bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP170: Social Deprivation and Stroke Severity at Presentation: Data From a London Teaching Hospital
Authors: Raiman Lewis , Antbring Richard , Amlani Sageet , Andrews Alexandra
Published: October 2018

Background:
Stroke is the most common cause of adult disability and the second most common cause of death in London, United Kingdom. Social deprivation has been demonstrated to be an important risk factor for stroke. It is unclear whether individuals from a lower socioeconomic background suffer more severe strokes. In this study we aim to investigate the relationship between social deprivation and stroke severity at presentation to hospital.

Method:
Data was prospectively collected on all patients presenting to a London tertiary stroke centre between 1
st
February 2014 and 1
st
March 2017. Stroke severity on presentation to the emergency department was measured by the National Institute of Health Stroke Scale (NIHSS). This data was linked using the patient’s zip code to the UK government’s published index of multiple deprivation decile (IMDD) - 1
st
decile being most deprived, 10
th
decile being least deprived. Univariate and multivariate regression analyses were performed to evaluate the association between social deprivation and stroke severity.

Results:
Data was available for all 2514 patients that presented between 1
st
February 2014 and 1
st
March 2017. The median IMDD was 3. There was an association with an increase in IMDD and increasing age at presentation (p<0.05 OR 1.48), decreasing prevalence of hypertension (p<0.05 OR 0.93) and decreasing prevalence of diabetes (p<0.05 OR 0.88). Adjusting for patient characteristics and time from onset of symptoms to presentation to hospital, there was an association with an increase in IMDD and lower NIHSS at presentation to hospital (p<0.05 OR 0.76).

Conclusion:
The patients that presented to our hospital during this study were more likely to be from a deprived area. Despite being younger, patients from more deprived areas were observed to have higher rates of hypertension and diabetes compared with patients from less deprived areas, and this should be the subject of targeted intervention in primary care. In our analyses, deprivation was associated with a more severe clinical presentation of stroke. This finding may contribute to worse outcomes following stroke in patients from more deprived areas, and the factors underlying this relationship should be investigated further.
Abstract TP172: Newly Diagnosed Atrial Fibrillation in Ischemic Stroke is an Independent Predictor of Mortality in Underserved Populations
Authors: Paz Rios Luis H , Sleiman Jose , Fuentes Harry , Iskander Fady , Kelly Michael , Warrior Lakshmi , Singh Anshu
Published: October 2018

Stroke is a major cause of death and disability in the United States and underserved communities are at higher risk for complications, severity and recurrence of stroke compared to the general population. Atrial fibrillation (A-fib) predisposes to ischemic stroke occurrence; however, newly diagnosed A-fib at the time of stroke, and its predictive value in the outcome of underserved patients has not been reported.

Aim:
To explore the clinical significance of newly diagnosed A-fib among underserved populations with ischemic stroke.

Methods:
Retrospective cohort of patients with acute ischemic stroke diagnosis at John H. Stroger Hospital in 2014. New A-fib confirmed by electrocardiography. Stroke events were confirmed by magnetic resonance imaging or computed tomography. Given our small event rate we dichotomized National Institute of Health Stroke Scale (NIHSS) into severe (≥15) and non-severe (<15) to make groups comparable. Demographic and potential confounding variables were independently extracted. SPSS version 24 was used and Kaplan Meier and Cox logistic regression with forward modeling were applied.

Results:
A total of 424 patients for the analysis, mean±SD age of 59.2±11.9 years, mostly male (57.5%), the majority African Americans (59.7%) followed by Hispanics (20.3%). The mean±SD follow up was 22.7±16.6 months, and 24 patients died (5.7%). A-fib was newly diagnosed in 8 (1.9%) patients and a third (37.5%) met indication or accepted anticoagulation. We adjusted for age, hypertension, diabetes, prior stroke, prior A-fib, anticoagulation, alcohol, smoking history and NIHSS. In our model NIHSS ≥15 was the strongest predictor or mortality (HR: 8.04; 95%CI: 2.14-30.25; p<0.01) followed by newly diagnosed A-fib (HR: 5.47; 95%CI: 1.29-23.12; p=0.02). Patients with newly diagnosed A-fib had worse overall survival when compared to those without A-fib (mean 517 days vs 1237 days, p<0.01).

Conclusion:
Our results are hypothesis generating, and suggest that ischemic stroke secondary to newly diagnosed A-fib carries worse overall survival. It’s plausible that this subset of patients may require a tailored longitudinal plan to reduce risk of poor outcomes in an undeserved population.
Abstract TP173: Does Cancer Chemotherapy Predispose to Stroke? A Systematic Literature Review
Authors: Dias da Silva Fernanda , Turner Melanie E , Murchie Peter , MacLeod Mary J
Published: October 2018

