bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of risk factors and development and validation of a nomogram for predicting overall survival in breast invasive lobular carcinoma
Authors: Yuan Mingjie , Yin Ying , Chu Zhaoxin , Yan Jianming
Published: January 2025

Objective: Invasive lobular carcinoma (ILC) of breast is a common pathological subtype of breast cancer, ranks second in terms of incidence rate following invasive ductal carcinoma. The aim of this study is to construct a nomogram for predicting overall survival (OS) in patients with ILC and to identify risk factors that affect their survival prognosis.
Methods: The patients diagnosed with ILC between 2010 and 2015 were extracted from Surveillance, Epidemiology, and End Results (SEER) database. They were randomly split into a training set with 18365 samples for model training and parameter tuning, and a validation set with 7872 samples for independent accuracy verification. The independent risk factors were screened by Lasso regression and multivariable Cox regression. A nomogram was constructed for the 3-year, 5-year, and 10-year overall survival rates based on these independent risk factors. Model efficiency was assessed through Harrell’s concordance index (C-index), Calibration curves, Receiver operating characteristic (ROC) curves and decision curve analysis (DCA).
Results: A total of 26,237 patients diagnosed with ILC were include. The following factors were identified as independent risk factors associated with OS: Age, Marital status, Grade, Estrogen receptor (ER), Progesterone receptor (PR), Surgery, Radiation therapy, and Tumor size(T), Lymph Node (N), and Metastasis (M) stages. The C-index was 0.795 in the training set, while in the validation set it was 0.791. The corresponding Area Under Curves (AUC) for 3-year, 5-year, and 10-year were 0.837, 0.828, and 0.791 in the training set, and 0.832, 0.826 and 0.781 in the validation set, respectively. The calibration curve of the nomogram showed good consistency, and the DCA curves also suggested that it can provide valuable guidance for clinical decision making.
Conclusions: The established nomogram predicting 3-year, 5-year, and 10-year OS for patients with ILC showed a good performance and it can help clinicians make more favorable clinical decisions.
Abstract 11: Sex differences in the association of brain frailty measures with functional outcomes after endovascular treatment: analysis of the ESCAPE-NA1 trial
Authors: Fujiwara Satoru , Fladt Joachim , Benali Faysal , Bala Fouzi , Singh Nishita , Tymianski Michael , Hill Michael , Goyal Mayank , Ganesh Aravind
Published: January 2025

Background:
Sex differences have been observed in functional outcomes after endovascular thrombectomy (EVT). Brain frailty markers like atrophy and small vessel disease burden have been shown to be associated with EVT outcomes. We aimed to investigate the association between imaging markers of brain frailty and functional outcomes after EVT in women and men.

Methods:
This study is a post hoc analysis of the ESCAPE-NA1 trial that evaluated the efficacy and safety of nerinetide in patients with large vessel occlusion receiving EVT within 12 hours of onset. Baseline CT was used to assess brain frailty markers including atrophy score, inter-caudate distance to inner table width ratio [CC/IT ratio]), white matter disease (Fazekas score), presence of lacunes and old infarctions, and follow-up MRI was used to assess microbleed and lacunes burden. Outcomes included the modified Rankin Scale (mRS) at 90 days (dichotomized as 0-2 vs 3-6, and ordinal/shift analysis). Multivariable logistic regression models were used to examine the association between imaging frailty measures and 90-day mRS separately in women and men.

Results:
A total of 1,102 participants (mean age 69.5 ± 13.7 years, 548 women) were analyzed. Women were older (74 vs. 69 years, p<0.0001), less likely to smoke (38% vs. 60%, p<0.0001), and had a lower baseline NIHSS (16 [12–21] vs. 17 [13–21], p=0.009), compared to men. Regarding imaging frailty measures, women had a lower CC/IT ratio (0.12 [0.09–0.15] vs. 0.13 [0.10–0.15], p=0.01), a higher Fazekas score (1 [0–2] vs. 0 [0–2], p<0.0001), and more frequent lacunes (27% vs. 22%, p=0.04). In the multivariable analyses, imaging frailty measures were generally associated with worse outcomes at 90-days; however, significant associations between these markers and 90-day mRS were observed only in women and not in men. CT-based markers such as cortical and subcortical atrophy, CC/IT ratio, old infarction carried significantly lower odds of 90-day mRS 0-2 in women but not men (Figure 1). Similar findings were also seen on shift analyses of the mRS. However, there were no statistically significant interactions by sex for these brain frailty measures.

Conclusion:
In this cohort of EVT recipients, significant associations between imaging brain frailty measures and 90-day outcomes were seen only in women and not in men. These findings merit validation in other cohorts as they suggest sex differences in the effects of brain frailty on post-stroke outcomes.
Abstract 23: Safety and Outcomes of the First 25 Patients Implanted with Vivistim at Atlantic Health System for Ongoing Motor Deficits Following Ischemic Stroke
Authors: Benitez Ronald , Chapple Kyle , Eskuchen Lauren , Hancock Jonathan , Hardinge Tara , Stopper Carl , Charlton Shannon , Spicka Samantha , Weiss Claire
Published: January 2025

Background:
Functional impairments following stroke remain a significant therapeutic challenge. Vivistim, FDA-approved since 2021, has shown consistent results, providing 2-3 more improvement in arm and hand function compared to intensive rehabilitation alone. At Atlantic Health System, 25 patients underwent Vivistim implantation and received Paired VNS rehabilitation.

Methods:
A multidisciplinary team at AHS identified, educated, and implanted Vivistim in 25 post-acute stroke patients with moderate-to-severe motor impairments in the arm and hand. Post-implantation, patients were referred to one of 11 sites. Regular follow-ups were conducted by the implanting team to monitor side effects, safety and efficacy of this novel intervention.

