bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP127: TAK-242, an Antagonist for Toll-like Receptor 4, Protects against Acute Cerebral Ischemia/Reperfusion Injury in Mice
Authors: Hua Fang , Wang Jun , Tang Huiling , Prunty Megan , Ishrat Tauheed , Atif Fahim , Sayeed, Iqbal , Stein Donald
Published: March 2022

Cerebral ischemia/reperfusion (I/R) induces
in situ
inflammatory responses which contribute to further brain injury. Toll-like receptors (TLRs) are a trans-membrane, pattern-recognition receptor family with important roles in the induction and regulation of immune/inflammatory responses. TLR4 is known to be involved in cerebral I/R injury and is considered a potential target for the treatment of ischemic stroke. This experiment evaluated the hypothesis that an exogenous TLR4 antagonist, TAK-242, protects brain from I/R injury. A mouse model of cerebral I/R was induced by transient middle cerebral artery occlusion (tMCAO). TAK-242 (3 mg/kg body weight) was intraperitoneally injected (i.p.) 1 hour after ischemia. Concentrations of TAK-242 in plasma and brain tissue were measured 3, 8, and 24 hrs after injection. Neurological scores were evaluated 24 hrs after cerebral I/R. Brain infarct areas were detected by TTC staining. Inflammatory cytokines were analyzed by antibody arrays 6 hrs after cerebral I/R. Group comparisons for infarct size were made with the t-test, and cytokine levels were analyzed by one-way ANOVA with
post-hoc
comparisons. Our results showed that the concentration of TAK-242 in plasma increased to 52.0 ng/ml 3 hrs after i.p, was maintained at 54.1 ng/ml 8 hrs after i.p., and decreased to 22.6 ng/ml 24 hrs after i.p. The concentration of TAK-242 in brain tissue increased to 26.1 ng/ml (ipsilateral) and 14.2 ng/ml (contralateral) 3 hrs after i.p, was maintained at 26.4 ng/ml (ipsilateral) and 15.1 ng/ml (contralateral) 8 hrs after i.p., and was still maintained at 25.0 ng.ml (ipsilateral) and 17.5 ng/ml (contralateral) 24 hrs after i.p. TAK-242 treatment significantly reduced brain infarct size (12.5%) compared to control mice (21.3%) (p<0.05). Cerebral I/R increased the levels of sTNF RI, sTNF RII, KC, GSCF, IL-6, MCP-1, MIP-1γ, and TIMP-1. TAK-242 treatment significantly reduced the levels of sTNF RII, MCP-1, MIP-1γ, and TIMP-1 (p<0.05). Our data demonstrate that TAK-242 can pass through the blood-brain barrier and that treatment with TAK-242 protects the brain from damage at the acute stage after cerebral I/R by mediating the expression of inflammatory cytokines.
Abstract WP129: The Potential Impact of Maintaining a 3-Hour IV tPA Window
Authors: Lyerly Michael J , Albright Karen C , Boehme Amelia K , Shahripour Reza Bavarsad , Houston James T , Rawal Pawan V , Kapoor Niren , Alvi Muhammad , Sisson April , Alexandrov Anne W , Alexandrov Andrei V
Published: March 2022

Background:
In 2008, the ECASS-3 trial demonstrated that IV-tPA could be safely administered for acute stroke patients presenting between 3 and 4.5 hours from symptom onset. Recently, the FDA rejected expansion of the 3 hour time window. We sought to determine the safety of the ECASS protocol at our center and assess how many fewer patients would be treated by restricting treatment to 3 hours.

Methods:
We reviewed charts from patients who received IV tPA at our comprehensive stroke center and excluded patients who were drip and ship. Patients were divided into two groups (receiving tPA within 3 hours of onset, receiving tPA between 3 and 4.5 hours from onset). Demographics, admission NIHSS and protocol deviations (NINDS and ECASS-3) were collected. Safety was assessed using any hemorrhagic transformation (MRI or CT), symptomatic ICH and systemic hemorrhage.

Results:
Two hundred and twelve patients were identified in our tPA registry between 2009 and 2011, of whom 36 received tPA between 3 and 4.5 hours. No statistical differences were seen between age (p=0.633), gender (p=0.677), race (p=0.207) or admission NIHSS (0.737). Protocol deviations from the ECASS 3 criteria were found in 20 patients (56%). The most common deviations were age > 80 (8/36, 22%) and aggressive blood pressure management (5/20, 25%). Safety outcomes were not different between the two groups (Table).

Conclusions:
Our data are consistent with previously reported international data that IV thrombolysis can safely be used up to 4.5 hours from symptom onset. By expanding the three hour time window, we were able to treat an additional 17% over three years at our stroke center without an increase in adverse outcomes. Physicians should not withhold thrombolytic therapy based solely on a three hour time window as this unnecessarily restricts the population of patients who could potentially benefit from treatment.
Abstract WP14: Where Should We Direct Our Efforts Among A Few In-hospital Steps From ER Arrival To Achieve Faster Recanalization In Acute Ischemic Stroke?
Authors: Mizokami Koji , Mori Takahisa , Iwata Tomonori , Miyazaki Yuichi , Nakazaki Masahito , Takahashi Yoichiro
Published: March 2022

[Back ground and purpose]
Faster recanalization is related to better clinical outcome in acute ischemic stroke. The purpose of our retrospective study is to analyze the time taken in various aspects of in-hospital care from ER arrival to arterial puncture in patients undergoing endovascular therapy and to find which step the longest is.

