bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP27: Decreasing Emergency Department admission rate for TIA contrasts with rising cost of TIA evaluation from 2013-2021
Authors: Mamer Lauren , Cranford James , Kocher Keith , Korley Frederick , Scott Phillip
Published: January 2025

Introduction:
For the 240,000 patients presenting to the emergency department (ED) annually with transient ischemic attack (TIA), a resource-intensive multimodal evaluation and possible admission to the hospital may help prevent a subsequent stroke. Multiple strategies to approach the location and timing of these evaluations exist. Using a nationally representative data source, we evaluated variation and trends in ED practices for patients with suspected TIA.

Methods:
Retrospective cross-sectional study of ED visits using the 2013-2021 National Emergency Department Sample, a 20% sample of ED encounters in the United States maintained by the Healthcare Cost and Utilization Project (HCUP). TIA diagnosis was determined by first-listed ICD-9 or -10 code. Imaging utilization was determined in discharged ED patients by CPT code for TIA related modalities. Factors associated with discharge from the ED in a TIA encounter were evaluated with a multivariable logistic regression.

Results:
Percentage of ED TIA patients discharged from the ED increased from 47% (95%CI 46-49) to 68% (95% CI 66-69) between 2013 and 2021. Average cost per discharged TIA encounter increased from $1559 (95% CI 1482-1635) to $2753 (95% CI 2649-2857). Imaging utilization in discharged TIA patients increased markedly between 2013 and 2021. In 2013, 3.6% (95% CI 2.8-4.4) of discharged TIA patients received a CTA Head during their evaluation, while in 2021 this had increased to 44%(95% CI 42-46). Logistic regression analysis for factors associated with discharge in ED TIA encounters in 2021 showed patients from rural areas were more likely to be discharged (OR 2.95 (95% CI 2.42-3.59) than those in densely populated areas (OR 0.68 (95% CI 0.54-0.86).

Conclusion:
Discharge rates for patients with TIA increased between 2013 and 2021, with a parallel increase in the ED charges for patients discharged with TIA. Utilization of imaging in the ED increased during the time interval and may explain some of this increased cost. This may suggest a shifting of previously inpatient TIA evaluations to the non-admitted ED setting. Likelihood of discharge with a TIA was inversely related with population density of the patient’s location. More resources should be focused on optimizing ED evaluation and follow up of TIA patients in non-urban areas.
Abstract WMP34: Achieving Fast Assessment and Stroke Triage in Kids (FAST-Kids)
Authors: Pearson Rachel , Hills Nancy , Bacon Kellie , Shelton Shelby , Moreno Tatiana , Kuchherzki Maria , Heyming Theodore , Schultz Carl , Fullerton Heather
Published: January 2025

Introduction:
Pediatric stroke, while one of the top 10 causes of mortality among U.S. children, remains underrecognized. Identification of pediatric stroke begins with those in the community and emergency medical services (EMS) who must recognize acute neurological symptoms (ANS) in a child as a medical emergency and appropriately triage these patients to facilitate urgent imaging. To describe the current state and inform quality improvement efforts, we examined (1) timing and predictors of neuroimaging among children with EMS activation for ANS, and (2) arrival modality and symptoms of children with acute stroke presenting to the emergency department (ED).

Methods:
This is a retrospective study of patients 1-14 years with an EMS activation for ANS (based on EMS primary symptom and impression codes) who were transported to Children's Hospital Orange County (CHOC) ED from 1/2019-6/2023 (Figure 1). We also identified all out-of-hospital strokes admitted to CHOC (ICD-10 search of discharge diagnoses) and determined the proportion of strokes presenting via EMS. We excluded those with major trauma or epilepsy.

Results:
Of 3888 children with EMS activations for ANS, 695 (17.9%) had neuroimaging: 570 (82.0%) had CT scan only; 125 (18.0%) also had MRI (Table 1). The median and IQR times to CT and MRI were 2.29 (1.56, 3.21) and 26.8 (16.3, 43.8) hours, respectively. Factors associated with imaging included age ≥5 years (p<0.001) and known medical conditions associated with increased stroke risk (<0.001). All patients with EMS primary impression codes of stroke had neuroimaging. Combining these data with the ICD-10 search, we identified 43 admissions for out-of-hospital acute stroke (Figure 2). Of those presenting with EMS activations, primary symptoms and impression codes were seizure, altered mental status, loss of consciousness, and headache, but not stroke. Of those who presented as ED walk-ins, the most common chief complaints were head injury and general neurologic complaint.

Conclusions:
Most children with EMS activations for ANS were not imaged; of those who were many had only CT and not MRI, the preferred imaging modality for diagnosing pediatric ischemic stroke. The many children who arrived as walk-ins suggests a lack of community awareness of pediatric stroke. Our findings call for more education of lay people and prehospital/ED providers of pediatric stroke, as earlier consideration may expedite diagnosis and increase opportunities for intervention.
Abstract WMP43: A Pilot Study Of Dopaminergic Enhancement Of Rehabilitation Therapy Early After Stroke
Authors: Cramer Steven , Brinkman Lorie , Holl Christina , Cardoso Ferreira Isabel , Atkinson Megan , Ha Kara , Nguyen Tiffany , Schwarz Anne , Feldman Marc , Ventoza Cristina , Shklanko Lauren , Stehman Andrea , Soleimani Nina , Kras Genevieve , Young Brittany , Roberts Pamela , Song Min-Keun , Chang Tracy , Su Michael , Gornbein Jeffrey , Le Vu
Published: January 2025

Introduction:
Restorative therapies have maximal impact when introduced early post-stroke. Dopamine modulates learning and plasticity, and its levels decrease after stroke, making it a key therapeutic candidate. For a restorative therapy to promote experience-dependent plasticity, concomitant training is needed and must be provided experimentally given low rehabilitation doses received with usual care (UC); here this was provided using an established telerehabilitation (TR) system.
Current hypotheses
: [H1] Adding intensive arm motor rehabilitation therapy to UC improves arm motor status more than UC alone, and [H2] Combining intensive arm motor therapy with levodopa further improves arm motor gains.

