bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP81: Low Dose tPA Worsens The Short Term Outcomes After Thromboembolic Stroke In Both Male And Female Diabetic Animals
Authors: Li Weiguo , Valenzuela John Paul , Dong Guangkuo , Ward Rebecca , Fagan Susan C , Ergul Adviye
Published: June 2021

Diabetes worsens stroke outcome and increases the risk of hemorrhagic transformation (HT) after ischemic stroke, especially with tPA treatment. We previously showed that low dose tPA decreased infarct size and improved functional outcome in both male and female control rats with embolic stroke. In the current study, we hypothesized that low dose tPA will also improve the functional recovery after the embolic stroke in both male and female animals with diabetes. Diabetes was induced in age matched male and female Wistar rats with high fat diet and low dose streptozotocin (30 mg/kg, i.p.). Embolic stroke was induced with middle cerebral artery occlusion. The animals were treated with or without tPA (1 mg/kg, i.v.) at 90 min after surgery. Neurological deficits (composite score and adhesive removal test-ART), infarct size, edema ratio, and HT index were assessed 3 days after surgery. The blood flow has increased in the tPA treated animals in the first 1 to 1.5 hr after treatment. The infarct size and edema was not significantly different in untreated animals, but HT was greater in female diabetic rats. The tPA treatment worsened HT in both genders with no change in infarct size. Decline in ART was worsened with tPA treatment in both sexes. Our data suggest that the low dose tPA after ischemic stroke has detrimental effects on the cerebrovascular recovery and functional outcome in both male and female animals with diabetes.
Abstract WMP87: Simulation Based Medical Education Improves Door to Needle Times in Acute Ischemic Stroke Management
Authors: Mehta Tapan V , Strauss Sara , Beland Dawn , Staff Ilene , Fortunato Gilbert , Lee Nora
Published: June 2021

Introduction:
Literature on the effectiveness of simulation based medical education programs used in acute ischemic stroke (AIS) care is scant. In an effort to improve coordination and door to needle time (DNT) for AIS care, a stroke simulation education training program for neurology nursing staff and neurology residents was implemented in a comprehensive stroke center.

Methods:
Hospital stroke registry was used for retrospective analysis. The study population was defined as all patients treated with IV-tPA for AIS in the emergency room from October 2008 to September 2014. Simulation training was implemented yearly, for a three month period starting from July 2011. All neurology residents and a group of nurses trained to respond to all AIS cases participated. Simulations were standardized, using deliberate practice with a trained live actor portraying stroke vignettes in the presence of a board certified vascular neurologist. During the period of study, there were no changes in Emergency Department stroke triage protocol, or changes in first provider response to AIS. The data was analyzed using IBM SPSS24 software.

Results:
We identified 448 patients admitted with AIS who were treated with IV-tPA. The average DNT on univariate analysis before and after intervention was 67.9 and 58.3 minutes [p <0.001]. A multivariate linear regression analysis was performed controlling for age, night/day shift, weekday/weekend, and blood pressure at presentation (>185/110). After controlling for confounders we found that simulation training independently reduced the DNT by 9.64 minutes [95% confidence interval (CI) 4.01 - 15.28, p=0.001]. Amongst other co-variates, only the systolic blood pressure >185 was associated with 14.27 minutes of delay in DNT [95% CI 3.36 - 25.191, p=0.011].

Conclusion:
Time to thrombolysis from symptom onset is a critical factor in AIS management and evidence shows improving the DNT could improve patient outcomes. In our six year study, integration of simulation based medical education for AIS reduced the average DNT by 9.64 minutes in multivariate analysis. Simulation based medical education therefore should be considered as a standard process for providers involved in the care of AIS patients receiving thrombolytic treatment.
Abstract WP109: Subacute Intranasal Administration of Tissue Plasminogen Activator Increases Corticospinal Tract Plasticity and Functional Recovery After Stroke in Mice
Authors: Qian Jian-Yong , Chopp Michael , Chen Ning , Liu Zhongwu
Published: June 2021

In addition to thrombolysis, tissue plasminogen activator (tPA) is involved in synaptic plasticity, dendritic remodeling and axonal outgrowth in the developing and injured CNS. We have demonstrated that tPA administered intranasally during the subacute phase after stroke enhanced neurological recovery in rats. In the present study, we examined the therapeutic benefits of intranasal tPA treatment on corticospinal tract (CST) axonal remodeling in adult mice with transgenic yellow fluorescent protein (YFP) labeling specifically in the CST subjected to permanent middle cerebral artery occlusion (MCAo). Animals were treated intranasally with 4 doses of human recombinant tPA (300 ug/dose) or saline (control) at day 7, 9, 11 and 13 after MCAo (n=10/group), respectively. An adhesive-removal test and a single-pellet reaching test were performed at 1, 3, and 7 days after MCAo, and weekly thereafter to monitor functional recovery. Animals were euthanized 4 weeks after stroke. There was no difference in lesion volume between control and tPA-treated groups (p>0.05). Compared with saline treated animals, significant functional improvements were evident in mice treated with tPA (p<0.05), as well as significantly increased CST axonal density in the denervated side of the gray matter of the cervical cord (p<0.01). We also isolated, and cultured primary embryonic YFP neurons with tPA at concentrations of 0.065, 0.65, 2.0 and 6.5 μg/ml, respectively, for 3 days, and observed that tPA dose-dependently increased neurite length and number (P<0.05). Our data suggest that delayed tPA intranasal treatment provides therapeutic benefits for neurological recovery after stroke by, at least in part, promoting CST axonal remodeling in the denervated spinal cord gray matter.
Abstract WP123: Neuroprotective Efficacy of P7C3-A20 After Ischemic Stroke
Authors: Loris Zachary B , Pieper Andrew A , Dietrich W. D
Published: June 2021

