bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract HUP19: Barthel Index Linguistic Adaptation and Validation in Hindi for Stroke Patients
Authors: Kumar Sanjeev , Bohra Arwa , Shah Nehal , Rai Nirendra , Singh Anshul , Wadnerkar Ankita , Goyal Sagar
Published: February 2024

Introduction:
Stroke contributes 87% of Disability-adjusted life years(DALYs) in low, middle-income countries. Patient-Reported Outcome Measures (PROMs) involve tools capturing patient perspectives on stroke's impact. The Barthel Index (BI), is widely used for predicting clinical outcomes, and non-standardized translations may cause disparities. A validated toolkit ensures clinical equivalence in translation.

Methodology:
A two-phase study translated and validated the BI in Hindi. Forward-backward translation and pre-testing involved a Hindi-speaking healthcare professional. Only confirmed stroke patients without concurrent spinal injury were included.

Results:
127 patients from AIIMS Bhopal participated, averaging 55.26 years (σ=14.13), with 70.08% males and 29.92% females. Various stroke types were observed:1.57% had a hemorrhagic ischemic stroke, 10.24% had a hemorrhagic stroke, 86.61% had an ischemic stroke, and 1.57% had a thromboembolic stroke. Exploratory factor analysis unveiled a 3-factor model, reflecting mobility (Factor 1), self-care (Factor 2), and bowel/bladder control (Factor 3). Cronbach's alpha values indicated good internal consistency for Factor 1 (α = 0.889) and acceptable for Factor 2 (α = 0.774). Difficulty Index was highest for bathing, while the transfer was easier. All items were easily discriminated against. (Discrimination Index>0.28)

Discussion:
BI-H exhibited validity and reliability in stroke patients, aligning with cultural aspects. Stroke-specific recommendations include subscales excluding bowel/bladder functions and two additional subscales for Factors 1 and 2. Cultural differences impact task difficulty, especially 'bathing', and 'eating' while 'toileting' needs both linguistic and cultural readaptation.

Limitations:
Linguistic adaptation should be followed by cultural validation. BI-H's applicability is confined to stroke patients, and its factor model may not extend to other conditions.
Abstract HUP20: Early Onset Hypertension Increases Risk Of Midlife Stroke Among Black Women
Authors: Aparicio Hugo J , Lioutas Vasileios , Shulman Julie G , Himali Jayandra J , Cozier Yvette , Sheehy Shanshan
Published: February 2024

Background:
Stroke at midlife contributes to earlier mortality and greater disability. There is a critical lack of data about early life stroke risk factors among Black women, a group with higher rates of hypertension compared to other racial groups. The hypothesis of the study is that early onset hypertension increases risk of midlife stroke among Black women.

Methods:
The Black Women’s Health Study is a prospective study of 59000 Black women from across the US who were followed since 1995. Baseline year for this analysis was the 1999 questionnaire. We included stroke-free participants younger than age 65 (46754 participants, mean age 42±9.6 [range 24-64] years). History of hypertension was determined by self-report, defined as physician-diagnosed hypertension with use of an antihypertensive medication or diuretic, or use of an antihypertensive alone. Ischemic and hemorrhagic stroke were ascertained by self-report at biennial health questionnaires. Using Cox models, we estimated risk of midlife stroke, comparing persons with and without hypertension before age 45, between ages 45-64, and at 10-year age intervals. Follow up was from 1999 until whichever came first: incident stroke, death, loss to follow-up, or end of study follow-up (12/31/19).

Results:
At baseline, 2980 (10.5%) of participants age <45 and 7147 (38.7%) of participants between ages 45-64 had hypertension. Stroke occurred in 1485 participants (3.2%) during up to 23 years of follow up (mean 17.1±5.0 years). Compared to women with no history of hypertension, Black women with hypertension before age 45 had a higher risk of midlife stroke (HR=2.23, 95% CI=1.79-2.78), after adjustment for age, neighborhood socioeconomic status, residence in Stroke Belt, smoking, body mass index, and diabetes. Risk was also increased with hypertension at midlife age 45-64 (HR=1.69, 95% CI=1.47-1.95) and was highest among those with hypertension at age 24-34 (HR=3.15, 95% CI=1.92-5.16).

Conclusion:
Black women with hypertension before age 45 have more than twice the risk of stroke at midlife and hypertension before age 35 more than triples the risk. The findings are important to inform public health interventions to expand hypertension screening and treatment in this high-risk population.
Abstract NS4: Can a Remote Telehealth-Based Program Support Survivors With Varying Social Needs Post-Stroke?
Authors: Sheehan Lauren , Winters Melanie , Wertheheimer Jeffrey , Tsai Nancey
Published: February 2024

Introduction:
There are significant and longstanding inequities in stroke prevalence and care as well as outcomes. Social determinants of health (SDOH) are known to be a risk factor in post-stroke recovery. SDOH also put individuals at higher risk for 90-day mortality. Social determinants are a significant contributor to disparities in health and specifically addressing SDOH needs may improve the health and outcomes of stroke survivors.

Methods:
An app-based, virtual care model was used to impact survivor quality of life and outcomes for stroke survivors and their care partners. As a part of program onboarding, the clinical navigator utilized the CMS Accountable Health Communities Health-Related Social Needs Screening Tool to assess survivor needs in five core domains including housing instability, food insecurity, transportation problems, utility needs, and interpersonal safety. As needs were identified, they were cross-walked to pre-populated community resource maps to aid the survivor in their recovery and support subsequent stroke prevention.

