bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T MP102: Antithrombotic Therapy After Acute Ischemic Stroke in Patients With Atrial Fibrillation
Authors: McGrath Emer R , Kapral Moira K , Fang Jiming , Eikelboom John W , O Conghaile Aengus , Canavan Michelle , O'Donnell Martin J ,   Ontario Stroke Registry
Published: March 2022

Background:
For patients with atrial fibrillation (AF) and ischemic stroke (IS), current guidelines recommend oral anticoagulation (OAC) alone for secondary stroke prevention. In a large prospective cohort of patients with acute IS and AF, we describe adherence with antithrombotic guidelines at hospital discharge and the association between antithrombotic regimen on discharge and risk of major vascular events and bleeding.

Methods:
Consecutive patients admitted with acute IS and AF included in the Registry of the Canadian Stroke Network (Jul 03-Mar 08). Multivariable Cox proportional hazards models were used to determine the association between antithrombotic regimen on discharge and time to the composite of death or readmission for recurrent stroke, myocardial infarction or major bleeding.

Results:
2,162 patients were hospitalized with acute IS and AF; 42% had severe stroke (mRankin 4-5 on discharge) and 29% had prior coronary heart disease (CHD). Median duration of follow-up was 3.3 (IQR 1.0-5.4) years. At discharge, 8.0% were prescribed no antithrombotic therapy, 21.6% antiplatelet (AP) alone, 39.3% OAC alone and 31.1% combination OAC and AP. Compared to OAC alone, no antithrombotic (HR 1.51, 95% CI 1.23-1.86) and AP therapy (HR 1.31, 95% CI 1.14-1.50), were associated with an increased risk of the primary outcome, while combination OAC and AP was associated with a trend towards a reduced risk of the composite (HR 0.91, 95% CI 0.80-1.04). No antithrombotic (HR 1.23, 95% CI 0.80-1.90) and AP therapy alone (HR 1.13 95% CI 0.86-1.48), were associated with a trend towards an increased risk of admission for a thrombotic event (recurrent IS or MI), while combination OAC and AP was associated with a trend towards a reduced risk (HR 0.85, 95% CI 0.66-1.09), compared to OAC alone on discharge. Results were consistent in subgroups with severe stroke. In those with CHD, use of OAC and AP was associated with a suggestion of a reduced risk of the composite (HR 0.79, 95% CI 0.61-1.02).

Conclusions:
Following IS in patients with AF, 30% of patients are not managed according to current antithrombotic guideline recommendations. Compared to antiplatelet therapy, OAC on discharge reduces the composite of mortality and major vascular events, even in patients with severe stroke.
Abstract T MP112: Cerebral Infarction and Brain Arterial Pathology in Hiv: Results From the Brain Arterial Remodeling Study (bars)
Authors: Gutierrez Jose , Elkind Mitchell S , Pizzirusso Maria , Goldman James , Chon Christina , Murray Jacinta , Dwork Andrew J , Morgello Susan , Marshall Randolph S
Published: March 2022

INTRODUCTION:
Individuals with HIV live longer since the advent of antiretroviral (ARV) drugs. However, aging with HIV is now associated with vascular disease. Mechanisms underlying this association have not been fully elucidated. We explored arterial correlates that might lead the association between HIV and cerebral infarction.

Methods:
The Brain Arterial Remodeling Study (BARS) is a collection of 336 brains from donors in the US (69%) and Macedonia (31%) from which large brain arteries have been collected, cut, embedded and stained with H&E and van Gieson. Atherosclerosis and stenosis were graded using Glagov’s method. Cerebral infarction was identified in autopsy. For this analysis, HIV cases (n=138) were age- and sex-matched to controls without HIV. Multivariate logistic and linear regressions were used to determine odds ratios and 95% confidence intervals (OR, 95% CI) assessed associations at P< 0.05.

Results:
Those with HIV (mean age 48.8 ± 9.1 years, 75% men) were more likely to be black (OR 5.0, 2.4-10.4) or Hispanic (OR 2.2, 1.2-3.9), hypertensive (OR 2.2, 1.3-3.5), dyslipidemic (OR 3.5, 1.1-11.0), cocaine users (OR 10.1, 4.6-22.4) and have cardiac disease (OR 2.0, 1.2-3.5). Cerebral infarction was more common with HIV (adjusted OR 2.8, 1.1-6.8). HIV brains were less likely to have atherosclerosis (OR 0.4, 0.3-0.7) or any stenosis > 25% (OR 0.4, 0.1-1.0). Among those with HIV, after adjusting for demographic and vascular risks, cerebral infarction was more prevalent with prior opportunistic infections (5.3, 1.2-22.9), higher CD4 count (OR 1.2, 1.0-1.4 per every 50 CD4 cell increment), and in those with intimal thickening in more than 75% of the lumen circumference (OR 4.0, 1.1-14.5). Predictors of circumferential intimal thickening in the HIV group included ARV at death (Beta 0.17, P=0.007), internal elastic lamina (IEL) gaps, Beta 0.22, P=0.02), and IEL duplication (Beta 0.28, P=0.001).

CONCLUSIONS:
Individuals with HIV in this study have a greater prevalence of vascular risks and cerebral infarction, yet the increased infarction prevalence is not associated with atherosclerosis. Patients with HIV have a non-atherosclerotic arterial phenotype consisting of circumferential intimal thickening with disruption of the internal elastic lamina.
Abstract T MP115: Association Between Cerebral Large/Small Vessel Disease and Incident Dementia in Patients with Vascular Risk Factors - Sub-analysis of OSACA2 follow-up study
Authors: Kitagawa Kazuo , Miwa Kaori , Yagita Yoshiki , Okazaki Shuhei , Sakaguchi Manabu , Mochizuki Hideki
Published: March 2022

Background and Purpose:
Involvement of vascular risk factors on dementia has attracted much attention. Several prospective studies have shown that the presence of cerebral small vessel disease (SVD) is associated with incident dementia. However, the significance of cerebral large vessel disease (LVD) on dementia development has not been examined thoroughly.