Methods:
Adults ≤30 days post-stroke having moderate-severe arm weakness were randomized (3:3:2) to (1) 6 wk of intensive daily arm motor TR + daily carbidopa/levodopa (25/100) before therapy (given for first 3 wk), on top of UC; (2) TR + placebo before therapy (given for first 3 wk), on top of UC, or (3) UC alone. TR was initiated in the inpatient rehabilitation facility and completed at home. Assessments were blinded and included Action Research Arm Test (ARAT; primary endpoint) and Fugl-Meyer (FM; secondary endpoint) at baseline and 10 wk later.

Results:
At baseline, subjects (n=25) were 13.2 days post-stroke, mean age 64.9 yr, ARAT 18.8, and FM 30.1.
[H1] TR vs. UC
: ARAT change from baseline to 10 wk later was 7.7 points higher in TR (23.8±2.8, n=16) vs. UC (16.1±3.2, n=9, propensity adjusted p=0.08). FM change was 12.3 points higher in TR (22.5±2.3) vs. UC (10.3±2.7, p=0.0027).
[H2] TR+levodopa vs. TR+placebo vs. UC
: ARAT change was not different between the 3 groups (p=0.17). However, FM change was: regression adjusted post hoc FM change with TR+levodopa (21.1±3.9) was significantly higher than change with UC (10.7±2.8, p=0.047), but FM change with TR+placebo (17.2±3.2) was not significantly higher than UC (p=0.103).

Conclusions:
Therapeutic trials of patients ≤30 days post-stroke can be difficult to implement, e.g., due to transitions of care. This study describes a method to study a restorative drug tightly linked with intensive rehabilitation therapy using a telehealth approach. This pilot study, though at risk of type II error, provides evidence that adding intensive rehabilitation therapy to UC early post-stroke improves outcomes, and supports the potential value of adding levodopa to intensive rehabilitation therapy in the early post-stroke population.
Abstract WMP44: Post Acute Care at Inpatient Rehabilitation Facilities Maximizes 1-Year Home Time among Patients with Acute Ischemic Stroke: Cluster Analysis of Health System and Statewide Data
Authors: Pan Alan , Wozny Joseph , Schaefer Caroline , Bako Abdulaziz , Nicolas Charlie , Potter Thomas , Caballero Elizabeth , Nair Rejani , Ganduglia-Cazaban Cecilia , Kim Yejin , Jiang Xiaoqian , Vahidy Farhaan
Published: January 2025

Background:
The post-acute journey for stroke patients is highly variable. We evaluated patient and health-system factors that contribute to the variability in 1-year home time (HT) by employing unsupervised learning (cluster analyses) among Acute Ischemic Stroke (AIS) patients.

Methods:
Texas statewide medical claims data on post-stroke care transitions were extracted from a CMS Qualified Entity housing data for ≥80% of the population (including 100% of Medicare Fee-for-Service). Clinical information on a matched sub-population was linked from the EMR of a 7-hospital certified stroke health system. K-means clustering was performed on 1) the statewide dataset on post-discharge care utilization, and 2) the hospital dataset which further included clinical and acute care features. The optimal number (k) of cluster centers was compared algorithmically using direct (average silhouette) and gap statistic methods. Cluster performance, with respect to distinguishing high risk patients more likely to have low HT post-discharge (i.e., total 1-year home time of <30 days), was evaluated by precision (positive predictive value), recall (sensitivity), and F1 score.

Results:
Between 2016 and 2020, 75,478 statewide AIS admissions were captured, while 2,889 AIS admissions were analyzed for the matched hospital system subgroup. Cluster models with k = 2 centers (vs. 3) provided distinctive risk profiles (Fig. 1A / 1B) and yielded better performance in classifying patients at higher risk of low HT (patients depicted in red cluster in Fig. 1C / 1D). The 2-cluster model demonstrated a high recall and correctly identified 93.1% of all high risk (low HT) patients (Fig. 1E). Precision was modest, with 57.2% of those patients flagged as high risk representing true predictions. Demographic and clinical patient characteristic differences were observed across HT strata, in both the statewide dataset and the hospital sub-group. These included advanced age (both cohorts), higher stroke severity (hospital cohort), and higher comorbidity burden (hospital cohort). Post acute care at an inpatient rehabilitation facility minimized the risk of low HT (vs. high HT: ≥ 300 days) in both the statewide (16.2% vs. 28.3%) and the hospital cohort (15.1% vs. 28.5%) (Fig. 2).

Conclusion:
Cluster analyses can elucidate high-risk patient profiles and guide in identifying intervenable targets and prioritizing provision of appropriate care, including rehabilitation, to optimize long-term patient outcomes.
Abstract WMP58: Social determinants of Health with Ischemic Stroke Patients treated with IV thrombolysis within a Public Safety Net Hospital
Authors: Grazi Jack , Law Susan , Soh James , Kang Derrek , Huang Anna
Published: January 2025

Introduction:
The management of acute ischemic stroke over the last three decades has seen an expansive progression in terms of medical and surgical interventions. In spite of these advances, stroke outcomes continue to be reliant on factors only attributable to the patient. The aim of this study is to understand the social determinants of health within our public safety net hospital. This is a descriptive study to evaluate demographics of stroke patients with IV thrombolysis in relation to social determinants of health (SDOH).

Methods:
All patients entered into the GWTG-Stroke registry for NYC Health+Hospitals/Kings County between 3/1/2022 and 3/31/2024. Any patients whose symptoms started after hospital arrival, were transferred to or from another hospital, or had unknown last known well were excluded. Chi-Square tests and logistic regressions were performed.

