bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract NS12: Effective Reduction of Stroke Readmissions Through Nurse Practitioner Initiated Follow -up Calls in a Comprehensive Stroke Center
Authors: Gibson Maryika I
Published: March 2022

Issue:
The Affordable Care Act, ACA Section III, encourages development of new transitional care models linking hospital reimbursements to improved quality, efficiency, and transparency in care delivery. Unplanned readmissions, a quality indicator, are costly under ACA and on the forefront of the Joint’s Commission effort to advance data utilization and improve care to stroke patients through the Comprehensive Stroke Center (CSC) certification requirements. Follow- up phone calls to patients discharged home from the hospital within seven days are embedded in the above requirements and can be a valuable tool in reducing unplanned readmissions and in improving support to stroke patients with complex psychosocial and medical needs.

Purpose:
Phone calls initiated by a Nurse Practitioner (NP) to stroke patients after discharge to home in our CSC aimed at increased medication compliance, avoidable readmission rate monitoring, and comparison of outcomes to those reported in the literature. In investigating trends we pursued opportunities to enhance care delivery, establish long-term relationship with patients, and empower them to involve actively in their care.

Method:
We utilized descriptive statistics in retrospective and prospective hospital data analysis extending our focus on development of quality improvement initiatives. Inclusion criteria consisted of age >18, primary diagnosis, and discharge disposition.

Results:
Between June 2014 and June 2015, after the calls introduction, we achieved an absolute risk reduction of 4.1% in short-term readmissions within 30 days. Compared to the year before readmission rates decreased by 60% with number needed to treat of 25 and preventative fraction of 40%, similar to reduction rates cited in current literature. Patients expressed satisfaction with care and in discussions with the NP helped identify improvement areas for our program. Limitations of the study include single center observations and specific characteristics of our regional population.

Conclusion:
When implemented as part of a transitional care model, telephone calls to stroke patients post hospital discharge to home conducted by an NP can be an effective tool in reducing unplanned readmissions and improve patient satisfaction with care.
Abstract NS2: Factors That Affect Health Promotion Behaviors in Urban Black Women
Authors: Hepburn Millie
Published: March 2022

Problem:
Black women have been shown to experience higher rates of morbidity and mortality as a result of stroke, cardiovascular disease, hypertension, diabetes and overweight and obesity than women of other races/ethnicities. Creating an understanding of the various factors that impact individual health promotion behaviors to reduce risk, such as health literacy, self-efficacy and readiness to change will support effective interventions to reduce health care disparities in this vulnerable population.

Method:
132 urban Black women in Midtown Manhattan in the service region of an academic medical center with a diverse population was chosen for this descriptive correlative study. Participants completed a questionnaire containing a demographic profile and survey instruments measuring health literacy, self-efficacy and readiness for change, and a detailed report of current health promotion behaviors.

Results:
Black urban women between 30 - 64 y (M = 45, SD = 9.72) participated. 72.6% completed high school, 25% had achieved a college degree. Pearson correlation showed positive correlation at the 0.01 level (2-tailed) between health literacy (r2 = .25), self-efficacy (r2 = .31) and readiness for change (r2 = .44) to health promotion behaviors. Self-efficacy was positively related to participation church organizations (r2 = .31) and a high body mass index (BMI) (F=25, p<.001). Participation in church organization was inversely related to high health literacy (r2 = .41). Among women scoring high in self-efficacy and low in health literacy, BMI scores averaged higher (BMI=35.2) than those with high health literacy scores (BMI=30.2). Conditions such as hypertension, diabetes, respiratory disorders and stroke were more prevalent if health literacy scores were low and self-efficacy was high. Women with low health literacy were less likely to seek medical care with a health care provider, take prescribed medications or receive routine preventative health care.

Conclusion:
Future research interventions geared to reduce health care disparities in Black women may be more effective in reducing modifiable conditions if performed in collaboration with community church organizations rather than from a health care provider alone.
Abstract NS7: The Effects of a Theory-based Health Empowerment Intervention on Self-management and Functional Recovery Post-stroke
Authors: Sit Janet W , Chair SY , Choi KC , Chan Yip Carmen WH , Ching Raina , Taylor-Piliae Ruth E , Tang SW
Published: March 2022

Introduction:
Self-management post-stroke is challenging due to its sudden and complex sequela. Identification of an effective intervention to foster self-management post-stroke is needed. We developed a 13-week Stroke Patient Empowerment Intervention (SPEI), guided by Shearer’s Theory of Health Empowerment, to foster patients’ inner resources and social-contextual resources to enhance self-management.

Objective:
To examine the effects of the SPEI (six 20-min small group sessions and 2 phone follow-ups) on self-efficacy (SE), self-management behaviour and functional recovery, compared to usual ambulatory rehabilitation care (UC).

Methods:
In this randomized controlled trial, Hong Kong Chinese participants (mean age=69 years, 48% women, 72% ischemic stroke, 89% hemiparesis and 63% tactile sensory deficit) received 13-weeks of SPEI+UC (n=105) or UC only (n=105). Generalized estimating equations were used assess changes in SE (stroke-specific and illness management), self-management behaviours (cognitive symptom management, communication with physician, medication adherence, and BP self-monitoring) and functional recovery (Barthel and Lawton Indices) over time (baseline=T0, 1-week=T1, 3-months=T2 and 6-months=T3 post-intervention) between groups, using intention-to-treat.

Results:
Those in the SPEI+UC group had significantly better illness management SE, self-management behaviours (cognitive symptom management, communication with physician, and BP self-monitoring), and functional recovery (Barthel and Lawton Indices), compared to UC. Changes in stroke-specific SE and medication adherence were not significantly different over time between groups (see Table 1). Attrition was low (16.7%).