Methods:
OSACA2 is a prospective cohort study for cardiovascular events and dementia in which patients with vascular risk factors undergo carotid ultrasound and blood sampling. Between 2001 and 2009, 1106 outpatients were enrolled. Among them, 600 patients who underwent brain MRI and had normal cognitive function were included in this study. Follow-up data for dementia occurrence were collected in June 2011. Baseline MRI was used to determine lacunar infarction as a sign of SVD. The presence of carotid stenosis as a sign of cerebral LVD was defined with 50% or more stenosis in carotid ultrasound.

Results:
Among 600 subjects (mean: 68 years, male: 57%), 264 patients (44%) had lacunar infarction, and 94 patients (16%) showed carotid stenosis. During the follow-up period of median 7.5 years, 50 patients had incident dementia (24 AD, 18 vascular dementia, 5 mixed type, 3 others). The presence of lacunar infarction had close association with dementia in Kaplan-Meier plots analysis (
p
<0.001). The association remained significant after adjustment with modifiable factors including history of stroke, APOE genotype and education year (HR:2.20, 95% CI [1.11-4.53]). However, the presence of carotid stenosis was not associated with incident dementia (
p
value=0.07).

Conclusion:
This study suggested that carotid stenosis have little association with future dementia while lacunar infarction had significant association. The impact of SVD on dementia could be much greater than that of cerebral LVD.
Abstract T MP120: Bone Morphogenic Protein Expression in Pericytes Is a Pathological Correlate of Vascular Cognitive Impairment
Authors: Uemura Maiko , Ihara Masafumi , Nagatsuka Kazuyuki , Kinoshita Ayae , Takahashi Ryosuke
Published: March 2022

Introduction:
Signaling abnormalities in transforming growth factor beta 1 (TGFβ1) are thought to play a detrimental role in pathogenesis of stroke and CARASIL, a hereditary type of vascular cognitive impairment (VCI). The largest group of TGFβ superfamily members, bone morphogenic proteins (BMPs), is known to contribute to pro-atherogenic phenotypic alterations in blood vessels or to play a detrimental role in neonatal hypoxia-ischemia. However, a comprehensive pathological analysis of BMPs in VCI and its comparison with Alzheimer’s disease (AD) has not been conducted.

Hypothesis:
We assessed the hypothesis that BMPs play a crucial role in pathogenesis of VCI.

Methods:
We evaluated post-mortem frontal lobe tissue from 7 VCI (mean ± SD, 80.9 ± 6.0 years old; brain weight, 1101 ± 89.9 g), 6 AD (81 ± 8.0 years old; 1056 ± 67.7 g), and 6 age-matched disease controls (73.8 ± 4.5 years old; 1190 ± 113.7 g). Brain sections were immunostained for TGFβ1 and brain-expressed BMPs (BMP-2, BMP-4, BMP-6, BMP-7, and BMP-9), and platelet derived growth factor receptor β (PDGFRβ) and α smooth muscle actin (αSMA) as pericyte markers. Besides, images of sections stained with conventional luxol fast blue were analyzed to estimate myelin attenuation by optical density.

Results:
The expression of BMP-2 and BMP-4 was significantly upregulated in VCI compared to AD and/or disease controls specifically in the white matter but not in the cerebral cortex. BMP-2 and BMP-4 was found on the abluminal surface of capillaries and preferentially colocalized with PDGFRβ than αSMA, suggesting their expression in relatively immature pericytes. Myelin density was most reduced in VCI compared to AD or disease controls, and the degree of myelin loss was significantly correlated with greater expression of BMP-2/4 in the white matter when all the 19 cases were combined.

Conclusions:
Our findings suggest that myelin loss evolves in parallel with BMP-2/4 upregulation in PDGFRβ-positive immature pericytes, with the highest upregulation in VCI. The increased BMP-2/4 expression may be a good pathological correlate of ischemic white matter damage associated with VCI.
Abstract T MP15: Post IV Thrombolytic Headache Does Not Predict Hemorrhagic Transformation Risk in Acute Ischemic Stroke
Authors: Razak Anmar , Young Kwon Soo , Chaudhry Saqib , Kneale Hillary , Al Jajeh Ammar , Hussain Syed
Published: March 2022

Background:
Headache, during or soon after IV infusion of tPA in patients with acute ischemic stroke (AIS) is a concern for hemorrhagic transformation (HT) per various AIS treatment protocols. However no data is available regarding the rate of HT in these patients or the prognostic significance of such headaches.

Objective:
To examine the significance of tPA associated headaches in terms of HT rates and clinical outcomes among AIS patients.

Methods:
AIS patients treated with IV tPA at a comprehensive stroke center between Jan, 2007 and Nov, 2012 were retrospectively reviewed for documented tPA associated headache; defined as new headache or worsening of pre-treatment headache in the first 24 hours post tPA. Out of 250 charts, headache status was documented in 193. For these, basic demographics including age, gender, and co-morbidities were collected. We compared and analyzed the two groups (headache vs. no headache) for differences in various clinical and radiological outcomes.

