bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T MP108: A Concentration Response Relationship Between the Active Metabolite of Clopidogrel and its Antiplatelet Activity
Authors: Wolff Stephen , Gengo Francis , Westphal Erica S , Rainka Michelle , Bates Vernice
Published: July 2021

Background:
Variability in antiplatelet response to clopidogrel is reported to be due, in part, to the reduced ability to metabolize clopidogrel to its active form. This can be a result of a genetic difference in metabolizer status or to drug interactions which can cause inhibition of either the CYP2C19 or CYP3A4 P450 isoenzymes. Although up to this point it has remained unclear whether there is a concentration dependent relationship between clopidogrel's active thiol metabolite and its antiplatelet effects and whether there is a threshold concentration of the active metabolite (AM) needed to produce an adequate antiplatelet effect, this 3-arm, complete crossover study demonstrates a statistical relationship between AM concentrations and antiplatelet response.

Methods:
Fourteen healthy male volunteers took clopidogrel doses of 25 mg, 50 mg, and 75 mg. Participants were excluded for tobacco, illicit substance, and alcohol use. AM concentrations were measured using liquid chromatography-mass spectrometry over a 4 hour period and an area under the curve (AUC) was calculated.

Results:
The median baseline whole blood platelet aggregation value was 8 Ω (IQR=7-8.5 Ω) and responsiveness to clopidogrel was defined as <6 Ω and a ≥60% decrease from baseline. Using a receiver operating characteristic (ROC) curve the optimal AUC
0-4
was found to be 784ng*min/mL. Sensitivity was 92.0% (95% CI: 48.0-100.0%) and specificity was 71.4% (95% CI: 46.4-85.7%). Area under the ROC curve was 84.0% (95% CI: 73.0-95.0%, p=1.867e-5) demonstrating statistical validity of the estimates of the AM threshold concentration needed to inhibit platelet aggregation. A Bayesian breakpoint analysis found the optimal threshold AUC to be in a range from 732-882 ng*min/mL.

Conclusions:
These findings could make it possible for clinicians to immediately tailor antiplatelet therapy to individual patients by measuring AM levels after the first dose of clopidogrel, conceivably preventing a secondary event at a time when risk is the highest. Additionally, research is ongoing to explore whether disease states commonly seen in stroke patients, such as diabetes, change the amount of the AM produced or whether they may actually result in a shift of the concentration response curve.
Abstract T MP114: PPARγ in Endothelial Cells Plays an Essential Role in Protecting Against Vascular Aging: Role of Oxidative Stress and Rho Kinase
Authors: Kinzenbaw Dale , De Silva T. Micheal , Sigmund Curt , Faraci Frank M
Published: July 2021

Although aging is the greatest risk factor for vascular disease and stroke, relatively little is known regarding mechanisms that regulate vascular aging. Endothelial dysfunction - a key element of carotid artery and cerebrovascular disease - progresses with age, greatly increasing the risk for ischemic stroke and cognitive impairment. The nuclear receptor peroxisome proliferator activated receptor-γ (PPARγ) is a ligand-activated transcription factor that may exert diverse effects depending on the cell type. Because little is known regarding the role of PPARγ in vascular aging, we used transgenic mice expressing a dominant negative mutation in human PPARγ (V290M) under control of the endothelial-specific vascular cadherin promoter (designated E-V290M) to examine the hypothesis that cell-specific interference with PPARγ would promote age-induced vascular dysfunction. Responses of carotid arteries from adult (11-12 mo) and old (24±1 mo) E-V290M mice and non-transgenic littermates were examined in vitro. Acetylcholine (an endothelium-dependent agonist) produced similar relaxation of arteries from adult control and E-V290M mice as well as old control mice. In contrast, responses to acetylcholine in arteries from old E-V290M mice were reduced by more than 50% in old E-V290M mice (P<0.01). Endothelial function in old E-V290M mice was not altered by indomethacin but was restored to normal by tempol (a superoxide scavenger) or VAS-2870 (an inhibitor of NADPH oxidase). Reactive oxygen species can activate Rho kinase (a potential mediator of vascular disease) and inhibition of Rho kinase with Y-27632 restored endothelial function to normal in old E-V290M mice. Relaxation of arteries to nitroprusside, which acts directly on vascular muscle, was similar in all groups. These findings provide the first evidence that age-related vascular dysfunction is accelerated following cell-specific interference with endothelial PPARγ through mechanisms involving oxidative stress and Rho kinase. This novel role for endothelial PPARγ has implications for understanding vascular pathophysiology as well as therapeutic approaches for age-induced large and small vessel disease.
Abstract T MP117: Early Cognitive Dysfunction is Associated With Poor Short Term Functional Outcome in Hospitalized Stroke Patients
Authors: Karamchandani Rahul , Vahidy Farhaan , Bajgur Suhas , Vu Kim Yen Thi , Choi H. Alex , Oladunjoye Adeolu , Hamilton Robert Kirk , Savitz Sean
Published: July 2021

Introduction:
More than one-half of all patients experience cognitive dysfunction (CD) after stroke, and up to one-third develop dementia. As a Comprehensive Stroke Center, we screen all stroke inpatients for CD, though the feasibility and utility of early screening have not been established. We assessed the hypotheses that early cognitive screening in hospitalized stroke patients is feasible and that early CD is associated with poor short term functional outcome.

Methods:
The medical records of all patients admitted with ischemic stroke (IS) or intracerebral hemorrhage (ICH) between 2/1/13 and 4/15/13 were reviewed. A Brief Neurocognitive Screening Test assessing registration, delayed recall, fluency, and orientation was performed (4 items from the Montreal Cognitive Assessment, higher score better; maximum 12 points). Patients were eligible if they did not have a medical condition precluding screening (e.g. death, comfort care).

