bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP20: Intravenous Glibenclamide For Large Hemispheric Infarction: Baseline Data From Initial Enrollees In The Charm Phase 3 Study
Authors: Sheth Kevin N , Kimberly W Taylor , Albers Gregory W , Campbell Bruce C , Cordonnier Charlotte , Hinson H E , Molyneaux Bradley J , Nogueira Raul G , Saver Jeffrey L , Steiner Thorsten , Toyoda Kazunori , Wintermark Max , Hareedy Randa , Wald Michael , Zhang Ray , Ziogas Nikolaos K , Rizzo Marco
Published: February 2022

Objective:
To present baseline data from initially enrolled participants in CHARM, a Phase 3 study evaluating whether intravenous (IV) glibenclamide (BIIB093) improves functional outcomes at 90 days in individuals with large hemispheric infarction (LHI) compared with placebo.

Background:
In preclinical models, glibenclamide reduces cerebral edema due to LHI by inhibiting the SUR1/TRPM4 cation channel. Phase 2 trial data suggested that glibenclamide compared with placebo may reduce 30-day mortality and increase rates of favorable functional outcomes.

Design/Methods:
CHARM is a global, randomized, double-blind, placebo-controlled trial (NCT02864953). Eligible participants (planned enrollment: 768) are 18-85 years old, with a diagnosis of acute ischemic stroke of the middle cerebral artery territory, and study drug treatment initiated within 10 hours of last known normal (LKN) time. Randomization is (1:1) to a 72-hour continuous infusion of glibenclamide or placebo and may receive standard of care reperfusion therapy. The primary endpoint is ordinal analysis of the modified Rankin Scale at 90 days in participants ≤70 years of age.

Results:
As of January 2021, 264 participants were randomized and 249 were dosed. Mean (SD) age 64 (12.4) years (n=249). Median time from LKN to dosing was 9.3 hours. At baseline, mean (SD) National Institute of Health Stroke Scale score was 20.4 (5.09); IQR (17-23). Participants with baseline imaging data (n=259) had documented qualifying LHI on MRI (38.6%), computed tomography perfusion (CTP; 35.1%), or non-contrast computed tomography (26.3%). Site investigator-read median infarct size on MRI/CTP was 135 mL (IQR 99 - 174 mL, n=249).

Conclusions:
Initially enrolled CHARM participants have imaging evidence of LHI and moderate-to-severe neurologic deficits. Ages 71-85 years have completed enrollment; remaining enrollees in CHARM will be ≤70 years of age. Enrollment is ongoing.
Abstract TP203: Predictors Of Alzheimer's Disease And Related Dementias Among Older Adults
Authors: Aggarwal Seema , Silos Christin , Savitz Sean I , Shams Shayan
Published: February 2022

Introduction:
Alzheimer’s disease and related dementias (ADRD) are a leading cause of disability and premature death in the U.S. The aim of this study was to identify demographic and clinical predictors (age, sex race/ ethnicity, marital status, education level, history of heart disease, myocardial infarction, stroke, hypertension, diabetes, anxiety and depression symptoms, subjective memory rating, clock drawing results) of ADRD in a cohort of adults over age 65.

Methods:
We obtained data for 2011 to 2020 from the National Health and Aging Trends Study (NHATS). NHATS contains a nationally representative sample of Medicare beneficiaries aged 65 years and older. We included participants with complete data (N=6161).

Results:
Logistic regression analysis (see Table 1) suggested that the odds of having ADRD were 2.24 times higher in participants who had a stroke than in those who had not (p<0.001). The odds of having ADRD were 45% less among Black individuals than among White individuals (p=0.02). Participants ≥75 years old had higher odds of ADRD than those <70 years old (p<0.001). Participants who experienced anxiety symptoms “nearly every day” were more likely to have ADRD than those who did not experience anxiety symptoms (p=0.04). Those rating their memory as fair or poor were more likely to have ADRD (p<0.001). Those with clock drawing results that were reasonably accurate or accurate were less likely to have ADRD than those with clocks that were unrecognizable (p=.03). The area under receiver operator curve for the regression model was 0.887.

Conclusions:
Our study findings that participants with a history of stroke, anxiety symptoms, and a poor memory self-rating were at higher risk for ADRD and those with accurate clock drawing tests were at lower risk for ADRD are consistent with prior studies. However, our finding that Blacks were at lower risk for ADRD is inconsistent with prior studies which suggests that additional research is needed.
Abstract TP209: Potential Embolic Sources Differ In Patients With Embolic Stroke Of Undetermined Source According To Age
Authors: Elmashad Ahmed , Hou Yan , Staff Ilene , Alberts Mark , Nouh Amre
Published: February 2022

Introduction:
Understanding the potential embolic source (PES) in ESUS patients may improve the diagnosis and treatment of such patients.

