bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP34: Race Differences in Emergency Department Stroke Diagnostic Practices
Authors: Schichtel Luke , Burke James , Kerber Kevin
Published: January 2025

Introduction:
Stroke misdiagnosis is not uncommon and Black people have a higher odds of stroke misdiagnosis than White people. Little is known about the reasons for misdiagnosis or how diagnostic pathways lead to error.

Hypotheses:
To explore possible explanations for race differences in stroke diagnosis, we examine two hypotheses. First, to understand where diagnostic pathways may err we quantified, whether race predicted whether receipt of initial imaging (ie. CT/MRI), hypothesizing that black people receive less imaging. Second, amongst individual that receive imaging, we hypothesized that Black people will be less likely to receive stroke diagnoses or be admitted to the hospital.

Methods:
We used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2011-2021. Our primary study population was adults with any neurologic chief complaint, defined using reason for visit (RFV) data. Our primary exposure was Black race. For each outcome, we built unadjusted, minimally adjusted, and fully adjusted survey-weighted logistic regression models to predict outcomes: receipt of imaging, stroke diagnoses and hospital admission. The minimally adjusted model added age, sex, and insurance to race/ethnicity. The fully adjusted model added vital signs, arrival by ambulance, triage level, episode of care, vascular risk factors, prior vascular disease and RFV-based characterization of stroke probability.

Results:
The mean age was across the ~146,000 emergency room visits 47.8 ± 19.7 and black people comprised 24.9% of the sample. Amongst individuals with a neurologic RFV, black people were less likely to get a CT (OR 0.79, 95% CI 0.72-0.88), MRI (OR 0.64, 95% CI 0.47-0.89), or any imaging (OR 0.78, 95% CI 0.71-0.86 ) in the unadjusted model. These effects persisted or were strengthened in the fully adjusted model: Black race-imaging association (OR 0.67, 95% CI 0.45-0.99). Conditioned on receiving imaging after full adjustment, there was no association between Black race and stroke diagnoses (OR 1.1, 95% CI 0.63-1.9) or hospital admission for stroke (OR 1.19, 95% CI 0.46-3.08).

Conclusion:
We found that Black people were less likely to receive imaging when presenting with neurologic reasons for visit, but that conditioned on receiving imaging, there were no differences in stroke diagnosis or hospitalization. This suggests that race differences in stroke diagnosis likely occur at or prior to the time of initial imaging selection.
Abstract TMP55: The Impact of Statin Intensity on Cerebral Vasomotor Reactivity, White Matter Hyperintensities, and Micro-Bleeds in Stroke Patients
Authors: Pirahanchi Yasaman , Shifflett Ben , Sabayan Behnam , Ravi Vikas , Carrion Penagos Julian , Bowers Jeffrey , Hailey Lovella , Morton Melissa , Modir Roya , Agrawal Kunal , Hemmen Thomas , Meyer Brett , Meyer Dawn , Bavarsad Shahripour Reza
Published: January 2025

Background:
Cerebral vasomotor reactivity (VMR) is crucial for regulating cerebral blood flow and neurological health. Research suggests that high-intensity statin therapy may improve VMR shortly after a stroke. This study aims to evaluate the duration of this improvement over three months and explore the association between white matter hyperintensities (WMH), cerebral micro-bleeding (CMB), and VMR as an endothelial function marker.

Methods:
We enrolled 120 ischemic stroke patients from July 2023 to June 2024 at an academic stroke center. Patients were divided retrospectively into high-intensity (40 or 80 mg Atorvastatin or equivalent) and moderate to low-intensity (10-20 mg Atorvastatin or equivalent) statin therapy groups. VMR was assessed using the Breath Holding Index (BHI) via transcranial Doppler ultrasound at two weeks and three months post-stroke. We analyzed the correlation between WMH, CMB, and VMR across different statin doses using multivariable regression, adjusting for baseline NIHSS, demographics, cerebrovascular risk factors, WMH, and CMB.

Results:
The cohort had an average age of 69.8 years, with 50.8% being male. High-intensity statins were used by 63 patients (52.5%). At baseline, the high-intensity group had a significantly higher BHI (Mean VMR: 0.9 vs. 0.7, P < 0.008), which remained higher at the three-month follow-up (Mean VMR: 0.8 vs. 0.7, P < 0.001). Baseline WMH was present in 29.2% of patients, and 18.3% had CMB. Patients with lower baseline VMR had a higher incidence of WMH (53.5% vs. 6.5%, P < 0.001), which persisted at three months (55.6% vs. 7.6%, P < 0.001). Lower baseline VMR was also associated with higher CMB rates (37.9% vs. 0%, P < 0.001), continuing at three months (40.7% vs. 0%, P < 0.001). The average baseline BHI was 0.65 in patients with WMH versus 0.81 in those without WMH (P < 0.001) and 0.64 in patients with CMB versus 0.79 in those without CMB (P < 0.001).

Conclusion:
High-intensity statin therapy positively affects VMR in stroke patients over three months. Lower VMR is associated with increased WMH and CMB, suggesting that optimizing statin treatment may improve vascular health and reduce stroke recurrence risk. Future research should investigate these findings further and assess the long-term effects of statin therapy on VMR and recurrent cerebrovascular events.
Abstract TMP59: Artificial Intelligence Improves Detection Sensitivity for Challenging Acute Ischemic Stroke Lesions on Diffusion-weighted Imaging
Authors: Jeong Younbeom , HA Sue Young , Ryu Wi-sun , Kim Beom Joon , Sunwoo Leonard
Published: January 2025

Introduction:
Diffusion-weighted imaging (DWI) is key for detecting acute ischemic brain lesions but struggles with hyperacute or small lesions that mimic artifacts. This randomized crossover trial assessed whether an artificial intelligence (AI) solution enhances diagnostic accuracy for these challenging lesions compared to conventional interpretation.