Conclusions:
This nurse-led SPEI was easily implemented and can readily be conducted in tandem with existing ambulatory stroke rehabilitation services, to foster self-management post-stroke and improve functional recovery.
Abstract TMP1: International Multicenter Study Demonstrating Safety of Intravenous Thrombolysis in Acute Ischemic Stroke Patients Harboring Unruptured Intracranial Aneurysms
Authors: Goyal Nitin , Tsivgoulis Georgios , Iftikhar Sulaiman , Zand Ramin , Sharma Vijay K , Male Shailesh , Barlinn Kristian , Katsanos Aristeidis H , Bodechtel Ulf , Arthur Adam , Elijovich Lucas , Alexandrov Ann W , Alexandrov Andrei V
Published: March 2022

Objective:
We sought to determine the safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients harboring unruptured intracranial aneurysm (UIA) in a prospective, multi-center study.

Methods:
We prospectively analyzed data from consecutive AIS treated with IVT during a 4-year period at four tertiary-care stroke centers. All patients routinely underwent CT or MR angiography during hospitalization. The presence of UIA was documented on the basis of neuroradiology reports. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH combined with an increase in NIHSS-score of ≥4 points.

Results:
Our multicenter study evaluated a total of 1398 AIS patients treated with IVT with available neurovascular imaging data. The presence of concomitant UIAs was identified in 42 cases (3.0%, 95%CI by adjusted Wald method: 2.2%-4.1%) harboring a total of 48 IAs. Four of the forty-two (8%) AIS patients had multiple aneurysms. The mean maximum diameter of UIA was 4.3±2.7mm ranging between 2-15 mm. Nearly all UIA were saccular (45/48, 94%) and the majority were located in the anterior circulation (29/48; 61%). The maximum diameter was ≥7mm and ≥10mm in 6 (12.5%) and 3 (6.3%) cases respectively. The rates of symptomatic and asymptomatic ICH were 2.4% (95%CI by adjusted Wald method: 0%-12.6%) and 7.1% (95%CI by adjusted Wald method: 1.8%-19.7%) respectively. The single sICH reported in our multi-center study was not caused by aneurysmal rupture, since the incidental aneurysm was located in the posterior communicating artery in the hemisphere that was contralateral to the sICH. The rates of in-hospital mortality and favorable functional outcome at hospital discharge (defined as modified Rankin Scale score of 0-1) were 2.4% (95%CI by adjusted Wald method: 0%-12.6%) and 50.0% (95%CI by adjusted Wald method: 35.5%-64.5%) respectively.

Conclusions:
Our prospectively collected multi-center data indicate the potential safety of IVT in AIS patients with UIA.
Abstract TMP104: Prevalence of Transcranial Doppler Monitoring in Aneurysmal Subarachnoid Hemorrhage: An Analysis of the Nationwide Inpatient Sample
Authors: Kumar Gyanendra , Albright Karen C , Donnelly John P , Shapshak Angela H , Harrigan Mark R
Published: March 2022

Background and Objective:
Transcranial Doppler (TCD) is endorsed by the American Heart Association/American Stroke Association, the American Academy of Neurology, and the Neurocritical Care Society for use in aneurysmal subarachnoid hemorrhage (aSAH) for surveillance of cerebral vasospasm (CV). However, data on utilization of TCD for CV detection and monitoring in aSAH are lacking. We estimated the proportion of patients with aSAH receiving TCD monitoring using the Nationwide Inpatient Sample (NIS).

Methods:
Data from 2002-2011 NIS were used to calculate the number of discharges with a primary diagnosis of aSAH per 100,000 discharges. Descriptive analysis of nationwide trends in TCD prevalence was performed. Teaching hospitals were examined separately for TCD utilization rates and this was done biennially to prevent small numbers.

Results:
Between 2002 and 2011, a total of 256,089 patients were discharged with a diagnosis of aSAH of which 3,850 underwent TCD monitoring. aSAH accounted for an average of 67.1 discharges per 100,000 annually (95% CI 61.3-72.8) from 2002-2011. Of these, only 1.5% (95% CI 0.4-2.6) underwent TCD examination. In teaching hospitals, aSAH accounted for an average of 108.5 discharges per 100,000 biennially (95% CI, 96.2-120.8), of which 2% (95% CI 1.0-4.0) underwent TCD examination. TCD utilization increased from <1% during the 2002-2005 period, to ≥1.5% during the 2006-2011 period (OR 2.3, 95% CI 1.0-5.7), an increase also seen in teaching hospitals.

Conclusion:
TCD is underutilized nationally in the care of aSAH. While the prevalence of TCD is low in teaching hospitals, it is nearly nonexistent in non-teaching hospitals.
Abstract TMP11: Hemicraniectomy versus Conservative Treatment in Large Hemispheric Ischemic Stroke Patients: a Meta-analysis of Randomized Controlled Trials
Authors: Ishfaq Muhammad F , Rahman Haseeb A , Thomas Abraham P , Imran Rajeel , Qureshi Adnan I
Published: March 2022

Background:
Several small trials have inconclusively evaluated the effect of hemicraniectomy in reducing death and disability in acute ischemic stroke patients with large hemispheric infarctions.

Objective:
To determine the effects of hemicraniectomy on clinical outcomes and mortality compared with conservative treatment in patients with large hemispheric infarctions.

Method:
Six randomized trials that compared hemicraniectomy with conservative treatment in acute ischemic stroke patients met the inclusion criteria. We calculated pooled odds ratios and 95% CIs (confidence intervals) using random-effects models. The primary endpoint was a favorable outcome defined by a modified Rankin scale grade of 0 (no symptoms), 1 (no significant disability), 2 (slight disability), and 3 (moderate disability) at 180 days post-randomization.

