bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP69: Association Between Computed Tomography Perfusion Parameters and Functional Independence in Acute Ischemic Stroke Post-Endovascular Therapy: A Secondary Analysis from the SELECT Study
Authors: Narangoli Adeeb , Yaghmoor Bassam , Pujara Deep , Alshaibi Faisal , Saidi Yazid , Shafiq Ameena , Albedaiwi Mohammed , Al Mostaneer Alhassin , Sundararajan Sophia , Sila Cathy , Opaskar Amanda , Xiong Wei , DeGeorgia Michael , Duncan Kelsey , Ray Abhishek , Hu Yin , Sunshine Jeffrey , Bambakidis Nicholas , Sarraj Amrou
Published: January 2025

Introduction:
Cerebral computed tomography perfusion (CTP) imaging has been well-established for identifying candidates for endovascular therapy (EVT) in acute ischemic stroke. This study investigates the association between CTP parameters and functional independence post-EVT using data from the SELECT study.

Methods:
We analyzed baseline CTP images from SELECT patients, focusing on those with available cerebral blood volume (CBV), cerebral blood flow (CBF), and time to maximum perfusion (Tmax) maps. Patients who received EVT and medical management only (MM) were included. Logistic regression models were created with age, national institutes of health stroke scale (NIHSS), time to arrival, occlusion location, transfer status, and CT ASPECTS as covariates, and functional independence at 90 days (modified Rankin score 0-2) as the outcome. Receiver operating characteristic (ROC) curves were generated, and area under the curve (AUC) values were calculated and compared using DeLong’s test.

Results:
Among 361 patients, 171 (139 EVT, 32 MM) had volumetric estimates for CTP parameters with pre-defined thresholds. Median (IQR) age and NIHSS were 68 (56-78) and 16 (12-20), and 48% were females. Estimates of different thresholds within a given CTP parameter showed high correlation (>0.8), and a moderate to high correlation (>0.4-0.6) was observed in estimates across different parameters (all p<0.05, figure 1). ROC curves revealed AUC values >0.7 for all CTP parameters in both EVT (figure 2) and combined (EVT + MM, figure 3) subgroups, with the highest values for CBF thresholds: <30% [EVT – AUC 0.7507, combined – AUC 0.8028], <34% [EVT – AUC 0.737, combined – AUC 0.7857] and <38% [EVT - AUC 0.7351, combined – AUC 0.7831], followed by CBV parameters and then Tmax parameters. No significant differences were found between AUC values of different CTP parameters (EVT: p=0.88; combined: p=0.46).

Conclusion:
All CTP parameters demonstrated high AUC values (>0.7) for functional independence at 90 days in acute stroke patients, particularly CBF <30%, indicating their potential as prognostic markers.
Abstract WMP7: Comprehensive safety and efficacy analysis of the full remote ischemic perconditioning among acute ischemic stroke patients in Catalonia(REMOTECAT) study cohort
Authors: Purroy Francisco , Mauri Capdevila Gerard , Subirats Teresa , Jiménez Xavier , Vicente-Pascual Mikel , Cardona Pedro , Paipa Merchán Andres Julian , Gomez-Choco Manuel , Muchada Marian , Pagola Jorge , Arque Gloria
Published: January 2025

Background and objectives:
Remote ischemic conditioning during cerebral ischemia ( PerRIC ) represents a new protection paradigm. We present the safety and efficacy analysis of the entire patient cohort of the multicenter double-blind REMOTECAT trial (.

Methods:
Patients with suspected stroke < 8 hours of evolution and motor RACE > 0 were included. The PerCI consisted of five inflation and deflation cycles of 5 minutes each, delivered using an AutoRIC device in the ambulance. The primary outcome was a modified Rankin Scale ( mRS ) score <=2 at 90 days. The safety variables were mortality at 3 months and neurological worsening (NE) at 24 hours and 5 days (NIHSS increase compared to baseline >4).

Results:
Between October 2022 and December 2023 and after an interruption of the study due to the COVID pandemic, a total of 200 patients from four university stroke centers were included: 41 (20.5%) with stroke mimics, 130 (65.0%) with ischemic stroke (IS), and 29 (14.5%) with hemorrhagic stroke (ICH). The mean age was 74.0 years while 78 [38.8%] were women. In only one patient, the application of RIC had to be stopped due to intense pain. Among the 159 patients with IS and ICH analyzed, 33 (20.8%) died. Neurological deterioration was observed in 19 patients (11.9%) at 24 hours and in 25 patients (15.7%) at 5 days. There were no differences between the PerRIC group and the sham group. After excluding 15 patients with a baseline mRS>2, the proportion of patients with a mRS<3 at 3 months was similar between the two groups (OR 1.40 [0.73-2.68]).

Conclusions:
PerRIC is safe but ineffective when considering together the cohort of patients with IS and ICH.
Abstract WMP74: Antithrombotic Therapy Delays Due To Neurosurgical Interventions After Traumatic Vertebral Artery Injuries Increases Stroke Risk
Authors: Yi Zixin , Vankawala Jessica , Koneru Manisha , Oliveira Renato , Santucci Joshua , Fox Nicole , Goldenberg-Sandau Anna , Khalife Jane , Tonetti Daniel , Jovin Tudor , Shaikh Hamza , Mossop Corey
Published: January 2025

Introduction:
Patients with traumatic vertebral artery injuries (TVAI) are at higher risk of ischemic stroke in the acute timeframe, which is mitigated by early antithrombotic treatment. However, TVAI patients commonly require neurosurgical interventions, such as spinal fixation for concomitant cervical spine injuries. The dilemma between risk of perioperative bleeding and benefit of stroke prevention guides practices for timing of antithrombotic therapy. This study aims to characterize the effect of delayed antithrombotic therapy due to neurosurgical interventions on TVAI patients.