Results:
Of 303 IS and ICH inpatients, 209 (68.98%) were screened for CD. Over 85% of all eligible patients were screened (87.1% IS and 81.1% ICH). In a multivariate logistic regression model, factors associated with being screened for CD included lower baseline NIHSS (OR 0.91, 95% CI 0.88-0.94) and IS subtype, as compared to ICH subtype (OR 1.97, 95% CI 1.1-3.52). Median scores (IQR) for IS and ICH patients were 8 (3-10) and 5.5 (1.5-9.5), respectively. More than half of all IS and ICH patients (56.94%) screened positive for CD (score < 9). Patients most likely to screen positive for CD included those of older age (OR 1.04, 95% CI 1.02-1.06) and increased NIHSS (OR 1.14, 95% CI 1.08-1.19). Screening positive for CD was associated with poor discharge/day 7 outcome (mRS > 3), independent of age, baseline NIHSS, and stroke subtype (OR 2.37, 95% CI 1.06-5.28).

Conclusion:
Screening hospitalized stroke patients for CD is feasible and CD in stroke inpatients is common. Older patients and those with more severe strokes are more likely to screen positive. Early CD is associated with poor short term functional outcome. Our results provide preliminary evidence supporting the use of early CD screening in stroke patients. Additional studies on quality of life and long-term outcome are necessary to further assess the utility of early CD screening.
Abstract T MP22: Defining Mild Stroke: Outcomes Analysis of Treated and Untreated Mild Stroke Patients
Authors: Spokoyny Ilana , Raman Rema , Ernstrom Karin , Hemmen Thomas M , Khatri Pooja , Meyer Brett C
Published: July 2021

Introduction:
Mild deficit is a relative contraindication for the administration of IV rtPA in the setting of acute stroke. However, the definition of "mild" has not been well specified until recently. Prior studies have shown that patients with mild ischemic stroke have substantial disability rates at hospital discharge and at 90 days. We investigated whether the application of this new definition altered the rates of disability overall, and in association with treatment.

Methods:
This analysis included all adult acute ischemic stroke patients from a prospective registry of consecutive patients (the UCSD SPOTRIAS database, 2003-2013) with 90 day mRS score available who were defined as “mild” using a recently proposed definition from the TREAT Task Force (NIHSS 0-5 and not clearly disabling based on pre-specified syndromes). Dichotomized 90-day mRS scores (0-1 vs. 2-6) were compared between treated and non-treated patients and the subgroup of non-treated patients whose only exclusion reason was "deficit too mild."

Results:
Of 212 TREAT-defined mild stroke patients, 54 were rtPA-treated. Treated and non-treated patients had similar baseline characteristics except that the treated group had more smokers (79.6% vs. 58.9%; p=0.008), higher median NIHSS (3 vs. 2; p<0.0001), and different racial makeup (p=0.011). In both groups, 37% had mRS 2-6 at 90 days. Of 158 non-treated patients, 36 were reported by the clinician to be excluded from rtPA because the deficit was "too mild"; these patients had no other rtPA exclusion criteria. These 36 patients had similar baseline characteristics to the treated population except for lower baseline NIHSS, and 33% had mRS 2-6 at 90 days.

Conclusion:
More than one-third of patients who fit the TREAT Task Force definition of "mild stroke" were not functionally independent (mRS 2-6) at 90 days, irrespective of treatment, raising the question of treatment efficacy for mild strokes. This study was likely underpowered to detect a significant treatment effect and is limited by its retrospective design. There remains equipoise regarding best acute treatment strategies for mild stroke patients. Randomized studies are necessary to determine rtPA treatment efficacy in mild stroke patients.
Abstract T MP27: Outcome Predictors in Basilar- versus Proximal Middle Cerebral Artery Occlusion: Data from the Endostroke-Registry
Authors: Singer Oliver C , Berkefeld Joachim ,   ENDOSTROKE Study Group
Published: July 2021

Background and Purpose:
Large vessel stroke is frequently associated with poor long-term clinical outcome despite multimodal treatment approaches. Here we compare outcome predictors in angiographic proven proximal Middle Cerebral Artery (MCA)- versus Basilar Artery (BA) occlusion undergoing endovascular stroke treatment (EVT).

Methods:
ENDOSTROKE is an investigator-initiated, industrially-independent multicenter, multinational registry for consecutive patients undergoing EVT for large vessel stroke. This analysis focuses on patients with angiographically proven M1-MCA (n=352) or BA-occlusion (n=121). Recanalization was defined as Thrombolysis in Cerebral Ischemia (TICI) scores 2b-3, good outcome as a Modified Rankin Scale (MRS) score of 0-2 assessed after 3 months.

Results:
77% of MCA- and 77% of BA-occlusions reached TICI 2b-3 recanalization, but good clinical outcome was achieved in only 31% vs. 40% of BA- vs. MCA-occlusions (n.s., Mann-Whitney-Test). Median age was 67 years (25
th
and 75
th
percentile: 59, 77) in BA-occlusion and 70 (58, 77) in MCA-occlusion (n.s.). Admission-NIHSS was significantly higher in BA-occlusion (22 (10, 29)) than in MCA-occlusion (15 (12, 19), p<0.001). Serum glucose and thromboycte count were not significantly different between MCA- and BA-occlusions. In MCA-occlusion, independent factors significantly associated with good clinical outcome were lower age, lower initial NIHSS, lower glucose as well as TICI 2b-3 recanalization. In BA-occlusion, only lower initial NIHSS was significantly associated with good clinical outcome (univariate and multivariate analysis). Time to recanalization was not significantly related to outcome in MCA- or BA-occlusions.

