bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP255: Visual Tools for Informed Decision-Making in Large Core Thrombectomy for Acute Ischemic Stroke
Authors: Mehta Amol , Goel Nupur , Brown Scott , Desai Shashvat , Jadhav Ashutosh
Published: January 2025

Introduction:
Several recent randomized clinical trials have demonstrated that EVT can improve functional outcomes and decrease mortality in patients with large ischemic cores. Despite these landmark findings, hyperacute decision-making in large core acute ischemic stroke (AIS) remains complex as these patients still experience high rates of disability and mortality. This study aimed to develop a visual decision aid to help patients and families understand the potential benefits and risks of EVT in large core AIS, facilitating more informed and timely decision-making.

Methods:
Data from six pivotal trials were pooled to evaluate the global disability outcome distributions based on the 90-day modified Rankin Scale (mRS) for patients undergoing EVT versus medical management. A visual decision tool was created using Kuiper-Marshall personographs to represent these outcomes as icon arrays. Calculations for benefit per hundred (BPH) and harm per hundred (HPH) were performed, factoring in rates of symptomatic intracranial hemorrhage (sICH) and decompressive hemicraniectomy. Net benefit was derived by subtracting HPH from BPH. The visual aid employs color-coded shifts in mRS scores to communicate risks and benefits clearly to patients and their families.

Results:
Pooled analysis demonstrated that 2.0% of patients in the EVT group achieved an mRS of 0 compared to 0.3% in the control group. Similarly, higher rates of mRS 1 (6.0% vs. 2.6%), mRS 2 (11.5% vs. 4.6%), and mRS 3 (17.0% vs. 12.5%) were observed in the EVT group compared to the control. Patients in the EVT group also had lower rates of severe disability and death (mRS 4-6), with 31.0% achieving mRS 6 (death) compared to 37.2% in the control group. sICH occurred at a rate of 5.5% in the EVT group versus 3.2% in the control group. Excess treatment harm, combining sICH and hemicraniectomy, was calculated at 4%. Using these pooled data, the BPH for EVT was calculated at 36.1%.

Conclusions:
This study highlights the therapeutic potential of EVT in reducing disability and improving functional outcomes for patients with large core AIS. The visual decision aid developed in this study aims to simplify communication of risks and benefits of EVT to patients and their families. By providing a clear, visual representation of potential outcomes, this tool enables better-informed, patient-centered decision-making in emergency settings, ultimately improving care and aligning expectations for all stakeholders.
Abstract WP26: Determinants of Neuropsychological Function after Aneurysmal Subarachnoid Hemorrhage
Authors: Sagues Elena , Van Dam Alexander , Gudino Andres , Dier Carlos , Salinas Ivonne , Cabarique Martin , Samaniego Edgar
Published: January 2025

Introduction:
Aneurysmal subarachnoid hemorrhage (aSAH) survivors suffer cognitive and behavioral challenges preventing their return to work and social activities. The factors that may affect neuropsychological outcomes after aSAH are not well characterized. This study aimed to analyze the clinical variables associated with the neuropsychological function in a large cohort of aSAH survivors.

Methods:
Patients with aSAH admitted to our institution since 2009 were recruited. Clinical variables, modified Rankin score (mRS) at discharge, hemorrhage volume, and the occurrence of vasospasm or new ischemia during hospitalization were collected. Patients underwent Montreal Cognitive Assessment (MoCA). Data was adjusted for sex, age, race, and years of education. Additionaly, patients completed the Beck Depression Inventory and the Stroke Specific Quality of Life questionnaires, while their families completed the Iowa Scale of Personality Changes. Univariate and multivariate analyses were performed to identify predictors of neuropsychological outcomes.

Results:
A total of 165 aSAH survivors were enrolled in the study. Short (32/165 patients) - and long-term outcomes (127/165 patients) were analyzed (3-12 months and 1 to 15 years post-aSAH respectively). In the short term, MoCA was significantly worse (<25
th
percentile for adjusted data, p 0.003) in patients with high mRS at discharge (median 3, IQR 2) compared to low mRS (median 1, IQR 2, OR:2.14, p 0.006). In the long term, MoCA was significantly worse in patients with higher Hunt and Hess (OR: 1.39, p 0.09), higher modified Fisher grades (OR: 1.29, p 0.1) and in patients who developed new radiological ischemia during hospitalization (OR: 3.42, p 0.03). Larger total hemorrhage volumes were significantly correlated with worse MoCA performance (β: 0.97, p=0.048, figure). Radiological vasospasm (β: -0.40, p 0.006), new ischemia (β: -0.37, p 0.012), and higher Hunt and Hess grades (β: -0.30, p 0.053) were identified as predictors of poorer quality of life. Additionally, lack of stamina and executive personality changes were among the most frequently reported changes by family members post-aSAH for patients.

Conclusion:
Short-term cognitive outcomes following aSAH are associated with the mRS at discharge, while long-term cognitive outcomes are predicted by the severity of aSAH as assessed by clinical scales. The development of new ischemia after aSAH independently predicts long-term cognitive outcomes.
Abstract WP269: Predicting post-stroke all-cause dementia incidence using machine learning models and electronic health record data
Authors: Ding Xueting , Dai Jiahui , Meng Yang , Xiang Liner , Albala Bruce , Castro Megan , Kurzman Alissa , Gutierrez Desiree , Boden Bernadette
Published: January 2025

Introduction:
All-cause dementia remains a significant public health concern, with stroke recognized as a key risk factor. Few studies have applied Machine Learning (ML) models to accurately predict cognitive impairment and dementia, yet none have specifically focused on post-stroke dementia risk prediction. This study aims to compare the efficacy of ML approaches and traditional biostatistical methods for predicting the incidence of one-year post-stroke all-cause dementia using electronic health record (EHR) data.