[Method]
Stroke Center Database was investigated retrospectively and included in our analysis were patients (1) who were admitted to our institution from January 2004 to June 2012, (2) who presented some neurological symptoms, (3) who underwent MRI following CT, which showed acute ischemic stroke caused by major vessel occlusion and no intracerebral hemorrhage, (4) who underwent endovascular therapy including local intra-arterial fibrinolysis, mechanical thrombectomy using balloon, Merci retrieval system and Penumbra system and stenting. We examined the times from ER arrival to arterial puncture (ER-AP), from ER arrival to CT ( ER-CT ), from CT to MRI ( CT-MR ), and from MRI to arterial puncture ( MR-AP).

[Result]
During the study period, 201 patients were included for retrospective analysis. The average ER-AP time was 177 minutes ( 49 - 455 minutes), the average ER-CT, CT-MR and MR-AP times were 29 minutes ( 0 - 197), 58 minutes ( 6 - 300) and 90 minutes ( 10 - 349), respectively. The MR to AP step spent the longest time and the CT to MR step was the second.

[Conclusion]
CT to MR and MR to arterial puncture times show wide variability and the times must be reduced to achieve faster recanalization by endovascular therapy.
Abstract WP15: Dexmedetomidine versus Propofol for Monitored Anesthesia Care (MAC) during Endovascular Therapy for Acute Ischemic Stroke
Authors: JOHN SEBY , SOMAL JASPREET , FARAG EHAB , HUSSAIN MUHAMMAD S , GOMES JOAO
Published: March 2022

INTRODUCTION:
Previous studies have reported that compared to MAC, general anesthesia during intra-arterial therapy (IAT) for acute stroke is associated with worse outcomes. Propofol (PROP) and dexmedetomidine (DXM) are commonly used agents for MAC. While PROP can be associated with significant hemodynamic changes, DXM has been linked to cerebral vasoconstriction and transient decreases in brain oxygenation. We studied if there was a difference in outcomes in patients who underwent IAT for acute anterior circulation ischemic stroke (AAIS) under PROP or DXM MAC.

Methods
A prospectively maintained neuroendovascular database identified all patients who underwent IAT for AAIS under MAC from January 2010 to December 2011. Patient demographics, stroke characteristics, baseline NIHSS and mRS scores, pre and post-treatment stroke volumes on diffusion-weighted imaging (DWI), intra-procedural hemodynamics, discharge/30-day outcomes and mortality were collected. Descriptive statistics, one-way ANOVA and uni/multi-variate analysis were performed.

Results
The study included 52 patients, 30 treated with DXM and 22 with PROP. There were no significant differences in demographics, baseline mRS and NIHSS scores. Occlusion of the ICA terminus was more common in the PROP group and M1 segment occlusions in DXM. Revascularization was achieved in 86% of patients in the DXM group compared to 81% in PROP. Mean maximum Mean Arterial Pressure (MAP) was 133 and 139 mm Hg in DXM and PROP groups respectively. There were more hypotensive episodes in the DXM group and use of pressors was also significantly higher (80% vs 20%). There were no significant differences in DWI infarct growth (mean volume DXM 56cc, PROP 62cc). Functional outcomes and mortality were similar (30% mortality in DXM, 32% in PROP).

Conclusion
This is the first study comparing outcomes after IAT under MAC for AAIS using different agents. Although counterintuitive, our data suggests that DXM was associated with more hemodynamic changes than PROP. No differences in clinical or radiographic outcomes were found. This finding along with known cerebral vascoconstrictive effects of DXM should prompt cautious use of DXM in IAT. Larger prospective studies are warranted to confirm our observation.
Abstract WP150: Restenosis after Carotid Endarterectomy
Authors: Kobayashi Norikata , Takasaki Morio , Ito Kaname , Maruyama Daisuke , Ishii Daizo , Morita Kenichi , Satow Tetsu , Kataoka Hiroharu , Iihara Koji
Published: March 2022

Background & Purpose:
Restenosis after carotid endarterectomy (CEA) has been reported to be associated with ischemic stroke. The aim of the study was to evaluate the factors associated with re-stenosis after CEA.

Methods:
Two-hundred and twelve CEAs were performed in 203 patients from January 2007 to March 2011 in our institution. In this cohort (n=202 CEAs, 194 pts), We included patients who had undergone serial imaging studies(CT angiogram (n=181) and/or ultrasonography (n=189)) postoperatively. Restenosis was defined as >50% stenosis on a CT angiogram and a >200 cm/sec Peak Systolic Velocity (PSV) on ultrasonography at the treated site. The factors associated with restenosis were analyzed retrospectively.

Results:
Overall, restenosis occurred in 14 cases (7.1%) and its incidence was not significantly different between symptomatic and asymptomatic groups (4.6% versus 10.2%, respectively, P=0.13). There was no restenosis in the cases involving operation with a patch graft (n=9) and who took cilostazol perioperatively (n=26), but there was no significant difference(P=0.4,P=0.16, respectively). Pathological examination showed a significantly lower incidence of restenosis with a rich lipid core (P=0.004) and significantly higher incidence with calcification (P=0.001). In the symptomatic group, no restenosis occured in cases operated within 14 days after the most recent symptom, but without significance (P=0.37).

Conclusion:
We showed that the restenosis rate was significant depending on the nature of carotid plaques. Restenosis was associated with unstable plaques. In symptomatic groups, restenosis occurred in relation to delayed surgery, suggesting a possible relation between carotid plaque stabilization and the development of restenosis after CEA.
Abstract WP153: Effects Of Clot Maturation And Intravascular Ultrasound Characteristics On Effectiveness Of Aspiration Thrombectomy
Authors: Watanabe Masaki , Majidi Shahram , Todo Akira , Chaudhry Saqib A , Adil Malik M , Alqadri Syeda L , Qureshi Adnan I
Published: March 2022

Background and Purpose:
We examined the relationship between clot maturation and associated echogenicity obtained by intravascular ultrasound (IVUS) on time required to aspirate clots by aspiration thrombectomy device (Penumbra system) in vitro settings.

