bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T MP115: Cerebral Ischemic Events Associated with Transcatheter Aortic Valve Replacement (TAVR): A Systematic Review
Authors: Herial Nabeel A , Mohammad Najwa S , Chughtai Morad , Qureshi Adnan I
Published: July 2021

Introduction:
Transcatheter aortic valve replacement (TAVR) has recently emerged as a treatment option in patients with symptomatic severe aortic stenosis. Cerebral ischemic events are recognized events associated with TAVR, however, a detailed analysis of such events is not performed.

Methods:
We performed a literature search to identify studies reporting outcome data at different time intervals following TAVR (peri-procedural/30-days, 1, 2, and 3 yrs). Data on the incidence of stroke/TIA was extracted from studies that used the Valve

Academic Research Consortium criteria and a comparison of stroke/TIA incidence between TAVR vs. surgical AVR, transfemoral (TF) vs. transapical (TA) approach, and self-expanding vs. balloon expanding valves is reported.

Results:
Peri-procedural stroke/TIA incidence after TAVR ranged from 1.6% to 5.5%. Incidence rates from the registries and meta-analyses were lower (2.3 - 2.8%) than those reported in the randomized clinical trials (RCTs) (4.6 - 5.5%). At 1-yr, pooled incidence rates from meta-analyses and RCTs ranged from 3.8 - 4.5% and 7.6 - 8.8%, respectively. Incidence at 2 and 3 yrs was 11.2% and 8.2% as reported in the RCT.

Meta-analyses revealed no difference in incidence rates between TAVR and SAVR at 30-d or 1 yr, but one RCT suggested a higher incidence of stroke/TIA with

TAVR at both these intervals. At 3 yrs, the stroke/TIA incidence incidence rates were similar between TAVR and SAVR. No difference in stroke incidence between the TF-TAVR and TA-TAVR approaches or the valve type was noted.

Conclusions:
In comparison to SAVR, existing data indicates a marginally higher incidence of stroke with TAVR during the peri-procedural period. Inconsistencies were noted in long term clinical outcomes including stroke/TIA incidence with TAVR. Future research should focus on patient selection, improvement in valve technology and procedural techniques to minimize the observed risk.
Abstract T MP116: Coated-Platelets Predict Stroke at 30 days in Patients with Transient Ischemic Attack
Authors: Kirkpatrick Angelia , Vincent Andrea , Dale George , Prodan Calin
Published: July 2021

Background:
Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, support a robust prothrombinase activity and provide a unique measure of platelet thrombotic potential. Coated-platelet levels are increased both in non-lacunar stroke and transient ischemic attack (TIA) compared to controls free of stroke or TIA. In addition, higher levels in non-lacunar stroke are associated with stroke recurrence. We now examine whether coated-platelet levels predict stroke at 30 days in TIA patients.

Methods:
Consecutive patients with a diagnosis of TIA established by a board certified neurologist were enrolled in this pilot study. The diagnosis was consistent with the tissue-based definition of TIA: a transient episode of neurological dysfunction without acute infarction. The absence of infarction was demonstrated by normal brain imaging studies. Those taking anticoagulants or with dementia were excluded. Coated-platelets were determined at baseline and reported as percent of cells converted to coated-platelets. A receiver operating characteristic curve (ROC) analysis was conducted to compare the ability of coated-platelets versus chance alone to predict incident stroke at 30 days.

Results:
We enrolled 171 patients. Ten strokes were observed at 30 days. ROC analysis showed significant improvement in the predictive ability of the coated-platelets model compared to chance (AUC: 0.78 ± 0.07 versus 0.50 ± 0, respectively; p < 0.0001). A cut-off of 51.1% for coated-platelet levels yielded a sensitivity of 0.80 (0.55-1.0; 95% CI), specificity of 0.73 (0.66-0.80), positive predictive value of 0.16 (0.06-0.26), and a negative predictive value of 0.98 (0.96-1.0).

Conclusions:
Among these subjects with TIA, coated platelet levels <51.1% at time of presentation had a negative predictive value of 98% for stroke at 30 days. These findings suggest a role for coated-platelets in stroke risk stratification following TIA.
Abstract T MP2: Infarct Pattern After Reperfusion: A Voxel Based Analysis
Authors: Antoniello Daniel , Rosenberg Jon
Published: July 2021

Background and purpose:
Recanalization reduces final infarct volume, an important predictor of clinical outcome. Lesion location is also a determinant of outcome, however, the extent to which recanalization affects lesion topography has yet to be explored. Are there brain regions more likely to be spared if recanalization occurs? We investigated this question by using voxel-based lesion mapping to examine the effect of recanalization on infarct topography in middle cerebral artery (MCA) occlusion.

Methods:
Consecutive patients with acute stroke from MCA occlusion were examined to identify brain regions characteristically spared with recanalization (R+) (TICI 2a to 3), but damaged in patients with persistent occlusions (R-). The lesions were drawn directly on the MRI or CT images and then transformed into stereotaxic space using MRIcroN software. Lesions were superimposed to create voxel-based lesion plots for each group. A leibemeister test was performed comparing the two groups at every brain voxel, with Bonferroni correction.

Results:
Twenty-one patients were included: 11 had endovascular recanalization (R+) and 10 received no or unsuccessful treatment (R-). The figure shows the lesion overlay plots and the statistical map resulting from the analysis. In total, 5,250,682 voxels were tested, yielding a Bonferroni corrected P <0.05 threshold of Z=5.6. No voxels were significantly more likely to be spared with recanalization. Mean stroke volumes were not significantly different (R-138cc, R+164 cc, P>0.1).

