bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract W P405: Association Between Coated-Platelet Levels and MCP-1 Among Patients with Asymptomatic Carotid Stenosis
Authors: Kirkpatrick Angelia , Vincent Andrea , Tafur Alfonso , Dale George , Prodan Calin
Published: July 2021

Background:
Extensive data support the link between inflammation and stroke. Coated-platelets, a subset of platelets with high procoagulant potential observed upon dual agonist stimulation with collagen and thrombin, are elevated in acute ischemic stroke also identify asymptomatic carotid stenosis patients at high risk for stroke or TIA. Because inflammation may be involved in coated-platelet synthesis, we explored whether inflammatory markers are associated with coated-platelet levels in with asymptomatic carotid atherosclerosis.

Methods:
Coated-platelet levels were assayed for 124 asymptomatic patients referred for carotid Doppler evaluation. Serum was obtained simultaneously for measurement of inflammatory markers using the Bio-Plex Pro Human Cytokine 27-plex Assay kit (Bio-Rad Laboratories). Hs-CRP was also measured. Inflammatory markers were analyzed as independent variables according to quartiles of marker concentration with coated-platelet levels as a continuous dependent variable. Backward stepwise regression was conducted to find the best combination of predictors of coated-platelet levels. Markers having bivariate correlations with coated-platelet levels at the 0.25 significance level were included as potential predictors. Relevant demographic and comorbid factors were also considered. Variables with p values < 0.05 were retained in the final model.

Results:
Bivariate analysis revealed significant correlations between coated-platelet levels and IL-7 (r= -0.22, p=0.013) and MCP-1 (r= -0.22, p=0.013). These and 7 variables correlating with coated-platelet levels at p≤0.25 (IL-10, IL-13, IL-5, IP-10, MIP-1b, RANTES, and previous stroke/TIA) were assessed using stepwise multiple regression analysis. MCP-1 was the only variable retained in the model (b= -2.99, SE=1.2, F=6.20, p=0.015, R2=0.062).

Conclusions:
There was a statistically significant inverse association between MCP-1 and coated-platelets, although the effect size was modest. These findings suggest that the role played by inflammation in coated-platelet synthesis, as assessed with currently available markers, is small. Thus, other mechanisms coated-platelet potential determination should be explored.
Abstract W P408: Novel Bioinformatics Approach Reveals Pathogenic Mechanisms in Cerebral Ischemia - A Step towards Preclinical Stroke Information Management System
Authors: Alawieh Ali , Sabra Zahraa , Sabra Mohamed , Zaraket Fadi
Published: July 2021

Introduction:
A plethora of pathophysiological mechanisms comes into play after ischemic stroke. They contribute to both primary and secondary insult and determine the functional outcome of the patient. Several drug treatable molecular pathways for stroke pathogenesis have been described over decades of research in cerebrovascular ischemic injury. However, none of these pathways acts independently and serves as a sole determinant of long-term outcome. This necessitates a standardized approach that merges previous efforts and reveals the full spectrum of interacting pathways in stroke pathogenesis.

Objective:
The aim of this study is to use advanced annotation and text mining strategies combined with systems biology resources to compile a spectrum of molecular pathways in the network of stroke pathogenesis and highlight therapeutic targets.

Methods:
We constructed and utilized a novel annotation tool for a semi-automatic annotation of literature for proteins/genes/pathways reported to be involved in stroke pathogenesis and recovery. Frequency of both occurrence and co-occurrence of extracted entities was computed. Functional annotation and clustering was performed to form a brain ischemic meta-proteome. Network of annotated protein-protein interaction was visualized and analyzed for enriched pathways and prominent hub proteins that are potential targets.

Results:
A total of 80,941 PubMed articles on brain ischemia were annotated and an additional 1,240 articles were obtained from alternative sources. Around 1,000 proteins were reported in stroke pathogenesis with a frequency of occurrence ranging between 2 and 879. The extracted brain ischemic proteome was found to match genetic association studies. Pathway analysis revealed that coagulation and complement pathway and calcium signaling were two most prominent pathways. Inflammatory mechanisms were the most significantly enriched processes in the brain ischemia proteome. Several hubs were identified in the network including TNF-α, VEGFA, NOS3, IL1B, PTGS2, ICAM1, IL6, and NGF.

Conclusion:
We present a meta-proteome for brain ischemia that reveals different interacting pathways in stroke pathogenesis and serves as a step towards a Preclinical Stroke Information Management System.
Abstract W P41: Multimodal Imaging ASPECTS: A Predictor Of Good Prognosis Before Thrombectomy
Authors: Cardona Pedro , Quesada Helena , Cano Luis , Lara Blanca , Rubio Francisco , Aja Lucia , Barranco Roger , De Miquel M. Angeles , Escrig Ana M.
Published: July 2021

BACKGROUND:
The goal of this study was to determine the accuracy and reliability of noncontrast CT (NCCT), perfusion CT parameters maps (CTP) an CT-angiography source images (CTASI), analyzed with ASPECTS (Alberta Stroke Program Early CT Scale), as final outcome predictors of endovascular stroke treatment.

METHODS:
Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed (04/2009-06/2014). In acute stroke patients NCCT, CTP-CBV (maps of Cerebral Blood Volume) and CTASI was performed according to our hospital guidelines before thrombectomy. We independently applied the ASPECTS in all baselines NCCT, CBV-CTP, CTASI and follow-up NCCT 24H. Receiver-operating characteristic curve (ROC) analysis was performed to determine optimal thresholds for imaging parameters to predict dichotomized good clinical outcome (modified Rankin score ≤2, mRS).

RESULTS:
From a database containing 402 thrombectomies, 94 underwent CTP and CTA for acute cerebrovascular ischemia. Ninety-one with MCA or ICA occlusion were identified for our study (49% women, mean age 64+/-13 years; NIHSS at admission 17). Successful recanalization (TICI 2b-3) was achieved in 73/91 patients (80%).

