bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP10: Effects of Tirofiban on Early Neurological Deterioration in Patients With Acute Ischemic Stroke: A Systematic Review and Meta- Analysis
Authors: Menegat Brenda Luana Rocha Soares , Menegat Ana Luiza Rocha Soares , Rocha Dantas Clara , Rachas Reis Mariana , de Souza Wagner Pedro , Simões Bárbara , Alves Mylena , Matheus Gustavo Tadeu , Bezerra Ian , Menegaz de Almeida Artur , Kelly Francinny , A de Moraes Francisco Cezar
Published: January 2025

Introduction:
Early neurological deterioration (END) is an adverse outcome of acute ischemic stroke that affects up to one-third of patients and is linked to poorer functional outcomes. Tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor blocker, is widely used in the treatment of atherosclerotic heart disease and percutaneous coronary intervention. Herein, we sought to assess whether Tirofiban reduces the severity of outcomes and improves stroke patient recovery through a systematic review and meta-analysis.

Methods:
We systematically searched Pubmed, Cochrane, Web of Science and Scopus for randomized clinical trials and observational studies. The studies compared the effects on the administration of Tirofiban or control on END in individuals with acute ischemic stroke. Risk ratio (RR) was used for binary outcomes and mean difference (MD) for continuous endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I
2
statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.

Results:
Seven studies and 2163 patients were included. Among them, 1132 (52,34%) were allocated to receive Tirofiban and 1031 (47,66%) received a placebo. The number of male patients was higher than females, with 1401 (64,80%), while 762 (35,20%) were women. The outcomes of END (RR 0.43; 95% CI 0.21 to 0.87; P=0.018715; I
2
=50%), 7th day National Institutes of Health Stroke Scale (NIHSS Score) (MD -1,03; 95% CI -2.03 to -0.02; P=0.045408; I
2
=72%) and score of 0 to 2 on the Modified Rankin Scale (mRS) for functional independence (MD -1.05; 95% CI -1.71 to -0.39; P=0.001916; I
2
=95%) presented statistical significance favoring the Tirofiban group. The following outcomes showed no statistical significance: mortality (RR 0.94; 95% CI 0.57 to 1.55; P=0.810315; I
2
=39%) and symptomatic intracerebral hemorrhage (RR 1.27; 95% CI 0.32 to 5.04; P=0.738112; I
2
=47%).

Conclusion:
Even though there was no significant difference between the groups in all outcomes, such as mortality and symptomatic intracerebral hemorrhage, Tirofiban induced a favorable impact on functional outcome and improved the prognosis in patients with acute ischemic stroke. This systematic review and meta-analysis suggest that Tirofiban is efficient in preventing early neurological deterioration and improving the mRS and NIHSS scores, however, new RCTs are needed to clarify our results.
Abstract TP11: Clinical Determinants of Decision-Making for Extended-Window Intravenous Thrombolysis
Authors: Schonewille Doxandabaratz Irati , Rubiera Marta , Juega Jesus , Iza Maider , Ribo Marc , MOLINA CATERIANO CARLOS , Simonetti Renato , Rizzo Federica , Olive-Gadea Marta , Rodríguez Villatoro Noelia , Rodriguez-Luna David , Rodrigo Gisbert Marc , Pagola Jorge
Published: January 2025

Introduction:
Current guidelines suggest using intravenous thrombolysis (IVT) for patients experiencing acute ischemic stroke within 4.5 hours of symptom onset. Nevertheless, recent clinical trials have explored the possibility of extending the IVT treatment window. Our aim was to identify factors influencing the treatment decision-making for extended-window intravenous thrombolysis (ewIVT) and the impact on different outcomes.

Methods:
Retrospective analysis of a prospectively acquired stroke center registry of acute ischemic stroke (AIS) patients. Awakening patients or those treated between 4.5 and 9 hours from symptom onset and presenting with a LVO or positive mismatch on brain computed tomography perfusion were evaluated. We compared IVT treated and non-treated patients and identified factors related with treatment decision. Patients that underwent thrombectomy, had ASPECTS<7 or formal ESO guideline exclusion criteria were excluded. The efficacy outcomes were the 3-months modified Rankin Scale (mRS) 0-1 or return to baseline mRS and an improvement of two points in the 24hrs-NIHSS or a 24hrs-NIHSS of 0. The safety outcome was the rate of symptomatic intracranial hemorrhage (SICH).

Results:
We included 79 patients (Table 1.) Twenty-two patients (27.8%) received IVT. IVT patients had similar stroke severity at baseline (median NIHSS 4.5 (2.0-6.0) vs. 4.0 (IQR 2.0-6.5); P=0.596) (Figure 1.) but presented higher ASPECTS (median 10.0 (IQR 10.0-10.0) vs. 10.0 (IQR 9.0-10.0); P=0.010) and more often had aphasia (63.6% vs. 24.6%, P=0.001). An adjusted logistic regression showed that main predictors of IVT treatment were aphasia (aOR 6.59, 95% CI 1.22-35.57; P=0.028) and favorable ASPECTS (aOR 7.05 95%CI 1.43-34.68 P=0.016). At 24 hours, 77.3% of patients in the IVT group experienced a NIHSS improvement, as compared with 36.8% in the control group (aOR 5.02, 95%CI 1.33-18.90; P=0.017). No patient in the IVT group presented with a SICH (3.6% in the control group). However, the mRS at 3 months was more favorable in the control group; 64.0% vs. 56.3% in the IVT group (aOR 0.19, 95% CI 0.03-1.19; P=0.076).

