bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP150: Superior Neuroprotective Efficacy of Elovanoids, a Novel Class of Homeostatic Lipid Mediators, in Experimental Stroke
Authors: Bazan Nicolas G , Obenaus Andre , Mukherjee Pranab , Jun Bokkyoo , Khoutorova Larissa , Petasis Nicos A , Belayev Ludmila
Published: June 2021

Objectives:
Ischemic stroke triggers a pattern of cellular and molecular disturbances that include lipid peroxidation, uncompensated oxidative stress, and neuronal injury. Recently, we have uncovered and characterized a novel neuroprotective signaling mechanism, which involves the activation of the biosynthesis of a family of lipid mediators in the brain made from omega-3 very-long-chain polyunsaturated fatty acids, that we named Elovanoids (ELVs). The present study evaluated ELVs, made of 32 and 34 C atoms in length (ELV-N32 and ELV-N34) and their potential mechanisms of action in cerebral ischemia.

Methods:
Male Sprague-Dawley rats were subjected to 2 h of middle cerebral artery occlusion (MCAo). Sodium salts (Na) or methyl esters (Me) ELVs were dissolved in artificial CSF and administered into right lateral ventricle at 3 h after onset of stroke. There were five groups: ELV-N32-Na, ELV-N32-Me, ELV-N34-Na, ELV-N34-Me (5μg/50μl), and CSF (50μl). Neurological function was evaluated on days 1, 3, and 7 after MCAo.
Ex vivo
MRI and immunohistochemistry were conducted on day 7.

Results:
All ELV treatments greatly improved neurologic scores in a sustained fashion up to the 7-day survival period. Ischemic core and penumbra volumes (computed from T2WI) were significantly reduced by all ELV treatments, and total lesion volumes were significantly reduced by ELV-N32-Na, ELV-N32-Me, ELV-N34-Na, and ELV-N34-Me compared to CSF-treated group (by 60%, 56%, 99%, and 91%, respectively). ELV-treated rats showed less infarction with an increased number of NeuN- and GFAP-positive cells as well as SMI-71-positive vessels in the cortex and less IgG staining in the cortex. ELV-mediated protection was extensive in the frontal-parietal cortex (tissue was salvaged by 57-96%), subcortex (73-75%), and total infarct volume, correction for brain swelling was dramatically reduced in all ELV-treated groups by 55-91%.

Conclusion:
We have shown that the administration of ELVs provides high-grade neurobehavioral recovery, decreases ischemic core and penumbra volumes, as well as attenuates cellular damage, blood vessel integrity, and BBB disruption.
Abstract WP156: Characterization of Tauopathy in a Rat Model of Post-Stroke Dementia Combining Acute Infarct and Chronic Cerebral Hypoperfusion
Authors: Kim Hahn Young , Chung Pil-Wook
Published: June 2021

Post-stroke dementia (PSD) is a major neurodegenerative consequence of stroke. Tauopathy has been reported in diverse neurodegenerative diseases. We investigated cognitive impairments and pathomechanisms of tauopathy in a rat model of PSD by modeling acute ischemic stroke and underlying chronic cerebral hypoperfusion (CCH) in the same animal. We performed middle cerebral artery occlusion (MCAO) surgery in rats, to mimic acute ischemic stroke, followed by bilateral common carotid artery occlusion (BCCAo) surgery, to mimic CCH. We performed behavioral tests and focused on the characterization of tauopathy through histology. Parenchymal infiltration of cerebrospinal fluid (CSF) tracers after intracisternal injection was examined to evaluate glymphatic clearance. In an animal model of PSD, cognitive impairment was aggravated when BCCAo was superimposed on MCAO. Tauopathy, manifested by tau hyperphosphorylation, was prominent in the penumbra when CCH was combined with acute ischemic stroke. Synergistic accentuation of tauopathy was more evident in the white matter. Oligodendrocytes and some neurons were colocalized with tau hyperphosphorylation. Parenchymal infiltration of CSF tracers was attenuated in the PSD model. Our experimental results suggest that CCH may aggravate cognitive impairment and tau hyperphosphorylation in a rat model of PSD by interfering with tau clearance through glymphatic pathway. Therapeutic strategies to improve clearance of brain metabolic wastes, including tau, may be a promising approach to prevent PSD after stroke.
Abstract WP158: Maximum Tolerated Dose of Exosomes Derived From Mesenchymal Stem Cells via Intra-Arterial Dosing in a Rat Stroke Model
Authors: Watanabe Mitsuyoshi , Nishimura Kengo , Bellio Michael , Khan Aisha , Hare Joshua M , Perez-Pinzon Miguel , Raval Ami , Yavagal Dileep R
Published: June 2021

Background:
Recent preclinical studies of stroke recovery have explored the possibility of utilizing exosomes (ES) instead of complete cells as therapeutic agents. ES are endosomal origin small-membrane vesicles with a size of 40 to 100nm in diameter, secreted from many types of cells including mesenchymal stem cells (MSCs). ES-encapsulated transfer of miRNAs promotes neurite remodeling and functional recovery of stroke in rats. The optimal route of delivery of ES in stroke is not established. While a few studies have shown efficacy of intra-venous exosomes administration for stroke, there is one study exploring intra-arterial exosome therapy (IAX) with single dose of 100ug exosomes. We propose intra-arterial delivery of exosomes in a dose escalation study to establish safety and early efficacy.

Methods:
Female ovariectomized Sprague-Dawley rats were exposed to MCAo for 90 min. Rats were treated with IAX (10, 50 and 100ug/0.5mL), IAMSCs (1x10
5
cells/0.5mL) or IA phosphate-buffered saline (IAPBS) at 1 day (1D) after MCAo. To test neurological and motor function, the standardized neurobehavioral test battery and the rotarod test were performed. The mean duration (in seconds) on the device was recorded from 3 rotarod measurements. The rats were tested at pre-surgery, 7, 15 and 30 days post-MCAo.