Results:
Of 193 patients, 63 (32.6%) had tPA associated headache. Headache patients (HP) were significantly younger (mean± SD, 59.5±17.4 vs. 69.9±15.5, p <.0001) and were 53% men compared to 49.2% of non-headache patients (NHP), p=0.537. Co-morbid conditions (hypertension, diabetic mellitus, coronary artery disease, previous TIA or stroke) did not significantly differ between the two groups, p>0.05. There were no statistically significant differences between HP and NHP in admission NIHSS (11.2±5.7 vs. 11.5±5.5, p=0.6458), NIHSS at 24 hours (6.5±5.7 vs. 7.4±6.9, p=0.4661), NIHSS at discharge (6.7±10.1 vs. 8.1±11.6, p=0.4482), HT [8 (12.7%) vs. 24 (18.4%), p=0.3], cervical artery dissection [3 (4.7%) vs. 5 (3.8%), p=0.764], length of hospitalization (6.29±5 days vs. 6.35±4.7 days, p=0.935), and disposition (Home: 53% vs. 43.1%; acute and sub-acute rehabilitation: 39.6% vs. 40%; nursing facility, hospice, and death: 6.4% vs. 16.9%, p=0.1001).

Conclusion:
tPA associated headache does not predict increased risk of HT and has no other prognostic significance in patient with AIS. Prospective studies with larger cohort may be needed to further explore this relationship.
Abstract T MP23: M2 Vessel Diameter and Clot Length Influence Degree of Successful Recanalization Within 6 Hours Of Iv-tpa Treatment
Authors: Desai Jamsheed A , Burns Paul A , Menon Bijoy K , Mishra Sachin , Goyal Mayank , Sohn Sung-il , Dowlatshahi Daurish , Calleja Sanz Ana I , Alcantara Josep P , Jin Albert Y , Boulanger Jean-Martin , Poppe Alexandre Y , Moreau Francois , Asil Talip , Hwang Yang-ha , Ahn Seong H , Asdaghi Negar , Mikulik Robert , Hill Michael D , Demchuk Andrew M
Published: March 2022

Introduction:
Occlusions of the M2 branch show recanalization rates of 44% at 2 hours post treatment with IV-tPA when measured by TCD however no studies have looked at recanalization rates in early (<6h) time windows with angiography.

Objectives:
We aim to define recanalization rates for M2 occlusions with IV-tPA in an early time window (<6H) using CTA and explore the role of M2 size and clot length in predicting successful recanalization.

Methods:
patients with acute intracranial occlusions were prospectively enrolled into the InterrSect study and had a baseline CTA at time of inclusion and within 6 hours of receiving IV-tPA. Baseline CTA was analyzed on the OSIRIX platform; two experienced raters measured M2 diameter at the proximal clot interface and M1 diameter at mid-segment on axial MIP images. Two experienced raters independently analyzed clot length and recanalization on follow-up CTA (75/81) and first run angiograms (6/81). Clot length was stratified as (long>15mm) or (short0.8) or (Low <= 0.8).

Results:
81 patients with M2 occlusions treated with IV-tPA were included in the study. Successful recanalization was achieved in 63.5% of patients with IV-tPA within 4-6 hours of bolus. Figure1 demonstrates a significant relationship between clot lengths, ratio M2/M1 to early recanalization (Fishers exact p= 0.035). Using general linear modelling, the rate of early recanalization is
1.9
times
(p= 0.018, 95%CI 1.12-3.37)
higher in the Short clot-Low M2/M1 ratio group when compared to the group with long clot and high ratio after adjusting for age.

Conclusion:
Small M2 clots treated with IV-tPA achieve early recanalization exceeding 80%; large M2 clots in comparison achieve recanalization rates below 50%. The later clots could be included in clinical trials comparing IV with endovascular therapy.
Abstract T MP41: Early Mobilization in Aneurysmal Subarachnoid Hemorrhage Accelerates the Recovery of Function
Authors: Olkowski Brian F , Binning Mandy J , Sanfillippo Geri , Warren Amy E , Veznedaroglu Erol , Liebman Kenneth M , Arcaro Melissa L , Slotnick Laurie E
Published: March 2022

Background and Purpose:
Survivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery that typically includes surgery, prolonged monitoring in intensive care and treatment focusing on the prevention of complications. Aware of the complications resulting from bed rest and immobility, our multidisciplinary neurocritical care team developed an early mobilization program for patients with aneurysmal SAH. The purpose of this study was to determine the effects of early mobilization on patient function and participation in rehabilitation.

Methods:
A retrospective analysis was conducted on 93 patients diagnosed with aneurysmal SAH. Fifty-five patients received early mobilization after aneurysm treatment by a physical therapist or occupational therapist in the neurosurgical intensive care unit. Early mobilization focused on functional training and therapeutic exercise in progressively upright positions. Participation criteria ensured neurologic and physiologic stability prior to the initiation of early mobilization program sessions. Outcomes were compared to a control group of 38 patients that received care prior to the implementation of the early mobilization program. Data was analyzed using an independent two-tailed t- test. A
p
value of less than .05 was accepted as significant.

Results:
Demographic and clinical characteristics between the two groups were similar (p>.05). The number of days from admission to participation in out of bed activity decreased in the early mobilization group (

=4.2) compared to the control group (

=6.4, p=.039). The number of days from admission to walking (50 feet or greater) decreased in the early mobilization group (

=6.4) compared to the control group (

=10.5, p=.004). A greater number of sessions that included out of bed activity were observed in the early mobilization group (

=6.5) compared to the control group (

=4.4, p=.013). An increase in the number of sessions that included walking (50 feet or greater) was observed in the early mobilization group but was not significant.

Conclusion:
Patients with aneurysmal SAH receiving early mobilization participated in out of bed and walking activity faster and achieved a higher level of function during rehabilitation sessions.
Abstract T MP47: Intentional Oral Food Intake Challenge Improves the Functional Outcome of Severe Stroke Patients
Authors: Yokoyama Yoko , Yokoyama Nobuhiko , Kagiyama Tomoko , Watanabe Yoshimasa , Ishimatsu Yoshihiro , Kusuda Kenji , Onoyama Kaoru , Ibayashi Setsuro
Published: March 2022

Background and Purpose:
Dysphagia is a common complication after stroke that ends up with severe physical disability in many cases. In our convalescent rehabilitation ward, we had observed that tube-fed stroke patients showed remarkable recovery of activities of daily living (ADL) after regaining oral food intake. This led to our hypothesis that intentional oral food intake challenge (IOFIC) might improve overall ADL recovery of severe stroke patients with dysphagia. To address this question, we started IOFIC in early stage of convalescent rehabilitation for tube-fed severe stroke patients since April 2011.