Results:
Of the (n=50) stroke survivors (median age of 62) that completed the 12-week survivor-led Navigator support program, 35% had one SDOH need, 16% had 2 SDOH needs, 16% had 3 SDOH needs, 3% had 4 SDOH needs and 28% had 5 or more SDOH needs. The most regularly identified areas of social need in the cohort were mental health (20%), financial strain (15.7%), employment (13.6%) and transportation (12.9%). These SDOH were addressed throughout the 90-day program based on individual access considerations. The 30- and 90-day all-cause readmission rates for survivors were 5% and 10%, respectively, superior to recent publications reporting 30-day unplanned readmission rates after stroke ranging from 8.7%-12.5%, and 90-day readmissions ranging from 18.9% to 20.7%.

Conclusion:
By assessing SDOH and providing specifically tailored post-acute resources to meet those needs, a tech-enabled platform with clinical navigator support can improve outcomes for stroke survivors with a variety of SDOH needs. Additional post-acute stroke care and targeted programming are needed to address the ongoing inequalities in the healthcare system as they relate to post-stroke care and recovery in populations with high SDOH needs.
Abstract NS6: Connecting the Dots; a Pharmacist-Led Care Transition Model for Stroke Patients Post-Discharge
Authors: Onyan Joshua L , Harris Jenna , Adamy Emily , Vallelunga Michelle F , Balotin Eric , Latorre Julius Gene S , Wee Claribel
Published: February 2024

Background/Purpose:
Stroke is a leading cause of adult disability worldwide, and one in four is due to recurrence, with the highest risk within the first 30 days post-discharge. Post-discharge follow-up is key to preventing hospital readmission and recurrent stroke. At our hospital, adult ischemic stroke (IS) patients are auto-enrolled in a pharmacist-led transitions of care program. Initially, our pharmacy team completes a medication history and reconciliation. Prior authorization and financial assistance services are offered. Patients who choose to remain enrolled are discharged with a 28-day supply of their medications, followed by all subsequent medications sent in adherence pill packs. Patients then receive a call 5-to-7 days post-discharge from a pharmacist to provide counseling on secondary stroke prevention and the importance of medication adherence. The pharmacist also ensures that the patient has scheduled follow-up appointments with both their primary care provider and the stroke clinic.

Methods:
In this retrospective cohort study, we included adult IS patients discharged from our center between October 2021 and July 2022. We compared those who chose to continue with our services beyond discharge with patients who opted out of our program. The primary outcome is medication adherence. The secondary outcome is the readmission rate.

Results:
Participation in our program resulted in an adherence rate of 98.5% compared with an adherence rate of 70.2% in those who declined to participate. Readmission was lower for participation, although not significantly so.

Conclusions:
Our program resulted in an improvement in medication adherence and a trend towards lower readmission rates amongst participating IS patients post-discharge. Further studies should be completed to examine the additional impacts of a pharmacist-led post-discharge program on secondary stroke prevention related to surrogate markers (Blood pressure, lipids, A1C, etc.) over time.
Abstract NS9: Nurse-Led Quality Improvement Initiative: Advancing Stroke Awareness in Communities Experiencing Racial and Ethnic Disparities
Authors: Rosenberg Antonieta , Anderson Marret , Doelger Meghan , Froehlich Anne , George Josephine , Kabacinski Andrea A , Suri-Finn Jillian , Wankmuller Gabriela
Published: February 2024

Background and Purpose:
As a Joint Commission Comprehensive Stroke Center, the provision of community education is a priority goal of our program. The majority of our existing community education program takes place in locations where we receive requests to provide these sessions. Analysis of our Get With the Guidelines (GWTG) data reveals gaps in early arrival to the hospital and Emergency Medical Service (EMS) utilization among African American and Hispanic populations. Providing educational resources within these populations may help to close these gaps and foster trust in the healthcare system. The aim of this proposed nurse-led quality improvement project is to improve hospital arrival times of African American and Hispanic stroke patients living in zip codes where GWTG data have identified gaps, through provision of targeted community education.

Methods:
The top zip codes associated with our target outcomes for improvement will be identified using GWTG pre-data from 2022 and 2023. We will partner with our Community Outreach department. We will identify educational venues and stakeholders among African American and Hispanic populations in these zip codes. We will provide education tailored to our identified populations including early recognition of stroke signs and symptoms, activation of EMS, stroke risk factors, and opportunities for treatment. Post implementation, GWTG data will be reviewed for any changes.

Results:
Using GWTG data, arrival mode, last known well time, and symptom discovery time to Emergency Department arrival as it pertains to zip codes, race and ethnicity will be reviewed and analyzed. The target zip codes’ data will be compared pre- versus post-implementation of community education efforts.

Discussion:
Through community education and partnership with the Community Outreach department we hope to improve timeliness of arrival to hospital among disproportionately affected racial minorities in our community for early stroke evaluation and treatment consideration.
Abstract TMP1: Cerebral Aneurysm Walls Contain Myoglobin That is Possibly Produced by Myofibroblasts and Contributes to Wall Thickening
Authors: Kimura Hidehito , Mori Tatsuya , Hayashi Kosuke , Ikeuchi Yusuke , Tanaka Kazuhiro , Shinohara Masakazu , Tomiyama Akio , KOHMURA EIJI , Sasayama Takashi
Published: February 2024

Background:
Cerebral aneurysms rupture at a thin-walled region; however, mechanisms of aneurysmal wall thinning and thickening remain unclear. Myoglobin scavenges nitric oxide and reactive oxygen spices which promote aneurysmal development.