Although the mechanisms are not entirely understood, cancer chemotherapy seems to increase the incidence of stroke and other thromboembolic events. We evaluated stroke incidence among cancer patients that undergo chemotherapy treatment, by conducting a systematic literature review. Studies were identified from Medline and EMBASE. A protocol was developed with a search strategy based on population, intervention, comparators, outcome, and study design criteria (PICOS), where the intervention was cancer chemotherapy and the outcomes included stroke. Quality was assessed using the critical appraisal skills (CASP) guidelines, the majority of studies included were of a cohort design. From 1089 titles, 57 full text articles were assessed for eligibility. After duplicate abstract review, at the end of the screening process 24 studies were identified, and data from 50,613 included participants extracted. The majority of patients were older than 65 years (35,153 participants). One study included all types of cancers, the other studies included only one type of cancer (12 types of cancer in all). Breast (5 studies) and testicular (4 studies) malignancies were the most prevalent. Any drug classified as cancer chemotherapy was included. Some studies clearly named individual drugs while others simply defined the intervention as chemotherapy. Seven studies used platinum-based drugs. Quality assessment using CASP suggested most studies were valid and of good quality. The risk of stroke was reported in 12 studies as a hazard ratio, with values ranging from 0.73 to 2.84 - five of these showed a statistically increased risk of stroke. For studies that reported the outcome as incidence, the values range from 0.14% to 11%. One study reported an odds ratio of 2.3 while another reported a standardised incidence ratio of 1.5. Due to study heterogeneity, a meta-analysis was not performed. Based on the results of individual studies, the evidence supports an increased risk of stroke in cancer patients treated by chemotherapy. Further exploration to identify which agents most increase stroke risk, and to look at other factors (such as primary prevention medication) influencing stroke incidence and outcome in cancer patients will help inform patient choice and clinician practice.
Abstract TP177: Previous Stroke/TIA History is Associated With Low Medication Adherence in a Multi-ethnic Cohort of Stroke Survivors
Authors: Khan Bilal , Goldmann Emily , Parikh Nina , Appleton Noa , Boden-Albala Bernadette
Published: October 2018

Introduction:
Proper adherence to medication regimens including antihypertensive, antidiabetic, and lipid-lowering medications has been shown to reduce risk of stroke-related events. Yet stroke and TIA survivors have suboptimal levels of adherence. Few studies have investigated how medication adherence differs between patients with previous stroke/TIA history compared to patients admitted for a first stroke event.

Methods:
The present analysis examined baseline data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, an RCT of a skills-based educational intervention in a multi-ethnic cohort of stroke/TIA patients (n=458). The primary outcome measure was medication adherence, which was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Medication adherence was calculated and categorized as low adherence (score<6; 39%) and medium/high adherence (score 6-8; 61%). The exposure was previous stroke/TIA events, and was categorized as no previous stroke/TIA events (67%) and at least one previous stroke/TIA event (33%). Unadjusted and adjusted logistic regression models were used to investigate the relationship between previous stroke/TIA events and medication adherence. The multivariable model adjusted for relevant clinical and socio-demographic characteristics.

Results:
The unadjusted logistic regression model assessing the relationship between previous stroke/TIA and medication adherence was not significant (OR: 0.70 , p=0.08, 95% CI: 0.47-1.05). But, after adjusting for select clinical and socio-demographic characteristics the model showed that patients with a history of previous stroke/TIA events were significantly less likely to have medium/high medication adherence compared to patients admitted for a first stroke event (OR: 0.59 , p=0.02, 95% CI: 0.38-0.93).

Conclusions:
As part of continued preventive efforts, educational interventions such as DESERVE are necessary after a first stroke/TIA to improve medication adherence and reduce risk of future stroke/TIA events.
Abstract TP18: Interventional Management of Carotid Occlusions in the Setting of Acute Stroke: An Experience at a Busy Comprehensive Stroke Center
Authors: Boutwell Christine M , Olds Karin , Akhtar Iqra , Martin Coleman , Holloway William , Akhtar Naveed
Published: October 2018

Introduction:
Carotid artery occlusion in the setting of acute stroke with concurrent intracranial involvement is a serious and deadly combination, and can prove to be a challenging endeavor when encountered. The stroke is usually more severe due to poor collaterals and successful revascularization is difficult to achieve, resulting in a higher morbidity and mortality. We aim to assess the revascularization rates and clinical outcomes in this subset of patients treated with endovascular therapy.

Methods:
An IRB approved retrospective chart review of cases presenting with acute ischemic stroke with carotid occlusions and concurrent intracranial involvement treated with endovascular therapy over a 4-year period was conducted. Of these reviewed cases, 75 patients had carotid occlusions with intracranial involvement. The carotid T occlusions and critical ICA stenosis with intracranial flow were excluded from the study.

Based on the CT and catheter angiogram findings, the 75 patients fell into two groups:

1) Group A (n=35): Carotid occlusion with underlying atherosclerotic disease/dissection resulting in occlusion and were treated with angioplasty and stenting followed by thrombus retrieval.

2) Group B (n=40): No underlying pathology was found and ICA was occluded due to a large embolus to the ICA with no anterograde flow in the ICA. This group was treated with thrombus retrieval alone.

Results:
Our data shows that the presence of a stent in the ICA does not adversely affect the intracranial recanalization rate (91.4% TICI
≥
2b). There was also no significant increase in hemorrhage rate with revascularization and antiplatelet therapy (2.9%). This finding was especially significant due to the large amount of wake up strokes in our study that were treated with intervention (17.3%). The successful reperfusion rate (TICI ≥2b) overall in both groups was 82.7%. In the successfully recanalized group, the mortality was 16% compared to the mortality in the unsuccessfully recanalized group (69.2%).

Conclusions:
Our study results show that it is possible to achieve a high success rate of revascularization and clinical outcomes with an endovascular approach to managing carotid occlusion with intracranial involvement.
Abstract TP180: Racial/Ethnic Differences in Sleep Duration and Sleep Disturbances Among Stroke Survivors
Authors: Nangle Emily , Goldmann Emily , Parikh Nina S , Appleton Noa , Boden-Albala Bernadette
Published: October 2018

Introduction:
Sleep disorders and short sleep duration have been associated with increased incidence of stroke. Despite evidence of racial/ethnic disparities in stroke, few studies have examined differences in sleep duration and disturbances by race/ethnicity among stroke survivors.

