bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP82: Estimated Glomerular Filtration Rate Decreases Transiently After Stroke in Patients With Atrial Fibrillation
Authors: Riaz Parnian , Phoa Keith , Kate Mahesh P , Gioia Laura C , Jeerakathil Thomas , Shuaib Ashfaq , Buck Brian , Butcher Kenneth
Published: March 2022

Introduction:
Oral anticoagulants (OACs) are often initiated in hospital after cardioembolic stroke. The agent and dose are both dependent on renal function. The optimal assessment of renal function in the early post-stroke period is unknown. We tested the hypotheses that 1) renal function is impaired early after stroke and 2) weight-based estimates of glomerular filtration rate (eGFR) are more sensitive to this acute change.

Methods:
We retrospectively recorded all serum creatinine measurements within 1 week of stroke in patients with atrial fibrillation (AF). Measurements were also taken in the year post-stroke. The Cockroft-Gault (CG), Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were used to calculated eGFR. Renal function was classified as normal (eGFR>50 ml/min), moderately (eGFR<50 ml/min), or severely impaired (eGFR<30 ml/min).

Results:
Measurements were recorded from 300 acute stroke patients over a 1 year period. Median time from symptom onset to first creatinine measurement was 5.2±14.2 h. Within 24 h of symptom onset, 66/300 (22%) and 72/300 (24%) patients had renal impairment (eGFR<50 ml/min/1.73m
2
) using the MDRD and CKD-EPI equations. The proportion of renal impairment increased to 37.4% (102/273, p<0.0001), when a weight-based calculation (CG) was used. Mean eGFR (CG) within 24 h of symptom onset (65.1±33.5 ml/min) was lower than that by day 7 (68.7±33.3 ml/min, p=0.001). The acute baseline renal impairment improved into normal range in 14/68 (20.6%, p<0.0001) patients within 7 days. Mean eGFR (64.7± 30.7 ml/min, p=0.383) remained stable following discharge (mean time from symptom onset to final assessment 47.4± 5.8 wks). Of the 20 patients with severe renal impairment, eGFR increased to >30 ml/min in 8 (40%, p<0.0001) within 7 days. A total of 231 patients (77%) were treated with an OAC within 7 days of onset. In 145 patients treated with a new OAC, the incorrect dose was initially prescribed in 60 patients.

Conclusion:
Acute renal impairment after stroke is common, and is most evident when weight-based eGFR is calculated. The transient nature of this renal impairment suggests OAC agent and dose selection may need to be adjusted following the acute stroke period
Abstract WMP93: Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy: Higher Prevalence Among Convexity Subarachnoid Hemorrhage Than Among Intracerebral Hemorrhage
Authors: Raposo Nicolas , Calviere Lionel , Cazzola Vanessa , Pastoura Sofia , Albucher Jean François , Ruidavets Jean-Bernard , Olivot Jean Marc , Chollet François , Larrue Vincent , Cognard Christophe , Bonneville Fabrice , Viguier Alain
Published: March 2022

Introduction:
Cerebral amyloid angiopathy (CAA) is a major cause of both lobar intracerebral hemorrhage (ICH) and cerebral microbleeds (CMB), especially in the elderly. Recently, acute convexity subarachnoid hemorrhage (cSAH) and cortical superficial siderosis (cSS) has been identified as markers of CAA. Although the clinical feature and the increased risk of future lobar ICH of cSS is well established, little is known about the specific pattern of CAA-related cSAH.

Hypothesis:
We hypothesized that clinical and imaging characteristics of CAA-related cSAH differ from CAA-related lobar ICH.

Methods:
We retrospectively analyzed clinical and MRI data of a monocentric cohort of 45 consecutive patients with an acute cSAH related to probable CAA and a comparison group of 70 consecutive patients presenting with an acute lobar ICH meeting Boston criteria for probable CAA.

Results:
cSAH patients were younger than ICH patients (mean age +/-SD: 75 +/-7 vs 78 +/-7; p=0.046). Transient focal neurological episodes (TFNE) were common among cSAH patients (84.4% vs 0%; p<0.001). Persistent focal neurological deficits were frequent among ICH patients (15.6% vs 98.6%; p<0.001). Prevalence of cSS was significantly higher among cSAH patients than among ICH patients (88.9% vs 60%; p<0.001) especially disseminated (66.7% vs 37.1%; p=0.002) and bilateral cSS (48.9% vs 28.6%; p=0.027). Number of lobar macrobleeds (median number [IQR]: 0 [0-1] vs 1[1-2]; p=0.07) and lobar CMB (median number [IQR]: 3 [1-6] vs 6 [2-14.75]; p=0.405) did not differ between the two groups.

Conclusions:
In CAA, patients presenting with cSAH are characterized by a younger age, TFNE as presenting symptoms and a higher prevalence of cSS than those presenting with Lobar ICH. These findings suggest that restricted hemorrhage into the subarachnoid space may play a crucial role in cSS physiopathology.
Abstract WP1: Evaluation of Clinical and Radiographic Variables Related to False Positive Detection of Tandem Carotid Artery Occlusion on CT Angiography
Authors: Rocha Marcelo , Aghaebrahim Amin , Jadhav Ashutosh , Jovin Tudor
Published: March 2022

Background and purpose:
CT angiography has been shown to result in up to 30% false positive detection of extracranial ICA occlusion in patients with acute ICA terminus occlusion. This may confound planning for acute endovascular intervention and cause inaccurate patient exclusion from related clinical trials of acute stroke therapy. We explored demographic, clinical variables, recanalization rates and outcomes that are associated with this radiographic artifact.