Objectives:
To investigate the biological role of myoglobin in aneurysmal wall.

Methods:
Cerebral aneurysmal wall samples were collected between August 2020 and March 2022 for proteomic analysis and immunohistology. We examined the co-localization of myoglobin expression within smooth muscle cells, identified by α-smooth muscle actin (α-SMA) staining, and myofibroblasts, identified by periostin staining. Collagen and myoglobin density in the same sample areas were investigated for its correlation in the aneurysm walls.

Results:
A total of 35 specimens were obtained from 21 patients who underwent aneurysmal clipping. Proteome analysis was performed using 11 specimens, which firstly detected myoglobin predominantly in the thickened wall. Among 24 formalin-fixed samples, 19 samples were found myoglobin expression. Myoglobin was mostly scattered within the vascular smooth muscle layer and tended to be expressed at sites where iNOS was scarce. Double-label immunofluorescence staining confirmed that the myoglobin-positive rate within α-SMA-positive cells/areas was 33.2±23.8%/31.3±37.8%, respectively, whereas within periostin-positive cells/areas it was 92.2±13.7%/79.8±29.5, respectively. A total of 32 areas were investigated for the correlation between collagen and myoglobin density , which a strong correlation was observed with a Spearman's rank correlation coefficient of 0.635 (p < 0.001).

Conclusions:
Cerebral aneurysmal walls express myoglobin, which may be produced by myofibroblasts in the wall. Areas with high myoglobin levels retain high levels of collagen fibers, and myoglobin may be involved in wall thickening by suppressing destructive changes in the extracellular collagen fibers.
Abstract TMP103: Trends in Ischemic Stroke-Related Mortality in Patients With Type 2 Diabetes in the United States, 1999-2020
Authors: Farhan Syed Husain , Khan Adam Bilal , Nasir Muhammad Moiz , Mushahid Hasan , Banatwala Umm E Salma , Taufiq Muhammad Usman , Mahmood Umar , Kumar Harsh , Ishtiaq Jawad , Ahmed Jawad , Siddiqi Rabbia , Farhan Syed Ali , Marsia Shayan
Published: February 2024

Background:
The pathological changes in lining of blood vessels associated with diabetes is a well-established risk factor for stroke, some studies suggesting a two times increase in risk compared to non-diabetics.

Methods:
Death certificates from CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2020 for ischemic stroke related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity.

Results:
From 1999 to 2020 there were 20,941 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004 (APC: -0.78), showing a sharp decline to 0.15 in 2007 (APC: -20.79), a near constant rate of 0.14 in 2007 (APC: -1.05), followed by a rapid increase to 0.44 in 2017 (APC: 44.55), and 0.66 in 2020 (APC: 14.59). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs women: 0.29) and 2020 (AAMR men: 0.78 vs women: 0.58). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.37 vs white: 0.31) and 2020 (AAMR AA: 0.97 vs white:0.63). Notably, a significant escalation in AAMR occurred from 2016 to 2020, affecting both populations; this trend reached its pinnacle in 2020 (2016 AAMR AA: 0.39 vs. white: 0.27) (2020 AAMR AA: 0.97 vs. white: 0.63).

Conclusion:
The findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2007. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasizes the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischemic stroke-related mortality in the T2DM population.
Abstract TMP105: Development and Validation of a Risk Prediction Model for Ischemic Stroke Among Individuals Newly Diagnosed With Cancer
Authors: Lun Ronda , Leentjens Jenneke , Cerasuolo Joshua , Kirkwood David , Kapral Moira K , Siegal Deborah , Sutradhar Rinku
Published: February 2024

Introduction:
Cancer is an emerging risk factor for ischemic stroke. The risk of stroke is highest during the first year after a new diagnosis of cancer, but no tools exist to identify which patients are at the highest risk..

Methods:
Using linked clinical and administrative health databases, we conducted a population-based retrospective cohort study of adults in Ontario, Canada with newly diagnosed cancer from 2010 - 2021 (excluding non-melanoma skin cancer & central nervous system malignancies). Patients were randomly selected for model derivation (60%) or validation (40%). The final model predicting stroke within 1 year following cancer diagnosis was derived using multivariable Fine-Gray regression with candidate predictors selected via backward elimination. Sub-distribution adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated, where all-cause mortality was treated as a competing event. Model performance of the validation cohort was assessed using the C-statistic & calibration plots for discrimination and calibration, respectively.

Results:
Of the 698,566 eligible patients, 418,911 were randomly allocated to derivation, and 279,576 to validation. The overall rate of stroke per 1000 person-years was 6.7 (6.4 - 6.9) for the derivation cohort. The final model included 22 predictors: age, sex, long-term care residency, history of heart failure, hypertension, dementia, asthma, atrial fibrillation, dyslipidemia, liver disease, ischemic stroke, transient ischemic attack, valvular disease, venous thromboembolism, hospitalization within the last 3 months, cancer type, cancer stage, cancer surgery or chemotherapy 3 months following diagnosis, and several 2-way interactions with age & cancer type. Discrimination was good, with a c-statistic of 0.73 in the validation cohort. The model was well calibrated, with points following the 45-degree line (Fig 1).