Conclusions:
While initial stroke severity is a potent prognostic factor in both, MCA- and BA-occlusion, other classical outcome predictors, especially patients′ age do not seem to be of as high importance in BA-occlusion as in MCA-occlusion. Presumably, those predictors are offset by the exact site of BA-occlusion (i.e. mid-basilar vs. top of the basilar) leading to differences in initial stroke severity and potentially early irreversible tissue damage to pivotal brain stem structures.
Abstract T MP33: Biomarkers of Ischemic Outcomes in Symptomatic Intracranial Stenosis (BIOSIS) - Preliminary Results
Authors: Frankel Michael R , Quyyumi Arshed , Zhao Yize , Long Qi , Le Ngoc-Anh , Waller Edmund K , Lynn Michael , Arenillas Juan F , Lane Bethany , Chimowitz Marc ,   BIOSIS and SAMMPRIS Investigators
Published: July 2021

Background and Purpose:
Intracranial atherosclerosis is a common cause of stroke. Although inflammatory biomarkers correlate with coronary artery disease, it is not known whether biomarkers of inflammation and endothelial repair are predictive of stroke in patients with intracranial atherosclerosis.The purpose of this study is to determine whether serum biomarkers of inflammation and the number of circulating progenitor cells (PCs) in patients with symptomatic intracranial stenosis are independent predictors of ischemic stroke.

Methods:
Blood samples from patients in SAMMPRIS, a clinical trial comparing stenting plus medical treatment with medical treatment alone in patients with symptomatic intracranial stenosis, were obtained at study entry. Levels of inflammatory biomarkers (PAI-1, E-selectin, hsCRP, LpPLA2) and PCs were analyzed in relation to outcome events. Pre-specified outcomes of interest included stroke in the territory of the symptomatic stenotic artery and any ischemic stroke. The hazard ratio (HR) for each biomarker was determined in relation to outcome events using continuous and dichotomized values (median as cutpoint).

Results:
There were 451 patients with baseline blood samples. Median follow-up was 32.4 months. In patients randomized to medical treatment only, dichotomized biomarker values revealed an association between elevated levels of PAI-1 [1.85 (0.95-3.62), p=0.07)], hsCRP [1.82 (0.96-3.44), p=0.06] and any ischemic stroke. PAI-1 was also associated with any ischemic stroke when analyzed as a continuous variable [1.2 (1.02-1.40), p=0.03]. None of the other inflammatory markers were associated with outcomes. Low levels of PCs enumerated as CD45
med
, CD34+/CD133+ dual positive cells also revealed a trend toward association with ischemic stroke in the territory of the symptomatic stenotic artery for the treatment groups combined [1.56 (0.93-2.63), p=0.09].

Conclusion:
Elevated levels of PAI-1 and hsCRP are associated with risk of any ischemic stroke in patients with symptomatic intracranial stenosis treated with aggressive medical therapy. Low PC levels also appear to be associated with increased risk of recurrent stroke. As the SAMMPRIS trial reaches completion, multivariable analyses will be completed.
Abstract T MP34: Correlates of Clot Length Assessed by Thin-Section CT in a Consecutive Series of Stroke Patients
Authors: Yoo Albert , Frei Don , Loy David , Heck Donald , Aceves Mario , Buell Hope , Kamalian Shervin , Morais Livia , Bitner Ashley , Bose Arani , Sit Siu Po
Published: July 2021

Purpose:
Thin-section (≤2.5mm) NCCT can be used to reliably measure clot length in anterior circulation occlusions. Clots ≥8mm long have a low probability of recanalization with IV rtPA alone, and a majority in the proximal anterior circulation meet this criterion. However, previous studies have had sampling limitations, and correlates of clot length remain to be identified.

Methods:
Data from an ongoing multicenter review were used to explore potential correlates of clot length. Eligible patients were those who presented within 8 hours of onset, had thin-section NCCT, and evidence of ICAT, M1, or M2 MCA occlusion. Variables of interest were age, sex, baseline NIHSS, ASPECTS, occlusion level, IV rtPA dose pre vs post scan, time from stroke onset to imaging, and IA recanalization. Univariate analyses were conducted with clot length as a dichotomized variable (≥8mm vs <8mm), and multivariate logistic regression was used to determine predictors.

Results:
Consecutive stroke admissions between August 2011 and March 2013 were reviewed at 3 US centers for eligibility, and 176 patients met criteria (mean age=71.2 years; 56% female; mean baseline NIHSS=17.3). Of the primary occlusions, 22.7% were ICAT, 55.2% M1, and 22.1% M2 MCA.

Hyperdense clot was visible in 88% (154/176) of cases. Patients with clot lengths ≥8mm had a higher mean baseline NIHSS (18 vs 14.9, p = .01), and lower mean ASPECTS (5.9 vs. 7.8, p=.003). Across occlusion levels, 97%, 75%, and 43% of ICAT, M1, and M2 MCA clots were ≥8mm respectively (p<.0001). Of these variables, only occlusion level was a significant multivariate predictor of clot length (OR=3.1; 95% CI,1.4-6.6 per proximal level, p=.005). Among patients who went on to IA therapy (n=62), clot length was not significantly associated with successful recanalization.