Ischemic stroke is a devastating condition with few therapeutics available. The recently identified neuroprotective compound P7C3-A20 (A20) inhibits mature neuronal apoptosis while increasing the net magnitude of postnatal neurogenesis. P7C3 compounds enhance flux of NAD in the salvage pathway, a proposed therapeutic utility in treating stroke patients. P7C3 has demonstrated efficacy in several preclinical neurodegenerative models, yet it has never been tested in focal cerebral ischemia. Implementing STAIR recommendations, a 90min rat middle cerebral artery occlusion was performed followed by immediate injection of A20 or vehicle and then twice daily injections for 7 days. The therapeutic window was assessed using the same experimental paradigm, with rats injected at a delayed time point (6hrs). Acutely (n=12/group), A20-treated rats had significantly fewer missteps in the sensorimotor grid-walk task (A20 mean (AM)=16.8±3; Vehicle mean (VM)=33.%±7.4), and chronically (28 days post-injury) had significantly reduced escape latencies on day 4 in the water maze task (AM=16.7±1.6; VM=24.2±1.7) than vehicle-treated controls. Behavioral improvements were associated with significantly decreased cortical (AM=0.44±0.03; VM=0.35±0.01) and hippocampal atrophy (AM =0.94±0.05; VM=0.81±0.03) and increased neurogenesis in the subventricular zone (AM=513±29; VM=356±31). Furthermore, normalized NAD levels decreased in vehicle-treated rats (VM=0.2±0.03) and this was rescued with A20 treatment (AM=0.35±0.04). A20 continued to demonstrate efficacy in sensorimotor and working memory behavior tasks when administered at 6hrs. Both A20-treated rat time points showed the most improvement with asymmetry in the cylinder task (Immediate AM=34.5±3.3; Delayed AM=40.7±3; Immediate VM=26.5±3.9; delayed VM=30.3±6.1) and working memory (Immediate AM=39.4±7.1; Delayed AM=41.9±6.5; Immediate VM=35.9±8.1; delayed VM=6.36±7.9) compared with vehicle controls (n=4-5/group). In conclusion, these studies demonstrate that treatment with A20 produces benefits on both degenerative and reparative processes after focal ischemia, which translates into behavioral improvement and suggests new therapeutic approaches to treat stroke patients.
Abstract WP124: Signal Intensity Ratio Does Not Predict Recurrent Stroke in Patients with Symptomatic Intracranial Atherosclerotic Disease
Authors: Ansari Owaiz , Sangha Rajbeer S , Ansari Sameer , Prabhakaran Shyam
Published: June 2021

Background:
Symptomatic intracranial atherosclerotic disease (ICAD) is associated with high risk for recurrent stroke. Identification of patients remains a challenge using clinical and radiographic markers. Recent research has identified signal intensity ratio (SIR) across stenotic lesions on time-of-flight magnetic resonance angiography (TOF-MRA) as a novel noninvasive marker of recurrent stroke risk. We sought to externally validate this approach in a single center analysis.

Methods:
From a prospective observational stroke registry since August 2012, we identified patients with ischemic stroke due to ICAD causing moderate-severe stenosis of the basilar, intracranial vertebral, intracranial internal carotid, or middle cerebral arteries. Using the method described previously, we calculated SIR values across the stenotic lesions corrected for background signal intensity from TOF-MRA performed within 7 days of index stroke admission. Outcomes were prospectively captured by phone interview at 1 and 3 months after stroke. Recurrent stroke was defined by new infarct in the territory of the stenotic artery or absent imaging confirmation, territory-specific clinical symptoms lasting > 24 hours. We evaluated whether baseline SIR values were different between patients with and without recurrent stroke overall and in subgroups by ICAD location. P-value < 0.05 was considered significant.

Results:
Among 99 consecutive patients with ICAD, 79 (80%) had interpretable MRAs at baseline (mean age 68.4 +11.2 years, 53.2% male, 53.2% black, median NIHSS score 3; 27.7% posterior circulation stenosis). Recurrent stroke occurred in 21.5% and 25.3% of patients at 1 and 3 months, respectively. Median SIR at baseline was 0.86 (interquartile range 0.56-1.04) and was not different those with vs. without recurrent stroke (1-month: 0.79 vs. 0.86, p=0.93; 3-month: 0.79 vs. 0.86, p=0.68). Results were not different by ICAD location.

Discussion:
In this single center prospective registry, we were unable to validate SIR on time-of-flight MRA as a marker of early recurrent stroke risk in patients with symptomatic ICAD. Further research is needed to identify novel predictors of recurrence in this high-risk cohort.
Abstract WP128: A Comprehensive Assessment of Atherosclerotic Burden in the Cervicocephalic Arterial Tree in Patients with Acute Ischemic Cerebrovascular Disease and Coronary Artery Stenosis
Authors: Ma Xin , Kong Qi , Wang Chen , Feng Wuwei , Ovbiagele Bruce , Ji Xunming
Published: June 2021

Background:
Coronary artery stenosis (CAS) is a common comorbidity in acute ischemic cerebrovascular disease (AICVD) patients, which may portend a worse outcome. However, few studies have comprehensively evaluated cervicocephalic atherosclerotic burden and its significance for predicting CAS in AICVD patients.

