bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP283: Incidence of Stroke in Patients with AF and history of Catheter Ablation
Authors: Leavitt Jonas , Gasparis Christopher , Coleman Kristie , Zafeiropoulos Stefanos , Zimmer Ari , Wolf Elliot , Varrias Dimitrios , Epstein Laurence , Mountantonakis Stavros
Published: January 2025

Introduction:
Catheter ablation (CA) is superior to medical therapy in the management of atrial fibrillation (AF). Current guidelines do not take into consideration the history of CA or its outcome when recommending chronic oral anticoagulation (OAC). The current clinical practice of prescribing (OAC) in patients with history of CA and how it relates to CVA is not well described.

Objective:
To investigate patterns, including modifiable and non-modifiable commonalities, in patients with atrial fibrillation and history of catheter ablation experiencing stroke

Methods:
We included patients who underwent a catheter ablation for symptomatic AF between 2014 and 2022 in one of eight hospitals in a large healthcare system and had at least a 1 year follow up after their procedure. A detailed query of our common inpatient and outpatient medical record was performed for medications including prescription and adherence to OAC, as well as occurrence of CVA post ablation.

Results:
Out of 2313 AF patients who underwent CA, 32 (1.4%) had a CVA (6 TIA, 26 stroke) within 5 years of ablation (Table 1). The median follow-up duration for the patient population was 1168 days post-ablation. Catheter ablation was presumed successful in 19/32 patients who experienced a CVA. Of the 32 who had a stroke event, 24 had ischemic strokes, 7 hemorrhagic, and 1 of unknown mechanism. Amongst those who had an ischemic stroke, 10 (41.7%) were cardioembolic. Within the cardioembolic stroke subgroup, 60.0% were on OAC (5 on Apixaban, 1 on Rivaroxaban) at the time of stroke, nearly a third (30.0%) had an elevated PT, and only half had evidence of AF recurrence prior to stroke (Table 2).Patients with CVA compared to those without were younger (Age 64.9 vs 69.6) and more likely to have coronary artery disease, peripheral artery disease, and chronic liver disease (p < 0.05), however they had similar CHADVASC scores (3.09 vs 2.74). In addition, no difference was found in recurrence of AF between the 2 groups. Patients with stroke had a greater 12-month mortality(Table 3).

Conclusions:
CVA occurred in 1.4% of patients with AF within 5 years after AF ablation. This study reports no difference in thromboembolic risk, compliance of OAC and recurrence of AF suggesting that CA might not affect the thromboembolic risk in such a period of time. Further studies are required to assess the effects of CA on long term cardioembolic risk.
Abstract TP285: Risk of Stroke in Patients with Head and Neck Cancer: A Systematic Review and Meta-Analysis
Authors: Liew Eda , Tan Jing Xuan , Low Chen Ee , Yeo Joshua , Goh Doreen Shu Lin , Teo Yao Hao , Teo Yao Neng , Senff Jasper , Sia Ching-Hui , Yeo Leonard , See Anna X , Tan Benjamin KJ , Tan Benjamin YQ
Published: January 2025

Introduction:
Previous studies have observed an increased risk of stroke in head and neck cancer (HNC) survivors. However, whether this risk is amplified with exposure to various treatment modalities including radiotherapy is less certain, as are any potential mechanisms by which this increase in risk is mediated. This study aims to investigate the risk of stroke in patients with HNC and whether cancer type and treatment modalities have varying effects.

Methods:
This PRISMA-adherent systematic review involved a systematic search of PubMed, SCOPUS and Embase for studies reporting stroke incidence in patients with HNC and without prior strokes since inception to April 25,2024. The study protocol was registered prospectively on PROSPERO. The hazard ratios extracted from the studies were pooled for meta-analyses. Random effects meta-analyses and meta-regressions were used for primary analysis. Subgroup analyses and meta-regression were performed to determine if key categorical and hierarchical variables influenced the results. Risk of bias was performed using the Newcastle Ottawa Scale.

Results:
22 studies [EL1] with 5,093,445 patients were included. The meta-analyses of nine studies showed that the risk of stroke was increased in patients with HNC compared to healthy controls (HR=1.45; 95%CI: 1.27-1.65, I2: 20%). Subgroup analyses demonstrated that the risk of stroke was significantly increased in HNC patients treated with radiotherapy alone compared to those treated with surgery alone (HR=1.66; 95%CI: 1.35-2.03, I2: 0%). Subgroup analyses also revealed an increased risk of stroke in HNC patients who had undergone any radiotherapy compared to HNC patients who had not undergone radiotherapy in the past (HR=1.47; 95%CI: 1.29-1.68, I2: 60%).

Additionally, HNC patients who had undergone definitive chemoradiotherapy had increased risk of stroke compared to HNC patients who had undergone definitive surgery with or without adjuvant chemoradiotherapy (HR=1.28; 95%CI: 1.09-1.49, I2: 86%).