Conclusions:
Presence of aphasia and ASPECTS were the main determinants of ewIVT. IVT was safe and induced early clinical improvement in AIS patients treated after 4.5 hours. Population and health-professionals’ education is crucial to promote treatment in these subgroups of patients and improve patient outcomes.
Abstract TP13: Effectiveness and safety of direct oral anticoagulation vs. warfarin for primary prevention of stroke and bleeding risk among patients with atrial fibrillation.
Authors: Jaiswal Vikash , Shama Nishat , Jaiswal Akash , Patel Nirmit , Rajak Kripa , Kalra Kriti , Ang Song Peng , Sawhney Aanchal , Danisha FNU , Shrestha Abhigan , Hanif Muhammad
Published: January 2025

Background:
Atrial fibrillation (AF) patients carry a high risk of stroke, and treatment related bleeding complications. Evidence for the safety and efficacy of anticoagulation remains sparse with conflicting results.

Objective:
We sought to investigate the effectiveness and safety of direct oral anticoagulant (DOAC) versus warfarin in atrial fibrillation patients.

Methods:
We performed a systematic literature search on PubMed, EMBASE, and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) from inspection until July 30th, 2024, without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.

Results:
A total of 7 RCTs with 79,001 patients were included (46069 in DOAC and 32932 in the warfarin group) in the analysis. The mean age of the patients in DOAC and the warfarin groups was 72.8 and 72.9 years, respectively. Pooled analysis of primary and secondary endpoints showed that DOAC significantly reduced the risk of stroke or systemic embolism by 18% (OR, 0.82(95%CI: 0.75-0.91), P<0.01), stroke by 19% (OR, 0.81(95%CI: 0.68-0.97), P=0.02), and hemorrhagic stroke by 57% (OR, 0.43(95%CI: 0.33-0.56), P<0.01) when compared with warfarin. However, the risk of ischemic stroke (OR, 0.96(95%CI: 0.78-1.18), P=0.69), major bleeding (OR, 0.84(95%CI: 0.67-1.06), P=0.14) and myocardial infarction (OR, 1.07(95%CI: 0.89-1.28), P=0.45) was comparable between DOAC and the warfarin group of patients. The use of DOACs was associated with lower odds of all-cause mortality (OR, 0.91(95%CI: 0.85-0.97), P<0.01) when compared with the warfarin group of patients.

Conclusion:
In this comprehensive analysis of randomized controlled trials data, the use of DOACs was associated with reduction in stroke or systemic embolism, hemorrhagic stroke, and all cause mortality, compared with warfarin therapy. Major bleeding risk was comparable between both groups of patients.
Abstract TP147: Aspirin and Aspiration: Improving swallow screen compliance with alliteration as a cognitive cue
Authors: Beavis James , Goncer Timothy
Published: January 2025

Background and Purpose:
Pneumonia remains a common complication of stroke. A formal dysphagia screening is the first line of defense for these patients. This community Primary Stroke Center (PSC) identified the need to improve swallow screen compliance both at the hospital and in the county at large. Internal data review revealed that, over a one-year period, the administration of aspirin accounted for 62% of all swallow screen fallouts. This project was developed to increase compliance with the swallow screen protocol for all patients admitted for acute ischemic stroke at one community hospital.

Methods:
Alliteration is well-documented as a useful tool for recall and memory in the psychological literature. The stroke team wanted to assess if promoting the alliterative association between “aspirin” and “aspiration” could improve swallow screen compliance. This was done via a three-pronged approach. A reminder was placed on to the Pyxis cubie for aspirin that read, “Aspirin&Stroke Patients: Think Aspiration! Please complete your swallow screen.” The association was socialized via flyers and huddles. A stroke committee was formed, and stroke committee nurses reviewed this new project with their colleagues. Data was collected retroactively for 19 months; 12 months prior to the intervention and 7 months after.

Results:
Swallow screen compliance improved from 79% prior to the intervention to 90% after the intervention.

Aspirin administration accounted for 62% of all fallouts prior to the intervention. This decreased to 33% after the intervention.

Conclusions:
Prevention of pneumonia is key to the clinical and financial success of an institution. This simple cognitive cue had an outsized impact on swallow screen compliance and the downstream improvements in patient care and expenditure. The success of this project underscores the importance of looking outside of nursing for inspiration and guidance.
Abstract TP17: Discovery and development of sovateltide, an endothelin-B receptor agonist to treat cerebral stroke patients
Authors: Gulati Anil
Published: January 2025

Sovateltide is a synthetic analog of ET-1 and has very high selectivity for ET-B receptors, which are in high concentration in the CNS. Sovateltide induces ET-B receptor-mediated signaling to produce significant anti-oxidative activity, antiapoptosis, mitochondrial fusion and biogenesis, angiogenesis, tissue re-perfusion, neuronal differentiation, tissue regeneration, and repair in the CNS, and a significant recovery in neurological and motor functions and a reduction in the infarct volumes. Studies in mice, rats, and dog models indicate that sovateltide is well tolerated and has a good safety margin.

Clinical studies were conducted to determine human safety and efficacy. Standard of care was provided to all the patients. The study drug was administered in three doses as an intravenous injection over 1 minute at an interval of 3±1 hours on days 1, 3, and 6. Patients received either saline or sovateltide (0.3 µg/kg) within 24 hours of the stroke onset.

