bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP428: Changes of Microstructural White Matter in Vascular Cognitive Disorder and Amnestic Mild Cognitive Impairment: a Diffusion Tensor Imaging Study
Authors: Yu Yang , Liang Xinyu , Gong Gaolang , Han Ying , Yin Changhao
Published: March 2022

Background:
White matter (WM) damage could be observed in both vascular cognitive disorder predementia (VCD-P) and amnestic mild cognitive impairment (aMCI). In the period of VCD-P, the degree of cognitive decline was similar to aMCI, but they are different in the specific cognitive domains. However whether the differences in cognitive domains are related to the pattern of WM impairment hasn’t been illustrated.

Hypothesized:
The region or degree of WM impairment differs from VCD-P to aMCI.

Methods:
All subjects include 28 patients with VCD-P, 34 aMCI and 39 normal controls (NC) underwent a comprehensive neuropsychological assessment and DTI. We compared fractional anisotropy (FA), mean diffusivity (MD) and axial diffusivity (AxD) of whole brain WM regions. Then the diffusion tensor was reconstructed, analyzed by tract-based spatial statistics.

Results:
Patient groups exhibited significant differences in FA, MD and AxD, the VCD-P group has a lower FA, higher MD and AxD. The different FA and MD region between VCD-P and aMCI was in left anterior limb of internal capsule, bilateral corona radiata, corpus callosum, cerebral peduncle, external capsule, posterior limb of internal capsule, fornix, inferior longitidinal fasciculus, inferior and superior fronto-occipital fasciculus, whereas in AxD it was showed in bilateral corona radiata, internal capsule, external capsule, corpus callosum, posterior thalamic radiation and superior longitudinal fasciculus.

Conclusion:
Our findings suggest that VCD-P and aMCI have divergent topography of WM microstructural changes in the degree and the region, the WM integrity was impaired more severe in VCD-P. The differences in regions may illustrate the clinical and neuropsychological features characterized by executive or memory deficit. These findings provide insights into the biological mechanism of cognitive disorders and highlight the potential of DTI as the imaging biomarker for diagnosis. All authors report no conflicts of interest. This work was supported by the National Natural Science Funds of China (Grant No. 81301188).
Abstract WP53: 24-hour Infarct Volume on Non-contrast CT as a Predictor of Functional Outcome at 90 days
Authors: Bai Helin Daniel , MacCormick Matthew , Cimflova Petra , Patel Shivanand , Menon Bijoy , Goyal Mayank , Hill Michael
Published: March 2022

Introduction:
Reliable early stroke prognostication has important implications for goals of care planning, treatment guidance, and disposition planning. At present, prediction of patient long term functional outcomes remains challenging.

Hypothesis:
Infarct volumes on early non-contrast CT may be a useful tool in predicting long term stroke functional outcomes.

Methods:
Non-contrast CT images from 557 patients in the ALIAS2 trial were collected. Infarct and hemorrhage volumes at 24hrs post treatment were measured by 4 investigators blinded to patient clinical information. Abnormalities were outlined manually on each image slice and final volumes were calculated using Quantamo 1.0, a volumetric analysis tool. The location and volume of the acute abnormalities were correlated with modified Rankin Scales (mRS) scores at 90-day follow-up using Pearson correlation coefficients.

Results:
There is a strong correlation between infarct volumes measured on CT at 24 hours with functional outcomes measured at 90 days r = 0.465 with every 18.6ml of brain infarct contributing to 1 point increase in mRS. Infarct volumes also correlated with number of hospital stays, patient death, and initial assessments using Alberta Stroke Program Early CT Score r= 0.211, 0.395 and -0.377 respectively. Acute hemorrhage volume correlated strongly with poor functional outcomes with 8.2ml of hemorrhage corresponding to 1 point increase in mRS r =0.468. A comparison of patients treated with placebo vs. high dose albumin showed no statistically significant difference in infarct volumes.

Conclusions:
Measurement of brain infarction on CT at 24 hours post treatment can predict long-term functional outcomes and maybe a useful tool in guiding management.
Abstract WP57: ASL MR Perfusion Imaging Detects Collateral Blood Flow Patterns and Dynamic Changes After Treatment in Acute Ischemic Stroke
Authors: Bokkers Reinoud P , Leigh Richard , Hsia Amie W , Lynch John K , Nadareishvili Zurab , Benson Ricard T , Latour Lawrence L
Published: March 2022

Introduction:
Vessel-encoded arterial spin labeling (ASL) perfusion MRI is a new non-invasive method that is able to assess collateral blood flow and the perfusion territories of the brain feeding arteries.

Hypothesis:
Collateral blood flow imaging with ASL MRI is feasible in acute stroke patients and can be used to study the relationship between infarct location, perfusion territories and collateral patterns, together with dynamic changes after treatment.

Method:
Consecutive acute stroke patients were imaged within 24 hours of onset. Follow-up imaging was performed at discharge and/or 30 days to assess changes in vascular distribution and final infarct size. The imaging protocol contained a vessel-encoded pseudo-continuous ASL, DWI and MRA sequence.

Results:
Twenty stroke patients were included (NIHSS, 10; range, 0-23). Twelve patients were treated with tPA and 3 with additional endovascular therapy. Median time from initial imaging to follow-up was 25 days (range, 3-36). 80% of the exams were interpretable. Thirteen subjects (70%) had an ischemic lesion within the expected perfusion territory; 12 within the internal carotid artery (ICA) territory and 3 from basilar artery. In 5 patients (25%), the infarct zone was fed through collateral pathways. Figure A demonstrates a patient with a left ICA occlusion and collateral flow through the anterior and posterior-communicating artery. In 2 of the 5 patients with collaterals there was a shift in the vascular distribution at FU with decline of collateralisation. Figure B shows a patient with a right-sided ICA dissection directly post endovascular therapy with collateral flow from the basilar artery and normalization of the vascular distribution after 30 days.