Conclusions:
Our analysis did not reveal brain regions characteristically spared with recanalization. Prior studies have shown reduced infarct volume after recanalization; ours did not, and this may be the underlying reason why no salvage pattern was observed. The effect of recanalization on stroke topography remains an important, unexplored area. We have shown that voxel-based lesion mapping has potential as a biomarker in endovascular therapy.
Abstract T MP21: Administration Of Atorvastatin During Angiogenesis After Stroke Promotes Long-term Restoration Of BBB In Peri-infarct Regions Of Rat Brains
Authors: Salayandia Victor M , Yang Yi R , Yang Lisa , Thompson Jeffrey F , Yang Yi
Published: July 2021

Our previous study shows that the newly formed vessels in peri-infarct regions of ischemic hemispheres have hyperperfusion and high blood-brain barrier (BBB) permeability at 3 weeks after stroke. This is due to lack of tight junction proteins (TJP), occludin and ZO-1, in endothelial cells of the new vessels. We proposed that at this stage pro-angiogenic agents could be used to facilitate restoration of BBB to promote functional neurovascular remodeling in peri-infarct regions. In this study, we investigated the effects of atorvastatin, as a pro-angiogenic agent, on the brain recovery stage after stroke.

Adult spontaneously hypertensive rats had a transient middle cerebral artery occlusion (MCAO) with reperfusion. Atorvastatin, at a low dose of 3 mg/kg, was delivered daily starting at 14 days after MCAO for 7 days via gavage. Multimodal MRI and behavioral test were performed at different times up to 8 weeks after MCAO. Animals were sacrificed at 8 weeks for immunohistochemical and biochemical analyses.

Multimodal MRI showed that treatment with atorvastatin reduced core-infarct size and restored cerebral blood flow compared with vehicle treated brain. RotoRod tests demonstrated that atorvastatin improves long-term behavioral outcome of the stroke rats. At 8 weeks, treatment with atorvastatin markedly increased expression of occludin and ZO-1 in pericytes and endothelial cells of angiogenic vessels in peri-infarct areas. Importantly, ZO-1, which was found in pericytes surrounding the angiogenic vessels, was seen in the endothelial cell forming continuous-line-like structure in atorvastatin treated brain. Factors associated with angiogenesis, such as VEGF-A, TGF-β1, and Alk-1, were significantly increased in atorvastatin treated group. We also found that atorvastatin significantly increased expression of connexin 43, which forms gap junctions to transfer molecules between cells, in pericytes and astrocytes surrounding the new vessels.

Our results indicate that treatment with low-dose atorvastatin during recovery can stabilize the newly formed vessels and facilitate full development of BBB. Pericytes and astrocytes play a key role in determination of functional BBB restoration.
Abstract T MP29: Contrast-Enhanced Ultrasound is Useful for Detection of Vulnerable Plaques
Authors: Motoyama Rie , Saito Kozue , Tonomura Shuichi , Ueda Hatsue I , Kataoka Hiroharu , Iihara Koji , Takahashi Jun C , Toyoda Kazunori , Nagatsuka Kazuyuki
Published: July 2021

Background and Purpose:
Vulnerable plaques of carotid arteries are characterized as the presence of large necrotic core, intraplaque hemorrhage (IPH), intraplaque neovascularization (IPN), and active inflammation with thin fibrous cap. MRI is widely used for the qualitative evaluation of the plaques in vivo and the high-intensity plaques (HIP) on magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images indicate containing necrotic cores with IPH, which indicates vulnerable plaques. However, we encounter the symptomatic cases without the presence of HIP on MPRAGE in clinical practice. Recent studies showed the efficacy for the evaluation of IPN using contrast-enhanced ultrasound (CEUS). We aimed to assess the vulnerability of the plaques without high intensity on MPRAGE images using CEUS.

Methods:
Between July 2010 and June 2014, we enrolled 69 patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and preoperatively examined CEUS and MRI (MPRAGE). All plaques were evaluated with CEUS and the contrast effects were classified semi-quantitatively (grade 0: absent, 1: small, 2: large, 3: extensive). We also divided the plaques into two groups (HIP group or non-HIP group) based on the signal intensity of the plaques on MPRAGE images. The results of MRI and CEUS were compared with histopathological findings of CEA specimens.

Results:
Fifty-eight plaques of all 69 patients showed HIP (41 were symptomatic), and eleven plaques were non-HIP (five were symptomatic: amaurosis fugax in three, cerebral infarction in two). In non-HIP group, symptomatic plaques were more enhanced (three in grade 2, two in grade 3) than asymptomatic plaques (one in grade 0, five in grade 1) using CEUS. Histopathological findings of all five CEA specimens from symptomatic patients showed that extensive IPN, large necrotic core, and active inflammation with thin fibrous cap which indicated vulnerable plaques, but small amount of IPH. These histological findings were compatible with the results of CEUS and MRI findings.

Conclusion:
CEUS may be useful for diagnosis of vulnerable plaques without high intensity on MPRAGE images.
Abstract T MP45: Incidence, Predictors And Mortality Related To Post-stroke Antidepressant Treatment
Authors: Mortensen Janne K , Larsson Heidi , Johnsen Søren P , Andersen Grethe
Published: July 2021

Objective:
To examine incidence, predictors and mortality related to antidepressant treatment after ischemic stroke in a clinical setting.

Methods:
Patients were identified from the Danish Stroke Registry which holds information on antidepressant treatment due to post stroke depression (PSD) and pathological crying (PC) from 2003-2010. Treatment initiation and mortality were analyzed using Kaplan-Meier curves and Cox regression. Potential predictors of antidepressant treatment were identified using multiple logistic regression.