Results:
Of the 294 total subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to hemicraniectomy compared with conservative treatment (294 subjects analyzed, odds ratio 2.00, 95% CI 1.12-3.53, p=0.02). Survival was also significantly greater among those randomized to hemicraniectomy (294 subjects analyzed, odds ratio 5.18, 95% CI 3.10--8.68, p< .001). The odds of favorable outcome were significantly greater among those randomized to hemicraniectomy compared with conservative treatment in trials that permitted recruitment of patients aged ≥60 years (256 subjects analyzed, odds ratio 1.89, 95% CI 1.05-3.42, p=0.03).

Conclusions:
Compared with conservative treatment, the odds of achieving a favorable outcome outcome at 6 months post-randomization is approximately 2 folds higher with hemicraniectomyin patients with large hemispheric infarctions
Abstract TMP111: Gradual Carotid Artery Stenosis in Mice Closely Replicates Hypoperfusive Vascular Dementia in Humans
Authors: Hattori Yorito , Enmi Jun-ichiro , Okamoto Yoko , Nagatsuka Kazuyuki , Kalaria Rajesh N , Iida Hidehiro , Ihara Masafumi
Published: March 2022

Rationale:
Existing rodent models of vascular cognitive impairment (VCI) show abrupt change in cerebral blood flow (CBF) and do not completely mirror clinical pathogenesis of VCI.

Objective:
To establish a mouse model of VCI where CBF gradually decreases with subsequent motor and cognitive impairment.

Methods and Results:
Adult C57BL/6J male mice were subjected to gradual common carotid artery stenosis (GCAS) surgery using an ameroid constrictor (AC) vessel-constricting device with inner diameter of 0.75 mm. The common carotid arteries narrowed gradually after gradual constriction of ACs over 28 days after GCAS, with subsequent 79.3% area stenosis due to smooth muscle cell proliferation and macrophage infiltration in the tunica intima. The 28-day survival rate was 100%. Arterial spin labeling demonstrated gradual and continuous reduction of cortical and subcortical CBF (ratio to the preoperative value) to 54.6% and 51.5%, respectively, over 28 days. However, magnetic resonance angiography showed increment of collateral flow signals in the leptomeningeal artery. Rarefaction and proliferation of astrocytes and microglia with loss of oligodendrocytes was found in the white matter at 32 days. Hippocampal neuronal loss was observed in only 25% of GCAS mice, consistent with lack of abnormalities in the Morris water maze test. The rotarod test showed motor impairment whereas the Y-maze test showed that working memory was impaired.

Conclusions:
The GCAS model successfully generated gradual and continuous CBF reduction over 28 days, with replication of key histological, radiological, and behavioral features associated with cerebral hypoperfusion leading to VCI.
Abstract TMP115: Diabetes-induced Neuronal Degeneration and Dysfunctional Neovascularization in the Hippocampus: Implications for Cognitive Impairment and Stroke
Authors: Ward Rebecca , Valenzuela John Paul , Ergul Adviye
Published: March 2022

Diabetes increases the risk of stroke and is associated with worsened cognitive outcome. We have shown that diabetes mediates immature and leaky new vessel formation in cortex and striatum and these changes are accompanied by cognitive deficits. However, the effect of diabetes on the vasculature in hippocampus, a major domain for memory and cognition, remained unknown.

Hypothesis:
Impaired cognitive function in diabetes is associated with neurovascular remodeling and activation of NLRP3 inflammasome in the hippocampus.

Methods:
Diabetes was induced through a high fat (45%) diet and 30mg/kg STZ injection in male Wistar rats (n=4). Vascular architecture was examined by space filling FITC. Immunohistochemistry was used to measure neuronal degeneration and NLRP3 expression. Cognitive function was assessed by novel object recognition test.

Results:
Vascular density and volume were increased the dentate gyrus (DG) and CA1, respectively, in diabetic rats. The DG had reduced numbers of neurons in diabetic rats, and the CA1, CA3 and DG all showed elevated cell death. Markers of the NLRP3, ASC and cryopyrin, showed elevated expression in the hippocampus. The recognition index was decreased in diabetic animals compared to control.

Conclusions:
These data suggest that the DG is sensitive to neurovascular remodeling in diabetes. Diabetes-induced NLRP3 activation may be involved in this remodeling and contribute to cognitive deficits in diabetes.
Abstract TMP14: Baseline Characteristics and Clinical Outcomes of Acute Symptomatic Internal Carotid Artery Stump
Authors: Lee Kyu Sun , Lee Sung Eun , Hong Ji Man , Lee Jin Soo
Published: March 2022

Background:
Theoretically, recurrent stroke symptoms caused by severe internal carotid artery (ICA) stenosis should resolve on progression of stenosis to complete occlusion. However, stroke symptoms may recur due to the occluded ICA stump (carotid stump syndrome). We investigated the clinical characteristics and treatment outcomes in patients with ICA stump.

Methods:
Subjects were recruited from a stroke registry at a university hospital (Feb 2005 to Jan 2015). The eligibility criteria were 1) extracranial ICA occlusion on computed tomographic angiography (CTA) as a stump morphology and 2) acute ischemic stroke or transient ischemic attack in the corresponding arterial territory <7 days from symptom onset. The exclusion criteria were 1) presumed etiology as cardiac embolism or other etiology (e.g., dissection, moyamoya syndrome, and vasculitis) and 2) concomitant carotid T type occlusion on CTA. A total of 114 patients were categorized into the stable (N=90) and unstable (N=24) groups. Unstable group indicated stroke recurrence in <3 months, or progression of ischemic stroke during hospitalization. Progression of stroke was defined as 1) change in NIHSS score ≥2 or 2) change of NIHSS score ≥1 with malignant change or increase of infarct size. Intensive statin treatment was defined as ≥10 mg of rosuvastatin and/or ≥20 mg of atorvastatin. Logistic regression analysis was performed to identify prognostic factors.