In ROC analysis higher CBV ASPECTS was associated with 90-day mRS score 0-2 (Area Under Curve=0.72;95% CI, 0.6-0.8; P:0.001) with optimal threshold of 8 (Sensivity 83%, Specificity 77%).

The CTASI ASPECTS was highly correlated with 24h NCCT ASPECTS (r: 0.65;Spearman p:0.001). Favorable clinical outcomes (mRS 0-2) was greater in patients with CBV ASPECTS >8 compared with ≤8 (71% vs 37%;p:0.001) and CTACI ASPECTS>8 compared with ≤8 (68% vs 37%;p=0.02).

In multivariate logistic regression CBV ASPECTS was associated with significant functional and radiological outcomes after adjustment for age, sex, time from CT to groin-puncture and baseline NIHSS (OR: 2.5; 95%CI:1.8-3.5, p:0.001).

CONCLUSIONS:
These results suggest that CBV ASPECTS approach can predict a favorable clinical outcome after endovascular treatment with good sensitivity and specificity.

CTASI ASPECTS may be more sensitive for detection of infarction and more accurate for predicting the final infarct size however not to predict clinical outcome.
Abstract W P412: Metabolic Syndrome Alters Cerebrovascular Architecture: Relevance to Cognitive Deficits and Stroke Outcomes
Authors: Valenzuela John P , Qu Zhi , Prakash Roshini , Li Weiguo , Ward Rebecca , Fagan Susan C , Ergul Adviye
Published: July 2021

Introduction:
Diet-induced metabolic syndrome (MetS) is an increasing risk factor for stroke. We have previously shown that high fat diet 1) increases infarct size and hemorrhagic transformation and worsens functional outcome after stroke and 2) impairs neurovascular function even before stroke. However, the impact of MetS on cerebrovascular architecture remained unknown. Hypotheses: 1) Diet-induced MetS causes pathological neovascularization; and 2) these changes lead to cognitive deficits at baseline and poor recovery after stroke. Methods: Male Wistar rats were given a control diet or low dose streptozotocin (30mg/kg) plus high fat (45%) diet for a period of eight weeks (n=4-8/group). Animals were then subjected to sham or middle cerebral artery occlusion (MCAO) surgery. Motor and cognitive functions were assessed by at Days 1, 3, 10 and 14 after stroke using Bederson’s Score, Beam Walking Test, and Novel Object Recognition. Vascular indices (branch density, tortuosity, vascular volume and surface area) were then measured in cortex and striatum using confocal imaging of FITC-filled vasculature. Results: Branch density was higher and recognition index was lower in the sham MetS group compared to sham control group. Stroke significantly reduced vascular volume and surface area in both groups, which was more prominent in the MetS group. Branch density was increased after stroke in the control group only. At Day 14, motor and cognitive scores in the sham MetS group were lower than control. Conclusion: Cerebrovascular structure, function, and cognition are impaired from diet-induced MetS alone . Collectively, these data suggest that cerebrovasculature is an early target in MetS and vasculoprotective strategies are needed to prevent cerebral complications.
Abstract W P414: Midterm Clinical Outcomes After Intervention versus Conservative Management for Brain Arteriovenous Malformation
Authors: Yuki Ichiro , Suzuki Tomoaki , Arakawa Hideaki , Ishibashi Toshihiro , Kaku Shougo , Kan Issei , Nishimura Kengo , Ikemura Ayako , Kambayashi Yukinao
Published: July 2021

Purpose:
Brain arteriovenous malformation (AVM) patients presented in our institution were divided into two groups based on the initial treatment strategy, “intervention” vs. “conservative management”, and the mid-term clinical outcomes of the two groups were compared.

Methods:
A total of 149 AVM patients were enrolled in this study. After thorough discussions with each patient on the risk and benefit of the treatment, 83 patients underwent either endovascular, surgical intervention, radiosurgery or combination of these different modalities (Group A). 66 patients chose conservative management until hemorrhage or clinical worsening from the AVM occurred (Group B). In each group, 1) the type of the initial presentation, 2) Spetzler-Martin (S-M) Grade, 3) modified Rankin Scale (mRS) and 4) symptomatic bleeding or neurological deterioration during the follow-ups were recorded. The clinical outcomes of each group was compared.

Results:
Group A; The type of initial presentation was, bleeding 45%, epilepsy 21%, incidental 18%, headache 8%, focal neurological deficit 5% and others 2%. During the average observation period of 1569 days, 42 patients (51%) showed angiographical obliteration. Overall complications were seen in 15 patients (18%). Complications with neurological deterioration (mRS≧3) was seen in 2 patients (2.4%).

Group B; The type of initial presentation was, incidental 33%, epilepsy 23%, bleeding 18%, headache 17%, focal neurological symptoms 3% and others 6%. During the follow-ups (778 days), 7 patients (10%) had hemorrhage or neurological deterioration, and all of them underwent treatment. One patient died immediately before the surgery due to substantial re-bleeding. Rupture rate was 4.5% / year, and neurological sequela (mRS≧3) was seen in 2.7% in this group.

Conclusion:
The risk of neurological deterioration during the observation period was similar in both groups. Considering the “treatment group” has higher risk of bleeding, the intervention (s) might have contributed to the prevention of the neurological deterioration. However, given the limited magnitude of neurological sequela induced by the bleeding, caution should be exercised in determining the treatment indications especially for the asymptomatic patients.
Abstract W P419: Correlation of Quantitative Susceptibility Mapping in Cerebral Cavernous Malformations with Clinical Features
Authors: Tan Huan , Mikati Abdul Ghani , Zhang Lingjiao , Liu Tian , Wang Yi , Robert Edelman , Gregory Christoforidis , Issam Awad
Published: July 2021

Quantitative susceptibility mapping (QSM) is a novel noninvasive magnetic resonance imaging (MRI) technique that was shown to accurately quantify the iron content in cerebral cavernous malformation (CCM) lesions. In this study, we aimed to correlate the baseline characteristics of CCM patients and their clinical activities with QSM measurements.

