bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP11: Predictors Of Early Neurological Deterioration After Dual Antiplatelet Therapy In Patients With Cerebral Infarction
Authors: Lee Eungjoon , Bae Jeonghoon , Kang Dong-wan , Yang Wookjin , HA Sue Young , Jeong Han-Yeong , Jeong Hae-Bong , Jung Keun-hwa , Kim Jeong-Min , Park Kwang-yeol , Lee Seung-hoon
Published: February 2022

Background:
Recent clinical evidence supports the early initiation of aspirin and clopidogrel combination for patients with minor stroke or high-risk transient ischemic attack (TIA) to prevent stroke recurrence. However, some of the patients still experience early neurological deterioration (END) despite optimal antithrombotic treatment. We investigated clinical and laboratory variables related to END after optimal antithrombotic treatment among the patients with non-cardioembolic stroke or TIA.

Methods:
The patients with minor neurological deficit who received aspirin and clopidogrel within 24 hours after symptom onset were selected from the prospective stroke registries of Seoul National University and Chung-Ang University Hospital, in Seoul, Korea. The END due to ischemic stroke (END_IS) was defined as two or more national institute health stroke scale increase within 5 days after stroke which us due to stroke progression or recurrence. Included patients were divided into two groups according to the presence of END_IS and demographic and laboratory variables were compared between the two groups. Multivariable logistic regression analysis was performed to assess the independent predictors of the END.

Results:
During the study period from January 2015 to January 2021, 33 (8.7%) out of 380 patients experienced END_IS. In multivariate analysis, independent predictors of END_IS were the presence of intracranial artery stenosis ≥ 50% (odds ratio [OR] 2.922, [95% CI, 1.342-6.364], p=0.007), higher initial NIHSS score, (OR 1.502 [95% CI 1.120-2.015], p=0.007), previous use of statin (OR 0.282 [95% CI 0.080-0.990], p=0.007) and higher serum D-dimer level (OR 1.408 [95% CI, 1.074-1.847], p=0.048).

Conclusions:
Intracranial artery stenosis, stroke severity, previous statin use, and D-dimer level were the independent predictors of END_IS after dual-antiplatelet treatment in patients with minor stroke. Future studies are necessary to develop an additional therapeutic strategy for the at-risk patient group.
Abstract WMP116: Age-related Dysfunction In Leptomeningeal Collateral Remodeling After Ischemic Stroke
Authors: WU TING , Ahn John , Kim Gab Seok , Marrelli Sean P
Published: February 2022

Introduction:
The leptomeningeal collaterals (LMCs) are specialized brain surface arterioles that interconnect the major cerebral artery territories. Good outcome following ischemic stroke is highly correlated with high collateral number and function. Unfortunately, with aging and disease, the LMCs demonstrate impaired dilatory capacity, reduced vessel diameter, and even complete vessel loss (rarefaction). The present study examined the chronic remodeling capacity of LMCs following permanent stroke in young and aged mice.

Methods:
Young and aged C57BL6 mice (5 and 20 months) were subjected to permanent distal middle cerebral artery occlusion (pdMCAO). At 2 weeks or 3 months, LMCs were evaluated for inner diameter and VWF expression (% LMC coverage). We compared the LMCs feeding the occluded MCA territory (LMC ipsi) to the contralateral equivalent vessels (LMC contra). Diameter change is reported as fold change relative to the distal-most arteriole (DMA) associated with each LMC.

Results:
Young male mice demonstrated increased diameter of LMC ipsi relative to DMA at both 2 weeks (1.36 ± 0.075; n=24 vessels/4 mice, P<0.01) and 3 months after stroke (1.27 ± 0.073, n=19 vessels/2 mice, P<0.01). LMC contra were 0.901 ± 0.064 and 1.01 ± 0.053 for the same time points (n=19 and 10 vessels, P=NS). VWF expression was significantly increased in LMC ipsi at 2 weeks (ipsi 10.9 ± 2.87 vs. contra 2.91 ± 0.82, P<0.05) and neared significance at 3 months (ipsi 6.45 ± 1.54 vs. contra 2.06 ± 0.264, P=0.051). Aged mice demonstrated increased diameter of LMC ipsi relative to DMA at 2 weeks (1.24 ± 0.052, n=25 vessels from 3 mice, P<0.01), but not at 3 months (1.08 ± 0.044, n=14 from 2 mice, P=NS). Notably, the 3 month LMC ipsi vessels demonstrated irregular diameter and characteristics of rarefaction. LMC contra were 0.897 ± 0.032 and 0.967 ± 0.092 for the same time points (n=17 and 8 vessels, P=NS). VWF expression was significantly elevated in LMC ipsi vs. LMC contra at 2 weeks (6.74 ± 1.33 vs. 1.87 ± 0.361, P<0.01), but not at 3 months (2.27 ± 0.387 vs. 1.81 ± 0.398, P=NS).

Conclusions:
Our data show lasting LMC remodeling in young stroke brain, consisting of increased LMC diameter and expression of VWF. With aging, LMC remodeling is transient and evidence of LMC rarefaction is apparent by 3 months.
Abstract WMP120: Vascular Risk Factor Reduction Is Associated With Corneal Nerve Regeneration In Patients With Tia And Ischemic Stroke
Authors: Khan Adnan , AKHTAR NAVEED , Wadiwala MUhammad Faisal , Al Qurashi Albandary , fatima Al-Khawaja fatima Al-Khawaja , Gad Hoda , Ponirakis Georgios , Petropoulos Ioannis , Saqqur Maher , Shuaib Ashfaq , Malik Rayaz
Published: February 2022

Background and Purpose:
Vascular risk factors are associated with transient ischemic attack (TIA), acute ischemic stroke (AIS) and corneal nerve damage. We have assessed if an improvement in vascular risk factors in patients with TIA and AIS is associated with corneal nerve regeneration.