Conclusion:
This analysis further validates the use of thin-section NCCT for measuring hyperdense thrombus, and suggests occlusion location is an important determinant of clot length, which may explain IV rtPA inefficacy in large vessels. It remains to be determined whether clot length is associated with the probability of successful mechanical thrombectomy by IA adjunctive therapy.
Abstract T MP38: A Simple Bedside Grading Scale Can Predict Severe Post-Stroke Upper-Limb Spasticity
Authors: Feng Wuwei , Gundran Andrew , Athreya Madhura , Perry Lindsay , Kautz steven , Adams Robert J
Published: July 2021

Background:
Upper-limb spasticity is a disabling complication after stroke; however, there is no clinical standard grading scale to predict spasticity. This study aims to identify a bedside grading scale with the information collected during the acute stroke phase to predict upper-limb spasticity in the chronic phase.

Methods:
This is a prospective cohort study of 44 patients with first-ever acute ischemic strokes with various degrees of motor impairment. Modified Ashworth Spasticity Scale (MASS) was used as a clinical assessment tool for spasticity assessment with biceps, wrist and finger flexors at 90 days (± 14 days). The highest value was used and severe spasticity is defined as MASS>=3. NIH Stroke Scale (NIHSS) is assessed between 2 to 5 days after stroke and 90 days (± 14 days) after stroke. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at days were identified by logistic regression. A risk stratification scale was developed with weighting of independent predictors based on strength of association.

Results:
Factors independently associated with upper-limb spasticity are NIHSS Arm score at baseline (p<0.001), location of lesion (p=0.003) and stroke lesion volume (p=0.004). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (1 point), <4(0 point); lnfarct location: subcortical lesion only or cortical lesion only (0 point), both subcortical and cortical lesions (1 point); infarct volume: >=20 cc (1 point), <20cc (0 point). None of 12 patients with score of 0 (0%) and 9 out of 10 patients with score of 3 (90%) developed severe spasticity. The likelihood of developing severe upper-limb spasticity increases steadily with grading scale score.

Conclusion:
A simple bedside grading scale can predict severe post-stroke limb spasticity at 90 days. It needs validation with an external dataset.
Abstract T MP43: Utility of Augmented Reality in Relation to Virtual Reality in Stroke Rehabilitation
Authors: Hondori Hossein M , Khademi Maryam , McKenzie Alison , Dodakian Lucy , Lopes Cristina V , Cramer Steven C
Published: July 2021

Introduction:
Virtual Reality (VR) has been found useful for numerous rehabilitation applications, but has some intrinsic constraints such as the need for a visuospatial transformation when guiding movements. Augmented Reality (AR) is a new approach to human-computer interaction that enables patients to interact directly with virtual objects. The current study compared AR and VR in a stroke rehabilitation setting.

METHODS:
The Fruit Ninja game simulates a rehab setting by having subjects perform repeated goal-directed wrist/hand reaching tasks. Subjects held a cup-shaped color-marker in the paretic hand, then reached for a virtual fruit target that sliced in 2 when reached. This game was implemented in both AR and VR settings, with identical movement demands across the two. The target plus real-time visual feedback on hand movements were provided by a computer monitor in VR, and by a projection onto a tabletop in AR. After undergoing baseline assessments (arm motor Fugl-Meyer scale (FMA) and Box and Blocks (B&B)), 10 patients with hemiparetic stroke >6 mo prior and age >18 yr played three 1-min rounds each of the AR and VR games; 4 other subjects who were unable to hold the color-marker object were excluded from current analysis.

RESULTS:
Of the 10 patients, age = 59±10 yr (mean±SD), FMA score = 57±11 (range 31-66), Hand/Wrist FMA subscore = 22±3 (range 15-24), and B&B score = 41±13 (range 16-58). When playing the exact same Fruit Ninja game, all 10 patients scored significantly (p<0.0001) higher in the AR setting (60±9 targets, range 48-78) as compared to the VR setting (48±8 targets, range 37-64 setting. Also, AR scores were stronger correlates of FM Hand/Wrist (rho=0.68, p<0.04) and B&B scores (rho=0.70, p<0.03) than were VR scores.

CONCLUSIONS:
This study shows promising results with use of Augmented Reality in a patient-computer interface. Results also suggest advantages as compared to use of a Virtual Reality approach, possibly due to the fact that moving the hand requires a visuospatial transform in the VR setting but not in the AR setting. Compared to VR, AR scores were higher and correlated better with clinical scores, suggesting great potential for the use of Augmented Reality in a patient-computer interface during stroke rehabilitation.
Abstract T MP59: Texas Stroke Intervention Pre-Hospital Stroke Severity Scale (aka LEGS score): A Triaging Tool for Interventional Stroke Therapy
Authors: Venizelos Alexander , Chen Sherman , Gianatasio Ryan , Coffman Stewart , Gamber Mark , Myers John H , Janardhan Vallabh
Published: July 2021

Introduction:
A pre-hospital stroke severity scale that correlates well with an NIHSS of 10 or greater as well as with large vessel occlusions, but is easier and faster to perform than full NIHSS, would be a very useful triaging tool to emergency medical services (EMS). The LEGS score (Lower extremity strength, Eyes/visual fields, Gaze deviation, Speech difficulty) is a 16-point pre-hospital stroke severity scale that is a shortened NIHSS-5.

Hypothesis:
We assessed the hypothesis that the LEGS score was a useful pre-hospital stroke severity scoring system to identify large vessel acute ischemic strokes.

Methods:
The LEGS score (0-16) and NIHSS (0-42) were performed in the emergency department over a 6-month period. We retrospectively reviewed those charts for correlation to an NIHSS of 10 or greater and evidence of large-vessel occlusion on either CT or MR Angiography within 48 hours of last known normal.