Methods:
a total of 65 patients (mean age: 39, age range: 3 - 76, 16 male, 49 female, 27 sporadic, 38 familial) were included. Imaging was performed on 3T systems. Lesions from all sporadic cases were included in the final analysis. In familial cases, only lesions identified on T2 weighted images and have maximum cross-sectional diameter greater than 5mm were included. A total of 241 lesions were analyzed.

Results:
Pearson’s correlation revealed that patient age at scan was positively correlated with the mean lesional susceptibility per patient (p<0.05, Figure 1a). Mean susceptibility for lesions with prior bleeding history was significantly higher than lesions without (p<0.05, Figure 1b). Longitudinal changes in lesional susceptibility were small in a short term (<14 months) in patients who were clinically stable (Figure 1c). In addition, a mixture of susceptibility levels was observed in different lesional blood byproduct depositions, as determined by contrast on the conventional MRIs (Figure 1d).

Conclusions:
Our prelimiary data suggested that: 1) lesions with longer duration harbor more iron; 2) lesions with prior bleeds harbor more iron deposition; 3) there are little changes in lesional iron deposition in patients who are clinically stable in a short time frame. In sum, QSM offered additional insights into the natural progression of the CCM disease in terms of the accumulation of lesional iron deposition.
Abstract W P423: Women Perceive Differences in Stroke Prevention Care Based on their Primary Care Physician’s Specialty
Authors: King Hanna , Balucani Clotilde , Stefanov Dimitre , Rosser Mary , Tark Brian , Lederman Elliot , Abulafia Ovadia , Levine Steven R
Published: July 2021

BACKGROUND:
Women have higher lifetime risk of stroke than men. Many women rely solely on their Ob/Gyn as their PCP; however, there are no data on women’s perceptions of stroke prevention (SP) care by their Ob/Gyn.

OBJECTIVES:
to explore (1) women’s perceptions of SP based on their PCP’s specialty; (2) if ethnicity or age influenced women’s selection of PCP specialty; and (3) women’s awareness of stroke prevalence and preferences for which type of PCP address their stroke risk factors.

METHODS:
We administered surveys to 224 women at Ob/Gyn (n = 132) and PCP (n = 94) clinics in Brooklyn, NY. Surveys consisted of 16 questions on patient demographics, awareness of stroke prevalence, stroke risk factors, specialties of physicians they regularly visit, preferences for SP and SP care received. Kruskall-Wallis and Mann-Whitney tests were used to compare ordinal variables. Fisher’s exact test was used for categorical variables.

RESULTS:
We found a difference (p < 0.0001) in the mean age (but not in other demographic variables) of women who only visited an Ob/Gyn (30.0yrs±6.0) compared with those who visited an Ob/Gyn and another PCP (44.2±15.9) and those who visited at least one non-Ob/Gyn PCP (55.7±17.7). Women recalled: BP measurement by Ob/Gyn in 75% vs. 95% by other PCP (p<0.001); cholesterol measurement by Ob/Gyn 24% vs. other PCP 59% (p<0.0001); diabetes screening (p = 0.17) and weight measurement (p = 1.0) were similar. Awareness of stroke prevalence differed (p = 0.04) among women visiting only an Ob/Gyn (mean 0.5±0.7 correct answers), women visiting Ob/Gyn and at least one other PCP (1.0±0.8) and women visiting only a non-Ob/Gyn PCP (1.2±0.8). Women reported a greater preference for addressing SP with their non-Ob/Gyn PCP (73%) vs. their Ob/Gyn (2%) vs. no preference (26%).

CONCLUSIONS:
Ob/Gyn are perceived to provide less SP care than non-Ob/Gyn PCP. However, most women would prefer to address SP with their non-Ob/Gyn PCP. Women who visit only an Ob/Gyn and no other PCP were younger and less aware of stroke prevalence than women who visited other PCP. This surrogate approach to actual SP care evaluation suggests a need for assessing Ob/Gyn practices in SP.
Abstract W P44: Predicting Omni-directional Lesion Growth in Acute Stroke using Multimodal Intensity Profiles
Authors: Scalzo Fabien , Chowdhury Wahid , Liebeskind David S
Published: July 2021

Introduction:
Mechanisms of lesion growth in acute stroke remain poorly characterized. Favorable imaging signatures related to regional tissue status may be disclosed with diffusion-weighted (DWI) and perfusion-weighted (PWI) imaging. Certain values of individual parameters, such as prolonged and decreased CBF, are associated with poor tissue recovery, yet scant data are available regarding the directionality of lesion growth and how different perfusion imaging parameters may be combined to best characterize lesion growth. We developed a probabilistic model that exploits DWI and multi-parametric PWI to predict likelihood of lesion growth in every 3D direction.

Hypothesis:
We test the hypothesis that combined intensity profiles of PWI features predict the likelihood of lesion growth, in every direction.

Methods:
Retrospective analysis of DWI and PWI acquired within 24 hours of symptom onset with FLAIR sequences acquired four days later. DWI and PWI were co-registered and the lesions were manually delineated on the baseline DWI and follow-up FLAIR. Intensity profiles of perfusion parameters (including CBV, CBF, MTT, TTP, Tmax) were extracted along discrete spherical coordinates (every 5 degrees). A nonlinear regression model was used to capture the relationship between the intensity profile along a direction and the amount of growth in that direction. A cross-validation was performed to evaluate the accuracy of the model in predicting the lesion growth in every direction at day 4.

