bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP113: Administration of Direct Angiotensin II Type-2 Receptor Agonist, Compound 21, Even After Stroke Prevents Ischemic Brain Damage
Authors: Mogi Masaki , Min Li-Juan , Jing Fei , Tsukuda Kana , Ohshima Kousei , Nakaoka Hirotomo , Iwanami Jun , Horiuchi Masatsugu
Published: July 2021

Objectives:
Previous our studies showed that angiotensin II type-2 (AT
2
) receptor stimulation protects neurons after brain ischemic damage using AT
2
receptor-deficient mice. Recently, Compound 21 (C21) is available to use as a direct AT
2
receptor agonist. We reported that administration of C21 induces vascular dilatation via bradykinin-nitric oxide pathway and maintains cerebral blood flow, resulting in prevention of cognitive impairment. These results inspired us the possibility that administration of C21 could protect ischemic brain damage; therefore, we assessed the effect of C21 on stroke expansion by not only pre-treatment, but also a treatment immediately after stroke.

Methods:
10 week-old wild-type male C57BL6 mice were subjected to the middle cerebral artery occlusion (MCAO) by electrocoagulation using a subtemporal approach. Ischemic area after stroke was evaluated by time-course analysis by magnetic resonance imaging (MRI) of the brain. C21 was administrated to mice 2 weeks before MCAO or immediately after MCAO treatment by intraperitoneal injection. Cerebral blood flow was evaluated by using 2D-laser speckle blood flow imaging system.

Results:
No significant remarkable change was observed in blood pressure in mice with or without C21 treatment. Pretreatment of C21 prevented ischemic brain damage 1 day after MCAO. In contrast, such preventive effect by C21 was not observed in AT
2
receptor-deficient mice. On the other hand, C21 treatment immediately after MCAO did not reduce ischemic area 1 day after MCAO, but remarkably reduced this 3 days after MCAO. Treatment with C21 prevented the reduced cerebral blood flow after MCAO.

Conclusions:
These findings indicate that AT
2
receptor stimulation by C21 prevents ischemic brain damage at least in part via maintaining cerebral blood flow even after stroke. Therefore, administration of C21 could work as a new therapeutical option in patients with stroke even in acute phase.
Abstract WP119: Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial
Authors: Easton J Donald , Johnston S. Claiborne
Published: July 2021

The Platelet-Oriented Inhibition in New TIA and minor ischemic stroke (POINT) Trial, is a prospective, randomized, double-blind, multicenter trial with the primary null hypothesis that, in patients with TIA or minor ischemic stroke treated with aspirin 50-325 mg/day, there is no difference in survival free of ischemic stroke, myocardial infarction, and ischemic vascular death at 90 days in those treated with clopidogrel (600 mg loading dose then 75 mg/day) compared to placebo when therapy is initiated within 12 hours of the time last known free of new ischemic symptoms.

Subjects are 18 years of age or older with high-risk TIA (defined as an ABCD
2
score > 4) or minor ischemic stroke (with an NIHSS < 3); each subject is followed for 90 days from randomization. A total of 4,150 patients will be recruited and the trial will be completed in 7 years. The first subject was enrolled on May 28, 2010.

Planned Number of Centers:
210; Present Number: 145 (06 AUG 2012)

Planned Number of Subjects:
4,150; Present Number: 1,008 (06 AUG 2012)

Sponsor:
University of California, San Francisco (UCSF); National Institute of Neurological Disorders and Stroke (NINDS)

Collaborators:
Neurological Emergencies Treatment Trials Network (NETT); Statistics and Data Management Center (SDMC) at Medical University of South Carolina (MUSC); POINT Clinical Research Collaboration (POINT CRC) at EMMES Corporation

Dates of Study:
October 2009 - September 2016

ClinicalTrials.gov
Identifier:

NCT00991029
;
http://clinicaltrials.gov/ct2/show/NCT00991029?term=POINT&rank=1
Abstract WP122: The Coexisting Leukoaraiosis In Ischemic Stroke Patients: How Does It Change Over Time?
Authors: Cho A-hyun , Lee Seung-Jae , Lee Si Baek , Han Soo-Jeong , Kim Woojoon , Kim Beum Saeng
Published: July 2021

Background:
The prevalence of leukoaraiosis or white matter hyperintensities (WMH) is getting higher with the easy accessibility of brain imaging. Their clinical significance has not been known yet. Herein, we aimed to investigate how they progress or regress over time in patients with ischemic stroke.

Methods:
We consecutively enrolled ischemic stroke patients who underwent brain MRI (T2-weighted image or fluid-attenuated inverse recovery (FLAIR) image) more than twice with at least a 6 month time-interval. Patients with pathologic lesions which cannot be distinguished from WMH were excluded. Clinical variables (age, sex, risk factors, stroke subtypes, and imaging time) were obtained by reviewing medical records. T2-weighted image or FLAIR image was used to assess the presence of WMH. WMH was visually measured with use of modified Fazekas grading by an independent investigator. The change of WMH was interpreted as 1)no change, 2)progress, 3)regression, 4)distinctive progress and regression. The descriptive analysis of the pattern of WMH change over time and factors associated with each pattern were analyzed.

Results:
The total number of enrolled patients were 100. Their age (mean±SD) was 67.5±11.8 years and 63 were male. The most common stroke subtype was small vessel disease (SVD, 43%), followed by large vessel disease (LVD, 27%), and cardioembolism (9%). The imaging time-interval (mean±SD) was 28.0±16.6 months. In 64 patients, WMH was observed on brain MRI. Among them, the WMH pattern didn’t change in 25 patients, progressed in 28, regressed in 10 and progressed in distinctive region and regressed in others in 4 patients. Three patients had newly developed WMH on their follow-up MRI. 51.9% (14/27) of patients with LVD showed progress, whereas 30.2% (13/43) of SVD showed progress. Regarding regression, 16.3% (7/43) of patients with SVD, 11.1% (3/27) of LVD showed regression. The presence of LVD was significantly associated with WMH progression (14/27 vs. 18/73, p=0.015). The WMH changing pattern was not affected by risk factors.