Methods:
AICVD patients admitted to a single stroke unit from January 1
st
, 2016 to June 30
th
, 2016 were consecutively enrolled and underwent combined coronary and cervicocephalic computed tomography angiography. CAS was defined as stenosis≥50% in at least one coronary artery. The burden of cervicocephalic atherosclerosis was evaluated based on the severity and extent of affected arteries. Univariate analysis and multivariate analysis were conducted to assess the difference between the group with AICVD and CAS and another group with AICVD only.

Results:
In 140 included AICVD patients, 44(31.4%) had concomitant CAS. Male (93.2% vs 77.1%,p=0.021), systolic blood pressure on admission (156.89 vs 148.57mmHg,p=0.044), known history of coronary artery disease (31.8% vs 7.3%,p<0.001), and serum creatinine level (64.53 vs 71.93mmol/L,p=0.027) were significantly different between the two groups. In multivariate analysis, the severity of atherosclerosis in the common carotid, intracranial vertebrobasilar or posterior cerebral arteries, the number of atherosclerotic extracranial, intracranial or total cervicocephalic artery segments, as well as the number of affected extracranial or total cervicocephalic artery segments with stenosis≥50%, were associated with the coexistence of AICVD and CAS, independently of conventional vascular risk factors.

Conclusions:
The risk for AICVD patients to have concomitant CAS may increase with the severity and extent of atherosclerosis in cervicocephalic arteries. A comprehensive assessment of atherosclerotic burden in the cervicocephalic arterial tree is important to predict CAS in AICVD patients.
Abstract WP129: MRI and Non Contrast CT Clot Imaging for Successful Large Vessel Clot Resolution of Posterior Circulation Ischemic Strokes
Authors: Mehta Siddhart , Panezai Spozhmy , Kulhari Ashish , Arango Audrey Z , Suhan Laura , DeCarvalho Briana , Patel Aashish , Kirmani Jawad F.
Published: June 2021

Background:
Thrombi retrieved from patients with an acute ischemic stroke with Large Vessel Occlusion (LVO) and correlation with hyperdense vessel sign seen on non contrast CT and blooming artifact seen on gradient-echo(GRE) MRI have given relevant insights into the pathophysiology of thrombotic lesions (RBC-dominant vs Fibrin-dominant). This may facilitate the development of safer noninvasive reperfusion treatment approaches. Our goal was to evaluate the benefit of anticoagulation for posterior circulation strokes based on imaging characteristics in patients where endovascular therapy was not justified.

Method:
Comprehensive prospective evaluation of patients who presented with posterior circulation LVOs at a community based, university affiliated comprehensive stroke center during one year period (January 2015-December 2015) was done. The clot characteristics on thin-sliced reformatted CT, CT Angiogram and GRE MRI were noted. The clot size and characteristics were followed by sequential imaging while the patients were on anticoagulation for presumed embolic thrombus.

Results:
Total 749 patients presented with acute ischemic stroke during the pre-specified time period. Of those 78 were posterior circulation strokes; of which, 7 had LVO and 4 underwent endovascular treatment. Endovascular therapy was not justified in 3 patients due to clinically stable exam. These patients were thought to have embolic etiology of stroke and therefore were started on anticoagulation. Group A (RBC-dominant thrombus; n=2) mean clot length was 15.5mm, measured on CT, CTA, MRI. GRE MRI showed blooming artifact around the area of thrombus. Thrombus resolved on repeat CTA at 48-72hours. Group B (Fibrin-dominant; n=1) 5.5mm clot was visualized only on CTA (nothing on CT head and MRI) and it persisted on repeat CTA at 48-72hours. Mean initial NIHSS was 2 (SD +/-

1 ). Mean discharge NIHSS was 0.33 (SD +/- 0.577). Mean discharge mRS was 0.67 (SD +/- 0.57).

Conclusion:
Hyperdense sign on reformatted thin-sliced CT head and blooming artifact on GRE MRI brain in patients with LVO can be used to characterize the composition of thrombus, which could be helpful in deciding medical therapy. A larger prospective randomized trial is needed to corroborate our findings.
Abstract WP131: Temporal Dynamics of Symptomatic Intracranial Atherosclerotic Plaque Post Contrast Enhancement. A Serial High-resolution MRI Study
Authors: Carbayo Alvaro , Martínez-Velasco Elena , Rodríguez-Velasco Margarita , Usero María , Calleja Ana , Cortijo Elisa , De Lera Mercedes , Reyes Javier , Muñoz Pedro , Arenillas Juan F
Published: June 2021

Background:
Identification of novel prognostic factors associated with the risk of stroke recurrence in patients with symptomatic intracranial atherosclerosis (ICAS) is needed. Intraplaque post-contrast enhancement (PCE) in high-resolution MRI (HRMRI) has been proposed as a potential marker of plaque activity. We aimed to study intraplaque PCE prevalence, temporal evolution and their associated factors, in patients with symptomatic ICAS.

Methods:
We studied 10 consecutive patients with symptomatic ICAS who underwent HRMRI within the first 15 days after stroke onset and a control HRMRI three months thereafter. At each timepoint, symptomatic plaque and wall area were measured in T2 sequences, whereas plaque and wall signal intensity were measured with and without gadolinium contrast in T1 sequence. All HRMRI data were post-processed by two independent readers using Osirix imaging software.

Results:
Baseline HRMRI showed PCE in 70% of patients. Among baseline variables, a significant correlation was found between T1 spontaneous intraplaque intensity and postcontrast intraplaque intensity. We could not observe a homogeneous temporal evolution of postcontrast intraplaque intensity during the first 3 months, with half of the patients showing a decrease and the remaining having stable or increased values. No significant associations with intraplaque intensity variation were found.

