bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP10: Intra-Arterial Thrombolysis After Failed Mechanical Thrombectomy: A STRATIS Registry Subgroup Analysis
Authors: Zaidi Syed , Castonguay Alicia , Jumaa Mouhammad , Mueller-Kronast Nils , Zaidat Osama
Published: June 2021

Background:
Limited prospective data exists on the use of intra-arterial (IA) thrombolytics as rescue therapy(RT) after failed mechanical thrombectomy(MT) in acute ischemic stroke(AIS) patients with large vessel occlusions LVO). The aim of this study is to investigate the use of IA recombinant tissue plasminogen activator(IA-rtPA) as RT in the prospective STRATIS Registry.

Methods:
Data from the STRATIS Registry, a multicenter study of AIS patients treated with the Solitaire stent-retriever as the first choice therapy within 8 hours from symptoms onset, were analyzed. Clinical and angiographic outcomes were compared between patients treated with and without IA-rtPA. Both anterior and posterior circulation occlusions were included in this substudy.

Results:
Of the 938 STRATIS patients with IA-tPA use reported, 809 and 129 were in the no IA-rtPA(83.2%) and IA-rtPA(13.8%)groups, respectively. No difference was seen in baseline demographics. Site of occlusion was similar between the groups, with the majority occurring in the MCA(72.4% versus 73.6%, p=0.74). IV-rtPA was administered in 63.0% and 70.5% of no IA-rtPA and IA-rtPA patients(p=0.11). Median IA-rtPA dose was 4mg(IQR 2-12). Mean onset to arterial puncture time was shorter in the IA-rtPA group(200.2±104.6 versus 228.2±98.5 minutes, p=0.003); however, mean puncture to procedure end time was longer in the IA-rtPA group(78.7±43.1 versus 63.1±35.9 minutes). Mean number of passes (2.2±1.4 versus 1.8±1.2,p=0.001) and rate of distal embolization(67.8% versus 54.5%, p=0.007) was significantly higher in the IA-rtPA group. Core lab adjudicated substantial reperfusion (mTICI≥2b) was achieved in 88.4% and 84.7% of no IA-rtPA and IA-rtPA patients(p=0.16). No difference was observed in rates of symptomatic intracranial hemorrhage(sICH) (1.4% versus 1.6%,p=0.70), good functional outcome (mRS≥2, 57.3% versus 59.2%, p=0.86), or mortality (15.5% versus 13.3%,p=0.80) at 90-days.

Conclusion:
Use of IA-rtPA after failed thrombectomy was not associated with an increased risk of sICH or mortality in the STRATIS Registry. These results suggest that IA thrombolysis may be a safe option as rescue therapy in select patients.
Abstract TP103: Neonatal Stroke Alters Communication of Microglial Cells With Microglia-Derived Exosomes and Microvesicles
Authors: Lecuyer Matthieu , Faustino Joel , Pathipati Praneeti , Vexler Zena
Published: June 2021

Inflammation modulates brain injury after perinatal arterial stroke. We previously demonstrated that microglial cells play an important role in protecting neonatal brain from acute stroke by phagocytosing dying neurons, attenuating cytokine accumulation and by protecting neurovascular integrity. Microglia may modulate injury in neonatal stroke via crosstalk between cells via other mechanisms, such as by releasing extracellular vesicles from microglia (MEV), including exosomes (MExo) and microvesicles (MMV).

Aim:
Elucidate the mechanisms of MEV communication with brain cells in injured neonatal brain and role of these vesicles in protection.

Methods:
Transient middle cerebral artery occlusion (tMCAO) was performed in postnatal day 9 (P9). Microglial cells were isolated by CD11b-conjugated beads from ischemic and contralateral cortex 24h after reperfusion and plated at same density for 96h. MEV were isolated by multi-step centrifugation (MMV) and ultra-centrifugation (MExo) and labeled with MiniClaret dye. Uptake of MEV from contralateral/ injured cortex by Iba1
+
-cells from contralateral and injured regions was determined 10, 30 & 120min. Images co-stained with flotillin-1, which is strongly expressed in MMV but not in MExo, were analyzed using Volocity
®
.

Results:
The uptake of MEV from injured cortex by microglia from injured cortex was significantly higher than uptake of contralateral-MEV by microglia from uninjured cortex (5-fold at 10min; p<0.0001) regardless of time. Uptake of MEV from injured regions by microglia from contralateral cortex and contralateral-MEV by microglia from injured cortex were low. While the number of ipsilateral and contralateral flotillin-1
+
-MMV was similar, uptake of flotillin-1
-
-MExo and ratio of ipsilateral MExo/MEV were significantly increase.

Summary:
Our data demonstrate selective enhancement of microglial communication with MEV from activated microglia after acute neonatal stroke as well as distinct MEV-subtype-dependent mechanisms of communication in injured brain. This mechanism could provide a better understanding of the role of microglia on the severity of neonatal stroke.

Support: AHA17IRG33430004, RO1NS44025, RO1HL139685
Abstract TP111: TRPM2 is a Therapeutic Target for Reversal of Stroke-Induced Dementia-Like Symptoms
Authors: Orfila James E , Dietz Robert M , Dingman Andra , Schroeder Christian M , Quillinan Nidia , Herson Paco S
Published: June 2021

Introduction:
Cognitive impairments and memory loss are common after stroke, with an emerging awareness of a high risk of conversion to post-stroke dementia. It is increasingly clear that in addition to neuronal injury following cerebral ischemia, impaired functional networks contribute to long-term functional deficits. Synaptic plasticity (long term potentiation; LTP) is the leading cellular model of learning and memory. Thus, we utilize electrophysiological recordings of hippocampal LTP as an indicator of network health following ischemia in combination with neurobehavioral assessments of memory function. TRPM2 channels are oxidative stress sensitive ion channels that have been implicated in ischemic injury.

