bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP124: Stroke Severity And In-hospital Death In Intracerebral Hemorrhage Patients Taking Antithrombotic Agents: Japan Stroke Data Bank
Authors: Arakaki Yoshito , Wada Shinichi , Yoshimura Sohei , Toyoda Kazunori , Sonoda Kazutaka , Nakai Michikazu , Sasahara Yusuke , Shiozawa Masayuki , Koge Junpei , Ishigami Akiko , Miwa Kaori , Iwanaga Yoshitaka , Miyamoto Yoshihiro , Koga Masatoshi ,   Japan Stroke Data Bank Investigators
Published: February 2023

Purpose:
The purpose of this study was to determine the associations between antithrombotic agents at onset and outcomes in intracerebral hemorrhage (ICH) patients.

Methods:
ICH patients admitted within 24 hours after onset from January 2017 to December 2020 were examined from a long-lasting nationwide hospital-based multicenter prospective registry, the Japan Stroke Data Bank. Patients were classified into 4 groups according to types of antithrombotic agents at onset: no-antithrombotic, antiplatelet, warfarin, and DOAC groups. Patients with combination of antiplatelet and anticoagulant agents were classified into respective anticoagulant groups. The outcomes were NIHSS on admission, in-hospital death and unfavorable outcome corresponding to mRS of 5-6 at discharge.

Results:
Of a total of 9,948 ICH patients (female: 4,329, age 70±15 years old), 77.4% of patients were classified into the no-antithrombotic group, 13.0% into the antiplatelet group, 3.9% into the warfarin group and 5.7% into the DOAC group. Median NIHSS on admission was 12 (interquartile range: 5-22), 13 (5-26), 15 (5-30) and 13 (6-24), respectively. In multivariable analysis, the warfarin group was significantly associated with higher NIHSS on admission (adjusted incidence rate ratio, 1.08 [95% CI, 1.05-1.12], setting the no-antithrombotic group as reference), but the antiplatelet group (1.01 [0.99-1.03]) or the DOAC group (0.97 [0.94-1.00]) was not. The rate of in-hospital death was 13.0% in the no-antithrombotic group, 17.8% in the antiplatelet group, 27.3% in the warfarin group and 18.9% in the DOAC group and that of unfavorable outcome was 30,8%, 41.9%, 48.6% and 41.5%, respectively. In multivariable analysis, the warfarin group was significantly associated with in-hospital death and unfavorable outcome (adjusted odds ratio: 1.62 [95% CI, 1.07-2.46] and 1.79 [1.23-2.6], respectively, setting the no-antithrombotic group as reference), but the antiplatelet group (1.14 [0.87-1.36], 1.11 [0.90-1.36]) or the DOAC group (1.07 [0.72-1.60], 1.27 [0.90-1.78]) was not.

Conclusion:
ICH patients taking warfarin at onset had higher NIHSS on admission, in-hospital death and unfavorable outcome compared to those without antithrombotic agents, but those taking DOAC did not.
Abstract WP125: Relationships Of Hemoglobin With Ischemic Lesions After Intracerebral Hemorrhage
Authors: Roh David , Boehme Ameila , Mamoon Rayan , Hooper Destiny , Cottarelli Azzurra , Ji Robin , Mao Eric , Kumar Aditya , Carvalho Poyraz Fernanda , Demel Stacie , Spektor Vadim , Carmona Jerina , Hod Eldad , Ironside Natasha , Gutierrez Jose , Guo Jia , Konofagou Elisa , Elkind Mitchell , Woo Daniel
Published: February 2023

Introduction:
Hemoglobin concentrations and diffusion weighted imaging (DWI) lesions are separately known to be associated with poor intracerebral hemorrhage (ICH) outcomes. Though hemoglobin concentrations are related to both hypoxia and thrombosis at their extremes, it is unknown whether hemoglobin concentrations relate to DWI lesions after ICH.

Methods:
Spontaneous, supratentorial ICH patients with available baseline hemoglobin and hospitalized MRI data enrolled into a multicenter cohort study between 2010-2016 were analyzed. Baseline hemoglobin was assessed as both a continuous variable (g/dL) and categorical variable (<11, 11 to <13, 13 to <15, >/=15 g/dL). Primary analyses assessed relationships of baseline hemoglobin with MRI DWI lesions. Secondary analyses assessed independent relationships of hemoglobin and DWI lesions with poor 3-month outcomes (modified Rankin Scale [mRS] 4-6). Separate multivariable regression models assessed these relationships after adjusting for relevant covariates.

Results:
Of 917 ICH patients analyzed, the mean baseline hemoglobin was 13.8 g/dL (+/-1.9), 60% were deep ICH, and DWI lesions were identified in 27% of the cohort. In our primary analyses, increased hemoglobin, defined as a continuous variable, was associated with DWI lesions (adjusted OR 1.21, 95% CI: 1.07-1.37) after adjusting for sex, race, ICH severity, time to MRI, and blood pressure treatment change. In secondary analyses, DWI lesions were associated with poor 3-month outcomes (adjusted OR 1.83, 95% CI: 1.24-2.69) adjusting for similar covariates. We identified associations of low hemoglobin categories, when referenced to hemoglobin 13 to <15 g/dL, with poor outcomes (<11 g/dL: adjusted OR 1.99, 95% CI: 1.05-3.79; 11 to <13 g/dL: adjusted OR 1.62, 95% CI: 1.04-2.52). Effect estimates of high hemoglobin (>/=15 g/dL) with poor outcomes were smaller and imprecise (adjusted OR 1.39, 95% CI: 0.89-2.17).