In the phase I clinical trial, conducted in healthy individuals, sovateltide had a short half-life of about 5 minutes and was safe and well tolerated. A phase II study was conducted on 40 patients with acute ischemic stroke. An improvement of ≥2 points on the mRS from baseline was observed in 60% and 40% of patients in the sovateltide and saline groups, respectively (p=0.0519; odds ratio 5.25). Phase III study was conducted in 158 acute ischemic stroke patients, of which 78 were in control, and 80 were in the sovateltide group. The data not available (6.4%) were assessed as "missing values" and were imputed using “MICE” by creating multiple imputations. The number of patients with mRS of 0-2 at 90 days was 53.58% in control and 76.25% in the sovateltide groups (p=0.0031). The number of patients with NIHSS of 0-5 at 90 days was 67.95% in control and 85.00% in the sovateltide groups (p=0.0114). The ordinal shift in mRS from 0-1 showed an absolute increase of 8% in the favorable outcome of sovateltide compared to the control group, while a shift in mRS from 0-2 showed an absolute increase of 22% in the favorable outcome of sovateltide compared to the control group.

Pharmacologically targeting ET-B receptors with sovateltide is safe and effective in improving neurological outcomes in cerebral ischemic stroke patients.
Abstract TP175: Hidden Core: Unveiling the Clinical Impact of CTP-Invisible Ischemic Lesions in Large Vessel Occlusion Stroke Treated with Thrombectomy
Authors: Inoue Manabu , Kamogawa Naruhiko , Yoshie Tomohide , Abe Soichiro , Ishiyama Hiroyuki , Shiozawa Masayuki , Yamaguchi Eriko , Imamura Hirotoshi , Kataoka Hiroharu , Ihara Masafumi , Koga Masatoshi , Albers Greg , Toyoda Kazunori
Published: January 2025

Background and Purpose:
Acute ischemic stroke (AIS) may present with an estimated core of 0 ml on CT perfusion imaging without a visible decrease in cerebral blood flow (CBF) maps. When the ischemic core is not visible, assessing the full extent of stroke severity can be challenging. We assessed the clinical outcomes of patients with and without a CBF core at stroke onset, who underwent mechanical thrombectomy.

Methods:
Data from the National Cerebral and Cardiovascular Center Endovascular Thrombectomy database (January 2018 to April 2024) were analyzed. Anterior circulation AIS patients with large vessel occlusion were grouped based on the presence of a CBF core, defined as either 0 mL or greater than 0 mL, with a relative CBF less than 30% of normally perfused tissue on CT perfusion imaging. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Secondary outcomes included mRS 0-1 at 90 days, symptomatic intracranial hemorrhage (sICH), and death.

Results:
A total of 704 patients (mean age 75±13 years, 52% women) were included in the study, with 214 having no CBF core (0 mL) and 490 having a CBF core. Median CBF core volume in the CBF core group was 26 mL (IQR 12-64). The median baseline NIHSS score was significantly lower in the no CBF core group (13; IQR 7-18) compared to the CBF core group (19; IQR 14-25, p < 0.01). Additionally, the no CBF core group had higher hemoglobin levels (p <0.01) and a lower percentage of M1distal (M1d) occlusion (15% vs. 23%, p=0.02). The rate of intravenous thrombolysis (45% vs. 39%, p=0.13) and the median time from onset to imaging (143 minutes vs. 162 minutes, p=0.43) were similar between groups. Favorable outcomes (mRS 0-2 at 90 days) were significantly more frequent in the no CBF core group (44% vs. 34%, p=0.01), as were excellent outcomes (32% vs. 20%, p <0.01). There was no significant difference in rates of sICH (4% vs. 3% p=0.81) and death (5% vs. 8%, p=0.26) between the groups. Logistic regression analysis, adjusted for age, sex, NIHSS, hemoglobin, blood glucose, M1d occlusion, and intravenous thrombolysis, showed a significant association between the absence of a CBF core and favorable outcomes, with an adjusted OR of 1.51 (95% CI 1.00-2.25, p=0.04).

Conclusions:
Stroke patients without a CBF core at baseline have better clinical outcomes. The higher incidence of M1d occlusions in the CBF core group suggests that these patients have poorer collateral flow, leading to more evident decreases in CBF.
Abstract TP178: Investigation of Computed Tomography Perfusion Imaging in Predicting Hyperperfusion Phenomenon After Carotid Artery Stenting
Authors: Yamamoto Hiroyuki , Maruyama Daisuke , Nanto Masataka , Hashimoto Naoya
Published: January 2025

Background:
Hyperperfusion phenomenon (HPP) constitutes a significant risk factor for adverse outcomes following carotid artery stenting (CAS). Currently, the sole method for evaluating the risk of HPP post-CAS is the invasive acetazolamide (ACZ) challenge test. This study aimed to identify the most effective parameters of computed tomography perfusion imaging (CTP) for detecting patients at risk for HPP after CAS, as a non-invasive alternative to the ACZ challenge test.

Methods:
Consecutive patients with internal carotid artery stenosis who underwent
123
I-IMP-SPECT at rest and CTP prior to CAS, and subsequently underwent
123
I-IMP-SPECT at rest the day following CAS, were included in this study between April 2019 and March 2024. The asymmetry index (AI) was calculated as the ratio of ipsilateral to contralateral cerebral blood flow (CBF) within the middle cerebral artery (MCA) territories, as measured by postoperative
123
I-IMP-SPECT at rest. HPP was defined as AI ≥1.1, and patients were categorized into two groups based on the presence or absence of HPP post-CAS. Additionally, we calculated the ratio of CBF, cerebral blood volume (CBV), mean transit time (MTT), and time-to-peak (TTP) within the affected MCA territories relative to the unaffected side, as determined by preoperative CTP using the Bayesian method, and compared these ratios between the HPP and non-HPP groups. Receiver operating characteristic (ROC) curve analysis was conducted to identify the most accurate CTP parameter for predicting HPP.

Results:
Forty-six patients were enrolled; four patients exhibited HPP after CAS, and one patient experienced a cerebral hemorrhage. Significant differences were observed in the CBV ratio (
p
=0.001), MTT ratio (
p
=0.003), and TTP ratio (
p
=0.011) between the HPP and non-HPP groups. ROC curve analysis demonstrated that the CBV ratio had the highest area under the receiver operating characteristic curve (AUC-ROC) for predicting HPP, with an AUC of 0.946 (95% CI, 0.86-1.0).