Conclusion:
We derived and validated a risk prediction model for ischemic stroke in patients with a new cancer diagnosis with good discrimination. Although our results require external validation, it has potential to identify individuals at highest risk for future randomized trials.
Abstract TMP107: Persistent Beta-Blocker Use and Mortality Reduction in Acute Ischemic Stroke Patients
Authors: Lee Keon-Joo , Kim Seong-eun , Guk Hyung Seok , Kim Beom Joon , Han Moon-Ku , Kim Joon-Tae , Choi Kangho , Shin Dong-Ick , Cha Jae-kwan , Kim Dae Hyun , Kim Dong-Eog , Park Jong-moo , Kang Kyusik , Lee Soo Joo , Kim Jae G , Oh Mi-Sun , Yu Kyung-Ho , Lee Byung-Chul , Hong Keun-Sik , Cho Yong-jin , Choi Jay Chol , Park Tai H , Park Sang-Soon , Kwon Jee-Hyun , Kim Wook-Joo , Lee Kyungbok , Lee Jun , Lee Ji Sung , Lee Juneyoung , Bae Hee-Joon , Kim Nakhoon
Published: February 2024

Background:
The efficacy of beta-blockers in acute ischemic stroke remains ambiguous. Research targeting high-risk patients, especially those with elevated heart rates, is crucial.

Methods:
A comprehensive multicenter registry of acute ischemic stroke patients was integrated with the National Health Insurance Service database. We focused on patients exhibiting a heart rate of ≥100 bpm between days 3-7 post-symptom onset. These patients were categorized based on whether they received a beta-blocker prescription by day 8. To account for potential imbalances, we employed Cox’s proportional hazard model with inverse-probability of treatment weighting based on propensity score. The primary outcome was composite of stroke recurrence, myocardial infarction, and mortality within a year post-stroke. Recognizing the significant discontinuation rate of beta-blockers, we conducted an additional analysis on persistent users and landmark analysis at 2-month, 1-year, and 2-year intervals.

Results:
Out of 5,049 patients, 1,623 (32.1%) were prescribed with beta-blockers by the 8th day. Beta-blocker usage did not significantly influence the primary outcome within the first year (IPTW adjusted HR [95% CI], 0.98 [0.86-1.12]). However, patients who consistently used beta-blockers beyond 2 months exhibited a reduced mortality risk (adjusted HR, 0.88 [0.78-0.99]). Landmark analysis further revealed that consistent beta-blocker usage notably decreased mortality risk at 8-day to 2-month (IPTW adjusted HR [95% CI], 0.80 [0.69-0.93]) and 2-month to 1-year intervals (IPTW adjusted HR [95% CI], 0.80 [0.68-0.94]).

Conclusion:
Our findings suggest that beta-blockers can potentially reduce mortality in acute ischemic stroke patients, with consistent usage being a pivotal factor.
Abstract TMP11: Cerebral Visual Impairment in Pediatric Stroke Patients Assessed by Virtual Reality Testing
Authors: Da Cruz Emily , Tambala Diana , Lynch Anna , Manley Claire , Bambery Melissa , Kelly Daniel , Alhadid Kenda , Merabet Lotfi , Musolino Patricia
Published: February 2024

Introduction:
Pediatric stroke is one of the leading causes of disability in children, many of whom incur brain injury affecting critical visual anatomical networks. Dedicated ophthalmologic examinations that detect cerebral visual impairment (CVI) - the leading cause of congenital visual impairment in developed countries - are not standard of care and can delay diagnosis and interventions. There is limited CVI data in pediatric stroke patients, and in this work we present data defining visual processing deficits in pediatric stroke patients.

Hypothesis:
We hypothesize that pediatric stroke patients will (1) demonstrate greater visual-spatial processing impairments than controls and (2) demonstrate increasing performance impairment as a function of increasing visual task demands.

Methods:
Using a virtual reality (VR) based visual search task system, we characterized significant deficits in higher-order visual processing of pediatric stroke patients (n = 17) as compared to healthy controls (n = 13). Stroke patients suffered from a perinatal (n = 8) or pediatric (n = 9) stroke - confirmed with brain MRI - affecting various vascular territories of the anterior and posterior circulations. The task required searching for on-screen targets with increasing visual complexity. Metrics such as reaction time, gaze error, shifted ellipse area, success rate, and pursuit saccade ratio were analyzed using unpaired group-level t-tests and considered significant if p < 0.05.

Results:
Stroke patients took longer to identify the target (p = 0.001), were less accurate in finding it (p = 0.007), and exhibited greater impairment in performance with an increasing number of distractors compared to healthy children. Groups had comparable task compliance, as indexed by an off-screen count metric.

Conclusion:
This original work demonstrates that pediatric stroke patients, particularly those with strokes affecting the middle cerebral artery and posterior circulation vascular territories, exhibit impaired higher-order visual processing. This highlights the urgent need for standardized clinical testing to provide quantitative performance measures of cortical visual processing. This will allow timely detection and implementation of interventional therapies.
Abstract TMP110: A Novel Model of Ischemia in Rats With Middle Cerebral Artery Occlusion Using a Radiopaque Blood Clot and a Microcatheter Under Fluoroscopy
Authors: Komatsu Teppei , Ohta Hiroki , Takeda Misato , Matsumura Yasuhiro , Yokoyama Masayuki , Wang Zuojun , Okano Hirotaka J , Iguchi Yasuyuki
Published: February 2024

Introduction:
Conventional thromboembolic stroke model requires ligation of the ECA, which is problematic for research of thrombolytic agents because cerebral blood flow is different from human stroke. We aimed to develop a novel thromboembolic stroke model that does not require arterial ligation, using a radiopaque blood clot and microcatheter.