Hypothesis:
Inhibition of TRPM2 channels reverse stroke-induced cognitive deficits.

Methods:
Extracellular field recordings of CA1 neurons were performed in acute hippocampal slices prepared 30 days after recovery from transient MCAO (45 min) in adult (6-8 week) mice. A behavioral fear conditioning paradigm was used to evaluate contextual memory 30 days after MCAO. Slices or mice were treated with our newly developed peptide inhibitor of TRPM2, termed tatM2NX.

Results:
Recordings obtained in brain slices 30 days after MCAO exhibited near complete loss of LTP; 161±9%, n=6 in sham compared to 115±4%, n=7 30 days after MCAO in the ipsilateral hippocampus. Similar deficit in LTP observed in the contralateral hippocampus. Remarkably, iv injection of 20 mg/kg tatM2NX on day 29 after MCAO reversed MCAO-induced loss of LTP when recorded on day 30, recovering to 175±9% (n=3). Memory function, measured using contextual fear conditioning, was consistent with our LTP findings. MCAO decreased freezing behavior, indicating lack of memory (62±5% in sham mice (n=5) and 24±3% in MCAO mice, n=4). This was reversed in MCAO mice given tatM2NX (20 mg/kg iv injection 24 hr before testing) on day 29 post MCAO, increasing freezing to 73±12% (n=3).

Conclusion:
These data indicate that our new TRPM2 channel inhibitor, tatM2NX, restores synaptic plasticity and memory function after experimental stroke. Therefore, inhibition of TRPM2 channels at chronic timepoints following ischemia may represent a novel strategy to improve functional recovery following stroke.
Abstract TP120: Complement Activation Contributes to Malignant Transformation of Stroke and Limits Cognitive Recovery After Reperfusion Therapy
Authors: Alawieh Ali M , Feng Wuwei , Spiotta Alejandro M , Tomlinson Stephen
Published: June 2021

Introduction:
Ischemic stroke involves an ischemic event followed by post-ischemic neuroinflammation, leading to acute mortality, neuronal loss, and impaired recovery. Standard of care reperfusion therapy (thrombolysis or thrombectomy) has a limited treatment window due to risk of hemorrhage, and leads to functional independence in only a subset of patients. We studied the role of complement and neuroinflammation in the pathophysiology behind the major clinical challenges of reperfusion therapy; the risk of hemorrhage and limited cognitive recovery.

Methods:
We used 3 stroke models, namely transient middle cerebral artery occlusion (MCAO), permanent MCAO and microembolic models, to investigate the effects of t-PA, mechanical reperfusion, rehabilitation therapy, and complement inhibition in mice. We used B4-Crry, a site-targeted inhibitor of C3 activation that specifically localizes to neoepitopes expressed in the post-ischemic brain following its intravenous administration. A retrospective analysis was also performed for cognitive and motor recovery in human patients following reperfusion therapy.

Results:
Complement inhibition with B4-Crry improved the safety, efficacy and treatment window of reperfusion therapy, decreased hemorrhagic transformation, and improved cognitive recovery. Despite reperfusion with t-PA, there was ongoing complement-dependent microglial activation and phagocytosis of hippocampal synapses for at least 30 days leading to pronounced long-term cognitive deficits. Administration of B4Crry, alone or in combination with thrombolytic therapy, limited complement deposition in the perilesional brain, and reduced microgliosis and synaptic uptake. Reperfusion therapy alone did not improve cognitive outcomes, even when combined with rehabilitation therapy. Reperfusion therapy did not improve cognitive outcomes in stroke patients.

Conclusions:
Although post-stroke reperfusion therapy limits the size of injury and improves motor deficits, post-reperfusion complement activation and neuroinflammation contribute to the malignant transformation of stroke acutely and seeds a chronic neurodegenerative inflammatory response. Complement modulation may be a promising adjuvant to reperfusion therapy.
Abstract TP124: 90-Day Disability Outcomes and Stroke Etiology: An ALIAS 2 Secondary Analysis
Authors: Goldstein Eric D , Reddy Vivek K , Lyden Stephanie , Majersik Jennifer J , de Havenon Adam
Published: June 2021

Background:
Acute ischemic stroke (AIS) treatment remains a leading cause of global morbidity and mortality despite advancements in therapeutic options. Cardioembolic AIS had previously been associated with the greatest long-term disability and mortality. Our aim is to provide an updated perspective of 90-day disability outcomes with regard to stroke etiology.

Methods:
This is a secondary analysis of the ALIAS 2 trial. The primary outcome was the 90-day mRS. Stroke etiology was defined based on TOAST criteria. Spearman’s Rho is used to determine correlation between etiology and mRS. Univariate and multivariate logistic regression models are fit to a binary stratification of our outcome (mRS 0-1 vs 2-6).

Results:
A total of 776 patients were enrolled between 2009 and 2012 with a mean (SD) age of 64.7 (12.7) years. The median (IQR) NIHSS was 11 (8, 17) with 55.3% being male, 76.7% white, and 89.7% having received IV TPA. Large artery atherosclerosis (LAA) (201/776, 25.9%), cardioembolism (271/776, 34.9%) and cryptogenic (196/776, 25.3%) were the most common AIS etiologies. The 90-day mRS had significant differences by TOAST category (rho = 0.013, p<0.001). Individuals with LAA had the highest mean 90-day mRS (Figure 1). LAA was associated with lower odds of good outcome in both univariate analysis (OR 0.68, 95% CI 0.48-0.96) and in a multivariate model (OR 0.66, 95% CI 0.45-0.97) adjusted for age, NIHSS, diabetes, hypertension, hyperlipidemia, sex, white race and administration of IV TPA.