Results:
Between 3/2022 and 3/2024, 1359 patients were analyzed after exclusion criteria and 141 patients were identified to have at least 1 SDOH. Individual Chi-Square analyses revealed a significant relationship between identification of SDOH and age, payment source, stroke diagnosis, and symptom resolution upon hospital arrival. When comparing age, patients aged 80+ were likely to have at least 1 SDOH compared to their counterparts less than 50 years old (2.31, 1.21-4.42, p<0.02). Compared to patients whose symptoms resolved upon arrival, those symptoms persisted after arrival are more likely to have at least 1 SDOH (1.78, 1.04-3.06, p<0.04). Patients using Medicare/Medicaid are more likely to have at least 1 SDOH compared to those with private insurance (2.19, 1.26-3.82, p<0.01). In a full logistic regression model including age, initial NIHSS score, race, sex, payment source, Hispanic ethnicity, and stroke diagnosis, only age (1.02, 1.01-1.04, p<0.02) and payment source (1.79, 1.01-3.16, p<0.05) were statistical predictors of a patient reporting SDOH.

Discussion/Next Steps:

Several factors have been demonstrated to be associated with social barriers to optimal stroke care. Medicaid/Medicare insurance status has been associated with readmissions and higher mortality than other patients.[1] This can be attributed to lower health literacy in such populations, thereby preventing accessing adequate medical care.

By acknowledging and addressing SDOH, we hope to provide more comprehensive stroke care to not only identify high risk patients, but also optimize care for patients within the healthcare system.
Abstract WMP59: A Multi-centre, Randomized, Controlled

S

tudy of External Counter

P

ulsation for Patients with Recent

A

therosclerotic Stroke (SPA)
Authors: Xiong Li , Chen Xiangyan , Leung Howan , Zhu Lixia , Leung Thomas , Wong Lawrence
Published: January 2025

Background and Purpose:
External counterpulsation (ECP) is a novel noninvasive method used to improve the perfusion of vital organs, which may benefit ischemic stroke patients. We aimed to test the hypothesis that ECP may improve disability in addition to best medical treatment in atherosclerotic stroke patients within 7 days of symptom onset.

Methods:
The trial was a multi-centre, randomized, controlled trial. Patients with cerebral large artery occlusive disease were randomized to 35 one-hour sessions of ECP group or no-ECP control group, in addition to best available evidence-based medical and rehabilitation treatment. Primary outcome was modified Rankin scale (mRS) grade at month 3, defined as a good outcome with a mRS≦2. Secondary outcomes were the scores of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI), stroke recurrence, overall mortality and the occurrence of vascular events by 3 months (recurrent stroke, acute coronary syndrome, deep vein thrombosis and hemorrhagic transformation or intracerebral hemorrhage).

Results:
In the randomized 189 patients from three hospitals, totally 5 patients were lost to follow-up at month 3. Therefore, 184 patients (97.4%) with moderate neurological deficit (mean NIHSS, 8.2) were included into the intention-to-treat analysis (90 ones in ECP group and 94 ones in No-ECP group, respectively). The groups were balanced in all demographic data. At month 3, there were no significant differences in the proportion of patients with good outcome (ECP 42.2% vs no-ECP 35.1%, P=0.322) and the secondary outcomes, except the incidence of vascular events with a favorable trend (ECP 3.3% vs no-ECP 8.5%, P=0.139). After adjusting for the factors not complying with trail design, a significant lower incidence of vascular events was found in 0.0% of 65 patients in ECP group compared to 9.1% of 88 patients in no-ECP group (P=0.021) at month 3 in per-protocol analysis.

Conclusion:
ECP did not statistically significantly improve disability in atherosclerotic stroke within 7 days of symptom onset in the RCT trial. However, per-protocol analysis showed that completion of total 35 one-hour sessions of ECP treatment is beneficial for reducing the incidence of new vascular events in atherosclerotic stroke after 3 months of onset.

Registration number: ChiCTR-TRC-07000706
Abstract WMP60: Consent Deviations in an Acute Ischemic Stroke Clinical Trial
Authors: Stalin Karen , Staugaitis Abbey , Davis Shannon Iris , Rogers Anthony , Tessmer Megan , Streib Christopher
Published: January 2025

Background:
MOST (Multi-arm Optimization of Stroke Thrombolysis) was a multicenter, randomized controlled trial of adjuvant argatroban, eptifibatide, or placebo in moderate to severe acute ischemic stroke patients who received intravenous thrombolysis within three hours of stroke onset. We compared protocol deviations between participants consented using conventional paper informed consent documents (ICDs) versus electronic informed consent (eConsent).

Methods:
MOST began in 2019 and was completed in 2023. When obtaining informed consent, research teams could elect to use conventional paper ICDs or an eConsent platform managed centrally by the NIH StrokeNet. We studied informed consent-related data clarification requests (DCRs) and reportable unanticipated events (UE) (i.e. protocol deviations). Data for all modalities of consent (paper-in person, paper-remote, eConsent-in person, eConsent-remote) were collected in WebDCU™. REDCap was used as a repository for completed eConsents. We used Chi-squared and Kruskal Wallis tests to detect differences between consent modalities and stratified by whether they were remote or in-person. Two authors reviewed UEs to determine if they were consent-related and to categorize themes; in cases of disagreement a third reviewer adjudicated the final decision.

Results:
The rate of DCRs and UEs per 100 enrollments for each consent modality is shown in Table 1. Pairwise testing revealed that eConsent-in person had significantly less DCRs than both paper-in person and eConsent-remote (p<0.001), but there was no difference between paper-in person and eConsent-remote (p=0.32). Paper-in person had significantly more UEs than both eConsent-in person and eConsent-remote (p<0.001); the rate of UEs for eConsent-in person was also less than eConsent-remote (p=0.04). The themes that emerged in order of frequency were: HIPAA form missing/incorrect, incorrect version of the main consent, wrong person/wrong section signed and miscellaneous problems.

