, disposition destination, and may be impacted by early outpatient follow-up where stroke risk factors and etiology continue to be evaluated.

Methods:
We retrospectively identified all acute ischemic stroke patients discharged from an 11-hospital network, the largest healthcare system in the state of Georgia, from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with ED visits within 30- and 90-days after discharge.

Results:
Of 2,191 patients, 143 (6.5%) had ED visits within 30 days and 296 (13.5%) within 90 days. The median age was 68 [IQR 57, 77]. History of heart failure (HF), atrial fibrillation (AF), chronic kidney disease and end stage renal disease each increased the likelihood of an ED re-visit within 30 and 90 days whereas diabetes mellitus increased the likelihood of an ED re-visit at 90 days only. In multiple logistic regression analyses, factors independently associated with 30-day ED visit was a history of HF (OR 1.57, 95% CI 1.07-2.28; p=0.02) and AF (OR 1.49, 95% CI 1.00-2.19; p=0.04); at 90 days, only an increased Charlson Comorbidity Index score was associated with ED visit (OR 1.09, 95% CI 1.02-1.16; p=0.01). There were 501 (23%) patients who completed an outpatient neurology clinic follow-up within 30 days of discharge, including 81 patients (4%) who completed a telemedicine outpatient visit; patients completing a telemedicine visit were less likely to have a 30-day ED visit than those who had an in-person visit (OR= 0.13, 95% CI 0.01-0.62; p=0.05).

Conclusion:
ED revisits after hospitalization for acute ischemic stroke are relatively common and associated with patients who have comorbid conditions including HF and AF. Our study suggests that telemedicine-based follow-ups were associated with lower rates of unplanned ED revisits within 30 days. Efforts to increase outpatient neurology clinic access through telemedicine may reduce ED visits after discharge for acute ischemic stroke patients.
Abstract TP159: When Experience Matters More than Size in Telestroke
Authors: Berry Lori , Savage Brittany , Banks Robin , Joiner Renee , Wells Erin , Womack Paige , Onteddu Sanjeeva Reddy , Nalleballe krishna , Dhall Rohit , Pait Thomas , Simon Bala , Vrudny David , Porter Austin , Culp William , Brown Aliza
Published: January 2025

Background:
The University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health&Innovation (IDHI) – Telestroke Program provides neurology support to 62 spoke hospitals across Arkansas. We retrospectively reviewed stroke consults who received Alteplase or Tenecteplase during the 2023 calendar year, to determine if years of program training influences time metrics. We examined Door to CT (Door2CT) and Door to Lytic (Door2Lytic) time with spoke hospital size and the year the spoke joined the telestroke program.

Methods:
Sixty-two Spoke hospital sites joined the telestroke program from 2008 to 2023 and were determined as veteran (2008 to 2018) or recently joined (2019 to 2023). Spoke hospital size was determined as bed size and included 0-25, 26-50, 51-100, 101-150, 151-200 and >200 beds. Both time metrics of Door2CT and Door2Lytic from calendar year 2023 were examined by both the year spoke hospitals joined and bed size using ANOVA.

Results:
Door2CT times were significantly faster at p=0.01, with improved times to CT by veteran hospital sites compared to recently joined sites (15.1±0.8 from sites who joined in 2008-2018 vs. 19.6±2.4 who recently joined 2019-2023, p=0.042, respectively). Door2Lytic minutes were also significant comparing veteran spoke hospitals to more recently added sites, (60.3±1.2 veteran sites vs. recently joined sites 66.8±3.5, p=0.041, respectively). Hospital size was not significant in Door2CT minutes at p=0.20; however the D2Lytic was significantly improved in the midsize spoke hospitals (51-100 and 151-200 size groups) that were comprised of veteran hospital sites, p=0.0002.

Conclusion:
Regardless of hospital size in a large telestroke system, veteran sites performed better in CT and lytic time metrics.
Abstract TP177: Characterization of Clot Composition with Radiomics
Authors: Gudino Andres , Ghannam Malik , Sagues Elena , Dier Carlos , Torres Maria , Garces Emily , Ojeda Diego , Saenz Samantha , Vargas-Sanchez Ariel , Samaniego Edgar
Published: January 2025

Introduction:
Approximately 30% of strokes are cryptogenic. Radiomics is a non-invasive imaging tool to analyze images at a voxel-by-voxel level. We correlated the histology of clots from patients with LVO with specific radiomic features, for a better determination of clot composition.

