bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP89: Nurse's Responses to Caregivers using a Web-based Supportive Intervention
Authors: Pierce Linda L , Steiner Victoria
Published: March 2022

Background:
Approximately 795,000 people experience a first time or recurrent stroke every year and most are cared for by family caregivers in home settings. Web-based interventions provide 24/7 access to support services and have been explored in the literature with caregivers of persons with chronic conditions, such as cancer, dementia, and stroke. Current research into nurses’ interactions with family caregivers in these web-based interventions is lacking.

Purpose:
Guided by Friedemann’s Framework of Systemic Organization, the aim of this descriptive study was to examine a nurse specialist’s e-mail comments to stroke family caregivers participating in a web-based supportive intervention used in a one-year randomized controlled trial (RCT).

Methods:
With institutional review board approval, caregivers in Ohio and Michigan (n=36) accessed the intervention support group and communicated by email with this nurse. These caregivers were primarily white women caring for a spouse, with an average age of 54 years (SD=12.2). The nurse moderated the group, answered caregivers’ questions, and offered support. Data were collected over a period of four years and the nurse’s responses were examined using rigorous content analysis.

Results:
From the nurse specialist’s narrative responses and questions/answers posted to the support group, five themes emerged and were drawn to Friedemann’s Framework. These themes included: socializing (coherence in Friedemann’s terms), dealing with emotions of the caregiver (individuation), taking care of the caregiver (individuation), accepting the caregiver role (individuation/system maintenance), and providing medical advice or referral related to the care recipient (system maintenance).

Conclusions:
Email interactions between the nurse and stroke family caregivers in this RCT revealed specific issues that these caregivers were struggling with, as well as methods that nurses might suggest to help address them. Healthcare providers can use this information to provide better, more informed care, and directed interventions for caregivers in dealing with stroke and its outcomes.
Abstract TMP9: The Neurovision Pilot Study: Non-cardiac Surgery Carries A Significant Risk Of Acute Covert Stroke
Authors: Mrkobrada Marko , Hill Michael D , Chan Matthew T , Sigamani Alben , Cowan David , Kurz Andrea , Sessler Daniel I , Jacka Michael , Graham Michelle M , O’Donnel Martin J , Dasgupta Monidipa , Emery Derek J , Gelb Adrian W , Gulka Irene , Heels-Ansdell Diane , Guyatt Gordon , Murkin John , Sahlas Demetrios J , Srinathan Sadeesh , St. John Phil , Tsai Scott S , Wendland Emily , Devereaux PJ
Published: March 2022

Introduction:
200 million patients worldwide undergo noncardiac surgery every year. Overt stroke is a serious complication of noncardiac surgery with significant impact on duration and quality of life. In the non-surgical population, covert stroke is 10 times more common then overt stroke and is associated with an increased risk of dementia and cognitive decline. The epidemiology of covert stroke after noncardiac surgery is not well characterized.

Study Objectives:
We undertook a pilot study to determine the incidence of covert stroke after noncardiac surgery.

Methods:
This was a prospective, international cohort study. Eligible patients were 65 years or older, and were admitted to hospital for at least one night after noncardiac surgery. A sampling strategy was employed to ensure a representative surgical population. Study personnel recorded clinical characteristics and the incidence of perioperative adverse events. We also assessed neurocognitive function, physical function and quality of life before surgery and 30 days after surgery. Patients underwent a brain magnetic resonance imaging (MRI) study between postoperative days 3 and 10. Fluid attenuated inversion recovery, gradient echo, T2 and diffusion-weighted imaging MRI sequences were obtained.

Results:
A total of 70 patients from three centres were enrolled in this study. The incidence of covert stroke was 11.4% (8/70 patients, 95% CI 5.9% to 21.0%). The single overt stroke was diagnosed after the research MRI study demonstrated findings of an acute stroke. All three centres experienced a similar prevalence of covert stroke (range 8.0% to 15.0%), and covert stroke was found in patients undergoing general (4/16), orthopedic (3/36), and urological/gynecological surgery (2/8).

Conclusions:
There is a significant risk of covert stroke after all types of noncardiac surgery. Given that globally 200 million adults undergoing major noncardiac surgery every year, postoperative covert stroke may be responsible for a significant proportion of small vessel cerebral ischemic disease in the overall population. A large study is needed to characterize the impact of postoperative covert stroke on clinically meaningful outcomes.
Abstract TMP92: Prevalence and Predictors of Recent Suicidal Ideation among US Stroke Survivors
Authors: Towfighi Amytis , Markovic Daniela , Ovbiagele Bruce
Published: March 2022

BACKGROUND:
Although approximately one third of individuals develop depression after stroke, little is known about the prevalence of suicidal ideation (SI). In this study, we assessed the prevalence and predictors of SI among stroke survivors.

METHODS:
We assessed prevalence of SI among adults (≥20 years) with self-reported history of stroke who participated in National Health and Nutrition Examination Surveys - a series of cross-sectional surveys of a nationally representative sample of the US population - from 2005 through 2010. SI in the past 2 weeks was determined from item 9 of the Patient Health Questionnaire 9 (PHQ-9). Sociodemographic factors, health behaviors, and comorbid conditions were examined as potential correlates. Random forest models were used to identify potential predictors of SI. Variables were sorted in the order of importance according to mean decrease in GINI index. Final model selection was made using a stepwise backwards procedure. Results were compared to persons with history of myocardial infarction (MI), diabetes and cancer.