Methods:
A retrospective review was conducted of a TVAI registry over 7 years (2016-2023) at a level 1 trauma center for patients who were treated with antithrombotics for stroke prevention. Rate of stroke determined to be related to TVAI within 14 days of injury was summarized. The relative risk (RR), attributable risk (AR), and number needed to harm for patients undergoing neurosurgical interventions were compared to the control group.

Results:
Among the 121 patients, 44 patients underwent neurosurgical intervention with mean 3.18 days (SD 2.16 days) before starting antithrombotics, which is a significantly longer duration than the 77 control cohort patients, whose mean time to antithrombotic start was 1.06 days (SD 1.15 days) (p < 0.0001). The incidence of stroke in the neurosurgical intervention group was 20.5%, which was significantly higher than 5.19% in the control group (p = 0.016). The RR was 3.94, and AR was 15.3%. For every 6.55 TVAI patients needing neurosurgical intervention for concomitant injuries, there will be one additional stroke event.

Conclusion:
Delayed antithrombotic therapy for two additional days on average in TVAI patients for neurosurgical interventions was associated with approximately four times greater risk of stroke. Future studies are needed to assess the risks of earlier antithrombotic treatment in this TVAI subpopulation, in order to optimize the antithrombotic therapy window for maximal stroke prevention and minimal hemorrhage risk.
Abstract WMP8: Timing of DAPT Administration And Clinical Outcomes in Patients With Transient Ischemic Attack or Minor Ischemic Stroke: A Meta-Analysis of 45,661 Patients
Authors: Desouki Mariam , Patel Tirath , Jeswani Bijay , shaikh shifa , Kauser Hena , Syed Saif , Abdelaziz Ahmed
Published: January 2025

Introduction:
Patients with transient ischemic attack (TIA) or minor ischemic stroke are at a high risk of recurrent stroke and neurological deterioration. Dual antiplatelet therapy (DAPT) of clopidogrel or ticagrelor has been used in these patients, however, the timing of DAPT administration from the onset of symptoms is unclear. We aimed to assess the timing of DAPT administration compared to aspirin in these patients.

Methods:
We searched PubMed, Scopus, Web of Science, and the Cochrane Library for relevant Randomized Controlled Trials (RCTs) addressing the timing of DAPT administration in patients with TIA or minor stroke compared to aspirin from inception until April 2024. Primary outcomes were the incidence of recurrent stroke and major bleeding. Dichotomous data were pooled as Odds Ratio (OR) with its corresponding 95% Confidence Interval (CI) using a random-effect model.

Results:
Twelve RCTs comprising 45,661 patients (22,827 in DAPT, and 22834 in aspirin) were included in the final analysis. Administration of DAPT within 24 hours or 72 hours was associated with a lower risk of recurrent stroke, with the following values, respectively (OR: 0.8, 95% CI: 0.73 to 0.88, p <0.001, and 0.6, 95% CI: 0.41 to 0.87, p =0.01). However, administration of DAPT within 24 hours was associated with a higher risk of major bleeding (OR: 1.83, 95% CI: 1.12 to 3.01, p =0.02), with no significant difference when administrated within 72 hours (OR: 1.54, 95% CI: 0.88 to 2.7, p= 0.13).

Conclusion:
Administration of DAPT within 72 hours from symptoms of TIA was associated with reduced incidence of recurrent stroke and without significant impact on major bleeding. On the other hand, 24-hour administration time was associated with a higher risk of major bleeding. Further RCTs with 72 hours administration time are warranted to validate these results.
Abstract WMP80: Dual Threat - Stroke in Infective Endocarditis: A 10-Year Retrospective Study on Patterns and Predictors of Outcomes
Authors: Mahajan Ishan , Remesh Pooja , Komakula Snigdha , Chandran Divyasree , RAO Deshmukh Anirudh , Ahamed Hisham , Varma Praveen , NAMBIAR VIVEK
Published: January 2025

Introduction:
Stroke is a devastating complication of infective endocarditis (IE) and is associated with poor outcomes. The underlying factors contributing to stroke in IE are not yet fully understood, leaving gaps in optimizing disease management and preventive strategies. In this study, we analyzed the radiological characteristics, functional outcomes and predictors of poor outcome in patients who developed acute stroke following a diagnosis of infective endocarditis.

Methods:
We conducted a retrospective study of patients diagnosed with infective endocarditis at a single tertiary center over a 10-year period from 2014 to 2023. Out of 526 cases, 511 had active infection and were screened for acute stroke associated with IE. We recorded baseline characteristics including age, gender, comorbidities, echocardiographic findings, vegetation location, microbiological profile, stroke type with radiological features, treatment strategies, and functional outcomes assessed by the Modified Rankin Scale (mRS). Descriptive statistical analysis was performed using IBM SPSS v.20, focusing on predictors of poor outcomes from radiological, microbiological, and echocardiographic data.

Results:
Among 511 patients with active IE, 13.3% (68) developed acute stroke, with 80.88% (55) being male. The mitral valve was the most common site for vegetations (66.12%, 41/62). Most cases were culture-negative (39.7%, 27/68), followed by Streptococci (11.76%, 8/68) and Enterococci (10.29%, 7/68). Ischemic strokes accounted for 77.94% of cases, while hemorrhagic strokes occurred in 22.05% (n=68). The middle cerebral artery (MCA) was most frequently affected (54.72%, 29/53). Hemorrhagic transformation was observed in 20.05% of stroke cases. Among hemorrhagic strokes, subdural hemorrhage occurred in 13.3% (2/15) and subarachnoid hemorrhage in 20% (3/15). A favorable outcome (mRS 0-2) was achieved in 41.17% of patients, while 58.82% had poor outcomes (mRS 3-6). The overall mortality rate was 33.82% (23/68), with 69.56% (16/23) of deceased patients having ischemic strokes, often involving the MCA territory (43.76%, 7/16).