Conclusions:
Over half of patients with stroke showed progress of WMH on their follow-up MRI. In addition, regression of WMH was also observed in 21.8% patients. Stroke subtype of LVD was associated with WMH progression.
Abstract WP124: Targeting Prodeath Signaling Upstream Of Mitochondria Damage-cathepsins In Astrocytes Contributes To Neuroprotection Against Cerebral Ischmia
Authors: Zhang Huiling , Xu Min , Yang Lei , Nobuhiko Katunuma , Ishidoh Kazumi
Published: July 2021

The roles of cathepsins in the ischemic astrocytic injury remain unclear. Here we test the hypothesis that the activation of cathepsin B and cathepsin L contribute to astrocytic injury via inhibiting cathepsins-mitochondrial apoptotic signaling patheways during acute focal ischemia and oxygen-glucose deprivation (OGD). In a rat model of pMCAO, CA-074Me, a selective inhibitor of cathepsin B, or Clik148, a selective inhibitor of cathepsin L, reduced the infarct volume, improved the neurological deficits and increased the expression of MAP2 and GFAP at 24 h after ischemia. In OGD-induced primary cultured astrocytes injury, CA-074Me or Clik148 significantly decreased the LDH leakage and increased the number of astrocytes in a dose-dependent fasion, and also increased the expression of GFAP. Immunofluorescence showed that the dots distribution of cathepsin L or cathepsin B was seen in astrocytes in the ischemic cortex of sham, while the diffussion distribution of cathepsin L or B was seen in astrocytes in the ischemic cortex of ischemic control rats at 3 h or 6 h after ischemia, suggesting the release of cathepsin L or cathepsin B from lysosome to cytosol after ischemia and the activation of cathepsin L or cathepsin B in ischemic astrocytes. pMCAO also induced the activation of caspase-3 in ischemic astrocytes at 12 h after iscemia. CA-074Me or Clik148 reversed pMCAO-induced activation of cathepsin B or cathepsin L and caspase-3 in ischemic astrocytes. Western Blot analysis showed that OGD induced an increase in activated cathepsin B or cathepsin L, tBid and Caspase-3, reduced Cyt-c in mitochondria and increased Cyt-c in cytoplasm in astrocytes. CA-074Me or Clik148 blocked OGD-induced an increase in activated cathepsin B or cathepsin L, tBid and caspase-3, and a reduction in mitochondria Cyt-c and an increase in cytoplasm Cyt-c. The current findings provide the first evidence that targeting prodeath signaling upstream of mitochondria damage-cathepsins in astrocytes contributes to neuroprotection against cerebral ischmia via blocking the activation of cathepsins-caspase apoptotic signaling pathway in astrocytes.
Abstract WP133: L-serine Treatment Confers Neuroprotection Against Permanent Focal Cerebral Ischemia In Rats Via Improving Regional Cerebral Blood Flow
Authors: Wang Guohua , Jiang Zhenglin , Ren Taojie , Li Xia , Zhang Yunfeng , Ke Kaifu , Gao Yanqin
Published: July 2021

Introduction:
L-serine plays critical roles in neuronal development and function. We have recently reported that L-serine protected against ischemic neuronal injury in vivo and in vitro. The mechanism underlying the neuroprotective effect of L-serine remains unclear. L-serine has been documented to induce a fall in mean arterial pressure through activation of small- and intermediate-conductance calcium-activated potassium channels on the endothelium. Such vasodilating action of L-serine in cerebral blood vessels has not been investigated.

Hypothesis:
Improving regional cerebral blood flow (rCBF) by L-serine contributes to its neuroprotection on the brain after permanent middle cerebral artery occlusion (pMCAO).

Methods:
Adult male Sprague-Dawley rats were randomly assigned to sham, vehicle or L-serine-treated groups. pMCAO was induced while monitoring rCBF. The neurological deficit scores, brain infarct volumes and physiological parameters were assessed. L-serine and D-serine content in the cortex was measured with high performance liquid chromatography.

Results:
Compared to vehicle treatment, administration of L-serine improved rCBF in the ischemic cortex and reduced the neurological deficits, infarct volume and cortical neuronal loss in a dose- and time-dependent manner. The improvement of rCBF and neuroprotective effect of L-serine were abolished by apamin plus charybdotoxin, which blocks the calcium-activated potassium channels on the endothelium, but not influenced by strychnine, an antagonist of glycine receptors. HPLC results shows that L-serine treatment increased the content of both L-serine and D-serine in the ischemic cortex. However, inhibiting the conversion of L-serine to D-serine by aminooxyacetic acid did not affect the L-serine-afforded protection, suggesting that the neuroprotective efficacy of L-serine is not related to the conversion of L-serine to D-serine.

Conclusions:
L-serine displayed a neuroprotective effect in the ischemic brain, at least partly due to an elevation in rCBF through cerebral blood vessel dilation mediated by the calcium-activated potassium channels on the endothelial cells. L-serine may be a potential novel therapy for ischemic brain injury.
Abstract WP135: Sinus Bradycardia as a Potential Predictive Factor for Paroxysmal Atrial Fibrillation in Stroke Patients
Authors: Hoshino Takao , Ishiduka Kentaro , Nagao Takehiko , Shimizu Satoru , Uchiyama Shinichiro
Published: July 2021

Background and Purpose
The detection rate of paroxysmal atrial fibrillation (PAF) in stroke patients is limited because they are often asymptomatic, or presenting sinus rhythm on ECG. To estimate the likelihood of PAF as a cause of ischemic stroke, we attempted to identify predictive factors for PAF using the data of sinus heart rate (SHR) on monitoring ECG.