Conclusion:
We report an increased risk of stroke in HNC patients, which is consistently raised when compared with the general population. This risk is more significant in patients who had undergone radiotherapy. Future research should aim to understand the pathogenesis of stroke in HNC patients and the effect of different treatment modalities on stroke risk to develop effective preventive strategies, thereby guiding the management for patients with HNC.
Abstract TP287: Prolyl Hydroxylase Inhibitor Desidustat Improves Stroke Outcomes by Enhancing Microglial Efferocytosis in Mice with Chronic Kidney Disease
Authors: Kaur Harpreet , Pandey Nilesh , Chandaluri Lakshmi , Martinez Alexa , Kshirsagar Samadhan , Patel Vishal , Stokes Karen , Orr Wayne , Yurdagul Arif , Rom Oren , Mohandas Rajesh , Jain Mukul , Joharapurkar Amit A , Dhanesha Nirav
Published: January 2025

Background:
Chronic kidney disease (CKD) is a known risk factor for stroke that leads to significant long-term disability. Efferocytosis, the process by which microglia engulf and clear apoptotic cells, is essential for stroke recovery. However, its impairment can hinder recovery and worsen the outcomes. Desidustat, an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor, has emerged as a promising treatment for anemia associated with CKD. Despite its clinical potential, its effects on microglial efferocytosis and subsequent effects on stroke recovery have not yet been studied.

Objective:
To evaluate the mechanistic role of desidustat in mitigating CKD-induced defective microglial efferocytosis and enhancing sensorimotor recovery following embolic stroke.

Methods:
CKD was induced in adult C57BL/6 mice by oral administration of adenine (50 mg/kg) for 28 days. Acute Ischemic stroke was induced in mice with CKD using an embolic model. Sensorimotor function tests (modified neurological severity score and corner test) were performed for up to 4-weeks post-stroke. Inflammation, apoptosis, and the effect of CKD on microglial efferocytosis following stroke were assessed 72 h post-stroke using in vitro and in vivo functional assays. Desidustat 15 mg/kg was administered orally starting on day 14 of adenine treatment and continued for 28 days post-stroke in mice with CKD. Human-induced microglial cells were used to evaluate the mechanistic role of desidustat in promoting efferocytosis of apoptotic neurons.

Results:
Mice with CKD exhibited elevated blood urea nitrogen and creatinine levels, accompanied by tubulointerstitial abnormalities and vascular fibrosis in the kidneys. Stroke induction in mice with CKD resulted in increased cerebral inflammation and reduced microglial efferocytosis 72 h post-stroke which was concomitant with worse neurological outcomes and sensorimotor function tests for up to 4 weeks as compared to controls. Desidustat treatment significantly reduced cerebral inflammation and enhanced microglial efferocytosis (72 h post-stroke) and improved neurological recovery and sensorimotor function for up to 4 weeks. In vitro mechanistic studies revealed that desidustat directly enhanced efferocytosis in a human microglial-neuronal co-culture assay.

Conclusion:
Our results demonstrated that desidustat treatment enhances microglial efferocytosis and improves neurological outcomes and sensorimotor deficits following ischemic stroke in mice.
Abstract TP288: Prevalence and Gender Differences in Carotid Atherosclerosis Among Adults: Evidence from a Cohort Study in China
Authors: Li Yapeng , Ma Mingze , Dong Xiaokang , Xu Yuming
Published: January 2025

Introduction:
Stroke ranks as the second leading cause of death globally and the foremost in China, contributing significantly to the nation’s disease burden. Carotid atherosclerosis (CAS) is a critical precursor to atherosclerotic cardiovascular disease and is closely associated with the development and progression of conditions such as stroke and poor prognosis. Despite its importance, data on the prevalence of CAS among adults (age 18 years and above) remain limited. This study aimed to determine the current prevalence of CAS and examine the associated gender differences in adults.

Methods:
From September 2021 to June 2022, we established a prospective cohort to study CAS and cardiovascular disease across 25 project sites in Henan, China, utilizing a multistage whole-population sampling method. Residents aged 18 years or older in the sampled areas were included in this study, and data were collected through questionnaires, physical examinations, laboratory tests, carotid ultrasound examinations, and biological sample collection. A consent information platform for data collection and quality control management was also developed. This study was approved by the Ethics Committee for Scientific Research and Clinical Trials of the First Affiliated Hospital of Zhengzhou University (No. 2021-KY-1289-001).

Results:
Among the 36,403 participants (14,676 males, 40.3%), the prevalence of stroke, heart disease, hypertension, diabetes mellitus, and dyslipidemia was 7.4%, 6.4%, 55.7%, 17.3%, and 40.2% respectively. After age standardization, the prevalence of cIMT, carotid plaque, and carotid stenosis was 23.24%, 16.75%, and 2.36%, respectively, with moderate to severe carotid stenosis observed in 0.49% of all participants. Additionally, the gender-stratified analysis revealed that carotid atherosclerosis was more severe in males, who exhibited higher rates of cIMT, plaque, stenosis, and moderate to severe stenosis compared to females (41.20% vs. 31.37%, 38.91% vs. 27.11%, 5.08% vs. 3.04%, and 1.49% vs. 0.69%, respectively).

Conclusions:
In conclusion, our study highlights that intima-media thickening and plaques are more prevalent in adult carotid arteries, with a significantly higher prevalence in males. These findings provide valuable evidence for authorities to implement health policies and identify high-risk populations, aiming to prevent the occurrence of stroke in both the general population and high-risk groups.
Abstract TP309: Differences in ischemic stroke hospitalizations and risk factor prevalence by age, sex, and race/ethnicity: Findings from the Get With The Guidelines (GWTG)-Stroke Registry, 2010-2021
Authors: Lichtman Judith , Chang Tiffany , Salinas Yasmmyn , Howard Virginia , Towfighi Amytis , Fonarow Gregg , Reeves Mathew , Goldstein Larry , Leifheit Erica
Published: January 2025

Introduction:
A nation-wide stroke surveillance system is not available in the US, limiting analyses to identify subgroups at disproportionate risk for ischemic stroke (IS). These data are needed to help inform targeted interventions to improve primary stroke prevention in high-risk populations. We assessed trends in IS hospitalizations and risk factor prevalence by age, sex, and racial/ethnic subgroups using data from GWTG-Stroke.