Conclusion:
ASL can access perfusion territories and collateral blood flow in acute stroke. It may potentially be used to identify brain tissue without adequate collateral blood flow and stratify patients suitable for appropriate (endovascular) therapy.
Abstract WP58: Evolution of FLAIR Volume and Signal Intensity Following Endovascular Stroke Therapy
Authors: Federau Christian , Mlynash Michael , Christensen Soren , Zaharchuk Greg , Cha Brannon , Wintermark Max , Lansberg Maarten , Albers Greg ,   DEFUSE 2 Investigators
Published: March 2022

Background:
Infarct volume is an important surrogate marker for assessing the efficacy of acute stroke therapies. We studied the evolution of acute stroke lesions on FLAIR images over time following endovascular therapy in a subgroup of patients (n=35) from the DEFUSE 2 study.

Methods:
FLAIR images were acquired both post-revascularization (median 12h after symptom onset) and at day 5. Patients were separated into two groups based on the degree of reperfusion achieved on Tmax>6s perfusion imaging (>90% vs. <90%). After co-registration and signal normalization, lesion volumes and signal intensity were assessed in both initial infarct (lesion visible after revascularization), and recruited infarct (additional lesion visible lesion on day 5).

Results:
All 35 patients had FLAIR lesion growth between post-revascularization and day 5. Median infarct growth was significantly larger in patients with 90% (8.12ml, p=0.003). In the initial infarct, signal intensity did not change between post-revascularization and day 5 in the >90% reperfused group, while it increased in the <90% reperfused group (p = 0.01). In the recruited infarct, signal increased significantly in both groups between post-revascularization and day 5 (p < 0.0001).

Conclusions:
Compared with patients who have <90% reperfusion, patients with >90% reperfusion have significantly less infarct growth between post- endovascular revascularization and day 5. Therefore, reductions in ischemic lesion growth attributable to reperfusion therapies are likely to be more apparent at day 5 compared to early post-revascularization.
Abstract WP59: Long-term Survival According to CBF Grade of MR Perfusion in Acute Stroke Patients With the Carotid Artery Occlusion
Authors: Mori Takahisa , Iwata Tomonori , Tanno Yuhei , Kasakura Shigen , Yoshioka Kazuhiro , Hirata Yumie
Published: March 2022

Background and purpose:
It is difficult to anticipate long-term survival in a hyperacute stroke stage. The aim of our study was to investigate whether or not simple probable CBF grading of MR perfusion was useful for anticipating long-term survival probability (SP) in acute stroke patients due to the carotid artery occlusion.

Methods:
Included were patients 1) who were admitted to our institution within 24 hours of onset between Jan 2005 and May 2014, 2) who underwent MRA displaying no carotid artery (ICA) in the affected side and 3) who were treated without any reperfusion therapy. We evaluated patients features, CBF grades, any death within 120 days. CBF grade was calculated by using bilateral time-intensity curves (TICs) of MR perfusion. TICs were generated on region of interests set at symmetrical positions of the bilateral MCA territories. According to the time to peak (TP) and the peak signal (PS) comparing the affected side (a) with the contralateral side (c), we regarded the affected-sided PSa divided by TPa as possible CBFa and the contralateral-sided PSc divided by TPc as possible CBFc. CBF grade 1 was defined as CBFa divided by CBFc (CBF%) less than 0.2, grade 2 as CBF% of 0.2 or more and CBF% less than 0.7 and grade 3 as CBF% of 0.7 or more.

Results:
Eighty-four patients matched our inclusive criteria. Average age was 77.9 years, median NISS on adm (NIH adm) was 19, DWI-ASPECTS (D-ACT) was 3. There were 27, 32 and 25 in grade 1, 2 and 3. Thirty-eight patients (45.2%) died within 120 days. In grade 1, 2 and 3, 22, 14 and 2 patients died within 120 days, and SP of the Kaplan-Meier method at 120 days was 18.5%,53.9%,92.0% (p<0.001), respectively. In addition, there were significant differences between any two grades (p<0.016).

Conclusion:
Simple CBF grading of MR perfusion was useful for anticipating long-term survival provability in the hyperacute stroke stage. Long-term SP in grade 1 patients was very low, whereas that in grade 3 patients was high.
Abstract WP6: RAPID Automated CT Perfusion Software Performance in Acute Ischemic Stroke From Anterior Circulation Tandem Occlusions
Authors: Haussen Diogo C , Dehkharghani Seena , Grigoryan Mikayel , Bowen Meredith , Rebello Leticia C , Nogueira Raul G
Published: March 2022

Purpose:
CT perfusion predicts ischemic core volumes in acute stroke (AIS), however assumptions within the pharmacokinetic model may engender errors in the presence of tracer delay or dispersion. We aim to evaluate the impact of hemodynamic disturbance due to tandem intracranial-extracranial anterior circulation occlusions upon the accuracy of the ischemic core estimation in an automated perfusion analysis tool (RAPID) among large-vessel AIS patients.

Materials and Methods:
A prospectively collected interventional database was retrospectively reviewed for all cases of endovascular treatment of AIS between September 2010-March 2015 for patients with anterior circulation occlusions with baseline CTP and full reperfusion (mTICI3). This study was IRB approved.

Results:
Out of 685 treated patients, 114 fit the inclusion criteria. The comparison between tandem (n=21) vs. non-tandem groups (n=93) revealed similar baseline ischemic core (20±19vs.19±25cc; p=0.8), Tmax>6s (175±109vs.162±118cc; p=0.6), Tmax>10s (90±84vs.90±91cc; p=0.9) and final infarct volumes (45±47vs.37±45cc; p=0.5), respectively. Baseline core volumes were found to correlate with final infarct volumes for the tandem (r=0.49; p=0.02) and non-tandem (r=0.44; p=<0.01) groups. The mean absolute difference between estimated core and final infarct volume was similar between patients with and without (24±41vs.17±41cc; p=0.5) tandem lesions.