Methods:
Patients diagnosed with AIS due to LVO between 2019 to 2024 were analyzed. Ten clots retrieved from mechanical thrombectomy were imaged with micro-computed tomography (micro-CT) and histologically analyzed. Radiomic features (RFs) from each clot were extracted and correlated with different clot components. NCCT images were co-registered with the corresponding slices obtained from histology. A larger cohort of 426 patients with NCCT scans obtained at presentation was subsequently analyzed. Clots displaying a hyperdense sign on NCCT were included. Stroke etiology was adjudicated based on the TOAST classification.

Results:
The analysis of micro-CT showed that total energy (TE), joint average (JA) and large dependence high gray level emphasis (LDHGLE) were specific for red blood cells (RBCs, p<0.001, p 0.003, and p<0.002, respectively). Fibrin’s RFs included minimum (MI) and 10 percentile (p .005, and p<0.001, respectively), and calcium RF’s difference variance (DV, p 0.05).TE, JA and LDHGLE were correlated with clots that had at least 70% RBCs (Rho 0.654 and 0.652, respectively). MI was correlated (Rho 0.795) with clots that had at least >80% of fibrin. The RFs of the NCCT segmentations of these clots revealed strong correlation with corresponding micro-CT values of TE (Rho 0.687) JA (0.809) and LDHGLE (rho 0.657). TE (AUC 0.800, sensitivity 0.750, specificity 0.800, cutoff 38244.3089) and LDHGLE (AUC 0.750, sensitivity 0.750, specificity 0.800, cutoff: 52.64) had significant accuracy for determining clots with higher RBC composition in NCCT. MI (AUC: 0.350, sensitivity: 0.500, specificity: 0.400, cutoff: 32.3) did not have accuracy in the identification of fibrin. A total of 145 of 426 patients had optimal clot visualization on NCCT. Fifty patients had a cardioembolic stroke, 45 LAA and 50 were cryptogenic. RFs for identification of RBCs (> 70%) were present in 60% of cardioembolic, 27% of LAA and 42% cryptogenic strokes.

Conclusion:
RFs are sensitive and specific to determine clots rich in RBC composition. Cardioembolic clots have higher RBCs compared with LAA and cryptogenic. Radiomic analysis is a novel non-invasive tool of determining stroke etiology.
Abstract TP187: Automated Assessment of Intracerebral Hemorrhage Volumes using the VIOLA tool Performs Similarly to ABC/2 in Predictive Modelling
Authors: Potter Thomas , Aamodt Eva , Borei Karim , Khan Osman , Bako Abdulaziz , Pan Alan , Liu Qinghui , MacIntosh Bradley , Vahidy Farhaan
Published: January 2025

Introduction:
Hemorrhage volume is a key prognostic characteristic for intracerebral hemorrhage (ICH) patients and has been included as an aspect of critical assessments, such as the ICH score. Hemorrhage measurement can be time consuming, prompting the value of automated hemorrhage assessment tools. Many of these, however, remain unvalidated in predictive models. We compared the performance of the VIOLA deep learning model (developed at www.crai.no) against the conventional ABC/2 method.

Methods:
An ICH group was created by randomly sampling from the Registry for Neurological Endpoint Assessment among patients with Ischemic and Hemorrhagic Stroke (REINAH) database, which that includes completed hemorrhage characteristic assessments (location, laterality, volume calculated via ABC/2, and intraventricular hemorrhage (IVH) presence). Computed tomography (CT) images used for ABC/2 calculations were retrieved, and the previous trained VIOLA deep learning tool was deployed locally to calculate the volume of parenchymal and intraventricular hemorrhage. ICH volumes were compared using the Wilcoxon Signed Rank test, and separate multivariable logistic regression models to predict in-hospital mortality were fit, including patient demographics, comorbidities, clinical characteristics, and volume quartiles, and adjusted odds ratios are reported. Akaike information criteria (AIC) was used to compare separate ABC/2 and VIOLA models.