Methods:
Data on self-reported sleep duration and sleep disturbances came from the baseline interview of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, a randomized clinical trial of a skills-based intervention to reduce vascular risk in a multi-ethnic cohort of 552 mild stroke/TIA patients. Sleep duration was defined as average hours of sleep per night in the past month, and sleep disturbances were measured using the Medical Outcomes Study (MOS) Sleep Disturbances Index, which ranges from 0-100, with higher scores indicating more frequent disturbances. Differences in sleep duration and disturbance score by race/ethnicity were assessed using t-tests and multiple linear regression adjusted for age, sex, education, current smoking and alcohol consumption, body mass index, marital/cohabitation status, number of household members, and depression score.

Results:
Overall, patients reported an average of 6.37 hours of sleep per night, and mean Sleep Disturbance Index score was 35.8. Mean sleep duration was significantly lower among non-Hispanic blacks than non-Hispanic whites (6.12 vs. 6.69 hours, p=0.004). Mean disturbance score was significantly higher among both non-Hispanic blacks and Hispanics compared to non-Hispanic whites (35.7 vs. 27.8, p=0.013 and 42.6 vs. 27.8, p<0.001, respectively). In adjusted models, sleep duration was no longer significantly associated with race/ethnicity. However, mean sleep disturbance scores remained significantly greater among non-Hispanic blacks and Hispanics compared to non-Hispanic whites (β=11.6, p=0.006, and β=8.8, p=0.039, respectively).

Conclusion:
Sleep disturbances were more frequent among Hispanics and non-Hispanic blacks, two populations that are disproportionately affected by stroke. Further research is warranted to understand the role differences in sleep may play in racial/ethnic disparities in stroke.
Abstract TP181: Prior Antiplatelet Use and Baseline Stroke Severity: A Population-Based Study
Authors: Mistry Eva A , Sucharew Heidi , Alwell Kathleen , Moomaw Charles J , Flaherty Matthew , Woo Daniel , Adeoye Opeolu , De Lo Rios La Rosa Felipe , Mackey Jason , Martini Sharyl , Ferioli Simona , Kissela Brett M , Kleindorfer Dawn O
Published: October 2018

Introduction:
There is conflicting evidence on the association of antiplatelet (AP) use prior to admission with baseline ischemic stroke (IS) severity. We evaluated this association within a large, bi-racial population.

Methods:
We identified all hospital-ascertained cases of IS that occurred in 2010 (including ED arriving, direct admits, and in-hospital strokes) within a population of 1.3 million. Specific AP used prior to presentation for IS were aspirin, clopidogrel, dipyridamole, prasugrel, and cilostazol. We excluded those on an anticoagulant (AC) medication for this analysis. Baseline IS severity was defined as NIH stroke scale score (NIHSS) on admission. A multivariable linear regression model including demographic and clinical variables with log-transformed NIHSS as the dependent variable was used to evaluate the effect of prior AP use on stroke severity (results shown as percentage change in NIHSS).

Results:
In 2010, there were 2259 IS cases, of which 1982 (22% black, 55% female, median age 70 years [58, 81]) were included in the analysis, and 998 (50%) had history of prior AP use. Unadjusted, minor stroke (NIHSS ≤5) was slightly less common in those with prior AP use compared with those without (68% vs. 72%; p=0.04). In the multivariable model among patients with history of atrial fibrillation (AF) yet not on AC, a significant 23% reduction in NIHSS (average NIHSS 6.00 to 4.88, p=0.02) was seen in those with prior AP use. No such association was found in patients with no history of AF. The table displays the multivariable model of stroke severity.

Conclusion:
We found that prior AP use did not have significant association with baseline stroke severity in the multivariable analysis. However, a subgroup of patients with history of AF had significantly less severe strokes with prior antiplatelet use.
Abstract TP183: Brain White Matter Lesions Are Indepentendly Associated With Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index
Authors: Nishiyama Yasuhiro , Otsuka Toshiaki , Muraga Kanako , Kimura Kazumi
Published: October 2018

Background:
The cardio-ankle vascular index (CAVI) is a surrogate marker of arteriosclerosis in patients with acute ischemic stroke that is independent of blood pressure. Brain white matter lesions (WMLs) on magnetic resonance imaging (MRI) is the core marker of cerebral small vessel diseases, including lacunar infarction or microbleeds. However, whether WMLs are associated with CAVI is still unclear. This study was conducted to clarify whether the WMLs detected during medical checkup in subjects without cardio-cerebrovascular diseases were associated with the CAVI or vascular risk factors.

Methods:
CAVI and vascular risk factors were assessed in 280 subjects (mean age, 52.6 years) who underwent brain MRI. Arterial stiffness was evaluated using CAVI. The patients were divided into two groups according to the presence or absence of WMLs. Clinical characteristics were compared between the two groups. WML was defined as a cap or pencil-thin lining of periventricular hyperintensity and/or punctate focus of a deep white-matter hyperintense lesion according to the Fazekas grades on fluid-attenuated inversion recovery (FLAIR).

