bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP12: No Association Between Outcomes And Anti-Factor Xa Levels For Heparin Monitoring In Patients With Cerebral Venous Thrombosis
Authors: Pirahanchi Yasaman , Salottolo Kristin , Burrell Christian , DiSalvo Lauren , Tang Xu , Bar-Or David , Bartt Russell
Published: February 2023

Introduction:
For patients with cerebral venous thrombosis (CVT), intravenous unfractionated heparin (UFH) is a cornerstone of anticoagulant therapy. Drawbacks of UFH include difficulty in reaching an optimal dose. Anti-factor-Xa (AFXa) assay is used to monitor UFH treatment. We sought to determine whether AFXa values are associated with outcomes in CVT.

Methods:
This pilot study included adults (≥18y) admitted to a CSC between 1/1/2018-12/31/2020 who were initially treated for CVT with low-intensity UFH drip and had at least one AFXa assay. AFXa therapeutic values were defined as 0.25 - 0.5 IU/mL. We examined percent of patients who became therapeutic within 24h of arrival, and time (hours) to reach therapeutic range. Outcomes included hospital LOS, bleeding event, and discharge disposition. Continuous data are presented as median (interquartile range). Significance was p<0.20.

Results:
51 CVT patients were included. The hospital LOS was 5 (4-9) days, 40 (78%) patients were discharged home, and 7 (14%) developed a bleed; 4 bleeds required no action. The time to start UFH was 2h (1-6) from arrival and the time to the first AFXa assay was 8h (4-11) from arrival. AFXa were drawn 4 (2-8) times per patient. AFXa assays were performed within 24h for 45 (88%) patients and 30 (67%) patients were in the therapeutic range. There was no association between study outcomes and therapeutic AFXa (
Table 1
). There was also no association between study outcomes and the time (h) to reach therapeutic range: discharge home vs. other location (11h vs. 14h, p=0.49), development of a bleed vs. no bleed (9h vs. 12h, p=0.44), and no correlation with hospital LOS (p=0.55).

Conclusions:
Most CVT patients were within the target AFXa range within 24h of arrival. The time to achieve therapeutic AFXa was not associated with better outcomes, although most patients had a favorable disposition and bleeding complications were infrequent.
Abstract TP120: Noncontrast Ct, Single-phase Cta, And Multiphase Cta Intracerebral Hemorrhage Expansion Scores
Authors: Rodriguez-Luna David , Pancorbo Olalla , Coscojuela Pilar , Lozano Prudencio , Rizzo Federica , Olive-Gadea Marta , Requena Manuel , Garcia-Tornel Alvaro , Rodriguez-Villatoro Noelia , Juega Jesus , Boned Sandra , Muchada Marian , Pagola Jorge , Rubiera Marta , Ribo Marc , Tomasello Alejandro , Molina Carlos A
Published: February 2023

Background:
Several noncontrast computed tomography (NCCT), single-phase computed tomography angiography (CTA), and multiphase CTA markers of intracerebral hemorrhage (ICH) expansion have been previously proposed. We derived and validated three scores for the prediction of hematoma expansion depending on the use of NCCT, single-phase CTA, or multiphase CTA markers of hematoma expansion.

Methods:
We prospective studied 276 consecutive patients with ICH within 6 hours from symptom onset. After deriving NCCT, single-phase CTA, and multiphase CTA scores in a 5-year period population (n=156), we validated them in a different 3-year period population (n=120). Outcome parameters included substantial hematoma expansion >6 mL or >33% at 24 hours (primary outcome) and poor outcome (mRS score >2) at 90 days.

Results:
The most accurate marker of hematoma expansion was spot sign in phase 1 of multiphase CTA (80.3%). The four independent predictors of substantial hematoma expansion included in the different scores were ultraearly hematoma growth (uHG) >5 mL/h, heterogeneous density, spot sign in phase 1 of multiphase CTA, and spot sign in any phase of multiphase CTA (Table). On each of the three scores, the proportion of patients that experienced substantial hematoma expansion increased with each point increase. C-index for both substantial hematoma expansion and poor outcome in the derivation and validation cohort was lower in NCCT expansion score than in single-phase CTA expansion score which, in turn, was lower than in multiphase CTA expansion score (Table).

Conclusions:
This study demonstrates the added prognostic value of more advanced CT modalities in acute ICH evaluation. Single-phase CTA score and, especially, multiphase CTA score, are more robust than NCCT score in the prediction of hematoma expansion and poor outcome. These scores may help to refine the selection of patients at risk of expansion and poorest outcomes in different decision-making scenarios.
Abstract TP122: Systolic Blood Pressure Variability Increases During The Initial 24 Hours After Intravenous Nicardipine Administration Among Patients With Primary Intracerebral Hemorrhage
Authors: Potter Thomas B , Bako Abdulaziz , Khan Osman , Pan Alan P , Britz Gavin W , Tannous Jonika , Vahidy Farhaan S
Published: February 2023

Background:
Systolic blood pressure variability (SBPV) has been associated with poor outcomes among patients with intracerebral hemorrhage (ICH). Intravenous nicardipine (IVN) is frequently used for blood pressure management among hospitalized ICH patients, however SBPV in response to IVN has not been characterized.

