bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP77: Simple Morphological Parameters Associated With The Rupture Risk Of Posterior Communicating Artery Aneurysms.
Authors: Ho Allen , Lin Ning , Stanley Mary , Charoenvimolphan Nareerat , Misra Sarthak , Frerichs Kai U , Day Arthur , Du Rose
Published: July 2021

Introduction:
The contribution of morphological characteristics to the treatment decision of unruptured aneurysms has not been established in a systematic and location specific manner. We present a large sample of posterior communicating (PComm) aneurysms that were assessed using a diverse array of morphological variables to determine the parameters associated with aneurysm rupture.

Methods:
Demographic and clinical risk factors of aneurysm rupture were obtained viachart review. Pre-operative CT angiograms (CTA) were evaluated with 3D Slicer© to generate 3-D models of the aneurysms and surrounding vascular architecture. Morphological parameters examined in each model included aneurysm volume, aspect ratio, size ratio, distance to bifurcation and origin points, aneurysm angle, vessel angles, flow angles, and parent-daughter angles. Univariate and multivariate analyses were performed to determine statistical significance.

Results:
From 2005-2011, 141 PComm aneurysms were treated in a single institution, and preoperative CTAs from 48 patients (32 ruptured, 16 unruptured) were analyzed. Those that underwent reoperation, were associated with arteriovenous malformations, or lacked a preoperative CTA were excluded. Ruptured aneurysms were associated with smaller volume, greater aspect ratio, greater size ratio, smaller internal carotid artery (ICA) to aneurysm neck angle, larger PComm flow angle, larger ICA to PComm angle, and smaller PComm to daughter vessel angle. Multivariate logistic regression revealed that a larger neck diameter, greater aspect ratio, greater size ratio, and shorter ICA bifurcation to aneurysm distance were the most strongly associated with rupture after adjusting for all other variables. Interestingly, volume of the aneurysm had a smaller effect size than most other variables and rupture risk was associated with smaller volumes.

Conclusion:
We found that larger neck diameter, greater aspect ratio, greater size ratio, and smaller ICA bifurcation to aneurysm distance to be highly associated with PComm aneurysm rupture. These are easily measured and physically intuitive parameters. They are more strongly associated with PComm aneurysm rupture than size alone and can be readily applied in clinical practice.
Abstract WMP113: Coated-Platelet Levels are Elevated in Subarachnoid Hemorrhage and Inversely Associated with Mortality at 30 Days
Authors: Prodan Calin I , Vincent Andrea S , Kirkpatrick Angelia C , Hoover Steven L , Dale George L
Published: July 2021

Background:
Coated-platelets are a subset of platelets with high procoagulant potential observed upon dual agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in non-lacunar ischemic stroke compared to either lacunar stroke or controls. In contrast, coated-platelet levels are decreased in patients with spontaneous intracerebral hemorrhage (ICH) and inversely correlated with bleed size. We now report the first investigation of coated-platelet production in patients with subarachnoid hemorrhage (SAH).

Methods:
Coated-platelet levels were determined in 38 consecutive patients with non-traumatic SAH within 48 hours from symptom onset and in 40 controls frequency-matched for gender, race and age. Results are reported as percent of cells converted to coated-platelets. Mortality at 1 month was obtained through chart reviews or telephone interviews. Baseline characteristics were compared either with a t-test for continuous measures or a Chi-square test for categorical measures.

Results:
Coated-platelet levels (mean±SD) were significantly higher in patients with SAH compared to controls (41.0±10.7% vs. 30.0±12.1%, p<0.0001). No differences were detected between patients and controls for demographics, medication use or pertinent comorbidities (p values >0.17). Among all patients, mortality at 1 month was 21% (8 deaths). Patients were then analyzed according to tertiles of coated-platelet levels (split at ≤36.6%, 36.6-45.5%, >45.6%). The 1-month mortality differed significantly between the coated-platelet tertiles (p=0.019, Fisher’s exact test), with 50% mortality (6/12) among patients in the lowest tertile (lowest levels) compared to 7.7% (1/13) among those in the middle and highest tertiles.

Conclusions:
Coated-platelet levels are elevated in SAH compared to controls for reasons not currently clear. However, the association between lower coated-platelet levels and mortality in SAH patients is compatible with prior observations made in ICH. These data also provide further evidence of the role played by these prothrombotic platelets in events leading to thrombosis or hemorrhage. Supported by Award 1I01CX000340 from the Clinical Science R&D Service of the VA ORD (Prodan)
Abstract WMP114: Increased Big Endothelin-1 in Human Cerebrospinal Fluid is Associated with Vasospasm and Poor 3-month Outcome Following Subarachnoid Hemorrhage
Authors: Chou Sherry H , Kuruppu Sanjaya , Feske Steven K , Suh Sarah , Orzell Susannah , Henderson Galen V , Sorond Farzaneh A , Du Rose , Smith Ian A , Lo Eng H , Ning MingMing
Published: July 2021

Background
Big endothelin (ET) is the precursor to ET-1, a potent vasoconstrictive peptide associated with vasospasm (VSP) in SAH. However, ET-1’s very short half-life limits its utility as a clinical biomarker. Big ET mediates in vitro microvascular vasoconstriction and has slower clearance, therefore may be a better candidate biomarker. We hypothesize that elevated CSF Big ET-1 is associated with VSP and poor outcome in SAH.

Methods
We prospectively enrolled consecutive SAH subjects, banked serial CSF samples, and evaluated their modified Rankin scores (mRS) via telephone follow-up every 3 months. Poor functional outcome was defined as mRS>2. Angiographic VSP was defined as >50% reduction in caliber of any vessel on post-SAH day 7 cerebral angiogram. In 49 SAH subjects, we compared CSF big ET by ELISA on post-SAH days 1, 3, 5, and 7 with respect to VSP and outcome using student’s t-test or Wilcoxon rank sum test depending on data normality. Logistic regression was used to adjust for important confounders.