Conclusion:
Our findings show that patients with ischemic stroke and IE face higher mortality rates. We observed that most strokes occurred in patients with vegetations on native mitral valves. These results emphasize the need for careful monitoring and effective treatment strategies for patients with native valve endocarditis to reduce stroke risk and improve outcomes.
Abstract WMP85: Site vs Core-lab CT ASPECTS read in the SELECT2 trial – assessment of trial eligibility and EVT treatment effect
Authors: Alshaibi Faisal , Pujara Deep , Hassan Ameer , Abraham Michael , sitton clark , Hussain Muhammad , Nguyen Thanh , Ortega-Gutierrez Santiago , Chen Michael , Saidi Yazid , Albedaiwi Mohammed , Yaghmoor Bassam , Al Mostaneer Alhassin , Johns Hannah Tabitha , churilov leonid , Parsons Mark , Grotta James , Ribo Marc , Hill Michael , Campbell Bruce , Sarraj Amrou
Published: January 2025

Introduction:
Eligibility for clinical trial enrollment is often determined by site investigators with subsequent re-adjudication by an imaging core lab. We sought to assess the differences between site-investigator reported CT ASPECTS with core lab adjudication, and how these differences affected trial eligibility and endovascular thrombectomy (EVT) treatment effect.

Methods:
Absolute and relative differences between site and core-lab reported CT ASPECTS were recorded in the SELECT2 randomized trial. The agreement between measures was illustrated using Bland-Altman plots. Cases with extreme discordance were further examined for differences in baseline characteristics, as well as whether trial eligibility and EVT treatment effect were impacted.

Results:
Of 352 enrolled, 346 patients had both site and core-lab ASPECTS available for evaluation. Median (IQR) values for site ASPECTS, core lab ASPECTS and the difference between site and core-lab ASPECTS were 4 (3, 5), 4 (3, 5) and 0 (-1, 1). Mean (95% CI) difference between site and core-lab ASPECTS was -0.03 (-0.19, 0.13), with higher limit of agreement at 2.83 and lower limit of agreement at -2.9 – Fig 1. Significant disagreement of ≥3-point difference between site ASPECTS and core-lab ASPECTS was observed in 25 (7%) patients, with 14 having site ASPECTS ≥ 3 points higher and 11 having core-lab ASPECTS ≥ 3 points higher.

EVT treatment effect was maintained based on site ASPECTS reads of 3-5 (aGenOR: 1.48, 95% CI: 1.16 to 1.89, p-value: 0.001) without significant heterogeneity as compared to other ASPECTS strata (p-interaction: 0.69) (Figure 2). In a sensitivity analysis excluding potential ineligible patients based on core lab reads [a) with core lab CT ASPECTS 0-2 and b) with core lab CT ASPECTS 6-10 and ischemic core estimates of <50ml], EVT treatment effect was maintained among patients with site read CT ASPECTS of 3-5 (aGenOR: 1.72, 95% CI: 1.26-2.34, p=0.001).

Conclusions:
Site investigator reads and core lab reads for ASPECTS score largely mirrored each other, with very low mean and median differences. Significant disagreement (≥3 points) between site and core-lab reads was limited and occurred in ~7% of cases. EVT benefit and treatment effect were maintained based on eligibility by investigators’ reads without heterogeneity in different ASPECTS strata.
Abstract WMP86: Acute intracranial stenting among patients with large vessel occlusion: Clinical and radiological outcomes of the RESISTANT International registry
Authors: Requena Manuel , Olive-Gadea Marta , Kaesmacher Johannes , Mujanovic Adnan , geyik serdar , SENADIM SONGUL , Cervo Amedeo , Salcuni Andrea , Moreu Manuel , Lopez-Frias Alfonso , Hassan Ameer , Miller Samantha , Zapata-Arriaza Elena , de Alboniga-Chindurza Asier , Bergui Mauro , Molinaro Stefano , Sousa Joao Andre , Gomes Fábio , Alexandre Andrea , Pedicelli Alessandro , Hofmeister Jeremy , Machi Paolo , Scarcia Luca , Kalsoum Erwah , Meira Torcato , Amorim José , Ortega-Gutierrez Santiago , Rodriguez Aaron , Capasso Francesco , Renieri Leonardo , Romano Daniele , Barcena Eduardo , AbdalKader Mohamad , Perry Da Camara Catarina , Yavagal Dileep , VEGA PEDRO , Ozdemir Atilla Ozcan , Smajda Stanislas , Khalife Jane , Biraschi Francesco , Castro Pedro , Siddiqui Adnan , Navia Pedro , Ntoulias Nikolaos , Velo Mariano , Zamarro Joaquin , Zaidat Osama , Sierra-Gómez Alicia , Marto Joao Pedro , tomasello alejandro
Published: January 2025

Background:
Acute intracranial stenting for the treatment of patients with large vessel occlusion in case of failed reperfusion or severe stenosis is a growing practice. Our aim was to explore the clinical and radiological outcome in a large multicenter and international registry.

Methods:
The RESISTANT registry is a multicenter and international retrospective registry of patients with large vessel occlusion stroke that underwent intracranial stenting due an acute stroke from 2016 to 2023. Primary endpoints was clinical outcome at 90 days. Secondary efficacy endpoints were final reperfusion (mTICI 2b-3), and stent patency at 24 hours. Safety outcomes included procedural complications, symptomatic intracranial hemorrhage and in-hospital mortality.