Conclusion:
Intraplaque PCE was found in the majority (70%) of symptomatic intracranial atherosclerotic plaques during the acute phase. Interestingly, spontaneous and postcontrast intraplaque T1 signal intensities were highly correlated. Intraplaque PCE declined during the first three months in half of the patients.
Abstract WP139: The Correlation Between Supraorbital Artery Flow Patterns and Degree of Carotid Artery Stenosis
Authors: Xu Xiao Tong , Ma Ning , Wu Huadong , Miao Zhongrong , Mo Dapeng
Published: June 2021

Objective:
Patients with internal carotid artery (ICA) occlusion or severe stenosis usually have collateral via ophthalmic artery (OA). However, the relationship of blood flow patterns of OA and the degree of ICA stenosis has been rarely reported. Transcranial Doppler (TCD) is a promising modality to assess OA collateral when ICA lesion. Considered OA characteristics including tortuosity and anatomical variations, we try to evaluate the supraorbital artery (SA), the one of OA terminal branches, to analyze the relationship of flow with the degree of ICA stenosis.

Materials and Methods:
From Jun 2012 to Jan 2015, TCD were performed to 40 patients with ICA stenosis before and after carotid artery stenting (CAS). SA blood flow patterns were compared with the degree of ICA stenosis confirmed by conventional angiography.

Results:
40 patients (29 men) were enrolled (mean age 64.9 yrs). Before CAS, the retrograde blood of SA was found in 40 patients. After stenting, the flow pattern reversed in 29 patients of these patients (29/40, 72.5%). The blood flow of SA was gradually reverse over time from angioplasty with balloon to several days after CAS. The patterns of these changes were categorized into four types: (A), flow spectrum completely reversed; (B), reverse flow spectrum associated with systolic notch; (C), flow spectrum forward at systolic and reverse at diastolic; (D), type flow spectrum entirely forward. Before balloon angioplasty (mean stenosis, 93.4%), A type was found in 39 of them, B type in 1 patient; after balloon dilatation (mean stenosis, 82.9%), 26 A types and 4 B, 5 C, 5 D types. Stent (mean stenosis, 14.9%), 1 A type, 4 B and 4 C, 29 D types.

Conclusion:
The flood flow patterns of SA may be associated with the degree of carotid stenosis evaluated with TCD and the blood flow may be reverse after CAS.

This work was supported by the National Natural Science Foundation of China (Contractgrant number: 81471390 to N.M).
Abstract WP142: Intravenous Tissue Plasminogen Activator for Patients with Mild and Rapidly Improving Ischemic Strokes and Large Vessel Occlusions: Examining In-hospital Outcomes
Authors: Wagner Jeffrey , McGraw Constance , McCarthy Kathryn , Jensen Judd , Orlando Alessandro , Bar-Or David , Bartt Russell
Published: June 2021

Background:
Upon hospital arrival, patients with mild or rapidly improving acute ischemic strokes (AIS) are frequently not treated with IV-tPA. Recent guidelines from the American Heart Association report that diagnosis on imaging of large vessel occlusion (LVO) despite mild stroke severity leads to increased risk of poorer outcomes. The objective of our study was to examine outcomes following tPA in this AIS population.

Methods:
The study included all AIS patients with an admission NIHSS ≤7 and diagnosis of a LVO on imaging from a single comprehensive stroke center between 2010-2016. Patients were excluded due to missing contraindications to tPA or with a symptom to arrival time of >4.5 hours (n=234). We compared patients who received tPA to those who received no treatment because of mild or rapidly improving symptoms. Outcomes were sICH, improvement in NIHSS score, discharge mRS ≤2, and in-hospital mortality. Patient characteristics were compared univariately, and step-wise logistic regression was used to adjust for confounding variables. Entry criterion was P=0.2 and exit criterion was P=0.07.

Results:
There were 76 patients with an AIS diagnosis of LVO. Of these patients, 39 (51%) were treated with tPA and 37 (49%) were not treated. Overall, the median (IQR) age was 72 (61-82.5). Patients treated with tPA had a median admission NIHSS of 5 (3-6), and a larger proportion were male (77%) and smokers (4%). Patients without tPA treatment had a median NIHSS of 2 (1-3), and a larger proportion had hypertension (49%). All outcomes were not significantly different between groups after adjustment (Table 1). There were no patients with sICH.

Conclusions:
Our study suggests that tPA in mild LVO patients does not introduce additional risk in terms of sICH, in-hospital mortality, change in NIHSS, or discharge mRS. Further justification for withholding tPA in this group should be based on 90-day mRS scores, in order to better understand long-term functional outcomes.
Abstract WP150: BeamSAT MRI Help to Identify Patients at Risk for Intolerance to Temporary Internal Carotid Artery Occlusion During CEA and CAS
Authors: Tanaka Jun , Hosoda Kohkichi , Yamamoto Yusuke , Imahori Taichiro , Fujita Atsushi , Kohta Masaaki , Yamamoto Daisuke , Nakai Tomoaki , Kohmura Eiji
Published: June 2021

Introduction:
Pencil Beam type presaturation (BeamSAT) pulse on a major cervical vessel enables selective suppression of blood flow signal of the applied vessel in MR angiography (MRA). By subtracting the BeamSAT pulse-added MRA of an internal carotid artery (ICA) from conventional MRA, only the contralateral ICA image (SubBeamSAT image) can be obtained (Figure A, B). In this way, an ICA-selective MRA with more physiologial flow pattern can be obtained, because it requires no powerful injection of contrast medium.

Purpose:
The aim of this study was to investigate whether preoperative assessment of the flow of Acom/A1 by SubBeamSAT image and posterior communicating artery (Pcom) by conventional MRA could identify patients at risk for intolerance to intraoperative temporary ICA occlusion.

