bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9: Autoregulation-based Blood Pressure Targets After Endovascular Thrombectomy
Authors: Petersen Nils H , Begunova Yelyzaveta , Olexa Madelynne , Bartolome David , Kumar Atul , Chen Yasheng , Dhar Rajat , Peng Teng , Ortega-Gutierrez Santiago , Falcone Guido J , gilmore emily j , Kim Jennifer , Schindler Joseph L , Sansing Lauren H , Matouk Charles , Sheth Kevin N
Published: February 2023

Background:
Optimal level blood pressure (BP) targets in acute stroke remain elusive. Tailored hemodynamic management after endovascular thrombectomy (EVT) may reduce the risk of reperfusion injury and promote penumbral recovery. Our study aimed to evaluate the relationship between personalized autoregulation-based BP targets, secondary brain injury, and functional outcomes.

Methods:
We prospectively enrolled 200 patients with acute ischemic stroke who underwent EVT. Autoregulatory function was continuously measured for >=24 hours using simultaneous recordings of near-infrared spectroscopy and mean arterial pressure (MAP). The resulting autoregulatory index was used to calculate and trend the BP range at which autoregulation was most preserved. Percent time and “dose” that MAP exceeded the upper limit or dropped below the lower limit of autoregulation (ULA, LLA) were calculated for each patient. Hemodynamic parameters were correlated with short-term clinical endpoints (symptomatic ICH), biomarkers of secondary brain injury (net water uptake, hemorrhagic transformation (HT), infarct progression), and 90-day functional outcomes.

Results:
Personalized BP targets were successfully computed in 195 patients (mean age 70 ± 16, 45% female, mean NIHSS 14, mean monitoring time 31 ± 28 hours). Time above the ULA was associated with worse functional outcomes at 90-days after adjusting for age, sex, NIHSS, ASPECTS and TICI (adjusted OR per 10% increase 1.4, 95% CI 1.1-1.6, P=0.004). The burden of hyperperfusion was significantly greater among patients with HT (median 2.7 vs. 3.2 mmHg*min, p=0.01) and sICH (median 2.8 vs. 4.8 mmHg*min, p=0.05) than in those without it. Furthermore, time spent above the ULA was significantly correlated with net water uptake at 72 hours (r=0.37, p=0.03). Among patients with unsuccessful reperfusion, there was a non-significant correlation between time below the LLA and infarct progression (r=0.35, p=0.064).

Conclusions:
In the largest study conducted to date, deviations from personalized BP targets were associated with an increased risk of secondary brain injury and worse functional outcomes. Autoregulation-oriented BP management represents a promising strategy for maximizing recovery after ischemic stroke.
Abstract 93: Effect Of Intravenous Tirofiban Following Successful Endovascular Thrombectomy On Functional Outcomes In Large Artery Atherosclerotic Stroke: Secondary Analysis Of A Randomized Clinical Trial
Authors: Huang Jiacheng , Kong Weilin , Liu Chang , Song Jiaxing , Li Fengli , Saver Jeffrey L , Zi Wenjie
Published: February 2023

Background:
Incomplete reperfusion contributes to reduced neurological recovery of patients with acute large vessel occlusion and successful reperfusion after endovascular thrombectomy. Intravenous tirofiban might enhance macrocirculatory and microcirculatory reperfusion in these patients, especially in those with large artery atherosclerotic stroke. We aimed to investigate whether treatment with adjunct intravenous tirofiban is associated improved outcomes following successful reperfusion in patients with acute large artery atherosclerotic stroke.

Methods:
In this subgroup analysis of RESCUE BT trial, patients with intracranial large artery atherosclerotic stroke and an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3 were included. The primary outcome was the difference in proportion of independent functional outcome, defined as a modified Rankin score of 0 to 2 at 90 days. Safety outcomes included the rates of symptomatic intracranial hemorrhage and 90-day mortality.

Results:
Among the 382 patients with intracranial large artery atherosclerosis stroke and successful reperfusion (median [IQR] age, 65 (55-72) years; 105 [27.5%] women), 175 patients (45.8%) were treated with intravenous tirofiban and 207 (54.2%) with placebo. The proportion of patients with independent functional outcome at 90 days was 54.3% (95/175) with tirofiban and 44.0% (91/207) with placebo (adjusted odds ratio [aOR], 1.59; 95% CI, 1.03-2.45;
P
= 0.04). Intravenous tirofiban was not significantly associated with an increased risk of symptomatic intracranial hemorrhage within 48 hours (12/175 [6.9%] vs. 11/207 [5.3%]; aOR, 1.41; 95% CI, 0.59-3.34;
P
= 0.44) or 90-day mortality (21/175 [12.0] vs. 34/207 [16.4%]; aOR, 0.71; 95% CI, 0.38-1.31;
P
= 0.27).

Conclusions:
Among patients with acute large artery atherosclerotic stroke and successful reperfusion following endovascular thrombectomy, adjunct intravenous tirofiban was associated with a higher rate of independent functional outcome, without higher rates of symptomatic intracranial hemorrhage or mortality. Confirmatory randomized trials in these patients are desirable.
Abstract 96: Independent Adjudication Of Get With The Guidelines Thrombectomy Imaging And Angiography Data Reveals Major Discrepancies
Authors: Kogan Daniel R , Cote Andre , Chatfield Fiona , Alfonso Rodel C , Colby Geoffrey , Johnson Jeremiah , Szeder Viktor , Raychev Radoslav , Tateshima Satoshi , Kaneko Naoki , Jahan Reza , Duckwiler Gary , Saver Jeffrey L , Sharma Latisha K , Nour May , Liebeskind David S
Published: February 2023

Introduction:
The Get with the Guidelines - Stroke (GWTG-Stroke) registry has been collecting endovascular thrombectomy (EVT) data on acute stroke interventions since 2015. The key variables associated with EVT, solely based on local site documentation, have never been independently adjudicated. We conducted a detailed analysis of single center EVT data as entered in the GWTG-Stroke registry.

