bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP114: Putrescine And Kynurenine Are Associated With Large Artery Atherosclerosis Stroke: Targeted Metabolomics Study
Authors: Lee Eungjoon , Kim Da Jung , Cho Joo-Youn , Jung Keun-hwa
Published: February 2022

Background:
Ischemic stroke is a diversified disease with various mechanisms. However, the current subtyping process is complicated and time-consuming. Metabolite-based biomarkers have promising potential to improve classification and profound understanding of the disease. We aimed to identify novel targeted metabolomics-based biomarkers that are clinically relevant to the diagnosis of large-artery atherosclerosis (LAA) stroke.

Methods and Results:
We acquired serum samples and clinical data from a hospital-based acute stroke registry. Patients experiencing ischemic stroke within a week of symptoms onset were recruited. Finally, 238 acute ischemic stroke participants (97 LAA patients and 141 non-LAA patients) were included. A targeted quantitative and quality-controlled liquid chromatography with tandem mass spectrometry metabolomics analysis was performed, several metabolomic signatures which showed statistically significant differences between LAA and non-LAA groups were selected. A multivariate regression model was created to independently predict the LAA stroke. We obtained 55 serum metabolomics signatures, and of these, 2 biogenic amines (putrescine and kynurenine) were selected as independent discriminants for LAA (odds ratio [OR], 0.0004; 95% confidence interval [CI], 4.819x10
-07
-0.3601 for putrescine; OR, 0.4325; 95% CI, 0.2232-0.8381 for kynurenine) after adjustment for patients’ sex, age, body mass index, stroke severity, and comorbidities.

Conclusions:
Targeted metabolomics approach provided an enhanced understanding of LAA stroke pathogenesis. We have identified putrescine and kynurenine as novel biomarkers for LAA stroke.
Abstract WMP117: Effects Of Chronic Remote Ischemic Conditioning In A VCID Mouse Appears RBCNOS3 Dependent
Authors: Khan Mohammad B , Siddiqui Shahneela , Kamat Pradip K , Wood Kristofer , Hess David C
Published: February 2022

Background and Purpose:
Chronic remote ischemic conditioning (C-RIC) is effective at improving cerebral blood flow (CBF) inducing vascular remodeling, and improving cognition in a bilateral carotid artery stenosis (BCAS) mouse model, a model for Vascular Cognitive Impairment and Dementia (VCID). This augmentation is associated with increases of plasma nitrite. Our aim was to determine if the beneficial effect of C-RIC was red blood cell (NOS3) dependent.

Methods:
Microcoil (01.8 mm) induced BCAS model was used to induce chronic hypoperfusion. Aged RBCNOS3-KO and its control groups, NOS3flox-flox male mice
(>12 months
) were randomly assigned to Sham RIC and RIC of both strains. RIC was started 7d post-surgery daily for 4 weeks. Behavioral test and CBF was performed before termination. Functional outcomes were assessed using novel object recognition (NOR) test for non-spatial working memory, and hanging wire and beam walk test for motor/muscular impairment. Histopathological staining was also assessed of the brain tissues.

Results:
C-RIC-therapy for 4 weeks did not improve CBF in the RBCNOS3KO groups at 4
th
weeks compared to ShamRIC groups. However, C-RIC therapy for 4 weeks significantly improved CBF in NOS3flox-flox groups compared to ShamRIC groups. Similarly, there was no significant change in the RBCNOS3 KO mice between the ShamRIC and RIC groups in the discrimination index/exploration time as determined by the NOR test or poor motor function as determined by hanging wire and beam walk test whereas the NOS3flox-flox mice did show improved cognition with RIC.

Conclusions:
The beneficial effect of C-RIC in the BCAS model is abrogated in RBCNOS3 KO mice indicating that the effect of C-RIC is NOS3 dependent.
Abstract WMP118: Preclinical Evaluation Of Circadian Rhythm In Ischemic Stroke Outcomes
Authors: Kamat Pradip K , Khan Mohammad B , Wood Kristofer , Siddiqui Shahneela , Hess David C
Published: February 2022

Background:
Stroke is a leading cause of disability and death worldwide. There is evidence that there is a circadian rhythm in stroke with peak occurrence in the morning (6 to 10 am). However it is not clear if the size of infarcts and the outcomes of stroke also varies during the 24 hour period

Hypothesis:
We hypothesized that the size of cerebral infarct and outcome from stroke would show circadian variation in a mouse suture occlusion model.

Methods:
Seven to eight-month-old C57BL/6J (Wild Type, n=10-15 mice/group) mice were randomly assigned to do stroke at the different time points of the day following zeitgeber time at ZT0, ZT6, ZT12, and Z18. Cerebral Ischemia was induced by occlusion of the middle cerebral artery (MCAO) for 60 min. Blood flow was monitored by Laser Speckle before, after occlusion, and at 24h. Neurological deficit was observed by using Bederson score at 24h and 48h. The corner test was used to detect unilateral abnormalities of sensory and motor functions in the stroke mice at 48h. TTC staining was done, 48 hours after stroke, to estimate brain infarction, and the infarct area was measured by using NIH-Image J software.

Results:
We did not find a significant difference in CBF at any time points. There was a significant increased (
p
<0.05) neurological deficit (Bederson score) at 48h during deep sleep period (ZT6, noon) stroke (1.55±0.17) in comparison to fully awake period stroke (1.1±0.1). In the corner test, we found right turn preference significantly higher (
p
<0.005) at noon/ZT6 (9.5±0.34) compared to the fully awake (5.5±0.34) (midnight, ZT18) period. Similarly, the infarction volume was significantly higher (
p
<0.05) during the sleep (ZT6, noon) period (29.32±5.03) in comparison to a fully awake midnight/ZT18 period (15.68±2.38).