Results:
CAVI was significantly higher in the subjects with than in those without WMLs (8.17 vs 7.22, p < 0.001). In the multivariable analyses, CAVI, particularly a 1-point increase in CAVI (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.68-3.03), was independently associated with the presence of WMLs. Hypertension (HT) was also independently associated with the presence of WMLs (OR, 2.01; 95% CI, 1.15-3.52). The effects of the four combinations of low/high levels of CAVI and the subjects with or without HT on the presence of WMLs were also analyzed. After adjustment for age, sex, and diabetes mellitus, the subjects with a higher CAVI (median, ≥7.4) and HT had greater odds that they may have WMLs (OR, 3.44; 95% CI, 1.04-11.4) than the subjects with lower CAVI and without HT. By contrast, the OR was not significant in the combinations of lower CAVI and HT, and higher CAVI and without HT.

Conclusions:
Both increased CAVI and HT were independently associated with the presence of WML even in its early stage. Nevertheless, the presence of a WML could be predicted more reliably by considering these two factors together rather than either alone.
Abstract TP192: Change in Cerebral Blood Flow Velocities Before and After Diuresis in an Outpatient Heart Failure Clinic
Authors: Gottesman Rebecca F , Williams Nicole , Gaddis Andrew , Simmons Tanya , Rouf Rosanne , Chandra-Strobos Nisha , Ziai Wendy
Published: October 2018

Background:
Cognitive deficits have been described in individuals with heart failure (HF), with worsening at the time of acute decompensation and volume overload. We evaluated transcranial doppler cerebral blood flow velocities (CBFVs), as an index of cerebral perfusion, before and after IV diuresis, in an outpatient HF clinic, to explore mechanisms of cognitive dysfunction during HF decompensation, and to test if velocities improved after diuresis.

Methods:
In an ongoing study of cognitive evaluation in an outpatient HF diuresis clinic, patients had CBFVs measured before diuresis, and again after completion of daily dosing of IV diuresis (1-7 days later, whenever they were considered to be euvolemic and no longer needing diuresis). Clinical signs and symptoms of volume overload including pulmonary edema, peripheral edema, and ascites were tracked by clinic staff. CBFVs (cm/sec) in several intracranial vessels were compared within individuals, with paired t-tests, before and after completion of the IV diuresis treatment. In linear regression models, we evaluated improvement in volume status in association with change in CBFVs.

Results:
A total of 21 individuals completed CBFVs before and after diuresis. In all vessels tested (table), CBFVs decreased after diuresis, and in many cases, went from a high to a normal value. Although numbers were small, those individuals with the most improvement in their volume status had more improvement in CBFVs in several but not all vessels. For several vessels, improvement in CBFV was significantly associated with improvement on some cognitive tests.

Conclusions:
CBFVs are frequently elevated in individuals with decompensated heart failure, with return to a normal range after diuresis. Further evaluation of CBFV as a potential mediator of cognitive dysfunction in HF is warranted.
Abstract TP194: Thrombophilia is Not Associated With Stroke Severity or Early Functional Outcomes in Young Adults With Ischemic Stroke
Authors: Salehi Omran Setareh , Lerario Michael P , Wu Xian , Diaz Ivan , Gialdini Gino , Merkler Alexander E , Kamel Hooman , Navi Babak
Published: October 2018

Background:
The clinical significance of thrombophilic conditions in patients with acute ischemic stroke (AIS) remains incompletely understood.

Methods:
Among patients in the prospective Cornell AcutE Stroke Academic Registry (CAESAR), we included patients 18 to 65 years with AIS between 2011-2015 who had any hypercoagulability testing within 6 months of their index stroke. The exposure of interest was thrombophilia (see Table 1 for definitions). The primary outcome was moderate-to-severe stroke, defined as an NIH Stroke Scale (NIHSS) score >5. The secondary outcome was the inability to walk at the time of discharge. Data was imputed for missing outcome values. A doubly robust estimator and ordinal regression analyses were used to test the association between an underlying thrombophilic state and clinical outcomes.

Results:
Among 1,721 patients with AIS in the CAESAR registry, 196 patients (mean age 47 years; 51% female) met our eligibility criteria. Of these 196 patients, 47 (24%) were discovered to have a thrombophilic state. Excluding patients with missing outcomes, we found that 9 (22%; 95% confidence interval [CI], 15-29%) patients with thrombophilia had a moderate or severe stroke on admission, as compared to 35 (32%; 95% CI, 25-40%) patients without thrombophilia (p=0.22). At the time of hospital discharge, 8 (17%; 95% CI, 12-23%) patients with thrombophilia were unable to walk, as compared to 31 (21%; 95% CI, 15-27%) patients without thrombophilia (p=0.49). After imputing data on missing outcomes and adjusting for demographics and vascular risk factors, an underlying thrombophilic state was not associated with moderate-to-severe stroke on admission (odds ratio [OR], 0.8; 95% CI, 0.3-2.2) or poor ambulatory status at discharge (OR, 1.7; 95% CI, 0.7-4.1).

Conclusions:
In a single-center study of young adults with AIS, we found no association between an underlying thrombophilic state and stroke severity or ambulatory status at discharge.
Abstract TP198: Risk of 30-day Hospital Readmission: Does Ischemic Stroke Subtype Matter?
Authors: Bjerkreim Anna Therese , Khanevski Andrej , Selvik Henriette Aurora , Thomassen Lars , Waje-Andreassen Ulrike , Naess Halvor , Logallo Nicola
Published: October 2018

Background:
Stroke patients are at high risk of new diseases. However, as there are differences in risk factors, outcome and treatment for the various ischemic stroke (IS) and transient ischemic attack (TIA) etiologies, there may also be differences in their risk and causes of readmission. We aimed to investigate frequency and causes for 30-day readmission for the different IS subtypes, and estimate each subtypes risk of cause-specific 30-day readmission.