Methods:
Retrospective review of a prospectively maintained database of acute endovascular therapy at UPMC between 2002 and 2015. Patients with isolated terminus ICA occlusion were selected from a previously derived cohort of cases with or without pseudo-occlusion of the extracranical ICA on pre-procedural CTA (false positives and true negatives). Comparisons between these two groups were evaluated with univariate analysis.

Results:
We reviewed 69 cases of isolated ICA terminus occlusion. 21 patients had false-positive occlusion of the extracranial ICA (group 1) and 48 patients had adequate CTA diagnosis (true negatives, group 2). Rates of IV tPA (33% vs. 29%) and median CTA to groin puncture time (98 vs. 80 min) were similar between the two groups. Terminus ICA occlusion types were as follows: ICA-I (19% vs 6 %), ICA-L (67% vs. 56%), ICA-T (14% vs. 37%). Manual aspiration thrombectomy was used in 68% of cases in group 1 compared to 38% of cases in group 2 (P=0.03), no difference in use of recanalization devices were found. TICI 2b/3 recanalization was achieved to similar extent (42% vs. 33%). Favorable outcome (90-day modified Rankin Scale ≤ 2) was achieved in 26% vs. 40% between the two groups (P=0.52).

Conclusions:
Patients with acute terminus ICA occlusion who are misclassified as having tandem ICA occlusions on CTA have similar characteristics than their respective controls in this small cohort. Although future studies with larger sample sizes are needed to tease out preliminary trends, the data support the need for optimization of current screening methods for tandem ICA occlusion in the acute setting.
Abstract WP110: The Next Generation of Autologous Bone Marrow Stromal Cell Transplantation Against Stroke
Authors: Shichinohe Hideo , Tan Chengbo , Saito Hisayasu , Miyamoto Michiyuki , Hamauchi Shuji , Abumiya Takeo , Nakayama Naoki , Kazumata Ken , Houkin Kiyohiro , Kuroda Satoshi
Published: March 2022

Background and purpose:
Recent studies have elucidated that the bone marrow stromal cells (BMSCs) have therapeutic potential against stroke. Some clinical trials have been starting up in practice. We aimed to evolve the autologous BMSC transplantation for stroke into the next generation.

Materials and methods:
Human BMSCs were cultured with human platelet lysate (hPL) instead of fetal calf serum (FCS). They were labeled with superparamagnetic iron oxide (SPIO). Rat ischemic stroke models were made and 5x105 cells were injected into the ipsilateral striatum stereotactically 7 days post-insult. Behavioral analysis, MRI for cell tracking, (18)F-FDG PET, and (123)I-Iomazenil SPECT were performed. The animals were sacrificed 5 to 8 weeks post-transplantation and histological analysis was performed.

Results:
There was no difference in the surface markers and cell proliferation between hPL and FCS. Although rotarod test showed that motor function deteriorated in rats suffered from permanent MCAo, BMSC-hPL transplantation enhanced recovery of the motor function, significantly. MRI demonstrated that SPIO-BMSCs aggressively migrated towards the lesion. Moreover, (18)F-FDG PET and (123)I-Iomazenil SPECT showed that BMSC transplantation promoted recovery of the glucose utilization and the binding potential of iomazenil in the peri-infarct area, respectively. Histological analysis supported the findings on MRI and showed the inclination for neural differentiation of donor cells.

Conclusion:
The hPL may be valuable and safe in expanding BMSCs. The application of bio-imaging techniques is also valuable for BMSC transplantation for stroke. Now we prepare the novel clinical trial against stroke, Research on Advanced Intervention using Novel Bone marrOW stem cell (RAINBOW) study. The present results are translated into the optimal design of the trial.
Abstract WP119: Effects of Indirect Revascularization with Synangiosis in New Vessel Formation in an Animal Model of Cerebral Ischemia.
Authors: Gonzalez Nestor R , Liou Raymond , Ooi Yinn , Laiwalla Azim , Toscano Juan F , McDonald Austin , Iruela-Arispe Luisa
Published: March 2022

Objective:
In order to study the mechanisms associated with neovascularization after indirect bypass (EDAS), we have developed a mice model of synangiosis and cerebral ischemia.

Method:
Healthy 12-24 week old male C57/BL6J mice were used. The temporalis muscle served as donor for the external carotid artery vessels through a window in the temporalis bone. The distal MCA was ligated after opening the dura. The temporalis muscle was reattached in direct apposition to the ischemic brain surface. Animals were sacrificed at one month and their heads were prepared in block. Brain slices were stained with CD31 (endothelial cell marker), Ki67 (proliferation maker), and DAPI (nuclear marker) antibodies. Confocal laser microscopy was used for immunofluorescent imaging. Standardized relative quantification of immunofluorescence staining was performed using ImageJ following the Arqués protocol. Inferential comparisons among groups were performed with a generalized linear model. Data was nested in the model by animal to account for intrasubject correlation.

Results:
A total of 12 mice were operated. One subject died after surgery (attrition rate 8%). All other subjects displayed no deficits. The number of DAPI+ cells/image was no different between the synangiosis and the control side. The index CD31/DAPI was significantly higher in the synangiosis side (mean 0.90 ± 1.13 vs. controls: 0.60 ± 0.65, p<0.001). The proliferation index Ki67/DAPI was significantly higher in the synangiosis side (mean 0.21 ± 0.08 vs. controls: 0.12 ± 0.05, p=0.03). There was 8% colocalization of the 3 markers on the synangiosis side and none on the controls.

