bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 186: Longer Term Effect of Lifestyle Intervention on Blood Pressure Control Among African Americans: One Year Follow-up of Shake, Rattle & Roll Trial
Authors: Nguyen Huynh Mai N , Young Joseph D , Hatfield Meghan , Alexeeff Stacey , Chinn Terrence , Sorel Mike , Sidney Stephen
Published: October 2018

Background:
In Kaiser Permanente Northern California (KPNC), an integrated healthcare system with a high overall hypertension (HTN) control rate, blacks still had poorer blood pressure (BP) control than whites. The “Shake, Rattle and Roll” (SRR) trial is named for: 1) “shake” the salt habit; 2) “rattle” the intensity of current BP management; and 3) adapt and “roll” out the interventions to other communities. Successful lifestyle (LS) interventions tend to be short-lived. We evaluated the effect of LS intervention in SRR on BP control at 12 months after the trial ended.

Methods:
SRR is a pragmatic cluster-randomized controlled trial conducted at Kaiser Oakland. All PCPs and their panels of black patients were randomized, stratified by panel size, to one of 3 arms: 1) usual care (UC); or 2) enhanced monitoring (EM) of KPNC BP management protocol; or 3) culturally tailored LS coaching focused on the DASH eating plan. Black patients from KPNC HTN Registry with a persistent high BP reading ≥ 140/90 qualified to be recruited into SRR. The intervention period lasted 12 months followed by 15 months of data collection with no participant contact. We assessed BP control rates using the latest follow-up BP measurements between enrollment and 27 months post-enrollment. Data on demographics and medications were collected from participants’ EMRs.

Results:
We randomized 98 PCPs. There were 1,129 enrolled in UC, 346 in EM and 286 in LS. Median age was 61 years. At the end of 12 months post-intervention, BP control rates were higher in LS than in UC (73.2% vs. 60.6%, p<0.001; Table). There was no difference across arms for adherence to BP medications, change in weight, or outpatient primary care utilization.

Conclusions:
Participants in LS arm continued to have better BP control than UC at 12 months after intervention ended in SRR. The sustainability of a culturally appropriate LS intervention with a focus on DASH should be studied further for implementation in adults with uncontrolled HTN.
Abstract 190: Improvements In Door To Needle Time Among Acute Ischemic Stroke Patients, 2008-2016
Authors: Tong Xin , Wiltz Jennifer L , George Mary G , Odom Erika , Coleman King Sallyann , Yin Xiaoping ,   PCNASP team, Merritt Robert
Published: October 2018

Introduction:
The clinical benefit of intravenous thrombolysis (IV tPA) in acute ischemic stroke (AIS) is time dependent. Achieving a door-to-needle time (DTN) ≤60 minutes for IV tPA is a quality care measure endorsed by the National Quality Forum.

Methods:
A total of 433,410 AIS admissions from 520 participated hospitals were identified in the Paul Coverdell National Acute Stroke Program (PCNASP) from 2008-2016. We assessed the overall temporal changes in DTN time and examined the factors associated with DTN ≤60 minutes by performing generalized estimating equations (GEE) modeling. The adjusted odds ratio (AOR) and 95% confidence interval (CI) were obtained.

Results:
There were total of 33,456 (8%) patients who received IV tPA (transfers excluded) with available door to needle times. The percentage of AIS patients who received IV tPA increased from 4.8% in 2008 to 9.8% in 2016, and significant increases were also observed among those with DTN ≤45 minutes (11.6% in 2008 to 35.1% in 2016, p<0.001), as well as with DTN ≤60 minutes (26.9% in 2008 to 60.5% in 2016, p<0.001) (Table). Patients aged 55-84 years were more likely to receive IV tPA within 60 minutes as compared to those aged 18-54. Arrival by EMS was a significant factor associated with DTN ≤60 minutes (AOR: 1.84, 95%CI: 1.74-1.95). Conversely, women, black patients as compared to white, patients with mild stroke (NIHSS score 0-4) as compared to ≥25, and patients with medical history of diseases associated with stroke were less likely to achieve DTN ≤60 minutes.

Conclusion:
Rapid improvements on DTN time were observed in PCNASP. Opportunities for quality improvements within these disparities should be further examined.
Abstract 26: Disparities in Post-Acute Stroke Rehabilitation Services Delivery: Preliminary Findings From the COMprehensive Post-Acute Stroke Services (COMPASS) Study
Authors: Penland Kristen N , Bushnell Cheryl D , Pastva Amy M , Psioda Matthew A , Levy Samantha M , Jones Berkeley Sara B , Abbott Rica M , Bettger Janet P , Freburger Janet K , Duncan Pamela W
Published: October 2018

Background:
Timely rehabilitation after stroke is essential for optimizing recovery. Patients discharged home can experience unnecessary service delays and gaps in care. Our aim was to examine sociodemographic characteristics associated with receipt of rehabilitation services within 30 days after discharge home in stroke or transient ischemic attack (TIA) patients.

Methods:
COMPASS is a cluster-randomized pragmatic trial measuring the effectiveness of the COMPASS model of care vs. usual care on functional status 90 days after stroke or TIA for patients discharged home. We analyzed data from 369 participants who enrolled in the intervention arm of the COMPASS trial, completed the post-acute clinic visit within 14 days, and the 30-day call between July 2016 and May 15, 2017. For those who were referred to rehabilitation services at hospital discharge or at the clinic visit, receipt of home health (HH) and outpatient (OP) rehabilitation services was reported by the participant during the 30-day call. Sociodemographic differences between those who did and did not receive these services were evaluated. We computed adjusted odds ratios with 95% confidence intervals using logistic regression to identify factors associated with receipt of rehabilitation services.