Methods
We enrolled 711 consecutive patients admitted to our hospital with acute ischemic stroke. Exclusion criteria were (1) persistent AF; (2) cardiac pacemaker; and (3) incomplete clinical investigations. Minimum and mean SHR on 24-hour Holter ECG were obtained. The presence of PAF was judged based on previous history, initial ECG, 24-hour Holter ECG, and cardiac monitoring by inpatient telemetry. The clinical characteristics were compared between patients with and without PAF (PAF and non-PAF group, respectively), and multiple logistic regression analysis was performed to identify predictors for PAF.

Results
Of all enrolled patients, 577 patients were eligible for analysis, and PAF was confirmed in 110 (19.1%). Clinical parameters showing a significant difference between PAF and non-PAF groups included: age (mean, 74.1 vs. 66.6,
P
<0.001); dyslipidemia (32.7% vs. 50.8%,
P
=0.001); lack of intra- or extracranial stenosis (54.0% vs. 79.1%,
P
<0.001); chronic heart failure (17.3% vs. 4.9%,
P
<0.001); and NIHSS score (median, 8 vs. 6,
P
=0.002). Minimum and mean SHR were lower in PAF group than in non-PAF group (46.4 vs. 54.1 bpm,
P
<0.001; 71.0 vs. 73.8 bpm,
P
=0.021, respectively). Percentages of patients with PAF were highest in the lowest quartiles of minimum and mean SHR (Figure). Multivariate analysis showed minimum SHR as one of independent predictive factors of PAF (OR 1.08; 95% CI 1.05 to 1.12;
P
<0.001).

Conclusions
Low SHR on monitoring ECG can be a novel predictive factor for PAF in ischemic stroke patients.
Abstract WP138: Jiedu Tongluo Injection, a Chinese Herbal Extract Complex Prescription, Protects Cerebral Ischemia/Reperfusion by Modulating Inflammatory Cascade
Authors: Wu Lifei , Tang Huiling , Hua Fang , Xing Yue , Guan Yalan , Zhao Dan , Liu Zhenquan
Published: July 2021

Background:
The pathological and physiological mechanism of cerebral ischemia/reperfusion (I/R) is considered to be related to energy metabolism failure, excitotoxicity, free radicals, Ca
2+
overload, and platelet activation, et al. In recent years, it is proved that inflammatory cascade plays an important role in I/R damage. Jiedu Tongluo injection (JDTL) is a compound prescription comprising of Geniposide (50 mg/ml), Panax Notoginseng Saponins (180 mg/ml), and Scutellarin (8 mg/ml), which are extracted from Chinese herb medicine. Several previous researches have proved that JDTL can inhibit experimental thrombosis and platelet aggregation significantly. We assessed the hypothesis that JDTL could ameliorate cerebral ischemia/reperfusion injury in rats by modulating inflammatory cascade.

Methods:
One hundred and twenty SD rats (4 months old, 250±20g) were subjected to middle cerebral artery occlusion for 2 hours followed by 24 hours reperfusion or sham operation. Vehicle, JDTL (4 ml/kg, 2 ml/kg, and 1 ml/kg respectively) were injected 15 minutes after ischemia. Neurobehavioral tests were conducted 1, 4, and 24 hours after reperfusion. Infarct size, adhesion molecule, inflammatory molecule, and transcription factors were measured at 24 hours after reperfusion.

Results:
JDTL 4 ml/kg and 2 ml/kg significantly ameliorated the neurobehavioral impairment (p<0.05) and decreased infarct size compared to vehicle (p<0.05). The result of ELISA showed that JDTL 4 ml/kg and 2 ml/kg down-regulated the expression of adhesion molecule (ICAM-1, VCAM-1 and E-selectin) and inflammatory factors (IL-1β, IL-6 and TNF-α) in the brain compared to vehicle (p<0.05). JDTL 4 ml/kg and 2 ml/kg also reduced the expression of NF-κB, p38, and p44/42 detected by immunohistology staining (p<0.05) and western blot (p<0.05).

Conclusion:
JDTL has a protective effect on rats after I/R injury by decreasing infarct size, down-regulating the expression of adhesion molecules, inflammatory factors, transcription factors and inhibiting MAPK pathway.
Abstract WP142: Low Risk Of Posterior Circulation Stroke In Ischemic Stroke Patients With Vertebral Artery Ositium Stenosis
Authors: Song Seung Hoon , Lee Joon Hwa , Moon So Young , Kim Hahn Young
Published: July 2021

Backgrounds
Atherosclerosis of vertebrobasilar artery is a major cause of the ischemic stroke in the posterior circulation. Vertebral artery ostium stenosis (VAOS) is occasionally observed in patients with acute ischemic stroke in anterior or posterior circulation. However, VAOS as a risk for stroke recurrence, especially for the posterior circulation stroke, has not been well studied. This study was performed to determine long-term outcome and clinical significance of VAOS in acute ischemic stroke patients.

Methods
As a prospective observational study of single stroke center registry, we studied risk of recurrent stroke and vascular outcome in acute ischemic stroke patients with VAOS, recruited consecutively from December 2007 to December 2010. VAOS was defined as more than 50% stenosis of either vertebral artery ostium on a contrast-enhanced MRA. Vascular risk factors and long-term outcome including recurrent stroke, cardiovascular event, vascular mortality, or all-cause mortality were investigated.