Results:
All 25 patients successfully underwent outpatient implantation, with no reported infections at the implant sites. One patient developed a hematoma that resolved without intervention. Another required device explantation approximately 410 days post-therapy due to tingling sensations near the implant site likely unrelated to the device. This patient maintained a 25-point improvement on the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) despite explantation, indicating sustained benefits. Of the 25, 22 completed the therapy protocol. The remaining three discontinued therapy due to unrelated complications: one experienced two grand mal seizures linked to changes in seizure medication, another sustained an arm injury from a fall, and the third developed double vision, impairing her ability to drive. Patient ages ranged from 40 to 80 years (mean 62.6), with time to implantation post-stroke ranging from 1 to 11 years (mean 3.6). The interval from implantation to therapy initiation varied from 8 to 32 days (mean 15.3). The baseline FMA-UE score averaged 33 (range 19-56), with an average post-therapy score of 43 (range 24-63), for a mean improvement of 9.53 points. Notably, the patient with the longest follow-up (22 months) showed continued progress, reducing her 9-Hole Peg Test time by 61.42 seconds over her assessment 6 months prior.

Conclusion:
This case series represents the largest cohort reported to date from a single implanting site in a real-world setting. Vivistim was implanted safely, with no infections or surgical complications. Patients showed positive responses to Paired VNS despite an average of 3.6 years post-stroke, supporting the efficacy of this innovative treatment in the chronic stroke population.
Abstract 24: Iron deposition changes of ipsilateral ventral posterolateral nuclei correlate with central post-stroke pain after thalamic infarction
Authors: Ye Chen , Tang Biqiu , Pan Ruosu , Kwapong William , Cao Le , Yan Yuying , Yang Tang , Zhang Xuening , Zhang Miaoqi , shuai jiang , Liu Junfeng , Tao Wendan , Lui Su , Wu Bo
Published: January 2025

Objectives:
To investigate the correlation between iron deposition changes in the lesioned thalamic nuclei and the presence and severity of central post-stroke pain (CPSP) after thalamic infarction using quantitative susceptibility mapping (QSM) technique.

Methods:
We consecutively enrolled patients with unilateral chronic thalamic infarction with radiological examination conformed . Detailed and multidimensional pain characteristics measured as follows: Douleur Neuropathique 4 (DN4) questionnaire for validation of neuropathic pain diagnosis, Short-Form McGill Pain Questionnaire (SF-MPQ) for comprehensive representation of pain experience, Present Pain Intensity index (PPI) for current pain severity upon examination, and Visual Analogue Scale (VAS) for overall pain feeling since symptom onset. Age- and sex-matched stoke-free healthy controls were recruited simultaneously. High resolution structural image 3D-T1 BRAVO and QSM sequences were obtained with 3.0T MRI. The voxel-lesion-symptom-mapping (VLSM) was used to determine lesioned thalamic nuclei at the high risk for CPSP. Then ipsilateral QSM values of the whole thalamus and subregions were compared with contralateral side and healthy controls. Partial correlation analysis were performed to explore the relationship between QSM value and pain severity.

Results:
Finally, 28 CPSP patients, 33 non-CPSP patients and 55 healthy controls were included in the study. Our results indicated no significant difference in overall QSM values of the whole thalamus among the groups. The VLSM results showed lesion involving ventral posterolateral nuclei (VPL) was highly orrelaed with occurance of CPSP (
p
FWE
=0.0092.). The QSM values of each subnuclei in the thalamus ipsilateral to infarction were lower compared with the contralateral side and healthy controls (
p
<0.001). Nonetheless, the QSM values in ipsilateral VPL were higher in CPSP patients campared with non-CPSP patients(
p
=0.003). Notably, the QSM values in the ipsilateral VPL were significantly correlated to pain severity (all
p
<0.05).

Conclusions:
The study showed that altered iron deposition in the VPL nuclei is associated with the occurrence and severity of CPSP following thalamic infarction. Aberrant iron deposition after ischemic thalamus stroke may play an important role in the pathogenesis of CPSP.

Key words:
Thalamic infarction; Central post-stoke pain; Iron deposition; VLSM; Quantitative susceptibility mapping
Abstract DP9: Enhancing Nursing Education to Improve Stroke Patient Education and Outcomes
Authors: STANEK ELSIE
Published: January 2025

Background:
Stroke is the fifth leading cause of death in Minnesota and in the United States. Stroke is a leading cause of long-term disabilities and is largely preventable (80%). Evidence indicates that patients receiving care from stroke specialized nurses, including nurse-led stroke prevention, show better outcomes. Stroke program leaders at a Primary Stroke Center identified this as an opportunity to improve stroke program education, quality of nursing care, and stroke patient outcomes.

Purpose:
The primary focus area was improving stroke-patient education to include individualized stroke risk factors. As our project progressed, the initial goal remained. The secondary focus was to see if the effect of in-person, hands-on (escape room) nurse education would improve individualized stroke-patient education compliance compared to eLearning and poster board education.

Methods:
All stroke cases from June 2023 - June 2024 were audited for documentation of individualized stroke-patient education. Utilizing stroke guidelines and scientific statements, a standardized practice of individualizing stroke-patient education was developed. Staff learning modules were developed including eLearning, unit poster board, and in-person learning (escape room). Throughout the project, completion rates of individualized stroke-patient education were compared. A nursing survey was conducted to evaluate confidence and knowledge post multimodality learning modules.