Method:
29 patients who underwent carotid endarterectomy (CEA) (n = 17) or carotid artery stenting (CAS) (n = 12) were enrolled in the current study. All patients underwent the SubBeamSAT images and conventional MRA pre- and post-operatively. Response to ICA temporally occlusion was recorded during the revascularization procedure.

Results:
Among twenty-nine patients, 4 patients who demonstrate neither the Acom/A1 flow on SubBeamSAT image (Figure. B) nor Pcom flow on MRA showed intolerance. In contrast, the remaining 25 patients who demonstrated Acom/A1 (Figure. A) and/or Pcom flow showed tolerance. Intolerance to ICA occlusion was excellently predicted by visualization of collateral flow via Acom and Pcom (specificity: 100%, sensitivity: 100%, p=0.00004).

Conclusions:
SubBeamSAT image is useful for evaluating the flow of Acom from A1 portion of the healthy side to A2 portion of the contralateral side, which is often difficult to evaluate with conventional MRA. With the SubBeamSAT image, it is feasible to evaluate the Acom/A1 flow accurately. In conclusion, SubBeamSAT image enables excellent prediction for the intolerance to temporary ICA occlusion.
Abstract WP156: Therapy-related Structural Plasticity Of Temporal White Matter Is Related To Naming Recovery In Aphasia
Authors: McKinnon Emilie , Glenn Russell , Wabnitz Ashley , Jensen Jens , Helpern Joseph , Bonilha Leonardo , Fridriksson Julius
Published: June 2021

Stroke is the leading cause of adult disability in the USA and aphasia is a common consequence of dominant-hemispheric strokes. It is unclear why some recover with speech therapy, while others persist with debilitating deficits. One theory suggests that therapy-related brain plasticity provides the anatomical substrate for improvements in language. In this longitudinal study, we assessed the integrity of the ipsi- and contralateral inferior longitudinal fasciculus (ILF) using diffusional kurtosis MRI (DKI), and examined its relationship with aphasia-therapy related changes in semantic errors. 8 subjects (age = 52.0±7.2y; 62% male; MRI time post-stroke = 50.25±29.8m) with chronic post-stroke aphasia received Language Action Therapy for a period of 3 weeks. Structural images (T1 & T2) and DKI (30 directions, b= [1000, 2000 s/mm
2
]) were acquired. We applied an innovative form of tractography using Diffusion Kurtosis Estimator and a WM mask as a seeding region. Lastly, we optimized the automated fiber quantification software to acquire along-tract diffusion measurements resulting in 100 nodal mean kurtosis (MK), mean diffusivity (MD) and fractional anisotropy (FA) measurements along major tracts. Compared to the contralateral side, the ipsilateral ILF shows diffusion characteristics often found in damaged neuronal tissue: high MD, low FA, and low MK (figure1).

The variability is larger on the ipsilateral side, and lowest MK correlated significantly with an increase in semantic errors (r=-0.84, p<0.05). None of the associations with FA and MD reached significance. Additionally, a therapy related reduction in semantic errors was associated with a longitudinal increase in MK (r=-0.89, p<0.05). In conclusion, ILF integrity captured using MK relates to clinical performance with lower MK predicting worse semantic language production, whereas therapy related increases in microstructural complexity (higher MK) were associated with a decrease in semantic errors.
Abstract WP168: Neutrophil to Lymphocyte Ratio is a Useful Predictor of Short-term Functional Outcome in Patients With Acute Ischemic Stroke
Authors: Kim Tae Jung , Kang Min-Kyung , Nam Kiwoong , Mo Heejung , An Sang Joon , Ko Sang-Bae , Yoon Byung-Woo
Published: June 2021

Introduction:
Inflammation is associated with the initiation and progression of cardiovascular diseases. The neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a prognostic marker in cardiovascular diseases. However, impact of NLR on the functional outcome in patients with ischemic stroke remains unclear.

Hypothesis:
The aim of the study was to investigate the prognostic role of the NLR in patients with acute ischemic stroke.

Methods:
A consecutive 1,113 patients who were admitted within 7 days after ischemic stroke onset between March 2010 and December 2014 were included for analysis. The patients were categorized into tertiles on the basis of NLR. We evaluated the short-term outcomes using a modified Rankin Scale (mRS) at three-months after onset of ischemic stroke. We divided patients into two groups with favorable outcome (mRS score ≤2) and unfavorable outcome (mRS score ≥3). We compared the clinical characteristics and NLR between two groups.

Results:
From all the patients included in this study (mean age, 67.8 years; men, 60.0%), 284 (25.5%) patients had unfavorable outcome. The patients with unfavorable outcome were older and more likely to have atrial fibrillation, history of previous stroke, and diabetes mellitus. In addition, participants with unfavorable outcome tended to have lower body mass index and higher initial NIHSS. The percentage values of the tertile 3 were significantly higher in the unfavorable outcome group (28.3% vs. 47.9%,
P
< 0.001). After adjustment for covariates, the highest tertile were at an exaggerated risk for unfavorable outcome [Odds ratio (95% confidence interval); tertile 3, 1.75 (1.17 - 2.63),
P
= 0.007].

Conclusions:
This study demonstrated that higher NLR predicted worse outcome at 3 months following acute ischemic stroke. This suggests that NLR could be a useful and reliable prognostic biomarker following acute ischemic stroke.
Abstract WP172: Increased Prevalence of Early Post Stroke Depression Among Single Women
Authors: Sugar Dana , Kucab Phillip , Madhavan Ramesh , Bhattacharya Pratik
Published: June 2021

Introduction:
Post stroke depression (PSD) is a common, yet under recognized sequelae of stroke. Detection and management of early PSD can enhance participation in rehabilitation and improve motor recovery. Early studies identified women as being at higher risk of developing PSD. Identifying gender specific features of PSD would assist better recognition and management of this syndrome. Our hypothesis was that PSD would be more common among women and gender differences would exist in features of PSD.