Results:
Among 5070 first ever stroke patients without prior antidepressant treatment, 32.5% were treated with antidepressants within six months after stroke, primarily with selective serotonin reuptake inhibitors. Approximately half of the treated patients started treatment during stroke admission (mean time after stroke: 7 days for PC and 10 days for PSD). The vast majority of treated patients started treatment within 90 days (86%). Among patients treated during admission 93.1% redeemed at least one prescription after discharge. The predictor most strongly associated with treatment was stroke severity. The adjusted hazard ratio of death was 0.39 (95% CI: 0.31-0.48) for treated patients as compared to non-treated patients.

Conclusion:
Antidepressant treatment after stroke was common and often initiated early. Although increasing stroke severity was a strong predictor of antidepressant treatment, treatment was associated with a lower mortality.
Abstract T MP51: Relation of Spontaneous Microembolic Signals to Stratification of Risk, Recurrence and Morbi-mortality of Ischemic Stroke by Transcranial Doppler: A Prospective Trial
Authors: Bazan Rodrigo , Braga Gabriel P , Bazan Silméia G , Hueb João C , Sobreira Marcone L , Luvizutto Gustavo J , Leite João P , Pontes-Neto Octávio M
Published: July 2021

Background:
The role of spontaneous microemboli signals (MES) by Transcranial Doppler (TCD) in the acute phase of stroke has been studied little and has potential application for locating emboligenic source and for predicting risk. We assessed the hypothesis that investigating MES prevalence in the acute phase of stroke is related to risk stratification, stroke recurrence and morbi-mortality. Methods: This is an analytic observational study of a single non-concurrent cohort with 111 patients diagnosed with ischemic stroke of anterior circulation in the first 48 hours of ictus. All patients underwent monitoring of the middle cerebral arteries by TCD for at least 30 minutes. The examiner who conducted the monitoring was unaware of the risk stratification of the patient (single-blinded). Then, the examination record was independently analyzed by two neurologists to identify the MES. After monitoring, risk stratification was carried out for all patients by complementary examinations; the recurrence and morbi-mortality were evaluated by ambulatory monitoring for months. The relation between risk factors, stratified for risk with MES was obtained by Odds-Ratio taking into consideration confounding factors (thrombolysis and anticoagulation level) at the moment of monitoring, and the relation of MES to stroke recurrence and morbi-mortality by multiple regression logistics, considering values statistically significant if p<0.05. Results: Of the 111 patients studied, 70 were male (63.1%), 90 white (81.1%), with median age of 68 years. The MES frequency was 7% in the total sample. There was a relation between MES and symptomatic carotid disease (OR=22.7;CI95%=(4.1-125.7);p<0.001), shorter time between ictus and monitoring commencement (OR=12.4; CI95%=(1.4-105.4);p=0.02), and stroke recurrence (OR=16.83;CI95%=(2.01-141);p=0.009). MES was not significantly related to morbi-mortality (OR=1.7;CI95%=(0.28-10.90);p=0.547), or to such risk factors as cardioembolic source or atrial fibrillation. Conclusions: It was found that MES detection shows higher correlation with symptomatic carotid disease, and shorter time between ictus and monitoring commencement, in addition to the presence of MES as a predictor for stroke occurrence.
Abstract T MP52: Probabilistic Atlasing of Acute Ischemic Stroke Topology
Authors: Ichwan Daniel , Scalzo Fabien , Liu Dezhi , Bergsneider Brandon , Anderson Ariana , Liebeskind David
Published: July 2021

Background:
Knowing which areas of the brain are most vulnerable to acute ischemic stroke can focus care on more effective, targeted therapies. By displaying lesion incidence, these susceptible regions are clearly illustrated and can be correlated with characteristics common to that population. While previous studies created DWI lesion atlases, we aimed to map the spatio-temporal topology of multi-modal MRI sequences from a large cohort of stroke patients onto a standard atlas coordinate system.

Methods:
Pre-treatment ADC and perfusion-weighted imaging (PWI) and post-treatment FLAIR MRI sequences for 241 acute ischemic stroke patients which were retrospectively processed. Lesion locations were circumscribed semi-automatically on the ADC and FLAIR images. Perfusion parameters were extracted from the PWI images using Bayesian hemodynamic parameter estimation. To account for anatomical variation, custom software was created to co-register the MRIs onto an atlas. Decomposing by NIHSS score items, the software then created probabilistic maps by overlaying and averaging the subgroup’s lesions and parameters within the atlas.

Results:
An multi-dimensional set of annotated, co-registered stroke images for ADC, PWI and FLAIR sequences was established. Incidence maps based on NIHSS score items displayed anatomic localization of presenting symptoms in various imaging modes, before and after reperfusion or other therapies (Figure). A software suite was produced that co-registers, atlases, and calculates incidence maps for any set of images.

Conclusions:
A framework to obtain spatial incidence maps was applied to ADC, PWI and FLAIR MRI of ischemic stroke. This instrument can co-register any annotated imaging parameters and compute lesion maps for any metric of interest. This novel atlasing method may be used to elucidate stroke etiology, predict lesion progression and identify optimal treatments based on individual imaging features at presentation.
Abstract T MP60: Impact of Aortic Arch Atheroma for Stroke Recurrence in Patients With or Without Atrial Fibrillation
Authors: Fujimoto Shigeru , Osaki Masato , Kumamoto Masaya , Kanazawa Makoto , Tagawa Naoki , Ishitsuka Takao , Kitazono Takanari
Published: July 2021

Background & Purpose:
In patients with embolic stroke of undetermined source, aortic arch atheroma evaluated using transesophageal echocardiography (TEE) is a possible embolic source. We investigated the impact of embolic sources including aortic arch atheroma for a stroke recurrences and death.