Results:
A total of 181 consecutive ischemic stroke patients were evaluated. LEGS score 4 or greater was a good predictor of an NIHSS of 10 or greater (59/181; positive predictive value 92%; and specificity 95%) and false positives noted was 5/181. LEGS score of less than 4 was a good predictor of an NIHSS of less than 10 (108/181; negative predictive value 91%; and sensitivity 95%) and false negatives noted was 10/181. Of those patients 155 underwent intracranial vascular imaging. LEGS score of less than 4 was a good test to rule-out large vessel occlusion (negative predictive value of 86%; 89/103), but had modest sensitivity (69%; 31/45) and positive predictive value (60%; 31/52). The LEGS score of 4 or greater, however, was fairly specific for determining large-vessel occlusions at 81% (89/110).

Conclusions:
LEGS score of 4 or greater has good correlation with an NIHSS of 10 or greater as well as modest correlation with large vessel occlusion on CT or MR Angiography. This shortened NIHSS-5 may be a useful pre-hospital indicator of patients who may benefit from endovascular intervention.
Abstract T MP6: Angiographic Arteriovenous Shunting in Large Vessel Occlusion Strokes: Not an Ominous Sign
Authors: Nogueira Raul G , Mendes Pereira Vitor , Davalos Antoni , Bonafé Alain , Castaño Carlos , Marcel Arnold , Liebig Thomas , Chapot René , Goyal Mayank , Sztajzel Roman , Scalzo Fabien , Johnson Mark , Besselmann Michael , Moreno Antonio , Schroth Gerhard , Gralla Jan , Liebeskind David S
Published: July 2021

Background:
The angiographic visualization of arteriovenous shunting (AVS) in large vessel occlusion strokes (LVOS) is thought to be a consequence of microcirculatory collapse in the setting of irreversible tissue injury and therefore may represent an ominous prognostic sign. We sought to establish the relationship between the presence of AVS on CT imaging characteristics and clinical outcomes in the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR) trial.

Methods:
STAR Trial patients with complete angiographic images were categorized according to the presence (AVS+) or absence (AVS-) of AVS at the end of the thrombectomy procedure. Baseline variables were compared to assess for any significant differences amongst the two groups. The impact of AVS on pre- and post-treatment CT imaging and in the rates of revascularization (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), good functional outcomes (90-day mRS≤2), and 90-day mortality was subsequently analyzed.

Results:
There was no significant differences in terms of age, baseline NIHSS, gender, time to treatment, or glucose levels between the AVS+ (n=52) and the AVS- (n=116) patients (Table 1). AVS+ patients had a non-significant trend towards more proximal occlusions. The presence of AVS did not have any significant impact on the rates of favorable CT imaging on either pre-treatment (AVS- vs. AVS+ ASPECTS>7: 65.5 vs. 72%;p=0.47) or post-treatment (ASPECTS>7:45.6 vs. 51%;p=0.61) scans. Similarly, AVS was not associated with any significant differences in the rates of good outcome (58.6 vs. 65.4%;p=0.49), mortality (8.6 vs. 3.8%;p=0.35), sICH (1.7 vs. 1.9%;p=0.92), or recanalization (89.7 vs. 92.3%;p=0.78).

Conclusions:
In contrast to the current belief, the angiographic visualization of AVS in LVOS patients does not appear to have any meaningful consequences in terms of infarct size or clinical outcomes and therefore should not influence treatment decisions.
Abstract T MP79: Correlation Between ST Segment Abnormalities at Admission and Worse Neurologic Outcome 90 Days After Stroke: a Prospective Trial
Authors: Braga Gabriel P , Gonçalves Renato S , Betting Luiz Eduardo G , Minicucci Marcos F , Bazan Rodrigo , Zornoff Leonardo A
Published: July 2021

Introduction:
Cerebrovascular diseases are important causes of disability and death. Cardiovascular diseases and stroke share most of the risk factors and there is an intense relation between cerebral and cardiac homeostasis. Electrocardiogram can be used as measurement of neurogenic cardiac abnormalities as it has been suggested that lesions in the insula may result in abnormal electrocardiographic (ECG) findings and increased risk of sudden death. We assessed the hypothesis that electrocardiographic changes in acute stroke could predict neurological outcome at 90 days

Methods:
It was a longitudinal prospective study, with stroke patients admitted in an acute Stroke Unit from March 2012 to March 2013. We included all stroke patients within 24h of symptom onset and diagnosis confirmed with head CT scans. We excluded patients with history of cardiac surgery, myocardial infarct and pulmonary thromboembolism within 2 weeks before stroke. We collect data about clinical history and demography, admission NIHSS score and ECG. All patients were followed and in hospital complications, length of stay and modified Rankin score at 90 days were registered. Follow up visits were done by a Neurologist blinded to admission ECG findings; and ECG were analyzed by a Cardiologist blinded to clinical aspects. Statistical analysis was done with logistic regression with correction to gender, admission NIHSS, presence of clinical complications and blood pressure control.

Results:
Of 247 admitted to stroke unit, 112 fulfilled inclusion criteria and agreed to participate. It was observed positive correlation between ST segment abnormalities on admission ECG and cardiac complications during hospitalization (OR 4.73, IC(95%) 1.49 - 14.98, p: 0.008), worse neurologic outcome at 90 days measured by Rankin 3 - 6 (OR 3.4, IC(95%) 1.07-11.12, p: 0.038), and death at the end of follow up (OR 4.25, IC(95%) 1.17-15.49, p: 0.028).