Methods:
We analyzed de-identified data extracted from the TriNetX network, covering 60 healthcare organizations. This study included patients aged 20+ who experienced their first stroke (any type) in 2018 (baseline). We excluded those with dementia history, lacking data 3 years after stroke onset, or without relevant health data within 3 years preceding stroke. We developed four models: Logistic regression (LR) with backward selection, regularized LR (LASSO and Ridge regression), and Random Forest (RF). The primary outcome was the incidence of all-cause dementia within one year post-stroke. Covariates included demographics, comorbidities, medications, laboratory measures, and vital signs. Model performance was evaluated using accuracy and the area under the curve (AUC) of the receiver operating characteristic (ROC).

Results:
The final cohort comprised 55,888 adults, of whom 8% developed all-cause dementia within the subsequent year. The sample was 48.4% female, with a distribution of 8.7% aged 20-44, 37.2% aged 45-64, and 54.0% aged 65+. About 64% were non-Hispanic Whites. Among those who developed dementia, 49.7% were female and 80.5% were 65+. They had slightly higher systolic blood pressure, lower BMI, higher rates of comorbidities, and medication use (Table 1). Performance metrics for the models were as follows: LR with backward selection (accuracy: 92.07%; AUC: 0.8033), LASSO regression (92.09%;0.8000), Ridge regression (92.04%; 0.8026), and RF (92.20%; 0.7828) (Table 2).

Conclusion:
This study demonstrated the feasibility of using ML models to accurately predict post-stroke all-cause dementia incidence. All models showed high accuracy and robust discriminative ability, with the RF model achieving the best accuracy and traditional LR displaying the highest AUC. ML approaches can effectively learn from the data to identify individuals at higher risk of post-stroke dementia, potentially enabling targeted interventions and improved patient care.
Abstract WP270: Prognostic Factors Associated with Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis
Authors: Khan Faizan , Yogendrakumar Vignan , Lun Ronda , Rochwerg Bram , Tran Alexandre , Ganesh Aravind , Barber Philip , Barakhanov Kazbek , Lioutas Vasileios , Ogren Joachim , Ois Angel , GIRALT-STEINHAUER EVA , Leng Xinyi , Tian Xuan , Leung wai hong Thomas , Verburgt Esmee , Verhoeven Jamie , de Leeuw Frank-Erik , Ildstad Fredrik , Fandler-Hoefler Simon , Aarnio Karoliina , von Sarnowski Bettina , Lorenzetti Diane , Coutts Shelagh , Hill Michael
Published: January 2025

Introduction:
Patients experiencing a transient ischemic attack (TIA) or minor stroke have a high long-term risk of subsequent stroke that persists for over one year following presentation. While risk stratification tools like the ABCD
2
score have been used to identify patients at high risk of stroke in the short-term (within the first 90 days), less is known about factors that determine long-term risk. Some studies suggest that traditional predictors of early stroke risk may not be associated with long-term risk, while others have reported conflicting results. We aimed to summarize the association between clinical, demographic, imaging factors and the long-term risk of stroke in patients experiencing TIA or minor stroke.

Methods:
We searched MEDLINE, Embase, and the Web of Science from inception to June 2024, for observational studies that examined factors associated with subsequent stroke in patients experiencing TIA or minor stroke during a minimum follow-up of one year. Two reviewers independently performed study screening and data extraction. For the primary analysis, we included prognostic factors if they were derived from a multivariable Cox proportional hazards model and reported in at least 2 studies. We contacted the corresponding authors of the studies to obtain adjusted effect estimates when these values could not be extracted from the reported data. We conducted random effects meta-analyses of adjusted hazard ratios and report pooled effect estimates with 95% confidence intervals.

Results:
Of 13051 citations identified, we included 28 studies examining 85,328 patients including unpublished data from 8 studies that we directly obtained from study authors. Factors associated with an increased risk of stroke at one year or beyond included male sex, older age, hypertension, diabetes mellitus, atrial fibrillation, history of stroke or TIA before the qualifying event, history of coronary artery disease, presence of hemiparesis, aphasia, baseline ABCD
2
score of 4 or greater, acute infarct on brain imaging, large-artery atherosclerosis, and cardioembolism (
Figure 1
).

Conclusion:
We have identified important prognostic factors associated with long-term risk of stroke after a TIA or minor stroke. These findings provide a framework for evidence-based risk stratification of patients who may require extended treatment and vigorous monitoring.
Abstract WP287: Impact of Multiple Social Determinants of Health on Blood Pressure Reduction Post Stroke: Analysis of Sex Differences
Authors: Ding Xueting , Wing Jeffrey , Castro Megan , Albala Bruce , Gutierrez Desiree , Boden Bernadette
Published: January 2025

Introduction:
Effective blood pressure (BP) control post-stroke is a critical secondary prevention strategy. Research shows that social determinants of health (SDOH) may influence this process by addressing underlying factors contributing to health disparities. We conducted a secondary analysis using data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study to investigate the cumulative effect of multiple SDOH domains on BP reduction in stroke survivors, with a particular focus on sex-specific outcomes.

Methods:
We applied the Healthy People 2020 framework to identify SDOH across the following domains: economic factors, education, social context, healthcare access, and neighborhood characteristics. Stroke survivors in the DESERVE skill-based intervention study completed a 6-month follow-up (n=361) and were classified into two groups based on the number of negative factors: <3 and ≥3 SDOH. The primary outcome was the reduction in systolic BP (RSBP) from baseline to the follow-up. We utilized t-test and ANOVA for initial comparisons, followed by multivariable linear regression models to examine the relationship between multiple SDOH and RSBP, adjusted for potential confounding variables, stratified men versus women.