Methods:
Consecutive EVT cases entered into both GWTG-Stroke and an independent research database at a large academic comprehensive stroke center were sampled from 2020-2022. For each case, the following EMR and PACS imaging variables related to EVT efficacy and safety outcomes were compared between GWTG-Stroke and core lab independent readings, including: site of target occlusion (STO), first-pass time (FPT), time mTICI >=2b50 first documented (reperfusion time), final mTICI score (0, 1, 2a, 2b50, 3; FTICI), presence of post-intervention hemorrhagic transformation (HT), and subtype/extent of HT.

Results:
The GWTG-Stroke registry EVT-imaging data variables document only 6/30 (20%) of the common data elements (CDEs) recommended by NINDS and 6/34 (18%) recommended by the FDA. Of the 80 cases sampled, 29 (36%) had discrepancies between GWTG-Stroke recorded data and independent core lab findings. In 4 cases (5%), reperfusion time was incorrect. In another 4 cases (5%), FTICI was incorrect, even when using the gross 2b50/3 categories. In 1 case (1.3%) STO was incorrect. In 2 cases (2.5%) patient data was not reported to GWTG-Stroke. In 21 cases (26%), HT was documented as not present, when in fact it was. Of those, 3 cases (4%) were PH2, while 18 cases (23%) were IPH of PH1 or less, SAH or SDH.

Conclusions:
Detailed analysis of the GWTG-Stroke registry on EVT for acute ischemic stroke reveal major discrepancies in numerous variables. In addition, the majority of variables recommended by NINDS and FDA for routine collection in thrombectomy procedures are not captured in GWTG-Stroke. Even the minority of recommended thrombectomy CDEs currently captured in GWTG-Stroke further contain subject level discrepancies in imaging and angiography outcomes when centrally adjudicated.
Abstract 98: The Impact Of Aspiration Catheter Size On Thrombectomy Outcomes Using Adapt Technique-analysis From The STAR Registry
Authors: Almallouhi Eyad , Anadani Mohammad , Al Kasab Sami , Maier Ilko , Jabbour Pascal M , Kim Joon-Tae , Quintero Wolfe Stacey C , rai ansaar , Starke Robert , Psychogios Marios , Samaniego Edgar A , Arthur Adam S , Yoshimura Shinichi , Grossberg Jonathan A , Alawieh Ali , Fragata Isabel , Cuellar Hugo , Polifka Adam , Mascitelli Justin , Osbun Joshua , Matouk Charles , Park Min S , Levitt Michael , Dumont Travis , Williamson Richard , Spiotta Alejandro M
Published: February 2023

Introductions:
Clinical trials have shown that aspiration thrombectomy is as safe and effective as stent-retriever thrombectomy. Multiple improvements have been made to the aspiration technique over the last few years. In this study, we aim to assess the effect of aspiration catheter bore size on the outcomes of A direct aspiration first pass technique (ADAPT) thrombectomy.

Methods:
We included patients who underwent ADAPT thrombectomy for M1 or internal carotid artery terminus (ICA-T) occlusions in the Stroke Thrombectomy and Aneurysm (STAR) database. Patients included between July 2016 and July 2022. We compared baseline characteristics, procedural metrics and outcomes between patients who underwent thrombectomy using small bore (0.035”-0.060”), medium bore (0.062”-0.068”) and large bore (0.070”-0.074”) catheters.

Results:
A total of 1158 patients were included; 576 (49.7%) females, 645 (70%) White, and 464 (40.6%) received IV-tPA. No difference was noticed in age, sex, and vascular risk factors between the 3 different groups. There was higher rate of IV-tPA in the small-bore catheter group (48.8%) compared to the medium and large bore catheter groups (38.4% and 36.7%, respectively) (P=0.03). Procedure duration was shorter when using medium (20 min) and large (18 min) compared to small bore catheters (30 min) (P=0.01). Both medium and large bore catheters were associated with higher rate of successful recanalization (88.9% and 87.9%, respectively) compared to small bore catheters (81.6%) (P=0.010). However, the difference in successful recanalization or procedure duration between medium and large bore catheters was not significant. No difference was noted in the rate of symptomatic hemorrhagic transformation (sICH) (4.7%, 5.3%, and 7.1%; P=0.345), 90-day favorable outcome (modified Rankin Scale 0-2) (41.8%, 39.3%, 40.8%; P=0.766) or 90-day mortality (18.1%, 23.5%, 24.4%; P=0.111) between the groups.

Conclusions:
Higher rate of successful recanalization and shorter procedure duration were observed when using medium and large bore aspiration catheters compared with small bore catheters in ADAPT technique. However, these procedural benefits were not observed when comparing large bore to medium bore catheters.
Abstract HUP14: Impact Of Socioeconomic Status And Race On The Access To Specialized Care And Enrollment/adherence In Clinical Trial In Cerebral Cavernous Malformations
Authors: Hage Stephanie F , Hagan Matthew J , Stadnik Agnieszka , Lee Justine , Romanos Sharbel G , Srinath Abhinav , Shenkar Robert , Girard Romuald , Hu Jianbo , Lee Connie , Awad Issam A
Published: February 2023

Background:
Cerebral cavernous malformation is a common lesion affecting more than a million Americans, with potential severe sequelae. It is unclear how socioeconomic status (SES) and race influence access to specialized care, and the enrollment and adherence in clinical trials aimed at novel therapies for CCM.