Methods:
Data for primary ICH patients who received IVN were retrieved from a stroke-specific bioinformatics pipeline. SBPV was quantified as the coefficient of variation (CV) of cuff-measured systolic blood pressure, and CV was calculated over the time periods 0-24 hrs prior to (Pre24), 0-24 hrs after (Post24), and 24-48 hrs after (Post48) initial IVN administration. Group differences were assessed using Friedman’s Test and Bonferroni-corrected Wilcoxon Signed-rank tests. Contributions of SBPV at each timepoint to poor in-hospital mortality or discharge to hospice (poor outcome) were assessed in separate multivariable logistic regression models adjusted for patient characteristics. Adjusted Odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results:
Data included 370 ICH patients with a median [interquartile range] age of 65 [54 - 76]. Patients included were 46.0% female, 41.1% Non-Hispanic White, 25.1% Non-Hispanic Black, 23.8% Hispanic, 8.1% Asian, and 1.9% other. Patients had a median CV of 9.2 [6.1-13.6] in the Pre24 period, 11.6 [9.46 - 13.9] in Post24, and 9.5 [7.6 - 12.1] in Post48. SPBV showed significant differences across timepoints (p=0.000), with Post24 showing elevated SBPV (vs. Pre24 (p=0.000) or Post48 (p=0.000), Figure 1A, B). In multivariable modelling, patients in the highest quartile of SPBV during the Post24 period showed increased risk of poor outcome: aOR (CI) 2.91 (1.06-8.01), Figure 1C.

Conclusions:
SBPV increases over the first 24 hours of IVN administration and patients with higher SPBV during this time are at higher risk for in-hospital mortality. SPBV management protocols need to be evaluated.
Abstract TP126: Rising Incidence Of Hydrocephalus In Patients With Intracerebral Hemorrhage In 20-year Analysis Of The National Inpatient Sample
Authors: Tabani Halima , Hardigan Trevor , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Introduction:
Hydrocephalus (HCP) is a common consequence of intracerebral hemorrhage (ICH) and is a predictor of poor outcomes in ICH patients. We aimed to characterize ICH patients with HCP and assess their clinical outcomes over a 20-year period.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of hydrocephalus on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
2,000,868 patients with ICH were identified; 9.2% had HCP. Patients with HCP had higher NIHSS (17.16±11.13 vs 10.77±9.14) and Elixhauser Comorbidity Score (10.64±8.79 vs. 10.4±9.12) at presentation, longer hospital stays (13.92±18.13 vs 8.13± 11.3 days) and higher hospital charges ($160,604.36± 225,493.62 vs $74,930.99± 137,200.59) (all p<0.001). After propensity matching, HCP patients had higher rates of surgical intervention (including EVD and ventricular shunt placement), and higher tracheostomy and PEG/G-tube requirement (all p<0.001). On multivariate analysis, HCP patients had higher in-hospital mortality (2.21; 95% CI: 1.85-2.65) and lesser likelihood of discharge home or short-term hospital (0.46; 95% CI: 0.35-0.61) (p<0.001).

Conclusion:
In this 20-year nationally representative propensity matched analysis of patients with ICH, those with concomitant HCP had higher rates of surgical procedures (EVD, ventricular shunt, tracheostomy and PEG). Incidence of HCP increased more than two-fold from2000-2019, suggesting worsening disease severity over the study period.
Abstract TP128: Hemorrhagic Transformation After Endovascular Thrombectomy Is Associated With Basal Ganglia Infarct Volume
Authors: Regenhardt Robert W , Bonkhoff Anna , Schirmer Markus D , Das Alvin S , Dmytriw Adam A , Vranic Justin , Gupta Rajiv , Rabinov James D , Stapleton Christopher J , Leslie-Mazwi Thabele M , Patel Aman B , Rost Natalia S
Published: February 2023

Introduction:
With continued expansion in indications for endovascular thrombectomy (EVT), understanding the pathophysiology of reperfusion injury and the risks of hemorrhagic transformation (HT) becomes increasingly important. Pre-EVT infarct topography may have implications for treatment decisions acutely (e.g. stenting), and with post EVT care (e.g. antithrombotics). We sought to quantify region-specific volumes of infarcted tissue on pre-EVT MRI, understand their importance for HT, and identify associations with clinical and imaging characteristics.

Methods:
Patients with pre-EVT MRI were identified from a prospectively maintained database. Each patient’s diffusion weighted sequence underwent manual infarct delineation and was registered to a standard space for overlay with cortical, subcortical, and white matter atlases. HT was defined as ECASS PH1 or PH2. Variables with p<0.10 in univariate analyses were included in multivariable models.

Results:
A total of 165 participants [median age 69 (IQR 56-79), 56% women] were identified. Intravenous alteplase was administered to 52%; 70% achieved TICI 2b-3 reperfusion. HT occurred in 8%. The distribution of pre-EVT infarcts was 48% (38-60%) white matter, 23% (6-47%) cortex, and 15% (4-28%) basal ganglia. Pre-EVT infarct volumes [median (IQR)] were 22 cc (12-43 cc) for total, 11 cc (6-19 cc) for white matter, 5 cc (1-19 cc) for cortex, and 3 cc (1-6 cc) for basal ganglia infarct. Paramagnetic sequences showed 3% had petechial hemorrhage and 40% had susceptibility vessel sign. Basal ganglia infarct volume was independently associated with HT (OR=1.342, 95%CI=1.002,1.797) in a model including white matter infarct volume, cortex infarct volume, smoking, and puncture-to-recanalization time. Basal ganglia infarct volume was linked to susceptibility vessel sign (Beta=0.233, p=0.006) and NIHSS (Beta=0.220, p=0.012), when controlling for total infarct volume.