RESULTS:
Between 2005 and 2010, an estimated 6,235,528 adults in the US reported a history of stroke. The prevalence of SI among stroke survivors was 7.8% (n=400,640), a higher prevalence compared to individuals with history of MI (6.2%), diabetes (5.2%), and cancer (4.1%). The random forest model revealed that the following variables predicted SI among stroke survivors with 74% sensitivity and 81% specificity (overall accuracy of 80%) in decreasing order of importance: depression score, age, BMI, education level, income to poverty ratio, female sex, and marital status. The first 5 predictors were also among the top 6 most important predictors of SI among persons with history of cancer, MI and diabetes. The best threshold of the PHQ-8 depression score for distinguishing stroke survivors with SI was PHQ-8 ≥ 7.

CONCLUSION:
One in twelve adult stroke survivors in the US endorsed recent SI, a prevalence that exceeded that of several other major conditions including cancer. Key sociodemographic variables may identify stroke survivors at highest risk. These results suggest there may be a need to incorporate screening for SI into the routine assessment of stroke patients.
Abstract TP1: Recanalization and Clinical Outcomes correlation in Acute Stroke: Meta Analysis
Authors: Nourollah-Zadeh Emad , Kass-Hout Omar , Mokin Maxim , Al-Masry Mahmoud , Kass-Hout Tareq
Published: March 2022

Objective:
Intravenous thrombolysis is still the only FDA approved therapy for acute ischemic stroke since the NINDS trial. The introduction of more aggressive and alternative acute stroke interventions and techniques has given rise to wide body of contemporary literature reporting patient outcomes across the various treatment modalities; these outcomes have yet to be comprehensively quantified and reviewed. The existing data is still lacking solid evidence of correlation between successful recanalization and good outcome.

Methods:
Data were collected through Medline search. Analysis of 140 articles published between the years 1985 - 2011 was done to compare clinical outcomes, complication and mortality rates between non-revascularized and revascularized groups in the setting of acute stroke therapy. Search key words included recanalization, reperfusion, thrombolysis, modified Rankin Scale (mRS), in combination with ischemic stroke and cerebral ischemia.

Results:
Pooled analysis of 140 studies including 4,313 patients conveyed recanalization rate. Based on recanalization status, mRS was accessible in 110 studies, Symptomatic Intracranial Hemorrhage (sICH) in 60 studies and mortality rate in 86 studies. Patients with successful recanalization had better chance of having good functional outcome measured by mRS at 90 days (OR, 4.99; 95% CI, 4.21 to 5.91). sICH rate was not statistically different between the two groups (OR, 1.25; 95% CI, 0.90 to 1.73). Mortality rate was less in patients with successful recanalization compared with non-recanalized (OR, 2.77; 95% CI, 2.27 to 3.38).

Interpretation:
Our results suggest a strong relationship between successful revascularization and better functional outcome with less mortality rate.
Abstract TP107: Stats Regulate Transcription Of 12/15-lox In Mouse Cortical Neurons Under Glutamate-induced Oxidative Stress
Authors: JUNG JOO EUN , van Leyen Klaus
Published: March 2022

Background and Purpose—
Oxidative stress during reperfusion following cerebral ischemic stroke causes neuronal death and various forms of cerebrovascular injury. 12/15-lipoxygenase (12/15-LOX) is a major contributor to these processes; however, the regulation of 12/15-LOX expression in the ischemic brain is still unknown. In this study, we investigated the transcriptional regulation of 12/15-LOX in primary cortical neurons subjected to oxidative stress.

Methods—
Immature cortical neurons were treated with glutamate. Western blots were performed for analysis of 12/15-LOX protein level and phosphorylation of STAT1 and 6 in response to glutamate stimuli. Primary mouse cerebral cortical neurons were transfected with small interfering RNA probes targeted to STAT1 or 6 and were used for real time RT-PCR for analysis of changes in 12/15-LOX mRNA level, and cell viability assay following glutamate treatment.

Results—
In preliminary screening of putative transcriptional factors on the promoters of mouse and human 12/15-LOX genes, we detected multiple putative binding motifs for STATs in the promoters of 12/15-LOX. Following glutamate treatment of primary cortical neurons, phosphorylation of STAT1 (Y701) and STAT6 (Y641), as well as 12/15-LOX protein levels, were significantly increased. Importantly, we found significant increases in mRNA levels of 12/15-LOX in mouse cerebral cortices subjected to ischemia reperfusion, which was paralleled in glutamate-treated primary cortical neurons. Gene silencing of STAT1 or 6 by siRNA transfection in primary cortical neurons reduced the levels of both 12/15-LOX mRNA and protein under glutamate-induced oxidative stress. Moreover, inhibition of STAT1 or 6 by siRNA transfection protected primary cortical neurons against glutamate-induced oxidative stress.

Conclusions—
This study increases our understanding of the transcriptional regulation of the 12/15-LOX gene in cerebral ischemic injury and oxidative stress, which will be important to guard against neuronal cell death. Identifying regulators of 12/15-LOX transcription may suggest new molecular targets for stroke therapy.
Abstract TP110: Bone Marrow Stromal Cells Enhance The Recovery of Peri-infarct Neuronal Integrity by Replacing The Damaged Neurons - A Serial
123
I-Iomazenil SPECT Study
Authors: Saito Hisayasu , Kuroda Satoshi , Miyamoto Michiyuki , Yamauchi Tomohiro , Shichinohe Hideo , Zhao Songji , Magota Keiichi , Kubo Naoki , Kuge Yuji , Tamaki Nagara , Houkin Kiyohiro
Published: March 2022

Background:
There is increasing evidence that bone marrow stromal cells (BMSC) have the potential to improve neurologic function when transplanted into the infarct brain. However, no methods have been established to objectively evaluate the effect of BMSC transplantation in clinical situation. Therefore, we aimed to assess whether the BMSC improve the neuronal viability on
123
I-iomazenil (IMZ) SPECT, when transplanted into the infarct brain of rats.