Conclusion:
This is the first report demonstrating that mice have larger infarcts and worse short term outcomes during their sleep period (noon/ZT6) than during their awake period (midnight/ZT18).
Abstract WMP119: Tanshinone IIa-loaded Nanoparticles And Induced Pluripotent Stem Cell-derived Neural Stem Cell Therapies Enhance Recovery In A Translational Pig Ischemic Stroke Model
Authors: Kaiser Erin E , Waters Elizabeth S , Yang Xueyuan , Fagan Madison M , Scheulin Kelly M , Sneed Sydney E , Jeon Julie H , Shin Soo K , Kinder Holly A , Kumar Anil , Platt Simon R , Duberstein Kylee J , Park Hea Jin , Xie Jin , West Franklin D
Published: February 2022

Induced pluripotent stem cell-derived neural stem cells (iNSCs) have led to cellular and functional recovery in ischemic stroke models. However, the therapeutic effects of iNSC treatment are limited by decreased cell survival in the cytotoxic stroke environment. Tanshinone IIA is a potential anti-inflammatory and antioxidative treatment that may modulate this harsh microenvironment and lead to improved iNSC survival in stroke tissue. To test this hypothesis, the combined effects of Tanshinone IIA-loaded nanoparticles (Tan IIA-NPs) and iNSCs were evaluated in a translational pig ischemic stroke model. 18 Yucatan pigs underwent middle cerebral artery occlusion and were assigned to the following treatment groups: PBS+PBS, PBS+iNSC, or Tan IIA-NP+iNSC. PBS or Tan IIA-NPs were administered intracisternally 1-hour post-stroke and either PBS or iNSCs were transcranially transplanted into the parenchyma 5 days post-stroke. Magnetic resonance imaging (MRI) was collected 24 hours post-stroke and 12 weeks post-transplantation. Immunohistochemistry was completed 12 weeks post-iNSC transplantation. MRI demonstrated that Tan IIA-NPs significantly reduced lesion volumes, midline shift, and intracerebral hemorrhage, while iNSCs improved white matter integrity. Immunohistochemistry revealed that Tan IIA-NP+iNSC treatment significantly increased NeuN+ neurons in the penumbra relative to PBS+iNSC and PBS+PBS treatment groups. Tan IIA-NP+iNSC treated pigs also showed significantly decreased Iba1+ immune cells and GFAP+ activated astrocytes in the penumbra relative to PBS+iNSC and PBS+PBS treated pigs. Tan IIA-NP+iNSC treated pigs showed significantly increased DCX+ neuroblasts at the lesion border and in the ventricular lining of the subventricular zone relative to PBS+iNSC and PBS+PBS pigs. In addition, PBS+iNSC treated pigs also showed significantly more DCX+ neuroblasts than PBS+PBS pigs. Collectively, Tan IIA-NPs in combination with iNSCs possess potential as a multifaceted neuroprotective and regenerative treatment for ischemic stroke patients. The robust tissue preservation and recovery responses in a predictive large animal model strongly support the continued evaluation of this novel combination therapy.
Abstract WMP23: Increased Central And Peripheral Monocytes/ Macrophages In Female Mice With Cerebral Amyloid Angiopathy
Authors: Finger Carson , Lee Juneyoung , Manwani Bharti
Published: February 2022

Introduction:
Cerebral amyloid angiopathy (CAA) is a known cause of cognitive impairment and intracerebral hemorrhage in the elderly. Cerebral microbleeds (CMBs) detected on MRI are the diagnostic hallmarks of this disease. Recent studies have shown increased CMBs and worst cognition in female CAA mice as compared to males. The underlying mechanisms for this sexual dichotomy are unclear. We hypothesized that increased inflammatory response in females contributes to neuronal damage and cognitive decline in CAA.

Methods:
C57BL6 Tg-SwDI male and female mice (12 months) were used as a mouse model for CAA. Peripheral blood and brain tissues were collected and single cell suspensions were acquired for immunophenotyping using flow cytometry. We used CD45, CD11b, Ly6C and CD3 antibodies to gate for monocytes/macrophages (CD45
high
CD11b
+
Ly6C
+
) and T cells (CD45
high
CD11b
-
CD3
+
) respectively. Data was analyzed using two sample t-test on GraphPad PRISM.

Results:
Our results demonstrated that in the peripheral blood, Tg-SwDI female mice had significantly increased frequency of monocytes/macrophages (CD45
+
CD11b
+
Ly6C
+
) as compared to males (females, 64±8.1%, n=10 vs. males, 33.9±6.9%, n=8, p=0.01). Similar to peripheral blood, there were significantly increased monocytes/macrophages (CD45
high
CD11b
+
Ly6C
+
) in the female brain (females, 36.5±6.3%, n=10, vs. males, 20.9±2.7%, n=8, p= 0.04). No significant differences were seen in T cells in the blood (females, 27±4.3% vs. males, 26.9±3.3%, p= 0.9) or brain (57.2±6.8% vs. 65.3±5.4%, p= 0.3).

Conclusion:
Recent studies suggest that vascular Aβ accumulation in CAA causes an innate inflammatory response, leading to further cognitive decline and CMB formation. Our results highlight a monocyte/macrophage driven pro-inflammatory milieu in female CAA mice which may contribute to worse outcomes. Regulation of monocytes/ macrophages and their cytokine-mediated inflammatory pathways may be a potential sex specific therapeutic target in CAA.
Abstract WMP30: How To Beat The Metrics With Telestroke: A Community Hospital Primary Stroke Center Experience
Authors: Boss Karrie , Heaton Sharon , Gulati Deepak
Published: February 2022

Background and Issues:
A community hospital primary stroke center (PSC) faced many challenges including inconsistent local neurology coverage as well as inefficient in-hospital workflows. This led to a decrease in number of patients treated with IV thrombolytics, a decline in meeting stroke metrics, and challenges in maintaining PSC certification.

Purpose:
To implement a Telestroke system of care that would provide advanced acute stroke management in a community hospital with the goal of improved stroke workflows, stroke metrics, and quality of care.

