bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP101: Clinical and Genetic Risk Factors Predict Atrial Fibrillation Based on Hypertrophic Cardiomyopathy
Authors: Kim Jin-Bae , Sohn Young Sul
Published: January 2025

Background:
Clinical and genetic predispositions are significant in predicting atrial fibrillation (AF); however, their role in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aims to elucidate the impact of clinical and genetic risk factors on the development of AF in patients with and without HCM.

Methods:
This retrospective analysis involved data from the UK Biobank cohort, collected between 2006 and 2010. The cohort comprised 500,543 individuals: 1,361 diagnosed with and 499,182 without HCM. Participants were stratified based on their validated polygenic risk score for AF: the bottom 10% constituted the low-risk genetic group, the top 10% comprised the high-risk genetic group, and the remainder comprised the intermediate-risk genetic group. We assessed the incidence of AF and cardiovascular complications and analyzed its predictors, including genetic risk.

Results:
We examined 1,180 patients with HCM (mean age 61.1±7.1, 63.0% male) and 476,238 participants without HCM (mean age 57.0±8.1, 45.3% male). During the 11.6-year follow-up period, the age- and sex-adjusted AF incidence rates for the low-, intermediate-, and high-risk genetic groups were 2.4, 3.6, and 5.4 per 100 person-years in patients with HCM and 0.2, 0.5, and 1.0 per 100 person-years in participants without HCM, respectively. Genetic risk was a less significant predictor of AF in HCM groups (HR:2.51, 95%CI:1.59–3.98) than in non-HCM groups (HR:4.77, 95%CI:4.47–5.09) (
P
=0.008 for interaction). Clinical risk factors, including male sex, body mass index, hypertension, and previous myocardial infarction, were less significant predictors of AF in patients with HCM than in those without HCM. A high genetic risk was significantly associated with the risk of cardiovascular complications in participants with and without HCM.

Conclusions:
Genetic predisposition was associated with the development of AF and cardiovascular complications in people with and without HCM; this association was weaker in the HCM group.
Abstract TMP104: Association of GLP-1 Receptor Agonist Use with Clinical Outcomes in Diabetic Patients Hospitalized for Ischemic Stroke
Authors: Viswanath Varun , Iourinets Julia , Jhaveri Aditya , Chahine Ahmad , Sehgal Neha , Morsi Rami , Badillo Goicoechea Elena , Thind Sonam , Desai Harsh , Kothari Sachin , Siegler James , Coleman Elisheva , Brorson James , Prabhakaran Shyam , Mansour Ali , Kass-Hout Tareq
Published: January 2025

Background and Purpose:
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM). We aimed to evaluate the association of GLP-1RA use with clinical outcomes in diabetic patients admitted for acute ischemic stroke (AIS).

Methods:
This single-center retrospective study included diabetic patients aged ≥18 years admitted for AIS from 2015-2023. GLP-1RA use was defined as a history of taking GLP-1RA at admission or being prescribed GLP-1RA at discharge. The primary outcome was the incidence of new ischemic stroke within 1 year. Secondary outcomes included functional independence (modified Rankin Scale score 0-2) and mortality at 90 days. Propensity score weighting was used to balance covariates between groups. Logistic regression was used to estimate log odds ratios (LORs) for outcomes.

Results:
Of 123 patients, 35 (28%) used GLP-1RA. The GLP-1RA group had lower incidence of new ischemic stroke at 1 year (2.9% vs 6.8%; adjusted LOR -1.13, 95% CI -3.21-0.95, p=0.28) and higher rates of functional independence at 90 days (67% vs 40%; adjusted LOR 2.38, 95% CI -0.12-4.87, p=0.06) compared to the non-GLP-1RA group, but these differences were not statistically significant. Mortality at 90 days was similar between groups (25% vs 26%; adjusted LOR 0.078, 95% CI -1.51-1.67, p=0.92).

Conclusions:
In this cohort of diabetic patients admitted for AIS, GLP-1RA use showed trends toward reduced incidence of recurrent stroke and improved functional outcomes, although not statistically significant. Larger prospective studies are needed to further evaluate the potential neuroprotective effects of GLP-1RAs in ischemic stroke.
Abstract TMP107: Midlife Vascular Risk Factors are Associated with Late-life Depression in the ARIC Study
Authors: Kanetkar Sylee , Gottesman Rebecca , Morrill Valerie , Walker Keenan , Schneider Andrea , Egle Marco
Published: January 2025

Objective:
Late-life vascular health and cerebrovascular disease have been identified as potential risk factors for late-life depression (LLD). However, the impact of midlife vascular health, which is strongly linked with other aspects of brain function, on LLD is less understood. This study examined associations of midlife vascular risk factors (VRFs), and the cumulative burden of these factors, with LLD.

Methods:
Individuals from the Atherosclerosis Risk in Communities (ARIC) Study were evaluated for VRFs (smoking, hypertension, diabetes, hypercholesterolemia, and obesity) at midlife (ages 44-66). To assess cumulative vascular risk burden, the number of VRFs were counted and categorized as 0, 1, 2, or ≥3. Approximately 20 years later, LLD was assessed at late-life (ages 66-90) as a Center for Epidemiological Studies Depression Scale (CES-D) score ≥9. The association between VRFs and LLD was examined using logistic regression models adjusted for age, race-center, sex, education, and APOEε4 carrier status. Models were stratified by race; interaction terms were evaluated to assess effect modification.