Results:
Prior to initiation of nursing learning modules, 24 hospitalized stroke-patient charts from June and July 2023 were audited for individualized stroke education (40%). After initiation of nursing learning modules, 183 hospitalized stroke-patient charts from August 2023 to June 2024 were audited for individualized stroke education (poster board 44%, eLearning 45%, escape room 75%). The post nursing learning module survey responses demonstrated improved learners’ knowledge for the interactive escape room (poster board average-good 77%, eLearning average-good 83%, escape room good-excellent 89%).

Conclusion:
By identifying educational gaps, we were able to enhance nursing education; which improved stroke-patient education and outcomes. In conclusion, nursing confidence and knowledge increased with the in-person escape room education. This suggests engaging in-person learning could be more effective in developing nursing knowledge, improving patient care, and positive patient outcomes.
Abstract TMP105: Frequency with which Patent Foramen Ovale are Causative vs Incidental in Elderly Patients with Cryptogenic Stroke
Authors: Iordanova Radostina , Liebeskind David , Saver Jeffrey
Published: January 2025

Background:
Paradoxical embolism through a PFO is a common etiologic mechanism in the 18-60 yo patients with otherwise cryptogenic stroke (CS). However, its importance as a cause of stroke in the elderly is less clear. Older individuals have more competing causes of stroke, potentially reducing the relevance of PFO-associated stroke; but they have more venous thromboembolism and greater right-to-left shunting, potentially enhancing PFO-associated stroke frequency. Clinical management would be aided by estimates of how often a PFO in an older patient with CS is causal vs. incidental.

Methods:
Through systematic search, we identified all case–control studies of the comparative frequency of PFO in patients with CS vs known stroke cause (KS). We performed a random-effects meta-analysis across these studies to determine the best estimate of the differential frequency of PFO in CS and KS among three age cohorts: 1) age 60 and older 2) age 50/55 and older; and age 70/75 and older. We then applied Bayes’ theorem to determine the probability that detected PFO is causal or incidental in these groups.

Results:
The systematic search identified: for age 60+, 1 study enrolling 397 patients (190 CS, 207 KS); for age 50/55+, 5 studies enrolling 1203 patients (534 CS, 669 KS); and for age 70/75+, 3 studies enrolling 431 patients (171 CS, 260 KS). Methods of PFO detection were TCD in 47% of patients, TTE in 5%, and TEE in 48%. Crude cumulative rates of PFO detection were: age 60+, CS 68/190 (35.8%) vs. KS 44/207 (21.3%); age 50/55+, CS 198/554 (35.7%) vs. KS 81/669 (12.1%); and age 70/75+, CS 58/171 (33.9%) vs. KS 43/260 (16.5%). In the formal meta-analyses, summary odds ratios for PFO in CS vs. KS patients were: age 60+, 2.06 (95% CI, 1.32-3.23), p = 0.001; age 50/55+, 4.23 (95% CI, 2.44-7.32), p = 0.00001;.and age 70/75+ 3.77 (95% CI, 1.27-11.24), p = 0.02. With the application of Bayes’ theorem, the corresponding probabilities indicated that, when present, PFO in patients with CS is causal in: age 60+, 51.5% (95% CI, 24.2-69.0%); age 50/55, 78.2% (95% CI, 60.4-83.9%); and age 70/75+,61.5% (95%CI, 21.0-91.1%).

Conclusion:
Although confidence intervals are wide reflecting moderate study sizes, current evidence indicates that in older patients with cryptogenic stroke and PFO, the PFO is causal in at least one half of patients. These findings support the performance of randomized trials of PFO closure in older patients with otherwise cryptogenic stroke.
Abstract TMP108: Incidence and Characteristics of Acute Ischemic Stroke after Cardiac Arrest
Authors: Trombin Marques Marina , Bao Kevin , Otero Matheus , Velasquez Gerardo , Peterson Katherine , Hemphill Claude , Hu Xiao , Sampaio Gisele , Westover Brandon , Lee Jong Woo , AmorimDe Cerqueira Edilberto
Published: January 2025

Introduction:
Brain injury is the main cause of death and disability post-cardiac arrest, and hypoxic-ischemic brain injury (HIBI) severity is associated with poor outcomes. There is limited information about the co-occurrence of acute ischemic stroke with HIBI post-cardiac arrest and its impact on outcome.

Methods:
We performed a retrospective analysis of brain MRI reports from patients with cardiac arrest in a multicenter cohort to evaluate the incidence of acute ischemic stroke and HIBI. Patients with MRI in the first 7 days after cardiac arrest were included. Patients with traumatic brain injury, intracranial hemorrhage, recent neurosurgical procedures, or ischemic stroke at admission were excluded. A secondary manual review by a board-certified vascular neurologist was pursued if the MRI report did not specify the absence of ischemic stroke. Univariate and multivariable analysis was performed to explore the characteristics of the ischemic lesions and to evaluate if it was related to poor functional outcomes (i.e., Cerebral Performance Category of 4-5).

Results:
Among 396 patients who met the inclusion criteria, 91 had cerebral infarction based on MRI (22.9%). The most common pattern of stroke was multifocal small embolic (51.6%), followed by single embolic (25.3%), watershed (12.1%), territorial (7%), and lacunar (5%). The patients with acute ischemic stroke were older (p<0.01). In the logistic regression, older age, non-witnessed cardiac arrest, and non-shockable rhythm were associated with worse prognosis (p<0.05). The presence of acute ischemic stroke was not significantly associated with the cause of arrest, percutaneous coronary intervention (PCI), or the use of targeted temperature management (TTM). Individuals with acute ischemic stroke had lower rates of HIBI (odds ratio [OR] 0,55 [0.34-0.87], p<0.01). In univariate and multivariate analysis, the presence of acute ischemic stroke was not associated with outcome, as opposed to the presence of HIBI (p<0.01).