Results:
A total of 49 patients were included in the analysis. Mean age was 68.7 (35-91). Median baseline NIHSS was 16 (2-31) and median mRS at discharge was 5 (1-6). Lowest prediction error (62 cm2 IQR [26 86]) in terms of average lesion surface and final directional growth error 7.91 mm IQR [5.2 10.3] was obtained by combining cBV, cBF, TTP, TMAX intensity profiles into a single input vector.

Conclusions:
For the first time, a direction-specific model of infarct growth has been developed. It provides quantitative insights about the likelihood of lesion growth surrounding a stroke. This prediction is not only based on closeness to the infarct core or the presence of penumbra but relies also on the complex dependencies between joint evidence found in multiple perfusion parameters.
Abstract W P5: Improvements in Procedural Times in the Evolution of Endovascular Treatment of Acute Ischemic Stroke
Authors: Frei Don , Patel Aman , Gupta Rishi , Bellon Richard , Huddle Daniel , Dooley Gwendolyn , Buell Hope , Adamski Kelly , Kuo Sophia , Bose Arani , Sit Siu Po
Published: July 2021

Purpose:
Endovascular therapies are increasingly used in the revascularization of acute ischemic stroke from large vessel occlusions. There have been many design improvement of these devices from their initial implementation to the recent newer generations of devices. The goal of this case review study was to assess if there was corresponding improvement in procedural times over the course of the evolution of these devices.

Methods:
We pooled prospective (Pivotal, PICS, START) and retrospective/registry (POST, RetroSTART, Speed 054) Penumbra trials. All obtained treatment at <8 hours. Data was collected and analyzed. Tested covariates (patient demographics, procedure time points) were considered in the multivariable model.

Results:
Among 1028 pooled subjects, 93 received treatment outside the 8 hour window, and an additional 8 subjects were excluded due to missing key data. The remaining 927 patients had a mean age of 65.9 years (SD=15.1) and 51.7% (478/925) were female. At admission, the average NIHSS was 17.4 (SD=6.2) and 100% of patients had a TIMI score of 0 or 1 (919/919).

Across the Penumbra trials, the time from PS on to off and overall procedure length have shown a significant decrease over time (p<0.0001, p=0.0001 ). From 2006 to 2011, the time from PS on to off decreased an average of 5 minutes per year. The reduction in time from PS on to off is also significantly associated with the increased catheter size (p=0.0001). Similarly, the average procedure time decreased significantly with the newer catheters from 99.9 minutes (SD=46.7) using the 026 catheter to 65.6 minutes (SD=36.3) using the 054 catheter (p<0.0001). Ultimately, shorter procedure time was a significant predictor of good outcome, measured by mRS score of 0 or 1 (p=0.021).

Conclusion:
These results suggest that the implementation of the newer and larger Penumbra catheters provides a quicker and more effective treatment method for treating acute ischemic stroke.
Abstract W P57: Telemedicine in Urban Primary Stroke Centers Overcomes the “Weekend Effect” in Door-to-Needle Times for Acute Ischemic Stroke
Authors: Yanase Lisa R , Lesko Alexandra , Stuchiner Tamela , Baraban Elizabeth
Published: July 2021

Purpose:
To assess whether utilization of telemedicine technology during weeknights and weekends improves door to needle times in Primary Stroke Centers (PSC). Background: There is a well-documented “weekend effect” of slower door-to-needle times for thrombolysis for acute ischemic strokes, compared to weekdays, ostensibly due to the absence of in-person vascular neurologists during evening and weekend hours. Telemedicine provides rapid access to stroke neurologists at rural sites, but a role in urban Primary Stroke Centers has not been defined. A possible reason for this is that current CMS guidelines restrict reimbursement for telemedicine to urban facilities. Method: Providence Stroke neurologists utilized telestroke within two metropolitan PSC “Hub” hospitals for assessment of acute stroke patients during off hours. We analyzed American Stroke Association’s Get with the Guidelines data for all IV-tPA treated ischemic stroke patients that presented at our PSC hubs from January 2010 through March 2014. Of 265 patients treated, 124 were weekday (8am-4pm) consults, and 141 were weekend (4pm Friday through 8am Monday) or evening (4pm-8am) consults. We compared door to needle times for daytime vs. evenings/weekends. Data was analyzed using one-way ANOVA and Pearson’s chi-square between groups for telestroke and non-telestroke cases. Results: We confirmed a significant weekend effect in our hubs, with a mean door to needle time of 54.2 minutes (± 18.4) for weekday and 67.6 minutes (± 28.8) for evenings/weekends (p<.0001). However, using telestroke significantly improved evening/weekend door-to-needle times with a mean of 62.2 (± 23.0) minutes (n=73) compared to 72.6 (± 32.7) minutes (n=68) when telestroke was not used, (p=.031). Conclusion: Our data supports using high-quality telemedicine in urban Primary Stroke Centers to improve stroke care by eliminating the treatment delays caused by the weekend effect. Given this finding, we feel CMS should revisit reimbursement methodologies.
Abstract W P58: Low Dose Versus Standard Dose Alteplase For Acute Ischemic Stroke Patients Within 4.5 Hours From Onset: A Comparative Effectiveness And Safety Study
Authors: Kim Beom Joon , Han Moon-Ku , Park Tai Hwan , Park Sang-Soon , Lee Kyung Bok , Lee Byung-Chul , Yu Kyung-Ho , Oh Mi Sun , Cha Jae Kwan , Kim Dae-Hyun , Lee Jun , Lee Soo Joo , Ko Young-Chai , Park Jong-Moo , Kang Kyusik , Cho Yong-Jin , Hong Keun-Sik , Kim Joon-Tae , Choi Jay Chol , Kim Dong-Eog , Shin Dong-Ick , Kim Wook-Joo , Lee Juneyoung , Lee Ji Sung , Yoon Byung-Woo , Bae Hee-Joon
Published: July 2021

Background:
The low-dose (0.6 mg/Kg) alteplase strategy to treat acute ischemic stroke patients became widespread in East Asian countries, without rigorous testing against the concurrent standard-dose (0.9 mg/Kg) regimen. The aim of the current study was to investigate the comparative effectiveness and safety of low-dose alteplase treatment against standard dose regimen.

