bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP284: MRI-based Non-invasive Assessment of Early Brain Injury and CBF for Functional Grading of Experimental Subarachnoid Hemorrhage in Mice
Authors: Sasaki Kazumasu , Nakamura Kazuhiko , Mutoh Tomoko , Kawashima Ryuta , Ishikawa Tatsuya , Mutoh Tatsushi
Published: March 2022

Introduction:
Subarachnoid hemorrhage (SAH) is a devastating form of stroke with high rates of mortality and disability. Evidence suggests that acute failure to restore cerebral blood flow (CBF) after SAH may be setting the stage of delayed cerebral ischemia. Despite increasing number of experiments using rodent models, little is known about the effect of CBF and neuro-behavioral profile on ischemic brain injury, vasospasm and neurological outcome for precise grading of this model to mimic clinical severity in humans.

Hypothesis:
To investigate the feasibility of MRI-based assessment of clot distribution and CBF for grading SAH severity in a mouse endovascular perforation model.

Methods:
SAH was induced by endovascular perforation in adult male C57BL/6 mice. CBF was estimated by MRI continuous arterial spin labeling with short delay after tagging. Neurological deficit and behavioral data were recorded by adhesion removal test and open field test, respectively. MRI and neuro-behavioral performance were assessed immediately after SAH induction and at 24, 72 hours after SAH. The time-course changes of each parameter and their relationships with MRI-based grading score using T2*-weighted image at 24 hours, new ischemic lesion detected by diffusion-weight image (DWI) at 72 hours, day 7 and 14, cortical vasospasm visualized by two-photon laser microscopy (performed between 48-72 hours), and final outcome based on the modified Garcia score at day 21 after SAH were analyzed.

Results:
Among a total of 60 mice, the mortality rates at 24 hours and day 21 were 17% and 30%, respectively. There were strong correlations between the CBF value at 72 hours after SAH and MRI grading (24% scored as grade 1, 18% as grade 2, 30% as grade 3, and 28% as grade 4) (r=0.75; P<0.001), incidence of microvasospasm (r=0.68; P<0.001), or functional outcome score at 21 days (r=0.81; P<0.001). Activity as measured by mean daily velocity (mm/sec) (r=0.54; P=0.008) or position rotation ratio (r=0.47; P=0.03) at 24 hours had also moderate correlation with the CBF value.

Conclusions:
Non-invasive MRI-based grading that includes both CBF and neuro-behavioral performance at 24 hours enables more accurate in vivo evaluation of SAH severity based on the prevalence of vasospasm and functional outcome.
Abstract TP308: Annual Trends in Door to Needle Time in a Statewide Telestroke Program
Authors: Hannah Jessica A , Adams Robert J , Debenham Ellen , Holmstedt Christine A , Ozark Shelly D , Turan Tanya N
Published: March 2022

Background and Purpose:
The goals of telestroke programs are to provide safe and efficient stroke care to hospitals. An important marker of efficient acute stroke care delivery is door-to-needle (DTN) time, the time it takes from entrance into the emergency department to administration of alteplase. We sought to determine if DTN time was improving over time within our statewide telestroke network.

Methods:
From 5/4/2008-7/12/2015, we prospectively collected data on DTN time from consultations performed in our 18-hospital statewide telestroke network. DTN time was recorded on 765 of the 4985 consults where alteplase recommendations were documented. For all active hospital sites combined, the yearly mean DTN time was determined and compared by year with a one-way ANOVA and Tukey test.

Results:
Of the total 6116 consults performed over the time period, there was an average of 95.5 total consults/year among all 18 sites and an average of 8.3 consults/active site/year. The mean +/- SD DTN for all of the consults in all years was 85.4+/-42.0. As shown in the Figure, we found a significant decrease in DTN over time at (p<0.001). In the post-hoc test, the following pairs were determined to be significantly different (at p<0.05): 2008 vs. 2015; 2009 vs. 2013, 2014, and 2015; 2010 vs. 2013, 2014, and 2015; 2011 vs. 2013, 2014, and 2015; 2012 vs. 2013, 2014, and 2015.

Conclusions:
Among a statewide Telestroke network, the mean DTN time continued to decrease over the last 7 years, reflecting more efficient delivery of acute stroke treatment. Since more efficient stroke care delivery is associated with better outcomes, this may be a contributing factor to the overall improved stroke mortality within the state.
Abstract TP315: Predictors of Thrombolysis Administration in Patients with Minor Stroke or TIA in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study
Authors: Asdaghi Negar , Romano Jose G , Wang Kefeng , Koch Sebastian , Ciliberti-Vargas Maria A , Dong Chuanhui , Gardener Hannah , Rose David Z , Burgin W. S , Waddy Salina P , Robichaux Mary , Gutierrez Carolina M , Waters Michael F , Sacco Ralph L , Rundek Tatjana
Published: March 2022

Background:
Minor stroke/TIA is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable amongst different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD Study.

Methods:
73,712 patients with ischemic stroke/TIA were prospectively enrolled from January 2010 to April 2015. We included 7,746 patients who had persistent neurological symptoms with NIHSS score ≤5 and arrived within 4 hours of symptom onset. Multilevel logistic regression analysis was used to identify independent predictors of thrombolysis in the subgroup of patients without contraindications to thrombolysis

Results:
6,826 patients (25% final diagnosis TIA, 75% minor stroke) were included (mean age=70±14 years), 52.7% male, 70.3% white, 13% black, 16.7% Hispanic, median NIHSS=2 (IQR=1,4). Patients who received thrombolysis (N=1281, 18.7%) were younger (67 vs. 70.7 years, P<0.001), had less vascular risk factors (HTN, DM, dyslipidemia), lower risk of prior vascular disease (MI, PVD, previous stroke) and had a higher presenting median NIHSS score (4 vs. 2, P<0.0001). In the multivariable analysis, younger age (OR 1.02, 95% CI 1.02-1.03, P<0.0001), white or Hispanic vs. black (OR 1.2, 95% CI 1.04-1.37, P=0.0097), early hospital arrival (unit change in 30 min.) (OR 1.26, 95% CI 1.21-1.31, P<0.0001), arrival by EMS (OR 1.28, 95% CI 1.08-1.49, P<0.0001), higher NIHSS score (OR 1.96, 95% CI 1.87-2.06, P<0.0001), altered level of consciousness (OR 1.43, 95% CI 1.11-1.85, P=0.0062) and aphasia at presentation (OR 1.34, 95% CI 1.13-1.58, P=0.0008) were independent predictors of thrombolysis administration.