Hypothesis:
PES differ in young vs old patients with ESUS.

Methods:
Young patients (age 18-49) with ESUS who were admitted to our stroke center from 2006 to 2019 were identified retrospectively and matched with next consecutive older patients (age 50-99) with ESUS by admission date. PES were categorized as atrial cardiopathy, AFib diagnosed during follow up, left ventricular disease (LVD), cardiac valvular disease (CVD), PFO or Atrial septal aneurysm (ASA) and arterial disease. Patients who had cancer or a coagulopathy were excluded. Rate of types and number of PES and stroke recurrence were determined and compared between young and older patients.

Results:
In young patients (55.3% women, median age 39 years), the most common PES was PFO/ASA and rate of other PES was low. Most of young patients had a single PES (54.1%), only 9 of the young patients had multiple PES. In older patients (41.7% women, median age 74 years), the 3 most common PES were atrial cardiopathy, LVD, and arterial disease. More older patients had multiple PES than single PES. More young patients as compared to older patients didn’t have any PES identified. The rate of stroke recurrence was lower in young patients as compared to older patients, the difference approached but did not reach statistical significance. During a median follow up of 3 years, only 3 young patients had recurrent stroke, two of them had unclosed PFO. There were no recurrent strokes among young patients with no PES identified. Among 9 older patients who had recurrent stroke, 6 had atrial cardiopathy, and AFib was detected in 4 patients during follow up.

Conclusions:
PFO is the only common PES in young patients with ESUS, atrial cardiopathy is the most common PES in old patients with ESUS. Rate of other types of PES and stroke recurrence is low in young patients.
Abstract TP213: Arcadia CSI (Cognition And Silent Infarcts): Update
Authors: Lazar Ronald M , Lansberg Maarten G , Howard George , Sheth Kevin N , Tirschwell David L , Wintermark Max , Harris Tashia , Myers Terina , KEMP Stephanie M , Cassarly Christy , Broderick Joseph P , Kamel Hooman , Elkind Mitchell
Published: February 2022

Introduction:
Cognitive decline and dementia after stroke is a major public healthcare problem, with dementia risk doubling over time, affecting more than 2M people in the US, with no current treatment. Silent brain infarction has been associated with cognitive decline, especially among those at risk for cardio-embolism. The therapeutic challenge is to prevent the occurrence of silent infarction to mitigate proactively the loss of cognitive function.

Methods:
The NINDS-funded ARCADIA-CSI is an ancillary study to ARCADIA, a randomized trial comparing apixaban vs aspirin to prevent recurrent clinical stroke in patients with cryptogenic stroke and left atrial cardiopathy. The aim of ARCADIA-CSI is to address whether apixaban might also reduce the incidence of silent infarction and be associated with better cognitive function over time compared to aspirin. Five hundred patients will be enrolled at least 90 days after the ARCADIA index stroke and undergo cognitive assessments at baseline and yearly thereafter using a telephone-based cognitive battery. We are testing the hypothesis that the slope of change in cognitive function is less steep during the follow-up period in patients on apixaban compared to patients on aspirin therapy. We will also collect an initial MRI around the time of the qualifying stroke and a follow-up MRI at the time that the subject completes participation in the ARCADIA parent study to assess the occurrence of new silent infarction.

Results:
As of August 12, 2021, the study has enrolled 188 subjects from 78 ARCADIA sites which have been green-lighted for enrollment in ARCADIA-CSI. A total of 61 sites have enrolled at least one subject. To date, there is a 95% completion of baseline cognitive exams and 98% completion at the 1-yr follow-up. We have obtained 91% of the clinical scans of the index stroke of which 95% have undergone central reading and interpretation.

Conclusion:
ARCADIA-CSI is designed to identify the most favorable medical approach to prevent the occurrence of silent infarction and cognitive decline in the setting of secondary stroke prevention. An update will be provided regarding the number of patients enrolled, centers green-lighted, and the completion rates of cognitive assessments, and MRIs obtained and interpreted.
Abstract TP214: Sex Differences In Non-Stenotic Carotid Plaque Burden Among Patients With ESUS
Authors: Reyes-esteves Sahily , Cucchiara Brett L , Sathya Anvitha , Oak Solomon , Vigilante Nicholas , Siegler James E
Published: February 2022

Background:
Sex differences in patients with embolic stroke of undetermined source (ESUS) and non-stenotic internal carotid artery (ICA) plaque have not been reported. Non-stenotic ICA plaque has been identified in patients with ESUS, is inversely proportional to cardioembolic stroke risk in our cohort, and could represent a stroke mechanism in these patients. Sex differences have been observed in patients with stroke and stenotic ICA plaque. Thus, we examined whether sex differences were present in a cohort of patients with ESUS and non-stenotic plaque.