Methods:
From February 2017 to November 2021, 4,071 suspected acute ischemic stroke patients underwent initial and follow-up DWI. A neurologist assessed ischemic stroke based on medical records, and a neuroradiologist established the ground truth using the neurologist's evaluation, MRI reports, and AI-marked DWI images. The accuracy of AI and MRI reports was then evaluated against this ground truth.

For a reader performance study, 874 challenging cases were selected: (1) infarct volume < 0.5 mL in the posterior circulation on follow-up DWI or (2) initial DWI within 3 hours of onset with infarct volume < 1.0 mL in the anterior circulation. Additionally, 80 negative and 40 positive control cases were included. Five readers (a neuroradiologist, two radiology residents, and two neurology residents) interpreted the DWIs, half with AI assistance and half without. After a 4-week washout, cases were re-evaluated with the groups reversed. We compared the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and Dice similarity coefficient (DSC) between readings with and without AI.

Results:
Of 3,981 patients, 3,465 had acute ischemic strokes, and 516 had MRI-negative transient ischemic attacks. The AI alone showed a positive predictive value (PPV) of 93.1% and a negative predictive value (NPV) of 81.3%. The PPV of AI varied significantly with predicted infarction volume: 81.7% for ≤ 0.5 mL vs. 99.5% for > 0.5 mL. With AI, the sensitivity of MRI reports could potentially increase from 98.5% to 99.7%, ensuring identification of all false negatives.

In the challenging case reader study, AI significantly increased AUC (0.848 vs. 0.927; p < 0.001) and sensitivity (74.59% to 90.59%; p < 0.001), with minimal impact on specificity (88.75% vs. 84.00%; p = 0.0496). AI-assisted segmentation also showed higher DSC compared to non-AI segmentation (0.742 vs. 0.523; p < 0.001).

Conclusions:
AI significantly improved the diagnostic performance for challenging acute ischemic lesions on DWI, demonstrating the potential to enhance stroke care.
Abstract TMP60: Using CTP based Disconnectome Mapping to identify optimal candidates for endovascular treatment in acute ischemic stroke.
Authors: Carone Davide , Garrard James , Zarrintan Armin , Brinjikji Waleed , Harston George , Kallmes David F
Published: January 2025

Background:
Identifying optimal candidates for endovascular treatment (EVT) remains an ongoing priority to maximize treatment efficacy. The recent large core trials have called into question the use of infarct volume alone for selecting patients. This study aimed at exploring the feasibility of using routinely acquired Computed Tomography Perfusion (CTP) to capture how lesion location impacts brain connectivity and how this in turn affects the ability to benefit from EVT.

Methods:
Consecutive patients from a multi-centric stroke imaging registry were included in this study if they had a proven anterior circulation large vessel occlusion (LVO) and available baseline CTP data. Hypoperfusion (Tmax >6 seconds) and ischemic core (relative cerebral blood flow <30%) maps were automatically generated using e-CTP (Brainomix, UK) and used to derive disconnection maps via a DTI template. A voxel-based, multivariate method (Sparse Canonical-Correlation-Analysis – LESYMAPS) was used to explore associations between disconnection maps and NIHSS subitems in recanalized patients. The mismatch between Tmax and core disconnection volumes (disconnection mismatch volume) (Figure 1) was used to predict modified Rankin Scale (mRS) at 3-months using an ordinal shift regression adjusted for age, recanalization status and infarct volume.

Results:
One-hundred and seventy-one patients were included. The median NIHSS was 16 (11.5 to 22). The total NIHSS was associated with disconnection predominantly within the left basal ganglia, brainstem and corpus callosum. Upper and lower limb deficits (NIHSS 5a, 5b, 6a, 6b) were associated with corticospinal tract disconnection, with negative correlations within the contralateral tracts (Figure 2). Language deficits were associated with left hemisphere tract disconnection, also showing negative correlations within the contralateral tracts. The disconnection mismatch volume was an independent predictor of functional outcome at 3-months (Table 1).

Conclusion:
The results from this study showed that it is possible to use routinely acquired CTP to capture the effects of stroke lesion on brain connectivity and its impact on functional outcome following recanalization treatment. Such an approach could enable more nuanced treatment selection for patients based on specific neurological deficits.
Abstract TMP68: Impact of Statin Initiation and Resumption on Mortality Following Intracranial Hemorrhage: A Meta-Analysis
Authors: Allaw Sammy , Baskaran Archit , Kozel Olivia , Aldaher Batool , Agwu Chibueze , Jhaveri Aditya , Smith Matthew , Morsi Rami , Desai Harsh , Kothari Sachin , Given Tyler , Metman Okker , Penagos Julian , Thind Sonam , Karar Lina , Chahine Ahmad , Sehgal Neha , Rana Rohini , Kass-Hout Tareq
Published: January 2025

Background:
The use of statins following intracranial hemorrhage (ICH) is disputed. Prior studies have found inconsistent effects of statins on the risk of subsequent ICH and other outcome measures. Moreover, many previous studies do not distinguish between post-ICH statin treatment in patients resuming previous statin therapy versus initiation in statin-naïve patients. This meta-analysis consolidates the evidence surrounding the use of therapies following ICH, with a focus on mortality in these two subgroups.

Methods:
A comprehensive search of MEDLINE, EMBASE, and The Cochrane Library was conducted up to 2024 to identify studies on statin initiation or resumption versus no statin use in intracerebral/intraparenchymal hemorrhage patients, yielding 8 studies meeting inclusion/exclusion criteria. The protocol was registered with PROSPERO, and data were analyzed using a Pairwise Meta Analysis in R, applying common and random effects models with heterogeneity assessed via I
2
statistics. Mortality outcomes were categorized into “short-term” (≤90 days) and “long-term” (>90 days to 1 year) mortality.