Methods:
Among the consecutive 1545 acute stroke patients, 542 patients who were admitted within 24 hours after the symptom onset, with ischemic lesions in the cortex or cerebellum on the diffusion-weighted image, NIH stroke scale of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. All 542 patients underwent TEE to search for embolic sources. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for average period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources.

Results:
Stroke recurrences were observed in 12.0% patients in group A, 11.8% patients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recurrence-free survival among the four groups (p=0.0076, log-rank test). Stroke recurrence was more frequent in group B than group C patients especially in the early phase from the onset. On COX proportional-hazards model analysis and diabetes mellitus (HR 1.73, p=0.0264) and aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146) were significant predictors for stroke recurrences and death from any cause.

Conclusions:
Severe aortic arch atheroma can independently be associated with stroke recurrences and death, furthermore, a combination of aortic arch atheroma and cardiogenic embolic sources showed more frequent events than each of them alone.
Abstract T MP65: Rate of Peri-Hematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage
Authors: Urday Sebastian , Beslow Lauren A , Goldstein David , Dai Feng , Zhang Fan , Vashkevich Anastasia , Ayres Alison , Battey Thomas W , Simard Marc J , Rosand Jonathan , Kimberly Taylor W , Sheth Kevin N
Published: July 2021

Background and Purpose:
There have been conflicting reports regarding the association between peri-hematomal edema (PHE) in spontaneous intracerebral hemorrhage (ICH) and outcome. We hypothesized that PHE expansion rate from baseline to 24 hours predicts mortality and poor functional outcome after ICH.

Methods:
ICH, PHE and intraventricular hemorrhage volumes were measured for 139 subjects who presented with primary ICH and received head computed tomography scans at baseline and 24-hours post-ICH. Subjects were retrospectively identified from a prospective cohort study of ICH. Inclusion criteria were age over 18 years with primary spontaneous supratentorial ICH. Exclusion criteria were infratentorial hemorrhage, primary intraventricular hemorrhage, or any suspected cause of secondary ICH. Logistic regression was performed to evaluate the relationship between PHE expansion rate and 90-day mortality and functional outcome. Poor functional outcome was defined as a modified Rankin Scale (mRS) score > 2.

Results:
There was a strong association between PHE expansion rate and mortality (OR 1.42, p = 0.0025) and a trend in the correlation between PHE expansion rate and poor outcome (OR 1.50, p = 0.07). In a multivariable model accounting for hematoma volume and time from symptom onset to 24 hour scan, PHE expansion rate was a significant predictor of mortality (OR 1.07, p = 0.032). In a multivariable model accounting for hematoma volume, age, Glasgow Coma Scale score, presence of intraventricular hemorrhage and time from symptom onset to 24 hour scan, PHE expansion rate predicted poor functional outcome (OR 2.58, p = 0.05).

Conclusions:
PHE expansion rate predicts outcome in ICH and may represent a novel therapeutic target.
Abstract T MP67: Different Hematoma Volume Threshold to Predict Favorable Outcome in Basal Ganglia and Thalamic Hemorrhage
Authors: Nakagawa Kazuma , King Sage L , Vento Megan A , Ing Marissa M , Stern Tracy S , Dittrich Denise N , Seto Todd B
Published: July 2021

Background and Purpose:
Hematoma volume is the strongest predictor of outcome in intracerebral hemorrhage (ICH). Historically, basal ganglia (BG) and thalamic ICH have been aggregated as “deep” ICH in the prior studies. We assessed whether BG and thalamic ICH have different hematoma volume threshold that is associated with 3-month functional outcome.

Design/Methods:
From a prospective observational cohort study of ICH patients between July 2011 and May 2014, we compared the hematoma volume of groups that achieved favorable outcome (modified Rankin Scale of 0-2) and unfavorable outcome (modified Rankin Scale of 3-6) at 3 months in BG and thalamic ICH patients. Based on the hematoma size analyses, four different ICH Score models were tested for their accuracy in predicting favorable 3-month outcome, using each component of the original ICH Score except for the hematoma size threshold: ≥30 mL (model 1), ≥15 mL (model 2), ≥10 mL (model 3), and ≥5 mL (model 4).

Results:
A total of 108 deep ICH patients (60 BG, 48 thalamic) with available 3-month outcome data were studied. For BG ICH, median hematoma volume for favorable outcome group was 10.7 mL [6.2-14.4] and unfavorable outcome group was 40.1 mL [21.0-86.3] (p<0.001). For thalamic ICH, median hematoma volume for favorable outcome group was 2.7 mL [1.2-9.9] and unfavorable outcome group was 9.8 mL [5.4-20.4] (p=0.002). For BG ICH, an area under the ROC curve for the different models of ICH Score was 0.85 (model 1), 0.88 (model 2), 0.84 (model 3), and 0.80 (model 4). For thalamic ICH, an area under the ROC curve was 0.86 (model 1), 0.87 (model 2), 0.85 (model 3), and 0.89 (model 4).

Conclusions:
Basal ganglia and thalamic ICH have different hematoma volume threshold that is associated with favorable 3-month outcome. Hematoma volume threshold of 15 mL for BG ICH and 5 mL for thalamic ICH may enhance the ICH Score for predicting favorable functional outcome.
Abstract T MP84: Quality of Stroke Care in India: the Indo-US Stroke Project
Authors: Singhal Aneesh B , PN Sylaja , Khurana Dheeraj , Kaul Subhash , Padma MV , Arora Deepti , Kaur Paramdeep , Schwamm Lee H , Pandian Jeyaraj D
Published: July 2021

Background:
There is limited information concerning the quality of care and outcomes after stroke in developing countries. We investigated stroke quality in 5 high-volume academic tertiary hospitals across India, using measures derived from the AHA GWTG-Stroke program.