Results:
There was no neurological worsening or mortality post IA exosome delivery at any dose tier. The Neurological deficit score of IAX 10ug treatment group at POD 7, 15 and 30, and IAX 50ug treatment at POD 15 were significantly improved in comparison to IA PBS. IAX 10ug treatment group showed trend of improvement in motor coordination compared to the IA PBS/MSC/higher doses of exosome treatment groups.

Conclusions:
The Neurological deficit scores of IAX 10ug treatment group were significantly improved in comparison to IA PBS. Lower dose than previously published might be most effective, and noninferior to IA-MSCs.
Abstract WP159: FPS-ZM1 Alleviates Neuroinflammation in Focal Cerebral Ischemia Rats via Blocking the RAGE/DIAPH1/NF-kappa B Pathway
Authors: Shen Lingling , Lu Dan , Xu Anding , Li Keshen
Published: June 2021

Introduction:
The receptor for advanced glycation end-products (RAGE), belonging to the cell surface immunoglobulin superfamily, is a multi-ligands receptor. It is reported that RAGE plays a crucial role in neuroinflammation and neurodegeneration diseases.

Objective:
In this study, we investigate the pathophysiological effect of RAGE and the therapeutically effect of its specific antagonist FPS-ZM1 in focal cerebral ischemia rats to provide an experimental evidence for the future clinical translational research.

Methods:
Sprague-Dawley male rats were anesthetized to receive the permanent middle cerebral artery occlusion (MCAO) or sham operation. After the operation, four groups of rats, the MCAO+vehicle, MCAO+FPS-ZM1, sham+vehicle and sham+FPS-ZM1 groups, were treated with FPS-ZM1 or vehicle as indicated above. One week later, neurological function was evaluated and then brain tissues were collected, along with 2,3,5-triphenyltetrazolium chloride staining, Nissl staining, TUNEL staining, Western blot and immunohistochemistry.

Results:
Treatment with FPS-ZM1 significantly attenuated the neurological deficit and reduced the infarct areas and necrotic neurons number. More interestingly, FPS-ZM1 decreased the ischemia-induced elevated levels of pro-inflammatory cytokines, inhibited the cell apoptosis and prevented the deposition of amyloid-beta and advanced glycation end products. FPS-ZM1 blocked the increase in RAGE levels and specifically, in levels of DIAPH1, the key cytoplasmic hub for RAGE ligand-mediated activation of cellular signaling. Downstream of RAGE/ DIAPH1, the increase in the protein level of phosphorylated NF-kappa B was also reversed by FPS-ZM1 in focal cerebral ischemia rats.

Conclusion:
These results illuminate that FPS-ZM1 treatment reduce neuroinflammation in focal cerebral ischemia rats and suggest that the RAGE/DIAPH1/NF-kappa B signaling pathway may contribute to alleviation of neuroinflammation by FPS-ZM1 in focal cerebral ischemia rats.
Abstract WP163: Clinical Characteristics of Fast and Slow Progressors of Infarct Growth Due to Anterior Circulation Large Vessel Occlusion
Authors: Rocha Marcelo , Desai Shashvat , Jovin Tudor , Jadhav Ashutosh
Published: June 2021

Background and Purpose:
Inter-individual variability of fast to slow progression of early infarct growth in anterior circulation large vessel occlusion (ACLVO) stroke has been previously well quantified. However, the underlying pathophysiology of these clinical phenotypes remains poorly understood. We aimed to determine clinical and radiographic variables associated with fast or slow progressor phenotypes of ACLVO stroke.

Methods:
Single-center retrospective study of all patients with intracranial ICA or MCA occlusion, with or without tandem cervical ICA occlusion, who underwent baseline advanced imaging including CTP or MRI within 24 hours of stroke onset. Fast progressors (ischemic core > 70 ml, < 6 hours of stroke onset) and slow progressors (ischemic core ≤ 30 ml, > 6 to 24 hours of stroke onset) were identified. Demographics, co-morbidities, admission NIHSS and ACLVO type were tested in univariate and multivariate analysis for association with fast or slow progressor status.

Results:
A total of 185 patients were included with mean age 71 ± 15 and NIHSS 17 ± 7; 60% were female. Patients had occlusion of the MCA in 72% or the intracranial ICA in 28% of cases. Of these, 20% had a tandem cervical ICA occlusion. In the early epoch, there were no significant differences in age, sex, NIHSS, co-morbidities or ACLVO type between fast progressors (n=19) versus controls (n=56). In the delayed epoch, the mean NIHSS was 14±6 in slow progressors (n=61) versus 19±7 in controls (n=49). Slow progressors had MCA occlusion in 80% versus 63% (p < 0.05) and tandem occlusion in 10% versus 35% of controls (p < 0.01). In multivariate logistic regression modeling, age (OR 1.04, 95% CI 1.01-1.07) and NIHSS (OR 0.87, 95% CI 0.81-0.93) but not ACLVO types were independently associated with slow progressor status.