Methods:
Patients with TIA or AIS and control subjects underwent assessment of clinical and vascular risk factors and corneal confocal microscopy (CCM) at baseline and 1-year follow up.

Results:
Eighty-one patients with TIA (n=28), AIS (n=53) and control subjects (n=56) were studied. Systolic blood pressure (SBP)(
P
=0.000), diastolic blood pressure (DBP) (
P
=0.000) and HbA1
c
(P=0.000) were significantly higher and HDL (
P
=0.000), corneal nerve fiber length (CNFL) (P=0.000), corneal nerve fiber density (CNFD) (P=0.000) and corneal nerve branch density (CNBD) (P=0.003) were significantly lower in patients with TIA/AIS compared to controls. At follow up, there was a significant decrease in triglycerides (-0.37 mmol/l, P=0.005), total cholesterol (-1.12 mmol/l, P=0.000); LDL-cholesterol (-1.08 mmol/l, P=0.000), SBP (-24.76 mmHg, P=0.000), DBP (-14.24 mmHg, P=0.000) and HbA1
c
(-0.50 mmol/l, P=0.027) and an increase in HDL (0.10 mmol/l, P=0.010), CNFL (1.48 mm/mm
2
, P=0.018), CNFD (1.66 no./mm
2
, P=0.024), and CNBD (26.90 no./mm
2
, P=0.000). The improvement in lipids and blood pressure was associated with an increase in corneal nerve parameters (
P
<0.05).

Conclusions:
An improvement in vascular risk factors in patients with TIA or AIS is associated with corneal nerve regeneration. CCM could be used to assess the effectiveness of risk factor reduction in patients with TIA or AIS.
Abstract WMP13: Delayed Stimulation Of Angiotensin II Type 2 Receptor Ameliorates Sensorimotor Deficits And Cognitive Decline After Stroke In Aged Hypertensive Rats
Authors: Alshammari Abdulkarim , Jones Tim W , Pillai Bindu , Kamat Pradip , Khan Mohammad B , Hess David C , Bosomtwi Asamoah , Ergul Adviye , Fagan Susan C
Published: February 2022

Hypertension and aging are leading risk factors for stroke and cognitive decline. Animal models fail to capture the complex interplay between these two pathophysiologic processes, limiting human translation of interventions. In the current study, we investigated the development of cognitive impairment in 18-month-old spontaneously hypertensive rats (SHRs) prior to and following a 30-minute tMCAO or SHAM. Sixty SHRs were kept for 18 months with cognitive assessments performed prior to and post-surgery. Baseline brain MRI was done at 18 months and then at day 3 and week 8 post-surgery. At day 3, rats were randomly assigned to blindly receive either C21 or normal drinking water for 8 weeks.

Results:
Over 18 months, SHRs demonstrated a progressive cognitive decline and significant abnormalities on MRI. Aged SHRs demonstrated an acceptably low 14% peri-operative mortality within 72 hours of tMCAO. Stroke resulted in sustained, significant sensorimotor deficits and C21 effectively enhanced sensorimotor recovery at week 8. Progressive cognitive decline continued after surgery, but C21 enhanced post-stroke, subacute associative and reference memory at week 5. There was no evidence of anhedonia at 8 weeks. MRI scans revealed no difference in ischemic lesion resolution between C21 and control. However, C21 treated rats had less cortical atrophy and reduced WM injury at 8 weeks.

Conclusions:
Aged SHRs with minor stroke demonstrated persistent sensorimotor deficits, which were significantly lessened with C21. The dramatic decline in exploration time with age was ameliorated with C21 treatment, evidence of preserved cognition.
Abstract WMP15: Temporal Trends In Medical Complications After Acute Ischemic Strokes In The United States From 2006-2017
Authors: Ahmed Rashid , Mhina Carl , Philip Karan , Albright Karen C , Latorre Julius G , Otite Fadar O
Published: February 2022

Purpose:
To evaluate age and sex-specific trends in prevalence of infectious and non-infectious complications (comps) following acute ischemic stroke (AIS) admissions in the United States (US) from 2006 to 2017.

Methods:
We identified all admissions with a primary AIS diagnosis (weighted n= 5,190,311) in the 2006-2017 National Inpatient Sample. We quantified the prevalence of infectious [pneumonia, sepsis, and urinary tract infection (UTI)] and non-infectious [acute kidney injury (AKI), acute myocardial infarction (AMI), deep venous thrombosis (DVT), pulmonary embolism (PE), gastrointestinal bleeding (GIB) hemorrhage and acute myocardial infarction (AMI)] comps in subgroups categorized by age and sex. Logistic regression models were used to evaluate trends in prevalence over time.

Results:
Across the study period, 24.3% of all AIS admissions had at least one comp but prevalence increased with age. UTI (12.2%) was the most common comp, but this was driven mainly by its high prevalence in older females (f) 60-79 y (16.0%) and F >=80 y (22.9%). AKI was the second most common comp (8.9%) in all patients, followed by pneumonia (3.3%) and AMI (2.7%). GIB (1.1%), DVT (0.9%), and PE (0.5%) were the least common. Any comp risk increased from 20.8% in 2006 to 25.9% in 2017. Risk of UTI and pneumonia declined over time (p <0.001) but this was more than counterbalanced by increased risk of noninfectious comps such as AKI, AMI, DVT, and PE (figure 1). This was most prominent for AKI where there was a >3-fold increase in risk across the study period (figure 1). After multivariable adjustment, AKI, AMI, PE, pneumonia, sepsis, and GIB were associated with increased odds of in-hospital death while UTI and DVT were inversely associated with mortality (all p-values < 0.01).