Methods:
Clots were formed by 3ml citrate-anticoagulated human venous blood was initiated by recalcification with CaCl2 86 μl/3ml and 5U/ml of thrombin. The clots were matured in saline at room temperature at different time period (2h, 6h, 24h, 48h, 72h) and 10mm of clots in length were transferred into silicone vessels 3mm in diameter with saline. Subsequently, Penumbra perfusion catheter was used proximal to the clot after acquiring the ultrasound image by IVUS. The time to remove clots was defined by the time interval between initiating aspiration and the time when all the clots were aspirated. Analysis of echogenicity on images acquired by IVUS was performed with the image analysis software using the histogram function. The gray scale median (GSM) measurement scale was referenced to GSM values of saline and silicone vessel.

Results:
A total 50 clots were studied. The time to remove clots increased with increasing clot maturation with longest time recorded at 48 hours (2h: 1.83±0.62, 6h: 2.13±0.54, 24h: 3.43±2.19, 48h: 4.27±2.19, 72h: 1.95±0.28 sec, ANOVA p=0.001). In IVUS study, a total of 50 clots were studied. GSM values increased significantly with increasing clot maturation (2h: 34.5±4.8, 6h: 37.4±6.0, 24h: 35.3±5.2, 48h: 40.6±5.3, 72h: 27.8±8.8, ANOVA p=0.0007). The highest GSM value was observed in 48 hours (p=0.0144,) and the lowest in 72 hours (p=0.0476, t- test, compared to GSM after 2h). Time to remove clot significantly correlated with higher GSM values (echogenicity) as determined by IVUS (Linear Regression, R2=0.13, p=0.0091).

Conclusion:
The effectiveness of aspiration thrombectomy depends upon the stage of clot maturation. The echogenicity of the clots determined by IVUS can identify the stage of maturation and subsequent response to apiration thrombectomy.
Abstract WP156: Moyamoya Syndrome - Comparison of Long Term Outcome of Conservative and Surgical treatment in India.
Authors: Sylaja PN , Sundaram Soumya , Menon Girish , ER Jayadevan , Sukumaran Sajith , Sreedharan Sapna
Published: March 2022

Background:
Revascularization surgery (RS) is the therapy of choice in Moyamoya disease (MMD). Due to rarity of disease and ethical concerns, randomized controlled trials about the treatment options are lacking. Very little information is available on the outcome of conservatively treated moyamoya patients.

Aim:
We compared the long term outcome of moyamoya patients treated conservatively to those who underwent RS.

Methods:
Our study population included all patients with moyamoya from 2002-2012. The demographic and clinical characteristics were obtained by retrospective chart review. The imaging details were reviewed. The follow-up information and outcome were obtained prospectively.

Results:
Of the 36 patients, 26( 72.2%) had MMD and 10 ( 27.8 %) had moyamoya syndrome. Of the patients with moyamoya syndrome, 6 had a well recognized risk factors( 2-Downs syndrome,1-Neurofibromatosis,2- atherosclerosis,1-vasculitis) and 4 had unilateral disease. The median age at onset of symptoms was 17.5years (range,10 months- 55 years). Fifteen patients belonged to pediatric group and 21 were adults. All the paediatric patients had ischemic events at onset and 10 (47.6 %) of the adults presented with haemorrhage. Twenty (55.6%) patients received conservative treatment and 16(44.4 %) underwent revascularization procedures. The median duration of follow-up was 28 months (range,3-90 months). Two of the surgically treated patients had recurrent ischemic events on follow up, but none of the conservatively treated patients had events. An excellent outcome (Modified rankin scale of ≤ 2) was seen in 12 (75%) of surgically treated patients and all of the conservatively treated patients. Of the 4 patients in the surgically treated group with poor outcome, one was due to recurrent stroke ,one due to postoperative stroke and 2 had severe stroke at onset.

Conclusion:
Compared to East Asians, our patients had a lower stroke recurrence rate and better functional outcome even with conservative treatement. The impact of RS in modifying the patients clinical course in Indian patients is difficult to evaluate. Future studies should focus on clinical and imaging predictors of progression to select moyamoya patients for RS.
Abstract WP181: Impact Of The Great East Japan Earthquake On Stroke Incidence Among Survivors In Sanriku Coastal Area.
Authors: Terayama Yasuo , Ogawa Akira , Sasaki Kazuhiro
Published: March 2022

Objective:
To examine the effects of tsunami-related lifestyle resulting from the Great East Japan Earthquake on stroke incidence among survivors in Pacific coastal area of Japan.

Design:
A retrospective study.

Setting:
Iwate Medical University, Japan.

Participants:
4120 Japanese, living in the coastal area who survived from the tsunami disaster. They are living in temporary shelters in 3 major districts of the Sanriku coastal area (Town of Yamada, Otsuchi and Takada). Their clinical data including blood pressure (BP), body mass index (BMI) were examined and compared with those before the tsunami disaster which were examined 12 months before the disaster.

Changes of BP and BMI representing tsunami-related lifestyle were analyzed and compared before and after the disaster and correlated with stroke incidence of these 3 areas.

Primary outcome measure:
Number of stroke patients.

Secondary outcome measures:
Changes of BP, BMI (body mass index).

Results:
Levels of BMI before the disaster (23.3kg/m
2
) continued to increase after 24 months (25.8kg/m
2
) among survivors in Takada area indicating poor living conditions compared to other areas (p<0.05).

Systolic BP (SBP) after 24 months among survivors in Takada area were also higher (158.2+22.4mmHg) compared to that before the disaster (133.4+34.5mmHg) while they were taking anti-hypertensive medications (p<0.05). Stroke incidence among people with increased BMI was abruptly increased from 2.3 to 5.7 patients/month before and after the disaster (p<0.05).