Results:
There were no significant inter-group differences with respect to age, sex, and mode of thrombolytic therapy. Metabolic syndrome and initial heparinization were both more frequent in the unstable group than in the stable group. (83.3% vs. 46.7%, p=0.001 and 41.7% vs. 10.0%, p<0.001, respectively). Frequency of intensive statin treatment was lower in the unstable group (41.7% vs. 65.6%, p=0.033). On multivariate analyses, metabolic syndrome, initial heparinization, and non-use of intensive statin therapy were independent risk factors for progression or recurrence.

Conclusion:
Metabolic syndrome was the main risk factor for progression/recurrence of stroke caused by ICA stump. Intensive statin treatment seems to be beneficial in these patients. The benefits of initial heparinization appear to be questionable.
Abstract TMP15: Circulating Antiangiogenic Profile Predicts Lower Degrees of Neovascularization After Indirect Revascularization With Encephaloduroarteriosynangiosis (EDAS) in Patients With Intracranial Atherosclerosis (ICAS)
Authors: Gonzalez Nestor R , Ooi Yinn , Laiwalla Azim , Restrepo Lucas , Ali Latisha , Liou Raymond , Rao Neal , Hinman Jason D , Liebeskind David S , Toscano Juan F , Saver Jeffrey
Published: March 2022

Objective:
To evaluate the hypothesis that circulating pro and antiangiogenic profiles predict the degree of angiographic neovascularization in patients undergoing EDAS for the treatment of symptomatic ICAS.

Methods:
This is a prospective observational study of circulating angiogenic factors in patients with arterial stenosis greater than 70% due to ICAS. All patients received intensive medical management. Patients with persistent symptoms underwent in addition EDAS revascularization. Twenty-one angiogenic factors were analyzed in serum samples collected at baseline, before surgery, using multiplex ELISA. All samples were run in duplicate and accepted as valid if the intersample variability was less than 20%. Patients have angiographic follow up 6 months after EDAS and a Neovascularization Index (NI) based on Perren grades and ASITN collaterals were calculated. Angiogenic profiles (APs) were defined using Principal Component Analysis (PCA). Seven profiles were selected for each time-point (Eigenvalue greater than 1.0). A regression model was built for the outcome variable NI using as predictor variables age, smoking history diabetes, and the 7 APs. Forward stepwise modeling with minimum BIC stopping rule was used to select the best fitted model.

Results:
Fifteen patients were enrolled. Mean age was 62.1 ± 12.3, 75% were females. The regression model demonstrated significant associations of age, diabetes and the AP 1-6 with the NI. Whole model P=0.023, Rsquare=0.93. The solution of the regression formula for the significant AP components revealed a strong negative association of the antiangiogenic factors endostatin and angiostatin (regression parameters -1.8 and -4.5, respectively, p=0.02). At 6 months follow up no patients had suffer strokes.

Conclusion:
In this prospective study of angiogenic factors in patients with ICAS undergoing EDAS revascularization, we have found that baseline levels of the antiangiogenic factors endostatin and angiostatin are significantly negatively associated to the degree of postoperative revascularization at 6 months. This finding supports the concept that neutralization of antiangiogenic factors may serve as a new pharmacological target to treat cerebral ischemia in patients with ICAS.
Abstract TMP21: Effect of Non-evidence Based Practices in Carotid Artery Stenting on Outcomes
Authors: Obeid Tammam , Arhuidese Isibor , Malas Mahmoud
Published: March 2022

Introduction:
During the past decade, novel intra-procedural carotid artery stenting (CAS) techniques have emerged. Primary stenting, which forgoes the use of any angioplasty, and proximal embolic protection have been utilized in an attempt to mitigate perioperative complications. However, the effectiveness of such techniques remains controversial. We sought to assess the effect of primary stenting, proximal embolic protection, comorbidities, medications and other patient-level factors on outcomes of CAS in a multispecialty national database.

Methods:
We analyzed all CAS cases in the Vascular Quality Initiative (VQI) database from 2005 to 2015. Only patients with a follow up of ≥30 days were included. Propensity score matching was used to assess the effect of primary stenting on primary composite end-point outcome of stroke/transient ischemic attack (TIA)/death within 30 days of the procedure. A logistic regression model was constructed to determine the effect proximal protection and other characteristics had on 30-day stroke/TIA/death.

Results:
A total of 3,584 patients satisfied our selection criteria (mean age was 69.5±9.9 years; males 62%). Composite perioperative stroke/TIA/death rate was 9.7% (stroke 5.5%; TIA 2.4%; death 2.8%) and new myocardial infarction rate was 1.2%. Primary carotid stenting technique was used in 213(6.0%) patients, while proximal embolic protection was utilized in only 132(4.0%) patients. In a well-matched cohort of 211 primary stenting patients (total 422 patients): the 30-day stroke/TIA/death rate was almost double in the treated cohort (13.2% vs 7.1%, P<0.05), while 30-day stroke/death rate was 4.6% higher in the primary stenting group (10.7% vs 6.1%, P=0.10). Proximal embolic protection had no significant effect on primary composite end-point (OR 0.68, P=NS), while P2Y12 antagonist use and a history of ipsilateral CEA each had approximately 30% reduction in risk of stroke/TIA/death (OR 0.71, P=0.03; OR 0.68, P=0.02).