Methods:
In 2019 a 172-bed community hospital PSC collaborated with a Telestroke program at a Comprehensive Stroke Center. This collaboration led to significant changes including ED physician leadership, standardized protocols with an increase in stroke alerts, EMS engagement, pre-mixing thrombolytics, dedicated stroke coordinator and education of all key personnel. The primary outcome measures were volume of stroke alerts, rate of thrombolytic use, and median door to needle before and after telemedicine implementation.

Results:
After one year of Telestroke utilization, the number of stroke alerts increased from 88 in 2018 to 256 in 2020 (290% increase). The number of patients receiving thrombolytics increased by 440% (10 in 2018 to 44 in 2020). Median door to needle time decreased from 56 mins in 2018 to 41 mins in 2020, an improvement of 15 minutes.

Conclusions:
Telestroke is a consistent and effective way to assess patients with suspected acute stroke in a community hospital setting. Key factors to its successful implementation include dedicated ED physician leadership, consistent protocol application, education and data sharing for motivation and continuous process improvement. In conclusion, Telestroke use increased access to stroke neurologists and improved thrombolysis rates and stroke outcomes.
Abstract WMP32: EMR Alert Improves Compliance With Dysphagia Assessment In Stroke Patients
Authors: Pascal Pamela , Fussner Julie M
Published: February 2022

Introduction:
Dysphagia in patients after a stroke is very common. There is a risk factor for aspiration pneumonia and is associated with worse patient outcomes. The American Heart Association guidelines recommend that a swallow screening be performed on all stroke patients prior to any oral intake. Stroke can present with a variety of symptoms and may not be identified at the time of the patient’s presentation. In analyzing patient data in which the dysphagia screening was not completed, it was identified to occur at the first oral intake of a medication. Our hypothesis is that if the nurse was alerted at the time of medication administration that a dysphagia screening needs to be completed, we could improve our compliance with this quality measure.

Method:
A new Electronic Medical Record (EMR) process was developed, that based on certain criteria, triggered an alert for the nurse when the first oral medication barcode was scanned. Within the alert there is a link to document the dysphagia screening. After documentation of the screening, the nurse is returned to the medication administration record to continue her administration. The criteria for triggering the alert is twofold. The first trigger is based on the presenting chief complaint on arrival to the emergency department. These would include chief complaints such as stroke symptoms, dizziness, weakness, etc. The second trigger occurs when the physician enters an order for dysphagia screening to be completed by nursing. With each of these triggers, the EMR logic looks to see if a dysphagia screen has already been documented and the alert only is generated if it has not. This process was initiated in the EMR in February 2021 for all 12 hospitals in the University Hospitals health system.

Results:
At University Hospitals Parma Medical Center dysphagia screening compliance improved from 82% in QTR 3 2020 to 90% in QTR 2 2021. Overall, in the University Hospital health system compliance improved from 85% in QTR 3 2020 to 89% in QTR 2 2021.

Conclusion:
An EMR alert has assisted the nurse to remember to complete this important dysphagia screening and improved compliance with this quality measure. In addition, nurses have reported an increase in satisfaction with the new workflow.
Abstract WMP36: Closing Gaps In Care Of Patients With Embolic Stroke Of Unknown Source: A Multi-disciplinary Approach
Authors: Ibrahim Lamya , Tariq Muhammad B , Ahmad Mohammad Jamil , Ekeruo Ijeoma A , Okpala Munachi , Gonzales Nicole R , Sharrief Anjail Z
Published: February 2022

Introduction:
Embolic Stroke of Undetermined Source (ESUS) describes non-lacunar ischemic strokes, with no definite etiology after minimal standard work-up. Approximately 17% of ischemic strokes are ESUS, and patients are generally younger with mild strokes and higher Quality-Adjusted Life Years at stake, given annual 5% recurrence. Additional cardiac evaluation is often required for ESUS evaluation. A Multi-Disciplinary Clinic (MDC) employing vascular neurology and cardiology may improve diagnosis and outcomes, facilitate shared decision-making, and provide an enhanced clinical experience for patients with ESUS. We describe our experience.

Methods:
The UTHealth ESUS clinic was established in April 2019, as a monthly half-day clinic. Patients with ESUS (and without known PFO) are referred following ischemic stroke hospitalization or after evaluation in the stroke clinic. Patients are seen by a vascular neurologist and a cardiologist (EP specialist) in a single visit to ensure standardized, appropriate secondary stroke prevention. The specialists review cardiac imaging and monitoring data and discuss the need for additional work-up. While some patients present to the clinic with an event monitor or implantable loop recorder (ILR) in place, others are referred for long-term monitoring following the encounter. Patients are also screened for clinical trials, and stroke fellows rotate through the clinic to gain experiences managing this patient population.

Results:
A total of 36 patients have been evaluated at the ESUS clinic. Median age was 63 (52-71) and 15 (41%) patients were women. Patients were seen a median of 30 days from discharge/referral. Long-term cardiac monitoring was performed in (95%) of patients, including with either a 30-day event monitor (n=15) or ILR (n=20). Two patients were found to have atrial fibrillation, and a different potential cause (PFO, large vessel disease) was detected in 3 others. Five patients were consented for the ARCADIA clinical trial.

Conclusion:
A Multidisciplinary ESUS Clinic offers a patient-centered approach which may facilitate care coordination for stroke prevention and clinical trial enrollment, while providing learning opportunities for trainees.
Abstract WMP52: Reduced Hospital Costs For Ischemic Stroke Treated With Tenecteplase
Authors: Warach Steven J , Winegar Angela , Ottenbacher Allison , Miller Collin , Gibson Daniel
Published: February 2022

Introduction:
Randomized trial evidence and data emerging from routine use support the non-inferiority on clinical outcomes of tenecteplase (TNK) compared to alteplase (ALT) for ischemic stroke thrombolysis. The lower cost of TNK is another potential advantage. We evaluated the hospital costs associated with either drug in a regional stroke network that switched to TNK.

Methods:
Our 10-hospital stroke network adopted TNK as local standard of care in September 2019. We previously reported clinical outcomes for TNK after 15 months (n=234) to the two prior years of ALT (n=354) using our regional REDCap stroke registry. The current analysis linked these registry patients to the hospital cost accounting system to compare cost categories between the two groups.