Methods:
A total of 1572 acute ischemic stroke patients who arrived within 4.5 hours from their last seen normal and treated with alteplase between November 2009 and March 2013 were identified from a prospective, multicenter and nationwide stroke registry database containing 15814 case records. Acute stroke management including the decision on the dose of alteplase was performed according to the current guideline and the attending physicians’ discretion. Inverse probability of low-dose strategy weighting (IPTW) by the propensity score was primarily utilized to remove baseline imbalance between the two doses.

Results:
From a total of 1572 cases who met the eligibility criteria, low-dose alteplase was infused in 464 (29.5%) subjects and standard-dose in 1108 (70.5%) cases. Low-dose group showed shorter onset-to-arrival delay, higher NIHSS score at arrival, and more frequent endovascular treatment. The balance between alteplase doses were adequately balanced using IPTW technique, and the low-dose alteplase treatment was not associated with a mRS score of 0 - 1 at 3 months and with symptomatic HT or 3-month mortality (see Figure A). When the analyses were limited to the subgroup without endovascular treatment, the neutral associations with mRS score 0 - 1 and symptomatic HT were retained but the odds for 3-month mortality was significantly lower in the low-dose alteplase group (see Figure B).

Conclusion:
The low-dose alteplase strategy was as comparable as the standard-dose treatment in terms of the effectiveness and safety, also with possibly decreasing 3-month mortality.
Abstract W P63: Intravenous Thrombolysis for Acute Ischemic Stroke in Nonagenarians
Authors: Guisado Raul , Malek Reza , Kelly-Tolley Ursula , Padidar Arash , Sachdev Harmeet
Published: July 2021

The safety and effectiveness of intravenous thrombolysis for acute ischemic stroke (AIS) has been established for populations older than 80 years of age . However, management of AIS in nonagenerians is not clear. Previous reports suggest that the rate of ICH after i.v. alteplase is not increased and the rate of early improvement is similar in nonagenerians compared to younger groups, but there is concern with overall mortality and functional outcomes.

We report on 20 consecutive patients with AIS treated with i.v. alteplase within 3 hours of onset in two Comprehensive Stroke Centers in San Jose, CA.

Methods:
Patients were immediately evaluated by members of the Stroke Team of each hospital. . Patients were eligible if they had disabling neurological symptoms, no contraindications for i.v.alteplase and were independent in ADLs prior to the index event. Non-contrast CT brain scan, CT perfusion and CT angiography of head and neck were used to determine the presence of potentially salvageable brain.

Results (Table):
Mean age was 91 years (range 90 - 98 years). The initial NIHSS was 15.7 ± 6.8. The median NIHSS at hospital discharge was 7.4 ± 8.4 (p <0.001). The median door to needle time was 50.5 minutes (range 36 - 74 minutes). There was no hemorrhagic transformation and no in-hospital mortality. The overall mortality rate at 90 days was 30% (6 of 20 patients) and the rate of good outcome in survivors, defined as mRS ≤ 3 at 90 days was 35.7% (5 of 14 patients).

Comment:
Intravenous thrombolysis for ischemic stroke in nonagenerians is safe and effective, with good rates of immediate improvement. However, the l90 days mortality rate is high and the long term functional outcome is poor. This data can be useful in helping families make treatment decisions in the most elderly patients with acute ischemic stroke.
Abstract W P65: Clevidipine Outperforms Other Agents in Emergent Acute Hypertension Treatment in Ischemic Stroke Pre-rt-PA
Authors: Brehaut Scott S , Roche Angelina M
Published: July 2021

Hypothesis:
Minimizing Acute Hypertension Treatment (AHT) time in rt-PA candidates is one means to reduce door to needle times. We have used nicardipine, labetalol and clevidipine at our institution for treatment of ischemic stroke patients in the ED. We assessed the hypothesis that if one agent could be identified that safely outperformed others, door to blood pressure control times could be improved in patients otherwise eligible for rt-PA.

Methods:
We evaluated all ischemic stroke ED patients receiving rt-PA at our institution from 1/1/07 - 1/31/14; data from ischemic stroke patients requiring AHT prior to administration of rt-PA were analyzed by agent.

Results:
Two hundred thirty two patients received rt-PA; 32 (14%) required AHT. Diagnoses: Unspecified Cerebral Occlusion, 21 (9%); Embolic

Ischemic Stroke, 8 (3%); Thrombotic Ischemic Stroke, 1 (<1%); Vertebral

Artery Occlusion Ischemic Stroke, 1 (<1%); Carotid Artery Occlusion Ischemic Stroke, 1 (<1%). Data were analyzed by agent. Five patients were excluded due to limited BP documentation; 12 patients received labetalol, 10 patients received clevidipine, and 2 patients received nicardipine. Three additional patients failed labetalol and were switched to clevidipine. Median time from drug initiation to BP goal (MTG) and median elapsed times from door to rt-PA administration (MET) were calculated. MTG and MET were:
Labetalol:
43 minutes (range 5 to 83) and 97.5 minutes (range 57 to 127);
Clevidipine:
16 minutes (range 6 to 24) and 54 minutes (range 50 to 120);
Nicardipine:
30.5 minutes (range 5 to 56) and 113 minutes (range 102 to 124).
Clevidipine Rescued MTG:
11 minutes (range 10 to 30). AHT volume administered, median (range):
Labetalol
15 ml (5-40);
Nicardipine
30.4 ml (16-44.8); and
Clevidipine
1.8 ml (0.7-8.6).