Conclusions:
Prolonged poor health including increased BP and BMI may contribute to the abrupt increase of stroke incidence 1 year after tsunami disaster.
Abstract WP182: Relationship Between Carotid Intima-Media Thickness and Periodontal Disease in an Urban Japanese Population: The Suita Study
Authors: Kida Momoyo , Kokubo Yoshihiro , Ono Takahiro , Yoshimuta Yoko , Takemura Kayoko , Kosaka Takayuki , Maeda Yoshinobu , Miyamoto Yoshihiro
Published: March 2022

Background and Purpose:
The association between periodontal disease and carotid intima-medial thickness (IMT) has been controversial. There are few population-based studies on the association. We assessed the hypothesis that periodontal disease was a risk factor for carotid atherosclerosis in a general urban Japanese population.

Research design and methods:
We studied 1,484 Japanese individuals (mean age 66.9 years) who underwent medical check-up, dental examinations, and carotid ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulb, and internal and external carotid arteries. Mean IMT was defined as the mean of the proximal and distal walls IMT for both sides of the CCA at a point 10 mm proximal to the beginning of each bulb. Subjects were divided into two groups: plaque (-) (maximum IMT less than 1.1 mm, n=235) and plaque (+) groups (maximum IMT equal or more than 1.1 mm, n=1249). Periodontal status was examined by Community Periodontal Index (CPI, code 0-4) by which subjects with CPI code equal or more than 3 (periodontal pocket [PP] group, n=758) and those with CPI code 4 (severe periodontitis [SP] group, n=244). We examined the relationship between plaque (+/-) and periodontal status by using age- and sex-adjusted chi-square test. Logistic regression model was used to analysis of mean and maximum IMT according to the periodontal status adjusted by cardiovascular risk factors.

Results:
Plaque (+) group tended to have periodontal pocket in both men and women (odd ratio [OR] =1.84, P<0.000). Women with plaque (+) tended to have periodontal pocket (OR=1.19, P=0.001) and severe periodontitis (OR=3.14, P=0.002). Mean IMT was significantly higher in both PP and SP groups (adjusted mean IMT= 0.82 mm (CPI code 0-2) and 0.847 mm (PP group), P=0.001; adjusted mean IMT=0.815 mm (CPI code 0-3) and 0.834 mm (SP group), P=0.002).

Conclusions:
In our population based study, periodontitis may be a risk factor for carotid atherosclerosis, especially in women.
Abstract WP184: Prediction of All-cause and Stroke Mortality by Carotid Intima-Media Thickness in Japanese Urban Cohort: The Suita Study
Authors: Kokubo Yoshihiro , Watanabe Makoto , Toyoda Kazunori , Miyamoto Yoshihiro
Published: March 2022

INTRODUCTION:
Carotid intima-media thickness (IMT) has been increasingly a subclinical marker for cardiovascular disease (CVD). However, few studies have examined the association between IMT and mortality. We assessed the hypothesis that carotid IMT was a predictor for mortality in a general urban Japanese population.

Methods:
We studied 5,605 Japanese individuals (mean age 60.1 years, without CVD) who completed a baseline survey and carotid atherosclerosis in the Suita Study, and were then followed for 11.7 years on average. Carotid IMT was evaluated by high-resolution ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulb, and internal and external carotid arteries. Mean IMT was defined as the mean of the IMT of the proximal and distal walls for both sides of the CCA at a point 10 mm proximal to the beginning of the dilation of each carotid artery bulb. Max-IMT was defined as the maximum IMT in the entire scanned area. The risks of all-cause mortality across carotid IMT were compared by the use of adjusted Cox proportional-hazards models.

Results:
In 65,897 person-years of follow-up, we documented 829 all-cause mortality (including 59 strokes, 92 ischemic heart diseases [IHD], and 370 cancers). The adjusted hazard ratios (HRs; 95% confidence intervals, 95% CIs) in the 3rd and 4th quartiles (0.85-0.925 mm and >0.925 mm) of the mean IMT for all-cause mortality were 1.63 (1.02-2.62) and 1.66 (1.03-2.68), respectively, and that in the 4th quartile for CVD mortality was 1.41 (1.01-1.98), compared with the 1st quartile (<0.75 mm). The HR (95% CIs) in the 4th quartile (>1.70 mm) of Max-IMT for all-cause mortality was 1.41 (1.01-1.98) compared with the 1st quartile (<1.0 mm). The adjusted HRs (95% CIs) for all-cause mortality were 2.06 (1.19-3.56) with 0.1 mm increases in mean IMT, and 1.27 (1.16-1.39) in men and 1.27 (1.09-1.47) in women with 0.1 mm increases in Max-IMT. Those for stroke, cerebral infarction, IHD, and cancer mortalities were 1.38 (1.05-1.80), 1.69 (1.18-2.43), 1.49 (1.20-1.86), 1.31 (1.17-1.46) with 0.1 mm increases in Max-IMT, respectively.

Conclusions:
Carotid IMT, especially Max-IMT is a strong predictor for all-cause, stroke, cerebral infarction, and IHD mortalities in general population.
Abstract WP187: Correlation between Infarct Shape and Volume and Ischemic Risk Factors and Recurrent Ischemic Rates in Small Subcortical Stroke; Data from the SPS3 Randomized Controlled Trial
Authors: Asdaghi Negar , Pearce Lesley , Nakajima Makoto , Bazan Carlos , Cermeno Franco , Lewis Brandy , Hart Robert G , Benavente Oscar
Published: March 2022

Background:
Most of lacunar infarcts (LI) are due to penetrating small vessel disease, although other mechanisms can be responsible for LI. We sought to determine the relationship between the size and shape of LI and underlying risk factors and recurrent ischemic stroke rates.