Results:
Of the 369 patients, 176 (47.7%) had ascertainment of receipt of services. Of the 115 patients referred to HH, 50 (43.5%) received it, and of 85 patients referred to OP therapy, 29 (34.1%) received it. There were no statistically significant differences in sociodemographic characteristics related to receipt of HH, but non-whites were less likely (3 of 20, or 15%) than whites (25 of 64, 34.9%) to receive OP therapy. After adjustment for NIHSS, ambulatory status at hospital admission, and age, non-white participants had a 78% decreased odds (OR 0.22; 95% CI 0.05, 0.95; p=0.04) of receiving OP therapy.

Conclusion:
These findings indicate that a significant gap exists between referral to and receipt of recommended post-acute stroke rehabilitation services. In addition, despite the small sample size, our results suggest that there may be a disparity in receipt of OP therapy for non-white patients relative to white patients.
Abstract 35: Hyperexcitability and Seizures in Primary Intraventricular Hemorrhage
Authors: Stretz Christoph , Sheikh Zubeda , Maciel Carolina B , Sheth Kevin N , Hirsch Lawrence J , Gilmore Emily J
Published: October 2018

Introduction:
While seizures are uncommon but reported in primary intraventricular hemorrhage (IVH), little evidence is available on the prevalence of hyperexcitable patterns on long term EEG monitoring.

Methods:
We sought to determine the prevalence of hyperexcitable patterns and seizures in patients with primary IVH who were extracted from a cohort consisting of patients with spontaneous intracerebral hemorrhage (sICH) who underwent continuous electroencephalogram (cEEG) monitoring between January 2013 and December 2016 at Yale-New Haven Hospital. Indications for cEEG monitoring included fluctuation of or depressed mental status, abnormal movements and a limited clinical exam. We recorded demographics, radiologic hydrocephalus, duration of EEG recording and EEG findings. Hyperexcitable patterns comprised generalized, bilateral independent or lateralized periodic discharges (PDs), lateralized rhythmic delta activity (RDA), brief potentially ictal rhythmic discharges (B(I)RDs), and spike-and-wave discharges (SW).

Results:
Of 196 adults with sICH who had cEEG performed, 13 patients (54% female) had primary IVH. Hydrocephalus was present in 9 patients (69%). Patients were monitored for a mean duration of 22.4 (± 14.7) hours. 9 patients had hyperexcitable patterns and/or electrographic seizures (70%): Electrographic seizures and co-existent hyperexcitable patterns were captured in 2 of 13 patients (16%) and hyperexcitable patterns without seizures in 7 of 13 patients (54%). Hyperexcitable patterns included periodic discharges (PDs) (4) (generalized, lateralized and bilateral independent, with and without rhythmicity), rhythmic delta activity (RDA) (5) (both lateralized and generalized, with and without sharps), brief potentially ictal rhythmic discharges(B(I)RDs) (1) and spike-and-wave discharges (SW) (1). There was no significant difference between patients with and without hydrocephalus and hyperexcitability or electrographic seizures (p= 0.76).

Conclusion:
Both electrographic seizures and/or patterns of hyperexcitability on EEG are common in our cohort of primary IVH patients. The exclusion or detection of non-convulsive seizures offers an opportunity for therapeutic intervention.
Abstract 37: The Efficacy and Safety of Cilostazol in Subarachnoid Hemorrhage. A Meta-analysis of Randomized and Non Randomized Studies
Authors: Ishfaq Ammad , Pandhi Abhi , Ishfaq Muhammad F , Ahmed Sundas I , Deep Aman , Singh Savdeep , Syed Muhammad Ali , Qureshi Adnan I
Published: October 2018

Objective:
Extensive research has long been focused on improving morbidity and mortality related to cerebral vasospasm which is well known as a major complication in subarachnoid hemorrhage (SAH) patients. The aim of this meta-analysis is to assess the effectiveness of cilostazol, a selective inhibitor of phosphodiesterase Type III, on cerebral vasospasm after SAH.

Methods:
Randomized and non randomized studies that compared effectiveness of cilostazol in SAH were included. A total of 6 trials met the inclusion criteria and were included in the meta-analysis. We calculated pooled risk ratios (RR) and 95% CIs (confidence intervals) using random-effects models. Primary end point was symptomatic vasospasm. Secondary end points were angiographic vasospasm, new cerebral infarct, mortality, and functional outcome i.e Modified Rankin scale ≤ 2.

Results:
Of the 618 total subjects, total of 136 (22%) symptomatic vasospasm events occurred during the follow-up period. The RR of symptomatic vasospasm was lower in patients treated with Cilostazol (RR = 0.43; 95% CI, 0.31-0.60; P < 0.001). Angiographic vasospasm was also significantly lower among those who received cilostazol as compared to control group (RR 0.67, 95% CI 0.51-0.84, p = .001). Cilostazol was associated with lower likelihood of new cerebral infarct in comparison to best medical therapy (RR 0.33 CI 95% 0.20-0.54, p<0.001). There was no difference between the risk of mortality between subjects who received airway cilostazol compared with those who were in control group (RR 0.64 CI 95% 0.15-2.76, p=0.55). There was improvement of mRS noted in patients who received cilostazol therapy (RR 1.21 CI 95% 1.05-1.39, p=0.008).