Methods:
The Indo-US Stroke Registry and Infrastructure Development Project, jointly funded by NINDS and the Indian Dept. of Biotechnology, includes 5 large academic centers in India and one in the US. Trained MD co-investigators and research coordinators prospectively collect data on consecutive adults with imaging-confirmed ischemic stroke <2 weeks after symptom onset. Data is entered into a web-based electronic database. The enrollment goal is 2000 subjects.

Results:
From November-12 to July-14, we enrolled 1944 patients across the 5 Indian centers. Mean age 58±14y (range 18-92), 67.3% males; median NIHSS 10. IV tPA was given to 11%, including 139/188 patients arriving 0-3 h and 76/98 arriving 3-4.5 hrs after onset; 57(3%) received IA lysis. By the end of Day 2, 91% received antithrombotics and 45% received DVT prophylaxis. Dysphagia screening prior to oral intake was completed in 1438 (75%); 44% failed the screen and 26% remained NPO during hospitalization. In-hospital complications included pneumonia (13%), DVT/PE (2%), and UTI (10%; nearly all had indwelling Foley catheters). Lipid panel obtained in 85% and HemoglobinA1C in 61%. Discharge meds included antiplatelets (90%), anticoagulants (23%), and lipid lowering agents (83%). Of 178 patients with atrial fibrillation, 84% were discharged on anticoagulation. Discharge education included information about stroke risk factors and awareness (93%), emergent evaluation for new symptoms (93%), prescribed medications (93%), smoking cessation (3%). In-hospital mortality was 6.4%; 66% were assessed for rehabilitation but 86% were discharged home.

Conclusion:
These data provide insights about stroke quality of care in large academic Indian hospitals, and suggest underuse of guideline-based care. Opportunities exist for establishing programs like GWTG-Stroke in India.
Abstract T MP9: Primary Thrombectomy Within 3 Hours Of Onset In Acute Ischemic Stroke From Occlusion Of Middle Cerebral Artery- A Pilot Study
Authors: Lodi Yahia M , Reddy Varun V , Hourani Anas , Shehadeh Karmel , Chou Joe , Devasenapathy Ashok , Petro George
Published: July 2021

Background:
Acute ischemic stroke (AIS) due to large artery occlusion (LAO) with high NIHSS (>10), especially in internal carotid artery terminus (ICA-T) are resistant to IV thrombolysis and endovascular thrombectomy is associated with better recanalization rates. IV thrombolysis in large clot burden (>8mm) (LCB) in the middle cerebral artery (MCA) is associated with poor recanalization and may impact outcome. However, thrombectomy in AIS with LAO within 3 hours is performed as secondary therapy after IV thrombolysis. Objectives: To evaluate the feasibility, safety and recanalization rate of primary thrombectomy within 3 hours in AIS with NIHSS >10 from occlusion of MCA with LCB. Additionally, we like to report the functional outcome. Methods: Based on institutionally approved protocol patients with LAO (ICA-T, MCA, vertebral-basilar artery) with LCB within 3 hours were offered primary thrombectomy as an alternative to IV rtPA. They were entered into a stroke database. Patients who underwent primary MCA thrombectomy within 3 hours from 2012 to 2014 were retrospectively analyzed using SAS software. Outcomes were measured using modified Rankin Scale (mRS).Results: 10 patients with MCA occlusion ;mean age 65±15.87 years and mean NIHSS 16±; chose primary thrombectomy after informed consent. Thrombectomy was performed using stent-retriever device in addition to intra-arterial rtPA (2-4 mg). Mean number of passes was 1.4±.7. Near complete (TICI2b) and complete (TICI3) recanalization was observed in all patients. Mean time to recanalization from symptoms onset was 160±37 minutes. Immediate post-thrombectomy, 24 hour and 30 day NIHSS score was 2.6±1.4, 1.9±3.7 and 0 respectively. There was no procedure related complication. Asymptomatic perfusion related hemorrhage developed in 3 patients. 30 day good outcome was observed in all cases (mRS0= 30%, mRS1=50%, mRS2=20%).Conclusion: Our pilot study demonstrates that primary thrombectomy in AIS due to MCA occlusion with LCB is not only feasible and safe, but associated with complete recanalization and good functional outcome. Larger randomized controlled studies are needed.
Abstract T MP92: Variation of Blood Pressure Response of Antihypertensive Agents in Acute Intracerebral Hemorrhage (ICH)
Authors: Lin Wei-Chen , Langefeld Carl D , Koch Sebastian , Moomaw Charles J , Chan Yu-Feng Y , Sheth Kevin N , Sekar Padmini , Osborne Jennifer , Woo Daniel
Published: July 2021

Objectives:
Elevated blood pressure (BP) in ICH often requires urgent treatment. Prior studies have shown racial-ethnic differences in response to chronic antihypertensive treatment. Racial-ethnic differences and specific locations of ICH may impact the response to acute antihypertensive treatment (aHTN) in ICH. The aim of this study was to analyze variation of response to aHTN drugs by race-ethnicity and location of ICH.