Conclusion:
Minor acutely presenting stroke patients were more likely to receive thrombolysis if they were young, white or Hispanic, and arrived early to the hospital with more severe neurological presentation specifically aphasia and altered level of consciousness. Identification of predictors of thrombolysis utilization is important in the design of educational programs and randomized trials to increase the use of thrombolysis for minor stroke.
Abstract TP326: Predictors of Surgical Feeding Tube Placement in Acute Ischemic Stroke
Authors: Brown Kristin , Barreto Andrew , Saeed Umair , Indaparu Hari , Vu Kim , Shoemake Paige , Clayton Alana , Cooper Stephanie , Xavier Andrea , Deguzman Isabel , Cai Chunyan , Jacobs Amber , Sharrief Anjail
Published: March 2022

Introduction:
Delays in decisions to pursue percutaneous endoscopic gastrostomy (PEG) tube placement may prolong hospitalization in patients with acute ischemic stroke (AIS). Prediction models in AIS have had inconsistent findings and have included race as a predictor despite there being no clear biological bases. We hypothesized that stroke severity would predict PEG placement and race would not be a significant predictor after controlling for other variables.

Methods:
Consecutive cases of AIS were identified from our inpatient registry (6/14- 4/15). Patients transferred to hospice or dying within 3 days of hospitalization were excluded. NIHSS, NIHSS level of consciousness 1A score, medical history, and demographic data were included in the model. Backward stepwise elimination using logistic regression was used to assess predictors of PEG placement. We also explored relationships between PEG placement and Penetration-Aspiration (PEN-ASP) scores (1-2, normal; 3-5, penetration, 6-8, aspiration) calculated using Fiberoptic Endoscopic Evaluation of Swallowing and Modified Barium Swallow Studies.

Results:
Among 757 AIS patients, 17.9% (136) of patients received a PEG tube. There was no association between race and PEG tube placement in univariate (Table 1; p=0.205 pearson Chi2) or multivariable models. In the multivariable model, significant predictors of PEG placement included arrival NIHSS (p < 0.0001), NIHSS level of consciousness 1A score (p < 0.0001), arrival GCS (p = <.01), Diabetes Mellitus (p<0.05), and prior intracerebral hemorrhage (p<0.05). Higher PEN-ASP scores were associated with need for PEG placement (p < 0.01).

Conclusions:
Our study represents the largest cohort of AIS patients undergoing PEG placement. Stroke severity and medical history, but not race, predict PEG placement in this study. Future AIS dysphagia studies should include objective dysphagia scales.
Abstract TP342: Central Origin of Fever Should not be Assumed in Stroke Patients
Authors: Mistry Eva , Barrios-Anderson Adriel , Paranilam Jaya , Wiese Jonathan , Volpi John
Published: March 2022

Introduction:
Fever worsens outcomes in patients with ischemic and hemorrhagic stroke. Fever can be infectious or non-infectious (central) in etiology. Previous literature suggests 32% of patients with ICH and 31% of ischemic stroke patients have noninfectious fever.

Hypothesis:
Central fever is rare in stroke patients undergoing a rigorous evaluation for infection.

Methods:
We retrospectively reviewed the electronic medical records of 419 patients with ICH (n=199), ischemic stroke (n=107) and subdural hemorrhage (SDH, n=113) from January 2011 to February 2014. We collected data on the following diagnostic measures: fever (temperature ≥ 100.4°F), Leukocytosis (white blood cell ≥ 11X109 cells/L), positive blood culture, positive urinalysis, positive chest X-ray, and use of non-prophylactic antibiotics. We identified patients who had evidence of fever without any other positives out of the above mentioned measures. These patients were identified as having noninfectious or central origin of their fever.

Results:
Of the 419 patients studied, 45 (22.6% of ICH), 27(25.2% of ischemic stroke) and 29(25.7% of SDH) patients with ICH, ischemic stroke and SDH respectively had fever at least once during the first 72 hours of their hospital stay. Of these patients with early fever, 8(4.02%), 3(2.8%) and 0 patients, respectively, had noninfectious fever. Out of 419 patients studied, 101(24.1%) patients had fever and 11(2.6%) of those were noninfectious in origin. Also, significantly higher number of patients with ICH had noninfectious fever as compared to patients with ischemic stroke (P=0.042). Additional analysis of the ICH population revealed that IVH was directly correlated with early fever incidence (p<0.001).

Conclusion:
Even though fever was commonly observed in about 25% of stroke patients, central fever was rare, occurring in fewer than 3%. Among stroke patients, those with intraventricular hemorrhage were most likely to have central origin of fever. Our data suggest that overall, infections etiologies of fever outnumber central fever approximately 10 to 1.
Abstract TP346: Implementation of a Tele-Swallow Safety Study
Authors: Morrell Kathryn , Hyers Megan , Stuchiner Tamela , Yanase Lisa R
Published: March 2022

Background:
Small or remote hospitals are often underserved by Speech Language Pathologists (SLP) for dysphagia evaluation of acute stroke patients. Telehealth is being used for an increasing range of services, but there is limited experience in using this technology for Teleswallow evaluations.