Conclusions:
Greater basal ganglia infarct volume was associated with a higher risk of HT when accounting for infarct volumes in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery perforator occlusion.
Abstract TP129: Increased Levels Of Matrix Metalloproteinases-induced BBB Dysfunction May Be Responsible For Increased Post-sich Hematoma Growth In Nicotine-exposed Rats.
Authors: Khushal Priyanka , Cho Sunjoo , Rehni Ashish K , Raval Ami P , Perez-Pinzon Miguel A , Dave Kunjan R
Published: February 2023

Spontaneous intracerebral hemorrhage (sICH) is the deadliest type of stroke, accounting for as high as 28% of all strokes. Tobacco use is one of the major risk factors of sICH, and it also worsens outcomes following sICH. In our earlier study, we observed that nicotine exposure increases TNFα levels in brain vessels, impairs BBB integrity, and increases post-sICH hematoma volume in a TNFα-dependent manner compared to saline-exposed controls. Earlier studies have demonstrated interactions between MMPs and TNFα. Increased levels of matrix metalloproteinases (MMPs) have been found in sICH patients and nicotine-exposed individuals. MMPs are involved in BBB breakdown, edema formation, hematoma expansion, and neuronal loss that follow hematoma development after sICH. In the present study, we tested the hypothesis that nicotine exposure-induced increase in TNFα is responsible for increased post-sICH hematoma volume in a MMP-dependent manner. To test our hypothesis, young male and female rats were exposed to chronic nicotine treatment for 2-3 weeks using osmotic pumps containing either saline or nicotine (4.5 mg/kg/day). Levels of MMPs (2, 3, 9, and 12) and GAPDH were evaluated in brain homogenates using Western blot. Nicotine-treated female rats showed a 37% (100±7 vs. 137±10, p<0.05), 144% (100±18 vs. 244±16, p<0.01), 29% (100±7 vs. 129±9, p<0.05), 22% (100±6 vs. 122±6, p<0.05), and 24% (100±6 vs. 124±7, p<0.05) increase in levels of pro and cleaved forms of MMP-3, cleaved form of MMP-9, pro and cleaved forms of MMP-12, respectively, compared to saline-treated female rats. We are in the process of evaluating levels of MMPs in male samples. Considering the role of MMP-9 in BBB integrity, using both TNFα and MMP-9 inhibitors, we are also in the process of evaluating if TNFα increases post-sICH hematoma growth in nicotine-exposed rats via increased levels of MMP-9. The results so far imply that increased TNFα levels in nicotine-exposed rats may be responsible for increased post-sICH hematoma growth in a MMP-dependent manner. Support: James Esther King Biomedical Research Grant 9JK08 and PK is a recipient of the Lois Pope Neuroscience Summer Research Fellowship.
Abstract TP130: Effect Of Antifibrinolytic Medication On Hematoma Expansion In Acute Ischemic Stroke Patients With Post Thrombolytic Intracerebral Hemorrhages
Authors: Khan Zalan W , Bains Navpreet , Raza Samina , French Brandi R , Siddiq Farhan , Chandrasekaran Premkumar N , Gomez Camilo R , Qureshi Adnan I
Published: February 2023

Background and Purpose:
Antifibrinolytic medications such as the synthetic lysine analogs tranexamic acid and ε-aminocaproic acid inhibit fibrinolysis by attaching to the lysine-binding site of the plasminogen molecule. However, the efficacy of intravenous (IV) antifibrinolytic medication in the prevention of hematoma expansion in acute ischemic stroke patients who develop post thrombolytic intracerebral hemorrhage (ICH) is unclear.

Methods:
We analyzed the effect of antifibrinolytic medication in acute ischemic stroke patients with post thrombolytic ICH on hematoma expansion over an 8-year period. The Region-of-Interest; method on a Horos Medical Image Viewer (Version 3.3.6) was utilized for hematoma volume measurement on serial computed tomographic scans. We compared changes in hemorrhage volume in patients who did and did not receive IV antifibrinolytic medication.

Results:
A total of 53 patients (mean age 69.7±14.3, 53% were men) with post thrombolytic ICH were analyzed. Twenty-six patients received antifibrinolytic treatment: 20 and 6 patients received a single IV dose of ε-aminocaproic acid (5 g) or tranexamic acid (1 g), respectively. Ten patients (38%) had a reduction or stabilization in hematoma volume (overall pre and post-treatment volumes were 17.43±16.23 cm3 and 25.14±26.57 cm3 respectively). Mean fibrinogen level in the antifibrinolytic medication group was 277 mg/dL; 3 patients had levels <200 mg/dL. In patients that did not receive antifibrinolytics, 16 (59%) out of 27 patients had a reduction or stabilization in hematoma volume (overall pre and post-treatment volumes were 19.74±32.32 cm3 and 27.15±52.58 cm3 respectively). The mean percent change in hematoma volume with antifibrinolytic medication treatment was 48% and without was 27%. [Figure 1]

Conclusion:
We did not identify any reduction in any of the measures of hematoma expansion with antifibrinolytic treatment in acute ischemic stroke patients with post thrombolytic ICH.
Abstract TP135: Underlying Intracranial Atherosclerotic Disease Is Associated With Worse Outcomes In Acute Large Vessel Occlusion Undergoing Endovascular Thrombectomy
Authors: Morsi Rami Z. , Thind Sonam , Karrison Theodore , Lee Harrison , Nahab Fadi B , Gupta Rishi , Carrión-Penagos Julián , Awad Issam A , Coleman Elisheva , Brorson James R , McKoy Cedric , Morales Jacqueline , Mendelson Scott J , Mansour Ali , Prabhakaran Shyam , Kass-Hout Tareq
Published: February 2023

Introduction:
Acute large vessel occlusion (LVO) can be secondary to thromboembolism or intracranial atherosclerotic disease (ICAD). Data on LVO management due to underlying ICAD are scarce. We hypothesized that patients with ICAD have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD.