Conclusion:
Our secondary analysis revealed that AIS with a NIHSS greater than 8 of LAA origin purported a worse 90-day disability outcome. This data may serve to remind clinicians that AIS from LAA may yield comparable or greater disability than cardioembolic AIS.

Figure 1: Mean 90-day disability outcome based on TOAST classification. LAA purported worse mean disability outcomes compared to other grouped etiologies.
Abstract TP127: Periprocedual Risk of Treatment for Carotid Stenosis Complicated With Cardiac Disease - J-ASPECT Study
Authors: Nishimura Ataru , Nishimura Kunihiro , Onozuka Daisuke , Kada Akiko , Kurogi Ai , Kurogi Ryota , Ren Nice , Arimura Koichi , Iihara Koji ,   the J-ASPECT Study Collaborators
Published: June 2021

Background and Purpose:
Heart disease is a common comorbid condition among patients undergoing carotid endarterectomy (CEA) and carotid artery stent placement (CAS). However, the outcomes of patients with heart disease who were treated with CEA/CAS have not been fully examined. We investigated the impact of heart disease on outcomes of CEA and CAS in general practice using the Japanese nationwide data from J-ASPECT study.

Methods:
We analyzed data from 23,366 patients of CEA or CAS (CEA 8,514, CAS 14,809) who had been hospitalized in the period from April 2012 to March 2017. We extracted data from the Japanese nationwide DPC database for patients who underwent CEA or CAS which were identified from procedural coding with Japanese original K-codes (CEA: K6092, CAS: K609-2). For further categorization of carotid artery stenosis patients with or without heart disease, we used the ICD-10 code (ischemic heart disease, valvular disease cardiomyopathy, conduction disturbance, cardiac arrhythmia, atrial fibrillation/atrial flutter and heart failure) to identify the presence of heart disease. Outcome (death within 30days) was compared between the patient who underwent CEA or CAS and patient with or without heart disease after adjustment for patient characteristics by using the logistic regression analysis.

Results:
Of the patients who underwent CAS or CEA, 2495 (29.3%) in CEA and 3930 (26.5%) in CAS were complicated with heart disease. Heart disease was not associated with the risk of death within 30days in both patients undergoing CEA (OR, 1.38; 95% CI, 0.54-3.55, p=0.5) or CAS (OR, 1.42; 95% CI, 0.93-2.16, p=0.099). Among heart disease, valvular disease was associated with increased the risk of death within 30days in patients undergoing CEA (OR, 6.71; 95% CI, 1.89-23.77, p=0.0032) and CAS (OR, 2.94; 95% CI, 1.05-8.20, p=0.004) after adjustment for potential confounders. Especially of the patients with valvular disease, aortic valve disease was significantly increased the risk of death within 30days (CEA: OR, 11.2; 95% CI, 3.13-39.8, p=0.0002, CAS: OR, 3.53; 95% CI, 1.07-11.6, p=0.038).

Conclusion:
Patients who were complicated with valvular disease, especially aortic valve disease had a high risk of death within 30 days after CEA or CAS.
Abstract TP13: External Validation of Stroke Prognostication Scales - A Retrospective Cohort Study
Authors: Jahangir Nauman , Lanzotti Nicholas , Gollon Kyle , Farooqi Mehwish , Buhnerkempe Michael , Shastri Ravi , Elias Augusto , Siddiqui Fazeel M
Published: June 2021

Introduction:
In recent years, many scoring models have been proposed to predict clinical outcomes after acute ischemic stroke. Aim of our study was to perform a comparative analysis of these scoring systems to assess predictive reliability.

Method:
This retrospective single center study included 166 community-based patients presenting with an acute ischemic stroke between 2015 and 2018 who had undergone mechanical thrombectomy with or without IV r-tPA administration prior to the procedure. Patients with unknown 90 day Modified Ranking Scale (mRS) were excluded from the study. We included SPAN-100, THRIVE, HIAT2, iScore , TPI, DRAGON, ASTRAL and HAT predictive models to our study. To predict MRS at 90 days, we first dichotomize mRS into two groups: scores of 0 and 1 and scores 2 and above. We then used logistic regression to find the association between a stroke score and the probability of having a 90-day mRS of 2 or above. Separate univariate logistic regressions were fit for each stroke score. We assessed the ability of each stroke score to predict 90-day mRS using the area-under-the-curve (AUC) of the receiver operating characteristic curve (ROC - plot of sensitivity against 1-specificity). AUC values range from 0.5 to 1 with values above 0.7 showing good discriminatory ability.

Results:
SPAN-100, HIAT2, iScore, and ASTRAL scores have similar predictive ability with AUC values over 0.7 (Table 1). The ASTRAL score had the highest predictive ability with a score above 31.5 indicating a high likelihood of a 90-day MRS ≥ 2 (Table 1). The TPI, DRAGON, and HAT scores all had AUCs below 0.65 indicating poor predictive performance in our data.

Conclusion:
The SPAN-100, HIAT2, iScore, and ASTRAL scores reliably predicts 90-day mRS of 2 or greater in patients with acute ischemic stroke.
Abstract TP132: Intensive Medical Management and Life-Style Modifications Can Be Successfully Applied in Combination With Indirect Surgical Revascularization for Symptomatic Intracranial Atherosclerotic Disease
Authors: Gonzalez Nestor R , Quintero-Consuegra Miguel D , Toscano Juan , Babadjouni Robin , Chang Daniel , Nisson Peyton , Jeffrey Saver
Published: June 2021

Introduction:
We present the results of using the strict model of intensive medical management (IMM) and life-style modification of SAMMPRIS in a phase 2 study of EDAS revascularization in patients with symptomatic intracranial atherosclerosis (ERSIAS).