Objective:
We describe barriers and potential solutions to implementation of an SLP Teleswallow program in the setting of an ongoing feasibility and safety study of 120 acute stroke patients.

Methods:
A team of 5 SLP’s with 3 to 33 years of stroke care experience, SLP Manager, a Telestroke Neurologist, and a data analyst, reviewed the literature to design this study. SLP’s trained on the Telehealth device. We standardized dysphagia evaluation using commercial texture products. Stroke patients are consented and randomized to Bedside vs Tele evaluation first. Patients then have the other evaluation by a second, blinded SLP. The Teleswallow SLP directs remote RN or CNA assistants, who have varying exposure to the Tele device and to swallow evaluations. SLP’s provided feedback on using the Tele device and on evaluating patients remotely.

Findings:
SLP’s describe patient, logistic, and professional challenges to Teleswallow. Patient issues were receptivity to Tele technology, language deficits and facial hair. Logistic issues were getting Tele device and study food to the room, device position for best view/lighting, and coordinating schedules for control station, patient, and RN. Professional issues were orienting remote RN, and RN interference with evaluation by cuing the patients.

SLP’s report a rapid learning curve in Tele device use, and in how to interact with remote patients and staff. Experience clearly enhanced comfort and efficiency, and likely improved reliability of evaluation. They found that visual and auditory experience with Teleswallow is similar to bedside evaluation, including in patients with aphasia.

Conclusions:
SLP satisfaction with Teleswallow technology and working with remote patients and RNs improved with experience. Implementation of Teleswallow evaluation was straightforward and feasible. Training with 4-5 mock patients and RN’s may enhance comfort with the process. Safety will be reported at conclusion of the study.
Abstract TP357: Blood Brain Barrier Damage Predicts Perihematoma Edema Volume in Intracerebral Hemorrhage
Authors: Bhuiyan Mariam , Leigh Richard , Barker Peter , Hanley Daniel F , Ziai Wendy
Published: March 2022

Background:
Early blood–brain barrier damage after acute intracerebral hemorrhage (ICH) has been qualitatively linked to subsequent perihematoma edema (PHE) formation. In this quantitative study, it was investigated whether the degree of blood–brain barrier damage evident on MRI scans was related to ICH and PHE volume in patients with acute ICH.

Methods:
Analysis was performed on a database of patients with acute ICH who underwent perfusion-weighted imaging (PWI) with gadolinium within 7 days of ICH onset. Postprocessing of the PWI source images was performed to estimate changes in blood–brain barrier permeability ipsilaterally within the perihematoma region and contralaterally in regions of chronic white matter disease. Mean permeability derangement (MPD) was calculated in these two regions of interest (ROI) for each patient by taking the mean of all voxels within the ROI that were two standard deviations above normal. Normal tissue was defined by an ROI selected in the contralateral hemisphere that did not have any chronic disease. MPD is expressed as a percent of gadolinium leakage compared to this intact tissue. CT images within 48 hours of MRI were analyzed for ICH and PHE volumes using computerized volumetrics.

Results:
Twenty-two patients were identified, 16 of whom experienced hypertenisve ICH, and 6 of which were classified as other etiology. The MPD (±SDs) was 14.9.±16.4% ipsilateral to ICH, 14.8±21.6% on the contralateral side (P=0.64). PHE volume was significantly associated with perihematoma MPD (β=10.49 [1.11 to 19.86]) and ICH volume (β=0.84 [0.77 to 0.92]). Permeability was non-significantly higher in patients with intraventricular hemorrhage extension (18.6±29.7% vs. 14.0±13.2%) and with systemic infection (24.2±23.9% vs. 12.2±13.8%). Permeability was not correlated with low density lipoprotein level or statin use.

Conclusions:
A perfusion-weighted imaging–derived index of blood–brain barrier damage measured during acute ICH detected focal increases in permeability of the perihematoma region and contralateral hemisphere, and was significantly associated with perihematoma edema volume.
Abstract TP365: Surgical Performance in Minimally Invasive Surgery Plus rt-PA for ICH Evacuation (MISTIE) Phase III Clinical Trial
Authors: Fam Maged D , Hanley Daniel , Stadnik Agnieszka , Jesselson Michael , Money Lynn , Wu Meijing , Camarata Paul , Lane Karen , Zuccarello Mario , Awad Issam
Published: March 2022

Introduction:
The MISTIE III trial aims to compare outcome following minimally invasive surgery plus thrombolysis versus best medical treatment for intracerebral hemorrhage (ICH). An image guided catheter is placed into the hematoma for ICH aspiration and rt-Pa administration. Surgeons at three levels of pre-specified experience with the procedure (pre-qualified PQ, qualified-probation QP, and fully qualified FQ) utilized one of three protocol-prescribed surgical approaches (anterior A, posterior B, and lobar C) based on the location and depth of the hematoma.

Objective:
To assess accuracy of catheter placement and efficiency of ICH evacuation in relation to surgical approach and surgeon experience in the first 89 cases randomized to surgical treatment in the ongoing trial (roughly third of projected enrollments), with 86 cases undergoing the procedure.

Methods:
The trial’s Surgical Center assessed prospectively the accuracy of initial catheter placement based on pre-articulated criteria, catheter replacement, and efficiency at ICH evacuation.

Results:
Average ICH volume was 49.7ml at clot stability, with mean 72 % evacuated post catheter removal. Approaches A, B and C were used in 52, 25, and 23% of cases, with overall good, suboptimal and poor catheter placements in 58, 31 and 10 % of cases, respectively. Catheters were replaced/repositioned in 24 cases. Approach B was associated with significantly higher rates of poor placement (27%) and replacements (68%) than the other approaches (P< 0.01). Surgeon experience was PQ, QP and FQ in 56, 20, and 24% of cases, and was not associated with significantly different placement accuracy or replacement rates. Relative reduction in volume of the hematoma by the end of treatment was not significantly different among the three approaches, nor among surgeons at the three levels of experience.