Results:
Among 6,198 participants, the mean age was 52 years, 58.7% were female, and 22.2% were of self-reported Black race. At midlife, 20.2% had 0 VRFs, 41.3% had 1 VRF, 27.2% had 2 VRFs, and 11.3% had 3 or more VRFs. In the overall sample, smoking (OR: 1.68, 95% CI: 1.32-2.12), diabetes (1.41, 95% CI: 1.00-1.98), hypertension (OR: 1.29, 95% CI: 1.02-1.61), and obesity (OR: 1.51, 95% CI: 0.79-1.20) were associated with LLD when combined in one model; hypercholesterolemia was not. Compared to individuals with 0 VRFs in midlife, individuals with 2 VRFs had greater odds of LLD (OR: 1.69, 95% CI: 1.21-2.38), and individuals with 3 or more VRFs had even greater odds of LLD (OR: 2.34, 95% CI: 1.62-3.41). There was effect modification by race: midlife diabetes was associated with LLD in White individuals (OR: 2.18, 95% CI: 1.42-3.25) but not Black individuals (OR: 0.69, 95% CI: 0.36-1.25, p-interaction: 0.0005). Further, having 3 or more VRFs was associated with LLD in White individuals (OR: 3.57, 95% CI: 2.31-5.56), but not in Black individuals (OR: 1.46, 95% CI: 0.75-3.03, p-interaction: 0.01).

Conclusion:
Midlife vascular risk factors, and the cumulative burden of these factors, were associated with late-life depression (LLD), especially among White individuals. Further studies should evaluate mechanisms for these associations.
Abstract TMP12: Artificial Intelligence-estimated Probability of Aortic Stenosis Is an Independent Predictor of Major Adverse Cardiac Events in Patients with Carotid Artery Disease After Carotid Endarterectomy
Authors: Mahmoudi Hamidabad Negin , Kalina Samuel , Nogami Kai , Lerman Lilach , Nardi Valentina , Lerman Amir
Published: January 2025

Background:
Atherosclerotic carotid artery disease is associated with a high risk of major adverse cardiac events (MACE) even with optimal risk factor management and surgical interventions such as carotid endarterectomy (CEA). Aortic stenosis (AS) is an age-related valve disease that is associated with a high rate of MACE. An artificial intelligence-based AS estimation algorithm (AI-AS) can identify AS with high accuracy using electrocardiogram. This study evaluates the prognostic value of AI-AS in patients with carotid artery disease undergoing CEA.

Methods:
We included patients with carotid artery disease undergoing CEA at Mayo Clinic from 2002-2023 if they had >30 days of follow-up and an electrocardiogram within one year before CEA. The electrocardiogram closest to the CEA date was used to calculate AI-AS (AS probability ranging from 0-1). MACE was defined as the composite of cardiac events, ischemic cerebrovascular accidents, and all-cause mortality during follow-up after CEA. A receiver operating characteristic curve and the Youden index were used to identify the optimal AI-AS cut-off value for predicting MACE. Kaplan Meier plot was used to depict MACE-free survival. Regression models were used to evaluate the predictive value of AI-AS for future MACE adjusting for clinical covariates.

Results:
A total of 665 patients with a median age of 72 [IQR:66, 78] years and 438 (65.9%) males were included. Over a median follow-up time of 7.1 [IQR:2.7, 11.5] years, MACE occurred in 419 (63%) of the patients, including 187 (44.6%) mortality, 161 (38.4%) cardiac events, and 71 (16.9%) cerebrovascular accidents. Median AI-AS was 0.32 [IQR:0.09, 0.55] in the total cohort, 0.34 [IQR:0.12, 0.56] in patients with MACE, and 0.30 [IQR:0.07, 0.53] in patients without MACE (P=0.038). AI-AS was a significant predictor of MACE (HR:2.38, 95%CI:1.64-3.46, P<0.001) in univariate Cox regression analysis. The optimal cut-off value of AI-AS for MACE was 0.419 (area under the curve: 0.55). Patients with high AI-AS (≥0.419) had a significantly lower MACE-free survival in the Log-rank test (
Figure 1
) and in the multivariable Cox regression model adjusted for covariates compared to low AI-AS (<0.419) patients (
Table 1
).

Conclusion:
AI-AS is an independent predictor of MACE in patients with carotid artery disease after CEA and can be used as a risk-stratifying tool in this patient population. Additional studies are needed to elucidate the mechanistic link between AS and MACE in these patients.
Abstract TMP21: Nurse Navigator Led Interdisciplinary Rounds Improve Patient Experience and Staff Perceptions of Communication and Collaboration
Authors: Sher Karen , Wilder Shailyn , Hovey Jenna , Procaccini Taylor , Asad Syed Daniyal
Published: January 2025

Background:
A post-pandemic culture without interdisciplinary rounds has led to a lack of communication between providers and nurses. This has negatively impacted patient experience and resulted in a perceived lack of collaboration among team members.

Purpose:
To demonstrate the positive impact of nurse navigator (NN) facilitated interdisciplinary rounds on patient experience scores, as well as nursing and provider opinions of communication respectively

Methods:
Six months of Press Ganey© patient experience data for focus item ‘
Staff worked together to care for you’
was collected for our neuroscience floors (N9 and N11) prior to starting a new rounding process. NN developed a protocol for interdisciplinary rounds and communicated this with nursing, providers, and unit secretaries. NN educated nurses and providers about the evidence-based benefits of team rounds. Unit secretary announced teams overhead as they arrived on the floor. NN facilitated introductions and in-person information sharing between nurses and providers. A survey was administered to nurses and providers to evaluate their opinions about quality of communication and perceived barriers to communication during floor rounds both in the pre- and post-implementation phase.