Results:
Participants had a mean age of 64.5 years, with 52.6% female. There were 27.7% non-Hispanic whites, 28.8% Hispanics, and 39.3% non-Hispanic Blacks. About 72.6% of participants had hypertension at baseline, and 31.6% experienced ≥3 SDOH. There was an averaged 6.9 mmHg RSBP over the 6 months with significant variations across different subgroups, as women showed a significantly greater average RSBP compared to men (8.19 mmHg vs. 5.44 mmHg, p=0.04). RSBP was greater among participants with fewer SDOH than multiple (7.51 mmHg for <3 SDOH vs. 5.54 mmHg for ≥3 SDOH, p=0.15) (Table 1). The adjusted regression models revealed having <3 SDOH was associated with a 2.61 mmHg greater RSBP compared to ≥3 SDOH (p<0.1), which was statistically significant among females (5.08 mmHg greater reduction, p<0.05), while negligible in males (Table 2).

Conclusion:
Our findings underscore the complex interplay between SDOH and post-stroke SBP management, revealing a disproportionate impact on female stroke survivors. The cumulative burden of multiple SDOH hinders effective RSBP, especially in females. Integrating SDOH considerations into stroke care is crucial to address health disparities and unique challenges faced by women.
Abstract WP291: Prevalence of Medical Complications in Acute Ischemic Stroke Patients with versus without Cancer
Authors: Gul Sedat , Clos Siara , Otite Fadar
Published: January 2025

Introduction:
Acute ischemic stroke (AIS) patients are prone to medical complications such as acute kidney injury (AKI), acute myocardial infarction (AMI), deep vein thrombosis (DVT), gastrointestinal bleeding (GIB), pneumonia, pulmonary embolism (PE), sepsis, and urinary tract infection (UTI). Cancer patients are also prone to these complications, but it remains uncertain how the prevalence of medical complications differs between AIS patients with (AIS-C) vs AIS without cancer (AIS-NC).

Methods:
We identified all primary adult (>=18 years) AIS hospitalizations with AIS-C and AIS-NC from the 2016-2019 National Inpatient Sample (NIS). AIS-C were classified as solid (AIS-SC), hematologic (AIS-HC), and metastatic (AIS-MC). We computed the weighted prevalence of complications in various AIS-NC and AIS-C subtypes and used multivariable-adjusted logistic regression models adjusted for age, sex, clinical, and hospital-level factors to compare the odds of complications in AIS-C vs AIS-NC admissions.

Results:
Of 2,037,800 AIS admissions, 0.9% had AIS-HC, 2.3% had AIS-SC, and 1.6% had AIS-MC. The prevalence of any medical complication was lower in AIS-NC (25.6%) vs all AIS subsets: AIS-HC (31.4%), AIS-SC (31.8%), and AIS-MC (43.0%) (figure 1). Thromboembolic complications including AMI, DVT, and PE were particularly prevalent in AIS-MC vs AIS-NC and other AIS-C subtypes (figure 1). After multivariable adjustment, all complications except AKI and UTI were more prevalent in all subsets of AIS-C vs AIS-NC admissions, but these differences were most pronounced for AIS-MC vs AIS-NC admissions. Specifically, AIS-MC admissions had greater odds of AMI (OR 3.10, 95%CI 2.60-3.69), DVT (OR 5.79, 95%CI 4.85-6.92), GIB (OR 2.38, 95%CI 1.78-3.18), PE (OR 7.60, 95%CI 6.10-9.48), pneumonia (OR 2.70, 95%CI 2.18-3.34) and sepsis (OR 1.83, 95%CI 1.41-2.37) compared with AIS-NC. AIS-SC patients had similar odds of UTI vs AIS-NC (OR 1.11, 95%CI 0.98-1.26) and AKI odds (OR 1.01, 95%CI 0.87-1.16) did not differ between AIS-MC vs AIS-NC admissions.

Conclusion:
AIS-C patients, particularly those with AIS-MC have 3-fold the prevalence of AMI, DVT, and PE compared with AIS-MC. Additional measures for preventing these complications in AIS-C are necessary. Pneumonia, sepsis, and GIB are also more prevalent in AIS-C vs AIS-NC, but AKI is just as common in AIS-C vs all subsets of AIS-NC.
Abstract WP292: Efficacy of Lipid-Lowering Therapies in Reducing Stroke Risk in Intracranial Atherosclerosis: A Systematic Review and Meta-Analysis
Authors: Abdelkader Omar , Shourav Md Manjurul Islam , Vallamchetla Sai Krishna , Elnaggar Ali , Ramadan Doaa , Badi Mohammed , Meschia James , Lin Michelle
Published: January 2025

Background:
Intracranial atherosclerosis (ICAS) is a common stroke cause, with a recurrent stroke risk of up to 18% per year despite treatment advances. Although lipid-lowering therapies reduce cardiovascular events, their effect on stroke risk in ICAS remains unclear.

Objective:
To perform a systematic review and meta-analysis assessing the efficacy of lipid-lowering therapies in improving stroke outcomes among patients with ICAS.

Methods:
A systematic search of PubMed, Embase, Web of Science, Cochrane, and other databases was conducted from inception to November 2023. Eligible studies compared lipid-lowering therapies (Statins and PCSK9i) to standard care or placebo in patients with ICAS. The primary outcome was the incidence of stroke. Pooled relative risks (RR) with 95% confidence intervals (CI) were calculated using a random-effects model, and forest plots were constructed. Chi-square and I 2 statistics were used to assess heterogeneity.