Conclusion:
Ongoing surgical education and quality monitoring in the MISTIE III trial have resulted in consistent rates of hematoma evacuation among surgeons of varying experience, and with different catheter trajectories, despite technical challenges with the posterior surgical approach. This documented optimization of the surgical task enhances the validity and subsequent generalizability of the ongoing trial.
Abstract TP370: Association Between Ventricular Symmetry and Perihematoma Edema in Intracerebral Hemorrhage
Authors: Feigert Caroline , Yeatts Sharon , Selim Magdy ,   On behalf of the HI-DEF Execultive Committee and Investigators
Published: March 2022

Purpose:
There is rising interest in the assessment of perihematoma edema (PHE) as a surrogate measure of the effectiveness of investigational therapies targeting secondary injury after intracerebral hemorrhage (ICH). However, assessment of PHE on CT scans is challenging. We hypothesized that the ratio of the volumes of the ipsilateral-to-contralateral ventricles (IL/CL) can provide an alternative estimate of PHE, and examined the association between IL/CL ventricles and semi-automated quantitative measures of PHE using non-contrast CT scans in subjects with spontaneous ICH.

Methods:
We examined the volumetric imaging data from 42 subjects who participated in the HI-DEF trial. We excluded subjects who had an intraventricular hemorrhage or an EVD placed (n=21). Quantitative measurements of ICH, PHE, and ventricular volumes were performed as a routine part of the trial using ANALYZE 11.0 software. We used Spearman correlation coefficient to describe the association between IL/CL and PHE.

Results:
A total of 42 CT scans were assessed (21 subjects each with both baseline and post-treatment scans, approximately 5 days later). We observed a significant correlation between PHE volume and IL/CL (r=-0.60, p<0.0001), and ICH volume + surrounding PHE (absolute PHE volume) and IL/CL (r=-0.65, p<0.0001). The correlation between relative PHE (PHE volume divided by ICH volume) and IL/CL was (r=0.50, p=0.009).

Conclusion:
IL/CL seems to correlate with quantitative measures of PHE, absolute PHE volumes and, to a lesser extent, relative PHE. Ventricular symmetry might be a suitable alternative to quantitative measures of PHE on CT scans. We plan to validate the potential usefulness of IL/CL and examine its impact on long-term outcomes in the ongoing iDEF trial.
Abstract TP372: CT Angiography Spot Sign, Hematoma Expansion and Outcome in Primary Pontine Intracerebral Hemorrhage
Authors: Morotti Andrea , Jessel Michael , Brouwers Bart H , Falcone Guido J , Schwab Kristin , Ayres Alison M , Vashkevich Anastasia , Anderson Christopher D , Romero Javier M , Gurol Edip M , Viswanathan Anand , Greenberg Steven M , Rosand Jonathan , Goldstein Joshua N
Published: March 2022

Background and Purpose:
The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and poor outcome in supratentorial intracerebral hemorrhage (ICH), but patients with brainstem ICH have typically been excluded from analyses. We investigated the frequency of spot sign and its relationship with hematoma expansion and outcome in patients with primary pontine hemorrhage (PPH).

Methods:
We performed a retrospective analysis of a prospectively collected cohort of consecutive PPH patients who underwent CTA. CTA first pass readings for spot sign presence were analyzed by two trained readers. Baseline and follow-up hematoma volumes on noncontrast CT scans were assessed by semi-automated computer-assisted volumetric analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio and accuracy of spot sign in predicting in-hospital mortality were calculated.

Results:
49 subjects met the inclusion criteria of whom 11 (22.4%) showed a spot sign. In-hospital mortality was higher in spot sign positive versus negative subjects (90.9% vs 47.4%, p=0.020). Spot sign showed excellent specificity (95%) and PPV (91%) in predicting in-hospital mortality. Absolute hematoma growth, defined as parenchymal and intraventricular hematoma expansion of any amount, was significantly higher in spot sign positive versus negative subjects (3.76 ± 8.55 vs 13.72 ± 20.93 mL, p=0.045).

Conclusions:
As with supratentorial ICH, spot sign presence is a common finding and is associated with higher risk of hematoma expansion and mortality in PPH.
Abstract TP377: Predictors of Diffusion-weighted Imaging Lesions and One-year Case-fatality in Intracerebral Hemorrhage
Authors: Mackey Jason , O'Connor Kevin F , Blatsioris Ashley D , Moser Elizabeth A , Ofner Susan , Carter Ravan J , Stevenson Alec , Hulin Abigail L , O'Neill Darren P , Cohen-Gadol Aaron A , Leipzig Thomas J , Woo Daniel , Kidwell Chelsea S , Williams Linda S
Published: March 2022

Introduction:
Diffusion-weighted imaging (DWI) lesions in intracerebral hemorrhage (ICH) have been associated with vasculopathy, blood pressure (BP) lowering, and poor functional outcomes. We sought to identify predictors of DWI lesion formation and one-year case-fatality in ICH.

Methods:
In this retrospective study of primary ICH at our institution from 2009-2011, cases were identified by ICD-9 code and verified by physician review. Only subjects undergoing brain MRI within 72 hours of presentation were included. In addition to standard chart review, we abstracted all BPs available prior to MRI. Vasculopathy severity was assessed by white matter disease score and microbleed burden. Univariate analysis was stratified by DWI lesion presence; logistic regression analyses assessed predictors of DWI lesions and all-cause one-year case-fatality.