Conclusions:
We identified novel relationships between higher baseline hemoglobin concentrations and DWI lesions in ICH patients. Further studies are required to clarify the role of hemoglobin concentrations on both cerebral small vessel disease pathophysiology and ICH outcomes.
Abstract WP128: Incidence Of Intracranial Hemorrhage And Clinical Outcomes In Fast Versus Slow Progressors As Defined By Aspects
Authors: Sahito Sindhu , Fourcand Farah , Ghori Arifa , Ali ChHassan , Singh Zamir , Joshi Rudra , Amireh Abdallah , Gadallah Nancy E , Tabibzadeh Navid , Mehta Siddhart , Kirmani Jawad F
Published: February 2023

Introduction:
Heterogeneity of collateralization in patients with acute ischemic stroke (AIS) is a marker of fast versus slow progression of penumbral consumption and infarct expansion. Our aim was to evaluate the relationship between time-dependent stroke progression and incidence of intracranial hemorrhage (ICH) and acute neurological deficits.

Methods:
Retrospective chart review of patients presenting with anterior circulation large vessel occlusion (LVO)-associated AIS at our comprehensive stroke center with 24 hours last known normal (LKN) who underwent endovascular thrombectomy (EVT) without intra-arterial thrombolytics or non-thrombolytics were included. We used Alberta Stroke Program Early CT Score (ASPECTS) on initial non-contrast CT to identify slow versus fast progressors. ASPECTS <=7 was defined as fast progressor. Subgroup analysis was performed based on LKN <3 hours, 3-9 hours, and 9-24 hours. We evaluated rate of hemorrhagic transformation using ECASS-3 criteria and determined change in NIHSS from baseline to discharge. Mann-Whitney U test and Fisher exact test statistic with Social science statistics software used for data analysis.

Results:
From September 2019 to December 2021, out of 268 subjects who underwent EVT, 48 met inclusion criteria. Mean age was 65.29 (95% CI 61.32, 69.27), and median presenting NIHSS was 16 (95% CI 14.39, 18.40). Mean ASPECTS was 7.71 (95% CI 7.21, 8.20). There was significant difference is hemorrhagic transformation rate between ASPECTS >7 and <=7 (Fisher value=0.018). Sample size was not large enough to perform subgroup analysis based on last known normal. However, there was a trend towards increase in hemorrhagic transformation rate with greater time from last known well at same ASPECTS score. Slow progressors also had a significant improvement in presenting and discharge NIHSS as compared to fast progressors (z-score is -3.10, p-value is 0.002).

Conclusion:
Our study suggests that ASPECTS score as assessed in different time windows to differentiate fast versus slow progressors is not only a predictor of clinical outcome, but also independently associated with risk of hemorrhagic transformation. Larger, prospective studies are needed to validate our results.
Abstract WP133: Assessing Aneurysmal Rupture Outcomes Using Automated Quantification Of Hemorrhage Volume
Authors: Miller Jacob M , Patel Rishi R , Jones Matthew T , Sanchez Sebastian , Krug Randall G , Samaniego Edgar A
Published: February 2023

Introduction:
Hemorrhage volume affects the risk of developing complications after aneurysmal subarachnoid hemorrhage (aSAH). This volume is quantified subjectively through the Fisher Scale. We developed an automated method to quantify intracranial hemorrhage and determine the risk of complications after aSAH.

Methods:
CT scans of patients with aSAH were analyzed. An image-processing algorithm was designed in MATLAB to quantify aSAH volume. The automated algorithm was developed with region-growing and 3D k-means clustering. Two independent raters manually measured hemorrhage volumes using PACS and correlated these measurements with the algorithm measurements in ten patients. Vasospasm and hydrocephalus were identified through chart and imaging review. Hydrocephalus was adjudicated as ventricular enlargement in the setting of aSAH. ROC analysis was performed to evaluate the association between blood volume and the incidence of vasospasm, hydrocephalus and need for a permanent ventriculoperitoneal (VP) shunt.

Results:
One hundred and forty-one patients were included in the analysis. The intraclass coefficient correlation (ICC) for inter-rater agreement in PACS was 0.988 (p < 0.001). The ICC for comparing automated versus manual volumes was 0.966 (p < 0.001). Bland-Altman analysis reported a mean difference of -3.14 mL between automated and manual measurements. Hemorrhage volume discriminated for the development of vasospasm (AUC = 0.692), hydrocephalus (AUC = 0.775), and need of permanent VP shunt (AUC = 0.669).

Conclusion:
Vasospasm and hydrocephalus were associated with higher volume of aSAH. Patients with higher volume of aSAH at presentation were more likely to require a permanent VP shunt. An objective method to automatically measure aSAH volume can aid in assessing risk of complications among patients with aSAH.
Abstract WP134: Long-Term Spontaneous Recanalization Rates Of Symptomatic Cervical Carotid Artery Occlusions
Authors: Roy Alexis T , Ahmed Rashid , Marquez Loza Alejandra , Crowe Jonathan , Montes Daniel , Hamam Omar , Romero Javier M , Silverman Scott
Published: February 2023

Background:
Long-term rates of spontaneous recanalization of a previously acutely symptomatic cervical internal carotid artery occlusion (ICAO) have not been well characterized. The purpose of this study was to determine the rate of ICAO recanalization after index transient ischemic attack (TIA)/stroke in patients with serial vessel imaging, and the clinical factors associated with recanalization.