Methods:
All surviving IS or TIA patients admitted to a large Norwegian Hospital between July 2007 and January 2014 were followed by review of medical records. Main outcome of interest was the first unplanned readmission within 30 days after discharge. Stroke etiology was classified according to the TOAST criteria as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other demonstrated cause (SOC), or stroke of undetermined cause (SUC). Cox regression was performed to assess 30-day readmission risk of all-cause and cause-specific readmission for the different IS subtypes.

Results:
Of 1890 patients, 10.6 % were readmitted within 30 days (43/245 (17.6%) LAA, 75/614 (12.2%) CE, 12/205 (5.9%) SVO, 6/33 (18.2%) SOC, 65/793 (8.2%) SUC). Most frequent causes were stroke-related events (sequela, progressive stroke and neurological symptoms), infections, recurrent stroke and heart disease, but causes of readmission were unevenly distributed among the different stroke subtypes. Patients with LAA or SOC had significant higher risk of all-cause readmission and recurrent stroke, and patients with SUC had significant lower risk of all-cause readmission.

Conclusion:
We found significant variations in frequency and causes of 30-day readmission for the different IS subtypes. This approach supports the concept of IS as an polyetiologic disease, with unevenly distributed risk factors and comorbidity between the different etiologies. At the conference, we will also present and discuss predictors for 30-day all-cause readmission.
Abstract TP199: Cerebral Microblees and Chronic Kidney Disease in Patients With First-ever Acute Ischemic Stroke or Transient Ischemic Attack
Authors: Nakamura Asako , Yasaka Masahiro , Kuwashiro Takahiro , Gotoh Seiji , Nakanishi Yasuyuki , Ueki Kana , Maeda Ayaka , Okada Yasushi
Published: October 2018

Introduction:
Cerebral microbleeds (CMBs) are extravasations of cerebral small vessels that manifest as small round homogenous deposits of hemosiderin, shown as signal loss on magnetic resonance imaging (MRI) T2*-weighted gradient-recalled echo. CMBs is a potential predictor of symptomatic stroke. The frequency of CMBs increases with age, hypertension and history of cerebrovascular disease. Some studies indicated the relationship between the CMBs and chronic kidney disease (CKD), but it remains unclear in patients with first-ever acute ischemic stroke (AIS) or transient ischemic attack (TIA). Our hypothesis is that the presence of CMBs is relative to the severity of CKD in patients with first-ever AIS or TIA.

Methods:
A single center retrospective study of 456 consecutive Japanese patients (mean age 71 years, 58.6% male) with first-ever AIS or TIA and early underwent 1.5T MRI T2*-weighted gradient-recalled echo were enrolled. CMBs were defined as homogeneous round signal-loss lesions with a diameter of <10 mm on 1.5T MRI T2*-weighted gradient-recalled echo. CKD stages were classified as normal (glomerular filtration rate (GFR): ≥90 mL/min/1.73 m
2
), mild CKD (GFR: 60-89.9 mL/min/1.73 m
2
), moderate CKD (GFR: 30-59.9 mL/min/1.73 m
2
), and severe CKD (GFR: <30 mL/min/1.73 m
2
). Multivariable logistic regression was used to determine associations of CMBs and severity of CKD and reported with odds ratios (OR) and 95% confidence intervals (CI).

Results:
The prevalence of CMBs in 141 (30.9%) of patients (10.5% had one CMBs, 10.5% had 2-4 CMBs and 9.9% had ≥5 CMBs), 7.4% strictly lobar CMBs and 23.5% deep/infratentorial CMBs. Compared with the reference group of normal, mild CKD (OR 2.54, 95% CI 1.17-6.15), moderate CKD (OR 2.87, 95% CI 1.20-7.51), and severe CKD (OR 5.95, 95% CI 1.68-21.7) were associated with the presence of deep/infratentorial CMBs but not strictly lobar CMBs.

Conclusions:
The presence of deep/infratentorial CMBs was significantly associated with severity of CKD in this population of first-ever AIS or TIA.
Abstract TP2: Characteristics Affecting the Outcome of Patients With Cardioembolic Stroke Treated With Endovascular Reperfusion Therapy
Authors: Hashimoto Tetsuya , Matsumoto Shoji , Hatano Taketo , Saka Makoto , Ando Mitsushige , Chihara Hideo , Takita Wataru , Tokunaga Keisuke , Kamata Takahiko , Tsujimoto Atsushi , Yamada Takeshi , Nagata Izumi
Published: October 2018

Background and Purpose:
Acute reperfusion therapy for patients with cardioembolic stroke (CES) is crucial because those patients often have large ischemic penumbra lesions. We investigated characteristics affecting the outcome of patients with CES treated with endovascular reperfusion therapy.

Methods:
We retrospectively reviewed 229 consecutive stroke patients with acute major cerebral arterial occlusion treated with endovascular reperfusion therapy from October 2010 to December 2016. We collected the following information: baseline characteristics, NIHSS score on admission, pretreatment imaging findings, time course, endovascular procedures, degree of reperfusion, complications, discharge diagnosis of stroke subtype, and outcome. Clinical data were compared between patients with CES and patients with other stroke types. Predictors of good outcome (the modified Rankin Scale score at 90 days of 0-2) were identified in patients with CES.