Conclusions:
Our model of synangiosis in mice was well tolerated and produced quantifiable neovascularization in the brain as indicated by the neovascularization indexes observed in confocal microscopy. This model of synangiosis is a promising tool for future studies of neovascularization and collateral formation in individuals with ischemia.
Abstract WP12: Impact of Transfer Status into a Comprehensive Stroke Center on Outcomes Among Intra-Arterial Therapy Patients
Authors: Frei Donald , Leonard Jan , Jensen Judd , Whaley Michelle , McCarthy Kathryn , Wagner Jeffrey , Bar-Or David
Published: March 2022

Introduction:
Clinical trials confirmed the benefits of intra-arterial therapy (IAT) for managing acute ischemic stroke (AIS). Yet not all hospitals are able to perform IAT, requiring rapid transfer of potential IAT candidates.

Hypothesis:
AIS patients receiving IAT who were admitted directly to a Comprehensive Stroke Center (CSC) would have similar outcomes to those transferred to the CSC from a less specialized hospital.

Methods:
Data were retrospectively abstracted for AIS patients treated with IAT at a CSC (1/2014 – 5/2015). Clinical characteristics and the following outcomes were compared in patients directly admitted to the CSC and those transferred: recanalization to TICI ≥2b, discharge and 90-day mRS (favorable, ≤2), sICH, and in-hospital mortality. Univariate and multiple logistic regression analyses were conducted.

Results:
IAT was performed in 133 patients; 34 (25.6%) directly admitted and 99 (74.4%) transferred to the CSC. Transferred patients were significantly younger, more often male, with fewer comorbidities, a longer time from symptom onset to arrival, but shorter time from arrival to groin puncture (table 1). Unadjusted outcomes were similar between groups (table 1). After adjusting for significant covariates (p<0.05), transferred patients were 89% less likely to have a favorable discharge mRS (OR=0.14 (0.02-0.47), p=0.003) than directly admitted patients. Transfers had a borderline worse 90-day mRS (p=0.07); no difference was observed between groups for the remaining outcomes (p>0.4 for all). Discharge mRS remained worse in transferred patients (p=0.01) after limiting the data to those arriving to the CSC <6 hours after symptom onset.

Conclusion:
Even after limiting the analysis to patients arriving to the CSC <6 hours after symptom onset, directly admitted IAT patients had more favorable outcomes than transferred IAT patients. This suggests select, potential IAT candidates, may benefit from bypassing centers not able to perform IAT.
Abstract WP127: Carotid Endarterectomy: The Change in Practice and Outcome Over 11 Years in an Australian Metropolitan Stroke Centre
Authors: Tse Gabrielle T , Kilkenny Monique F , Bladin Chris F , Grigg Michael J , New Gishel , Dewey Helen M
Published: March 2022

Background:
Carotid endarterectomy (CEA) has long been known to be an effective procedure for stroke prevention in patients with symptomatic carotid artery stenosis. However, its best practice has been in evolution with more recent evidence regarding optimal surgical timing, patient selection and choice of endovascular intervention versus surgery. Understanding the changes in CEA practice over time provides insights into how successfully evidence from research is translated into clinical practice.

Objective:
To investigate changes in practice and outcome of CEA over time in an Australian stroke centre hospital.

Hypothesis:
We hypothesized that the practice of CEA would change in line with new evidence in medical literature.

Methods:
All patients who underwent CEA from 2004-14 and carotid angioplasty and stenting (CAS) from 2003-08 were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, pre-operative imaging utilization, surgical timing and outcome. Chi square test, Mann-Whitney U test and multivariable logistic regression models were used in statistical analysis.

Results:
There were 510 CEA performed in 2004-14 and 95 CAS in 2003-08. The proportion of patients undergoing CEA increased from 60% to 90% from 2004-08 (p<0.001). CAS patients were more likely to have cardiac comorbidities and have restenosis as an indication. From 2004-14, the proportion of CEA patients >80 years old increased (p=0.001) and the proportion of asymptomatic patients decreased (OR 0.9 [0.87,0.99] p=0.003) over time. Median time from symptom onset to surgery decreased from 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (Q1: 5, Q3: 37) in 2014 (p<0.001). Use of pre-operative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (p<0.001). Overall 5.9% of CEA were complicated by death, stroke, or acute myocardial infarction with no change over time.

Conclusions:
The trends in CEA practice at our institute align with international trends and guidelines. This result may provide a representative indicator of Australian hospital practice.
Abstract WP128: Susceptibility Weighted Magnetic Resonance Imaging and Regional Cerebrovascular Reservoir Capacity in Angiographically Proven Large Artery Disease in Acute Ischemic Stroke and Transient Ischemic Attack
Authors: Lee Si Baek , Kim Joong-Seok , Won Yoo Dong , Yoo Do-Sung
Published: March 2022

Background:
The cortical vessel signs on susceptibility-weighted MRI (SWI) has been known for reflecting oxygen demand in ischemic brain. In large arterial steno-occlusive disease of ischemic stroke, evaluating regional cerebrovascular reservoir (rCVR) capacity is important to predict future stroke risk. However, it is practically difficult to perform all of the studies such as digital subtraction angiography (DSA), Diamox challenging SPECT study for the assessment of perfusion status and rCVR in acute setting. We selected patients who had undergone those methods and evaluated the associations among the collateral pattern, perfusion status and SWI pattern.

Methods:
From a cohort of patients consecutively admitted for stroke or transient ischemic attack (TIA), we selected patients with DSA-proven unilateral large artery steno-occlusive lesion. Cerebral angiogram was graded systematically in a blinded fashion for collateral flow, using ASITN/SIR grading system. We also evaluated rCVR by Diamox SPECT and the cortical vessel signs (CVS) on SWI were classified as normal, mild, moderate and prominent compared with opposite side. Demographic and clinical variables, initial NIHSS score and modified Rankin scale (mRS) scores at discharge were collected. We divided these patients in two groups according to rCVR capacity and compared clinical and imaging status.