Conclusions:
In conclusion, this study showed that ECG findings at admission, especially ST segment abnormalities, were correlated to higher chance of in hospital cardiac complications, worse neurologic outcomes and mortality at 90 days.
Abstract T P110: Combined Task-Specific and Cognitive Strategy Training in Subacute Stroke: A Phase II Randomized Controlled Trial
Authors: McEwen Sara E , Wolf Tim , Baum Carolyn , Polatajko Helene
Published: July 2021

Background and Objectives:
Task-specific training (TST) may improve basic mobility and activities of daily living; however, used alone, these improvements are not generalized and transferred to home, community, or work settings, nor do they impact overall health status. In contrast, approaches incorporating cognitive strategy training have shown great promise in these areas, suggesting that a combined approach may have a greater overall effect. Cognitive Orientation to daily Occupational Performance (CO-OP) is an approach that uses cognitive strategies in combination with TST. The objective of this trial is to estimate the effect of CO-OP compared to standard out-patient rehabilitation on health status and functional skill performance in adults less than 3 months post stroke

Methods:
Participants less than 3 months post ischemic stroke (ICD-10 codes 163, 164) and admitted to outpatient rehabilitation services at 2 sites were randomized to receive either standard out-patient therapy (ST) or CO-OP. The main outcomes, administered pre, post, and at 3-month follow-up by a blind assessor, were health status (Stroke Impact Scale-SIS), and functional skill performance (Performance Quality Rating Scale-PQRS).

Results:
At the time of interim analysis, 21 participants (mean age 60.2 years, 33% female) were enrolled, 11 CO-OP and 10 ST. Post-test data were available for 14, follow-up for 8. SIS scores indicated larger changes for CO-OP for 7 of 9 domains, moderate effect for the composite physical health outcome SIS-16 at post-test (Cohen’s d=0.6), and large effect at follow-up (Cohen’s d=2.2). CO-OP had a large effect on PQRS scores for functional skills not trained in therapy (Cohen’s d=3.2), suggesting transfer beyond the clinical setting.

Conclusions:
The CO-OP treatment approach is associated with greater improvements than standard rehabilitation in most health status domains and in performance of skills untrained in therapy, indicating transfer beyond the clinical setting. A multi-site Phase III trial is warranted.
Abstract T P113: Orpington Prognostic Scale: A Predictive Tool for Discharge Outcome in a Hyper Acute Stroke Unit
Authors: Mohapatra Sushmita , Jones Amy M
Published: July 2021

Introduction:
An accurate assessment of the severity of impairment and prediction of prognosis following stroke is important for determining rehabilitation needs of stroke patients. The study investigated the predictive ability of the Orpington Prognostic Scale (OPS) administered within 72 hours of stroke onset, in determining discharge destination post admission to a Hyper Acute Stroke Unit (HASU) in the United Kingdom.

Method:
Prospective analysis of OPS data were collected from 247 patients with confirmed diagnosis of stroke admitted to HASU. OPS scores were recorded between 0 to 72hours of admission and compared to discharge destination at 72 hours. Predictive ability of the tool and association with other variables were analysed using logistic regression and multivariate analysis.

Results:
Low OPS score (<3.2) had high positive predictive value (PPV 88.63%)for discharge home and high OPS score (>3.2) had high predictive value (PPV 98.39) for patients requiring further inpatient rehabilitation. OPS had high specificity and sensitivity for the above, independent of age, gender, type and site of stroke, stroke severity, previous social support and co-morbidity.

Conclusions:
OPS could be a valuable tool in predicting the discharge destination from a HASU and thereby facilitate the identification of early rehabilitation needs, 72 hours post stroke by predicting the need for further management. OPS < 3.2 were highly likely to go home with or without support/therapy. Whereas OPS > 3.2 were highly likely to require further medical/therapy input in an inpatient setting.
Abstract T P114: Effect Endovascular Closure Procedure on the Quality of Life in Stroke Patients with Patent Foramen Ovale
Authors: Feeney-Heinzelmann Kathleen , Deng Wenjun , Wickham Thomas , Elia Mikaela , Inglessis Ignacio , Silverman Scott , Gonsalves Christina , Calvanio Ron , Lo Eng H , Palacios Igor , Buonanno Ferdinando , Ning MingMing
Published: July 2021

Introduction:
Patent foramen ovale (PFO), an opening between the left and right atria, is an independent stroke risk factor associated with more than 150,000 strokes per year in the US. PFO stroke patients tend to be younger - most are of child bearing age, enjoy an active lifestyle and are a major component of the work force, who are not long-term anticoagulant candidates. While trials are ongoing to compare closure vs medical treatment, younger stroke patients tend to prefer endovascular closure rather than long-term anticoagulation. Here we investigate the effect of PFO closure for stroke prevention on patients’ quality of life.

Methods:
Patients were recruited per IRB-approved protocol from the MGH Cardio-Neurology Clinic. To quantify the effect of PFO closure on depression and anxiety, validated Becks Depression and Anxiety Inventory were performed by research nurses at 3 months before and 3-6 months after PFO closure. Clinical data on stroke severity, outcome and blood samples were also collected.

Results:
32 consecutive PFO stroke patients, adjudicated by two vascular neurologists (average age 50.75, range 22-59; 56% male) were enrolled. No new treatments (e.g. anti-depressant/anti-anxiety meds) were initiated during the study. After successful PFO closure, patients had significantly improved anxiety (3 vs 5.75, p= 0.043) and depression scores (2.58 vs 3, p= 0.05) (Figure). Cortisol level also lowered post PFO closure (data not shown due to space).