Conclusions:
Optimized CTP analysis employing rigorous normalization, thresholding, and voxel-wise analysis is reliable for ischemic core prediction in AIS patients despite underlying extracranial carotid steno-occlusive disease.
Abstract WP60: Distal Hyperintense Vessels on FLAIR is a Marker of Collateral Flow Grade and Outcomes in Patients with Acute Ischemic Stroke
Authors: Miura Masatomo , Nakajima Makoto , Singu Takaomi , Nagao Yoichiro , Inatomi Yuichiro , Yonehara Toshiro , Terasaki Tadashi , Ando Yukio
Published: March 2022

Background:
Collateral grade on cerebral angiography has great predictive significance for patient outcome, which is important to determine indication for endovascular therapy in acute ischemic stroke (AIS). Distal hyperintense vessels (DHV) on fluid-attenuated inversion recovery imaging (FLAIR) is a noninvasive and useful imaging marker that reflects leptomeningeal collateral flow. We investigated whether DHV in patients with AIS was associated with collaterals grade on cerebral angiography and clinical outcome after endovascular therapy.

Methods:
We retrospectively reviewed patients with AIS who had internal carotid artery or middle cerebral artery occlusion in three comprehensive stroke centers from August 2011 to July 2015. We selected those who underwent FLAIR sequence before endovascular therapy. Presence of DHV was evaluated using a previously-published method. Collateral grades on pre-treatment cerebral angiography were assessed with the American Society of Interventional and Therapeutic Neuroradiology Collateral Grading System on angiography (grade 0-4). We analyzed the relationship between DHV and patient characteristics, collateral flow grade, and good clinical outcomes (modified Rankin Scale [mRS] of 0-2 at 90 days).

Results:
A total of 38 patients (aged 71.7 ± 10.3 years; men, 71%; NIHSS score, 20 ± 6; median DWI-ASPECTS, 8) were included. DHV was detected in 29 patients (76%). Presence of DHV was significantly related to better collateral flow grade on angiography (2.5 vs. 1.3, p = 0.006), lower NIHSS score on day 7 (median, 7.8 vs. 16.3, p = 0.034), and higher rate of mRS 0-2 at 90 days (69% vs. 11%, p = 0.005), but was not related to DWI-ASPECTS (p = 0.819) or Thrombolysis in Cerebral Infraction (TICI) 2b/3 reperfusion rate (p = 0.128). In multivariate analysis, both presence of DHV (OR, 17.7; p = 0.013) and TICI 2b/3 reperfusion (OR, 21.3; p = 0.002) were independent predictors of mRS 0-2 at 90 days.

Conclusions:
DHV on FLAIR is a marker of collateral flow status and might predict better clinical outcomes in patients with AIS. Using FLAIR sequence for evaluation of collateral status might be useful to select candidates for endovascular therapy.
Abstract WP62: Regional Leptomeningeal Score on TOF-MRA Predicts Collateral Flow Grade and Clinical Outcome in Patients with Acute Ischemic Stroke
Authors: Miura Masatomo , Nakajima Makoto , Singu Takaomi , Nagao Yoichiro , Inatomi Yuichiro , Yonehara Toshiro , Terasaki Tadashi , Ando Yukio
Published: March 2022

Background:
Collateral status at baseline is an important predictor of clinical outcome in patients with acute ischemic stroke (AIS). Non-contrast time-of-flight MR angiography (TOF-MRA) might provide information of blood flow features non-invasively. TOF-MRA could become a marker of collateral status and clinical outcome in patients with AIS.

Methods:
We retrospectively reviewed patients with AIS who had internal carotid artery or middle cerebral artery occlusion in three comprehensive stroke centers from August 2011 to July 2015. Those who underwent TOF-MRA sequence before endovascular therapy were investigated. Collateral status on TOF-MRA was graded by the previously-published regional leptomeningeal collateral (rLMC) score on CT angiography (0-20); collateral grade on angiography was assessed with the American Society of Interventional and Therapeutic Neuroradiology Collateral Grading System (0-4). We analyzed the relationship between rLMC score on TOF-MRA and patient characteristics, collateral flow grade, and good clinical outcome (modified Rankin Scale [mRS] of 0-2 at 90 days).

Results:
A total of 38 patients (aged 71.7 ± 10.3 years; men, 71%; NIHSS score, 20 ± 6; median DWI-ASPECTS, 8) were included. Collateral grade on angiography was 0 to 1 in 10 (26%) patients, 2 in 6 (15%), 3 in 19 (50%), and 4 in 3 (7%), which was correlated to rLMC score on TOF-MRA (p < 0.001). Higher rLMC score on TOF-MRA was not related to baseline DWI-ASPECTS and reperfusion (Thrombolysis in Cerebral Infraction [TICI] 2b/3) after endovascular treatment, but was related to mRS 0-2 at 90 days (p = 0.021). All patients with high rLMC score (15-20) demonstrated mRS 0-2 at 90 days, whereas 69% of those with medium rLMC score (8-14) and 31% of those with low rLMC score did. In multivariate analysis, both rLMC score on TOF-MRA (OR, 1.5 per 1 point; p = 0.009) and reperfusion (TICI 2b/3 reperfusion; OR, 49.9; p < 0.001) were independent predictors of mRS 0-2 at 90 days.