Results:
A total of 407 patients were retrieved from RIENAH. Included patients had a median age of 68 [55-77], were 42.8% female, 43.7% White, 18.7% Black, 22.4% Hispanic, 9.6% Asian, and 5.7% Other/Declined. IVH was present in 48.4% of the cohort and 24.6% experienced in-hospital mortality. Hemorrhages assessed via VIOLA yielded a median of 23.70 [7.02-69.18] cm
3
, significantly higher than those determined by ABC/2 (14.33 [5.19-37.47] cm
3
,p<0.001), and more patients showed volumes over 30cm
3
using VIOLA (78 (43.7%) vs 131 (32.2%)). In logistic regression modelling, patients with top-quartile hemorrhage volumes in either ABC/2 or VIOLA assessment had higher odds of in-hospital mortality (ABC/2 aOR: 3.32 [1.01-10.94]; VIOLA: 4.50 [1.33-15.19]). The VIOLA-based model showed similar AIC to the ABC/2 model, indicating roughly equivalent model fit (263.9 vs 261.9)

Discussion:
Hemorrhage volume assessment using the VIOLA tool performed comparably than ABC/2 in prognostic modelling and provides a viable alternative to manual assessment.
Abstract TP194: Total Small Vessel Disease Score Is Associated With Intraventricular Extension Among Patients With Intracerebral Hemorrhage
Authors: Sato Takeo , Tsuchimochi Yuka , Hamada Yuki , Kawabata Yutaro , Iwamoto Kana , Takaguchi Go , Matsuoka Hideki
Published: January 2025

Background&Aims:
Intraventricular extension (IE) is associated with unfavorable prognosis among patients with intracerebral hemorrhage (ICH). However, factors associated with IE are unknown. We aimed to elucidate the relation between IE and small vessel disease (SVD) in ICH.

Methods:
Consecutive patients with acute ICH admitted between July 2012 and November 2023 were retrospectively screened using Kagoshima Medical Center Stroke Database. The inclusion criteria were as follows: 1) onset to door time within 7 days; 2) availability of SVD evaluation using total SVD score on MRI; and 3) availability of IE evaluation on admission and more than 24 hours after admission on CT. Total SVD score was calculated as the sum of points for each of the following four imaging findings (each scored as 1 point, maximum score 4): 1 or more old lacunes, the presence of white matter hyperintensity (periventricular: Fazekas grade 3 and/or deep white matter: Fazekas grade 2–3), 1 or more cerebral microbleeds, and 11 or more basal ganglia enlarged perivascular spaces. We investigated the association between SVD burden and IE by performing Poisson regression analyses with a robust variance estimator adjusted by sex, age, excessive alcohol intake, use of antiplatelet drugs and anticoagulants before admission, hypertension, body mass index, hemorrhage location, and hemorrhage size.

Results:
We screened 608 consecutive ICH patients. Of them, 449 were identified (234 [52%] males, median age 75 years). IE was observed in 151 patients (34%). In multivariable analysis, total SVD score was independently associated with IE (prevalence ration (PR) 1.188, 95% CI 1.063-1.329,
p
= 0.002, Figure 1). Further, a positive linear trend was observed between total SVD score and IE in reference to total SVD score 0 (total SVD score 0: PR 1.000, total SVD score 1-2: PR 3.769, total SVD score 3-4: PR 4.109,
p
= 0.011 for trend, Figure 2). Finally, among the four items comprising the total SVD score, white matter hyperintensity (PR 1.406 95% CI 1.041-1.899,
p
= 0.026, Figure 3) and cerebral microbleeds (PR 1.800, 95% CI 1.068-3.036,
p
= 0.027, Figure 3) were associated with IE.

Conclusions:
In acute ICH patients, higher total SVD score was associated with IE even after adjusted by risk factors for ICH, hemorrhage location, and hemorrhage size. Especially, white matter hyperintensity and cerebral microbleeds may have effects on the incidence of IE.
Abstract TP195: Evaluating the Diagnostic Utility of Brain MRI after Lobar Intracranial Hemorrhage
Authors: Saund Amardeep , Li Ya-Huei , Tunguturi Ajay , Hou Yan
Published: January 2025

Introduction:
Spontaneous intracerebral hemorrhage (ICH) has heterogeneous etiologies. Brain MRI with and without contrast is usually performed at admission to search for angiogram-negative ICH causes (cerebral amyloid angiopathy [CAA], cavernoma, and malignancy). Another MRI may be repeated after 3 to 6 months to further exclude underlying lesions. This study aimed to evaluate the use of brain MRI for identifying the etiology of lobar ICH in current practice.