Results
CSF big ET elevation on post-SAH day 1 is associated with poor 3-month outcome (4.2 vs. 2.0 ng/mL, p=0.0048), and big ET elevation on post-SAH day 3 shows trend towards association with poor 3-month outcome (1.15 vs. 3.09 pg/mL, p=0.057). CSF big ET level on post-SAH day 1 is significantly associated with 3-month outcome (p<0.0001) after adjusting for age, Hunt and Hess (HH) and Fisher grades and aneurysm treatment modality by logistic regression. CSF big ET elevation on post-SAH day 7 is associated with VSP (5.2 vs. 3.9 pg/mL, p=0.045). Logistic regression shows CSF big ET level on post-SAH day 7 is significantly associated with VSP (p=0.02) after adjusting for age, HH and Fisher grades and aneurysm treatment modality.

Conclusion
Early elevation of CSF big ET is strongly and independently associated with SAH 3-month outcome after adjustment for important clinical confounders. CSF big ET elevation on post-SAH day 7 is also independently associated with angiographic VSP. A larger study with a replication cohort is necessary to validate big ET as a biomarker for SAH outcome and VSP. Further studies with concomitant measurements of endothelin-converting enzyme and ET-1 are necessary to elucidate the role of CSF big ET in VSP and brain injury following SAH.
Abstract WMP115: The Metabolic Syndrome Components and Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Dearborn Jennifer L , Knopman David , Sharrett Richey , Schneider Andrea L , Jack Clifford , Coker Laura , Alonso Alvaro , Selvin Elizabeth , Mosley Thomas , Gottesman Rebecca F
Published: July 2021

Background:
Midlife obesity is associated with dementia in later life, but how the metabolic syndrome (MetS) relates to cognitive change is less understood. We hypothesized that MetS would be more predictive of 6-year cognitive decline than its individual components in a large biethnic cohort (the ARIC study) and that combinations of risk factors would further increase likelihood of change.

Methods:
The MetS was defined in 1987-89 on 10,687 participants with two cognitive assessments at two time points. In subjects aged 44 to 66, obesity measures included body mass index (BMI) and waist-to-hip ratio (WTHR). The main outcome measure was change in 1990-92 to 96-99 of three cognitive tests: Delayed Word Recall (DWR), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Linear and logistic regressions were all adjusted for age, combined race-center, sex, education, smoking, drinking, coronary artery disease and prior stroke. Change was measured as the difference divided by the number of years between visits.

Results:
At baseline, the prevalence of MetS was 22% (mean age 54 years, 27% black, 55% female, and 28% BMI>30 kg/m2). Subjects with MetS performed in the lowest test quintile (adjusted ORs: DWR 1.3 95% CI 1.1-1.4) in 1996-99, and much of this effect size was explained by an elevated WTHR (DWR OR 1.3 CI 1.1-1.5) and diabetes (DWR OR 1.4 CI 1.2-1.7). MetS was not associated with annual cognitive change, and diabetes was the only significant component associated with change (adjusted beta: DWR 0.03 p=.01, DSST 0.2 p<.001, WFT 0.09 p=.01).

Conclusion:
MetS at ages 44 to 66 was associated with worse cognitive function at follow-up, but not with annual cognitive decline over several years. Elevated WTHR and diabetes explained most of the association of MetS with cognitive function measures, and diabetes with cognitive decline. Until we have a definition of the MetS more based on pathophysiology, the components of the MetS should be the focus of analysis in future studies.
Abstract WMP16: Improved Prediction of Hemorrhagic Transformation in Acute Stroke Patients Using Lowered Cerebral Blood Volume on MRI and Clinical Severity by NIHSS
Authors: Saini Sundeep , Warach Steven , Luby Marie ,   for the LESION NINDS Investigators
Published: July 2021

Objectives:
Hemorrhagic transformation of the ischemic lesion is a common thrombolytic complication when treating acute stroke patients with standard IV-tPA. In a retrospective study we demonstrated that patients that have HT post-thrombolysis have a significantly lowered cerebral blood volume (CBV) on their pre-thrombolysis MRI compared to non HT patients. The objective of this study was to determine prospectively whether reduced CBV in combination with stroke severity can predict the occurrence of HT in patients post-thrombolysis.

Methods:
Patients were selected from the NINDS Stroke Registry if they: had an acute ischemic stroke located in the MCA territory, were treated with standard IV-tPA, had a pre-treatment MRI with evaluable DWI and PWI, and had post-treatment MRI evaluation for HT. A rater calculated CBV maps in PMA™ (ASIST-Japan) and performed image registration and region of interest analyses in MIPAV™ (NIH). The rater repeated the CBV analysis without image registration using DICOM software available on the scanner. Multinomial regression with covariates of baseline NIHSS, DWI lesion size, and CBV ratio was performed. All MRI scans were reviewed by expert readers blinded to the CBV analyses to determine the presence of HT using the ECASS-II criteria.

Results:
Seventy-six patients met the study criteria with a mean (SD) age of 68.1 (±14.1) years, median baseline NIHSS of 12 (IQR25-75: 5-18) and median onset to first MRI of 109 minutes (IQR25-75: 82-157). Thirty-six percent of patients (27/76) were positive for HT post-thrombolysis. The mean CBV ratio was 0.25 (STD ± 0.23) in the positive HT patients compared to 0.55 (STD ±0.24) in the negative HT patients. Multinomial regression demonstrated that the CBV ratio < 0.5 (p<0.006) and baseline NIHSS > 15 (p<0.034) significantly predicted the occurrence of any HT. The CBV ratio < 0.5 was the only independent predictor of severe HT, PH1 or PH2 (p<0.008). DWI lesion size using > 100 ml involvement of the MCA territory was not significant in predicting any or severe HT.