Results:
In 142 patients with CES, age was older (76±11 vs. 70±13 y, p<0.01), premorbid detection of atrial fibrillation (AF) was more frequent (60 vs. 7 %, p<0.01), NIHSS score on admission was higher (median, 18 vs. 15, p<0.01), the existence of susceptibility vessel sign (SVS) on MRI was more frequent (58 vs. 29 %, p<0.01), duration of endovascular procedures was shorter (90±51 vs. 143±83 min, p<0.01), and the time from onset to the end of endovascular procedures was shorter (321±204 vs. 412±238 min, p<0.01) than in 87 patients with other stroke types. There were no significant differences in reperfusion success, complications, and good outcome (42 vs. 43 %, p=0.99) between the two groups. In patients with CES, age (OR 0.44, 95% CI 0.24-0.77), premorbid detection of AF (OR 0.32, 95% CI 0.12-0.85), NIHSS score on admission (OR 0.93, 95% CI 0.87-0.98), the time from onset to the end of procedures (OR 0.97, 95% CI 0.95-0.99), and symptomatic intracranial hemorrhage (OR <0.01, 95% CI 0-0.12) were negatively associated, and successful reperfusion (OR 7.22, 95% CI 2.14-28.02) was positively associated with good outcome.

Conclusions:
SVS on pretreatment MRI may be helpful in identifying CES. Patients with CES are older and severer but can be treated in a shorter time from stroke onset, cancelling the former disadvantage.
Abstract TP200: Plaque Vulnerability on Contrast-Enhanced Carotid Ultrasound is Associated With Pathogenesis of Acute Cerebral Infarction
Authors: Li Jinxin , Zhao Xingquan , Yu Haige , Ning Bin , He Wen
Published: October 2018

Objective:
To analyze the relationship between carotid plaque vulnerability on contrast-enhanced carotid ultrasound (CEUS) and underlying stroke pathogenesis in acute cerebral infarction.

Methods:
Patients from Beijing TianTan hospital, who suffered from acute cerebral infarction in anterior circulation, attributing to intra/extracranial large artery atherosclerosis, were enrolled. Infarction imaging characteristics were evaluated on diffusion weighted imaging sequence with brain MRI and vulnerable plaques were assessed with CEUS within 14 days since the onset of the symptoms. Participants also attended a follow-up after 90±7 days. Logistic regression was used to analyze the relationship between plaque vulnerability and imaging characteristics. Survival analysis was performed to evaluate the predictive effects of vulnerable plaques on ischemic stroke relapse.

Results:
Between October 2015 and December 2016, a total of 93 patients were enrolled. Vulnerable plaque was found in 35 (37.6%) participants on CEUS and was an independent risk factor of embolization (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.19-11.12; P=0.02), especially in patients without intracranial large artery atherosclerosis (odds ratio, 5.67; 95%CI, 1.36-23.67; P=0.02). However, this relationship was not found when plaques were detected with traditional carotid ultrasound. When analyzing with single-factor Kaplan-Meier curve, vulnerable plaque on CEUS was also an indicator of stroke relapse within 3 months (P=0.04).

Conclusion:
For patients with acute cerebral infarction attributing to atherosclerosis, compared to carotid ultrasound, CEUS is more precise when assessing the vulnerability of the plaques. Vulnerable plaque on CEUS is associated with stroke mechanisms and prognosis, which may provide more evidence for making appropriate secondary prevention plans.
Abstract TP201: Carotid Artery Flow as Determined by Real-Time Phase-Contrast Flow Mri and Neurovascular Ultrasound: a Comparative Study of Healthy Subjects
Authors: Maier Ilko , Hofer Sabine , Joseph Arun A , Merboldt Klaus-Dietmar , Tan Zhengguo , Schregel Katharina , Knauth Michael , Bähr Mathias , Psychogios Marios-Nikos , Liman Jan , Frahm Jens
Published: October 2018

Background:
The assessment of carotid artery flow by neurovascular ultrasound (nvUS) may be complemented by real-time phase-contrast (RT-PC) flow MRI which apart from quantitative flow parameters offers velocity distributions across the entire vessel lumen.

Methods:
The feasibility and diagnostic potential of RT-PC flow MRI was evaluated in 20 healthy volunteers in comparison to conventional nvUS. RT-PC flow MRI at 40 ms temporal resolution and 0.8 mm in-plane resolution resulted in velocity maps with low phase noise and high spatiotemporal accuracy by exploiting respective advances of a recent nonlinear inverse model-based reconstruction. Peak-systolic velocities (PSV), end-diastolic velocities (EDV), flow volumes and comprehensive velocity profiles were determined in the common, internal and external carotid artery on both sides.

Results:
Characteristics in pulsatility and laminar flow, including individual flow abnormalities shown on nvUS, could be reproduced and visualized in detail by RT-PC flow MRI. Fig. 1 shows a representative color-coded duplex sonography with doppler spectrum (A), flow volume measurement by RT-PC flow MRI (B) and a three-dimensional representation of through-plane velocities at peak systole (C) and end diastole (D) in the internal carotid artery. PSV to EDV differences revealed good agreement between both techniques, mean PSV and EDV were significantly lower and flow volumes were higher for MRI.

Conclusions:
Our findings suggest that RT-PC flow MRI may add to clinical diagnostics, e.g. by alterations of dynamic velocity distributions in patients with carotid stenosis. Lower PSV and EDV values than for nvUS mainly reflect the longer MRI acquisition time which attenuates short peak velocities, while higher flow volumes benefit from a proper assessment of the true vessel lumen.
Abstract TP206: Association of a Polymorphism From the Protein Convertase Subtilisin Kexin Type 9 in Atherosclerotic Ischemic Stroke in Two Latin American Populations
Authors: Barboza Miguel A. A , Serrano Fabiola , Jara Aurelio , Silva Sandra , Arauz Antonio
Published: October 2018

Background:
the association of gain-of-function polymorphisms in PCSK9 gene has been proposed as a risk factor for coronary atherosclerotic disease, and recently with atherosclerotic ischemic stroke.