Conclusion:
Primary carotid stenting carries a higher risk of perioperative stroke/TIA/death in CAS than traditional use of angioplasty. Proximal embolic protection has no significant effect on outcomes while P2Y12 antagonists and having a prior CEA reduce the chances of stroke/TIA/death.
Abstract TMP28: Upper Extremity Motor Impairment After Ischemic Stroke - Implications for Stem Cell Therapy
Authors: Delavaran Hossein , Aked Joseph , Arvidsson Andreas , Lindvall Olle , Kokaia Zaal , Norrving Bo , Lindgren Arne
Published: March 2022

Introduction:
Experimental studies show that stem cells can improve motor recovery in animal stroke models. In humans, upper extremity motor impairment (UEMI) is a major consequence following stroke and can entail substantial disability. As stem cell therapy (SCT) may become clinically applicable to promote arm/hand motor recovery after stroke, we aimed to examine the frequency and recovery of UEMI, as well as its’ correlation to functional status and health-related quality of life (HRQoL), in a selected sample of stroke patients potentially suitable for SCT.

Methods:
Consecutive first-ever ischemic stroke patients (n=108) were included in the Lund Stroke Recovery Study in 2009-2011 if: they were aged 20-75 years; underwent brain DW-MRI within 4 days of stroke onset; and their baseline stroke severity was 1-18 according to the National Institutes of Health Stroke Scale (NIHSS). All survivors were invited to a clinical follow-up after 3.5-5.5 years, including: NIHSS arm and extended NIHSS hand items to assess UEMI; Fugl-Meyer upper extremity section (FM-UE) to thoroughly examine UEMI; Action Research Arm Test (ARAT) to evaluate arm/hand function; Modified Rankin Scale (mRS) to assess functional status; and Stroke Impact Scale (SIS) to evaluate HRQoL. UEMI was defined as ≥1 on NIHSS arm/hand items. UEMI recovery was assessed by the change in NIHSS arm/hand scores between baseline and follow-up (ΔNIHSS arm/hand).

Results:
Of 97 stroke survivors, 83 participated in the follow-up. Among survivors without recurrent stroke (n=76), 54% had UEMI at baseline and 28% had remaining UEMI at follow-up. The median ΔNIHSS arm/hand was [-1] (range=[-4] - 1). FM-UE scores were strongly correlated to ARAT (r
s
=0.68,
p
<0.01), mRS (r
s
=[-0.67],
p
<0.01), SIS strength domain (items 1a+1b; r
s
=0.68,
p
<0.01), and SIS hand function domain (r
s
=0.71,
p
<0.01).

Conclusions:
UEMI may be an appropriate target for SCT in stroke as UEMI is prevalent, and strongly correlates to long-term functional status and HRQoL. Our findings confirm previously reported heterogeneity in UEMI recovery, the mechanisms of which need to be addressed in future studies to optimize patient selection for SCT.
Abstract TMP31: Two Doses of Remote Limb Ischemic Conditioning Augment Learning in Healthy Adults
Authors: Cherry-Allen Kendra M , Gidday Jeff M , Lee Jin-Moo , Hershey Tamara , Lang Catherine E
Published: March 2022

Background and Purpose:
Remote limb ischemic conditioning (RLIC), delivered through brief intermittent bouts of blood pressure cuff inflation on the arm, has recently been shown to have neuroprotective effects. Because the mechanisms through which RLIC promotes tissue protection are multifactorial and epigenetic, RLIC holds promise as a neurorecovery agent to augment learning and optimize rehabilitation outcomes following a stroke. The purposes of this study were to test if RLIC enhanced motor and cognitive learning in human adults compared to a sham treatment and to determine if RLIC at 20 mmHg above systolic blood pressure would yield equivalent results as RLIC to 200 mmHg.

Methods:
Thirty adults were randomized to three treatment groups (n=10 per group), and participated in a 7 day protocol of RLIC/sham conditioning followed by motor and cognitive training, to induce learning. Learning was assessed at the end of the 7th day and at 2 and 4 week follow-ups. Data were analyzed using repeated measures ANOVAs with planned post-hoc comparisons to analyze group-by-time interaction effects.

Results:
Despite the same initial motor performance, the two RLIC groups had larger improvements after training at Day 7 compared to the sham group (mean seconds in balance change score ± SEM; RLIC+20: 16.9 ± 1.5 secs; RLIC200: 16.6 ± 1.0 secs; sham: 9.6 ± 1.4 secs; p ≤ .001). Improvements in motor performance in the RLIC groups were retained at 2 week (p = .001) and 4 week (p ≤ .001) follow-ups. There was also a trend towards greater improvements in cognitive performance after training at Day 7 in the two RLIC groups compared to the sham group (mean correct response reaction time change score ± SEM; RLIC+20: -98.4 ± 14.2 ms; RLIC200: -93.0 ± 20.5 ms; sham: -46.6 ± 13.1 ms; p = .074). The two RLIC groups were equivalent at each time point for motor (p = 0.56 - 0.99) and cognitive (p = 0.79 - 0.97) performance.

Conclusions:
RLIC, induced with cuff inflation as low as 20 mmHg above systolic blood pressure, had a robust effect on both motor and cognitive learning paradigms in healthy adults. RLIC could be a low-cost and clinically-feasible strategy to augment learning and enhance neurorehabilitation following stroke.
Abstract TMP46: Computed Tomography of Non-Stenotic Carotid Plaque in Patients with Embolic Stroke of Undetermined Source (ESUS)
Authors: Coutinho Jonathan M , Derkatch Sheldon , Potvin Alphonse R , Tomlinson George , Kiehl Tim-Rasmus , Silver Frank L , Mandell Daniel M
Published: March 2022

Introduction:
In up to 25% of patients with an ischemic stroke, the standard investigations fail to identify a cause. Many of these cryptogenic strokes are thromboembolic, but without an established source, so called “embolic strokes of undetermined source” (ESUS). Non-stenotic carotid plaque is a potential source.