Conclusion:
Infectious comps declined, while noninfectious comps, particularly AKI, increased following AIS admissions from 2006 to 2017. Additional efforts are needed to minimize comp risk following AIS.
Abstract WMP2: Neighborhood Socioeconomic Disadvantage Drives Inequities In Thrombolytic Therapy For Patients With Acute Ischemic Stroke
Authors: Pan Alan , Potter Thomas , Bako Abdulaziz T , Meeks Jennifer , Tannous Jonika , MCCANE Charles D , Garg Tanu , GADHIA RAJAN R , Misra Vivek , Volpi John J , Chiu David , Vahidy Farhaan S
Published: February 2022

Background:
The role of neighborhood socioeconomic disadvantage as a barrier to utilization of thrombolytic therapies among acute ischemic strokes (AIS) patients is not well characterized.

Methods:
Using data from 7 comprehensive and primary stroke centers across a diverse metropolitan, we analyzed intravenous tissue plasminogen activator (tPA) and mechanical thrombectomy (MT) utilization rates among AIS patients across various levels of Area Deprivation Index (ADI). Exact patient addresses were geocoded, and state-level ADI ranks (1 - 10) were calculated. Multivariable logistic regression models were fitted to evaluate the association between high ADI and thrombolytic therapy (tPA and/or MT vs no tPA or MT). Among the treated, Last Known Well to Treatment Time (LKNW-TT) across ADI ranks was analyzed. Odds ratios (OR) and 95% confidence intervals (CI) are reported.

Results:
Between May 2016 and Apr 2021, a total of 2,900 AIS patients with complete data were included (mean age: 68.5 years, 49.9% female, 58.4% White, 12.9% Hispanic, median [IQR] ADI rank: 4 [2-7]). The overall treatment utilization rate was 35% (tPA only: 16.7%; MT with/without tPA: 18.3%). In a fully adjusted model, higher ADI was independently associated with lower likelihood of overall treatment (OR, CI: 0.93, 0.89-0.96), treatment with tPA alone (OR: 0.95, CI: 0.91-0.99) and utilization of MT (OR: 0.90, CI: 0.85-0.95) (Figure). LKNW-TT among tPA-treated patients was longer for those residing in top 50% of ADI neighborhoods (highest vs lowest 50
th
percentile ADI rank) - median [IQR] minutes: 135 [86-179] vs 122 [90-180]. No differences for MT were observed: 268 [188-544] vs 270 [199-460] minutes.

Conclusion:
Socioeconomic disadvantage may lead to lower utilization of thrombolytic therapies among AIS patients, potentially driven by delayed presentation or treatment. Targeted educational and awareness efforts are needed among disadvantaged populations to equitably improve stroke outcomes.
Abstract WMP28: The Safety And Feasibility Of Early Mobility In Acute Ischemic Stroke Patients After IV Alteplase
Authors: Rhoten Jeremy B , Pagel Julie , Strong Edwin , Karamchandani Rahul
Published: February 2022

Background and Purpose:
Acute stroke patients who receive intravenous (IV) alteplase have historically remained on bedrest for the first 24 hours after infusion completion. We sought to determine the safety and feasibility of mobilizing patients with low NIHSS between 6 and 24 hours post-alteplase infusion.

Methods:
Patients with NIHSS ≤5 after IV alteplase infusion were included. We excluded patients also undergoing mechanical thrombectomy. Subjects were stratified into an early mobilization group and a standard care group based on nursing compliance with an early mobilization protocol. Safety endpoints included falls, neurological deterioration in NIHSS (increase of ≥ 2 points), and physiological events (defined by out-of-range vital signs). Each safety endpoint was quantified for both groups. Additionally, demographic characteristics and past medical history were compared between the groups to identify any statistically significant differences (p < 0.05).

Results:
Between June 2020 and April 2021, 93 acute stroke patients received IV alteplase and had an NIHSS of ≤5 following thrombolytic therapy. Of the included subjects, 54 received early mobilization while 39 did not. There were no statistically significant differences in gender, race, or past medical history between the two groups. Among safety endpoints, there were no reported instances of falls, neurological deterioration in NIHSS, or significant physiological events in either group.

Conclusions:
Our study demonstrates that instituting early mobilization as soon as 6 hours after alteplase infusion completion is safe and feasible mild acute stroke patients. Future studies should explore efforts to increase the number of patients who receive early mobilization and investigate functional outcomes between patients receiving early mobilization compared to standard medical care.
Abstract WMP34: Early Oral Feeding Following Removal Of Feeding Tube In Stroke Patients Based On The Modified Volume-viscosity Swallow Test
Authors: Ye Ting , Zhou Huijun
Published: February 2022

Objective:
Dysphagia is common in patients with acute ischemic stroke patients (AIS). Feeding tubes are often placed to prevent aspiration pneumonia and supply nutrition when swallow function impaired are detected. However, little is known about when and how to start oral feeding in AIS. The purpose of this study is to establish a feasibility and effective intervention for early oral feeding following removal of feeding tube in patients with AIS.

Methods:
A total of 37 patients with AIS who were removed feeding tubes and start oral feeding in our hospital from 2017 to 2021 were retrospectively analyzed. An intervention program for early oral feeding, which consisted of the modified volume-viscosity swallow test (V-VST) and mechanical soft diet, was fully operationalized from October 2020 to July 2021. Outcomes were compared between an early oral feeding intervention group of 17 patients and a historical control group of 20 patients from July 2017 to September 2020. We compared the baseline characteristics between the groups. To analyze aspiration pneumonia probability, the Kaplan-Meier method were used.