Conclusion:
Cilostazol administration may improve the outcome of patients with SAH. Further studies are needed to confirm this efficacy of cilostazol
Abstract 60: Sequential Combined Treatment of Pifithrin-a and (+)-phenserine Enhances Neurogenesis and Functional Recovery After Stroke
Authors: Barnett Austin , Kim Paul , Jin Yongming , Turcato Flavia , Carmody Margaret , Luo Yu
Published: October 2018

Background and Purpose:
Due to the limitation in treatment window of the rtPA (recombinant tissue plasminogen activator), the development of delayed treatment for stroke is needed. Utilizing a specific p53 inhibitor (PFT-a), our group has previously reported enhanced proliferation and survival of endogenous progenitor cells in-vivo, leading to enhanced functional recovery in stroke animals days and weeks after stroke onset. Recently, a role for amyloid-ß protein precursor (APP) has been implicated in synapse formation, neural plasticity, and the differentiation of neural stem cells. In this study, we examined the efficacy of delayed post-stroke treatment of sequentially combined PFT-a (post-stroke day 5-12) and an amyloid precursor protein inhibitor, (+)-phenserine (post stroke day 13-27) on functional recovery after stroke and the response of endogenous neural progenitor cells in SVZ and SGZ in stroke animals.

Methods:
We utilized a genetically inducible NSC-specific reporter mouse line (nestin-CreERT2-R26R-YFP) to label and track neural stem cell proliferation, survival, and differentiation in ischemic brain. We evaluated functional recovery at 4 weeks after stroke using locomotion analysis, novel object recognition and Barnes maze tests for cognitive function.

Results:
Our results show that delayed and combined treatment with PFT-a and (+)-phenserine resulted in increased proliferation and differentiation of YFP positive neuronal stem cells in post-stroke mice compared to vehicle treated stroke mice. In addition, the combined treatment cohort showed improved functional recovery in both locomotor (open field) and cognitive functions (NOR and Barnes maze) starting at 2 weeks post stroke and sustained up to 4 weeks after stroke.

Conclusions:
Our data suggest that sequential combination treatment strategy that enhances proliferation and neuronal differentiation of endogenous neural stem cells can work synergistically and improve the functional recovery after stroke through increased neurogenesis. This may provide a prolonged treatment window for improving functional recovery after stroke.
Abstract 63: Collaterals in Thrombectomy for MCA Occlusion: Mapping the Collaterome in the Trevo Retriever Registry
Authors: Liebeskind David S , Zhang Yanchang , Scalzo Fabien , Veznedaroglu Erol , English Joey , Baxter Blaise W , Budzik Ronald F , Bartolini Bruno M , Krajina Antonin , Malek Ali , Sarraj Amrou , Gupta Rishi , Nogueira Raul G ,   for the Trevo Retriever Registry Investigators
Published: October 2018

Background:
The delay and dispersion of collateral circulation to the MCA territory is readily available prior to endovascular thrombectomy for acute ischemic stroke (AIS). Factors associated with collateral grade have never been established in such an extensive population, reflecting diverse subjects from around the world. Largescale data from the Trevo Retriever Registry enables mapping of the MCA collaterome for the first time.

Methods:
The Imaging and Angiography Core Lab of the Trevo Retriever Registry independently conducted prospective evaluation of angiography in more than 1,500 subjects. Collaterals were systematically scored using ASITN grade prior to thrombectomy. Descriptive statistics detailed the distribution of collateral grades and analyses with demographic, imaging and clinical variables to explore key associations with routinely acquired registry data.

Results:
890 subjects (68.5 ± 15.1 years; 54.6% women; baseline NIHSS median 15 (10-19)) with AIS due to MCA occlusion had angiography of collateral circulation centrally adjudicated. Proximal M1 MCA occlusion was noted in 671/890 (75.4%). Collateral grade prior to thrombectomy included grade 4 or most robust collaterals in 38/890 (4.3%), 3 in 294/890 (33.0%), 2 in 467/890 (52.5%), 1 in 80/890 (9%) and 0 or none in 11/890 (1.2%). Baseline collaterals at angiography and pre-procedure ASPECTS were closely correlated (r=0.439, p<0.001) with more modest correlation between collateral grade and CTP/DWI (rrCBF<30% or ADC<620) infarct core (r=-0.31, n=391; p<0.001) or CTP/PWI (Tmax>6s) hypoperfusion at-risk (r=-0.10, n=391; p=0.043) volumes. First pass mTICI≥2b occurred in 553/858 (64.5%) with final mTICI≥2b in 824/890 (92.6%). Collateral grade prior to thrombectomy (each 1-point increment, after adjustment for other predictors) was strongly associated (OR 1.38 95%CI (1.12-1.7), p=0.002) with good clinical outcomes (mRS 0-2) at 90 days.

Conclusions:
Largescale mapping of collaterals prior to MCA thrombectomy reveals marked variation in the extent and functional impact of the collaterome. The preponderance of partial perfusion in the downstream ischemic territory prompts the need to investigate and leverage the protective nature of the collaterome in AIS.
Abstract 69: Long-term Vascular Morphological Changes and Clinical Events in Intracranial Artery Dissection
Authors: Makita Naoki , Koga Masatoshi , Nakamura Yuki , Ide Toshihiro , Wada Sinichi , Yamaguchi Yoshitaka , Ihara Masafumi , Toyoda Kazunori
Published: October 2018

Background and purpose:
The morphological change of intracranial artery dissection (IAD) is important in the diagnosis and therapeutic management. Long-term follow-up data of IAD patients are limited. We aimed to elucidate long-term morphological changes and clinical events in IAD patients.

Methods:
From a prospective single-center stroke registry between 2011 and 2016, we identified consecutive patients with idiopathic IAD based on the recently proposed criteria (Debette S, et al. Lancet Neurol 2015;14:640-654) who had follow-up MRA at 180 days of onset or later. Serial vascular morphological changes on follow-up MRA, and dissection associated ischemic and hemorrhagic stroke events during follow-up were analyzed.