Methods:
Patients aged 18 to 80 who were admitted with spontaneous supratentorial lobar ICH between September 2016 and March 2023 were included. The etiology of ICH at discharge was reviewed and compared by age groups: 18-49 years, 50-69 years, and 70-80 years. Time to the newly identified etiology by repeated brain MRI after discharge was assessed for undetermined etiology. Descriptive statistics were the primary analysis.

Results:
A total of 197 eligible patients were identified. On discharge, a higher proportion of young patients aged 18-49 (32.1%) were found to have a vascular malformation compared to 9.3% and 6.4% for patients aged 50-69 or 70-80 (p=0.001). Probable CAA was the most commonly identified etiology in patients aged 70-80 (43.6%) compared to 5.4% of patients aged 50-69 (p<0.001). Brain malignancy was more commonly found in patients aged 50-69 (25.3%) compared to other age groups (11%, p=0.025).

The etiology remained undetermined for 68 patients on discharge: 28.6%, 44.0% and 28.7% of patients aged 18-49, 50-69 and 70-80, respectively. Among these, 33 (48.5%) had ≥1 brain MRI performed during follow-up, yet only 24 (35.3%) underwent a repeated brain MRI within 6 months of admission (median: 2.2 months; range: 1.0-5.8 months). New etiologies were identified in 8 patients: One brain MRI repeated at 1.9 month detected an underlying AVM in a patient aged 57; Two MRIs repeated around 8 months revealed an underlying glioblastoma in a patient aged 44 and a cavernoma in a patient aged 64; and MRIs performed at a median of 60 months (range: 29-70 months) discovered new microhemorrhages or lobar ICH in 5 patients, leading to a diagnosis of probable CAA.

Discussion:
Findings confirmed the value of brain MRI for patients with supratentorial lobar ICH during admission. Repeating brain MRI around 3-6 months after the initial MRI had a low rate of detecting underlying lesions for patients with undetermined etiology, yet it should be considered particularly for patients younger than 70 years old.
Abstract TP201: Factors associated with development of venous thromboembolism in patients with intracranial hemorrhage.
Authors: Hataway Felicia , Wang Lingling , Morgan Charity , May Jori , Lin Chen
Published: January 2025

Background:
Patients with intracerebral hemorrhage (ICH) are known to have a higher risk of venous thromboembolism (VTE) than patients with acute ischemic stroke, but the factors underlying this difference have not been clearly identified. We investigated common characteristics of patients admitted for ICH to both determine the frequency of VTE in the population and to identify risk factors for the development of VTE.

Methods:
This study was a single center, retrospective review of consecutively admitted patients with ICH between January 2014 to May 2019 at an academic tertiary referral hospital. We calculated odds ratios (OR) and 95% confidence intervals (95%CI) for development of VTE based off demographics and clinical characteristics. Risk factors with significant OR were then analyzed by multivariate logistic regression.

Results:
The final cohort included 465 patients with ICH, with 58 developing in-hospital thromboembolic events (12.5%). Time to start of chemoprophylaxis overall was 5.12 days (±4.56), for patients who developed VTE the time to chemoprophylaxis was 10.09 days (±7.55), and for those without VTE 4.18 days (±2.93). Delayed initiation of chemoprophylaxis reached statistical significance (p<0.0001) in patients who ultimately developed VTE.

There were several factors that were significantly associated with presence of VTE: black race OR 2.87 (95% CI: 1.530-5.939, p=0.0027), presence of intraventricular hemorrhage OR 2.20 (95% CI: 1.240-3.91, p=0.0071), placement of extraventricular drain OR 6.12 (95% CI: 3.2-11.73, p=<0.0001), craniotomy OR 4.635 (95% CI: 1.952-11.007, p=0.0005), and ICH score ≥2 OR 4.346 (95% CI: 1.784-10.587, p=0.002).

Factors which were not clearly associated with presence of VTE included gender, age, ICH location (deep or lobar), recurrent ICH, ICH etiology, procedures other than extraventricular drain and craniotomy, and whether patients were on anticoagulation or antiplatelet agents prior admission.