Methods:
We picked up 119 consecutive severe stroke patients who were on tube-feeding on admission and discharged from our convalescent rehabilitation ward between Apr. 2009 and Mar. 2013. Their functional independence measure (FIM) scores on admission were lower than 55 to select severe stroke patients. We divided the patients into the Pre-IOFIC (Apr.2009-Mar.2011) and the After-IOFIC (Apr.2011-Mar.2013) groups, and compared the recovery rate of oral food intake, FIM scores on admission and discharge, FIM gain during the admission period, and final destination of the patients. Statistical analyses were performed using t-test, Mann-Whitney U-test, and χ
2
-test.

Results:
Patients’ age ranged between 39 and 97 (72±14), and 71 were male and 48 were female. Comparing the Pre-IOFIC (n=59) and Post-IOFIC (n=60) groups, there was no significant difference in age, sex, stroke type, and FIM on admission. There were significant differences in the Pre-IOFIC and the Post-IOFIC groups in terms of the percentage of patients who regained full oral food intake (10.2% vs. 70.0%, p<0.001), the percentage of patients who were able to return to their home (25.9% vs. 50.9%, p<0.01), and FIM gain during the admission period (6.0±10.8 vs. 17.8±19.9, p<0.001).

Conclusions:
Our data indicates that IOFIC during post-stroke rehabilitation greatly improves the ADL outcome of severe stroke patients with dysphagia. Oral food intake may be the “gate step” to the functional recovery in stroke rehabilitation.
Abstract T MP48: Determinants of Early and Late Recovery After Acute Ischemic Stroke: A Multicenter Stroke Registry-based Observational Study
Authors: Jang Min Uk , Kang Jihoon , Kim Beom Joon , Hong Jeong-Ho , Yeo Min Ju , Han Moon-Ku , Lee Byung-Chul , Yu Kyung-Ho , Cho Yong-Jin , Hong Keun-Sik , Park Jong-Moo , Kang Kyusik , Cha Jae Kwan , Kim Dae-Hyun , Ahn Jin Young , Park Tai Hwan , Lee Kyung Bok , Lee Soo Joo , Ko Youngchai , Lee Jun , Kim Joon-Tae , Kim Dong-Eog , Choi Jay Chol , Lee Juneyoung , Lee Ji Sung , Bae Hee-Joon
Published: March 2022

Background:
Recovery after acute ischemic stroke is usually bi-phasic. It begins early with speed and slows down after the first month. Many factors have been reported as determinants of functional outcomes. However, there is a paucity of information on their differential effects on early and late recovery.

Methods:
Using a multicenter prospective stroke registry database, we identified ischemic stroke patients who were hospitalized within 7 days of onset to 12 hospitals, who were discharged within 30 days. Early recovery was defined as improvement of ≥ 4 points or > 50% in the NIH Stroke Scale (NIHSS) scores between baseline and discharge, and late recovery was as improvement of ≥ 1 point in mRS scores between discharge and 3 months. Multivariate logistic regression analysis was performed to estimate effects of independent variables considering a correlation between the two dependent variables, early and late recovery.

Results:
During 54 months, 11088 patients met the eligibility criteria. Early recovery was observed in 36% and median NIHSS change from baseline to discharge was 3 points. Late recovery was found in 33%. Multivariate analysis for revealed that 1) age, pre-stroke mRS, initial NIHSS and prior statin use were associated with both the early and late recovery, 2) onset to arrival time, large artery atherosclerosis, previous stroke, initial blood glucose level, congestive heart failure, thrombolytic treatment were with the early recovery only, and 3) cardioembolism and statin at discharge were with the late recovery only (p’s<0.05). Tests for estimating equality showed that age, onset to arrival time, initial NIHSS, initial blood glucose level, systolic blood pressure, smoking, thrombolytic treatment had differential effects on early and late recovery (p’s<0.05).

Conclusion:
Many of known determinants of 3-month functional outcome may have differential effects on early and late recovery of acute ischemic stroke.
Abstract T MP51: Concordance of Emergency Medical Services and Neurology Times Last Seen Normal in Acute Ischemic Stroke Patients
Authors: Steed Nell Rose E , Kasshout Omar , Bryant Katja , Brasher Cynthia , Kasshout Tareq , Stayman Aaron , Belagaje Samir , Anderson Aaron , Frankel Michael , Nogueira Raul , Gupta Rishi , Yepes Manuel , Nahab Fadi
Published: March 2022

Background and Purpose:
The establishment of a patient’s time last seen normal (TLSN) is an important step for medical decision making in the current treatment paradigm of acute ischemic stroke patients. While both emergency medical services (EMS) and neurologists evaluate stroke patients, there is limited data on the concordance of TLSN as determined by the two groups. The purpose of our study was to identify the frequency of clinically significant differences between reported TLSN by EMS and neurology providers.

Methods:
We performed a retrospective chart review of acute ischemic stroke patients brought in to Emory University Hospital by EMS who were treated with IV thrombolysis from January 2010 to April 2013 to obtain the TLSN. For this analysis, we included only those patients who had documentation of TLSN by both EMS and neurology providers. A clinically significant difference between reported TLSN by EMS and neurology providers was defined as a discrepancy >30 minutes.