Methods:
We included individuals recruited through the Ethnic/Racial Variations of Intracerebral Hemorrhage study with elevated BP on presentation and received labetalol, nicardipine, or hydralazine as the initial aHTN or who received no treatment despite elevated BP. We excluded individuals treated with multiple aHTN, treated with other aHTN, or lacking documentation of dose. The primary outcome measure was mmHg change in BP per 10 mg of drug administered. Changes in BP were tested using the Wilcoxon rank sum test.

Results:
A total of 1153 cases were available for analyses (35% white, 34% black, 31% Hispanic). Blacks were most likely to be treated acutely (52%), followed by Hispanics and whites (41%; 34%; p<0.01). For all three aHTN drugs, no significant racial-ethnic difference in systolic (SBP) or diastolic (DBP) response was found (p=0.92 for SBP; p=0.17 for DBP). Neither SBP nor DBP response differed by drug for lobar (p=0.36 SBP; p=0.25 DBP), deep (p=0.99 SBP; p=0.29 DBP) or posterior fossa (p=0.26 SBP, p=0.11 DBP) locations.

Conclusion:
In this large, multiethnic study of ICH, we are unable to detect a difference in BP response to hydralazine, labetalol, and nicardipine across race-ethnicity or locations of ICH. This finding suggests that the most commonly used aHTN agents in ICH regimens do not need to be tailored to ethnicity or ICH location. A larger cohort may provide greater power to detect a smaller difference between the agents.
Abstract T MP94: Venous Thromboembolism Complications In Patients With Intracerebral Hemorrhage
Authors: Osborne Jennifer , Testai Fernando , Sekar Padmini , Moomaw Charles J , James Michael L , Vashkevich Anastasia , Flaherty Matthew L , Woo Daniel
Published: July 2021

Introduction:
Intracerebral hemorrhage (ICH) is often more severe than ischemic stroke. Venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE) can extend length of stay and impede recovery. For ICH patients, there is the added challenge of timing and dosage of anticoagulation used to prevent VTEs. We sought to describe the rate of VTE and factors associated with it among ICH cases in a multi-ethnic population.

Methods:
ERICH is a multi-center, prospective case-control study of ICH among white, black, and Hispanic patients. Data were collected by hospital chart review and personal interview. CT Images were collected and analyzed by a neuroimaging core. Past medical history and acute clinical data were examined for association with VTE during the hospital stay.

Results:
Between 8/1/10 and 12/31/13, 2276 cases of ICH were enrolled. CT data are available for 2038 patients. Of these, 63 had VTE complications: 41-DVT, 16-PE, and 6 - both DVT and PE. In univariate analysis, Blacks, previous history of DVT, low GCS at presentation, increased ICH volume, presence of intraventricular hemorrhage (IVH),and need for intubation. In comparison, patients at higher risk for PE were those with past medical history of PE and required intubation (Table). In addition, patients with DVT and PE had higher modified Rankin Scale at both hospital discharge and 3 months. In multivariate analysis, only previous VTE, the need for intubation and the presence of IVH were associated with DVT or PE.

Conclusion:
We confirmed within a large and ethnically diverse ICH patient population that clinically diagnosed VTE events are relatively rare at 3%. The strongest risk factor for development of DVT/PE was a prior history of DVT/PE. But the most prevalent risk factor was a need for intubation. Further study is needed to understand the efficacy of VTE preventative strategies among ICH patients.
Abstract T MP97: Stroke Awareness And Modifiable Risk Factors Of Stroke Among Community-residing Adults With Prehypertension
Authors: Song Hee-Young
Published: July 2021

Introduction:
To reduce the stroke risk and long-term disability related to the sequela of stroke in these individuals with prehypertension, it would be critical to be aware of modifiable stroke risk factors they have and control them, and to recognize warning symptoms of stroke and to present hospital right after the onset of them.

Objectives:
This study was undertaken to explore the awareness on stroke including knowledge on stroke and recognition on their own modifiable lifestyle risk factors; to identify the relationships between the level of awareness and the presence of lifestyle risk factorsamong community-residing adults with prehypertension.

Methods:
A total of 126 participants between the aged 42.2 years old were recruited by a convenient sampling in two urban areas in South Korea. Along with BP and anthropometric measurement, trained interviewers interviewed participants with a structured questionnaire including demographic characteristics; stroke awareness measured by knowledge on risk factors, symptoms, and treatment of stroke andrecognition regarding whether their BP, body weight, blood glucose, and cholesterol are within normal limits; lifestyle risk factors of participants. Data were analyzed using SPSS statistics 20.0

Results:
Mean systolic BP of participants was 128.8 mmHg and mean diastolic BP, 83.70 mmHg.The risk factors for stroke identified most by respondents were hypertension and stress. The warning symptom of stroke described by respondents most was “suddenconfusion, trouble speaking or understanding”.Only 19.6% ofrespondentsreplied that they would call an ambulance if they thought that they were having a stroke, and 35% of participants claimed that they knew whether their cholesterol levels were normal.Those who were currently non-smokers and moderate drinkers showed significantly higher level of stroke awareness (p <.05).

Conclusions:
The results suggest the desirability of improving the level of awareness of stroke among prehypertensive adults in the community.Established stroke risk factors such as heart disease and diabetes, and appropriate response including calling an ambulance at first to respond to warning symptoms should be addressed in a stroke prevention education for this population.
Abstract T P10: Therapeutic Time Window for Endovascular Therapy of Acute Ischemic Stroke Depends on THRIVE Score: A Retrospective Single-center Study
Authors: Todo Kenichi , Sakai Nobuyuki , Kono Tomoyuki , Hoshi Taku , Imamura Hirotoshi , Adachi Hidemitsu , Yamagami Hiroshi
Published: July 2021

Background and purpose:
The outcome after endovascular therapy in acute ischemic stroke is associated with onset-to-reperfusion time (ORT). The Totaled Health Risks in Vascular Events (THRIVE) score is also an important pre-thrapeutic predictor of outcome. We hypothesized that the therapeutic time window is narrower in patients with the higher THRIVE score.