Methods:
This was a single-center, retrospective analysis from 2012-2020 of patients presenting with TIA/stroke due to an acute cervical ICAO. Patients were included if follow-up neck vessel imaging (CTA, MRA or ultrasound) was performed after index TIA/stroke. Recanalization was classified as the presence of continuous flow within the cervical carotid artery on repeat imaging. Patients were excluded if they received catheterization of the occluded artery during index admission or if the occlusion was previously documented (i.e., chronic).

Results:
Fifty-five patients were included in this study (mean age 61 ± 12 years, 27% female). The most common etiology for cervical ICAO was atherosclerosis (71%), followed by dissection (22%). Twelve patients (22%) demonstrated recanalization on follow-up imaging at a median of 125 days from index TIA/stroke (range 2-1072 days). Three patients with recanalization underwent carotid revascularization with endarterectomy or stenting. The administration of intravenous alteplase during index stroke admission was associated with recanalization (p=0.008). However, discharge antithrombotic regimen (antiplatelet or anticoagulation) or the etiology of the occlusion were not associated with recanalization (p=0.48 and p=0.73, respectively). There was no difference in 6-month recurrent TIA/stroke rates between those with recanalization (1 patient, 8.3%) and those without recanalization (4 patients, 9.3%), p=1.0.

Conclusion:
Cervical ICAO recanalization occurred in 12 (22%) patients in our cohort at follow-up and allowed for carotid revascularization procedures in 3 (25%) of these patients. Outpatient follow-up cervical vessel imaging should be considered after symptomatic cervical ICAO, as identifying spontaneous recanalization can alter management.
Abstract WP139: Current Practice Trends In The Management Of Cervical Artery Dissection - Preliminary Results
Authors: Koriesh Ahmed , Yaghi Shadi , Meschia James F , Brown Robert D , Keser Zafer
Published: February 2023

Introduction:
Cervical artery dissection (CAD) is a well-recognized cause of acute ischemic stroke, especially in young adults, accounting for up to 20-25% of all cases. Several studies reported an incidence between 2.5-5 per 100,000 in the general population. However, the actual incidence may be higher as many patients remain asymptomatic. Even though CAD is one of the leading causes of ischemic stroke, there is a lack of consensus in management. Our study surveyed practicing clinicians involved in the management of CAD to characterize current practice trends and provide a foundation for future research.

Methods:
An online case-based questionnaire with 11 questions regarding the management of cervical artery dissection was developed and piloted internally with 12 Mayo Clinic cerebrovascular neurologist/neurosurgeons. The survey was finalized, and initially sent to the STOP-CAD study group. We then sent the survey to practicing vascular neurologists across different academic institutions. Surveys were sent to 126 unique individuals.

Results:
A total of 42 clinicians completed the questionnaires. The response rate was 33% (42/126). Aspirin antiplatelet monotherapy was seen as the most appropriate therapy for asymptomatic CAD (81% [34/42]). Anticoagulation was the treatment of choice for cases with CAD and concomitant intraluminal thrombus (74% [31/42]). Most (74% [31/42]) of the participants recommended repeat imaging at three months. However, no consistent response regarding the type of antithrombotic agent for symptomatic CAD without intramural thrombus or cases with pseudoaneurysm. There was marked variability regarding the duration of antithrombotic therapy, ranging from three months to life-long treatment.

Conclusion:
Marked variability was seen in the management of CAD, especially regarding the choice of antithrombotic agent in symptomatic and complicated (stenosis or pseudoaneurysm) cases and the duration of such therapy, which reflects the lack of definitive clinical trial data. Ongoing research is needed to better guide the optimal management of these patients.
Abstract WP141: The Combined Effect Of Blood Pressure And Translesional Pressure Ratio Impacts The Stroke Mechanisms Of Intracranial Atherosclerosis
Authors: Chen Zimo , Qin Haiqiang , Liu Jia , Mo Jinglin , Wang Yongjun
Published: February 2023

Introduction:
ICAS confers the greatest risk of stroke, but the pathophysiology of stroke mechanismremains unclear. Essentially, plaque rupture is a physical process of structural failuredue to destructive biomechanics, and hypoperfusion is due to low perfusion pressure,which act as 2 major stroke mechanisms in sICAS. Notably, blood pressure (BP)plays key role in determining both biomechanics and perfusion of ICAS.

Hypothesis:
ICAS could result in significant BP change which may further influence strokemechanism. High local pressure gradient across ICAS may cause plaque rupture andthe subsequent artery-to-artery embolism, whereas low perfusion pressure atpost-stenosis area may restrict perfusion and induce the subsequent borderzoneinfarcts
(Fig)
.

Method:
A total of 339 sICAS patients due to 50-99% stenosis in MCA or ICA were includedfrom CNSR3. By Newton-Krylov-Schwarz method, CFD models were built based onTOF-MRA
(Fig)
. Translesional pressure ratio (PR) across ICAS was calculated as:pressurepoststenotic/pressureprestenotic. SBP gradient was calculated as: SBPх(1-PR),indicating the SBP drop across ICAS. Perfusion pressure at post-stenosis area wascalculated as: MAPхPR.

Results:
After adjustment, high SBP gradient and low perfusion pressure was shown tocorrelate with cortical infarcts (p=0.041) and borderzone infarcts (borderlinesignificant, p=0.059)
(Fig)
. Between the 2 parameters, Pearson correlation coefficient=-0.854, p <.0001. The cutoff of SBP gradient and perfusion pressure for the above 2stroke mechanisms was 14.4mmHg and 94.4mmHg, respectively.