Conclusions:
Although greater frequency of MCA occlusion and absence of tandem cervical ICA occlusion were prevalent amongst slow progressors, only age and NIHSS were independent predictors. Future studies are needed to better characterize the underlying clinical substrates for fast versus slow progression of ACLVO stroke.
Abstract WP171: Are We Correctly Measuring Cerebrovascular Reserve Capacity: A Study on Multiple Sequential Post-Acetazolamide Injection Cerebral Blood Flow Measurements Using Arterial Spin Labeling in a Moyamoya Patient Population?
Authors: Fahlstrom Markus , Enblad Per , Wikström Johan , Lewén Anders
Published: June 2021

Introduction:
Cerebrovascular reserve capacity (CVRC), an important predictor and prognostic factor for patients with moyamoya disease (MMD), can be derived by measuring cerebral blood flow (CBF) before and after administration of acetazolamide (ACZ). Commonly, a single CBF measurement is performed after ACZ injection at a time point varying between 5 to 20 minutes, whereas the dynamic temporal response using sequential CBF measurements has not been studied extensively. Furthermore, current literature reports group averaged CVRCs with high standard deviations indicating a patient-specific CVRC is spread over a wide range of values. The aim of this study was to assess the temporal dynamic response of CBF and derived CVRC during the ACZ challenge using arterial spin labeling in patients with MMD.

Methods:
Ten patients with MMD were included before and/or after revascularisation surgery and examined on a 3T MR scanner. CBF maps, based on 3D-pseudocontineous arterial spin labeling, were acquired before and 5, 15 and 25 minutes after an i.v. ACZ injection and registered to each patient’s 3D-T1-weighted image. A vascular territory template was spatially normalised to patient-specific space, defined by the 3D-T1-weighted image, including bilateral ACA, MCA and PCA. A post label delay of 2500 ms and large regions-of-interests were used to account for possible arterial transit time artefacts. CVRC was calculated as CBF augmentation post-ACZ injection relative to baseline.

Results:
A total of sixteen examinations were analysed. Average peak CBF augmentation occurred at 5 min post-ACZ injection, successively decreasing at 15
-
and 25 min post-ACZ injection
.
CVRC followed a similar pattern. Peak CBF augmentation mostly occurred at 5 min for all vascular regions (frequency distribution 5 min: 64 %, 15 min: 23 %, 25 min: 13 %). Average ratio between CVRC calculated using 15 min CBF augmentation and CVRC using true peak CBF augmentation (5, 15 or 25 min) was 0.80 to 0.90 for all vascular regions.

Conclusion:
CVRC assessed using 15 min as a single post-ACZ injections time point may underestimate CVRC in average by 10 % to 20 % because of individual temporal patient response. The use of multiple post-injection time points is warranted.
Abstract WP173: The Association Between Aortic Arterial Stiffness, Carotid Intima-Media Thickness and Carotid Plaques in Community-Dwelling Older Adults. A Population-Based Study (the Atahualpa Project)
Authors: Del Brutto Victor J , Del Brutto Oscar H , Mera Robertino M , Sedler Mark J , Costa Aldo F , Matcha Gautam , Generale Laura M , Torpey Andrew P , Peralta Leslie D , Hill John P , Rundek Tatjana , Romano Jose G
Published: June 2021

Background:
Information on the associations among arterial stiffness, carotid intima-media thickness (cIMT) and carotid plaques as biomarkers of atherosclerosis is limited. We aimed to assess whether aortic pulse wave velocity (PWV) - as a surrogate of arterial stiffness - is associated with increased cIMT and the presence of carotid plaques in a cohort of older adults of Amerindian ancestry.

Methods:
Atahualpa residents aged ≥60 years (n=320) underwent aortic PWV determinations, and carotid ultrasound for cIMT and plaque assessment. Multivariate models were fitted to assess the independent association between the aortic PWV, and cIMT and carotid plaques (as dependent variables), after adjusting for relevant confounders. Differences in risk factors across these biomarkers were investigated.

Results:
Mean values of aortic PWV were 10.3±1.8 m/s, and those of cIMT were 0.91±0.21 mm (24% had a cIMT >1 mm). Carotid plaques were observed in 118 (37%) subjects. In univariate analyses, risk factors associated with an increased aortic PWV included age, female gender, poor physical activity and high blood pressure. An increased cIMT was associated with age, male gender, poor diet, high blood pressure and severe edentulism. The presence of carotid plaques was associated with increasing age, poor physical activity and high blood pressure. A fully-adjusted generalized linear model showed a significant association between aortic PWV and cIMT (β: 0.028; 95% C.I.: 0.001 - 0.056;
p
=0.047). In contrast, a logistic regression model showed no association between aortic PWV and carotid plaques (OR: 1.14; 95% C.I.: 0.83 - 1.56;
p
=0.423), after adjusting for relevant confounders.

Conclusions:
This study shows an independent association between aortic PWV and cIMT but not with carotid plaques. These biomarkers may indicate distinct phenotypes for atherosclerosis.
Abstract WP180: Measuring Tissue Motion During Carotid Endarterectomy Using Video-based Analyses
Authors: Sugiyama Taku , Ito Masaki , Kazumata Ken , Nakayama Naoki , Houkin Kiyohiro
Published: June 2021

Background:
During carotid endarterectomies (CEA), perioperative stroke and cranial or cervical nerve injuries are the most common major complications. Many experts have emphasized the importance of careful and gentle manipulation around carotid plaques. However, there have been no methodological assessments that quantitatively measure ‘gentleness’. This study was aimed to propose a novel metric for gentle surgical maneuvers during CEA.

Methods:
Using surgical video-based motion software, the motion of the carotid artery around plaque was analyzed and quantified during a CEA. Kinematic parameters (minimum and maximum acceleration, and maximum and mean velocity) were compared among the surgical tasks and techniques, as well as between novice and expert surgeons.

Results:
The surgical tasks of dissecting the common carotid artery, passing the proximal vessel loops, and ligating vessels showed the highest absolute values of kinematic parameters. Dissections perpendicular to the line of the internal carotid artery tended to show higher kinematic parameters than those in the parallel direction, with blunt dissections typically higher than sharp dissections. The kinematic parameters of novice surgeons were significantly higher than those of experts, and receiver operating curve analysis showed a strong discriminative power. The kinematic parameters in the case of postoperative ischemic stroke also showed the highest absolute values.