Conclusion:
Preoperative CTP could effectively identify patients at risk for HPP after CAS. The CBV ratio may serve as a reliable parameter, potentially obviating the need for the invasive ACZ challenge test.
Abstract TP179: Hyperintense Acute Reperfusion Marker Sign in Patients with Diffusion Weighted Image-negative Transient Ischemic Attack
Authors: Kim Taewoo , Heo Sung Hyuk , Woo Ho , Kim Bum Joon , Lee Kyung Mi , Chang Dae-il , Park Sangil
Published: January 2025

Background:
The hyperintense acute reperfusion marker (HARM) sign is a hyperintense signal observed on postcontrast fluid-attenuated recovery inversion images and is strongly associated with cerebral ischemic insults. The clinical significance of the HARM sign in transient ischemic attack (TIA) has rarely been studied, unlike that in stroke. This study investigated the relationship between the HARM sign and various clinical factors in diffusion-weighted imaging (DWI)-negative TIA. Furthermore, we investigated the relationship between the HARM sign with recurrence of TIA and ischemic stroke.

Methods:
We included 329 consecutive patients with DWI-negative TIA and divided them into two groups according to the HARM sign: 299 patients in the HARM(-) group and 30 patients in the HARM(+) group. Clinical information, brain imaging, and follow-up data were gathered from medical records and phone calls and compared using the HARM sign.

Results:
The patients with HARM sign were older (70.7 vs. 64.4 years, p = 0.007), had more previous TIA or stroke history within 12 months (26.7% vs. 4.0%, p < 0.001), and had higher systolic blood pressure (154.3 vs. 144.1, p = 0.022). The HARM(+) group also had a shorter symptom duration of <1 hour (63.3% vs. 38.8%, p = 0.009) and more symptomatic stenosis (50–99%) or occlusion (60.0% vs. 14.0%, p < 0.001). Among the transient neurological symptoms, only cortical symptoms were more prevalent in the HARM(+) group (30.0% vs. 8.7%, p = 0.002). The total follow-up duration of both groups was similar, and the Kaplan-Meier analysis showed a higher cumulative incidence of recurrent stroke in the HARM(+) group (log-rank test, p = 0.007). However, multivariate Cox analysis indicated that symptomatic stenosis or occlusion, rather than the HARM sign, was independently associated with stroke recurrence.

Conclusion:
The HARM sign in DWI-negative TIA patients is linked to older age, recent cerebrovascular events, shorter symptom duration, and large artery stenosis or occlusion. While the HARM sign correlates with higher recurrence of ischemic stroke, large artery stenosis or occlusion is the primary independent predictor.
Abstract TP181: Advanced Diffusion and Functional MRI Measures Are Associated with Microstructural Morphology and Cognitive Function in Subacute Ischemic Cerebellar Stroke
Authors: Urday Sebastian , Clements Rebecca , Kurani Ajay , Montero Miguel , Grafman Jordan , Harvey Richard , Ingo Carson
Published: January 2025

Introduction:
The mechanisms of cognitive dysfunction following ischemic cerebellar stroke (CS) are not well understood. Furthermore, traditional clinical stroke MRI protocols often cannot identify subtle and early changes in normal appearing tissue of the cerebellum. We aimed to implement an advanced MRI protocol in subacute CS patients to better understand outcomes.

Hypothesis:
The MRI markers for tissue microstructure and cerebrovascular function (CVF) in the cerebellum will provide mechanistic insight into post-stroke cognitive dysfunction.

Methods:
After 4 weeks of stroke onset, 13 first-time subacute mildly-impaired ischemic stroke participants (PPT) were imaged on a 3T Siemens Prisma MRI scanner with an advanced multi-shell diffusion-weighted protocol to map of Non-Gaussian Diffusion (NGD) and a multi-echo resting-state functional protocol with a breath-hold task (rs+BH-fMRI) to map CVF. PPT demographics: 62.6(11.44) years, sex (11 males), race (1 Latino, 2 Asian, 4 black, 6 white), NIHSS median = 1 (IQR 0-3), Montreal Cognitive Assessment (MoCA) median = 25 (IQR 21-28). 3 PPTs were diagnosed with right cerebellar stroke (CS), and 10 PPTs were diagnosed with non-cerebellar subcortical stroke (NCS). Statistical analyses were performed to: 1) identify the group differences between the CS PPTs versus the NCS PPTs for both NGD and rs+BH-fMRI metrics in the normal appearing white and gray matter of the infarcted cerebellum, and 2) for all PPTs, correlate the NGD metrics in the left 'unaffected' cerebellum white matter versus MoCA score.

Results:
Fig. 1 shows the group comparison for significantly increased NGD (p<0.05) in the infarcted hemisphere of CS PPTs versus NCS PPTs. Classical fractional anisotropy (FA) did not reach significance. Fig. 2 shows the individual rs+BH-fMRI data (Fig. 2), where the amplitude of the CVF response was significantly decreased for the CS PPTs versus NCS PPTs in the infarcted cerebellum (p=0.043). Fig. 3 shows the correlational analysis in the 'unaffected' left cerebellar hemisphere with significantly increased NGD (r=0.473, p=0.038) with respect to MoCA scores. Classical FA did not reach significance.