Results:
Of 131 patients who were brought in by EMS and received IV thrombolysis during the study period, 109 (83%) had documentation of TLSN by both EMS and neurology providers (mean age 69.6 ± 16.5 years; 51% female). EMS and neurology providers reported the same TLSN in only 44% of cases. However, a difference of >30 minutes between the 2 groups was found in only 15% of cases. In a multivariable logistic regression analysis, the only variable found to be a predictor of discrepancy >30 minutes between EMS and neurology providers was first medical contact in the morning (midnight to 10 AM)(p=0.02); race, sex, EMS provider company, and baseline NIHSS score were not predictors.

Conclusion:
While TLSN obtained by EMS and neurology providers varied in more than half of patients, only 15% of cases had a >30 minute discrepancy. Acute ischemic stroke patients presenting in the morning were more likely to have a clinically significant difference in TLSN reported by EMS and neurology providers.
Abstract T MP64: John Henryism, Race-Ethnicity and Stroke Risk: Pilot Findings From the DESERVE Trial
Authors: Benn Emma K , Quarles Leigh , Sofianou Anastasia , Perez Veronica , Nieto Vanessa , Boden-Albala Bernadette
Published: March 2022

Background:
Stroke is characterized by race-ethnic disparities in incidence, recurrence and mortality. Little work has examined stroke disparities within a psychosocial context. John Henryism (JH) is a construct which describes an individual’s self-perception that they can overcome the demands of their environment through hard work and determination. At high levels, JH is associated with HTN in African Americans with limited education.

Aim:
This study aims to assess the relationship between High JH and burden of stroke risk markers in a multiethnic mild stroke/ TIA cohort.

Methods:
As part of the ongoing DESERVE trial, we collected baseline demographics, medical hx, psychosocial and physical assessments. JH was assessed using an 8-item likert scale. Risk burden included waist circumference >40 in for men and >35 in for women; BMI>30; hdl <40 mg/dL for men and <50 mg/dL for women, triglycerides ≥150 mg/dL, HTN, and diabetes. Metabolic syndrome was defined using ATP III criteria. We examined bivariate relationships between JH, demographics, and vascular outcomes using the students-t and chi-squared tests, as appropriate. We explored the interaction between JH and education on vascular risk factor distribution.

Results:
In a pilot sample of 121 DESERVE participants; mean age of 64.1 years; 49% were male, 28% with <HS education; 20% were White, 41% Black and 33% Hispanic. Risk burden was high with over 80% of the cohort hypertensive. Blacks and Hispanics were significantly more likely to have diabetes (p= 0.002); abdominal obesity (p=0.01) and metabolic syndrome (p=0.02). Median JH score was 20, out of a possible range of 1 - 24. We observed a marginally significant association between JH and race/ethnicity with higher proportions of High JH among Blacks and Hispanics (p=0.06), as well as non-significant trends of High JH among younger participants and those with <HS education (30% vs. 26%, p=0.6).

Conclusion:
Preliminary findings from DESERVE suggest that the burden of risk factors among multi ethnic stroke survivors may be positively associated with JH. Focus on risk reduction efforts without accounting for social determinants may lead to ineffective interventions.
Abstract T MP65: Moderate Alcohol Use Protects from Intracerebral Hemorrhage: Findings from the Ethnic/racial Variations of Intracerebral Hemorrhage (ERICH) Study.
Authors: Koch Sebastian , Brown Mark W , Moomaw Charles J , Langefeld Carl D , Martini Sharyl R , Braimah Janet , Osborne Jennifer , Woo Daniel
Published: March 2022

Background:
The relationship between alcohol use and stroke is complex. A U-shaped relationship has been identified for ischemic stroke, while a more linearly increasing risk has been found for hemorrhagic stroke. Previous investigations of alcohol and risk on hemorrhagic stroke have not consistently reported on the separate risk of intracerebral hemorrhage (ICH). We here report on the association of alcohol use and risk of ICH in ERICH.

Methods:
ERICH is a multi-center, prospective, case-control study of a race-ethnically mixed population with ICH. Controls were identified through random digit dialing to match cases by age (+/- 5 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black and Hispanic) and geographic area. Records of cases were reviewed for past medical history and data on ICH presentation. All cases and controls underwent a comprehensive interview which includes questions regarding alcohol use. We categorized alcohol use as none, rare (<1 drink a month), moderate ( ≥1 drink per month and ≤2 drinks daily), intermediate (>2 but <5 daily) and heavy (≥ 5 daily). Odds ratios for each category were calculated using the no use alcohol group as a reference.

Results:
A total of 740 cases were matched with controls. Mean age was 58±12, 55% were male, 44% non-Hispanic black, 31% non-Hispanic white and 25% Hispanic. Cases were more likely to report no (52 vs. 37%) and heavy alcohol use (12% vs. 5.2%). Controls were more likely to report rare (12 vs. 6%), moderate (41 vs. 26%) and intermediate (5 vs. 4%) alcohol use. The odds ratios were 0.47 (CI: 0.27-0.82) for rare, 0.58 (CI: 0.40-0.83) for moderate, 0.57 (CI: 0.27-1.19) for intermediate and 1.54 (CI: 0.87-2.72) for heavy use after adjustment for baseline group differences.

Conclusion:
These findings demonstrate a protective effect of rare and moderate alcohol use on ICH risk in a multi racial-ethnic population. There was a non-significant trend for heavy alcohol use and increasing ICH risk. The results support previous recommendations on the moderate use of alcohol and cardiovascular disease prevention.
Abstract T MP71: Evaluation of a Community-Wide Stroke Preparedness Intervention: Results of the ASPIRE Study
Authors: Boden-Albala Bernadette , Edwards Dorothy F , Wing Jeffrey J , Gibbons M. C , Hsia Amie , Kidwell Chelsea S
Published: March 2022

Background:
Lack of education about stroke preparedness and needed action, particularly in underserved communities may prevent seeking timely care.

Aim:
To evaluate the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project.