Conclusions:
This study shows that tissue motion parameters could be a novel and feasible surrogate marker for the objective assessment on the ‘gentleness’ of surgical performance in CEA. Such an objective measurement might be applicable towards enhancing surgical education and risk management.
Abstract WP182: Re-Analysis of Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial Using the New Food and Drug Administration (FDA) “On Label” Criteria
Authors: Walia Sargun S , Huang Wei , Lobanova Iryna , Siddiq Farhan , French Brandi R , Gomez Camilo R , Qureshi Adnan I
Published: June 2021

Background:
Due to higher rates of 1-month stroke and death with Wingspan intracranial stent placement observed in SAMMPRIS, FDA announced a more limited indication for Wingspan stent. We compared the results of intracranial stent placement with best medical treatment in patients who met “on label” criteria with those who were treated as “off label”.

Methods:
Patients recruited in the SAMMPRIS trial were classified as “on label” if: age 22 to 80 years, stenosis of 70%-99%, baseline modified Rankin Scale score ≤ 3, ≥2 ischemic events in the vascular territory of the stenotic lesion with at least 1 ischemic event while on medical therapy, and stent placement ≥8 days after the last stroke. All other patients were classified as “off label”. The primary endpoint was any stroke or death occurring within 30 days of enrollment, or any stroke or death within 30 days of any revascularization procedure of the qualifying symptomatic intracranial artery done during follow-up, OR an ischemic stroke in the territory of the symptomatic intracranial artery from day 31 after study entry to completion of follow-up.

Results:
A total of 31 (6.87%) among 451 recruited patients met the “on label” criteria. The relative risk of primary endpoint was lower in “on label” patients treated with stent placement compared with best medical treatment (RR 0.8, 95 % CI 0.2 - 2.9) but higher in “off label” patients (RR 1.65, 95 % CI 1.0-2.4). Primary endpoint was seen in 20% and 23.4% of patients treated with stent placement in “on label” and “off label” patients, respectively. Primary endpoint was seen in 25% and 14.2% of patients treated with best medical treatment in “on label” and “off label” patients, respectively. In Cox Proportional Hazards analysis with primary endpoint as dependent variable, the interaction between “on label” and treatment (stent versus best medical treatment) was not significant (p=0.6713).

Conclusion:
The new FDA “on label” criteria may identify a group of who may benefit from intracranial stent placement due to higher risk of primary endpoint in those treated with best medical treatment. However, the criteria appears to be very stringent and only a small proportion of patients may meet the “on label” criteria.
Abstract WP19: Reliability of CT Perfusion in the Posterior Circulation in Comparison to the Anterior Circulation
Authors: Adhikari Srijan , Moore Justin , Qureshi Abid Y
Published: June 2021

Background:
DAWN and DEFUSE-3 excluded posterior-circulation cases, but in practice endovascular therapy (EVT) is common due to life-threatening large-vessel occlusions. Often CT perfusion (CTP) is acquired to aid in the decision-making of these cases, but the reliability of using CT perfusion in the posterior-circulation is unknown

Hypothesis:
Given the differences in hemodynamics (~20% of total CBF to the basilar, reduced mean velocity, and differences in collateral supply) penumbra estimates using RAPID software will be less accurate in predicting the final infarct volume on DWI.

Methods:
In patients who did not receive any treatment (tPA or EVT), the Tmax >6s, as operationally defined as penumbra, should approximate the infarct on DWI. As such, only posterior circulation patients without EVT or tPA were included. Anterior circulation patients were matched on demographics, medical history, outcomes. A ratio of Tmax/DWI was calculated to assess how closely perfusion approximated final infarct folume. Nonparametric correlation with Kendall’s tau-b was also performed.

Results:
Eleven patients with a posterior circulation large-vessel occlusion (pc-LVO) were compared to 30-matched patients with anterior circulation (ac-LVO). Age was 62.4±16 for ac-LVO vs. 64.5±13 for pc-LVO. Significant differences were seen in sex with ac-LVO 82% male, and pc-LVO 46% male (t=-2.06 p=0.046). Pc-LVO also had more subjects with an unknown last known well. Mean admission NIHSS was 15.6±8 ac-LVO, and 16.4±10 in pc-LVO group was similar. Mean discharge NIHSS was 12.6±9 ac-LVO vs 12.4±10 pc-LVO. NO signficicant difference in 30d mRS, 24h NIHSS, or mortality within 90d. As excpected in the anterior circulation cases final infarct volume correlated with Tmax>6s Kendall’s tau-b=0.57 (p=0.000013), and Tmax>8s (tau-b=0.55), Tmax>10s (tau-b=0.55. Whereas, In the posterior circulation Tmax>6s (tau-b=0.41, N.S.), but Tmax>8s (tau-b=0.64, p=0.007) and Tmax>10(tau-b=0.69, p=0.005). Seen another way the ratio of Tmax>6s:DWI = 2.47 (ac-LVO) vs 5.84 (pc-LVO) (t=-1.22, p=0.004, but Tmax>8s 1.57 vs 1.50 (t=0.11, p=9.12).