Results:
Seven observational studies and two randomized controlled trials involving 1,902 ICAS patients were included. Of these, 801 received lipid-lowering therapy, and 1,101 received standard care or placebo. The weighted mean follow-up was 17.6 months (IQR 9.75-25.5). The weighted mean age was 63.7 years (range 55-68) for the lipid-lowering group and 64.0 years (range 50-66) for controls. Females comprised 42% of both groups. Hypertension was present in 74% of the intervention group and 71% of controls. A history of stroke was reported in 32% of the intervention group and 29% of controls. The weighted mean baseline LDL level was 105 mg/dL in the intervention group and 107 mg/dL in controls. The weighted mean change in LDL pre- and post-treatment in the intervention group was -47.18 mg/dL, compared to -12.39 mg/dL in controls. The incidence of ischemic stroke was 5.0% (40/801) in the lipid-lowering group versus 13.0% (143/1,101) in controls (RR 0.40; 95% CI 0.24-0.64; P<0.001, Figure 1a). Subgroup analysis of studies comparing statin versus no statin treatment showed an RR of 0.40 (95% CI 0.30-0.92; P<0.05, Figure 1b). Another subgroup analysis comparing PCSK9 inhibitors and statins versus statins only found an RR of 0.44; 95% CI 0.20-0.96; P<0.05, Figure 1c).

Conclusions:
Lipid-lowering therapies significantly reduce the risk of ischemic stroke in patients with intracranial atherosclerosis. The addition of PCSK9 inhibitors to statins appears to provide added stroke risk reduction.
Abstract WP295: Associations between measures of structural racism and acute ischemic stroke outcomes in the US
Authors: Polineni Sai , Polineni Praneet , Santos Daniel , Daniel David , Dhamoon Mandip
Published: January 2025

Background:
Structural inequity, including structural racism, is increasingly linked to stroke measures. Prior work has shown that ecosocial models quantifying constituent domains of structural racism correlate with acute ischemic stroke (AIS) incidence. It remains unclear if such models can further account for the not yet fully explained racial disparities in stroke outcomes.

Methods:
We performed a national, population-based analysis of Medicare beneficiaries aged
>
65 years enrolled in Medicare from January 1, 2016 to December 31, 2019, resulting in 71,078,619 eligible adults, of whom 844,406 had a primary diagnosis of AIS. In separate models, we estimated the odds ratio (OR) and 95% confidence intervals (CI) of three outcomes (inpatient mortality, 30-day mortality, and discharge home) using multilevel logistic models for clustered data, with data clustered at the county level. Structural racism variables were tested in separate models, adjusting for sex, age, urban vs. other location, and Black vs. White race.

Results:
The composite structural racism score was strongly correlated with inpatient mortality (1.16, 95% CI: 1.10-1.22) without a significant interaction with race (p=0.62). Both 30-day all-cause mortality (p=0.04) and discharge home (p=0.02) significantly interacted with race. For each unit increase in structural racism, Black individuals had 4.5% increased odds of 30-day mortality and 5.8% decreased odds of being discharged home, whereas White patients had a 6.5% increase in 30-day mortality and 3.5% decrease in odds of discharge home.

Conclusions:
Both racial and geographic disparities in short-term outcomes after AIS are strongly correlated with structural inequity across the United States.
Abstract WP308: Elevating Stroke Awareness in Native American Communities: The Success of a Focused Campaign in Montana
Authors: Dhamodharan Haritha , Guzman Joani , Brown Stefanie , Burcham Heather , Wintermeyer Jay , Picou Kylie
Published: January 2025

Introduction:
Stroke mortality rates are highest among Native Americans compared to all other racial and ethnic groups in the U.S. This population faces significant health and socioeconomic disparities, including elevated stroke risk. In Montana, Native Americans comprise approximately 6.5% of the population with 78,000 individuals. For Mission: Lifeline Stoke Montana, a key objective was to improve stroke outcomes in Native American communities through tailored public awareness campaigns.

Methods:
In 2021, 398 Native Americans were surveyed to assess baseline stroke awareness. In 2023, 415 Native Americans responded to a post-campaign survey to evaluate impact. Data were analyzed using descriptive statistics in Qualtrics. Additionally, de-identified secondary data from the GWTG-Stroke registry were used to assess stroke outcomes among Native American patients at participating Montana hospitals from 2021 to 2023.

Results:
Both baseline and follow-up survey samples comprised approximately 33% males and 66% females. At baseline, 75% of respondents correctly identified calling 911 as the appropriate initial response to stroke symptoms, which increased to 88% at follow-up. Most respondents at both baseline and follow-up indicated a preference for an ambulance for transportation to the hospital for a stroke. Familiarity with the F.A.S.T. acronym increased from 65% to 73% with over half of respondents correctly identifying an individual letter of F.A.S.T. compared to 85% at follow-up. Smaller increases occurred regarding discussions with a medical professional about the risk of stroke, with 64% at baseline and 60% at follow-up reporting they had not engaged in such discussions. Additionally, GWTG data showed a slight decrease in in-hospital mortality from Native American stroke patients between 2021 (10.8%) and 2023 (9.3%) and the percentage of patients discharged home increased from 55.4% to 57.0% in the same period.