Methods:
ASPIRE is a multi-level program [individual/community, hospital, EMS] using a community-engaged approach to stroke preparedness targeted to underserved black DC communities. The aim is to decrease acute stroke (AS) presentation times and increase intravenous tissue plasminogen activator (IV tPA) use. Phase 1 included 1) Enhancement of EMS focus on AS; 2) Implementation/enrichment of AS protocols to move DC hospitals to Primary Stroke certification; 3) Pre-intervention (PRE) AS patient data collection in all 7 acute care DC hospitals; 4) Focus group/survey identification of barriers to emergency stroke care to create a culturally tailored intervention. Phase 2 was a 1 year city-wide intervention. Phase 3 was 1 year post-intervention (POST) acute stroke data collection to assess changes in IV tPA use and AS presentation time. We compare PRE vs. POST AS parameters among ischemic stroke cases that arrived within 168 hours of stroke onset, excluding hospital transfers (n=84). We performed logistic regression models for AS arrival ≤ 3 hours.

Results:
Phase 1 identified 687 ischemic stroke cases, 85% black, 58% women; 56% ≥ 65 yrs. Phase 2 conducted 531 community interventions for 10,256+ participants; performed 3,289 intervention evaluations; distributed 19,000 preparedness bracelets and 14,000 stroke warning magnets. In Phase 3, we identified 684 ischemic stroke cases, 79% black, 58% women; 56% ≥ 65 yrs. We report significant increases in AS arrival time ≤ 3 hours (14% to 27%; p<0.0001) and in IV tPA use (4% to 9%; p<0.001). In a logistic model, significant predictors of ED arrival ≤ 3 hours included (OR; 95% CI): POST vs. PRE (1.8; 1.4 - 2.4); White vs. Black (2.0; 1.8 -2.8); Male (1.3: 1.0 -1.8); and EMS (3.6: 2.5 - 5.0).

Conclusion:
ASPIRE shows significant success increasing the proportion of AS arrivals to ED ≤ 3 hours and increasing IV tPA utilization. Culturally tailored community interventions can be effective in increasing stroke preparedness in underserved urban communities.
Abstract T MP73: Effect of Hospital Factors on Individual-Level Early Do-Not-Resuscitate Orders in Ischemic Stroke
Authors: Zahuranec Darin B , Burke James F , Kelly Adam G , Holloway Robert G , Morgenstern Lewis B
Published: March 2022

Background:
Race-ethnic (R/E) minorities are less likely to have Do-Not-Resuscitate (DNR) orders than non-Hispanic whites. Since race and ethnicity cluster by hospital, institutional factors may contribute to this variability in DNR orders. We investigated the influence of hospital-level proportion of R/E minorities on R/E differences in individual-level DNR decisions.

Methods:
Cases of ischemic stroke were identified from the California State Inpatient Database (age >=50, 2005-2011, ICD-9 codes 433.x1, 434.x1, 436 in primary position). Hospitals were classified by the proportion of R/E minority (Black or Hispanic) patients seen at each institution (reported as quartiles). Individual-level early DNR orders (within 24 hours) were reported by individual-level race-ethnicity (White, Asian, Hispanic, or Black), stratified by hospital-level proportion of R/E minority (Black or Hispanic) patients using multilevel logistic regression with a random hospital intercept.

Results:
A total of 259,953 cases of ischemic stroke across 370 hospitals were included (Mean age 74, Female 53%, White 59%, Black 8.8%, Hispanic 17%, Asian 8.9%, Others 6.0%). There was variability in the proportion of R/E minority patients seen at the hospital level (Black: range 0-82%, median 2.3%; Hispanic: range 0-96%, median 12.2%). Increasing hospital-level proportion of minority patients seen was associated with less use of DNR orders across all R/E groups. Similar effects were seen when stratified by hospital-level quartile of Black (Figure “A”) or Hispanic (Figure “B”) patients (p<0.001 for both). White patients with ischemic stroke admitted to hospitals that cared for more minority patients used early DNR orders at a frequency similar to R/E minorities.

Conclusions:
The probability of an early DNR order after ischemic stroke is due not only to different treatment patterns across R/E groups, but also to differential treatment patterns at hospitals that care for more R/E minorities.
Abstract T MP77: Incidence of Neurofluctuation in Patients with Subcortical Ischemic Stroke - Results from a Prospective Cohort Study
Authors: Vahidy Farhaan S , Hicks William J , Acosta Indrani , Hallevi Hen , Peng Hui , Pandurengan Renganayaki , Gonzales Nicole , Barreto Andrew , Martin-Schild Sheryl , Wu Tzu-Ching , Rahbar Mohammad H , Bambhroliya Arvind , Grotta James C , Savitz Sean I
Published: March 2022

Subcortical strokes (SCS) are associated with stroke progression. The primary objective was to assess the incidences of neurological deterioration and its spontaneous reversal in SCS patients. We also estimated the risk of poor outcome associated with deterioration.

Methodology:
A prospective cohort of SCS patients was enrolled based on clinical exam and imaging studies, and was followed through the course of hospitalization. NIH stroke scale (NIHSS) assessments were performed daily and whenever symptoms worsened (increase of ≥ 1 in motor scale). Modified Rankin Scale (mRS) score at discharge was used to assess outcomes. Patients received standard of care stroke therapy including IV t-PA as per AHA guidelines, and episodes of deterioration were managed conservatively. The Anderson Gill Cox proportional hazard model was used to analyze factors associated with time to deterioration and spontaneous reversal. Log binomial regression was performed for estimation of risk of poor outcome.