Results:
Table 1 shows the hospital costs overall and by hospital category. Total costs were greater for the ALT group: median (IQR) $15,841 (12,300, 22,323) for ALT vs $13,382 (10,686, 20,636) for TNK (p<0.001). The greatest difference was in total Pharmacy costs $9,288 (8,657, 11,751) vs $6,997 (6,460, 7,972), p<0.001. Table 2 shows the overall costs savings and higher net clinical benefit (% patients with good outcome minus % with poor outcome) seen at hospital discharge associated with TNK use.

Discussion and Conclusion:
In our regional hospital network after 15 months, TNK thrombolysis of stroke was associated with reduced overall costs, driven primarily by Pharmacy costs. An expanded analysis including other markets that switched to TNK in our national hospital system is in progress. If the current results generalize, the savings potential with a switch to TNK as the standard could be substantial for the health care system.
Abstract WMP6: Trendelenburg (Head Down) Positioning In Acute Large Vessel Occlusion Ischemic Stroke Improves Penumbral Perfusion And Is Well-tolerated: The Head-start Study
Authors: Kleinig Timothy J , Cheong Edmund , Goh Rudy , Dodd Lizzie , Hampton Carole , Cagi Lavenia , Chia Nicholas , Harvey Jackson , Scroop Rebecca , Garcia-Esperon Carlos , Campbell Bruce
Published: February 2022

Introduction:
It is uncertain whether lowered head position improves penumbral perfusion in ischemic stroke. Although a transcranial Doppler trial in large vessel occlusion (LVO) patients suggested improvement, a large pragmatic clinical trial in mixed stroke patients was neutral. We tested the tolerability and effect on penumbral perfusion of 20-degree head-down (Trendelenburg) positioning in patients with acute LVO stroke using automated quantitative CT perfusion (CTP).

Methods:
We enrolled LVO patients aged ≥60, 0-24h after onset, with ≥30mL anterior circulation CTP lesion volume (delay time [DT]>3, MISTAR software). CTP was repeated after 5 minutes of 20-degree Trendelenburg positioning using a custom-designed foam wedge. Neurological status (National Institutes of Health Stroke Scale [NIHSS]) and blood pressure were recorded in routine (30 degree up) and Trendelenburg position. Trendelenburg positioning was maintained for 24h if perfusion lesion volume significantly decreased (≥5mL) and reperfusion treatment was suboptimal.

Results:
The target of 25 patients were enrolled (14 [56%] male, median age 76 (interquartile range [IQR]71-84), baseline modified Rankin scale score 0 [IQR0-0], median NIHSS 20 [IQR 13-24]). Most patients (15/25 [60%]) had an acute M1 middle cerebral artery (MCA) occlusion, 6 (24%) an occluded M2 MCA and 4 (16%) an occluded ICA. Stroke etiology was predominantly (15/25 [60%]) cardioembolic.Median (IQR) DT>3seconds lesion volume was significantly reduced by Trendelenburg compared with conventional horizontal CT positioning (114mL [94-204] vs 149mL [76-153] p=0.0027)). This was not explained by changes in blood pressure, which was unaltered (mean 148mmHg (+/- standard deviation 29) vs 143 (+/-27); p=0.129). Head position did not alter clinical severity (NIHSS 13 [IQR 9-28]) in both positions). A significant lesion volume reduction with Trendelenburg positioning was seen in 15/25 patients (60%); 7 received continued Trendelenburg positioning due to incomplete reperfusion. Head down positioning was well tolerated in the majority (4/7 [57%]), without serious adverse events.

Conclusion:
Head-down (Trendelenburg) positioning improves penumbral perfusion in acute LVO ischemic stroke and is well-tolerated.
Abstract WMP61: Simultaneous Cerebral Blood Flow And Blood Volume Thresholding Produces Consistent Volumes Between Computed Tomography Perfusion Deconvolution Algorithms
Authors: Chung Kevin J , Lee Ting-yim
Published: February 2022

Introduction:
Computed tomography perfusion (CTP) allows estimation of infarct volume in patients with acute ischemic stroke, but significant differences have been reported between CTP deconvolution algorithms.

Hypothesis:
We hypothesized that cerebral blood flow (CBF) and blood volume (CBV) dual thresholding estimates infarct volumes accurately and remain consistent between deconvolution algorithms.

Methods:
Data were from the open-source ISLES dataset, which comprised of patients with acute ischemic stroke who received admission CTP and infarct delineated from diffusion-weighted imaging (DWI) acquired <3 hours of CTP and prior to treatment. CBF and CBV maps were calculated with a model-independent (filtered Fourier Transform) and a model-dependent (box-tail model) deconvolution algorithm using identical arterial input functions and Gaussian-filtered source images. Infarct was estimated using standard CBF<30% relative to the contralateral hemisphere and a CBF<30%+CBV<38% dual threshold. Volume agreement between DWI and CTP lesions was determined by the mean difference ± standard deviation (DWI minus CTP). Consistency of CTP lesion volumes between deconvolution algorithms was characterized by the Pearson correlation (r) and a paired t-test.

Results:
Of 63 included patients, median DWI lesion volume was 28.0 (interquartile range: 13.3 to 57.2) ml. With model-independent and model-dependent deconvolution, respectively, mean differences were 35.7±40.4 ml and 10.9±47.6 ml using CBF<30%, and 37.1±40.2 ml and 28.5±28.6 ml using CBF+CBV thresholding. Between model-independent and model-dependent CTP lesion volumes, Pearson correlation was moderate for CBF<30% (r=0.645, p<0.001) and excellent for CBF+CBV thresholding (r=0.903, p<0.001). Paired t-tests were significant for both CBF<30% and CBF+CBV thresholding (p<0.001).