Results:
Among 890 patients enrolled, 862 fulfilled inclusion criteria. Median age was 67.0 years (IQR 59.0-77.0), 558 (64.7%) were males and median NIHSS was 12 (IQR 7.0-19.0). Occlusion location was proximal in 758 (87.9%) patients and anterior circulation was affected in 613 (71.1%) patients (390 M1-MCA, 142 terminal ICA). The indication for intracranial stenting was failed reperfusion (mTICI 0-2a) in 456 patients (52.9%). After intracranial stenting, successful recanalization was achieved in 764 (88.6%) with a reocclusion rate during admission of 11.9% and missing controls of 17.7%. The rate of symptomatic intracranial hemorrhage was 8.1%. At 90 days, the median mRS was 3 (IQR 1-6). Successful recanalization and regular flow after stenting were predictors of functional outcome at 90 days. No variables were independently associated with early reocclusion or symptomatic intracranial hemorrhage.

Conclusion:
Acute intracranial stenting was an effective therapy for patients with failed reperfusion or severe stenosis. Successful reperfusion and regular flow after stenting predicted functional outcome. Prospective studies are warranted to confirm efficacy and safety.
Abstract WMP91: Comparison of clinical outcomes and complications in patients undergoing Carotid Artery Stenting (CAS) with or without pre and post-stent balloon angioplasty.
Authors: Martucci Maria , Hussain Shazam , Hassan Ameer , Siddiq Farhan , Sheriff Faheem , Kan Peter , Janjua Nazli , Asif Kaiz , Grandhi Ramesh , Alaraj Ali , Niazi Muhammad , Mansour Ossama , Chen Michael , Bushnaq Saif , Tanweer Omar , Ezzeldin Rime , Zwein Mohammad , Mealer LeighAnn , Navpreet Bains , miller samantha , Colina Gabriela , Rodriguez Gustavo , Maud Alberto , Almajali Mohammad , Barakat Benan , Edhayan Gautam , Froukh Musaab , Salah Walid , Nico Elsa , Ashraf Shehab , Radaideh Yazan , Quispe-Orozco Darko , Zaidat Osama , Ezzeldin Mohamad
Published: January 2025

Background and Objective:
Carotid artery stenting (CAS) is a procedure that has been established as a safe and effective alternative to carotid endarterectomy in high surgical risk patients. There are procedural questions that remain unanswered, specifically, the safety of pre-stent balloon angioplasty versus post-stent versus both. The objective of our study is to understand the risk and safety of these procedural techniques.

Methods:
Multicenter retrospective data related to angioplasty balloons, stents, complications due to pre and post-stent angioplasty along with the modified Rankin score (mRS) before and after the procedure were collected from January of 2015 until December of 2022. Statistical analysis was performed to correlate this data with risks of complications and clinical outcomes.

Results:
A total of 1355 patients were enrolled. We found that patients who underwent pre-stent angioplasty, or both (pre and post-stent angioplasty) had a higher risk of complications compared to those who only had post-stent angioplasty. There were more complications in patients who did not undergo post-stent angioplasty as compared to those who did undergo angioplasty (p=0.018, OR=0.513). Follow-up MRS at 30-90 days was higher if the balloons in both pre-stent angioplasty (p=0.016) and post-stent angioplasty (p=0.020) stent angioplasty were not inflated to nominal pressure. Follow up MRS was statistically higher (p=0.01) in patients with open-cell stents than closed-cell stents. Open-cell stents were more likely to undergo post-stent angioplasty (p<0.001) while closed-cell stents were more likely to undergo pre-stent angioplasty (p=0.002).

Conclusions:
Patients who underwent post-stent angioplasty alone had less risks of complications compared to pre-stent angioplasty or combination. This is contrary to prior studies published on this subject and could be related to improvement in technique and in technology in recent years. There is a higher rate of post-stent angioplasty in patient who received open cell stents, but these also had higher mRS at 30-90 days compared to closed cell stents.
Abstract WMP92: Assessing Effects of Intra-Arterial Verapamil on Cerebral Hemodynamics and Autoregulation Following Aneurysmal Subarachnoid Hemorrhage
Authors: Stoehr Kaitlyn , Jayasundara Sithmi , Vargas David , Thinzar Pwint , Rapuano Amedeo , Maarek Rafael , Beekman Rachel , Magid-Bernstein Jessica , OKeefe Lena , Matouk Charles , Hebert Ryan , Gilmore Emily , Kim Jennifer , Petersen Nils
Published: January 2025

Background:
Impaired cerebral autoregulation has been linked to worse outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Delayed cerebral ischemia and vasospasm are critical complications of aSAH, and intra-arterial (IA) verapamil can be employed as pharmacologic spasmolysis in severe or refractory cases. However, the impact of this treatment on cerebral hemodynamics and blood flow autoregulation remains unknown.

Methods:
We evaluated near-infrared spectroscopy (NIRS) and mean arterial pressure (MAP) recordings from aSAH patients who underwent angiography with infusion of IA verapamil for anterior circulation vasospasm. NIRS-derived regional oxygen saturation (rSO2) from the affected hemisphere was correlated with MAP to derive the optimal blood pressure (MAP
OPT
) at which cerebral autoregulation was the most preserved, as well as the associated lower and upper limits of autoregulation (LA). Hemodynamic and autoregulatory parameters were compared at three 24-hour intervals: baseline, before, and after intervention. Data were excluded if there were fewer than 6 hours of calculated autoregulatory parameters in any of the three epochs or greater than 4 hours between data availability and the intervention start or end.

Results:
The study included 27 interventions (mean verapamil dose 24 ± 10 mg, monitoring time 19.7 ± 3.5 hours per 24-hour period) across 15 patients (mean age 56 ± 11 years, 40% female, Hunt Hess 3.4 ± 0.9, modified Fisher 4 ± 0). From baseline (6.4 ± 3.8 days prior to intervention) to the time of intervention, there was a significant increase in actual MAP, MAP
OPT
, and LA (p<0.001), accompanied by a decrease in rSO2 (p=0.001, Table 1). Following intervention, the time spent above the upper limit of autoregulation decreased from 17.1 ± 2.3% to 12.1 ± 1.7% (p=0.02), while autoregulatory parameters and tissue oxygenation remained stable. Sensitivity analysis limited to the first intervention for each patient confirmed similar findings.