Conclusion:
Final infarct volume was not significantly associated with Tmax>6s in posterior circulation cases. Instead Tmax>8s is more reliable.
Abstract WP198: Assessment of Changes in Muscle Mass, Strength, and Quality and Activities of Daily Living Among Stroke Patients
Authors: Irisawa Hiroshi , Mizushima Takashi
Published: June 2021

Introduction:
After stroke, paralysis reduces muscle strength on the affected side. The lost muscle strength can be partially restored through stroke rehabilitation. However, even if muscle strength is restored, it is not clear whether muscle mass and quality improve. In recent years, it has become possible to measure muscle mass noninvasively using bioelectrical impedance analysis. Additionally, it is known that the phase angle measured by bioelectrical impedance analysis reflects muscle quality. We measured changes in muscle strength, mass, and quality using a hand dynamometer and bioelectrical impedance analysis in patients undergoing rehabilitation after stroke and examined their relationships with activities of daily living (ADLs) improvement.

Hypothesis:
Post-stroke rehabilitation improves muscle strength, mass, and quality, as well as ADLs.

Methods:
This retrospective study was performed at two stroke rehabilitation units from January 2017 to March 2019. Muscle mass and quality were assessed using bioelectrical impedance analysis. ADLs were assessed using the functional independence measure (FIM). We measured the grip strength of the non-affected and affected sides as muscle strength. Each measurement was performed at admission and 4 weeks later. We assessed changes in motor FIM items and examined relationships among data.

Results and Conclusions:
This study included 179 patients (mean age, 75.5±13.0 years; male/female, 89/90; mean duration after stroke, 27.6±8.7 days). Patients received stroke rehabilitation (159.8±21.6 min/day) 7 days a week individually. Muscle strength and quality significantly increased after 4 weeks on both the non-affected and affected sides. Muscle mass decreased, but there was no significant difference. The results were similar when analyzed by sex. Changes in muscle strength and quality were significantly correlated with ADLs improvement (r=0.56 and 0.43, respectively), but muscle mass was not correlated with ADLs improvement. Thus, post-stroke rehabilitation improves muscle strength and quality, as well as ADLs. Muscle mass is not appropriate to measure the effects of stroke rehabilitation, and it is desirable to instead use muscle strength and quality to assess stroke rehabilitation.
Abstract WP200: Robot-assisted Arm Training in Subacute Hemiplegic Stroke Patients
Authors: Kim Hyun Jung , Jo Ye Jin , Kim Jun Yup , Hong Jun-taek , Kim Deog Young
Published: June 2021

Background and Aims:
Robotic rehabilitation therapy has been tried as a novel technology in field of upper extremity rehabilitation of stroke patients. However, the previous trial revealed the additional effect of robotic therapy compared to conservative therapy. We aimed to investigate whether the same intensity robot-assisted arm training(RAT) was more effective on the recovery of motor and improvement of upper limb function than conventional occupational therapy(COT) in subacute first-ever hemiplegic stroke patients (Fig.1).

Methods:
The clinical assessment included Fugl-Meyer Assessment(FMA), Motricity Index(MI), Functional Independence Measure(FIM), Motor Function Test(MFT), Wolf Motor Function Test(WMFT), Trunk Control Test(TCT), Maximal Voluntary Torques(MVT), Visual Analogue Scale(VAS) for pain, and Active Range of Motion(AROM). The repeated measures ANOVA was used to compare the results of longitudinal analyses between two groups (SPSS Inc., Chicago, IL, USA).

Results:
The all parameters measured at baseline did not differ between two groups. Both groups showed significant improvements in FMA, MI, FIM, MFT, WMFT, TCT, MVT, and AROM after treatment (P<0.05). However, the results of longitudinal analyses during the 8-week study period did not show significant difference between two groups except VAS in AROM (p=0.011) and AROM of shoulder adduction (p=0.032) (Table 1).

Conclusions:
This study did not agree that robot-assisted arm training combined with conventional occupational therapy in subacute post-stroke hemiplegic patients may be superior to the same intensity conventional occupational therapy.
Abstract WP202: Decompressive Hemicraniectomy After Malignant Middle Cerebral Artery Ischemic Stroke in a Developing Country is Associated With Poor Long Term Functional Outcome and High Mortality
Authors: Homem Hellen C , Montalverne Francisco J , Carvalho Fernanda M , Ramos Junior Francisco , Ramos Heitor F , Ferreira Thiago S , Lima Fabricio O
Published: June 2021

Background:
Decompressive hemicraniectomy (DH) is a level IA therapy for malignant middle cerebral artery (MCA) infarction. However, randomized trials were performed in high income countries with better access to post-stroke care and rehabilitation services. We aimed to assess long term functional outcome and the associated prognostic factors of patients undergoing DH in Brazil.

Methods:
From January 2013 and July 2018, all patients undergoing DH for malignant MCA infarction in a single comprehensive stroke center were retrospectively identified. Outcomes were the modified Rankin Scale (mRS) (dichotomized as ≤ 4 vs. > 4) and mortality at follow-up. The mRS at follow-up was collected prospectively by telephone using a validated structured interview. Logistic regression analysis was performed to assess independent predictors of outcome.

Results:
Eighty patients who underwent DH for malignant MCA infarction were identified. Age ranged from 16 to 78 years (median 48 years, IQR 42 - 54,7 years), 46 (57.6%) were males and median time from stroke onset to hemicraniectomy was 30.75 hours (IQR 17.8-46.0). Hospital discharge mRS ≤ 3 and ≤ 4 was observed in 5 (6.2%) and 74 (92,5%) patients respectively. Follow-up information was available for 65 (81.2%) patients. At follow-up (raging from 1.1 to 5.6 years), mRS ≤ 4 was observed in 23 (35.3%) patients. In binary logistic regression analysis, age (OR 1.09, 95% CI 1.02 - 1.17, p=0.01), and right MCA infarction (OR 16.70, 95% CI 1.8-152.30, p=0.01) were independently associated with a worse functional outcome at follow-up. Admission NIHSS (OR 1.0 ,95% CI 0.8-1.3, p=0.45), IV rt-PA (OR 0.5, 95% CI 0.08-3.00, p=0.46) or time of hemicraniectomy (OR 1.00, 95% CI 1.00 - 1.00, p=0.94) were not associated with functional outcome at follow-up. Mortality was 26% (N=21) at hospital discharge and 46% (N=30) at follow-up.