Methods:
Adult subjects admitted with ischemic stroke were recruited. The Beck Depression inventory II was administered between 30-90 days after the stroke. Depression symptoms and scores were analyzed by gender.

Results:
A total of 91 patients were included [Men: 42 (46.1%); Women 49 (53.9%); median age: men 55 (18-80) vs. women 57 (29-85); p 0.41]. Women had somewhat more diabetes (37.8% vs. 20.5% in men, p 0.08) and more likely to be single (68.7% vs. 42.5% in men, p 0.006). There was a high prevalence of early PSD, 42.8%. There was a higher frequency of PSD among women 49% vs. 35.7%, though not statistically significant. Women had a higher frequency of mild and moderate scores, whereas men had more severe PSD (figure). Both genders had similar scores for cognitive and somatic symptoms of depression. The most frequently reported symptoms were "loss of energy"(higher in women 89.8% vs. 71.4% in men, p 0.02), "fatigue", "loss of pleasure" and "change in sleep pattern"; similar among both genders. Among single women, median scores were 16 (0-53), more than double that of men: 7 (0-40); p 0.08. Scores in cognitive and somatic domains were higher among single women than single men. In conclusion, PSD is very frequent, affecting nearly half of female stroke patients, particularly if they are single. The symptoms may be somatic, affecting energy levels and sleep. Identification of patients at high risk of PSD will enable early treatment, with improved outcomes and quality of life.
Abstract WP175: Attitudes to Stem Cell-based Treatments Among Ischemic Stroke Patients
Authors: Aked Joseph , Delavaran Hossein , Lindvall Olle , Norrving Bo , Kokaia Zaal , Lindgren Arne
Published: June 2021

Background:
Pre-clinical studies have shown that stem cell therapy (SCT) may improve recovery after stroke, and clinical trials investigating safety are ongoing. It is important to consider stroke patients’ knowledge and attitudes about SCT, as these factors may have implications for the possible clinical use of SCT. Therefore, we examined the knowledge and attitudes about SCT among stroke patients potentially suitable for such therapy.

Methods:
We recruited consecutive first-ever ischemic stroke patients admitted to Skåne University Hospital in Lund, Sweden, in 2009-2011. Included patients were aged 20-75 years, had a National Institutes of Health Stroke Scale (NIHSS) score of 1-18, and underwent DW-MRI within 4 days of stroke onset. Patients with severe comorbidity, contraindications to MRI, and/or infratentorial stroke were excluded. A clinical follow-up was performed after 3-5 years assessing stroke severity (NIHSS), stroke recovery (NIHSS
baseline
- NIHSS
follow-up
; ΔNIHSS), functional status (modified Rankin Scale; mRS), comorbidity (Charlson Comorbidity Index; CCI), and patient-reported outcome (Stroke Impact Scale; SIS). The participants also completed an 8-part questionnaire on knowledge and attitudes about SCT.

Results:
Of 108 patients at baseline, 84 participated in the follow-up. In total, 12% had prior knowledge of SCT. Also, 63% had positive attitudes towards it. Positive attitudes towards SCT were associated with male sex (crude OR: 3.7; 95% CI: 1.5-9.6;
P
=0.006) and better patient-reported outcome (crude OR: 1.0; 95% CI: 1.0-1.0;
P
=0.034). No such associations were found for age, education, functional status and stroke severity at follow-up. Likewise, willingness to participate in clinical SCT trials was associated with male sex (crude OR: 5.4; 95% CI: 1.8-16.2;
P
=0.003) and a higher degree of stroke recovery (crude OR: 1.3; 95% CI: 1.1-1.7;
P
=0.005).

Conclusions:
Our findings may have implications for SCT trials in stroke as most stroke patients had limited knowledge about SCT, indicating a need for patient education programs. The attitudes towards SCT were mostly positive and willingness to participate in SCT trials was associated with male sex and higher degree of stroke recovery, which may affect patient selection.
Abstract WP184: Differential Risk of Embolic Stroke Among Stroke Free Community Dwellers With Distinct Categories of Subcortical Infarct
Authors: Gutierrez Jose , Kulick Erin R , Santiago Maria , Rundek Tatjana , Sacco Ralph , Wright Clinton , Elkind Mitchell
Published: June 2021

Introduction:
Cortically-based subclinical infarcts are considered risks for embolic stroke, but few studies have stratified subcortical SBI by penetrating versus medullary artery location. We hypothesized that subclinical medullary infarcts are due to small emboli and are predictors of embolic stroke.

Methods:
Stroke-free participants in the Northern Manhattan Study underwent a brain MRI to assess for subclinical biomarkers of vascular disease. Subcortical brain infarcts were defined voids >3mm on axial T1 and FLAIR images, with perilesional FLAIR hyperintensities referred to as pathology-informed subclinical brain infarcts (PI-SBI). Each subcortical PI-SBI was rated as penetrating or medullary by two vascular neurologists blinded to stroke subtypes. Participants were followed prospectively for incident stroke. Two vascular neurologists ascertained ischemic stroke subtypes independent of brain MRI imaging at baseline. Embolic stroke required a cardiac source or based on a superficial location. Cox proportional risk models generated hazard ratios and 95% confidence intervals (HR, 95% CI) adjusting for age, sex, ethnicity and traditional vascular risk.