Results:
Mortality events occurred in 2946 out of 9501 patients (31.0%) in the control group, 123 out of 2248 patients (5.5%) in the statin initiation group, and 787 out of 3944 patients (20.0%) in the statin resumption group. For the ≤90 days timeframe, the random effects model showed a significant reduction in mortality with statin initiation, with a relative risk (RR) of 0.15 (95% CI [0.081; 0.26], p < 0.0001), and with statin resumption, the RR was 0.32 (95% CI [0.18; 0.55], p < 0.0001). Heterogeneity was high, with an I
2
of 84.3%. For the >90 days up to 1 year timeframe, statin initiation was associated with a reduction in mortality, with an RR of 0.39 (95% CI [0.29; 0.53], p < 0.0001). Statin resumption also showed a reduction in mortality, with an RR of 0.65 (95% CI [0.46; 0.92], p = 0.0145). Heterogeneity was moderate, with an I
2
of 41.7%.

Conclusion:
Statin therapy following ICH, whether through initiation or resumption, is associated with a significant reduction in mortality both within 90 days and beyond 90 days up to one year. Interestingly, statin initiation showed a stronger effect compared to resumption. These findings support the continuation or initiation of statins in the acute phases of ICH management regardless of previous statin use.
Abstract TMP73: Endovascular therapy for acute ischemic stroke beyond 24 hours after onset: Japan Stroke Data Bank
Authors: Inui Ryoma , Tanaka Kanta , Toyoda Kazunori , Yoshimura Sohei , Miwa Kaori , Yoshie Tomohide , Nakahara Jin , Miyamoto Yoshihiro , Minematsu Kazuo , Koga Masatoshi
Published: January 2025

Background:
The therapeutic time window of endovascular therapy (EVT) for acute ischemic stroke (AIS) has been expanded up to 24 hours of onset. Patients with AIS beyond 24 hours may also benefit from EVT, but the actual status of this clinical issue is unknown.

Purpose:
To evaluate the real-world status of EVT for AIS beyond 24 hours of onset using a nation-wide stroke registry, Japan Stroke Data Bank (JSDB). JSDB is an ongoing hospital-based multicenter prospective registry of hospitalized patients with acute stroke or transient ischemic attack within 7 days of onset.

Methods:
From the JSDB dataset, patients with AIS who underwent EVT from 1996 through 2021 were analyzed. Patients were divided into 3 groups according to time from onset to hospital arrival (early: <4.5 hour; late: 4.5–24 hour; and very late: >24 hour). Outcomes included the favorable outcome (mRS 0–2 or return to pre-stroke mRS at discharge) and in-hospital mortality.

Results:
Among the 256,293 stroke patients, 91,907 AIS patients available for analysis were included in the present study. EVT was implemented in 6.9% (6,356/91,907) (median age 78 years; 41.6% women; median NIHSS score 16). The EVT rate by time window groups was 11.8% (4,258/36,044) for the early, 5.3% (1,676/31,328) for the late, and 1.7% (422/24,535) for the very late group. In the very late group with EVT, baseline NIHSS score was lowest (median 17 points in the early group, 14 points in the late group, and 5 points in the very late group), cardioembolism was least common (67.2%, 53.5%, and 22.0%, respectively), and large artery atherosclerosis was most common (17.9%, 30.8%, and 55.7%, respectively). Favorable outcome was more frequently achieved in the very late group (52.9%) than in the early (41.6%) and late (36.5%) groups. Symptomatic intracranial hemorrhage was more frequently seen in the very late group (6.0%) compared to the early (2.9%) and late (3.8%) groups, but in-hospital mortality was comparable among the time window groups (8.1% in the early group, 7.1% in the late group, and 6.6% in the very late group).

Conclusions:
Outcomes after EVT for patients with AIS beyond 24 hours were not necessarily worse than for patients with AIS up to 24 hours, but the patient profile in the very late group with EVT differed significantly from that in the early and late groups; developing optimal patient selection strategies for very late AIS may be required.
Abstract TMP74: 3-HKA Promotes the Vascular Remodeling after Stroke by Modulating the Activation of A1/A2 Reactive Astrocytes
Authors: Chen Jun-Min , Shi Guang , Yu Lulu , Shan Wei , Zhang Xiangjian , Wang Qun
Published: January 2025

Background:
Ischemic stroke is the most common cerebrovascular disease worldwide and the leading cause of permanent disability, which imposes a heavy burden on society and families. Currently, there are still limited treatments for improving long-term recovery after cerebral infarction. Recent studies have found that the development and prognosis after stroke are closely related to abnormal tryptophan metabolism. In this study, we aimed to identify tryptophan metabolites with ischemic protective effects in stroke patients and animal models and determine their mechanisms of action.

Methods:
Metabolomics analysis using liquid chromatography-mass spectrometry was performed to identify differentially bioactive metabolites in plasma samples from 46 acute ischemic stroke (AIS) patients and 35 healthy controls and validated in experimental animals, identifying decreased levels of 3-hydroxy-kynurenamine (3-HKA) after stroke. We then examined the role of 3-HKA in stroke mice and performed proteomic analysis to elucidate the molecular mechanisms of 3-HKA.