Methods:
We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between January 14, 2018 and October 24, 2021. Presence of ICAD at LVO site was determined by the interventionalist. We compared in-hospital mortality, 90-day mortality, and 90-day modified Rankin Scale (mRS) scores between those with and without ICAD, in unadjusted and adjusting logistic regression models.

Results:
Among 215 patients (mean age 67.1±16.0 years; 60.5% female; 80.5% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p=0.027 and 29.0% vs. 14.7%, p=0.035, respectively). Substantial reperfusion (TICI ≥2b) was achieved less often (84.2% vs. 94.4%, p=0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p=0.054). In-hospital and 90-day mortality were more common (36.8% vs. 15.8%, p=0.003 and 52.6% vs. 26.6%, p=0.002, respectively) and favorable functional outcome (mRS 0-2) at 90 days was less common (7.9% vs. 33.9%, p=0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in-hospital mortality (OR=4.1, 95% CI 1.7-9.7), 90-day mortality (OR=3.7, 95% CI 1.6-8.6), and poor functional outcome at 90 days (OR=5.5, 95% CI 1.6-19.4).

Conclusions:
Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT. Further research is warranted to understand factors associated with worse outcomes and investigate alternative interventional approaches and medical management in this high-risk population.
Abstract TP137: Rescue Angioplasty And/or Stenting For Acute Large Artery Occlusion Of Posterior Circulation With Underlying Intracranial Atherosclerosis
Authors: Aytenfisu Ermias M , Desai Sohum , Saei Hamzah , Tekle Wondwossen G , Hassan Ameer E
Published: February 2023

Background:
Prior studies have shown rescue intracranial angioplasty and/or stenting (PTAS) is safe and efficacious in acute large vessel occlusion (LVO) of the anterior circulation with underlying intracranial atherosclerotic disease (ICAD). We investigated the safety and efficacy of acute intracranial angioplasty and/or stenting in patients with posterior circulation intracranial atherosclerosis-related occlusion (ICAS-O).

Methods:
Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between January 2016- May 2022, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage (ICH), the mortality rate at discharge, and recanalization rate and favorable clinical outcome, modified thrombolysis in cerebral infarction score (mTICI) and favorable clinical outcome (modified Rankin Scale (mRS), were examined. The outcomes between acute PTAS + MT in the anterior and posterior circulation were compared.

Results:
There were a total of 75 acute ischemic stroke (AIS) patients who underwent rescue PTAS, of which 15 (20.0 %) were posterior circulation ICAS-O group. Baseline characteristics were similar between the groups except for gender (6.7 % vs 45.0) and atrial fibrillation (21.7% vs 0.0%). There was no statistical difference in discharge NIH Stroke Scale (mean, 18 vs 23%, P = 0.860) or favorable outcome (modified Rankin Scale ≤ 2) at 90 days (46.7% vs 38.7 %, P = 0.477) between the posterior and anterior ICAS-O groups respectively. Symptomatic ICH rate tended to be higher in the anterior group (11.7 vs 6.7%, P = 0.495).

Conclusions:
Rescue angioplasty and/or stenting seem safe treatment options for posterior circulation ICAS-related LVO. Further larger multicenter prospective studies are required to corroborate the results of our study.
Abstract TP138: The Effect Of Dominant Division Catheterization In Mechanical Thrombectomy On First Pass Effect And Clinical Outcome
Authors: Amireh Abdallah , Snyder Thomas , Fourcand Farah , Strauss Sara , Nagy Muhammad , Abbasi Hamidreza , Marandi Elahe , Vyas Shrinjay , Joshi Rudra , Percival Brigitte , Zacharatos Haralabos , Mehta Siddhart , Kirmani Jawad F
Published: February 2023

Introduction:
The middle cerebral artery (MCA M1 segment) bifurcates into anterior and posterior divisions (M2 segments) in 78% of the population. When feasible, preferential catheterization of the dominant division is performed during endovascular thrombectomy (EVT) in patients with acute ischemic strokes (AIS). Our aim was to evaluate the association of dominant division catheterization in EVT with first pass effect and clinical outcome.

Methods:
Retrospective chart review of AIS patients presenting to our comprehensive stroke center with AIS secondary to MCA M1 and/or internal carotid artery (ICA) terminus occlusions who underwent standardized EVT defined as proximal flow arrest, distal aspiration, and stent retriever. Patients receiving intra-arterial thrombolytics and/or non-thrombolytics were excluded. Digital subtraction angiographic images were reviewed to determine if dominant M2 branch catheterization was performed on first pass. Modified Thrombolysis in Cerebral Infarction (mTICI) score and 90-day modified Rankin score (mRS) were evaluated. TICI score of 2B or greater was considered successful recanalization. mRS ≤ 2 was considered good clinical outcome. Social science statistics software was used for data analysis.

Results:
From June 2019 to November 2021, 126 patients with MCA M1 and/or ICA terminus occlusions who underwent standardized EVT, 76 met the inclusion criteria. Fifty were excluded as they had codominant M2 branches. Mean age was 72 (95% CI 68.69, 75.31) and median NIHSS was 18 (95% CI 16.16, 18.72). Thirty-eight percent (n=34) of subjects were male. Fifty-seven subjects underwent dominant division catheterization during first pass. First pass recanalization was significantly associated with catheterization of dominant branch (Fisher value: 0.0002). Catheterization of dominant branch during first pass was not associated with total number of passes (Fisher value: 0.17). Administration of IV thrombolytics prior to procedure (n=19) was not significantly associated with pre-procedure recanalization (Fisher value: 0.38).