Conclusion:
PFO stroke patients have improved quality of life after PFO closure as measured by validated quantitative anxiety and depression scales under the care of a team of nurses, physicians and neuropsychologist. These findings demonstrate the importance of a multi-disciplinary approach to stroke patient care, and also the effect of endovascular closure in improving the quality of life in younger stroke patients. Future studies are needed in a larger cohort with long term follow-up to validate these results.
Abstract T P122: Functional Independence Measure Scores Predict Self-care Levels Required for Post-acute Stroke Patients Classified by the Long-Term Care Insurance System in Japan: A Multicenter Retrospective Cohort Study
Authors: Saji Naoki , Kimura Kazumi , Ohsaka Goro , Higashi Yasuto , Teramoto Yoichi , Usui Masanobu , Kita Yasushi
Published: July 2021

Background and purpose:
Early prediction of clinical outcomes in stroke patients is socioeconomically important. The aim of this study was to clarify whether Functional Independence Measure (FIM) scores on admission can predict their discharge destinations and future self-care levels required for post-acute stroke patients classified by the Long-Term Care Insurance (LTCI) system, the national insurance plan for care in Japan.

Methods:
We enrolled post-acute stroke patients admitted to 12 convalescent rehabilitation wards (CRW) from 9 acute stroke centers. A CRW was defined as a specialized ward for intensive rehabilitation to prevent a bedridden state and to promote home rehabilitation by improving ability to perform activities of daily living. We evaluated self-care abilities using FIM scores and modified Rankin Scale (mRS) scores as traditional assessment scales and compared with certified self-care levels within the LTCI system (seven levels; slight impairment to bedridden). We divided patients into those who were discharged home from a CRW and all others.

Results:
Among 1261 patients (47% female, mean age 75 years), 984 (78%) were discharged home. FIM scores at discharge were significantly correlated with both mRS scores at discharge and certified self-care levels within the LTCI system (P < .001). The cut-off values for home discharge were a FIM score on admission of 50 points and an age of 75 years. On multivariate analysis, FIM scores ≥50 on admission [odds ratio (OR), 95% confidence interval (95% CI); 5.80, 4.30-7.91] and age <75 years (2.16, 1.60-2.95) were independently associated with home discharge.

Conclusions:
FIM scores in post-acute stroke patients can predict self-care levels within the LTCI system. Early prediction of self-care levels may promote careful preparation of healthcare planning and improve the efficiency of stroke management.
Abstract T P131: Residential Ethnic Segregation and Stroke Risk in Mexican Americans in the BASIC Project
Authors: Patel Rajiv C , Smith Melinda A , Morgenstern Lewis B , Lisabeth Lynda D
Published: July 2021

Background:
Neighborhoods with high racial-ethnic segregation may have weak community cohesion, low neighborhood trust, and high levels of stress which may impact stroke risk factors such as hypertension. We tested the hypothesis that greater residential ethnic segregation is associated with higher stroke risk in a bi-ethnic community.

Methods:
Strokes were identified from the BASIC Project in Nueces County, Texas from 2000-2010. Residential ethnic segregation (range: 0-1) was derived for each census tract (used to define neighborhoods) in the county based on 2000 census data. The measure reflects the probability that a Mexican American (MA) shares their neighborhood with another MA and was categorized into: 1) predominantly non-Hispanic white (NHW, <0.3), 2) ethnically mixed (0.3-0.7), or 3) predominately MA (>0.7). Poisson models were used to examine the association between residential ethnic segregation and stroke risk unadjusted and adjusted for age, sex, ethnicity and neighborhood income. Effect modification by ethnicity was examined in the fully adjusted model, and models were run stratified by ethnicity.

Results:
A total of 2,857 strokes were included. Median residential ethnic segregation was 0.52 (IQR: 0.38-0.77). In the unadjusted model, predominately MA census tracts had greater stroke risk than predominantly NHW census tracts [ethnically mixed: RR=1.23 (95% CI: 1.12-1.35); predominately MA: RR=1.67 (95% CI: 1.51-1.83)]. After adjustment, residential ethnic segregation was not associated with stroke risk [ethnically mixed: RR=1.00 (95% CI: 0.71-1.42); predominately MA: RR=1.11(95% CI: 0.76-1.61)]. Effect modification by ethnicity was not significant (p=0.37), but in the stratified model limited to MAs, predominately MA census tracts had a trend toward higher stroke risk compared to MAs living in predominately NHW census tracts [RR=1.41 (95% CI: 0.94-2.12)] after adjustment for demographics and neighborhood income.

Conclusions:
Stroke risk for MAs was greater in neighborhoods with high ethnic segregation than in predominantly NHW neighborhoods suggesting that features of highly segregated neighborhoods may contribute to elevated stroke risk in MAs.
Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly
Authors: Howard George , Cushman Mary , Banach Maciej , Kissela Brett M , Goff David C , Soliman Elsayed Z , Judd Suzanne E , Howard Virginia J ,   for the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Published: July 2021

Purpose:
The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding.

Methods:
REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated.

Results:
With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor).

Discussion:
The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.
Abstract T P142: Mortality and Stroke Recurrence in Obese Stroke Patients: The Obesity Paradox in a London-Based Population
Authors: Gomes Filomena , Emery Peter W , Weekes Christine E
Published: July 2021

INTRODUCTION

Several studies have shown a paradoxical association between body mass index (BMI) and mortality after stroke. However, the association between BMI, waist circumference (WC) and mortality and stroke recurrence is unclear.

This study aimed to determine the associations between BMI, WC and mortality and stroke recurrence at 6 months post stroke.

METHODS

Patients were recruited from consecutive admissions at 2 hyper-acute stroke units in London and were classified into 4 categories of BMI (underweight, normal weight, overweight and obese) and quartiles of WC. Outcomes were obtained for each patient through a national database that contains details of all hospital admissions.