Conclusions:
Using advanced MRI protocols we demonstrated that novel NGD metrics and breath-hold based fMRI measures are sensitive to cerebellar morphology post-stroke and correlate with cognitive function. These measures can be used to identify trajectories for recovery and accelerated cognitive impairment after ischemic CS.
Abstract TP188: The relative cerebral blood volume (rCBV) >42% is independently associated with hemorrhagic transformation in successfully reperfused anterior circulation large vessel occlusion
Authors: Lakhani Dhairya , Balar Aneri , Khan Musharaf , Salim Hamza , Koneru Manisha , Wen Sijin , Hillis Argye , Heit Jeremy , Albers Greg , Dmytriw Adam , Wintermark Max , Nael Kambiz , Rai Ansaar , Yedavalli Vivek
Published: January 2025

Introduction:
Pretreatment CT Perfusion (CTP) marker relative cerebral blood volume (rCBV) <42% lesion volume has recently been shown to predict poor collateral status (CS), infarct volume, and unfavorable 90-day functional outcomes. However, there are no studies assessing its association with hemorrhagic transformation (HT). This study aims to evaluate the relationship between rCBV <42% volume and HT.

Patients and Methods:
This retrospective study included patients with acute ischemic stroke secondary to large vessel occlusion (AIS-LVO) in the anterior circulation who achieved successful recanalization at two comprehensive stroke centers between September 1, 2017, and October 1, 2023. Successful recanalization was defined as modified treatment in cerebral infarction (mTICI) ≥ 2b. Logistic regression and ROC analysis were used to assess the relationship between rCBV <42% and HT.

Results:
A total of 150 patients (median age: 69 years) met the inclusion criteria. Multivariable logistic regression analysis, accounting for age, sex, hypertension, hyperlipidemia, diabetes, prior stroke or transient ischemic attack, admission NIHSS, ASPECTS, and intravenous thrombolysis, revealed that rCBV <34% (aOR: 1.01, p<0.05), rCBV <38% (aOR: 1.01, p<0.05), and rCBV <42% (aOR: 1.01, p<0.05) volumes were independently associated with HT. ROC analysis showed that rCBV <42% (AUC = 0.61, p<0.05) performed slightly better than rCBV <38% (AUC = 0.59, p<0.05) and rCBV <34% (AUC = 0.59, p<0.05) in predicting HT. In contrast, commonly used CT perfusion markers, such as rCBF <30% and Tmax >6s volumes, did not show significant associations with HT.

Discussion:
Our results further validate the role of rCBV <42% as a poor prognostic biomarker for HT in anterior circulation LVO cases that achieved successful reperfusion following mechanical thrombectomy (MT). The risk of HT is higher in large core cases post-MT. Given the increasing interest in performing MT in AIS-LVO cases regardless of core size and collateral status, following recent successes in large-core trials, CTP markers like rCBV <42% could serve as valuable prognostic indicators for predicting HT.

Conclusion:
The rCBV <42% lesion volume is independently and negatively associated with HT in successfully reperfused AIS-LVO patients.
Abstract TP192: Late Blood Pressure Elevation After Initially Normal Levels Predicts Early Neurological Deterioration In Acute Intracerebral Hemorrhage
Authors: Simonetti Renato , Pancorbo Olalla , Rodriguez-Villatoro Noelia , Rizzo Federica , Muchada Marian , Rodrigo-Gisbert Marc , Olive-Gadea Marta , Mayol Jordi , Garcia-Tornel Garcia-Camba Alvaro , Molina Carlos , Rodriguez-Luna David
Published: January 2025

Introduction:
Elevated blood pressure (BP) is common in acute intracerebral hemorrhage (ICH) and is associated with poor neurological outcomes. However, about a quarter of patients present with normal BP, and this group is understudied. We aimed to evaluate the association between patterns of BP course and clinical outcomes.

Methods:
We conducted a retrospective cohort study using prospectively collected data from consecutive acute ICH patients who were scanned within 6 hours of symptom onset over a 7-year period. Patients underwent 24-hour noninvasive BP monitoring, and clinical outcomes were recorded at 24 hours. Patients were treated under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mmHg), and sustained (target stability for 24 hours) BP protocol when systolic BP (SBP) was ≥150 mmHg. Patterns of BP course were classified as Early High when SBP was ≥150 mmHg on admission, Late High when SBP was <150 mmHg on admission but increased to ≥150 mmHg within the first 24 hours, requiring treatment, and Steady Low when SBP spontaneously remained <150 mmHg from admission to the 24-hour follow-up. The primary outcome was early neurologic deterioration (END), defined as an increase in NIHSS score by ≥4 points or death within 24 hours. Multiple logistic regression analysis was adjusted for age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension.

Results:
We included 424 patients (mean age 72.1±13.7 years, 263 [62.0%] male). At baseline, mean SBP was 168.2±28.3 mmHg, median onset-to-imaging time 124 (80–218) minutes, and median ICH volume 14.9 (5.8–39.3) mL. The distribution of BP patterns was as follows: Early High in 335 (79.0%) patients, Late High in 65 (15.3%), and Steady Low in 24 (5.7%). END occurred in 147 (34.7%) patients. There was a steady increase in the frequency of END across BP patterns: Steady Low 12.5% (3/24), Late High 26.2% (17/65), and Early High 37.3% (127/335) (
P
=0.012, Figure 1). The occurrence of SBP ≥150 mmHg (Early or Late High) was independently associated with END (aOR 7.6, 95% CI 1.9–53.3).

