bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP128: Determinants of Hemorrhagic Transformation After Emergent Extracranial Internal Carotid Artery Stenting for Tandem Occlusions
Authors: Rodriguez-Villatoro Noelia , Ribo Marc , Tomasello Alejandro , Muchada Marian , Pagola Jorge , Boned Sandra , Juega Jesús , García-Tornel Álvaro , Requena Manuel , Deck Matías , Pancorbo Olalla , Piñana Carlos , Hernandez David , Rubiera Marta , Coscojuela Pilar , Molina Carlos , Rodriguez-Luna David
Published: June 2021

Background and Purpose:
Extracranial internal carotid artery (ICA) lesion in the setting of tandem occlusions is a therapeutic challenge, and hemorrhagic transformation (HT) is one of the leading causes of poor clinical outcome. We aimed to determine determinants of HT for tandem occlusions undergoing emergent extracranial ICA stenting during endovascular treatment (EVT).

Methods:
We performed a prospective, observational cohort study of consecutive patients with non-cardioembolic ischemic stroke due to tandem occlusion who underwent EVT with extracranial ICA stent placement during the procedure from April 2013 to June 2019 in a single stroke center. We compared clinical (vascular risk factors, previous antiplatelet treatment, and IV rtPA), radiological (ASPECTS at admission and in-stent thrombosis at 24 hours) and serological (platelet count, fibrinogen, total cholesterol, HDL-cholesterol, and LDL-cholesterol) parameters according to the presence of HT in 24 hours CT-scan.

Results:
One-hundred and eight patients were included: 78.7% were men, mean age 68.5±14.3 years, median time from symptoms onset to treatment was 220 (150-337.5) minutes, median ASPECTS at admission was 9 (8-10). Eighty-six (79.6%) patients presented an extracranial ICA occlusion, and 22 (20.4%) a high-grade (>50%) stenosis. In 88 (81.5%) patients the etiology of extracranial ICA lesion was ateroma, and in 20 (18.5%) was a dissection. Intravenous rtPA was administered in 47 (43.5%) patients. Successful recanalization (mTICI ≥2b) was achieved in 83 (76.9%) patients, and extracranial ICA recanalization in 108 (100%) patients. Type 2 diabetes (OR 1.5, 95% CI 1.1-3.5), higher fibrinogen levels (OR 4.6, 95% CI 1.6-12.9), and ASPECTS <7 at admission (OR 2.1, 95% IC 1.1-5.1) were found as independent predictors of HT in multiple logistic regression analysis.

Conclusions:
Patients with a non-cardioembolic ischemic stroke due to tandem occlusion who present type 2 diabetes, higher fibrinogen levels, or ASPECTS <7 at admission are at high risk of HT. In these particular cases, it might be useful to stent with a stent that does not need double antiplatelet treatment immediately after the procedure.
Abstract TP129: Intraoperative Prediction of Cerebral Hyperperfusion Syndrome After STA-MCA Bypass Surgery by a Newly Developed Hyperspectral Imaging System
Authors: Iwaki Katsuma , Arimura Koichi , Takagishi Sou , Iihara Koji
Published: June 2021

Background:
Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is the important treatment of moyamoya disease and other cerebral ischemic situations. However, cerebral hyperperfusion syndrome (HPS) may occur after vascular reconstructive surgery including STA-MCA bypass.
123
I-IMP-SPECT is useful to diagnose HPS after surgery, but there is no intraoperative device to predict HPS. Using intraoperative hyperspectral imaging data captured by hyperspectral camera (HSC), we can get the oxygen saturation value (SO2) of brain surface during surgery. We may predict HPS by analyzing intraoperative cerebral cortex SO2.

Objective:
To investigate whether the data from HSC during surgery is useful for prediction of postoperative HPS.

Methods:
10 consecutive patients performed STA-MCA bypass were collected hyperspectral images of cerebral cortex by HSC before and after bypass. We got the SO2 data and analyzed the rate of change and correlation with HPS.

Results:
3 patients presented temporary neurological deterioration several days after surgery and
123
I-IMP SPECT revealed focal intense increase in CBF at the sites of anastomosis. In these HPS patients, the rate of change of SO2 of cerebral cortex before and after bypass significantly increased in comparison with the patients didn’t present HPS (1.524 vs 1.089, P=0.0017). The receiver operating characteristic curve reveals if the rate of change of SO2 is more than 1.17, postoperative HPS is likely to occur (sensitivity=83%, AUC=0.81).

Conclusions:
Using the HSC, we may predict the occurrence of HPS after STA-MCA bypass. HSC can be the useful device in postoperative treatment for prevention of HPS.
Abstract TP130: The Clinical Value of Magnetic Resonance Vessel Wall Maging in Patients With Central Nervous System Vasculitis
Authors: Guo Yu , Xiao Jiayu , Fan Zhaoyang , Xia Shuang
Published: June 2021

Background and Purpose:
Prompt and accurate diagnosis of central nervous system (CNS) vasculitis is essential for treatment decision making and prevention of irreversible brain damage. However, diagnosis is often challenging even with digital subtraction angiography and biopsy. The purpose of this study was to investigate the value of magnetic resonance vessel wall imaging (MR-VWI) in diagnosis and management of CNS vasculitis.

Methods:
We retrospectively reviewed 13 patients with clinically defined CNS vasculitis who underwent intracranial MR-VWI. Two patients had imaging follow-up after treatment. The imaging protocol included conventional T1/T2 brain MR, diffusion-weighted imaging, MRA, and pre- and post-contrast T1-weighted whole-brain MR-VWI. An experienced neuroradiologist reviewed MR-VWI images to characterize vessel wall characteristics (lumen narrowing, pattern of wall thickening, and grade of contrast enhancement) at major intracranial arterial segments. Additionally, the changes in the brain parenchyma and meninges were evaluated.