Results:
The length of stay in hospital was significantly longer in the control group compared with the early oral feeding group (16.70±5.24 vs 12.88±4.46; P=0.024). Patients in the control group tolerated tube feeding longer days ( 9.45±2.93 vs 6.59±3.57; P=0.011 ). A log-rank test found no significant difference in aspiration pneumonia between the two groups ( P =0.111).

Conclusions:
Our data suggest that the intervention for early oral feeding can be used safely and possibly.
Abstract WMP35: Assessment Of Spatial Neglect In Acute Stroke Patients: Results Of A Cross-country Pilot Study To Validate A Simplified Version Of The Catherine Bergego Scale
Authors: Klinke Marianne , Hjaltason Haukur , Azouvi Philippe , Matijosaitis Vaidas
Published: February 2022

Background:
Spatial neglect (SN) is present in about 20% patients in acute stroke units. If left unidentified SN may obstruct rehabilitation. The 10-item Catherine Bergego Scale (CBS) is increasingly recommended for SN assessment and has excellent psychometric properties. However, a standardized assessment with the CBS takes around 30-40 minutes to complete, making it rather unrealistic for nurses and physicians to use in the fast pace of the stroke unit.

Objectives:
To test a revised protocol for the CBS to make its routine use feasible in acute stroke units. We will: a). Compare the time used to administer the original version of the CBS with the simplified version of the CBS (sCBS), b). evaluate the agreement between the results of the CBS and sCBS, c). establish the interrater agreement between two rates, R1+R2, when scoring the sCBS, and d). correlate the sCBS with stroke severity and disability.

Methods:
Out of 98 consecutive stroke patients from the stroke units in Kaunas and Reykjavik, 15 with right-sided SN were included within five days following stroke. A structured assessment with the CBS established the presence and severity of SN. Patients identified with SN using the original structured assessment underwent a replicated evaluation with a simplified version of the sCBS. Two raters assessed the participants with the sCBS while they were blinded to the other rater’s scores. Stroke severity was assessed with NIHSS and disability with smRS.

Results:
There was a positive correlation between the NIHSS and the severity of SN r(13) = .78, p = .001. and the smRS and SN r(13) = .72, p =.002. On average it took 42 minutes to assess patients with mild/moderate SN with the CBS versus 14 minutes with the sCBS. Patients with very severe SN took <10 minutes to assess, both with the CBS and sCBS, because many scale items were impossible to score. A total of 54 items were impossible to score across patients with the CBS. Significantly more items could be scored using the sCBS (p< .05; 39 items, r1 and 40 items, r2).

Conclusions:
In contrast to the original CBS, the sCBS is more assessment-friendly for application in bedridden acute SN patients. We expect that the shortening of the assessment time may enhance SN screening in stroke units.
Abstract WMP39: Geographic Variation In The Prevalence Of Internet Use Among Us Men And Women With Stroke: Implications For Telerehabilitation
Authors: Zhu Cenjing , Tran Phoebe , Dreyer Rachel P , Lichtman Judith H
Published: February 2022

Background:
Prior studies have identified sex, age, and geographic differences in post-stroke rehabilitation use in certain US areas. Internet use is an important prerequisite to the adoption of telerehabilitation, which has shown promise in equalizing access to follow-up care among stroke patients. We aimed to assess 30-day internet use disparities between male and female stroke patients by age and within each US state.

Methods:
We identified US adults 18y and older with a self-reported history of stroke from the Behavioral Risk Factor Surveillance System surveys, a nationally representative dataset (2015-2017). Internet users were identified as those who responded “Yes” to the question, “Have you used the internet in the past 30 days?” Prevalence of internet use was compared between sex and age groups and by state. Survey weights were applied in all analyses.

Results:
Among 55260 individuals with stroke (57.5% women), 57.8% reported using the internet in the preceding 30 days. The overall prevalence of internet use was similar between women (58.2%, 95% CI: 57.0-59.4%) and men (57.4%, 95% CI: 56.1-58.8%). Female stroke patients had higher internet use than their male counterparts until age 65+y (all p<0.0001,
Figure 1a
). Substantial differences in internet use by state were found for women and men with stroke, with stroke survivors in Louisiana reporting the greatest difference (women 51% vs. men 36%) (
Figure 1b
).

Conclusions:
Overall, less than 60% of US stroke survivors reported recent internet use, with marked variation by sex, age, and across states. Study findings may inform individual state’s actions to improve internet use among women 65+y who bear a greater stroke burden yet have lower internet use than men. Efforts to increase internet use in specific stroke patient subgroups may facilitate future telerehabilitation expansion and help to reduce sex- and age-based disparities currently present in post-stroke care.
Abstract WMP4: Tenecteplase For The Treatment Of Acute Ischemic Stroke: A Systematic Review And Meta-analysis Of Real World Evidence
Authors: Katsanos Aristeidis , Psychogios Klearchos , Turc Guillaume , Sacco Simona , Aguiar de Sousa Diana , De Marchis Gian Marco , Palaiodimou Lina , Ahmed Niaz , Sarraj Amrou , Menon Bijoy K , Tsivgoulis Georgios
Published: February 2022

Background and Purpose:
Tenecteplase is being evaluated as an alternative intravenous (IV) thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized controlled clinical trials. However, several research teams have published their real-world experience with tenecteplase for the treatment of AIS.

Methods:
We searched Medline and Scopus for non-randomized clinical trials and observational cohort studies (prospective or retrospective) comparing IV tenecteplase (at any dose) to IV alteplase for patients with AIS. We calculated the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95%CI) for the association of tenecteplase vs. alteplase use and outcomes of interest. We pooled estimates using random-effects models. The primary outcome was the probability of modified Rankin scale (mRS) score of 0-2 at 90 days. Non-inferiority of tenecteplase vs. alteplase for the primary outcome in the meta-analysis was set at margins of 1.3% and 5% based on a recent survey.