Results:
Supplementation of 3-HKA improves long-term sensory and motor recovery in ischemic stroke and increases ipsilateral cerebral blood flow. 3-HKA can also promote angiogenesis, stimulate the formation of functional blood vessels, and repair the blood-brain barrier, thereby enhancing post-stroke remodeling. Meanwhile, 3-HKA inhibits the activation of neurotoxic (A1-like) astrocytes but promotes the polarization of neuroprotective (A2-like) astrocytes. Mechanistically, 3-HKA inhibited the activation of AIM2 inflammasomes, and AIM2 expression was increased mainly in astrocytes at 7 and 14 days after stroke, suggesting that 3-HKA may regulate astrocyte-mediated vascular remodeling. Consistently, in primary mouse brain microvascular endothelial cells and astrocyte co-culture, 3-HKA promoted angiogenesis after oxygen-glucose deprivation (OGD). In astrocytes, the effects of 3-HKA on enhancing vascular remodeling in vitro and in vivo were abolished after lentiviral or AAV overexpression of AIM2. Overexpression of AIM2 in astrocytes by lentivirus or AAV counteracted the effect of 3-HKA on augmenting vascular remodeling in vitro and in vivo.

Conclusions:
Our results suggest that tryptophan metabolism is disturbed after stroke, with decreased 3-HKA levels. Supplementation of 3-HKA may foster vascular remodeling by regulating the activation of A1/A2 astrocytes after stroke, thereby improving long-term neurological recovery.
Abstract TMP79: Post Thrombectomy Transcranial Doppler Parameters and Clinical Outcomes
Authors: Jumah Ammar , Batista Savio , Yelam Theja , Anderson Aaron , Sigman Erika , Dolia Jaydevsinh , Haussen Diogo
Published: January 2025

Introduction:
Previous evidence indicated that transcranial doppler (TCD) parameters were associated with functional outcome in large vessel occlusion stroke (LVOS) patients who undergo mechanical thrombectomy (MT). We aim to 1) evaluate if TCD-derived pulsatility index (PI) and mean flow velocity (MFV) may predict clinical outcomes in LVOS after successful MT reperfusion, and to 2) assess if the PI is different in patients that received intravenous thrombolysis (IVT), indicating potential beneficial impact on microvascular reperfusion.

Methods:
This is a retrospective analysis of consecutive patients treated with MT for AIS secondary to a middle cerebral artery (MCA) M1 segment or intracranial internal carotid artery terminus (ICA) LVO. The study period spanned from January 1, 2018, to June 12, 2024; we only included patients with excellent reperfusion, defined as thrombolysis in cerebral infarction [TICI] grade 2c-3, who had TCD studies within 24 hours of their procedure. Patients without TCD studies, or with a poor temporal window were excluded. Ipsilateral and contralateral MFV and PI were collected for both the MCA and anterior cerebral artery (ACA). The primary outcome was the correlation between 3-month functional outcomes, assessed using the modified Rankin Scale (mRS), and the collected TCD parameters. Statistical correlations were performed using Pearson correlation.

Results:
Out of 1962 patients treated within the study period, 703 had MCA-M1 or i-ICA occlusions and TICI 2c-3, and only 229 had TCD within 24h and a good temporal window. Median age was 64.5 (IQR 56-75.5) years and 126 patients (55%) were males, 187 (81.7%) had an MCA-M1 and 42 (18.3%) an ICA-T occlusion. The median ASPECTS score was 8 (IQR 7-9) and the rate of IVT was 29.3%. Functional independence and mortality at 90 days were 49.3% and 14.4%, respectively. There was no association between MCA MFV (linear correlation coefficient -0.016;p=0.88) or PI (-0.08;p=0.47) and mRS at 90 days. The mean PI in patients that received IVT and did not receive IVT was comparable (mean 1.24 [SD0.06] vs 1.73 [SD0.54];p<0.001; adjusted for hypertension and occlusion location).

Conclusion:
In a homogeneous population of i-ICA/MCA-M1 occlusion with full reperfusion, TCD-derived parameters were not found to be associated with clinical outcomes. The PI was comparable between patients with and without IVT, and the finding substantiates the suggestion of IVT-related microvascular clearance.
Abstract TMP81: Endovascular Thrombectomy Outcomes in Acute Ischemic Stroke With Oral Anticoagulation Use: Secondary Analysis From the SELECT Study
Authors: Yaghmoor Bassam , Narangoli Adeeb , Pujara Deep , Al-Shaibi Faisal , Saidi Yazid , Shafiq Ameena , Al Mostaneer Alhassin , Albedaiwi Mohammed , Sundararajan Sophia , Opaskar Amanda , Sila Cathy , Xiong Wei , DeGeorgia Michael , Duncan Kelsey , Hu Yin , Ray Abhishek , Sunshine Jeffrey , Bambakidis Nicholas , Sarraj Amrou
Published: January 2025

Introduction:
Using oral anticoagulation (OAC) at baseline is hypothesized to increase the risk of hemorrhagic transformation after endovascular thrombectomy (EVT). However, several prior studies evaluating EVT in patients on OAC demonstrated conflicting results regarding functional and safety outcomes. We aimed to characterize the association between baseline use of OAC and EVT outcomes from SELECT, a multicenter, prospective cohort study.

Methods:
From SELECT study, patients with acute ischemic stroke and large vessel occlusion within 24 hours from onset who received EVT were identified. Patients were stratified based on baseline OAC use, and their clinical and imaging characteristics and functional and safety outcomes were described and compared.