Conclusions:
In conclusion we found of AHT drugs prescribed in this study population, clevidipine demonstrated the shortest median time-to-BP control, the shortest median door-to-rt-PA administration and the lowest administered volume. On the basis of these data, clevidipine is now first line AHT for rt-PA candidates at our institution. The study is ongoing.
Abstract W P72: Quantitative Analysis of The Blood Flow Reduction In Brain Aneurysms Treated By Flow Diverter Stents
Authors: Chien Aichi , Yu Qianyi , Zosso Dominique
Published: July 2021

Purpose:
This pilot study demonstrates an approach to quantitatively analyze the blood flow reduction in intracranial aneurysms treated by flow diverter stents (FDS).

Method:
2D digital subtraction angiography (DSA) images from 13 aneurysm patients were analyzed with the model. Each patient had 2 sets of consecutive DSA images (3 frames/sec and 6 ml/sec contrast injection rate) acquired before and after FDS treatment. The mean age of the patients was 55, ranging from 5 to 86 years old. The model extracted contrast-agent concentration profiles from each DSA image’s ROIs (inlet, aneurysm, and outlet regions) to calculate the blood contrast-agent mixture ratio, which reflected the percentage of blood not being diverted into aneurysm. To evaluate image quality, signal-to-noise ratio (SNR) and the relative-standard-deviation (RSD, a measure of results’ dispersion), 10 additional sets of ROIs were randomly generated for each DSA image set and also analyzed.

Result:
The model showed that the 13 patients’ blood contrast-agent mixture ratios increased by 48% on average after FDS treatment. This demonstrates that the blood flow into the aneurysms was significantly (
p
< 0.0006) reduced after FDS treatment. The study also found an inverse relationship between the input image SNR and the RSD of output results. The correlation coefficient of image SNR and mixture ratio RSD was -0.6257 for pre-FDS treatment image sets, and -0.4512 for post-FDS treatment image sets. To control the dispersion of results for future studies, images with SNR > 11.2487 were recommended in order to yield results with RSD < 0.15 for 95% C.I.

Conclusion:
Blood flow reduction due to FDS treatment in patients with brain aneurysms can be measured directly by 2D DSA. This study also verified the impact of input image quality on flow reduction estimation.
Abstract W P75: New Generation Hydrogel Endovascular Aneurysm Treatment Trial
Authors: Zammar Samer G , Hamade Youssef J , Ward Jennifer , Yip Byron K , Reinholdt Nicole , Bendok Bernard R
Published: July 2021

Background:
Endovascular treatment of intracranial aneurysms has seen significant advances. One major limitation of the endovascular approach is durability of treatment and aneurysm recanalization. To address this issue, one approach was the development of hydrogel-coated coils. Hydrogel expands upon exposure to blood and thus enhances coil packing density. Higher initial coil packing density may potentially result in lower rates of recurrence.

Hypothesis:
The 2nd Generation HydroCoil Embolic System allows for a higher packing density, higher initial occlusion, lower recanalization, and lower retreatment rates compared to bare platinum coils.

Objective:
To compare clinical and angiographic outcomes (initial complete occlusion, recanalization, retreatment, and adverse event rates) in patients receiving the 2nd Generation HydroCoil Embolic System versus patients receiving bare platinum coils.

Methods:
This is a randomized, controlled, multicenter, post-market clinical trial. Subjects between 18 and 75 years of age with ruptured or unruptured intracranial aneurysms (3-14 mm in size) who are amenable to endovascular treatment are randomly assigned 1:1 to one of two treatment arms: 1) the HydroCoil Embolic System (HES), or 2) bare platinum coils. No bioactive coils, 1st generation HydroCoils or liquid embolics are allowed in the study. In the HES arm, up to 10% of total coil length using bare platinum is allowed if deemed necessary by the investigator. Any type of bare platinum coil may be utilized in the bare platinum arm. Assist-devices can be used at the discretion of the investigator. The duration of the open enrollment phase will be 24 months or until the required number of subjects are enrolled (n = 600). Each subject will have a post-procedure follow-up of at least 18 months. Subjects will be recruited from up to 50 national and international centers. Each Investigational Site will be expected to enroll at least 20 Subjects.

Results:
A total of 368 patients have been enrolled to date in the study. The study is still ongoing.

Conclusions:
A limitation of endovascular aneurysm treatment is recurrence. This trial aims to answer the question of whether the new generation hydrogel coil reduces recurrence rates when compared to bare platinum coils.
Abstract W P94: Recovery From Plasticity Impairments in Pediatric But Not Adult Mice Following Cardiac Arrest and Cardiopulmonary Resuscitation
Authors: Quillinan Nidia , Shimizu Kaori , Deng Guiying , Traystman Richard , Herson Paco
Published: July 2021

Objectives:
The goal of this study was to assess neuronal injury and synaptic plasticity impairments in Purkinje cells in pediatric and adult mice following cardiac arrest and cardiopulmonary resuscitation. We hypothesized that synaptic impairments in pediatrics would be less severe than in adult mice.

Methods:
Pediatric ( 21-25 day old) and adult (8-12 week) male mice were subjected to 8 minutes cardiac arrest followed by cardiopulmonary resuscitation or sham surgery. Purkinje cells were labeled using anti-calbindin antibody and cell density was analyzed to examine neuronal injury. To examine synaptic function, whole-cell voltage clamp recording on acute cerebellar slices was performed at 1 and 7 days after CA/CPR or sham surgery. Excitatory postsynaptic currents (EPSCs) resulting from parallel (PF) or climbing fiber (CF) stimulation were recorded. Long-term depression (LTD) was induced by simultaneous parallel and climbing fiber stimulation (1 Hz, 5 min).