Conclusion:
More than one-fifth of the comatose patients after cardiac arrest present acute ischemic stroke on MRI. The most common pattern is multifocal embolic, which may be related to cardiac embolism and hypercoagulable state after the arrest and not from PCI or cardiac arrest rhythm. The detection of acute ischemic stroke is higher among individuals without HIBI and is not associated with worse outcomes.
Abstract TMP111: Perivascular von Willebrand factor (VWF) promotes irregular remodeling of leptomeningeal collaterals in response to sustained increased luminal flow.
Authors: WU TING , Doan Andrea , Ahn John , Andersohn Alexander , Cruz Miguel , Yee Andrew , Kim Gab Seok , Marrelli Sean
Published: January 2025

Introduction:
VWF is an endothelial protein with known roles in hemostasis and thrombosis. We previously demonstrated abnormal deposition of VWF in the
mural
layer of leptomeningeal collateral arterioles (LMCs) during flow-induced outward remodeling. Additionally, LMC remodeling was attenuated in VWF KO mice, suggesting a modulating role for VWF. We now test the hypothesis that intramural VWF potentiates LMC remodeling in response to sustained increased luminal flow.

Methods:
VWF protein was infused into the cisterna magna (CM) of WT and VWF KO C57BL/6 mice (3-7 mos females) to deliver VWF to the perivascular space around the leptomeningeal arteries (2.5 mg/ml at 1 ul/min; 5-7ul total). To confirm successful delivery of VWF to the wall of the leptomeningeal vessels, brain surface preparations containing the cortical leptomeningeal vessels were “planed off” and evaluated for VWF and smooth muscle actin (SMA) immunofluorescence at one hour after VWF infusion (cohort 1). In a subsequent experiment, right common carotid artery ligation (rCCAL) was performed on VWF KO and WT mice to induce increased flow in collateral vessels supplying the right MCA territory (cohort 2). VWF or vehicle was injected via CM at 16 hours after the rCCAL. At 3 days post-rCCAL, the intact leptomeningeal vessel preparations were evaluated by immunofluorescence (Ki67&SMA) and morphometric analyses.

Results:
[Cohort 1] WT and VWF KO mice demonstrated exogenous VWF protein surrounding the leptomeningeal vessels and within the mural layer. VWF KO mice were used to distinguish between endogenous and exogenous VWF. [Cohort 2] At 3 days, rCCAL induced endothelial cell proliferation (Ki67+) and outward vascular remodeling of collateral vessels supplying rescue flow following carotid ligation. In the VWF infusion group, there was a significant increase in Ki67+ ECs, 14.1 ± 3.1 vs. 5.4 ± 1.2 per mm of vessel of the control group (
p
= 0.042). In VWF KO mice, VWF infusion also increased the number of Ki67+ ECs, showing 18.3 ± 3.2 vs. 6.1 ± 2.8 per mm of vessel in the control group (
p
< 0.0001). In both WT and VWF KO mice, VWF infusion promoted non-uniform LMC remodeling.

Conclusions:
Our study demonstrates that VWF in the vascular wall of LMCs potentiates the adaptive response to increased luminal flow, albeit with irregular resulting vascular morphology. These finding suggest that the presence of intramural VWF may contribute to abnormal vascular remodeling in the brain.
Abstract TMP119: Suppression of microRNA-145 alleviates the vascular cognitive impairment in a multiple microinfarction model
Authors: Gao Huanjia , Zacharek Alex , Powell Brianna , Mccann Mikkala , Zhang Zhenggang , Chopp Michael , Liu Xianshuang
Published: January 2025

Background:
Vascular cognitive impairment (VCI) is the second most frequent subtype of dementia following Alzheimer's disease. However, the underlying mechanism has not been fully understood and there is no effective treatment for VCI. MicroRNAs (miRNAs) play critical roles in the pathologies of cerebral ischemia and dementia. This study aims to identify key miRNAs that may mediate cognitive outcomes using multiple microinfarction (MMI), a VCI model.

Methods:
MMI was induced by the administration of cholesterol crystals (70-100µm) into the internal carotid artery. Male Wistar rats (10-12 month) subjected to MMI or sham operation were euthanized 28 days after MMI (n=8/group). Total RNAs were isolated from the striatal tissues and miRNA-sequencing was performed. AAV-PHP.Eb carrying miR-145-5p sponge was delivered by the Intracerebroventricular injection at 2 days prior to MMI to knockdown miR-145-5p. The mNSS (modified Neurological Severity Score) and cognition tests were examined at 2 weeks after MMI.

Results:
MiRNA-sequencing analysis showed that compared to sham rats, MMI significantly up- and down-regulated 4 and 9 miRNAs respectively. Bioinformatics analysis revealed that these miRNAs were highly associated with the oligodendrocytes/myelination (miR-210 and miR-125), BBB (miR-665 and miR-29), and inflammation (miR-322), etc. Amongst them, miR-145 was the top upregulated miRNA in the striatum after MMI. In situ hybridization demonstrated that miR-145 expression was highly upregulated in the smooth muscle cells, which was negatively correlated with the decrease of contraction marker of smooth muscle cells (SMCs). Treatment of MMI rats with AAV-miR-145 sponge significantly reduced sensorimotor deficits assayed by lower mNSS score. Furthermore, MMI rats administered AAV-miR-145 spent less time on the closed arm in the EPM (AAV-miR-145 VS control AAV: 182±28 VS 263±9 (s), P=0.01) and showed less freezing time in the OFT (AAV-miR-145 VS control AAV: 205±9 VS 246±11 (s), P=0.015), compared with those treated with control AAV. These data indicate that inhibition of miR-145 reduces depression-like behavior and cognitive deficit induced by MMI.