Results:
Forty-three (15%) out of 285 patients used OAC at baseline, 29 (10%) were on vitamin K antagonists (VKA), and 14 (5%) were on direct oral anticoagulants (DOAC). OAC users were older (median age 75 years old vs 65) and had higher comorbidities - hypertension (88.4% vs 71.3%), diabetes mellitus (41.9% vs 25.7%), atrial fibrillation (64.3% vs 28.2%), and congestive heart failure (23.8% vs 9.6%), had smaller ischemic core volume at baseline (median [IQR]: 0cc [0-12] vs 11cc [0-32][SS1] ), and received alteplase less often (46.5% vs 69.0%, P <0.05 for all). OAC use was not significantly associated with worse clinical outcomes such as functional independence (modified Rankin Scale 0-2, OAC 44.2%, no OAC 54.5%, aOR 0.74, 95% CI: 0.33 to 1.68, p-value: 0.48) [SS2] [SS3] and mortality (OAC 20.9%, no OAC 12.0%, aOR 2.01, 5% CI: 0.68 to 5.89, p-value: 0.21); no OAC users had symptomatic intracranial hemorrhage (figure 1, table 1). There were no statistically significant differences between VKA vs DOAC users, including functional independence (48.3% vs 35.7%, aOR: 0.09, 95% CI: 0.01 to 1.59) and mortality (17.2% vs 28.6%, aOR: 1.90, 95% CI: 0.04 to 87.88; P >0.05 for both; table 2).

Conclusion:
Almost 1 in 7 patients receiving EVT had baseline use of OACs, with higher comorbidities. OAC use at baseline was not associated with poor functional outcomes. We also did not observe symptomatic intracranial hemorrhage among EVT patients with baseline OAC use, suggesting limited safety concerns due to hemorrhagic transformation. There was no difference in outcome between VKA users and DOAC users.
Abstract TMP97: Association Between Race/Ethnicity and New Onset Atrial Fibrillation and Stroke Following Noncardiac Surgery
Authors: Rudolph Maira , Mpody Christian , Borngaesser Felix , Wongtangman Karuna , Wachtendorf Luca Johann , Khandaker Rafi , Suleiman Aiman , Schaefer Maximilian , Di biase Luigi , Garcia Mario , Stiles Brendon , Bhatt Deepak , Nafiu Olubukola , Eikermann Matthias , Karaye Ibraheem
Published: January 2025

Background:
Racial differences in postoperative atrial fibrillation (POAF) and stroke rates following noncardiac surgery are not well understood and may be influenced by varying betablocker prescription patterns.
1

Methods:
This multicentric retrospective observational study included 205,886 adult patients without pre-existing atrial fibrillation who underwent non-cardiac surgery between 2005 and 2021 at two tertiary care academic healthcare networks in the Bronx, New York, and Boston, Massachusetts. The study population consisted of 133,500 (65%) Non-Hispanic White (NHW), 38,237 (19%) Non-Hispanic Black (NHB), and 34,149 (17%) Hispanic individuals. The exposure variable was self-identified race and ethnicity with NHW patients serving as the reference group. The incidence of POAF within 30 days of surgery and postoperative stroke within the first year after the procedure were assessed. Modified Poisson regression with robust error variances was used to evaluate the association between race/ethnicity and POAF and postoperative stroke, adjusting for pre-defined confounders. Mediation analysis was used to determine whether beta-blocker use modified the association between race/ethnicity and stroke.

Results:
NHB and Hispanic patients were less likely to develop POAF than NHW patients (NHB: RRadj = 0.59; 95%CI: 0.52-0.68; P < .001; Hispanic: RRadj = 0.65; 95%CI: 0.56-0.76; P < .001) but more likely to experience postoperative stroke (NHB: RRadj = 1.39; 95%CI, 1.30-1.49; P < .001; Hispanic: RRadj = 1.34; 95%CI, 1.24-1.46; P < .001). NHB and Hispanic patients were also more likely to be on preexisting beta-blocker therapy than NHW patients (NHB: RRadj = 1.10; 95%CI: 1.07-1.14; P < .001; Hispanic: RRadj = 1.07; 95%CI: 1.03-1.12; P < .001). Beta-blocker use was significantly associated with an increased risk of postoperative stroke (RRadj = 1.17; 95%CI: 1.11-1.24; P < .001) and explained 16% (95%CI: 14%-20%) and 20% (95%CI: 16%-26%) of the variability in postoperative stroke rates among NHB and Hispanic patients, respectively.

Conclusion:
NHB and Hispanic patients are at higher risk of developing postoperative stroke following noncardiac surgery compared to NHW patients, despite having a lower risk of POAF. This increased stroke risk may be partially attributable to the higher likelihood of preoperative beta-blocker prescriptions in these populations.

Reference

1 - POISE Study Group. The Lancet. 2008 May 31;371(9627):1839-47.
Abstract TMP98: Low-dose Rivaroxaban plus Antiplatelet Treatment in Patients With Symptomatic Intracranial Atherosclerotic Stenosis：A Prospective Observational Study
Authors: Zhang Ding , Zhao Zhaoyang , Qian Yiwei , Zhou Yifang , Pei Lulu , Cao Yuan , Song Bo
Published: January 2025

Background:
The secondary prevention of symptomatic intracranial atherosclerotic stenosis (sICAS) remains a significant challenge. In the recent COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial, the combination of low-dose rivaroxaban with antiplatelet therapy demonstrated better efficacy in preventing vascular events in patients with coronary atherosclerosis compared to antiplatelet therapy alone. This study aimed to evaluate the efficiency of dual pathway inhibition on recurrent stroke and vascular events in patients with sICAS.

Methods:
Patients with sICAS admitted within 7 days of symptom onset were identified from the hospital-based database from January 2019 to June 2023. We compared the clinical outcomes of low-dose rivaroxaban combined with antiplatelet therapy (Rivaroxaban 2.5mg bid plus asprin or clopidogrel) and antiplatelet therapy alone (dual antiplatelet therapy or antiplatelet monotherapy) among patients with sICAS. The primary outcome was a composite of all-cause death, ischemic stroke or transient ischemic attack, and acute coronary syndrome within one year post-stroke. Propensity score matching was performed in a 1:3 ratio for the two groups of patients to mitigate confounders, adjusted hazard ratios (HR) were estimated using multivariate Cox regression model. The win-ratio method was employed to assess the composite outcome.

