bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP48: Air Versus Land Transfers For Endovascular Thrombectomy In A Hub-and-spoke Comprehensive Stroke Network
Authors: Yong Vivien T , Donnelly Joseph , Hong Jae Beom , Diprose William K , Caldwell James R , Lee Shane S , McGuinness Ben J , Brew Stefan , Barber P. Alan
Published: February 2023

Background:
Endovascular thrombectomy (EVT) is only available at larger comprehensive stroke centers, with inter-hospital transfer by road or air ambulance required for patients who first present to a primary stroke centre. We aimed to evaluate if there were differences in outcomes in patients transferred for EVT via air.

Methods:
The setting is a hub-and-spoke model, with one EVT center which receives patients from three metropolitan and 12 more distant regional primary stroke centers. Consecutive EVT patients were identified from a mandatory registry, which includes data on mode of transfer to the EVT center. The primary outcome was 90-day functional independence (modified Rankin scale ≤2). Secondary outcomes included successful recanalization (Thrombolysis In Cerebral Infarction score ≥2b), early neurological improvement (National Institutes of Health Stroke Scale (NIHSS) reduction by ≥8 points or a reduction to ≤1 at 24 hours), symptomatic intracranial hemorrhage, and 90-day mortality.

Results:
1102 patients (622 (56%) men, median [interquartile range, IQR] age 69 [58-78], 966 (88%) anterior circulation strokes, median [IQR] baseline NIHSS 16 [11-20]) were identified. 801 (73%) patients presented to the EVT center by road and 301 (27%) regional patients transferred by air. The mean (standard deviation, SD) distance travelled to the EVT center was 9.6 (1.2) miles by road and 106.8 (50.9) miles by air. The two groups were well-matched at baseline except a higher thrombolysis rate in the air transfer group (53% vs 45%,
p
=0.022). Patients transferred by air had longer last-known-well to EVT groin puncture times (median [IQR] 365 [294-539] vs 225 [170-355] minutes,
p
<0.001), however there were no differences in the proportion of patients with 90-day functional independence (151 (50%) by air vs 427 (53%);
p
=0.388) or 90-day mortality (44 (15%) by air vs 122 (15%);
p
=0.874), or any of the other secondary outcomes.

Conclusions:
In this hub-and-spoke model, patients transferred for EVT from regional centers by air had similar outcomes at 90-day to those presenting to a metropolitan center, despite the longer transfer times. Comprehensive stroke centers should not be discouraged from considering patients from more distant centers who require air transfer.
Abstract WP50: Stress Hyperglycemia And Early Neurological Deterioration In Patients With Acute LVO And Low NIHSS
Authors: Kim Yong Soo , Kim Beom J , Yoo Joonsang , Han Jung Hoon , Kim Bum Joon , Kim Chi Kyung , Kim Jae Guk , Kim Joon-Tae , Park Hyungjong , Baik Sung Hyun , Han Moon K , Bae Hee-Joon
Published: February 2023

Introduction:
Stress hyperglycemia is an essential survival response. However, it is associated with poor prognosis after ischemic stroke, and its contribution to collateral failure is not well defined. We investigated whether stress hyperglycemia would be associated with early neurological deterioration (END) in acute large vessel occlusion (LVO) patients who present with mild neurological deficit.

Methods:
From a multicenter stroke registry, ischemic stroke patients with acute anterior circulation LVO and mild symptoms (NIHSS<6) were included and were grouped by a history of diabetes before the index stroke. Stress hyperglycemia ratio (SHR) was calculated as a ratio of serum glucose at arrival over glycosylated hemoglobin. END was defined as an increase in total NIHSS≥2 or any increase in the NIHSS consciousness or motor sub-scores.

Results:
Among a total of 731 mild LVO patients (mean age 68.0±12.9 years; 62.7% male), 172 (23.5%) had a history of diabetes, and 73 (10.0%) were newly diagnosed with diabetes during admission. The SHR was higher in known diabetic patients compared to no-DM / newly diagnosed diabetic patients (24.3±8.5 vs. 21.8±5.6, p-value<0.01). END occurred in 94 (12.9%) patients. The second (T2) and third (T3) tertile groups of SHR were more likely to experience END than the lowest tertile group (adjusted odds ratio (aOR) 2.29 [95% confidence interval (CI), 1.26-4.17] for T2; aOR 1.85 [95% CI 1.01-3.39] for T3). The association was maintained in the no-DM / newly diagnosed diabetic subgroup but not in cases with a history of diabetes (p for interaction=0.047). [Figure]

Conclusions:
Stress hyperglycemia was associated with END in acute LVO patients with low NIHSS, especially in the subgroup of patients without or newly diagnosed diabetes. In patients without a history of diabetes, where the physiologic response to hyperglycemia may currently be preserved, intensive glycemic control may benefit in maintaining leptomeningeal collaterals.
Abstract WP53: The Assessment Of Brain Water Content At Posttraumatic Ischemia: Ct Perfusion Study
Authors: Trofimov Alex , Agarkova Darya , Trofimova Kseniia , Lidji-Goryaev Kyrill , Atochin Dmitriy N , Nemoto Edwin M , Bragin Denis E
Published: February 2023

Background:
The influence of cerebral edema and secondary insults on the clinical outcome of traumatic brain injury (TBI) is well known. The studies of the brain water homeostasis dynamics at TBI remain rare, which determines the relevance of our work. The purpose is to study the changes in brain water homeostasis after TBI of varying severity compared to the cerebral microcirculation parameters.

Materials:
This non-randomized retrospective single-center study complies with the Helsinki Declaration. One hundred twenty-eight patients with posttraumatic ischemia (PCI) after moderate-to-severe TBI in the middle cerebral artery territory who presented between July 2015 and February 2022 to our hospital were included. PCI was determined using perfusion computed tomography (CT), and brain edema was determined using net water uptake (NWU) on baseline CT images. The patients were divided according to Marshall’s classification. Multivariate linear regression models were performed to analyze data.

Results:
NWU in PCI zones was significantly higher than in non-ischemic zones (8.1% versus 4.2%;
P
<0.001). In the multivariable regression analysis, the mean transit time increase was significantly and independently associated with higher NWU (

R
2

= 0,089,
P
<0.01). In the PCI zone, cerebral blood flow (CBF), volume (CBV), and time to peak (TTP) were not significantly associated with NWU values (
P
>0.05). No significant differences existed between the NWU values in PCI foci in different Marshall groups (
P
=0.308).

Conclusion:
The Marshall classification does not seem to be able to predict the progression of posttraumatic ischemia. The blood passage delay through the cerebral microvascular bed was significantly accompanied by brain tissue water uptake increase in the PCI focus.
Abstract WP54: Factors Associated With First Year Inpatient And Outpatient Rehabilitation Use Among Acute Ischemic Stroke Patients
Authors: Rajan Suja S , Grotta James C , Yamal Jose-Miguel , Parker Stephanie , Jacob Asha , Savitz Sean I
Published: February 2023

Introduction:
Stroke is a leading cause of long-term disability in the U.S., and 90% of stroke survivors have residual movement impairment. Inpatient and outpatient rehabilitation is critical for restoring functionality and quality of life among survivors. However, there are few studies evaluating the patterns and predictors of rehabilitation use among stroke survivors.

Methods:
This study used 947 tPA-eligibe patients from an observational, prospective, multicenter, clinical trial in the U.S., who had complete 1 year follow-up utilization data, collected quarterly as self-reported surveys. We determined the occurrence and length of stay for inpatient rehabilitation, and occurrence and number of visits for outpatient rehabilitation. Logistic and linear regressions were used to examine predictors associated with these occurrences and intensities.

Results:
The majority of rehabilitation use occurred during the first quarter with 19% and 33% of patients using inpatient and outpatient rehabilitation respectively, and rehabilitation use fell considerably over the rest of the year (Table 1). Higher disability at baseline (mRS≥2 and not living at home) reduced rehabilitation use, and higher disability at discharge increased rehabilitation use. Being uninsured reduced rehabilitation use. Other socio-demographic characteristics (such as age, gender and race-ethnicity), baseline comorbidities, and type and timeliness of therapies after stroke did not have an effect on rehabilitation use.

Conclusion:
Rehabilitation use is highest during the first 3 months after discharge. Patients with higher discharge disability are more in need of rehabilitation, hence receive it. Patients already disabled at baseline are often excluded, probably due to a combination of rehabilitation entry requirements and perceived lack of potential benefits. Access barriers, such as lack of insurance reduced rehabilitation use suggesting an unmet need among stroke survivors.
Abstract WP58: Corticomotor Input Integrity To The Dorsi-plantarflexors And Motor Control In Chronic Stroke
Authors: Anderson Trenley , McCabe Jessica , Skelly Margaret , Salameh Ahlam , Hisel Terri , Pundik Svetlana
Published: February 2023

Objective:
To improve recovery of gait after stroke, we need to attain better understanding of lower extremity motor control. Transcranial magnetic stimulation (TMS) allows for evaluation of corticomotor input (CMI) integrity. Our objective was to explore the relationship between CMI to the dorsi-/plantarflexors and measures of motor impairment and gait speed.

Methods:
Fugl-Meyer for Lower Extremity (FM), gait speed and TMS Motor Evoked Potentials (MEP) were collected for 27 ambulatory chronic stroke survivors. Maximum MEPs (MEP
max
) were collected for paretic and non-paretic tibialis anterior (TA) and lateral gastrocnemius muscles (Gastroc) using a cone-shaped TMS coil targeting primary motor cortices. We collected MEPs while seated participants activated their tested muscles to 20% of maximum effort. MEPs were normalized by the maximum compound muscle action potentials obtained by stimulation of the peripheral motor nerves. Symmetry of the corticospinal motor output was calculated as ratio of the normalized paretic and non-paretic MEP
max
. Analysis included descriptive statistics, paired t-test and Pearson correlation. Non-normally distributed data was log-transformed.

Results:
Study participants were 65.7±7.5 years old, 5.3±4.4 years after stroke and 81% male. Their mean±SD FM was 24.6±3.7 and gait speed was 0.74±0.38 m/s. For both TA and Gastroc, paretic MEP
max
were significantly smaller than non-paretic (p=3.8e
-18
). For Gastroc, higher ratio of paretic/non-paretic MEP
max
correlated with lesser impairment measured with FM (r=0.42, p=0.027). For TA, the correlation was lower and did not reach statistical significance (r=0.33, p=0.088). Gait speed did not have a significant correlation with MEP
max
. FM moderately correlated with gait speed (r=0.44, p=0.02).

Conclusion:
Gastroc MEP might be a better biomarker of motor impairment than TA. Thus, CMI to TA and Gastroc may provide different information in elucidating the mechanism of lower limb motor control. Gait speed does not correlate with CMI for dorsi-/plantarflexors which suggests that motor control of ambulation (gait speed) may differ from that of isolated joint movement (FM).
Abstract WP60: Greater Enrichment Of Neuronal Function Can Be Reflected In
Blood Plasma
Samples Following The Stroke.
Authors: Huang Shaoling , Guo Wei , Claypool Jonathan , Chen Jonathan , Kim Hanjun , Yancey Ryan , Yin Xing , Moody Melanie R , Aronowski Jaroslaw A , Savitz Sean I , booher keith
Published: February 2023

Acute ischemic stroke induces widespread cellular necrosis and apoptosis and activation of inflammation. These mediate release of cell-free DNA (cfDNA) into the circulation. Although increased cfDNA concentrations have been associated with clinical outcome in stroke, data concerning neuronal cfDNA is rare. In this study, we assessed the association of cfDNA with neuron biomarkers in patients with acute ischemic stroke.

Methods:
Thirteen patients without stroke and four patients with middle cerebral artery occlusion were recruited at UT Memorial Hermann Hospital. Blood plasma samples were collected and cfDNA samples were prepared for whole-genome bisulfite sequencing (WGBS) in order to generate quantitative DNA methylation datasets. The resulting WGBS data were analyzed for epigenetic biomarker identification using bioinformatic statistical approaches. CelFiE was used for cell deconvolution, designed to accurately estimate the relative abundances of cell types and tissues present in plasma cfDNA from methylation sequencing, a technique frequently referred to as cell deconvolution.

Results:
Differential methylation statistical analysis comparing the stroke against the non-stroke group of samples found 3493 DNA methylation differences. Pathway Analysis discovered greater enrichment for neuronal function with the top hit being “Neuronal System” followed by activity surrounding synapses, demonstrating that a clear enrichment of methylation change in neuronal pathways can be reflected from
blood plasma
samples following the stroke. Cell deconvolution showed trends of increased megakaryocyte and neutrophils which are involved in the post-stroke immune response. It may be that the secreted neutrophil nuclear DNA in blood plasma drives the increase in the observed proportion of neutrophil cell type in the stroke group samples. Principal Component Analysis demonstrated good separation between the stroke and normal groups.

Conclusion:
Blood sample can be used for circulating cfDNA analysis and neuron biomarker discovery for acute ischemic stroke prediction/recovery.
Abstract WP61: Impact Of Post-stroke Post Traumatic Stress Disorder On Quality Of Life
Authors: Renati Swetha , Hilker Nicholas , Hairston Marla , Cen Weiliang , Chen Henian , Bozeman Andrea , Beba Abadal Kanita , Rose David , Burgin William S
Published: February 2023

Introduction:
After an ischemic stroke or transient ischemic attack (TIA), patients may have post-event anxiety and re-experience transient neurological symptoms. However, some stroke patients develop persistent and disabling symptoms of post-traumatic stress disorder (PTSD). Data on post-stroke post-traumatic stress disorder (PS-PTSD) is sparse.

Methods:
We conducted a single-center observational pilot study of 20 adult patients diagnosed with stroke or TIA in the previous 31 days to 1 year. Patients completed the PTSD Check List-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), stroke specific Quality of Life Scale-12 (SS-QOL-12), modified Rankin Scale of disability, and the National Institutes of Health Stroke Scale. The PCL-5 is a 20 item self-report score assessing symptoms of re-experiencing (Criterion B), avoidance (Criterion C), negative alterations in cognition or mood (Criterion D), and hyperarousal (Criterion E). Subjects were classified as having PS-PTSD with PCL-5 score ≥33 or endorsement of moderate symptoms in at least one B item, one C item, two D items, and two E items.

Results:
Twenty patients completed the PCL-5 and 19 completed the follow up scales. Seven patients (35%) were found to have PS-PTSD. Higher PCL-5 scores were significantly correlated with lower SS-QOL12 scores indicating worsened quality of life (r= -0.709, P=.001) and higher PHQ9 scores representing more depressive symptoms (r= 0.727, P<0.001). The effect was most prominent in the SS-QOL-12 domains of mood, language, upper extremity function, and family roles (Table 1).

Conclusion:
PS-PTSD was found to be prevalent after stroke and TIA with 35% of patients having significant PTSD symptomology. These patients were also more likely to have concurrent depressive symptoms and worsened quality of life.
Abstract WP63: Somatosensory Evoked Potentials As A Measure Of Sensorimotor Impairment In Hemiparetic Stroke
Authors: Williamson Jordan , Sikora William A , Lepak Louis V , Cheema Carolyn , James Shirley , Sidorov Evgeny V , Yang Yuan
Published: February 2023

Introduction:
Stroke is the leading cause of serious, long-term disability. Previous neuroimaging studies have demonstrated that the cortical motor system might be reorganized following a stroke, with an increasing recruitment of the contralesional hemisphere. The control of movement requires sensory feedback; however, it is unknown if there is a similar hemispheric shift in the somatosensory system to adapt to the change in the motor system and if this is related to the impairment.

Hypothesis:
Cortical somatosensory reorganization occurs post stroke and is related to sensory and motor impairment.

Methods:
This proof-of-concept study assessed early phase cortical somatosensory processing in chronic hemiparetic stroke participants (n=9) using electroencephalograph (EEG). Components P50 and N100 of sensory evoked potentials (SEPs) were extracted and compared to motor and sensory impairments.

Results:
Pearson correlation analysis found that the amplitude of SEP component P50 is negatively correlated with Fugl-Meyer Upper Extremity (FM-UE) Motor Score in stroke (R=-0.630, P=0.047) and the amplitude of SEP component N100 is positively correlated with the Erasmus modifications to the Nottingham Sensory Assessment (EmNSA) (R=0.705, p=0.025).

Conclusion:
This information potentially helps predict the severity of motor and sensory impairments based on SEP measures. This is clinically significant, because if an assessment for sensorimotor impairments could be done from a “pure” sensory perspective using SEP, this would improve assessments in those with severe impairments or after an acute stroke in those with limited functional movements. Additionally, it may provide clinicians with enhanced sensory feedback-based interventions for rehabilitation post stroke.
Abstract WP64: Wrist Proprioception In The Subacute Period After Stroke
Authors: Young Brittany , Kim Won-Seok , Yadav Rishika , Rana Shivam , Han Simon , Batth Rajan , Sakthi Shivani , Farahmand Eden , Patel Darshan , Luo Jason , Ramsey Christina , Feldman Marc , Cardoso Ferreira Isabel , Holl Christina , Nguyen Tiffany , Su Michael , Chang Tracy Y , Cramer Steven C
Published: February 2023

Background:
Proprioception is critical to motor control. The prevalence, severity, and clinical correlates of deficits in wrist proprioception early after stroke have received limited attention and were examined in patients admitted to an inpatient rehabilitation facility (IRF).

Methods:
Patients admitted for stroke to our IRF (n=18) and older healthy controls (n=12) completed the Wrist Position Sense Test (WPST), a validated, quantitative proprioception measure, as well as motor and cognitive testing. Patients were serially tested when available (n=12).

Results:
In controls, mean (± SD) WPST error was 9.1 ± 3.6 deg in the dominant wrist and 9.2 ± 4.5 deg in the nondominant wrist. In patients with stroke, WPST error was 18.6 ± 9 deg in the more affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6 deg in the less affected wrist, which was abnormal in 55.6% of patients. Error in the more affected wrist was higher than in the less affected wrist (p=0.003), dominant wrist of controls (p=0.001), and nondominant wrist of controls (p=0.003). Retesting in patients a mean of 11 days later found error was not significantly changed (17 ± 7.7 deg in more affected wrist and 15.6 ± 16.3 deg in less affected). Among controls, higher dominant hand WPST error correlated with poorer 9-hole peg (rho=0.75, FDR-corrected p=0.048) and Box & Blocks (r=-0.77, FDR-corrected p=0.048) scores; these relationships were not seen in patients with stroke. WPST error in either hand of patients with stroke was not related to MoCA, NIHSS, or Fugl-Meyer scores.

ConclusionS:
Deficits in wrist proprioception are common early after stroke, with average error twice that of healthy controls. These differences are not explained by cognitive or motor deficits. Relationships that proprioception has with motor function in healthy subjects are disrupted early after stroke.
Abstract WP70: Emergency Department Visits For Hypertensive Urgency And Risk Of Subsequent Stroke
Authors: Liberman Ava L , Lappin Richard , Razzak Junaid , Parikh Neal S , Merkler Alexander E , Ng Catherine , Kamel Hooman
Published: February 2023

Introduction:
Chronic hypertension is an established long-term risk factor for stroke. However, little is known about short-term stroke risk after an episode of acute severe hypertension without evidence of target organ damage (i.e., hypertensive urgency [HU]). We evaluated the short-term risk of stroke after an ED visit with HU resulting in discharge home (treat-and-release).

Methods:
We performed a case-crossover study using deidentified administrative claims from all nonfederal EDs and hospitals across 11 states. The study cohort comprised patients diagnosed with any stroke (ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage), defined using validated
ICD-10
codes, between 2016-2018. We tabulated and compared incident ED visits for HU during case periods (2-week intervals from 0-24 weeks before the index stroke) to control periods (equivalent time periods exactly 1 year earlier). ED visits with HU were ascertained using the
ICD-10
code I16.0, which we validated through detailed chart review of 50 patients at our center resulting in a code sensitivity and specificity of 100% and 96%, respectively. We used McNemar’s test for matched data to calculate risk ratios (RRs) for an ED HU visit occurring before stroke.

Results:
Among 45,063 patients with stroke, 22,417 (50%) were female and 37,577 (83%) had a prior diagnosis of hypertension. There were 201 patients with stroke who had at least one ED visit for HU during the preceding 24 weeks. An ED visit for HU was significantly more common in the 2 weeks before stroke compared to the 2-week control period 1 year earlier (RR, 5.1; 95% CI, 2.4-12.7; p<0.0001). The association between stroke and preceding ED visit for HU decreased in magnitude with increasing temporal distance from stroke and was no longer significant by the 7-8 week period before stroke (Figure 1).

Conclusion:
Treat-and-release ED visits for HU are associated with a significantly increased short-term risk of stroke.
Abstract WP72: Psychological Distress Is Prevalent Among Family Surrogate Decision Makers In The Year After Stroke And Differs By Ethnicity
Authors: Zahuranec Darin B , Becker Christopher J , Lank Rebecca J , Ortiz Carmen , Zhang Guanghao , He Kevin , Case Erin , Morgenstern Lewis B
Published: February 2023

Introduction:
We investigated long-term psychological distress among stroke family surrogate decision makers in Mexican Americans (MAs) and non-Hispanic Whites (NHWs).

Methods:
Ischemic and hemorrhagic stroke patients from the Brain Attack Surveillance in Corpus Christi (BASIC) project and their family surrogate decision makers from the Outcomes Among Surrogate Decision Makers in Stroke (OASIS) were enrolled. Family surrogates completed validated measures of post-traumatic stress (NSESSS), anxiety (GAD-7), and depression (PHQ-8) at discharge, 3, 6, and 12 months. Ethnic differences were assessed with multilevel linear mixed models, sequentially adjusted for pre-specified covariates as shown in the table.

Results:
There were 301 family surrogates for 241 stroke patients. MA patients were younger and less likely than NHWs to have died before the initial outcome interview (43% vs 56%, p=0.05), with no difference in baseline severity. MA family surrogates had lower educational attainment, income, and less use of advance care plans than NHWs. High scores on measures of psychological distress were common at all time points (Table). All psychological outcomes were worse among MAs on unadjusted analyses (Table). Symptoms of post-traumatic stress remained worse among MAs in the fully-adjusted model. Ethnic differences in anxiety were attenuated after adjustment for family demographics. Ethnic differences in depression were attenuated after adjustment for socioeconomic factors. Advance care plans were not associated with outcomes after accounting for other covariates and did not seem to confound any ethnic differences.

Conclusions:
Psychological distress is prevalent among family surrogate decision makers in the year after stroke and may be worse among MAs. Efforts are needed to support family members of all ethnic groups after severe strokes.
Abstract WP73: Associations Between Acute Hospital Characteristics And Discharge Decisions For Inpatient Versus Skilled Nursing Facility Based Rehabilitation Among Medicare Acute Stroke Patients
Authors: Simmonds Kent P , Burke James , Andary Michael , Luo Zhehui , Kozlowski Allan , Reeves Mathew J
Published: February 2023

Introduction:
Hospitals strongly influence whether acute stroke patients receive stroke rehabilitation at Inpatient Rehabilitation Facilities (IRFs) or Skilled Nursing Facilities (SNFs), but little is known about drivers of variation. Our objective was to quantify the impact of hospital-level factors on discharge decisions.

Methods:
A cohort of acute stroke patients who were discharged to IRFs or SNFs was generated from Medicare data (2011-2014). A multi-level random effects logistic regression model that included patient- and hospital-level predictors (fixed effects) of discharge to an IRF (vs. SNF) was constructed. From this model, the amount of variation in discharge decisions due to hospitals was estimated from the intraclass correlation coefficient (ICC). Average effect sizes of hospital-level factors were estimated by adjusted odds ratios (aORs). Variations in effect sizes of factors between hospitals was estimated using 80% Interval Odds Ratios (80% IORs) which reflects a range of estimated effect sizes of factors across individual hospitals.

Results:
The cohort included 1,816 acute care hospitals which discharged 66,548 patients to IRFs and 68,867 patients to SNFs. Acute hospitals accounted for a quarter of the variation in IRF (vs. SNF) discharge (ICC=0.26). Important hospital-level factors associated with IRF discharge included IRF affiliation (aOR=2.53, 95% CI: 2.25-2.84), urban setting (aOR=1.71 95%CI:1.44-2.03) and Southern vs. Mid-west CMS region (aOR=3.12 95% CI: 2.55-3.83). All 80% IORs were wide which indicates substantial variation in the effects of these factors across hospitals which suggests that despite several significant aORs, much of the hospital-level variability remains poorly explained.

Conclusion:
Hospitals account for a quarter of the variation in use of IRFs (vs. SNFs). Several hospital-level factors were associated with IRF discharge but there was wide variation in the effects of these factors across hospitals.
Abstract WP78: Low Cost Stroke Management Strategy With Hospital Outcome And One Year Follow-up From A Single Stroke Center, India
Authors: PAMIDIMUKKALA VIJAYA , NUTAKKI SRINIVASA RAO , PETLURI GAYATHRI , POLAVARAPU NAREN , K LAKSHMI PRASANNA , M BHARGHAVI DEVI , DULAM DEEPIKA , YELAMANCHI RAMACHANDRA PRASAD , YAKKALA VISWA JYOTHI , PERUMALLA HIMA SANJANA , POLAVARAPU VEERA RAGHAVA SARMA
Published: February 2023

Introduction:
Stroke is a leading cause of economic burden in the Low Middle Income countries (LMIC’s). We want to study the outcome of acute strokes treated under Government scheme with minimal package (For Ischemic Stroke - 257 USD & For hemorrhagic stroke - 399 USD), but offered evidence-based stroke care other than thrombolysis.

Methods:
From January 2021 to March 2021, a total of 350 cases were treated in our Ankineedu stroke center. Out of these 125 (36%) acute stroke patients are treated under subsidized economical stroke care from admission to discharge. In-patient mortality, 3 months follow up and 1 year follow up recorded. All patients received standard medical treatment in Stroke unit with Antiplatelets, statins, DVT prophylaxis, Antihypertensives, dysphagia assessment, physiotherapy and Neurosurgery when required. All basic stroke investigations done - CT scan, MRI scan, MR Angio, Neck vessel doppler, Lipids, Renal Function test, RBS, ECG and ECHO. All patients discharged on secondary prevention. Average length of stay is 10 days.

Results:
There were 94 men and 31 women, age ranged from 18 years to 85 years (median 55 yrs). Type of stroke: Ischemic Stroke -74% and Haemorrhagic stroke - 26%, 4 patients (3.2%) underwent Neurosurgery. Risk factors: Hypertension - 82 (66%), Diabetes - 45 (36%), Cardiac problems - 17 (13.6%), Smoking - 20 (16%), Alcohol - 15 (12%). Total In-house mortality 5 (4%) and the remaining patients outcome at 3 months - Good outcome with modified rankin scale (mRS) 0-2 in 83 patients (66%), Fair Outcome with mRS (3-4) - 35 (28%), 1 patient (0.8%) bedridden and 1 patient (0.8%) died at home. Out of 125 patients, 60 patients (48%) came for 1 year follow up, of these 88% had mRS (0-2), 12% had mRS (3-5).

Conclusion:
In resource poor countries we can offer basic stroke care model to all needy patients with reasonable outcome. However, the follow up needs to be strengthened.
Abstract WP8: A Comprehensive Analysis Of The Effect Of Intravenous Tirofiban In Combination With Endovascular Thrombectomy On Functional Outcomes In Patients With Large Vessel Occlusion Stroke: The RESCUE BT Trial
Authors: Kong Weilin , Huang Jiacheng , Liu Chang , Li Fengli , Zi Wenjie
Published: February 2023

Background:
In the RESCUE BT (Endovascular Treatment With versus Without Tirofiban for Stroke Patients with Large Vessel Occlusion) trial, enrollment in extended time window was based on non-contrast computed tomography. To assess whether tirofiban was safe and effective in the RESCUE BT trial according to advance imaging selection criteria based on current American Heart Association guidelines.

Methods:
This is a secondary analysis of a multicenter, double-blinded and randomized trial that was conducted at 55 centers in China and involved 950 participants with stroke with large vessel anterior circulation occlusion from October 2018 to October 2021. All randomized patients were screened according to the current guidelines and were followed up for 90 days from stroke onset. The primary outcome was the distribution of the 90-day modified Rankin scale (mRS) scores. Secondary outcomes included the rates of functional independence (mRS 0-2) and favorable outcome (mRS 0-3). Safety outcomes included the incidences of symptomatic intracranial hemorrhage (sICH) within 48 hours and 90-day mortality.

Results:
A total of 652 patients (319 in tirofiban group and 333 in placebo group) who met the current guidelines were included in this analysis, with median (IQR) age of 68 (58-75) years, 278 (42.6%) were women. The median 90-day mRS score was 3 (IQR, 1-4) in tirofiban group, and 3 (IQR, 1-4) in placebo group. The adjusted common odds ratio (OR) for a lower level of disability with tirofiban than placebo was 1.08 (95% confidence intervals [CI] 0.83-1.42). Incidence of sICH (10.1%
vs
6.3%; adjusted OR 1.70 [95%CI 0.95-3.04]) was not different between groups. However, intravenous tirofiban might be associated with lower disability level (adjusted common OR 1.74 [95%CI 1.14-2.65]; P=0.01) in large artery atherosclerosis patients.

Conclusions:
There was no significant difference in severity of disability at 90 days with intravenous tirofiban compared with placebo among patients with large vessel anterior circulation occlusion undergoing endovascular therapy according to current guidelines. We observed potential benefits of tirofiban in large artery atherosclerosis patients, and further randomized controlled trials are warranted to validate the present results.
Abstract WP83: An Artificial Intelligence Based Approach To Clinical Trial Recruitment: The Impact Of Viz Recruit On Enrollment In The Embolise Trial
Authors: Hassan Ameer E , Desai Sohum , Saei Hamzah , Aytenfisu Ermias M , TEKLE WONDWOSSEN
Published: February 2023

Background:
EMBOLISE (NCT 04402632) is an ongoing randomized controlled trial investigating the safety and efficacy of middle meningeal artery embolization for the treatment of subacute or chronic subdural hematoma (SDH). We hypothesized that the implementation Viz RECRUIT SDH, an artificial-intelligence (AI)-based mobile recruitment platform, would aid enrollment by automatically pre-screening suspected candidates for SDH and coordinating communication and image sharing among the entire research team.

Methods:
Patient enrollment in EMBOLISE prior to and after implementation of Viz RECRUIT SDH at a primary (PSC) and comprehensive stroke center (CSC) was compared. Viz RECRUIT SDH automatically detects SDH in head non-contrast computed tomography (NCCT) images and reports the volume, maximum thickness, and midline shift. The EMBOLISE trial was activated on May 5, 2021, and Viz RECRUIT SDH was activated on October 6, 2021; therefore, the pre-Viz cohort consisted of all patients from EMBOLISE to Viz activation (131 days), and the post-Viz cohort consisted of all patients from Viz activation until August 18, 2022 (316 days). For the post-Viz cohort, additional data is presented on AI-based screening metrics.

Results:
Prior to implementation of the AI-based software, there were 5 patients enrolled (0.99 patients/month). After implementation of the software for trial screening, enrollment increased by 36% to 1.35 patients/month (14 total enrolled), and there were no screen failures. Over the entire post-Viz period, a total of 6804 NCCTs were prescreened by Viz with 208 total SDH detections (3% prevalence). A total of 50 detections were made at the PSC and 158 came from the CSC. 79% of all alerts for suspected SDH were viewed, and 48% of all viewed alerts occurred within 10 minutes.

Conclusions:
The implementation of an AI-based software for the automatic screening of SDH patients increased the enrollment rate in the EMBOLISE trial. Moreover, in a busy research institution with 13 active studies in 2022, the automatic alerts of all potential patients keep our attention on EMBOLISE with coordinated screening and communication in a single mobile application.
Abstract WP86: Racial Disparities In Post-acute Service Utilization In The United States After Intracerebral Hemorrhage
Authors: Di Lorenzo Rodica , Uchino Ken , Bruckman David , Schold Jesse , Man Shumei
Published: February 2023

Introduction:
Intracerebral hemorrhage is a leading cause of long-term disability. Survivors often require significant post-acute care to enhance recovery and decrease disability. Racial/ethnic disparities in hospital discharge destinations can affect patient outcomes and population health.

Methods:
Data were obtained from the 2017 and 2018 National Inpatient Sample from the Healthcare Cost and Utilization Project. Patients with intracerebral hemorrhage who were admitted directly from the emergency department were included. Discharge destinations were classified as: Home/Routine (home without home health care); Home Health Care (HHC); and Facility (inpatient rehabilitation or skilled nursing facility). Survey-weighted binomial and multinomial logistic regressions were used to examine associations of race/ethnicity with discharge to one pathway versus others, adjusting for age, sex, neighborhood income, insurance status, comorbidities, proxies of stroke severity, and hospital characteristics.

Results:
The study included 91435 weighted admissions for intracerebral hemorrhage with a racial distribution of 59.7% Whites, 20.9% Hispanics, 21.4% Asian/Pacific Islanders, and 19.7% Blacks. In-hospital mortality was 22.9%, while 18.1% of patients were discharged to Home/Routine, 9.7% to HHC, and 45.1% to a Facility. Hispanics were most likely to be discharged to Home/Routine (24.0%) and least likely to be discharged to a facility (38.7%). Compared to non-Hispanic Whites, other race-ethnic groups had lower odds of being discharged to a facility over home with or without homecare services with the lowest odds amongst Hispanics (adjusted OR, 0.72; 95% CI, 0.70-0.73), followed by Asians/Pacific Islanders (adjusted OR, 0.76, 95% CI, 0.73-0.78), and Blacks (adjusted OR, 0.95; 95% CI, 0.94-0.97).

Conclusion:
Patients of non-white race-ethnicity admitted with intracerebral hemorrhage are less likely to be discharged to a facility (inpatient rehabilitation or skilled nursing facility) than their white counterparts. The lowest rate of facility discharge was seen among Hispanics. Whether lower formal post-acute service utilization result in worse post-stroke outcomes requires further studies.
Abstract WP87: Sex-based Variation In Acute Stroke Care Via Telestroke
Authors: Sevilis Theresa , Avila Amanda , McDonald Mark , Chalfin Renata , Fowler Mariecken , Amir Murtaza , Heath Gregory W , Avino Lorianne , Zaman Mohammed , Boyd Caitlyn , Gao Lan , Devlin Thomas
Published: February 2023

Objective:
Assess for treatment differences by sex and their potential contributors among telestroke evaluations. Background: Studies have shown sex differences in stroke care. Female patients have both lower thrombolytic treatment rates with OR as low as 0.57 reported and worse outcomes. With improved access to care through telestroke and updated standards of care, there is potential to reduce or alleviate these disparities.

Methods:
Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 203 facilities (23 states) from January 1, 2021 to April 30, 2021 were extracted from the Telecare
TM
database. The encounters were reviewed for age, sex, last known normal (LKN), arrival time, consult call time, needle time, thrombolytics candidate, premorbid modified Rankin Score (p-mRS), NIHSS score, screen time, stroke risk factors (hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, coronary artery disease and previous stroke), antithrombotic use, admitting diagnosis of stroke, and reason not treated with thrombolytic. The treatment rates, Door-to-needle (DTN) times, and variables of treatment were compared for females and males.

Results:
There were 18,783 (10,073 female and 8,710 male) total patients included. Of the total, 6.9% of females received thrombolytics compared to 7.9% of males (OR 0.86, 95% CI 0.75-0.97, p=0.006). Median DTN times were shorter for males (38 minutes) than females (41 minutes), p<0.001. Male patients were more likely to have an admitting diagnosis of stroke, p <0.001. Female patients <50 and ≥80 years of age were treated at a higher rate than males, while males 50-79 were treated at a higher rate than females. Multivariate analysis of the 50-79 age group did not show a difference in the thrombolytics treatment rates (female 7.6% and male 8.3%, p= 0.752), but did show males had higher rates of all stroke risks factors.

Conclusion:
While the overall lower treatment rate for females in univariate analysis was consistent with previous studies, the difference was not seen in multivariate analysis. The treatment differences between males and females were negated once the significant sex-based differences in stroke risk factors are taken into consideration.
Abstract WP88: Discrepant Nationwide Trends In Outcomes Of Acute Ischemic Stroke Depending On Severity: The Japan Stroke Data Bank
Authors: Koge Junpei , Yoshimura Sohei , Koga Masatoshi , nakai michikazu , Wada Shinichi , Sasahara Yusuke , Shiozawa Masayuki , Miwa Kaori , Ishigami Akiko , Sonoda Kazutaka , Iihara Koji , Ikawa Fusao , Itabashi Ryo , Iwanaga Yoshitaka , Miyamoto Yoshihiro , Kobayashi Shotai , Minematsu Kazuo , Toyoda Kazunori
Published: February 2023

Background and Purpose:
Whether specific patient groups have benefited from advances of treatment technologies including acute reperfusion therapy is uncertain. We aimed to investigate long-term trends of acute reperfusion therapy and functional outcomes according to the stroke severity using a large clinical registry.

Methods:
In the nationwide, hospital-based, multicenter, prospective registry cohort from the Japan Stroke Data Bank between January 2000 and December 2020, patients with ischemic stroke were studied. The baseline National Institutes of Health Stroke Scale (NIHSS) score of 10 or more was considered as possible large vessel occlusions (LVOs). Secular changes were assessed per 5-year categories (2000-2005, 2006-2010, 2011-2015, 2016-2020). Outcomes included favorable outcome (mRS score was 0 to 2 at discharge), and in-hospital mortality.

Results:
Of 235,695 patients, 127,741 ischemic stroke patients (76,850 men [60.2 %]; median age 75, [interquartile range, 66-82] years) with available data on NIHSS score were analyzed. NIHSS score was ≥10 in 31,747 patients (24.9%). In both patients with NIHSS ≥10 and those with NIHSS <10, the frequencies of intravenous thrombolysis (1.6% to 26.5%, and 0.3% to 6.9%, respectively) and endovascular therapy (2.0% to 29.8%, and 0.8% to 3.8%, respectively) increased from the 2000-2005 period to the 2015-2020 period. In patients with NIHSS ≥10, favorable outcome was more frequent in the 2015-2020 cohort than that in the 2000-2005 cohort (adjusted odds ratio, 1.63; [95% CI, 1.44-1.85]). In contrast, patients with NIHSS <10 had a decreased favorable outcome in the 2015-2020 cohort than that in the 2000-2005 cohort (adjusted odds ratio, 0.80; 95% CI, [0.75-0.85]). In-hospital mortality decreased in both patients with NIHSS ≥10 and NIHSS <10 per step on the 5-year categories.

Conclusions:
Over the 20-year period, acute reperfusion therapy has increasingly been provided to patients with NIHSS ≥10. Favorable outcomes significantly increased in patients with NIHSS ≥10 but decreased in those with NIHSS <10 over time. In-hospital mortality decreased across all NIHSS scores.
Abstract WP89: Listen: Language Impact On Stroke Time To Evaluation And Intervention
Authors: Poynor Briana , Meyer Dawn M , Agrawal Kunal , Van Orden Kimberlee , Torres Dolores , Alwood Benjamin T , Hemmen Thomas M
Published: February 2023

Introduction:
Previous reports raised concerns that time dependent treatments in acute ischemic stroke (AIS) might be delayed on non-English speaking patients. Here we report an analysis of patients after AIS stratified by primary language who were admitted to two large comprehensive stroke centers in California. The purpose of this analysis was to examine the impact of primary language on treatment times, frequency and causes of not using thrombolysis.

Methods:
We included all patients admitted between 12/2019-4/2022 who presented to a Comprehensive Stroke Center (CSC) using the electronic medical record (EMR). Language preference was identified as English (ES) or Non-English (NES). We compared comorbidities, demographics, baseline NIHSS, stroke time metrics [stroke onset to arrival (LTD), arrival to CT (DTC), arrival to tPA (DTN)], frequency of tPA administration and exclusion for last known normal (LKN) > 4.5 hours between ES and NES. We utilized Chi-squared, t-test, ANOVA as appropriate and a p value of <0.05 was significant.

Results:
We identified 1815 patients, ES n=1489, NES n=326. There was no significant difference in the mean age between groups (ES 67±16; NES 66±16, p=0.93). There was no significant difference in mean LTD between groups (NES 99.3±58.9 minutes (min); ES 83.6±52 min). There was no significant difference in mean DTC between groups (NES 13.2±8.5 min; ES 12±10.2 min). There was no significant difference in mean DTN between groups (NES 54.4±23.3 min; ES 53.8±27.9 min). There was a significant difference in ambulance arrival (p=0.001), HTN (p=0.01), DM (p=0.001), drug/alcohol use (p=.001), and smoking (p=.001). There was no significant difference in LKW to door (p=.12), DTC (p=.44), DTN (p=0.88).

Conclusion:
Primary language did not affect acute stroke time metrics at this academic CSC. This is likely due to the 24/7 availability of interpreter services at this CSC. Further studies must assess the impact of language preference on stroke time metrics and outcome in a heterogenous sample of healthcare settings. Communicating in patients’ preferred language is vital to rapid care and patient engagement in the acute stroke setting.
Abstract WP9: Number Needed To Treat With Intravenous Tenecteplase To Reduce The Need For Mechanical Thrombectomy In Large Vessel Occlusion Acute Ischemic Stroke Patients: Real-world Experience Data.
Authors: Platko Steven , Bensabeur Fatima , Peters David , Darwich Noor , Rotsching Nicholas , Wagner Jacob , Ugur Umran , Reynolds Shelly L , Terry John B , Cheng-Ching Esteban
Published: February 2023

Objective:
We sought to describe short term outcomes in patients with large vessel occlusion acute ischemic stroke (LVOAIS) who were treated with intravenous tenecteplase (TNK) as compared to alteplase, focusing on reduction in the need for mechanical thrombectomy (MT).

Background:
In LVOAIS, TNK has shown improved reperfusion and outcomes with a similar safety profile to alteplase. Ultra-early reperfusion has been described with TNK which would prevent the need for MT. We analyze the magnitude of this effect in a “real-world” setting.

Design/Methods:
In this retrospective study, demographic, clinical, and imaging information from patients with LVOAIS treated with intravenous thrombolysis was collected. Data was compared between the group treated with TNK and alteplase.

Results:
One hundred eighty-six patients met the criteria for the study (LVOAIS and candidates for IV thrombolysis and MT). Of these, 144 patients received tPA and 42 received TNK. Nine had clinical improvement prior to groin puncture and did not require angiography. This phenomenon occurred in 2.1% who received IV tPA and 14.3% who received TNK (p=0.005). For 8.2 patients treated with TNK rather than tPA, one catheter angiography would be prevented. When combining the number of patients who had recanalization on angiography before MT, and those who had clinical improvement prior to angiography, there were a total of 23 patients. This was noted in 9.7% of patients who received tPA, and 21.4% of those who received TNK (p=0.043). For 8.5 patients treated with TNK rather than tPA, one patient will have spontaneous recanalization either angiographically or with clinical improvement, preventing the need for MT.

Conclusions:
Intravenous TNK in patients with LVOAIS reduces the need for catheter angiography and mechanical thrombectomy.