Conclusion:
Our results uncovered the deregulated miRNAs associated with myelination, white matter and vascular damage after MMI. Also, our data suggest that miR-145 could be a potential therapeutic target by the regulation of SMCs against VCI. Thus, our data provides new insights into the molecular mechanisms underlying VCI.
Abstract TMP61: Ixodes ricinus-Contact Phase Inhibitor (Ir-CPI) reduces neutrophil-mediated injury and promotes recovery following intracerebral hemorrhage in a mouse model
Authors: Pireaux Valerie , Demoulin Stephanie , Warrinnier Hans , Godfroid Edmond
Published: January 2025

Introduction:
Secondary brain injury following intracerebral hemorrhage (ICH) is largely driven by neuroinflammation, which is exacerbated by neutrophil infiltration and their release of neutrophil extracellular traps (NETs). This process disrupts the blood-brain barrier and increases neuronal death. The present study investigates the efficacy of Ir-CPI, an inhibitor of neutrophil-mediated thromboinflammation, in reducing neutrophil-driven damage and promoting functional recovery post-ICH.

Methods:
ICH was induced in mice via bacterial collagenase injection into the right striatum. Mice were then treated with either PBS, Ir-CPI or enoxaparin. Treatments were administered intravenously immediately after stroke. Cerebral lesion and hemorrhage volumes were assessed up to 14 days by MRI. Neutrophil infiltration, NET release, and neuronal degeneration were evaluated histologically. Functional recovery was assessed using the Corner test and the Bederson’s scale.

Results:
After ICH induction, Ir-CPI did not increase cerebral lesion or hemorrhage volumes compared to PBS. Ir-CPI resulted in lower hemorrhage volumes than the enoxaparin group on Day 1. By Day 14, the volume of hemorrhage in the Ir-CPI group was significantly reduced in comparison to Day 1. Additionally, Ir-CPI decreased neutrophil infiltration and NETs release in the hemorrhagic area, along with a reduction in neuronal degeneration. In contrast, enoxaparin had no significant impact on reducing neutrophils or neuronal damage. Functional recovery was superior in the Ir-CPI group, with the Corner test showing a significant improvement from Day 1 to Day 5 compared to the PBS and enoxaparin groups. By Day 14, the Ir-CPI group's performance did not significantly differ from baseline, indicating enhanced long-term motor function and spatial awareness. The Bederson’s score also demonstrated a significant improvement in the Ir-CPI group, with lower scores between Day 1 and Day 5 compared to the other groups, thereby highlighting Ir-CPI's effectiveness in reducing neurological deficits.

Conclusions:
Ir-CPI is a promising therapeutic agent for patients suffering from ICH, exhibiting both safety and efficacy in reducing neutrophil-driven brain damage and enhancing functional recovery. These findings indicate that Ir-CPI may be beneficial in mitigating secondary brain injury and improving patient outcomes following ICH. The potential of Ir-CPI is currently being evaluated in the Phase IIa BIRCH trial (NCT05970224).
Abstract TMP64: Ultra-Early Hematoma Expansion is Associated with Ongoing Hematoma Growth and Functional Outcomes: A STOP-MSU Secondary Analysis
Authors: Mutimer Chloe , Wu Teddy , Zhao Henry , churilov leonid , Campbell Bruce , Cheung Andrew , Meretoja Atte , Kleinig Timothy , Choi Philip , Ma Henry , Cloud Geoffrey , Grimley Rohan , Shah Darshan , Ranta Anna , Mahawish Karim , Yogendrakumar Vignan , Sharma Gagan , Davis Stephen , Donnan Geoffrey , Yassi Nawaf
Published: January 2025

Introduction:
Hematoma expansion (HE) is strongly associated with mortality and disability in intracerebral hemorrhage (ICH). While it is accepted that the majority of this expansion occurs early after onset, there is limited data on HE and associations with outcome in the ultra-early time window (within 3 hours of symptom onset). We aimed to (a) estimate the incidence of HE within the ultra-early period of ICH, (b) describe hematoma growth dynamics over time, and (c) investigate the associations between ultra-early HE and clinical outcomes after ICH.

Methods:
We performed a planned secondary analysis of the STOP-MSU international multicenter randomized controlled trial. The trial compared tranexamic acid (TXA) with placebo in 201 patients with primary ICH presenting within 2 hours of symptom onset. Repeat CT imaging 1 hour after treatment commencement was optional, and patients who underwent this ultra-early re-imaging were included in this descriptive study. Hematoma expansion was defined as growth by either >33% or >6ml from the baseline hematoma volume.

Results:
We included 105 patients with ultra-early re-imaging (median age 66 years, 40% female, 53% TXA). Median time from onset to baseline imaging was 74min (IQR 56-87min), and between baseline and ultra-early re-imaging was 95min (IQR 74-132min). Forty-one patients (39%) had ultra-early HE. These patients had larger baseline hematoma volumes (15.9ml vs 9.1ml, p=0.03) and similar rates of intraventricular hemorrhage (22% vs 29.7%, p=0.38), compared to those without ultra-early HE. No effect of TXA on ultra-early HE was observed (TXA 41.1% vs placebo 36.5%, p=0.61).

Of 92 patients with both ultra-early and 24 hour re-imaging available, 31 patients had ultra-early HE. Of these, 9 (29%) had further growth at 24 hours, compared to 4/61 patients (6.6%) with no ultra-early growth (p<0.01). Median hematoma growth rate significantly reduced over time compared to the onset-to-baseline imaging period (clustered median regression p<0.01) (Figure 1).

Ultra-early hematoma expansion was associated with poor functional outcomes (mRS 3-6; aOR 3.87 [1.21-12.40], p=0.02) and mortality (aOR 6.16 [95% CI 2.15-17.68], p<0.01), adjusted for treatment group.