Methods:
The BMSC were harvested from rats and were cultured. The rats were subjected to permanent middle cerebral artery occlusion. The BMSC or vehicle was transplanted into the ipsilateral striatum at 7 days after the insult. Using
123
I-IMZ SPECT, The
123
I-IMZ uptake was measured at a day before and at 4 weeks after BMSC transplantation. The distribution of engrafted cells and the expression of neuron-specific γ-aminobutyric acid (GABA) receptor protein in the peri-infarct area were examied, using fluorescence immunohistochemistry.

Results:
The
123
I-IMZ uptake was markedly low in the dorsal peri-infarct neocortex at a day before transplantation. However, BMSC transplantation significantly improved the
123
I-IMZ uptake in that area at 4 weeks after transplantation. The ratio of
123
I-IMZ uptake in the ipsilateral to contralateral dorsal neocortex significantly increased from 53.4 ± 17.3% to 77.3 ± 16.3% in the BMSC group (P<0.01). On the other hands, the values did not change significantly in the vehicle group. The ratio of the GABA
A
receptor-positive cells in the ipsilateral to contralateral dorsal neocortex was significantly higher in the BMSC group than in the vehicle group (P<0.01).

Conclusion:
These findings strongly suggest that BMSC may improve the peri-infarct neuronal integrity when transplanted into the infarct brain at clinically relevant timing.
123
I-IMZ SPECT may be a valuable modality to scientifically prove the beneficial effects of BMSC transplantation on the host brain in clinical situation.
Abstract TP112: Post-conditioning with Isoflurane Reduces Ischemia-induced Hemorrhage and Brain Injury Following MCAO in Rats: A Longitudinal Study with MRI
Authors: Taheri Saeid , Shunmugavel Ananda
Published: March 2022

The objective of this study was to use multimodal MR imaging to evaluate the effect of isoflurane on short-term and long-term neuronal tissue damage and neurological deficits after focal brain ischemia in rats and correlate the improvement with the behavioral outcome.

Male Wistar/Kyoto rats were divided into 4 experimental groups; Control (Group I, n=5), Sham (Group II, n=5), MCAO (Group III, n=20) and MCAO with isoflurane treatment (Group IV, n=20). Animals were anesthetized with 5% isoflurane and maintained on 2% isoflurane during surgery. MCA was transiently occluded (90 min) using intra-luminal thread. After surgery, group IV was kept under 2% isoflurane for 90 min period. Other groups were allowed to recover immediately after the surgery. Animals were subjected to MRI to measure, infract volume, edema and blood flow in 8 in vivo imaging sessions performed at 6, 12, 24, 48, 72h (short term) and 7, 14 and 21d (long term) post MCAO. Anatomical, diffusion and arterial spin labeling (ASL) were performed with 7T MR Scanner. The following parameters were used in DTI; TE/TR=23/5000 ms, diffusion directions 30, b=100, 850, and 1850 s/mm2, FOV 4.0 x 4.0 cm, 12 slices with thickness 1 mm, and matrix 128 x 128. Standard ASL sequence was used to calculate the regional blood flow. Diffusion images were processed to generate diffusion parameter maps. Mean diffusion parameters calculated in the infarct regions were manually drawn on T2 maps. Behavioral improvement was measured in terms of latency on rotarod and beam walk.

Rats post-conditioned with isoflurane did not show hemorrhage during short term or long term post MCAO, while non-conditioned rat develop hemorrhage after short term post MCAO. Lesion in the cortical area was noticed since 6h post MCAO. However, cortical lesion was significantly reduced in the treatment group. Post-conditioned rats had significantly higher latency on rotarod and lesser number of foot faults on beam walk test measured on day 3,7,14 and 21 of MCAO, implying isoflurane mediated functional protection.

Our results for the first time, at the longitudinal level show that maintaining MCAO rats under isoflurane environment before reperfusion offers enhanced neuroprotection and recovery from behavioral dysfunction through reduced brain hemorrhage.
Abstract TP113: Arginase-1 and S100a12 are Novel Candidates for the Study of Post Stroke Immune Suppression
Authors: Brooks Steven D , Stinehart Kyle , Rellick Stephanie , Doll Danielle , VanGilder Reyna , Barr Taura
Published: March 2022

Objective:
Stroke-induced immune suppression is common and clinically observed by the neutrophil- lymphocyte count ratio (NLR). The NLR can predict stroke recovery. The purpose of this study was to identify the relationships between the NLR and our previously established genomic profile for the characterization of immune pathways affecting stroke recovery.

Methods:
Patients with imaging confirmed ischemic stroke (IS) or transient ischemic attack (TIA) were recruited from West Virginia University Hospital (WVUH) in Morgantown, WV. White blood cell (WBC) differentials were performed on admission then analyzed as a ratio between the neutrophil and lymphocyte counts. Recovery was determined at 90 days for stroke patients only via the Modified Rankin Scale score (MRS). Peripheral blood samples were collected within 24 hours from symptom onset in Paxgene RNA tubes. Total RNA was extracted, amplified, and the expression of ARG1, CA4, CCR7, CSPG2, IQGAP, LY96, MMP9, ORM1, and S100a12 was quantified via Taqman PCR. The gene expression profile was compared to the NLR and MRS via Spearman rho correlation coefficient.

Results:
A total of 9 IS and 4 TIA patients were included in this study. The mean age of the IS patients was 72 years and TIA patients 70 years. Expression of ARG1 was significantly correlated with elevated NLR at baseline (r=.93, p=.001) for both IS and TIA and poor 90 day MRS (r=.86, p=.01) following IS. Elevated expression of S100A12 was correlated with higher neutrophil count (r=.67, p=.07) and total WBC (r= .78, p=.02) as well as with ARG1 expression (r=0.72; p=0.008) in both patient cohorts.