Methods:
We retrospectively studied consecutive 109 ischemic stroke patients with successful reperfusion after endovascular therapy between October 2005 and March 2014 at a single institute (Kobe City Medical Center General Hospital). Inclusion criteria was as follows: National Institutes of Health Stroke Scale (NIHSS) score ≥8, stroke symptom duration ≤8 h, premorbid modified Rankin Scale (mRS) score ≤2, and thrombolysis myocardial infarction score 2-3. We analyzed the relationships of ORT, THRIVE score, and THRIVE+ORT score with good outcome (mRS ≤2 at 3 months). The THRIVE+ORT score was defined as the sum of the THRIVE score and ORT (h).

Results:
Median ORT was 5.5 h (IQR; 4.4-7.1 h), median THRIVE score was 5 (IQR; 4-6), and median THRIVE+ORT score was 10.8 (IQR; 9.2-12.5). Good outcome rates for patients with ORT ≤4 h, >4 and ≤6 h, >6 and ≤8 h, and >8h were 50.0%, 45.8%, 37.0%, and 21.4%, respectively (p=0.3), those with THRIVE score ≤3, >3 and ≤5, >5 and ≤7, and >7 were 57.1%, 51.4%, 28.3%, and 20.0%, respectively (p9 and ≤11, >11 and ≤13, and >13 were 64.0%, 44.1%, 34.4%, and 16.7%, respectively (p<0.05). Multivariate logistic regression analysis revealed that THRIVE+ORT score was an independent predictor of good outcome after adjusted for THRIVE score (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.082-1.728) or after adjusted for ORT (OR, 1.517: 95% CI, 1.160-1.983).

Conclusion:
Our study showed that THRIVE+ORT score was associated with outcome that was independent from THRIVE score or ORT. This is the first report to suggest that patients with the higher THRIVE score require the shorter ORT for good outcome.
Abstract T P109: Prediction Of Asymptomatic Cerebrovascular Diseases Before Bypass Surgery For Peripheral Artery Disease
Authors: Kumamoto Masaya , Fujimoto Shigeru , Oosaki Masato , Kanazawa Makoto , Tagawa Naoki , Nakamizo Akira , Inoue Takuya , Tuchimochi Ryosuke , Ishitsuka Takao
Published: July 2021

Background & Purpose:
Cerebrovascular disease (CVD) and peripheral artery disease (PAD) sometimes coexist with each other. We investigated predictive factors for CVD before bypass surgery for PAD.

Subjects & Methods:
For the present study, 200 consecutive PAD patients who were planned to undergo a bypass surgery for their lower extremity artery were included. Before the surgery, all patients were studied by ankle brachial index (ABI), duplex carotid ultrasonography, magnetic resonance imaging (MRI) including diffusion weighted imaging (DWI), and MR angiography. A stenosis of ≥50% or occlusion of the major intracranial or extracranial cerebral arteries was defined as a significant CVD. We also investigated the predictive factors for significant cerebrovascular lesions.

Results:
Of the total 200 patients (137 men; 69%, 74±9 years old) studied, a significant CVD of the intracranial or extracranial cerebral arteries was observed in 104 (52%) patients: 57 (29%) in intracranial arteries and 68 (34%) in extracranial arteries. There were asymptomatic ischemic lesions on MRI in 116 (59%) patients. Among them, 13 (7%) patients had asymptomatic high-intense lesions on DWI. In patients with significant CVDs, dyslipidemia (63% vs 47%, p=0.0455), diabetes mellitus (67% vs 37%, p<0.001), prior ischemic stroke (65% vs 48%, p=0.0328), and prior ischemic heart disease (63% vs 46%, p=0.0189) were more frequent, and ABI value was lower (0.34 vs 0.45, p=0.0369) in comparison to patients without CVDs. On ROC curve analysis, the most accurate ABI cut-off value for predicting significant CVDs was 0.46. Prevalence of CVDs tended to increase with the increasing number of risk factors described above (44% in patient with 1, 56% in patient with 2, 71% in patient with 3, 69% in patient with 4, 80% in patient with 5; P<0.0001 for armitage trend). On multivariate analysis, dyslipidemia (OR, 1.93; 95% CI, 1.00-3.81) and diabetes mellitus (OR, 3.06; 95% CI, 1.62-5.86) were independent predictors for significant CVDs.

Conclusions:
In PAD patients before the bypass surgery, significant CVDs were observed in 52%. Dyslipidemia and diabetes mellitus were independent predictors for significant CVDs. Number of the predictive factors was also important for predicting CVDs.
Abstract T P112: The Effect of Monoaminergic Drugs on Motor Cortex Excitability, Motor Performance and Psychophysics
Authors: Belagaje Samir R , Kesar Trisha , Pergami Paola , Korb Charles , Hobbs Gerald , Buetefisch Cathrin
Published: July 2021

INTRODUCTION:
The benefit of pharmacologic augmentation of stroke recovery remains unclear. As post-stroke motor recovery depends on training-dependent plasticity, we wanted to test the effect of these drugs on the excitability of primary motor cortex (M1), kinematic and psychophysical measures.