Methods:
The sample included patients discharged from GWTG-Stroke participating hospitals in 2010-2021 with a final diagnosis of IS. We conducted a stratified analysis to determine the proportionate composition and temporal trends in IS hospitalizations by race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, or Other), sex (women, men), and age (18-44, 45-64, 65+ y). We then used logistic regression to calculate the unadjusted prevalence odds for 10 stroke risk factors for the different race/ethnic, sex, and age groups.

Results:
There were 4,229,981 IS hospitalizations (mean age 70.1±14.4 y, 49.8% women) from 2,771 hospitals. The Hispanic and Other groups comprised an increasingly greater proportion of total IS hospitalizations over the study period in both women and men and in all age groups (P for trend <0.001;
Figure 1
). Within each racial/ethnic group, hospitalizations for IS were particularly high for younger (i.e., age <65 y) NHB men (53% of hospitalizations), Hispanic men (47% of hospitalizations), and NHB women (43% of hospitalizations), as compared to NHW women and men (25% and 35% of hospitalizations, respectively;
Figure 2
). The prevalence odds of common stroke risk factors including hypertension, diabetes, and overweight/obesity were higher for NHB vs NHW subgroups (e.g., NHB women 18-44 y OR 2.71 [95% CI 2.63-2.79] for hypertension, 1.90 [1.83-1.96] for diabetes, 1.24 [1.20-1.28] for overweight/obesity; NHB men 18-44 y OR 2.33 [2.26-2.40] for hypertension, 1.71 [1.65-1.77] for diabetes, 1.09 [1.05-1.13] for obesity/overweight) and Hispanic vs NHW subgroups (e.g., Hispanic women 18-44 y OR 1.22 [1.17-1.28] for hypertension, 1.69 [1.61-1.77] for diabetes; Hispanic men 18-44 y OR 1.22 [1.18-1.27] for hypertension, 1.83 [1.75-1.92] for diabetes;
Figure 3
).

Conclusions:
Stroke prevention efforts particularly targeting hypertension, diabetes, and overweight/obesity in younger NHB and Hispanic women and men may provide an opportunity to address their disproportionately high hospitalizations for IS.
Abstract TP313: Lipoprotein(a) Concentrations and prognosis of ischemic stroke
Authors: Jin Aoming , Xue Jing , xu jie
Published: January 2025

Background:
Lipoprotein(a) (lp(a)) concentrations is an independent risk factor of atherosclerotic cardiovascular disease (ASCVD). The association between lp(a) and prognosis of ischemic stroke patients is uncertain.

Hypothesis:
The study is aimed to investigate the shape and the association of the risk of short-term and long-term stroke recurrence across the distribution of lp(a) concentrations, and explore whether combining ASCVD risk has an influence on the association.

Method:
Patients with acute ischemic stroke within 7 days in the Third China National Stroke Registry (CNSR-III) having lp(a) measurements were included in the study. The outcomes were stroke recurrence within one year and two years. ASCVD risk included diabetes mellitus, stroke history and early onset. Based on ASCVD risk and lp(a) concentrations, there were four groups: lp(a)<30 mg/dL, lp(a) 30-70 mg/dL without ASCVD risk, lp(a) 30-70 mg/dL with ASCVD risk, and lp(a) >70 mg/dL without ASCVD risk. To display the shape of the relationship between lp(a) and stroke recurrence within two years, lp(a) concentrations were modeled using natural cubic splines with median concentration serving as the reference adjusted by confounders. And the association was assessed using Cox proportional hazards models and Kaplan-Meier curves.

Result:
Among 9952 included patients with the mean age of 63 years and 69% of male, the median lp(a) concentrations was 18.06 (inter-quartile range, 8.85-35.66) mg/dL. The relationship between lipoprotein(a) and stroke recurrence appeared linear across the distribution. Compared to patients with lp(a)<50 mg/dL, lp(a)>=50 mg/dL was associated with a higher risk of stroke recurrence (adjusted HR for one-year outcome:1.19, 95%CI: 1.01-1.41, p =0.04; adjusted HR for two-year outcome:1.21, 95%CI: 1.04-1.40, p =0.01). Compared to patients with lp(a)<30 mg/dL, lp(a) 30-70 mg/dL combined with ASCVD risk was associated with a higher risk of stroke recurrence (HR:1.21, 95%CI: 1.04-1.42, p =0.03), but no increased risk was found in patients with lp(a) >70 mg/dL without ASCVD risk (HR:0.90, 95%CI: 0.65-1.26, p =0.55).

Conclusion:
Lipoprotein(a) concentrations was associated with short-term and long-term prognosis of ischemic stroke, with a linear risk gradient across the distribution. Baseline ASCVD risk may influence the association between lp(a) and stroke recurrence.
Abstract TP315: Heterogeneity in Stroke Prevalence Among Asian American Subgroups in California
Authors: Ding Xueting , Castro Megan , Albala Bruce , Boden Bernadette
Published: January 2025

Introduction:
While Asian populations appear healthier than non-Hispanic Whites overall, recent studies have highlighted significant health disparities within Asian subgroups in the US. However, most US health databases aggregate Asians into broader categories, limiting understanding of subgroup-specific risks. This study aims to investigate the disparity in stroke risk among Asian subgroups in California – a state where nearly 30% of U.S. Asians live.