Conclusion:
We have identified a significant correlation between the expression of ARG1, S100a12 and the NLR for IS and TIA patients, as well as with ARG1 and outcome following IS. Elevated ARG1 decreases T-cell proliferation resulting in immune suppression. S100A12 modulates neutrophil activity. Our data suggests that ARG1 and S100A12 are interesting candidates for the study of the immune response following cerebral ischemia. Further studies are required to confirm this relationship when controlling for age, disease severity and comorbid conditions.
Abstract TP115: The Increase In Plasma Angiotensinogen Is Associated With The Reduction Of Neurological Severity In Ischemic Stroke
Authors: Ago Tetsuro , Matsuo Ryu , Kamouchi Masahiro , Kuroda Junya , Kasahara Naoko , Isomura Tetsu , Awano Hideto , Suzuki Kazuo , Kiyohara Yutaka , Kitazono Takanari
Published: March 2022

Background and Purpose:
Activation of the renin-angiotensin system (RAS) is a crucial factor leading to the development of hypertension and atherosclerosis, thereby causing brain infarction. However, the significance of RAS in the acute phase of brain infarction has not been fully understood. Our goal was to elucidate the significance of RAS in the acute phase of ischemic stroke.

Methods:
We measured plasma angiotensinogen (AGTN), angiotensin-converting enzyme (ACE) and some associated biomarkers, and examined clinical information in 171 ischemic stroke patients at 5 time points (days 0, 3, 7, 14 and 90) after the onset and 171 age- and gender-matched healthy subjects.

Results:
plasma AGTN values were increased in all stroke subtypes with different profiles in the acute phase of brain infarction: they were continuously elevated in atherothrombotic brain infarction, while they fluctuated in cardioembolic and lacunar infarction. On the other hand, plasma ACE values remained decreased from the onset to the 90 day in all subtypes, suggesting that the final product Angiotensin II (Ang II) was increased in the plasma and suppressed the production of ACE in a feedback mechanism during the period. AGTN values were not significantly associated with blood pressure. Among the biomarkers we tested, AGTN was highly associated with adrenocorticotropic hormone (ACTH) (r = 0.62, p < 0.0001), but not with other pituitary hormones and inflammatory cytokines (IL-1b, IL-6 and TNFa). Neurological severity assessed by NIH Stroke Scale at day 0 was associated negatively with the AGTN values, while positively with ACE.

Conclusions:
Ang II production may be increased in the acute phase of brain infarction with decreased plasma ACE in all subtypes and different profiles of AGTN according to stroke subtypes. Increased production of AGTN leading to the increase in Ang II appears to be associated with the reduction of neurological severity in ischemic stroke.
Abstract TP124: Mediators of the Age Effect among Patients Treated with Carotid Artery Stenting: The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST)
Authors: Voeks Jenifer H , Farb Richard I , Heck Donald V , Roubin Gary S , Moore Wesley S , Logan William , Longbottom Mary E , Howard George , Brott Thomas G
Published: March 2022

Background
An increased risk of periprocedural stroke and death has been reported for older patients treated with carotid stenting (CAS). Selection of patients for CAS could be improved if patient or artery characteristics responsible for this higher risk could be identified.

Methods
The 1123 CREST patients randomized to CAS who received CAS within 30-days were analyzed. From the CREST sites, risk factors for atherosclerosis (hypertension, diabetes, and dyslipidemia) and arterial characteristics by angiography (lesion length, eccentric lesions, ulcerated lesions, and percent stenosis) were assessed. From the CREST core labs, potential mediators of the age effect included peak systolic velocity (ultrasound core, available on 853 patients) and arterial characteristics (angiographic core, available on 1042 patients, narrow/no ulcer or wide mouth, lesion location, and distal tortuosity). Mediation analysis assessed impact of adjustment for these factors on the magnitude of the estimated increased risk for CAS at older ages.

Results
After adjustment for sex and symptomatic status, there was a 1.72-times (95% CI: 1.26 - 2.37) increased risk of periprocedural stroke and death associated with each decade of patient age. Adjustment for lesion length as assessed in the clinical center significantly attenuated this increased risk at older ages to 1.66 (95% CI: 1.20 - 2.29, p = 0.039), an 8.3% attenuation. No other factor showed evidence as a contributor to the periprocedural increased risk of stroke and death in older patients (p > 0.10).

Conclusion
These data suggest that a longer carotid artery lesion length is a significant contributor to the increased risk of CAS in the elderly. However, attenuation of the age effect was modest, less than a 10% change in the hazard ratios. Other potential mediators such as tortuosity and atherosclerosis of the aortic arch and great vessels were not assessed. Non-anatomic factors that are more common with advancing age such as cerebral white matter disease and subclinical dementia were also not assessed and may play a role in how elderly patients respond to ischemic insults.
Abstract TP127: Association between Carotid Stiffness and Carotid Plaque: The Northern Manhattan Study
Authors: Kuo Frank , Della-Morte David , Gardener Hannah , Cabral Digna , Elkind Mitchell S , Sacco Ralph L , Rundek Tatjana
Published: March 2022

Background and Purpose:
Carotid plaque (CP) and increased carotid artery stiffness (STIFF) are intermediate pre-clinical markers of atherosclerosis and important predictors of cardiovascular disease (CVD) and ischemic stroke (IS). This study sought to investigate the association between STIFF and carotid plaque burden (plaque number; total plaque area-TPA) in a multiethnic population-based cohort from the Northern Manhattan Study (NOMAS).