Conclusion:
The rate of DCRs and UEs were highest for paper in-person consent modality. These findings are most likely attributable to having typed vs handwritten data fields, required and forced-entry fields, a built-in reminder to complete HIPAA authorization, and centralized version control. This highlights the potential for eConsent to alleviate the research burden related to error mitigation and remittance in clinical trials; especially if scaled across research networks.
Abstract WMP61: Age and Admission NIH Stroke Scale but Not Radiologic Collateral Status Predict Modified Rankin Score in Large and Medium Vessel Occlusion Ischemic Strokes
Authors: Srinivas Tara , Lakhani Dhairya , Balar Aneri , Xu Risheng , Salim Hamza , Yedavalli Vivek
Published: January 2025

Introduction:
Neuroimaging is increasingly useful in predicting response to endovascular treatment (EVT) among acute ischemic stroke (AIS) patients. While radiologic collateral status is a known correlate of reperfusion and mortality in AIS patients with large vessel occlusions (LVOs) of the anterior circulation, whether this imaging marker is associated with patient functional status following EVT is unclear. Furthermore, the utility of collateral status in predicting outcomes of medium vessel occlusions (MeVOs), which account for 25-40% of AIS and are promising candidates for EVT, remains unknown. We evaluated the adjusted association of collateral status parameters with 90-day post-EVT functional outcomes in AIS patients with LVOs and MeVOs.

Methods:
We retrospectively evaluated AIS patients treated at our institution between January 9, 2017, and January 10, 2023. The following inclusion criteria were applied: (i) CTA-confirmed anterior circulation large or medium vessel occlusion; (ii) diagnostic CT perfusion was performed; (iii) mechanical thrombectomy was performed. A low modified Rankin score (mRS) indicating good functional outcomes (i.e., functional independence) was defined as less than or equal to 2, in accordance with prior studies. Univariate and multivariate logistic regression analyses were conducted to determine associations between demographic, clinical, and radiologic factors and mRS ≤ 2.

Results:
A total of 277 LVO (mean age 66.3 ± 16.6, 57.0% female) and 106 MeVO (mean age 70.3 ± 13.9, 57.5% female) patients met inclusion criteria. On multivariate regression adjusted for race, age, sex, hypertension, diabetes mellitus, atrial fibrillation, radiologic features, IV alteplase administration, and admission NIHSS, young age (p = 0.0003) and low admission NIHSS (p = 0.006) were associated with good functional outcomes in LVO stroke (Table 1). Similarly, low admission NIHSS (p = 0.02) was associated with good functional outcomes in MeVO stroke (Table 2).

Conclusion:
No significant association was detected between collateral status parameters — including single-phase CTA, multiphase CTA, and CT perfusion measures — and AIS functional outcomes following EVT in either LVO or MeVO strokes. Thus, although prior research suggests that good collateral status can predict successful reperfusion, collateral status parameters may be suboptimal for determining management of AIS in patients undergoing EVT where functional outcome is prioritized.
Abstract WMP68: Elevated Flow Velocity in Transcranial Doppler: Discrepancies Between Actual Vasospasm Locations and Flow Measurements
Authors: Kim Yongwoo , Kim Alexander , Williams Josef , Withington Charles , Tefera Eshetu , Felbaum Daniel , Mai Jeffrey , Tahir Rizwan , Liu Ai-Hsi , Armonda Rocco , Chang Jason
Published: January 2025

Background and Purpose:
Transcranial Doppler (TCD) has been widely used to predict cerebral vasospasm in subarachnoid hemorrhage (SAH) patients by monitoring the mean flow velocity (MFV) of major cerebral arteries. However, the accuracy of TCD in identifying specific arteries with vasospasm is questionable. This study investigates the correlation between elevated MFVs in TCD and actual vasospasm locations, evaluating the influence of adjacent artery vasospasms.

Materials and Methods:
We conducted a retrospective observational study. Between March 2017 and December 2020, 256 SAH patients admitted to our hospital underwent TCD monitoring. The presence and arterial distribution of vasospasm were confirmed via conventional angiography. Statistical analysis included bivariate mixed-effects linear regression and logistic regression to explore the relationships between the MFV values and the presence and location of vasospasms.

Results:
Of the 256 patients, 188 met the study criteria, yielding 367 hemispheres for analysis. Significant correlations were found between the MFV values of the middle cerebral artery (MCA), anterior cerebral artery (ACA), and internal carotid artery (ICA). Vasospasm was associated with elevated MFVs not only in the directly affected arteries but also in adjacent ones. Logistic regression indicated a significant association between the presence of vasospasm and increased MFV in the respective artery. However, ACA vasospasm showed significant associations only with elevated MCA MFV.

Conclusion:
These findings challenge the traditional assumption made with TCDs that MFV increases correlate with vasospasm in the corresponding artery. Rather, elevated MFVs should be considered a general marker of potential vasospasm within the anterior cerebral circulation. This study underscores the interconnected response of cerebral arteries to vasospasm and the need for comprehensive evaluation when elevated MFV is observed.
Abstract WMP72: Diagnostic Accuracy of Cone-Beam CT for Acute Intracranial Hemorrhage in Suspected Ischemic Stroke Patients: A Systematic Review and Meta-analysis
Authors: Ferrone Nicholas , Sanmartin Maria , O'Hara Joseph , Jimenez Jean , Ferrone Sophia , lee Un Jung , Morales Jaclyn , White Timothy , Wang Jason , Katz Jeffrey , Sanelli Pina
Published: January 2025

Introduction:
Emerging technologies, such as Cone-Beam CT (CBCT), may improve workflows in acute ischemic stroke (AIS). Direct-to-angiography workflow relies on CBCT to exclude intracranial hemorrhage (ICH) to determine treatment eligibility for intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Prior studies evaluated CBCT for ICH detection using small, selected cohorts and variable diagnostic metrics yielding a wide range of sensitivity and specificity values. Our purpose was to synthesize available evidence to determine the diagnostic accuracy of CBCT for ICH detection, with particular focus on specific hemorrhage types: intraparenchymal (IPH), subarachnoid (SAH), and intraventricular (IVH).