Aims:
we investigated the effect of E607G single nucleotide polymorphism (SNP) on the risk association of ischemic atherosclerotic stroke in two Latin-American (Costa Rica and a Mexico) cohorts.

Materials and methods:
Cases were selected according to A1 ASCOD phenotype criteria for atherosclerotic stroke from databanks in both countries, matched with stroke-free controls. Genotyping of the SNP was performed using real time polymerase chain reaction-based restriction fragment length polymorphism, and then confirmed by direct sequencing. Univariate analysis for high-risk genotype and Hardy-Weinberg equilibrium was assessed. Ancestry was confirmed for both populations.

Results:
One hundred ninety six (100 Costa Rican and 96 Mexican) ischemic atherotrombotic stroke cases, and 198 (100 Costa Rican and 98 Mexican) age-, gender- and risk factors-matched controls were included. Lipid profiles among cases and controls were consistent, with no significant differences among basal values. Main risk factors were higher in cases than in controls: hypertension (74.1% vs. 57.4%), known hypercholesterolemia (59.9% vs. 35.7%), diabetes (42.1% vs. 27%), and current smoking (34.5% vs. 21.4%). Partial anterior circulation infarction (59.4%), mainly from extracraneal atherosclerotic source (61.2%), with a median NIHSS score of 7, were the most important characteristics of cases included. High-risk genotype profile from E670G (GG), was present only in one control and one case from the entire population, with no association found for the homozygous model.

Conclusion:
the E607G polymorphism of the PCSK9 gene is not associated with an increased risk and severity of ischemic stroke in a Costa Rican and Mexican cohort.

Keywords:

PCSK9 gene, E607G, R218S, F216L, atherosclerotic stroke, polymorphism,
Abstract TP209: History of Diabetes, Drug Abuse and Smoking Predict Recurrence of Ischemic Stroke in the Young
Authors: Ahmed M.Khaleeq , Kamal Haris , Zhang Charles , Crumlish Annemarie , Koh Ye Rin , Ching Marilou
Published: October 2018

Introduction:
Ischemic stroke (IS) in the young portends a high mortality and morbidity. IS in this population has etiologies that differ from that of the older and carries unique risk factors (RF) that may predict recurrence.

Objectives:
We aimed to determine the demographic, medical and social RF that are associated with recurrence of IS in patients with a sentinel event prior to the age of 50.

Methods:
This is a single center case control study conducted between Jan 2009 and May 2017. All patients with IS <50 years of age who survived were evaluated for recurrence. Demographics, laboratories, medical and social history were obtained through chart review. Independent T tests were applied for continuous variables and Chi Squared or Fisher’s exact test for categorical variables. Cox regression analysis was used to determine variables associated with recurrence. A p-value of <0.05 was considered significant.

Results:
A total of 875 patients under age 50 were found to have IS. After a follow up of (mean ± SD) 1385 ± 880 days, a total of 90 (10%) patients suffered at least one recurrence at 560 ± 723 days post-discharge (range 3-2480 days). History of diabetes, drug abuse and smoking were found to be significantly different between the controls and recurrence groups (p = 0.001, p = 0.004, p = 0.021; respectively). Univariate predictors of recurrence included black race (Hazard Ratio [HR] 1.68, p = 0.023), history of diabetes (HR 2.04, p = 0.002), drug abuse (HR 2.73, p < 0.001), smoking (HR 1.70, p = 0.013), and HbA1c (HR 1.15 per 1% increase, p < 0.001). All non-demographic predictors remained significant when normalized for age, race and gender. Multivariate regression found history of diabetes, drug abuse and smoking to be predictive of recurrence (HR of 1.96, p = 0.026; 2.25, p = 0.004; 1.63, p = 0.04; respectively). Recurrence occurred in 5/12 (42%) patients positive for all three RF versus 22/333 (7%) that are devoid of the above RF.

Conclusions:
In summary, stroke in the young recurrence rate was 10% in our study population. History of diabetes, drug abuse, and smoking were found to be associated with recurrence suggesting that risk factor modification is important. Larger cohort studies are needed to further validate these findings..
Abstract TP21: Admission Hyperglycemia and Acute Large Vessel Occlusion Stroke Outcomes After Endovascular Therapy
Authors: Bouslama Mehdi , Barreira Clara M , Haussen Diogo C , Grossberg Jonathan A , Belagaje Samir R , Bianchi Nicolas A , Anderson Aaron M , Frankel Michael R , Nogueira Raul G
Published: October 2018

Background:
Hyperglycemia on admission is known to be associated with poor outcome after intravenous or intra-arterial thrombolysis treatment in patient with acute ischemic stroke. However, its effect on mechanical thrombectomy outcomes remains elusive. We investigated whether clinical and procedural outcomes differ between normoglycemic and hyperglycemic patients with large vessel occlusion stroke after endovascular therapy.

Methods:
We reviewed our prospectively collected endovascular database at a tertiary care academic institution between 9/2010-12/2016. Hyperglycemia was defined as admission serum glucose >140mg/dl. All patients that underwent ET for anterior circulation large vessel occlusion acute ischemic stroke were included and categorized into two groups according to their glycemic status. Baseline and procedural characteristics, as well as outcome parameters were compared.