Conclusions:
Most hematoma growth occurs in the ultra-early period. The presence of ultra-early HE is associated with ongoing hematoma growth, poor functional outcomes and mortality, and could be a therapeutic target for clinical trials.
Abstract TMP87: Reasons for Deferring Thrombectomy in Pediatric Large- and Medium Vessel Occlusion
Authors: Lee Sarah , Teeyagura Prathyusha , Jackson Karla , Mayne Elizabeth , Gauna Jeilo , Pal Ria , Heit Jeremy
Published: January 2025

Introduction:
Mechanical thrombectomy (MT) is increasingly being performed in children with stroke due to large and medium vessel occlusion (LVO and MeVO). While retrospective series suggest favorable outcomes after MT, selection criteria for the pediatric population have not been defined. We aimed to analyze characteristics of children with LVO and MeVO and describe reasons for not pursing MT in children with acute vascular occlusion.

Methods:
The Stanford Pediatric Stroke Registry retrospectively enrolled pediatric patients with acute arterial ischemic stroke (AIS) admitted to our tertiary care center between 2007-2024. For this analysis, we included patients age 29 days-21 years with acute neuroimaging and clinical documentation available for direct review. LVO was defined as occlusion of the extra-/intracranial Internal Carotid Artery (eICA/iICA), Middle Cerebral Artery (MCA)-M1, Anterior Cerebral Artery (ACA)-A1, vertebral artery (VA) or basilar artery (BA). MeVO was defined as occlusion of the MCA-M2, MCA-M3 or ACA-A2. Patient charts were reviewed for documentation of medical decision-making, and reasons for forgoing MT were assigned by two pediatric neurologists trained in stroke (SL) and neurocritical care (EM). Clinical and imaging characteristics were compared using chi-squared or Fishers Exact test for categorical variables and Mann-Whitney U test or t-test for continuous variables. Results were reported using descriptive statistics.

Results:
Among 208 children with acute AIS, 82 (39.4%) had LVO/MeVO (Figure 1); 14 children had multiple occlusions for a total of 114 vascular occlusions (90 LVO, 24 MeVO). Patients with LVO/MeVO were older, had higher NIHSS and more often underwent contrast perfusion imaging compared to non-LVO/MeVO patients (Table 1). Among LVO/MeVO patients, Moyamoya Arteriopathy (MMA) was the final diagnosis in 10 (5 with a pre-existing diagnosis). Excluding those, 72 patients (34.6%) had a non-MMA vascular occlusion. MT was performed in 18 patients; of the 64 who did not undergo MT, the most common primary reasons intervention was not pursued were 1) concern for arteriopathy or infection (n=15) and 2) completed/large infarct burden (n=14, Figure 2).

Conclusions:
LVO/MeVO is not uncommon in children. In our cohort, LVO/MeVO was diagnosed in over 1/3 of children with acute AIS, and a quarter of those underwent MT. Further multicenter prospective studies are needed to define MT selection criteria in this unique population.
Abstract TMP96: The Use of Direct Oral Anticoagulants in Pediatric Arterial Ischemic Stroke
Authors: Torres Marcela , Schenk Allyson , Vega Calderon Isabel , Herring Rachelle
Published: January 2025

Introduction:
Pediatric arterial ischemic stroke (AIS) affects 1-2 per 100,000 children. Although rare, mortality and morbidity is significant with approximately 10% recurrence rate within the first year. Despite this, evidence-based treatment and prevention guidelines of pediatric AIS remain insufficient. Direct oral anticoagulants (DOACs) are approved in many countries for the treatment and prevention of pediatric venous thrombosis but its use in pediatric arterial thrombosis is less established. This study is the first to evaluate the off-label use of rivaroxaban in pediatric AIS.

Methods:
A retrospective chart review was approved by Cook Children’s Medical Center (CCMC) institutional review board. Patients (0 to <18 years) treated at CCMC for acute AIS that received rivaroxaban between June 21, 2021-April 1, 2024 were reviewed. Patients treated for concomitant venous thrombosis and/or without follow up imaging were excluded. Data was de-identified and SAS 8.3 was used for analysis. Given small sample, data were summarized using descriptive statistics.

Results:
Thirty-two patients were reviewed and 14 met eligibility criteria. Patient demographics and medical history are summarized in Table 1. All had acute AIS confirmed via brain magnetic resonance imaging (MRI), with most strokes affecting the anterior circulation (8, 57.1%) and with arteriopathy as the most common stroke etiology (10, 71.4%) (Table 2). Thirteen (92.9%) received antithrombotic therapy (heparin, enoxaparin, acetylsalicylic acid) prior to DOAC initiation and all 14 were given rivaroxaban afterwards. At the time of data analysis, patients had a median of 4 months of DOAC therapy (interquartile range: 3-7). Four patients remain on treatment (28.6%), 7 completed treatment (50.0%), 1 stopped due to the rivaroxaban shortage (7.1%), 1 discontinued due to bleeding complications (concomitant antiplatelet therapy) (7.1%), and 1 discontinued due to treatment failure (7.1%). All other adverse events were minor not requiring treatment discontinuation (Table 3).