Methods:
We analyzed a cohort of patients harboring CCM lesions screened for IRB approved research studies between 01/2010 -12/2021 at an accredited center of excellence for CCM, leading NIH funded clinical studies. Demographics, lesion location, history of hemorrhage, insurance type and area of deprivation index (ADI) were collected. Insurance type was categorized as commercial, Medicare/Medicaid, or out-of-pocket. The ADI ranking score was analyzed per decile with 1 (least disadvantaged) through 10 (most disadvantaged). Primary outcomes were clinical follow-up within a year from the 1
st
visit for all CCM patients (excluding pregnancy), and enrollment/adherence among eligible subjects for first in disease NIH funded clinical trial [clinicaltrials.gov NCT02603328]. Statistical analysis (Chi
2
test; t-test) was applied to determine whether these differed in ADI groups, races or insurance type categories.

Results:
Despite the institution’s location in an area with majority African American population and lower SES, only 11.5% of subjects were African American, and the majority (52.8%) had a high SES (ADI 1-3). As expected, patients who had a symptomatic bleed were more likely to follow-up (p=0.01), and those with brainstem lesion were more likely to enroll and adhere in clinical trial (p=0.02). Correcting for these confounders, there was no difference in rates of clinical follow-up or enrollment/adherence among different ADI groups, races or insurance coverage.

Conclusion:
Access of disadvantaged patients and races to a center of excellence care and research remains limited despite geographic proximity to their community. Contrary to common belief, patients with poor SES and African Americans are as likely to follow-up and enroll/adhere in clinical trials, if provided access to specialized care. Mitigation efforts should target systemic causes of low access to specialized care among poor and African American patients.
Abstract HUP16: Disparities In Stroke Care In The Metro Detroit Area
Authors: Mohamud Ali , Choudhury Omar , Katramados Angelos , Latack Katie , Phillips Stephanie , Zaman Iram F
Published: February 2023

Introduction:
According to the AHA, approximately 795,000 people suffer a stroke per year. Studies have also shown that people with a lower socioeconomic status (SES) have a higher mortality rate at 1 year following a stroke. Rehabilitation is fundamental to stroke recovery but requires adequate access to health care and support systems. Patient with lower socioeconomic status may not have adequate access to health care or the support systems leading to delays in transfer to rehabilitation centers, longer hospital stays, increased complication rates, and poorer outcomes.

Hypothesis:
Patients with lower SES have longer hospital stays and are more likely to be discharged home rather than to inpatient rehabilitation centers.

Methods:
Retrospective observational cohort study of 744 patients discharged from Neurology units with primary diagnosis of acute ischemic stroke. Patients were grouped by zip code into bottom 50 median household income (lower SES) and top 50 median household income (higher SES). Income data was obtained from the United States Census Bureau.

Results:
Fewer patients with lower SES were discharged by hospital day 5 compared to those with higher SES (58% vs. 68%). Additionally, more patients with lower SES were discharged home rather than to a rehabilitation center after hospital day 5 (15% vs. 7%).

Conclusion:
Those from communities with lower SES had longer hospital stays and were less likely to be discharged to rehabilitation centers after longer hospital stays. Longer hospital stays suggests those with lower SES encounter obstacles that prevent and even preclude transfer to rehabilitation centers. Larger studies should be performed to identify and ameliorate factors that limit access to proper post-stroke care such as adequate rehabilitation.
Abstract HUP2: Assessment Of Acute Ischemic Stroke Disparities By Primary Language In A High Patient Volume Comprehensive Stroke Center Serving A Diverse Metropolitan City
Authors: Ross Lindsey , Mirocha James , Lee Harlem , Ditman Elisa , Figueroa Sonia , Paletz Laurie B , Song Shlee S , Torbatti Sam , Harris Jennifer
Published: February 2023

Background:
Language barriers can have a major impact on the quality of care that patients with acute ischemic stroke (AIS) receive. We sought to assess the impact of patient language on quality benchmarks of AIS therapy and clinical outcomes at a high-volume comprehensive stroke center (CSC).

Methods:
A retrospective analysis of AIS patients presenting to a CSC between 2015 to 2020 was performed. Data included demographics, NIH Stroke Scale scores (NIHSS), discharge diabetic and hypertensive medications, length of stay (LOS), discharge functional status, 30-day readmission, and 30-day mortality. Quality benchmarks and outcomes were analyzed by the five most prevalent primary languages including English, Spanish, Russian, Farsi, Korean and Other. All non-English speaking patients received medical interpretation via digital or in-person translation.

Results:
3,812 AIS patients were identified. English language represented 80.2% (n=3091), Spanish 7.6% (n=238), Russian 4.1% (n=184), Farsi 3.0% (n=129), Korean 1.5% (n=47) and Other 3.6% (n=122).There were no significant differences in the rate of intravenous thrombolysis (P=0.52), door-to-needle time (P=0.91), door-to-puncture time (P=0.85), LOS (P=0.089) and 30 day readmission (P=0.74) among groups. In univariable analysis, Spanish 74.7%, Korean 84.4%, Russian 73.4%, Farsi 78.2% and Other 70.0% had significantly (P< 0.05) higher rates of post stroke disability (mRS> 2) compared to the English group 60.7%. A higher rate of 30-day mortality was noted in the Korean 17.8% compared to the English group 7.3%. The Spanish group had a higher rate of mechanical thrombectomy than the English group (11.8 vs 6.5%, P=0.009). Adjusting for age, sex, NIHSS and comorbidities, multivariable logistic regression models for post stroke disability (mRS>2) continued to show significant differences with Spanish (OR=1.66, P=0.008) and Farsi (OR=1.89, P=0.017) vs English.