Methods:
We used multivariable-adjusted regression models to examine the independent associations of STIFF with plaque number (negative binomial regression) and TCAP (multinomial logistic regression) among 876 subjects with carotid ultrasound imaging assessments and free of stroke and myocardial infarction.

Results:
Prevalence of CP was 57%. Among those with plaque, the mean TPA was 22.61±23.00 mm
2
, median=14.83. The mean STIFF was 6.66±0.63. STIFF was positively associated with the number of carotid plaques in multivariable-adjusted models. An association was also suggested between STIFF and TPA, but it was attenuated slightly and lost statistical significance after adjusting for anti-hypertensive medication use and vascular risk factors.

Conclusion:
Exploring the possible interrelationships between the vascular structure and function may lead to a better understanding of the pathophysiology of atherosclerosis and better preventive treatments of vascular diseases.
Abstract TP128: The Clinical Implications Of Cerebrogenic Myocardial Injury In Acute Stroke
Authors: Ahn Sungho , Kwon Sunuck
Published: March 2022

Background and purpose:
Serum cardiac troponin-I (cTnI) can be increased in acute stroke. It has been hypothesized that elevated cTnI levels in stroke are due to cerebrogenic myocardial injury (CMI) caused by sympathoadrenal activation. However, there is still little information for clinical implications of CMI. The aim of this study was to identify the relationships between CMI and clinical characteristics of stroke patients.

Methods:
We performed a retrospective analysis of 2114 consecutive stroke patients. We excluded the patients with other conditions for cTnI elevation including acute coronary syndrome, congestive heart failure, chronic kidney disease and myocarditis. Finally, we divided those selected patients into 2 groups: 1) CMI group: cTnI≥0.06 ng/l; 2) non-CMI group: cTnI<0.06 ng/l. We compared demographics, stroke severity by the mNIHSS, stroke types and stroke locations. Univariate analysis was used to screen for predictive factors (P≤0.10) and these variables were entered into the final multivariable logistic regression model along with gender and age.

Results:
Of 2114 consecutive patients, 254 patients (12.01%) were defined as CMI group. CMI was associated with older age (67.49±12.54 vs 65.35±12.61; p=0.011), ischemic heart disease (11.8% vs 7.4%; p=0.015), higher mNIHSS (8.40±7.29 vs 6.12±6.00; p<0.001) and rapid heart rate (81.48±19.15 vs 77.71±18.02, p=0.005). Gender, hypertension, diabetes, atrial fibrillation, hyperlipidemia, stroke location, stroke type, and blood pressure had no significant association with CMI. In logistic regression analyses, CMI was significantly associated with ischemic heart disease (OR 1.81; 95% CI 1.17-2.80), mNIHSS (OR 1.05; 95% CI 1.03-1.07), heart rate (OR 1.01; 95% CI 1.00-1.02) after controlling for gender and age.

Conclusions:
This study showed that the patients with severe neurological deficits, ischemic heart disease, and rapid heart rate were predisposed to CMI. These findings support that abnormal sympathetic activations are important in CMI and these reactions are related with severity of stroke and vulnerability of heart against ischemic insult. Further prospective studies are needed to evaluate the clinical significance of CMI in acute stroke patients.
Abstract TP142: Prevalence of Cerebral Ischemic Events in Extraluminal Protruding Intracranial Atherosclerotic Plaques: Analysis of Intracranial Vessels from the Nun Study
Authors: Majidi Shahram , Semaan Edouard , Chaudhry Saqib A , Santa Cruz Karen S , Suri M Fareed K , Qureshi Adnan I
Published: March 2022

INTRODUCTION:
The prevalence and clinical significance of extraluminal protruding plaques in intracranial arteries is not fully understood. We aimed to identify the prevalence of ischemic events in persons with extraluminal protruding plaques in intracranial arteries.

METHODS:
A random sample of 100 subjects from Nun Study repository of post-mortem intracranial arteries was inspected. The study is a longitudinal study of aging and Alzheimer’s disease funded by the National Institute on Aging including 678 participants. A total of 61 subjects with visible atherosclerotic changes (defined as change in vessel wall color) were selected. The specimens were placed in a liquid container and an angiographic catheter was placed in vessel of interest. Angiography was obtained in multiple planes. Percentage luminal stenosis was measured using proximal or distal normal vessel as reference. Using microscopic images, extraluminal protruding plaques was then sequentially measured.

RESULTS:
Out of 61 subjects, 41 (67%) had angiographically detectable atherosclerotic plaques. Thirteen (13%) subjects had extraluminal protruding plaques and the remaining 7 (20%) subjects have neither angiographic stenosis nor extraluminal protruding plaques. Mean life expectancy was higher in patients with angiographic stenosis and outside plaque protrusion (59 and 51 versus 47 years). The prevalence of lacunar infarct, large infarct (>1.5cm) in autopsy, and infarction identified in patient’s brain MRI were all higher in patients with extraluminal protruding plaques than patients without any plaque (38% versus 29%, 37% versus 31%, and 15% versus 14%, respectively). Mean serum cholesterol level was higher in patients with extraluminal protruding plaques (264 mg/dl versus 205 mg/dl). The prevalence of dementia in patients with angiographic stenosis, extraluminal protruding plaques, and no wall thickness change was 80%, 20%, and zero, respectively.