Methods:
We analyzed 2013-2019 Behavioral Risk Factor Surveillance System (BRFSS) data from California. Stroke prevalence was determined by self-reported diagnosis. Asian subgroups were categorized as East Asian (Chinese, Japanese, Korean), South Asian (Indian, Pakistani), Southeast Asian (Filipino, Vietnamese, Cambodian), and Other Asian. Logistic regression models examined odds of stroke prevalence by Asian broadly and detailed categorized subgroups using non-Hispanic Whites as the reference and adjusting for age and sex.

Results:
Among 1,768 Asian participants, females comprised 47% overall, ranging from 37% (South Asians) to 52% (Southeast Asians). The mean age for all Asians is about 42 years, and the subgroups show similar results. Detailed subgroups showed Filipinos had the highest female proportion (54%) and Indians the lowest (36%). Age distribution showed Japanese were oldest (52 years) and Cambodians youngest (37 years). After adjusting for age and sex, East Asians demonstrated significantly lower odds of stroke prevalence (OR=0.43; 95% CI: 0.24-0.77) compared to non-Hispanic Whites. Southeast Asians had increased stroke risk (OR=1.17), although non-significant. In detailed subgroup analysis, Chinese showed lower stroke prevalence (OR=0.39; 95% CI: 0.17-0.87), while Cambodians had significantly higher prevalence (OR=4.43; 95% CI: 1.02-19.23).

Conclusions:
Our findings reveal significant heterogeneity in stroke prevalence among Asian American subgroups in California. The fluctuation in results underscores the importance of disaggregated analyses in stroke research, and future research should expand upon these findings to uncover the underlying causes in the variance. This study is the beginning of an important roadmap to mitigating stroke disparities in Asian populations by tailoring stroke prevention and treatment methods to specific Asian subgroups, rather than integrating all subgroups into a singular broad category.
Abstract TP34: Association between Acute Stage Blood Pressure Variability and Post-Stroke Cognitive Impairment in Atrial Fibrillation-Related Acute Ischemic Stroke
Authors: Lee Minwoo , Cheon Dae Young , Choi Sang Won , Kim Yerim
Published: January 2025

Background:
Elevated blood pressure variability (BPV) has been associated with worse outcomes in stroke survivors. This study aimed to investigate the relationship between systolic and diastolic BPV and post-stroke cognitive impairment (PSCI) in patients with acute cardioembolic stroke due to atrial fibrillation.

Methods:
Using data from a prospective stroke registry, we consecutively enrolled 143 patients with acute cardioembolic stroke. Cognitive function was evaluated three months post-stroke using the Korean version of the Vascular Cognitive Impairment Harmonization Standards. PSCI was defined as a z-score of less than -2 standard deviations for age, sex, and education-adjusted means in at least one cognitive domain. Multiple logistic regression was used to assess the association between BPV during the first 7 days of admission and PSCI, adjusting for age, sex, education, vascular risk factors, initial stroke severity, and neuroimaging characteristics.

Results:
Among the 143 participants (mean age 70 years; 60.1% male; median initial NIHSS score of 5), PSCI was identified in 67 patients (46.9%). The standard deviations of both systolic and diastolic blood pressures were significant predictors of PSCI (aOR 1.09; 95% CI 1.01–1.17 and aOR 1.14; 95% CI 1.01–1.29, respectively). The mean values of both SBP and DBP were also significantly associated with PSCI.

Conclusions:
Our findings demonstrate that both systolic and diastolic BPV in the acute phase of cardioembolic ischemic stroke are independently associated with PSCI at three months. These results underscore the importance of monitoring and managing blood pressure variability in the acute stroke setting to reduce the risk of cognitive decline.
Abstract TP35: Age-dependent activation of Cellular Senescence in the Penumbra Contributes to Stroke Injury
Authors: Ouvrier Blake , Ismael Saifudeen , Bix Gregory
Published: January 2025

Introduction:
Ischemic stroke is a devastating brain injury and a leading cause of mortality and morbidity worldwide. Age is the most influential co-morbidity, modulating stroke severity, occurrence, and cognitive impact. We have previously found that stroke causes a marked increase in cellular senescence and senescence-associated secretory phenotype (SASP). In the aged brain, cells develop into SASP which induces neuroinflammation and further transform the healthy cell to senescent cells (SC) via paracrine signaling. Although there is a baseline amount of SCs in the aged brain, accumulating evidence suggests that pathological insults, such as stroke, traumatic brain injury, infection, cause a stress-induced premature senescent (SIPS) event. This event forces the healthy cells into SC’s, propagating brain injury and weakening neuroprotective mechanisms via release of SASP markers. However, the role of SC’s in the penumbra development has not yet evaluated.

Hypothesis:
Senescent cells and SASP originating from the ischemic core induce a senescent penumbra, which contributes to ischemic damage in an age-dependent manner.

Methods:
Middle cerebral artery occlusion was induced in young (7 weeks) and aged (16 months) C57 male mice using the photothrombotic model. Sham and stroked brains were perfused and then hemispheres were harvested and fresh frozen separately for protein and mRNA analysis of markers of SASP, senescence, and inflammation by western blot, qPCR, and immunofluorescence.