Methods:
Using male Sprague Dawley rats (n=14) and two sham operated rats were included, a microcatheter (inner diameter, 0.42mm; outer diameter, 0.55mm) was navigated from the caudal ventral artery to the left ICA using fluoroscopy. A blood clot (0.86 mm in diameter, 3 mm in length) containing zirconium dioxide was advanced in the catheter by injection of physiological saline to establish local occlusion. Both fluoroscopy at 1, 3, 6, 24 h and TTC staining at 24 h after stroke model creation were performed. Neurological deficit score was measured.

Results:
The success rate in selectively embolized of ACA and MCA bifurcation was 93% (13 of 14 cases). The median operating time was 7 min (interquartile range; 4-15 min). The median infarct volume (mm
3
) was 248 (interquartile range; 239-280) 24 h after occlusion. Neurological deficit scores before and at 1, 3, 6, and 24 h after model creation differed significantly (
P
< 0.001). Fluoroscopy showed the position of the radiopaque blood clot remains the same for 24 h after creating the model in 12 of 13 cases (92%). Sham-operated rats revealed no infarction and no neurological deficit.

Conclusions:
We present a novel rat model for focal infarct only in the MCA territory using a radiopaque blood clot. Fluoroscopy was able to identify whether the blood clot could migrate and recanalize.
Abstract TMP115: White Matter Loss and Neurological Deficits Due to Chronic Global Hypoperfusion Are Worsened in a Mouse Model of Cerebral Amyloid Angiopathy
Authors: Khan Romeesa , Guzman Gary , Do Trang , Tan Chunfeng , Devlin Patrick , Le Ngoc Mai , Ritzel Rodney , McCullough Louise D , Maniskas Michael E
Published: February 2024

Cerebral amyloid angiopathy (CAA) is a disease of small and medium-sized vessels, characterized by amyloid deposition in the brain vasculature. The incidence of CAA increases with age and pathophysiological features (i.e., amyloid) overlap with that of Alzheimer’s Disease (AD). Cerebral hypoperfusion (CH) impairs the integrity of the blood brain barrier and contributes to cerebral atrophy and white matter loss. However, the link between hypoperfusion and vascular amyloid deposition remains understudied. We induced global CH with bilateral carotid artery stenosis (BCAS) in CAA mice of both sexes. We hypothesized that chronic CH accelerates cognitive decline in CAA, increases white matter damage, and induces gliotic changes in the brain. Using a mouse model of CAA (Tg-SwDI), male and female mice (12wks-old) were randomized to either BCAS (n=15) or sham (n=11) surgery. Cognitive (Y-maze (YM), NORT, Water Maze (WM)) and motor function (Open Field (OF)) testing was performed by a blinded investigator prior to surgery (baseline) and at regular intervals until tissue harvest 6 months post-BCAS. Brains were harvested for immunohistochemical (IHC) analysis (Kluver-Barrera (KB), Iba-1, GFAP, Myelin Basic Protein (MBP)) and flow cytometry. Sex-specific changes in spatial memory (YM) and learning (NORT/WM) were present in CAA BCAS mice, with females having an earlier onset of deficits than males. Female BCAS mice displayed deficits in cognition (NORT) at 3 (p=.003), 4 (YM, p=.0007), and 5-months (p=.01) after BCAS. Male BCAS mice demonstrated cognitive deficits 5 months post-BCAS (NORT, p=.001). Both female and male BCAS mice had poorer cognition (WM, p=.001) 6 months post-BCAS. IHC demonstrated increased demyelination (MBP, p=.004) and atrophy (KB) in the anterior corpus collosum (p=.04) and significant cortical gliosis (p=.02). The hippocampus contained higher numbers of NOX2-expressing (p= .051) and lipid-rich microglia in BCAS (p=.042) versus sham mice. Neuronal loss and increases in endothelial-cell amyloid levels were also found in BCAS CAA mice, using flow cytometry. Global CH accelerates cognitive deficits in a CAA model, an effect that is accelerated in female mice and led to gliosis, white matter damage, and lipid-accumulating microglia.
Abstract TMP16: Impact of Door-to-Imaging and Imaging-to-Door Times on Door-in-Door-out Times in Interhospital Transfers of Patients With Stroke
Authors: Royan Regina , Stamm Brian , Giurcanu Mihai , Messe Steven R , Jauch Edward C , Prabhakaran Shyam
Published: February 2024

Introduction:
Urgent inter-hospital transfer ensures timely access to therapies for acute ischemic stroke. Door-in-door-out (DIDO) represents the total amount of time a patient spends in the transferring emergency department (ED) before transfer. DIDO time is an important quality metric for the care of acute stroke; however, little is known about the influence of process steps on DIDO times and which steps most often cause delays.

Methods:
This was a retrospective cohort study of patients in the American Heart Association Get With The Guidelines®-Stroke registry with ischemic stroke presenting January 2019 to December 2021 transferred from the ED at the presenting hospital to another acute care hospital for evaluation of thrombolytics, endovascular therapy or post-thrombolytic care. The primary independent variables were door-to-imaging and imaging-to-door times, and the primary outcome was DIDO time. Multivariate GEE regression models were performed to assess the comparative contributions of interval process times to variation in DIDO time, controlling for patient and hospital-level characteristics.

Results:
Among 24,662 patients (50.5% male, mean age 68.3 years, 73.2% White), mean DIDO time was 171.4 min (SD: 149.5), mean door-to-imaging time was 18.3 min (SD: 34.1) and mean imaging-to-door time was 153.1 min (SD: 141.5). A 1 min increase in door-to-imaging time was associated with a 1.33 min increase in the mean DIDO time, while a 1 min increase in imaging-to-door time was associated with a 1.02 min increase in mean DIDO time. The baseline model (without door-to-imaging or imaging-to-door included) had an R2 of 0.03. With door-to-imaging included in the GEE model, R2 was 0.13; whereas the model with imaging-to-door included had an R2 of 0.95.