Results
Of 773 acute ischemic stroke patients, underwent contrast-enhanced MRA, 149 (19.2%) had more than 50% VAOS (age, 70±10 years). All patients had intensive medical treatment and 11 patients underwent angioplasty and stenting. During 327 patient-years of follow-up (mean, 2.2 years), there were 8 ischemic (3 in posterior circulation, 5 in anterior circulation), 5 hemorrhagic, and 2 unknown stroke. The annual rate of events were 1.36% for posterior circulation ischemic stroke, 3.64% for all ischemic stroke, 5.91% for all stroke, 1.36% for vascular death, and 9.55% for all cause mortality. Symptomatic VAOS, concomitant stenosis of other vertebrobasilar arteries or carotid arteries, or stroke subtype was not associated with long-term outcome.

Conclusions
Long-term outcome of acute ischemic stroke patients with more than 50% VAOS was favorable on intensive medical treatment and selective angioplasty and stenting. Vertebral artery ostium stenosis may not be a major risk factor for the recurrent ischemic stroke in the posterior circulation.
Abstract WP154: Chinese-Canadian Stroke Patients With Diabetes Display Unique Hypertension Profile: A Ten-year Epidemiology Study
Authors: Lam Susy , Chu Joseph Y
Published: July 2021

Background:
Significant differences in stroke characteristics were previously discovered to exist between Chinese and Caucasian patients with diabetes mellitus. What remains unknown is if differences in hypertension (HTN) characteristics exist between genders and between the two ethnic groups.

METHODS:
During 2001-2011, patients of JYC were seen at his Toronto Neurology clinic and at William Osler Health System, Brampton Site. Chinese diabetic stroke patients were selected by last name and birth country; similarly diagnosed European patients were age-sex matched correspondingly. HTN severity grade (HSG) guidelines were obtained from the WHO - [HSG 1: BP>140/90, HSG 2: BP>160/100, HSG 3: BP>180/110]. A stratification table obtained from WHO outlined prognosis using number of risk factors in correspondence to HSG. Data was analyzed for: poor prognosis risk, HSG, and BP values.

RESULTS:
Mean age of Chinese cohort at the time of stroke diagnosis (n=35) was 68.6 years. Caucasian mean age (n=129) was 68.7 years. The Chinese cohort was less likely than Caucasians to have poor prognosis when classified as low risk (P<0.05). However, a higher proportion of Chinese had poor prognosis than Caucasians when classified as high risk (0.05<P<0.10). In terms of HTN statistics, Caucasian males had a higher SBP than Chinese males (P<0.05). A higher proportion of Chinese have a low HSG of 0 compared to Caucasians, while Caucasians more likely had a HSG of 3.

CONCLUSION:
Significant differences in HTN characteristics exist between the Chinese and Caucasian diabetic stroke community within the Toronto population. Results show that despite Caucasians more likely scoring a high HSG, Chinese diabetic stroke patients seem to have poorer prognosis than Caucasians who were similarly classified to them. Results suggest that Chinese have more concurrent risk factors and indicate significant differences in BP profiles between Caucasians and Chinese diabetic stroke patients.
Abstract WP161: Improvement in Cerebral Hemodynamic Parameters and outcomes after Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients with Severe Steno-occlusive Disease of Intracranial Carotid and Middle Cerebral Artery
Authors: yeo leonard , Ahmad Aftab , ke jia teo , lwin sein , Tsai yeo T , ning chou , sinha arvind , hock luen teoh , chan bernard , sharma vijay
Published: July 2021

Background and Objective
—Older as well as the recent extracranial-intracranial (EC/IC) bypass trial in patients with symptomatic carotid occlusion failed to demonstrate reduction in stroke recurrence. However, the role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated the changes in various hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass surgery for impaired cerebral vasodilatory reserve (CVR).

Methods
—Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged hexamethylpropyleneamine oxime single-photon emission computed tomography (HMPAO-SPECT). STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were followed-up for cerebral ischemic events.

Results
—112 patients (73males, mean age 56yrs; range 23-78yrs) fulfilled our inclusion criteria. HMPAO-SPECT demonstrated impaired CVR in 77 (69%) patients. Forty-six of them underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. During follow-up (mean 24 months; range 4 to 33months), only 6/46 (13%) patients in bypass group developed cerebral ischemic events as compared to14/31 (45%) cases on medical therapy (absolute risk reduction 32%, p=0.008).

Conclusion
—STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in hemodynamic parameters and reduction in stroke recurrence
Abstract WP169: Endovascular Recanalization For The Total Occlusion Of The Internal Carotid Artery At Subacute To Chronic Stage: Clinical Outcome And Pitfalls
Authors: Terada Tomoaki
Published: July 2021

Objective:
The efficacy and pitfalls of endovascular recanalization for totally occluded internal carotid occlusion were evaluated.

Materials and methods:
Twenty-five cases (twenty six lesions) of symptomatic internal carotid occlusion with hemodynamic compromise or recurrent symptoms were treated at the subacute to chronic stage using an endovascular technique. At the same period, total 1200 carotid artery stenting was performed in our group. Parodi’s embolic protection system or modified Parodi’s technique was used during the recanalization procedure to prevent embolic stroke by reversing the flow from the distal internal carotid artery to the common carotid artery.