Conclusions:
We demonstrated the hemodynamic hypothesis of stroke mechanism in sICAS thatartery-to-artery embolism and hypoperfusion could be attributed to the combinedeffect of blood pressure and translesional PR. Accordingly, a double-edged role of high BP level in sICAS may further surface, which can induce destructivebiomechanics but relieve hypoperfusion simultaneously.
Abstract WP143: Use Of CTP For Evaluation Of EVT Candidates In The Early Time Window (<6 Hours From Lkwt) Does Not Delay EVT T And Use Of CTP Beyond 6 Hours Improves Speed Of EVT
Authors: Marginean Horia , Corless Leslie , Loh Yince , Bavarsadshahripour Reza , Windisch Thomas , Guerrero Adrieanne , Lopez George , Hancock Sarah , Tarpley Jason W
Published: February 2023

Introduction:
Computerized Tomography Perfusion (CTP) improves detection of distal occlusion and aids in patient selection for endovascular therapy (EVT) for acute ischemic stroke (AIS). As EVT continues to evolve, it is important to assess if CTP continues to aid in the evaluation of AIS or if it adds unnecessary time. Here we assess whether the imaging approach used to evaluate EVT patients was associated with improved door to device times or clinical outcomes. Specifically, we assessed whether CTA alone vs CTA/CTP combined had an effect on door to device (DTD) for EVT, discharge disposition and 90-day mRS.

Methods:
Data from 1357 AIS EVT patients from 17 hospitals was obtained from a multi-state health system’s stroke registry between Jan 1, 2018, to Apr 11, 2022. Multivariable mixed-effect linear and logistic regression models were employed to identify the association of evaluation type with DTD, discharge disposition and mRS, adjusting for age, sex, race, mode of arrival, NIHSS, stroke mechanism, medical history, and TICI score. Multivariable ordinal regression model was used with mRS as ordinal variable. Each clinical outcome was assessed for last known well (LKW) to arrival below 6 hours and between 6 and 24 hours.

Results:
The median age was 74 years, 729 (47.7%) were male; 958 (70.6%) arrived in less than 6 hours from LKW and 399 (29.4%) in the interval between 6 and 24 hours. CTA and CTP evaluation was used for 829 (61.1%) patients. In the multivariable models, evaluation with both CTA and CTP was significantly associated with a decrease of the DTD when LKW to arrival was > 6 hours (n= 955, regression coefficient -16, 95% CI -27, -3.6, p = .01) and had no effect on DTD inside of 6 hours. No significant association was found between evaluation type and discharge disposition or 90-day mRs after adjustment for covariates.

Conclusions:
In EVT patients presenting inside of 6 hours, addition of CTP to CTA caused no delay in DTD and in those presenting from 6-24 hours adding CTP shortened DTD by 16 minutes. This may reflect that CTP allows for more confident and expeditious treatment. These results along with no effect of evaluation type on clinical outcome argue that there is no disadvantage to the use of CTP inside of 6 hours and a clear time advantage beyond 6 hours.
Abstract WP145: Racial Disparity In Outcomes Of Acute Ischemic Stroke In The United States: A 20-year Analysis Of The National Inpatient Sample From 2000-2019
Authors: Hardigan Trevor , Yaeger Kurt , Philbrick Brandon , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Background:
Acute ischemic stroke (AIS) is associated with a high rate of morbidity and mortality. We aimed to characterize racial disparities in patients with AIS over a 20 year period and examine the prognostic impact of race on functional outcomes.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Discharge location was used as a surrogate for functional outcome. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
A total of 10,415,286 patients with AIS were identified. Mean Age was 70.91±13.8 years. Patients were 61% White, 14.3 % Black, 6.6% Hispanic, and 2.4% Asian. Average NIH Stroke Scale differed significantly among the groups, with Asian patients having more severe disease than White, Black, or Hispanic patients (p<0.001). After multivariate analysis, Black patients had worse odds for discharge home than white patients (AOR 0.8, 95%CI: 0.77-0.83, p<0.001) with a higher likelihood of discharge to nursing/long-term care facilities (AOR 1.3, 95%CI: 1.26-1.34, p<0.001). In hospital mortality was less in Black (AOR 0.64, 95%CI: 0.58-0.7) and Hispanic (AOR 0.78, 95% CI: 0.69-0.87) patients (p<0.001).

Conclusions:
This 20 year nationally representative analysis of racial disparities in patients with AIS shows that while Black patients have worse odds of discharge home, they are less likely than White patients to die in the hospital. White patients make up the majority of cases, but their percentage of total AIS cases decreased while Black patients increased over the twenty year study period.
Abstract WP147: The Effect Of Aortic Arch And Carotid Artery Anatomy Parameters On The Conversion From A Transradial Artery Approach To A Transfemoral Artery Approach For Mechanical Thrombectomy At A Comprehensive Stroke Center
Authors: Nisar Taha , Lebioda Konrad , Roriguez Jorge , Patel Jimmy , Lee James , Bach Ivo , Memon Muhammad Z , Singla Amit , Khandelwal Priyank
Published: February 2023

Introduction:
Transradial approach (TRA) is emerging as an alternative to the traditional transfemoral approach (TFA) for mechanical thrombectomy (MT). We aim to identify various aortic arch and carotid artery anatomy parameters associated with a conversion from a TRA to a TFA for MT at a comprehensive stroke center (CSS).