Conclusions:
Our analysis reveals persistent disparities in AIS outcomes by primary language, with patients with limited English proficiency suffering worse disability after AIS. The effect of communication barriers on outcomes of stroke care in the inpatient setting requires further evaluation to close this gap.
Abstract HUP20: Association Of Sleep Disorders And Mortality Among Stroke Survivors: Are There Disparities By Race/ethnicity?
Authors: YU Yunting , Lekoubou Alain , Markovic Daniela , Ovbiagele Bruce , Towfighi Amytis
Published: February 2023

Background and Rationale:
Sleep disorders are associated with increased mortality among stroke survivors. Although minority groups are disproportionally affected by stroke, it remains unclear if there are race/ethnic differences in association between sleep disorders and mortality among stroke survivors.

Methods:
Using the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014, we examined the association between sleep disorder (doctor’s diagnosis as well as positive answer to question “ever told doctor you have trouble sleeping) and cardiovascular and all-cause mortality stratified by race/ethnicity (non-Hispanic White, Black, Mexican American, other Hispanic, other race/ethnicity) in adult patients (≥18 years) with a self-reported history of stroke. The first model was adjusted for sociodemographic variables (age, sex, level of education, and income). The second model further adjusted for clinical variables (body mass index and history of coronary artery disease, myocardial infarction, hypertension, diabetes, and cancer).

Results:
Out of total of 1045 stroke survivors, 443 (42.4%) had sleep disorders, including 44.3% (Standard error-SE: 2.8%) of non-Hispanic White individuals, 43.6% (SE: 3.6%) of Black individuals, 41.6% (SE: 3.5%) of Mexican Americans, 46.6% (SE: 8.6%) of other Hispanic individuals, and 47.6% (SE: 7.4%) of other races. There were no significant relationships between race/ethnicity and the presence of sleep disorders in any of the models. Overall, the presence of sleep disorders was associated with higher all-cause mortality in model 1 (Hazard Ratio, HR: 1.69, 95% confidence interval, CI: 1.11-2.43) and model 2 (HR: 1.71, 95%CI: 1.13-2.59). There were no significant associations between sleep disorders and cardiovascular mortality. There were no significant interactions between race/ethnicity and outcomes (all-cause and cardiovascular mortality).

Conclusion:
In this nationally representative sample of stroke survivors, nearly half had a history of sleep disorder. Sleep disorders were independently associated with all-cause mortality, but there were no race/ethnic differences in prevalence or outcomes.
Abstract NS4: Impact Of System-wide Implementation Of Tenecteplase For Ischemic Stroke Thrombolysis On Quality Metrics And Outcomes
Authors: Tubergen Tricia , Fisher Sarah B , Kremers Meghan , Miller Malgorzata , Tsai Jenny , Kline Andrew , Min Jiangyong , Wees Nabil , Khan Nadeem I , Ahrar Asad , Singer Justin , Mazaris Paul , Packard Laurel , Oostema John A , Khan Muhib
Published: February 2023

Background and Purpose:
Tenecteplase (TNK) has recently been demonstrated to be an effective thrombolytic agent in patients with acute ischemic stroke. Our 9-hospital stroke network transitioned to tenecteplase as the standard stroke thrombolytic in April 2022. We assessed the impact of TNK use in routine clinical practice on quality metrics and outcomes.

Methods:
System Stroke Committee (Vascular Neurology, Emergency Medicine, Pharmacy, Nursing) evaluated the scientific evidence, performed a cost analysis and decided to implement TNK system wide. Proposal was submitted to Pharmacy and Therapeutics (P&T) committee. Education plan for providers, nursing and pharmacy was developed and training provided. A before and after analysis was conducted to compare consecutive patients who received thrombolysis for acute ischemic stroke between Jan 2022 to July 2022 before and after the transition to tenecteplase. Quality metrics of National Institute of Health Stroke Scale (NIHSS) on presentation, door to thrombolysis; door in door out of the regional facility; safety outcome of any hemorrhagic transformation and functional outcome of NIHSS at discharge are compared between patients who received TNK versus tPA.

Results:
A total of 121 ischemic stroke patients treated with thrombolysis were included: 62 patients received TNK and 59 patients received tPA. NIHSS on presentation was similar between the groups (TNK 8 IQR [2-10] vs. tPA 7 IQR [3-11] p=0.73). Door to thrombolysis was similar (TNK 60.3±40.9 min vs. 60.1±44 min; p=0.98) as was door-in-door out time (TNK 186±68.4 min vs. tPA 145±70 min p=0.09) between the groups. Intracerebral hemorrhage rates were not different (TNK 8% vs. tPA 6% p=0.78). Discharge NIHSS was similar between the groups (TNK 1 IQR [0-5] vs. tPA 1 IQR [0-4]; p=0.85).

Conclusion:
Tenecteplase implementation as stroke thrombolytic of choice in a large stroke network did not impact performance on quality metrics, safety and outcomes.
Abstract NS5: Utilization Of A Post-Neuro Interventional Radiology Procedure Handoff Smartphrase Leads To Improved Completion Rates Of Mandatory Nursing Monitoring And Documentation
Authors: Punsalang Lorina , Hossepian Katherine , Gaffney Denise , Mkrtumyan Alvina , Le Duy , Cheng Pamela , Sangha Navdeep S , Ajani Zahra
Published: February 2023

Background:
In 2009, The Joint Commission (TJC) mandated hospitals to establish handoff communication measures in preventing sentinel events. Comprehensive Stroke Centers in the U.S. have similar mandates. Additionally, one of the top ten TJC CSC survey finding is missed assessment and documentation, particularly on post-neuro interventional radiology (NIR)procedures. Achieving 100% compliance is challenging due to the intricacy of NIR workflow and gaps in the handoff communication process between NIR and PACU or ICU.