Results:
Of these 13 patients (6 men, age 28-70 years), 4 had acute infarction. Six patients had intracranial artery stenosis on MRA, but 11 patients showed vessel wall abnormality on MR-VWI. Eleven patients showed multiple, smooth, wall thickening and pronounced contrast enhancement, which were concentric in 9 and eccentric in 2. Two of these 11 patients had follow-up imaging after treatment; imaging findings remained stable in one and the degree of wall thickening and enhancement reduced in the other. In 2 of 13 patients, meningeal enhancement was observed in the absence of vascular wall thickening.

Conclusions:
MR-VWI depicts CNS vasculitis with characteristic multiple, smooth, vessel wall thickening and contrast enhancement, with most of cases being of concentric pattern. These features may provide useful information for early and accurate diagnosis as well as for tracking treatment response.
Abstract TP137: Characteristics of Perfusion Profiles in Patients With Chronic Internal Carotid Artery Occlusion
Authors: Chang Jill Ting-Yu , Christensen Soren , Mlynash Michael , Marks Michael P , Heit Jeremy J , Kemp Stephanie , Albers Gregory W , Lansberg Maarten G
Published: June 2021

Introduction:
Internal carotid artery (ICA) occlusion may cause an acute stroke or may remain asymptomatic for years. Differences in the perfusion characteristics between patients with acute symptomatic ICA occlusions and those with chronic ICA occlusions have not been defined. The aim of this study is to identify the characteristics of the relatively “benign” perfusion pattern associated with chronic asymptomatic ICA occlusions and to determine if this pattern can be differentiated from the pattern observed in acutely symptomatic cases.

Methods:
We included 31 chronic ICA patients who had no history of a cerebral ischemic event for at least 1 year at the time of imaging and 20 patients with acute ischemic stroke caused by ICA occlusions from DEFUSE 2. All patients underwent MRI with perfusion. Perfusion parameters, including Tmax lesion volumes, hypoperfusion index (Tmax10/Tmax6), and CBV index (rCBV in Tmax6) were calculated by RAPID software. The status of the CBV, CBF, and MTT in the ischemic hemisphere was also rated by visual inspection on a 3-point scale (unchanged, reduced or increased). Differences were assessed by Mann-Whitney and Fisher’s exact tests.

Results:
The average age was 65.0±9.9 years in chronic vs. 64.7±14.2 years in acute ICA occlusion group (
p
=0.90). Most of the chronic ICA patients had no territory with Tmax>10s (29/31) or Tmax>8s (24/31) in the ischemic hemisphere. The average Tmax lesion volumes were lower in the chronic ICA group (Tmax>6 of 14 ml and Tmax>4 of 81 ml) than in the acute ICA occlusion group (Tmax>6 of 131 ml and Tmax>4 of 220 ml,
p
<0.0001 for both, Figure). CBV was unchanged in all chronic occlusion cases. In the acute occlusion group, there were 12 out of 20 cases (60%) with decreased CBV (
p
<0.0001). CBF was decreased in 1 (3%) patient with a chronic occlusion and 17 cases (85%) with acute occlusions (
p
<0.0001). MTT prolonged in 7 cases (22%) with chronic occlusions vs. all cases (100%) with acute occlusions (
p
<0.0001).

Conclusions:
Several features on perfusion MRI distinguish chronic ICA occlusions from acute occlusions. Patients with chronic ICA occlusions tend to have none or a minimal volume of tissue with Tmax>8s or >10s delay, smaller volumes of tissue with Tmax>4s and >6s delay, and normal appearing CBV and CBF maps.
Abstract TP142: Inpatient Mortality Rates in Endovascular Stenting and Angioplasty of Intracranial Vertebral and Basilar Arteries
Authors: Amireh Abdallah , Kuybu Okkes , Chernyshev Oleg , Kelley Roger E , Javalkar Vijayakumar
Published: June 2021

Objective:
To compare inpatient mortality rates in patients who underwent intracranial endovascular stenting and/or angioplasty of the vertebral artery or basilar artery by analyzing data from the National inpatient sample database (2012-2015).

Methods:
We extracted data utilizing ICD-9 diagnosis codes for occlusion and stenosis of vertebral artery with or without stroke (433.20, 433.21) and occlusion and stenosis of basilar artery with or without stroke (433.00, 433.01). The cohort included total of 201 patients. Binary logistic regression and Chi-square tests were utilized for data analysis.

Results:
A total number of 201 patients underwent either intracranial angioplasty alone or stenting with or without angioplasty for either vertebral or basilar artery stenosis. Male patients were predominant (74%). The majority were 51 to 75 years of age (76.1%). 55% of the patients had stenosis of the basilar artery, 45% had vertebral artery stenosis. The majority of patients underwent stenting with or without angioplasty (69%); 47% had basilar stenting and 53% had vertebral stenting. The common co-morbidities observed were hypertension (84%), diabetes mellitus (37%), peripheral vascular disease (20%) and obesity (14%). The overall mortality rate in this cohort was 17.4%. The mortality rate was significantly higher in patients with basilar artery stenosis when compared with vertebral artery stenosis regardless of type of procedure performed (24% vs 9%, P = 0.004). The mortality during hospitalization was not significantly affected by the type of procedure (angioplasty vs stenting with or without angioplasty), or by the aforementioned comorbidities. The significant predictor of mortality was basilar artery stenosis (OR 2.87, 95% CI 1.18-6.98, P =0.02).