Conclusions:
rLMC score on TOF-MRA is a noninvasive and feasible parameter of collateral flow status and related to clinical outcome in patients with AIS. TOF-MRA might be a useful non-invasive imaging method to select candidates for endovascular therapy.
Abstract WP63: Clinical Utility of Whole-brain 4D-CTA Using a 320-detector Row CT Scanner in the Evaluation of Spontaneous Lobar Intracerebral Hemorrhage
Authors: Tajiri Hiroyuki
Published: March 2022

Purpose:
We performed a retrospective study on the capacity of 320-detector row computed tomography (CT) scanners to detect vascular lesions in spontaneous intracerebral hemorrhage, particularly using whole-brain four-dimensional CT angiography (4D-CTA).

Materials and methods:
Subjects were patients brought to our hospital emergency room between April 2011 and August 2015 who were diagnosed with spontaneous intracerebral hemorrhage by non-contrast CT. Contrast-enhanced CTA (including 4D-CTA) was performed for all patients with a 320-detector row CT scanner soon after confirming a hemorrhagic lesion. Patients with bleeding in common sites for subarachnoid hemorrhage, intraventricular hemorrhage, or hypertensive intracerebral hemorrhage (basal ganglia, thalamus, brain stem, or cerebellar dentate nucleus) were excluded. Evaluation items were:

-Hematoma size (estimated bleeding volume)

-Number and frequency (%) of cerebrovascular lesions detectable with 4D-CTA

-In patients who had cerebral angiography (CAG), the concordance rate between the detection rate and the Spetzler-Martin grade for AVMs or Cognard classification for dural arteriovenous fistulas (dAVFs) was calculated. Definitive diagnosis was made by consensus between two neuroradiologists.

Results:
Subjects were 125 patients diagnosed with spontaneous intracerebral hemorrhage during the study period (72 men (57.6%); mean age, 58.4±17.2 years; range, 20-88 years; mean estimated bleeding volume, 17.5±12.6 mL). A vascular lesion was detected as the source of bleeding with 4D-CTA in 10 of the 125 patients (8.0%), of whom 5 had AVM, 3 had dAVF, 1 had Moyamoya disease, and 1 had obstruction of the superior sagittal sinus. In patients who underwent CAG at a later date, 4D-CTA offered almost the same diagnostic power as CAG.

Conclusion:
Whole-brain 4D-CTA using a 320-detector row CT scanner was useful for diagnosing spontaneous intracerebral hemorrhage, particularly for detecting cerebrovascular lesions.
Abstract WP66: Posterior Communicating Artery May Decrease the Severity of Hyperacute Posterior Circulation Ischemic Stroke and Predict Clinical Outcomes
Authors: Seo Kwonduk , Suh Sang Hyun , Lee Kyung-Yul , Kim Ji-Hwa , Lee Sung-Ik , Lee Kee-oog
Published: March 2022

Background and Purpose:
Hyperacute posterior circulation ischemia (PCI) is known to have poor clinical outcomes. Pretreatment ischemic lesion is an outcome predictor in patients with basilar artery occlusion. When basilar artery occlusion occurs, collateral blood flow can be reversed through hemodynamic connections between posterior communicating artery (PComA), first PCA segment, and carotid artery. We hypothesized that the presence of PComA is related to less severe ischemia and favorable outcome in the patients with hyperacute PCI.

Methods:
We retrospectively selected patients with acute ischemic lesion in posterior circulation who had received thrombolysis from stroke registry between June 2008 and September 2013. All patients were examined by CT angiography (CTA) before treatment. The NIHSS scale was used to assess initial stroke severity. The presence of PComA was confirmed based on axial CTA source images. The outcome of patients was defined as modified Rankin Scale score (mRS) after three months.

Results:
Seventy-five patients (45 male; mean age: 69 years, range; 29-91 years) were treated by multimodal thrombolytic therapy (27 intravenous only, 37 intra-arterial only, 11 intravenous and intra-arterial method). Thirty-four of 75 patients (45.3%) had bilateral PComAs and 36 of 75 patients (48%) had unilateral PComA. Initial NIHSS scale was significantly lower in patients with bilateral PComAs than patients with absent or unilateral PComA (mean NIHSS scale 12.38±9.02 vs. 18.73±9.19, p=0.004). The rate of favorable outcome (mRS 0-2) was significantly higher in patients with bilateral PComAs in comparison to patients with unilateral or absent PComA (78.6% vs. 27.3%, p<0.001).

Conclusions:
PComA is related to initial severity of hyperacute PCI. Well-developed collateral flow is associated with less severe ischemic damage, and as a consequence, leads to more favorable outcomes. Further prospective clinical trials are required to confirm the effect of PComA on clinical outcomes of hyperacute PCI.
Abstract WP7: A Projection of Endovascular Therapy Eligibility in the United States: A Population-based Analysis
Authors: Khatri Pooja , Moomaw Charles J , Alwell Kathleen S , Khoury Jane C , Heldner Mirjam , Fischer Urs , Kissela Brett , Adeoye Opeolu , Flaherty Matthew L , Woo Daniel , Ferioli Simona , Mackey Jason , Martini Sharyl , de los Rios La Rosa Felipe , Vagal Achala , Kleindorfer Dawn O
Published: March 2022

Introduction:
After five randomized trials in 2015 demonstrating benefit, endovascular therapy (EVT) is the new standard of care for selected acute ischemic stroke (AIS) patients. Stroke systems must rapidly adapt to provide this time-sensitive therapy to eligible patients.

Objective:
To estimate the number of EVT-eligible AIS patients in the US annually using Class I and IIa eligibility criteria from the 6/2015 AHA/ASA guideline update.