Results:
Press Ganey© scores for ‘
Staff worked together to care for you’
improved on both floors post-implementation. The hospital designated Top Box Score for N9 was met 3/6 months (50%) following the initiation of interdisciplinary rounds compared to 2/6 months (33%) prior. The average six-month Top Box Score for N9 improved from 59% to 67% and that of N11 improved from 65% to 74%. Twenty nursing surveys and 15 provider surveys were received pre- and post-implementation. Post-implementation surveys showed 40% of nurses rated the quality of Neurology provider communication
Very Good
compared to 15% prior. Nurses reported an increased comfort level in approaching Neurology providers with questions and concerns (80%
Very/Extremely comfortable
compared to 62% prior). An overwhelming 80% of providers endorsed being able to identify patient’s nurse as
Very Easy/Somewhat Easy
vs 39% prior and reported discussing patient’s plan of care with the nurse in person during rounds
Often/Very
Often
40% of the time vs 17% prior.

Conclusions:
Instituting nurse navigator facilitated interdisciplinary rounds is an effective way to improve patient experience and promote communication and a collaborative work milieu among team members.
Abstract TMP23: HASTE! Curated Evidence Reveals Time Efficiencies in Stroke Intervention Pathway: Review of 1,362 Patients Across 16 Thrombectomy-capable Facilities
Authors: Remington Gina
Published: January 2025

Background:
Swift intervention is crucial to achieving optimal outcomes in patients presenting with an acute ischemic stroke due to large vessel occlusion (LVO). The goal of this real-world, retrospective, records-based study was to assess process components driving door-to-reperfusion times across 16 facilities.

Methods:
A total of 1,362 patient records from a large healthcare system between August 2020 to December 2021 were reviewed retrospectively across 16 facilities throughout the United States. Each facility (n=16) completed a 196-question care pathway survey with clear differentiation between direct arrival and interfacility transfer modes of arrival. Elastic Net Regularization was used to account for patient-level characteristics in a subsequent multi-variable linear regression, revealing care pathway indicators associated with decreased door-to-reperfusion times. Actionable indicators were categorized and ranked using statistically significant coefficients and p-values. Confounders, (e.g. facility-related volume, level of stroke certification) were accounted for in the analysis and, subsequently, results were interpreted by a 16-member Nurse Working Group and an 8-member Physician Working Group. Preferred practice recommendations for thrombectomy-capable facilities were generated.

Results:
Overall, mean reperfusion rate (TICI 2B or higher) was 90.3% and mean door-to-reperfusion time was 116 minutes (SD ± 56, 108 mins (71, 152)). Mean door-to-puncture time was 83 minutes (74 min, (43,109)). Significant and highly-ranked care pathway indicators were classified into three categories: people, process, and technology. Programs with evidence of (1) full integration of CT techs into stroke alerts; (2) neuro-dedicated personnel prior to and at time of arrival; (3) standardized intake and communication protocols from door to puncture; (4) remote access for rapid imaging interpretation; and (5) established protocols for baseline imaging and anesthesia were associated with significantly higher time efficiencies across the continuum-of-care.

Conclusions:
Establishing evidence-based, preferred practices for mechanical thrombectomy across each care segment from door to recanalization can enhance stroke care pathway tactics to optimize patient outcomes. Future work will be to evaluate changes in time to reperfusion post-implementation of these preferred practices and to assess impact on patient outcomes.
Abstract TMP3: Identifying Sex-specific Biomarkers of Unruptured Cerebral Aneurysms through Revisiting Cerebral Aneurysm Transcriptomes
Authors: Chen Yi-Wei , Chien Aichi
Published: January 2025

Cerebral aneurysms (CA) arise from the sites of weakened artery walls in the brain, and they may cause hemorrhagic stroke, coma, and death when they rupture. Studies have revealed sex differences in ~1.5 times higher prevalence of CA and ~1.5 times higher CA rupture rate in females. It is believed that mechanisms of CA formation in women may differ from those in men; however, sex-specific CA biomarkers are poorly identified. We hypothesized that sex-specific CA biomarkers can be identified through cross-comparison between sexes using transcriptomics. Here, we reanalyzed 100 RNAseq samples containing 62 unruptured CAs (20 males/42 females) and 38 normal (19/19) acquired from 3 datasets of 6 manuscripts published between 2016 and 2021 for sex-specific biomarker identification in unruptured CA. Reanalysis of ~40K differentially expressed genes (DEGs) of transcriptomes filtered 1,106 and 1,133 CA genes in males and females respectively under the cutoff set at a 2-fold difference with a significant difference at p<0.05 (
Image 1A-B
). 117 genes were conserved biomarkers for both sexes, and the remaining 989 and 1,016 genes were classified as sex-specific biomarkers of unruptured CA in males and females, respectively (
Image 1C
). In Gene Set Analysis (GSA), intriguingly, although the ribosome biogenesis in eukaryotes pathway (03008) was enriched in both sexes, rRNAs were highly expressed in females whereas snoRNAs were predominant in males. Besides, pathways linked to micro-/onco-immunity jumped out but were distinct in both sets of biomarkers (05165, 05146, 05203, 04151&04061 in females, 05150, 05206, 05205, 05202, 04060&04630 in males). REACTOME analysis also highlighted pathways associated with DNA integrity and repair (5693532, 69481, 69620, 69473, 5693538, 5693606, 5693565, 5693607&5693567) in females, and pathways related to antimicrobial immunity (6798695, 6803157, 5683057, 1462054, 1461973, 168256&168249) in males (
Image 2
). Finally, STRING functional protein analysis identified multiple hub genes including COLs (collagen) and WNTs (Wnt signaling) in females, and DEFAs (defensin), BPI (bactericidal permeability-increasing protein), and LCN2 (lipocalin, anti-bacterial innate immunity) in males, which aligns abovementioned pathways (
Image 3
). These analyses suggest that antimicrobial immunity is a risk factor for CA. Taken together, this study reveals sex-specific CA biomarkers and provides insights for sex-dependent pre-diagnosis for future studies.
Abstract TMP44: Factors Predicting Acute Ischemic Strokes Missed by Stroke Neurologists
Authors: Sewell Brice , Kramer Ethan , BISSENAS ASHLEY , Johnson Edna , Swords Gabriel , Singh Amita , Wilson Christina
Published: January 2025