Conclusion:
Our study suggests that catheterization of dominant branch during thrombectomy is associated with higher rates of first-pass successful recanalization.
Abstract TP139: Characterizing Patients With Dysphagia Following Acute Ischemic Stroke: A Propensity Matched Analysis Of The 2000-2019 National Inpatient Sample
Authors: Vasan Vikram , Hardigan Trevor , Devarajan Alex , Rossitto Christina P , Chapman Emily K , Schuldt Braxton R , Downes Margaret H , Odland Ian C , Fifi Johanna T , Kellner Christopher P , Mocco J D , Majidi Shahram
Published: February 2023

Introduction:
Dysphagia is a common complication among acute ischemic stroke (AIS) patients and is associated with increased mortality and morbidity. A complete understanding of the characteristics of patients who present with dysphagia after AIS is warranted.

Objective:
To identify the risk factors and outcomes of patients presenting with dysphagia after AIS over twenty years.

Methods:
A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for dysphagia on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3.

Results:
10,415,286 patients with AIS were included; 956,662 (9.2%) had in-hospital dysphagia. A higher percentage of patients with dysphagia were older, had higher Elixhauser Comorbidity Score, higher NIH Stroke Scale (NIHSS) score and a were insured by Medicare (p<0.001). After propensity matching, patients with dysphagia after AIS were less likely to experience in-hospital mortality (OR 0.61; 95%CI: 0.60-0.63) or be discharged home (AOR 0.51; 95%CI: 0.51-0.52), had decreased length of stay (0.43 days; 95%CI: 0.36-0.50), and had increased hospital charges ($14411.96; 95%CI: 13565.68-15257.44) (all p<0.001).

Conclusion:
This propensity matched 20-year national analysis confirmed that dysphagia is a significant issue following AIS. These patients were more frequently male with worse neurological presentations. Despite better odds for survival and shorter hospital stay, they experience significant functional deficits at discharge and have increased hospital costs.
Abstract TP140: Association Between Optimal Mismatch Ratio And Favorable Outcome By ASPECTS And Ischemic Core Volume
Authors: Kida Hiroyuki , Yoshimoto Takeshi , Inoue Manabu , Koga Masatoshi , Ihara Masafumi , Toyoda Kazunori
Published: February 2023

Purpose:
We aimed to clarify the association between optimal mismatch ratio and favorable outcome of acute ischemic stroke-large vessel occlusion (AIS-LVO) patients who underwent endovascular therapy (EVT) by Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) and ischemic core volume (ICV).

Methods:
We enrolled consecutive patients from 2017 to 2021 with prestroke modified Rankin scale (mRS) scores of 0 to 2 who were available for computed tomography perfusion or perfusion-weighted imaging before treatment and underwent EVT for anterior AIS-LVO within 24 hours from onset. Patients with ICV less than 10 mL or those who did not achieve successful recanalization with extended Thrombolysis In Cerebral Infarction scale score ≥2b were excluded. We dichotomized patients by ASPECTS (≥6 and <6), and then by ICV (≤70 mL and >70 mL). Sensitivity and specificity were calculated from receiver operating characteristic (ROC) curve and to identify the optimal mismatch ratio for achieving favorable outcome, defined as mRS score 0 to 2 at 3 months.

Results:
Eighty patients (women, 31; median age, 75 [interquartile range (IQR), 69-83] years; median NIHSS score, 19 [14-24]; median ASPECTS, 7 (IQR, 6-9); median ICV, 32 (IQR, 16-64) mL] were enrolled. Of these, 45 (56%) patients had favorable outcomes. The threshold of optimal mismatch ratio for favorable outcomes were 11.2 in patients with ASPECTS ≥6 [area under curve (AUC) 0.55, P=0.47; sensitivity 0.25, specificity 0.92], 3.1 in those with ASPECTS <5 (AUC 0.36, P=0.43; sensitivity 0.40, specificity 0.70), 11.2 in those with ICV <70 mL (AUC 0.52, P=0.84; sensitivity 0.24, specificity 0.92), and 3.6 in those with ICV ≥71 mL (AUC 0.55, P=0.82; sensitivity 0.50, specificity 0.90).

Conclusions:
The cut-off values of optimal mismatch ratio for favorable outcomes were 11 in patients with ASPECTS ≥6 or ICV <70 mL, and approximately 3 in those with large ICV.
Abstract TP143: A Retrospective Study Comparing Clinical Outcomes For Thrombectomy-treated Patients With Large Vessel Occlusion Who Met Or Did Not Meet AHA/ASA Eligibility Criteria
Authors: Wallace Jessica , Lesko Alexandra C , Yanase Lisa R , Patel Kishan
Published: February 2023

Introduction:
In 2015, the AHA/ASA Stroke Guidelines recommended thrombectomy to treat large vessel occlusions (LVOs) based on multiple clinical trials that demonstrated efficacy and safety. Given the strict eligibility criteria employed by these trials, the guidelines recommended thrombectomy for a limited patient population. However, in real-world settings, patients who do not meet eligibility criteria still undergo thrombectomy at the discretion of their treating physician. The purpose of this study is to compare clinical outcomes and complication rates of thrombectomy patients who do not meet the AHA/ASA criteria to those that do.