Methods:
ERSIAS was a mid-development, single surgical arm trial that enrolled patients closely matched to those recruited in SAMMPRIS with the exception of including also individuals with occlusions of the intracranial arteries. In addition to surgery, primary and secondary risk factors were strictly managed and a life-style modification program with monthly phone calls to encourage adherence to medication, diet, physical activity, and smoking cessation was applied. Every 3 months, patients were clinically evaluated and data of adherence to medical regimen was collected.

Results:
As previously reported, the rate of recurrent stroke in ERSIAS at one year was 7.7%. ERSIAS required patients to have ceased smoking for at least 6 months before enrollment. Of the 52 patients enrolled only 5 had a relapse in their smoking habit (9.6%). At the end of the study four stopped smoking, representing a failure on smoking control of only 2%. Patient’s engagement in vigorous physical activity increased from 43% at baseline to 84% at follow-up (p=0.03). Median LDL values at baseline, 6 months, and 12 months were 83.9 (IQR 65.2), 70.9 (IQR 38.8), and 77 (IQR 78.25), respectively. At an individual level 75.6% of patients had improvement in LDL control. The SBP goal (<160mmHg) was achieved in 91% of patients, and a reduction of SBP was observed in 65.9% at either 6 or 12 months. Median HbA1c values in diabetic (DM2) patients were 6.3% (QR 2.5) at baseline, 5.1% (IQR 2.5) at 6 months, and 5.9% (IQR 2.8) at 12 months, accounting for an improvement in 60% of patients at either 6 or 12 months.

Conclusion:
A dedicated follow-up program optimized medical adherence and results in ERSIAS. The surgery did not affect the ability of patients to engage in exercise or adhere to medical management. The IMM model of SAMMPRIS was successfully applied in this surgical trial. Strict observance of the improvements in medical management should be integrated in future interventional studies for ICAD.
Abstract TP134: Effects of Strict Anesthesia Management in a Trial of Surgical Revascularization for Intracranial Atherosclerosis
Authors: Toscano Juan F , Quintero-Consuegra Miguel D , Chang Daniel , Babadjouni Robin , Nisson Peyton , Saver Jeffrey , Gonzalez Nestor R
Published: June 2021

Introduction:
Specific aspects of anesthesia management in clinical trials for cerebrovascular diseases have not been systematically addressed. As part of the EDAS Revascularization for Intracranial Atherosclerosis (ERSIAS) trial, we enforced strict management of hemodynamic parameters to prevent cerebral hypoperfusion during surgery.

Methods:
All patients enrolled in ERSIAS received intensive medical management, including antiplatelet therapy, even the day of surgery. Before every operation, a set of specific goals were discussed with the anesthesia team in a preoperative briefing, including strict regulation of SBP (lower limit = patient’s baseline when asymptomatic - upper limit = 200 mmHg), end-tidal CO
2
(ETCO
2
) (35-45 mmHg while intubated), and fluid balance (even to positive 2L). Printed goals were posted by the anesthesia stations, anesthesia equipment alarms were set to the predetermined goals, and surgeons had continuous access to the patient’s vitals. Range-deviations lasting more than 5 minutes were recorded. Mannitol and high doses of steroids were avoided.

Results:
Fifty-two patients underwent EDAS surgery, four had ischemic strokes, and only one patient had perioperative ischemia. There was a significant reduction in the standard deviation variance of intraoperative SBP compared to the SBP during clinic visits (14.9 vs.23.9 mmHg p<0.01), reflecting a tighter SBP control during surgery. SBP goal deviations occurred in five cases, resulting in one perioperative stroke. In general, strokes were more common among patients with SBP goal deviations (20% vs.4.7%). Mean ETCO
2
was 38mmHg (SD=1, Range: 35-41 mmHg). There was only one ETCO
2
goal deviation with no clinical consequences. Fluid balance ranged between -0.25 and 3.1L, with a mean 1.2L (SD=0.6L). Mean estimated blood loss was 37 mL (SD=16, Range: 10-80mL). There were five deviations from the fluid protocol not associated with clinical complications.

Conclusion:
A goal-oriented pre-surgical briefing with anesthesia team and practical implementations, as discussed above, were effective in reducing hemodynamic variability in the ERSIAS trial. Rigorous SBP management is key in averting stroke during EDAS. Future trials should include standardized anesthesia protocols.
Abstract TP14: Endovascular Thrombectomy May Improve Outcomes in Patients with Acute Ischemic Stroke and Pre-Morbid Stroke Disability
Authors: Parsha Kaushik N , Reddy Sujan Teegala , Bajgur Suhas , Qadri Syed K , Pujara Deep , Savitz Sean , Sarraj Amrou
Published: June 2021

Background:
Whether Endovascular Thrombectomy (EVT) may improve clinical outcomes in patientswith Pre-Stroke disability as compared to medical management only (MM) is unknown.

Methods:
A retrospective analyses of anterior circulation LVOs (ICA, MCA M1/M2) with mRS 2-4presenting 0-24 hrs from last-known-well to a single comprehensive stroke center was performed.Patients were stratified based on the treatment received into EVT and MM. The primary outcome was90-day mRS. Safety (sICH and mortality) was a secondary outcome. Ordinal analysis compared the twogroup for a shift towards less severe disability with EVT and identified variables independentlycorrelated with better and worse outcomes in both EVT and MM.