Conclusions:
Pre-treatment CBV ratio used in combination with baseline NIHSS are promising predictors of HT after standard IV-tPA. The ability to calculate CBV ratios directly on the scanner supports usage in acute intervention decision making.
Abstract WMP23: Well-controlled Warfarin Therapy in Acute Ischemic Stroke Patients with Atrial Fibrillation Associated with Lower Rate of Lesion Recurrence
Authors: Nomura Eiichi , Ohshita Tomohiko , Imamura Eiji , Wakabayashi Shinichi , Kajikawa Hiroshi , Matsumoto Masayasu
Published: July 2021

Objectives:
The optimal timing of warfarin administration for acute ischemic patients with atrial fibrillation (AF) has not yet been established because the risk of early symptomatic recurrence is not high and hemorrhagic transformation commonly occurs. Recent studies have reported a high frequency of recurrent lesions detectable on diffusion-weighted MRI within a few weeks after acute ischemic stroke. We hypothesized that well-controlled warfarin therapy could prevent acute ischemic stroke patients with AF from developing recurrent lesions.

Methods:
We retrospectively examined consecutive acute ischemic stroke patients with AF treated in our hospital between 2008 and 2011 who were given warfarin within 2 weeks of admission and had diffusion-weighted MRI and blood test for prothrombin time and international normalized ratio (PT-INR) both on admission and at 2 weeks. Warfarin was started as early as possible and heparin (10,000 units a day) was also administered until the PT-INR target (2.0-3.0 for patients aged < 70 years or 1.6-2.6 for those ≥ 70 years recommended for the stroke patients with AF at chronic stage by Japanese Guideline for the Management of Stroke 2009) was achieved. We classified the enrolled patients into 2 groups according to their PT-INR: The well-controlled group (WCG) was defined as those in whom target PT-INR was achieved at 2 weeks, and those in whom the target could not be achieved at 2 weeks were classified as the poorly-controlled group (PCG).

Results:
There were 123 patients (median age of 79.0, 62 male and 61 female) who met the criteria for the present study, consisting of 52 WCG patients and 71 PCG patients. There were also no significant differences in demographics, common risk factors, severity of stroke, or median starting day of warfarin (second day from admission) between the 2 groups. The median PT-INR of WCG was 1.9 (1.7-2.3) and that of PCG was 1.6 (1.3-2.9), showing significant difference (P=0.0169). WCG had a significantly lower rate of new recurrent lesions on diffusion-weighted MRI at 2 weeks than PCG (17.3% vs. 36.6%, respectively, p=0.0190).

Conclusions:
Our findings suggested that well-controlled warfarin therapy with heparin bridging reduces the recurrence of lesions in acute ischemic stroke patients with AF.
Abstract WMP35: Low Level Laser Therapy (LLLT) Protects Against Oxygen-Glucose Deprivation-Induced Neuron Death by Modulating Nitric Oxide and ROS Production In Vitro
Authors: Yu Zhanyang , Liu Ning , Li Yadan , Zhao Jianhua , Lo Eng H , McCarthy Thomas J , Tedford Clark E , Wang Xiaoying
Published: July 2021

Background:
LLLT has been shown to be neurorprotective against cerebral ischemia in animals. Initial human clinical trials demonstrated safety and potential beneficial profiles. A pivotal clinical trial with TLT is ongoing for ischemic stroke. However, the underlying neuroprotective mechanisms require further definition. We previously showed LLLT protected primary neurons against OGD. In the current study, we tested the hypothesis that LLLT may attenuate OGD-induced nitric oxide (NO) and ROS production and associated cell survival signaling, causing reduced cell death in primary mouse cortical neurons.

Method:
At day 8 of culture, neurons were subjected to 4 hr OGD. LLLT was applied at 2 hr reoxygenation. NO level, nNOS expression, ROS level, and cell survival signaling were measured post-LLLT. Cell death was measured at 20 hr after OGD. Results were expressed as fold of normal control, mean ± SEM, n = 3-5 per group, P <0.05 was considered statistically significant.

Results:
OGD significantly increased NO level in primary neurons (2.12 ± 0.47, 2.67 ± 1.07, and 2 ± 0.77 at 5 min, 30 min and 1 hr post-treatment, respectively), but the increase was significantly reduced by LLLT (1.08 ± 0.44 at 5 min and 1.45 ± 0.73 at 30 min post-LLLT). OGD also significantly increased nNOS mRNA level (2.17 ± 0.42, 3.99 ± 1.7, and 2.60 ± 0.7 at 5 min, 30 min and 1 hr post-treatment, respectively), while the increase was significantly ameliorated by LLLT (0.50 ± 0.08 at 30 min and 0.34 ± 0.45 at 1 hr post-LLLT). Additionally, 50 uM NO donor SNAP exposure for 48 hr induced 23.6 ± 2.5% cell death, which was significantly ameliorated by LLLT (12.3 ± 4.2% cell death), indicating LLLT may directly protect NO-mediated neurotoxicity. Furthermore, LLLT significantly reduced OGD-induced ROS production at 5 min, 30 min and 1 hr post-LLLT. Finally, OGD suppressed neuron survival signaling p-Akt and Bcl-2 protein expressions, but they were significantly rescued by LLLT.