Conclusion:
The overall mortality in this cohort of patients who underwent angioplasty vs stenting with or without angioplasty for basilar or vertebral intracranial artery stenosis was 17.4%. Mortality rate was significantly higher in patients with basilar artery stenosis (24%) compared to those with vertebral artery stenosis (9%). The type of procedure performed (angioplasty vs stenting with or without angioplasty) had no significant statistical impact.
Abstract TP148: A Simplified Novel Stroke Prognostication Scale for Patients Receiving Mechanical Thrombectomy
Authors: Lanzotti Nicholas , Jahangir Nauman , Gollon Kyle , Farooqi Mehwish , Buhnerkempe Michael , Siddiqui Fazeel M , Elias Augusto
Published: June 2021

Introduction:
Various stroke scales exist to predict outcomes after acute ischemic stroke (AIS). We propose a simplified novel scale based on individual variables previously used in other scales to predict outcome after AIS.

Methods:
166 consecutive patients presented with AIS between 2015 and 2018 who received mechanical thrombectomy. We collected the following variables: age, sex, NIHSS, HTN, diabetes, atrial fibrillation, stroke subtype, CHF, cancer, renal dialysis, preadmission disability, systolic blood pressure, 3-item stroke severity scale, last known well (LKW) to tPA administration, LKW to ED arrival, use of thrombolytic therapy, presence of visual field defect, level of consciousness, and visible hypodensity on CT (none, <1/3 MCA territory, or ≥1/3 MCA territory). All other missing data was addressed using multiple imputation. Logistic regression analysis was performed to find their association with poor prognosis (mRS 2 or greater). Because we desired a relatively simple model for clinical use, we fit models using the least absolute shrinkage and selection operator (LASSO) to both select important predictors and prevent overfitting.

Results:
The LASSO selected sex, age, 3-item stroke severity, and visible hypodensity on a CT to be in the predictive model. Females, older individuals, more severe strokes, and patients with a visible hypodensity covering ≥1/3 of the MCA territory were found to be associated with increased risk of a 90 day MRS of 2 or greater. This model had reasonable discriminative ability in line with many of the other stroke scores studied (internally validated AUC = 0.69, 95% CI [0.55, 0.72]). A risk threshold of 0.78 maximized the sum of specificity (0.90) and sensitivity (0.52). This model was further discretized into an easy to use risk score (Table 1).

Conclusion:
We propose a simplified novel stroke prognostication scale with high specificity in predicting poor prognosis in stroke patients receiving mechanical thrombectomy.
Abstract TP152: Sensory Function Improvement is Related to White Matter Changes During Rehabilitation
Authors: Sadeghikhah Soha , Skelly Margaret , McCabe Jessica , Salameh Ahlam , Pundik Svetlana
Published: June 2021

Objective:
Structural changes related to recovery of sensory function are not well understood. Previously, we demonstrated a relationship between improved sensory function and increased cortical thickness in ipsilesional occipitoparietal and contralesional temporoparietal areas following rehabilitation of patients with chronic stroke(Pundik et al, 2018). The objective of the current work was to evaluate changes in white matter (WM) tracts originating in these cortical regions where thickness changes were related to enhanced sensory function after rehabilitation in chronic stroke.

Methods:
Chronic stroke survivors (n=18) received 12 weeks of upper limb sensory-motor rehabilitation. Outcome measures were sensory acuity (monofilament test, a sum over 9 locations on the hand; best score 25.47) and DTI measures of diffusivity [mean (MD), radial (RD), axial (AD)] and fractional anisotropy (FA). DTI analysis included: probabilistic tractography from seeds where cortical thickness changes correlated with sensory recovery, creation of a group-based tract by combining individual tracts, tract-based analysis using Spearman correlation, significance at p<0.05 with Bonferroni correction, and voxel-based analysis permutation inference for general linear modeling.

Results:
Subjects were 53.9±12.1 years old, 1.9±1.2 years after stroke and 27.8% female. Monofilament score improved from 46.6±13.1 to 43.9±12.9. Improved sensory acuity correlated with increased AD (rho=0.69, p=0.002), RD (rho=0.59, p=0.0093) and MD (rho=0.63, p=0.005) in the tract originating in the ipsilesional occipital pole. Voxel-based analysis between changes in MD and in monofilament identified a statistically significant cluster (family-wise error corrected p=0.03) within a subcortical region of the tract originating in the ipsilesional occipital pole.

Conclusion:
Improved sensory acuity after rehabilitation was related to DTI-measured microstructural changes in WM tracts. These findings further support the notion of structural plasticity associated with sensory function improvement during rehabilitation in chronic stroke.
Abstract TP159: Unilateral Spatial Neglect as an Independent Prognostic Factor for Poor Fim Efficiency in Patients With Mild to Moderate Ischemic Stroke
Authors: Shimomura Ryo , Himeno Takahiro , Terasawa Yuka , Sato Kota , Nakamichi Atsuhito , Nishigaki Masakazu , Itaya Takahiro , Kohriyama Tatsuo
Published: June 2021

Background and Purpose:
Unilateral spatial neglect (USN) is often observed in ischemic stroke patients suffered their right parietal lobe. USN is an obstacle to undergo rehabilitation smoothly, then might influence the recovery of activities of daily living (ADL) after stroke. We aimed to clarify the association between the presence of USN after ischemic stroke and the ADL improvement.

Methods:
Consecutive patients with first-ever ischemic stroke and left limb paralysis who admitted to within 7 days from onset during February 2011 and March 2019 were included. Patients met the following criteria were excluded: mRS ≥3 before onset, NIHSS >15 on admission, without left limb paralysis, and missing NIHSS or functional independence measure (FIM) score on admission. Multiple regression analysis was performed to investigate the association between FIM efficiency score of acute phase and following factors: age, sex, acute reperfusion therapy (using an intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy), FIM score on admission, and other clinical characteristics. All data were collected retrospectively using our electrical health record.