Methods:
We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Systematic searches were last performed on April 1, 2024 in EMBASE, PubMed, Web-of-Science, Scopus, and CINAHL databases. Inclusion criteria: (1) Studies reporting diagnostic metrics of CBCT for ICH; (2) Studies using a reference standard to determine ICH. Exclusion criteria: (1) Case reports, abstracts, and reviews; (2) Studies without patient-level data. Pooled estimates and 95% confidence intervals (CI) were calculated for the Log diagnostic Odds ratio (DOR), sensitivity, and specificity for ICH and hemorrhage types using random-effects and common-effects models.

Results:
Seven studies were included in the meta-analysis yielding 466 patients (
Fig 1
). Pooled Log DOR, sensitivity, and specificity (95%CI) for ICH were 5.28 (4.11,6.46), 0.88 (0.79,0.97), and 0.99 (0.98,1.0), respectively (
Fig 2,3
). Pooled sensitivity (95%CI) for IPH, SAH, and IVH were 0.98 (0.95,1.0), 0.82 (0.57,1.0), and 0.78 (0.55,1.0). Pooled specificity (95%CI) for IPH, SAH, and IVH were 0.99 (0.98,1.0), 0.99 (0.97,1.0), and 1.0 (0.98,1.0).

Conclusion:
CBCT had high specificity for ICH and hemorrhage types. However, sensitivity was lower and varied with the highest sensitivity for IPH followed by SAH and IVH. These findings indicate that CBCT may be reliable for exclusion of ICH in determining MT eligibility in AIS patients who are not IVT candidates. However, the high false-negatives of CBCT for SAH and IVH requires caution for IVT decision-making, where missing a small hemorrhage could result in devastating outcomes.
Abstract WMP76: Trends in ischemic stroke hospitalization and outcomes in the United States pre- and peri- COVID-19 pandemic: A National Inpatient Sample study
Authors: Jafarli Alibay , Kasper Rachel , Saver Jeffrey , McCullough Louise , Lioutas Vasileios , Salehi Omran Setareh , Di Napoli Mario , Mansouri Behnam , Birnbaum Lee , Ismail Mohammed , Ozdemir Atilla Ozcan , Divani Afshin
Published: January 2025

Importance:
The COVID-19 pandemic significantly disrupted healthcare systems worldwide, impacting the management of acute ischemic stroke (AIS). Understanding changes in AIS admissions, treatment patterns&outcomes during the pandemic is essential for optimizing stroke care in future public health crises.

Objective:
To evaluate the impact of the COVID-19 pandemic on AIS admissions, treatment utilization, complications&outcomes in the U.S. from 2016 to 2021, focusing on the pre-pandemic (2016-2019)&peri-pandemic (2020-2021) periods.

Methods:
A retrospective observational cohort study utilizing the National Inpatient Sample (NIS) nationwide database, analyzing weighted hospital discharge records over 6 years, encompassing urban, rural, teaching &non-teaching hospitals.

Participants were AIS patients aged 18 years&older (n=3,154,154), identified using ICD-10 codes. Sociodemographic characteristics such as age, sex, race&comorbidities were evaluated. The mean patient age was 70.0 ± 0.03 years, with an average length of stay of 5.1 ± 0.01 days&an adjusted mean cost of $16,765 ± 71. Men accounted for 50.5% of the cohort. AIS hospitalizations from 2016 to 2021 were collected, comparing pre-&peri-pandemic periods. Primary outcomes included AIS admission trends, while secondary outcomes included reperfusion therapy utilization, intubation&ventilation rates, discharge disposition&complications.

Results:
AIS admissions increased from 507,920 in 2016 to 535,694 in 2021. A demographic shift was observed, with the proportion of male patients rising from 49.8% to 51.4%&the mean age decreasing from 70.3 to 69.7 years (p < 0.0001). Most patients were White (69.5% in 2016), but their proportion decreased over time, while Black, Hispanic&Asian/Pacific Islander cases increased (p 0.5734). Reperfusion therapy usage increased, with mechanical thrombectomy (MT) rising from 2.2% to 5.6% in 6 years. Intubation/ventilation rates grew from 4.8% pre-COVID to 5.5% peri-COVID (p < 0.0001). Subarachnoid&intracerebral hemorrhage rates had increased throughout the 6 years in the group with MT-only intervention (p .011&.002, respectively).

Conclusions:
The COVID-19 pandemic led to significant shifts in AIS hospitalization patterns, including changes in age distribution, increased reperfusion therapy use&rising complications. These findings highlight the need for adaptive public health strategies&resource allocation to maintain stroke care during future crises.
Abstract WMP88: Balloon-mounted versus Self-expanding stents in bail out thrombectomy: impact of the stent design in the RESISTANT registry cohort
Authors: tomasello alejandro , Salcuni Andrea , Kaesmacher Johannes , Mujanovic Adnan , geyik serdar , SENADIM SONGUL , Piano Mariangela , Moreu Manuel , Lopez-Frias Alfonso , Hassan Ameer , Miller Samantha , Zapata-Arriaza Elena , de Alboniga-Chindurza Asier , Bergui Mauro , Molinaro Stefano , Sousa Joao Andre , Gomes Fábio , Alexandre Andrea , Pedicelli Alessandro , Hofmeister Jeremy , Machi Paolo , Scarcia Luca , Kalsoum Erwah , Amorim José , Meira Torcato , Ortega-Gutierrez Santiago , Rodriguez Aaron , Renieri Leonardo , Capasso Francesco , Gadea Marta , Romano Daniele , Barcena Eduardo , AbdalKader Mohamad , Perry Da Camara Catarina , Yavagal Dileep , VEGA PEDRO , Ozdemir Atilla Ozcan , Smajda Stanislas , Khalife Jane , Biraschi Francesco , Castro Pedro , Siddiqui Adnan , Navia Pedro , Ntoulias Nikolaos , Velo Mariano , Zamarro Joaquin , Zaidat Osama , Sierra-Gómez Alicia , Marto Joao Pedro , Requena Manuel
Published: January 2025