Methods:
We ascertained all hospitalized AIS patients ≥18 years old in 2010 using ICD-9 codes 430-436 within the 1.3 million Greater Cincinnati/Northern Kentucky (GCNK) population. Two groups were selected: (1) IV rtPA (IVT)-eligible: arrival ≤3.5 hours from onset and no standard contraindications, and (2) IVT-ineligible but potentially EVT-eligible: arrival ≤5 hours from onset, NIHSS ≥6, platelets ≥50k, and INR ≤3.0. For each group, we estimated the rate of large-vessel occlusion (LVO) by baseline NIHSS using a 2,152-patient prospective database at University of Bern. Other criteria included prestroke mRS 0-1 and ASPECTS ≥6 (estimated 75% prevalence). We also considered expanded eligibility of mRS 0-3 and ASPECTS ≥5 (estimated 85% prevalence). Regional rates were age/race/sex-adjusted to 2010 US census data.

Results:
Regional eligibility for IVT and EVT among 2297 AIS patients is shown in the Figure. Projecting to the US, 30,607 patients would be IVT-eligible, and 5582 patients would be EVT-eligible annually. Expanded EVT eligibility would lead to 18,094 EVT-eligible patients nationally.

Conclusion:
Within the GCNK population, 1.0% of AIS patients (including 11.3% of IVT-eligible patients) are EVT-eligible based on Class I and IIa AHA/ASA recommendations. We project 5582 EVT-eligible patients in the US annually, and up to 18,094 using expanded eligibility. Estimates are limited by the use of cohort-based LVO and ASPECTS rates, and the projection of urban GCNK region arrival time patterns to the broader US population.
Abstract WP72: Administration Rates for IV TPA Varies by Type of Stroke Center
Authors: Alberts Mark J , Williams Scott , Hampel MJ , Schmaltz Stephen , Donini-Lenhoff Alessandra , Baker David
Published: March 2022

Background:
Despite advances in endovascular stroke therapy, the use of IV TPA remains the most prevalent acute therapy for ischemic stroke. The earlier that IV thrombolytic therapy is initiated, the better the patient outcome. We analyzed data from different types of hospital stroke centers to determine if differences the rates of IV TPA administration exist. Our hypothesis was that IV TPA would be administered more consistently at Comprehensive Stroke Centers (CSCs) than Primary Stroke Centers (PSCs) and non-center certified facilities (NC).

Methods:
We examined data submitted to the Joint Commission for STK-4 (acute ischemic stroke, arrival within 2 hours and IV TPA administered within 3 hours) from Q4 2013 through Q3 2014. Measure rates were analyzed for the three certification groups (CSC, PSC and NC) to see if there were any significant differences in performance using logistic mixed effects models
.
Drip and ship patients were excluded from the analysis.

Results:
We had patient-level data from 54 CSCs, 989 PSCs, and 334 NC facilities. The average annual number of ischemic stroke admissions at each were: 367 for CSCs, 169 for PSCs, and 73 for NCs. The average annual number of patients treated with IV TPA was 23.6 at CSCs, 14.9 at PSCs, and 6.2 at NCs. The rates of IV TPA administration to eligible patients was 91% at CSCs, 85% at PSCs, and 52% at NCs. CSCs had statistically significantly higher rates of IV TPA administration compared to PSCs (p < 0.001), and PSCs had higher rates compared to NCs (p < 0.001). We did not collect data about IV TPA use out to 4.5 hours after stroke onset.

Conclusions:
Patients admitted to a certified stroke center are more likely to receive IV TPA than at non-certified facilities. CSCs administer IV TPA to a higher percentage of patients than either PSCs or NC facilities. While not every hospital can become a CSC, perhaps educational efforts and care paradigms at CSCs can be emulated at other facilities to increase the use of IV TPA in appropriate patients.
Abstract WP77: Symptomatic Intracranial Hemorrhage Rates and Intravenous Tissue Plasminogen Activator Treatment Time Windows: Does Treatment Window Make a Difference?
Authors: Wagner Jeffrey C , Orlando Alessandro , Fanale Christopher , McCarthy Kathryn , Whaley Michelle , Jensen Judd , Bar-Or David
Published: March 2022

Introduction:
There are no data to support the hypothesis of an increased risk of symptomatic ICH (sICH) with the later 3-4.5h IV-tPA treatment window, compared to the <3h window.

Hypothesis:
There is a significant difference in the odds of suffering a sICH if treated with IV-tPA <3h, compared to 3-4.5h.

Methods:
This was a 6-year retrospective observational cohort study. All adult (≥18 yrs) patients admitted with an ischemic stroke between 1/2010-6/2015 and treated with IV-tPA were included in the study. Patients receiving IA treatment were excluded (n=244). Outcomes for this study were sICH (4-point increase in NIHSS within 36h with new ICH seen on CT), in-hospital mortality and favorable discharge mRS (≤2). Chi-squared, Fisher’s exact and Wilcoxon rank-sum tests were used to compare proportions and medians between groups. Multivariate, stepwise logistic regression was used to assess differences in the odds of outcomes; entry and exit criteria for covariates were p=0.20 and p=0.10.

Results:
561 (90%) were treated <3h, 64 (10%) were treated 3-4.5h. A significantly larger proportion of patients in the IV-tPA ≤3h group, compared to the IV-tPA 3-4.5h group were aged ≥80 years and white (both p<0.01). 13 (2%) patients suffered a sICH. There were no significant demographic or clinical differences between patients suffering a sICH and those who did not. Patients treated with IV-tPA <3h had a significant 76% decreased odds of suffering a sICH (Table 1); no covariates found. 70 (11%) of patients died. After adjustment, patients treated <3h had a significant 59% reduction in the odds of dying (Table 1). 251 (42%) were discharged with a favorable discharge mRS. After adjustment, patients treated <3h had a 71% increase in the odds of a favorable outcome, trending toward significance (Table 1).