Conclusions:
Most acute ICH patients experienced an SBP ≥150 mmHg within 24 hours, even among those who initially presented with lower BP. Patients who initially had SBP <150 mmHg but later experienced an increase to ≥150 mmHg were at a significantly higher risk of END. Overall, BP elevation, regardless of initial BP levels, is a strong predictor of END in acute ICH patients.
Abstract TP20: Intravenous thrombolysis versus early antiplatelet therapy in acute Ischemic Stroke with Small Artery Occlusion
Authors: Gao Yuan , ce zong , Zhang Ke , Liu Hongbing , Li Yapeng , Liu Kai , Li Yusheng , Yang Jing , Song Bo , XU YUMING
Published: January 2025

Backgrounds:
There remained a debate about the efficacy and safety of intravenous thrombolysis (IVT) on functional outcome compared to early antiplatelet therapy for ischemic stroke patients with small artery occlusive (SAO), and whether it could reduce the occurrence of early neurological deterioration (END) in the acute phase.

Methods:
Ischemic stroke patients with SAO who received IVT or early antiplatelet therapy only were screened from a prospective, multi-center ischemic stroke registry study from January 2021 to June 2021. The primary outcome was 3-month functional outcome by modified Rankin scale (mRS). The secondary outcome was symptomatic intracerebral hemorrhage (sICH) and END defined as an increase in total National Institute of Health stroke scale score (NIHSS) ≧ 2 points or in motor score ≧1 points within 7 days after admission.

Results:
A total of 1,125 patients with SAO were finally included (394 received IVT and 731 received early antiplatelet therapy), 411 (36.5%) experienced unfavorable outcomes (mRS > 2) at three months, sICH occurred in 3 patients (0.27%), all within the IVT group. Additionally, 213 patients (18.9%) experienced END. After propensity score matching and multivariable adjustment, IVT was significantly associated with a reduced likelihood of unfavorable outcomes at 3 months (adjusted odds ratio [aOR] 0.447, 95% CI 0.305–0.656), with no significant difference in END (aOR 0.867, 95% CI 0.569–1.321). Subgroup analysis indicated that patients with elevated traditional risk factors derived more benefit from IVT compared to those with high inflammatory response markers (aOR 0.405, 95% CI 0.244–0.673) on functional outcomes.

Conclusion:
IVT was associated with reduced incidence of unfavorable outcomes at three months, but failed to prevent END during hospitalization in SAO stroke patients. Patients with elevated traditional risk factors at admission may benefit more from thrombolytic therapy compared to those with high inflammatory response indicators.
Abstract TP203: Effects of Cyclooxygenase Inhibitors on Patients with Acute Intracerebral Hemorrhage
Authors: Yeh Shin-Joe , Tang Sung-Chun , Jeng Jiann-Shing
Published: January 2025

Introduction:
Celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, has been shown to reduce perihematomal edema in patients with acute intracerebral hemorrhage (ICH), but its effect on outcome was largely unclear. This study aimed to evaluate the effects of COX inhibitors (COXi) on patients with acute ICH.

Methods:
This study retrospectively enrolled patients with acute ICH hospitalized in our Hospital between Jan. 2015 and Dec. 2020. The exclusion criteria were delayed hospitalization for more than 10 days, transferal to other hospital within 10 days, ICH etiologies as trauma, structural lesion, medication, or systemic diseases. Although aspirin belongs to COXi, aspirin users were excluded because of the antiplatelet effect. Patients with continuous usage of COXi for at least three days were defined as COXi users. The effects of using COXi before or after ICH were analyzed individually. Good functional outcome was defined as modified Rankin Scale score 0-2 at 3 months.

Results:
A total of 1,022 patients were enrolled, in whom 35 (3.4%) used COXi within 2 weeks before ICH while 154 (15.1%) used COXi within 4 weeks after ICH. Patients using COXi before ICH were older, had a lower hemoglobin level, and more lobar hematoma. Patients using COXi after ICH were younger, had a lower NIHSS score, and higher percentage of operation. In multivariate logistic regression models, using COXi before ICH was associated with a higher mortality risk [using within 1 week: adjusted odds ratio (aOR) 3.20, 95% CI (1.13, 9.06), p = 0.028; within 2 weeks, aOR 2.78, 95% CI (1.03, 7.51), p = 0.044]. On the contrary, using COXi after ICH was associated with a lower mortality risk [using within 3 weeks: aOR 0.45, 95% CI (0.23. 0.87), p = 0.018; within 4 weeks, aOR 0.44, 95% CI (0.23, 0.84), p = 0.013]. The usage of COXi after ICH was associated with a good functional outcome specifically in patients with a non-operated lobar hematoma [OR 2.75, 95% CI (1.16, 6.54), p = 0.022], and in those with a non-operated smaller hematoma (<30 mL) [OR 1.65, 95% CI (1.01, 2.70), p = 0.047]. Furthermore, ICH etiology of amyloid angiopathy was significantly associated with pre-ICH usage of COXi [aOR 2.90, 95% CI (1.36, 6.17), p = 0.006].

Conclusions:
This study demonstrated different effects of COXi usage before and after ICH on long-term functional outcome and mortality in patients with acute ICH, specifically depending on hematoma location, volume, and operation.
Abstract TP206: Late Afternoon and Evening Onset ICH Associated with Hyperacute Neurological Deterioration and Worse 90-day Outcomes
Authors: Mun Katherine , PARIONA FATIMA , Sharma Latisha , Sanossian Nerses , Stratton Samuel , Eckstein Marc , Conwit Robin , Liebeskind David , Shkirkova Kristina , Avila Gilda , Kim-Tenser May , Saver Jeffrey
Published: January 2025

Background:
Recent studies have demonstrated time of day variations in ischemic stroke presentation and outcomes with findings that events occurring in the evening hours tend to be more severe, progress faster, and have poorer outcomes. Much less is known about circadian/diurnal influences on intracerebral hemorrhage.

Methods:
We analyzed patient records with a final diagnosis of intracerebral hemorrhage (ICH) from the Field Administration of Stroke Therapy - Magnesium (FAST-MAG) randomized trial database. Patients were grouped into six discrete 4-hour time windows by symptom onset time. Patient demographics, clinical features, medical history, stroke severity, and were examined for association with time of day.