Purpose:
To determine if the utilization of a post-NIR handoff smartphrase, the PAMM, can improve the completion of post-NIR procedure documentation and help achieve the TJC standard.

Methods:
The stroke team, NIR stroke champion and nursing informaticist developed the PAMM smartphrase. The acronym stands for procedure, assessment, medication, and monitoring- encompassing all compulsory post-NIR monitoring parameters. Education and training commenced in May 2021. The project was implemented in June 2021. NIR nurses were added to the PAMM smartphrase in the Epic system and provided a one-pager jobaid. July to December2021 data were analyzed using Microsoft Excel and reported bi-monthly to the Stroke Committee.

Results:
There were 172 records reviewed. Of that, 129 used the PAMM smartphrase. 81%(105) had 100% documentation completed. Of the 43 cases that did not use the PAMM, only67% (29) of the cases had 100% documentation completed. The remaining 33% (14 cases) had missed assessments, from a missing pulse check to a missed puncture site check. The data showed the PAMM smartphrase utilization was correlated with a higher documentation completion rate versus the non-utilization of the PAMM [81% (105) vs 67% (29)].

Conclusion:
Utilization of the PAMM post-NIR procedure standardized handoff smartphrase resolved handoff communication gaps, improved the monitoring and documentation completion rates, and helped achieve TJC standard compliance.
Abstract NS7: Time To Reversal Is Brain - A Retrospective Analysis Of Door To Needle Times Of Anticoagulation Reversal Agents In Intracranial Hemorrhage, A Single Center Retrospective Analysis
Authors: Walo Richard , Burns Katherine , Idogun Precious , Concha Mauricio , Stone David , King Tonya , Quimby Susan
Published: February 2023

Objectives:
Anticoagulant associated intracranial hemorrhage (AA-ICrH) accounts for 10-25% of all intracranial hemorrhages and anticoagulation (AC) at the time of the event more than doubles mortality risk. No guidelines for target times to treatment have been established for the administration of AC reversal agents despite their rapid onset of action. We evaluated AC reversal treatment times among patients with AA-ICrH presenting to a single large community hospital with institutional target times established in 2018.

Methods:
Retrospective chart review was performed for all AA-ICrH treated with reversal agents in Sarasota Memorial Hospital Comprehensive Stroke Center, Sarasota, Florida, between 2018-2021. Clinical and non-clinical variables were collected. Predictors with p<0.20 in the univariate analysis were investigated further in a multivariable model.

Results:
We identified 175 patients, 60% male, 94% Caucasian. FXa inhibitors were used among 67%, warfarin 29% and dabigatran 4%. Half the cohort was treated with andexanet, 46% PCCs and 4% idarucizumab. Arriving via EMS, 70%, transfers from other facilities 14%, walk-ins 10%, and inpatients 6%. Overall, 62% arrived ≤3 hours from symptom onset, 52% and 20% presented under trauma alert (TA) and stroke alert (SA) protocols, respectively. Overall median [IQR] DTN and CTN times (in minutes) were 103 [69-182] and 81 [55-126] respectively, and order-to-needle time, 38 [31-46]. DTN and CTN times among EMS arrival were 98 [69-160] and 70 [54- 110], respectively, for walk-ins, 204 [144-262] and 88 [66-130], respectively (p<0.05). DTN ≤90 and ≤60 minutes was seen in 69% and 38% of SA and 48% and 14% of TA, respectively. CTN ≤60 minutes was achieved in 58% of SA and 35% of TA. The only two significant independent predictors of faster DTN times were SA protocol on arrival and arrival mode (p<0.001).

Conclusions:
Similar to ischemic strokes, arrival by EMS or under SA protocol was associated with faster DTN and CTN times for AC reversal therapies in patients presenting with AA-ICrH. Our institution’s proposed time goals for DTN ≤90 and CTN ≤60 minutes for >75% of patients remained unmet. Nationally accepted target times for AC reversal therapies used in certified stroke centers could help achieve these goals.
Abstract TMP1: Xuesaitong Improves The Prognosis Of Patients With Ischemic Stroke
Authors: Wu Longfei , Wu Chuanjie , Zhang Chi , Song Haiqing , Gao Ying , Ji Xunming
Published: February 2023

Introduction:
Stroke, characterized by high morbidity, disability, and mortality, has become one of the major threats to human health. In recent years, many studies have begun to focus on the treatment of ischemic stroke by traditional Chinese medicine. Xuesaitong, extracted from the precious Chinese herbal medicine panax notoginseng, has shown strong neuroprotective effects in the laboratory. We conducted the present study to investigate the efficacy and safety of xuesaitong in patients with ischemic stroke.

Hypothesis:
For patients with ischemic stroke within 14 days of onset, the combination of xuesaitong soft capsule and aspirin can further improve the 90-day functional outcome.

Methods:
This multicenter, randomized, double-blind, placebo-controlled clinical trial including 3072 patients with ischemic stroke was conducted at 67 centers in China between July 30, 2018, and June 1, 2020. Eligible patients were randomly assigned to receive xuesaitong plus aspirin (xuesaitong group) or placebo plus aspirin (control group). The primary efficacy outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2. The primary safety outcome was serious adverse events at 90 days.