CONCLUSIONS:
Extraluminal protruding plaques without angiographic stenosis appear to be associated with ischemic events in patients. Higher prevalence of ischemic events in these patients warrants early detection using high resolution MRIand possible intervention.
Abstract TP145: Effect of Carotid Revascularization Endarterectomy Versus Stenting Trial Results on Performance of Carotid Artery Stent Placement and Carotid Endarterectomy
Authors: Hussein Haitham M , Adil Malik M , Qureshi Adnan I
Published: March 2022

Introduction:
Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) results, published in 2010, showed no difference in outcome between carotid artery stenting (CAS) and carotid endarterectomy (CEA). We aim to determine whether there has been any change in utilization or outcomes of CAS and CEA after CREST results.

Methods:
We determined the frequency of CAS and CEA procedures performed in the state of Minnesota, in the years 2009 (pre-CREST period) and 2011 (post-CREST period), using data from the Minnesota Hospital Association. Pre- and post-CREST CAS and post-CREST CEA rates and outcomes were compared with pre-CREST CEA (reference). In-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis.

Results:
A total of 2,718 patients underwent CEA or CAS in pre- and post-CREST period. The frequency of CAS increased from 8.2% to 11.5% of the total patients treated (p=0.004). In the pre-CREST period, CAS group (compared with CEA) were younger, had higher rate of diabetes mellitus and congestive heart failure, in-hospital occurrence of urinary tract infection, sepsis, and myocardial infarction. In the post-CREST period, CAS group did not differ from CEA group in demographics, medical co morbidities, or in-hospital complications except UTI. Hospital stay and hospital charges were greater with CAS compared to CEA, however, the differences in 2011 were less than in 2009. After adjusting for age, sex, relevant risk factors and hospital complications, compared with pre-CREST CEA, pre-CREST CAS was associated with higher neurological complications (odds ratio [OR] 3.3; 95% confidence interval [CI] 1.1-10; p=0.03), cardiovascular complications (OR 5.0; 95% CI 1.8-14; p=0.001), and composite outcome of neurological complications, cardiovascular complications, or death (OR 4.0; 95% CI 1.8-8.6; p=0.0007). There was no difference in outcomes or procedure-related complications between post-CREST CAS and either pre- or post-CREST CEA.

Conclusion:
There has been a significant increase in the number and improvement in outcome of CAS procedures performed after publication of CREST results in state of Minnesota, presumably due to higher rates of CAS performance in average surgical risk patients.
Abstract TP150: Intracranial steal phenomenon in Patients with Severe Steno-occlusive Disease of Intracranial Carotid or Middle Cerebral Artery
Authors: sharma vijay , yeo leonard , Ahmad Aftab , sinha arvind , chong vincent F , wong lily Y , jie su , hock luen teoh , chan bernard
Published: March 2022

Background:
Intracranial stenosis is a strong risk factor for stroke recurrence. In severe stenosis, perfusion is maintained by collaterals and cerebral autoregulation (CA). CA may be impaired due to inadequate cerebral vasodilatory reserve (CVR) & intracranial steal phenomenon, so called ‘reversed-Robin Hood syndrome (RRHS)’. Identification of patients with inadequate CVR and RRHS may help in selecting high-risk patients.

Methods:
We prospectively included patients with symptomatic and severe stenosis of intracranial carotid (ICA) & middle cerebral artery (MCA). CVR was evaluated with TCD & breath-holding index (BHI) <0.69 represented inadequate CVR. RRHS was detected as transient velocity reduction in affected artery when flow increased in the reference artery. Patients with RRH were further evaluated with acetazolamide-challenged HMPAO-SPECT.

Results:
TCD detected inadequate CVR in 112 patients (79 males, mean age 57yrs; range 23-79yrs) with severe intracranial stenosis of ICA or MCA. RRHS with a median steal magnitude of 17% (inter-quartile range, IQR 10) was seen in 35 (31%) patients. HMPAO-SPECT demonstrated perfusion deficit (median 8%; IQR 13%) in 33 out of these 35 cases (sensitivity 78%, specificity 96% with positive predictive value 96%). A strong relationship between RRH on TCD and SPECT was noted on ROC curve analysis (area under curve 0.93; 95% confidence interval 0.88-0.98;p<0.00001). Linear relationship was seen between TCD steal magnitude and SPECT (Pearson correlation coefficient, r=0.643;p<0.0001). Patients with RRHS were at a higher risk of developing recurrent cerebral ischemia (RR 1.7, 95%CI 1.2-3.6; p=0.04).

Conclusions:
Intracranial steal phenomenon in patients with severe intracranial stenosis is associated with high risk of cerebral ischemic events. Acetazolamide-challenged HMPAO-SPECT is reliable in the diagnosis of reversed Robin Hood syndrome in patients with severe steno-occlusive disease of intracranial carotid and middle cerebral artery. Identification of RRHS might help in identifying a target group of patients for possible revascularization
Abstract TP156: Re-analysis of the SAPPHIRE and CREST Trials Using Weighted Composite Endpoints
Authors: Asaithambi Ganesh , Suri M Fareed K , Qureshi Adnan I
Published: March 2022

Background:
Composite endpoints were used in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) and Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trials to compare outcomes between those who underwent carotid artery stent (CAS) placement and those who underwent carotid endarterectomy (CEA) for treatment of carotid artery disease (CAD). However, using composite endpoints assumes that each individual outcome is of equal clinical importance.

Objective:
To determine if there was a difference in effectiveness between CAS and CEA in treating CAD if weighted composite endpoints were used in the two randomized trials.

Methods:
Long-term results were examined for each trial (3 years for SAPPHIRE and 4 years for CREST). Each outcome was given a weighted measure based on a point system [death=5; major stroke=4; minor stroke=2; and myocardial infarction=1]. Study populations were amplified by using a constant coefficient (sum of all points=12). Results were then compared between the CAS and CEA groups to determine statistical significance.