METHODS:
Nine able-bodied individuals (4 males) participated in 4 test sessions at least 1 week apart during which they were administered one oral dose of 4 different medications: placebo (P), amphetamine 10mg (A), methylphenidate 20mg (M), carbidopa/levodopa 25/100mg (D). We used transcranial magnetic stimulation (TMS) to measure the effects of the different drugs on M1 excitability. Motor evoked potentials (MEP) were elicited using TMS at intensities of 35-80% of maximum stimulator output. The Boltzmann function was calculated for MEP amplitudes and compared across the 4 drug conditions. The effects of the drugs on psychophysics and movement kinematics were captured by a 2d accelerometer mounted on the dorsum of the hand. We measured the reaction time and the peak acceleration and dispersion of directions of auditory paced ballistic wrist extension movements.

RESULTS:
Comparison of the 4 different equations for the Boltzmann sigmoid curve where R max represents the maximum MEP amplitude; k, the slope of the curve; and S50, the intensity that produced half of the maximum MEP amplitude revealed significant differences between drug conditions. Compared to P, A led to a significant decrease in the maximum MEP amplitude (p= 0.00015), while D increased it (p=0.013). The other two parameters were similar to placebo. M had no effect on any of the three parameters. The different drugs had no statistically significant effect on the kinematic measures or reaction time.

CONCLUSIONS:
These results indicate that the neuromodulatory effect of drugs on M1 excitability differs, which may point to different mechanisms mediating the beneficial effects of these drugs on functional recovery after stroke. It would also support the notion that the beneficial effect of the drugs on recovery is likely due to improved kinematics or psychophysics of executions during training.
Abstract T P123: Impairment in Cognitively Demanding Driving Situations after Acute Mild Ischemic Stroke
Authors: Hird Megan A , Vesely Kristin A , Christie Leah E , Alves Melissa A , Pongmoragot Jitphapa , Saposnik Gustavo , Schweizer Tom A ,   Stroke Outcomes Rsch Canada Working Group
Published: July 2021

Introduction:
Guidelines established by prominent governing bodies recommend that patients should wait a minimum of one month before resuming driving after stroke; however, these guidelines are not based on empirical evidence. Furthermore, many patients report resuming driving within the one-month period post-stroke. The aim of this study was to investigate the driving performance of mild stroke patients within the acute phase of injury. It was hypothesized that patients with acute stroke would exhibit more errors in general (e.g. collisions, speed exceedances, centre line crossings) and during cognitively demanding aspects of driving (i.e. left turns with traffic), but not routine aspects of driving (i.e. straight driving and right turns).

Methods:
The current study used driving simulator technology (STISIM) to compare the driving performance of 10 patients with acute mild ischemic stroke (NIHSS<7, within 7 days post-stroke) to that of 10 healthy, age- and education-matched controls. Patients and controls completed several driving tasks that increased in complexity, from routine right and left turns to cognitively demanding left turns with traffic, where most accidents occur, and a bus following task, which requires a high degree of sustained attention.

Results:
On average, stroke patients committed over twice as many errors as controls (12.4 vs 6.0, p< 0.01). Although there was no difference between patients and controls in the number of errors committed during routine right and left turns, patients committed more errors during left turns with traffic (2.4 vs 1.3, p<0.05) and a bus following task (8.2 vs 2.1, p<0.05).

Conclusions:
Patients with acute mild ischemic stroke may be able to maintain driving performance during basic tasks (e.g. straight driving, right turns) and deficits may become apparent during cognitively complex tasks (e.g. left turns with traffic and bus following). The results highlight the importance of healthcare professionals providing driving advice to their patients post-stroke, particularly in the acute phase of injury. Future longitudinal research is required to determine when patients with mild stroke can safely resume driving.
Abstract T P126: Diabetes Mellitus and K-Modified Barthel Index at 6 Months after Stroke: A Prospective Multicenter Study
Authors: Jang Shin Yi , Kim Yun-Hee , Sohn Min Kyun , Lee Jongmin , Kim Deog Young , Lee Sam-Gyu , Shin Yong-Il , Oh Gyung-Jae , Lee Yang-Soo , Joo Min Cheol , Han Eun Young , Lim Young Shil , Chang Won Hyuk , Lee Ahee , Kim Jeong Hyun
Published: July 2021

Introduction:
Few studies investigated the diabetes mellitus (DM) as a predictable factor of 6 months K-Modified Barthel Index (KMBI) outcome after stroke.

Aims:
The aim of this study is to investigate whether DM predicts the outcome of KMBI at 6-month after stroke with adjustment for cardiovascular disease risk factors, socioeconomic position and health behavior factors.

Methods:
This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation (KosCo). The sample included 1,199 stroke patients aged 45-92 years. FIM score was assessed at 6 months after onset. We divided subjects into two age groups: the middle aged (45-64 year-old) and the elderly (over 65 year-old). Subjects who met one of the following requirements were defined as having DM: taking an oral hyperglycemic agent, using insulin, clinical diagnosis of diabetes, or a fasting glucose level >125 mg/dL.

Results:
The mean age of the middle aged group was 55.8(±5.44) year-old and the elderly group was 74.3(±6.14)(p<0.001). The distribution of DM was 20.8% and 28.9%, respectively (p<0.001). The mean 6-Month KMBI was 91.7 (±20.7) and 78.4 (±33.1), respectively (p<0.001). The 6-Month KMBI significantly decreased in DM group compared to the non DM group after adjustment for confounding factors. In the middle aged group, the 6-Month KMBI decreased in DM group (p<0.01), but in the elderly group.

Conclusions:
This hospital-based cohort study showed that DM may predict poor 6-Month KMBI outcome, especially, for the middle aged group (Supported by Korea Centers for Disease Control and Prevention (2013E3301701)).