Results:
Among 3072 patients who were randomized, 2966 (96.5%) were included in the full analysis set to assess the efficacy outcome, 2970 (96.7%) were included in the safety set to assess the safety outcome. At 90 days, 1328/1487 (89.3%) patients in the xuesaitong group and 1218/1479 (82.4%) patients in the control group achieved functional independence (odds ratio, 1.79 [95% CI, 1.45-2.21]; P<0.001). The rate of serious adverse events was 15/1488 (1.01%) in the xuesaitong group versus 16/1482 (1.08%) in the control group (P=0.85).

Conclusions:
Among patients with ischemic stroke, xuesaitong plus aspirin significantly increased the likelihood of functional independence at 90 days. Trial registration: Chictr.org Identifier: ChiCTR1800016363.
Abstract TMP10: Lower Household Income Is Associated With Worse Functional Outcomes In Hospitalized Stroke Patients With COVID-19 Across A Multi-institutional Chicago-wide Cohort
Authors: Stamm Brian , Royan Regina , Trifan Gabriela , Alvarado-Dyer Ronald , Saleh Velez Faddi , Taylor Will , Pinna Pranusha , Reish Nicholas , Vargas Alejandro , Goldenberg Fernando D , Schneck Michael J , Biller Jose , Testai Fernando , Caprio Fan Z , Gorelick Philip B , Liotta Eric M , Batra Ayush
Published: February 2023

Introduction:
The COVID-19 pandemic has exacerbated health disparities associated with socioeconomic status across the United States. However, little is known about how income mediates recovery and functional outcomes after stroke associated with COVID-19.

Methods:
This was a multi-institutional, retrospective study of consecutively hospitalized patients presenting in March through November 2020 to one of five comprehensive stroke centers in the Chicago area. Patients who tested positive for SARS-CoV-2 by RT-PCR assay of nasopharyngeal or oropharyngeal swabs and had radiographically confirmed stroke were included. Patient income was dichotomized at the median Chicago household income ($72800 annually). Logistic regression was used to examine the relationship between income and good functional outcome, defined as modified Rankin Scale (mRS) 0-3 at discharge, after ischemic stroke. Race and ethnicity were not included in the adjusted models given these variables were highly collinear with income.

Results:
Across five hospitals, 159 patients were included. Black patients comprised 48.1% of the sample, White patients 38.6%, and Hispanic patients 27.7%. Patients were most frequently publicly insured (60.7%), with severe COVID-19 symptoms requiring ICU care (49.7%) and symptomatic stroke at presentation (77.7%). Median patient income was $46,938 [SD: $32,460-63,219]. Ischemic stroke occurred in 115 (72.3%) patients (median NIHSS 7, IQR: 0.5-18.5); hemorrhagic stroke in 37 (23.7%); and cerebral venous sinus thrombosis (CVST) in 4 (3.4%). When controlling for age, sex, severe COVID-19 disease, and NIHSS, functional outcome from ischemic stroke was mediated by patient income. Patients with household income above the reported median for the Chicago area were more likely to have a good functional outcome at discharge (OR 7.53, 95% CI 1.61 - 45.73; P=0.016).

Conclusions:
Patients with lower household income were more likely to have poor functional outcomes, despite controlling for stroke and COVID-19 severity. Income may play a role in mediating recovery from COVID-19-associated stroke. Further studies are needed to evaluate the influence of other social determinants of health on COVID-19 associated stroke outcome and recovery.
Abstract TMP100: Gestational Headaches Are Associated With The Risk Of Postpartum Stroke
Authors: Kim Chi Kyung , Nam Ki-Woong , Kim Han Jun , Han Jung Hoon , Oh Kyungmi
Published: February 2023

Background:
Chronic primary headaches (CPHs) are known to increase the risk of stroke in women. However, the effect of a novel headache during pregnancy (G-HA) on the occurrence of subsequent stroke is unknown. In this study, we evaluated the association between G-HA and postpartum stroke in women.

Methods:
Based on the Korean National Health Insurance Service database, we included consecutive women hospitalized for delivery between 2007 and 2008. G-HA was defined as the novel CPH diagnosed during pregnancy, and was divided into migraine and other CPH groups. Primary outcome was determined any stroke, ischemic stroke, and hemorrhagic stroke that occurred during the identification period from delivery to December 31 2016. All diseases were identified based on data registered in the database using the International Classification of Disease-10
th
Revision-Clinical Modification codes.

Results:
A total of 919,810 women were evaluated. In multivariable cox regression analysis, G-HA was significantly associated with postpartum stroke [adjusted hazard ratio (aHR) = 1.65, 95% confidence interval (CI): 1.32-2.06]. The close association between G-HA and postpartum stroke was the strongest with migraine (aHR = 2.32, 95% CI: 1.59-3.40), but it was also statistically significant with other CPHs (aHR = 1.40, 95% CI: 1.07-1.83). According to the stroke subtype, G-HA showed a close correlation with ischemic stroke (aHR = 1.87, 95% CI: 1.45-2.41), but not with hemorrhagic stroke.

Conclusions:
We demonstrated that G-HA, especially migraines, was associated with postpartum stroke occurrence in women. This close association was evident in ischemic stroke and not hemorrhagic stroke.
Abstract TMP102: Differences In Platelet Procoagulant Potential Between Lobar And Deep Microbleeds In Patients With Non-lacunar Stroke - A Potential Clue To Mechanisms?
Authors: Delpirou Nouh Claire E , Kirkpatrick Angelia C , Ray Bappaditya S , Ramirez-Salazar Sergio , RABADI MEHEROZ , Xu Chao , Dale George L , Prodan Calin I
Published: February 2023

Introduction:
Coated-platelets are a subset of highly procoagulant platelets observed upon dual-agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in patients with ischemic stroke and associated with stroke recurrence. Lower levels of coated-platelets are present in ischemic stroke patients with early hemorrhagic transformation or in those with microbleeds. We now investigate if the number and location of microbleeds are associated with coated-platelet levels following non-lacunar stroke.