Results:
721 ischemic stroke patients with left limb paralysis (320 women, median age 76) were included. Median FIM efficiency score was significantly lower in patients with USN than without USN (n=240, 481; 0.83 vs 1.63, respectively). Multiple regression analysis showed that USN, age, and acute reperfusion therapy were significant prognostic factors of FIM efficiency (coefficient and 95% confidence interval [CI]: -0.135 [-0.771 to -0.153], -0.106 [-0.022 to -0.002], and 0.224 [0.136 to 0.305], respectively).

Conclusions:
USN significantly influence the recovery of ADL after ischemic stroke. Clinicians should adequately evaluate USN after stroke and undergo USN-specific rehabilitation for them to optimize the effect of post-stroke rehabilitation. USN-specific rehabilitation might lead to better FIM efficiency.
Abstract TP163: Electrode Montage and Dose of Non-Invasive Stimulation - Considerations for Stroke Recovery Studies
Authors: Schlaug Gottfried , Shinde Anant
Published: June 2021

Transcranial direct current stimulation (tDCS) is increasingly being used as a possible tool to enhance plasticity in brain regions that might undergo remodeling after a stroke. Our aim was to determine whether dose and montage of tDCS leads to differential changes in regional cerebral blood flow (rCBF) and differential effect on a finger sequence motor learning experiment.

Methods:
A total of 20 right-handed healthy subjects participated in 6 imaging and 6 motor learning sessions. Brain images of non-invasive blood flow (using arterial spin labelling) were obtained before (6min), during (10min), as well as after (8min) tDCS was applied within the MRI scanner. For the motor sequence learning experiment as well as for the imaging studies, we used three different dose levels (Sham, 2mA, and 4mA) and two different electrode montages (unihemispheric or bihemispheric). In both montages, the anodal electrode (excitability increasing) was placed over the right motor region (C4) while the cathodal electrode (excitability decreasing) was placed either over a left supraorbital region (unihemispheric montage) or over the left motor region (C3; bihemispheric montage). Imaging data were processed and analyzed using SPM12. For the finger sequence learning task, subjects were asked to type a randomly chosen sequence of 7 items (using numbers 2-5 on a computer keyboard) with digits 2-5 of each hand several times before and immediately after a 10 min stimulation period.

Results:
After unihemispheric and bihemispheric stimulation, left hand showed more improvement in finger sequence learning than right hand, although a linear trend as a function of dose was observed in both montage conditions. rCBF increased during the Stimulation condition and showed a clear linear effect of dose in the peri-rolandic region. Bihemispheric stimulation showed similar, but stronger effects and revealed additional activation of frontomesial regions in the 4mA condition.

Conclusion:
tDCS dose has an effect on regional surrogate markers of neuronal/synaptic. Effects in a finger sequence learning showed a similar dose effect. Montage (unihemispheric versus bihemispheric) shows differential brain effects, but based on our preliminary analysis no clear behavioral effects.
Abstract TP17: Outcomes in Octogenarians Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Single Center Experience
Authors: Aboul Nour Hassan , Khadem Alsrouji Owais , Dharaiya Devashi , Mohamed Ghada , Chebl Alex , Kole Max , Marin Horia
Published: June 2021

Background:
Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in the elderly presents a unique set of challenges and opportunities. Most existing studies include patients up to the age of 90 with stricter criteria of inclusion for patients ≥ 80 years of age. The following study compares the outcomes in octogenarians compared to younger patients in a single center.

Methods:
We conducted a retrospective chart review of patients who were ≥ 80yo who underwent MT from March 2016 to July 2019. Data on age, recanalization score measured by Thrombolysis in Cerebral Infarction (TICI) score and clinical outcomes were compared to 126 patients < 80 years of age treated during the same time period. Clinical outcomes were classified based on modified Rankin score (mRS) at discharge. Poor outcomes were defined as mRS 4-6. Good recanalization was defined as TICI score 2b or 3.

Results:
Eighty-three patients with a median age of 86±4.34yo were compared to 126 patients with median age of 63±12.48yo (p<0.0001). Good recanalization was achieved in 74% of patients ≥80yo compared to 84% in patients <80yo (p= 0.06). Poor outcomes were reported in 74.6% of patients ≥80yo compared to 47.0% in patients <80yo (p<0.0001). All-cause mortality was 28.9% in the ≥80yo vs 12.9% in the < 80yo (p=0.006).

Conclusion:
In our cohort, the clinical outcomes among octogenarians receiving MT were worse than in younger patients despite no difference in recanalization. Various factors may be responsible including overall health status, comorbid conditions and neuroplasticity. Further prospective multicentral studies are needed to better understand the benefit of MT in octogenarians.
Abstract TP170: Dihomo-Gamma-Linolenic Acid Decreases Hemorrhagic Complications in Acute Ischemic Stroke
Authors: Yasuda Takaya , Ito Munekatsu , Hori Shinya , Mikami Kazuyuki , Bando Toshiaki , Shimo Daisuke , Kuroyama Takahiro , Ueno Yasushi
Published: June 2021

Introduction:
Dihomo-gamma-linolenic acid (DHLA) is an omega-6 essential fatty acid related to thrombotic diseases. There are many reports about the ratio of eicosapentaenoic acid to arachidonic acid which associates with coronary and brain ischemia. But there is no report focusing on DHLA and acute ischemic stroke (AIS). We report a new correlation between DHLA and hemorrhagic complications (HC).