Methods:
Data from patients discharged from October 2017 to February 2021 with LKW <= 6 hours were retrospectively abstracted from electronic medical records. Patients under 18 or with posterior circulation stroke were excluded. Patients were grouped by AHA/ASA criteria for thrombectomy treatment into met (M) vs. not-met (NM). The M group criteria were defined as pre-stroke modified Rankin score (mRS) 0-1, occlusion of the internal carotid artery (ICA) or middle cerebral artery (M1), NIH stroke score (NIHSS) of >=6 on arrival, and ASPECTS>=6. All other patients were categorized as NM. Primary outcomes were 90-day mRS, median change from arrival to 90-day mRS, discharge disposition, and treatment complications. Descriptive analyses were performed using Chi-squared test, Fisher’s exact test, or median test, as appropriate.

Results:
Among 225 patients who met inclusion criteria, 151 (67.1%) M and 74 (32.9%) NM patients were identified. NM patients had worse mRS scores at 90-days (6.0 [4.29, 6.00] vs. 3.0 [0.00, 6.00]) compared to M patients. However, change from pre-stroke to 90-day mRS was not significant between groups (M: 3.0 [1.00, 5.00] vs NM: 3.0 [1.00, 4.00], p<.846.) No differences were found between M or NM for discharge disposition or treatment complications.

Conclusions:
While patients in the NM group had worse 90-day mRS scores compared to the M group, the change in mRS scores from pre-stroke to 90-day were the same for both. Results support that thrombectomy treatment of LVOs is safe and effective for both groups. Expansion of AHA/ASA guidelines should be considered.
Abstract TP144: VARIANCE-S: Variability Of Assessed Bp Readings In Acute Neuro-intervention Cases And Its Effect On Outcomes Pertaining To Sex Differences
Authors: Van Orden Kimberlee , Stansizewski Thomas , Agrawal Kunal , Torres Dolores , Poynor Briana , Alwood Benjamin T , Meyer Brett C , Meyer Dawn M
Published: February 2023

Introduction:
Sex differences exist in thrombolytic stroke treatment and outcome and likely in endovascular thrombectomy (EVT). Previous analysis has shown a significant correlation of blood pressure variability (BPV) and sex. The purpose of this study was to assess sex differences in a sample of patients with good recanalization post-with EVT and examine the impact of BPV.

Methods:
We conducted a retrospective analysis of prospectively collected data from an IRB approved Stroke Registry of two academic Comprehensive Stroke Centers in Southern California between 2017 and 2022. Patients were included if they had 1) anterior circulation ischemic stroke due to large vessel occlusions (LVO) and 2) underwent successful EVT defined as a TICI 2b or 3 result. Male and female subjects were compared for age, sex, Hispanic ethnicity, initial NIHSS, history of HTN, current antihypertensive use, symptom onset to groin puncture time, door to groin puncture time, and symptomatic ICH (sICH), BPV, onset to groin, and door to groin . Good outcome was defined as mRS 0-2. Chi squared a t-test were used as appropriate.

Results:
We included 131 females and 124 males. There was a significant difference between males and females in: 1) history of a fib (76% v 64%, p=0.42); 2) atrial fibrillation during admission (36% v 50%, p=0.01); 3) age (male 67 v female 73 years, p<0.001); 4) post-EVT SBP (137mmHg v 144mmHg, p-0.02). There was a significant difference in onset to groin (p=0.41), but no significant difference in door to groin (p=0.59). When adjusting for time of onset, there was no significant difference in thrombolysis prior to EVT between groups. There was no significant difference in sICH (6 male v 4% female, p=0.50), 90 day mRS (p=0.81); or discharge disposition (p=0.56). BPV was significantly correlated with sex but not significant for any interaction effect with the variables assessed.

Conclusion:
This study found no significant sex differences in outcome in this sample. The systems of care provided by an academic, CSC ensure that all patients’ care is expedited and provides the best opportunity for a good outcome in both sexes. Studies of sex differences in EVT treatment and outcome in multiple stroke care settings are vital to reduce disparities in care.
Abstract TP149: Balloon Mounted Drug Eluting Stents For Treatment Of Intracranial Atherosclerosis In Emergent Large Vessel Ichemic Stroke
Authors: Sivapatham Thinesh , Satti Sudhakar R , Eden Timothy J
Published: February 2023

Introduction:
Intracranial atherosclerotic disease (ICAD) is an important etiology of ischemic stroke, and often poses a challenge to successful endovascular reperfusion in the setting of emergent large vessel stroke (ELVS). We aimed to evaluate the safety and efficacy of balloon-mounted drug eluting stents (DES) in the treatment of ELVS.

Methods:
Retrospective review of endovascular database from our comprehensive stroke center from Jan 2021 - Aug 2022. Patients undergoing endovascular therapy for anterior circulation ELVS with ≥70% stenosis in the target vessel treated with DES were included. Patients with tandem cervical carotid lesions requiring stenting were excluded. Primary outcomes were symptomatic intracranial hemorrhage (sICH) within 72 hrs and mortality at 30 days. Secondary outcomes were feasibility of treatment with DES and recurrent stroke within 30 days.

Results:
Of 359 endovascular stroke interventions performed, 11 patients met the inclusion criteria. Mean age was 60 [51-78], and 7 (64%) were female. Target lesions included 8 M1 (73%), 1 M2 (9%), 1 cavernous ICA (9%), and 1 ICA/M1 junction (9%). Average time from last known well to arterial puncture was 14 hrs, 15 mins [1 hr, 9 mins to 25 hrs, 23 mins]. 2 patients (18%) received IV alteplase. Average ASPECT score 8.3 [5-10], average core infarct 10 mL [0-48] and average mismatch 68 mL [12-179]. 5 procedures (45%) performed via radial access and 6 via femoral (55%), all under general anesthesia. 5 patients (45%) underwent mechanical thrombectomy and 6 (55%) underwent angioplasty prior to DES. 3 (27%) underwent primary DES treatment. Average pre-treatment stenosis was 83% [70-95%], average post-treatment stenosis was 14% [0-45%]. All DES were delivered successfully with no procedural complications. All patients achieved successful reperfusion (8 TICI 3 [73%], 2 TICI 2C [18%], and 1 TICI 2B [9%]). Average NIHSS score was 12.4 [5-28] at presentation and 7.5 [0-20] at 7-10 days. There were no sICH at 72 hrs, and no deaths at 30 days. 1 patient returned with stroke secondary to stent occlusion at 29 days, with successful TICI 3 recanalization following angioplasty.