Conclusion:
The large effect size of DH for malignant MCA infarction is significantly diminished in the population of patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. Poor access to post-stroke care and rehabilitation services might be possible reasons for the results observed.
Abstract WP203: National Institute of Neurological Disorders and Stroke Common Data Elements: Public Review and Updates to the Stroke Recommendations
Authors: Gay Katelyn , Collie Damon , Sheikh Muniza , Esterlitz Joy , Saver Jeffrey , Warach Steven , Wright Clinton B , Mendoza-Puccini Maria Carolina , Janis Scott ,   Stroke V2.0 CDE Working Group
Published: June 2021

Objective:
The National Institute of Neurological Disorders and Stroke (NINDS) initiated the Common Data Element (CDE) project to provide standardized clinical research data collection formats that increase the efficiency and effectiveness of studies and reduce start-up time, as well as improve data quality and facilitate and accelerate data sharing. In 2010, Stroke-specific CDEs were posted on the NINDS CDE website. The Stroke Oversight Committee (OC) reviewed Core CDEs in 2015; and in 2018, recommended that Stroke CDEs undergo a comprehensive review and update to Version 2.0.

Background:
In August 2018, a Stroke V2.0 Working Group (WG) consisting of over 50 worldwide subject matter experts was convened by NINDS. The WG was asked to review all current Stroke CDEs and subarachnoid hemorrhage and unruptured cerebral aneurysms (SAH) CDEs (developed in 2017) for harmonization and inclusion within Stroke V2.0.

Methods:
The Stroke V2.0 WG divided into eight domain-specific subgroups: Biospecimens, Biomarkers, and Laboratory Tests; Hospital Course and Acute Therapies; Imaging; Long Term Therapies; Medical History and Prior Health Status; Outcomes and Endpoints; Stroke Presentation and Vital Signs; and Stroke Types and Subtypes. Subgroups met regularly to review, revise and add to the existing Stroke CDEs based on developments in stroke research. Following an internal WG review, a public review of the draft updates will be held. The WG will consider public feedback before V2.0 is finalized. The Stroke OC plans to review the project status at the 2020 International Stroke Conference.

Results:
The Stroke V2.0 CDE recommendations will include updated and new template case report forms, data dictionaries, instrument informational documents and guideline documents. The updates will reflect the current state of science, streamline CDE recommendations, and incorporate SAH CDEs. Stroke V2.0 CDEs will be available on the NINDS CDE website in 2020.

Conclusions:
The NINDS CDEs are periodically revised as research progresses. Through the update of the Stroke CDEs to V2.0, the initiative strives to maintain the utility of CDEs as a valuable clinical research resource. NINDS encourages use of CDEs to standardize research data collection across studies.
Abstract WP207: Current Incidence, Epidemiological and Clinical Characteristics of Reversible Cerebral Vasoconstriction in the United States
Authors: Patel Smit D , Oliver Otite Fadar , Lima Jussie , Khandelwal Priyank , Ollenschleger Martin
Published: June 2021

Background:
There is a paucity of contemporary data on incidence, epidemiological and clinical characteristics of reversible cerebral vasoconstriction syndrome (RCVS) in the United States. This study aimed to address these gaps in knowledge.

Method:
All patients with a primary and secondary diagnosis of RCVS were identified from the 2016 National Readmissions Database (n=1,152) using International Classification of Disease-10 code I67.841. Unique patients were defined using the NRD’s unique patient identifier. Overall and sex-specific incidences of RCVS were computed by combining RCVS counts with the 2016 US census population data. RCVS comorbidities, complications and outcome were presented using descriptive statistics.

Result:
The overall incidence of RCVS per million population (SE) was 4.62 (0.14) but the incidence in women 7.20 (0.24) was nearly four times that of men 1.91(0.13). Mean age (SE) was 47.2(0.9) but up to 87% of patients were < 65 years. Most common comorbidities seen in these patients were hypertension 51.7%, diabetes 19.3%, hyperlipidemia 25.4%, inflammatory disorders 20.7%, pregnancy 7.6%, postpartum 8.6%, and preeclampsia-eclampsia conditions 4.4%. Illicit drug abuse was nicotine 24.2%, cannabis 7.7%, alcohol 3.1% and cocaine 1.1%. A cerebral angiogram was documented in 25.1% of cases, and spinal tap in 16.3%. Most common associated complications included subarachnoid hemorrhage 21.3%, migraine 18.6%, ischemic stroke 14%, intracerebral hemorrhage 8.6%, epilepsy 9.3%, brain edema 7%, PRES 6.7%, and thunderclap headache 5.9%. Majority of patients were admitted to urban 88% and larger bedside hospital 60%. Majority of patients have private insurance 46% followed by Medicaid 24% and Medicare 23%. Average inpatient cost ($) was 25,135 ± 1,690.9 and length of Stay (Days) was 8.0 ± 0.4. Excellent outcomes were reported including 71% discharge to home, 14% of patients were discharged to a facility and in-hospital mortality was rare (0.4%).