Conclusions:
Increased incidence of thrombosis was clearly associated with several factors including race, presence of intraventricular hemorrhage, ICH score of 2 or 3, intervention with EVD or craniotomy, and delay to initiation of chemoprophylaxis.
Abstract TP21: Efficacy and Safety of Sacubitril/Valsartan in Patients with Acute Ischemic Stroke and Hypertension within 24-72 hours
Authors: Liu Ying , Zhang Guangzheng , DING Jing
Published: January 2025

Introduction：
The efficacy of blood pressure (BP) reduction of Sacubitril/valsartan has been proved in hypertension patients, yet not in patients with acute ischemic stroke (AIS). We aimed to investigate the efficacy and safety of Sacubitril/Valsartan in AIS patients with hypertension within 24-72 hours of symptom onset.

Methods：
Between November 2022 and May 2024, patients with AIS within 24-72h of symptom onset and BP≥140/90 mmHg were enrolled and randomly assigned to receive Sacubitril/Valsartan (100-200mg qd) or other antihypertensive medications determined by clinical physicians as the ratio of 1:1. Randomized antihypertensive treatment strategy was required to complied for 14 days, and allowed to be changed after day 14 if the BP control was not satisfied. All enrolled patients received other early medical managements based on the AIS guideline. The primary outcome was the proportion of participants who had a modified Rankin scale(mRS) score of 0-1 at 90 days. The secondary outcome was the rate of target BP control (mean BP<140/90mmHg) at day 14, the mRS distribution at 90days. The safety outcome was the rate of hypotension (<100/60mmHg at any measurement within 14 days).

Results:
Forty-eight patients were assigned to the Sacubitril/Valsartan group and forty-seven were assigned to the group of other antihypertensive agents, with mean time from symptom onset to randomization was 60.0±11.3 hours and 57.0±14.8 hours, respectively. Mean systolic BP was reduced from 162mmHg to 136mmHg in the Sacubitril/Valsartan group and from 162mmHg to 137mmHg in the control group after 14 days. Baseline NIHSS in two groups was 3.5±1.5 and 3.7±2.3, respectively. The proportion of mRS 0-1 at day 90 did not differ between two treatment groups. The rate of BP target was not significantly different between two groups at day 14. Sacubitril/Valsartan group showed a trend of lower mRS than the control group, though no significant difference was found (1.2±0.9 vs 1.5±1.2, p=0.22). No hypotension occurred in either group.

Conclusions:
For mild AIS patients within 24-72 hours of symptom onset, Sacubitril/Valsartan showed similar efficiency and safety in reducing high blood pressure to other antihypertensive agents. Although it did not increase the proportion of mRS0-1 at day 90, a trend of lower mRS in the Sacubitril/Valsartan group was demonstrated. Multi-center RCT studies including AIS patients with high NIHSS score are warranted to further confirm these results.
Abstract TP229: Comparison of 30-Day Readmission Rates in Elective and Nonelective Carotid Endarterectomy and Carotid Artery Stenting: A Nationwide Cohort Study
Authors: Padarti Akhil , Amritphale Amod , Upadhyaya Parth
Published: January 2025

Background:
Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are two types of carotid revascularization procedures performed on symptomatic patients. Frequently, carotid artery stenosis is found during stroke workup and these patients undergo revascularization during the same nonelective admission. Conversely, revascularization can be postponed in the acute setting and patients undergo the procedure in a subsequent elective admission. Hospital readmission rates can help identify the optimal strategy to minimize post-procedural complications. The purpose of this study is to analyze 30-day readmission rates in elective and nonelective CAS and CEA procedures.

Methodology:
The 2017 National Readmission Database is queried for hospital admissions for CAS and CEA procedures. All admissions are stratified into elective and nonelective hospitalizations. A total of 5045 elective CAS, 29317 elective CEA, 3553 nonelective CAS, and 8491 nonelective CEA procedures are analyzed for a subsequent non-elective 30-day readmission.

Results:
There is a significantly lower 30-day readmission rate in elective CAS relative to CEA (4.8% vs 5.6%, P<0.001), while there is no such difference between nonelective CAS and CEA (10.6% vs 10.3%, P=0.582). Comorbidities such as PAD, depression, and other mental health disorders predict readmission after elective CAS, while heart failure, AKI, CAD, COPD, CKD, lipid disorders, DM, obesity, anemia, cancer, and dementia are predictive after elective CEA. CVA/TIA, respiratory failure, and substance abuse predict readmission for both elective carotid revascularization procedures. Likewise, comorbidities such as COPD, substance abuse, lipid disorders, liver failure, and cancer predict readmission after nonelective CAS, while AKI, respiratory failure, DM, GI bleeding, and anemia are predictive after nonelective CEA. Heart failure, CKD, and liver failure predict readmission in both nonelective carotid revascularization procedures.