Methods:
Coated-platelet levels, reported as percent of cells converted to coated-platelets, were assayed in consecutive stroke patients. The number and location of microbleeds (deep vs lobar/mixed) on 1.5 T MRI was recorded by two independent reviewers. Correlations between number of microbleeds and demographics, vascular risk factors, stroke subtype, medications and laboratory values (platelet count, MPV, Hgb, WBC, CRP) were calculated using the Spearman correlation coefficient. Logistic regression was used to identify factors independently associated with location.

Results:
There were 249 stroke patients analyzed, with a mean age of 65.7 years (range 42 to 91). Microbleeds were present in 72/249 patients (29%), ranged from 1 to 14 lesions and were classified as deep (47) or lobar/mixed (25) distribution. Inter-rater agreement was excellent (91%). The number of microbleeds correlated negatively with coated-platelet levels (adjusted r = -0.41, p < 0.001) after adjusting for age (r = 0.11, p = 0.09). Variables independently associated with lobar/mixed as opposed to deep location of microbleeds included coated-platelet levels (47.0±35.0% vs 26.7±10.2%, p = 0.005) and prior stroke (10/25 vs 9/47, p = 0.028).

Conclusions:
Lower levels of coated-platelets are associated with increased number of microbleeds. In addition, coated-platelet levels are higher in patients with lobar/mixed as compared to those with deep distribution of microbleeds, a finding possibly linked to amyloid metabolism abnormalities described in this subset of procoagulant platelets. These data support a role for differential involvement of platelet procoagulant potential in mechanisms leading to development of cerebral microbleeds.
Abstract TMP105: Migraine With Aura Risk Score, Medication Use And Composite Cardiovascular
Authors: McCain Caylee , Martin Chylee , Kerley John , Logue Makenzie , Trivedi Tushar , Melikov Petr , Gottesman Rebecca F , Rosamond Wayne D , Sen Souvik
Published: February 2023

Background:
The migraine with aura risk score (MARS) was developed to predict the risk of ischemic stroke in patients with migraine with aura. Certain medications (estrogen replacement therapy-ERT, triptans and ergot alkaloids) have been postulated to increase cardiovascular risk. We tested if MARS or medications increased risk of ischemic stroke, cardiovascular event, and death.

Methods:
Migraine with aura patients (N=430) in the Atherosclerosis Risk in Communities Cohort were considered in this study. Those who had events prior to being evaluated were excluded leaving 420 patients. MARS was calculated at visit 3 (1993-1995) and patients were stratified as low (≤2) and high (≥3) risk groups. Medication uses were recorded on the same visit.

Results:
Of the 420 patients with a history of migraine with aura (age, mean±standard deviation=58.5±5.5, 349 female, 344 white), 49 patients had an ischemic stroke, 79 had a cardiovascular event, and 192 died during a 25-year follow-up period. The high-risk group was noted to have hazards ratio (HR) of 4.41 (95% CI 2.45-7.94) for ischemic stroke, 5.89 (95% CI 3.69-9.38) for cardiovascular event, and 3.56 (95% CI 2.66-4.79) for death, compared with the low-risk group. HR for composite events was 3.60 (95% CI 2.73-4.75). Kaplan-Meier Survival curves are depicted below (Logrank p<0.0001). Among medications only ERT (used in 34%) was associated with a significantly lower risk of composite events (HR 0.63, 95% CI 0.47-0.84), no significant difference for triptans (used in 1%) or ergot alkaloids (used in 4%).

Conclusion:
MARS≥3 increased the risk of composite events. Triptans and ergot alkaloids were not associated with increased risks and ERT was associated with a lower risk of composite events. The MARS finding needs validation in an external dataset and medication effects need confirmation in a randomized clinical trial.
Abstract TMP106: Decline In The Severity Of Hospitalized Ischemic Stroke 2005-2015: The Greater Cincinnati/Northern Kentucky Stroke Study
Authors: Reeves Mathew J , Ding Lili , Khoury Jane C , Robinson David , Stanton Robert J , Alwell Kathleen S , Haverbusch Mary , Woo Daniel , Ferioli Simona , Adeoye Opeolu M , Flaherty Matthew L , Mackey Jason , De Los Rios La Rosa Felipe , Khatri Pooja , Demel Stacie , Coleman Elisheva R , Martini Sharyl , Mistry Eva , Jasne Adam , Slavin Sabreena , Star Michael , Walsh Kyle , Kleindorfer Dawn O , Kissela Brett M
Published: February 2023

Background:
Monitoring changes in ischemic stroke severity at the population level is important as changes in risk factors and clinical treatments could influence stroke severity. We describe trends in the distribution of NIHSS across 3 time periods in a population-based epidemiologic stroke study.

Methods:
In 2005, 2010, and 2015 all adult acute ischemic strokes occurring within the Greater Cincinnati area presenting to 15 hospitals were ascertained using discharge codes (ICD-9 433-436; IDC-10 I63-I68, G45-46). Following physician verification, confirmed ischemic stroke cases underwent chart abstraction including estimation of a retrospective (rNIHSS) score at presentation. Descriptive statistics (rNIHSS median, IQR) were generated by survey year, demographics, and medical history. Using a binary definition of stroke severity (median rNIHSS score > 4 versus < 4), multivariable logistic regression was used to estimate changes in stroke severity over time, adjusting for potential confounders. Random effects were used to account for multiple admissions occurring in the same subject.