Conclusion:
RCVS is still rare in the US but the current incidence in women is almost four times that of men. Subarachnoid hemorrhage appears to be the most common documented comorbidity but in-hospital mortality is rare.
Abstract WP210: Preventability of Stroke Due to Large Vessel Occlusion Treated With Thrombectomy
Authors: Suzuki Shuichi , Nguyen Brandon , Lara Wadi , Moores Lisa , Kim Jeein , Yuki Ichiro , Xu Jordan , Paganini Hill Annlia , Fisher Mark
Published: June 2021

Background and Objective:
Mechanical Thrombectomy (MT) is standard treatment for stroke due to large vessel occlusion (LVO). However, extent of preventability of these strokes is generally not addressed. This study analyzes stroke preventability for patients treated with MT for LVO.

Subjects and Methods:
We conducted retrospective analyses of stroke patients treated with MT for LVO at UC Irvine Medical Center from June 2008 to March 2019. We obtained data including age, NIH Stroke Scale (NIHSS) at onset, and (beginning in 2015) 90-day outcome measured by modified Rankin Scale (mRS). We used the Stroke Preventability Score (SPS, 0-10 points) from our prior work (JAMA Neurology 2016, 73:186), based on how well patients had been treated given their hypertension, hyperlipidemia, atrial fibrillation, and prior stroke history. We examined associations of SPS with age, NIHSS at onset, and mRS.

Results:
For 301 patients treated with MT for LVO, mean ± standard error of age was 60±0.1 years (range 18-97) and NIHSS was 17±0.4 (range 0-37, n=282); one-third (n=96) were male. SPS was calculated for 273 patients, with mean±SE 2.1±0.1 (range 0-8). Over two-thirds (n=184, 67%) demonstrated some degree of preventability (SPS 1 or higher), while 23% (n=64) showed high stroke preventability (SPS 4 or higher). Among 119 patients with mRS data, stroke preventability was associated with age (66±2.5, 69±2.4 and 79±1.7 years for no, low and high SPS, respectively; p<0.002). Stroke preventability was also associated with NIHSS at onset (15±1.3, 16±0.9, and 20±1.4 for no, low and high preventability, respectively; p<0.04). SPS was significantly correlated with age (r=0.33, p<0.0002), NIHSS (r=0.29, p=0.002), and mRS (r=0.22, p=0.02). The partial correlation coefficient for SPS remained significant after adjusting for age and NIHSS.

Conclusion:
Nearly one-quarter of patients, with LVO treated with MT, presented with strokes that were highly preventable. High stroke preventability tended to be seen in older patients, patients with more severe deficits, and (to a lesser extent) patients with poor outcome. While most acute stroke treatment efforts focus on streamlining workflow, these findings demonstrate the enduring importance of stroke prevention in this patient population.
Abstract WP213: Association Between Thoracic Aorta Surgery and Long Term Risk of Stroke in Adults
Authors: Huq Tashfin , Simonetto Marialaura , Navi Babak B , Kamel Hooman
Published: June 2021

Introduction:
Thoracic aorta surgery carries a risk of perioperative stroke, but the long-term incidence of stroke after the perioperative period in these patients remains unclear. We therefore assessed the long-term risk of stroke in patients who underwent thoracic aorta repair.

Methods:
We performed a retrospective cohort study using 2008-2015 claims data from a nationally representative 5% sample of Medicare beneficiaries. Our exposure of interest was thoracic aorta surgery, defined using
ICD-9-CM
hospital procedure codes for endovascular graft implantation (39.73) or surgical resection and replacement (38.45). Our primary outcome was ischemic stroke, defined using previously validated
ICD-9-CM
diagnosis codes. Patients with stroke during the index surgical hospitalization were excluded, since our focus was on long-term stroke risk after the perioperative period
.
Cox proportional hazards analysis was used to examine the association between thoracic aorta surgery and stroke risk after adjustment for demographics and vascular risk factors. Given a clear violation of the proportional hazards assumption, we calculated period-specific risk estimates.

Results:
Among 1,751,719 beneficiaries (mean age 73 ±8 years), 1,402 underwent thoracic aorta repair. During 4.6 ±2.2 years of follow-up, 62,702 patients were diagnosed with ischemic stroke. The incidence of stroke was 1.24% (95% CI, 0.93-1.66%) per year after thoracic aorta repair compared to 0.77% (95% CI, 0.76-0.78%) per year in patients without thoracic aorta surgery. In adjusted models, there was an increased risk of stroke in the first 120 days after discharge from thoracic aorta surgery (HR, 2.1; 95% CI, 1.2-3.7), but no heightened risk was seen beyond 120 days after discharge from surgery (HR, 0.7; 95% CI, 0.5-1.0).

Conclusions:
In a large sample of Medicare beneficiaries, thoracic aorta surgery was associated with an increased risk of ischemic stroke in the first 120 days after hospital discharge, but there was no excess risk beyond that time point.
Abstract WP221: Very Brief Intervention Improves Stroke Response in a Randomized Trial: Stroke Ready Very Brief Intervention
Authors: Skolarus Lesli E , Cielito Robles Maria , Mellanie Springer , Lin Chun Chieh , Corches Casey , Oliver Alina , Burke James
Published: June 2021

Introduction:
Stroke pre-hospital delay has not improved over time.

Hypothesis:
Stroke Ready, a very brief (5 minute), theory based, peer-led, stroke preparedness intervention, will increase stroke response compared with a control intervention.

Methods:
We performed a randomized, single-blind controlled trial among adults in Flint, MI. The stroke preparedness intervention group received a Stroke Ready pamphlet and action plan, while the control group received stroke prevention materials - both delivered during a one-to-one interaction with a trained peer educator. Research staff, blinded to group intervention assignment, assessed baseline and immediate post-intervention outcomes. Primary outcome was change in stroke response (behavioral intent to call 911) using a community-modified stroke action test (range 0-12). Secondary outcome was change in stroke symptom recognition (range 0-8). We conducted descriptive analyses and used a linear regression model to evaluate the effect of the intervention on stroke response after adjustment for pre-intervention intent, age, education, race, marital status, history of stroke, stroke in someone they know and psychological constructs.