Results:
Purkinje cell loss was observed in pediatric (24% cell loss) and adult (32% cell loss) mice following CA/CPR. Long-term depression, a reduction of synaptic strength of PF EPSCs was observed in adult and pediatric sham controls following PF+CF stimulation (46.6 ± 10% of baseline n= 5 and 55.4 ± 6.1% n= 3, respectively). LTD was absent in pediatric and adult mice at 24 hours after CA/CPR (96.1 ± 5.2% n =6 and 89.4 ± 4.5% n=2, respectively). At 7 and 30 days after CA/CPR LTD was absent in adult mice (81.6 ± 10.8% n=6 and 86.5 ± 8.9% n=4) but had returned in pediatric mice at 7 days after CA/CPR (70 ± 5.4% n=3).

Conclusions:
The results of this study suggest that CA/CPR results in significant Purkinje cell loss in pediatric and adult mice. LTD was absent at 24 hours at both ages and was observed at 7 days after CA/CPR in pediatric but not adult mice. These results suggest enhanced recovery of synaptic plasticity at this developmental stage.
Abstract W P97: Post-ischemic Trans-arterial Regional Hypothermia Therapy Attenuates Microvascular Narrowing due to Astrocyte End-feet Swelling and Inhibits Subsequent Inflammatory Reactions in Ischemia Reperfusion Injury
Authors: Kurisu Kota , Abumiya Takeo , Nakamura Hideki , Shimbo Daisuke , Kazumata Ken , Nakayama Naoki , Shichinohe Hideo , Hokari Masaaki , Osanai Toshiya , Shimizu Hiroshi , Houkin Kiyohiro
Published: July 2021

Background and Purpose:
We previously presented the robust neuroprotective effects of post-ischemic trans-arterial regional hypothermia therapy in I/R injury model rats (ISC 2014, San Diego). This treatment showed a significant suppression of infarct volume and inflammatory reaction at 24hrs after reperfusion. To characterize the neuroprotective effects in terms of microvascular integrity, we investigated microvascular morphological changes and inflammatory reactions by a time course analysis within 24hrs.

Methods:
At reperfusion onset, 2hr-MCAO rats were divided into cold saline group (10°C, 20ml/kg of trans-arterial infusion from the recanalized artery for 15mins), warm saline group (37°C, in the same manner as cold saline group), and control group (recanalization only). Microvascular morphological changes were examined by vWF Immunohistochemistry (IHC) and transmission electron microscopy (TEM), and inflammatory reactions were examined by Western blotting and IHC at the time point of 0hr, 2hrs, 6hrs, and 24hrs of reperfusion.

Results:
IHC analysis and TEM observation revealed that astrocyte end-feet swelling occurred at 2hrs and progressed to 6hrs, and microvascular narrowing due to the swelling occurred at 6hrs in control group. This microvascular morphological change was attenuated in cold saline group. While endothelial ICAM1 overexpression started at 6hrs in control group, MPO, MMP9, and Iba-1 overexpression occurred only at 24hrs in the same group. These inflammatory reactions were also inhibited in cold saline group.

Conclusions:
Post-ischemic trans-arterial regional hypothermia therapy attenuated astrocyte end-feet swelling from 2hrs and the swelling induced microvascular narrowing at 6hrs. The treatment also inhibited endothelial ICAM-1 overexpression at 6hrs, and subsequently inhibited inflammatory reactions at 24hrs. The maintenance of microvascular morphological and functional integrity may be the primary cause of the neuroprotective effects by the regional hypothermia.
Abstract 105: Collateral Blood Flow and Inflammatory Markers in Intracranial Atherosclerosis: Angiography and Biomarker Correlates in the BIOSIS and SAMMPRIS Trials
Authors: Liebeskind David S , Noreen Samantha M , Long Qi , Zhao Yize , Quyyumi Arshed , Le Ngoc-Anh , Waller Edmund K , Cotsonis George A , Lynn Michael J , Lane Bethany , Nahab Fadi , Elkind Mitchell S , Cloft Harry J , Fiorella David J , Derdeyn Colin P , Turan Tanya N , Arenillas Juan F , Chimowitz Marc I , Frankel Michael ,   for the BIOSIS and SAMMPRIS Investigators
Published: July 2021

Background:
Collateral blood flow, modulated by inflammation and arteriogenesis, alters ischemic injury in intracranial atherosclerosis. We investigated the potential link between several inflammatory and arteriogenic biomarkers with angiographic findings at enrollment in BIOSIS/SAMMPRIS.

Methods:
Baseline angiography and blood biomarkers of BIOSIS/SAMMPRIS, which included subjects with stroke or TIA due to 70-99% intracranial stenosis were analyzed. Collateral blood flow status at angiography was categorized by the combination of antegrade flow (TICI) and corresponding extent of collaterals (ASITN/SIR). Collateral status was analyzed with respect to blood progenitor cell markers (CD34) at baseline and inflammatory biomarkers (Plasminogen Activator Inhibitor-1 (PAI-1), E-selectin, high sensitivity C-reactive protein (hsCRP) and Lipoprotein-associated phospholipase A2 (Lp-PLA
2
) activity and concentrations) at baseline, 30 days and 4 months.

Results:
376 subjects (mean age 60.44 years SD 11; 149/376 (39.6%) women) enrolled in BIOSIS/SAMMPRIS had angiography of collaterals and biomarker data. Collateral perfusion was impaired in 71 (19%) and intermediate in 188 (50%), with robust collaterals in 117 (30%) subjects. Better collateral status was associated with younger age (p=0.001), male sex (p=0.029) and greater baseline physical activity (p=0.007). Baseline blood progenitor cell (CD34+) counts were unrelated to angiographic features at enrollment, whereas inflammatory Lp-PLA
2
activity was linked (p=0.059) with blood flow categories, and lower hsCRP (p=0.025) with better collaterals. Lp-PLA
2
activity was lowest in those with robust collaterals at 30 days (p=0.070) and 4 months (p=0.120). Those with robust collaterals had the greatest decrease in Lp-PLA
2
activity (p=0.021) and concentration (p=0.027) by 30 days, with a continued decline of Lp-PLA
2
activity (p=0.037) to 4 months. Disparate trends in inflammatory markers were seen in the medical and stenting arms.