Results:
Induction of stroke causes increased expression of key markers of cellular senescence such as IL-1α, IL-6, p21, p16 and CXCR2 in the ischemic penumbra. This expression is more pronounced in the young- stroked mice than the aged-stroked mice compared to age-matched sham mice with comparable infarct volume. Stroke did not cause further increase in SASP significantly in aged animals.

Conclusion:
Senescence and SASP in the peri-infarct area are greatly associated with stroke in an age-dependent manner. Therefore, senescent cells in the penumbra are a key contributor to post-stroke brain injury. Modulation of Senescence and SASP would be a therapeutic avenue for the management of severity of post-stroke brain.
Abstract TP382: Genome-wide DNA Methylation Profiling Reveals Low Methylation Variability in Moyamoya Disease
Authors: Cheng Michelle , Tokairin Kikutaro , Ito Masaki , Lee Alex , Teo Mario , He Shihao , Steinberg Gary
Published: January 2025

Background:
Moyamoya disease (MMD) is a chronic cerebrovascular disorder that can affect both children and adults. It is characterized by chronic and progressive narrowing of the cerebral arteries and the formation of fragile collateral blood vessels. The narrowed arteries can lead to lead to stroke and neurological dysfunctions. Considering that MMD is mostly sporadic and gene-environment interactions play an important in various diseases, we sought to investigate epigenetic modifications in MMD, focusing specifically on changes in DNA methylation magnitude and variability.

Methods:
We performed genome-wide DNA methylation using Illumina 850K Methylation EPIC BeadChip, in two racially distinct adult female cohorts: A Non-Asian cohort (13 MMD patients and 7 healthy controls) and an Asian cohort (14 MMD patients and 3 healthy controls). An additional external cohort with both sexes (females: 5 MMD patients and 5 healthy controls, males: 5 MMD patients and 5 healthy controls) was included for validation.

Results:
Our findings revealed subtle changes in the magnitude of DNA methylation, but a strikingly low DNA methylation variability between MMD patients and healthy controls across both female MMD cohorts. In the Non-Asian cohort, only 6 probes showed increased variability, compared to 647 probes that showed decreased variability. Similarly, in the Asian cohort, the MMD group also displayed a reduced methylation variability across all 2845 probes. Further analysis showed that these differentially variable probes are associated with genes involved in key biological processes such as methylation and transcription, DNA repair, cytoskeletal remodeling, natural killer cell signaling, cellular growth, and migration.

Conclusions:
These findings mark the first observation of low methylation variability in any disease, contrasting with the high variability observed in other disorders. This reduced methylation variability in MMD may impair patients’ adaptability to environmental changes, such as hemodynamic stress, thereby disrupting vascular homeostasis and contributing to MMD pathology. These findings offer new insights into the mechanisms of MMD and suggest potential avenues for treatment strategies.
Abstract TP388: Integrating standard-of-care clinical stroke workup within in silico embolic stroke models for etiology disambiguation
Authors: Roopnarinesingh Ricardo , Mukherjee Debanjan , Majee Sreeparna , Cao Kelly , Rinkel Leon , Coutinho Jonathan
Published: January 2025

Introduction:
Embolic Stroke of Undetermined Source (ESUS) accounts for a critical proportion of all ischemic strokes. Disambiguating embolism etiology is important to improve treatment efficacy and reduce recurrent events. Patient-specific in silico models can shed valuable insights on embolus source-destination mapping. This requires reliable and accurate pre/post-stroke hemodynamic models, which benefit from integrating multiple modes of patient information from imaging and clinical records. This is a major state-of-the-art challenge. Here, we present a workflow for multi-modal data integration from standard-of-care workup towards recreating a data-rich digital twin of stroke patients.

Methods:
Our workflow integrates non-contrast and contrast-enhanced head-neck CT and cardiac CT, trans-thoracic echo, and perfusion imaging, along with clinical variables such as HR, systolic/diastolic volumes, and stroke locations (with NIHSS scores). Quantitative data from these sources are then integrated into a hemodynamic model by processing features such as arterial structure, inlet flow, tuned resistance boundary conditions, cardiac timing, and stroke location. Resulting hemodynamic data was used to further simulate embolus movement towards stroke site. Statistical sampling simulations using this model were conducted to evaluate the likelihood that an occlusion location corresponded to cardiogenic, aortogenic, or other arterial sources.

Results:
We present our complete in silico workflow, and demonstrate the outcomes using a small cohort of 5 patients acquired from a clinical database (anonymized, IRB exempt). We demonstrate that the workflow yields high-resolution space-time varying patient hemodynamic patterns. Additionally, the embolus source-destination likelihood mapping provides detailed quantitative insights on the embolism etiology in these stroke patients. These findings indicate that our workflow and resulting digital twins can be a valuable tool in addressing the current clinical challenges in discerning embolism etiology in ESUS cases.