Results:
Of 500 subjects in the overall ICH cohort 98 met inclusion criteria for this analysis, of which 20 (20.4%) had DWI lesions. Selected univariate analysis is shown in the Table. In the best clinical model fit, intraventricular extension (OR 5.63 (1.60, 19.85), p=0.007), microbleeds (OR 3.43 (0.95, 12.34), p=0.06), and delta systolic BP lowering (((max systolic BP-min systolic BP)/max systolic BP)*100) (OR 0.97 (0.95, 0.99), p=0.0005) were associated with DWI lesion presence. Overall one-year case-fatality was 16.3%; age (OR 1.04 (1.00, 1.07), p=0.05), GCS (OR 1.30 (1.09, 1.56), p=0.004), and DWI lesions (OR 3.80 (1.14, 12.61), p=0.03) were independently associated.

Conclusions:
Predictors of DWI lesions in ICH include underlying vasculopathy but the impact of BP lowering on DWI lesion formation remains unclear. Further investigation of BP effects on DWI lesion formation is warranted with larger cohorts given the association with DWI lesions and one-year case-fatality. Future trials of BP control in ICH should consider stratifying by imaging biomarkers for underlying vasculopathy.
Abstract TP381: Evaluation Of A Modified Home Care Intervention For Stroke Patients In Transition From Hospital To Home
Authors: Chen Lu , Sit Janet
Published: March 2022

Introduction:
In the past two decades, there has been 84% increase of stroke prevalence in China. Since transitional care facilities are lacking in China, most of the stroke survivors return home after discharged from acute hospital setting. Routine disease-oriented discharge planning does not match individual home care needs.

Objective:
To evaluate the effectiveness of a modified home care (HC) intervention to facilitate the transition of care for stroke survivors from hospital to home.

Methods:
Using a quasi-experimental study design, stroke survivors from a 115-bed stroke unit in teaching hospital in China were recruited. HC subjects (n=168) received nurse-led pre-discharge preparation and post-discharge follow-ups, which beganon admission until 30-days post hospital discharge(a total of 4 hours,5 sessions,48 minutes on average). Hospital length of stay (LOS), stroke-related readmission rates, ability to perform activities of daily living (ADLs), and medication adherence were assessed at 30-days post-discharge. Historical controls (n=173)that received routine discharge planning, including standardized patient education about stroke and one telephone follow-up, were used as the comparison group (CG).

Results:
Subjects were on average 65.10 years old, 51% women, 74% ischemic stroke, 26% hemiparesis. The HC group had significantly better outcomes with a reduced hospital LOS(HC=11.3±2.2days vs.CG=12.4±4.3 days, p = 0.03), decreased stroke-related readmission rate(HC=1.2% vs.CG=6.4%, p = 0.02), increased ability to perform ADLs observed by Barthel Index. (HC=38.3±10.2vs.CG=32.1±10.3, p = 0.03) and medication adherence (HC=95.8%vs.CG=53.2%, p = 0.004), compared to CG.

Conclusions:
Our findings suggest that the modified HC intervention, incorporating nursing care planning and follow-ups across care settings, is effective in enhancing the transition from hospital to home, in terms of hospital care utilization and patient outcomes.
Abstract TP4: Pre-treatment Systolic Blood Pressure Levels Predict Final Infarct Volume, and Early Outcomes Following Endovascular Treatment for Acute Ischemic Stroke Patients With Emergent Large Vessel Occlusion
Authors: Goyal Nitin , Tsivgoulis Georgios , Khorchid Yasser M , Iftikhar Sulaiman , Doss Vinodh T , Zand Ramin , Chang Jason J , Hoit Dan , Alexandrov Andrei V , Arthur Adam , Elijovich Lucas
Published: March 2022

Background & Purpose:
High pre-treatment systolic blood pressure (SBP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for acute ischemic stroke (AIS) patients with emergent large vessel occlusion (ELVO). We sought to evaluate the association of of pre-treatment SBP with other outcome measures after EVT including final infarct volume (FIV) and favorable outcome (FO) at three-months.

Methods:
We conducted a retrospective cohort study evaluating AIS patients presenting with anterior circulation ELVO in a tertiary care stroke center during a 4-year period. Admission stroke severity was documented using NIHSS-score. Pre-treatment SBP and DBP were measured using automated cuff. Two investigators calculated the FIV using ABC/2 methodology. FO was defined as mRS score of 0-2 at 3 months.

Results:
Our study population consisted of 116 patients with anterior circulation ELVO (mean age 63±13 years, 51% male, median admission NIHSS-score: 17 points, IQR 14-21, median FIV: 30cm3, IQR: 8-94) who were treated with EVT. Systemic thrombolysis was administered in 75 patients (65%). A total of 38 patients (33%) achieved FO, while in-hospital and three-month mortalities were 27% and 31% respectively. Higher pre-treatment SBP was positively correlated to increased FIV (r: +0.225; p=0.020). Patients with FFO had lower pretreatment SBP (151±24mmHg vs 165±28mmHg; p= 0.010), while pretreatment SBP levels were higher in patients who died during hospitalization (169±34mmHg vs 156±24mmHg; p=0.043). A 10mmHg increment in pretreatment SBP was independently (p=0.010) associated with an increase of 12cm3 in FIV (95%CI: 3-21) in multiple linear regression models adjusting for demographics, vascular risk factors, pretreatment DBP, admission NIHSS, intravenous thrombolysis, onset to revascularization and successful revascularization. A 10mmHg increment in pretreatment SBP was independently (p=0.012) associated with a lower likelihood of FFO at three months (OR: 0.64; 95%CI: 0.45-0.91) in multiple logistic regression models adjusting for multiple confounders.