Conclusion:
These results suggest LLLT protection against OGD may be partially through reducing OGD-induced NO and ROS production, and restoring OGD-suppressed cell survival signaling.
Abstract WMP36: The Sonic Hedgehog Signaling Pathway Mediates Cerebrolysin-Improved Neurological Functions after Stroke
Authors: Zhang Li , Chopp Michael , Zhang Zheng Gang
Published: July 2021

Cerebrolysin, a mixture of neurotrophic peptides, enhances neurogenesis in experimental neurodegenerative diseases and stroke. Sonic hedgehog (Shh) signaling pathway stimulates neurogenesis after stroke. In the present study, we tested the hypothesis that the Shh signaling pathway mediates Cerebrolysin enhanced neurogenesis and functional recovery after stroke. Rats were subjected to embolic middle cerebral artery occlusion (MCAo). To examine whether blockage of the Shh signaling pathway abolishes the Cerebrolysin induced neurogenesis and functional recovery, Cyclopamine (0.2mg/kg), a Shh receptor inhbitor, or vehicle (45% 2-hydroxypropyl-cyclodextrin) was intraventricularly infused using an osmotic pump for 28 days starting 24h after MCAo with or without intraperitoneally (IP) administration of Cerebrolysin (2.5ml/kg, daily for 28d). For mitotic labeling, Bromodeoxyuridine (BrdU, 100mg/kg, IP) was administered daily for 7 days starting 24h after MCAo. Neurological functional tests including, adhesive removal test, foot-fault test, and modified neurological severity score (mNSS) were performed weekly for 5 weeks after stroke. Treatment with Cerebrolysin significantly (p<0.05) increased the number of BrdU positive cells (148±24/mm
2
vs 90±9/mm
2
in the vehicle group, n=10/group) in the ipsilateral subventricular zone (SVZ), which was associated with significant improvement of functional recovery from week 3 thought week 5 after MCAo compared with vehicle treated rats. However, inhibition of the Shh pathway with Cyclopamine significantly reduced BrdU positive cells (51±10/mm
2
) in the SVZ, and cyclopamine treated animals failed to improve neurological function compared with vehicle treated rats. Furthermore, Cyclopamine completely reversed the effects of Cerebrolysin on SVZ cell proliferation (90±10/mm
2
) and functional recovery. These results demonstrate that the Shh pathway mediates Cerebrolysin-enhanced neural progenitor proliferation and improves functional recovery in rats after stroke.
Abstract WMP44: A Meta-Analysis of Drug Eluting Stents vs Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease
Authors: Sheth Nakul , Gupta Vikas , He Wenzhuan , Gordon Shariyah , Prestigiacomo Charles J , Gandhi Chirag D
Published: July 2021

A Meta-Analysis of Drug Eluting Stents vs.
Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease

Background:
—Although a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared to bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial.

Methods:
—A search strategy was used using the terms "stents," "drug-eluting stents," "atherosclerosis," "vertebral artery," and "vertebrobasilar insufficiency" through Medline. Five studies met the criteria for a comparative meta-analysis. The technical and clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis and recurrent symptoms and overall survival were compared between the DES and BMS groups using the Mantel-Haenszel method with fixed and random effect models.

Results:
—The mean pretreatment stenosis was 83.8±4.2% in the DES group (n = 156) and 80.12±2.7% in the BMS group (n = 148). There was no significant difference in the technical success (OR = 1.528, p = 0.622), clinical success (OR = 1.917, p = 0.274) and periprocedural complications (OR = 0.741, p = 0.614) between the two groups. The rates of technical success, clinical success and periprocedural complications were 98.78%, 95.77% and 1.94% for the DES group vs. 100%, 97.96% and 2.96% for the BMS group. There was no periprocedural mortality, stroke or TIA. The mean clinical and radiological follow-up times were 19.1±6.9 and 14.23±1.5 months respectively, for the DES arm and 26±7.6 and 20.5±3.3 months, respectively, for the BMS group. A 0.388 odds ratio of no-restenosis in the BMS to DES arms (p = 0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs. 15.49%, respectively). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs. 11.26%; OR = 3.319, p = 0.011) and TVR (4.83% vs. 19.21%; OR = 4.099, p = 0.001). There was no significant difference between overall survival (OR = 0.655, p = 0.32).

Conclusion:
—A lower rate of restenosis, recurrent symptoms and target vessel revascularization was noted in the DES group.
Abstract WMP51: High-sensitivity C-reactive Protein In Asymptomatic Elderly Subjects Is Associated With a Higher Risk For Silent Brain Infarction
Authors: Kim Chi K , Kwon Hyung-Min , Chung Jong-Won , Oh Mi-Young , Kim Chang-Hun , Ryu Wi-Sun , Jang Hyunduk , Ko Sang-Bae , Lee Seung-Hoon , Yoon Byung-Woo
Published: July 2021

Objective:
Inflammatory processes are involved in the pathogenesis of atherosclerosis, and it has been known that high-sensitivity C-reactive protein (hs-CRP) is associated with coronary heart disease. However, the association of hs-CRP with subclinical cerebrovascular disease is less well established. We investigated the association of hs-CRP with silent brain infarction (SBI) as a marker of subclinical cerebrovascular disease in elderly subjects without history of overt stroke.

Methods:
Neurologically asymptomatic elderly subjects (n=1,443; age ≥ 65 years) who visited for routine health check-ups were included in this study. The level of hs-CRP was measured and the presence of SBI was determined by brain MRI.

Results:
A total of 223 subjects (15.5%) had one or more SBIs, and the average hs-CRP level was significantly higher in subjects with SBI (2.2 mg/L) than in those without (1.4 mg/L). Compared with the lowest hs-CRP group (0-0.9mg/L), the proportion of SBI in the highest hs-CRP group (≥ 3 mg/L) was increased (27.1% vs. 13.6%). After adjusting by age, gender and the history of hypertension, diabetes, smoking, hyperlipidemia and coronary heart disease, the risk of SBI was increased significantly two-fold in the highest hs-CRP group compared with the lowest group.