Results:
Among 380 patients with ICH, 90% had last known well times during the day between 07:00 – 22:59. Thirty-two baseline patient features were generally similar across the six time-of-day intervals, except initial field systolic blood pressure was highest between 19:00 – 22:59 (mean 181 mmHg vs 165 – 176 mmHg) and last known well to paramedic evaluation longest between 03:00 – 10:59 (median 27 min vs 16 – 23 min). Among outcomes, early neurologic deterioration showed diurnal variation, with peaks of 47% between 15:00 – 18:59 and 49% between 19:00 – 22:59 vs 21% – 41% in other intervals (Figure 1). A higher proportion of patients were severely disabled (mRS 5) or dead (mRS 6) at 90 days in the 19:00 – 22:59 (54%) and 23:00 – 02:59 (64%) than in other time intervals.

Conclusions:
Hemorrhagic strokes with late afternoon to evening onset times are associated with increased frequency of hyperacute neurological deterioration and poorer 90-day outcomes. This finding suggests that circadian influences upon stroke course have commonalities across ischemic and hemorrhagic stroke subtypes.
Abstract TP207: Cerebral Amyloid Angiopathy Prevalence and Risk of Future Cerebrovascular Events and Mortality in Patients Presenting with Possible Transient Ischemic Attack
Authors: Bruce Samuel , Heidari Parisa , Castigliego Pasquale , Shamailova Sofiya , Dalla Vecchia Luiz Alexandre , Navi Babak , Murthy Santosh , Kamel Hooman , Kurmann Christoph , Kaesmacher Johannes , Goeldlin Martina , Jung Simon , Seiffge David , Fischer Urs , Buecke Philipp , Liberman Ava , Beyeler Morin
Published: January 2025

Introduction:
Cerebral amyloid angiopathy (CAA) can present with transient focal neurological episodes and is itself associated with a heightened risk of intracerebral hemorrhage (ICH). Therefore, in patients with suspected transient ischemic attack (TIA), CAA can impact diagnostic evaluation and antithrombotic management. However, among patients presenting with possible TIA, there are few data on the prevalence of CAA and its associated risk of future cerebrovascular events and mortality.

Methods:
We retrospectively analyzed consecutive patients presenting to Bern University Hospital, Switzerland between 2015 and 2019 with reversible neurological deficits lasting <24 hours and no evidence of acute ischemia on brain MRI. Two neurologists reviewed these patients’ MRI scans to evaluate for CAA according to the Boston Criteria, v2.0. Long-term outcomes included mortality, which was determined through the Swiss Population Registry, and subsequent cerebrovascular events (ICH, ischemic stroke, and TIA), which were assessed via electronic health record review. Cox regression models were used to evaluate the association between possible or probable CAA and outcomes after adjustment for age, sex, ABCD2 score, and antithrombotic use at discharge.

Results:
Of 1,117 subjects presenting during the study period with transient neurological symptoms and no acute ischemia on MRI, 21 (2%) met radiographic criteria for possible CAA and 30 (3%) met criteria for probable CAA. During a median follow up of 4.8 (interquartile range, 3.3-6.3) years, 7 patients (1%) had an ICH, 62 patients (5%) had an ischemic stroke , 72 patients (6%) had a TIA, and 181 patients (16%) died. In multivariable Cox regression analysis, there was no association between possible or probable CAA and the risk of future cerebrovascular events (adjusted hazard ratio [aHR], 0.94; 95% CI, 0.37-2.35) or mortality (aHR, 1.30; 95% CI, 0.83-2.01).

Conclusions:
In a cohort of patients presenting with possible TIA, the prevalence of radiographic criteria for possible or probable CAA was 5%. We did not find an association between possible or probable CAA and the risk of future ICH, ischemic stroke, TIA, or mortality. Further studies are needed to inform optimal diagnostic evaluation and management of patients meeting CAA diagnostic criteria presenting with transient neurological deficits.
Abstract TP210: Myelin in the Macrophage Response to Intracerebral Hemorrhage-Relevant Signals
Authors: Sun Leonardo , DeLong Jonathan , Velazquez Sofia , Landreneau Margaret , Sansing Lauren
Published: January 2025

Introduction:
Blood-derived macrophages become activated and contribute to a toxic environment in the brain after intracerebral hemorrhage (ICH). However, after three days, these macrophages become reparative and essential to tissue repair and recovery. The mechanisms by which this happens are poorly understood, but both myelin and cholesterol have been implicated in suppressing the macrophage response to different inflammatory signals. We have previously demonstrated through RNA sequencing that myelin suppresses responses to a broad range of diverse stimuli, while cholesterol only suppresses the response to lipopolysaccharides (LPS). The LXR agonist T091317 also suppressed responses, but not to the extent of myelin. We hypothesized that myelin would suppress cytokine production in the macrophage response to S100A9 and LPS.

Methods and Results:
Murine bone marrow-derived macrophages were pretreated with myelin for 18 hours before stimulation with S100A9 or LPS. Cytokine concentrations of TNF, IL-6, CCL2, and IL-10 were measured by cytometric bead array and analyzed by flow cytometry. Myelin seemed to have no significant effect on TNF production (Fig 1A). Myelin limited IL-6 production in response to S100A9 but not to LPS, but the LXR antagonist GSK2033 was unable to reverse this suppression (Fig 1B). Myelin increased CCL2 production in response to both stimulations in an LXR-dependent way (Fig 1C). IL-10 production was decreased in the myelin-treated conditions, and GSK2033 was unable to reverse this (Fig 1D).