Method:
We conducted a retrospective single center case-controlled study in Japan. Among all cases of AIS from January 2015 to May 2019, we selected those who had intravenous infusion of tissue plasminogen activator (tpa) with or without endovascular treatment (EVT). Tpa was administered at 0.6mg / kg according to guidelines in Japan. Intracranial hemorrhage confirmed by imaging within 24 hours after tpa was defined as HC. We considered the patient background including lipids and outcomes: mRS0-2 after 90 days, recurrence within 30 days, any complications. We also divided all cases into two groups; the presence (A) or absence (B) of HC, and examined factors that contribute to HC. Lipid fractions (DHLA, AA, EPA, docosahexaenoic acid) were measured before tpa.

Result:
In the eligible 111 patients, 59 were male, and the median age was 77.4±11.5 years old. There were 30 cases of HC (A); HC within infarction (14), beyond or other than infarction (7), SAH associated with EVT (9), traumatic (0). There were significant differences between two groups: age(median, A:85.0, B:75.0[p<0.001]), Alb(median, A:3.70, B:3.95mg/dL[p=0.0172]), D dimer (median, A:1.95, B:1.10μg/mL[p=0.0254]), DHLA (A:32.0, B:43.5μg/mL[p=0.0295]), eGFR (median A:54.9, B:64.0 [p=0.0129]), and NIHSS (median A:17.5, B:9.0 [p<0.001]). The mRS0-2 after 90 days was 7/30 (23.3%) in A, and 51/81(62.9%) in B [p<0.001].There were no significant differences in clinical type of AIS, lipids other than DHLA, and recurrence of stroke within 30 days.

Conclusion:
DHLA, age, D dimer, and renal function were significantly associated with HC in resuscitation therapy for AIS. The prognosis was poor in cases of HC. We emphasize DHLA as a new finding. DHLA may be related to vascular vulnerability. There is a possibility that early improvement of DHLA can reduce HC, lead to good prognosis, and decrease the cost.
Abstract TP172: Effect of Playing Golf on Cardiovascular Diseases and Death in Older Persons: The Cardiovascular Health Study
Authors: Qureshi Adnan I , Saeed Omar , Suri M. Fareed K
Published: June 2021

Importance:
Golf

is played by about 25 million people in United States and may reduce the risk of cardiovascular diseases by providing regular exercise and stress relief.

Objective:
To test whether playing golf regularly reduces the risk of myocardial infarction (MI), stroke and/or death among elderly persons.

Design, Settings, and Participants:
We analyzed data from the Cardiovascular Health Study (CHS), an NHLBI-funded the population-based, prospective observational cohort study of risk factors for cardiovascular disease in adults 65 years or older. Starting in 1989, and continuing through 1999, participants underwent annual extensive clinical examinations and 6 monthly clinic visits, and once clinic visits ended, participants were contacted by phone to ascertain occurrence of cardiovascular events. Golf status was inquired at baseline and longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years. Persons who played golf for at least 1 month per year were considered as regular golf players. We performed Cox proportional hazards analysis to determine the effect of playing golf on incident MI, stroke, and death during follow up after adjusting for potential confounders.

Results:
The mean (SD) age of the entire cohort (n = 5888) was 72.8 (5.6) years; 2466 (41.9%) were men. Golf was played regularly by 384 persons. During follow-up, 31 (8.1%) participants had stroke and 38 (9.9%) had MI. Overall mortality rate was 1,115 deaths per 100,000 population. There was a significantly lower rate of death among persons who played golf regularly compared with those who did not (24.6% vs 15.1%). There was no difference in the rates of MI or stroke among those who played golf regularly. In the multivariate analysis, death was less likely among persons who played golf regularly (HR 0.6, 95% CI (0.4-0.7; p-<.0001) compared with those who did not after adjusting for age, race, gender, hypertension and diabetes mellitus. Their risk of MI (HR 1.0, 95% CI 0.7-1.3) or stroke (HR 1.0, 95% CI 0.7-1.5) was not lower among golf players in the multivariate analysis.

Conclusions:
In this large, population-based study, elderly persons who played golf were at lower risk of death. However, the protective effect of playing golf was not related to reduction in cardiovascular events.
Abstract TP177: Stroke Camp Provides Respite for Caregivers of Stroke Survivors
Authors: Mathews Maureen
Published: June 2021

Background:
Stroke is the leading cause of disability in the US. Approximately one in four patients with stroke is disabled. Providing daily care to stroke survivors long term is very burdensome to the family. The wellbeing and respite of the care givers (CG) has not been studied well in the past. In this study, we focused on quality of life (QOL) of the CGs of stroke survivors. The Retreat and Refresh Stroke Camp (RRSC), initiated in 2004, offers respite, opportunities to develop new relationships, and provides education/access to resources to CG.

Methods:
QOL of a convenience sample of stroke CG attending the Retreat and Refresh Stroke Camp (RRSC) in 2016 -2018 was assessed using the Adult Carer Quality of Life Questionnaire (ACQOLQ). The ACQOLQ addresses 8 subcategories of QOL: support for caring, caring choice, caring stress, financial matters, personal growth, sense of value, ability to care, and care satisfaction. A high (11+) subcategory score indicates high quality of life in that category and a low score (0-5) indicates a low quality of life and potential difficulties. Emails were sent to all CG with a link to the survey on Survey Monkey. Results were analyzed using descriptive statistics and Student t test was used to compare QOL between females and males.

Results:
A total of 149 CG were assessed including 123 (83%) females and 26 (17%) males. The majority (91%) were Caucasian Americans. The average age was 61.8 (SD=11.7) years old with a range of 27 to 86 years. More than half (56.1%) worked over 40 hours per week. The average of caring time was 7 (SD=6.6) years. The average total score of ASQOLQ was 62.4 (SD=8.9) and the average score in eight subcategories varied between 6.4 and 10.1, indicating a moderate quality of life. Females had a higher score of caring stress than males (6.7 vs 5.2, p=0.027), but no difference was found in other subcategories.