Conclusion:
Higher pretreatment SBP is an independent predictor of increased FIV and lower likelihood of three-month FFO in patients with ELVO who undergo EVT.
Abstract TP428: Antithrombotic Therapy in Patients With Atrial Fibrillation and Prior Stroke in GLORIA- AF Phase II (Global Registry on Long-term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation, Phase II)
Authors: Diener Hans-Christoph , Huisman Menno V , Halperin Jonathan L , Dubner Sergio J , Ma Chang S , Rothman Kenneth J , Zint Kristina , Elsaesser Amelie , Paquette Miney , Teutsch Christine , Lip Greg Y , Bartels Dorothee
Published: March 2022

Introduction:
Given their substantial risk of recurrent stroke, patients with atrial fibrillation (AF) and prior stroke are at highest risk. Such patients should be pre-scribed oral anticoagulants (OAC), either a Vitamin K Antagonist (VKA) or Non-VKA OAC (NOAC).

Methods:
Using an inception cohort design, GLORIA-AF collected data on choice of antithrombotic therapy for patients with newly identified AF at risk of stroke (CHA2DS2VASc scores ≥ 1) in the course of routine care. We examined the use of an-tithrombotic therapy in those with prior stroke.

Results:
From 15,092 patients in Phase II of GLORIA-AF enrolled in 5 geographical regions worldwide (Europe, North America, Asia, Latin America and Africa/Middle East), 1,582 patients (median age 75 years, 54.9% male) had previous stroke, with a median CHA2DS2-VASc score of 5, compared with a score of 3 in those without previ-ous stroke (n=13,500). For 10 patients previos stroke status was unknown.

In those with previous stroke, VKA alone was prescribed in 25.2%, VKA plus an-tiplatelet therapy (AP) in 5.8%, NOAC alone in 42.9%, NOAC plus AP in 7.7%, and AP alone in 12.1%; 6.3% received no antithrombotic therapy. Proportions were broadly similar in males and females. In comparison, among patients without prior stroke the proportions on AP only or no therapy were a little higher (20.2 versus 18.3%). Among those with prior stroke, proportions on AP alone in Asia, Europe, and North America were 24.2, 9.9 and 5.6% respectively, while proportions on no antithrombotic therapy in these regions were 16.3, 3.2 and 4.5%.

Conclusion:
In this prospective registry, AF patients with prior stroke and a median CHA2DS2-VASc score of 5, approximately 18% were treated with AP alone or no an-tithrombotic therapy, and the treatment gap was greater in Asia than in Europe or North America.
Abstract TP48: Prediction of Neurologic Outcome after Ischemic Stroke with Volumetric Measurements on CT and MRI
Authors: de Havenon Adam , Donleavy Bailey , Wang Haimei , Chung Lee , Majersik Jennifer
Published: March 2022

Background:
CT perfusion (CTP) and MR diffusion-weighted imaging (DWI) interpretation is typically qualitative. Manual quantitative volumetric measurement is too labor-intensive to be practical in the setting of acute ischemic stroke (AIS).

Hypothesis:
Compared to a manual technique, automated volumetric analysis of CTP and DWI in AIS patients will be a strong predictor of neurologic outcome at follow-up.

Methods:
We reviewed 123 inpatients from 2010-2014 with AIS, admission CTP, and clinical follow-up. Using the automated Olea Sphere software, we calculated CTP maps of cerebral blood volume (CBV) and mean transit time (MTT) using oSVD and Bayesian deconvolution. We used the OsiriX software to manually draw regions-of-interest corresponding to CBV and time-to-drain lesion volume on CTP, and core volume on DWI (in 74%). A multivariable ordinal logistic regression model was fitted to the outcome of modified Rankin Scale (mRS) at follow-up with covariates that had a p<0.2 and the primary predictor variables of stroke core, hypoperfused area, or mismatch volume. Mismatch was defined as CBV subtracted from MTT or time-to-drain.

Results:
Patients had mean (± SD) age of 64 ± 16 years; 54% were male; 91% of strokes were in the anterior circulation; mean NIHSS was 13 ± 8; mRS was 2.6 ± 2.1 at 82 ± 46 days to follow-up. Logistic regression found that stroke core was predictive of outcome with both automatic vs manual processes; the automated processes were predictive of outcome for the hypoperfused area measurements; and neither method of measuring mismatch was predictive for outcome (Table 1).

Conclusion:
Our data suggests that automated volumetric analysis of the stroke core and hypoperfused area, but not mismatch, provides accurate neurologic prognosis. Compared to manual volumetric measurements, automated software is more time efficient and may have superior predictive ability.
Abstract TP67: Cerebral Microbleeds Are Associated With Hemorrhagic Infarction Among Acute Ischemic Stroke Patients With NVAF: The SAMURAI-NVAF Study
Authors: Shiozawa Masayuki , Yoshimura Sohei , Kamiyama Kenji , Takizawa Shunya , Okuda Satoshi , Okada Yasushi , Kameda Tomoaki , Nagakane Yoshinari , Hasegawa Yasuhiro , Shibuya Satoshi , Ito Yasuhiro , Nakashima Takahiro , Takamatsu Kazuhiro , Nishiyama Kazutoshi , Todo Kenichi , Kimura Kazumi , Furui Eisuke , Terasaki Tadashi , Shiokawa Yoshiaki , Yagita Yoshiki , Kario Kazuomi , Kinoshita Naoto , Matsubara Soichiro , Yamagami Hiroshi , Koga Masatoshi , Toyoda Kazunori ,   the SAMURAI Study Investigators
Published: March 2022

Background and purpose:
Cerebral microbleeds (CMBs) are prevalent among stroke patients, and have shown to be the risk factor for the future ischemic or hemorrhagic stroke in several reports. However, the significance of CMBs among acute ischemic stroke patients, especially those with non-valvular arterial fibrillation (NVAF), remains unknown.

Methods:
Of 1,192 patients who participated in the SAMURAI-NVAF study (an ongoing prospective, multicenter, observational study), 1,099 patients (77.6±10.0 y.o, 620 men) underwent a T2* weighted image (T2*WI). Association of CMBs detected on T2*WI with the incidence of any hemorrhagic infarction (any HI and PH) and PH2 seven days after the index stroke and symptomatic hemorrhagic events and modified Rankin Scale (mRS) at discharge were assessed.