Results:
The number of ischemic stroke admissions in the 2005, 2010, and 2015 surveys was 1778, 1903, and 1933, respectively (Table). The median (IQR) rNIHSS scores were 3 (2-7), 3 (1-6), and 2 (1-6) across the 3 surveys, respectively; the proportion of admissions with rNIHSS > 4 was 48%, 39% and 37%, respectively. After adjusting for demographics, medical history and pre-stroke function, compared to 2005, the odds ratio for more severe stroke was 0.69 (95% CI= 0.60-0.79, p=0.001) in 2010 and 0.63 (95% CI= 0.55-0.73, p=0.001) in 2015.

Conclusions:
In this population- based study there was a statistically significant change in the severity of ischemic stroke hospitalizations with increases in the proportion of milder strokes over time. Potential reasons for this change need to be explored but could include changes in risk factors, clinical treatments or diagnostic approach.
Abstract TMP108: Improvements In Sleep Apnea Are Associated With Improvements In NIHSS In The First Year After Stroke.
Authors: Brown Devin , Zhang Guanghao , Shi Xu , Kwicklis Madeline , Chervin Ronald , CASE Erin , Lisabeth Lynda D
Published: February 2023

Introduction:
Sleep apnea, a very common condition among post-stroke patients, is associated with worse functional, cognitive, and neurological outcomes after stroke. Little is known about the association between change of sleep apnea and changes in outcome over time.

Methods:
Associated with the Brain Attack Surveillance in Corpus Christi (BASIC) project, ischemic stroke patients (2016-2019) were offered sleep apnea testing with a portable respiratory monitor (ApneaLink Plus) shortly after stroke and at 3, 6, and 12 months post-stroke. Sleep apnea was quantified using the respiratory event index (REI), the number of apneas plus hypopneas per recording hour. At 3, 6, and 12-months post-stroke, functional outcome was assessed using activities of daily living (ADL)/instrumental activities of daily living (IADL) score (1-4, lower better); cognitive outcome was assessed using the Modified Mini-Mental State Examination (3MS) (0-100, higher better); neurological outcome was assessed using the NIHSS (0-42, lower better). Multivariate mixed models were fitted under a Bayesian approach to obtain random slopes in REI over time and the three outcomes (1-unit change in outcome per month), adjusted for age, sex, ethnicity, pre-stroke function and cognitive status, education, marital status, stroke history, tpa use, recurrent stroke, and depression. Linear regression models assessed the association between random slope of REI and random slopes of the three outcomes.

Results:
Of the 482 Mexican American or non-Hispanic white participants with at least one REI measurement, in fully adjusted models, improvement in sleep apnea was significantly associated with improvement in NIHSS (0.0094 (95% CI: 0.0070, 0.0118)) but not with changes in ADL/IADL or 3MS.

Conclusions:
Improvement in sleep apnea paralleled improvement in neurological status over the first year after stroke.
Abstract TMP109: Labeling And Isolating Cell Specific Neuronal Mitochondria And Their Functional Analysis In Mice Post Stroke
Authors: XIN Hongqi , Liu Zhongwu , Golembieski William , Zhang Yi , Liu Xianshuang , Zhang Zheng Gang , Chopp Michael
Published: February 2023

Introduction:
In vivo neuronal mitochondria dysfunction post stroke has not been well investigated.

Methods:
Using Mito-tag mice in combine with local infection of AAV9 produced from plasmids carrying Cre-recombinase controlled by neuronal promoters, we generated reporter mice expressing a hemagglutinin (HA)-tagged EGFP that localizes to mitochondrial outer membranes in synaptophysin (SYN) and calmodulin-kinase II (CaMKII) glutamatergic neurons localized to cerebral cortex. These mice were subjected to permanent middle cerebral artery occlusion and sacrificed 14 days post stroke. Fresh brain tissues were excised from the ischemic core (IC), ischemic boundary zone (IBZ) as well as from the homologous contralateral hemisphere, and the crude mitochondrial fractions (CMF) were extracted. Neuronal mitochondria were then isolated from the CMF by anti-HA magnetic beads (Thermo Scientific) and their specificity and oxidative phosphorylation (OXPHOS) complexes were confirmed by means of Western-blot. Seahorse assay was employed to measure oxygen consumption rate (OCR) of the isolated mitochondria as an indicator of mitochondrial function.

Results:
The bead pulled components were co-precipitated with GFP and enriched with mitochondrial markers, e.g. voltage-dependent anion channel, cytochrome C, and COX IV, but lacked the Golgi protein RCAS1 as well as endoplasmic reticulum markers: Heme-oxygenase 1 and Calnexin, indicating that specific neuronal mitochondria have been selectively isolated. Western-blot data showed that OXPHOS components in SYN
+
and CAMKII
+
neuronal mitochondria were significantly downregulated in the IBZ and further decreased in the IC compared to the contralateral tissue, which was associated with the significant reductions of mitochondrial function measured by OCR (p<0.05, respectively, for both neuron types). These data suggesting dysfunction of neuronal mitochondria post stroke.

Conclusions:
We, for the first time, measure mitochondrial function in 2 types of neurons post stroke. By introducing specific neuronal promoter controlled Cre recombinase to Mito-tag mouse, mitochondria from individual neuronal linage cells can be efficiently labeled and isolated to investigate functional change post stroke.