Conclusion:
Imaging-to-door time accounts for a greater proportion of the variance in DIDO times than door-to-imaging time. Though the opportunity for improvement in DIDO is greater through reduction of imaging-to-door time, door-to-imaging time has greater per-minute effect on DIDO. While existing guidelines and care resources heavily focus on reducing door-to-imaging times, further attention is warranted to reduce imaging-to-door times in the management of acute ischemic stroke.
Abstract TMP18: Real-World Challenges in US Thrombectomy Transfers: Difficulty Finding an Accepting Hospital, Prolonged Travel, and Differing Perceptions of Transfer Requirements
Authors: Nandwani Jaan , Adu-Kyei Diandra , Penn Madeline , Shah Salonee , Davy Connor M , Mocco J D , Dhamoon Mandip S , Jette Nathalie , Stein Laura K
Published: February 2024

Introduction:
Transfers can improve access to endovascular thrombectomy (ET). However, benefit is highly time-dependent and transferred patients experience poorer outcomes. We assessed perceptions of transfers processes between sending and receiving hospitals.

Methods:
We utilized an ongoing 2023 nationwide US electronic survey of hospitals that treat stroke patients with revascularization therapy and have publicly available contact information. Respondents were stroke directors or coordinators. Survey items analyzed included questions on certification status, transfer processes, volumes, times, delays, and requirements for transfers. We performed cross-sectional analyses of hospitals that send/receive ET transfers. We used descriptive statistics and chi-squared tests to compare sending and receiving cohorts.

Results:
Of 144 responding hospitals at the time of analysis, 70.1% (n=101) receive and 29.9% (n=43) send ET transfers. Most (76.2%) receiving hospitals are comprehensive stroke centers and most (95.3%) sending hospitals primary stroke centers (p<0.05). Only 39.5% of sending hospitals send ≥20 transfers annually vs. 64.4% of receiving hospitals that receive ≥20. More than 1/2 send/receive transfers to/from facilities >60 miles away, and 50% pass a closer capable hospital en route. Average door-in-door out time is >90 minutes for 51.2% of sending hospitals, and 35.0% spend >50% of this time on non-care coordination. Concerningly, 34.9% of sending hospitals are sometimes/always unable to find an accepting hospital. Perceptions of requirements for transfer vary between receiving and sending hospitals: 30.7% vs. 76.7% require large vessel occlusion confirmation, 1% vs. 14% perfusion imaging and 14.9% vs. 32.6% an available bed prior to transfer (p<0.05).

Conclusion:
In this real-world sample, transfers are common, perceptions of requirements for transfer differ, and there are actionable delays. Concerningly, sending hospitals are often unable to find an accepting hospital and closer hospitals are frequently passed en route. Future interventions could standardize and provide oversight of regional stroke systems of care.
Abstract TMP20: Mapping the Expansion of the Minnesota Stroke System of Care
Authors: Anderson Nicky , Styles Emily , Vang Charly
Published: February 2024

Objectives:
Stroke is the fifth leading cause of death in Minnesota (MN) and in the United States. The state of MN a has a unique geographical layout with many healthcare facilities located in rural areas. In 2013 legislation was passed authorizing the Minnesota Department of Health to designate hospitals as Acute Stroke Ready Hospitals, Primary Stroke Centers, and Comprehensive Stroke Centers. When a hospital joins the MN Stroke System they maintain vital infrastructure, expertise, and care processes to provide high quality stroke care in accordance with evidence-based guidelines. We used geographic information systems (GIS) methods to visualize the growth and expansion of the Minnesota Stroke System and quantify its reach to Minnesotans across the state over a 10-year period.

Methods:
Using the Network Analyst extension of ESRI ArcGIS Desktop 10.8.2, 30- and 60- minute drive time service areas were calculated around each designated hospital in 2013, 2017 and 2023. Census block groups were identified where the mean center of population fell within the 30-minute drive time areas and the populations of those block groups were summed. A percentage was calculated using the total Minnesota population as the denominator.

Results:
In 2013, only 66% of Minnesota’s population lived within 30 minutes of a designated stroke center and 80% lived within a 60-minute drive time. Stroke designated hospitals (19) were largely concentrated in metropolitan areas, leaving many rural Minnesotans without ready access to stroke centers. After the first cycle in 2017, or three-year period post statute, drive time status increased to 90% of the population living within 30 minutes of a designated stroke system hospital and 98% living within a 60- minute drive time. As of 2023, 94% of Minnesotans now live within a 30-minute drive of a designated Stroke System Hospital and 99% live within a 60-minute drive time.

Conclusions:
Stroke statute was the catalyst for improving stroke care access in MN. The voluntary system of care expanded rapidly from 19 initial hospitals to 119 over a 10-year period. This progress means more than 1.9 million additional Minnesotans now have better access to emergency stroke care.
Abstract TMP21: Hospital Characteristics Influencing Discharge Disposition Following Acute Stroke: Findings From the Get With the Guidelines-Stroke Registry
Authors: Sutherly-Bhadsavle Loretta J , Akbik Feras , Ido Moges S , Bayakly Rana , Nahab Fadi B
Published: February 2024

Background:
Medical comorbidities and stroke risk factors explain only a proportion of stroke incidence and outcomes in different populations. Our analysis aimed to determine if hospital characteristics are associated with discharge home following acute ischemic stroke (AIS) hospitalization.