Conclusions:
Endovascular treatment of ICAD-related ELVS with DES is safe and effective, and warrants further investigation.
Abstract TP15: Rationale And Ongoing Status In A Phase 3 Trial Of Nelonemdaz, A Novel Neuroprotection Drug, For Patients With Acute Ischemic Stroke And Reperfusion
Authors: Lee Jin Soo , Lee Ji Sung , Gwag Byoung Joo , Choi Dennis W , An Chun San , Kang Hyun Goo , Song Tae-Jin , Ahn Seong Hwan , Kim Chang Hun , Kwon Sun U
Published: February 2023

Background:
A phase III Rescue On reperfusion Damage in cerebral Infarction by Nelonemdaz (RODIN) trial has been launched since December, 2021 and patients are being enrolled.

Rationale:
Nelonemdaz (previously, neu2000) targets (1) selectively the 2B subunit of the N-methyl-D-aspartate glutamate receptor, the activation of which causes Na+ and Ca++ influx into neuronal cells and then induces downstream death-signaling pathways, and (2) free radical species, which are released both from the downstream pathways of glutamate receptors and from following reperfusion injury. Phase I and II trials showed its safety and a tendency of clinical outcome improvements.

Methods:
RODIN is a multicenter, double-blinded clinical trial. A total of 496 patients will be randomly assigned into nelonemdaz and placebo groups. Patients will be included if they have an acute ischemic stroke (National Institutes of Health Stroke Scale score ≥8 scores) caused by intracranial large vessel occlusion in the anterior circulation (Alberta Stroke Program Early CT Score ≥4), and they are expected to undergo endovascular thrombectomy within 12 hours after stroke onset. The primary endpoint is a favorable shift in the modified Rankin Scale (mRS) score at 90 days after the first dose of drug, analyzed by the Cochran-Mantel-Haenszel shift test.

Ongoing status:
By August 23, 2022, 210 patients have been enrolled. It is expected that enrollment could be finalized until spring season of 2023.

Conclusions:
This trial will clarify the efficacy and safety of nelonemdaz in patients with acute ischemic stroke and endovascular thrombectomy. This study was registered in ClinicalTrials.gov, number NCT05041010.
Abstract TP150: Outcome Of Patients With Lacunar Strokes In The Era Of Thrombectomy
Authors: van der Geest Yael , Disanto Giulio , Bianco Giovanni , Sihabdeen Shairin , Pileggi Marco , Strambo Davide , Michel Patrik , Kahles Timo , Nedeltchev Krassen , Fischer Urs , Bonati Leo , Kaegi Georg , Escribano Jose Bernardo , Carrera Emmanuel , Nyffeler Thomas , Bolognese Manuel , Wegener Susanne , Luft Andreas , Medlin Friedrich , Renaud Susanne , Mono Marie-Luise , Remonda Luca , Machi Paolo , Psychogios Marios , Kaesmacher Johannes , Wardlaw Joanna M , Cereda Carlo W
Published: February 2023

Introduction:
Endovascular treatment (EVT), in particular mechanical thrombectomy, has dramatically improved the clinical outcome of patients with large vessels occlusion (LVO) of the anterior circulation. In contrast, the benefits of EVT cannot be applied to lacunar strokes (LS). The absence of a LVO in LS has been historically associated with a more favorable outcome, but in the new era of EVT, this assumption may not be correct anymore. We aimed to test the general assumption that LS have a better prognosis than other stroke subtypes, and analyze the outcome of LS treated with IVT as compared to strokes with LVO treated with IVT and/or mechanical thrombectomy in the multicentric Swiss Stroke Registry.

Methods:
retrospective propensity score matching analysis of patients from the Swiss stroke registry (SSR) with lacunar stroke treated with thrombolysis versus LVO of the medial cerebral artery treated with EVT (with or without thrombolysis). Primary endpoint was a shift analysis of mRs at 90 days after stroke. Secondary outcomes were favorable functional outcome (mRS 0-1), independence (mRS 0-2), survival with high disability (mRS 3-5) and mortality (mRS 6) at 90 days.

Results:
From 13'227 patients, the propensity score method matched (sex, age, NIHSS, time to treatment, prior anticoagulation, pre-stroke modified Rankin Score, mRs) 538 patients (269 in each group. There was no difference between groups in mRs shift analysis at 90 days after stroke (OR=0.99, 95%CI=0.73-1.35, p=0.952). There was also no significant difference in mRS 0-1 (59.9% vs 55.8% respectively; OR=0.79, 95%CI=0.55-1.16, p=0.75). LS+IVT patients showed a non-significant trend towards mRS 3-5 (OR=1.23, 95%CI=0.78-1.94, p=0.38), while patients treated with EVT had a slightly, non-significant, higher mortality (6.3% vs 1.9%, p=0.38).