Results:
Among 1,308 patients, 123 (9.4%) were prescribed rivaroxaban and antiplatelet therapy. In the matched population, the primary endpoint event rate in this group was lower (11/123 [8.9%] vs. 63/369 [17.1%], P=0.029). Multivariate Cox regression analysis revealed a significant benefit from low-dose rivaroxaban (adjusted HR=0.459, 95% CI: 0.234-0.897, P=0.023). In addition, coronary heart disease (adjusted HR=1.674, 95% CI: 1.013-2.766, P=0.044) was identified as a risk factor associated with composite outcome during the 1-year follow-up. In the analysis of the hierarchical composite end point, the results for the primary end point favored rivaroxaban plus antiplatelet therapy (win ratio=1.948, 95% CI: 1.134-3.346, P=0.016).

Conclusions:
Low-dose rivaroxaban combined with antiplatelet therapy was superior to antiplatelet therapy alone for the prevention of all-cause death, recurrent stroke and acute coronary syndrome among patients with sICAS. These findings are preliminary and warrant further investigation through randomized controlled trials.
Abstract TP100: Predictors of Skilled Nursing Facility Length of Stay and Discharge after Aneurysmal Subarachnoid Hemorrhage
Authors: Porto Carl , Feler Joshua , Chuck Carlin , Torabi Radmehr , Moldovan Krisztina , Furie Karen , Wolman Dylan , Mahta Ali
Published: January 2025

Introduction:
Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality. Survivors often require extended care at skilled nursing facilities (SNF) or long-term acute care centers (LTAC). The need for long-term institutional care and distribution of patients returning to independence is unclear. We sought to identify predictors of discharge from extended care facilities to home in aSAH patients.

Methods:
We conducted a retrospective review of a prospectively maintained database of aSAH patients treated at a single center from June 2016 to March 2024. Included patients were discharged from the hospital to an extended care facility. Patients were grouped by whether they were discharged from extended care to home and the estimated facility length of stay (LOS) was determined. Demographics, aSAH characteristics, hospital complications, and post-aSAH neurological status were analyzed. Predictors of extended care facility discharge to home were determined using independent-sample t-tests, Fisher analyses, and multivariable logistic regression. Facility LOS predictors were identified using cumulative link modeling.

Results:
Of 450 aSAH patients, 61 (13.5%) were discharged to a SNF. No patients discharged to LTAC returned home and were not reviewed further. Among SNF patients, 49 (80.3%) were discharged home (
Figure 1)
. Discharged patients were younger (mean 63.3±11.5 years vs. 70.2±9.3, p=0.040;
Figure 2
) and had lower modified Fisher scores (3 [IQR 3-4] vs. 4 [IQR 4-4], p=0.046;
Figure 3
). Intraventricular hemorrhage (OR 0, 95% CI 0-1.12, p=0.043), tracheostomy (OR=0.14, 95% CI 0.14-1.01, p=0.048), and gastrostomy tube (PEG) placement (OR=0.13, 95% CI 0.03-0.51, p=0.003) were associated with lower odds of SNF discharge. Patients discharged home had shorter hospital LOS (26±10 vs. 39±15 days, p<0.001) and lower mRS scores at discharge (4 [IQR 4-5] vs. 5 [IQR 4-5], p=0.028) and 90-days post-discharge (4 [IQR 3-5] vs. 6 [IQR 5-6], p=0.001). Multivariable regression identified old age, PEG and hospital LOS as independent predictors of SNF discharge. Tracheostomy, PEG, and symptomatic vasospasm predicted SNF LOS.

Conclusions:
A majority of aSAH patients were discharged from SNF to home. Those not discharged were more medically complex with neurological deficits. These results may guide goals of care discussions, suggesting that patients unfit for home discharge may benefit from SNF placement to bridge hospitalization and independence.
Abstract TP110: Impact of High-Intensity Training on Cardiopulmonary and Lipid Profiles in Stroke Rehabilitation: A Systematic Review and Meta-Analysis
Authors: Rizwan Ahmed Aisha , Restrepo Natalia , koppanatham aishwarya , Chochol Pawel , Varkey Thomas
Published: January 2025

Introduction:
Cardiovascular comorbidities are highly prevalent in patients who suffer from cerebrovascular disease. Peak oxygen uptake (VO
2
peak) is a well-established, independent predictor of cardiovascular health and premature mortality. Dyslipidemia also contributes significantly to cardiovascular disease risk. Although previous studies have demonstrated improvements in these parameters with any exercise, the evidence remains inconclusive regarding which exercise intensity offers the greatest benefit. This systematic review and meta-analysis aims to compare the effects of high-intensity training (HIT) with other exercise intensities, including moderate intensity (MIT) and usual activity (UA).

Methods:
We systematically searched the PubMed, Cochrane, Embase, and Scopus databases for studies comparing HIT with MIT or UA in stroke patients. We evaluated changes from baseline in VO
2
peak, serum LDL, and HDL levels. Additionally, a separate analysis comparing HIT with MIT and UA was conducted for VO
2
peak.

Results:
A total of eight studies, involving 338 patients, were included in our analysis, with 163 (48%) of these patients undergoing HIT. The pooled analysis revealed that VO
2
peak was significantly higher in the control group compared to the HIT group, with a mean difference (MD) of 2.01 ml/kg/min (95% CI: 0.85-3.18, p < 0.01). Further analysis of four studies comparing HIT with MIT and three studies comparing HIT with UA showed that VO
2
peak was significantly higher following MIT (MD 2.03; 95% CI: 0.70-3.35; p < 0.01) and UA (MD 3.73; 95% CI: 0.87-6.59; p = 0.01). A separate analysis of three studies involving 148 patients showed no significant difference in serum LDL levels (MD 0.51; 95% CI: -0.46-1.49; p = 0.30) or serum HDL levels (MD -0.02; 95% CI: -0.16-0.13; p = 0.83).