Conclusions:
tPA treatment windows impact sICH, mortality and favorable mRS rates. Ensuring thrombolytic therapy is received <3h from symptoms is vital for decreasing the risk of suffering an sICH.
Abstract WP81: Headache-clinical Symptom as a Contributor of Intravenous Thrombolysis Decision Making in “Stroke Alert”
Authors: Pandav Vijay M , Mayberry Jordan , Sharma Rohan , Wedlake John , Johnston Sarah , Thompson David M , Sidorov Evgeny V
Published: March 2022

Introduction:
Headache (HA) is more commonly associated with stroke mimics than with acute ischemic stroke (AIS). Acute neurological deficit associated with HA at presentation during “Stroke Alert” may adversely affect decision to undertake intravenous (IV) thrombolysis. Advocacy of rapid and early IV thrombolysis for AIS may lead to inappropriate use of such therapy for stroke mimics rather than for AIS.

Hypothesis:
Headache associated with acute neurological deficit during “Stroke Alert” is less likely to receive thrombolytic therapy as compared to those without headache.

Methods:
We performed chart review of all adult patients presenting with “Stroke Alert” at our comprehensive stroke center in 2013. During this period our imaging protocol for IV tissue plasminogen activator administration (tPA) included non-contrast head CT. We compared the IV tPA administration rate in patients with and without HA and also evaluated patients receiving and missing IV tPA for respective diagnoses.

Results:
At our institution, 331 patients presented as “Stroke Alert” in 2013. Ninety (28%) patients reported HA at presentation. IV tPA was administered to 51 “Stroke Alert” patients (15.4%). Only 5/90 patients (5.55%) who presented with HA received IV tPA compared to 46/241 patients (19.1%) who did not present with HA (p =0.018). None of the patients with HA who received IV tPA had AIS on subsequent imaging as compared to 6/85 in patients with HA who did not receive IV tPA (Odd ratio 1.11, CI; 0.055 to 22.411, p=0.94). The median NIHSS was 5 in the HA and IV tPA group compared to 2.5 in the HA and no-IV tPA group. The discharge diagnosis in the HA and no- IV tPA group was migraine in 51 (60.7%), intracranial hemorrhage in 11 (13.1%), AIS in 6 (7.05%) and toxic metabolic encephalopathy in 4 (4.7%) patients. None of the stroke mimic patients who received IV tPA had hemorrhagic complications. The probability of “Stroke Alert” patient with HA being correctly diagnosed with AIS was 6.67% and receiving IV tPA was 5.56%.

Conclusion:
Likelihood of “Stroke Alert” patients with headache and acute neurological deficits being treated with IV thrombolysis is low. Incidence of AIS in patients with HA and acute neurological deficits not treated with thrombolysis was equally low which is reassuring.
Abstract WP82: Retrospective Study of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Negative Post-treatment Neuroimaging
Authors: Hendrick Stephanie , Haveman-Gould Bradley , Min Jiangyong , Groenhout Amy , Deol Baljit , Farooq Muhammad U
Published: March 2022

Introduction:
Current AHA/ASA guidelines recommend administration of tissue plasminogen activator (t-PA) for ischemic stroke (IS) with a door-to-needle time of 60 minutes or less, which sometimes results in administering intravenous t-PA in patients with alternative diagnoses such as stroke mimics and transient ischemic attacks. The goal of this study was to determine the incidence of negative neuroimaging for IS in our acute stroke registry patients who received IV t-PA. Secondary outcomes included the incidence of stroke mimics and complications following t-PA therapy.

Hypothesis:
We anticipate that the complication rate of administering IV t-PA in IS patients with negative neuroimaging and stroke mimics will be minimal.

Methods:
Patients who received IV t-PA for acute IS at our primary stroke center from January 2012 through December 2014 were selected. Data were collected via retrospective chart review.

Results:
We identified144 patients who received IV t-PA, of which 74 (51%) were diagnosed with an IS and 35 (24%) with a stroke mimic, 21 (15%) with TIA and 14 (10%) with negative neuroimaging IS. Baseline risk factors, race and gender were similar between all four groups. Overall 78.5% of patients were Caucasian, 60.4% were female and the mean total risk factors were 3.47. We found a significant difference between ages of patients with stroke mimics compared to patients with TIA (53.6 years versus 76.4, respectively, p-value < 0.01), but no statistic difference between negative neuroimaging IS and neuroimaging confirmed IS (71.1 and 72.1 years, respectively). Additionally, patients with confirmed IS had higher NIHSS scores at admission compared to patients with stroke mimic, TIA and negative neuroimaging IS (9.75 versus 5.67, 4.00 and 5.05 respectively, p-value < 0.01). Symptomatic ICH occurred in 7 (9.5%) of the confirmed IS patients, of which 4 led to death. There were no cases of symptomatic ICH in the other groups.

Conclusions:
Overall 49% of patients were found to have negative imaging. Our study supports the safety of IV t-PA administration in neuroimaging negative strokes and stroke mimics. Future studies are needed to look at outcomes such as discharge disposition, need for rehabilitative services and mRS scores up to 12 months following discharge.
Abstract WP88: Hemodynamic Localizations in Anterior Communicating Artery Aneurysms in Comparison With Middle Cerebral Artery Aneurysms With Computational Fluid Dynamics Analysis
Authors: Fukuda Shunichi , Shimogonya Yuji , Fukuda Miyuki , Tsuskahara Tetsuya
Published: March 2022

Introduction:
In a series of reports using an animal model of experimentally induced cerebral aneurysms (CAs), we have proposed that an increase in wall shear stress (WSS)-related hemodynamics initiates CA development. Although several studies tried to clarify detailed hemodynamic stress in human CAs with computational fluid dynamics (CFD), the results so far are controversial. Thus, we started the multi-institutional prospective clinical trial to examine hemodynamics-related factors for CA development, enlargement, and rupture with CFD, named CFD ABO Study. We have proposed “normalized transverse WSS” (NtransWSS); a newly modified indicator based on transWSS for multi-directional disturbed flow, and indicated significant importance of WSS-associated disturbed flow in CA formation. We show here the interim report of the trial.