Background:
Intracranial stenting is increasingly performed after thrombectomy failure. Stent selection and procedural strategies are heterogenous between centers. Our aim is to evaluate the clinical and radiological impact of stent design among these patients.

Methods:
The RESISTANT registry is a multicenter, international, retrospective study of patients with acute ischemic stroke who underwent intracranial stenting from 2016 to 2023. This analysis compares outcomes based on stent type and evaluates the role of pre- and post-stenting angioplasty. The primary endpoint was 90-day good clinical outcome defined as modified Rankin Scale 0 to 2. Secondary outcomes included final reperfusion, and early stent patency (within 48 hours). Safety outcomes included procedural complications, symptomatic intracranial hemorrhage, and in-hospital mortality.

Results:
Among 859 patients in the RESISTANT registry, 176 underwent intracranial stenting with balloon-mounted stent (BMS) and 683 with self-expandable stent (SES). The Vertebrobasilar location was more frequent in patients who received BMS (46.6% vs 24.0%, p<0.001); other baseline variables were similar between groups. Angioplasty was performed more frequently before (SES: 54.0% vs BMS: 39.2%, p<0.001) and after SES (SES: 21.1% vs BMS: 9.2%, p<0.001). Successful reperfusion (mTICI 2b-3) was similar between groups (BMS: 91.2% vs SES: 89.1%) and the rate of residual intracranial stenosis was higher in SES patients (57.1% vs 35.6%, p<0.001). Reocclusion, procedural complications and symptomatic intracranial hemorrhage rates were similar between groups. At 90 days, the rate of good clinical outcome was higher among those patients treated with SES (44.7% vs 29.5%, aOR 1.74 (95%ICI 1.07-2.82)).

Conclusions:
Among patients who underwent rescue intracranial stenting, patients treated with self-expandable stents had a better outcome than patients treated with balloon-mounted stent at 90 days despite similar rates of symptomatic intracranial hemorrhage, successful recanalization and early reocclusion.
Abstract WMP89: Association of thrombectomy with clinical outcomes in elderly patients presenting beyond 24 hours of last known well – A secondary analysis of SELECT LATE study
Authors: Pujara Deep , Kleinig Timothy , Hassan Ameer , Cardona Pedro , Ortega-Gutierrez Santiago , Abraham Michael , Manning Nathan , Goyal Nitin , Blackburn Spiros , sitton clark , Wu Teddy , Blasco Jordi , Sangha Navi , Arenillas Juan , Opaskar Amanda , McCullough-Hicks Margy , Wallace Adam , Arthur Adam , Grotta James , Parsons Mark , Ribo Marc , Albers Gregory , Campbell Bruce , Sarraj Amrou
Published: January 2025

Introduction:
Randomized clinical trials have demonstrated efficacy and safety of endovascular thrombectomy (EVT) among patients presenting up to 24 hours of last known well (LKW). Recent reports have suggested EVT could result in better functional outcomes with acceptable risk profile even in patients presenting beyond 24 hours of LKW, but exploration of the role of EVT in elderly patients presenting beyond 24 hours is limited.

Methods:
We aimed to evaluate functional and safety outcomes for EVT in patients with age ≥80y with a large vessel occlusion (LVO) beyond 24 hours of LKW, from a pooled, international cohort (17 centers across US, Spain, Australia and New Zealand) between 7/2012 and 12/2021. Primary outcome was a shift on modified Rankin Scale score at 90-day follow-up.

Results:
Of 301 included, 88 (53 EVT, 35 medical management MM) were aged ≥80y, with 57 females and 21 nonagenarians. Median(IQR) NIHSS - 17.5 (11-22),CT ASPECTS - 7(4-9), ischemic core 5.5 (0-26) ml. Overall, as age increased, clinical outcomes worsened (acOR: 0.64, 95% CI: 0.55-0.74, p<0.001 per 10 year increment). However, EVT was associated with a shift towards better functional outcome among patients with age≥80y (acOR: 8.31, 95% CI:2.80-24.68, p<0.001) and among patients with age<80y (acOR: 2.11, 95% CI: 1.22-3.66, p=0.008), with a significant interaction (p-int:0.047 – fig1) suggesting higher improvement within octogenarians. Estimates of Functional independence (EVT: 27% vs MM: 6%, aOR: 11.86, 95% CI: 1.75-80.28, p=0.011) and mortality (EVT: 42% vs MM: 71%, aOR: 0.16, 95% CI: 0.05-0.52, p=0.003) also favored EVT, with similar results obtained using inverse probability of treatment weights [Table 1]. 4 patients within EVT arm and no patients within MM arm developed symptomatic ICH. Among octogenarians receiving EVT, lower presentation NIHSS (aOR: 0.77, 95% CI: 0.64-0.92, p=0.003 per point increment) and presence of M2 occlusion (aOR: 11.01, 95% CI: 1.15-105.36, p=0.037 were independently associated with functional independence at 90-day follow-up), but not time to procedure (aOR: 0.99, 95% CI: 0.96-1.02, p=0.64, fig2).