Introduction:
Understanding factors that contribute to missed diagnoses of acute ischemic stroke (AIS) may improve diagnostic accuracy. Prior studies have focused on the failure of non-neurologists to recognize AIS. The aim of this study was to understand the characteristics of stroke-alerted patients whose symptoms were misattributed to a stroke mimic by the responding vascular neurology team.

Methods:
A retrospective chart review was conducted on patients seen by the vascular neurology team as a stroke alert at a single Joint-Commission-certified Comprehensive Stroke Center between 1/2021-2/2022. Patients whose symptoms were erroneously attributed to a stroke mimic at the time of assessment but later confirmed by MRI as AIS (“missed stroke”) were compared to 200 consecutive cases of stroke patients who were correctly diagnosed (“accurate stroke”) and 200 who were correctly diagnosed with a stroke mimic (“accurate mimic”). Patient characteristics were compared with univariate analysis, using chi square or Kruskal-Wallis H test as appropriate.

Results:
1823 stroke alerts were reviewed to identify 40 patients with missed stroke (incidence 2.2%) of which the median age was 66 years (IQR 58-81), median NIHSS was 5 (IQR 1-18), and 40% presented within the 4.5h-treatment window for thrombolysis. Patients with missed strokes were more likely female than those with accurate strokes (57% vs 39%, p<0.01), have a history of diabetes (43% vs 26%, p=0.03), and were more likely to receive recommendation for seizure workup (25% vs 8%, p<0.01). Compared to accurate mimics, missed strokes were significantly associated with prior substance use disorder (30% vs 11%, p<0.01) and presentation outside the 4.5h window (60% vs 40%, p<0.01). While not statistically significant, missed stroke patients were numerically more likely to be younger, non-Caucasian, have history of prior seizure, present with dizziness or encephalopathy, or be intubated.

Conclusions:
Although misattribution of acute stroke symptoms to non-vascular causes by the vascular neurology team was rare, several factors distinguished missed stroke patients. These data align with prior studies that women and those with non-focal symptoms are at higher risk of misdiagnosis by non-neurologists. Education about these factors to avoid framing and anchoring biases could improve the diagnostic accuracy of the responding neurology team and, potentially, patient outcomes.
Abstract TMP47: Impact of Life’s Essential 8 on Mortality after Stroke
Authors: Scott Lisa , Lian Kendra , Markovic Daniela , Towfighi Amytis
Published: January 2025

Background:
Life’s Essential 8 (LE8) is a cardiovascular health (CVH) metric proposed by the American Heart Association (AHA) that includes blood glucose, blood pressure, lipid levels, diet, physical activity, nicotine exposure, body mass index, and sleep duration. LE8 is used as a tool to assess and improve CVH outcomes. Little is known about the association between LE8 and mortality after stroke.

Methods:
We included data from participants aged 20 and older with self-reported stroke who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Data was linked with National Death Index mortality data through 2019. The association between poor and ideal LE8 scores and all-cause mortality and CV mortality rates after stroke were determined in 3 models: (1) unadjusted; (2) adjusted for sociodemographic factors (age, sex, race/ethnicity, poverty income ratio (PIR)) and (3) further adjusted for comorbidities (Charlson Comorbidity Index).

Results:
During the study period, 1,019 out of 26,670 individuals reported a prior stroke. When assessing mortality in those with poor CVH, although the direction of the hazard ratios (HR) suggested an increased risk of CV mortality with higher numbers of poor LS8 metrics, the associations were not significant in any of the models. However, for all-cause mortality, the risk increased with a higher number of poor CVH metrics. Possessing at least 4 poor CVH metrics was associated with a higher risk of all-cause mortality (Model 1 HR 1.69, 95%CI 1.13-2.52; Model 2 HR 2.25, 1.51-3.35; Model 3 HR 2.10, 1.39-3.20). Conversely, possessing at least 4 ideal metrics was associated with lower CV mortality in the unadjusted model, (HR 0.35, 0.15-0.85) but this association was no longer significant in Models 2 and 3. Possessing at least 4 ideal CVH characteristics was associated with lower all-cause mortality in all 3 models (Model 1 HR 0.50, 0.29-0.85; Model 2 HR 0.54, 0.31-0.92; Model 3 HR 0.56, 0.33-0.96). Higher LE8 scores were associated with lower CV mortality in Model 2 (HR per point LE8 score 0.98, 0.96-0.99) and Model 3 (0.98, 0.96-0.99) and all-cause mortality in Model 2 (0.98, 0.97-0.99) and Model 3 (0.98, 0.97-0.99).

Conclusion:
A higher LE8 score correlates with an increased risk of both CV and all-cause mortality in stroke survivors. Possession of at least 4 ideal CVH metrics is associated with a nearly two-thirds risk reduction in CV mortality and 50% risk reduction in all-cause mortality.
Abstract TMP49: Exploration Of Perfusion Patterns Throughout the Acute Phase In Stroke Patients With Different Stroke Etiologies
Authors: Hong Lan , Wang Xinru , HE ZHIJIAO , Liu Xinyu , Li Siyuan , Zhang Anqi , Cao Nan , Cheng Xin , Dong Qiang
Published: January 2025

Background and Objective:
A stable perfusion pattern may guarantee a good clinical outcome in acute stroke patients. This study aimed to explore the differences of perfusion patterns over the acute phase in acute stroke patients with different etiologies.