Conclusions:
CBF+CBV lesion volumes had improved consistency between deconvolution algorithms while achieving similar agreement to DWI lesion volumes compared to the standard CBF<30% threshold. Further adjustment of CBF+CBV thresholds are required to improve accuracy to DWI lesion volumes but show promise in standardizing CTP lesion volumes across deconvolution algorithms.
Abstract WMP62: Assessment Of Cerebral Hemodynamic Patterns In Cervical Arterial Dissection Using Quantitative Magnetic Resonance Angiography
Authors: McGuire Laura S , Ryoo James , Amin-hanjani Sepideh , Atwal Gursant , Charbel Fady T , Alaraj Ali A
Published: February 2022

Background:
Cervical arterial dissection accounts for 2-3% of all ischemic strokes. The pathophysiologic mechanism of the ensuing neurological sequelae is largely attributed to embolic phenomenon. The degree to which the dissection may limit cerebral blood flow and its relationship to symptoms is currently not well characterized. This study is the first to evaluate and quantify blood flow using quantitative magnetic resonance angiography (QMRA) in this patient population.

Methods:
A retrospective chart review was completed in patients at this institution with cervical arterial dissection between August 31, 2009, to September 1, 2019. Inclusion criteria were adults (≥18 years) with diagnosis of dissection of the common carotid artery, internal carotid artery, or vertebral artery, who received QMRA neuroimaging. The cases were reviewed for clinical presentation, diagnosis, management strategy, and radiologic imaging finding. Flow index was calculated using the ipsilateral vessel flow divided by the contralateral flow. Statistical analyses were completed using SPSS software (Version 27, IBM Corporation, Armonk, NY).

Results:
A total of 41 patients were included in this study, 53.7% male and 46.3% female, with mean age 46.0 +/- 11.9 years. Twenty-one patients (51.2%) had ICA dissections while 19 patients (46.3%) had VA dissections, and 1 patient had both ICA and VA vessels affected. Patients with ischemia on MRI demonstrated lower flow in the ipsilateral vessel when compared to those patients without ischemia on MRI at diagnosis and follow-up (p=0.003). Although flow improved over time, patients continued to remain stratified: patients with the lowest index on presentation tended to continue to have low flow in the ipsilateral vessel (p=0.000). Using the flow index in ROC analysis to predict ischemia on MRI yielded an area under the curve of 0.833 (p=0.002); ROC analysis of the percent of total flow for ischemia on MRI found an AUC of 0.895 (p=0.000).

Conclusion:
This study represents the first to assess vessel flow in patients with cervical arterial dissection using QMRA. Patients with lower flow as a result of dissection appear to be at higher risk of ischemia on presentation, emphasizing the role of hemodynamics in the underlying pathophysiology.
Abstract WMP69: Features Of Calcified Carotid Atherosclerosis Are Associated With Stroke In Patients With Embolic Stroke Of Undetermined Source
Authors: Song Jae W , Cao Quy , Siegler James E , Woo John H , Cucchiara Brett L
Published: February 2022

Introduction:
We examined qualitative features of calcified plaque in patients with embolic stroke of undetermined source (ESUS).

Methods:
A retrospective cohort of anterior circulation acute ischemic stroke patients with CTA neck and meeting criteria for ESUS was identified. A segmentation software measured carotid bifurcation calcified plaque volumes. A neuroradiologist manually measured maximum carotid wall and calcified wall thickness (WT), maximum craniocaudal calcified plaque length, degree of circumferential involvement (none, punctate, 90°, 180°, 270°, 360°) and assessed for intimal, transmural, and adventitial calcifications. Descriptive statistics included medians and interquartile ranges. Differences between ipsilateral (carotid
ipsi
) and contralateral (carotid
contra
) carotid arteries to stroke side were tested using Wilcoxon Signed-Rank, McNemar, and marginal homogeneity tests.

Results:
Ninety-four subjects met criteria for ESUS. Mean age was 65 years and 55% were women. Carotid
ipsi
had a significantly higher volume of calcified plaque [Vol
ipsi
=39.1 (12.4, 86.7) vs Vol
contra
=25.9 (4.9, 71.7), p=0.05] and maximum calcified WT [CalcWT
ipsi=
1.4 (0, 2.6) vs CalcWT
contra
=0 (0, 2.1), p=0.03] than carotid
contra
. There were no significant differences in the maximum craniocaudal calcified plaque length (p=0.09) or degree of circumferential calcified plaque involvement (p=0.35) between carotid
ipsi
and carotid
contra
. Intimal (p=0.03) but not transmural (p=0.14) or adventitial (p=0.12) calcifications were significantly more frequent in carotid
ipsi
than carotid
contra
. A subgroup analysis (n=48) including either carotid artery measuring ≥3mm in maximum WT showed intimal calcifications remained significantly associated with stroke side (p=0.02; Figure).

Conclusion:
Higher calcified plaque volumes, calcified wall thickness and intimal calcifications may be associated with ischemic stroke in patients with ESUS.
Abstract WMP78: Microstructural Alterations And Vascular Dysfunction In Cerebral Amyloid Angiopathy
Authors: Horn Mitch J , Gokcal Elif , Becker John , Das Alvin S , Levine Isabelle , DiPucchio Zora , Zanon Zotin Maria Clara , Schwab Kristin , Goldstein Joshua N , Viswanathan Anand , Rosand Jonathan , Biffi Alessandro , Polimeni Jonathan , Greenberg Steven M , Gurol Edip M
Published: February 2022

Background:
Cerebral amyloid angiopathy (CAA) causes impaired vascular reactivity to physiologic stimuli that mediates CAA-related white matter hyperintensities (WMH) but its relationship to microstructural changes has not yet been tested. We hypothesized that the degree of vascular dysfunction would be associated with alterations in white matter microstructure in patients with CAA.

Methods:
Fifty-five non-demented probable CAA patients underwent high-resolution structural MRI including Diffusion-Weighted Imaging (DWI) and functional MRI (fMRI). WMH volume was quantified and expressed as percent of total intracranial volume (pWMH). Vascular reactivity was measured as the amplitude of the blood-oxygenation-level-dependent response (BOLD_Amp) to a visual stimulus. Peak Width of Skeletonized Mean Diffusivity (PSMD) was calculated from DWI and used as a marker of microstructural integrity.