Results:
The cumulative incidence of deterioration was 43.3% and of those who deteriorated, spontaneous reversal occurred in 37.8%. The median time to deterioration was 21 hours from stroke onset. Use of IV t-PA was significantly associated with both deterioration (HR: 2.25, 95% CI: 1.13 - 4.49) (Figure 1a) and spontaneous reversal (HR: 4.36, 95% CI: 1.36 - 14.01) (Figure 1b). Deteriorated patients had a higher risk of poor discharge outcome (mRS ≥ 3) (RR: 1.80, 95% CI: 1.71 - 1.93), after adjusting for age, initial stroke severity, and use of IV t-PA.

Conclusion:
The results from this study establish a natural history of neurofluctuation in patients with SCS. Our data suggests that deterioration occurs early in these patients, and only about a third of deteriorated patients reverse spontaneously. Furthermore, deterioration is associated with poor short term functional outcome. There is a need to develop and test novel therapies to treat neurological deterioration in SCS.
Abstract T MP80: Prior Beta Blocker Use is Associated with Favorable Outcome in Patients with Acute Insular Stroke
Authors: Park Kwang-Yeol , Avery Ross , Sabuncu Mert Rory , Neto Octavio Pontes , Ay Hakan
Published: March 2022

BACKGROUND:
Sympathetic nervous system activation during acute ischemic stroke (AIS) can lead to a number of undesirable changes such as hyperglycemia, left ventricular stunning, and immunosuppression and thereby could potentially result in worsening of clinical and tissue outcome. We hypothesized that prior beta blocker (BB) use could be beneficial in patients with AIS by opposing increased sympathetic activity.

METHODS:
This was a consecutive study of patients with AIS conducted as a part of an ongoing prospective NIH-funded study (Heart-Brain Interactions Study). The relationship between BB use within 24 hours prior to stroke onset and outcome measured by modified Rankin Score (mRS) at 3 months was tested using multiple logistic regression. Infarcts including the insula and/or the surrounding opercular cortex were classified “insular”.

RESULTS:
There were 402 BB-users and 612 BB non-users. BB-users were older and more often had vascular risk factors such as coronary artery disease, atrial fibrillation, and congestive heart failure. Univariate analyses revealed that prior BB use was associated with decreased probability of good outcome (OR 0.72, 95% CI 0.55 - 0.93 for mRS<3). A multivariable analysis adjusting for differences between BB-users and BB non-users showed that BB use was not a predictor of either good or bad outcome (OR 1.33, 95% CI 0.90 - 1.96). However, there was a significant interaction between BB use and insular infarction (p=0.04). A second multivariable model also including the interaction term showed that prior BB use was a significant predictor of favorable outcome in patients with infarcts including the insula (OR 2.21, 95% CI 1.03 - 4.75).

CONCLUSIONS:
These findings suggest that BB therapy may be beneficial in selected patients with AIS whose infarcts encompass the insula.
Abstract T MP84: Early Specialist Management of In-Hospital Stroke Patients
Authors: Manawadu Dulka , Choyi Jithesh , Kalra Lalit
Published: March 2022

Background and Objectives:
In-hospital stroke (IHS) is associated with high mortality and disability but management is delayed compared with out of hospital stroke presenting to emergency rooms. The hypothesis prior to data collection was that early referral and specialist management of IHS patients will be associated with lower mortality and better functional outcomes at 90 days.

Methods:
Pre-specified analysis of prospective registry data of consecutive hospitalised stroke patients between January 2009 and December 2010 fulfilling the criteria: 1) admission to hospital with a non-stroke diagnosis; 2) onset of new neurological deficits after admission; 3) CT/MRI confirmation of new ischaemic or haemorrhagic changes.

Intervention:
Early referral and specialist management of IHS within 3 hours of symptom onset versus late referral after 3 hours. Specialist management consisted of neurological assessment, thrombolysis if appropriate, vascular investigations, anti-thrombotic treatment and transfer to stroke unit for physiological optimisation and prevention of complications.

Main Outcomes: Blinded assessment of d
ichotomised modified Rankin Scale (mRS) score of 0-2 and all-cause mortality at 90 days. All patients completed 90 day follow up.

Results:
Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 years; 51% male), of whom 78 were ischaemic and 6 haemorrhagic. There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 of the 37/78 (47%) potentially eligible patients. Early specialist management improved functional outcomes (mRS 0-2 at 90 days 40% v 7%, p=0.001) but not all-cause mortality (32% v 37%, p=0.74). Early specialist management was an independent predictor of mRS 0-2 at 90 days [OR 1.13 (95% C.I. = 1.10-1.27), p=0.002] after adjusting for age, cause for hospital admission, stroke severity and thrombolysis.

Conclusions:
Early referral and specialist management of IHS patients improved functional outcomes but did not reduce mortality at 90 days, independent of thrombolysis. Further studies are needed to confirm its benefit in wider clinical practice.
Abstract T MP85: Does Pre-Stroke Disability Affect Acute Evaluation, Treatment and Outcomes After Stroke?
Authors: Herial Nabeel A , Raman Rema , Ernstrom Karin , Rapp Karen , Schlick Konrad H , Modir Royya , Meyer Dawn M , Meyer Brett C , Hemmen Thomas M
Published: March 2022

Background:
Pre-stroke disability is expected to influence outcome in stroke. Enrollment of clinical trials in stroke is frequently limited to patients with pre-stroke modified Rankin score (mRS) of ≤2. Our objective is to explore evaluation, treatment and outcomes in stroke patients with pre-stroke mRS 3-5.

Methods:
We included all patients from the acute stroke code database (UCSD SPOTRIAS from Mar 2005 - Jul 2013 with known pre-stroke mRS, baseline NIHSS and 90-day mRS and confirmed diagnoses: Acute ischemic stroke (AIS), transient ischemic attack (TIA), intracerebral hemorrhage (ICH). We assessed onset time to arrival, arrival time to- (CT, exam, treatment, decision) and outcomes (90-day mRS, discharge destination) by pre-stroke disability stratified by mRS (Group 1: mRS 3-5, Group 2: mRS 0-2). Good outcome was defined as discharge to home or acute rehab, or return to pre-stroke mRS or better.