Methods:
This study included acute ischemic stroke patients who arrived at Huashan Hospital, Fudan University within 24 hours of last known normal. All patients underwent baseline multimodal CT scan (including CT angiography [CTA] and perfusion imaging), and had confirmed large vessel occlusion or severe stenosis of anterior circulation. Recanalization status was evaluated through follow-up perfusion or angiography imaging. Final infarct volume (FIV) was assessed by follow-up CT or magnetic resonance imaging within 7 days after arrival. Penumbral stability was assessed using the Perfusion-Infarct Index (PFI)，which was defined as 1 - (FIV - baseline infarct core) / baseline penumbra. For patients without recanalization, a stable penumbral pattern was defined PFI> 0.9. Kaplan-Meier survival curve analysis was used to explore the difference of PFI between patients with cardioembolic (CE) and large artery atherosclerotic (LAA) etiology during the acute phase. For patients without recanalization, stepwise logistic regression analysis was conducted to identify independent predictors of a stable penumbral pattern.

Results:
A total of 250 acute ischemic stroke patients were included, with 160 classified as LAA-related stroke and 90 as CE-related stroke. Kaplan-Meier survival curve analysis revealed that LAA-related stroke patients had a higher PFI value compared to CE-related stroke patients throughout the acute phase (P=0.02). Of the 88 patients who did not achieve recanalization, patients with LAA-related stroke were more likely to have a stable penumbral pattern compared with patients with CE-related stroke (39% vs. 10.3%, P=0.01). Stepwise logistc regression analysis demonstrated that baseline NIHSS ≤8 (OR: 8.8, 95% CI: 2.9 - 26.4, P <0.001) and core growth rate ≤7 ml/h (OR: 9.7, 95% CI: 1.1 - 83.8, P =0.04) were independent predictors of a stable penumbral pattern.

Conclusion:
Patients with LAA-related stroke are more likely to maintain a stable perfusion pattern through the acute phase compared to patients CE-related stroke. Baseline NIHSS ≤8 and core growth rate ≤7 ml/h were independent predictors of a stable penumbral pattern during the acute phase.
Abstract TMP7: The Obesity Paradox in Asymptomatic Intracranial Arterial Stenosis: Implications for Stroke Risk and Prognosis
Authors: Yuan Weizhuang , Ding Manqiu , Liu Yiyang , Cao Yufan , Zhou Huanyu , Zou Yinxi , Liu Caiyan , Xu Wei-hai
Published: January 2025

Background and purpose:
Intracranial arterial stenosis (ICAS) is an important cause of ischemic stroke and is associated with a poor prognosis. Obesity has been reported to be associated with a more favorable prognosis in patients with coronary heart disease, but its impact on ICAS remains largely unexplored. This study aimed to investigate the association between obesity and prognosis in patients with asymptomatic ICAS.

Methods:
This retrospective cohort study included ICAS patients without stroke history, all of whom had been assessed with transcranial Doppler indicating more than 50% stenosis. Participants were categorized into four groups based on their body mass index (BMI): underweight (BMI<18.5 kg/m
2
), normal weight (18.5≤BMI<24 kg/m
2
), overweight (24≤BMI<28 kg/m
2
) and obese (BMI≥28 kg/m
2
). The primary outcomes were the occurrence of ischemic stroke and the functional outcomes, which were assessed using the modified Rankin Score (mRS). A poor prognosis is defined as an mRS>2. The association between BMI and prognosis of asymptomatic ICAS was investigated by multivariable analysis.

Results:
A total of 1248 asymptomatic ICAS patients were included, distributed as follows: 46 underweight, 516 normal weight, 522 overweight, and 164 obese. With a median follow-up of 48 months, the incidence of ischemic stroke was 8.7%, 6.5%, 5% and 1.2% across the underweight, normal weight, overweight, and obese groups, respectively. The poor prognosis rates were 25.6%, 9.5%, 4.7%, and 5.7% in the same respective groups. Multivariable Cox regression analysis revealed that BMI (hazard ratio: 0.87; 95% confidence interval [CI]: 0.79-0.95; p=0.001) was significantly associated with a reduced risk of ischemic stroke, after adjusting for age, sex, cancer status, smoking, alcohol consumption, hypertension, diabetes, hyperlipidemia, cerebral vascular surgery, and the number of ICAS lesions. Logistic regression (odds ratio: 0.85, 95%CI: 0.78 - 0.93, p<0.001) and linear regression (β: -0.03, 95%CI: -0.037 to -0.023, p<0.001) consistently demonstrated a negative correlation between BMI and poor functional outcome after adjustment.