Hypothesis:
We hypothesized that among patients with ESUS, there is an association between non-stenotic carotid atherosclerotic plaque diagnosed using CT angiography and ipsilateral ischemic stroke.

Methods:
From a prospectively maintained stroke registry, we identified consecutive patients between January 2012 and March 2015 with a carotid territory ischemic stroke, who fulfilled the diagnostic criteria for ESUS. Two radiologists, blinded to clinical information, independently measured carotid plaque thickness ipsilateral and contralateral to the ischemic stroke using CT angiography.

Results:
Eighty-five of 1038 ischemic stroke patients were included in the analysis. There was no difference in the degree of carotid artery stenosis ipsilateral versus contralateral to ischemic stroke (median 0% versus 0%, p=0.98). There was a weak correlation between degree of carotid artery stenosis and carotid plaque thickness (R2 = 0.26, p<0.001). Plaque thickness ≥ 5 mm (9/85 versus 1/85, p=0.008), ≥ 4 mm (16/85 versus 4/85, p=0.002), and ≥ 3 mm (30/85 versus 13/85, p=0.001) were each more common ipsilateral than contralateral to ischemic stroke. Plaque thickness ≥ 2 mm had the same frequency ipsilateral and contralateral to ischemic stroke.

Conclusions:
Our data suggest that large, non-stenotic carotid plaque may be an important source of embolism in patients with ESUS. We evaluated non-stenotic plaque using routine CT angiography, a method that could be easily translated into clinical practice.
Abstract TMP48: Characteristics of Cryptogenic Stroke Patients with Occult Cancer
Authors: Gon Yasufumi , Sakaguchi Manabu , Terasaki Yasukazu , Sasaki Tsutomu , Mochizuki Hideki
Published: March 2022

Objective:
Ischemic stroke with occult cancer is a relatively rare but a significant complication in clinical practice. The aim of this study is to clarify the characteristics of cryptogenic stroke patients with occult cancer.

Methods:
Between January 2006 and February 2015, 1191 patients with acute ischemic stroke were extracted from a prospectively collected stroke database of Osaka University Hospital. Among them, 165(14%) patients, including 108 patients without diagnosed cancer and 57 patients with active caner at the time of ischemic stroke onset, were diagnosed with cryptogenic stroke etiology. We compared the clinical characteristics between cryptogenic stroke patients with occult cancer and without cancer. All data are expressed as median and interquartile ranges or counts and percentages.

Results:
Among 108 patients without diagnosed cancer in cryptogenic stroke etiology, there were 11 patients with occult cancer and 97 patients without cancer. Compared with the cryptogenic stroke patients without cancer, those patients with occult cancer had lower body mass index (18.4 [16.5-20.4] vs 22.9 [20.3-25.6] kg/m2, p < 0.001), lower serum albumin (3.3 [2.4-3.5] vs 4.0 [3.7-4.2] g/dl, p < 0.001), higher plasma D-dimer levels (5.89 [0.80-12.55] vs 0.48 [0.27-0.93] μg/ml, p < 0.0001) and C-reactive protein (0.51 [0.13-6.22] vs 0.13 [0.04-0.34] mg/dl, p = 0.01), and more multiple vascular lesions (73% vs 14%, p < 0.0001). Five patients (45%) presented with distal metastases at diagnosis.

Conclusion:
Cryptogenic stroke patients with occult cancer have lower nutritional status, higher plasma D-dimer levels, and more multiple vascular lesion patterns. In patients with cryptogenic stroke having such characteristics, a detailed examination is needed to check for the presence of cancer.
Abstract TMP50: Suppression of α-synuclein Mitigates Secondary Ischemic Brain Damage
Authors: Kim TaeHee , Kaimal Balarama , Vemuganti Raghu
Published: March 2022

α-synuclein (α-syn) is one of the most abundant proteins in mammalian brain that is known to be a major player in the neurodegeneration observed in chronic conditions like Parkinson’s disease (PD). Several mechanisms were proposed for α-syn-induced neuronal death in PD including inflammation, oxidative stress, mitochondrial fission, and autophagy. Interestingly, all these pathophysiologic mechanisms also mediate neuronal death after acute CNS insults like stroke. Therefore, we examined whether α-syn contributes to post-stroke neuronal death and neurological dysfunction. Rodents were subjected to transient middle cerebral artery occlusion (tMCAO) and α-syn induction was silenced with a cocktail of α-syn-specific siRNAs. The levels of α-syn were estimated with qPCR and Western Blots. Post-ischemic motor deficit was evaluated with rotarod, beam walk and adhesive removal test 1 to 7 days after ischemia, and infarct volume was measured on cresyl violet stained brain sections. Cellular changes after ischemia were examined using immunofluorescence staining. Following tMCAO, α-syn levels were significantly up-regulated and phosphorylated at serine-129 in ischemic penumbra. Interestingly, in the ischemic brain non-phosphorylated and phosphorylated α-syn species translocated into the neuronal nuclei. We also observed that silencing α-syn by α-syn siRNA cocktail before tMCAO significantly decreased the infarction and improved the motor function. The neuroprotective effects were still observed when α-syn siRNAs were administered 30 min after the tMCAO. We found that the rate of survival at 7 days after a 90 min tMCAO was significantly higher in α-syn KO mice compared to wild-type control mice. Furthermore, α-syn suppression significantly mitigated the post-ischemic oxidative stress (8-OHdG and 3-NT), apoptosis (cleaved Caspase-3) and mitochondrial dysfunction (phospho-Drp1). Thus, we show that α-syn plays a critical role in neuronal death following stroke. Furthermore, phospho-S129 α-syn in the neuronal nuclei might be a potential mediator of the induction of ischemic brain damage. Preventing α-syn expression is a potential therapeutic target to minimize post-stroke brain damage.
Abstract TMP53: Ifn-γ-inducible Protein 10 (IP-10) Levels Increase With Age and Stroke
Authors: Harris Nia , Verma Rajkumar , Ritzel Rodney , Chauhan Anjali , McCullough Louise
Published: March 2022