Methods:
872 images from the 3020 patients enrolled in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial were included in this analysis. SPS3 is a multi-center randomized trial of MRI proven lacunar stroke patients. Participants with confirmation of their index event by DWI were reviewed. Infarct volume was measured planimetrically, and shape was classified as ovoid/spheroid, slab, stick, or multi-component based on visual analysis after 3D reconstruction of axial MRI slices using OsiriX software.

Results:
Infarct shape was ovoid/spheroid in 67%, slab in 10%, stick in 6%, and multi-component in 17% of patients. Median infarct volumes differed by shape with the smallest LI volumes observed in ovoid/spheroid: 0.52, 0.76, 0.62, and 0.93 respectively, p < 0.001. Patients with ovoid/spheroid LI were of similar age (means 61 vs. 62 yr, p = 0.4), sex (57 vs 60%, p=0.5), and hypertension status (81% vs. 80%, p = 0.7), but more likely to be diabetic (43% vs. 32%, p = 0.003) and have IHD (17% vs. 10%, p =0.02) vs. those with other shapes combined. Prevalence of relevant intracranial large vessel occlusion on vascular imaging was 7% in the ovoid/spheroid S3 group and 9% in others (p = 0.5). The 6-year re-current stroke rate was 16.1% with 91 strokes occurring. There was no difference in reinfarction rate based on shape or volume.

Conclusion:
Lacunar strokes comprise a heterogeneous group of cerebral infarction likely secondary to variable etiologies. In this preliminary analysis infarct shape was correlated with risk factors but not with stroke infarct. Final analysis will be presented and likely the ongoing SPS3 data analyses will elucidate these differences.
Abstract WP19: Safety and Validity of mechanical Thrombectomy and Thrombolysis on Severe Cerebral Venous Sinus Thrombosis
Authors: Li Sijie , Meng Ran , Ji Xunming
Published: March 2022

BACKGROUND:
Although the vast majority of patients suffering from cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, nevertheless, there remains a subgroup of patients that do not respond to the conventional anticoagulation treatment. These patients, especially the younger people as documented by hospital based studies, have a high morbidity and mortality rate. While the wide spectrum of clinical presentation in most CVST patients makes the diagnosis difficult at an earlier time, endovascular thrombolysis offers an aggressive option to treat CVST.

OBJECTIVE:
To verify the safety and validity of mechanical thrombectomy combined with thrombolysis in patients with severe CVST.

METHODS:
A total of 52 patients diagnosed with CVST from January 2007 to December 2010 were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 ~1500×10
3
IU intravenous sinus injection via a jugular catheter after confirming CVST diagnoses by magnetic resonance imaging (MRI)/magnetic resonance venography (MRV) or digital subtraction angiography (DSA). Information obtained on the patients included recanalization status of venous sinuses as evaluated by MRV or DSA, at admission, during operation and 3 and 6 months follow-up after treatment.

RESULTS:
The percent of patients that showed complete and partial recanalization were 86% and 6% respectively after the mechanical thrombectomy combined with thrombolysis treatment, while 8% of the patients showed no recanilization. The modified Rankin Scale (mRS) scores were 1.0±0.9, 0.85±0.63 and 0.37±0.53 at discharge and at 3 and 6 months follow-up respectively. A total of 6 patients died despite receiving aggressive treatment. No relapsed cases were seen after 3 to 6 months of follow-up.

CONCLUSION:
Thrombectomy combined with thrombolysis is safe and valid to use in severe cases of CVST. However, a large scale multicenter clinical trial is warranted.
Abstract WP194: Impact Of Total Energy Intake On Stroke Mortality Is Greater Than That Of Coronary Heart Disease: A 24-year Follow-up Of Representative Japanese (NIPPON DATA80), 1980-2004
Authors: Nagai Masato , Fujiyoshi Akira , Ohkubo Takayoshi , Miura Katsuyuki , Okuda Nagako , Hayakawa Takehito , Yoshita Katsushi , Arai Yusuke , Nakagawa Hideaki , Nakamura Koshi , Miyagawa Naoko , Takashima Naoyuki , Kadota Aya , Murakami Yoshitaka , Okamura Tomonori , Okayama Akira , Ueshima Hirotsugu ,   NIPPON DATA80 Rsch Group
Published: March 2022

INTRODUCTION:
Previous studies showed that calorie restriction decreased blood pressure and plasma lipid, and increased longevity. However, impact of total energy intake (EI) on mortality from cardiovascular disease (CVD) including types of CVD has not been studied. We assessed the hypothesis that lower EI was associated with decreased risk of CVD, coronary heart disease (CHD), and stroke mortality.

Methods:
We studied the association between EI and mortality form all CVD, CHD, and stroke using the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged (NIPPON DATA80) database with a 24-year follow-up. We followed a random sample of 8,825 Japanese aged ≥30 years (mean age, 50.0 years at baseline in 1980; 43.3% men) without history of CVD, kidney disease, or diabetes. Those with lack of information about EI or extreme EI (sex-specific intake of highest or lowest 0.5%) were also excluded. EI was calculated from a 3 days weighed food record method. We classified the participants into sex-specific quintiles of EI (the lowest quintile: men<2,025.1 kcal/day, women<1,627.0 kcal/day, the highest quintile: men≥2,776.8 kcal/day, women≥2,219.7 kcal/day). We used Cox proportional-hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for sex, age, body mass index, smoking, drinking, systolic blood pressure, blood glucose, and total cholesterol.

Results:
Multivariate HR in the lowest quintile (in reference to the highest quintile) from all CVD was significantly decreased (HR: 0.78, 95%CI: 0.62-0.98). The association was more remarkable for stroke mortality (HR: 0.67, 95%CI: 0.48-0.93) than for CHD mortality (HR: 0.82, 95%CI: 0.49-1.37). After further adjustment of multivariate HRs for sodium/potassium ratio, we observed similar results.