Conclusion:
High-intensity training, based on a moderate sized pooled sample, does not offer superior advantages in changes from baseline in cardiopulmonary parameters compared to different exercise intensities. Future well-structured randomized controlled trials are needed to evaluate different exercise intensities and durations for more definitive conclusions. Nevertheless, the early data seems to indicate that there are no differences between exercise modalities.
Abstract TP121: More Thrombectomy Transfers and Simpler Network Structures in Vertically Integrated ED-Hospital Pairs
Authors: Gusler Matthew , Deligkaris Christos , Zha Alicia , Burke James
Published: January 2025

Background:
Stroke transfer networks have rapidly evolved with limited central organization in response to the emerging and evolving evidence base for endovascular thrombectomy (EVT). Simultaneously, the US healthcare system has undergone a period of rapid consolidation with large hospital systems purchasing smaller hospitals and physician practices, an evolution termed “vertical integration” (VI). The effect that vertical integration has on emergency stroke care is unclear. This analysis longitudinally characterizes VI and non-VI stroke transfer networks to assess their evolution.

Methods:
Using the 2016-2018 US Centers of Medicare Fee-For-Service files, we captured patients with ischemic stroke who had an ED-hospital transfer, defined as a beneficiary with: 1) any outpatient ED claim the day of or prior to the inpatient stroke claim, 2) an ED discharge status indicating transfer to an acute care hospital, and 3) originating and receiving facilities with different NPI numbers. We defined an ED-hospital dyad to be vertically integrated if the ED and hospital shared the same health system ID in the Agency for Healthcare Research and Quality's Compendium of US Health Systems. We characterized the vertical integration of the stroke transfer networks using descriptive statistics and the structure using multiple edge directed graphs.

Results:
We identified 13287, 14217, 15169 stroke transfers in 2016, 2017, and 2018, respectively. In 2016, 29% of VI stroke transfer network dyads had ≥1 transfer with EVT compared to only 17% of non-VI dyads. While the overall fraction of dyads with ≥1 transfer with EVT increased over time (2016: 20%, 2017: 25%, 2018: 28%), the relatively higher fraction in VI dyads with ≥1 transfer with EVT compared to non-VI dyads remained stable (2017: VI 32%, non-VI 22%; 2018: VI 35%, non-VI 26%).

In VI stroke transfer networks in 2016, EDs sent stroke transfers to 1.2 hospitals on average, while hospitals received stroke transfers from 2.1 EDs. In non-VI stroke transfer networks, EDs sent stroke transfers to 1.9 hospitals on average, while hospitals received stroke transfers from 3.8 EDs. There was no substantial change in 2017 or 2018.

Conclusion:
From 2016 to 2018, a greater proportion of VI stroke transfer dyads had transfers for EVT than non-VI stroke transfer dyads. VI EDs on average transferred to fewer receiving hospitals than non-VI EDs, while VI hospitals on average received patients from fewer EDs than non-VI hospitals.
Abstract TP140: The Blood Proteome Profiling Identifies Biomarkers Associated With Ischemic Stroke Prognosis
Authors: He Jiachen , Chen Xi , Chen Jian , Ji Xunming , Wu Di
Published: January 2025

Blackground:
Due to the narrow therapeutic time window and strict indications, there are still a large number of patients unable to receive thrombolysis and endovascular therapy, resulting in a poor long-term functional prognosis. Moreover, it is unclear what effective therapeutic targets as well as molecular systemic changes in stroke in the chronic phase. Therefore, to provide useful insights into its pathogenesis, identification of therapeutic targets and biomarker discovery, we analyze the proteomic profile of blood in ischemic stroke patients in order to gain insights into the disease.

Method:
We use proteomics technologies to examine serum at baseline and use the modified Rankin Scale (mRS) to evaluate neurological function at baseline and 3-month follow-up after ischemic stroke. Based on data-independent acquisition mass spectrometry and parallel reaction monitoring (PRM) technology, we implement a staged discovery-confirmatory pipeline in serum samples from better prognosis patients(n=48) and poor prognosis patients(n=50) according to mRS to comprehensively identify and validate more accurate biomarker performance characteristics of candidate proteins.

Results:
In this proteomic study, we characterize 4,740 circulating proteins and 324 differentially expressed proteins in 98 patients. We identify circulating proteomic signatures for ischemic stroke prognosis, and correlate these with clinical data to develop a proteomic profile of 14 markers. Based on machine learning algorithms such as LASSO regression and exhaustive feature selection (EFS), we finally identify some biomarkers (IQGAP2, LYZ, PDGFD, EHD3, CETP, FYB1) are validated as contributors to the ischemic stroke prognosis model through verification of an additional 58 serum samples. (AUC range:0.65-0.99).

Conclusion:
We identify potential biomarkers and therapeutic targets and offer an opportunity for more precise prognosis and treatment in ischemic stroke.
Abstract TP145: Stroke INSPIRE Community Support Program for Stroke Survivors and Caregivers – An Overview
Authors: Holt Elizabeth
Published: January 2025

Background:
Located in Twin Cities, Minnesota (MN), HealthPartners Stroke INSPIRE (HPSI) is a free stroke survivor support program which offers support groups, education, peer mentoring, and leisure-based engagement opportunities for stroke survivors and caregivers. This 25-year-old program, which originated out of one hospital, is experiencing significant growth throughout the Midwest. Program growth is facilitated by the addition of virtual and in-person programs and has expanded to support a healthcare system of eight hospitals. HPSI provides support to stroke survivors and caregivers throughout the state of MN and internationally. HPSI program growth is supported by stroke system leadership and statewide partners. Expansion of HPSI has prompted data collection about participant demographics, experiences and priorities of stroke survivors and caregivers.