Conclusion:
The stroke awareness campaign launched by the Mission: Lifeline Stroke Montana program achieved success in improving stroke awareness among Native American populations, a group historically challenging to engage, especially in identifying the initial response to stroke symptoms as calling 911. However, continued efforts are necessary to bridge existing gaps and sustain advancements. Emphasis in future awareness campaigns should be placed on encouraging Montanans to talk a with healthcare professional regarding stroke risk.
Abstract WP312: Left Atrial Septal Pouch and Risk of Cryptogenic Stroke: A Systematic Review and Meta-Analysis
Authors: Xu Jennifer , Kang Jihoon , Schilling Jonathan , Paganini-Hill Annlia , Kim Jin Kyung , Fisher Mark
Published: January 2025

Background:
The left atrial septal pouch (LASP) is a blind-ended structure resulting from incomplete fusion of the septum primum and septum secundum during embryonic development, unlike a patent foramen ovale that leaves an interatrial channel open. Recent studies have suggested that LASP could serve as a site for thrombus formation, although its role as an independent risk factor for thromboembolic stroke remains unclear. The aim of this systematic review and meta-analysis was to evaluate and summarize the evidence that the presence of a LASP is a risk factor for cryptogenic stroke.

Methods:
We searched PubMed and EMBASE to identify relevant studies. The association between LASP and cryptogenic stroke was estimated by the odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed by χ2-based Q-test.

Results:
Eight studies with 2,357 participants from the USA, Europe, and Asia were used in the meta-analysis. We found a significant association between cryptogenic stroke and the presence of LASP (OR 1.60, 95% CI 1.27 to 2.02, p < 0.001). No evidence of heterogeneity was found (Q=6.33, p = 0.50).

Conclusions:
This systematic review and meta-analysis adds supports a relationship between LASP and cryptogenic stroke. Further studies are needed to characterize how LASP may impact the risk of recurrent stroke, as well as identification of optimal stroke prevention strategies in the presence of LASP.
Abstract WP319: Reliability and validity of self-reported risk factors for stroke and dementia
Authors: Tack Reinier , Senff Jasper , Kimball Tamara , Prapiadou Savvina , Tan Benjamin Yong Qiang , Yechoor Nirupama , Rosand Jonathan , Singh Sanjula , Anderson Christopher
Published: January 2025

Introduction:
Stroke and dementia are among the leading causes of mortality globally. This can be mitigated through targeting modifiable risk factors. Identification of those at-risk through screening tools could be facilitated by inclusion of self-reported risk factors rather than reliance on clinical data. We aimed to determine whether self-reported risk factors are reliable in identifying at-risk individuals and whether self-reported risk factors can predict stroke and dementia-related mortality.

Methods:
In this study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 1999-2018 linked to death certificate records up to December 2019, we included participants with available data on both self-reported and measured hypertension, hypercholesterolemia, diabetes, kidney disease, hearing impairment and overweight. We assessed the ability of self-reported risk factors to dichotomize risk on a population level, compared confusion matrices and F1-scores between different questions, and compared the prospective validity of self-reported and measured risk factors through Cox proportional hazards models.

Results:
Included participants ranged from 16,966 participants for hearing impairment to 59,319 for BMI. Reliability of self-reported risk factors was high in overweight (F1 0
.
81) and diabetes (F1 0
.
71), moderate in hearing impairment (F1 0
.
59) and hypertension (F1 0
.
56) and low in hypercholesterolemia (F1 0
.
49) and kidney disease (F1 0
.
25). Compared to measured risk factors, self-reported risk factors were associated with similar hazard ratios for stroke and dementia mortality.

Conclusions:
The reliability and validity of self-reported risk factors for stroke and dementia differs between risk factors and depends on the phrasing of the questions, but overall predicts mortality similar to measured risk factors. Screening tools that incorporate self-reported risk factors could improve identification of high risk individuals in communities with lower health literacy or access to care.
Abstract WP320: Disparities in Stroke-Related Mortality Among HIV Patients based on race and gender in the United States from 1999 to 2020, analysis from Center for Disease Control and Prevention of Wide-Ranging On-Line Data (CDC-WONDER)
Authors: Sohaib Muhammad , Maaz Hafiz , Munir Anam , Junaid Muhammad , Ahmed Muhammad
Published: January 2025

Background:
The intersection of HIV and stroke presents a significant public health concern, with stroke-related mortality in HIV patients influenced by various demographic factors such as race and gender. This study aims to elucidate the trends in stroke-related mortality among HIV patients in the US over two decades, stratified by race and gender.

Methods:
Data from the CDC-WONDER database was analyzed from 1999 to 2020 to assess stroke-related mortality rates among HIV patients. Age-adjusted mortality rates were calculated, and trends were analyzed using Joinpoint regression to identify changes in mortality patterns over time. The analysis was stratified by race (Black or African American, White) and gender (male, female).

Results:
Stroke-related mortality among HIV patients showed a significant initial decline from 1999 to 2001 with an Annual Percent Change (APC) of -21.57% (p<0.05), followed by a more gradual decline from 2001 to 2018 (APC = -1.16%, p<0.05). However, there was a marked increase in mortality rates from 2018 to 2020 (APC = 22.32%, p<0.05). For Black or African American patients, the mortality rate initially decreased significantly from 1999 to 2001 (APC = -15.70%, p<0.05) and continued to decline more gradually until 2014 (APC = -2.67%, p<0.05). Post-2014, an increasing trend was observed (APC = 3.88%, p<0.05).
In contrast, White patients experienced a sharp decline in mortality from 1999 to 2001 (APC = -25.06%, p<0.05), followed by a stable period until 2018 (APC = -0.58%, p<0.05).
However, a significant increase was observed between 2018 and 2020 (APC = 31.16%, p<0.05). Among male HIV patients, mortality rates declined significantly from 1999 to 2001 (APC = -18.32%, p<0.05) and continued to decrease until 2012 (APC = -2.56%, p<0.05). A slight increase was observed from 2012 to 2020 (APC = 4.39%, p<0.05). Female patients exhibited a similar trend with an initial decline from 1999 to 2001 (APC = -16.57%, p<0.05), followed by a steady decline until 2018 (APC = -2.34%, p<0.05). A marked increase in mortality rates was observed from 2018 to 2020 (APC = 26.94%, p<0.05).