Conclusion:
Elevated hs-CRP level was found to be associated with the presence of SBI. This result suggests that inflammatory processes may be related to the subclinical cerebrovascular disease.
Abstract WMP55: Vessel Wall Characteristics using High Resolution Magnetic Resonance Imaging in Reversible Cerebral Vasoconstriction Syndrome and Central Nervous System Vasculitis
Authors: Cerejo Russell , John Seby , Hammad Tariq , Obusez Emmanuel C. , Hajj-ali Rula , Calabrese Leonard , Hussain Muhammad S. , Jones Stephen E. , Hui Ferdinand , Uchino Ken
Published: July 2021

Introduction:
Reversible cerebral vasoconstriction syndrome (RCVS) and central nervous system (CNS) vasculitis often have similar initial clinical presentation, laboratory findings and imaging features creating a diagnostic dilemma. High-resolution-3-Tesla Magnetic Resonance Imaging with Gadolinium contrast (HR-MRI) is a non-invasive method to look at intracranial vessel wall characteristics.

Methods:
A retrospective analysis of all patients with a diagnosis of RCVS or CNS vasculitis that underwent HR-MRI at our institution was performed. Inclusion criteria for RCVS were clinical presentation, no aneurysmal subarachnoid hemorrhage, normal cerebrospinal fluid and reversible multifocal intracranial vessel stenosis whereas criteria for CNS vasculitis were cases with positive brain biopsy or typical clinical presentation, course and laboratory markers with rheumatology and stroke neurology agreement in diagnosis. Demographics, clinical presentation, laboratory testing, imaging studies and outcomes were collected.

Results:
Eleven patients with RCVS [10 (90.9%) females, mean age 45.2] and 8 with CNS vasculitis [6 primary CNS vasculitis, 6 (75%) males, mean age 43.5] were included in the study. No abnormal vessel wall enhancement or thickening was seen in any of the RCVS patients in areas of vessel stenosis. Six (75%) of CNS vasculitis patients had vessel wall thickening or enhancement (p=0.001 for comparison to RCVS) and the remaining 2 patients had HR-MRI performed 6 and 10 years after diagnosis and chronic treatment. All RCVS patients who had follow up HR-MRI demonstrated resolution of the multifocal stenosis. Two out of 4 CNS vasculitis patients with subsequent HR-MRI imaging had decrease in vessel wall thickening and enhancement after immunosuppressive therapy.

Conclusion:
In acute stages of presentation, HR-MRI may be useful in differentiating RCVS from CNS vasculitis. It may also be useful in following the disease course to look for resolution of intracranial vessel stenosis in RCVS or treatment response in vasculitis. Further studies are needed to confirm the utility of HR-MRI in diagnosis and disease progression in RCVS and vasculitis.
Abstract WMP8: Imaging Variables as Predictors of Outcome after Intra-Arterial Therapy: The Superiority of Collateral Circulation
Authors: Sarraj Amrou , Sitton Clark W , Boehme Amelia K , Lutzker Steven L , Mir Osman , Bibars Wafi , Wu Tzu-Ching , Albright Karen , Martin-Schield Sheryl , Barreto Andrew D , Liebeskind David S , Grotta James C , Savitz Sean I , Nguyen Claude B
Published: July 2021

Background

Early ischemic changes on CT, collateral circulation, clot location and extension are important determinants of outcome in patients with large artery occlusion (LAO). We compared these variables as predictors of outcome in patients treated with intra-arterial therapy (IAT).

Methods

We identified 86 AIS patients who received IAT at our center for LAO (MCA or ICA) from 01/08 to 05/11. Univariate logistic regression analysis was used to identify radiographic variables obtained on (CT/CTA) that predicted poor (mRS 4-6) and good (mRS 0-2) discharge outcomes. The CTA collateral score (CS), from 0 (absent) to 3 (complete), was measured. Spearman’s correlations and ROC curves evaluated the performance of CS against ASPECTS and clot burden score (CBS).

Results

Table 1 shows the baseline characteristics. Patients with CS (0-1) on CTA had a significantly higher odds of a poor outcome (OR 8.96, 95%CI 2.42-33.19, p=0.001); this effect was maintained when using mRS 5-6 (OR 2.77, 95% CI 1.11-6.88, p= 0.03). These results persisted after adjustment for revascularization (TICI ≥ 2) (Table 2). Moreover, patients with good CS (2-3) had a significantly greater odds of independence (mRS 0-2) at discharge (OR 15, CI 95% 1.88-119.8, P=0.01), and was maintained when adjusting for no or only partial revascularization (TICI < 2) (OR 9.36, CI 95% 1.10-79.4, p=0.04). The distribution of mRS demonstrates a shift toward better outcomes in patients with CTA≥2 (figure 1). Although both scores were good predictors of outcome, CS performed better than ASPECTS in identifying patients who have poor or good outcome after IAT (Table 2, figures 2A, 2B and 2C). Clot location or extension measured on CBS did not correlate with clinical outcomes.

Conclusion
The status of collaterals on CTA is a pivotal determinant of clinical outcome in patients who undergo IAT for LAO. The collateral score can improve selection for IAT by identifying patients who may benefit and those who may not.
Abstract WMP88: Modified Rehabilitation has Long-Term Impact on Walking for Individuals with a TIA
Authors: VanPuymbroeck Marieke , Schmid Arlene , Carter Susie , Koester Wanda , Docherty Carrie
Published: July 2021

Background and Purpose:
Transient Ischemic Attacks (TIAs) often signal looming health threats. If not addressed, TIAs lead to stroke in over half of individuals. Usual care following a TIA typically is only pharmacological, in spite of the known potential for exercise to reduce stroke risk factors. Therefore, the purpose of this study was to determine the long-term (1-year) impact of a modified rehabilitation program on individuals who had a TIA.