Conclusions:
Our analysis demonstrated a decrease in tissue oxygenation and an increase in limits of autoregulation from baseline to the time when intervention was performed for vasospasm post-aSAH. IA verapamil administration was associated with a reduction in time spent above the upper limit of autoregulation, suggesting that pharmacologic spasmolysis for severe or refractory vasospasm may lead to improvement in autoregulatory physiology. Further exploratory analyses are ongoing.
Abstract WMP98: Use of Direct Oral Anticoagulants (DOACs) Compared to Aspirin for Secondary Prevention of Embolic Stroke of Undetermined Source (ESUS): A Systematic Review and Meta-analysis.
Authors: Varkey Thomas , Restrepo Natalia , koppanatham aishwarya , Chochol Pawel , Rizwan Ahmed Aisha , Alexandrov Andrei
Published: January 2025

Background:
The use of oral anticoagulation (OAC) for stroke prevention in embolic stroke of undetermined source (ESUS) is hypothesized to be beneficial over conventional antiplatelet use. However, large randomized controlled trials (RCTs) have not found clear benefits, even when assessing cardioembolic enriching features. Therefore, this study aimed to perform a meta-analysis exploring the efficacy and safety of direct oral anticoagulants (DOACs) following ESUS.

Methods:
PubMed, Scopus, and Cochrane Central were systematically searched for studies comparing DOACs versus aspirin after ESUS. The primary outcome was stroke recurrence, and the safety outcome was major bleeding. A random-effects model was used for the analyses. Statistical analysis was performed using Review Manager Web 8.0.0 (RevMan Web).

Results:
14,582 patients were included from 9 studies, of which 4 were RCTs. 7,341 (50.3%) received DOACs as secondary prevention. For stroke recurrence, there was noted non-statistically significant trends towards benefit for DOACs (OR 0.93; 95% CI 0.81 - 1.06; p = 0.29; I2 = 34%). No differences were found for major bleeding (HR 1.57; 95% CI 0.86 - 2.86; p = 0.15; I2 = 63%). Among the atrial cardiomyopathy subgroup, no benefit was observed (OR 0.88; 95% CI 0.50 - 1.55; p = 0.67; I2 = 39%).

Conclusion:
There is insufficient evidence to recommend the use of DOACs instead of aspirin following ESUS for the prevention of stroke recurrence. Nevertheless, the fears of increased bleed risks were also not seen. Further efforts should be directed towards identifying potential embolic sources and the specific population that could benefit from OAC.
Abstract WP102: Evaluating Door to Blood Pressure Treatment Goals in Intracerebral Hemorrhage
Authors: Johnson Leonard , Peiris Iranthi , Guzik Amy , Lycan Sarah
Published: January 2025

Background and Purpose:
2022 Intracerebral Hemorrhage (ICH) guidelines encourage treatment of blood pressure (BP) as soon as possible following identification of ICH. Our academic comprehensive stroke center (CSC) evaluated the initiation of antihypertensive medications and target systolic BP goals for ICH patients.

In patients with acute spontaneous ICH, we aimed to improve timeliness of BP treatment through education of nurses provide providing hyperacute ICH care.

Methods:
A retrospective chart review was conducted on patients presenting to the CSC from May 2023 - November 2023&December 2023 - May 2024, utilizing Get With The Guidelines® data. BP timepoints included the time to antihypertensive medication (Door to Initiation), and time to reaching BP goal (Door to Systolic Goal). In addition, we analyzed barriers to implementation.

Education was developed by the CSC core stroke team and provided to nurses who care for patients with ICH in the hyperacute phase. Nurses were provided education in orientation and in-real-time about BP goals for ICH, and education was adjusted to address barriers.

Results:
Door to initiation of antihypertensive medication administration decreased from 53 minutes (52.38%) to 33 minutes (90.91%). There was noted Improvement in Door to Systolic Goal from 109 minutes (55.0%) to 99 minutes (57.14%). Barriers to implementation included time constraints on staff in the Emergency Department (ED) to titrate continuous drips. Staff needed additional coaching on antihypertensive drips and rapid titration to reduce BP. Patients with airway compromise, staffing models, and high acuity assignments factored in the prioritization for reducing BP.

Conclusion:
Nursing education improved door to antihypertensive administration in patients with ICH from 53 minutes to 33 minutes. Following the intervention, 90.9% of patients had an initiation of an antihypertensive under one hour. However, only 57% met the systolic BP goal within 90 minutes. Additional focus is needed to identify time goals to achieve systolic BP.

“This work represents the author’s independent analysis of local or multicenter data gathered using the AHA Get With The Guidelines® (GWTG) Patient Management Tool/IQVIA Registry Platform but is not an analysis of the national GWTG dataset and does not represent findings from the AHA GWTG National Program.”
Abstract WP105: External Validation of a Large Vessel Occlusion Stroke Diagnostic Algorithm That Uses Arm Weakness and a Headpulse Device
Authors: Nguyen Tuyet Thao , xNguyenx xIvyx , Ng Kwan , Fontenette Roderick , Nishijima Daniel , Liu Xin , Keenan Kevin
Published: January 2025

Introduction:
The term “headpulse” refers to imperceptible head movements associated with each cardiac contraction, as measured by a cranial accelerometry device with electrocardiogram leads. Prior research at another hospital used asymmetric arm weakness (AAW) and headpulse data to create an algorithm that was 91% sensitive and 93% specific for large vessel occlusion (LVO) stroke. This original study used convenience sampling of emergency department (ED) patients with suspected stroke and transfer patients with known LVO stroke. As a result, 23/68 (34%) of patients had LVO stroke diagnoses. External validation is needed in a separate, larger, and more representative sample of suspected stroke patients where the prevalence of LVO stroke is expected to be much lower (5-15%).