Results:
From Jan 2012 - Aug 2019, 101 patients were identified (EVT=42, MM=59). Baselinecharacteristics were similar in the two groups. EVT resulted in higher rates of mRS 2 and 3 (15% vs 4%,P=0.064) and a shift towards better outcomes (adj cOR 1.142; 95% CI1.050-1.369, p=0.039) as comparedto MM only (Figure 1). There was no significant difference in the composite outcome of sICH andmortality (aOR=0.47, 95% CI 0.307 - 1.810, p=0.167). Higher ASPECTS was associated with betteroutcomes in EVT (adj cOR 1.312 for each point, 95%CI 1.021 - 3.859, p-0.027) while higher NIHSS (adjcOR 0.886 for each point increment in NIHSS, 95%CI 0.793-0.951, p-0.034), left hemispheric strokes (adjcOR 1.615; CI 1.24 - 4.5; p = 0.04) independently correlated with worse outcomes in MM.

Conclusions:
EVT may result in better outcomes and avoid worsening disability in patients with Prestrokeimpairment without increasing safety concerns. Those with more severe and left hemisphericstrokes were more likely to have devastating outcomes if not treated with EVT.
Abstract TP143: Credibility, Expectancy and Satisfaction With Community-Based Telepractice Treatment for Aphasia
Authors: Ellis Charles , Briley Patrick M , Fang Xiangming
Published: June 2021

Introduction:
Telepractice has been used successfully to treat acute stroke in individuals in rural communities. Less progress has been made in using this approach for the treatment of post-stroke conditions such as aphasia. Few studies have examined telepractice approaches to treat aphasia in community settings.

Hypothesis:
Community-based telepractice approaches for the treatment of post-stroke aphasia are: (1) credible and individuals with will aphasia will expect to achieve improved outcomes and (2) clients with aphasia will be satisfied with the telepractice approach at the conclusion of treatment.

Methods:
30 individuals with post-stroke aphasia were enrolled in the community-based aphasia treatment program that consisted of a maximum of 12 treatment sessions. Treatment sessions were tailored to the needs of the person with aphasia (PWA) and based on a Language Oriented Treatment Approach. The primary outcomes for the study were credibility, expected outcomes and satisfaction with the program. Treatment credibility and expected outcomes were measured at enrollment using the Credibility-Expectancy Scale. Client satisfaction was measured post-treatment using the Client Satisfaction Scale-8.

Results:
The mean age of the sample was 61 years and the mean Western Aphasia Battery-Revised (WAB-R) aphasia quotient score was 75 indicating mild-moderate aphasia impairment. The average credibility score at enrollment was 22/27 indicating the participants believed the treatment approach was logical and useful. The average expected improvement from the aphasia treatment that was reported at the time of enrollment was 68%. Those participants who completed the aphasia treatment reported a mean CSQ-8 score of 31/32 indicating high satisfaction with the treatment approach.

Conclusions:
Telepractice treatments for the comprehensive treatment for aphasia have been slow to emerge. This approach is feasible, credible and acceptable to PWA. This study also showed telepractice treatment for aphasia is satisfying to PWA. Future studies should be designed to explore both community-based and home-based telepractice approaches to improve access to care for PWA.
Abstract TP145: Kinematics of Turning 360
O
in Healthy Older Adults and Stroke Survivors
Authors: Nyangau Norah , Soangra Rahul , Krishnan Vennila
Published: June 2021

Introduction:
The action of turning is used in everyday tasks around the home and in the community. Studies show that stroke affects sensorimotor functionality which can explain the difficulty in turning that stroke patients experience. This study explores an innovative approach to quantifying the kinematic differences in stroke survivors and healthy adults during full 360
o
turning.

Methods:
A total of 28 older adults (age: 68±10 yrs) with 14 stroke survivors (Fugyl-Meyer 23±4) and 14 healthy participants participated in this study. Data collection was performed in the Gait Rehabilitation and Research Lab (GRAIL) with 26 reflective markers placed on lower extremity bony landmarks of all participants. Subjects were instructed to stand at resting positions with each foot on separate force plates. Turning protocol included full 360
o
turn back to initial position and the subjects’ were free to choose the side and speed on their own.

Results:
Marker data from foot were utilized to obtain time variables for each turn which included: Swing/Stance, Turn Cycle, Foot Off and Foot Strike (Left and Right), Single Support (SS) and Double Support (DS). SS time for Stroke participants was significantly higher than the controls (5.49 s versus 3.45s)(p=0.0054). The number of turn cycle was higher post-stroke (5.4 versus 3.3) (p=0.001). The average number of swing and stance durations were higher in stroke individuals (p=0.0004).

Conclusion:
This is the first study defining turn cycles, stance, swing, and double support time in a turn cycle. This definition of turn cycle is important in understanding stroke turning and its comparison with healthy older adults can provide clinically relevant information for turning in stroke survivors. Turning parameters could be used as biomarkers of rehabilitation among stroke survivors.
Abstract TP146: Rate of Functional Improvement for Stroke Patients Plateaus During Inpatient Rehabilitation
Authors: Taleb Shayandokht , Durand Amy , Huynh Melissa , Parsha Kaushik , Parker Dorothea , Zhang Xu , Verduzco-Gutierrez Monica , Savitz Sean I
Published: June 2021

Introduction:
Functional outcomes and length of stay (LOS) are common outcome measures in stroke patients at Inpatient Rehabilitation Facilities (IRF).

Aim:
To examine trends in functional outcomes among patients with hemorrhagic versus ischemic stroke in IRF.