Results:
We enrolled 51 patients (13 women; mean age, 52±13 years) who met the criteria of definite (n=39) and probable (n=12) idiopathic IAD. The vertebral artery was the leading dissected artery in 73% followed by anterior cerebral artery in 12%. The median follow-up period was 1.8 years (range 0.6 - 6.1). The initial MRA showed stenosis without dilation or occlusion in 27 patients, pearl and string sign in 16, dilation without stenosis in seven and almost normal finding in one. During the follow-up period, Ischemic stroke recurred within 15 days (median 11 days) for seven and at 686 days in another patient, and none had hemorrhagic stroke. Serial vascular morphological change occurred in 46 (90%). Of those, 37 (80%) had morphological improvement (stenosis regression >50% in 20, aneurysm diameter reduction >20% in two and both in 15) and nine (20%) had morphological progression (stenosis progression >50% in five and aneurysm enlargement >20% in four) from baseline. After 90 days of onset, morphological improvement and progression were still observed in 30 (65%) and five (11%) patients, respectively. There was no significant association between ischemic stroke events and vascular morphological progressions (P = 0.667).

Conclusions:
Ninety percent of patients with IAD had serial vascular morphological change, in particular one tenth had the morphological progression after 90 days of onset. In contrast, ischemic stroke events mainly occurred within 15 days of onset.
Abstract 71: Circulating Inter-alpha Inhibitor Protein Levels Decline After Stroke in Humans: Exogenous Supplementation is Protective in Multiple Animal Models of Ischemic Stroke
Authors: Venna Venugopal Reddy , Roy-O’Reilly Meaghan A , Howe Matthew D , Lee Juneyoung , Zhu Liang , Stonestreet Barbara , Lim Yow-Pin , McCullough Louise D
Published: October 2018

Introduction:
Inter-alpha Inhibitor Proteins (IAIP) are a family of endogenous plasma and extracellular matrix molecules. IAIPs have been shown to down-regulate inflammation, inhibit destructive serine proteases, and bind extracellular histones to neutralize cytotoxicity. Interestingly, many of these factors also regulate neuroprotection after stroke. In our initial studies, we found that IAIP treatment was neuroprotective in the middle cerebral artery occlusion model. Here, we analyzed if stroke alters IAIP using plasma samples from both mice and human stroke patients, and we investigated whether IAIP could provide neuroprotection using multiple stroke models.

Methods:
C57BL/6 mice were subjected to stroke with an autologous thromboembolic clot followed by reperfusion using t-PA. A separate cohort underwent the permanent occlusion model. Mice were randomized to receive IAIP or vehicle at 6h and 18h after stroke onset. Infarct was assessed 48h after reperfusion with t-PA, or 72h after permanent occlusion. Plasma samples from stroke patients and vascular risk factor matched controls were used for changes in IAIP levels using ELISA. Statistics were performed by two-sample t-test or Wilcoxon rank-sum test. P <0.05 considered significant.

Results:
IAIP treatment significantly reduced total injury size (t-PA alone 22±2% vs. t-PA+IAIP 13±3%; n=4-5/grp). Protection was also seen after permanent occlusion (vehicle 59.4±3.9% vs IAIP 39.5±5.9%; n=6-8/gp, p<.05), showing efficacy of IAIP in two different models. IAIP treatment improved survival rates (82% with IAIP vs 63% with vehicle) and neurological scores compared to vehicle group (p<0.05). Mean IAIP levels were significantly lower (stroke patients 134.4 ug/ml; n=51 vs controls 157.5 ug/ml; n=40), in parallel, increased IAIP-Histone complexes were seen in these patients. Similar changes were identified in mouse samples.

Conclusions:
Our results show that delayed IAIP treatment can significantly reduce cell death in both permanent ischemia and/or in combination with t-PA. IAIP could potentially represent an important, novel treatment for stroke. Our studies in combination with t-PA further strengths this clinical translatability and to design personalized dosing based on IAIP levels.
Abstract 73: Triggering Receptor Expressed on Myeloid Cells-2 Expression derived From Microglia Contributes to Neurological Recovery in Experimental Ischemic Stroke
Authors: Kurisu Kota , Zheng Zhen , Kim Jong Y , Shi Jian , Hseih Christine , Yenari Midori A
Published: October 2018

Background and Purpose:
We previously reported that triggering receptor expressed on myeloid cells-2 (TREM2) expression promotes post-ischemic phagocytosis and leads to neurological recovery. However, the precise underlying mechanism is not fully understood yet. In present study, we aimed to clarify which pool of myeloid cells (brain resident microglia versus macrophage derived from circulation) are contributing to its beneficial role in post-ischemic recovery, with the usage of bone marrow (BM) chimeric mice.

Methods:
BM chimeric mice were created by BM transplanting BM from TREM2 knockout (KO) and wild type (Wt) mice into KO and Wt recipient mice. Thus, 4 groups (Wt (donor) to Wt (recipient), KO to Wt, Wt to KO, KO to KO; n=6/each) of BM chimeric mice were produced, then were subjected to dMCAO surgery. Neurological function was observed until 14 days after surgery. Infarct volume and immunohistological analysis (myeloid cell activation and infiltration: isolectin B4 (IB4) and CD11b; phagocytosis: oil red o and CD68; TREM2 expression) was also undergone.

Results:
Compared to mice lacking brain TREM2 (WT to KO and KO to KO), mice with intact TREM2 in brain microglia (KO to WT and WT to WT) showed better neurological recovery (p<0.05), and smaller infarct volume (p<0.01). Myeloid cell activation and infiltration (IB4) was significantly decreased in order of WT to WT, KO to Wt, Wt to KO, KO to KO (p<0.05). Likewise, number of TREM2 positive myeloid cells (CD11b) showed similar decreases. Oil red o staining demonstrated that mice with intact TREM2 in microglia (KO to WT and WT to WT) showed more accumulation of foamy macrophages, compared to mice lacking TREM2 in brain (Wt to KO and KO to KO). Furthermore, both the number and proportion of TREM2 positive phagocytes (CD68) was significantly higher in mice with intact TREM2 in the brain, compared to mice lacking brain TREM2.