Results:
Patients had a mean age of 69.3±7.4 years and 36 (65%) had intracerebral hemorrhage (ICH). The mean PSMD was [(3.92±0.8) х 10–4 mm2/s] and the mean BOLD_Amp was 1.15±0.2%. Neither PSMD nor BOLD_Amp differed between patients with ICH and those without (p>0.2 for all comparisons). PSMD significantly correlated with older age (r=0.335, p=0.012), with higher pWMH (r=0.792, p<0.001) and with lower BOLD_Amp (r= –0.5, p<0.001). PSMD showed a trend to increase more in patients with hypertension (HT) than without ([(4.09±0.8) х 10–4 mm2/s] vs. ([(3.74±0.8) х 10–4 mm2/s], p=0.097). BOLD_Amp also correlated with pWMH (r= –0.409, p=0.002). In a linear regression analysis, decrease in BOLD_Amp was independently associated with increased PSMD corrected for age, sex, HTN, ICH and pWMH (β= –0.91, 95%CI (–1.77)-(–0.05), p=0.037). pWMH was also associated with PSMD in this model (β=1.22, 95%CI 0.89-1.54, p<0.001).

Conclusion:
This study supports the view that vascular dysfunction in CAA is closely linked with CAA-related global ischemic injury including MRI-visible white matter injury as well as microstructural tissue disruption.
Abstract WMP79: Elevated Cardiac Troponin Levels In Patients With Non-traumatic Intracerebral Hemorrhage
Authors: Kim Junghyun , Sekar Padmini , Castillo Norma K , Langefeld Carl , Hillmann Maureen L , Birnbaum Lee , Sheth Kevin N , Flaherty Matthew L , Woo Daniel , Testai Fernando
Published: February 2022

Background:
Elevated cardiac troponin (cTn) levels are frequently encountered after intracerebral hemorrhage (ICH). In small cohorts, increased cTn was associated with in-hospital mortality. This study investigated the factors associated with elevated cTn in ICH cases and its relationship with outcome.

Methods:
We examined maximum cTn levels within 48 hours of hospital arrival in subjects enrolled in the Ethnic Racial Variations of Intracerebral Hemorrhage (ERICH) study. ERICH is a multi-center prospective study designed to examine ethnic variations in the risk, presentation, and outcomes of ICH. Elevated troponins were defined as cTn>0.1 mg/dL. Poor outcome was defined as modified Rankin Scale (mRS)≥3 at 3 months. We used logistic regression analysis with backward elimination to identify factors associated with elevated cTn levels and their relationship with poor outcome. The model included baseline demographics and clinical characteristics with at least weak association at baseline (p<0.2). Results are presented as odds ratios (OR) with their correspondent 95% confidence intervals (CI).

Results:
Of the 2061 included in the analysis, 39% were females and 177 (9.4%) had elevated cTn levels. The sample was 31% white, 33% Hispanic, and 36% black. In univariate analysis, blacks, prior use of opioids or marijuana, low Glasgow coma scale (GCS) on admission, and presence of intraventricular hemorrhage (IVH) were associated with elevated cTn (p<0.05 of all). In the multivariate model, blacks (OR=1.60, 95% CI 1.06-2.41), previous use of opiates (OR=2.27, 95% CI 1.23-4.21) or marijuana (OR=2.07, 95% CI 1.23-3.50), GCS on presentation (OR=0.90, 95% CI 0.87-0.94), presence of IVH (OR=1.42, 95% CI 1.01-2.00), and first measured systolic blood pressure (SBP) (OR=1.01, 95% CI 1.00-1.01) were associated with elevated cTn. Elevated cTn was associated with mRS>3 at 3 months (OR=2.17, 95% CI 1.43-3.30).

Conclusion:
Elevated cardiac troponin was associated with worse 3 month outcome independent of ICH severity. Surprisingly, sympathomimetic drug use was not associated with peak troponin while opiate and marijuana use were. Our results suggest the need to understand why blacks may have a greater susceptibility to myocardial injury after ICH.
Abstract WMP8: Efficacy Of Combined Use Of Stent Retriever And Aspiration Catheter In Mechanical Thrombectomy For Acute Ischemic Stroke
Authors: Okuda Tomohiro , Arimura Koichi , Tokunaga So , Yamaguchi Shinya , Mizokami Taichiro , Yoshida Hidenori , Ito Osamu , Nishimura Ataru , Iwaki Katsuma , Yoshimoto Koji
Published: February 2022

Background and Purpose:
Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) using a stent retriever (SR) or contact aspiration (CA) has been established as standard therapy. The efficacy of combined use of an SR and aspiration catheter (combined technique: CBT) to achieve successful recanalization has not been fully elucidated. Here, we investigated the safety and efficacy of CBT compared with MT with the single use of an SR or CA.

Methods:
We analyzed 763 consecutive patients who underwent MT for AIS in the anterior circulation between January 2013 and January 2020 at six comprehensive stroke centers. The patients were divided into two groups based on the technique in the first attempt for thrombus removal: the CBT group and single device (SR/CA) group. The rate of successful recanalization with first pass (SRFP), the rate of final successful recanalization, and other procedural outcomes were compared between the groups.

Results:
A total of 571 patients (CBT group, 270; SR/CA group, 301 [SR: 128, CA: 173]), were analyzed. The rate of SRFP (mTICI 2c-3, 41.1 % vs. 27.9 %; p = 0.001; mTICI 3, 34.0 % vs. 25.5 %; p = 0.027) and final mTICI 2b-3 recanalization (88.8 % vs. 82.0 %; p = 0.024) was significantly higher, puncture to reperfusion time was shorter (median [IQR], 43 [31.2-69] vs. 55 (38-82.2) min; p = 0.004) and the number of passes were fewer (mean ± SD, 1.74 ± 0.93 vs. 1.99 ± 1.01; p = 0.002) in the CBT group compared with the SR/CA group. Procedural complications did not differ between the two groups. Subgroup analysis revealed that CBT was more effective for women, patients with cardioembolic stroke, internal carotid artery, and M2 occlusion.