Results:
CMBs were detected in 256 patients (23.2%); single CMB in 96, 2-4 CMBs in 109, and ≥5 CMBs in 51. Hemorrhagic infarction was more frequent as the number of CMBs increased (21.5%, 21.9%, 26.6%, and 33.3% in patients with 0, 1, 2-4, and ≥5 CMBs, respectively: p=0.024, analyzed by Cochran-Armitage test for trend). PH2 was identified in 2.5%, 0%, 2.8% and 3.9%, respectively (p=0.824), symptomatic hemorrhagic event in 1.2%, 1.0%, 0%, and 0%, respectively (p=0.5910), and mRS 3-6 in 51.5%, 54.2%, 54.1%, and 62.7%, respectively (p=0.4370). Presence of CMBs was independently associated with any hemorrhagic infarction [odds ratio (OR) 1.72; 95% confidence interval (CI) 1.18-2.51; p=0.005] after adjustment for age, sex, premorbid mRS, infarct size, infarct number, and intravenous thrombolysis, but not with PH2 (p=0.639), symptomatic hemorrhagic events (p=0.633), or mRS 3-6 (p=0.212). Among 253 patients receiving intravenous thrombolysis or endvascular therapy, CMBs were also independently associated with hemorrhagic infarction (OR 2.75; 95%CI 1.27-6.04; p=0.010), but not with the other outcomes.

Conclusions:
CMBs were associated with any hemorrhagic infarction in acute ischemic stroke patients with NVAF regardless of receiving thrombolysis or not. However, they were not associated with PH2, symptomatic hemorrhagic events, or unfavorable vital or functional outcomes.
Abstract TP68: Recanalization of Large Vessel Occlusion in the Golden Hour of IV tPA Administration for Ischemic Stroke
Authors: Bernatowicz Rodica , Donohue Megan , Hussain M. S , John Seby , Uchino Ken , Wisco Dolora
Published: March 2022

Introduction:
Intracranial large vessel occlusions (LVO) are responsible for approximately 45% of ischemic strokes and the cause of detrimental ischemic strokes associated with poor outcome and high mortality. Little data exist about rates of LVO recanalization with ultra-early administration of IV tPA.

Hypothesis:
IV tPA given within the first, so called "golden hour", of symptom onset increases recanalization rates in LVO.

Methods:
Retrospective chart review of all patients who received tPA and were subsequently treated in our health system in 2014. We identified patients that had occlusion of internal carotid artery (ICA) , M1 middle cerebral artery (MCA), A1 segment anterior cerebral artery (ACA), or basilar artery on CTA, MRA, or angiography and compared recanalization rates within 6 hours after administration of IV tPA between those that received tPA ultra-early (≤ 1 hour after symptom onset) versus those that received tPA beyond 1 hour.

Results:
In 2014, 168 patient received IV tPA of which 35 had LVO. Of these, 9 patients received tPA within one hour of symptom onset while the remaining 26 patients were treated after one hour. Both groups did not differ in regards to age, gender, initial NIHSS, and occluded vessel.

Table 1 summarizes the results.

Conclusions:
Ultra-early IV tPA administration within the "golden hour" appears to have higher LVO recanalization rates as compared to later treatment. Further studies of reperfusion rates in LVO strokes with ultra-early thrombolysis are warranted.
Abstract TP71: Prior Asymptomatic Parenchymal Hemorrhage Does Not Increase the Risk for Intracranial Hemorrhage After Intravenous Thrombolysis
Authors: AbdelRazek Mahmoud , Mowla Ashkan , Abdelhamid Nour , Sawyer Robert
Published: March 2022

Background:
The NINDS Trial demonstrated the efficacy of intravenous (IV) recombinant tissue plasminogen activator (rtPA) in improving neurologic outcome in patients presenting with acute ischemic strokes. Patients that had a prior history of intracranial hemorrhage (ICH) were excluded from this trial, possibly due to a hypothetical increase in the subsequent bleeding risk. Thus there is little data available, whether against or in favor of, the use of IV rtPA in patients with prior ICH. We aim to aid in determining the safety of IV rtPA in such patients through a retrospective hospital based single center study.

Methods:
We reviewed brain imaging (including CT, MRI T1, T2, T2* and DWI) of all the patients who received IV rtPA at our comprehensive stroke center from January 2006 to April 2014 for evidence of prior ICH at the time of IV rtPA administration. Their outcomes were determined in terms of subsequent development of symptomatic ICH as defined by the NINDS trial.

Results:
Brain imaging for 640 patients was reviewed. A total of 27(4%) patients showed evidence of prior ICH at the time of IV thrombolysis, all intra-parenchymal. Of these 27 patients, 11 had prior frank macrobleeds and 16 had prior microbleeds. Only one patient (3.7%) developed subsequent symptomatic ICH after the administration of IV rtPA, and was from the microbleed group. Of the remaining 613 patients that received IV rtPA, 25 patients (4.1%) developed symptomatic ICH. There was no statistical significance in the rate of post thrombolysis symptomatic ICH between the two groups (p=0.69).

Conclusion:
This retrospective study provides limited (Level C) evidence that patients with imaging evidence of prior asymptomatic intra-parenchymal hemorrhage presenting with an acute ischemic stroke do not show an increased risk of developing symptomatic ICH after IV thrombolysis.
Abstract TP79: Patient Refusal and Informed Consent-related Delays for Stroke Thrombolysis in Chicago
Authors: Mendelson Scott J , Aggarwal Neelum T , O'Neill Kathleen A , Richards Chris , Prabhakaran Shyam
Published: March 2022

Objective:
To describe consent-related failures in patients eligible for tissue plasminogen activator (tPA) and to assess if race-ethnic disparities exist in the informed consent process for intravenous tPA for acute ischemic stroke (AIS) at primary stroke centers (PSCs) in Chicago, Illinois.