Conclusions:
Although our results suggest TREM2 expression in both microglia and circulating macrophage were crucial for post-ischemic recovery, its beneficial effect was greater when TREM2 was present in brain resident microglia.
Abstract 79: Chronic and Acute Hypertension in Ischemic Stroke Are Distinct Markers of Impaired Collateral Circulation
Authors: Liebeskind David S , Ayata Cenk , Brown Scott , Raychev Radoslav , Scalzo Fabien , Broderick Joseph P , Tomsick Thomas A , Cipolla Marilyn J ,   for the IMS III Investigators
Published: October 2018

Background:
Acute blood pressure (BP) elevation in acute ischemic stroke (AIS) is common, yet the link with collateral circulation remains elusive due to lack of longitudinal data on premorbid hypertension (HTN) and serial BP changes within an individual. Precision medicine for AIS and management of HTN requires an understanding of collateral circulation.

Methods:
The Interventional Management of Stroke III angiography core lab prospectively evaluated collateral circulation utilizing the ASITN scale prior to endovascular therapy. We used these data to discern the relationship of clinical and imaging markers of premorbid HTN with acute, serial BP measures and collaterals.

Results:
Collaterals at angiography were graded in 276/331 (83%) subjects. Higher initial BP was associated with impaired collateral status, driven by diastolic BP (ASITN 0-1: mean 88.9 ± 23.5 mmHg (n=70); 2: 82.7 ± 18.5 mmHg (n=106); 3-4: 79.4 ± 15.0 mmHg (n=95); p=0.002) but not systolic BP (ASITN 0-1: mean 153.7 ± 31.5 mmHg (n=71); 2: 147.8 ± 29.0 mmHg (n=107); 3-4: 146.8 ± 28.3 mmHg (n=95); p=0.153). Premorbid HTN was linked with worse collaterals (ASITN 0-1: 88.9% (64/72); 2: 78.7% (85/108); 3-4: 64.2% (61/95); p=0.001). Admission anti-hypertensive medications were tied to worse collaterals (ASITN 0-1: 76.4% (55/72); 2: 64.8% (70/108); 3-4: 57.3% (55/96); p=0.036). Prior infarction on baseline imaging was also a marker of worse collaterals (ASITN 0-1: 33.3% (24/72); 2: 24.3% (26/107); 3-4: 19.1% (18/94); p=0.039). Serial BP from pre-randomization to post-tPA, however, was unrelated to collateral status. Multivariate modeling to predict collateral grade revealed that history of HTN (OR 0.29 95%CI (0.13, 0.64); p=0.002) and diastolic BP measured post-stroke but pre-randomization (per 10 mm Hg) (OR 0.80 95%CI (0.69, 0.93); p=0.004) were both distinct markers of impaired collaterals. The poorest collaterals were seen in those with both history of HTN and acutely elevated BP.

Conclusions:
Chronic and acute HTN are both potent predictors of impaired collaterals in AIS. Understanding how HTN affects the structure and function of collaterals and response to acute BP changes is critical for future hypertensive management and collateral augmentation.
Abstract 81: Time From Imaging to Endovascular Reperfusion Predicts Outcome in Acute Stroke
Authors: Tsai Jenny P , Mlynash Michael , Christensen Soren , Kemp Stephanie , Kim Sun , Mishra Nishant , Federau Christian , Nogueira Raul G , Jovin Tudor , Devlin Thomas G , Akhtar Naveed , Yavagal Dileep R , Bammer Roland , Straka Matus , Zaharchuk Gregory , Marks Michael P , Lansberg Maarten , Albers Gregory
Published: October 2018

Objective:
This study aims to describe the relationship between CT perfusion-to-reperfusion time and the probability of functional independence in a cohort of patients undergoing endovascular therapy for acute ischemic stroke.

Methods:
We included data from the CT Perfusion to predict Response in Ischemic Stroke Project (CRISP) in which all patients underwent a baseline CT perfusion (CTP) scan prior to endovascular therapy. Patients were included if they had a mismatch on their baseline CT perfusion scan and achieved successful endovascular reperfusion. Patients with mismatch were categorized into ‘target mismatch’ and ‘malignant mismatch’ profiles, according to the volume of their Tmax>10s lesion volume (target mismatch <100 mL; malignant mismatch >100 mL). We investigated the impact of CTP-to-reperfusion times on probability of achieving functional independence (mRS 0-2) at day 90 and radiographic outcomes at day 5.

Results:
Of 156 included patients, 108 (59%) had the target mismatch profile, and 48 (26%) had the malignant mismatch profile. In patients with the target mismatch profile, CTP-to-reperfusion time showed no association with functional independence (p=0.84), whereas in patients with malignant mismatch profile, CTP-to-reperfusion time was strongly associated with lower probability of functional independence (OR=0.08, p=0.003). Compared to patients with target mismatch, those with the malignant mismatch profile had significantly more infarct growth (90 [49-166] vs. 43 [18-81] mL, p=0.006) and larger final infarct volumes (110 [61-155 vs. 48 [21-99] mL, p=0.001]).

Conclusion:
Patients with the target mismatch and malignant mismatch profile respond differently to time delays between baseline imaging and endovascular reperfusion; those with the malignant profile demonstrate a more rapid decline in favorable clinical outcomes and have greater infarct growth.
Abstract NS4: Predictors of Ischemic Stroke and Stroke Mimic During Pregnancy
Authors: Meyer Chelsea , Murillo Jennifer , De Havenon Adam
Published: October 2018

Introduction:
The risk of ischemic stroke is significantly higher in pregnancy. However, the neurologic symptoms that accompany stroke can be mimicked by other conditions. Because ischemic stroke has the potential for acute treatment, it is important to identify these patients quickly.