Conclusion:
A 24-year follow-up of NIPPON DATA80 demonstrated that lower EI was associated with decreased risk of CVD mortality: the association was more remarkable for stroke mortality than for CHD mortality.
Abstract WP195: ICD9 Ischemic Stroke Code Validity Biased By Demographics
Authors: Alwell Kathleen , Khoury Jane , Moomaw Charles J , Kleindorfer Dawn O , Eilerman Jane , Woo Daniel , Flaherty Matthew , Ferioli Simona , Adeoye Opeolu , Khatri Pooja , Kissela Brett
Published: March 2022

Background:
Collecting and reporting stroke incidence is a time intensive and costly endeavor, so many researchers prefer to utilize administrative databases to ascertain rates and trends. Incidence rates of stroke and TIAs reported in the literature varies based on differing methodologies and populations used for estimation. We sought to examine the demographic differences between the validated cases and non-cases of ischemic stroke (IS) in a population-based study.

Methods:
The Greater Cincinnati/ N. Kentucky Stroke Study, a population-based epidemiologic study, collected data on all potential stroke and TIA cases among residents of a 5-county region in 2005. All medical records with discharge ICD-9 codes 430 through 436 were reviewed by study nurses, and those classified as potential cases were reviewed by stroke team physicians, who determined which events were actual verified cases and classified them by stroke subtype. We specifically examined 433.x1 and 434.x1 which are the ICD-9 codes most commonly assigned for ischemic stroke.

Results:
Of the original 2335 individual medical records assigned ICD9 codes 433.x1 and 434.x1, 80% were verified as ischemic strokes. Of the 2206 verified IS cases in adults (≥18 years old) in 2005, 1873 (85%) had an ICD9 discharge code of 433.x1 or 434.x1. Potential strokes found to be non-cases were more likely to be patients who were older or living in a nursing home (Table).

Conclusions:
Ischemic stroke incidence rates that are based solely on subtype-defined ICD9 codes from administrative databases are likely to be biased with respect to population demographic and thus may not accurately reflect the population incidence. Meaningful population-based epidemiology requires both ICD9 codes and medical record review to ensure accurate incidence reporting.
Abstract WP204: Paradoxical Increase in Stroke Mortality Among Asian Indians in United States
Authors: Adil Malik M , Khan Shayaan M , Khan Mahnoor , Rahim Basit , Qureshi Adnan I
Published: March 2022

Background and Purpose:
Asian Indians are one of the largest groups of Asians living in the United States. Due to a paucity of data, we performed this study to better characterize the stroke mortality and risk factors among Asian Indians in the United States.

Methods:
Analysis of the U.S. multiple-cause-of-death files for 2004 to 2009 and National Health and Interview Survey (2004-2005 and 2009-2010) were analyzed. Age-adjusted fatal stroke incidence, stroke rate ratio with 95% confidence interval (CI), and average annual percentage change over 5 years were also calculated.

Results:
The annual incidence of fatal strokes was lowest among Asian Indians (194 per 100,000) followed by American Indians and Alaska Natives (207 per 100,000), Whites (282 per 100,000) and African Americans (362 per 100,000). Compared with Whites, the stroke rate ratio was 0.7(95% CI 0.5-0.8) for Asian Indians. Significantly lower rates of hypertension and cigarette smoking among Asian Indians in 2004-2005 (compared with whites) explained the lower rates of fatal stroke. The average annual percentage change over 5 years was 12.2%, -0.6%, -2.6%, and -2.6% Asian Indians, American Indians and Alaska Natives, Whites, and African Americans, respectively. The increase in stroke mortality among Asian Indians was observed despite lower rates of hypertension and cigarette smoking in 2009-2010.

Conclusions:
The paradoxical increase in stroke mortality among Asian Indians over the last 5 years (in contrast to other population subsets) is concerning. A better understanding of the predisposing factors for the observed increase is required through targeted efforts.
Abstract WP21: Safety And Feasibility Of Repeated Thrombolytic Therapy In Patients With Acute Ischemic Stroke
Authors: Yoo Han Soo , Song Tae Jin , Song Dongbeom , Kim Young Dae , Lee Hye Sun , Heo Ji Hoe , Nam Hyo Suk
Published: March 2022

Background:
Several studies reported that repeated thrombolysis in patients with myocardial infarction or pulmonary embolism is safe. There are scant reports about repeated thrombolysis in patients with acute stroke. Recently, mechanical thrombectomy showed promising results in recanalization of occluded cerebral artery. However, no studies so far have evaluated the safety and feasibility of repeated thrombolytic therapy in the era of multimodal thrombolytic treatments.

Methods:
We investigated the patients with acute ischemic stroke who received thrombolytic therapy from Yonsei Stroke Registry for 10 years. The patients were divided into the repeated thrombolytic therapy group and the group who received thrombolysis once. Using propensity score to adjust for basic demographic, clinical, and treatment characteristics, we analyzed the rates of recanalization (Thrombolysis in Cerebral Infarction >=2), good outcome (modified Rankin Scale 0-2), and symptomatic intracranial hemorrhage.

Results:
Of the 437 patients who received thrombolytic treatments (IV in 41.4%, intra-arterial in 19.7%, and multimodal treatments in 38.9%), repeated thrombolysis was undergone in 7 patients (1.6%). Median age of repeated thrombolytic therapy group was 67.5 years old (range 50 to 78) and three of them were males. The median time interval between first and repeated treatment was 1.3 years (range 6 days to 6 years). Median NIHSS score was 15 (IQR 10-20). Six patients (85.7%) of 7 repeated treatment group had atrial fibrillation. After propensity matching there was no significant difference between repeated thrombolytic treatment and single treatment groups in the recanalization rates (100% vs. 85.7%, p = 0.28), and good outcome at 3 months (71.43% vs. 57.14%, p = 0.655). No symptomatic intracranial hemorrhage was occurred in the repeated thrombolytic treatment group.