Conclusion:
While overall stroke-related mortality among individuals with HIV has decreased over the past two decades, significant racial and gender disparities persist. The alarmingly high mortality rates among African Americans with HIV emphasize the urgent need for targeted interventions to address the underlying social and health inequities contributing to this disparity.
Abstract WP322: Socioeconomic and Gender Disparities in Stroke-Related Mortality Among Dilated Cardiomyopathy Patients: A Comparative Analysis of U.S. and Texas Data Using CDC WONDER
Authors: Naz Sidra , Lohana Sameer , Hazique Mohammad , Adeem Mudassar , Naz Hira
Published: January 2025

Introduction:
Dilated cardiomyopathy (DCM) is increasingly identified cause of cardioembolic ischemic stroke. We aim to analyze annual mortality trends and demographic factors related to stroke in DCM patients in the U.S.&Texas from 1999 to 2020,with the goal to guide public health initiatives&enhance prevention strategies.

Methods:
The data from the CDC's WONDER database from 1999 to 2020,focusing on stroke and DCM-related mortality (ICD-10 code I64.0 “Stroke”&Code I42.0 “DCM”) in adults aged ≥25 years was analyzed using joint point regression analysis, annual percent changes (APCs) in age-adjusted mortality rates (AAMRs) with 95%confidence intervals across various demographic (sex, race/ethnicity, age) subgroups were calculated.

Results:
The AAMR for stroke-associated DCM related mortality decreased in the US from an adjusted rate (AR) 99.6 in 1999 to 50.4 in 2015 (APC: -3.10%; 95% CI: -3.52% to -1.82%) after which it further reduced to 40.2 in 2018 (APC: -7.46%; 95% CI: -8.35% to -6.34%)&then it increased to 44 in 2020 (APC: 4.25%; 95% CI: 2.47% to 5.79%). In Texas, AAMR for stroke-associated DCM-related mortality decreased from AR 107.8 in 1999 to 41.6 in 2018(APC: -8.31%; 95% CI: -10.36% to -4.74%)after which it increased to 42.6 in 2020(APC: 2.35%; 95% CI: -5.11% to 6.54%). Males had higher consistently higher AAMRs than females (49.1 vs. 39.4). The AAMR in the US men decreased from 107.2 in 1999 to 43.1 in 2018(APC: -6.89%; 95% CI: -7.96% to -5.69%) and then it increased to 49.1 in 2020 (APC: 6.36%; 95% CI: 4.33% to 8.25%). The AAMR in the US women decreased from 93.3 in 1999 to 37.3 in 2018 (APC: -7.85%; 95% CI: -9.15% to -6.44%) after which it increased to 39.4 in 2020(APC: 2.33%; 95% CI: -0.51% to 4.69 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (71.4), followed by the NH American Indian or Alaska Native with an AAMR (46) and the NH White population with an AAMR (42.2). The low-risk populations were the Hispanic or Latino(34.1) and the NH Asian or Pacific Islander (30.7). Oklahoma, Arkansas, Mississippi,&Alabama in the upper 90th percentile for stroke-associated DCM-related AAMRs, showed about twice the mortality rates compared to states in the lower 10th percentile.

Conclusions:
The mortality rates from stroke-associated DCM have overall risen in both the United States and Texas over past two decades, specifically men and (NH) Black or AA, (NH) American Indian or Alaska Native and (NH) White, are at high risk.
Abstract WP332: Association between Neurological Complications and Carotid-cerebral Artery Disease after Coronary Artery Bypass Grafting
Authors: Liu Yi , Zhu Yunpeng , Jin Wei , Jin Zhijia , Gu Jianwei , Zhao Qiang
Published: January 2025

Objective:
To investigate the epidemiology of carotid-cerebral artery disease in coronary artery bypass grafting (CABG) patients and explore the influence of different degrees of carotid-cerebral artery disease on postoperative neurological complications.

Method:
We prospectively collected and analyzed 1002 consecutive patients who underwent CABG between March 2020 to November 2022 in our single center. Computed tomography angiography (CTA) was performed preoperatively. Patients were then divided into two cohorts with or without carotid-cerebral artery disease (defined as stenosis of any carotid, vertebral or intracranial artery≥50%). The primary outcome was the early neurological complications (within 7 days post-CABG), defined as a composite of stroke, delayed awakening (≥48h after withdrawing sedative), and severe delirium (ICU CAM-II score≥2).

Results:
Of the overall 1002 patients, the most susceptible arteries of stenosis≥50% were internal carotid artery(34.2%, 686/2004). vertebral artery (19.5%, 390/2004). and common carotid artery (17.3%, 347/2004). Basilar artery (2.3%, 23/1002) was the least affected. Extracranial lesions were present in 77.9%(781/1002) of patients, intracranial lesions in 35.7%(358/1002) and both intracranial and extracranial lesions in 32.2%(323/1002). Early neurological complications post-CABG occurred in 104 patients (10.4%), including 16(1.6%) with stroke, 45(4.5%) with delayed awakening and 60(6.0%) with severe delirium. Patients with carotid-cerebral artery disease had a higher risk of appearing early neurological complications (risk ratio [RR], 2.09; 95% CI, 1.39-3.13), stroke (RR, 3.66; 95% CI, 1.05-12.78), delayed awakening (RR, 1.87; 95% CI, 1.01-3.48), severe delirium (RR, 1.97; 95% CI, 1.15-3.38). Patients with carotid-cerebral artery disease still increased the risk of early neurological complications (adjusted RR, 1.66; 95% CI, 1.10-2.51) after adjustment possible confounders. As the degree of carotid-cerebral artery disease increased, there was a statistically significant linear upward trend in the incidence of all primary outcomes (P<0.05 for all).