Methods:
A retrospective chart review was performed on pregnant patients from 2009-2014 using ICD-9 codes for stroke or other related vascular diseases. The diagnosis was based on the neurologist evaluation and neuroimaging. We identified candidate variables with p<0.2 in univariable analysis and derived a predictive model using interactive variable selection, then fit logistic regression models to the outcome of ischemic stroke.

Results:
Thirty-eight patients met inclusion criteria, of which 13 had ischemic stroke (Table 1). Mimic diagnoses included: venous sinus thrombosis (8), intracerebral hemorrhage (2), complicated migraine (7), non-epileptic seizure (3), seizure (2), transient ischemic attack (1), and conversion disorder (2). The best model to predict ischemic stroke included age greater than 29 years and history of 1
st
degree relative with stroke (Figure 1).

Conclusion:
Our scoring system is a promising hypothesis-generating concept that requires validation in a larger cohort of pregnant patients.
Table 1:
Baseline characteristics of patients with ischemic stroke versus mimics and p-value for difference (using Student’s t-test or the Chi-squared test).

Figure 1:
Comparison of the area under the Receiver Operating Characteristic curve for Model 1 (current smoking and age>29), Model 2 (migraine with aura and age>29), Model 3 (family history of stroke and age>29).
Abstract NS6: Post TPA Neuro Vitals, a New Approach With the Help of an Old Friend
Authors: Lee Jason , Broadway Katie , Jeansonne Stephanie W
Published: October 2018

Background:
Post tissue plasminogen activator (tPA) physiological and neurological vital sign checks are an important and required part of stroke patient care. Physiological monitoring is aided by modern technology and the ability to automate the transfer of data to patient records and alert nurses of detrimental changes. The neurological checks are still a manual entry and performance of the task by nurses that must be performed very frequently and can take several minutes to complete properly. Many systems have defaulted to the use of the NIHSS for these checks.

Method:
Using parts of the NIHSS, selected items were used to show neurological changes, have lower variability and decrease the time required to evaluate yet maintain patient safety. With IRB approval, a retrospective study of all patients that received tPA at Houston Methodist Hospital Medical Center and had NIHSS scores entered into the EPIC system. The NIHSS was collected for the baseline through the 24 hour post tPA administration time only. Cases that had a 2 point increase or more were evaluated for neurological imaging due to a change in patient condition. These NIHSS changes were compared to our Houston Methodist Stroke Change Score tool.

Results:
75 patients met the criteria for inclusion from June 1
st
, 2017 through Dec 31
st
, 2017. 30 cases had a 2 point change or more in the NIHSS. 13 cases met criteria for comparison of scales. 100% correlation between NIHSS and the HMSCS for a 2 point change or more for all cases found that had significant neurological changes and symptomatic hemorrhagic transformation.

Conclusions:
This was found to be a positive result for our study. Use of the HMSCS is being introduced to our facility in place of the NIHSS for post tPA monitoring. The NIHSS was timed and took over 8 minutes on average for a nurse to complete fully. The HMSCS was timed and took less than 3 minutes on average to complete fully. We have estimated that average nurse would gain 5 min per exam at each of the 36 time points without compromising patient safety or quality.
Abstract TMP107: Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC) Protocol: Novel Method for Evaluating Human Stroke
Authors: Fraser Justin F , Collier Lisa , Gorman Amy , Salmeron Katie , Edwards Danielle , Davis Stephanie , Alhajeri Abdulnasser , Grupke Stephen , Roberts Jill , Bix Gregory J , Pennypacker Keith
Published: October 2018

Background:
Research in ischemic stroke struggles from failures to translate stroke conditions between animal models and human patients. With mechanical thrombectomy, we have for the first time developed a protocol to facilitate tissue banking of intracranial thrombi as well as the blood immediately proximal and distal to it. These tissues provide a unique resource to correlate changes in the human condition to animal models. Our aim was to develop a reproducible protocol to bank these specimens for future gene expression and proteomic analysis.

Methods:
We developed an IRB-approved protocol for tissue processing during thrombectomy (www.clinicaltrials.gov NCT03153683). The protocol was a joint clinical/basic science effort among multiple laboratories and the Neurointerventional Radiology Service Line. We placed laboratory supplies in the angio suite, and developed a step-by-step protocol for specimen retrieval and processing.

Results:
Our protocol successfully yielded samples for analysis in all but one case. In our preliminary dataset, the protocol yielded adequate amounts of tissue for distal blood, proximal blood, and thrombus. We present the tissue banking protocol for dissemination, and highlight the training protocol and mechanics of on-call research staffing for 24/7 tissue processing. In addition, preliminary integrity analyses demonstrated high quality yields for RNA and protein.

Conclusion:
We have developed a novel tissue banking protocol to capture thrombus, and both proximal and distal blood to the intracranial thrombus in human stroke patients. The specimens are captured during the thrombectomy procedure, and allow us to study the initial molecular response to ischemic stroke in the human condition in ways previously unavailable.
Abstract TMP110: The Correlation of Through Plasmatic Concentration of Dabigatran and
CES1
Genotype With Major Bleeding in Stroke Patients
Authors: Tomek Ales , Janský Petr , Olšerovã Anna , Boudníkovã Anna , Kešnerovã Petra , Šarbochovã Ivana , Ružickovã Tereza , Magerovã Hana , Paulasovã Schwabovã Jaroslava , Kaplan Vojtech , Lacinova Zuzana , Matoska Vãclav
Published: October 2018

Introduction:
Dabigatran is direct thrombin inhibitor approved in the prevention of stroke in patients with atrial fibrillation. It was shown in the RELY trial substudy that genetic variants could contribute to interindividual variability in concentrations of the active metabolite of dabigatran and influence the safety of treatment. Carriage of the
CES1
rs2244613 minor allele was associated with lower exposure to active metabolite and with a lower bleeding risk compared to wild-type allele.