Methods:
The analyses included AIS patients hospitalized from January 1, 2015 to December 31, 2019 who were ambulating at baseline. The primary outcome measure was discharge to home. Hospital-level characteristics including time and day of arrival, location of stroke onset, transport mode, hospital bed size and stroke center certification status. The relative odds of outcome were assessed using a multivariable logistic regression.

Results:
Of 1,171,519 observations included in our analysis, median age was 71 years, 49% were female and 78% were of white race. As shown in the Table, factors associated with lower odds of home discharge included night-time arrival, stroke onset in a chronic care facility, arrival by ambulance, geographic location, and no stroke center certification; these factors were independent of social determinants of health such as education, income, employment status, poverty, and frequency of foreign-born residents at patients’ residence county. There was a trend towards improved outcomes over the study period.

Conclusion:
Hospital level characteristics influence likelihood of home discharge after AIS, independent of social determinants of health.
Abstract TMP28: Forced-Rate Aerobic Cycling Enhances Motor Recovery in Persons With Chronic Stroke: A Randomized Clinical Trial
Authors: Linder Susan , Davidson Sara , Bischof-Bockbrader Andrea , Li Yadi , Lapin Brittany , Singh Tamanna , Lee John , Bethoux Francois , Alberts Jay
Published: February 2024

Introduction:
The potential for intensive aerobic exercise to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate aerobic exercise paired with an abbreviated session of upper extremity (UE) repetitive task practice (FE+RTP) compared to time-matched UE repetitive task practice (RTP only) on the recovery of motor function in individuals with chronic stroke.

Hypothesis:
We hypothesized that FE+RTP would yield greater improvements in UE motor recovery compared to time-matched RTP only.

Methods:
A randomized clinical trial was conducted in which participants (N=60) completed 24 sessions of FE followed by RTP (FE+RTP) or time-matched RTP alone. The FE+RTP group exercised at 60-80% of heart rate reserve on a motorized stationary semi-recumbent cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP. The primary UE outcomes were the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT). The Six-minute Walk Test (6MWT) assessed walking capacity.

Results:
Sixty individuals 60.5 (±10.6) years of age were enrolled, and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8±44.4 versus 222.8±28.4, P<0.001) and time (72.7±6.7 versus 37.8±2.4 minutes, P<0.001) compared to FE+RTP. Both groups improved on the FMA (FE+RTP, 36.2±10.1 to 44.0±11.8 and RTP only, 34.4±11.0 to 41.2±13.4, P<0.001) and ARAT (FE+RTP, 32.5±16.6 to 37.7±17.9 and RTP only, 32.8±18.6 to 36.4±18.5, P<0.001). A group main effect was not observed. The FE+RTP group demonstrated greater improvements on the 6MWT (274.9±122.0 to 327.1±141.2 meters) compared to the RTP only group (285.5±160.3 to 316.9±170.0, P=0.004).

Conclusions:
While both interventions elicited comparable improvements in UE motor recovery, the summative value of FE+RTP in improving UE and lower extremity function was demonstrated.
Abstract TMP3: Overexpression of Alk1 in Brain Endothelial Cells Alleviates the Severity of Brain Arteriovenous Malformations in Alk1 Mutant Mice
Authors: Yadav Alka , Liang Rich , Press Kelly , Schmidt Annika , Shabani nabikandi Zahra , Huang Sally , Gonzalez Trevor , Asokan Aravind , Su Hua
Published: February 2024

Background and purpose:
Brain arteriovenous malformation (bAVM) can cause life threatening intra-cranial hemorrhage. Currently, there is no effective medical therapy available to treat bAVM patients. Mutation of activin receptor-like kinase 1 (
Alk1
also called
ACVRL1
) causes a familiar form of bAVM. Genetically overexpression of Alk1 in endothelial cells (ECs) recurs the phenotype of
Alk1
deficient mice. We
hypothesize
that transduction of
Alk1
gene into brain ECs using an adeno associated viral vector (AAV) may lead to cure of bAVM in
Alk1
mutant mice.

Methods:
To identify a AAV capsid that can transduce brain ECs after intravenous (i.v.) delivery, several engineered AAV capsids were screened. A single-stranded CBA promoter driven tdTomato transgene was packaged in these capsids and delivered i.v. to wild-type mice. Tissues were collected 4 weeks later. After identifying a capsid, cc84, that can transduce brain ECs effectively after i.v. deliver, we package CMV-Alk1 transgene into AAV.cc84. Brain AVMs were induced on PdgfbiCre;
Alk1
f/f
mice through intra-brain injection of AAV1-VEGF followed by intraperitoneal injection of 1.25 mg/25g tamoxifen two weeks later. AAV.cc84-Alk1 was delivered to PdgfbiCre;
Alk1
f/f
mice through i.v. injection at the time of tamoxifen treatment Histological analyses were used to analyze viral transduction in the brain and liver, vessel density, and abnormal vessels in the brain and liver inflammation. Liver and kidney function were analyzed by colorimetric assays for Alkaline Phosphatase Activity (ALP), Alanine Transaminase Activity ALT), and Creatinine levels (Cr).

Results:
After i.v. injection, AAV-cc84 transduced a high percentage of brain ECs and a few hepatocytes. AAV.cc84-Alk1 treatment reduced vessel density (p=0.008), abnormal vessels (p=0.034), mouse mortality rates (20% vs 60% respectively) compared to the AAV.cc84-RFP (control vector) treated PdgfbiCre;
Alk1
f/f
mice. The levels of ALP, ALT and Cr were similar between AAV injected and uninjected mice.