Results:
At 3 years, there were a total of 56 and 67 adverse outcomes in the CAS and CEA groups, respectively, in the SAPPHIRE trial. At 4 years, there were a total of 215 and 190 adverse outcomes in the CAS and CEA groups, respectively, in the CREST trial. Based on weighted composite endpoints, the CAS group had a significantly lower rate of adverse outcomes compared to the CEA group in the SAPPHIRE trial (p<0.0001) but a significantly higher rate of adverse outcomes in the CREST trial (p<0.0001).

Conclusion:
With the use of weighted composite endpoints, one can provide more clinically relevant information by discriminating among adverse outcomes and describing differences with greater discriminatory power. Based on weighted composite endpoints, there is clear superiority of CAS over CEA in the SAPPHIRE trial, but the converse is true of results from the CREST trial.
Abstract TP158: Angiographic Feature And Stroke Presentation Of Adult Moyamoya Disease
Authors: Jang Dong Kyu , Lee Kwan-Sung , Rha Hyung-Keun , Huh Pil-Woo , Yang Jiho , Park Ik-Sung , Ahn Jae-Geun , Sung Jae-Hoon , Han Young-Min , Park Jae Hyun
Published: March 2022

Background and Purpose:
Adult moyamoya disease (MMD) has a different clinical presentation compared as pediatric MMD. The present study was conducted to elucidate the correlation of angiographic characteristics and stroke presentation in adult MMD patients.

Methods:
We conducted a retrospective analysis of radiologic features of 315 adult patients with definite moyamoya disease which was proved by digital subtraction angiography according to the guidelines of the Research Committee on Spontaneous Occlusion of the Circle of Willis (MMD) of the Ministry of Health and Welfare in 1997. Comparison of angiographic stage and stroke patterns for 630 hemispheres was performed according to stroke presentation.

Results:
The mean age of diagnosis was 41.5 (
±
11.7) years. Male to female ratio was 1 to 1.85. One hundred eighty five patients (57.8%) experienced the acute stroke at diagnosis. There was stroke episode prior to diagnosis in 139 patients (43.4%). Among 63 patients (19.7%) who had not experienced any stroke, there was TIA in 44 (13.7%) and no symptoms in 19 (5.9%). Angiographic stage was 50 in 1 (7.8%), 170 in 2 (26.6%), 221 in 3 (35.5%), 129 in 4 (20.2%), 61 in 5 (9.5%) and 9 in 6 (1.4%). Stroke rates were significantly different according to angiographic stage (P=0.041). The occlusion of middle cerebral artery was a significant association with ipsilateral acute stroke (P=0.01). The occlusion of anterior cerebral artery (ACA), middle cerebral artery (MCA), fetal-type posterior cerebral artery was significantly associated with stroke type (P=0.001, 0.002, 0.018). Cerebral blood flow and cerebral vascular reactivity were also strongly associated with ipsilateral acute stroke (P<0.001).

Conclusions:
In adult moyamoya disease, angiographic stage, MCA occlusion and hemodynamic status are associating factors with stroke development. Occlusion patterns of major arteries are different according to stroke type.
Abstract TP16: Occurrence Of Femoral Nerve Injury Among Patients Undergoing Transfemoral Percutaneous Catheterization Procedures In United States
Authors: Tariq Nauman , Adil Malik M , Chaudhary Saqib , Qureshi Adnan I
Published: March 2022

Background:
The proximity of femoral nerve to femoral artery renders it vulnerable to injury during transfemoral percutaneous catheterization procedures.

Objective:
To determine the incidence of femoral nerve injury in patients undergoing cardiac catheterization in a nationally representative inpatient database.

Methods:
We analyzed the data from Nationwide Inpatient Sample release annually. We pooled the data from 2002 through 2010 and identified patients using the ICD 9 CM procedures codes who underwent transfemoral percutaneous catheterization procedures. We subsequently identified occurrence of femoral nerve injury in this cohort of patients. Baseline characteristics, co-morbid conditions, in hospital complications and discharge outcomes (mortality, minimal disability, and moderate to severe disability) were compared between the two groups.

Results:
Of the 14255031 patients who underwent percutaneous catheterization procedures, 508 (3 per 1000 procedures) developed femoral nerve injury. The incidence of femoral nerve injury was higher in women: 57% vs 39%%, p<0.004. Patients with coexisting congestive cardiac failure or coagulopathy had a non-significantly increased incidence of femoral nerve injury. There was no in-hospital mortality among patients who developed femoral nerve injury; however, the rate of discharge to nursing facility was higher in patients with femoral nerve injury: 19% vs 10%, p<0.001. After adjusting for age, gender , presence of congestive cardiac failure and coagulopathy femoral nerve injury during percutaneous catheterization procedures was independently associated with moderate to severe disability at discharge (Odds ratio, 2.3; 95% confidence interval, 1.4-3.8, p<0.001)

Conclusion:
Femoral nerve injury is a rare complication during percutaneous catheterization procedures which may increase the likelihood of moderate to severe disability at discharge.
Abstract TP164: Significance of the Thrombus Component as a Predictor for Malignant Middle Cerebral Artery Infarction
Authors: Horie Nobutaka , Morikawa Minoru , Tateishi Yohhei , Fukuda Yuhtaka , Fukuda Shuuji , Hayashi Kentaro , Izumo Tsuyoshi , Tsujino Akira , Nagata Izumi
Published: March 2022

Background and Purpose—
Malignant middle cerebral artery (MCA) infarction is one of the most devastating forms of ischemic stroke, and identification of predictors of a malignant course of the MCA or internal carotid artery (ICA) infarction is exceedingly important. Here, we investigated whether thrombus component defined with MR imaging could predict malignant changes in the acute stage of the cerebral infarction.