Results:
Recanalization of the occluded ICA was possible in 23/26 (88.5%) lesions. The occlusion points were cervical internal carotid artery : 19, and petrous - cavernous ICA : 4 in successfully recanalized cases. The patient’s ischemic symptom disappeared completely after the treatment and new ischemic symptoms did not appear related to the treated leision. Single photon emission computed tomography findings demonstrated the improvement of hemodynamic compromise in all cases with hemodynamic compromise. One case (4.3%) caused right middle cerebral artery branch occlusion during the procedure but his neurological symptoms were stable because of preexisting hemiparesis. One case (4.3%) demonstrated asymptomatic re-occlusion at the treated site.

Discussion:
Endovascular recanalization was possible and effective to improve hemodynamic compromise, although the incidence of this treatment is only 2.2% of the total 1200 carotid artery stenting in our series. However, there still several problems existed, such as hyperperfusion syndrome after recanalization, cerebral embolism during the treatment, and durability after treatment, and difficult identification of the occlusion point before the treatment.

Conclusion:
Endovascular recanalization using an embolic protection device can be considered as an alternative treatment for the symptomatic internal carotid occlusion with hemodynamic compromise or refractory to antiplatelet therapy, even in the subacute to chronic stage of the illness.
Abstract WP171: Surgical Strategy And Results Of Additional Bypass For Patients With Moyamoya Disease Refractory To Previous Surgery
Authors: Kuroda Satoshi , Akioka Naoki , Kashiwazaki Daina , Hamada Hideo , Kuwayama Naoya , Houkin Kiyohiro
Published: July 2021

Introduction
—It is well known that surgical revascularization can improve cerebral hemodynamics and prevent further ischemic cerebrovascular events in moyamoya disease. However, a certain subgroup of patients repeats ischemic attacks even after surgery because of insufficient surgery or disease progression during follow-up periods.

Hypothesis
—Relevant designs and techniques in additional bypass surgery can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.

Methods
—This study included totally 7 patients (9 hemispheres) with moyamoya disease refractory to previous bypass surgery. There were 5 children and 2 adults. They underwent previous bypass surgery in Japan and Europe 6 to 240 months before admission. Based on precise clinical and radiological analysis, cerebrovascular events were considered to occur because of insufficient bypass surgery in 5 patients and disease progression in the ipsilateral posterior cerebral artery in 2. Surgical strategies included wide craniotomy to cover the area where cerebral hemodynamics is still impaired and appropriate bypass procedures such as STA-MCA anastomosis, OA-PCA anastomosis, and indirect bypass. Using [123]I-IMP SPECT or [15]O-gas PET, cerebral hemodynamics was precisely examined before and after surgery

Results
—Postoperative course was uneventful and cerebral hemodynamics significantly improved in all 7 patients. Postoperative cerebral angiography revealed that additional bypass provided collateral blood flow to ischemic area before surgery. Ischemic cerebrovascular events rapidly resolved in 5 patients and gradually decreased in 2.

Conclusion
—This study strongly suggests adequate surgical design and procedures can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.
Abstract WP178: Social Factors Causing Delay Of Hospital Visit In Stroke Patients
Authors: Suzuki Satoshi , Yanagida Tomoko , Fujimoto Shigeru , Inoue Takuya , Jinnouchi Juro
Published: July 2021

Objective:
Stroke should be treated immediately after the onset; however, a variety of factors cause delay of hospital visit. Here we examined this issue focusing on the social factors.

Materials and Methods:
A consecutive series of 469 patients was collected prospectively between May 2007 and March 2009. All patients were admitted within 2 weeks after the onset of stroke. Median age of patients was 75 years old.

Results:
Median time between the onset of stroke and hospital visit (“delay”) was 12.7 hours, ranging from 0.1 to 333.6. Ninety-two patients (20%) lived alone and 377 patients lived with their family or stayed at nursery homes. There was no significant difference in “delay” among them (p=0.41). The “delay” was further analyzed according to the styles of living together in 377 patients. Living with spouse caused a significant delay in hospital visit comparing to living at nursery homes (p=0.0001) and to living with their children (p=0.004), respectively. Living styles was categorized in 3 patterns; i.e., living alone (“alone”), living with spouse (“spouse”), and others (“others”). Median “delay” was 14.8 hours in “alone”, 18.9 hours in “spouse”, and 8.25 hours in “others”, respectively. There was a significant difference between “alone” and “others” (p=0.018), and between “spouse” and “others” (p<0.0001), respectively. Knowledge of rt-PA and use of ambulance cars significantly caused an earlier visit to the hospital (p=0.0006 and p<0.0001, respectively). On the other hand, consultation to family doctors, even by telephone, caused a significant delay of hospital visit (p<0.0001). Two hundred and eighty-eight patients recognized the symptoms by themselves and it was also a significant factor for the delay of hospital visit (p<0.0001). The after-hours onset of stroke was not a causative factor for the delay of hospital visit.

Conclusions:
Both living with spouse and living alone were risk factors for the delay of hospital visit. Knowledge of rt-PA, use of ambulance cars caused early hospital visit. Consultation to family doctors, even by telephone, and recognition of symptoms by patients themselves caused delay of hospital visit. The after-hours onset of stroke did not affect “delay”. The enlightenment to the general public is required.
Abstract WP183: Heart Rate Variability Is Associated With Stroke, Independent Of Traditional Cardiovascular Risk Factors
Authors: Zeki Al Hazzouri Adina , Haan Mary
Published: July 2021

Introduction:
U.S. Hispanics show higher burden of stroke compared to non-Hispanic whites. Stroke-related disparities may be driven by differences in cardiovascular disease (CVD) risk factors. Subclinical measures of CVD such as Heart Rate Variability (HRV) are highly sensitive and strong predictors of CVD events. Yet, the majority of work is limited to clinical settings. We assessed the hypothesis that reduced HRV is associated with higher prevalence of stroke in community-dwelling older Mexican Americans from the Sacramento Area Latino Study on Aging and that this association persists above and beyond traditional CVD risk factors.