Conclusion:
AAV.cc84 mediated EC overexpression of Alk1 reduced bAVM severity in
Alk1
deficient mice indicating that AAV.cc84 is a promising gene therapy vector to treat bAVMs.
Abstract TMP32: Race and Ethnic Differences in Rehabilitation and Functional Recovery Post-Stroke Within the Florida Stroke Registry - Transitions of Care
Authors: Bishop Lauri , Gardener Hannah , Johnson Karlon , Gutierrez Carolina M , Brown Scott C , Asdaghi Negar , Perue Gillian Gordon , Kirk-Sanchez Neva , Romano Jose G , Rundek Tatjana
Published: February 2024

Introduction:
Historically, non-Hispanic black (NHB) and Hispanic stroke survivors have been discharged at a poorer functional level than non-Hispanic whites (NHW). The purpose of this study was to examine race and ethnic differences in rehabilitation prescription and participation at time of discharge (DC) and in modified Rankin Scale (mRS) at 30- and 90-days post-stroke.

Methods:
The Transitions of Stroke Care Disparities Study is designed to reduce disparities and optimize post-stroke care in hospital-to-home transitions. Survivors of ischemic stroke and intracerebral hemorrhage from a subset of 165 hospitals in the Florida Stroke Registry were included in the Get with the Guidelines-Stroke® (GWTG-S) database. Race and ethnicity, therapy prescription and participation, and mRS were extracted from GWTG-S, and by self-report at 30- and 90-days after DC. Race and ethnic differences were assessed in therapy prescription, participation, and mRS using binary logistic regression adjusted for age, sex, stroke severity (NIHSS), and DC walking ability.

Results:
In 1,129 stroke survivors (mean age 64y, 45% women, 55% NHW, 23% NHB, 22% Hispanic, 76% independent walkers at DC), 29% were prescribed inpatient and 50% outpatient rehabilitation at DC. Multivariable analysis showed NHW were significantly less likely to be prescribed inpatient therapy compared to NHB [OR 0.56, 95%CI (0.35-0.88)] or Hispanics [OR 0.50, 95%CI (0.31-0.80)]. Hispanic individuals [OR 1.69, 95%CI (1.20-2.38)] were significantly less likely to be prescribed outpatient therapy compared to NHW or NHB. No differences in therapy participation were seen between NHW and NHB [OR 1.16, 95%CI (0.69-1.97)] or Hispanics [OR 1.41, 95%CI (0.82-2.43)]. No differences in mRS were seen between NHW and NHB [30-days, OR 0.85, 95% CI (0.52-1.39); 90-days, OR 0.68, 95%CI (0.42-1.11)] or Hispanics [30-days, OR 0.63, 95% CI (0.37-1.10); 90-days, OR 0.61, 95%CI (0.36-1.03)].

Conclusions:
Although there were significant race and ethnic differences in therapy prescription setting, no race and ethnic differences were seen in therapy participation or in mRS at either 30- or 90-days. Further research is warranted to examine race and ethnic differences in stroke recurrence and readmission rates.
Abstract TMP39: Paucity of Evidence-Based Patent Foramen Ovale Severity Ratings in Transesophageal Echocardiogram Clinical Reports
Authors: Sun Philip Y , Tobis Jonathan M , Liebeskind David S , Alfonso Rodel C , Saver Jeffrey L
Published: February 2024

Introduction:
The presence of a large physiologic shunt, defined as >20 left atrial microbubbles within 3 cardiac cycles on transesophageal echocardiography (TEE), is a key, randomized controlled trial-validated, indication for patent foramen ovale (PFO) with a closure device in patients with otherwise cryptogenic ischemic stroke. The frequency with which this information is available to treating physicians from clinical TEE reports has not been well delineated.

Methods:
Among consecutive ischemic stroke patients admitted to an academic medical center undergoing TEE between January-June 2023, TEE reports were reviewed to determine frequency with which formal, clinical-trial definition-adherent characterization of PFO shunt size was provided, frequency of informal PFO shunt size descriptions, and correlations with transcranial Doppler (TCD) formal shunt grades (Spencer Grades 1-5).

Results:
Among the 50 patients, median age was 64 (IQR 58-74.5), and 20 (40%) were female. On TEE, shunt presence was assessed by bubble study in 38 (76%), direct Doppler alone in 6 (12%), and neither in 6 (12%). Among patients with bubble study, a right-to-left shunt (RLS) potentially due to PFO was present 15 (39%). RLS severity was quantified in 27% (4/15) of PFO patients, all with formally small (<20) shunts. For the remaining 11, reports informally characterized shunt severity with various descriptive terms, including “mild” (7 cases), “mild/trace” (1), “moderate” (2), and “large” (1). TCD bubble studies were performed in 67% (10/15) of the TEE RLS PFO patients. Shunt severity correlation between TEE and TCD was 100% (3/3) for the formally quantified TEE shunts, but poor for the 7 informally assessed TEE shunts, with 60% (3/5) of shunts deemed “mild” on TEE quantified as intermediate-large on TCD, 1/1 deemed “moderate” on TEE quantified as intermediate on TCD, and 1/1 deemed “large” on TEE quantified as miniscule on TCD.

Conclusions:
Quantified, evidence-based ratings of PFO shunt severity were present in less than 3 of every 10 TEE reports, and unquantified, informal size estimates correlated poorly with TCD quantification of shunt severity. Patient management would be aided by inclusion of formal PFO shunt size quantification in all clinical stroke patient TEE reports.