Methods:
Headpulse recordings were prospectively obtained during stroke alerts for patients presenting directly to the UC Davis ED from 2020–2023 during business hours. A secondary analysis enriched with transferred LVO stroke and intracranial hemorrhage (ICH) patients was added in response to low enrollment of these diagnoses. Examinations and diagnoses were obtained by chart and imaging review. LVO stroke was defined as an acute symptomatic occlusion of the internal carotid, M1, M2, or basilar arteries. The algorithm being externally validated counted patients without AAW as negative for LVO stroke. For patients with AAW, the previously reported Support Vector Machine model used headpulse data to predict LVO stroke or not (Figure 1). Diagnostic statistics were compared to AAW alone, and Vision Aphasia Neglect (VAN) tests.

Results:
Thirteen of 304 patients (4%) were diagnosed with LVO stroke in the primary analysis. The secondary analysis added 11 LVO stroke, 10 ICH, 1 non-LVO stroke, and 2 mimic patients (Table 1). The AAW plus headpulse algorithm undergoing external validation was less sensitive (54 vs 91%) and less specific (87 vs 93%) than the original analysis. AAW was more sensitive but less specific than the algorithm. VAN was more sensitive and slightly more specific (Table 2).

Conclusion:
The lower sensitivity of this AAW plus headpulse algorithm during external validation suggests it is not a good candidate for prehospital validation. The small sample of LVO strokes led to wide sensitivity confidence intervals. The additional LVO stroke patients in the secondary analysis did not improve the sensitivity point estimate. Our results highlight the importance of external validation.
Abstract WP110: Direct Helicopter EMS to CSC Transport of Suspected LVO Strokes Improves Timeliness of Thrombectomy vs EMS Patients Transported to a PSC and transferred
Authors: Ciechanowski Mary , Rosenbaum Robert , Sivapatham Thinesh , Gannon Kimberly , Eisenman Justin , Dworkin Mollee
Published: January 2025

Introduction:
Delaware (DE) is comprised of 3 counties, with 7 hospitals within the stroke system. The state’s only CSC located in the northernmost county receives transfers from 1 PSC midway in the state and 3 PSCs in the southernmost county (figure 1). Historically PSC door time to CSC skin puncture time by interfacility transport can range from 3.5 to >5 hours from the furthest DE PSC. Utilizing ground EMS and Delaware State Police (DSP) helicopter EMS (HEMS) transport, DE developed a process to identify potential acute LVO patients and transport directly to the CSC to reduce time to mechanical thrombectomy (MT).

Methods:
In November 2022, DE EMS Standing Orders changed the pre-hospital stroke evaluation tool from RACE to the Visual, Aphasia, Neglect (VAN) assessment. DE EMS identified patients who were VAN+ and utilized HEMS for direct transport to the CSC statewide.

If EMS identified a VAN+ patient in Kent or Sussex counties, the local PSC medical control approved for direct CSC transport while considering thrombolytic timing.

DSP met the ground EMS crews at a pre-designated landing zone to receive the patient.

Ground EMS notified the CSC to prepare for the standard stroke alert evaluation.

Results:
From January 2023 to June 2024, 183 patients were flown by DSP HEMS directly to the CSC bypassing a PSC.

Of those, 59% had a final diagnosis of stroke (AIS and nontraumatic ICH/SAH)

Of those with AIS, 60% were positive for an LVO

Of those patients with LVO, MT was completed on 71%, compared to rate of 52% in prior years

Kent County: EMS arrival to skin puncture median time was 2.00 hours compared to 3.75 hours for interfacility transfer from the PSC.

Sussex County: EMS arrival to skin puncture median time was 2.5 hours compared to 4.00 hours for interfacility transfer time from the 2 Sussex PSCs combined (figure 2).

Statewide the median time for EMS arrival to skin puncture for patients who were MT candidates was 2.25 hours vs 3.88 hours, 1.6 hours faster than PSC to CSC transferred patients.

CSC time includes obtaining imaging which may already have been completed at the PSC for interfacility transfers.

Conclusion:
Early LVO patient identification and pre-hospital helicopter EMS transport directly to the CSC reduced the time from EMS arrival to skin puncture for MT patients in Delaware by 1.6 hours. This was 41% faster compared to those arriving at the CSC via interfacility transfer from PSC, and increased the rate of thrombectomy on eligible patients by 19%.
Abstract WP111: Bilateral Upper Limb Motor Priming Paired with Task Specific Training for Rehabilitation in People with Chronic Stroke (BUMP): A Randomized Clinical Trial.
Authors: King Erin , schauer jacob , Prabhakaran Shyam , Wax Alexandra , Urday Sebastian , Trevarrow Michael , Madhavan Sangeetha , Corcos Daniel , Stoykov Mary E
Published: January 2025

Introduction:
Few treatments have been shown to be efficacious for the 75% of individuals who have persistent moderate to severe upper extremity (UE) hemiparesis. Bilateral upper limb motor priming (BUMP) combined with upper limb therapy presents a potential practical solution to maximize recovery across a range of upper limb impairment levels. BUMP is a repetitive sensorimotor intervention which affects brain excitability by using mirror bilateral, wrist movements via a device with a mechanical linkage so the less affected and affected hands move symmetrically. We aimed to assess the magnitude of change in arm function in people with moderate-to-severe UL hemiparesis undergoing 30 hours of BUMP + task-specific training (TST), compared to a group receiving 30 hours of control priming (CP) + TST. Here we present the results of the BUMP trial.