Conclusions:
The findings suggest the presence of an obesity paradox among patients with ICAS, where obesity is associated with a reduced risk of ischemic stroke and a more favorable prognosis in asymptomatic ICAS patients.
Abstract TP111: Multielectrode Network Stimulation (ME-NETS) with tDCS modulates connectivity between brain regions as demonstrated by concurrent tDCS and rs-fMRI – implications for facilitating stroke recovery
Authors: Schlaug Gottfried , Shinde Anant
Published: January 2025

Non-invasive transcranial direct current stimulation (tDCS) can modulate activity of targeted brain regions. Whether tDCS can reliably and repeatedly modulate intrinsic connectivity of entire brain networks is unclear. We used concurrent tDCS-MRI to investigate the effect of high dose anodal tDCS (4mA) on resting state connectivity between cortical regions within the Arcuate Fasciculus (AF) network, which spans the temporal, parietal, and frontal lobes and is connected via a structural backbone, the Arcuate Fasciculus (AF) white matter tract. The Arcuate Fasciculus Network plays an important role in the auditory-motor feedforward and feedback control of vocalizations and speech-language functions. The degree of injury to the Acuate Fasciculus Network on the dominant hemisphere is related to speech motor/language impairment after stroke. A rudimentary AF-network typically exists on the non-dominant hemisphere that might be enhanced and fostered to show plastic changes after stroke. We tested this approach with non-invasive high dose electrical stimulation. Effects of high-dose tDCS (4mA) delivered via a single electrode placed over one of the AF nodes (single electrode stimulation, SE-S) was compared to the same dose split between multiple electrodes placed over AF-network nodes (multielectrode network stimulation, ME-NETS). While both SE-S and ME-NETS significantly modulated connectivity between AF network nodes (increasing connectivity during stimulation epochs), ME-NETS had a significantly larger and more reliable effect than SE-S. Moreover, comparison with a control network, the Inferior Longitudinal Fasciculus (ILF) network on the same hemisphere targeted by tDCS suggested that the effect of ME-NETS on connectivity was specific to the targeted AF-network. This finding was further supported by the results of a seed-to-voxel analysis wherein we found ME-NETS primarily modulated connectivity between AF-network nodes, meaning cortical regions such as the Inferior Frontal Gyrus, the Supramarginal Gyrus, and the posterior superior temporal gyrus, which constitute the nodal regions of the AF network. Finally, an exploratory analysis looking at dynamic connectivity using sliding window correlation found strong and immediate modulation of connectivity during three stimulation epochs intermingled with no-stimulation epochs within the same imaging session suggesting that the intrinsic connectivity between these regions can reliably and repeatedly be modulated.
Abstract TP113: Cerebellar Intermittent Theta Burst Stimulation in Post-Stroke Gait Impairment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: De Souza Abner Lucas , de Vasconcelos Anna Victoria , WAGNER FERNANDA , Reis Soares Filipe , Ventura Artur , Moro Izabela , Queiroz Ivo
Published: January 2025

Background:
Persistent gait impairments affect nearly half of stroke survivors six months post-stroke, despite standard rehabilitation. Intermittent theta burst stimulation (iTBS), a specialized form of repetitive transcranial magnetic stimulation (TMS), has shown promise in enhancing neural circuit activity and promoting long-term potentiation. While traditionally targeting the primary motor cortex, recent studies suggest that cerebellar iTBS may further improve gait and balance by modulating cerebello-cortical pathways.

Aim:
This meta-analysis aims to evaluate the efficacy of cerebellar iTBS in improving gait and balance in stroke patients.

Methods:
We conducted a systematic search in PubMed, Embase, and the Cochrane Library until August 2024, following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Included studies were peer-reviewed randomized controlled trials (RCTs) that assessed the effects of cerebellar iTBS on balance, assessed using the Berg Balance Scale; gait, measured through 3D gait analysis and the Timed Up and Go (TUG) test; and activities of daily living, assessed via the Barthel Index, in post-stroke patients with persistent gait and balance impairments. Meta-analyses were performed using a random-effects model.

Results:
Seven RCTs involving a total of 230 post-stroke patients (iTBS group, n=115) were included in this meta-analysis. The analysis revealed a significant improvement in balance (standardized mean difference [SMD] = 1.20, 95% confidence interval [CI] 0.12 to 2.29, p = 0.03). However, the TUG test did not demonstrate a significant change (SMD = 0.04, 95% CI: -0.37–0.46, p = 0.83), potentially reflecting variability in baseline gait performance. The 3D gait analysis showed a favorable but non-significant trend towards step length improvement (SMD = 0.71, 95% CI: -0.82–2.23, p = 0.37). Notably, a significant enhancement was observed in activities of daily living (SMD = 1.24, 95% CI: 0.49–1.98, p = 0.001).

Conclusions:
This meta-analysis suggests that cerebellar iTBS significantly enhances activities of daily living in post-stroke patients, with a potential but less consistent impact on balance and gait. These findings highlight the promise of cerebellar iTBS as an adjunctive therapy in stroke rehabilitation, though further high-quality RCTs are needed to clarify its specific therapeutic benefits.
Abstract TP131: Factors Impacting Racial and Ethnic Disparities in the Use of Intravenous Thrombolytics in a Large Western US Healthcare System
Authors: Stuchiner Tamela , Lowenkopf Ted , Marginean Horia , Purdon Barbara , Carman Lisa , Kowal Stacey , Lin Shih-Wen , Mearns Elizabeth
Published: January 2025

Introduction:
Studies of racial and ethnic disparities in using intravenous thrombolytics (IVT) for stroke in large healthcare systems and specific US states are lacking. This study examines potential contributors to disparities in IVT administration in a large Western healthcare system overall and by state (AK, CA, OR, TX and WA).

Methods:
This retrospective analysis of a systemwide stroke registry analyzed patients with ischemic stroke admitted January 2016 to September 2023. Patients aged <18 years, those arriving >4.5 hours from last known well (LKW), those with stroke occurring post hospital arrival and those receiving endovascular treatment were excluded. Generalized linear models were used to assess whether some racial and ethnic patient groups were less likely to receive IVT vs White patients, adjusting for age, National Institutes of Health Stroke Scale score at admission, LKW to arrival time, previous stroke, atrial fibrillation/flutter, obesity, mode of arrival, door-to–computed tomography scan time, insurance status and facility certification status.