Methods:
Analysis of HPSI participant demographic, quality of life, attendance and support group topic trends were gathered from the HPSI Impact Pilot Quality Improvement Project (SIIP-QIP) and program tracking tools were reviewed. The SIIP-QIP collected qualitative information regarding stroke survivor demographic information, and perceptions of their Quality of Life, Affect and Well Being via the NEURO-Quality of Life Short Form.

Results:
HPSI has experienced a 36.3% increase in average group attendance sizes since October of 2022, with the average group sizes ranging from approximately 9-23 participants (Fig. 1). The most common support group topics are represented in Fig. 2 and 3. Demographic analysis indicates that 29.5% of participants had their most recent stroke in the last 1-5 years, while 38.7% experienced their most recent stroke over 6 years ago. Additionally, 45% of participants drive themselves, 63.2% reside in a major metropolitan area, 92.7% are non-Hispanic/Latino, 88.4% are white, 75% are 61 years old or older, 54.5% are male, and 45.5% are female. Perceptions of quality of life were generally consistent those who were not participating in HPSI.

Discussion:
As evidenced by consistent growth, high participant engagement, and demographic review, there is a need for expansion of community-based stroke specific support programming. Further study is needed to determine strategies for implementation of such programs in culturally diverse and rural communities. Research should explore the effects of stroke type and severity on support group participation and perceptions of quality of life.
Abstract TP166: Refining Deep Learning Application Diagnostic Accuracy in Intracerebral Hemorrhage (ICH): Focus on Subtle Hemorrhage Detection
Authors: Tassy Maxime , Chang Peter , Chow Daniel , Filippi Christopher G , Ayobi Angela , Avare Christophe , Chaibi Yasmina , Laletin Vladimir
Published: January 2025

Introduction:
Deep-learning (DL)-based applications for Intracerebral Hemorrhage (ICH) detection on non-contrast computed tomography (NCCT) scans have demonstrated the potential to enhance diagnostic accuracy and efficiency amid the increasing radiologist workload. However, the sensitivity and specificity of these applications remain suboptimal, particularly in cases with subtle ICH (ICH volume < 5ml) and when confounding factors are present. This study aimed to enhance DL-based application, reduce false positives and improve the detection of subtle ICH.

Methods:
This study compared two versions of the DL-based application for ICH detection (CINA-ICH, Avicenna.AI, La Ciotat, France), both using a hybrid 2D/3D architecture. The first version, CINA-ICH, was trained on 8,994 representative CT scans (1,034 ICH+) from a cohort diverse in patient characteristics and acquisition parameters. The improved version, CINA-ICH(i), was trained on the same dataset enriched with 600 challenging cases (several confounding factors present) and included a specialised 3D network for subtle ICH detection, that underwent independent training on 2,238 CT-scans including 399 subtle ICH. The evaluation dataset included 479 NCCT scans (131 ICH+ including 24 subtle ICH) from over 200 U.S. hospitals, 4 scanner makers and 35 scanner models. Ground truth was determined by consensus among three board-certified radiologists. Sensitivity, Specificity, Accuracy and Matthews Correlation Coefficient (MCC) of CINA-ICH and CINA-ICH(i) were evaluated with a detailed analysis of false positive cases and subtle ICHs.

Results:
CINA-ICH(i) demonstrated a statistically significant (p<0.05) improvement in diagnostic performance compared to CINA-ICH: 88.5% vs. 83.2% for sensitivity, 94% vs. 85.6% for specificity, and 92.5% vs. 85% for accuracy. MCC for CINA-ICH(i) was improved from 0.65 to 0.81. CINA-ICH(i) reduced false positives from 50 to 21, effectively minimizing the detection of spurious findings and anatomical structures such as falx cerebri and sinuses. Additionally, CINA-ICH(i) enhanced the recognition of subtle ICH, detecting 37.5% of cases compared to only 8.3% detected by CINA-ICH.

Conclusions:
The implemented strategy to enhance the DL-based algorithm successfully increased ICH detection accuracy. This advancement demonstrates the potential for optimized algorithms to better support clinical decision-making by reducing false positives and improving the detection of subtle ICH cases.
Abstract TP300: Association between Coffee consumption and risk of Stroke: A Meta-analysis
Authors: Jaiswal Vikash , Deb Novonil , Shrestha Abhigan , Danisha FNU , Kanagala Sai Gautham , Sawhney Aanchal , Hanif Muhammad , Ang Song Peng , Patel Nirmit , Gera Asmita
Published: January 2025

Background:
Coffee is one of the most widely consumed beverages in the world, and contains caffeine in it. Previous pre clinical studies and meta analysis have shown conflicting results with majority supporting that coffee consumption was associated with lower risk of stroke.

Objective:
This study aims to investigate the association between coffee consumption and risk of stroke.

Methods:
We performed a systematic literature search on PubMed, EMBASE, and ClinicalTrials.gov for relevant studies from inspection until August 10th, 2024, without any language restrictions. Risk ratios (RR) and 95% confidence intervals (CI) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.

Results:
A total of 10 studies with 2,35,969 patients were included. The mean age of the patients was 55.6 years. Pooled analysis showed that people who consumed >4 cup of coffee/day were having higher odds of all stroke (RR, 1.33(95%CI: 1.05-1.67). However, there was no such association between low to moderate (1-3 cup) coffee consumption and stroke risk (RR, 1.24(95%CI: 0.94-1.64).

Conclusion:
High coffee consumption was associated with higher risk of stroke, however not with low to moderate coffee consumption. It can help individuals who are addicted to more coffee drinking/day to avoid stroke risk.