Methods:
Seventy-six participants with moderate to severe hemiparesis, ≥6 months post stroke, were stratified by baseline impairment and randomized using 2 computer-generated number lists to receive BUMP or CP prior to receiving the same TST protocol. Over 6 weeks, participants received 30 hours of BUMP + TST or CP (defined as sham electrical stimulation) + TST. The primary outcome was the change in Fugl Meyer Assessment Upper Extremity (FMA-UE) score from baseline to follow up, 8 weeks after treatment ended. Outcome assessors were masked to group assignment. Analyses were intention to treat. We also report clinically meaningful response rates defined as a change in FMA-UE score of 6 points or greater.

Results:
Participants were randomized to either BUMP (N=37) or CP+TST (N=36). One person was withdrawn from the BUMP group and 2 people from the CP group. At follow up (8 weeks post-treatment end), both groups showed significant improvement in the FMA-UE. Those in BUMP and CP saw a mean change of 5.68 (SE 0.76, p<0.001) and 5.87 (SE 0.76, p<0.001), respectively, with a mean difference of –0.20 (95% CI= [−2.37, 1.97], SE=1.08, p=0.86). A response of ≥6 points was observed in 46% in BUMP and 50% in CP.

Conclusions:
For both groups, clinically significant improvements in arm and hand function were maintained at follow-up. This study represents the largest FMA-UE change achieved with just 22.5 hours of TST in individuals with moderate to severe hemiparesis. Although no beneficial effect of BUMP was found, the improvement in both groups was comparable to the VNS-REHAB trial which required an invasive procedure.
Abstract WP117: AI-driven Electromagnetic Field Therapy to Reduce Global Disability in Patients with Subacute Ischemic Stroke: Trajectory of Potential Benefit in the EMAGINE 1 Trial
Authors: Saver Jeffrey , Duncan Pam , Stein Joel , Cramer Steven , Bornstein Natan
Published: January 2025

Background and Aims:
Non-invasive, frequency-tuned, low-intensity electromagnetic network targeting field (ENTF) stimulation therapy has shown signals of reducing global disability at 90 days post-stroke in subacute ischaemic stroke patients with moderate-severe disability and upper-extremity impairment in the EMAGINE 1 randomized trial, but the pace of potential response has not been delineated.

Methods:
We conducted a multicenter, double-blind, randomized, sham-controlled, trial enrolling participants 4-21 days post-stroke with baseline modified Rankin Scale 3-4 and Fugl-Meyer Assessment Upper-Extremity 10-45. Participants were allocated to active or sham treatment, of stimulation paired with an evidence-based, functional, repetitive, home-based physical exercises regimen for 45 one-hour sessions, five times per week within the first 90 days from stroke. Global disability mRS was assessed at baseline, day 45, and day 90.

Results:
Participant age was 59.0 (
+
12.5), 33% were female, and study treatment was initiated at day 14 (IQR 12-19) post-stroke. The evolution of mRS distribution in the active and sham stimulation groups is shown in the Figure. At day 45, there was evidence of potential treatment benefit for functional independence (mRS 0-2, active vs sham 50% vs 35%, adjusted p=0.05) though not in freedom-from-disability (mRS 0-1, 5% vs 2%). By day 90, after further recovery in both treatment groups, there was evidence of potential treatment benefit for both freedom-from-disability (mRS 0-1, 26% vs 11%, adjusted p=0.03) and functional independence (mRS 0-2, 83% vs 74%, p=0.13). Shift on the mRS trichotomized at 0-1/2/3-6 similarly showed signals of benefit at day 45 (adjusted p=0.07) in addition to day 90 (adjusted p=0.02).

Conclusion:
ENTF therapy showed safety and preliminary efficacy in reducing global disability among subacute ischaemic stroke patients with severe baseline disability, with potential benefit accruing at mRS 0-2 by day 45 and at both mRS 0-1 and 0-2 by day 90. These results require confirmation in an adequately powered prospective trial.
Abstract WP121: Psycological sequelae in Cervical Artery Dissection patients - likely an underestimated risk
Authors: Svaerke Katrine , Engelter Sophia , Marugg Cilgia , Kaufmann Josefin Emelie , rosenbaum sverre , Brunner Eveline , Christensen Hanne , Engelter Stefan , Traenka Christopher
Published: January 2025

Background:
Most patients with Cervical Artery Dissection (CeAD) have a good functional long-term (LT) outcome. Earlier studies suggest that outcomes are worse when psychological sequela and LT-quality of life (QoL) are considered. In CeAD-patients, we assessed LT-QoL, frequency of increased anxiety levels, post-traumatic stress disorder (PTSD, DSM-IV criteria), depression, fatigue, cognitive complaints and (ii)explored if baseline characteristics can identify patients at high risk of developing the aforementioned.

Methods:
LT-follow-up (LT-FU, ie >=12 months after baseline) study including consecutive CeAD patients treated at the University Hospital Basel (CH). Patients with excellent 3-month outcome (ie mRS 0-1) and no prior formal diagnosis of psychiatric disorder were eligible for inclusion. Patients were asked to answer pre-defined, established (eg HADS depression scale, SF-36, Checklist Individual Strength) questionnaires.

Results:
Data from 89 CeAD (56%, n=50 male) patients were analyzed. LT-FU was performed at a mean of 69.1 months (range 15-351 months) after baseline. At LT-FU, 36% (32/89) of participants reported feeling more anxious compared to before the CeAD. Threshold for formal diagnosis of anxiety was met by 14.6% (13/89) – ie 2x as high as the current global prevalence of anxiety in the general population. 11.2% of participants met the criteria for PTSD diagnosis – ie >5x the estimated 12-m-PTSD-prevalence in the general Swiss population. 19.1% (17/89) reported depression at any point between baseline and LT-FU, 48.3% (43/ 89), scored above thresholds for abnormal fatigue. Those who experienced heightened levels of anxiety experienced reduced QoL in 6/8 measured domains. Participants who met criteria for PTSD diagnosis scored lower on 4/8 QoL-domains. A higher degree of dissociation during index CeAD and a higher degree of cognitive complaints at LT-FU predicted heightened anxiety levels at LT-FU. Occlusion of the dissected artery, tinnitus at baseline and prior smoking predicted the presence of PTSD at LT-FU.