Background:
Disparities in stroke care include observed differences in stroke incidence, severity, mortality, acute management, and rehabilitation. There are no data regarding race-ethnic disparities in informed consent for tPA.

Methods:
A retrospective analysis of stroke admissions using the Get With The Guidelines (GWTG) Stroke registry of 15 PSCs in the city of Chicago between January 2013 and June 2015. We analyzed the proportion of consent-related failures (delay or refusal) among tPA-eligible patients who were treated > 60 minutes from arrival or did not receive tPA, overall and stratified by race.

Results:
There were 1,029 (39.1% white, mean age 65.1 years) tPA-eligible patients presenting through emergency departments at the 15 PSCs. Among these, 324 (31.5%) received tPA 60 minutes, and 569 (55.3%) did not receive tPA. Of those with delayed or no treatment (n=705), 72 (10.2%) experienced consent-related failures. There was a trend toward higher rates of consent-related failures in non-whites vs. whites (12.1% vs. 7.4%; p=0.056).

Conclusions:
At Chicago’s PSCs, consent-related delay or refusal of consent occurs in at least 7% of tPA-eligible patients. Furthermore, non-whites may be more likely to experience consent-related failures than whites. Consent-related delays, as with any treatment delay in tPA eligible patients, may result in worse outcomes. Further research should focus on barriers to informed consent in stroke thrombolysis, specifically addressing potential race-ethnic disparities in the informed consent process.
Abstract TP95: Hypothyroidism is Associated With Cerebral Aneurysms in Women
Authors: Atchaneeyasakul Kunakorn , Tiperneni Anita , Zhang Tony , Khandelwal Priyank , Snelling Brian , Dharmadhikari Sushrut , Ambekar Sudheer , Guada Luis , Ramdas Kevin , Yavagal Dileep
Published: March 2022

Background:
Endocrine dysfunction, including thyroid function, has been known to affect cerebral vascular dysfunction. Hypothyroidism has been shown to cause mucopolysaccharide deposition which has been associated with the weakening of blood vessel walls and aneurysm formation in some case reports. However, the connection between hypothyroidism and cerebral aneurysm has not been well studied. We hypothesized that hypothyroidism maybe associated with occurrence of cerebral aneurysms.

Methods:
We performed a retrospective case-control study of consecutive patients receiving cerebral angiography at our tertiary-care academic medical center. Inclusion criteria included undergoing 3-vessel angiography. Exclusion criteria included any ruptured aneurysm or previous intracranial hemorrhage. Medical history of hypothyroidism was noted along with all other risk factors. The control group of patients did not have any intra-cranial abnormality on angiography. Patients with cerebral aneurysm were matched with controls for known risk factors of cerebral aneurysm, including: age, hypertension, and smoking history. Cases were further subdivided base on gender given females are known to have higher incidence of hypothyroidism.

Results:
From 2008 through 2013, 82 female and 59 male patients with aneurysms were identified for this study and were matched with equal numbers of controls. Among women, hypothyroidism was present in 20.7% (17/82) among patients with cerebral aneurysms vs. in only 6.1% (5/82) among matched controls: odds ratio (OR) 4.03 (95% CI 1.41-11.51, p=0.01). Among men, 8.5% (5/59) cases and 0/59 controls had hypothyroidism, showing no significant association, with an odds ratio of 12.01 (95% CI 0.65-222.3, p=0.095).

Conclusion:
We found a significant association of history of hypothyroidism with cerebral aneurysm in women in our patient cohort. Given the potential pathophysiologic connection between hypothyroidism and vascular wall dysfunction, this should be explored further.
Abstract WMP1: Factors Influencing Differential Outcomes in Stent Retriever Trials: Comparison to a new Outcome Model Based on Percent Utilization of rt-PA
Authors: Mandava Pitchaiah , Martini Sharyl R , Shah Vishank A , Fabian Roderic H , Kent Thomas A
Published: March 2022

Background:
While stent-retriever randomized clinical trials (RCTs) were uniformly positive, their designs differed. Here, we assessed whether trials also differed in the magnitude of improvement and if factors could be identified that distinguished the best performers. Because % utilization of rt-PA in the control arms varied, we developed a multi-dimensional outcome model from the control arms of all IV tPA RCTs treating various % of subjects and their baseline stroke severity (NIHSS). This model was used to compare each trial’s functional outcome (mRS
<
2) and mortality at their own baseline without need for statistical manipulation. We assessed factors that potentially distinguished the best performers.

Methods:
The model was developed from 54 RCT control arms representing >11,000 subjects treating between 0-100% with IV rt-PA. 3-D non-linear functions were fit to the 90-day mortality and mRS 0-2. This model includes ±95% statistical interval surfaces to assess whether a trial’s outcomes surpass the variability inherent in a sample of RCT subjects (Neurology 85:274-83, 2015). 6 stent retriever RCTs were compared.

Results:
The models showed excellent fit: mRS 0-2 (r
2
=0.83, p<<0.001) and mortality (r
2
=0.65, p<<0.001) Figs 1a, 1b. All stent retriever arms exceeded mRS 0-2 +95% surface indicating better than expected efficacy, but the degree of improvement varied: 30-40% absolute improvement over expected outcome was seen in EXTEND and SWIFT-PRIME, compared to 12% for SWIFT and REVASCAT. The 2 top performers had a 75 minute shorter treatment time. Both treated 100% with IV rt-PA compared to SWIFT (33%) and REVASCAT (68%).

Conclusion:
A new outcome model based on stroke severity and % IV rt-PA permitted analysis of stent-retriever therapy compared to a large population. Best outcomes were related to shorter treatment time and higher utilization of rt-PA, suggesting a treatment interaction between these modalities. Factors influencing mortality are being analyzed.