Aim:
To determine the influence of gene
CES1
polymorphism rs2244613 and through plasmatic concentration of dabigatran on occurrence of major bleeding in stroke patients.

Methods:
Prospective observational monocentric study in consenting stroke patients initiated on dabigatran. Primary outcome was major bleeding defined using ISTH criteria. DNA analysis of CES1 polymorphism rs2244613 was done with RFLP analysis. Through concentration of dabigatran was measured with liquid chromatography-tandem mass spectrometry (LC-MS/MS) at least 7 days after initiation.

Results:
110 patients after cardioembolic stroke, mean age 70,2 (SD 12.7), 56 (50.9%) women, were enrolled. Mean follow-up time was 19.9 months (total 182.2 patient years). 68 (61.8%) patients were wild-type, 37 (33.6%) were minor allele heterozygotes and 5 (4.5%) were homozygous minor allele carriers. Through dabigatran concentration were non-significantly lower in minor allele carriers: 132.8 (SD 98.7) ng/ml in wild-type patients, 112.2 (80.0) in heterozygotes and 95.6 (SD 88.1) in homozygotes. There were 6 episodes of major bleeding, all in patients with wild-type genotype. The patients with dabigatran level above 160 ng/ml (upper quartile) were more likely to have major bleeding, HR 5.74 (95% CI 1.05 - 31.42, p = 0.044). Age and renal function did not correlate with the bleeding.

Conclusion:
Patients with higher dabigatran concentration had significantly higher major bleeding risk. Minor allele carriers had non-significant trend for having lower through dabigatran level. Personalized dabigatran dosing based on pharmacogenetics and monitoring plasmatic levels should be studied in future trials with the aim to increase the safety of treatment.
Abstract TMP117: Characterization of Patients With Embolic Strokes of Uncertain Source in the Navigate-ESUS Trial
Authors: Kasner Scott E , Sharma Mukul , Wang Youngjun , Wang Yilong , Lavados Pablo , Davalos Antoni , Shamalov Nikolay , Lindgren Arne , Uchiyama Shinichiro , Cunha Luis , Hart Robert , Mundl Hardi , Connolly Stuart J ,   The NAVIGATE ESUS Investigators
Published: October 2018

Background:
The New Approach riVaroxaban Inhibition of Factor Xa in a Global trial vs. ASA to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial is an international randomized phase III trial comparing rivaroxaban versus aspirin in patients with recent ESUS. While these patients share the common stroke mechanism of ESUS, the underlying potential embolic sources vary, and therefore a detailed description of the baseline characteristics across key subgroups is essential.

Methods:
A total of 7000 patients were enrolled and the study will continue until at least 450 primary events have occurred. The primary efficacy outcome is time to recurrent stroke or systemic embolism. Baseline characteristics collected in the trial include demographic features, medical history, qualifying stroke information, baseline functional and cognitive status, and the results of diagnostic testing. Pre-specified subgroups analyses for the primary safety and efficacy outcomes include: age, sex, race, global region, body mass index, weight, estimated glomerular filtration rate, stroke or TIA prior to qualifying event, time from qualifying stroke to randomization, duration of cardiac rhythm monitoring, PFO, hypertension, and diabetes mellitus.

Results:
Participants were recruited from 460 sites in 31 countries between December 2014 and September 2017. A summary of baseline characteristics for the initial 6271 participants (will be updated) according to prespecified age subgroups are shown in the Table. Additional subgroup comparisons will be presented.

Conclusions:
NAVIGATE ESUS will be the largest randomized trial comparing antithrombotic therapeutic strategies for secondary stroke prevention in patients with ESUS. The study population encompasses a wide array of patients across multiple continents with important differences according to age. The results are expected to have a global impact.
Abstract TMP120: Treatment Rate of Atherosclerotic Risk Factor Among Young Adults Compared to Older Adults
Authors: Leppert Michelle H , Campbell Jonathan , Burke James , Bernard Timothy , Traystman Richard , Poisson Sharon , Ho Michael
Published: October 2018

Background:
The aggressive management of atherosclerotic risk factors (ARF) has been accredited with the declining incidence of stroke in older adults. The goal of this study was to look at treatment patterns of ARF in young adults compared to older adults.

Methods:
A commercial claims database was used, containing enrollees between ages 15 to 45 for young adults and ≥ 55 for older adults from 2001 to 2014. Diagnosis for ARF including hypertension, diabetes and hyperlipidemia were established based on 2 outpatient or 1 inpatient claim. Hospitalization with the primary diagnosis of stroke were identified. Of patients with an ARF diagnosis, we looked for the presence of any medication claims including oral antihypertensive, antihyperlipidemics, and antidiabetics (including injectables) based on the Generic Product Identifier (GPI) codes.

Results:
Included in the analysis were 3,770,474 young adults with mean age 28 and 1,552,351 older adults with mean age 60. From 2001 to 2014, the overall prevalence of hypertension, diabetes and hyperlipidemia were 7.68%, 2.65%, and 7.85% respectively in young adults, compared to 47.8%, 18.0% and 46.6% respectively in older adults. Treatment rate of hypertension, diabetes and hyperlipidemia improved faster annually in older adults (1.9%, 1.7%, 1.8% respectively) than young adults (0.96 %, 0.99%, 0.61%, respectively, p<0.01). For young and older adults with stroke, overall treatment rates for hypertension and dyslipidemia were higher than those without stroke (p 0.028 to <0.0001). However, diabetes was treated at a lower rate in those with stroke for both young (61.9% vs. 66.3%, p=0.001) and older adults (57.9% vs. 61.3%, p < 0.001).