Conclusions:
In a pooled international cohort of octogenarians who presented beyond 24 hours with an LVO, EVT was associated with better functional outcomes, higher functional independence and lower mortality. Lower stroke severity and presence of M2 occlusion were independently associated with functional independence at 90-day after EVT.
Abstract WMP9: The Effect Of Remote Ischemic Conditioning On Acute Infarct Growth In Patients With Acute Ischemic Stroke - Subgroup Analysis From The RESIST Trial
Authors: Lysdahlgaard Simon , Blauenfeldt Rolf , Andersen Grethe , Mikkelsen Irene , Dupont Kristina , Gude Martin , Dalby Rikke
Published: January 2025

Background:
Remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is a safe and promising neuroprotective therapy in acute ischemic stroke (AIS). The results from recent clinical trials show mixed results on clinical outcomes and may depend on the studied population, timing- and dosage of RIC. In this study, we evaluated the effect of RIC on infarct growth measured from baseline to 24-hour on diffusion-weighted magnetic resonance imaging (MRI) scans using a deep learning (DL) segmentation method.

Methods:
In this predefined sub-study of the Remote Ischemic Conditioning in Patients with Acute Stroke Trial (RESIST), we compared the change in brain infarct volumes from the acute MRI (baseline) to the 24-hour MRI, between the RIC and Sham-treated patients. Infarct volumes were automatically segmented using an ensemble DL approach, which was optimized on a previous study population. Mann-Whitney U test was used to assess differences in infarct growth between treatment groups, considering an interquartile range and setting a significance threshold at p < 0.05.

Results:
RESIST includes 384 AIS patients, with 346 analyzed; 32 were excluded for only having baseline scans, and six for insufficient segmentation due to incomplete or disrupted MRI scans. No significant differences were found in mean age (P=0.481) or gender ratio (P=0.715) between the Sham (n=184; mean age = 70.79; female/male = 117/67) and RIC (n=162; mean age=69.83; female/male=107/55) groups. For the primary endpoint there was no difference in mean infarct growth (from baseline to 24-hour) between RIC 6.18 mL (SD 31.18) and Sham 5.83 mL (SD 25.26), P=0.824. Supplemental subgroup analysis will be presented at the conference.

Conclusion:
Pre-hospital and in-hospital RIC treatment did not result in reduced 24-hour infarct growth in patients with AIS. This is the largest study to date examining the effect of RIC on infarct growth, with subgroup analysis that will be presented at the conference.
Abstract WMP93: Long-term Outcomes of Total endovascular Reconstruction of Symptomatic Internal Carotid Artery Chronic Total Occlusions: An 18-year Experience
Authors: Chebl Alex
Published: January 2025

Background:
Chronic total internal carotid artery occlusion (CTO) can be associated with a high (22-25%) annual risk of stroke with limited therapeutic options. Total endovascular reconstruction (TER) is increasingly feasible but mid-term and long-term outcomes have not been reported.

Methods:
Data from all patients treated with carotid CTO treated with TER over the past 18years were collected in a database. Patients were selected based on the presence of angiographically proven symptomatic carotid occlusion, adequate landing zone and concurrent impairment of cerebrovascular reserve or recurrent ischemia despite maximal medical therapy. They were treated via a femoral approach using conventional CTO techniques with balloon expandable and/or self-expanding stents. Neurological evaluation of NIHSS, mRankin and carotid U/S were performed at discharge, 30days, and all subsequent follow-up. All TIA, stroke, death, and MI were recorded during follow-up. Angiographic follow-up was performed between 6-12months when possible.

Results:
Twenty-six symptomatic patients with a mean age of 65±7.8years were treated. Technical success was achieved in 22/26 (85%) on first attempt and in 3/4 on second attempt for total success rate of 25/26(96%). Total 30-day stroke/death/MI was 6.9% (2 ICH, both in first 3 years of experience). There were no recurrent events during 15.2±9.8months (median 12) of follow-up. Restenosis was found in 5/26 (19.2%) of patients; 2/5 were in unstented segments of the ICA. There was one case of asymptomatic carotid occlusion at 7months. The median mRS dropped from 2 to 1 at follow-up.

Conclusion:
TER is feasible in most patients with carotid CTO and is associated with a 30-day event rate lower than reported for STA-MCA bypass surgery. It is associated with good long-term stroke reduction despite a 19.2% risk of restenosis. Carotid re-occlusion is rare. Randomized trials are needed to validate this approach.
Abstract WMP97: Glymphatic Dysfunction as a Link Between Cerebral Small Vessel Disease, Sleep Disorders, and Cognitive Decline: Insights from a Longitudinal Community Cohort Study
Authors: Zhou Rong , Zhong Weiyi , Ying Yunqing , Xu Jiajie , Cheng Xin
Published: January 2025

Background:
The advancement of age is associated with an increased incidence of both cerebral small vessel disease (CSVD) and sleep disorders, which are recognized as risk factors for cognitive decline. Recent studies suggest that the glymphatic system may play an important role in these relationships.

Methods:
In this cross-sectional and longitudinal study, participants from Shanghai Aging Study underwent multi-modal MRI, Pittsburgh Sleep Quality Index (PSQI) and neuropsychological assessment. Diffusion tensor image analysis along the perivascular space (DTI-ALPS) index was employed to evaluate the function of glymphatic system. Spearman correlation and partial correlation analyses were used to explore the relationships between CSVD burden/sleep disorders, glymphatic dysfunction, and cognition. Furthermore, mediation analysis was conducted to investigate the potential mediating effects of DTI-ALPS in the association between CSVD/PSQI and cognition. We further examined the interaction effects between CSVD burden and sleep disorders on cognitive outcomes.