Results:
The sample included 1290 NOMAS participants (mean age 71±9 years, 60% women, 66% Hispanic, 75% with hypertension) who were followed on average 9±3 years. At baseline, 19% of participants had PI-SBI (11% medullary artery, 7% penetrating artery and 3% cortical). During follow up, 80 participants (6.2%) had stroke (3.6% embolic, 2.4% due to intracranial artery disease (i.e. small and large), and 0.2% other subtypes). In a fully adjusted model, medullary artery (2.04, 1.00-4.14) and not penetrating artery PI-SBI (1.64, 0.99-2.70) predicted risk of embolic stroke. Distal field PI-SBI (i.e. cortical + medullary artery) were even more robust predictors of embolic stroke (2.17, 1.11-4.25). Penetrating artery (1.98, 1.09-3.61) and not medullary artery PI-SBI (HR 1.03, 0.34-3.06) predicted risk of intracranial artery stroke.

Conclusions:
Subtyping PI-SBI by location and plausible mechanisms may help with risk stratification for clinical trials testing stroke prevention strategies. Our data suggest not all subcortical infarcts are due to small vessel disease.
Abstract WP2: Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke
Authors: Bekelis Kimon , Missios Symeon , MacKenzie Todd , Tjoumakaris Stavropoula , Jabbour Pascal
Published: June 2021

Background:
The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate, and has not been studied in clinical trials. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke.

Methods:
We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay (LOS).

Results:
Of the 1,308 patients undergoing mechanical thrombectomy for acute ischemic stroke, 492 (37.6%) underwent general anesthesia, and 816 (62.4%) underwent conscious sedation. Employing an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% CI, 1.9% to 11.0%), and 8.4 days longer LOS (95% CI, 2.9 to 14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent one death. Our results were robust in a sensitivity analysis utilizing mixed effects regression, and propensity score adjusted regression models.

Conclusions:
Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case fatality and LOS. These considerations should be taken into account when standardizing acute stroke care.
Abstract WP20: Efficacy and Safety of Mechanical Thrombectomy in Emergent Large Vessel Occlusions with Concomitant Cervical Internal Carotid Artery Occlusion
Authors: Goyal Nitin , Tsivgoulis Georgios , Pandhi Abhi , Khorchid Yasser M , Ojha Abhishek , Chang Jason J , Safouris Apostolos , Magoufis Gergios , Hoit Daniel , Elijovich Lucas , Alexandrov Andrei V , Arthur Adam S , Zand Ramin
Published: June 2021

Introduction:
Recently, five published major randomized controlled clinical trials have demonstrated that timely mechanical thrombectomy (MT) of acute ischemic strokes (AIS) with emergent large vessel occlusion (ELVO) is safe and improves functional outcomes. However, data evaluating the efficacy and safety of MT in ELVO patients with concomitant cervical internal carotid artery (cICA) occlusion is limited. The purpose of this study is to evaluate efficacy and safety of MT in ELVO patients with concomitant cICA occlusion

Methods:
We prospectively analyzed consecutive AIS patients with anterior circulation ELVO who underwent stent-retriever or primary aspiration thrombectomy at two tertiary stroke centers. Outcome measures in our study were 3-month mortality and modified ranking scale (mRS), as well as symptomatic intracranial hemorrhage (sICH). Safety and efficacy outcomes were compared between ELVO patients with and without concomitant cICA occlusion.

Results:
A total of 137 AIS patients had anterior circulation ELVO and underwent MT (age 63 ± 14, 49% male, median NIHSS 17, IQR [13-20]). ELVO patients with concomitant cICA occlusion (n=19) did not differ in terms of rates of sICH (0% versus 11%, p=0.21), complete recanalization (68 % versus 68%, p=1.00), onset to groin puncture time (minutes [IQR] 268 [211-379] versus 225 [165-312], p=0.47), 3-month mortality (35% versus 26 %, p=0.55), and mRS of 0-2 at 3 months (41% versus 45%, p=0.80) when compared with ELVO patients without concomitant cICA occlusion (n=118). Admission NIHSS was higher among ELVO patients with concomitant cICA occlusion (median [IQR], 18 [15-22] versus 16 [12-19], p=0.01), and they tended to have higher groin puncture to recanalization time (minutes [IQR] 74 [42-97] versus 49 [38-78], p=0.09). The ordinal shift analysis did not show any difference in favorable outcomes in two groups in unadjusted analyses or after adjustment for admission NIHSS and groin to recanalization time (common OR=0.78 [95% CI: 0.27-2.29, p=0.66]). Angioplasty was performed in 11 of 19 ELVO patients with concomitant cICA occlusion. Three patients required stent placement.

Discussion:
Our study indicates that MT can be performed safely and effectively in ELVO patients with concomitant cICA occlusion.
Abstract WP214: Innovative Presentation of Stroke Symptoms Improves Stroke Awareness Among African American Women
Authors: Beal Claudia
Published: June 2021

Background:
African American women exhibit low stroke awareness in national surveys. Public education materials may not provide meaningful representations of stroke symptoms for African American women. Videos with actors portraying stroke onset may hold promise for improving stroke symptom awareness.

Purpose:
A pilot study tested efficacy of
Sisters Against Stroke
(SAS) online intervention to improve identification of stroke symptoms and appropriate action in response to suspected stroke, and to estimate effect sizes for a larger study.