Methods:
Using a prospectively collected database of stroke patients admitted in our health system of 5 IRFs in Houston, we reviewed patients with either ischemic or hemorrhagic stroke between 1/18 to 6/19. The main outcome measure was the FIM scores. The relationship between LOS and FIM score improvement were analyzed using a third order polynomial regression model.

Results:
Among 88 patients, 43% were female and 60% had an ischemic stroke. The median LOS was 21 days (IQR14, 26) for all patients; 22 (IQR16, 30) in patients with hemorrhagic stroke; 20.5 (IQR14, 25) in patients with ischemic stroke (P: 0.24). Based on change in FIM, stroke patients benefited the most from IRF in the first 17 days (P<.0001) while the improvement rate declined significantly afterwards with the highest FIM score change of 32. The FIM score changes were not significantly different when adjusting for CMI. There were no significant differences in FIM changes and extent of temporal benefit between ischemic and hemorrhagic strokes. Moreover, bathing, dressing, tub transfer and walking were the areas of greatest improvement (Median change: 2 for all variables).

Conclusion:
Stroke patients in our IRF network benefit the most on FIM in the first 17 days. Further studies are needed to identify factors that could maximize functional gains in IRF.
Abstract TP149: Aphasia Recovery After Ischemic Stroke
Authors: Gronberg Angelina , Henriksson Ingrid , Lindgren Arne
Published: June 2021

Background:
Establishing aphasia prevalence and outcome after ischemic stroke can facilitate strategies for treatment of aphasia. Few studies of aphasia recovery after ischemic stroke have included consecutive, unselected patients. Our aim was to identify acute and chronic prevalence of aphasia in an unselected consecutive cohort of patients with ischemic stroke.

Methods:
218 patients with first-ever acute ischemic stroke were included prospectively and consecutively in the Lund Stroke Register Study. Patients with 1) dementia or psychiatric disorders; 2) non-native Swedish language; or 3) decreased consciousness were not included. Language assessment was made at baseline (within 6 days, median 3 days) after stroke onset by trained research nurses using the NIHSS sub-item 9, “Best Language” to screen for aphasia. Patients with aphasia (score of 1-3 on NIHSS item 9) were re-assessed with NIHSS item 9 by speech and language pathologists at 1 month, 3 months and 12 months after stroke.

Results:
Of 218 first-ever ischemic stroke patients 52 patients (24%) had aphasia according to NIHSS item 9 (median age 75 years; n=25 female). The distribution of the scores 1-3 at baseline were n=32, n=11, and n=9, respectively. At the 1 year follow-up, 31 patients (67%; n=5 deceased, n=1 drop out) had recovered from aphasia (n=28 with initial NIHSS item 9 score of 1, n=2 with initial NIHSS item 9 score of 2), even though all patients with initial global aphasia (NIHSS item 9 score of 3) had remaining aphasia (NIHSS item 9 score ≥ 1). Figure 1shows aphasia recovery (n=52) according to NIHSS item 9.

Conclusions:
A majority of patients with mild aphasia recover substantially from aphasia within 1 year after stroke. Patients with initial global aphasia all suffer from remaining aphasia 1 year after stroke. This suggests that this population might especially benefit from an early onset comprehensive, long-term aphasia treatment plan.
Abstract TP150: Effects of Pre-existing Psychotropic Medication Use on a Cohort of Patients With Ischemic Stroke Outcome
Authors: Jayaraman Dilip , Henninger Nils , Silver Brian , Moonis Majaz , Rothschild Anthony , Jun-Oconnell Adalia H
Published: June 2021

Background:
Although SSRI use for ischemic stroke related motor recovery has been studied with mixed results, the effects of the pre-existing psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke outcome is unknown.

Objective:
We sought to determine the prevalence of PPMU, and the clinical outcome in a cohort of patients presenting with acute ischemic strokes.

Methods:
We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke that were included in an institutional stroke registry between January 2015 and December 2017. Baseline characteristics, functional outcome measured by mRS, cardiovascular complications and death within 90 days and 365 days were recorded. The control was defined as a group of ischemic stroke patients that were not on psychotropic medications pre- and/or post-ischemic stroke.

Results:
The prevalence of PPMU in the studied cohort was 21.4% (69/323). The prevalence of female gender in PPMU was higher compared to the control and post stroke-psychotropic medication use groups (P<0.001), and the patients with PPMU had similar vascular risk factors compared to the control (NS), except for an increased presence of hyperlipidemia (68.1% vs. 57.5%, p<0.05). Among the patients with an available 90-day follow-up (n=175) and 365-day follow-up (n=246), there was no statistically significant difference in outcome events of MI, stroke, death, and dementia. The mRS was higher on PPMU and poststroke-psychotropic medication use groups compared to the control group within the 365-day follow-up (P=0.013).

Conclusion:
The prevalence of PPMU is common in ischemic stroke, and it is not associated with worsened post-stroke complications within 1 year.
Abstract TP156: NIH Stroke Scale at Discharge as a Predictor for Return to Work Status After Mild Stroke
Authors: Taboada Susan B , Wisialowski Caroline , Blum Jennifer , Clark Sarah , Staff Ilene , Nouh Amre
Published: June 2021

Background:
A significant proportion of patients are unable to return to work (RTW) post stroke. While post-stroke depression and fatigue have been linked to patients’ RTW status, the role of discharge NIHSS has not been studied.

Objective:
To evaluate role of stroke severity, depression, fatigue, and cognitive impairment on patients’ ability to RTW.