Conclusion:
CeAD patients seem to be at increased LT risk for anxiety, depression and PTSD compared to the background population. These mental health outcomes concur with a decrease in QoL. Severity of vascular pathology and dissociation during the index event might predict psychological sequlae in these patients. Further, prospective, ideally interventional studies investigating psychological sequela in CeAD patients are warranted.
Abstract WP126: Identifying Characteristics Associated with Development of Posttraumatic Stress Disorder in Young Adult Stroke Survivors
Authors: Palmisano Caitlin , Mixon Lakeisha , McArdle Patrick , Yarbrough Karen , Cronin Carolyn
Published: January 2025

Introduction:
Posttraumatic stress disorder (PTSD) has emerged as a mental health barrier that can be experienced by survivors of stroke. PTSD triggered by thoughts of stroke impacts a patient’s ability to optimize their health outcome and maintain compliance with secondary prevention. A young adult stroke clinic treating survivors aged 18-50 in an urban setting in Maryland implemented a standardized practice to screen all patients for PTSD. A retrospective data analysis was performed to determine prevalence of PTSD in the young stroke population and identify predictive characteristics.

Methods:
Clinic patients were eligible for screening if they were survivors of ischemic or hemorrhagic stroke. The PCL-5 was utilized as the validated PTSD screening tool. Patients were asked to think about their stroke as the stressful event when answering the questions on the tool. A score on the PCL-5 of ≥ 31 was considered positive for PTSD and < 31 was negative. Only the initial screening for each patient was included in the analysis. Additional data collected included demographics, medical history, mental health history, substance use at time of stroke, and mRS at the time of visit. Data collection began in September 2023. Univariate analysis was done to identify which characteristics are associated with developing symptoms of PTSD after stroke.

Results:
A total of 106 young stroke survivors were screened. Mean age of first stroke was 39.5 years (range 5-50), 57.5% were female (61/106), and 57.5% were black (61/106). PTSD was prevalent in young adult stroke survivors at a rate of 17% (18/106). Compared to patients without the following characteristics, there was a significant increase in the rate of developing PTSD after stroke for patients with a history of anxiety (OR 5.1, 95% [1.2-21.5]) or active smoking (OR 3.8, 95% [1.18-12.4]). The remaining characteristics did not have statistically significant associations with PTSD.

Conclusion:
PTSD prevalence in this age group of stroke survivors is consistent with what is reported in the literature for all stroke survivors. Preliminary analysis shows there may be predictive characteristics of young stroke survivors who develop PTSD, which can impact their recovery and secondary prevention. The first months are the most impactful in stroke recovery. Further data collection and analysis should be done in this population to look for additional characteristics associated with PTSD to identify at-risk patients early.
Abstract WP127: Impact of High Intensity Interval Training on Neuropsychiatric Disorders and Serum BDNF Levels Post-Stroke. A Systematic Review and Meta-analysis
Authors: Rizwan Ahmed Aisha , Restrepo Natalia , koppanatham aishwarya , Chochol Pawel , Varkey Thomas
Published: January 2025

Introduction:
Cognitive impairment, mood disorders, and reduced serum BDNF levels are common in stroke patients. Previous studies suggest that aerobic exercise improves these outcomes by enhancing oxygenation. Herein, the authors compare the effectiveness of high-intensity interval training (HIIT) with low (LIT) and moderate (MIT) intensities and usual activity (UA) in stroke patients.

Methods:
We systematically searched PubMed, Cochrane, Embase, and Scopus databases for studies comparing HIIT with LIT, MIT, or UA in stroke patients. We evaluated change from baseline in cognitive improvement, mood disorders including anxiety and depression, and serum BDNF levels. Subgroup analyses were conducted based on stroke onset and exercise intensity, and separate analyses compared HIIT with each control group to assess cognitive improvement at different intensity levels.

Results:
A total of ten non-randomized and randomized studies were included in the analysis. Seven studies involving 373 patients showed no statistically significant difference in cognitive improvement between HIIT and the control group (std. MD 0.09; 95% CI -0.13 to 0.30; p=0.43). Separate analyses also revealed no significant differences between HIIT and LIT (std. MD -0.06; 95% CI -0.54 to 0.41; p=0.60), HIIT and MIT (std. MD 0.03; 95% CI -0.30 to 0.37; p=0.85), and HIIT and UA (std. MD 0.20; 95% CI -0.13 to 0.53; p=0.23). Subgroup analysis for chronic stroke did not show significant differences either (std. MD 0.07; 95% CI -0.19 to 0.34; p=0.58). Additionally, an analysis of four studies involving 281 patients found no significant difference in mood disorders (std. MD -0.21; 95% CI -0.62 to 0.21; p=0.33). A separate analysis of four studies with 130 patients also revealed no significant difference in serum BDNF levels between the two groups (std. MD 3.65; 95% CI -0.37 to 7.67; p=0.08). However, subgroup analysis indicated that serum BDNF levels were 3.32 ng/mL higher in the MIT group compared to the HIIT group.

Conclusion:
High-intensity-interval training does not demonstrate a significant advantage in cognitive improvement, mood disorders, or serum BDNF levels when compared to different exercise intensities. However, MIT is associated with increased serum BDNF levels compared to HIIT. Future robust RCTs are needed to compare different exercise intensities and durations to provide more conclusive results.