Results:
A total of 100 patients were selected. Men were 64 (64%) and mean age was 66.1 (range of 34 to 88). Sixty-three patients had ICA steno-occlusive (32 with occlusion), 35 had MCA steno-occlusive lesions (17 with occlusion) and remaining 2 had tandem lesions. In Diamox SPECT, 34 patients (34%) showed preserved rCVR. Patients with preserved rCVR more had stenotic lesions (p=0.003) and good collateral pattern (p=0.026), while patients with reduced rCVR more had higher grade CVS pattern (p=0.018).

Conclusion:
Cortical vessel signs on susceptibility-weighted image have an association with regional cerebrovascular reservoir capacity. And this snapshot image would be a useful tool in the real world of clinical practice in evaluating cerebrovascular perfusion status. But longer follow up in much larger populations are needed.
Abstract WP130: Non-moyamoya Vessel Network Formation Along Steno-occlusive Middle Cerebral Artery
Authors: Xu Wei-Hai , Xu Yu-Yuyuan , Li Ming-Li , Hou Bo , Sun Zhao-Yong , Zhou Hai-Long , Feng Feng , Gao Shan
Published: March 2022

Introduction:
“Deep tiny flow voids” (DTFV), defined as three or more flow voids along occlusive middle cerebral artery(MCA) on at least two consecutive T2-weigthed image slices of high-resolution magnetic resonance imaging(HR-MRI), were recently proposed as a sign of pathological collaterals formation.

Objective:
In this study, we sought to examine the prevalence and clinical relevance of DTFV in patients with steno-occlusive MCA disease.

Methods:
We retrospectively reviewed the HR-MRI and clinical data of 477 patients with MCA steno-occlusive disease. The presence and distribution of DTFV were observed. The relationships among DTFV, the degree of stenosis, and infarctions were analyzed. To clarify the difference between DTFV and moyamoya collaterals, we also compared the HR-MRI findings of 102 patients with moyamoya disease and the patients with DTFV.

Results:
DTFV were revealed in 112 (23.5%) patients. The prevalence of DTFV was 1.4% in mild stenosis (<50%),12.8% in moderate stenosis (50-70%), 40.6% in severe stenosis (70-99%) and 50.7% in occlusions of MCA. DTFV were more common in asymptomatic than in symptomatic patients with severe stenosis (49.3% vs 30.9%, p=0.025) and occlusions (68.0% vs 41.7%, p=0.033). As high as 71.4% DTFV distributed in more than 3 of 4 quadrants around MCA stem. Obvious flow voids in basal ganglia region were observed in 58 (56.9%) patients with Moyamoya disease, but in none of patients with DTFV (p<0.001).

Conclusions:
DTFV are common in patients with severe steno-occlusive MCA, especially in asymptomatic patients. We hypothesize DTFV are suggestive of non-Moyamoya vessel network formation due to chronic hypoxia and ischemia.
Abstract WP134: Treatment of Internal Carotid Artery Stenosis With Heart Disease in Japan; J-ASPECT Study
Authors: Sayama Tetsuro , Kurogi Ryota , Nishimura Ataru , Iihara Koji
Published: March 2022

Background:
It is well-known that patients with carotid artery stenosis often merge the heart disease, including coronary artery disease. In Japan, there is no nationwide report about it. Here through J-ASPECT study that utilizes the Japanese Diagnosis Procedure Combination (DPC) and receipt database, we examined the carotid artery treatment complicated with heart disease in Japan.

Object and method:
Object: Of the 1,369 certified training institutions in Japan, 847 hospitals responded to a questionnaire survey. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2012 and March 31, 2013 were obtained from the Japanese Diagnosis Procedure Combination database.

Method:
During the treated surgery code, cases of carotid endarterectomy (CEA, K6092), and carotid artery stenting (CAS, K609-2) were extracted. Patients with heart disease was defined when ICD-10 codes for heart disease were recorded on admission as comorbidity. We compered the mortality rate, modified Rankin Scale at discharge, period of hospitalization, medical expenses, and postoperative complications.

Result:
CEA was carried out in 1655 patients and CAS was done in 2533 patients. Percentage of comorbidity with heart disease was 30% in CEA, and 25% in CAS. Treatment for carotid artery stenosis with heart disease tended to select CEA (p <0.001). Coronary artery disease accounted for 60-70% of merged heart disease. The presence of heart disease did not affect the prognosis of CEA patients. On the other hand, although the actual number of patients is small, mortality within 7 days after surgery in CAS patients, patients with heart disease, was 4-fold higher than the patients without heart disease.

Conclusion:
In this report, we clarified the current status of the carotid artery treatment with heart disease in Japan. Our study showed the excellent surface of the carotid artery treatment in Japan to indicate the equal treatment results in cases with and without heart disease.
Abstract WP140: Infarct Location Predicts Quality of Life Outcomes After Minor Stroke
Authors: Sangha Rajbeer S , Bernstein Richard , Cella David , Corado Carlos , Curran Yvonne , Naidech Andrew , Ruff Ilana , Prabhakaran Shyam
Published: March 2022

Introduction:
Neuro-QOL was developed to provide researchers with a continuous, validated, patient-reported measurement of quality of life. Previous studies suggest that minor ischemic stroke (MIS) can lead to disability and impaired quality of life in a substantial proportion of patients. We hypothesized that infarct location predicts 3-month QOL in patients with MIS.