Conclusions:
CBT could increase the rate of SRFP and shorten the puncture to reperfusion time without increasing procedural complications.
Abstract WMP83: Derivation And Validation Of The SAVED
2
Score For Prediction Of Unfavorable Modified Rankin Scale Score Following Intracerebral Hemorrhage
Authors: Coleman Craig I , Concha Mauricio , Koch Bruce , Lovelace Belinda , Christoph Mary J , Cohen Alexander T
Published: February 2022

Introduction:
Functional outcome data following intracerebral hemorrhage (ICeH) is often unavailable or difficult to collect from real-world data sources. We sought to develop a composite scoring system for predicting functional outcome post-ICeH using various proxy measures and risk factors that can be easily and accurately assessed retrospectively.

Methods:
Data from patients with spontaneous ICeH in the prospective, observational ERICH study were used to derive a risk stratification score (SAVED
2
) to predict an unfavorable modified Rankin Scale (mRS) score (defined as 3-6) at 90 days. Independent predictors of unfavorable mRS were identified via multivariable logistic regression. Significant predictors were assigned score weights based on the effect size. Area under the curve (AUC) was used to measure the score’s discriminative ability. External validation was performed using data from the Phase 3 ATACH-II trial in patients with spontaneous supratentorial ICeH.

Results:
There were 2175 patients from ERICH with valid mRS data who survived to hospital discharge. Predictors independently associated with unfavorable 90-day mRS and their corresponding point values included: need for ventilation (odds ratio [OR] = 2.7; 1 point), hospital length of stay ≥8 days (OR = 2.7; 1 point), prior stroke history (OR = 2.8; 1 point), age ≥70 years (3.8; 1 point), and discharge to locations other than home (OR = 5.3; 2 points). Incidence of unfavorable 90-day mRS increased with higher SAVED
2
scores (
P
<0.001; Table). The AUC in ERICH was 0.82 (95% confidence interval [CI]: 0.80-0.84). External validation in 882 eligible patients from ATACH-II found an AUC of 0.74 (95% CI: 0.70-0.77).

Conclusions:
The SAVED
2
score predicted unfavorable mRS in patients with ICeH based on easily accessible data collected at hospital discharge. SAVED
2
could potentially serve as a tool to approximate functional outcome post-ICeH when standard outcome measures, such as mRS, are unavailable.
Abstract WMP91: Angiographic Predictors Of Balloon Test Occlusion Outcomes
Authors: Mendez Aldo A , McCarthy David J , Tonetti Daniel A , Desai Shashvat M , Mountz James M , Gardner Paul A , Jovin Tudor G , Jadhav Ashutosh P
Published: February 2022

Introduction:
Balloon test occlusion (BTO) with adjunctive single-photon emission computed tomography (SPECT) has been utilized to predict clinical tolerance after permanent internal carotid artery (ICA) occlusion. Cerebrovascular anatomical characteristics might predict BTO outcomes and identify patients susceptible to test failure.

Methods:
We performed a single center retrospective study of patients who underwent catheter based cerebral angiogram and ICA BTO from July 2013 to June 2020. SPECT imaging was completed in all the patients who passed the clinical BTO; technetium 99m-ethyl cysteinate dimer was injected intravenously after 15-30 min of occlusion and induced hypotension. The diameter of each of the vessels of the Circle of Willis was measured angiographically. The severity of hypoperfusion on SPECT imaging was classified as none, mild, low intermediate, high intermediate, and severe.

Results:
A total of 57 patients underwent BTO; neoplasia was the most common indication (n=43, 75%). Twelve patients (21.1%) developed neurologic symptoms and clinically failed the BTO; 45 patients (78.9%) passed and proceeded to SPECT. Contralateral dominant vertebral artery (p=0.02), smaller ACom (p=0.002) and ipsilateral PCom (p=0.03) diameters were correlated with clinical BTO failure. Smaller ACom was most predictive with an AUC of 0.907. The Youden index identified an ACom diameter threshold of 1.1 mm, which demonstrated a sensitivity of 91.7% and specificity of 77.8% (OR 0.026, 95% CI 0.003 - 0.226, ROC=0.847) for the prediction of BTO failure. Patients with severe SPECT asymmetry had significantly smaller caliber ACom arteries (ACom median diameter 0.95 mm vs. rest of cohort median 1.4; p=0.0073).

Conclusions:
BTO outcomes may be predicted using angiographic findings. A small (<1.1 mm) anterior communicating artery, and, less significantly, a small ipsilateral posterior communicating artery can be used to identify patients who are likely to fail BTO.
Abstract WMP94: Frequency And Outcome Of Endovascular Rescue After Carotid Endarterectomy: Analysis Of The National Inpatient Sample
Authors: Golnari Pedram , Nazari Pouya , Ansari Sameer A , Cantrell Donald , Shaibani Ali , Potts Matthew , Jahromi Babak S
Published: February 2022

Introduction:
Secondary thrombosis or embolism in the immediate period after carotid endarterectomy (CEA) may require urgent/emergent endovascular rescue (i.e., carotid artery stenting [CAS] and/or thrombectomy). We aimed to estimate the proportion such rescue procedures after CEA in a national setting, and to compare their outcomes to CEA patients not undergoing endovascular rescue.

Methods:
Using the 2018 National Inpatient Sample database and ICD-10 codes, all adult patients undergoing CEA were selected. Endovascular rescue was defined as CAS or thrombectomy performed on the same side as CEA, on the same day as or the days after CEA, and in the same hospitalization.