Methods:
SALSA is a prospective cohort study with 7 annual visits. In a subsample of 869 participants, we assessed HRV at either visit 5 or 6 using the ANS2000 which is an ECG monitor and respiration pacer. Several R waves are detected in a deep breath cycle resulting in the estimation of Regular R bar, a measure of HRV. R bar was analyzed in quartiles (Q1 to Q4= low to high HRV). We ascertained stroke based on self-report of a physician diagnosis, hospitalization, and death based on ICD-10 codes I60 to I69. We used logistic regression models to estimate the associations between quartiles of HRV and the odds of having had a first-ever stroke at any time during the study. We reported prevalence odds ratios (OR) and 95%CI.

Results:
A total of 124 first-ever strokes occurred across the study period. The odds of a stroke was 109% higher in Quartile 1 HRV (OR=2.09; 95%CI=1.13; 3.90), 65% higher in Quartile 2 (OR=1.65; 95%CI=0.88; 3.10), and 1% higher in Quartile 3 (OR=1.01; 95%CI=0.52; 1.99), as compared to Quartile 4, adjusted for age, sex, income, smoking, alcohol consumption, diabetes, systolic blood pressure, beta blocker and dementia status.

Conclusion:
Our results suggest that reduced HRV is associated with ever having a stroke, above and beyond traditional CVD risk factors.
Abstract WP189: Prediction of Apnea Hypopnea Index among Stroke and TIA Patients
Authors: Sico Jason , Ofner Susan , Yaggi H. Klar , Bravata Dawn
Published: July 2021

INTRODUCTION:
Obstructive sleep apnea (OSA) is common among patients with stroke and TIA. Previously validated OSA screening instruments used in the general population are largely based on reported symptoms; when applied to those with cerebrovascular disease, they have shown poor correlation with the presence of OSA diagnosed via polysomnography (PSG). We sought to develop a cerebrovascular disease specific prediction model for OSA that is less reliant on symptomatology.

Methods:
We used data from a multi-site randomized, controlled strategy trial that included ischemic stroke and TIA patients at two VA hospitals. Data on patient demographics, vital signs, anthropomorphic measurements, past medical history, medications, stroke severity, and sleep questionnaires were obtained. All patients received PSG. Sleep apnea was defined as present if the apnea-hypopnea index (AHI) was ≥5. Because approximately half of subjects had OSA, discrimination was difficult; thus, AHI was used as the outcome for our prediction model. Epworth Sleepiness Scale (ESS)≥10, the Berlin Questionnaire>10, and Sleep Apnea Clinical Score (SACS)≥15 were considered ‘high risk’ for OSA. Bivariate regression models were used to assess the strength of the association between predictors and the outcome (log AHI+1); those statistically significant at the 0.1 level were entered into a multi-variable regression model. Backward elimination was used until all remaining variables were significant at the 0.05 level.

Results:
Among 194 Veterans, 119 (61.3%) had an AHI≥5. Neck circumference > 16 inches, systolic blood pressure less than 132 mmHg, peripheral vascular disease, and recent hospitalization for congestive heart failure were associated with increase in log AHI; history of chronic obstructive pulmonary disease/asthma was associated with a decrease in log AHI (R2=0.13). ESS≥10 (p=0.86) and Berlin Questionnaire >10 (p=0.80) were not associated with log AHI. The SACS≥15 was associated with AHI (p=0.01); however, it did not remain significant in the final model.

Conclusions:
A model using blood pressure, neck circumference and past medical history data was predictive of AHI. Further work is required to validate the use of this model in a larger cerebrovascular disease cohort.
Abstract WP192: Secular Trends in the Incidence, Mortality and Survival Rates of Cardiovascular Disease in a General Japanese Population: the Hisayama Study, 1961-2009
Authors: Hata Jun , Ninomiya Toshiharu , Doi Yasufumi , Hirakawa Yoichiro , Fukuhara Masayo , Mukai Naoko , Nagata Masaharu , Gotoh Seiji , Kamouchi Masahiro , Kitazono Takanari , Kiyohara Yutaka
Published: July 2021

Background:
Changes in lifestyle and advances in medical technology during the past half century have been likely to affect the incidence and mortality of cardiovascular diseases and the prevalence of their risk factors in Japan.

Methods:
We established 5 cohorts consisting of residents of the town of Hisayama, Fukuoka, Japan, aged 40 years or older without a history of cardiovascular disease in 1961, 1974, 1983, 1993, and 2002. Each cohort was followed up for 7 years.

Results:
The age-adjusted incidence and mortality rates of ischemic stroke decreased significantly in men and women over the past half century. These decreasing trends were the greatest in the earlier period (from the 1960s to the 1970s) and slowed down in the recent period (from the 1980s to the 2000s). The incidence and mortality of intracerebral hemorrhage decreased significantly in men but not in women. The incidence and mortality of coronary heart disease decreased in women, but did not show a clear change in men. Five-year survival rates of stroke and acute myocardial infarction increased significantly with time. While the prevalence of hypertension did not show a drastic secular change, the proportion of individuals with antihypertensive treatment increased consistently, and mean systolic and diastolic blood pressures among hypertensive participants significantly decreased over the study period. On the other hand, the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply.