Results:
A total of 931 patients qualified for the study of which 289 (31%) had hyperglycemia on admission. Those with hyperglycemia were older (p=0.001), had more comorbidities and more severe strokes as assessed by the NIHSS (19[15-23] vs 17[13-21], p=0.01). In univariate analysis, Hyperglycemic patients had lower rates of successful reperfusion (mTICI2b-3, 85.4% vs 90.6%,, p=0.02) and 90-day good outcomes (mRS 0-2, 32.7% vs 52.3%, p<0.01) and higher rates of parenchymal hematomas (11.5% vs 7.5%, p=0.04) and 90-day mortality (35% vs 16.6%, p<0.01). After adjustment for confounders, Hyperglycemia remained associated with decreased successful reperfusion (OR 0.55 95%CI [0.31-0.96], p=0.03) and good outcome (OR 0.52 95%CI [0.34-0.79], p=0.002) and increased mortality (OR 2.39 95% CI [1.45-3.82], p<0.001). However, it was no longer a predictor of parenchymal hematomas.

Conclusions:
Our study confirms that hyperglycemia is associated with poorer procedural and clinical outcomes in patients undergoing mechanical thrombectomy for large vessel occlusion strokes.
Abstract TP217: A Brief Educational Intervention Improves the Accuracy of Emergency Medical Services Stroke Recognition
Authors: Oostema John A , Chassee Todd , Edberg Allison , Baer William , Reeves Mathew
Published: October 2018

Background:
EMS stroke recognition and hospital prenotification facilitate rapid stroke treatment. However, EMS stroke recognition is suboptimal. To promote stroke recognition, we deployed a 30-minute online EMS educational module in a single southwestern Michigan county.

Methods:
Following 12 months of baseline data collection, the online module was completed by all paramedics in the study county. An interrupted time series design was used to measure the impact of the educational intervention in the subsequent 9 months. Prehospital and hospital data were collected for all EMS suspected stroke cases and hospital confirmed strokes that were missed by EMS. We compared the sensitivity and overcall (false positive) rate of an EMS stroke impression during the pre- and post-intervention periods. We also compared stroke scale documentation, prehospital notification, and door-to-CT (DTCT) times.

Results:
Over a 21-month period, 1656 cases were included: 744 EMS identified strokes, 408 EMS missed strokes, and 504 EMS overcalled cases (not strokes). Following the intervention, EMS sensitivity for stroke recognition increased from 65.3% to 71.5% (p=0.048) without change in the proportion of overcalls (39.4% to 40.8%, p=0.65). However, improvement in sensitivity was limited to the first post-intervention quarter (65.3% to 74.0%, p=0.027), and returned to baseline thereafter (figure). Among 1109 confirmed stroke cases, EMS hospital prenotification improved following the intervention (57.1% to 81.6%, p<0.0001) but there was no change in stroke scale documentation (67.4 % vs. 67.8%, p=0.93). A higher likelihood of a DTCT time ≤25 minutes was observed only in the first post-intervention quarter (55.4% vs. 43.5%, p=0.0045).

Conclusions:
A brief, web-based educational intervention was associated with higher EMS stroke recognition without an increased rate of stroke overcalls. Although improvements were transient, they coincided with improved DTCT times.
Abstract TP218: Mobile Stroke Unit Improves Time to Treatment in Suburban Community
Authors: Shownkeen Harish , Lindstrom Anne , Graham Steve , Iacob Tudor , Crumlett Hillary , Mohajer-Esfahani Mehr
Published: October 2018

Introduction:
Recent evidence suggests that Mobile Stroke Units have demonstrated improved time to treatment in urban settings. These vehicles are equipped to respond to out of hospital strokes and begin treatment with the use of IV alteplase. The evidence is limited to urban settings and the full impact of mobile stroke units on stroke treatment times and outcomes should be studied in urban, suburban and rural communities. This abstract aims to describe the impact of a mobile stroke unit in a suburban community.

Hypothesis:
A mobile stroke unit in a suburban setting can improve time to treatment for stroke patients for ischemic stroke patients.

Methods:
The mobile stroke unit responds to a 6 town area within the hospital’s EMS (Emergency Medical Services) system, data from mobile stroke unit patients was compared to data from stroke patients brought to the Emergency department by conventional EMS from January-June 2017. The mobile stroke unit is dispatched for patients deemed as potential strokes by the centralized 911 dispatch. The patient is then evaluated by a specially trained crew consisting of a critical care paramedic and a critical care nurse. Neurology evaluation occurs via telemedicine. The mobile stroke unit is equipped with IV alteplase. Data is collected EMS EMR and imported to stroke database. Inclusion criteria includes: 18 years or older, receive treatment in mobile stroke unit or emergency department, treated with IV alteplase.

Results:
Ischemic stroke patients cared for by the Mobile Stroke Unit received IV alteplase (n=4) 25 minutes faster from time of dispatch than patients arriving to the Emergency Department (n=7). 100% of mobile stroke unit patients treated with IV alteplase had a 90 day modified rankin score of 2 or less (n=2) compared to 66% in the Emergency Department group (n=3). Symptomatic intracranial hemorrhage rate was 0% in both groups.

Conclusions:
Patients treated in the mobile stroke unit demonstrate a decrease in time to treatment and a preliminary improvement in outcomes. Data is not significant at this time due to small sample size, however, the data is encouraging and should continue to be studied. In conclusion, the use of a mobile stroke unit in a suburban setting provides a time to treatment benefit.