Conclusion:
Repeated thrombolysis for chronologically separate acute ischemic stroke was rarely performed by the stroke team. Our data showed that repeated thrombolysis was safe and feasible.
Abstract WP210: Prothrombin G20210A Mutation and Ischemic Stroke Risk in European Ancestry: The Genetics of Early Onset Stroke Study and Meta-Analysis of 2304 Young-Onset Stroke Cases
Authors: Jiang Baijia , Hamedani Ali , Cheng Yuching , Koontz Deborah , Bean Christopher J , Gallagher Margaret , Hooper W C , Sparks Mary J , McArdle Patrick , O’Connell Jeffrey R , Stine O C , Wozniak Marcella A , Stern Barney J , Mitchell Braxton D , Kittner Steven J , Cole John W
Published: March 2022

Background:
Although the prothrombin G20210A mutation has been implicated in increased risk for venous thrombosis, its role in arterial ischemic stroke is unclear, particularly among young adults. To address this issue, we examined the association between prothrombin G20210A and ischemic stroke in Caucasian participants of the Genetics of Early Onset Stroke (GEOS) Study (n=396 cases) and also performed a meta-analysis of 17 case-control studies (n=2304 cases) examining the effect of prothrombin G20210A on ischemic stroke risk in young adults (<55 years).

Methods:
A population-based case-control study identified 396 cases of women and men 15 to 49 years of age of European ancestry with first-ever ischemic stroke and 426 matched controls. Logistic regression was used to calculate odds ratios for the entire population and for subgroups stratified by gender, oral contraceptive use, smoking status, and age category.

Results:
In the GEOS study, the prothrombin G20210A mutation was associated with a large but non-significant increase in ischemic stroke risk (OR=2.4, 95% CI: 0.9-6.5, p=0.08). However, among adults aged 15-42 (younger than the median age), cases were significantly more likely to have the prothrombin mutation than controls (OR=5.9, 95% CI: 1.1-28.5, p=0.03), whereas adults ages 42-49 were not (OR 1.1, 95% CI 0.3-4.4, p=0.94). In the meta-analysis of prior studies, the prothrombin G20210A mutation was significantly associated with stroke risk (OR 1.4, 95% CI: 1.1-1.9, p=0.02) with these results increasing in precision with addition of the GEOS results (OR=1.5, 95% CI: 1.1-2.0, p=0.005).

Conclusion:
The prothrombin mutation is associated with ischemic stroke in young adults. The GEOS data suggests that, within the young adult age range, the prothrombin G20210A mutation may have an even stronger association among those with the earliest onset strokes. The finding of a stronger association in the ‘younger’ young adult population requires replication in other studies.
Abstract WP224: Etiology of Lesions with Restricted Diffusion in the Corpus Callosum
Authors: Wilson Christina A , Mullen Michael T , Messé Steven R
Published: March 2022

Background:
Infarction of the corpus callosum (CC) is a rare event that has been poorly described in the literature. Multiple non-vascular lesions may also cause restricted diffusion in the CC on MRI, leading to diagnostic uncertainty. We sought to identify the etiology of lesions with diffusion restriction in the CC, hypothesizing they were often due to a non-vascular etiology and, in cases of infarct, that the mechanism of stroke would often be atypical.

Methods:
CC lesions with diffusion restriction on MRI were identified in the radiology database at our institution over a 10 year period using the search terms “callosum,” “diffusion,” and “restricted/restriction”. Known trauma, brain tumor, and/or post-surgical cases were excluded. Radiographic and clinical features were independently reviewed by two investigators to determine the etiology of the lesion and the underlying mechanism. Vascular and non-vascular cases were compared.

Results:
One hundred and twenty one cases were reviewed. Of these, 67% were stroke and 33% were non-vascular. Lesions were present in the genu in 26%, body in 30%, and splenium in 63% of cases; 17% had lesions in multiple territories and 5% in all territories. Additional lesions with restricted diffusion were found outside of the CC in 80% of cases. Atypical mechanisms of stroke such as vasculitis or hypercoaguable state were most common (37% of stroke cases), followed by cardioembolic (28%), cryptogenic (22%), large vessel (7%), and multiple causes (5%). The most common non-vascular etiology was demyelination (35%). Patients with a non-vascular lesion were younger, (46 years vs 56 years, p=0.0036), more often had lesions in multiple CC segments, 25% vs 12% (p=0.078), less often had additional lesions outside the CC (68% vs 86%, p=0.014) and were less likely to have vascular risk factors including hypertension (24% vs 76%, p=0.02), diabetes (19% vs 81%, p=0.06), and atrial fibrillation (7% vs 93%, p=0.03).

Conclusions:
Diffusion restriction in the CC is due to a non-vascular cause in one third of cases. In cases of stroke, atypical etiologies are common. Clinical and imaging characteristics can help distinguish stroke from non-vascular lesions in the CC.
Abstract WP233: Prehospital Stroke Screen Accuracy in a State with an Emergency Medical Services Protocol for Routing Patients to Acute Stroke Centers
Authors: Asimos Andrew , Bogenschneider Shana , Humphrey Angela D , Brice Jane H , Rosamond Wayne D , Goldstein Larry B , Studnek Jonathan R
Published: March 2022

Background:
A growing number of states are enacting legislation or regulations that direct emergency medical service (EMS) routing to state designated or Joint Commission Certified Stroke Centers, based on prehospital stroke screens performed by EMS providers.

Objective:
Assess the sensitivity and specificity of the Cincinnati Prehospital Stroke Screen (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) when performed by EMS providers in the context of a state-wide EMS stroke patient transport protocol.