Method:
In this single armed pilot study, we modified cardiac rehabilitation (typically offered to individuals post-myocardial infarction), for individuals with a TIA. The standard cardiac rehabilitation structure (1.5 hrs per session, 3x per week, for 6 weeks) was implemented in the month following TIA. Exercises increased progressively in terms of speed or elevation until the workload was identified by participants as “somewhat hard” (approximately 12-14 on the Borg Scale of Perceived Exertion). We measured patients pre- and post- the 6 week intervention, and then again at 6 months and 1 year post-intervention to determine long-term impact.

Results:
Fourteen participants completed measures at 1-year. While systolic and diastolic blood pressure (SBP, DBP) reduced substantially from pre- to post- intervention (SBP= 130.5 pre-test, 124.14 post-test; DBP= 72.14 pre-test, 67.57 post-test), these changes did not persist at 1-year. However, repeated measures analysis of variance (RM ANOVA) with Greenhouse-Geisser correction determined that mean gait speed improved significantly over 1-year (F(1.697, 22.057) = 18.412, p=.000). RM ANOVA with Bonferroni correction also indicated that endurance statistically improved over 1 year (F(3, 39) = 7.491, p =.000).

Discussion:
Results revealed that both gait speed and endurance increased post-intervention, and remained higher than pre-intervention at 1-year post-TIA. Improvements in gait speed and endurance have potential to increase participation in community life, as individuals may be more likely to engage in activities if their mobility is enhanced. This increased engagement may lead to increased physical activity, which may reduce stroke risk factors.
Abstract WMP89: Bilateral Priming Followed by Task Specific Training Can Improve Moderate to Severe Post-Stroke Upper Extremity Hemiparesis
Authors: Stoykov Mary E , Corcos Daniel M
Published: July 2021

INTRODUCTION:
Priming techniques to facilitate improved motor performance have been examined in stroke rehabilitation research. Reported techniques include transcranial electric (TES) or magnetic (TMS) stimulation, both of which are costly and approved only for research purposes. Here, we examine a motor priming technique which is cost-effective and clinically feasible. This priming technique consists of continuous, symmetrical, rhythmic, wrist flexion and extension. A novel device, the “rocker,” is used which has a mechanical linkage promoting symmetry of both arms. Previous studies examining bilateral priming plus task specific training (TST) found the combination to be more effective than TST alone. However, there have been no studies that: 1) compare bilateral priming to a unilateral version of the same, and 2) examine priming in severely impaired stroke survivors.

Hypothesis:
The objective of this pilot study was to test our hypothesis that bilateral priming combined with task specific training (TST) would be effective in stroke survivors with severe upper limb impairment.

Methods:
We collected pilot data in 6 individuals with severe upper extremity hemparesis receiving either bilateral priming or unilateral priming followed by TST. The entire intervention was approximately 4 weeks with a total of 30 hours of priming plus training. Participants were tested at pre-/post-intervention, and at 4-week follow-up. Behavioral Measures included a bilateral motor function measure (Chedoke Arm and Hand Activity Index, CAHAI) and a unilateral measure (Fugl-Meyer Test of Upper Extremity Function, FMUE). Transcallosal inhibition (TCI) persistence was measured using TMS.

Results:
At post intervention, the bilateral priming group demonstrated a 9 point increase (improvement) as compared to the unilateral one (3.67 point increase) in the CAHAI. The FMUE change scores were 6.0 and 3.66 for the bilateral and unilateral priming groups respectively. Gains persisted at 4-week follow-up. Transcallosal inhibition was more normalized in the bilateral priming group at discharge.

Conclusion:
In conclusion, we found preliminary evidence to support our hypothesis that bilateral priming plus TST is effective for individuals with severe hemiparesis.
Abstract WMP9: Impact of Collateral Blood Flow on Clinical Presentation, Diffusion and Perfusion Imaging, Infarct Growth and Clinical Outcome in the DEFUSE 2 Trial
Authors: Marks Michael P , Lansberg Maarten G , Mlynash Michael , Olivot John-Marc , Straka Matus , Kemp Stephanie , McTaggart Ryan , Inoue Manabu , Tipirneni Aaryani , Zaharchuk Greg , Bammer Roland , Albers Gregory W ,   DEFUSE 2 Investigators
Published: July 2021

Objective:
To determine the relationships between angiographic collaterals and diffusion/perfusion imaging, subsequent infarct growth and clinical outcomes in DEFUSE 2 study patients.

Methods:
Patients undergoing endovascular therapy within 12 hours of stroke onset were prospectively enrolled. Only patients with a TICI score of 0, 1 and ICA/M1 occlusion at baseline were included in this analysis. A blinded reader assigned a collateral score using a previously described 5 point scale,

from 0 (no collateral flow) to 4 (complete/rapid collaterals to entire ischemic territory). Analysis was dichotomized to poor flow (0-2) versus good flow (3-4). Collateral score was correlated with baseline NIHSS, DWI volume, PWI volume (Tmax > 6), TICI reperfusion, infarct growth and mRS at day 90.

Results:
Sixty patients had TICI 0, 1 ICA/M1 occlusions and adequate angiographic images to evaluate collaterals. Baseline NIHSS correlated with collateral score (p=0.002). Median NIHSS for patients with poor collateral flow (0-2) was 18 (IQR, 13-22) versus 14 (10-17) for those with good flow (3-4), p=0.025. Baseline T max > 6 volume correlated with collateral score (p=0.002). Median volume of tissue at risk (T max > 6) in those with poor collateral flow was 115 ml (IQR, 74-136) versus 82 (51-109) with good flow, p=0.012. Collateral score did not correlate with baseline DWI volume. TICI reperfusion (0-3) correlated with collateral score (p=0.027). Patients with poor collateral flow had 29% TICI 2b-3 reperfusion versus 65.5% with good flow, p=0.009. Those with poor reperfusion (TICI 0-2a) showed a trend to more infarct growth with poor collaterals, 92 ml (52-194) [mean (IQR)] versus 36 ml (14-106) with good collaterals, p=0.06. Patients with poor collaterals who reperfused (TICI 2b-3) were still likely to have a mRS 0-2 at 90 days compared to those without reperfusion; OR 12 (95% CI, 1.6-98).