Background:
IP-10 is a pro-inflammatory CXC chemokine that acts as a chemo-attractant for monocytes and T cells. Prior work has shown that IP-10 levels increase after experimental stroke. IP-10 levels are correlated with degree of neurological injury; lower levels are associated with better outcome. Importantly, although nearly three quarters of strokes occur in aged people, no studies have examined IP-10 levels in aged stroke patient or animal populations. As mice and humans age, there is a progressive increase in pro-inflammatory factors circulating in the blood. Consequently, we hypothesize that aged populations will have significantly higher post-stroke IP-10 levels.

Methods:
Young (2-3 months) and aged (20 months) male C57BL6 mice were subjected to 60 minutes (24hr and 28 day group) or 90 minutes (72hr group) of MCAO and randomly split into 3 groups (n=5/group). Mice were sacrificed 24hrs, 72hrs, or 28 days after sham or stroke surgery. We collected serum samples from the 24hr and 28-day group and brain samples from the 72hr group. We also collected young (37-69yrs; n=18) and aged (70yrs; n=23) human serum samples 24hrs after imaging-confirmed ischemic stroke. IP-10 levels were assessed via ELISA (mouse) and cytokine multiplex assay (human).

Results:
Aged mice had significantly higher serum IP-10 levels than young mice (102.43±9.21pg/ml vs. 61.99±8.98pg/ml; p<.0001). However, there was no significant difference in either age group 24hrs after stroke. There was an interaction effect of age and stroke 72hrs after stroke, (F (1,14) =10.25, p<.006); aged stroke mice had the highest brain IP-10 levels. There was a significant increase in serum IP-10 levels in aged stroke mice compared to aged sham (45.47±5.32pg/ml vs. 23.26±0.31pg/ml; p<.03) and in aged stroke compared to young mice (45.47±5.32pg/ml vs. 15.72±2.63pg/ml; p<.005) 28 days after stroke. However, there was no difference between young stroke and sham. Lastly, in line with our animal data, serum IP-10 levels were significantly higher in aged humans (p<.02).

Conclusions:
This study demonstrates that aging exacerbates post-stroke brain and serum IP-10 levels in both mice and human subjects. Blocking IP-10 may be especially beneficial in improving post stroke recovery in aged populations.
Abstract TMP54: The Role of Erythrocyte Cd47 in Intracerebral Hematoma Clearance
Authors: Ni Wei , Xi Guohua , Song Jiawei , Keep Richard F , Hua Ya
Published: March 2022

Background:
Enhancing hematoma clearance through phagocytosis may reduce brain injury after intracerebral hemorrhage (ICH). In the current study, we investigated the role of CD47 in regulating erythrophagocytosis and brain injury after ICH in nude mice.

Methods:
This study was in two parts. First, male adult nude mice had an intracaudate injection of 30μl saline, blood from male adult wild type (WT) mice or blood from CD47 knockout (CD47 KO) mice. Second, mice had an intracaudate injection of 30μl CD47 KO blood with clodronate or control liposomes. Clodronate liposomes were also tested in saline-injected mice. All mice then had magnetic resonance imaging to measure hematoma size and brain swelling. Brains were used for immunohistochemistry and Western blot.

Results:
Erythrophagocytosis occurred in and around the hematoma. Injection of CD47 KO blood resulted in quicker clot resolution. Hematoma volume (assessed by T2* lesion volume) showed no difference between two groups at day 1 (14.3 ± 2.9 vs. 14.4 ± 3.2 mm3, p>0.05). However, when ICH was induced with CD47 KO blood, MRI T2* volumes were significantly smaller compared to WT blood at day 3 (7.8 ± 1.7 vs.11.8 ± 4.3 mm3, p<0.01). CD47 KO blood also resulted in less brain swelling, and less neurological deficits compared to WT blood. Higher brain heme oxygenase-1 levels and more microglial activation (mostly M2 polarized microglia) were found after CD47 KO blood injection at day-3. Co-injection of clodronate liposomes, to deplete phagocytes, caused more severe brain swelling (day 3: 7.1 ± 4.1 vs. 2.0 ± 2.0% in the control liposome group, p<0.05) and less clot resolution (day 3: 10.9 ± 2.3 vs. 7.7 ± 1.8 mm3 in control liposome group, p<0.05).

Conclusion:
These results indicated CD47 has a key role in hematoma clearance after ICH.
Abstract TMP59: Experimental Pediatric Cardiac Arrest and Cardiopulmonory Model Reveals Sex-specific Estrogen Signaling
Authors: Deng Guiying , Herson Paco S , Traystman Richard J
Published: March 2022

Objective:
Pediatric sudden cardiac arrest (CA) is an unfortunate and devastating condition, often leading to poor neurologic outcomes. However, little is known about the pathophysiology of pediatric CA. We have developed a unique pediatric cardiac arrest and cardiopulmonary (CA/CPR) mouse model to characterize the sex-specific response of the adolescent brain to global cerebral ischemia and assess the neuroprotective effect of estrogen at this developmental stage.

Methods:
C57BL/6 male and female mice (postnatal day 20 to 25 ) were subjected to 8 min of CA followed by CPR. Juvenile male and female mice were randomized to estradiol (E2, 100μg/kg, iv) or vehicle, administered 30 min after resuscitation. P38-MAPK inhibitor SB203580 (2 mg/kg) alone or in combination with E2 was given 30 min after resuscitation (iv) in females. Hippocampal neuronal damage was analyzed 3 days after CA/CPR by H&E staining. Statistical analyses were performed using ANOVA and t tests, with P<0.05 considered significant.