Methods:
We used a validated method of deterministic matching to link a statewide Prehospital Medical Information System database, that includes prehospital stroke screen results, to a Statewide Emergency Department (ED) Surveillance System database containing ED disposition diagnosis ICD-9 codes. We compared EMS stroke screen results to the ED ICD-9 codes for ischemic and hemorrhagic stroke and TIA.

Results:
Over a 24 month period, we identified 3,901 linked records with a prehospital impression of acute stroke. This included 2,419 (62%) records with a completed and conclusive stroke screen result. There were 1,202 patients (50%) with a completed CPSS and 1,217 patients (50%) with a completed LAPSS. Ninety-four EMS agencies from 65 of the state’s 100 counties were represented in the complete data. The CPSS was 80% (95% CI 76-83%) sensitive and 46% (95% CI 42-50%) specific, whereas the LAPSS was 73% (95% CI 69-76%) sensitive and 42% (95% CI 38-46%) specific for identifying patients with an ED diagnosis of stroke or TIA.

Conclusion:
When performed and conclusively recorded by many different EMS agencies across one state, the CPSS and LAPSS had similar test characteristics. If prehospital screening is to be used to determine transport diversion to acute stroke centers, improving the specificity of these screens would be optimum.
Abstract WP234: Timeliness of Thrombolytic Therapy Using Telemedicine
Authors: Ali Latisha K , Tran Victor H , Starkman Sidney , Kim Doojin , DaSilva Leonard , Kalanithi Suman , Samuels Todd , Saver Jeffrey L ,   Specialists on Call Physician Panel
Published: March 2022

Background:
Ischemic stroke guidelines recommend an arrival to treatment initiation time of ≤60 minutes. Recent national data suggest that fewer than one-third of patients treated with intravenous thrombolysis (tPA) had door-to-needle times (DTNT) ≤60 minutes. Telemedicine is a potential timesaving, efficient means for evaluating patients experiencing acute stroke. We evaluated our DTNT for our California telestroke network to determine if early access to a stroke neurologist improved the DTNT.

Methods:
We reviewed data on acute ischemic stroke patients treated with tPA within 3 hours of symptom onset for 18 California hospitals as part of the Specialists on Call (SOC) telemedicine network, a national, Joint Commission certified telehealth provider. Data from 2010-2012 were studied to determine the frequency and characteristics of patients treated with DTNT ≤60 minutes.

Results:
Among the 112 patients treated with tpa, 54% of patients were female, average age 70, median NIHSS 10 (interquartile range 5-18). DTNT was ≤60 minutes in 27.7% of patients evaluated. 10.1% of patients were treated in ≤70 minutes and 22.3% in ≤90 minutes. Consultants responded to consult request in <15 minutes but there was often a long delay between arrival and consult request. Mean door to consultation request time was 76 minutes. Mean time from consult start to tPA recommendation was 35 minutes. The proportion of patients with DTNT ≤60 minutes varied widely by hospital but there was a trend to faster DTNT in the 5 hospitals designated as Joint Commission certified Primary Stroke Centers.

Conclusions:
Telemedicine enables patients to be treated within time windows similar to that of national clinical practice with in-person response at facilities without access to a stroke neurologist. Shortening the door to consultation request time may help improve our DTNT. Our data correlate with national data in that less than one-third of patients treated with intravenous tPA had DTNT≤60 minutes. Telemedicine should be included as part of national stroke target timelines for in-person delivered therapy. These findings further support the need for a targeted initiative to improve the timeliness of reperfusion in acute ischemic stroke.
Abstract WP235: Improved Paramedic Identification of Stroke: Utility of the Izumo Prehospital Apoplexy Scale and Prehospital Stroke Registry
Authors: Mitaki Shingo , Bokura Hirokazu , Yamaguchi Shuhei , Kobayashi Shotai
Published: March 2022

Background and Purpose
In Japan, rt-PA has been approved for use since 2005 for treating acute ischemic stroke within 3 hr of onset. Since emergency medical service (EMS) is often the first medical contact for stroke patients, EMS is an important step in stroke recovery. Recently, we developed the Izumo Prehospital Apoplexy Scale (IPAS) and started the prehospital stroke registry, including IPAS scores and information on diagnosis, therapy, and prognosis. We share this registry with EMS and exchange the data electronically; this helps providing regular feedback to EMS on accurate diagnosis, treatment, and prognosis of patients. The purpose of this study is to determine the effects of our feedback system on stroke care.

Methods
We retrospectively reviewed the prehospital stroke registry to identify all patients evaluated using the IPAS and transported by EMS to our hospital between January 2010 and June 2011. We divided the patients into 2 groups: those evaluated between January 2010 and September 2010 (first period) and between October 2010 and June 2011 (second period). Sensitivity, specificity, and positive and negative predictive values of IPAS were determined. To assess the utility of IPAS on shortening of the duration from stroke onset to hospital arrival, we performed two comparisons; first, the comparison before and after IPAS introduction, second, the comparison between first and second period after IPAS introduction.

Results
During the study period, 220 patients evaluated with IPAS were transported to our hospital. The sensitivity (0.86 versus 0.95,
p = 0.03
) and positive predict value (0.65 versus 0.78,
p = 0.02
) of the paramedic’s stroke/TIA identification significantly improved in the second period than in the first period. The duration from onset to arrival at the emergency department was significantly shorter in the second period (2.2 h versus 1.9 h,
p = 0.04
). Moreover, the duration was significantly shorter with IPAS use than without (3.8 h versus 2.2 h,
p = 0.005
).

Conclusions
Sharing the prehospital stroke registry with EMS resulted in a 9% increase in sensitivity for identifying stroke patients in the prehospital setting. Moreover, feedback system contributed to shortening the duration from stroke onset to arrival at the emergency department.