Results:
Among 16,833 patients included, 45.0% received IVT. Overall, Black patients were less likely to receive IVT vs White patients (
Table 1
), but this was not significant. By state, Black patients were less likely to receive IVT vs White patients in OR and WA (
Table 1
). While Black and White patients had similar LKW to arrival times, Black patients were younger, had more severe strokes and used emergency medical service (EMS) at higher rates vs White patients (
Table 2
). Compared with White patients, American Indian/Alaska Native patients were younger and used EMS at higher rates. Hispanic/Latino and Native Hawaiian/Pacific Islander patients were also younger and had more severe strokes than White patients.

Conclusions:
These data suggest that racial and ethnic disparities in stroke treatment vary by geography within a large healthcare system. Further analyses into the underlying factors are needed to guide tailored education at the local level.
Abstract TP14: Telestroke-guided Intravenous Thrombolysis among patients with minor acute ischemic strokes.
Authors: Shah Smit , Bhatt Nirav , Al-Qudah Abdullah , Khalifa Moustafa , Palegar Thanmayi , Ogiso Hiromi , Cence Kristina , Miao Christopher , Doheim Mohamed , Al-Bayati Alhamza , Starr Matthew , Rocha Marcelo , Nogueira Raul
Published: January 2025

Introduction:
Telestroke (TS) plays an important role in extending Vascular Neurology (VN) expertise. Minor acute ischemic stroke (AIS), defined as presentation National Institute of Health Stroke Scale (NIHSS) 0-5 accounts for majority of AIS patients. Most studies evaluating Intravenous Thrombolysis (IVT) in this population were performed utilizing in-person assessments by VN experts, and data surrounding IVT for minor strokes utilizing TS platforms is lacking. Furthermore, determining the degree of disability among minor stroke patients may be particularly challenging when evaluating patients over TS platforms. We sought to describe our experience of TS-guided treatment of minor AIS patients with IVT within our large academic TS network.

Methods:
This is a retrospective analysis of a prospectively maintained TS database spanning over 45 hospitals within our TS network staffed by academic VN service (VN fellows and fellowship-trained VN attendings) between January 2021 and April 2023. We included all consecutive patients who presented with NIHSS 0-5 and collected demographic variables, clinical/imaging characteristics, time-metrics and discharge outcomes. Video to IVT time (VTN) was defined as the time elapsed between beginning of the TS video evaluation to IVT administration. Symptomatic Intracranial hemorrhage (sICH) was defined according to the Heidelberg bleeding classification.

Results:
192 patients were included in our analysis. Median age was 67.8 (58.3 – 76.6) years, median NIHSS was 3 (2-4), median VTN was 21.5 (17.0 – 29.0) min, and median LKWT – IVT administration time was 156.0 min (111.8 – 213.0). 47 (24.5%) patients had to be pre-treated for resistant hypertension. Large vessel occlusion (LVO) was detected in 25/190 (13.2%) patients, and an additional 9 (4.7%) patients had a distal medium vessel occlusion (DMVO). AIS was the final diagnosis in 92 (47.9%) patients. 6 (3.1%) patients had sICH. 140 (72.9%) patients were discharged home and 22 (11.5%) were discharged to rehabilitation facility. 6(3.2%) patients suffered in-hospital mortality.

Conclusion:
Our experience of TS-guided IVT for minor stroke patients within a large, academic TS network demonstrated time-metrics and clinical outcomes comparable to those observed in previous RCTs evaluating IVT in this population assessed via in-person evaluations. Further research is needed to explore safety and efficacy of TS-guided IVT for minor stroke patients across other large TS systems.
Abstract TP172: Implementation of Fundus Cameras in 10 Stroke Certified Emergency Departments for Emergent Detection of Central and Branched Retinal Artery Occlusion.
Authors: Rho Howard , Gilbert Thor , Modjtahedi Bobeck , Hauser DeHaven Amanda , Chu Eugene , Sangha Navi
Published: January 2025

Introduction:
The 2021 AHA/ASA Scientific Statement on Retinal Artery Occlusion (RAO) indicated treatment with thrombolytics may be effective and systems should prioritize its early recognition. We describe the phased deployment of fundus cameras across 10 Emergency Departments (EDs) in a southern California health system for emergent visualization and diagnosis of monocular vision loss.

Methods:
Program Development:
In 2022, Vascular Neurology, ED and Ophthalmology initiated discussions to deploy fundus cameras to support emergent diagnosis of monocular vision loss. The fundus camera image ordering was integrated with the electronic medical record (EMR). Department leaders socialized the program with training sessions and job aids.

Operational Scope:
Any medical professional working in the ED was permitted to operate the device. A small group of “superusers” were identified at each medical center to obtain competency in camera operation. In-person training sessions for ED physicians/staff covered order placement, image capture and transmission, troubleshooting and device maintenance.

Acute Vision Loss Workflow:
Patients presenting with monocular vision loss within 4.5 hours of last known well time follow the code stroke algorithm predicated on BEFAST symptoms. A stat CTH is obtained, followed by a teleneurologist examination. If patient presents with only monocular vision loss, a fundus photo is captured and remotely emergently interpreted by an ophthalmologist. If photo is consistent with an RAO, thrombolysis is offered.

Results:
From July 2022 to June 2024, 1079 fundus photos were obtained across 10 stroke centers. The mean age (SD) was 55.9yrs (17.6). The percent female was 55%. The racial/ethnic breakdown of individuals who had a fundus photo was 32.4% White, 14.5% Black, 12.1% Asian, 7.9% Other and 33% Hispanic. 27 (2.5%) of patients were diagnosed with RAO, out of which 4 patients received thrombolytics. Non-thrombolytic patients were given antiplatelets and admitted for further assessment of RAO etiology. Those who did not receive thrombolytics were all outside of the 4.5-hour time to treat. 26 (2.5%) had a final diagnosis of a cerebral ischemic stroke.