Conclusion:
In this study, 14 pediatric AIS patients were treated with rivaroxaban. Only one had it discontinued for patient safety but concomitant therapy with acetylsalicylic acid, made rivaroxaban causality inconclusive. The only treatment failure in our series was a patient with bow hunter syndrome. Even though this study suggests rivaroxaban might be a safe and effective therapeutic option in pediatric AIS, additional research is needed.
Abstract TP107: Beyond Repair: Resurrecting Neurons through Stem Cell Therapy
Authors: Hamdan Tesnim , Witt Iryna , Ascandar Nameer , Basaran Ali , Brewer Yukiko A. , Chyshkevych Iryna
Published: January 2025

Introduction:
The intricate network of neurons orchestrates essential functions within the human body. Ischemic stroke, a major neurological disorder, challenges this network, leading to irreversible damage and functional impairment due to the limited regenerative capacity of neuronal tissues. Stem cells, with their unique properties of self-renewal and differentiation into various cell types, present a promising therapeutic avenue. This systematic review evaluates the efficacy and safety of stem cell therapies in treating ischemic stroke, aiming to restore neuronal structure and function.

Objective:
Our goal is to provide insights into the therapeutic potential of stem cell interventions for ischemic stroke, specifically their impact on clinical outcomes, functional recovery, and quality of life. This review synthesizes evidence from randomized clinical trials conducted between 2015 and 2024.

Methods:
A comprehensive search of databases such as PubMed, MEDLINE, and Cochrane Library identified relevant randomized clinical trials involving stem cell therapy for ischemic stroke.

Results:
Current data shows that various types of stem cell therapy are safe for treating neurological diseases, particularly ischemic stroke. While these therapies have enhanced motor recovery and neuroplasticity, their effectiveness in reducing scar size remains to be conclusively demonstrated. Notable improvements in patient outcomes include significant enhancements in the Modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Additionally, imaging studies have shown increased neurogenesis and enhanced integrity of the corticospinal tract in the peri-infarct area.

Conclusion:
The review highlights a remarkable finding: a single administration of stem cells can yield measurable clinical improvements lasting at least 12 months post-treatment. This long-term effect is unprecedented among non-device or non-acute treatments for ischemic stroke, challenging current therapeutic approaches like thrombolysis.

This systematic review underscores the transformative potential of stem cell therapy in addressing the challenges of ischemic stroke. Despite significant advancements, further research is essential to fully understand the mechanisms, optimize treatments, and fully harness the regenerative capabilities of stem cells, paving the way for innovative treatments that offer renewed hope for stroke patients.
Abstract TP116: Evaluation of the Clinical Efficacy of Rehabilitation Therapy Using the Complex Upper and Lower Limb Robot Gait Rehabilitation System (GTR-A) in Stroke Patient
Authors: BAIK JISOO , SHIN YONG IL , Ko Sung-Hwa , Hwang Hyun Ji , Yang Jung Hyun , Lee Kyeongjae , Lee Jung Lim , Yeo Hyunjoo , Min Munki
Published: January 2025

Background and aims:
Conventional approaches for stroke rehabilitation primarily involve static muscle strengthening exercises, weight bearing and shifting by therapists. Robot-assisted gait training facilitates the learning of reproducible symmetric gait patterns and reduces expenditure. The GTR-A (HUCASYSTEM, Korea), a robotic gait rehabilitation device for both upper and lower limbs, utilizes end-effector-based movement and provides training to enhance gait function. In this study, we aim to elucidate the clinical efficacy of rehabilitation therapy using GTR-A in subacute/chronic stroke patients.

Methods:
This study was a prospective, randomized, controlled clinical trial. There were 14 participants in total, with 7 in each of the experimental and control groups (table. 1). The gait abilities were evaluated using the berg balance scale (BBS), 6-minute walk test (6MWT) and cardiopulmonary exercise testing. Over period of 4 weeks, the experimental group underwent 10 sessions of robot-assisted rehabilitation for 30minutes/day, 3times/week in addition to conventional physical therapy for 30min/day, 5times/week. The control group received 10 sessions of only conventional physical therapy for 60minutes/day, 5times/week.

Results:
In the experimental group, significant improvements were observed in both BBS and 6MWT. However, there was no significant increase in maximal oxygen consumption. In contrast, the control group did not show significant functional improvements (table. 2).

Conclusion:
The combination of conventional rehabilitation therapy and robotic gait training using GTR-A showed superior outcomes in the recovery of gait function compared to conventional therapy alone.
Abstract TP128: Association Between Hospital Volume and Outcomes of Surgical Procedures for Carotid Stenosis in Japan
Authors: Mizuno Yusuke , Shinjo Daisuke , Inoue Norihiko , Fushimi Kiyohide
Published: January 2025

Background:
Postoperative complication rates of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis are recommended to be maintained below a certain threshold. While the association between hospital volume and the complications has been reported, the situation is uncertain in Japan, one of the countries with the highest density of neuro-specialists. This study aimed to investigate the association between hospital volume and outcomes in patients who underwent CEA or CAS in Japan.

Methods:
We retrospectively analyzed data from the Japanese nationwide inpatient database on CEA and CAS procedures performed between 2018 and 2021. Hospitals were categorized into four quartiles based on surgical volume, ranging from highest (Q1) to lowest (Q4), with approximately equal numbers of procedures in each quartile. The association between hospital volume and moderate to severe disability (modified Rankin scale > 2 at discharge), in-hospital mortality, perioperative stroke, perioperative pneumonia, and length of hospital stay (LHS) was investigated using multivariate logistic regression and other appropriate analyses.