Methods:
We performed a retrospective chart review of patients who underwent MT at a CSS from 1/2019 to 12/2021. We compared various aortic arch and carotid artery anatomy parameters between patients who had a successful MT via the TRA versus those who required a conversion from a TRA to a TFA for MT. A blinded board-certified neuroradiologist used the pre-MT CT Angiogram to document different aortic arch and carotid artery anatomy variables. A binary logistic regression analysis was performed, controlling for age, gender, presenting mean arterial pressure (MAP), presenting serum glucose, Hb A1C, LDL, left hemispheric location, and the location of occlusion [proximal (ICA or M1 segment of the middle cerebral artery) versus distal (M2 segment of the middle cerebral artery)].

Results:
68 patients met our inclusion criteria. The mean age was 66.08±15.09 years. 12 (17.65%) patients had to be converted from a TRA to a TFA for MT. In our cohort, the absence of a double subclavian-innominate curve (55.36% vs. 27.28%; OR, 12.5; 95 % CI, 1.76-88.52; P 0.011) and a higher diameter of the aortic arch at the apex (28.75±2.38mm vs.27.5±2.88mm; OR, 1.44; 95 % CI, 1.01-2.06; P 0.042) were significantly associated with a conversion from TRA to TFA. The other aortic arch and carotid artery anatomy parameters were not significantly associated with the conversion from a TRA to a TFA, as shown in the Table.

Conclusion:
Among aortic arch and carotid artery anatomy parameters, the absence of a double subclavian-innominate curve and a higher diameter of the aortic arch at the apex were significantly associated with a conversion from a TRA to a TFA for MT in our cohort.
Abstract WP148: The M1-2 MCA Angle And Reperfusion During Thrombectomy
Authors: Gupta Akash , Apfel Ryan , Yavagal Dileep R , Zaidat Osama , Jadhav Ashutosh P , Levy Elad , Saver Jeffrey L , Liebeskind David S
Published: February 2023

Introduction:
Mechanical thrombectomy with stent retrievers has been demonstrated to improve outcomes in patients with large vessel occlusion. M2 MCA occlusions pose a challenge when M2 branch takeoff has an acute angulation. Acute angles reduce the efficacy of interaction of the device with the clot as the force may be diminished in the vector of the clot. We sought to determine if the Tiger device is affected by an acute angle at the M1-2 MCA junction.

Methods:
The Tiger retriever trial was a prospective single-arm multicenter trial to assess efficacy of the Tiger-21 and Tiger-17 devices. A total of 160 patients were enrolled, including 37 with a M2 MCA occlusion. The core lab independently measured the angle on AP projection of the M1-M2 junction blinded to the clinical and radiographic outcomes. Patients were compared for successful reperfusion and if a hemorrhage occurred to assess if angulation was associated with these outcome measures.

Results:
A total of 37 patients suffered a M2 MCA occlusion with a mean age 67±16 years and a median NIHSS of 14. The overall rate of first pass TICI 2C/3 was 15/37(40.5%) with 11/37(29.7%) suffering an asymptomatic hemorrhage and no patients noted to have a symptomatic hemorrhage. The final reperfusion of TICI 2b/3 was achieved in 32/37(86.5%) of patients. Patients with excellent M2 TICI 2C/3 reperfusion had a more obtuse angle (113±25 degrees. vs. 92±35 degrees, p<0.03). Patients who suffered an asymptomatic intracranial hemorrhage had a trend towards more acute angulation of the M1-M2 MCA (89±34 degrees vs. 108±31 degrees, p< 0.11). Three patients had an angle <45 degrees all of which suffered asymptomatic subarachnoid hemorrhages. Patients who had an angle <90 degrees also were noted to require more passes to achieve reperfusion compared to patients with angles >90 degrees (3±2.6 vs. 1.8±1.1, p< 0.04).

Conclusions:
In the TIGER study, an acute angle at M1-M2 MCA branch point was associated with a reduced rate and need for more passes to achieve successful reperfusion. The acuity of the angle makes catheterization difficult with the force vector diminished along the axis of the clot. The current study identifies an opportunity for technological advancements to overcome this anatomical challenge in M2 MCA thrombectomy.
Abstract WP149: Racial Disparity In Intracerebral Hemorrhage Severity And Outcome: A 4-year Analysis Of The National Inpatient Sample From 2016-2019
Authors: Hardigan Trevor , Yaeger Kurt , Philbrick Brandon , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Background:
Racial disparity in ICH management and outcome is a major concern. We sought to evaluate the impact of race on ICH severity and outcome in a nationally representative database.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Discharge location was used as a surrogate for functional outcome. Univariate analysis with t-tests or chi-square performed as appropriate, and significant variables were entered into a multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for race on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
A total of 390,015 patients with ICH were identified over the four years; 97,220 (24.9%) had a reported NIH Stroke Score (NIHSS). Mean Age was 69.22 ± 14.3 years. Patients were 61% White, 16.6 % Black, 9.9% Hispanic, and 4.8% Asian. Average NIHSS differed significantly among the groups, with Asian patients having more severe disease than White, Black, or Hispanic patients (p<0.001). After multivariate analysis, Hispanic patients had greater odds of discharge home compared to White patients (AOR 1.3, 95% CI 1.12-1.51, p<0.05). Black patients had greater odds of discharge to nursing care facilities (AOR 1.12, 95%CI: 1.02-1.23, p<0.001). In hospital mortality was less in Black (AOR 0.7, 95%CI: 0.6-0.81), Asian (AOR 0.66, 95% CI: 0.51-0.83) and Hispanic (AOR 0.67, 95%CI: 0.55-0.8) patients (all <0.05).