Conclusion:
Fundus camera deployment for the assessment of acute monocular vision loss improves management of RAO patients with thrombolytics and/or allows further assessment of the etiology in a more urgent manner.
Abstract TP173: Automated Vessel Landmark Detection and AIF/VOF Validation for Enhanced CTP Analysis in Acute Ischemic Stroke
Authors: Lee Eunwoo , Lee Kijeong , Kim Gi-Youn , Yang Hyeonsik , Hwang Jundong , Kim Donghyeon , Jung Woo Sang , Choi Jin Wook
Published: January 2025

Introduction:
Computed tomography perfusion (CTP) is essential in the management of acute ischemic stroke, as it determines patient eligibility for reperfusion therapy. Accurate measurement of perfusion parameters requires precise identification of the regions of interest (ROIs) for arterial input function (AIF) and venous output function (VOF). Traditional methods for setting the ROIs, based on criteria such as time to peak (TTP) and high amplitude, often suffer from inaccuracies due to individual vessel variability and signal interference. To overcome these limitations, we developed an AI-driven approach that uses machine learning to detect vascular landmarks and refine ROI selection, thereby successfully generating an improved CTP map.

Methods:
We used a dataset of 499 stroke patient CT cases from 2021 to 2023, with vessel landmarks manually annotated by radiologists. Of these, 50 cases were for testing, and 449 were used for training. Our system includes two components: (1) an AI model for ROIs detection and (2) an ML model for ROIs intensity validation. The AI model, based on a Unet with ResNet as the encoder, detects eight ROIs from 4D CTP images. It is optimized using mean squared error (MSE) loss to reduce the difference between predicted and ground truth (GT) landmarks. The second component, an ML model, differentiates AIF from VOF landmarks and checks intensity normality. We used XGBoost to evaluate intensity validity and a multi-layer perceptron (MLP) to verify consistency with predicted landmarks. Both models were trained using radiologist-verified data, and data augmentation was applied to improve robustness.

Results:
The AI model showed an average Euclidean distance error of 4.37 mm on the test set, indicating accurate vessel localization. The ML model achieved 0.815 accuracy, 0.92 sensitivity, and 0.725 specificity in distinguishing AIF from VOF. Our method also correlated strongly with manual radiologist segmentation, with Pearson R
2
scores of 0.93 for CBF < 30% and 0.913 for Tmax > 6 seconds.

Conclusion:
In this study, we propose a novel AI and ML-based framework for optimizing ROI selection for AIF/VOF in CTP analysis. Our approach improves vessel localization and intensity validation while producing CTP maps closely aligned with manual expert review. This method offers a promising alternative to conventional techniques, enhancing perfusion analysis precision and supporting better clinical decision-making in acute ischemic stroke management.
Abstract TP176: CT-based lesion water imaging but not MR-FLAIR signal intensities differentiate early reversible ionic from irreversible vasogenic edema
Authors: Broocks Gabriel , Kemmling Andre , Faizy Tobias , Meyer Lukas , Fiehler Jens , Werner Rene , Alfke Karsten , Lev Michael
Published: January 2025

Purpose:
In ischemic stroke, MRI and CT are both utilized to estimate lesion progression distinguishing reversible from irreversible tissue injury and are therefore used for acute treatment decision-making. On MRI, relative increase of fluid-attenuated inversion recovery signal (rFLAIR) is thought to represent vasogenic edema indicating irreversible tissue injury. On CT, progressing hypoattenuation is the imaging correlate of ischemic net water uptake (NWU), which can be quantified by densitometry and may reflect both ionic edema, which is potentially reversible, and irreversible vasogenic edema following blood-brain barrier breakdown. The relationship of rFLAIR and NWU has not been compared directly. We hypothesized that the degree of early CT-based NWU is directly linked to rFLAIR in patients undergoing both modalities on admission.

Methods:
Observational retrospective study of patients with acute anterior circulation ischemic stroke undergoing both CT and MRI on admission with visible core lesion on diffusion-weighted imaging. DWI-FLAIR mismatch was rated on MRI and quantitative NWU was measured on admission-CT. Multiparametric MRI signal changes were measured including rFLAIR and correlated to CT-based NWU with respect to time from symptom onset-admission.

Results:
53 patients were included. The median NWU was 7.7% (IQR: 4.9-13.0) and the median rFLAIR 1.38 (IQR: 1.21-1.72). There was no correlation between NWU and rFLAIR (r=0.15, p=0.48); however, NWU was significantly higher in FLAIR-positive versus FLAIR-negative cases (11.2% versus 5.5%, p<0.0001) and NWU significantly correlated with time (r=0.62, p<0.0001), while rFLAIR did not (r=0.1, p=0.73). In logistic regression analysis, higher NWU was significantly associated with FLAIR-positivity (OR: 1.31, 95%CI:1.11-1.56,p=0.001), and the optimal cut-off for NWU to classify FLAIR-positivity was 7.4% (AUC: 0.82, 95%CI: 0.70-0.94).

Conclusion:
CT-based quantitative NWU distinguished FLAIR-positive from FLAIR-negative cases, significantly correlating with progressing time from onset while rFLAIR showed no correlation to time. Hence, NWU and rFLAIR might depict a different early lesion pathophysiology. A low degree of NWU without a correlate on FLAIR might represent early ionic edema, which is potentially reversible and could therefore explain cases of reversible lesion hypodensity.