Results:
The analysis included 26,675 CEA or CAS procedures performed in 681 hospitals. The overall rates of disability, mortality, perioperative stroke, and pneumonia were 7.4%, 0.5%, 6.6%, and 5.0%, respectively. The rates of disability in Q1, Q2, Q3, and Q4 quartiles were 6.0%, 7.5%, 8.5%, and 7.4%, respectively (Table 1). After adjusting for covariates, Q3 and Q4 were associated with a higher risk of disability (Q3: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.22 – 1.64, Q4: OR 1.41, 95% CI 1.00 - 1.37). Furthermore, Q2, Q3, and Q4 quartiles were associated with a higher risk of perioperative stroke (Q2: OR 1.46, 95% CI 1.26 - 1.70, Q3: OR 1.45, 95% CI 1.25 - 1.69, Q4: OR 2.04, 95% CI 1.77 – 2.36) and pneumonia (Q2: OR 2.01, 95% CI 1.68 – 2.39, Q3: OR 1.89, 95% CI 1.59 – 2.26, Q4: OR 1.79, 95% CI 1.50 – 2.14). The mortality rate was comparable among the four quartiles (Table 2). Additionally, Q2, Q3, and Q4 quartiles were associated with longer LHS. Similar results were observed in patients aged 80 and above.

Conclusions:
Our findings suggest an association between lower hospital volume and poorer patient outcomes following CEA or CAS. This study indicates the importance of considering surgical volume as a factor to improve outcomes of CEA and CAS in Japan.
Abstract TP130: Identifying Facilitators and Barriers to Positive Illness Perceptions in Younger Stroke Survivors during Acute Hospitalization
Authors: Craven Mary , McVeigh Taylor , Choksi Devanshi , Mallick Akashleena , Ranman Tanzeela , Kourkoulis Christina , Mora Samantha , Rosand Jonathan , Yechoor Nirupama
Published: January 2025

Background:
Despite increasing stroke incidence in US adults younger than 44 years, little is known about their illness perceptions, which have been shown to impact stroke recovery and possibly secondary prevention. This study’s objective is to identify facilitators and barriers to positive illness perception of stroke survivors and their caregivers during acute hospitalization.

Methods:
Stroke survivors and caregivers participated in virtual focus group sessions with structured interview guides assessing perceptions of hospitalization and general wellbeing. Sessions were recorded and transcribed using NVivo software. Framework method was used for analysis; three independent coders developed a comprehensive codebook from transcripts. Framework matrices were used to identify recurrent themes, which were then determined to be facilitators or barriers to positive illness perception during acute hospitalization.

Results:
Stroke survivors and caregivers (n=12) participated in seven focus group sessions. Younger survivors (n=4; 3 male, 1 female survivors) were aged 25 to 44, compared with older survivors (n=8; 3 female survivors, 5 female caregivers) aged 45 to 84. Across each phase of acute hospitalization, five themes related to illness perceptions emerged: (1) symptom recognition and health system navigation; (2) communication of diagnosis and management; (3) presence of a champion; (4) clinician bias; (5) psychological distress. Figure 1 shows how stroke survivors, based on their age, experienced the acute hospitalization and how illness perception was shaped by these themes. Clinician bias, psychological distress, and the inability to recognize stroke symptoms emerged as unique barriers for younger stroke survivors.

Conclusion:
Despite a similar diagnosis, illness perceptions of younger stroke survivors were distinct compared to older counterparts. Younger survivors experienced bias and psychological distress, exposing differential treatment in care. A facilitator to positive illness perception among both populations was the presence of a champion; in younger survivors, advocacy of a partner was crucial for diagnosis, suggesting the importance of symptom recognition in younger populations. Future studies are required to explore the transferability of our findings and to investigate clinician recognition of stroke in younger populations.
Abstract TP141: Who Obtains Informed Consent for Endovascular Thrombectomy in Acute Stroke? A Survey of Clinicians.
Authors: Mbonde Amir , Alsarah Ali , Demaerschalk Bart , Dmytriw Adam , Moyer Quentin , Hirsch Joshua , Singhal Aneesh , Leslie-Mazwi Thabele , Rost Natalia , Patel Aman , Young Michael , Regenhardt Robert
Published: January 2025

Introduction:
Informed consent (IC) plays a central role in medical care and research. Practices for endovascular thrombectomy (EVT) in acute stroke are not well elucidated. We investigated the clinical roles and medical specialties of individuals who obtain IC for EVT, aiming to provide insights for enhancing the process in contemporary stroke care.

Methods:
We conducted a survey from July to December 2023 among clinicians involved in acute stroke care. Utilizing Qualtrics, we disseminated a structured questionnaire through various national and international platforms including the American Academy of Neurology and StrokeNet. This analysis summarizes findings pertaining to the characteristics of those who obtain EVT IC at the respondents’ institution.

Results:
Among 168 participants, 71% were staff physicians, 70% practiced in the United States (US), and 70% were based at academic centers. The most common medical specialties obtaining EVT IC were neurology (77%), followed by neurosurgery (41%), radiology (30%) and emergency medicine (10%) (
Table 1
). Staff physician (61%) was the most common clinical role involved, followed by fellows (43%), residents (48%), and advanced practice providers (APP, 36%) (
Table 2
). Non-US institutions were more likely to utilize a provider from neurology alone (50% vs. 31%, p=0.016) and staff physicians (76% vs. 54%, p=0.008), while US institutions were more likely to utilize providers from neurosurgery (51% vs. 18%, p<0.001), APPs (43 vs. 18%, p=0.002) and residents (56% vs. 28%, p=0.001). Non-academic institutions more frequently used emergency medicine providers (25% vs. 5%, p<0.001) and APPs (50% vs. 31%, p=0.031), while academic institutions commonly utilized neurosurgery providers (48% vs. 18%, p=0.001), residents (59% vs. 13%, p<0.001) and fellows (52% vs. 18%, p<0.001).

Conclusion:
This study highlights the diverse medical specialties and clinical roles of persons obtaining IC for EVT, with neurologists and staff physicians being the most frequently utilized. These variations likely reflect availability and capacity of certain providers in different settings. Future efforts to optimize the IC process should be multi-disciplinary, with standardized content that addresses issues such as ischemic core volume, outcome expectations and diversity.