Results:
We identified 6 studies comparing IV tenecteplase (n=583) to IV alteplase (n=904). Patients receiving tenecteplase had higher odds of successful recanalization (OR=2.82, 95%CI: 1.12, 7.11; adjusted OR=2.38, 95%CI: 1.18, 4.81) and early neurological improvement (OR=4.88, 95%CI: 2.03, 11.71; adjusted OR=7.60, 95%CI: 1.97, 29.41) when compared to alteplase. Tenecteplase was non-inferior (when applying the 5% non-inferiority margin) to alteplase for the primary outcome of mRS 0-2 at 90 days (absolute risk difference=0.06, 95%CI: -0.04, 0.15; OR=1.20, 95%CI: 0.86, 1.67; adjusted OR=1.24, 95%CI: 0.88, 1.76). No difference in the risk of symptomatic intracranial hemorrhage was uncovered between the two groups (OR=0.96, 95%CI: 0.45, 2.07; adjusted OR=0.92, 95%CI: 0.47, 1.81).

Conclusion:
Real world evidence suggests that tenecteplase has a comparable efficacy and safety profile to alteplase for the treatment of AIS, while being possibly superior in achieving successful reperfusion and early neurological improvement.
Abstract WMP40: Premovement Sensorimotor Oscillations Are Associated With Motor Status In Chronic Stroke
Authors: Chalard Alexadre , Srinivasan Ramesh , Cramer Steven C
Published: February 2022

Introduction:
Oscillations in the beta frequency range within sensorimotor cortex play a key role in normal motor control. Beta band activity decreases after stroke in association with motor impairment. Changes in sensorimotor beta band electrical activity in the time period preceding movement onset have received limited study in patients with stroke, although these events are critical to genesis of movement. Here we test the hypothesis that premovement beta band sensorimotor activity is associated with level of motor impairment.

Methods:
27 subjects with stroke (age 60±14 yr, 46±57 mo post-stroke) and 23 healthy subjects (age 59±12 yr) performed a cued shoulder rotation movement during EEG (256 channels). EEG was analyzed in the window -1500ms to +500ms relative to the movement onset. Event-related desynchronization (ERD) in the beta (15 - 30 Hz) frequency range was computed in a cluster surrounding lead C1.

Results:
Subjects with stroke showed significantly decreased beta ERD amplitude in the -350 ms to -130 ms premovement time window compared to controls (gray box in Fig A, p<0.01). Fig B shows the topographic distribution of beta ERD during this time window, which is smaller in area among subjects with stroke. Beta ERD amplitude correlated with the proximal Fugl-Meyer motor score during the time window -300 ms to +100 ms relative to movement onset (Fig C), maximally correlating at 200ms before movement (r=-0.56, p < 0.01).

Conclusion:
Premovement beta ERD is reduced in amplitude and spatial distribution after stroke. This decrease in premovement beta oscillatory activity is associated with greater motor impairment. Measures of premovement electrical activity provide useful insights into motor system dysfunction after stroke and are attractive biomarker candidates given their ease of collection at the bedside.
Abstract WMP47: Differences In Readmission Post-stroke Between Mexican Americans And Non-Hispanic Whites: The Basic Project
Authors: Hill Christopher J , Kwicklis Madeline D , Shi Xu , Case Erin , Almendarez Elizabeth , Cox Melinda A , Lisabeth Lynda D , Morgenstern Lewis B
Published: February 2022

Introduction:
Mexican Americans (MAs) are less likely to receive post-stroke intensive rehabilitation, more likely to suffer from depression, and have worse functional, neurologic and cognitive outcomes compared with non-Hispanic whites (NHWs). The aim of this study was to determine if there is a difference between readmission rates post-stroke among NHWs and MAs.

Methods:
This was a population-based study of all validated strokes among MAs and NHWs in Nueces County, Texas, October 2019 - March 2021. Baseline demographic and clinical information was recorded from the chart including comorbidity index, age, sex, and NIHSS. Follow up calls were made to the patient or their proxy at 2 week intervals post-discharge up to 12 weeks. Readmission was assessed by asking the patient or proxy if the patient had been readmitted for any reason. P-values were obtained using Fisher exact tests of equivalence between NHWs vs MAs. Additionally, Poisson regression with robust standard errors was used to investigate the association between readmission and race-ethnicity adjusting for age, sex, log of NIHSS, and comorbidity index, with an offset to account for differences in length of observation.

Results:
403 patients (256 MAs and 147 NHWs) were followed. Of these, there were 65 total (16.1%) including 42 MAs (16.4%) and 23 NHWs (15.6%) who reported readmission within a 12 week follow up period. Table 1 provides the regression results. There was no ethnic difference in readmission rate. Median comorbidity index was higher for MAs when compared to NHWs (3 vs 2, p=.00345) but was not associated with readmission. Only stroke severity was associated with readmission.

Conclusion:
In our study of patients followed up after discharge post-stroke, a similar proportion of MAs reported readmission compared to NHWs. Overall, the readmission rate was high, with approximately 1 in 6 patients requiring readmission within 90 days. Renewed efforts to promote health post-stroke are needed.
Abstract WMP49: Higher Risk Of Stroke Recurrence With Increased Plasma D-dimer Levels: A Systematic Review And Meta-analysis
Authors: Rupareliya Chintan , Gowda Supreeth N , Jnaneswaran Geethu , Raju Athul Raj , Cartagena-Santana Juliana , Valdez Confesora , Buhl Leon Maria Cristina , Spasova Violeta , Galan Mirian , Singh Sandeep , Desai Rupak
Published: February 2022

Background:
D-dimer has been evaluated as an independent marker of ischemic stroke. The non-existence of a clear consensus and pooled data about the use of D-dimer as a predictive biomarker for assessing the risk of stroke recurrence led us to perform this systematic review and meta-analysis.