Results:
258 participants were included in this study (average age, 68.5 years), among which 133 participants were followed up after a 7-year interval. At baseline, DTI-ALPS was significantly correlated with PSQI (r = -0.174, p = 0.005) and various imaging biomarkers of CSVD after adjusting for age, gender, vascular risk factors, and ApoE4. Additionally, DTI-ALPS was significantly correlated with executive function (r = -0.237, p < 0.001), memory (r = 0.146, p = 0.02), and visuospatial ability (r = 0.154, p = 0.014). Mediation analysis indicated that DTI-ALPS simultaneously mediated the association between CSVD burden/sleep disorders and cognitive decline, with a complete mediation effect of 19.22% between CSVD burden and executive function, 13.03% between PSQI and memory. Interaction analysis showed that the impacts of sleep disorders on general cognitive function and executive function were more significant among older adults at high risk of CSVD. Longitudinally, classic imaging biomarkers of CSVD as well as DTI-ALPS were significantly related to long-term changes in cognition.

Conclusion:
The study reveals that glymphatic dysfunction serves as a link to closely connect sleep disorders/CSVD with cognitive decline in community-dwelling older adults. Moreover, the interaction effect between two risk factors emphasizes the importance of individualized sleep management in the elderly at high risk of CSVD.
Abstract WP10: Safety and Efficacy of Intravenous Cangrelor for Acute Rescue Cervical and Intracranial Stenting in Ischemic Stroke
Authors: Khan Farhan , Madour Joseph , Kala Narendra , Torabi Radmehr , Moldovan Krisztina , Wolman Dylan , Jayaraman Mahesh , Furie Karen , Yaghi Shadi
Published: January 2025

Background:
Increased immediate and delayed re-occlusion rates, up to 33%, are reported in patients undergoing acute stenting for tandem lesions, with symptomatic hemorrhage rates around 10-15%. Intraprocedural intravenous (IV) cangrelor is emerging as a bridging therapy for antiplatelet inhibition during acute stenting in ischemic stroke. We report our single-center experience with IV cangrelor in patients undergoing rescue stenting.

Methods:
We conducted a retrospective analysis from a single-center large vessel occlusion registry from July 2015 to October 2023. Patients who underwent emergent stenting and received IV cangrelor (30 mcg/kg bolus, then 4 mcg/kg/min), followed by dual antiplatelet therapy upon achieving enteric access, were included. The primary outcome was re-occlusion of cervical or intracranial arteries, assessed immediately, early (within 24 hours), and at follow-up. Secondary outcomes included symptomatic hemorrhage or death (based on ECAS-III criteria) and early neurologic deterioration (defined as a change in NIHSS score of ≥4 within 24 hours). Continuous variables were summarized with means and standard deviations; categorical variables were presented as frequencies and percentages. T-tests compared continuous variables, while chi-square or Fisher’s exact tests analyzed categorical variables.

Results:
Among 220 patients, 201 (91%) underwent cervical stenting, and 19 (9%) received intracranial stenting. The mean age was 68 years (SD ± 11.50), with a male predominance of 63%; 85% did not experience immediate, early, or delayed re-occlusion, a rate lower than previously reported. The symptomatic hemorrhage rate was 10.76%, consistent with prior literature. No significant differences in symptomatic hemorrhage were found between cervical and intracranial stenting groups (10% vs. 1%, p = 0.3) or between those with and without IV thrombolytics (11% vs. 10%, p = 0.80). Early neurologic deterioration occurred more frequently in the intracranial stenting group (33% vs. 17%, p = 0.23), though not statistically significant. At 90 days, favorable outcomes (mRS 0-2) were similar between the intracranial and cervical stenting groups (42% vs. 49%, p = 0.55).

Conclusion:
IV cangrelor can be considered as a bridging therapy for antiplatelet inhibition during acute rescue stenting. Larger studies are needed to validate these findings.
Abstract WP104: Clustering of True Mobile Stroke Hotspots with Geospatial Software Analysis
Authors: Vora Shivam , Hake Joshua , Willis Corbin , Hall Mae , Jennings Nate , Katz Brian , Rai Vivek , Loochtan Aaron , Hicks William , Crow Dan
Published: January 2025

Background:
Previous findings have shown high mobile stroke unit (MSU) call density scattered across a coverage area. We sought to differentiate the geographic pattern of MSU calls carrying an accurate diagnosis of an acute cerebrovascular condition using a geospatial software analysis.

Methods:
The Mobile Stroke Treatment Unit of metropolitan Columbus, Ohio, provides emergency stroke care coverage for 325 square miles spanning 47 zip codes. Our MSU is operational from 0700-1900 and is dispatched for all 911 calls designated as probable or definite strokes. We retrospectively reviewed all MSU calls from June 2019 to December 2023. We retrospectively reviewed charts to confirm the final diagnosis and included only patients with an acute cerebrovascular condition. The calls were organized into 3 time epochs (0700-1100, 1101-1500, 1501-1900). Each call address was geocoded and entered into the ESRI/ArcGIS Online geospatial analysis software. Call addresses were then clustered into hexagonal grids with a distance band of 1 km for hotspot analysis. Statistically significant hotspots were qualitatively defined as clustered grids with high activity and quantitatively defined as having a Gi Bin score > 2, which correlates to statistical confidence > 95%.

Resuts:
We received 7442 calls during our study period. Of these calls, 738 were retrospectively confirmed as a stroke. From 0700-1100, 4 regions were considered hotpots (Blue). From 1101-1500, 3 regions were considered hotspots (Red). From 1501-1900, 1 region was considered a hotspot (Purple). Two particular regions showed proximity over consecutive time epochs.

Conclusion:
Our study showed that MSU actual stroke call density may have less variation compared to previous undifferentiated studies. Geographic analysis shows relative clustering of these hotspots, which can aid in strategic MSU deployment.