Conclusions:
This nationally representative analysis demonstrates that Black patients have worse hospital outcomes after ICH while the rate of in-hospital mortality seen in Whites was higher in comparison to other races. White patients were the majority of cases and had an overall stable trend of good discharge outcome. Incidence of in-hospital mortality was highest in the Black patients over four years.
Abstract WP152: Trends In Stroke Patients With Associated Seizures: A 20-year Analysis Of The National Inpatient Sample From 2000-2019
Authors: Hardigan Trevor , Yaeger Kurt , Philbrick Brandon , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Background:
Seizure is a known complication following acute ischemic stroke (AIS) that can lead to severe morbidity. We sought to better characterize the risk factors for stroke following AIS and evaluate in-hospital outcomes in these patients.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for dysphagia on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
A total of 10,415,286 patients with AIS were identified; 694,495 (6.6%) had seizures. Patients with seizures had higher Elixhauser Comorbidity Score (14.81 ± 8.13 vs. 9.40 ± 8.76; p<0.001) and NIH Stroke Scale (NIHSS) Score (9.46 ± 8.68 vs. 6.50 ± 7.18; p<0.001). Patients with seizures were more likely to be female, younger, African American race, smokers, covered on Medicaid, be in the 0-25% percentile median income bracket, and be placed on a ventilator (all p<0.001). After propensity matching, seizure patients were slightly less likely to experience in-hospital mortality (AOR 0.94; 95%CI: 0.92-0.97), less likely to be discharged home (AOR 0.92, 95%CI:0.9-0.93), and had increased hospital charges ($6696.08; 95%CI: $5728.65-7663.51)(all p<0.001).

Conclusions:
Approximately 7% of patients with AIS experience seizure while hospitalized, with an overall stable incidence over 20 years. Seizure is more likely to occur in women and younger patients and is associated with worse functional outcomes. The percentage of patients with seizures in AIS remained similar per year despite an increase in the absolute numbers.
Abstract WP154: Low-field Portable Mri For Routine Post-thrombectomy Assessment Of Ongoing Brain Injury
Authors: Sujijantarat Nanthiya , Koo Andrew , Jambor Ivan , Malhotra Ajay , Crawford Anna , Mazurek Mercy , Parasuram Nethra , Yadlapalli Vineetha , Chavva Isha R , Antonios Joseph , Elsamadicy Aladine , Renedo Daniela , Hebert Ryan , Schindler Joseph L , Sansing Lauren H , De Havenon Adam H , Olexa Madelynne , Iglesias Juan E , Rosen Matthew , Kimberly W Taylor T , Petersen Nils H , Sheth Kevin N , Matouk Charles
Published: February 2023

Introduction:
Conventional MRI (cMRI) is not routinely available post-mechanical thrombectomy (MT), which can preclude accurate infarction assessment. Our objective was to evaluate the use of low-field portable MRI (pMRI) for bedside evaluation post-MT, including its use as a post-procedural baseline monitor.

Methods:
Low-field pMRI was used to obtain bedside imaging in post-MT patients between December 2021 to August 2022 at Yale-New Haven Hospital. All pMRI exams were conducted in the standard ferromagnetic environment of the IR suite. Volumetric analyses were performed by a neuroradiologist using 3D Slicer software. If cMRI was not available for comparison, a CT was used. Patients’ charts were reviewed for pre-revascularization MAP and occurrences of MAP dropping by 10% and 20% from individual baselines between the time of pMRI and delayed imaging.

Results:
A total of 25 patients (64% females, median age 77 years-old [IQR 69.5-84.5]) underwent bedside pMRIs in the IR suite post-MT. The median time from last known normal to access was 6 hours [IQR 4-17]. The median pMRI examination time was 30 minutes [IQR 17-32]. Of the 24 patients with available delayed imaging, 7 (29.2%) had infarct progression compared to immediate post-MT pMRI, while 15 patients (62.5%) had stable/decreased stroke volume. Two patients (8.3%) had parenchymal hemorrhage type 2 and were excluded from further analysis. There was no statistically significant difference between the proportions of favorable TICI scores (85.7% in the infarct progression group vs. 92.3% in the stable/decreased infarct group, p=1.00). Patients with infarct progression had comparable pre-revascularization MAP compared to those with stable/decreased delayed infarct volume (mean of 100.3±4.6 vs. 101.9±15.9 respectively, p=0.727) but had more occurrences of MAP dropping by 10% and 20% of their baseline between the time of pMRI and delayed imaging (mean of 35.0±23.3 vs. 14.7±11.3 occurrences, p=0.011; and mean of 21.7±16.5 vs. 8.5±9.5 occurrences, p=0.026, respectively).

Conclusions:
The use of low-field MRI in the post-MT setting can facilitate benchmark brain monitoring and serial examinations to evaluate the impact of potential physiological perturbations that may impact ongoing brain injury.
Abstract WP155: Long-term Outcomes And Comfort Care Transitions For Stroke Patients With Severe Baseline Disability With And Without Endovascular Thrombectomy
Authors: Awad Amine , Young Michael J , Andreev Alexander , Dmytriw Adam A , Vranic Justin , Rabinov James D , Stapleton Christopher , Das Alvin S , Singhal Aneesh B , Rost Natalia S , Patel Aman B , Regenhardt Robert W
Published: February 2023

Introduction:
Patients with baseline disability account for up to one-third of stroke presentations. Despite growing evidence supporting their benefit from endovascular thrombectomy (EVT), there remains controversy in treatment selection. We compared the long-term outcomes and the likelihood of comfort care for large vessel occlusion (LVO) stroke patients who presented with severe baseline disability treated with EVT versus medical management.