Conclusion:
Women are the primary caregivers for stroke survivors and bear a significantly higher burden of caring stress. Society should focus more attention to provision of resources to assist in relieving this burden. A camp opportunity for supporting caregivers and survivors may help in providing respite to these family members
Abstract TP178: The Decline of the Age-Adjusted Mortality Rate of Subarachnoid Hemorrhage in Shimane Prefecture, Japan
Authors: Matsuda Shingo , Ikawa Fusao , Ohzono Iori , Yoshiyama Michitsura , Hidaka Toshikazu , Kurisu Kaoru
Published: June 2021

Object:
This study aimed to assess the relationships between trend of mortality rate from subarachnoid hemorrhage (SAH) and blood pressure and smoking prevalence among about 700,000 residents of Shimane prefecture, Japan.

Methods:
A retrospective review was performed to identify the age-adjusted mortality rate from SAH calculated using the standard population of Japan in 2010 and changes in population of Shimane prefecture used the date based on government statistics during 1999 through 2017. Blood pressure dates were extracted from Ministry of Health, Labour and Welfare during 2008 through 2015, and smoking prevalence from Cancer Registry and Statistics. Cancer Information Service, National Cancer Center, Japan every 3 years since 2001.

Result:
Age-adjusted mortality rate from SAH in Shimane prefecture tended to decline by 3.6% between 1999 through 2017 regardless of gender, as 14.86 (95%CI:14.65-15.07) per 100,000 person-year in 1999 to 7.96 (95%CI:7.81-8.11) in 2017. The Population of Shimane prefecture, where one of the most aging region in Japan, was decreased by 10.4% since 764,291 in 1999 to 684,668 in 2017. Blood pressure was invariable during 2008 through 2015, while smoking prevalence decreased since 2001 to 2016, as 25.0% to 18.0%.

Conclusion:
Age-adjusted mortality rate from SAH in Shimane prefecture have declined since 1999 to 2017, regardless of decrease of population and advancement of aging region. The factor of decline might be not only development of treatment and management, but decrease of incidence of SAH in Japan accompanied by improvement of smoking prevalence or lifestyle habitation.
Abstract TP179: No Need to 'Card' Here; Cocaine/Opioid Use in Middle Age and Stroke
Authors: Brown Aliza T , Backus Marzella , Onteddu Sanjeeva , Nalleballe Krishna , Sheng Sen , Haldal Shilpa , Joiner Renee , Kapoor Nidhi , Benton Tina , Lowery Curtis
Published: June 2021

Background:
Drug overdose from 1999 to 2017 in the US has continued to increase. Rural America has seen an increase in methamphetamine (Meth) users. Meth usage in Arkansas and its effects on stroke incidence and treatment are all largely unknown. Drug abuse can cause an immediate stroke or increase the risk of stroke either by damage to the cerebrovasculature, hypertension, or by affecting vital organs. Here we retrospectively examined strokes from 57 rural communities that self-reported positive for drug use from a large telestroke program for age, thrombolysis, alcohol and smoking use, gender, race, deficit level and symptom to door time.

Hypothesis:
Incidence of drug use is greater among younger age groups and increases the incidence of stroke in younger age categories.

Methods:
We analyzed consult prospective data from 2015 to 2018 of the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES) telestroke program for consults who self-reported as positive for drug use. We included all stroke assessed consults for age (ranged by decade), thrombolysis (alteplase use), alcohol and smoking use, consult gender, race, initial deficit level at presentation using the national institutes of health stroke scale (NIHSS) and symptom to door time (minutes).

Results:
In 2015 to 2018 the number of consults positive for drug use per person were 2,349, 1,747, 1,910 and 1,137 per 100,000, respectively. Sixty-two percent of drug users were in their 40’s and 50’s (p<0.0001) with hypertension (p<0.0001). Drug users were most frequently smokers (73%) and consumed alcohol (39%) at p
<
0.0001. Significantly fewer received alteplase (20%, p=0.039). There was no difference of gender in drug use (p=0.08). Almost half of the drug users were consulted for stroke but were not confirmed as stroke (46%, p=0.045). Symptom to door time average was lower in drug users, though not significant at 56.4±10 vs. 68.9±1.9 minutes, p=0.37. There was no effect of race in incidence of drug use, or deficits.

Conclusion:
While the incidence of drug use does persist in the rural communities, demographics suggest it is more common in the middle age group than younger patients.
Abstract TP188: Doppler Velocity Ratio Parameter Adjunct to Conventional Risk Scores May Enhance the Predictability of Ischemic Stroke in Asymptomatic Carotid Stenosis
Authors: Lee Yongseok , Kang Min Kyoung
Published: June 2021

Introduction:
The prediction of ischemic stroke in patients with asymptomatic carotid stenosis (ACS) is important in clinical practice. Conventional cardiovascular risk scores may be used for these purpose, although not validated. We also incorporate carotid doppler ultrasonography (CDU) parameters to validate whether they may enhance the predictive power of conventional risk scores for ischemic stroke in ACS.

Hypothesis:
Conventional risk score combined with CDU parameters may predict the risk of ischemic stroke in ACS.