Methods:
We identified MIS (NIHSS ≤ 5) with confirmed acute infarcts on DWI, admitted between August 2012 and July 2013, and who underwent Neuro-QOL outcomes assessments at 3 months. Impaired QOL was defined as T-scores >0.5 SD worse than the general population mean of 50 (SD 10) in any of 5 domains: upper extremity, lower extremity, executive functions, general concerns, and social satisfaction. We analyzed the relationship between acute infarct locations and impaired QOL in univariate and multivariate analysis. We further stratified our analysis by any rehabilitation services (RS) received post-discharge.

Results:
Among 169 patients (mean age 64.3 years, 54.4% male, 24.9% black, median initial NIHSS score 1, 36.7% received RS post-stroke), impaired QOL was noted in 56 (33.1%) patients at 3 months (56.5% in patient with vs. 19.6% in those without RS, p<0.001). Patients with left hemispheric infarcts (45.8 vs. 20.9%, p=0.001) and thalamic-brainstem infarcts were more likely to have impaired QOL (54.1 vs. 27.3%, p=0.002). In multivariable analysis, left hemispheric (adj. OR 3.45, 95% 1.61-7.41) and thalamic-brainstem infarction (adj. OR 4.59, 95% CI 1.91-11.00) were independent predictors of impaired QOL adjusting for age, NIHSS score, and recurrent stroke. Stratifying by RS, left hemispheric (34.0% vs 8.3% p=0.001) and thalamic-brainstem lesion location (52.6% vs 12.5% p<0.001) was significantly associated with QOL only in those who did not receive RS.

Discussion:
Left hemispheric and thalamic-brainstems infarcts were independently associated with impaired QOL, especially in MIS patients who did not receive rehabilitation services post-stroke. These data imply that specific acute infarct locations predict patient-reported impairments in QOL and may be useful biomarkers for future studies of targeted rehabilitation services in MIS patients.
Abstract WP151: Increased Risky Driving in Acute Compared to Chronic Ischemic Stroke Drivers
Authors: Hird Megan A , Vesely Kristin A , Saposnik Gustavo , Macdonald R. Loch , Schweizer Tom A
Published: March 2022

Introduction:
Guidelines recommend that patients refrain from driving in the acute phase of stroke. Patients are permitted to resume driving if no significant motor, cognitive, or perceptual deficits are present. This study investigated the driving performance of patients with mild ischemic stroke in the acute and chronic stages of recovery. It was hypothesized that patients with acute stroke would commit more risky driving errors (e.g. collisions, lane deviations) and that patients with chronic stroke would perform comparably to healthy matched controls.

Methods:
Driving simulator technology (STISIM) was used to compare the driving performance of 11 patients with acute mild ischemic stroke (NIHSS<5, <1 month post-stroke), 11 patients with chronic mild ischemic stroke (NIHSS<5 at discharge, >3 months post-stroke), and 11 healthy age- and education-matched controls. Participants completed a city-driving task and a car following task, which requires sustained attention and error monitoring.

Results:
Patients with acute stroke committed over three times as many risky driving errors compared to healthy controls during the city-driving task (6.2 vs. 1.7, p<0.01). Acute stroke patients made more errors (8.7 vs. 2.0, p<0.05) and had difficulty maintaining proper lane position (p<0.05) compared to controls during the car following task. Patients with chronic stroke committed fewer errors than acute stroke patients during the car following task (3.0 vs. 8.7, p<0.05) and tended to commit fewer risky driving errors during the city-driving task (2.7 vs. 6.2, p=0.076). Patients with chronic stroke performed comparably to controls during the driving tasks.

Conclusions:
Results suggest that patients with acute mild ischemic stroke may demonstrate impaired driving ability and that performance may improve in the chronic phase of recovery. The results reinforce the importance of refraining from driving in the acute phase of stroke and suggest that patients with good functional and cognitive recovery may be safe to resume driving in the chronic phase of injury. A large-scale longitudinal study is required to determine the optimal time for patients to resume driving after stroke.
Abstract WP169: Racial Disparities n Risk of Stroke and Mortality Among Patients Undergoing Rhythm Control of Atrial Fibrillation
Authors: Durrani Asad F , Soma Siva , Althouse Andrew , Qin Dingxin , Leef George , Saba Samir
Published: March 2022

Introduction:
Racial disparities in cardiovascular therapies and outcomes have been previously reported. We sought to investigate the risks of stroke and death in African American (AA) and white patients undergoing rhythm control of atrial fibrillation (AF).

Hypothesis:
AA patients have greater risk of stroke and death compared to white patients.

Methods:
We collected data on 5632 white and 241 AA patients that initiated rhythm control therapy for AF at our institution from 2006-2013. Cox proportional-hazards models were used to assess risk factors for stroke and mortality by race.

Results:
Patients were followed for a median of 40 months (range 1-101). AA patients had higher risk of stroke (6.6% vs. 3.9%, p=0.01) and all-cause mortality (16.2% vs. 13.1%, p=0.03) than white patients. Multivariate modeling confirmed the higher risk of stroke (HR=1.98, 95% CI [1.18-3.31], p=0.01) and mortality (HR=1.49, 95% CI [1.04-2.06], p=0.02) in AA patients after adjusting for baseline differences between race groups (age, HTN, DM, heart failure, and chronic kidney disease). AA patients with DM had an especially high risk of stroke (see Figure).