Conclusions:
The combined carotid-cerebral artery disease was common in CABG patients, with the internal carotid artery, vertebral artery and common carotid artery being the most susceptible. Patients with carotid-cerebral artery disease was independently causally associated with early neurological complications after CABG.
Abstract WP334: Prevalence and Characteristics of Acute Ischemic Stroke and Intracranial Hemorrhage in patients with Immune Thrombocytopenia Purpura and Thrombotic Thrombocytopenic Purpura: A Systematic Review and Meta-Analysis
Authors: Ahmad Syed , Liu Olivia , Feng Amy , Kalra Andrew , Dev Apurva , Spann Marcus , Gusdon Aaron , Chaturvedi Seemant , Cho Sung-Min
Published: January 2025

Background:
There is an emerging understanding of stroke risk in patients with immune thrombocytopenia purpura (ITP) and immune thrombotic thrombocytopenia purpura (iTTP). We aimed to determine the prevalence of acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) in patients with ITP and iTTP in a systematic review and meta-analysis.

Methods:
We used PubMed, Embase, Cochrane, Web of Science, and Scopus using text related to ITP, iTTP, stroke, AIS, and ICH from inception to 11/3/2023. Our primary outcome was to determine prevalence and chronicity of AIS and/or ICH in a cohort of ITP or iTTP patients (age >18). Our secondary outcomes were to determine stroke associated with thrombopoietin receptor agonists (TPO-RAs) in ITP patients and risk factors associated with stroke in ITP and iTTP patients.

Results:
We included 42 studies with 118,019 patients (mean age=50 years, 45% female). Of those, 27 studies (n=116,334) investigated stroke in ITP patients, and 15 studies (n=1,685) investigated stroke in iTTP patients. In all ITP patients, the prevalence of AIS and ICH was 2.1% [95% Confidence Interval (CI) 0.8%-4.0%] and 1.5% (95% CI 0.9%-2.1%), respectively. ITP patients who experienced stroke as an adverse event from TPO-RAs had an AIS prevalence of 1.8% (95% CI 0.6%-3.4%) and an ICH prevalence of 2.0% (95% CI 0.2%-5.3%). Prevalence of stroke did not significantly differ between all ITP patients and those treated with TPO-RAs. iTTP patients had a prevalence of AIS and ICH of 13.9% (95% CI 10.2%-18.1%) and 3.9% (95% CI 0.2%-10.4%), respectively.

Subgroup analysis revealed the prevalence of AIS and ICH was greater in iTTP patients vs. all ITP patients (p<0.01 and p=0.02, respectively). Stroke occurrence was reported in the acute phase (7.9% and 45%) and chronic phase (91.8% and 55%) in ITP patients (not specifically due to TPO-RAs) and iTTP patients, respectively. Meta-regression analysis revealed none of the collected variables (age, sex, history of diabetes or hypertension) were risk factors for stroke in all ITP patients, although there were high levels of data missingness.

Conclusions:
Prevalence of stroke was lower in all ITP patients vs. iTTP patients. ITP patients experienced a similar prevalence of stroke regardless of if they were specifically denoted to have been treated with TPO-RAs or not, supporting the continued use of TPO-RAs in management. Risk factors for stroke remain unclear, and future studies should continue to investigate this relationship.
Abstract WP339: Pharmacological Inhibition of 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) in Aged Male and Female Mice Confers Neuroprotection after Ischemic Stroke
Authors: Gunraj Rachel , Yang Changjun , Howell John , Liu Lei , Candelario-Jalil Eduardo
Published: January 2025

Background:
Ischemic stroke triggers the metabolic reprogramming of cells in the infarct core and surrounding penumbra. These cells experience a shift towards glycolysis as their primary metabolic pathway, as it is faster than alternative pathways and can be performed anaerobically. This allows cells to survive longer in the hypoxic, low-glucose environment; however, long-term metabolic shift has been shown to inhibit the resolution of the inflammatory response and contribute to worsening outcomes in other cardio and neurovascular diseases. One primary driver of glycolysis is 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3). This enzyme is upregulated after injury and synthesizes fructose-2,6-biphosphate, an allosteric regulator of phosphofructokinase-1, which catalyzes the first rate-limiting step in glycolysis. Previous research in our lab supports a neuroprotective effect of PFKFB3 inhibition after stroke in young male mice. Here, we investigate whether PFKFB3 blockade impacts stroke outcomes in aged female and male mice.

Hypothesis:
Because glycolytic shift prolongs the inflammatory response and cell death, and PFKFB3 upregulates glycolysis after stroke, inhibition of PFKFB3 is neuroprotective in ischemic stroke.

Methods:
We induced permanent distal middle cerebral artery occlusion in aged female and male C57BL/6J mice (18-20mo), followed by treatment with a highly selective PFKFB3 inhibitor AZ67 (30mg/kg; Female N=10; Male N=7) or vehicle (Female N=9; Male N=7). Doses were administered intraperitoneally shortly after stroke onset with three repeated i.p. doses over the course of 48h. Open field, neurological deficit scoring, and adhesive removal tasks were administered at baseline, 24h, and 48h post stroke, after which mice were euthanized by perfusion, and brains were sliced and stained with TTC to quantify infarct size.