Methods:
From January 2010 to December 2017, we were retrospectively enrolled consecutive asymptomatic patients with more than 50% carotid stenosis by CDU criteria. Medical records of all participants were reviewed to assess conventional risk scores (Framingham stroke risk score (FSRS) and ASCVD risk score) and to confirm the occurrence of ischemic stroke events for up to 10 years. The peak-systolic-velocity (PSV), peak-systolic-velocity-ratio and peak-systolic-and-end-diastolic-velocity-ratio (PSV/EDV, PER) between internal and common carotid artery were evaluated. Univariate Cox proportional hazard regression, time-dependent Cox regression, and net reclassification index (NRI) were used to assess the predictability of explanatory variables and models.

Results:
A total of 150 patients (mean age 71.5 years, 111 males) were enrolled. During the follow-up period (mean 4 years), twelve ischemic stroke events were observed. In ROC curves for prediction of ischemic stroke in ACS, the AUC of the FSRS and ASCVD was 0.606 (CI 0.449-0.762) and 0.576 (CI 0.448-0.708). Among all CDU parameters, only higher PER was significantly associated with increasing risk of ischemic stroke (HR 1.764, CI 1.089-2.439, p=0.034). The addition of PER improved the predictive power; AUC of the FRSR and ASCVD risk score combined with PER was 0.649 (CI 0.506-0.792, p<0.001) and 0.621 (CI 0.499-0.742, p=0.007), respectively. NRI of PER combined FRSR was +10.7% (p=0.014) and +8.2% (p=0.042) for PER combined ASCVD risk score.

Conclusion:
The predictability of conventional risk scores has predictive power to ischemic stroke in ACS, although not substantial. This predictive power may be enhanced by doppler velocity ratio parameter, especially PER.
Abstract TP194: Relation Between Lipoprotein (a) and Cerebral Arteriosclerosis
Authors: Park So Hyun , Kim Jeong-Min , Park kwangyeol
Published: June 2021

Background:
Lipoprotein(a) is known to be associated with increased atherosclerotic burden and vascular event. We investigated the relationship between lipoprotein(a) level and cerebral arteriosclerosis burden, including both atherosclerosis and small vessel disease.

Methods:
Consecutive patients with acute cerebral infarction or transient ischemic attack who had been through both brain imaging and serum lipoprotein a level analysis were included in the study. For cerebral atherosclerosis, intracranial arterial calcification status at cavernous portion of internal carotid artery and cerebral atherosclerosis score as the sum of major cerebral arterial stenosis were measured from brain CT angiography. Assessed cerebral small vessel disease phenotype included white matter hyperintensities, old lacune, cerebral microbleeds and extensive perivascular space. The patients were categorized into four groups according to the predefined cut-off values of lipoprotein(a) (15, 30, 50mg/dL).

Results:
A total of 990 patients were included with 457 female patients (mean age = 68.2 ± 12.8 years). Overall cerebral atherosclerosis score or total small vessel disease burden was not increased according to increased lipoprotein(a) group, although the proportion of the patients with severe calcification showed increasing tendency. Multivariable logistic regression analysis revealed that increased lipoprotein(a) was independently associated with severe calcification (group 4, odds ratio = 1.68, confidence interval = 1.01 – 2.80). Increased lipoprotein(a) was associated with the presence of white matter hyperintensities and extensive perivascular space, but not associated with old lacune or cerebral microbleed.

Conclusion:
Lipoprotein(a) is independently associated with severe calcification of intracranial artery. The impact of elevated lipoprotein(a) toward small vessel disease burden seems to be different according to its phenotype.
Abstract TP196: Characteristics And Outcomes Of Acute Stroke Among Black Adults By Sex, Paul Coverdell National Acute Stroke Program 2012-2018
Authors: Odom Erika , Tong Xin , Coleman King Sallyann
Published: June 2021

Introduction:
The nation’s highest rates in stroke deaths are among Blacks. After years of decline, the death rate began to stall around the beginning of this decade. This study will describe differences in stroke characteristics and outcomes by sex within this racial group.

Method:
The study is limited to patients identified as black and admitted with a clinical diagnosis of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or ischemic stroke (IS) in the Paul Coverdell National Acute Stroke Program (PCNASP) from 2012-2018. In total, there were 105,676 admissions from 521 participating hospitals. We compared sociodemographic and clinical characteristics by sex within this racial group.

Results:
Among stroke admissions for black patients, 14,785 (14.0%) were ICH, 4,520 (4.3%) were SAH, and 86,371 (81.7%) were IS. Black women suffered a greater proportion of ICH (5.3% vs 3.2%, p<.0001) and a smaller proportion of SAH (13.0% vs 15.0%, p<.0001) than black men. Black women who suffered an IS were more likely to arrive by EMS than black men (49.7 vs. 47.7%). Black men who suffered an ICH or IS were more likely than black women to be transferred from another hospital (ICH: 34.1% vs 32.4%; IS: 11.9% vs 10.7%). Black men were more likely than black women to be discharged home after IS (50.9% vs 48.1%). Across stoke types, a greater proportion of black men were able to ambulate independently at discharge.

Conclusion:
In this sample, IS was the most common diagnosis among both men and women (81.8% vs 81.7%) and well-known cardiovascular disease risk factors were identified. Although a number of differences between men and women were found to be statistically significant, the clinical impact is unknown. Clinicians and public health practitioners may need to develop targeted interventions or services for black women to reduce disparities in stroke and risk factors within this racial group.
Abstract TP199: Association Between Left Atrial Enlargement and Poor Collaterals in Large Vessel Occlusion
Authors: Cannistraro Rocco J , Brott Thomas G , Meschia James F , Eidelman Benjamin H , Barrett Kevin M , Huang Josephine F , Lin Michelle P
Published: June 2021

Introduction:
Left atrial enlargement (LAE) is associated with atrial fibrillation, a frequent cause of large vessel occlusion (LVO) leading to ischemic stroke. Leptomeningeal collaterals protect tissue from ischemia, but the association between collaterals and structural heart disease is not well described. We aim to investigate the association between LAE and cerebral collaterals during acute LVO when microvasculature, vasodilation, and chronotropic competence are critically important.