Conclusion:
In this retrospective observational study, certain comorbidities increase the likelihood of readmission after carotid revascularization procedures. In conclusion, the most frequent etiology of readmission for elective procedures is cardiac complications, e.g. heart failure and myocardial infarction, while the most frequent source for nonelective procedures is neurological complications, e.g. CVA/TIA. This data provides further insight into the risks involved in carotid revascularization procedures.
Abstract TP233: Machine Learning Model to Predict Changes in Neuroimaging Profiles Following Delayed Transfer for Stroke Thrombectomy
Authors: Skorseth Paige , Chen Huanwen , Rewinkel Scott , Kim Daniel , Amin Sonesh , Shakal Scott , Priest Ryan , Nesbit Gary , Clark Wayne , Colasurdo Marco
Published: January 2025

Introduction:
Patient selection for endovascular thrombectomy (EVT) relies heavily on neuroimaging characteristics. While nearly all stroke patients undergo neuroimaging during acute triage, many patients do not initially present to EVT-capable centers, and interhospital transfer for the EVT procedure can result in significant time delays. Whether patients with prolonged transfer times should undergo repeat imaging prior to EVT is an area of active debate. To guide clinicians on when to re-image EVT-candidates, we sought to construct a machine learning algorithm (MLA) to predict vessel recanalization, ischemia progression, and imaging stability.

Methods:
This was a retrospective study of EVT candidates with internal carotid or middle cerebral artery occlusions arriving at a single comprehensive stroke center 1.5 to 6.0 hours from initial neuroimaging. Clinical and radiographic information was collected. A sub-cohort was used to train a gradient-boosted, tree-based MLA to create a model to predict infarct progression, imaging stability, and vessel recanalization on repeat imaging based on initial clinical and imaging characteristics. The performance of the MLA was then independently assessed in an independent validation cohort.

Results:
Three hundred seventeen patients were included; 69.4% of patients had stable imaging, 14.5% had ischemia progression (ASPECTS decay of 2 or more), and 16.1% had vessel recanalization. Two hundred twelve were assigned to the training cohort, and 105 to the validation cohort. In the MLA derived from the training cohort, NIH stroke scale improvement, stroke onset to initial imaging time, intravenous thrombolysis administration, initial ASPECTS, and collateral score were the most important predictors for repeat imaging outcomes. In the validation cohort, the MLA had AUCs of 0.81 (95%CI 0.72-0.90), 0.82 (95%CI 0.72-0.91), and 0.89 (95%CI 0.77-1.00) for imaging stability, ischemia progression, and vessel recanalization, respectively. The MLA also had excellent F1 scores (0.87 and 0.95 for stability and no recanalization) and calibration (Brier score of 0.17 and 0.08 for stability and no recanalization, respectively).

Conclusion:
An MLA to guide clinical decision making for EVT-candidates who experienced significant transfer delays performed well in predicting imaging stability, and it can be used to identify patients who will not likely benefit from repeat imaging.
Abstract TP234: Title: Comparison of Associated Factors Between Pneumonia and Stroke Deaths in Mechanical Thrombectomy for Large Vessel Occlusions
Authors: Takaishi Satoshi , Ueda Toshihiro , TAKEUCHI MASATAKA , MORIMOTO MASAFUMI , Yamamoto Ryoo , Tsuboi Yoshifumi , SHOGO KAKU , Ito Hidemichi , Onodera Hidetaka , Tatsuno Kentaro , Usuki Noriko , Hasegawa Yasuhiro , Yamano Yoshihisa
Published: January 2025

Background:
In mechanical thrombectomy (MT) for large vessel occlusions (LVO), approximately 10-20% of patients die within 90 days, with pneumonia and stroke due to cerebral infarction being the primary causes of death. This study compared the factors associated with pneumonia and stroke deaths using data from the K-NET registry, which records cases of MT in Kanagawa, Japan.