Conclusions:
African-American patients treated with a rhythm management strategy had significantly greater risk of stroke and all-cause mortality compared to white patients. AA patients with DM had an especially high risk, but the difference between AA patients vs. white patients was not explained by differences in baseline risk factors. Further investigation is required to determine the root causes of these racial disparities.
Abstract WP180: Quantification of Cerebral White Matter Hyperintensities and Stroke Subtype Stratification for Predicting Stroke Outcomes
Authors: Kim Dong-Eog , Ryu Wi-Sun , Woo Sung-Ho , Schellingerhout Dawid , Hong Keun-Sik , Jeong Sang-Wuk , Kim Beom-Joon , Lee Byung-Chul , Jang Min Uk , Park Tai-Hwan , Lee Soo Joo , Cha Jae-Kwan , Lee Jun , Kim Joon-Tae , Yu Kyung-Ho , Park Jong-Moo , Lee Kyung Bok , Lee Juneyoung , Lee Kiwon , Bae Hee-Joon
Published: March 2022

Objective:
To measure the impact of cerebral white matter hyperintensity (WMH) burden on the outcomes of stroke in general, and stroke subtype specifically.

Methods:
A total of 3814 acute ischemic stroke patients were prospectively enrolled from 11 stroke centers. WMH volume on MRI were quantified and categorized into quintiles. First, the impact of WMH on 3-month modified Rankin scale (mRS) in the entire patient population was studied, and in each stroke type that was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Then, we analyzed inter-group differences by: initial NIH stroke scale at admission, early neurological deterioration during the first 3 weeks after stroke onset, and functional recovery as well as stroke recurrence during the 3-month period following the initial infarct.

Results:
Mean age was 67.1 ± 12.9, and 58.7% were men. In large artery atherosclerosis (LAA) stroke, top two WMH quintiles were independently associated with mRS at 3months. However, only the highest quintile was associated with mRS at 3 months in small vessel occlusion (SVO) and cardioembolism (CE). WMHs were independently associated with initial neurological severity in SVO stroke, but not in other subtypes. WMHs were related with early neurological deterioration only in LAA stroke. Regardless of stroke subtypes, WMHs were not associated with stroke recurrence. Higher WMH volume was independently associated with poor functional recovery in LAA stroke but not in CE subtype.

Conclusion:
To our knowledge, this is the first study to demonstrate that WMH volume is an independent predictor of outcomes for certain types of stroke subtypes.
Abstract WP186: Prevalence of Health Care Discrimination Among Stroke Survivors: Data From a National Longitudinal Study of Older Americans
Authors: Nguyen Thu , Glymour Maria , Nuru-Jeter Amani
Published: March 2022

Background:
On-going management and follow-up care is important to ensure optimal outcomes among stroke survivors. Previous encounters with discrimination in health care settings can deter patients from pursuing care, compromise management of risk factors, and increase the risk of poor functional outcomes and recurrent stroke. However, little is known about how frequently stroke patients encounter discrimination in health care settings.

Methods:
We use data from the 2008 and 2010 Health and Retirement Study, a national longitudinal study of US residents age 50+, to examine the experience of health care discrimination among those reporting a history of stroke (N=1,338). Health care discrimination was assessed using two items. Respondents were asked how often they received poorer service or treatment from doctors or hospitals (six item response ranging from “every day” to “never”). A follow-up question asked participants what they think are the reasons for these experiences (i.e., race, gender, physical disability, and financial status). Participants are instructed to mark all that apply. The second health care discrimination item asked if they had ever been unfairly denied health care or treatment (yes/no). We describe the prevalence of self-reported health care discrimination overall and stratified by race/ethnicity, applying weights to represent the US non-institutionalized population age 50+ in 2008.

Results:
Approximately 20% of respondents with a history of stroke report receiving poorer service or treatment from doctors or hospitals, and 4% report ever being denied health care. Among people who reported receiving poorer service or treatment, age was the most commonly reported reason for experiencing health care discrimination (33%) followed by physical disability (19%). Among African Americans, race was the most common reason (42%) followed by age (33%).

Conclusion:
Perceived discrimination in health care settings -- related to age, disability, and race -- are common among stroke survivors. These experiences may impact receipt of health care, adherence to clinical recommendations, and long term outcomes. Future research should assess relationships between perceived health care discrimination and clinical outcomes.
Abstract WP193: Age Related Trends in Stroke Patient Readmission
Authors: Parker Nadine , Lindsay Patrice , Fang Jiming , Hill Michael D , Swartz Richard
Published: March 2022

Introduction:
Improvements in stroke patient care have led to increases in stroke survivors. However, these survivors are prone to hospital readmission, a burden for both patients and health system deserving of greater investigation. We hypothesize rates and risk factors for stroke patient readmission are not consistent across age. Thus, our aim was to characterize age related patterns of post stroke readmission including trends in patient and healthcare factors.

Methods:
Using the Discharge Abstract Database, a collection of hospital discharge records maintained by the Canadian Institute for Health Information, patients aged 18+ discharged with the main diagnosis of stroke/TIA between 2003-2014 were identified. Three age groups (18-44, 45-64, 65+) were determined for comparison of age related trends in stroke readmission. Trends were identified using the Cochran-Armitage and Jonckheere-Terpstra tests for binary and larger categorical events respectively. Kaplan-Meier analysis for 90-day recurrence, Chi-squared and multivariable Cox regression analysis for probability and risk of readmission were also performed.

Results:
A total of 267,768 patients had at least one stroke admission and were discharged alive. The mean age overall was 72 ±14.34 where 4% were aged 18-44, 23% aged 45-64, and 73% aged 65+. The younger groups were predominantly male and the oldest more female (p<0.0001). There were 48,078 (18%) patients readmitted to hospital of which 69% had a recurrent stroke. Rates of death and recurrence were highest among older patients (p<0.0001). Older patients had longer hospital stay than young (p<0.0001), suffered more comorbidities (p<0.0001), and more discharges to long-term care (p<0.0001). Patients aged 18-44 had the shortest time to readmission (mean=478 ±729 days, p<0.0001) and were more likely to be treated by a neuro-specialist. Cohen’s Kappa analysis revealed patients aged 18-44 had the highest agreement between index and recurrent stroke type (κ=0.44 (95%CI 0.38-0.49))

Conclusions:
Age related differences in stroke readmission is evident. With this information better targeted treatment and prevention strategies can be implemented.
Abstract WP199: Hemorrhagic and Ischemic Stroke Risk Among Persons With Pain
Authors: Sico Jason J , Fenton Brenda T , Carroll Constance , Goulet Joseph , Brandt Cynthia , Kerns Robert
Published: March 2022

Introduction:
Pain frequently occurs after ischemic and hemorrhagic stroke. Though conditions such as hypertension are associated with both pain and stroke, little is known about the relationship between pain and stroke risk.