Conclusions:
We introduce a pipeline of transforming raw patient-specific information from multi-modal imaging and clinical parameters into a cohesive, data-rich in silico model for embolic stroke comprising the full heart-to-brain pathway. This offers a flexible digital twin approach for elucidating stroke etiologies in patient-specific scenarios.
Abstract TP401: Impact of tissue Plasminogen Activator on thrombus weight and composition.
Authors: Sakuta Kenichi , Ghovvati Mahsa , Guo Lea , Tsukagoshi Eisuke , Imahori Taichiro , Kaneko Naoki
Published: January 2025

Background and Purpose:
In the current era, where mechanical thrombectomy (MT) has become the gold standard for treating large vessel occlusions in acute ischemic stroke, the role of intravenous tissue plasminogen activator (tPA) remains pivotal. It is well-established that pre-thrombectomy administration of tPA can enhance recanalization rates and excellent outcomes, leading to an increased adoption of this combined treatment approach. Understanding how tPA alters clots occluding large vessels is of crucial clinical importance for improving outcomes in thrombectomy when tPA is combined. This study seeks to elucidate the temporal changes in clots characteristics post-tPA administration, providing insights that could optimize the timing and strategy of subsequent mechanical intervention.

Methods:
We utilized a modified Chandler loop technique to generate RBC-rich clots from ovine blood for simulating clot analogs. The clots were treated with 10 μg/ml concentration of Alteplase to evaluate clot dissolution. An in-vitro MCA occlusion model, replicating human neurovascular anatomy, was used to assess the impact of clot treatment under dynamic flow conditions. Clots were analyzed for weight changes before and after treatment, and detailed pathological analyses were conducted using advanced imaging techniques. Statistical significance was determined using Student t test and 2-way repeated-measures ANOVA, with p-values <0.05 considered significant. All analyses were performed using SPSS software.

Results:
In the tPA group, clot weight decreased over time, with an average reduction to 46.7% of the initial value after 1 hour of solution exposure. In contrast, the control group showed relatively stable clot weight, remaining around 80% throughout the 1-hour exposure (P<0.001). Figure showing fhe fibrin content of the clot in the tPA group decreased significantly from 10.3% to 4.5% over time (P=0.038), whereas in the control group, it remained relatively unchanged, going from 7.3% to 8.1% (P=0.868).

Conclusion:
This study confirmed that tPA effectively reduces clot weight and decreases the fibrin content within clots. Our results suggest that tPA administration not only reduces clot mass but also modifies its structural integrity, thereby potentially increasing the success rate of subsequent mechanical thrombectomy procedures.
Abstract TP42: Chronic cerebral hypoperfusion impairs brain iron metabolism in aged mice
Authors: Monga Sheelu , Moruno-Manchon Jose
Published: January 2025

Introduction:
Aging and chronic cerebral hypoperfusion (CCH) are major risk factors for Vascular contribution to cognitive impairment and dementia (VCID), which is a heterogeneous group of disorders characterized by cognitive deficits secondary to cerebrovascular pathology. Importantly, patients with CCH show enhanced brain iron deposition and iron metabolism dysregulation, which have been associated with different types of dementia and neurodegenerative disorders, such as Alzheimer’s disease, Huntington’s disease, VCID, etc. Recent studies have proposed different mechanisms involved in VCID induced by CCH in young small rodents. However, no study has elucidated the molecular changes that occur in CCH models using aged animals. Thus, we hypothesize that brain iron metabolism is dysregulated in an aged mouse model of VCID.

Methodology:
We induced CCH through bilateral carotid artery stenosis (BCAS) by ligating carotid arteries with 0.18 mm diameter coils in 17-18 months C57BL/6 mice of both sexes. Sham mice underwent the same surgery without coil ligation. After surgery, mice were maintained for 5 months; then, they were tested for open field, elevated plus maze, and fear conditioning. After behavior tests, their brains were analyzed for histochemistry analysis and qPCR.

Results:
We observed that BCAS mice showed increased velocity (p=0.016) and distance moved (p=0.009) in the open field test, and they showed a higher number of visits to open arms (p=0.026) in the elevated plus maze, compared with sham mice. Furthermore, the percentage of freezing time in the fear conditioning test was significantly reduced in BCAS mice (p=0.037), compared with sham mice. We also found that the number (p=0.039) and size (p=0.003) of iron deposits increased in the striatum of BCAS mice, compared with sham mice. Interestingly, the relative expression of genes involved in iron metabolism such as
Ncoa4
(codes mediator of ferritinophagy) and
Ftl1
(coding for iron storage protein ferritin light-chain), were significantly reduced (p=0.007, p=0.001, respectively) in the striatum, but not in the cortex, of BCAS mice, compared with sham mice.

Conclusion:
Our data indicates that BCAS mice showed enhanced anxiety-like behavior and impaired conditioning memory, increased iron deposition, and impaired iron metabolism in their striatum, compared with sham mice. Next, we will determine if restoring brain iron metabolism in BCAS mice can mitigate CCH-induced phenotype.
Abstract TP48: Cognitive Impairment After Incident Stroke in The Cameron County Hispanic Cohort
Authors: Musfee Fadi , North Kari , Fisher-hoch Susan , McCormick Joseph B , Savitz Sean
Published: January 2025

Introduction:
Vascular cognitive impairment and vascular dementia are diagnosed based on brain vascular changes related to strokes. However, the change in cognitive function in the same individual before and after strokes is not well-documented especially among Hispanics. We examined the intra-individual cognitive performance before and after an incident stroke in a longitudinal cohort of Hispanics (Cameron County Hispanic Cohort (CCHC)). CCHC participants were recruited randomly for reasons other than strokes and were followed every 5 years for up to 20 years.