Results:
A total of 572 patients with AIS (416, 73%), TIA (133, 23%), and ICH (23, 4%) were identified. Group 1patients with pre-stroke mRS 3-5 (69, 12%) were older (mean ± SD: 80 ±11 versus 68 ± 7 y, p<0.001), mostly women (70% vs. 41%, p<0.001), had history of hypertension (84% vs. 71%, p=0.029), prior cerebrovascular disease (43% vs. 28%, p=0.012), neuropsychiatric disease (23% vs. 6%, p<0.001), other CNS disease (35% vs. 6%, p<0.001), and higher baseline NIHSS (mean ± SD: 14.9 ± 9 vs. 6.4 ± 8, p<0.001) compared to Group 2. Majority (61%) of Group 1 had a mRS score of 3 followed by mRS 4 (38%). There were no differences in onset to arrival, arrival time to- stroke code initiation, neuro exam, CT imaging, and treatment decision between groups. No difference in stroke patients eligible for IV thrombolysis (44% vs. 36%, p=0.23) or treated with IV r-tPA. Discharge to home or acute rehab was less frequent in ischemic stroke patients of Group 1 (44% vs. 77%, p<0.001). However, patients returning to a pre-stroke mRS score or better at 90 days was not different between groups (40% vs. 47%, p=0.39). C
onclusions:
Using return to baseline as good outcome measure demonstrated patients with pre-stroke disability benefit from acute evaluation and treatment. Patients with pre-stroke moderate disability (mRS 3) may particularly be considered for inclusion in future clinical trials.
Abstract T MP95: Ethnic Differences in Initial Stroke Severity Vary by Age: The Brain Attack Surveillance in Corpus Christi (BASIC) Project
Authors: Wing Jeffrey J , Baek Jonggyu , Sanchez Brisa N , Lisabeth Lynda D , Smith Melinda A , Morgenstern Lewis B , Zahuranec Darin B
Published: March 2022

Background:
Ethnic differences in stroke severity may vary by age or be explained by differences in risk factors (e.g. atrial fibrillation (Afib), diabetes). Our goal was to investigate ethnic differences in initial stroke severity.

Methods:
Ischemic stroke cases were identified from the population-based BASIC project. NIHSS was determined from the medical record or abstracted from the chart. Ethnicity was ascertained from the medical records and reported as Mexican American (MA) or non-Hispanic white (NHW). Quantile regression was used to model the distribution of NIHSS by age group (45-59, 60-74, 75+) to test whether ethnic differences exist over different quantiles of NIHSS (5% increments). Crude models were run to examine the interaction between age group and ethnicity; models were then adjusted for hypertension, Afib, coronary artery disease, and diabetes. Results were adjusted for multiple comparisons across 19 quantiles (5 to 95%).

Results:
There were 4,366 ischemic strokes, with median age 72 years (IQR: 61-81), 55% MA and median NIHSS of 4 (IQR: 2-8). In the crude model, in younger (45-59) and older (75+) age groups, MAs had one point higher NIHSS than NHWs at the median and for some lower quantiles (all p<0.001), but no severity difference was seen in the 60-74 group. At the 95% quantile of NIHSS in the younger age group (Figure), MAs had significantly less severe strokes than NHWs by 6 points (p<0.001). However, in the older age group, there was a reversal of this pattern, with MAs’ strokes being more severe than NHWs by about 1 point. After full adjustment, similar trends could be seen at the lower quantiles, but the pattern of older MAs having more severe strokes at the higher quantiles became more apparent at the 85% and 95% quantiles, suggesting that this severity difference was not due to differences in risk factors.

Conclusion:
Ethnic differences in initial stroke severity varied by age. Age should be considered when looking at race/ethnic differences in severity.
Abstract T P119: Effective Pre-Planned Center Selection to Optimize Sample Heterogeneity in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Multi-site Trial
Authors: Nelsen Monica A , Park Caron , Lane Christianne J , Wolf Steven L , Dromerick Alexander W , Winstein Carolee J
Published: March 2022

For phase III RCTs, sample heterogeneity is useful for both generalizability of findings and providing insight into treatment effects for specific subgroups. Prior studies in stroke rehabilitation have rarely explored differences in intervention effects between racial and ethnic subgroups across participating sites. We examined participant characteristics across centers, with the hypothesis that strategic use of a multi-center structure across 3 distinct urban geographical areas (Atlanta, GA, Los Angeles, CA and Washington, DC) would generate a sample diverse enough to explore differences in treatment effects by racial and ethnic subgroups

Methods:
The ICARE Stroke Initiative is a randomized multi-center clinical trial designed to compare the effectiveness of the Accelerated Skill Acquisition Program (ASAP) to an equivalent dose of usual and customary outpatient occupational therapy (DEUCC) and a monitoring only usual therapy group (UCC). Demographics, stroke characteristics and cognitive outcomes collected at baseline for randomized participants (N = 361) were compared across the 3 centers using ANOVA or χ2 tests for continuous and categorical outcomes, respectively.

Results:
We found significant differences in race and ethnicity (p<0.001); the highest proportion of African-Americans came from the Atlanta and DC centers, and the highest proportion of Hispanic/Latinos came from the Los Angeles center. Additional unanticipated differences between centers in baseline characteristics include: age, referral source, stroke location, stroke severity as measured by the NIH Stroke Scale, Short Blessed Memory Test, DKEF’s verbal fluency sub-score of category switching, and pre-randomization hours of outpatient occupational therapy (p<0.05).

Conclusions:
ICARE’s strategic center selection resulted in a diverse and robust dataset, allowing for post hoc exploration of treatment effect differences by subgroup and for the intention-to-treat analysis, determination of generalizability of treatment effects across a racially and ethnically diverse population.