Methods:
A quasi-experimental nonequivalent comparison group design was used to randomize 44 women to the SAS intervention group (n =23) or wait-list comparison group (n = 21). Data were analyzed with Friedman and Wilcoxon Signed-Rank tests to examine the effect of SAS immediately after the intervention (time 2) and one month later (time 3) on (1) perceived self-efficacy to recognize stroke symptoms; (2) perceived self-efficacy for correct action in response to symptoms; (3) ability to name American Stroke Association (ASA) FAST stroke symptoms; (4) ability to identify stroke symptoms presented in written vignettes; and (5) ability to identify appropriate action in response to stroke symptoms presented in written vignettes. Effect size estimates were calculated by converting z scores to
r
.

Results:
The SAS group showed improvement in perceived self-efficacy for correct action in response to stroke at time 2 (Z = -3.090,
p
= .002,
r
= -.46) and time 3 (Z = -3.34,
p
= .001,
r
= -.49); ability to identify stroke symptoms presented in written vignettes at time 2 (ζ = -2.95,
p
= .003,
r
= -.43) and time 3 (ζ = -3.381,
p
= .001, r = -.50); and ability to identify correct action in response to symptoms presented in written vignettes at time 2 (ζ = -2.179,
p
= .03,
r
= -.32) and time 3 (ζ = -3.018,
p
= .003,
r
= -.44). No improvement was found in ability to name ASA FAST symptoms or perceived self-efficacy to recognize stroke symptoms.

Conclusions:
An online stroke awareness intervention incorporating videos of actors portraying stroke onset showed efficacy to improve stroke awareness among African American women. Testing in a randomized clinical trial is warranted.
Abstract WP216: "BEAST" at the University of Virginia: Demographic and Phenotypic Data of Patients Contributing to a Biorepository to Establish the Etiology of Sinovenous Thrombosis
Authors: Chiota-McCollum Nicole A , Ehrlich Matthew , Johansen Michelle , Rahman Shareena , Chapman Smith Sherita , Worrall Bradford B
Published: June 2021

Introduction:
Cerebral venous sinus thrombosis (CVST) occurs in 3-4 per 1 million individuals per year, accounting for approximately 1% of all strokes. Multiple etiologic risk factors for CVST have been identified, with known inherited thrombophilias accounting for 22% of cases. In 15% of cases, no known risk factor is identified. Studying the genetics of CVST holds the potential to identify at-risk groups, determine disease severity and prognosis, and consider novel therapies. BEAST is an international effort to identify genetic determinants of CVST, from which a recent discovery genome-wide association study (GWAS) identified 2 new associated loci.

Methods:
We are enrolling patients at least 18 years of age with a diagnosis of CVST who are willing to provide informed consent and a biospecimen to a central DNA repository. Patients are identified prospectively in clinical practice, and retrospectively using the Univ of Virginia clinical data repository.

Results:
Since 2012, twenty-eight patients have been enrolled. Demographic and phenotypic data are presented in the Table. Patients range in age from 19 to 65 years, with a mean of 40.5 (SD 14). Headache was the most common presenting symptom, occurring in 60%, followed by seizure (25%), mental status disturbance (21%), aphasia (11%) and mono- or hemiparesis (7%). Imaging revealed focal cerebral edema and/or venous infarction in 7 patients (25%) and hemorrhage in 5 patients (18%); no arteriovenous fistulae were identified. Acute treatments included intravenous or low molecular weight heparin (25/28, 89%) and anti-epileptic medications (7/28, 25%); three patients underwent local thrombolysis or endovascular intervention (11%).

Conclusion:
Understanding the association between phenotype and genetic determinants of CVST has the potential to advance the diagnosis and management of this challenging entity. Enrollment in BEAST continues and a replication cohort GWAS is anticipated in the near future.
Abstract WP217: Association Between Atrial Fibrillation and Spinal Cord Infarction
Authors: Mir Saad A , Pishanidar Sammy D , Merkler Alexander E , Navi Babak B , Kamel Hooman
Published: June 2021

Introduction:
Spinal cord infarction (SCI) is a rare ischemic event comprising 1% of all strokes. In many cases of SCI, the cause remains undetermined. Case reports have suggested a relationship between cardiac embolism and SCI, but the association between the most common cause of cardiac embolism, atrial fibrillation (AF), and SCI has not been evaluated.

Hypothesis:
AF is associated with SCI.

Methods:
We performed a retrospective cohort study using inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries. Our predictor variable was AF, ascertained by previously validated ICD-9-CM codes. The primary outcome was SCI, defined as ICD-9-CM diagnosis code 336.1 (vascular myelopathy) among patients who underwent spinal magnetic resonance imaging to rule out a compressive lesion and who did not have a concomitant diagnosis of degenerate joint disease, the most common cause of non-traumatic compressive myelopathy. In sensitivity analyses, we also excluded SCI cases accompanied by codes for traumatic spinal cord injury, spinal cord abscess, or spinal or aortic surgery. Cox proportional hazards analysis was used to assess the relationship between AF and SCI while adjusting for demographic characteristics and vascular risk factors.

Results:
Among 1,638,461 patients with a mean 3.9 years of follow-up, 423,856 had AF and 22 developed SCI. The annual incidence of SCI was 8.2 (95% confidence interval [CI], 4.4-15.4) per million in patients with AF compared to 2.3 (95% CI, 1.3-4.0) per million per year in those without AF. After adjustment for demographic characteristics and vascular risk factors, AF was associated with a higher risk of SCI (hazard ratio [HR], 4.8; 95% CI, 1.7-13.6). The association between AF and SCI persisted or grew stronger after excluding those with concomitant diagnoses of spinal cord injury, spinal abscess, and spinal or aortic surgery.

Conclusions:
In Medicare beneficiaries, AF was associated with increased risk of subsequent SCI. These results suggest the need for a thorough evaluation of potential underlying cardioembolic sources in patients with otherwise unexplained SCI.