Methods:
This prospective observational study included 3,187 patients registered in the K-NET registry from 2018 to 2021. Deaths occurring within 90 days due to pneumonia were classified as the pneumonia death group, while deaths due to cerebral infarction, any intracranial hemorrhage (ICH), or subarachnoid hemorrhage were classified as the stroke death group. Comparative analyses were conducted between these two groups.

Results:
The median age of patients was 78 years. A total of 359 patients (11.3%) died within 90 days, including 83 (2.6%) in the pneumonia death group and 132 (4.1%) in the stroke death group. Compared to the stroke death group, the pneumonia death group was significantly older (83 vs. 81 years), had a higher proportion of males (67.5% vs. 47.0%), had more patients with a pre-stroke modified Rankin Scale (mRS) score of 3-5 (32.5% vs. 19.7%), had a higher ASPECTS score (7 vs. 5), and had a higher incidence of first-pass effect (FPE) (45.8% vs. 28.0%). However, there were significantly fewer cases of any ICH in the pneumonia death group (7.2% vs. 31.1%). The time from disease onset to death was significantly longer in the pneumonia death group (28 days vs. 3 days). Multivariate analysis revealed that stroke deaths were significantly associated with occlusion sites, low ASPECTS, subarachnoid hemorrhage, any ICH, and high baseline NIHSS scores. In contrast, pneumonia deaths were significantly associated with older age, male sex, and high baseline NIHSS scores.

Conclusion:
Compared with the stroke death group, the pneumonia death group in patients undergoing MT for LVO had a significantly higher incidence of older age, male sex, and pre-stroke functional dependence, along with fewer hemorrhagic cases and a higher incidence of FPE. Older age and male sex were significant factors specifically associated with pneumonia death.
Abstract TP241: Large Vessel Occlusion Stroke in A Population: Prevalence, Presenting Characteristics, Treatment, and Mortality
Authors: Aziz Yasmin , Sucharew Heidi , Robinson David , Stanton Robert , Ferioli Simona , Woo Daniel , Haverbusch Mary , LaPorta Joseph , Wechsler Paul , Menzies Lauren , Wright Shea , Nobel Lisa , Stamm Brian , DeLosRiosLaRosa Felipe , Slavin Sabreena , Walsh Kyle , Mistry Eva , Khatri Pooja , Kleindorfer Dawn , Kissela Brett
Published: January 2025

Background:
Large vessel occlusion (LVO) is associated with high morbidity and mortality but has had major advances in treatment options. Prior studies in the United States have been limited by referral bias. We sought to study the population-based prevalence, presenting features, management, and mortality of LVO stroke.

Methods:
From the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS), we selected patients with a diagnosis of acute ischemic stroke (AIS) using ICD-10 codes in adults ≥18 years of age presenting with symptomatic intracranial LVO stroke confirmed on vessel imaging within study year 2020. LVO stroke was defined as occlusion limited to the intracranial internal carotid artery (ICA), the M1 segment of the middle cerebral artery (MCA), and the basilar artery (BA). Non-LVO stroke included events due to any other cause. All cases were physician reviewed using GCNKSS epidemiologic criteria. Demographic information, medical history, presenting features, use of advanced imaging, and treatment were collected for each patient. Prevalence was calculated with 95% confidence interval (CI) per 100,000 using 2020 census Demographic and Housing Characteristics in the GCNKSS region. Mortality from any cause within 30 days was calculated using the National Death Index.

Results:
In 2020, 3,033 AIS events were ascertained in the GCNKSS, with a median age of 69 years (IQR 60-80), 24% black, and 52% female. Events with no vessel imaging available were excluded (n=283). Of the remaining 2,750 events, 279 (10.1%) presented with LVO stroke and had similar demographics to the overall cohort. The prevalence of LVO was 24.7 per 100,000 people (95% CI: 21.9, 27.8). In descriptive analysis, LVO stroke events presented earlier and with higher NIHSS than those without. 159 (14.1%) presented with an intracranial ICA, M1, or BA occlusion among all ischemic events within 6 hours of last known normal. Discharge mRS was also higher (TABLE 1). The 30-day mortality for first time stroke was 30.1% (95% CI: 24.6, 36.0) for stroke due to LVO compared to 8.1% (95% CI: 7.0, 9.2) in non-LVO stroke.

Conclusion:
One in ten ischemic stroke patients harbor an intracranial ICA, M1, or BA occlusion at the population level. They continue to demonstrate worse outcomes despite treatment advances.