Results:
Our findings show a neuroprotective effect of PFKFB3 inhibition after stroke in both female and male aged mice. Mice receiving the PFKFB3 inhibitor showed significantly smaller infarcts and improved functional recovery after stroke. These results, in conjunction with our previous data in young males, further support the hypothesis that PFKFB3 inhibitors could be a viable option for the treatment of ischemic stroke.
Abstract WP344: Nitro-Oleic Acid Preserves Blood-Brain Barrier and Improves Neurovascular Function in Ischemic Stroke through PPARγ Activation
Authors: Xiong Tianqing , Qiu Na , Li Shun , Sun Ping , Huang xinlei , Yin Kejie
Published: January 2025

Introduction:
Nitro-oleic acid (OA-NO
2
) is an endogenous peroxisome proliferator-activated receptor-γ (PPARγ) ligand and can activate this receptor under both physiological and pathological conditions. In this study, we explore the role and molecular mechanisms of OA-NO
2
in maintaining blood-brain barrier (BBB) integrity and enhancing neurovascular function during ischemic stroke, with a particular emphasis on the activation of PPARγ signaling pathways.

Methods:
EC-selective PPARγ conditional knockout (EC-PPARγ cKO) and wild-type (WT) mice underwent 1-hour middle cerebral artery occlusion (MCAO) with 1 to 7 days of reperfusion. Mice were treated with oleic acid (OA) or OA-NO
2
(10 mg/kg) via tail vein 2 hours after MCAO. Sensorimotor function was assessed using the rotarod, foot fault, and adhesive tape removal tests. BBB integrity was measured with fluorescein-dextrans, and brain infarct was analyzed with anti-MAP2 immunostaining. Peripheral immune cell infiltration was examined by immunofluorescent methods. Total RNA and proteins were extracted from brain tissue. BBB tight junction mRNAs, proteins, and inflammatory factors were quantified using qPCR and Western blotting.

Results:
OA-NO
2
treatment significantly enhanced sensorimotor function in stroke mice compared to the OA group. However, this beneficial effect was lost in the EC-PPARγ cKO mice. Compared to OA controls, intravenous administration of OA-NO
2
led to reduced BBB leakage in ischemic brains, as indicated by a significant decrease in the extravasation of BBB tracers. This reduction in BBB leakage was also abolished in the EC-PPARγ cKO mice. Furthermore, OA-NO
2
treatment reduced brain infarction in stroke mice, but this protective effect was completely reversed in the EC-PPARγ cKO mice. Interestingly, OA-NO
2
treatment promoted a shift towards an anti-inflammatory microglial phenotype (M2) in the peri-infarct regions of EC-PPARγ WT mice, but not in EC-PPARγ cKO mice. Mechanistically, OA-NO
2
increased levels of major endothelial tight junction mRNAs and proteins, including Claudin 5 and ZO-1, in EC-PPARγ WT mice but not in EC-PPARγ cKO mice following ischemic stroke.

Conclusions:
Treatment with OA-NO
2
effectively reduces BBB leakage-triggered peripheral immune cell infiltration, brain infarction, and long-term neurobehavioral deficits in mice following ischemic stroke. The neurovascular protection conferred by OA-NO
2
primarily operates through PPARγ-dependent signaling pathways.
Abstract WP345: Syndecan-4 Is a Novel Target for Protecting Brain Against Ischemic Stroke
Authors: HUANG Xiaowen , PING Zhihui , Zong Jiuyu , Hoo Ruby Lai Chong
Published: January 2025

Introduction:
Ischemic stroke is an acute metabolic and cerebrovascular disease that leads to high mortality and disability rate in the world. Database analysis in patients and rodents suggest Syndecan-4 (Sdc4) may play a potential role in ischemic stroke, but the underlying mechanisms remain unclear. As a kind of transmembrane core protein, Sdc4 may initiate intracellular signaling via either its protein core ectodomain or cytoplasmic domain. Therefore, it is of great significance to investigate the specific function of Sdc4 and its potential as a novel therapeutic target in ischemic stroke.

Methods:
The serum level of shed Sdc4 extracellular domain in patients with ischemic stroke and mice with transient middle cerebral artery occlusion (MCAO) was determined. Sdc4 global knockout mice (GKO) and their wildtype (WT) littermates were generated and subjected to MCAO to investigate whether Sdc4 deficiency alters functional outcome following ischemic stroke and its underlying mechanisms. Infarct volume, neurological deficits, neuroinflammation, and blood-brain barrier (BBB) integrity were assessed.

Results:
Shed Sdc4 level in the serum of both patients with ischemic stroke and mice with MCAO was decreased acutely at 24 hours after disease onset, while cerebral Sdc4 expression was significantly increased in the ipsilateral brain hemisphere of mice. Infiltrated macrophages were identified as the major cerebral source of Sdc4. Sdc4 deficiency reduced the infarct volume in mice subjected to MCAO, compared to that of the WT controls. Neurological deficit and neuroinflammation were also attenuated in Sdc4 GKO mice following MCAO. Furthermore, Sdc4 GKO mice showed an improved BBB integrity.

Conclusions:
These results reveal that altered serum and cerebral Sdc4 level are implicated in the pathogenesis of ischemic stroke. Genetic deletion of Sdc4 significantly prevents brain injury in mice at 24 hours following MCAO. Further investigation is warranted to explore underlying mechanisms of Sdc4 mediated brain injury in ischemic stroke.