Results:
Analysis of histological damage 72 hrs after CA/CPR showed no difference between male (49.4 ± 10.2%, n=5) and female (62.8 ± 1.3%, n=5) pediatric mice. However, estrogen reduced neuronal injury from 62.8 ± 1.3% to 30.6 ± 5.6% (n=6, P<0.05) in female mice. In contrast, estrogen did not alter injury in juvenile males (55.8 ± 6.0%, n=6). P38-MAPK inhibitor blocked the neuroprotection of estrogen in female mice when given simultaneously with E2, increasing injury from 30.6 ± 5.6% to 55.1 ± 8.1% (n=4, P<0.05). However, P38-MAPK inhibitor alone had no effect on injury level in juvenile females (53.7 ± 6.6%, n=5).

Conclusions:
Pre-pubertal male and female animals exhibit equvalent injury following global cerebral ischemia, in contrast to the extensive literature demonstrating relative protection in the adult female provided by estrogen. Interestingly, estradiol decreases neuronal damage in juvenile females, but not males following CA/CPR, indicating that there is sex difference in neuronal damage in the P20-25 mice after global cerebral ischemia. Moreover, this sex-specific estrogen neuroprotective signaling requires P38-MAPK pathway.
Abstract TMP6: Safety From Acute Carotid Revascularization in Octogenarians With Recently Symptomatic Carotid Stenosis
Authors: De Rango Paola , Farchioni Luca , Manzone Alessandra , Simonte Gioele , Pelliccia Selena , Cieri Enrico , Caso Valeria , Lenti Massimo
Published: March 2022

Background:
Old age is a main factor increasing perioperative risks especially in emergency. Guidelines recommend performing carotid endarterectomy (CEA) in the acute period after onset of a transient ischemic attack (TIA) or stroke. There are concerns on the benefit from acute carotid revascularization in old patients due to increased periprocedural stroke/death risks exposure during an emergency procedure that could offset the long-term benefit.

This study aimed to analyze 30-day and late risk of stroke/death after acute carotid revascularization in symptomatic patients with >80years.

Methods:
Data of 282 consecutive patients (28.4% females; mean age 73.9y) undergoing carotid revascularization within 15 days from stroke/TIA ,in 2009-2015, were analyzed. Octogenarians and younger patients were compared for presentation, 30-day and late stroke/death rates using multivariable and survival analyses.

Results:
There were 79 (28%) patients with >80 years (34.2% females): 33(42%) were treated within the first 7 days and 10 (13%) within 48hours from symptom onset. Stroke was the index event in 34(43%); in 11(14%) recurrent TIA.

Baseline comorbidity profile, presenting symptoms and timing of treatment were comparable between old and young patients, but the rate of preoperative cerebral infarction was lower in octogenarians: 36.2% vs. 52.5% (P=0.031).30-day stroke/death rate was 2.5% in octogenarians (2/79) and 3.4% (7/203) in younger patients (OR 0.73; 95%Cl,0.15-3.58; P=0.99).There were one 30-day death and no cerebral hemorrhage among octogenarians. No 30-day stroke/death occurred in procedures within 48h. In adjusted analyses octogenarian was not associated with increased stroke/death risk. At 4-year all cause survival was lower (58%) in octogenarians than in younger patients (91%%,P=<0.0001); freedom from stroke rates was indeed comparable (90.3% vs. 93.2%;P=0.27).

Conclusions:
Octogenarians undergoing carotid revascularization within the acute (15 days) or hyperacute (48 hours) period after TIA/stroke show 30-day stroke/death and 4-year stroke rates comparable to younger patients. Given the higher age-related risk of stroke exposure and recurrence, the benefit from an acute carotid treatment in octogenarians may be relevant.
Abstract TMP69: Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions After Stroke
Authors: Lichtman Judith H , Leifheit-Limson Erica , Wang Yun , Goldstein Larry B
Published: March 2022

Background:
Reducing readmission within 30 days of hospital discharge is a national priority. Care in high-quality skilled nursing facilities (SNFs) could lower readmission rates, but its impact on stroke readmissions at the community level has not been assessed. We evaluated the relationships of SNF quality metrics with readmissions within 30 days of stroke discharge

Methods:
We used 2010-2012 data from the CMS Nursing Home Compare 5-star quality rating system of 4 metrics (health inspections, quality performance, and registered nurse and total staffing hours/resident/day; each rated from 1 to 4 stars). Hospital 30-day risk-standardized readmission rates after ischemic stroke were obtained from CMS Hospital Compare. Hospital and SNF zip codes were used to aggregate data to the healthcare community level (defined by NCHS Health Service Areas). We fit mixed models, weighted by community-specific total hospital discharges, to evaluate the relationship between community-specific SNF quality ratings and readmissions.

Results:
There were 1,813 healthcare communities with a total of 1,170,817 residents across 11,989 SNFs and 2,603 unique hospitals. Within a community, there was a median of 4 SNFs per hospital. Among 482,124 discharges for stroke during the study period, the median community-specific hospital 30-day readmission rate was 13.3% (IQR 1.62). An increase of 1 star for each of the 4 metrics in the SNF quality composite was associated with a 0.42% decrease in the stroke readmission rate (figure). Among the individual metrics, only the registered nurse and total nurse staffing measures were associated with lower stroke readmissions.

Conclusions:
Hospitals located in healthcare communities with higher-performing SNFs had lower 30-day readmission rates after stroke. Efforts to increase SNF nurse staffing levels may represent an opportunity to decrease 30-day readmissions after stroke.