Conclusion:
Collaterals correlate with baseline clinical stroke severity and the PWI volume. In addition, good collaterals correlate with higher rates of reperfusion (TICI 2b-3). When patients do not reperfuse, good collaterals appear to limit infarct growth.
Abstract WMP96: The Iscore Predicts Clinical Response To Thrombolysis: Results From VISTA
Authors: Saposnik Gustavo , Johnston S. C , Reeves Matthew , Bath Philip M , Ovbiagele Bruce ,   for the VISTA Investigators,   for the Stroke Outcomes Rsch Canada (SORCan- ) Working Group
Published: July 2021

Background:
The iScore is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. It includes demographics, stroke severity and subtype, comorbidities, pre-stroke status, and glucose on admission.

Objective:
To determine the ability of the iScore to predict the clinical response after iv thrombolysis (tPA) in the Virtual International Stroke Trials Archive (VISTA).

Methods:
We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration. We explored the association between the iScore (as continuous and binary [<200 and ≥200] measures) and the outcomes of interest.

Outcome Measures:
The primary outcome was death or disability at 90 days defined as a modified Rankin scale (mRS) 4-to-6. Secondary outcomes included death at 90 days and favorable outcome (mRS 0-2).

Results:
Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 712 (10%) had an iScore ≥200. Patients with higher iScore had worse clinical outcomes (p<0.0001 for all outcomes; c-statistics 0.777 for mRS0-6 and 0.748 for death at 90 days). Overall, an iScore ≥200 was associated with nine fold higher risk of death or disability at 90 days (OR 9.41, 95%CI 7.00-12.6). Similar trends were observed for secondary outcomes (Figure). tPA administration in stroke patients with an iScore≥200 was associated with a lower risk of death or disability at 90 days (OR 0.48; 95%CI 0.32-0.72). There was a direct interaction between the iScore and tPA for both death or disability and death alone at 90 days (p-value for the interaction <0.001).

Conclusion:
The iScore is a useful tool that can be used to estimate clinical outcomes after tPA. Although outcomes were poorer for the high-risk group (iScore≥200), the benefits of tPA in this group were greater than for low-risk patients. Figure
Abstract WP107: Optogenetic Stimulation of Human Neural Stem Cell Grafts In Ischemic Brain
Authors: Daadi Marcel , Lee Soo Yeun , Bajar Bryce , Lo Maisie , Ramakrishnan Charu , Sun Guohua , Deisseroth Karl , Steinberg Gary
Published: July 2021

Optogenetically engineered neural stem cells (NSCs) provide a targeted approach to probe the role of neural circuits NSC-based cell therapy in experimental stroke models. A large body of work provides evidence that the therapeutic benefits of NSC grafts are mediated by replacement of cells lost to injury or disease and by secretion of neurotrophic and regenerative factors. Currently the potential of the grafted cells to modulate local circuits and to modify motor performances in animal model of ischemic brain injury is not well understood. This study explores whether optogenetic stimulation of NSC grafts will modulate neural differentiation and integration into the local circuitry.

We isolated multipotent NSCs from human embryonic stem cells. The NSCs were transduced with lentiviral vectors carrying the channelrodopsin-2 (ChR2) gene fused with enhanced yellow fluorescent protein (ChR2-EYFP) under the EF1alpha promoter. The ChR2 expression and response of the NSC progeny to blue light stimulation (470 nm) was confirmed in vitro. To test the function of these cells in stroke model, Sprague Dawley rats were subjected to middle cerebral artery occlusion (65 minutes). One week later, immunosuppressed rats received transplantation of NSCs (2 x 105) into the ischemic boundary zone in the striatum. Chronic optogenetic stimulation of the grafted cells was carried out daily after transplantation for 1 month. Five animal groups were established: vehicle, vehicle with stimulation, NSC transplant with chronic stimulation, NSC transplant without chronic stimulation and NSC with control (non-ChR2) vector. Animals in all groups were tested weekly for their motor performance through testing spontaneous forelimb use during lateral exploratory movement and the vibrissae-elicited forelimb-placing test. Preliminary results suggest that animals that received chronic stimulation showed an enhanced sensorimotor performance in comparison to animals that did not receive stimulation. The effects of long-term optogenetically-controlled stimulation of the grafted cells on the cellular differentiation and functional recovery in animals with ischemic brain injury will be presented.
Abstract WP147: Multimodal CT: Favorable Outcome Factors In Acute Middle Cerebral Artery Stroke With Large Artery Occlusion
Authors: Lee Joon Hwa , Song Seung Hoon , Moon So Young , Kim Hahn Young
Published: July 2021

Background
In acute stroke patients with large artery occlusion, we investigated the usefulness of multimodal CT as an initial predictor for a favorable outcome in addition to clinical findings. We studied which parameters of multimodal CT might be the most reliable predictors for favorable outcomes, and combination of these multimodal CT parameters to increase predictive validity, compared to a single parameter.