Methods—
We retrospectively analyzed 468 consecutive patients with cerebral infarction in our institute from 2007 to 2011. In all the patients, initial MR imaging including T2 star (T2*), diffusion weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR) and MR angiography were performed and susceptibility vessel sign (SVS) on T2* was evaluated in relation to the brain swelling on CT 24 hours after the initial imaging. Correlation of the thrombus component between MRI and CT was also evaluated.

Results—
One hundred and twelve patients showed MCA main trunk or carotid T occlusion. Among them, 38 patients were t-PA failed or did not undergo endovascular treatment. Twenty eight patients had ICA occlusion and 10 patients had MCA main trunk occlusion. SVS was apparent in 17 (45%) patients, and there was no significant difference between SVS positive and SVS negative group in age (75.6 vs. 72.3 years old), time to arrival (84.4 vs. 106.9 min) and NIH stroke scale (19.5 vs. 18.7). On the other hand, DWI area was significantly larger in SVS positive group (189.3 vs. 107.6 ml). DWI area was also significantly correlated with brain swelling 24 hour later regardless of SVS. Most SVS positive patients showed MCA dense sign on CT performed 24 hours later (85.7% vs. 29.4%).

Conclusions—
Susceptibility vessel sign on MRI, which suggests RBC rich thrombus, indicates early maturation of the infarct in the MCA area, but could not predict following malignant change.
Abstract TP171: Purpose in Life and Risk of Cerebral Infarction
Authors: Levine Steven R , Boyle Patricia A , Yu Lei , Wilson Robert S , Schneider Julie A , Bennett David A
Published: March 2022

Background:
Purpose in life (PIL), the sense that life has meaning and direction, is associated with a reduced risk of Alzheimer’s disease, incident disability, and mortality among community-dwelling older persons.

Objective:
To test the hypothesis that PIL is associated with reduced risk of cerebral infarction.

Methods:
Longitudinal clinical-pathologic cohort study. Subjects were from the Rush Memory and Aging Project (MAP). Older persons without dementia completed a standard measure of PIL using a structured interview and 10-item scale derived from Ryff’s Scales of Psychological Well-Being. The number of chronic gross & microscopic cerebral infarctions (each expressed as 0,1, or >1) were identified on a uniform neuropathologic examination blinded to clinical information. Semiquantitative assessments (0 to 3) of atherosclerosis and lipohyalinosis were also performed. The associations of PIL with cerebral infarction, cerebral vessel pathology were examined using linear regression and mixed models adjusted for age, sex, & education.

Results:
347 subjects had both PIL and brain pathology assessed. Scores on the measure of PIL ranged from 2.1 to 5.0 (mean 3.5, SD 0.48). On postmortem examination, gross/macroscopic cerebral infarcts were found in 112 (32.28%) persons (51 with 1, 61 with >1) and microinfarcts were found in 84 (24.21%) (54 with 1, 30 with > 1). PIL was associated with a reduced odds of gross cerebral infarcts (estimate = 0.57, SE = 0.24, p = 0.02) and there was a trend (p = 0.096) toward an association with microinfarcts. PIL was not related to the type or severity of cerebral vessel pathology. In subsequent logistic regression models, the association of PIL with gross cerebral infarcts persisted after adjustment for depressive symptoms, BMI, smoking, diabetes, and measures of socioeconomic status. However, the association of PIL with gross infarcts was reduced to a trend (estimate = 0.46, SE = 0.26, p = 0.08) after adjustment for systolic blood pressure, suggesting partial mediation.

Conclusions:
Lower PIL may be a risk factor for macroscopic cerebral infarction in old age without a direct effect on atherosclerotic cerebral vessel pathology.
Abstract TP176: Residential Proximity to High Traffic Roadways is Associated with Post-Stroke Mortality
Authors: Wilker Elissa H , Wellenius Gregory , Mostofsky Elizabeth , Lue Shih-Ho , Gold Diane , Schwartz Joel , Mittleman Murray
Published: March 2022

Background:
Living in areas with higher pollution has been associated with incidence of ischemic stroke and higher rates of all-cause mortality. There is considerable interest in the relative role of traffic related pollution specifically, but less is known about the relationship between traffic related pollution and long term survival after stroke. We hypothesized that living closer to a busy roadway is associated with a higher rate of post-stroke mortality in the Boston area.

Methods:
We identified 1763 consecutive patients age ≥21 years admitted to Beth Israel Deaconess Medical Center with neurologist-confirmed ischemic stroke between April 1, 1999 and October 31, 2008 and residing in the Boston metropolitan area. The Social Security Death Index was used to identify deaths through June 2012. We obtained average daily traffic counts from the Massachusetts Department of Transportation and geocoded patients’ addresses to determine distance to the nearest roadway averaging ≥10,000 vehicles/day. Categories of residential distance were defined as ≤100 meters (m), 100 to ≤200 m, 200 to ≤400 m or >400 m from a busy roadway. Models were adjusted for demographics, medical history, and socioeconomic factors.

Results:
Among 1682 stroke patients with complete data, there were 826 deaths [median follow up = 4.6 years]. We observed a higher rate of post-stroke mortality among people living closer to high traffic roadways. Patients living ≤100 m from high traffic roadways had a 23% (95% CI: 2%, 49%) higher rate of post-stroke mortality than patients living >400 m away (Figure, p-trend=0.04).

Conclusions:
In this study, living close to a busy roadway was associated with an elevated mortality rate. This relationship remained statistically significant after adjustment for individual and neighborhood level factors, providing further evidence of the association between traffic-related pollution and mortality in a susceptible population.