Methods:
A retrospective study was conducted using a survey completed by a convenience sample of patients during follow-up in stroke clinic. The survey included PHQ-9, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). Demographic, work status, and clinical data (discharge NIHSS, mRS, medical history) were also collected. NIHSS was evaluated both continuously and dichotomized (
<
1, > 1). Patients who did and did not RTW were compared using chi square tests of proportions and Wilcox Ranked Sum tests; independence of factors was explored using logistic regression predicting RTW.

Results:
Out of 135 patients surveyed, 41% (N=56) reported employment at the time of their stroke. Of those, a significant percentage of patients were unable to RTW post stroke (57.1%); 39.3% (N=22) were unable to RTW due to physical limitations. Further analysis revealed patients who did not RTW were more likely to suffer from fatigue (p=0.026), have higher rates of cognitive impairment (p=0.027) and a higher NIHSS at discharge (p<0.001). Very low NIHSS was a very strong RTW predictor as patients with an NIHSS ≤ 1 at discharge were 15 times more likely to RTW than patients with a higher NIHSS (p=.001). Patients who worked in professional, managerial, or artistic occupations pre-stroke were more likely to return to work than those in public service, skilled or unskilled labor occupations (p=0.023). In multivariate analyses, fatigue, cognitive impairment and depression were no longer significant when NIHSS at discharge was a covariate. Type of occupation was independent of NIHSS.

Conclusions:
For patients with mild stroke, NIHSS at discharge indicating minimal to no disability is a strong independent predictor for RTW status. For patients with greater deficit, depression, fatigue and cognitive impairment could play a greater role; additional studies of patients with greater variety of stroke severity would be needed.
Abstract TP157: Functional Oral Intake Scale is Associated With Poorer Outcomes Following Stroke
Authors: De Souza Juli T , Paiva Sérgio , Ribeiro Priscila , Tanni Suzana , Minicucci Marcos , Winckler Fernanda , Leonardo Zornoff , Polegato Bertha , Bazan Silmeia , Modolo Gabriel , Bazan Rodrigo , Azevedo Paula
Published: June 2021

Background:
Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications.

Objective:
Verify whether Functional Oral Intake Scale (FOIS) score during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke.

Methods:
A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and FOIS, in which FOIS 1-3 - tube feeding, 4-5 - oral feeding requiring food consistency changes, and 6-7 - oral feeding with no changes in food consistency. mRs≥3 90 days after discharge was considered disability. The data were adjusted for the NIHSS score, sex, age, type of stroke, and presence of thrombolysis. Significance level of 5%.

Results:
Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate . A FOIS score of 6-7 may be a protective factor against disability (mRs≥3) (OR:0.17; CI:0.005-0.56; p=0.004), and FOIS 1-3 at hospital discharge increased the risk of mRs≥3 (OR:14.97; CI: 2.68-83.65; p=0.002) and mortality (OR:9.79; CI:2.21-43.4; p=0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and FOIS 1-3 at discharge were associated with death from any cause. Important to highlight that the interaction of FOIS 1-3 at discharge and pneumonia further enhanced mortality chance (OR:113; CI:1.40-9.097; p=0.035).

Conclusion:
Dysphagia or FOIS 1-3 at discharge are markers of poor prognosis after stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.
Abstract TP167: Behavioral Change Intervention and Predictors of Self-Management Blood Pressure Control in Underserved Post-Stroke Population
Authors: Kimmel Barbara , Fujimoto Kayo , Saliba Rima , Anderson Jane A
Published: June 2021

Background:
Although stroke is an acute event caused by chronic conditions such as high blood pressure (BP), diabetes and unhealthy lifestyle, 80% of all strokes are preventable through awareness and risk factor management. Little is known about predictors of BP control in underserved post-stroke patients engaged in self-management (SM). We examined association between patients Readiness to Change (RTC) behavioral intention and demographics, on BP control following implementation of six weeks risk factor reduction program (V-STOP) delivered via videoconferencing to stroke survivors with focus on the BP control.

Methods:
Under pre/post quasi-experimental design, patients participated in six weeks educational sessions aimed to control modifiable stroke risk factors. Sixty-six patients participated and 44 completed RTC scale and provided BP measurements at baseline and at the end of intervention. The average patient’s age was 58, 57% were male and majority (71%) were white. Almost half of patients finished high school, 65% had annual income less than $25,000, 55% did not have any insurance. The association between predictors and BP control was evaluated using logistic regression in univariate and multivariate analysis. Statistically or biologically significant predictors were considered in multivariate analysis.

Results:
Multivariate analysis showed that patient age and education impact BP control endpoint. BP control frequency at six weeks was 78% for patients who were younger than 60 years and had no higher education (n=14, reference group), 88% for those younger than 60 who had higher education (n=7, OR=2, p=0.6), and 92% for patients who were older than 60 and had higher education (n=11, OR=3.1, p=0.034). BP control frequency was lowest (62%) for patients older than 60 years who had not received higher education (n=8, OR=0.46, p=0.3). No other factors evaluated impacted BP control.

Conclusion:
Our results suggest that older patients who received education higher than high school may be more likely to benefit from the stroke SM program implemented. Targeted programs may be required for patients with different demographics. No significant associations were found between RTC scores and BP control. These findings require validation in larger datasets.
Abstract TP168: Efficacy of a Pictogram to Promote Stroke Knowledge Among Illiterate Korean Elderly
Authors: Shin Cha-Nam , Sim Jeongha , Ahn Dongchoon
Published: June 2021

Background and Purpose:
Extensive research supports the importance of knowledge in stroke prevention and reducing prehospital delay time. However, the level of stroke knowledge among Korean older adults remains low. In particular, older adults who are illiterate lack of stroke information despite being at high risk. The purpose of this study was to develop and examine the efficacy of a pictogram to enhance stroke knowledge in the high-risk and illiterate older adults.