Conclusions:
Lacunar strokes - which cannot directly benefit from thrombectomy therapy - when treated with IVT and matched on key prognostic variables, seem to have similar outcomes as LVO strokes treated with EVT. This observation confirms that lacunar stroke is not a benign entity and therefore suggests that reperfusion therapy should be addressed with the same intensity as LVO stroke.
Abstract TP151: Predictors Of Mechanical Thrombectomy Failure
Authors: Webb Matthew , Essibayi Muhammed Amir , Al Kasab Sami , Maier Ilko , Psychogios Marios , Jabbour Pascal M , Kim Joon-Tae , Quintero Wolfe Stacey , rai ansaar , Starke Robert , Samaniego Edgar A , Arthur Adam S , Yoshimura Shinichi , Grossberg Jonathan A , Alawieh Ali M , Fragata Isabel , Osbun Joshua , Matouk Charles , Park Min S , Levitt Michael , Dumont Travis , Williamson Richard , Spiotta Alejandro M , Kan Peter , De Leacy Reade A , Crosa Roberto , Casagrande Walter , Gory Benjamin , Mokin Maxim , Romano Daniele , Moss Mark , Chowdry Shakeel , Behme PD Dr. Daniel , Mascitelli Justin , Limaye Kaustubh
Published: February 2023

Background:
Mechanical thrombectomy is standard of care for acute ischemic stroke secondary to LVO however MT failure (MTF) occurs in approximately 15% of cases.

Objective:
Investigate patient and procedural characteristics that predict MTF.

Methods:
Retrospective review of prospectively collected, Stroke Thrombectomy and Aneurysm Registry. Patients who underwent MT for LVO were included and categorized by MT Success (MTS) or MTF, defined as mTICI≥2b or <mTICI2b, respectively. Demographics, pretreatment, and treatment information were included in UVA and MVA for prediction of MTF.

Results:
A total of 8452 patients were analyzed, and 1301(15.4%) experienced MTF.MTF patients were older(73 vs.71, p=0.008)had higher poor premorbid mRS(10.8% vs 8.4%, p=0.17).Onset to puncture was greater in MTF group(442 vs.411 min, p=0.006).There were more ICA occlusions(15.6% vs. 13.5%)and basilar occlusions(7.8% vs.6.2%)in the MTF group and more M1 occlusions(42.2%vs.37.5%)in the MTS group (p<0.001).More patients underwent aspiration as the final technique in the MTS group(35.3% vs 32.9%).Number of passes(3 vs 2)and procedure time (77.3 vs 46.1 min) were higher in the MTF group (p<0.001). More patients in the MTF group required IA thrombolytic(14.7% vs. 8.3%, p<0.001).More patients in the MTS group had rescue stenting(7.9% vs 4.8%).There were more complications (14.7% vs 6.2%) and more symptomatic ICH(9.9% vs 5.7%, p<0.001)in the MTF group. Favorable outcome at 90 days was greater in the MTS group(42.6% vs 18.3%, P<0.001).On UVA, age, poor pretreatment mRS, posterior circulation occlusion, final technique SR, increased number of passes, increased procedure time were associated with increased odds of MTF, while M1-M2 occlusions and rescue intracranial stenting with decreased odds of MTF. These correlations remained significant on MVA for final technique SR, rescue intracranial stenting, number of passes, and procedure time.

Conclusion:
MTF is associated with more complications and worse outcome. Final use of aspiration and rescue intracranial stenting may increase chances of recanalization.
Abstract TP153: Basilar Artery Occlusion Management: Specialist Perspectives From After The BEST Of BASICS Study
Authors: Edwards Christopher , Drumm Brian , Siegler James E , Schonewille Wouter J , Klein Piers , Huo Xiaochuan , Chen Yimin , Strbian Daniel , Liu Xinfeng , Hu Wei , Ji Xunming , Li Chuanhui , Fischer Urs , Nagel Simon , Puetz Volker , Michel Patrik , Alemseged Fana , Sacco Simona , Yamagami Hiroshi , Abdalkader Mohamad , Yaghi Shadi , Strambo Davide , Kristoffersen Espen S , Sandset Else C , Mikulik Robert , Tsivgoulis Georgios , Aguiar De Sousa Diana , Pedro Marto João , Lobotesis Kyriakos , Roi Dylan , Berberich Anne , Demeestere Jelle , Meinel Thomas R , Rivera Rodrigo , Poli Sven , Duy Ton Mai , Zhu Yuyou , Li Fengli , Sang Hongfei , Thomalla Götz , Parsons Mark , Campbell Bruce C , Chen Hui-Sheng , Raymond Jean , Nogueira Raul G , Jovin Tudor G , Qiu Zhongming , Miao Zhongrong , Banerjee Soma , Nguyen Thanh N
Published: February 2023

Background:
Two early basilar artery occlusion (BAO) randomized controlled trials did not establish superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to medical management may differ between clinician specialties.

Methods:
We conducted an international survey (1/1/22-3/31/22) regarding management strategies in acute BAO prior to the announcement of 2 trials indicating superiority of EVT, and compared responses between interventionalists (INT) and non-interventionalists (nINT). Selection practices for routine EVT based on neuroimaging and clinical features were compared between the two groups using descriptive statistics.

Results:
Among the 1245 respondents (nINT=702), INT more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p<0.01). A similar proportion of INT and nINT responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific circumstances (p=0.45). Among respondents who would recommend EVT, there was no difference in the maximum pre-stroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups (p>0.05), although nINT more commonly preferred perfusion imaging (24.2% vs. 19.7%, p=0.04). Among respondents who indicated they would randomize to medical management, INT were more likely to randomize when the NIHSS was ≥10 (15.9% vs. 6.9%, p<0.01).

Conclusions:
Following the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a patient to medical treatment. There were small differences in preference of advanced neuroimaging, although these preferences were unsupported by clinical trial data.