Conclusions:
The measurement of protein responses may be more informative than transcriptional responses and it can help validate the RNA seq. Myelin suppressed some cytokine production, but not to the extent of what was shown in the RNA seq. This suggests that myelin may play a role in the suppressive response of macrophages to ICH, but other components are involved as well.
Abstract TP211:
In silico
drug repurposing identifies transcriptional mitigators of blood-induced neurotoxicity in an organoid model of intracerebral hemorrhage
Authors: Seah Carina , Schuldt Braxton , Vicari James , Lebakken Connie , Richards William , Greuel Kaylie , Parham Kailyn , Kellner Christopher
Published: January 2025

Introduction:
The optimal therapeutic window for evacuation of intracerebral hemorrhage (ICH) is controversial, balancing risk of prolonged exposure to blood-induced neurotoxicity against risk of post-operative rebleeding. Pharmacologic mitigators of neurotoxicity have the potential to lengthen this therapeutic window, extending the opportunity for favorable surgical outcomes. Here, we identify a blood-induced transcriptomic signature in an organoid model of ICH and perform an
in silico
screen to identify reversers of blood-induced toxicity.

Methods:
Single-cell RNA sequencing was performed on 96,725 cells across 18 human neural organoids comprising multiple cell types, treated with 5% blood for either 6 or 24 hours. Alignment, filtering, and analysis was performed using cellranger, SoupX, Scrublet, and Seurat. Gene associations to blood exposure were conducted using mixed-effect linear modeling. Significant expression signatures were determined using Benjamini-Hochberg multiple testing correction (FDR <5%). To identify compounds that may reverse the blood-exposure signature, we applied the Broad Institute Connectivity Map query tool to calculate a weighted enrichment score between the blood-induced signature and curated expression signatures of known therapeutic compounds. Compounds with a significant enrichment score FDR<0.05 were considered “reversers”.

Results:
Single-cell sequencing identified distinct transcriptomic impacts of 24-hours of blood exposure, including astrocyte reactivity (TGFb response, p=2.41x10
-3
), endothelial vasculogenesis (p=8.73x10
-9
), and neurotoxicity (glutamate receptor signaling, p= 1.12x10
-3
). To identify therapeutics with potential to reverse this signature, we performed an
in silico
drug screen, identifying 345 compounds targeting 119 unique mechanisms of action. Ten classes of drugs reversed blood-induced signatures in all three cell types, including adrenergic receptor antagonists, dopamine receptor antagonists, histamine receptor antagonists, acetylcholinesterase inhibitors, calcium channel blockers, phosphodiesterase inhibitors, HDAC inhibitors, MAPK inhibitors, and antibiotics.

Conclusion:
The neurotoxic effects of blood may be mitigated by a number of compounds targeting convergent mechanisms of toxicity across cell types. These candidates may represent novel therapeutic compounds to widen the window for safe and effective ICH evacuation and are ideal candidates for screening in scalable
in vitro
organoid models of ICH.
Abstract TP216: Artificial Intelligence-Based Atrial Fibrillation Detection Predicts Mortality After Carotid Endarterectomy
Authors: Mahmoudi Hamidabad Negin , Kalina Samuel , Nogami Kai , Lerman Lilach , Nardi Valentina , Lerman Amir
Published: January 2025

Introduction:
Patients with atherosclerotic carotid artery disease are at high risk of mortality in the long-term follow-up after carotid endarterectomy (CEA), partly due to dysrhythmia. Atrial fibrillation (AF) is a common cardiac dysrhythmia linked to stroke and cardiovascular events. An artificial intelligence-based electrocardiogram (ECG) AF algorithm (AI-AF) can effectively identify silent AF. We aimed to assess the effectiveness of AI-AF in predicting mortality in patients with carotid artery disease undergoing CEA.

Methods:
Patients with carotid artery disease undergoing CEA at Mayo Clinic from 2002-2023 were included if they had >30 days follow-up and an ECG within one year before CEA. The ECG closest to the CEA date was used to calculate AI-AF (probability of AF ranging from 0 to 1). All-cause mortality rates after CEA were obtained from clinical records. The optimal AI-AF cut-off value for predicting mortality was calculated using a receiver operating characteristic curve and the Youden index. Long-term survival after CEA was depicted with a Kaplan Meier plot and compared with the Log-rank test. Univariate and multivariate Cox Regression models were used to assess the predictive value of AI-AF for mortality, adjusting for age, sex, body mass index, diabetes mellitus, hypertension, and hyperlipidemia.

Results:
A total of 636 patients with a median age of 72 [IQR: 66, 78] years and 414 (65.1%) males were included. The median AI-AF was 0.056 [IQR: <0, 0.171]. Over a median follow-up time of 7.1 [IQR: 2.7, 11.5] years, mortality occurred in 326 (51.3%) patients. AI-AF significantly predicted mortality in univariate and multivariate Cox regression analysis (HR: 3.47, 95%CI: 2.34-5.16, P<0.001; HR: 2.30, 95%CI: 1.44-3.68, P<0.001, respectively). The best cut-off value for AI-AF for mortality prediction was 0.025 (area under the curve: 0.608). High and low AI-AF were defined as AI-AF≥ 0.025 and <0.025, respectively. Mortality was significantly higher in high AI-AF compared to low AI-AF patients (P<0.001, Figure 1A,1B), and high AI-AF was a significant predictor of mortality (univariate: Figure 2; multivariate Cox regression: HR: 2.11, 95%CI: 1.56-2.84, P<0.001).

Conclusion:
AI-AF can identify patients with a higher risk of mortality after CEA. This finding supports a role for AI algorithms in risk stratification of patients with carotid artery disease following CEA. Future studies are needed to elucidate the contribution of AF to all-cause mortality.