Conclusions:
The incidence and mortality rates of ischemic stroke in both sexes, intracerebral hemorrhage in men, and coronary heart disease in women decreased significantly, probably owing to better management of hypertension. However, the decreasing trends in ischemic stroke slowed down recently and there was no clear change for coronary heart disease in men, probably because the benefits of hypertension control were negated by increasing prevalence of metabolic risk factors. In addition to strict control of hypertension, urgent management of metabolic disorders is needed for further prevention of cardiovascular disease in Japan.
Abstract WP201: Racial Disparities among Incident Ischemic Stroke Cases in the District of Columbia: the ASPIRE Study
Authors: Wing Jeffrey J , Kidwell Chelsea S , Edwards Dorothy F , Fernandez Stephen J , Morgenstern Lewis B , Gibbons M C , Boden-Albala Bernadette
Published: July 2021

Background:
Racial disparities in ischemic stroke incidence have been found in previous studies with blacks having higher rates compared to whites. Recent data has suggested a decrease in stroke incidence but not necessarily a decrease in race differentials. We sought to document incidence of ischemic stroke and explore race-ethnic differentials in the urban, Washington, DC metro area.

METHODS:
ASPIRE is a multi-dimensional intervention with a three-pronged approach (community, hospital, EMS) to acute stroke preparedness targeted to increase IV tPA utilization in underserved black communities in DC. Using a comprehensive active and passive surveillance strategy including stroke admission alerts, stroke champions, admission/discharge data and chart review, the ASPIRE research team prospectively identified all hospitalized incident ischemic strokes between January 2008 and July 2012. Direct age-adjusted rates were estimated using age specific proportions from the 2010 census of the DC population for each sex, gender and race subgroup.

RESULTS:
Over 4.5 years, we captured 691 incident ischemic strokes: mean age 67 yrs +/- 15 yrs; 79% were blacks; and 55% females. Over 45% of the incident ischemic strokes occurred in black-females. Risk factors including hypertension (79%), diabetes (39%), and current smoking (28%) were significantly greater for blacks than whites. The age-adjusted average annual incidence rate per 100,000 was 226 overall: 171 for blacks, 45 for whites; 65 for black-males; 19 for white-males; 106 for black-females; and 26 for white-females

CONCLUSION:
We report significant racial disparities in the incidence of hospitalized ischemic in the DC metro area despite potential undercounting of non-hospitalized stroke cases, and potential competing mortalities in black men (ie. ICH, homicide, AIDS). This continued excess burden of ischemic stroke, particularly in black females, highlights the ongoing importance of projects such as ASPIRE to continue education and preparedness among those with increased risk.
Abstract WP206: Brain Natriuretic Peptide Should Be A Predictive Marker Of Long-term Mortality In Ischemic Stroke Survivors
Authors: Shibazaki Kensaku , Kimura Kazumi , Fujii Shuichi , Sakai Kenichiro , Aoki Jyunya
Published: July 2021

Background and Purpose
We investigated whether brain natriuretic peptide (BNP) can serve as a biological marker of long-term mortality in ischemic stroke survivors.

Methods
We prospectively enrolled consecutive patients with ischemic stroke within 24 hours of onset from April 2007 to December 2010 and measured plasma BNP upon admission. Survivors were followed up to 12 month after stroke onset. Patients were divided into two groups: the deceased group and the survival group. The factors associated with long-term mortality were investigated by multiple logistic regression analysis.

Results
A total of 736 patients who were alive at hospital discharge were included (mean age, 72.8 years; 439 males). Death was observed in 130 (17.7%) patients. The median (interquartile range: IQR) of age (81(74-86) years for the deceased group vs. 72 (64-79) years for the survival group, P<0.0001), frequencies of prior ischemic stroke (30% vs. 20%, P=0.0104), hemodialysis (10% vs. 2%, P=0.0002), atrial fibrillation (42% vs. 30%, P=0.0058), mRS score at discharge (4 (3-5) vs. 2 (1-4), P<0.0001), cardioembolism (45% vs. 34%, P=0.0102), creatinine level (0.80 (0.60-1.19) vs. 0.73 (0.58-0.90), P=0.0044), and BNP level (170.0 (74.0-393.0) vs. 50.0 (19.0-146.0) pg/ml, P<0.0001) were significantly higher in the deceased group than in the survival group. In multivariate analysis, age >75 years (odds ratio [OR], 2.89; 95%CI, 1.80-4.65, P=0.0001), hemidialysis (OR, 6.59; 95%CI, 2.47-17.59, P=0.0002), mRS score >3 at discharge (OR, 4.39; 95%CI, 2.77-6.97, P<0.0001), and a plasma BNP >100.0 pg/ml (OR, 3.98; 95%CI, 2.35-6.72, P<0.0001) were found to be independently associated with long-term mortality. BNP remained independent predictors of long-term mortality not only cardioembolism [BNP >200.0pg/ml (OR, 2.45;

95%CI, 1.22-4.90, P=0.0114)] but also non-cardioembolism [BNP >50.0pg/ml (OR, 4.01; 95%CI, 2.15-7.48, P=0.0001)]. Thus, the mortality rate according to the BNP level was as follows: 6% of patients with <50 pg/ml, 16% with 50 to <100 pg/ml, 27% with 100 to <200 pg/ml, 28% with 200 to <400 pg/ml, and 45% with ≥400 pg/ml.

Conclusions
BNP level upon admission can predict long-term mortality in ischemic stroke survivors.
Abstract WP207: Serum Urate As A Potential Risk Factor For Intracranial Atherosclerotic Disease
Authors: Wan Xin , Dai Chengbo , Zhang Xiong , Wang Shuo , Cao Yumin , Wang Lijuan
Published: July 2021

Introduction
While serum urate is associated with cardiovascular disease, the relationship between serum urate and cerebrovascular atherosclerotic diseases remains controversial. Intracranial atherosclerotic disease (ICAD) is more prone to affect Asian population and the most common cause of ischemic stroke in China. There are few studies observed the associations between serum urate and ICAD.