Results:
A total of 68005 patients undergoing CEA were studied (mean age±SD: 71.24±8.97, 39735 [58.4%] male). Of these, 310 (0.5%) patients underwent endovascular rescue (220 [71%] CAS, 60 [19.4%] thrombectomy, and 30 [9.7%] both). In 240 (77.4%) of these patients, rescue was performed the same day as CEA. Patients undergoing endovascular rescue were not different in age (p=0.21) or sex (p=0.06) but were different in race (p=0.02), income (p=0.002), and insurance (p<0.001) compared to patients without rescue (Table). Patients undergoing rescue had a longer length of hospital stay (5.6±5.1 vs 2.9±4.4 days, p<0.001), lower frequency of routine discharge (58.1% vs 82.4%, p<0.001), and higher mortality (4.8% vs 0.5%, p<0.001).

Conclusions:
Endovascular rescue is rarely needed in the immediate postoperative period after CEA but is associated with worse outcomes and higher mortality. A better understanding of factors associated with endovascular rescue may help better predict and prevent the need for such procedures.
Abstract WMP98: Association Between Serotonin Receptor Antidepressant Use And 90-day Mortality After Acute Ischemic Stroke: Propensity Score Analysis Of 10-year Real-world Data
Authors: Ifejika Nneka L , Bako Abdulaziz , Pan Alan , Potter Thomas , Baig Eman , Tannous Jonika , Johnson Carnayla , Meeks Jennifer , Vahidy Farhaan S
Published: February 2022

Introduction:
Post-stroke depression is associated with higher mortality. Unfortunately, the use of antidepressants (AD) as stroke treatment adjuvants has not been established due to a lack of placebo controls and concerns that selective serotonin reuptake inhibitor (SSRI) initiation
after
stroke may increase mortality.

Methods:
Using ICD-10 diagnosis/procedure, procedural terminology codes and medications, we identified index ischemic strokes (IS) with and without AD use (SSRIs, Serotonin Antagonist Reuptake Inhibitors, Serotonin Norepinephrine Reuptake Inhibitors) 1 year pre and post event, using deidentified pooled data from a 50 healthcare organization network (8/2011-7/2021). Non adult (<18 yrs) and intracerebral hemorrhage were excluded. AD and no AD patients were propensity score (PS) matched for demographic, comorbidity and clinical variables. Standardized mean difference (SMD) assessed match adequacy. Absolute Risk Difference (RD) and Risk Ratios (RR) with 95% Confidence Intervals (CI) were reported for 90-day mortality in the PS-matched sample. Kaplan-Meier (KM) analysis with log rank test (LRT) was performed.

Results:
Among 910,749 patients with an index IS, 634,599 met the inclusion criteria, of whom 136,219 (21.5%) had AD use before and after IS. Significant pre-match differences in demographic and clinical parameters were observed between the AD and no-AD groups (table). PS algorithm generated a 1:1 optimally matched sample (95% SMD reduction) of 78,815 AD and no AD IS patients each, with significant covariate differences for female sex, mood disorder diagnosis, systolic blood pressure and cardiovascular medication use (table). In the matched sample, the 90-day mortality risk post-IS was significantly lower in the AD group. RD: -3.4%, RR(CI) 0.54(0.52-0.56). LRT P<0.0001, KM curve shown in the graphic.

Conclusion:
AD utilization
before and after
IS demonstrates significantly lower 90-day mortality in real world multicenter data.
Abstract WP104: Radiographic Predictors Of Aneurysmal Etiology In Patients With Aneurysmal Pattern Subarachnoid Hemorrhage
Authors: Baumgartner Karl , Meyer Aiden , Mandel Daniel , Moody Scott , Stretz Christoph , Wendell Linda C , Thompson Bradford , Reznik Michael , Furie Karen L , Mahta Ali
Published: February 2022

Introduction:
Spontaneous angiogram-negative subarachnoid hemorrhage (anSAH) can represent a diagnostic dilemma as there is no vascular etiology identified and patients may require further imaging, including multiple angiograms, and have prolonged hospital stays. We sought to determine radiographic predictors of aneurysmal cause based on admission non-contrast head CT.

Methods:
We performed a retrospective case control study of patients who were admitted for spontaneous subarachnoid hemorrhage (SAH) with suspected aneurysmal etiology to an academic center from 2016 to 2021. Patients with pure convexity SAH were excluded. We compared blood thickness (continuous variable) in the basal cisterns and Sylvian fissures and modified GRAEB scores on admission head CT between the two groups. We subsequently developed a predictive model to identify aneurysmal etiology.

Results:
Of 148 included patients (mean age 56 years [SD 12.7]; 55% female, 70% white), 61 were aneurysmal SAH (aSAH) and 87 were anSAH with no vascular etiology. Median modified GRAEB score was higher in aSAH than anSAH (6 [IQR2-10] vs 0 [IQR0-4], p<0.001). Mean blood thickness was greater in the Sylvian fissure (8mm [SD 5.8]vs 3mm [SD 5.2]; p<0.001), interpeduncular (9mm [SD 5.3]vs 6mm [SD 4.2]; p=0.005), quadrigeminal (3mm [SD 3.7] vs 1mm [SD 2]; p=0.003), crural (6mm [SD 3.7] vs 3mm [SD 2.2]; p=0.014), and ambient cisterns (6mm [SD 7.1] vs 3mm [SD 2.6], p=0.0015) in aSAH compared to anSAH, but less in prepontine cistern (3mm [SD 3.8] vs 5mm [5.2], p=0.006). Our 8-point scoring model is based on differences in radiographic features. Receiver operating characteristics (ROC) curve analysis showed high accuracy in predicting aneurysmal etiology (area under the curve [AUC] 0.79, 95% CI 0.70-0.88; odds ratio 1.45 per point increase, 95% CI 1.24-1.70; p<0.001).

Conclusion:
The proposed scoring tool can aid clinicians in predicting aneurysmal etiology in patients with aneurysmal pattern SAH using measurements from admission head CTs. Eliminating an aneurysmal etiology of anSAH earlier may reduce the need for further extensive work up, hospital length of stay and associated complications, thereby reducing health care related costs. This model needs to be validated in a larger multi-center study.