Hypothesis:
Unlike MCA aneurysms, anterior communicating artery (Acom) aneurysms usually have inlet flow from both sides of internal carotid arteries, which may cause more complicated hemodynamic circumstances, contributing to higher rupture rate of Acom aneurysms. In order to clarify this hypothesis, we elucidated differences in hemodynamics between Acom and MCA aneurysms.

Methods:
Three-dimensional CT angiographic images of human CAs and patient-specific flow velocities as inlet boundary conditions were used for CFD analysis.

Results and Conclusions:
In Acom aneurysms, WSS was lower over the entire aneurysm than neighboring arteries (p=0.02), but higher at neck of the CA (p=0.02). WSS gradient was higher at the neck (p=0.02). NtransWSS and OSI were higher over the entire aneurysm (p=0.02) and at the neck (p=0.02 and 0.04, respectively). Although distributions of some hemodynamic metrics in MCA aneurysms were statistically similar in Acom aneurysms, OSI at the neck was not significantly higher. In addition, WSS over the entire aneurysms of Acom was much lower as compared with MCA aneurysms (p=0.03). At the neck of Acom aneurysms compared with MCA aneurysms, NtransWSS and OSI were higher while WSS was lower (not significant). High WSS under disturbed flow may be involved in CA development, and low WSS with turbulences in rupture. Markedly lower WSS in Acom aneurysms may be associated with higher rupture rate in this site.
Abstract WP90: Intraoperative Premature Rupture of Middle Cerebral Artery Aneurysms: Risk Factors and Sphenoid Ridge Proximation Sign
Authors: Park Jaechan Park
Published: March 2022

Object:
The investigation of surgical cases of a ruptured middle cerebral artery (MCA) aneurysm to identify the risk factors of an intraoperative premature rupture.

Methods:
Based on an 8-year period and among 927 patients with a ruptured intracranial aneurysm, the medical records of 182 consecutive patients with a ruptured MCA aneurysm were examined for cases of a premature rupture, and the risk factors were then investigated. The considered risk factors included: the patient age, gender, WFNS clinical grade, modified Fisher grade, presence of an ICH, frontal ICH, temporal ICH, volume of the ICH, maximum diameter of the ruptured MCA aneurysm, length of the pre-aneurysmal M1 segment between the carotid bifurcation and the MCA aneurysm, and the presence of a sphenoid ridge proximation sign. The use of axial source images and a three-dimensional reconstruction of the brain CTA revealed a sphenoid ridge proximation sign based on the spatial proximation between a potential rupture point of the MCA aneurysm and the cortical arachnoid of the sphenoidal sylvian fissure, adjacent superficial sylvian veins, and the sphenoid ridge.

Results:
A total of 11 patients (6.0%) suffered a premature rupture of the MCA aneurysm during surgery. The premature rupture occurrences were classified according to the stage of the surgery as follows: 1) craniotomy and dural opening (n = 1), 2) aspiration or removal of the ICH (n = 1), 3) retraction of the frontal lobe (n = 1), 4) dissection of the sphenoid segment of the sylvian fissure to access the proximal vessel (n = 4), and 5) peri-aneurysmal dissection (n = 4). Univariate and multivariate analyses revealed that the presence of a sphenoid ridge proximation sign, a frontal ICH associated with the ruptured MCA aneurysm, and the length of the pre-aneurysmal M1 segment were all statistically significant risk factors for a premature rupture of a MCA aneurysm.

Conclusions:
Patients exhibiting a sphenoid ridge proximation sign, the presence of a frontal ICH, and/or a short pre-aneurysmal M1 segment are high-risk patients for an intraoperative premature rupture of a MCA aneurysm. Such high-risk MCA aneurysms have a superficial location close to the arachnoid in the sphenoidal compartment of the sylvian fissure and have a rupture point directing anteriorly.
Far away from Pārsa: Empire, Borders, and Ideology in Achaemenid Bactria
Authors: Ferrario Marco
Published: March 2022

Recently, a corpus of primary sources related to the Northeastern fringes of the Achaemenid Empire (courtly-style seals bearing narrative depictions of warfare between representatives of the King and Central Asians) has been used to support the hypothesis that, at least from Xerxes’ reign, the people of the eastern satrapies provided a constant threat to the Empire in these crucial regions and, consequently, to its stability. Given its implications (e. g., in the light of evidence like the ADAB documents, from which a different picture emerges), such a statement deserves closer scrutiny. After having summarized the main arguments supporting it, the paper problematizes it, while arguing for a dialectical framework as the theoretical paradigm better suited to understand the relationships between Achaemenid power and the people(s) living at its Central Asian borderlands.
A Copper Statuette from South-Eastern Iran (3rd Millennium B.C.)
Authors: Eskandari Nasir , Shafiee Mojgan , Mesgar Ali Akbar , Zorzi Federico , Vidale Massimo
Published: March 2022

We present a copper alloy statuette confiscated by the Iranian security forces in the surroundings of Jiroft (Kerman, Iran) with other artifacts of the 3rd millennium B.C. Its iconography is discussed with synthetic reviews of selected snake-related iconographic themes in coeval ancient Mesopotamia, Iran, and southern Central Asia. Two micro-fragments, analyzed by ESEM, revealed the alloy and an unusual decorative treatment of its surface. The statuette hints at an important mythological or religious identity so far unknown.
On the Emergence of the Iranian Apocalypse Between the Sixth and Seventh Centuries
Authors: Agostini Domenico
Published: March 2022

The Iranian apocalyptic texts belong to the body of Pahlavi literature that was written in the ninth and tenth centuries. While most scholarship points to the early Islamic reworking and redaction of these apocalyptic accounts, which is clearly evident in the overlapping narratives, various late Sasanian historical and apocalyptic material still seems to be detectable.