Methods:
Individuals who presented with LVO were identified from a prospectively maintained database from January 2017 to December 2020. Severe baseline disability was defined as modified Rankin Scale (mRS) 3-5. Delta mRS was defined as the difference between baseline and 90-day mRS. Logistic and ordinal regressions were performed to evaluate the relationships between EVT and outcomes.

Results:
A total of 175/1007 (17%) patients were identified with severe baseline disability. The median age was 82 (IQR 70-89), and 59% were female. Thirty-two (18%) patients with severe baseline disability were treated with EVT. EVT was independently associated with improved delta mRS (B=-1.048; 95%CI=-1.777,-0.318; p=0.005) when accounting for age and NIHSS. However, EVT did not reduce the odds of transitioning to comfort care (aOR=0.794; 95%CI=0.347,1.818; p=0.585) when accounting for age and NIHSS. Seventy-six (43%) patients with severe baseline disability were transitioned to comfort care. Of the 99 patients who were not transitioned to comfort care, 18 were treated with EVT. In this subgroup not transitioned to comfort care, EVT was independently associated with improved delta mRS (B=-2.794; 95%CI=-4.002,-1.586; p<0.0001) when accounting for age and NIHSS.

Conclusions:
Among patients with severe baseline disability, EVT is associated with less post-stroke accumulated disability without limiting transitions to comfort care. EVT is compatible with goal-concordant care in patients with severe baseline disability; it should not be routinely withheld on the sole basis of baseline disability.
Abstract WP156: Thrombectomy Alone Versus Bridging Intravenous Alteplase In The US Population: A Pseudo-randomized Controlled Trial
Authors: Salazar-Marioni Sergio , Abdelkhaleq Rania , Niktabe Arash , Tariq Muhammad Bilal B , Martinez-Gutierrez Juan Carlos , Sheth Sunil , Kim Youngran
Published: February 2023

Introduction:
Recent randomized controlled trials (RCT) failed to demonstrate non-inferiority of skipping IV tPA in patients with planned endovascular therapy (EVT). None of these studies included patients from the US due to regulatory challenges. Given practice patterns vary relative to Asia and Europe, we sought to address this topic using a validated alternative to RCTs, fuzzy regression discontinuity design (RDD).

Methods:
From our prospectively maintained multi-center registry we identified patients with LVO AIS treated with EVT with and without IV tPA treatment from 1/2018 - 9/2021. We used the time cutoff for IV tPA as our discontinuity and assumed subjects on either side of the cutoff have markedly different probabilities of receiving the treatment but are similar in other relevant characteristics. The primary outcome was good functional outcome defined as 90-day mRS 0-2 and it was compared between these two populations immediately adjacent to the cutoff using local linear regressions.

Results:
Among 694 patients with LVO AIS who received EVT, median age was 69 [IQR 59-79], 50%, were female, 44% White, 24% Black, and 14% Hispanic. 51% received IV tPA, with median onset to treatment time of 109 min [IQR 79-160]. We observed a sharp drop (47%) in the probability of tPA around the cutoff time of 4 hours (allowing 30 minutes for in-hospital evaluation), while there were no significant differences in other relevant features at the cutoff, validating the underlying RDD assumptions (Figure A). Overall, 33% of patients achieved good functional outcomes and there were no significant differences around the cutoff time (Figure B). In fuzzy RDD, there was no evidence of an association of receiving tPA with good functional outcome with regression discontinuity of only 1.0% (p=0.98)

Conclusion:
Our study provides the highest quality US-based evidence supporting the findings of the outside US trials, demonstrating no benefit of skipping IV tPA in patients with planned EVT.
Abstract WP158: Impact Of Atrial Fibrillation On Clinical Outcomes After Endovascular Thrombectomy: A Post-Hoc Analysis Of The Defuse-3 Trial
Authors: Zamzam Ahmad , Lusk Jay , De Havenon Adam H , Yaghi Shadi , El Husseini Nada K , Lansberg Maarten G , Albers Gregory W , Mac Grory Brian C
Published: February 2023

Introduction:
Previous studies have failed to show an interaction between known atrial fibrillation (AF) and treatment effect of endovascular thrombectomy (EVT) performed within 6 hours of time last known well. However, it is not known if these findings apply to patients treated beyond 6 hours. The objective of the present study is to determine if a known diagnosis of AF exhibits effect modification on the association between treatment (EVT vs. medical therapy) and outcomes in patients >6 hours from time last known well.

Methods:
We performed a post hoc analysis of the DEFUSE-3 trial investigating the functional outcomes in study participants stratified by AF status. Our primary endpoint was functional outcome as measured by the modified Rankin Scale (mRS) score. We constructed an ordinal logistic regression model to determine the association between EVT/medical therapy and mRS in subgroups by AF status. Secondary endpoints include functional independence (mRS 0-2 vs. 3-6), final infarct volume, sICH, and mortality, examined via binary logistic or linear regression. We fit treatment modality*AF interaction terms.

Results:
Among 182 participants, 62 had AF (34 randomized to EVT) and 120 did not have AF (58 randomized to EVT). Patients with AF were older (median: 76.5 vs 66.5), presented with a higher NIHSS (median: 17 vs 16), and received IV tPA less frequently (4.8% vs. 12.5%). In patients with AF, the odds of a one-point improvement in mRS in EVT vs. medical therapy were 4.56 (95% CI: 1.79-12.17), while in patients without AF, the odds were 2.42 (95% CI: 1.27-4.67). We found no significant interaction between AF and EVT for the primary or secondary endpoints.