Methods:
We conducted a prospective study to measure cognitive function changes among those presented with incident stroke. Strokes were self-reported and we used mini-mental score test (MMSE) to asses for cognitive impairment at each visit. Incident strokes were identified after excluding all those who reported the presence of a stroke at their first visit. We measured intra-individual cognitive performance via paired student t-test by comparing MMSE scores before and after incident stroke in the same individual. We conducted a prospective longitudinal study using mixed linear models adjusted for age and education to assess for associations of MMSE scores with several cardiometabolic indicators among those who had an incident stroke. All analyses were preformed using R software.

Results:
We identified 87 incident strokes (total N=4692) in the CCHC. Subjects with strokes had a mean (sd) age of 61.4 (13.9) and a mean (sd) MMSE score of 26.7 (4.47). Over half of the subjects with strokes were females (55 (63.2%)), diabetic (44 (50.6%)), hypertensive (58 (66.7%)), and had metabolic syndrome (44 (50.6%)). Although the mean (median) MMSE scores for after strokes (25.50(27.00)) were lower compared to pre strokes (26.16(28.00); there were no statistically significant changes in the intra-individual MMSE scores before and after strokes (p value >.05). Mixed linear models adjusted for age and education showed that diabetes (Beta: -1.4, 95%CI: - 0.14 - -2.73) to be significantly associated with a lower cognition function in those with strokes.

Conclusions:
Although there were no significant changes in intra-individual MMSE scores before and after a stroke; our adjusted models showed that diabetes was significantly associated with a lower cognitive function among our stroke cohort. The use of self-reported strokes, and our small sample size might bias our results towards the null.
Abstract TP50: Improvement in Alteplase Administration Time in Rural Emergency Department
Authors: Parks Patti
Published: January 2025

Background and Issue:
The rural, critical access emergency department (ED) team was not consistently meeting the door-to-needle goal of 45 minutes for alteplase administration to acute stroke patients. The team’s process was ineffective in preparing for alteplase administration, resulting in delays in the administration of the thrombolytic.

Purpose:
The quality improvement project aimed to create a new, consistent process to administer alteplase to acute stroke patients promptly.

Methods:
There was a delay in acute stroke patients receiving alteplase after arrival to the rural, critical access ED. All stroke activations were reviewed as per the program’s guidelines. During the review, specific patterns were identified as barriers to meeting the program’s goals. It was noted that staff were accessing the automated medication cabinet multiple times for medications. The staff would retrieve the alteplase from the cabinet after the order was entered into the electronic medical record and then return to the cabinet to remove antihypertensives to treat the patient’s blood pressure before the alteplase administration. The action plan focused on creating a new process of establishing a virtual alteplase kit, which included two antihypertensive medications, in the automated medication cabinet. A stroke team member would retrieve the alteplase kit from the automated medication cabinet when the stroke activation was announced. While the patient was receiving the computed tomography exam, the team mixed the alteplase and prepared it for administration. Upon returning to the ED, the team obtained the patient’s weight and anticipated the alteplase order. Once the order was submitted by the physician and verified by the pharmacist, the team proceeded to administer the appropriate dose of alteplase.

Results:
Developing the virtual kit and the consistent process of retrieving the kit and early mixing of the alteplase in stroke activations, led to the team meeting the goal for alteplase administration. Before implementing the new process, the team met the alteplase door-to-needle goal 40% in one year. With the implementation of the consistent process and the virtual kit, the team met the door-to-needle goal 67% in less than a year.

Conclusion:
Implementing a standardized process in the rural, critical access emergency department decreased the door-to-needle time of the administration of alteplase, provided streamlined patient care, and improved patient outcomes.
Abstract TP52: Thunderstruck: The Power of Staff Recognition to Decrease Door-to-Needle Times
Authors: Djakovic Mirjana , Rainey Joy , De Lauriea Margaret , Wadina Adam , Abdul Azeem Mohammad
Published: January 2025

Background:
Door-to-thrombolytic therapy time is critical in acute stroke management, affecting treatment effectiveness and patient outcomes. Enhancing processes to minimize this time is essential for improving patient outcomes. Since 2022, our door-to-IV thrombolytic time has remained stagnant. Our current program goal is to achieve a Door to Needle (DTN) time of less than 45 minutes (min) in 80% of patients, provided there are no documented barriers beyond program's control. After considering various initiatives to reduce DTN times, the program has decided to pilot the use of meaningful recognition.

Purpose:
This study aims to use meaningful multidisciplinary recognition to reduce DTN administration times, thereby improving the overall efficiency and effectiveness of acute stroke care.

Methods:
Beginning January 1, 2024, the 'Lightning Award' was introduced to recognize the multidisciplinary team achieving the fastest DTN time of the month, specifically under 45 min. The multidisciplinary team consisted of emergency room physician, vascular neurology attending and resident, emergency room nurse, pharmacist, and computed tomography (C.T.) technologist. The team with the fastest DTN time was recognized during the Stroke and Emergency Department Quality Improvement Meetings, where they were presented with a certificate and a commemorative pin.

Results:
Data on DTN administration times were collected from electronic health records over 8-month period (January 1 to August 1, 2024). A total of 28 cases were analyzed, revealing a median DTN time of 42 min. This represents a significant improvement compared to the median DTN time of 55 min in 2022, reflecting a 23.6% reduction in time. Furthermore, in 2022, only 29% of patients achieved a DTN time within the 45 min window. However, following the introduction of the "Lightning Award" in 2024, the proportion of patients meeting DTN within 45 min benchmark increased to 61%. This improvement highlights the positive impact of the multidisciplinary recognition initiative on optimizing stroke treatment times.