Methods
The parameters of multimodal CT, including non-enhanced CT (NECT), CT angiography, perfusion CT parameters, CT angiography source image (CTA-SI), and collateral flow, were analyzed in 66 consecutive patients with acute middle cerebral artery stroke with large artery occlusion. To evaluate the predictive validity of individual parameters for favorable outcome at 3 month follow-up (modified Rankin scale≤ 2), receiver operating characteristic (ROC) curves were generated, and optimum predictive cutoff- Alberta Stroke Program Early CT Score (ASPECTS) was calculated. ROC curves of the individual parameters and their combinations were analyzed by pairwise comparison. As an additional imaging predictor to clinical findings for favorable outcome, crude or adjusted odds ratios of individual parameters, predefined by the optimum predictive cutoff-ASPECTS, were assessed through univariate or multivariate analyses.

Results
Optimum predictive cutoffs for favorable outcome as follows: CTA-SI ASPECTS ≥ 7, cerebral blood volume (CBV) ASPECTS ≥ 6, NECT ASPECTS ≥ 10, good collateral flow, and cerebral blood flow ASPECTS ≥ 2. On the multivariate analyses, CTA-SI ASPECTS ≥ 7, CBV ASPECTS ≥ 6, and good collateral flow were associated with a favorable outcome. On the ROC analyses by pairwise comparison, the combination of those parameters had better predictive validity compared to a single parameter only: CBV (p = 0.039), CTA-SI (p = 0.038), and collateral flow (p < 0.001).

Conclusion
Among the various parameters of multimodal CT, CTA-SI ASPECTS ≥ 7, CBV ASPECTS ≥ 6, and good collateral flow might be the most reliable predictors for favorable outcomes in acute stroke patients with large artery occlusion. Moreover, considering these parameters simultaneously might improve the predictive validity of multimodal CT for functional outcome.
Abstract WP158: Validation of a Preliminary Prediction Model with MR Plaque Imaging to Estimate Risk for New Ischemic Brain Lesions after Carotid Endarterectomy or Stenting
Authors: Hosoda Kohkichi , Akutsu Nobuyuki , Fujita Atsushi , Kohmura Eiji
Published: July 2021

[Objective]
Recently, we reported a preliminary prediction model with carotid plaque MRI to estimate risk for new ischaemic brain lesions after CEA or CAS. The objective of this study was to validate this model in new set of patients with carotid stenosis.

[Methods]
One hundred four patients with carotid stenosis undergoing treatment (63 CEA, 41 CAS) were used as a training set for construction of a preliminary prediction model to estimate risk for new ischemic brain lesions after CEA or CAS. T1 and T2 signal intensity of carotid plaque were measured on black-blood MRI. Associations among MRI findings, treatment, clinical factors, and occurrence of new ischemic lesions on DWI 1 day after treatment were studied by logistic regression. The validity of the prediction model was examined using a new set of patients with carotid stenosis (n = 43) as a validation set.

[Results]
In the training set, new DWI lesions after treatment were observed in 25 patients (24%). The model demonstrated that T1-signal intensity and CAS were positively associated with new lesions on post-treatment DWI scans, and T2 signal intensity was negatively associated (Fig. 1). The C-index was 0.79, which indicated some predictive value. In the validation set, new DWI lesions after treatment were observed in 10 patients (23%). However, C-index was 0.6 and positive predictive value was 33% (Fig. 2), which suggested overfitting of our model and/or differences in case-mix between the training set and validation set.

[Conclusions]
Our preliminary prediction model may provide some useful information for decision-making regarding treatment strategy, but needs further collection of patients to improve its predictive value.
Abstract WP205: Long-chain n-3 Polyunsaturated Fatty Acids Intake and Cardiovascular Disease Mortality Risk in a General Japanese Population: NIPPON DATA80
Authors: Miyagawa Naoko , Miura Katsuyuki , Okuda Nagako , Kadowaki Takashi , Takashima Naoyuki , Nagasawa Shin-ya , Nakamura Yasuyuki , Matsumura Yasuhiro , Hozawa Atsushi , Fujiyoshi Akira , Hisamatsu Takashi , Yoshita Katsushi , Ohkubo Takayoshi , Okamura Tomonori , Okayama Akira , Ueshima Hirotsugu ,   the NIPPON DATA80 Rsch Group
Published: July 2021

BACKGROUND:
In Western populations, long-chain n-3 polyunsaturated fatty acid (LCn3FAs) intake was shown to be inversely associated with the risk of cardiovascular diseases, particularly that of cardiac disease. Dietary intake of LCn3FAs among Japanese is generally higher than those of Western populations due to their higher intake of fish and shellfish. However, little is known regarding whether an inverse association exists in a population with higher LCn3FAs intake. Furthermore, evidence for association with stroke risk has been limited.

OBJECTIVES:
To investigate the association between LCn3FAs intake and the risk of cardiovascular diseases and stroke in a Japanese general population.

METHODS:
We followed-up a total of 9,190 community-dwelling individuals (56.1% women, mean age of 50.0 years) randomly selected from 300 areas across Japan and free from cardiovascular diseases at baseline. Dietary LCn3FAs intake was estimated using household weighed food records. Cox models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence interval (95%CI) according to sex specific quartiles of LCn3FAs intake. HRs were adjusted for age, sex, cardiovascular risk factors, dietary sodium and other nutritional factors.

RESULTS:
During 24 years of follow-up, 879 cardiovascular deaths were observed. The median daily intake of LCn3FAs was 0.37%kcal. Median value of the lowest quartile of LCn3FAs intake (0.18%kcal) in the present study was twice as high as the average intake in U.S. population. Adjusted HR for cardiovascular disease mortality was lower in the highest quartile of LCn3FAs intake (HR 0.80; 95%CI, 0.66-0.96) compared with the lowest quartile, and the trend was significant (
P
=0.038). The similar but statistically non- significant trends were observed for cardiac death and stroke death.

CONCLUSIONS:
In a representative sample of Japanese with high LCn3FAs intake, the risk of total cardiovascular disease mortality was inversely and independently associated with LCn3FAs intake, and the risk of stroke also showed similar tendency.