Hypothesis:
Pain will be associated with increased hemorrhagic rather than ischemic stroke.

Methods:
We examined stroke among Veterans in the Musculoskeletal Disorder (MSD) Cohort, which contains 4.1 million Veterans diagnosed with at least one musculoskeletal disorder between 2001 and 2011. All conditions were identified via ICD-9 codes and all comorbidity defined as occurring one year prior to and six months after the date of first MSD diagnosis. Pain was measured by the pain intensity numeric rating scale score on the date of first MSD diagnosis. Logistic regression was used to examine the association between pain and stroke subtype.

Results:
Comorbid hemorrhagic (n=9,141; 0.22%) and ischemic (n=19,301; 0.47%) strokes were uncommon in the MSD cohort. The majority of hemorrhagic stroke patients (88%) had their stroke following their first MSD diagnosis, compared with 58% of ischemic stroke patients (p<.0001). After controlling for sociodemographic characteristics, medical comorbidities (including hypertension), and BMI, persons with pain had a higher odds of having a hemorrhagic, rather than an ischemic stroke (odds ratio ∼ 1.35, confidence interval = 1.2, 1.6). When examining odds including persons without stroke (multinomial model), severe pain (versus ‘no pain’) was significantly associated with increased odds of hemorrhagic stroke (versus ‘no stroke’). When comparing ischemic stroke to no stroke, odds ratios at all pain levels revealed significantly higher pain in those patients without comorbid ischemic stroke.

Conclusion:
Pain was associated with increased odds of having a hemorrhagic stroke (compared to ischemic). Only severe pain increased the odds of hemorrhagic stroke (compared to ‘no stroke’). Pain was significantly decreased in the ischemic stroke group compared to the group without comorbid stroke. Further work is necessary to understand mediators and moderators between pain, increased hemorrhagic (e.g., NSAID use) and decreased ischemic (e.g., aphasia) stroke risk.
Abstract WP204: Increase in Rates of Pregnancy Hospitalizations With Concomitant Stroke 2000 to 2012: The National Inpatient Sample
Authors: Khoury Philip R , Khoury Jane C
Published: March 2022

Introduction:
There has been limited publication of temporal trends in rates of stroke during pregnancy. The HCUP National Inpatient Sample (NIS) is a set of longitudinal databases, originally encompassing all discharges from 20% of the available community non-rehabilitation hospitals each year. In the year 2000, 994 hospitals yielded 7,450,992 unweighted discharge records. Beginning in 2012, the most recent year included in this analysis, the sampling scheme changed to a 20% random sample of discharges from each participating hospital. This resulted in data from 4,378 hospitals, yielding 7,296,968 unweighted discharge records.

Methods:
Using pregnancy related discharges in patients greater than 14 years(y) of age from the NIS between 2000 and 2012, we set out to determine if rates of pregnancy related hospital stays which included a diagnosis of stroke, have changed over time. Stroke was defined by ICD-9 codes of 430.xx for subarachnoid hemorrhage (SAH), 431.xx and 432.9x for intracranial hemorrhage (ICH); and 433.x1, 434.x1, and 436.xx for ischemic stroke (IS). Pregnancy was defined by ICD-9 codes of 630.xx to 679.xx (undelivered), and DRG (v18 or v24) between 370 and 375 or ICD9 V27.x (delivered). Appropriate NIS discharge weights were used to estimate national rates and determine variance. Stroke rates are reported per 100,000 pregnancy related discharges. Trends over time were tested.

Results:
Rates for stroke increased from 15 (4 ICH, 4 SAH, 7 IS) in 2000, to 26 (6 SAH, 8 ICH, 12 IS) in 2012 (p<.001). Stroke in women who delivered during the hospitalization increased from 4.8 to 6.6 (ns), while in those hospitalized during gestation and discharged undelivered, the stroke rate increased from 103 to 223 (p<.001). The increase was predominately in IS. Rates increased from 12 to 18 for women aged < 25 y; from 16 to 27 for women between 25 and 34 y; and from 28 to 47 for women 35 y and older, over the 12 year period.

Conclusion:
The diagnosis of stroke in pregnancy related hospital stays increased by 73% between 2000 and 2012. The reason for this could be changes in coding or diagnoses, or a true increase in stroke incidence, but further study is needed.
Abstract WP209: Pre-morbid Glycemic Control in Patients With Type II Diabetes Does not Modify Short-term Outcome in Acute Ischemic Stroke
Authors: Cyprich Janelle , Boehme Amelia K , Samai Alyana A , George Alexander , Ryan Matthew T , El Khoury Ramy , Martin-Schild Sheryl
Published: March 2022

Background:
The presence of pre-morbid diabetes is a predictor of worse outcome following acute ischemic stroke (AIS). Hyperglycemia on admission is also associated with more severe strokes and poorer outcomes in patients with or without established diabetes. We aimed to examine the relationship between pre-morbid diabetes management and outcome following AIS.