Conclusions:
Inflammatory biomarkers are linked with collateral blood flow status in intracranial atherosclerosis. The impact of physical activity, medications and other therapeutic investigations may disclose important mechanisms to avert ischemia.
Abstract 121: Mechanisms of Cortical Superficial Siderosis in Cerebral Amyloid Angiopathy
Authors: Charidimou Andreas , Boulouis Gregoire , Roongpiboonsopit Duangnapa , Haley Kellen , Auriel Eitan , van Etten Ellis , Ayres Alison , Schwab Kristin , Martinez-Ramirez Sergi , Viswanathan Anand , Greenberg Steven M , Gurol M. Edip
Published: July 2021

Introduction:
Mechanisms of cortical superficial siderosis (cSS) in cerebral amyloid angiopathy (CAA) are unknown, but might include in situ bleeding from amyloid laden superficial vessels or blood products redistribution from acute lobar intracerebral hemorrhage (ICH).

Hypothesis:
We aimed to identify factors related to the extent and multifocality of cSS.

Methods:
We analyzed consecutive CAA-related ICH patients diagnosed with Boston criteria from a prospective cohort. cSS multifocality, was rated for spatially distinct foci involvement and bi-hemispheric distribution on a 0-4 scale (1 point: 1 sulcus or focal immediately adjacent sulci, 2 points: 2 or more non-adjacent sulci OR more than 3 adjacent sulci, in each hemisphere) with excellent interrater reliability (k=0.87). Radiological markers of CAA and ICH characteristics were assessed using quantitative methods or validated visual scales, and their association with cSS multifocality was investigated in multivariable regression.

Results:
The cohort included 312 CAA patients (53% male; mean age 71.7). cSS was found in 34.6%: unifocal in 42 patients (13.5%), multifocal in 66 (23.1%). Presence and multifocality of cSS were not related with characteristics of the acute ICH such as ICH volume, ICH side or areas of acute subarachnoid blood on initial CT. ICH side did not predict cSS side or multifocality at that side. cSS multifocality was related to the presence of IVH in patients who had a single ICH without microbleeds (MB), but not in patients with multiple hemorrhagic lesions (ICH and/or MBs). In ordinal logistic regression, cSS multifocality was related to lobar microbleeds burden (OR: 1.57; 95%CI: 1.27-1.94; p<0.0001) and MRI centrum semiovale perivascular spaces (PVS, OR: 2.05; 95%CI: 1.26-3.33; p=0.004) but not basal ganglia PVS or leukoaraiosis volume. A secondary analysis using Cox regression showed that cSS multifocality was an independent risk factor for recurrent ICH (HR: 2.21; 95%CI: 1.09-4.52 and 3.91; 95%CI: 1.40-10.9 for multifocality presence and severity) after adjusting for other confounders.

Conclusion:
Extent and multifocality of cSS appear to be markers of CAA severity and independent predictors of ICH recurrence, and can provide insights potential into pathomechanisms.
Abstract 126: Importance of Untreated Hypertension for Intracerebral Hemorrhage
Authors: Walsh Kyle B , Adeoye Opeolu , Sekar Padmini , Osborne Jennifer , Moomaw Charles J , Langefeld Carl D , Woo Daniel
Published: July 2021

Introduction:
Hypertension (HTN), particularly untreated HTN, has been found to be a significant risk factor for ICH in predominately white ICH populations. We evaluated the risk of treated and untreated HTN on ICH in a multi-ethnic case-control study.

Hypothesis:
Treated and untreated HTN confer variable risk for ICH by race/ethnicity.

Methods:
The Ethnic/Racial Variations of ICH (ERICH) study is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 recruitment centers using hot-pursuit. Controls matched to cases 1:1 by age (±5 years), sex, race/ethnicity, and metropolitan area were recruited by random-digit dialing. Subjects were interviewed to determine whether they had a history of HTN and if they took medications to reduce blood pressure.

Results:
Between 9/2010 and 6/2015, 891 white, 833 black, and 599 Hispanic case/control pairs were enrolled. Higher proportions of black and Hispanic ICH with HTN were untreated, compared with whites (43.3% and 48.3% vs. 33.2%; p=.0002 and p<.0001, respectively). When adjusted for medical insurance status, a significant difference persisted for whites vs. Hispanics (p=.002), but not whites vs. blacks (p=.197). In multivariate analyses adjusted for alcohol use, anticoagulation, hypercholesterolemia, education, and insurance status, treated HTN was a significant risk factor for ICH in whites (OR=1.72, 95% CI 1.33-2.22, p<.0001), blacks (3.04, 2.13-4.34, <.0001), and Hispanics (2.57, 1.64-4.00, <.0001). Untreated HTN was a substantially greater risk factor for ICH for all three racial/ethnic groups: whites (9.53, 5.88-15.45, <.0001), blacks (11.10, 7.06-17.47, <.0001), Hispanics (9.65, 5.49-16.95, <.0001). In the subtype analyses of deep, lobar, and infratentorial ICH, untreated HTN resulted in ORs of 3.50 to 24.81, with statistical significance for all subtypes and ethnic groups.

Conclusion:
Treatment of HTN reduces the risk of ICH conferred by HTN markedly, but not completely. Untreated hypertension, which is significantly more prevalent among black and Hispanic ICH cases than among white cases, confers at least a 9-fold risk of ICH regardless of race. Treatment of hypertension is expected to have substantial impact on risk of ICH.