Chi-square tests were used to compare mortality and stroke recurrence rates. Cox Proportional Hazards Models were used to compare mortality risk and survival curves between different BMI categories and WC quartiles.

RESULTS

Of 543 recruited patients, 51% were males and 87% had an ischaemic stroke, with a mean age of 74.7 years (range 22-99).

There were significant inverse associations between BMI and WC and risk of mortality at 6-months post-stroke (see table) (
p=0.001
and
p=0.04,
respectively). After adjusting for possible confounders (age, ethnicity, gender, severity and type of stroke, stroke risk factors), these associations were attenuated (
p=0.06
for BMI and
p=0.
11
for WC).

No significant differences were found in stroke recurrence rates between BMI groups (underweight 3.7%, normal weight 3.8%, overweight 4.5%, obese 2.8%; p=0.91) or WC quartiles (Q1 2.8%, Q2 5.1%, Q3 3.5%, Q4 3.6%; p=0.83).

CONCLUSION

After a stroke, being obese and having a larger waist circumference was associated with reduced mortality but did not affect the risk of a recurrent stroke.
Abstract T P15: Could Intra-Arterial Thrombolysis Safely Enhance Efficacy of Mechanical Thrombectomy for Acute Ischemic Stroke?
Authors: Zhang Yi , Kelly Adam , Tang Wan , Griggs Robert , Wang Henry , Jahromi Babak , Young Kate , Benesch Curtis
Published: July 2021

Background:
Occlusion of large intracranial arteries is associated with disability and death. In this study we assess whether intra-arterial thrombolysis(IAT) safely enhances efficacy of mechanical thrombectomy.

Method:
We studied consecutive patients with acute large vessel occlusion. We compared 2 groups:(1) thrombectomy plus IAT and(2) thrombectomy alone (non-IAT). Recanalization was defined by TIMI ≥ 2.

Results:
Between 12/2007 and 10/2012, 87 patients(age 67±16years) received 88 thrombectomy procedures. The median admission NIHSS was18. Forty six cases were treated IAT. Overall recanalization was 60%. Recanalization was seen more frequently in cases using IAT (72%) compared to non-IAT(48%)(
p=0.02
). IAT tended to associate with fewer numbers of arterial attempts than non-IAT (2.37±1.76 vs. 3.07± 1.98) (p=0.08) but longer procedure duration(119± 53 minutes vs. 90± 55 minutes)(
p=0.02
). The rate of symptomatic hemorrhagic transformation, in-hospital and 3 month mortality rates were not significantly different between IAT and non-IAT(p=0.90, p=0.99 and p=0.72), respectively.

Conclusions:
During mechanical thrombectomy, IAT is associated with increased recanalization rate and longer procedure duration. Mechanical thrombectomy with concomitant IAT appeared relatively safe.
Abstract T P158: Prolonged Atrial Electrical Mechanical Delay on Echocardiography in Patients With Cryptogenic Stroke
Authors: Kim Dae-Hyun , Choi Seong-HO , Park Jong-Seong , Nagh Hyun-Wook , Cha Jae-Kwan
Published: July 2021

Backgrounds and Purpose:
One quarter of strokes are cryptogenic, and subclinical atrial fibrillation may be a common etiologic factor. Prolonged atrial electrical-mechanical delay was known as a predictor of paroxysmal atrial fibrillation (AF). We evaluated whether the prevalence of prolonged atrial electrical-mechanical delay suggesting the presence of atrial substrates for paroxysmal AF may be higher in patients with cryptogenic stroke.

Methods:
We retrospectively reviewed data from patients with ischemic stroke who were admitted to our hospital between January 2011 and December 2012, and selected patients with cryptogenic stroke who underwent echocardiography. Patients who underwent echocardiography for health care examination were enrolled in control group. Age, sex and underlying risk factors were matched in two groups. Atrial electrical-mechanical delay (PA interval) was defined as the time interval (msec) from the initiation of P wave on surface electrocardiogram to the initiation of trans-mitral inflow on pulse wave Doppler echocardiogram during late diastole. Clinical significance of PA interval was evaluated.

Results:
Total 130 patients in cryptogenic stroke group and 130 persons in control group were enrolled. Mean age was 63 ± 11 years and 176 (68%) were male. The PR interval (178 ± 27 vs. 165 ± 27 msec,
p

< 0.0001) and PA interval (74 ± 15 vs. 61 ± 13 msec,
p
< 0.0001) were longer in cryptogenic stroke patients. The body mass index (23 ± 3 vs. 24 ± 3,
p
= 0.043) was lower and mitral E/E’ ratio (8.8 ± 3.0 vs. 8.0 ± 2.6 msec,
p
< 0.0001) was higher in cryptogenic stroke group. Prolonged PR (OR: 1.019, CI: 1.009 - 1.029,
p
< 0.0001) and PA (OR: 1.068, CI: 1.045 - 1.093,
p
< 0.0001) intervals, and lower body mass index (OR: 0.919, CI: 0.846 - 0.998) were risk factors for cryptogenic stroke in univariate logistic regression analysis. Prolonged PA (OR: 1.060, CI: 1.035 - 1.086,
p
< 0.0001) and PR (OR: 1.019, CI: 1.004 - 1.034,
p
= 0.011) intervals, and lower body mass index (OR: 0.845, CI: 0.764 - 0.935,
p
= 0.001) were risk factors for cryptogenic stroke in multivariate logistic regression analysis.

Conclusion:
The prevalence of prolonged atrial electrical-mechanical delay suggesting atrial substrates for paroxysmal AF was higher in patients with cryptogenic stroke.