Methods:
Studies reporting the risk of stroke recurrence with varying degrees of high D-dimer levels were screened through August 2021 using PubMed/Medline, Scopus, EMBASE and Web of Science databases and relevant keywords. Random effects models by Dersimonian & Laird were used for meta-analysis and subgroup analysis. I
2
statistics were used for heterogeneity assessment. The leave-one-out method was used for sensitivity analysis.

Results:
This systematic review included 5040 patients from 9 studies consisting of >60% males. There was a high burden of cardiovascular comorbidities, smoking and diabetes in stroke patients with or without associated diagnoses and high D-dimer levels. Compared to low D-dimer levels, higher plasma D-dimer levels were associated with ~80% (aOR 1.79, 95% CI: 1.24-2.59) increased risk of stroke recurrence. The odds of stroke recurrence were significantly high in the stroke cohorts including patients with mean age <70 years (OR 2.44, 95%CI:1.00-5.94, p<0.05) with high D-dimer levels
(Fig. 1)
. In addition, elevated D-dimer levels showed a robust association for stroke recurrence in studies with higher sample size (n>500 vs. n<500: OR 2.48, 95%CI:1.18-5.19, p<0.05) and studies reporting late recurrence (vs. early recurrence: ≥1 month vs <1 month: OR 2.07, 95%CI:1.23-2.55, p<0.01).

Conclusion:
This meta-analysis showed that high D-dimer levels were associated with nearly 80% higher odds of stroke recurrence irrespective of the etiology of index stroke events. Stronger associations were seen in studies with a mean age <70 years and a higher sample size. Late-onset recurrence had a stronger association with high D-dimer levels compared to early-onset.
Abstract WMP51: Outcome Prediction In Late-Window Endovascular Treatment - Application Of MR PREDICTS To Patients Treated Beyond 6 Hours
Authors: Marko Martha , Venema Esmee , Menon Bijoy K , Mulder Maxim , Dippel Diederik W , Lingsma Hester , Roozenbeek Bob , Demchuk Andrew M , Hill Michael D , Goyal Mayank , Almekhlafi Mohammed
Published: February 2022

Introduction:
Outcome prediction tools for large vessel occlusion (LVO) stroke patients receiving endovascular treatment (EVT) focus on patients treated within 6h from onset. We aimed to apply a validated tool to EVT-treated patients in the late window (beyond 6h from onset) and to investigate any outcome differences according to the imaging paradigm used for selection.

Methods:
MR PREDICTS is a prediction tool of the effect and benefit of EVT on functional outcome based on MR CLEAN and HERMES data sets. We applied the algorithm to patients treated with late-window EVT from three multicenter international trials (ESCAPE, ESCAPE-NA1, and ProVe-IT). We assessed the model performance by calculating its discrimination and calibration for the overall patient sample and for the subset of patients who underwent CTP.

Results:
We included 152 patients: 93 (61.2%) from the control arm of ESCAPE-NA1, 35 (23.0%) from ProVe-IT, and 24 (15.8%) from ESCAPE. Median age was 68.0 years (IQR: 58.0 - 77.2), median baseline NIHSS was 16 (IQR: 12 - 20) and 72.4% had M1-occlusions. Median time from onset to groin puncture was 592min (IQR: 496 - 666). Good functional outcome (mRS 0-2) at 3 months was achieved in 72/152 patients (47.4%). The averaged predicted probability of mRS 0-2 was 47.6%. In the CTP-subgroup 44/94 patients (46.8%) achieved mRS 0-2, the averaged predicted probability of mRS 0-2 was 46.5%. Evaluation of model performance resulted in a reasonable discriminative ability (Harrel’s c-statistic: overall 0.75, 95%CI 0.67 - 0.82, CTP-subgroup: 0.73, 95%CI 0.62 - 0.82, figure 1).

Conclusions:
The outcome-prediction model performed reasonably well when applied to EVT patients in the late time window. Our data supports the use of available prediction tools in patients treated beyond 6h of symptom onset until specific models are developed for late-window patients.
Abstract WMP53: Venous Thromboembolism Among Medicare Beneficiaries Hospitalized With Acute Ischemic Stroke With And Without History Of Covid-19
Authors: Tong Xin , Yang Quanhe , Merritt Robert K
Published: February 2022

Introduction:
Venous thromboembolism (VTE) is a common medical complication following acute ischemic stroke (AIS). Studies have suggested that VTE rates were higher among patients with a history of COVID-19. We examined the risk of VTE in AIS patients with and without a history of COVID-19 among Medicare beneficiaries.

Methods:
We identified Medicare fee-for-service (FFS) beneficiaries aged ≥65 years with AIS hospitalizations from 04/01/2020 to 06/30/2021. COVID-19 cases were identified by the first diagnosis of COVID-19 on a claim at any health care setting. We defined AIS with COVID-19 if the dates of COVID-19 diagnoses were earlier than AIS admission dates. To identify VTE for each AIS admission, we used the following secondary diagnoses codes: ICD-CM-10: I80, I81, I82, I26. We compared the prevalence ratio (PR) of VTE between AIS patients with and without a history of COVID-19.