Methods:
We conducted a pretest-posttest nonequivalent control group design study and compared differences in stroke knowledge before and after the intervention. A total of 117 older adults (82 in the intervention group and 35 in the control group) who were 60 years and older residing in community participated in the study. Participants in the intervention group received a pictogram-based education, while participants in the control group received a powerpoint-based education. Stroke knowledge was measured by structured survey questionnaires. Descriptive statistics for sample characteristics, repeated measure ANOVA for the efficacy, and independent t-test for satisfaction comparison between groups were used.

Results:
The intervention group showed a higher increase in stroke knowledge (F=16.45), awareness of risk factors (F=15.71), stroke warning signs and symptoms (F=17.29), and action at stroke (F=19.36) compared to the control group at p <.001. Also, the intervention group reported that they would recommend the education program to others (t=2.64, p<.05) and the program was applicable to real situation (t=4.47, p <.001), which were scored higher than the control group.

Conclusions:
The data revealed that a pictogram-based education is more effective than a powerpoint-based education among illiterate older adults. Replicated studies with this pictogram in a larger randomized controlled trial is warranted, which may give greater validity to our findings. Future longitudinal research is recommended to examine retention of stroke knowledge over the long term.
Abstract TP173: Reduced Ejection Fraction and Left Atrial Dilatation are Independently Associated With Cardioembolic Stroke
Authors: Hosseini Farahabadi Maryam , Milani-Nejad Shadi , Liu Shimeng , Yu Wengui , Shafie Mohammad
Published: June 2021

Introduction:
The role of heart failure and left atrial dilatation as independent risk factors for ischemic stroke has remained controversial. The goal of this study is to evaluate the association between reduced ejection fraction (EF) and left atrial dilatation with cardioembolic stroke.

Methods:
Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016-2017 were included based on the following criteria: age >18 and availability of echocardiogram within 3 months of diagnosis. Stroke was subdivided into cardioembolic and non-cardioembolic based on MRI findings. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51%(male), 41-53% (female), moderately abnormal: 30-40% (same in both genders), and severely abnormal: <30% (same in both genders). Other variables included: left atrial volume size categorized into normal (≤34 ml/m
2
) vs. enlarged (≥35 ml/m
2
), gender, hypertension (SBP≥140 or DBP≥ 90), and known history of atrial fibrillation.

Results:
Two hundred eighteen patients were identified to have cardiomebmolic stroke and two hundred thirty-five with non-cardioembolic stroke. Among patients with cardiomebmolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged left atrium, respectively, as compared to 19 (8.1%) and 65 (27.7%) in patients with non-cardioembolic stroke. The number of patients with reduced EF and left atrial enlargement were significantly higher in patients with cardioembolic stroke (P<0.001). The odds of cardioembolic stroke were 2.0 and 8.8 times higher in patients with moderately and severely reduced EF, respectively, when compared to patients with normal EF. The odds of cardioembolic stroke was 2.4 times higher in patients with enlarged left atrial size when compared to patients with normal left atrial size.

Conclusions:
Our results have shown an independent association between moderately and severely reduced EF and enlarged left atrial size with cardioembolic stroke. Heart failure and left atrial dilatation may increase the risk of stroke regardless of the presence of atrial fibrillation, which warrants further studies to determine the appropriate treatment for secondary stroke prevention such as anticoagulation.
Abstract TP175: To Study the Correlation of Environmental and Physical Factors With Cerebral Collateral Circulation
Authors: Mainali Shraddha , Wing Jeffrey , Tariq Areej , Abd Elazim Ahmed , Fritz Joel , Strohm Tamara , Nimjee Shahid
Published: June 2021

Introduction:
Presence of functional leptomeningeal collaterals has been found to be one of the key determinants of good outcomes. We evaluated the effects of certain environmental and physical factors in cerebral collateral circulation.

Methods:
After IRB approval, data was collected from prospective institutional Neurocritical Care and Stroke Registry. Stroke patients presenting with acute anterior circulation large vessel occlusion between May 2013 and August 2018 were included. Collaterals were graded based on CT-Angiogram and CT-Perfusion images obtained on presentation, by a blinded Neuroradiologist as good (grade 3-4) and poor (grades 0-2). Ohio air pollution data (2013-2018) were obtained from the US EPA and summarized as a single mean concentration by monitor. Strokes were geocoded and linked with the closest monitor. Odds of good (vs. poor) collateral grade were compared using BMI (linear), smoking status, antiplatelet medication use, and mean PM
2.5
concentration (cubic). Sensitivity analyses assessed additional adjustment by sex and change in NIHSS (admission to discharge).

Results:
A total of 73 strokes were analyzed with 48% male, mean BMI of 30.4 (SD=7.2), and 22% with good collateral grade. For each kg/m
2
greater BMI, the odds of having good collaterals (vs. poor) were 11% higher (OR: 1.11; 95%CI:1.01-1.22;
p
=0.029). Higher PM
2.5
concentrations were suggestive of lower odds of good collaterals (
p
=0.124). Antiplatelet medication use (OR: 2.10; 95%CI:0.59-7.45) and smoking status (OR: 1.35; 95%CI:0.73-13.9) were not associated with the odds of having good collateral grade. After controlling for change in NIHSS and sex, higher BMI remained associated with good collateral grade (fig.1).

Conclusions:
Higher BMI was independently associated with higher odds of good collateral grade; this association needs to be explored in larger population taking other factors like age and medical comorbidities into account.