Conclusion:
Proportion of treatment for ARF in older adults improved at a faster rate than young adults. Overall treatment rates of diabetes was higher in young adults likely due to proportionally more cases of type 1 diabetes. Hyperlipidemia was treated at a much lower rate in young adults than older adults.
Abstract TMP2: Mechanical Thrombectomy in the Oldest of the Old: Is 90 the New 60?
Authors: Frontera Jennifer A , Arcot Karthikeyan , Boden-Albala Bernadette , Gordon David , Liff Jeremy , Ogedegbe Olugbenga , Scher Erica , Turkel-Parella David , Tiwari Ambooj , Farkas Jeffrey
Published: October 2018

Introduction:
Though some randomized trials of mechanical thrombectomy included octo- and nonagenarians, there is little data on outcomes among the oldest of the old.

Methods:
Consecutive patients with ischemic stroke admitted to a single, comprehensive stroke center were prospectively enrolled in a registry between 9/2014-2/2017. Rates of mechanical thrombectomy were compared over 10-year patient age epochs. Among those who underwent thrombectomy, recanalization rates, and discharge disposition were compared over age epochs after adjusting for admission NIHSS using multivariable logistic regression analysis. Cochrane-Armitage test of trend was used to assess for dose effect of age on discharge disposition. Good discharge disposition was defined as discharge to home, acute rehabilitation or outpatient physical therapy.

Results:
Of 1245 ischemic stroke patients, 221 (18%) underwent mechanical thrombectomy. Thrombectomy occurred in 13/75 (17%) aged 40-49, 23/176 (13%) aged 50-59, 41/274 (15%) aged 60-69, 53/289 (18%) aged 70-79, 55/287 (19%) aged 80-89, and 30/108 (28%) aged 90-99. There was no significant difference in thrombectomy rates per age epoch after adjusting for NIHSS. TICI2b-3 recanalization rates (85-93% of cases), IV tPA use (25/221, 11%), and withdrawal of life-sustaining therapy (7%) did not differ significantly across age epochs. However, after adjusting for admission NIHSS, the rates of good discharge disposition decreased proportionately, in a dose effect manner with each 10-year increase in age (Cochrane-Armitage 16.06, P<0.001, adjusted odds ratio 0.7, 95%CI 0.6-0.9, P=0.002). Good discharge disposition occurred in 69% of those aged 40-49, 61% aged 50-59, 68% aged 60-69, 62% aged 70-79, 46% aged 80-89 and 33% aged 90-99.

Conclusions:
Despite similarly excellent recanalization rates among stroke patients aged 80-99 years who underwent mechanical thrombectomy, good discharge disposition was significantly worse in the oldest of the old after adjusting for admission NIHSS. Nonetheless, nearly half of octogenarians and a third of nonagenarians who underwent mechanical thrombectomy were able to go home or to acute rehabilitation.
Abstract TMP26: D-4f Treatment of Stroke in T2dm Mice Increases Abca1 Signaling and Promotes Neurorestorative Effects
Authors: Venkat Poornima , Cui Xu , Chopp Michael , Zacharek Alex , Yu Peng , Shen Yi , Chen Jieli
Published: October 2018

Background:
D-4F is an apolipoprotein-A1 mimetic peptide that improves stroke outcome in non-diabetic mice. In this study, we employ D-4F as a novel neurorestorative treatment for stroke in type 2 diabetic mice and investigate the ATP-binding cassette transporter (ABCA1) signaling pathway for treatment derived benefits.

Methods:
Male BKS.Cg-m+/+Leprdb/J (db/db)-T2DM mice (2-3m) and brain specific ABCA1 knockdown (ABCA1-B/-B) and control ABCA1fl/fl mice induced with T2DM using a combination of high fat diet and low dose Streptozotocin, were subject to distal MCAo (dMCAo) and treated with or without D-4F (16mg/kg, oral) starting 24h after dMCAo daily for 14 days (n=8/group). Following neurological evaluation, animals were sacrificed at 14 days after stroke. FITC labeled D-4F was administered orally at 24h and 48h after dMCAo (n=6/group) to test if D-4F passes the blood brain barrier. Electron Microscopy was employed to evaluate myelination. Laser capture micro-dissection was employed to extract tissue from the ipsilateral corpus callosum to test ABCA1 gene expression.

Results:
D-4F treatment in T2DM stroke mice significantly improves neurological function, increases axon density, arteriogenesis and angiogenesis in the ischemic boundary zone compared to non-treated T2DM stroke mice (p<0.05). FITC labeled D-4F passes the blood brain barrier and homes to ischemic brain regions. D-4F treatment in T2DM stroke mice significantly increases ABCA1 gene expression. D-4F co-localizes with blood vessels, oligodendrocytes, and ABCA1 positive cells, while ABCA1 co-localizes with neurons and endothelial cells in the ischemic brain. ABCA1-B/-B mice have significantly decreased myelination compared to ABCA1fl/fl mice in the white matter tracts of the corpus callosum. D-4F treatment significantly improves neurological functional outcome after stroke in T2DM-ABCA1-fl/fl mice but not in T2DM-ABCA1-/- mice, indicating that ABCA1 signaling is a key mediator of D-4F induced neurorestorative effects after T2DM stroke in mice.

Conclusions:
D-4F treatment in T2DM mice subjected to stroke significantly improves stroke outcome, vascular and white matter remodeling which may be attributed, at least in part, to D-4F induced increased ABCA1 signaling activity.