Conclusion:
Our study did not show a significant interaction between AF status and EVT, with the caveat that the study may be underpowered to detect such an effect. The trend for greater treatment effect should be evaluated in larger studies.
Abstract WP161: Does History Of Atrial Fibrillation (Afib) Impact TICI Scores In Acute Ischemic Stroke Patients Receiving Endovascular Treatment With Or Without Iv Thrombolytics? Results From A Large Health System In Six Western States Of The United States
Authors: Bavarsad Shahripour Reza , Marginean Horia , Corless Leslie , Arnold Lisa , Guerrero Adrieanne , Lowenkopf Ted J , Singh Tarvinder , Lesko Alexandra C , Loh Yince , Pirastehfar Mohsen , Tarpley Jason W
Published: February 2023

Introduction:
Despite the importance of Afib in stroke, it is unclear whether patients with acute ischemic stroke (AIS) and Afib have a different response to reperfusion with IV thrombolysis (IVT) and/or endovascular treatment (EVT) compared to non-Afib patients. Patients with AIS due to Afib may have difficulty achieving favorable TICI scores (The thrombolysis in cerebral infarction).This study aimed to compare the TICI scores in patients with and without a history of Afib treated with EVT and/or IVT.

Methods:
Data on consecutive AIS patients (a multi-state health system’s stroke registry) treated with EVT and/or IVT for five years (2018 -2022) were evaluated. Patients were stratified into two groups, 1- EVT only with or without a history of Afib; 2- IVT plus EVT with or without a history of Afib.Multivariable mixed effect logistic regressions were performed to evaluate if patients with AFib showed a difference in TICI scores (favorable outcome : TICI: 2b-3) within the two treatment groups adjusting for patient age, sex, race and ethnicity, NIHSS on admission, blood glucose on admission, SBP on admission and history of diabetes, CAD/prior MI, carotid stenosis, smoking, dyslipidemia, heart failure, or being overweight.

Results:
The cohort consists of 3311 patients with a median age at arrival 73 years and median NIH Stroke scale 16, who were 51.7% females, 68% white, 23.9% diabetes mellitus, 51.6% dyslipidemia , 20.5% CAD , 13.6% smoking, 53.6% overweight, 14.9% HF.In group 1 (EVT) :2350 patients:37.3% had Afib and 93.6% achieved a score of TICI 2b-3 .In group 2 (EVT+IVT): There were 961 patients, 28.7% having Afib with 94.9% achieving TICI 2b-3. After adjustment, there was no difference in the TICI scores between two groups .

Conclusions:
In this study, atrial fibrillation did not significantly impact TICI scores in AIS patients treated with EVT. The study also supports the efficacy of EVT in combination with IVT in the population with Afib.
Abstract WP164: Acute Carotid Stenting Versus Conservative Management For Tandem Carotid Occlusions: Insights From STAR
Authors: Essibayi Muhammed Amir , Anadani Mohammad , Almallouhi Eyad , Yaghi Shadi , Maier Ilko , Jabbour Pascal M , Kim Joon-Tae , Wolfe Stacey Quintero , Rai Ansaar , Starke Robert , Psychogios Marios , Shaban Amir , Arthur Adam S , Yoshimura Shinichi , Howard Brian , Alawieh Ali , Fragata Isabel , Cuellar Hugo , Polifka Adam , Mascitelli Justin , Osbun Joshua , Matouk Charles , Park Min S , Levitt Michael , Dumont Travis , Williamson Richard , Altschul David , Spiotta Alejandro M , Al Kasab Sami
Published: February 2023

Introduction:
Management of anterior circulation emergent large vessel occlusion with tandem carotid occlusion (TCO) remains a challenge during mechanical thrombectomy (MT). To day, there is no consensus regarding emergent carotid stenting (ECS) in the setting of MT with TCO. We aimed to compare the outcomes of ECS versus conservative management (MT alone) among patients with TCO.

Methods:
Data from the Stroke Thrombectomy and Aneurysm Registry between 2010 and 2022 was interrogated. Only patients with concomitant occlusions of cervical carotid and proximal ipsilateral intracranial segments of the ICA or MCA were included in the analyses. We compared baseline, procedural charecteristics, successful reperfusion (mTICI 2b-3), favorable 90-day good outcomes (mRS 0-2), intravenous tPA administration and symptomatic ICH between patients who did or did not undergo ECS. Multivariate regression was performed adjusting for variables of clinical importance. Propensity score matching for IV tPA use was performed to explore its safety with stenting.

Results:
Among 9812 thrombectomy patients, 688 patients had TCO; 132 underwent emergent stenting and 444 had MT alone. Patients who did not undergo ECS had a higher prevalence of atrial fibrillation (33.9% Vs 9.2%, P<.001), higher admission NIHSS scores (18 Vs 14, P<.001), shorter time from symptom onset to puncture (275 minutes Vs 333 minutes, P=0.029), and were predominantly women (59.2% Vs 33.6%, P<0.001).Patients with stenting had lower mortality rates ( 17.5% Vs 29.6%, P=0.009), and higher rates of successful reperfusion (83% Vs 95%, P=0.001). No difference in mRS 0-2 (37.5% Vs 30.4%, P=0.178) or sICH were seen (11.1% Vs 15.4%, P=0.219). Propensity score matching analysis (n=129 in each group) demonstrated better rates of reperfusion (94.8 Vs 84.4%, P=0.011) in the stenting group. Advanced age, higher admission NIHSS and lower ASPECT scores were associated with worse clinical outcomes.

Conclusion:
ECS during MT for TCO appears to be safe and is associated with better clinical and angiographic outcomes compared to conservative management.