Results:
Among 178,830 Medicare FFS beneficiaries with AIS admissions, 6.1% had a history of COVID-19 and 2.6% had VTE as a complication. VTE prevalence among AIS patients with a history of COVID-19 was 3.98% (95% confidence interval (CI), 3.62-4.36%) and 2.53% (95% CI, 2.46-2.61%) among patients without a history of COVID-19. The adjusted PR of VTE was 1.55 (95% CI, 1.40-1.70, p<0.001) comparing AIS admissions with a history of COVID-19 and those without a history of COVID-19. Non-Hispanic Black patients had the highest VTE prevalence, 6.14% among those with a history of COVID-19 and 3.89% among those without a history of Covid-19, as compared to other race/ethnicity groups. Both Non-Hispanic White and non-Hispanic Black patients with a history of COVID-19 had >50% increased risk of VTE than those without a history of COVID-19 (Adjusted PR, 1.59, 95% CI, 1.42-1.78 for Non-Hispanic White, 1.58, 95% CI, 1.28-1.94 for Non-Hispanic Black, p<0.001).

Conclusion:
AIS patients with a history of COVID-19 had an increased risk of VTE compared with patients without COVID-19. Healthcare professionals should be aware of the increased risks of VTE among AIS patients with COVID-19 and implement protocols for early VTE prevention.
Abstract WMP60: Characteristics Of Us-born Versus Foreign-born Stroke Survivors
Authors: Vargas Alejandro , Ovbiagele Bruce , Markovic Daniela , Towfighi Amytis
Published: February 2022

Introduction:
Black US residents face a disproportionate burden of both ischemic and recurrent stroke. There is a paucity of information about the impact of nativity on stroke prevalence among Black individuals in the US. The objective of this study was to evaluate prevalence of and factors associated with stroke among US Black individuals by region of birth.

Methods:
Using the 2000-2018 National Health Interview Survey (NHIS), we identified individuals who identified as Black, aged 25-74 years. Stroke was determined by self-report. Respondents were stratified by age (25-55 or 56-74 years) and location of birth (US-born vs foreign-born [Caribbean, South and Central America (CSCA), or Africa]). Using logistic regression models, we assessed factors associated with stroke prevalence, adjusting for sociodemographic (sex, education, income) and medical characteristics (smoking, BMI), stratified by region of origin.

Results:
Among 64,717 respondents (weighted n= 12,983,173), 88.3% were US-born, 8.0% were from CSCA, and 3.7% were from Africa. Prevalence of stroke was 3.8% among US-born, 1.4% among CSCA, and 0.7% among those of African origin. In unadjusted logistic regression models foreign-born Black individuals were less likely to have had a stroke compared to those who were US-born (OR 0.37, 95% CI 0.28-0.48 for CSCA-born and OR 0.18, 0.11-0.30 for African-born). These findings remained significant after adjusting for covariates (adjusted OR 0.44, 0.34-0.57 for CSCA, OR 0.39, 0.23-0.63 for Africa). After adjusting for covariates, among 25-55 year old individuals, the odds of stroke were lowest for those who had recently immigrated (OR stroke for foreign born vs. US born Black individuals in US < 5 years: OR 0.21, 0.05-0.83; 5-14 years: OR 0.24, 0.10-0.60; ≥ 15 years: OR 0.41, 0.25-0.68). A similar pattern was seen for those over 55 years (< 5 years: OR 0.18, 0.04-0.76; 5-14 years: OR 0.31, 0.12-0.78; ≥ 15 years: OR 0.56, 0.42-0.74).

Discussion:
Foreign-born Black individuals have lower prevalence of stroke than US born Blacks individuals. Homogenizing racial and ethnic groups without including differential characteristics may mask key epidemiologic trends and limit public health efforts and targeted interventions.
Abstract WMP70: A Novel Hyperspectral Imaging System For Intraoperative Prediction Of Cerebral Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Anastomosis In Patients With Moyamoya Disease
Authors: Iwaki Katsuma , Arimura Koichi , Murata Masaharu , Nishimura Ataru , Okuda Tomohiro , Koyanagi Yuya , Yoshimoto Koji
Published: February 2022

Background:
Postoperative cerebral hyperperfusion syndrome (CHS) may occur after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for moyamoya disease (MMD). Predicting postoperative CHS is challenging; however, we previously presented the feasibility of using a hyperspectral camera (HSC) for monitoring intraoperative changes in brain surface hemodynamics during STA-MCA bypass.

Objective:
To investigate the utility of HSC to predict postoperative CHS during STA-MCA bypass for patients with MMD.

Methods:
Hyperspectral images of the cerebral cortex of twenty nine patients with MMD who underwent STA-MCA bypass were acquired by an HSC before and after anastomosis. We then analyzed the changes in oxygen saturation after anastomosis and assessed its correlation with CHS.

Results:
Five patients experienced transient neurological deterioration several days after surgery.
123
I-N-isopropyl-iodoamphetamine single-photon emission computed tomography scan results revealed an intense, focal increase in cerebral blood flow (CBF) at the site of anastomosis without any cerebral infarction. Patients with CHS showed significantly increased oxygen saturation (SO
2
) in the cerebral cortex after anastomosis relative to those without CHS (33 ± 28% vs. 8 ± 14%, P<.0001). Receiver operating characteristic analysis results show that postoperative CHS likely occurs when the increase rate of cortical SO
2
value is more than 15% (sensitivity, 85.0%; specificity, 81.3%; area under curve, 0.871).

Conclusions:
This study indicates that hyperspectral imaging of the cerebral cortex may be used to predict postoperative CHS in patients with MMD undergoing STA-MCA bypass.
Abstract WMP86: 24-hours Nihss As A Predictor Of 90-day Outcome In The Stratis Registry
Authors: Castonguay Alicia C , Zoghi Zeinab , Zaidi Syed F , Mueller-Kronast Nils , Zaidat Osama , Jumaa Mouhammad A
Published: February 2022

Background:
Previous studies have suggested that 24-hour NIHSS may serve as a surrogate marker for functional outcomes in acute ischemic stroke patients. Here, we examine if 24-hour NIHSS is a predictor of 90-day mRS in the prospective Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke (STRATIS) Registry.