Hypothesis
We assessed the hypothesis that elevated serum urate level is associated with intracranial atherosclerotic disease and serum urate is a potential risk factor for intracranial atherosclerotic disease.

Methods
Clinical data of 411 patients undergoing cerebral angiography were analyzed, and they were separated into groups according to the findings of cerebral angiography: Extracranial cerebral artery atherosclerosis (ECAA) group included 115 patients had at least one of extracranial carotid or vertebral arteries was stenosised beyond 50%; intracranial atherosclerotic disease(ICAD) group included 173 patients had at least one of intracranial large artery was stenosised beyond 50%; control group included 123 patients had none cerebral large artery stenosis. The relationship between serum urate level and ICAD was explored.

Results
The mean serum urate level of ICA group(345.50±95.83μmol/L) and ECCA group(337.71±98.72μmol/L) are significantly higher than control group(298.21±83.85μmol/L,

P

<0.01), and the ICAD group had a markedly higher rate of patients that had abnormal serum urate level than control group (the proportion of patients that serum urate level above 420μmol/L in ICAD and control group is 23.4% and 11% respectively,

P

<0.05). The proportion of ICAD patients increased significantly with the raise of serum urate level (we divided all the patients into 4 groups according to the quartiles of serum urate level, the proportion of ICAD patients of each group is 31.9%, 36.2%, 47.1% and 52.9% respectively,

χ
2

= 7.898 ,

P

=0.048). Logistic regression analysis shows that serum urate level is one of the independent risk factors of ICAD (OR=1.0007, 95%CI:1.003-1.011,

P

<0.05).

Conclusion
The elevated serum urate level is correlate with ICAD and is a underlying independent risk factors of ICAD.
Abstract WP217: Hemodynamics of the Internal Jugular Vein in Healthy Subjects Using Quantitative magnetic resonance angiography
Authors: Du Xinjian , Amin-Hanjani Sepideh , Ansari Lara , Charbel Fady
Published: July 2021

Objective:
To study the hemodynamics of cerebral venous system by evaluation of the internal jugular veins (IJV) using quantitative magnetic resonance angiography (QMRA) in healthy subjects.

Methods:
263 healthy subjects (129 females; 134 males; mean age 50 ± 16 years) with no history of cerebrovascular disease were evaluated in supine position with QMRA at 3T. Flow rates of the internal carotid artery (ICA) and vertebral artery (VA) were quantified prospectively with 2D phase contrast MR imaging. IJV flow rates were retrospectively measured from previously acquired 2 D phase contrast imaging of the neck between the C5 and C6 level. Total internal jugular venous flow (TIJVF=LIJV + RIJV) was compared to total cerebral flow (TCBF=ICAs + VAs). Regression analysis was used to examine the effects of age, mean blood pressure (MBP), and other variables on TIJVF.

Results:
LIJV flow rates (229 ± 141 ml/min) was significantly less than RIJV (362 ± 165 ml/min) (P< 0.0001). TIJVF (592 ± 177 ml/min) was 84% of TCBF (703 ± 115). As expected, TIJVF was significantly dependent on TCBF (p<0.0001). Unlike TCBF, TIJVF did not depend on age (p= 0.3), nor on MBP (p=0.5), or on gender (p=0.6).

Conclusions:
IJVs are the principle outflow pathway of intracranial blood. Reference values for flows in IJVs and TIJVF may help in the evaluation of conditions characterized by venous outflow obstruction (e.g. venous sinus thrombosis or pseudotumor) or excessive venous output (e.g. arterio-venous fistulae or malformations), as well as investigation of conditions hypothesized to be associated cerebral venous insufficiency, such as multiple sclerosis.
Abstract WP226: Topography of Dilated Perivascular Spaces in Patients with Markers of Cerebral Amyloid Angiopathy and Hypertensive Vasculopathy
Authors: Martinez-Ramirez Sergi , Pontes-Neto Octavio , Dumas Andrew P , Auriel Eitan , Gurol Mahmut Edip , Greenberg Steven M , Viswanathan Anand
Published: July 2021

Objectives:
To investigate whether the topography of dilated perivascular spaces (DPVS) corresponds with markers of particular small vessel diseases such as cerebral amyloid angiopathy (CAA) and hypertensive vasculopathy.

Methods:
Patients were recruited from an ongoing single-center prospective longitudinal cohort study of patients evaluated in a memory clinic. All patients underwent structural, high-resolution MRI, and had a clinical assessment performed within 1 year of scan. DPVS were rated in basal ganglia (BG-DPVS) and white matter (WM-DPVS) on T1 sequences, using an established 4-point semi-quantitative score. DPVS degree was classified as high (score >2) or low (score ≤ 2). Independent risk factors for high degree of BG-DPVS and WM-DPVS were investigated.

Results:
Eighty-nine patients were included (mean age 72.7 ± 9.9 years, 57% female). High degree of WM-DPVS was more frequent than low degree in patients with presence of strictly lobar MB (45.5% versus 28.4% of subjects). High BG-DPVS degree was associated with older age, hypertension, and higher WMH volumes. In multivariate analysis increased lobar MB count was an independent predictor of high degree of WM-DPVS [OR 1.53 (95% CI 1.06-2.21), p=0.02]. By contrast, hypertension was an independent predictor of high degree of BG-DPVS [OR 9.4 (95% (CI 1-85.2), p=0.04].

Conclusions:
The associations of WM-DPVS with lobar MB and BG-DPVS with hypertension raise the possibility that the distribution of DPVS may indicate the presence of underlying small vessel diseases such as CAA and HV, in patients with cognitive impairment.