Hypothesis:
Left atrial enlargement is associated with poor collaterals.

Methods:
We reviewed consecutive patients presenting with middle cerebral and internal carotid LVO who underwent thrombectomy from 2012 to 2017. Patients with CT angiogram of the head and echocardiogram were included. Poor collaterals were defined as ≤ 50% filling on CT angiogram. LAE was defined as left atrial volume index ≥ 35 mL/m
2
. Multivariate logistic regression analysis was performed to evaluate the relationship between LAE and poor collaterals with adjustment for age and hypertension.

Results:
There were 128 eligible patients. The mean age was 68± 15 years, median NIHSS was 17, and 51 (39.8%) had LAE. Baseline characteristics are described in the table. Poor collaterals were observed in 50 (39%) patients. Patients with LAE were more likely to have poor collaterals compared to those with normal left atrial size (52.9% vs. 29.9%, p=0.009). After adjusting for age and hypertension, a trend towards association remained (OR 2.00, p=0.089).

Conclusion:
Our results indicate that patients with LVO and LAE were more likely to have poor collaterals. Further research is warranted to determine the cause of the association. One possibility is shared pathophysiology affecting both cardiac and cerebral vasculature such as microvascular disease or endothelial dysfunction. Alternatively, structural heart disease causing chronotropic incompetence may lead to poor collateral filling.
Abstract TP200: African American Young Adults with Ischemic Stroke Have High Rates of Left Ventricular Hypertrophy
Authors: Hou Yan , Aradine Elizabeth , Ryan Kathleen , Mehndiratta Prachi , Chaturvedi Seemant , Cronin Carolyn A , Phipps Michael S , Wozniak Marcella A , Merino-Juarez Jose G , Dutta Tara M , Cole John W , Kittner Steven J
Published: June 2021

Introduction:
It is well known that African Americans (Afr-Am) have a higher prevalence of hypertension (HTN) compared to Whites. Few studies have compared Afr-Am and Whites for the prevalence of left ventricular hypertrophy (LVH; a marker of long-standing hypertension) in young ischemic stroke patients with and without a history of hypertension to assess hypertension severity and undiagnosed longstanding hypertension. We hypothesized that the prevalence of LVH by echocardiography would be higher in Afr-Am than in their White counterparts.

Methods:
We identified 1033 patients from a population-based case control study of young patients with first-time ischemic stroke (age 18 to 49 years old, enrolled from 1992-2006) from the Baltimore-Washington area. Patients (n=191, 16%) without an echocardiogram were excluded yielding an analysis sample of 842. Prevalence of LVH by echocardiography (Echo-LVH) were determined in those with and without a history of HTN, stratified by sex and race. Age-adjusted odds ratios and 95% confidence intervals comparing Afr-Am and Whites for the prevalence of Echo-LVH were calculated by logistic regression.

Results:
Of the 842 young stroke patients included in this study, the median age was 43.0, 55.2% were men, and 48.7 % were Afr-Am. Echo-LVH was common in young patients with ischemic stroke, even patients without a prior history of hypertension. Afr-Am women, both with and without a history of HTN, had higher age-adjusted prevalence of LVH than White women. Afr-Am men with no history of HTN had higher age-adjusted prevalence of Echo-LVH than White men. Afr-Am men with history of HTN had the highest prevalence of LVH, but the age-adjusted comparison with White men with HTN did not achieve statistical significance.

Conclusions:
The evidence suggests that Afr-Am have greater end organ damage from HTN, even among those who do not have an established diagnosis of HTN. These findings emphasize the need for earlier screening and treatment of HTN in young Afr-Am adults.
Abstract TP205: Association Between Morphological Variations of Extracranial Internal Carotid Artery and Cerebral White Matter Hyperintensities
Authors: Yan Yuying , Wu Bo , Cao Yirui , Jiang Shuai , Sun Jiayu
Published: June 2021

Background:
Cerebral white matter hyperintensities (WMHs) often remain asymptomatic until they widely affect brain structure. The association between small and large vessel diseases is worth studying. We aimed to explore the relationship between morphological variations of extracranial internal carotid artery (EICA) and WMHs. The classic evaluation system of artery variations failed to describe the compound abnormities, and therefore some novel parameters were proposed in this study.

Methods:
Neck CT angiography scans and brain MRI data of 97 patients with acute ischemic stroke were retrospectively analyzed. The angle of EICA, tortuosity index (TI), deviation degree (DD) and angular number (AN) were measured as parameters of artery morphological variations (Figure). The severity of WMHs was assessed by Fazekas Scale. Differences of vascular morphological variations between mild and severe white matter lesion groups and factors independently associated with WMHs were analyzed.

Results:
Compared with the patients with mild WMHs, patients with severe WMHs were older (
P
=0.001), had higher average systolic blood pressure (
P
=0.026), larger median TI (
P
<0.001) and median DD (
P
<0.001). Also, more patients with severe WMHs had sharp blood vessel angles (
P
=0.001) and history of stroke (
P
=0.034). Sharp blood vessel angle (OR 4.056, 95%CI 1.578-10.467) and TI (OR 1.037, 95%CI 1.007-1.068) were independently associated with severe WMHs proved by multivariate logistic analysis. Several regression models suggested that age and history of stroke had close relationship with WMHs.

Conclusions:
Sharp angle of EICA and TI were independently associated with severe WMHs. Besides, age and history of stroke were firmly related to white matter lesions.