Conclusion:
The "Lightning Award" initiative improved DTN times in acute stroke care, reducing the median DTN time by 23.6% and increasing the percentage of patients treated within 45 min from 29% to 61%. These findings highlight the effectiveness of multidisciplinary recognition in enhancing stroke treatment efficiency and suggest the potential for similar initiatives in other time-sensitive areas of healthcare.
Abstract TP54: In Hospital Stroke Alert: Impact of One-on-One Education
Authors: Patterson Michele , MOORE TRACY , Sanchez Briana
Published: January 2025

Background:
Comprehensive Stroke Center assigned annual education using self-learning [SL] via an online learning system [OLS] with post-test upon completion. Education for all staff included BE FAST to remember stroke symptoms and immediate actions to take when recognized for in-hospital stroke alert activation [IH-SA-A]. “BE FAST Fridays” [BFF] were implemented May 2024 and voluntary in-person, one-on-one education [1:1E] was conducted every Friday to assess current knowledge, review BE FAST and actions to take for IH-SA-A. The teach-back method was used to assess overall understanding. Flyers and day-of-event overhead announcements were shared for staff awareness. Event was held in the hospital front lobby for visibility. Breakfast and stroke t-shirts were provided after completing 1:1E. Designated “BE FAST Office Hours” [BFOH] were implemented June 2024 to allow for ongoing 1:1E.
PURPOSE
Evaluate the impact of SL via an OLS and 1:1E conducted through BFF and BFOH on IH-SA-A.

Method:
Retrospective review of 1,202 education records in 2024 was conducted to determine total 1:1E participation. Participants were grouped as re-education [1:1E after SL] and initial education/new staff [1:1E only] for analysis. Retrospective review of 54 IH-SA-A was conducted to determine those that occurred before 1:1E [PRE] Jan 2022-April 2024 and after 1:1E [POST] May-July 2024. POST IH-SA-A were evaluated for 1) positive brain imaging [PBI]; 2) transfer to higher level of care [THLC]; 3) thrombolytic administration [TA]; and 4) mechanical thrombectomy [MT]. All groups were divided into hospital departments [HD] for analysis.

Results:
Total participants 655, included 76% 1:1E after SL and 24% 1:1E only. Highest number of participants and 1:1E after SL were PACU/Adult Units [P/A], Women’s Services [WS], and Other Staff [OS]. Highest number of 1:1E only were P/A and OS. IH-SA-A increased from monthly average of 1.57 PRE to 3.33 POST with increases in all HD. Largest increase was in Stroke Unit and P/A. WS had 1 IH-SA-A POST after having 0 PRE. Outcomes of POST IH-SA-A included 50% PBI, 63% THLC, and 10% MT.

Conclusion:
Education using 1:1E format provided enhanced individualized experiences that resulted in increased BE FAST recognition leading to increased IH-SA-A. While SL provides flexibility for completion and ease of tracking, staff are more likely to benefit from 1:1E that encourages active listening/discussion, allows for questions, and provides targeted feedback.
Abstract TP56: Educational support in the transitional care: a qualitative meta-synthesis of the experiences of caregiver-stroke survivor dyads
Authors: Petrosino Francesco , Bartoli Davide , Trotta Francesca , Vellone Ercole , Alvaro Rosaria , Pucciarelli Gianluca
Published: January 2025

Background and Purpose:
Stroke is the main cause of disability in the adult population. Only 25% of stroke survivors fully recover their prior level of functioning; 75% survive with some form of impairment, and half of them lose their capacity for self-sufficiency, which has a significantly negative impact on their quality of life. The purpose of this study was to to evaluate the impact of customized training interventions on the experience of the caregiver-stroke survivor dyad during the complex transitional care period.

Methods:
A critical interpretative meta-synthesis approach was adopted. Sample selection was guided by the SPIDER framework, while identification of eligible studies was informed by the PRISMA criteria. A comprehensive search was conducted across Scopus, PubMed and CINAHL up to October 2023 to identify all studies examining lived experiences and perceptions of caregivers and stroke survivors regarding the suitability of training supports provided during the pivotal transitional care period. The methodological quality and risk of bias were critically evaluated using the authoritative Joanna Briggs Institute Checklist for Quality Assessment and Review Instrument.

Results:
Out of the 394 articles initially found, only 10 met eligibility criteria and were included. Text analysis revealed two themes that encapsulate the lived experience of caregivers and stroke survivors as related to transitional care supports: 1) acknowledging that life will never be the same and 2) growing recognition of the so-called new normal. The first theme incorporated six significant subthemes. These included the need for information and training, uncertainty about the future, participation, realistic assessments of evolving training needs, coordinated discharge planning; as well as psychological distress. The second one consisted of three interrelated subthemes: variation in perceived roles and responsibility after a stroke, availability and perceived adequacy of post-discharge support, and adapting processes to change.

Conclusions:
The meta-synthesis provided evidence that a lack of tailored and targeted training support negatively affected both members of the dyad. Unaddressed information and training increased experiences of anxiety, uncertainty, and stress during transitional care. The ability to adapt to post-stroke and achieve a satisfactory quality of life is strongly associated with the informational and training support given during the transitional care period.