Methods:
Data from the STRATIS Registry, a multicenter, non-randomized, observational study of AIS LVO patients treated with the Solitaire stent-retriever as the first-choice therapy within 8 hours from symptoms onset, were analyzed. Patients with premorbid mRS>2, posterior circulation stroke, missing 24 NIHSS or 90-day mRS were excluded from the analysis. The ability of 24-hour NIHSS (continuous and thresholds ≤6 and ≤8) to predict 90-day mRS using logistic regression was examined. The models were adjusted for age, baseline NIHSS, hypertension, diabetes, atrial fibrillation, IV-tPA use, time to recanalization, and revascularization status.

Results:
Of the 938 STRATIS patients, 662 with 24-hour NIHSS and 90-day mRS were included. A model trained with the continuous 24-hours NIHSS had higher predictive power (sensitivity 0.89, specificity 0.76, AUC 0.89±0.013, P<0.001) than the models trained with thresholds ≤6 and ≤8.

Conclusion:
When adjusted for covariates, 24-hour NIHSS as a continuous variable was the strongest predictor of dichotomous mRS outcomes in STRATIS patients. Twenty-four hour NIHSS ≤6 and ≤8 present the second and the third best results, respectively.
Abstract WMP93: Somatosensory Evoked Potentials Monitoring In Acute Ischemic Stroke (Promise) Study: A Biomarker Of Functional Recovery Prior To Mechanical Thrombectomy (clinicaltrials.gov: NCT04099615)
Authors: Martinez Alicia , Lucente Giuseppe , Arbex Andrea , Ramos Alba , Almendrote Miriam , Millan Monica , Perez de la Ossa Natalia , Gomis Meritxell , Dorado Laura , Hernandez-Perez Maria , Castano Carlos , Remollo Friedemann Sebastian , Garrido Alicia , Guanyabens Nicolau , Lopez-Cancio Elena , Coll Jaume , Davalos Antonio
Published: February 2022

Hypothesis:
Somatosensory evoked potentials (SEPs), as surrogate of cerebral blood flow, may give substantial additional predictive value to that provided by clinical and imaging factors and optimize the selection of patients benefiting from mechanical thrombectomy (MT)

Methods:
Bilateral median nerve SEPs were recorded before and continuously during MT in consecutive patients with AIS and anterior LVO. N20 response ipsilateral to the ischemic hemisphere was measured. The adjusted predictive value of the N20 on functional Independence (modified Rankin Scale score ≤2) after MT was analyzed by binary logistic regression and its predictive value on the full range of disability by ordinal logistic regression. We constructed different regression models with other clinical and imaging predictors at the pre- and in- hospital setting to determine the independent predictive power of N20 for a potential treatment decision-making

Results:
A total of 223 patients were recruited. A blinded reading of SEPs recordings identified presence of N20 in 110 (49.3%), absence in 58 (26%) and not assessable in 55 patients due to radiofrequency interferences. Prior to MT, N20 had positive predictive value (PPV) of 93% (95%CI, 0.8 to 0.98) and increased 10 fold the likelihood of good functional outcome at 7 days (adjusted OR, 9.9; 95%CI, 3.1-44.6). Receiver operating curves showed that N20 had a higher capacity to predict good functional outcome (AUC 0.82) than models constructed with pre-hospital (age, sex, serum glucose, median blood pressure, NIHSS; AUC 0.75) or in-hospital (NIHSS, ASPECTS; AUC 0.72) factors. During MT, N20 had PPV of 100% (95% CI, 0.85-1) and was the unique independent factor associated with functional independence (adjusted OR, 2.74; 95%CI, 1.90-4.29). Perfusion CT or MR was available in a subgroup of 116 patients. Baseline N20 showed a higher capacity to predict good functional outcome (n=168, AUC 0.71) compared with ischemic core (n=127, AUC 0.66), ischemic penumbra (Tmax>6) (n=116, AUC 0.54) and collateral status (n=191, AUC 0.61)

Conclusions:
SEPs monitoring is a fast and bedside technique that could complement current clinical factors in terms of increasing the eligibility of AIS patients for MT and improving prognosis.
Abstract WMP97: Differences Between Atrial Fibrillation Detected Before And After Stroke And Tia: A Systematic Review & Meta-analysis
Authors: Fridman Sebastián , Jimenez Ruiz Amado , Vargas-Gonzalez Juan Camilo C , Sposato Luciano A
Published: February 2022

Background and Purpose:
Recent evidence suggests that patients with atrial fibrillation (AF) detected after stroke (
AFDAS
) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke (
KAF
). We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF.

Methods:
We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until 30-June-2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death.

Results:
We included 21 studies comprising 22,566 patients with ischemic stroke or transient ischemic attack. Patients with AFDAS had a lower CHA2DS2-VASc score (standardized mean difference [
SMD
] -0.47, 95% confidence interval [
95% CI
] -0.60, -0.34), and lower prevalence of vascular comorbidities including coronary artery disease (odds ratio [
OR
] 0.50, 95%CI 0.42, 0.61), congestive heart failure (OR 0.37, 95% CI 0.31, 0.44), peripheral artery disease (OR 0.44, 95%CI 0.29, 0.68), and previous stroke (RD 0.38, 95% CI 0.25, 0.58). Patients with AFDAS had a higher left ventricular ejection fraction (SMD 0.25, 95% CI 0.20, 0.30) and smaller mean atrial diameter (SMD -0.65, 95% CI -0.99, -0.31) than those with KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types.

Conclusions:
We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum.