bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP3: Prediction Model For Medical Rescue Treatment Strategies In Patients With Incomplete Reperfusion
Authors: Mujanovic Adnan , Kurmann Christoph , Dobrocky Tomas , Meinel Thomas , Almiri William , Grunder Lorenz , Beyeler Morin , Lang Matthias , Jung Simon , Klail Tomas , Hoffmann Angelika , Seiffge David , Heldner Mirjam , Pilgram-Pastor Sara , Mordasini Pasquale , Arnold Marcel , Piechowiak Eike , Gralla Jan , Fischer Urs , Kaesmacher Johannes
Published: February 2023

Background:
After successful reperfusion is achieved (extended Thrombolysis in Cerebral Infarction (eTICI) ≥2b50), decision on pursuing additional treatment strategies in order to achieve complete reperfusion (eTICI=2c/3), is multifactorial and depends on patient’s clinical and imaging characteristics. We have developed and validated a clinical decision tool to provide individualized predictions on achieving delayed reperfusion based on individual patient data.

Methods:
Single-center registry analysis for all consecutive patients admitted between 02/2015 - 12/2020. Primary variable of interest was perfusion imaging outcome in patients with incomplete reperfusion (eTICI 2a-2c), evaluated on the 24-hour follow-up imaging. This variable was dichotomized into delayed reperfusion, in case of non-observable perfusion deficit, and persistent perfusion deficit, in case of perfusion deficit captured on the final angiography imaging. Final model variable selection was performed via bootstrapped (n=200) stepwise backwards regression. Model was split into a training and testing set (80:20 ratio), with 10-fold cross validation resampling.

Results:
372 patients (50.8% female, mean age 74) were included, with 228 (61.2%) of them having delayed reperfusion. Final model identified seven variables of importance including: age, sex, atrial fibrillation, Intervention-to-Follow-Up time, maneuver count, eTICI and collateral status. Model’s discriminative ability for predicting delayed reperfusion was adequate (AUC 0.83, 95% CI 0.74 -0.92), with an overall adjusted calibration (Brier score 0.17, 95% CI 0.15-0.18).

Conclusions:
Current model presents a tool that may aid clinical decision-making process in selection of patients for pursuing additional treatment strategies after incomplete reperfusion has been achieved. This is an important next step towards personalized treatment of stroke patients undergoing mechanical thrombectomy.
Abstract TMP38: Remote Research Practices Enhance Acute Stroke Clinical Trial Enrollment
Authors: Streib Christopher D , Staugaitis Abbey , Tessmer Megan , Khan Shayan , Gaffney Denise , Broderick Joe , Khatri Pooja , Sangha Navdeep S
Published: February 2023

Background:
Many acute stroke clinical trials (ASCTs) are underpowered, inconclusive, or terminated early. A pervasive challenge to ASCT recruitment is the physical separation of patients, their legally authorized representatives, research coordinators, and clinician investigators when trial-eligible patients present emergently. Remote research practices (RRPs) may aid time-critical ASCT enrollment and follow-up, however, their feasibility and effectiveness are understudied.

Methods:
We retrospectively reviewed ASCT enrollment (NCT03785678, NCT03735979, NCT02072681) at two institutions. Essential clinical trial elements (ECTEs) consisted of eligibility screening, informed consent, randomization, study intervention, and inpatient/outpatient follow-up assessments. When conventional in-person clinical research was not possible, ECTEs were attempted via RRPs utilizing either telemedicine evaluation or telephone communication. The primary outcome was the successful execution of accurate, complete ECTEs by research communication modality (in-person, telemedicine, or telephone). The secondary outcome was the protocol violation rate by modality. We utilized Fisher’s Exact Test for primary and secondary outcomes and descriptive statistics to report RRP utilization.

Results:
A total of 1600 individual ECTEs were attempted on 169 subjects. RRPs were utilized for 53.7% of ECTEs (19.1% telemedicine, 34.6% telephone). ECTEs were more likely to be completed successfully with telemedicine (100%) than in-person (98.5%) or telephone (92.2%), (p<0.01). Additionally, protocol deviations were less common with telemedicine (0.0%) than in-person (2.6%), or telephone (2.8) (p=0.04). Randomization (94.7%) and outpatient assessments (90.3%) were frequently completed via RRPs compared to eligibility screening (39.1%), informed consent (40.2%), supervision of study intervention (36.8%), and inpatient assessments (21.9%).

Conclusion:
RRPs were widely utilized. Telemedicine execution of ECTEs was associated with the highest rate of successful completion and lowest rate of protocol deviations. These findings, while retrospective and confounded by indication, suggest RRPs are effective and require confirmatory study.
Abstract TMP40: Cost Analysis Of A Pooled Coordinator Model Versus Traditional Staffing For Acute Stroke Trials
Authors: Staugaitis Abbey , Staloch Jessica , Puskarich Michael , Streib Christopher D , Biros Michelle H
Published: February 2023

Introduction:
Enrollment in acute stroke clinical trials (ASCTs) is complex and unpredictable. Traditional staffing models (TSMs) of research coordinator coverage assign a single research coordinator to cover specific clinical trials, whereas pooled staffing models (PSMs) utilize staff research coordinators to cross-cover multiple clinical trials, typically beyond traditional daytime hours.

Methods:
We calculated actual PSM costs accrued during one year (1/1/21-12/31/21) for two Phase III ASCTs (NCT03735979, NCT03785678). PSM costs were obtained from existing billing records for specific research coordinator tasks billed hourly ($78/hour) and a “retainer fee” ($690/month) for 24-7 on-call research coordinator coverage. Aspects of research coordinator work included: enrollment, data entry, query resolution, monitor visits, regulatory management, meetings, training/retraining, and patient visits. We compared PSM costs to the cost (salary + fringe) of a TSM full-time research nurse (1.0 full-time equivalent [FTE]) in the identical job class and salary as those employed in the PSM.

Results:
The estimated one-year cost (salary + fringe) of a 1.0 FTE RN research coordinator was $109,755.36. During the study period, there were 19 enrollments in NCT03735979; 9 occurred outside daytime working hours. The PSM cost was $60,813, equivalent to 0.55 FTE of coordinator coverage in a TSM with 90.0% more enrolled subjects. Additionally, there were 6 enrollments for NCT03785678; 4 outside daytime working hours. The PSM cost was $69,857.00, equivalent to the cost of 0.64 FTE of standardized research coordinator in a TSM with 200% more enrolled subjects.

Conclusions:
We demonstrated that a PSM for ASCT can be cost-effective for individual studies while increasing enrollment opportunities through 24-7 coordinator coverage. PSMs may offer a solution to the staffing and coverage challenges faced by many institutions seeking to participate in emergent clinical trials. Cost increases or savings with the PSM model would be dependent upon staff compensation, rates of enrollment, and reimbursement at individual sites.
Abstract TMP45: Nanobiotechnology-based, Ultra-rapid Test For Brain Injuries To Accelerate Differential Diagnosis Of Stroke From Mimics
Authors: Satchell Emma K , Cohen Roy , Caccia Allison , Nelson Jacquelyn , Attia Maximos , Harris Marc , Lunsford Phillip , Christiansen Gregory , Cagir Burt , Travis Alexander
Published: February 2023

Introduction:
Stroke is the 5th leading cause of death, and a leading cause of long-term disability in the US. Thus, there is a need for a rapid biomarker-based screen that enables an objective and timely diagnosis and better patient outcome; however, the lack of such a technology delays diagnosis and treatment, increases misdiagnosis, and leads to the overuse of thrombolysis in patients with stroke mimics.

Methods:
Here we present pilot data of a nanobiotechnology based test platform, in which enzyme-functionalized nanoparticles (TET, Tethered Enzyme Technology) are used for ultra-rapid biomarker detection. As proof of concept, we used TET to quantify the enzymatic activity of a widely studied brain injury biomarker, neuron-specific enolase (NSE), in a trial performed at a regional stroke center.

Results:
Plasma from 36 suspected stroke and 17 asymptomatic subjects (Total N=53) was tested to determine levels of the novel biomarker NSE catalytic activity (NSE-A) versus the conventional NSE protein (NSE-P). Based on clinical diagnoses, our data demonstrate a significant increase in the levels of NSE-A in subjects suffering from injury to neurons (BI, Brain Injury) compared to those with negative diagnoses (Neg, stroke mimics). Moreover, we show that NSE-A provides a considerable diagnostic advantage over the NIH Stroke Scale or NSE-P (Figure 1A-C) in both clinical utility and speed. In diagnosis of stroke mimics (including TIAs and Neg) versus BI, NSE-A showed significantly better performance than NIHSS or NSE-P, as shown by ROC and AUC analyses (Figure 1D).

Conclusions:
TET-based detection of NSE-A can rapidly differentiate patients suffering a neuronal injury, including stroke, from those presenting with stroke mimics. Upon further development of a point-of-care test for NSE-A and other biomarkers, TET could be an asset to ongoing efforts to streamline stroke patient care, reduce door to needle time, and decrease overall brain injury and long-term disability.
Abstract TMP51: A Big-data Neuro-informatics Infrastructure To Support Research Pipelines For Cerebrovascular Disease
Authors: Potter Thomas B , Pratap Sharmila , Nicolas Charlie , Khan Osman , Pan Alan P , Bako Abdulaziz , Hsu Enshuo , Johnson Carnayla , Baig Eman , Kelly Hannah , Jones Stephen , Britz Gavin W , Tannous Jonika , Vahidy Farhaan
Published: February 2023

Background:
Cerebrovascular disease has significant gaps in translational and outcomes research. We provide the framework for a neuro-informatics pipeline, “Registry for Neurological Endpoints Assessment Among Patients with Ischemic and Hemorrhagic Stroke (REINAH)”, aimed at harnessing ‘big data’ across a 7-hospital certified stroke healthcare system.

Methods:
An automated extract, transform, load (ETL) process imports all clinical inpatient and outpatient data for patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), cerebral amyloid angiopathy (CAA) and matched controls. Following validation, a 2
nd
stage ETL merges geocoding data for area deprivation index and generates domain specific dashboards. Neuroimaging and physiological wave form data are imported and analyzed for infarct / hemorrhage characteristics, cerebral small vessel disease burden, and hemodynamic variability. Cross linkages between REINAH and Medicare claims data have been established with > 98% overlap. Functional, cognitive, and quality of life outcomes are collected up till 365-days after discharge.

Results:
As of August 5, 2022, REINAH hosts data on 18,746 patients, including primary encounters for 1,863 ICH, 13,964 AIS, 1,264 SAH, and 3,307 TIA patients. Median (IQR) age for patients is 69 [58-79] years, including 51.7% Female, 15.6% Hispanic, 64.4% White, 24.6% Black, 5.4% Asian. Median Glasgow Coma Scale scores for AIS and ICH are 15 [14-15] and 13.5 [7-15], respectively. The successful contact rate for outcomes assessment is 70.9%, with 69.8% of responders providing consent for follow up. REINAH layout and demographics are shown in Figure.

Conclusions:
Mature data pipelines are needed to support validated and rapid evidence synthesis. REINAH provides a highly curated, clinically focused platform for stroke research that may impact patient care and post-stroke outcomes.
Abstract TMP58: Telestroke Evaluation And Treatment Of CRAO: Current Practice And Opportunities For Improvement
Authors: Capouch Samuel , Musser William S , Williams Linda S
Published: February 2023

Background:
The VA National Telestroke Program (NTSP) provides acute care to more than 60 facilities nationwide. Central retinal artery occlusion (CRAO), is not an acute stroke per se but may trigger a telestroke consult; management of these patients is not standardized. The purpose of this project was to examine clinical characteristics, telestroke evaluation, and visual outcomes for patients with monocular vision loss seen in the NTSP.

Methods:
This was a retrospective chart review of NTSP consults from 3/2018 -6/2021. We identified cases by review of all patients with non-stroke/TIA diagnosis and reviewed all those with monocular visual symptoms. Data were obtained from the NTSP dataset and subsequent chart review including: time of symptom onset to NTSP consult, initial and follow-up (f/u) diagnosis and visual acuity (VA), carotid imaging results, receipt of tPA, and type of f/u. Descriptive data were summarized for all patients, those with f/u, and those with final diagnosis of retinal ischemia.

Results:
Of the 40 patients identified, mean time to presentation was > 8 hours, 3 were treated with tPA, and 31 (78%) had f/u with ophthalmology/optometry (Table). Among 31 patients with f/u, 42% (N = 13) had final diagnosis of retinal ischemia (CRAO/BRAO, venous occlusion or retinal TIA); 11 (36%) had another ocular diagnosis, 3 (10%) had other retinal pathology and 4 (13%) had a non-ocular diagnosis. Only 3 of 13 (23%) had improved VA at f/u, one of these three had received tPA.

Conclusion and potential impact:
Fewer than 50% of acute telestroke patients who present with monocular vision loss have a final diagnosis of CRAO, most present far outside the thrombolysis window, and visual outcomes among those with retinal ischemia are poor. Efforts focused on improving acute diagnosis of CRAO via tele-retina imaging and reducing patient time to presentation are needed prior to testing standardized thrombolysis treatment protocols for patients with CRAO.
Abstract TMP59: Economic Burden Of Strokes In The Emergency Department
Authors: Taneja Kamil , Patel Karan , Diaz Michael , Root Kevin , Batchu Sai , Zhang Alex
Published: February 2023

Introduction:
Stroke is a common cause of mortality in the US. However, the economic burden of stroke on the healthcare system is not well known. In this study, we aim to calculate the annual cumulative and per-patient cost of stroke.

Methods:
We conducted a retrospective analysis of Nationwide Emergency Department Sample (NEDS). We calculated annual trends in cost for stroke patients from 2006 to 2019. Cost was corrected for inflation to the 2021 January US Dollar. A multivariate linear regression with patient characteristics (e.g. age, sex, Charlson Comorbidity Index) as covariates was used to identify factors for higher costs.

Results:
In this study time-period, 2,998,237 stroke patients presented to the ED and 2,481,171 (83%) were admitted. From 2006 to 2019, the cumulative ED cost increased by a factor of 7.0 from 0.49 ± 0.03 to 3.91 ± 0.16 billion dollars (p<0.001, Figure 1A). The cumulative inpatient (IP) cost increased by a factor of 2.7 from 14.42 ± 0.78 to 37.06 ± 2.26 billion dollars (p<0.001, Figure 1B). Per-patient ED charges increased by a factor of 3.0 from 1950 ± 64 to 7818 ± 260 dollars (p<0.001, Figure 1C). Per-patient IP charges increased by 89% from 40.22 ± 1.12 to 76.06 ± 3.18 thousand dollars (p<0.001, Figure 1D). The top 5 risk factors (all with a p-value<0.001) for high ED and IP costs are displayed in Figure 2.

Conclusion:
Stroke places an increasingly substantial burden on the US healthcare. Furthermore, the cost of care is significantly related to service intensity and the patient’s age.
Abstract TMP62: High Levels Of Ldl Cholesterol And Hb A1c Hindering Mitigation Of Intracranial Arterial Diseases After Acute Ischemic Stroke
Authors: Kim Do Yeon , Kim Jonguk , Bae Hee-Joon , Kim Jun Y , Kang Jihoon , Han Moon-Ku , Jung Cheolkyu , Baik Sung Hyun , Sunwoo Leonard , Kim Jae Hyoung , Kim Beom J
Published: February 2023

Introduction:
Intracranial arterial disease (ICAD) may have dynamic temporal changes which high-resolution MR (HR-MR) images can visualize. Until now, there is only limited evidence on the risk factor for the evolution of ICAD after ischemic stroke.

Method:
We have collected acute ischemic stroke patients admitted to a single referral stroke center between 01/2015 and 06/2019 with baseline and follow-up HR-MR images on their ICAD lesions. A total of 246 patients were identified, and for the current pilot study, HR-MR images from 93 patients were used. Degree of stenosis on T1/gadolinium-enhanced (Gd) T1 sequences, remodeling index on proton-density sequence, and enhancement signal on Gd-T1 sequence were measured. Temporal changes were defined as (1-([parameters at the initial]/[parameters at the follow-up])*100. The temporal changes of image parameters were compared by bivariate baseline blood risk factors, such as LDLC (
≥
100 vs. <100 mg/dL) and HbA1c (
≥
6.5 vs. <6.5%).

Result:
A total of 93 patients were analyzed for the pilot study. Temporal changes in the degree of stenosis, remodeling index, and enhancement signal of ICAD lesion were -19.6
±
50.3%, 2.9
±
45.6%, and -15.0
±
31.6%, respectively. ICAD parameters were further mitigated in lower levels of selected markers, such as the degree of stenosis (-24.9±37.6% from lower vs. -16.0±57.5% from higher LDLC, P =0.37; -23.0±54.9% from lower Hb A1c vs. -9.3±32.3% from higher Hb A1c, P =0.16) and the enhancement signal (-18.0±29.1% from lower vs. -12.9±33.2% from higher LDLC, P=0.45; -17.1±32.2% from lower Hb A1c vs. -6.5±28.4% from higher Hb A1c, P=0.17). Linear associations between change in the enhancement signal and LDLC in higher LDLC (B=0.38, P=0.01) and degree of stenosis and Hb A1c in higher Hb A1c (B=0.49, P=0.02) were observed.

Conclusion:
ICAD lesions in acute ischemic stroke patients may have temporal appearance changes. Baseline LDLC and Hb A1c levels may be used as a marker for the evolution of ICAD.
Abstract TMP64: Association Of Brain Arterial Diameters With Demographic And Anatomical Factors In A Multi-national Pooled Analysis Of Cohort Studies
Authors: Del Brutto Victor J , Khasiyev Farid , Liu Minghua , Spagnolo-Allende Antonio , Qiao Ye , Melgarejo Arias Jesus D , Guzman Vanessa A , Sanchez Danurys , Andrews Howard , Pyne Jeffrey D , Morales Clarissa D , Rundek Tatjana , Wright Clinton B , Farrell Meagan T , Seshadri Sudha , Romero Jose R , Maestre Gladys E , DEL BRUTTO OSCAR , Brickman Adam , Manly Jennifer , Mayeux Richard P , Sacco Ralph L , Elkind Mitchell , Chen Christopher , Saima Hilal , Wasserman Bruce , Gutierrez Jose
Published: February 2023

Objectives:
Brain arterial dilation is an increasingly recognized cerebrovascular disease marker. However, demographic and anatomical factors may influence brain arterial diameters within the normal spectrum. We hypothesize that age, sex, height, total cranial volume (TCV) and fetal posterior cerebral arteries (fPCA) presence correlate with brain arterial diameters across diverse populations.

Methods:
We included participants with available time-of-flight MRA from 9 cohort studies across the United States (4), Ecuador (1), Venezuela (1), South Africa (1) and Singapore (2). Arterial diameters of the basilar artery (BA), cavernous internal carotid arteries (ICAs) and middle cerebral arteries (MCAs) were measured using LKEB Automated Vessel Analysis (LAVA) software. Linear regression models were fitted to assess the association between brain arterial diameters and exposures. The R-squared was calculated to assess the extent of brain arterial diameter variation explained by the variables studied.

Results:
The sample included 6,269 participants (mean age 68 years; 42% men). Unilateral fPCA was found in 12.6% and bilateral fPCAs in 3.0%. Older age, male sex and TCV were uniformly correlated with larger BA, ICA and MCA diameters (Table). Unilateral and bilateral fPCAs showed a negative correlation with BA diameter and a positive correlation with ICA diameters in a dose-dependent manner. Models fitted for age, sex, TCV, and fPCA presence explained on average 24, 16 and 12 % of the BA, ICAs and MCA diameter interindividual variation, respectively. Using height instead of TCV decreased the R-squared by 2% on average.

Conclusions:
In this pooled analysis of cohort studies, we found brain arterial diameters consistently correlate with age, sex, TCV and fPCA presence. These factors should be considered to define abnormal arterial diameter cut-offs across populations. If resources are limited or if bedside applicability is desired, height could be used instead of TCV.
Abstract TMP67: Automated Measurement Of Vascular Tortuosity: Association With Baseline Clinical Characteristics And Impact On Thrombectomy Procedures
Authors: Canals Pere , Li Jiahui , Balocco Simone , Díaz Oliver , Tomasello Alejandro , Ribo Marc
Published: February 2023

Introduction:
Vascular tortuosity is considered one of the main barriers for mechanical thrombectomy in stroke. We developed a fully automatic algorithm for vascular tortuosity characterization and explored the association of several anatomical features with baseline characteristics and procedural outcomes.

Methods:
An automatic software integrating segmentation, centerline extraction and vessel labelling, was used to extract features directly from computed tomography angiograms (CTA) of stroke patients undergoing transfemoral endovascular treatment. Mean diameter and tortuosity index (TI) of the carotid arteries and brachiocephalic trunk were used as relevant tortuosity indicators. Patients were compared according to seven different clinical conditions and four procedural measures.

Results:
518 patients (51% female, 74.8±12.9 years) were included in this study. Women presented significantly smaller vessels and increased TI in both carotid arteries (
p
<.01). Hypertension and atrial fibrillation were associated with higher TI in both carotid arteries (
p
<.01). Age correlated with TI in all vessels (.35<
r<
.52,
p
<.01). Patients with longer time to first angiographic run and time to revascularization presented higher TI in all ipsilateral carotid segments (
p
<.05).

Conclusion:
An automated software was successfully used to characterize anatomical vascular features from CTA. Gender, age, hypertension and atrial fibrillation were found to influence vascular tortuosity. The algorithm was able to detect higher TI in ipsilateral carotid arteries of patients with further difficult catheter access or longer time to revascularization. This information could potentially be used to plan best arterial access site.
Abstract TMP71: Hypoperfusion And Thromboembolism Are Codominant Stroke Mechanisms In Adult Moyamoya Disease
Authors: Ballout Ahmad A , Libman Richard B , Choi Yuna , Schneider Julia R , Black Karen , Sideras Panagiotis , Ayoub Marc S , Arora Rohan , Langer David J , Dehdashti Amir R , Katz Jeffrey M
Published: February 2023

Background:
Treatment of moyamoya disease (MMD) has predominantly focused on flow augmentation since the mechanism of ischemic stroke has largely been attributed to hemodynamic failure. Recent studies have challenged this notion suggesting that thromboembolism may play a dominant role. The aim of our study was to investigate the mechanisms of ischemic stroke in MMD by assessing the relationship between infarction patterns and Quantitative Magnetic Resonance Angiography (QMRA) flow state.

Methods and Results:
This is a retrospective study of adult patients with suspected MMD that presented with MRI confirmed acute ischemic stroke predating or following QMRA by a maximum of six months, between 2009 and 2021. Of the 177 consecutive patients with MMD that underwent QMRA, 35 patients met inclusion, consisting of 41 hemispheres. Flow-status was dichotomized into low-flow and normal-flow based on published criteria. Mixed pattern was the most frequent finding (70.7%), followed by embolic (17.1%), perforator (7.3%), and internal borderzone (IBZ) (4.9%). Infarction patterns were then dichotomized into IBZ+ (internal borderzone alone or mixed) and IBZ- (no internal borderzone constituent) based on the constituents of the patterns. Low-flow states were insignificantly more frequent with IBZ+ compared to IBZ- (48.4% vs. 20.0%, p = 0.14). Ipsilateral PCA fractional flow was significantly higher with IBZ+ compared to IBZ- (345.0% vs. 214.7%, p = 0.04).

Conclusions:
Mixed infarction pattern was the most common pattern of infarction in patients with MMD, implying that at least 2 interrelated stroke mechanisms of hypoperfusion and thromboembolism likely coincide. An association between ICA flow status and the pattern of infarction was not found. Prospective studies evaluating the utility of antithrombotic agents in MMD are needed.
Abstract TMP76: Left Atrial Appendage Closure In Atrial Fibrillation Patients At High Intracranial Hemorrhage Risk
Authors: Abramovitz Fouks Avia , Das Alvin S , Daoud Nader , Gokcal Elif , Rotschild Ofer , Greenberg Steven M , Gurol Edip M
Published: February 2023

Background:
Lifelong oral anticoagulant (OAC) use is associated with higher intracranial hemorrhage (ICH) risk in nonvalvular atrial fibrillation (NVAF) patients. We aimed to assess the long-term outcomes of left atrial appendage closure (LAAC) in NVAF patients at high baseline ICH risk, as LAAC was FDA-approved for NVAF patients who have a reasonable rationale to seek a nonpharmacological alternative to lifelong OAC use.

Methods:
We collected baseline and follow up data from consecutive NVAF patients who had LAAC because of either past ICH or finding cerebral microbleeds (CMB) on MRI without ICH (CMB-only). The outcome measures were the occurrence of ICH or acute ischemic stroke (AIS) after LAAC.

Results:
Out of a total of 644 LAAC performed in a single hospital system between 2015-2022, 142 NVAF patients had LAAC with WATCHMAN because of past ICH or CMB-only. Their mean age was 75.8± 7.6, 41 were female (29%). Mean CHA
2
DS
2
-VASc score was 5.24±1.4. Of the 142 patients, 67 (47.2%) had intraparenchymal hemorrhage (IPH, 52% related to cerebral amyloid angiopathy [CAA]), 19 (13.4%) had non-traumatic subdural hemorrhage (SDH), 36 (25.3%) had traumatic ICH (T-ICH), and 20 (14.08%) were CMB-only (65% with CAA pattern). Eighty-one patients were discharged on OAC (57%) and 133 patients were not taking OAC at 1 year (94%). Over a mean 1.98 years follow up, one patient had recurrent non-traumatic IPH (incidence rate [IR] 0.36 per 100 patient-years), four had traumatic ICH/SDH due to severe falls (IR 1.4%/year), and five had AIS (IR 1.78%/year).

Conclusions:
In NVAF patients at high ICH risk, our results show a 74% decrease in AIS risk (actual 1.76%/year vs expected 6.8%/year based on CHA
2
DS
2
-VASc). Despite the very high ICH risk population studied including at least 48 CAA patients, only one patient had a recurrent IPH after LAAC. LAAC should be considered in NVAF patients at high ICH risk and studied in RCTs in this cohort.
Abstract TMP81: Immunocompetent Neural Organoids Respond To Blood Stimulation: A Novel Model Of Intracerebral Hemorrhage
Authors: Schuldt Braxton R , Vicari James M , Kellner Christopher P
Published: February 2023

Introduction:
The lack of treatments for intracerebral hemorrhage (ICH) suggests the need for novel preclinical models of this disease. To that end, this study aimed to explore the utility of an ICH neural organoid model.

Methods:
Human neural organoids consisting of several cell types, including microglia, were provided by Stem Pharm, Inc. On DIV 21, organoids were treated with human whole blood (n=3 organoids in each condition) for 24 hours. To serve as positive and negative controls, one organoid was treated with lipopolysaccharide (LPS) for 24 hours and three remained untreated. Human IL-6 concentrations were measured in the culture media prior to and after treatments using an enzyme-linked immunosorbent assay (ELISA) and the fold-change from baseline was normalized to the negative control condition. A one-way ANOVA with Dunnett’s test was then performed to compare IL-6 secretion between the control and treatment conditions.

Results:
LPS and blood stimulation both induced IL-6 secretion after 24 hours. The greatest fold increase in IL-6 concentration relative to the control group was observed with 10% blood stimulation (29.76 +/- 7.91, p<0.0001) followed by LPS (23.43 +/- 11.18, p<0.001) and 5% blood (22.56 +/- 7.91, p<0.0001). Significant fold increases in IL-6 secretion were also observed in the lower concentration conditions of 2.5% (15.75 +/- 7.91, p<0.001), 1.25% (11.46 +/- 7.91, p<0.01), and 0.6% blood (11.60 +/- 7.91, p<0.01).

Conclusion:
This preliminary study is the first to explore a neural organoid model of ICH. Comparable to LPS, the observed trends in IL-6 secretion suggest that whole blood is a potent, dose-dependent inducer of organoid inflammation. Given the blood-induced neuroinflammation that occurs during ICH, these initial results support a potential role for neural organoids in ICH modeling. Future work will aim to further characterize the organoid inflammatory response and validate this ICH model system via gene expression analyses.
Abstract TMP9: Covid-19 Increases The Risk Of Malignant Middle Cerebral Artery Infarction In Acute Stroke
Authors: Santos Isabel , Dousseau Gabriella , Avezum Luisa , Piva Mariana , Tolentino Mateus , Terehoff Igor , Domingues Pedro , Canedo Nalcer , Machado Michel , Rocha Maria Sheila G
Published: February 2023

Introduction:
Stroke as a presenting feature of COVID-19 infection is being increasingly recognized. The prevalence of malignant middle cerebral artery syndrome (MMC) in acute stroke associated with COVID-19 is yet unknown.

Methods:
This is a retrospective cohort study of ischemic stroke patients admitted in a health center in Brazil. We investigated the prevalence of malignant middle cerebral artery syndrome in COVID-19 and associated stroke patients.

Results:
We included 881 ischemic stroke patients (53% male). COVID-19 patients represented 5.3% (N = 47). Mean age was 65.6 years (SD 13.2). COVID-19 patients were significantly younger (mean: 61.4 years; SD: 13.5; p = 0.025) and disclosed a higher odds of previous ischemic heart disease (OR: 4.1 - CI: 1.98-8.16). The frequency of main stroke risk factors was similar for both groups. COVID-19 patients had significantly higher NIHSS (11 points vs 8.2 in non-Covid-19 group - p = 0.006). MMC occurred more frequently in COVID-19 patients (19.5% vs 4.1% of non-covid-19 group - p < 0.001) (Risk ratio: 5.1; CI: 2.63-10.01 - p < 0.001). COVID-19 stroke patients had a longer hospital stay (p < 0.001) and disclosed a higher risk for in-hospital infection (Risk ratio: 4.3 - CI: 2.47-7.53). Rankin scale at 90 days was significantly higher for COVID-19 patients (p <0.001). Case-fatality was higher among COVID-19 stroke patients (49.4% vs 2.5% in non-covid-19 group; p < 0.0001). Among those patients with MMC, the lethality was significantly higher among COVID-19 patients (66.6% vs 41.3% in non-covid-19 group; p< 0.0001). Multivariate logistic regression with MMC as outcome and adjusted for age, sex, NIHSS and comorbidity index, disclosed COVID-19 infection as the main independent preditor for MMC (OR: 6.3 - CI: 2.26-17.52 - p < 0.0001 - adjusted R2 = 0.2623).

Conclusion:
In this cohort study, COVID-19 infection was an independent predictor for malignant middle cerebral artery syndrome in ischemic stroke.
Abstract TMP91: Patterns And Outcomes Of Endovascular Thrombectomy Among Patients Over Age 80: The Florida Stroke Registry
Authors: Sharashidze Vera , Ying Hao , Wang Kefeng , Gardener Hannah , Alkhachroum Ayham , Gutierrez Carolina M , Rose David , Krementz Nastajjia , Dong Chuanhui , Mehta Brijesh P , Jameson Angus , Rundek Tatjana , Yavagal Dileep R , Romano Jose G , Sacco Ralph L , Asdaghi Negar
Published: February 2023

Introduction:
Patients older than 80 years of age are under-represented in randomized trials of endovascular thrombectomy (EVT). In the large Florida Stroke Registry, we aimed to evaluate the impact of age on EVT outcomes in routine clinical practice.

Methods:
Prospectively collected data from Get with the Guidelines- Stroke hospitals participating in the Florida Stroke Registry from January 2010 to April 2020 were reviewed. The impact of age on discharge outcomes was studied using multivariate analysis with generalized estimating equations adjusting for sex, race, NIHSS, time from onset to treatment, intravenous thrombolysis, and hospital-based characteristics (size, EVT volume, and stroke center certification), and region.

Results:
Among 8,344 EVT patients (mean age 71±15, 49% male), 32.9% were ≥ 80 years of age. Patients ≥ 80 years were more likely hypertensive (76% vs 63%), with atrial fibrillation (56% vs 26%), presented earlier to the hospital (onset to arrival 108 vs 126 min), with more severe strokes (NIHSS 17 (IQR=11) vs 15 (IQR=11)) and less likely to ambulate independently at baseline. Short term discharge outcomes and treatment complications, stratified by age ≥ 80 or < 80 are shown in the Table. In multivariable analysis, elderly patients were less likely to achieve independent ambulation (OR: 0.37, CI 0.32, 0.43) and be discharged home/rehabilitation (OR 0.36, CI 0.33, 0.40). In the continuously adjusted model, for every year increase in age, the odds of independent ambulation decreased by 3% per year (p<0.001) for patients 60-80 years of age and decreased by 7% for those over the age of 80.

Discussion:
In routine practice, one third of endovascularly treated LVO patients are over 80. Our data shows that EVT is safe in this population; however, age remains an independent predictor of poor discharge outcomes, especially in those over the age of 80.
Abstract TMP92: Effect Of Serious Adverse Events After Endovascular Thrombectomy On Clinical Outcome In Acute Ischemic Stroke With Large Vessel Occlusion: A Pooled Analysis From DEVT And Rescue BT Trial
Authors: Luo Weidong , Wu Qianjin , He Haoran , Zhao Ning , Liu Xing , Zi Wenjie
Published: February 2023

Background:
Using the pooled database of the DEVT and the RESCUE BT Trial, the objective of this study was to assess the serious adverse events (SAE) profile and their clinical impacts among patients with ischemic stroke due to large vessel occlusion treated with endovascular thrombectomy.

Methods:
A post hoc analysis was performed by using database of the multicenter, randomized DEVT and RESCUE BT clinical trials. SAEs as reported by investigators at any time-point during the hospitalization and the 90-day follow-up period were analyzed on their frequency and that of any of their outcomes (death, and life threatening, new and/or prolonged hospitalization, disability/incapacity). The primary end point was favorable outcome, as defined by a score of 0 or 1 on the modified Rankin scale (mRS) of neurologic disability (which ranges from 0 [no symptoms] to 6 [death]) at 90 days. Logistic regression analysis was used to determine the effect of SAE on clinical outcome and the predictors of SAE.

Results:
Among 1182 randomized patients undergone endovascular thrombectomy, 1758 SAE occurrences were identified, affecting 828 (70.1%) patients. The three most frequent SAEs were pneumonia (n=620, 52.5%), intracranial hemorrhage within 48 hours (n=359, 30.4%) and systemic bleeding (n=174, 14.7%). Patients suffering from at least one SAE had a lower odds of reaching a favorable outcome at 90 days (adjusted odds ratio, 0.350 [95% CI, 0.249-0.492],
P
<0.001). Higher age (
P
=0.001), higher NIHSS (
P
<0.001), intracranial segment of internal carotid artery (ICA) (
P
=0.012) and puncture to recanalization time (
P
<0.001) were predictors for the occurrence of SAE.

Conclusions:
SAEs were observed in about 7 in ten patients, and were more frequent in elderly, functionally-impaired, longer procedure time, and intracranial ICA-occluded among patients with ischemic stroke treated with endovascular thrombectomy. These findings may provide clinicians and patients with more accurate risk of SAEs after endovascular thrombectomy.
Abstract TP10: Realtime Tenecteplase Recanalization Rates And Clinical Outcomes In Patients With Medium Vessel Occlusion Stroke
Authors: Snyder Thomas , Haimi Joshua , Fourcand Farah , Ali Ch Hassan , Dubinski Ilya , Le Yenna , Gadallah Nancy E , Zacharatos Haralabos , Mehta Siddhart , Kirmani Jawad F
Published: February 2023

Introduction:
The goal of this study was to evaluate recanalization rates, incidence of hemorrhagic transformation, and clinical outcomes in patients with medium vessel occlusion (MVO) strokes receiving tenecteplase (TNK) and endovascular treatment (EVT) to add to the growing fund of knowledge of TNK in AIS.

Methods:
We conducted a retrospective cohort study of prospectively collected AIS patients who received TNK and EVT from October 2020 to June 2022 at our comprehensive stroke center. We included subjects with MVO defined as occlusion of the M2 segment or more distal of the middle cerebral artery without involvement of the M1 segment, A1 segment or more distal of the anterior cerebral artery, or P1 segment or more distal of the posterior cerebral artery. Patients receiving intra-arterial thrombolytics or non-thrombolytics were excluded. We defined successful recanalization as Modified Thrombolysis in Cerebral Infarction (mTICI) 2b or greater and symptomatic hemorrhage as change in NIHSS ≥ 4 with temporally associated hemorrhage. Hemorrhagic transformation was classified using ECASS-3 criteria. Social science statistics software was used for data analysis.

Results:
Out of 77 patients who received TNK and EVT, 16 subjects had MVO and were included in analysis. Mean age was 68.56 (95% CI 60.20, 76.93). Fifty six percent (n=9) of subjects were female. Median presenting NIHSS was 10.5 (95% CI 7.17, 14.07). Median 90 day mRS was 1 (95% CI 0.76, 2.62). No subject recanalized prior to EVT. Hemorrhagic transformation occurred in 43.75% (n=7) of subjects, and symptomatic intracerebral hemorrhage (ICH) occurred in 1 subject (6.25%) with PH-2. There was no ICH in subjects who did not recanalize post-EVT (n=3). No significant change was found from baseline NIHSS compared to discharge NIHSS (U=95.5, z=1.21, p=0.11).

Conclusions:
TNK in MVO may be associated with increased risk of hemorrhagic transformation. However, given that all subjects underwent EVT and the known incidence of post-procedural contrast staining on CT, the incidence of asymptomatic hemorrhagic transformation may be overestimated. This is further supported by good clinical outcomes and low incidence of symptomatic ICH.
Abstract TP11: Acute Stroke Randomized Clinical Trials: What Factors Help Trials Achieve Their Intended Sample Size?
Authors: Aziz Yasmin , Sucharew Heidi , Strong Brent , Reeves Mathew J , Broderick Joseph P
Published: February 2023

Background:
We performed a systematic review of acute stroke trials to determine features associated with premature termination of trial enrollment.

Methods:
MEDLINE was searched for stroke RCTs between 1/1/2013-6/11/2020. Included studies were Phase 2 or 3, had a preplanned sample size ≥100, had time to treatment within 24 hours of onset for TIA, ischemic stroke, or ICH, and were published in a major clinical journal (BMJ, Circulation, Stroke, Neurology, JAMA, JAMA Neurology, Lancet, Lancet Neurology, NEJM). Studies were deemed prematurely terminated if authors reported early termination. Study variables and inclusion criteria are listed in Table 1. Complex trials required specialized training and expertise, high degree of monitoring, or procedural intervention. Univariate Chi-square tests/Fisher’s exact test were used to determine characteristics associated with early termination, and multivariable lasso logistic regression was used to select the most important predictors.

Results:
Of 1,219 studies assessed, 69 trials met eligibility criteria for inclusion (Table 1); 34 (49%) were prematurely terminated. In univariate analysis, variables associated with premature termination were complexity of treatment, industry involvement, exclusion of older patients, and presence of a futility stopping rule. In lasso regression, complex treatment trials (OR 3.77, 95% CI 1.30-10.97, versus moderate or simple trials combined), presence of a futility rule (OR 3.56, 95% CI 1.02-12.40 versus no rule), and geographic region (North America OR 1.97, 95% CI 0.57-6.81 versus all other regions combined) were selected as important factors.

Conclusion:
Half of acute stroke trials were terminated prematurely. Broadening inclusion/exclusion criteria and simplifying the complexity of trials may decrease the likelihood of unplanned premature termination, whereas planned futility analyses may appropriately terminate trials early, saving money and resources.
Abstract TP110: Incident ICU Transfer Characteristics Among Ischemic Stroke Patients: A 4-year Retrospective Analysis
Authors: Amar Jordan Y , Koleske Joshua , Butler Michael , Padalia Arjun , Shelton Georgia , Laurido-Soto Osvaldo
Published: February 2023

Background:
Neurologic patients transferred to an intensive care unit (ICU) have increased length of stays, mortality, and healthcare cost. There is limited data regarding incident transfers in stroke-specific cohorts. We sought to identify clinical features, transfer timing, and outcomes of patients admitted with ischemic stroke who required ICU escalation.

Methods:
We identified all patients age >18 admitted to our institution with a principle diagnosis of ischemic stroke between 2016 and 2019. We included patients requiring transfer to an ICU at any point in their hospitalization. We identified indications for transfer (IFT), time to ICU transfer (TTI), and outcomes at discharge and at 90-days post-discharge. We subdivided the IFT into neurologic and non-neurologic etiologies, and used chi-square testing and Kaplan-Meier curves with log-rank modeling to identify differences between patients with neurologic and non-neurologic transfer indications.

Results:
3176 patients were admitted with a principle diagnosis of ischemic stroke across the four-year study period. 118 stroke patients (3.7%) underwent incident ICU transfer, 49 (41.5%) due to neurological causes and 69 (58.5%) due to non-neurological causes. The most common neurologic IFTs were cerebral edema (51.0%) and intracerebral hemorrhage (14.3%). The most common non-neurologic IFTs were respiratory decline (47.8%) and shock (21.7%). There were no differences in stroke characteristics (last known normal prior to arrival, baseline NIHSS, thrombolytic rates) between patients with neurologic vs. non-neurologic IFTs. Patients with neurologic IFTs had shorter mean TTI (2.45 vs. 4.80 days; p = 0.035) and were less likely to be discharged home compared to patients with non-neurologic IFTs (21.7% vs. 6.1%; p = 0.021). We corroborated differences in IFTs by adjusted log-rank comparisons on survival analysis. There were no significant difference in length of ICU stay (4.66 vs. 4.83 days) or total length of stay (12.37 vs 16.75 days).

Conclusions:
Most ischemic stroke patients’ incident ICU transfers occur in the first 48 hours, highlighting the need for early vigilance. Neurologic and non-neurologic etiologies for IFT may contribute to the patients’ disposition outcome.
Abstract TP111: The Role Of Hypomagnesemia In Acute Ischemic Stroke: Analyses Of The Mimic-iv Database
Authors: Jhou Hong-Jie , Chang Ting-Hsuan , Yang Li-Yu , Chen Po-Huang , Chang Shuhao
Published: February 2023

Background/Objective:
Hypomagnesemia is commonly seen in critically ill patients and may cause complications and increase mortality. The study is conducted to investigate the patient’s characteristics and outcomes of critically ill patients with acute ischemic stroke (AIS) and hypomagnesemia.

Hypothesis:
We hypothesize that patients with acute ischemic stroke (AIS) and hypomagnesemia associate with poor prognosis.

Methods:
Patients with AIS are identified in the Medical Information Mart for Intensive Care IV database from 2008 to 2019. Hypomagnesemia is defined as ≤ 1.5 mEq/L. Propensity score matching is conducted to balance clinical heterogeneity using age, sex, Charlson Comorbidity Index (CCI), Acute Physiology Score (APS) III. We measured the linearity association between the hypomagnesemia and in-hospital mortality using a restricted cubic splines model.

Results:
Totally, we included 1,486 patients with AIS (103 patients having hypomagnesemia). Compared with patients without hypomagnesemia, those with hypomagnesemia were older (69.6±12.6 v.s. 68.6±14.3;
P
= 0.477; Table 1) and had higher CCI (7.8±2.3 v.s. 6.8±2.7;
P
< 0.001; Table 1), and APS III (43.0±20.5 v.s. 39.5±19.0;
P
= 0.074; Table 1). After matching, 103 pairs were left. There is no difference regarding in-hospital mortality (14.6% v.s. 13.5%;
P
= 0.766; Table 1) between each two group, even after matching (14.6% v.s. 14.6%;
P
= 1.000; Table 1). There was a non-significant negative linear trend between hypomagnesemia and in-hospital mortality (Figure 1).

Conclusions:
Patients with hypomagnesemia have poor characteristics; however, hypomagnesemia is not a risk factor of in-hospital mortality.
Abstract TP117: Temporal Serum Iron And Hemoglobin Changes In Patients From The High Dose Deferoxamine In Intracerebral Hemorrhage Trial
Authors: Roh David , Shen Qi , Carvalho Poyraz Fernanda , Kumar Aditya , Cottarelli Azzurra , Mao Eric , Foster Lydia S , Yeatts Sharon D , Hod Eldad , Selim Magdy H
Published: February 2023

Introduction:
Following intracerebral hemorrhage (ICH), elevated cerebral tissue iron concentrations are seen. It is unclear how peripheral serum iron concentrations change over time and how they relate to anemia after ICH. Given the known impacts of iron concentrations and anemia on clinical outcomes, we explored serum iron biomarker and hemoglobin concentration changes after acute ICH.

Methods:
A post hoc analysis of patients with available serial (baseline and 5 day) serum biomarker data from the multicenter, High Dose Deferoxamine in Intracerebral Hemorrhage (HI-DEF) trial was performed. Changes of serum hemoglobin, iron, transferrin, and ferritin were assessed using repeated measure ANOVA analyses. Deferoxamine treatment and poor 90 day modified Rankin Scale 4-6 were separately assessed as between subject factors for these laboratory changes.

Results:
Of 42 ICH patients analyzed, the mean age was 64, 62% were male, median ICH volume was 15.7mL (IQR 5.7-37.5), and baseline anemia was seen in 19%. We identified significant decrements of hemoglobin (mean difference -1.4 g/dL; 95%CI: -1.9 to -0.9; p<0.0001), iron (mean difference -16.9 ug/dL; 95%CI: -29.7 to -4.1; p=0.01), transferrin (mean difference -43.9 ng/mL; 95%CI: -56.6 to -31.3; p<0.0001), and conversely, significant ferritin elevations (mean difference 104.5 ug/L; 95%CI: 52.5-156.6; p<0.0001) at 5 days. Anemia was identified in 43% of patients at 5 days. Deferoxamine did not have a significant impact on these repeated measures. Patients with poor long-term outcomes had greater decrements in hemoglobin compared to those with good outcomes (mean difference: -1.5 g/dL; 95%CI: -2.6 to -0.3; p=0.01).

Conclusions:
Serum iron and hemoglobin concentrations decrease significantly over time following ICH. Patients with worse long term ICH outcomes had greater hemoglobin decrements during their hospitalization. The aggregate iron biomarker and hemoglobin concentration changes suggest anemia development may be due to anemia of inflammation. Further work is required to address the pathophysiologic difference between systemic and central iron homeostasis mechanisms following ICH and the impacts that ICH has on inflammation, systemic iron homeostasis, anemia, and clinical outcomes.