Methods:
Patients who presented to our center with AIS between 07/2008-07/2014 were included if pertinent past medical history and admission laboratory values of HbA1C were obtained at admission. Logistic regression was used to assess differences in baseline, in-hospital, and outcome variables in patients with well-controlled diabetes (DM+/C+) and poorly controlled diabetes (DM+/C-) as compared to those with no diabetes (DM-). Well-controlled diabetes was defined as an admission laboratory value of HbA1C < 7% in a patient with diabetes per history. The primary outcome measure was poor functional outcome (modified Rankin Scale > 2) on discharge.

Results:
A total of 1,375 cases were analyzed; 924 patients (67.2%) in the DM- group, 260 patients (18.9%) in the DM+/C- group, and 191 patients (13.9%) in the DM+/C+ group. After adjustment for age, NIHSS score at baseline, and tPA administration, DM- patients were significantly less likely to experience poor functional outcome compared to DM+/C+ patients (OR=0.70, 95% CI 0.48-1.04, p=0.0025). No significant difference was observed between the DM+/C- and DM+/C+ groups with respect to poor functional outcome (OR=0.86, 95% CI 0.58-1.26, p=0.5720).

Conclusions:
The absence of diabetes in the setting of AIS is associated with less likelihood of poor functional outcome. However, patients with well-controlled diabetes did not differ in functional outcome following ischemic stroke compared to those with poorly controlled diabetes, suggesting that the diagnosis of diabetes itself has clinical relevance to early outcome after ischemic stroke, regardless of the level of control at stroke onset.
Abstract WP219: Chagas Disease is an Independent Risk Factor for Stroke or Death: Long-term Results From a Hospital-based Cohort
Authors: Gonçalves Beatriz M , Oliveira-Filho Jamary , Andrade Alisson L , Barreto-Neto Nestor , Ferreira Isadora L , Fernandes Rodrigo D , Reis Carolina C , Resende Lucas L , Lordelo Morgana J , Jesus Adriano A , Porto Louise M , Pereira Camila B , Catto Marília B , Muiños Pedro J , Jesus Pedro A , Reis Francisco J , Aras Roque , Fernandes André M , Filho Joel A , Furie Karen L
Published: March 2022

Introduction:
Chagas disease is a major cause of cardiomyopathy and cardioembolic stroke in Latin America. However, stroke has been reported in patients without cardiomyopathy.

Hypothesis:
We aimed to determine if Chagas is associated with combined events of stroke or death.

Methods:
Open hospital-based cohort of consecutive stroke-free individuals with suspected heart failure or asymptomatic Chagas (positive serologic test only) followed from February, 2002 to July, 2015. Endpoint was combined events of stroke or death. Potential confounders included age, sex, cerebrovascular risk factors, echocardiographic left ventricular ejection fraction and EKG rhythm, adjusted in a multivariable Cox regression.

Results:
Participants were 556 individuals, mean age 55 (+/- 12) years, followed for a mean of 2.3 (+/- 1.5) years, leading to 1297 person-years of observation. Chagas was present in 288 (52%) and cardiomyopathy in 444 (80%) individuals at baseline. There were 2.2 strokes and 8.4 stroke or death events per 100 person-years among patients with Chagas, when compared to 1.3 strokes and 6.5 stroke or death events per 100 person-years among non-chagasic patients. In the model adjusted for potential confounders, Chagas remained an independent predictor of stroke or death (hazard ratio = 2.52; 95% confidence interval = 1.29 - 4.95, p=0.007).

Conclusions:
Chagas disease is associated a 2.5-fold increase in the rate of early stroke or death independently of cardiac disease. Non-cardioembolic mechanisms for stroke should be further investigated in this population.
Abstract WP220: The Association Between Collagen-binding Protein of Streptococcus Mutans and Deep Microbleeds
Authors: Tonomura Shuichi , Ihara Masafumi , Nomura Ryota , Nakano Kazuhiko , Toyoda Kazunori , Nagatsuka Kazuyuki
Published: March 2022

Introduction:
Poor oral hygiene had been recognized as a vascular risk factor. Recently, we showed that cnm gene positive Streptococcus mutans (cnm-positive S.mutans) encoding collagen-binding protein (CBP) was associated with intracerebral hemorrhage (ICH). Deep cerebral microbleeds (CMBs), a biomarker of hemorrhagic small vessel disease, is also associated with cnm-positive S.mutans in a population cohort study.

Hypothesis:
In this study, we aim to ascertain the correlation in acute stroke setting and investigated whether other factors, collagen binding activities of each S.mutans strain’s CBP or inflammatory markers, effects in the correlation.

Methods:
We enrolled 99 acute stroke patients between February and August 2014. S.mutans was isolated from saliva, and cnm-gene was screened using PCR technique and collagen binding activities was evaluated using type I collagen assay. CMBs were evaluated on T2* gradient-recalled echo MRI.

Result:
67 subjects with ischemic stroke, 5 with transient ischemic attack, and 27 with ICH were included. The presence of cnm-positive S. mutans was significantly associated with ICH [odds ratio vs. ischemic stroke, 3.8; 95% CI, 1.06-13.8], increased number of deep CMBs [median (IQR), 3 (2-9) vs. 0 (0-1), p=0.0002], and fibrinogen [361 (336-459) vs. 320 (274-365) mg/dl, p=0.01]. The relative ratio for number of deep CMBs, cnm-positive S.mutans was 2.2 [95%CI 1.1-4.7] after adjustment of age, sex, systolic blood pressure and creatinine clearance. In subjects positive for S. mutans, collagen binding activity was positively correlated with the number of deep CMBs [γ=0.054; R2, 0.405; p<0.0001].

Conclusions:
In acute stroke setting, we ascertained that cnm-positive S.mutans is independently associated with deep CMBs and ICH, and inflammation may have a mechanistic link.