This article reassesses the identification of some Iranian apocalyptic figures, in order to discuss the origin of some literary models that were likely shared with some coeval neighboring traditions. It will thereby situate the emergence of Iranian apocalyptic ideas between the end of the sixth to the first decades of the seventh century.
An Etymological Note on YAv. mūra-: Is it Really “Idiot, Stupid, Foolish”?
Authors: Belelli Sara
Published: March 2022

The present contribution is a first step of an ongoing investigation on the conceptualisation of “stupidity, foolishness, madness” in Iranian, as a selected case-study for an assessment of the controversial role played by phonosemantic/ideophonic paradigms in lexical production and areal diffusion of cognate words. The discussion will challenge the commonly- accepted interpretation of the Young Avestan term mūra- as prototypically referring to mental/cognitive impairment, based on a review of the attempts at etymological reconstruction and a closer scrutiny of disregarded evidence from Middle and New Iranian.
New Persian yādgār
Authors: Nafisi Nadereh
Published: March 2022

The paper is devoted to the analysis of the specific terminological usage of a polysemantic lexeme, yādgār (generally meaning today “souvenir, keepsake; remembrance”), in New Persian of the Classical period, particularly in the Shahnama by Firdausi (10th century).
The Ethno-Religious Contradictions as Threats to the North Caucasus Stability and Integration
Authors: Popov Maxim
Published: March 2022

Latent ethno-religious conflicts remain the most destructive of contemporary threats to the North Caucasus integration and stability. The fundamental issue that requires a constructive solution in order to ensure security in this region is the promotion of ethnic peace and tolerance. This research aims to analyse how deep-rooted ethno-religious contradictions can affect regional stability and conflict resolution strategy. The paper attempts to answer an essential research question that unresolved protracted contradictions have fundamental consequences for the North Caucasus. The growing regional disintegration, deep social inequalities, and ineffective institutions all add significantly to the appeal of radical Islamist ideology, erode trust in the state, and constitute a key reason the North Caucasian conflicts are so difficult to resolve. All of these increase the citizens’ alienation from the state and promote the search for radical alternatives, including ISIS and jihad: ethno-religious radicalism becomes a major conflict driver.
Immortality and Longevity through Yoga in the Tirumantiram
Authors: Wittich Agi
Published: March 2022

Tirumūlar yoga reveals the practices through which one may achieve longevity and immortality. Prolonging life aids the yogi to accomplish yoga’s final transcendent state of consciousness, samadhi, in which the yogi’s consciousness is absorbed into the god Śiva. Although a person’s lifespan is determined by the time of their conception, birth, and actions, life expectancy can be prolonged by certain yogic techniques. This is attested to in Tirumūlar’s seminal text Tirumantiram, in which he claims to have reached samadhi and to have lived for thousands of years. Tirumūlar details four yoga systems – Aṣṭāṅgayoga, Khecarīyoga, Candrayoga, and Paryaṅgayoga – that are meant to preserve life energy. These systems include practices designed to retain vital energies such as breath and semen retention, awaken and elevate the life force, and lead to immortality. The yoga’s final immortal state of samadhi resembles a deathlike state, which is said to be the ultimate blissful state of living.
The Triggers of Transformation
Authors: Kędzia Ilona
Published: March 2022

This article studies the comprehensive medico-alchemical Tamil text Six Hundred Verses by Siddhar Yākōpu. Through an analysis of selected sections of this text, the article explores the discourse on the preparation called cavukkāram. Cavukkāram seems to be crucial for the medico-alchemical system exposited in the book, where it is portrayed as a potent catalyst that enables both alchemical operations on inanimate matter and remarkable transformations of human beings. The article explores the recipes, powers, and further processing for cavukkāram, drawing out ambiguities and inconsistencies in the discourse on the substance and the equivocalness of the text. It concludes that Six Hundred Verses describes, among other things, several different methods of preparing a substance called cavukkāram; the vocabulary in the recipes is highly ambiguous, and certain ingredients are presented as rare and difficult to attain – all of which adds to the obscurity of the discourse.
Explorative Study of Indian Medicines in Singapore
Authors: Sébastia Brigitte
Published: March 2022

Compared to ayurveda, siddha medical practice and use outside India has hardly been investigated. Based on an ethnography of siddha and ayurveda clinics conducted in 2019 in Singapore, and secondarily, in southern Malaysia, this paper analyzes the development of these medicines in terms of adaptations, transformations, and the strategies or avoidance necessary to respond to clients/patients’ demands and to fit in with the regulations for traditional medicines. Whereas siddha medicine is well established in Malaysia, it is hardly discernible in Singapore, represented by only two clinics: a long-standing one reflecting the tradition, and a recent one, illustrating the process of modernization impelled by the institutionalization of medical knowledge. The practice of ayurveda, by contrast, has seen a significant expansion since the beginning of the twenty-first century in these two countries, a dynamism impelled by its reputation abroad which has been spurring Indian practitioners to migrate and popularize it.
Two notes on Proto-Ersuic
Authors: HILL Nathan W.
Published: March 2022

This paper looks at the history of Tosu using 'forward reconstruction'. It concludes that Proto-Ersuic changed *-im to *-am already before its breakup as a unity, but the ‘brightening’ of *-a- to -i- took place independently in Tosu and Lizu-Ersu. In Tosu this brightening did not target labial (or velar) initial words lacking an inherited medial *-j-. A number of changes in the history of Tosu probably preceded brightening, namely *-um, *-ak > -o and *-u, *-it, *-at, *-ra > -e. In contrast, the change *-e- > -i- in Tosu, of unclear conditioning, appears to be quite late. A dissimilation *CeCe > CeCa is potentially also a recent change.