Results:
We enrolled 129 participants (74 intervention; 55 control). Mean age was 60 years (SD 14); 61% were women, 89% were African American and 19% were not high school graduates. Intervention participants had greater improvement in stroke response than control participants (figure 1), which remained after full adjustment (improvement in average score for stroke response was 1.7 higher in intervention participants than control participants, 95% CI 0.9-2.5, p<0.0001). There was no difference in stroke symptom recognition (figure 1).

Conclusion:
The Stroke Ready very brief intervention increased stroke response. This new approach using a very brief, one-to-one interaction with trained peer educators is a promising, scalable, intervention to increase stroke response.
Abstract WP225: Fetal-Type Posterior Cerebral Artery: A Not So Benign Anatomical Variant?
Authors: Strecker Nico , Kahles Timo , Kubacka Marta , Tissira Nadir , Garcia Esperon Carlos , Findling Oliver , Gruber Philipp , Remonda Luca , Nedeltchev Krassen
Published: June 2021

Introduction:
The fetal-type of the posterior cerebral artery (ftPCA) is a remnant of the embryonic cerebral vasculature and describes a predominant supply of the PCA territory by a branch of the internal carotid artery. It is usually considered a benign anatomical variant with a prevalence ranging between 3% and 40%. Given the larger supply of the brain parenchyma by the anterior circulation in this variant, ftPCA is often associated with a hypoplastic basilar artery and thus a reduced vertebrobasilar blood flow.

Hypothesis:
Attenuated blood flow through the vertebrobasilar system in patients with a ftPCA is associated with an increased risk of infratentorial ischemic stroke.

Methods:
We prospectively analyzed 625 consecutive acute stroke patients from our comprehensive stroke center. Cerebral MRI was used to identify stroke location. PCA territory blood supply was classified in 5 subcategories using CT or MRI angiography: 1) total ftPCA (i.e. complete supply via PCOM); 2) predominant ftPCA; 3) balanced PCA (supply via PCOM and P1); 4) predominant P1, and 5) complete P1 supply. Variants 1) and 2) were considered ftPCA for further analysis. We compared the frequencies of anterior, posterior, infratentorial, and multiple territories strokes between patients with and without ftPCA.

Results:
There were 215 patients (34%) with ftPCA. Patients with ftPCA were significantly more likely to suffer from an infratentorial stroke than those without the ftPCA variant (20% vs 12.2%, P = 0.009). In contrast, anterior, posterior, and multiple territories stroke did not differ between groups. When posterior territory strokes were attributed to the corresponding P1 or PCOM supply, there was no difference in the frequency of vertebrobasilar stroke (i.e. infratentorial plus P1-PCA) between patients with and without ftPCA (P=0.864). Mean cross sectional area of the basilar artery was significantly lower in patients with ftPCA compared to those without ftPCA (6.6mm2 vs. 9.7mm2, P<0.001).

Conclusion:
Fetal-type PCA is associated with a higher frequency of infratentorial stroke and a lower cross sectional area of the basilar artery. Possibly, hemodynamic factors influence infratentorial stroke risk in patients with ftPCA.
Abstract WP230: Stroke Characteristics and Outcomes in Patients With Current Generation Centrifugal Flow Left Ventricular Assist Devices
Authors: Inamullah Ovais , Chiang Yuting , Weiss Martin , Lutz Michael , Milano Carmelo , Blue Laura , Luedke Matthew , El-Husseini Nada
Published: June 2021

Introduction:
Stroke is a devastating complication of left ventricular assist device (LVAD) therapy and a leading cause of mortality in this group. The newer HeartMate (HVAD, 2012) and HeartMate 3 (HM3, 2017) devices use a continuous flow centrifugal pump with a magnetically levitated rotor that may cause less thrombosis and stroke. We aim to compare the rate and severity of strokes in the setting of the new generation LVADs.

Methods:
This was a single-center retrospective cohort study at a single US academic medical center. The cohort includes all subjects at Duke University Medical Center who received either an HM3 or HVAD LVAD between September 2009 through February 2018 and had a cerebrovascular accident while the LVAD was in place. Descriptive statistics were calculated to compare the clinical variables for individuals receiving either the HVAD or HM3 device. 95% confidence intervals were calculated when appropriate.

Results:
A total of 163 HVAD patients and 84 HM3 patients were included in the analysis. Strokes occurred more commonly among those with HVAD (14.7%, 9.7%-21.1%) compared to those with HM3 (6.0%, 2.0%-13.3%). About 62.1% of strokes were ischemic. Patients with HM3 were older and had a higher rate of cardiovascular risk factors. The initial mean NIHSS was higher in HM3 patients (24.6, 11.9-37.3) compared to those with HVADs (16, 10.9-21.1). Mortality within 30 days was higher in HM3 patients (60.0%, 14.7%-94.7%) compared to HVAD patients (45.8%, 25.6%-67.2%). Patients were more likely to be disabled (mRs> 3) at 3 months if they had an HM3 (80%, 28.4%-99.5%) compared to those who had an HVAD (54.2%, 32.8%-74.4%).

Conclusion:
Strokes occurred more commonly among those with HVAD compared to HM3, but the strokes in those with HM3 tended to be more severe at onset compared to HVAD with a higher 30 days mortality and more disability at 3 months. The difference in stroke frequency may suggest that the HM3 is less prone to thrombosis. The difference in mortality may have been secondary to patients with HM3 being older and with more cardiovascular risk factors or could be related to a reduction in minor strokes causing a shift to worse outcomes. Additional studies are needed to understand the predictors of stroke in the setting of the new generation LVADs.