Methods:
A retrospective multicenter cohort of consecutive patients with ESUS was queried (2015-2021). Patients with unilateral, anterior circulation ESUS who had a CTA neck scan and a transthoracic echocardiogram (TTE) were included. Multiple linear regression was used to model independent contributors to thicker ipsilateral plaque.

Results:
Of the 273 included patients with unilateral anterior ESUS and adequate TTE or TEE, 133 (49%) were women. While vascular profiles were largely similar, women were older but had less significant ipsilateral plaque compared to men (Table). After adjustment for independent predictors of greater ipsilateral plaque, female sex remained strongly and independently protective against plaque thickness (β -0.46, 95%CI -0.83- -0.09), while older age (β 0.03/yr, 95%CI 0.01-0.04), tobacco use (β 0.38, 95%CI 0.002-0.76), and coronary artery disease (β 0.46, 95%CI -0.05 - 0.97) were associated with thicker ICA plaque.

Conclusion:
Non-stenotic ICA plaque may contribute to ESUS, but it is less common in women than men. Further investigation of factors that might account for this difference, such as hormonal factors, is warranted.

Table.
Abstract TP221: Hyperacute Anterior Circulation Stroke Due To Atherosclerotic Occlusion Still Have Risks Of Cardioembolism
Authors: Sakuta Kenichi , Nakada Ryoji , Kitagawa Tomomichi , Sato Takeo , Takatsu Hiroki , Miyagawa Shinji , Komatsu Teppei , Sakai Kenichiro , Sakai Kenichiro , Mitsumura Hidetaka , Yaguchi Hiroshi , Iguchi Yasuyuki
Published: February 2022

Background and Purpose:
The difference among anterior and posterior circulation stroke regarding vascular risk factors is commonly known. Our aim is to verify the difference of clinical backgrounds between anterior and posterior circulation in hyperacute stroke with large vessel occlusion (LVO) caused by atherosclerotic occlusion (AO).

Methods:
This multicenter, retrospective study included LVO patients who were performed revascularization therapy (thrombectomy, intravenous thrombolysis, or both) between October 2017 and May 2021. The definition of AO was the fixed residual stenosis/occlusion at the initially occluded lesion confirmed in the second angiographic imaging performed 7 days later from symptom onset. The patients were dichotomized by LVO location, anterior or posterior. Traditional risk factors and laboratory data were compared.

Results:
Among the 1770 consecutive stroke patients admitted during the study period, 162 patients (104 men, median age 76 years old) were enrolled in our study. AO was diagnosed in 41 patients (25%; 27% of anterior circulation vs. 17% of posterior, P=0.291). In total cohort, patients with anterior circulation showed higher frequency of atrial fibrillation, lower glycosylated hemoglobin level, higher D dimer level, and higher brain natriuretic peptide level (Figure 1 black bar). The cohort of AO patients had a similar tendency (Figure 1 blue bar).

Conclusion:
One fourth of patients with LVO are AO. In anterior circulation stroke with AO, attention should be paid to stroke recurrence due to not only atherosclerosis but embolism.
Abstract TP236: Brain And Infarct Temperature Changes With Active Conductive Head Cooling: A Magnetic Resonance Spectroscopy Imaging Study
Authors: Diprose William K , Morgan Catherine , Diprose James , Wang Michael , Campbell Doug , Barber P A
Published: February 2022

Background and Purpose:
Active conductive head cooling (HC) is a simple and non-invasive intervention that may potentially slow infarct growth in patients with stroke. Using magnetic resonance spectroscopy imaging (MRSI), we investigated the effect of HC on brain and systemic temperatures.

Methods:
A cooling cap (WElkins Temperature Regulation System, 2nd Gen) was used to administer HC for 80 minutes to healthy volunteers and patients at least 6 months following a large vessel occlusion stroke. Serial MRSI scans were obtained before and during HC. Brain temperature was estimated using the Metabolite Imaging and Data Analysis System software package, which allows voxel-level temperature calculations using the chemical shift difference between metabolite (N-acetylaspartate, creatine, choline) and water resonances. Rectal temperature, the 11-point Numerical Pain Rating Scale score, heart rate, and blood pressure were measured. The primary outcome was the mean difference in brain temperature before and after HC.

Results:
Eleven participants (6 healthy volunteers, and 5 post-stroke) had a total of 66 MRSI scans performed over 80±5 minutes of HC. An average absolute temperature of -1.3±0.5°C was delivered via the cooling cap to the scalp of the participants. Following HC, significant reductions in brain temperature (ΔT = -0.9±0.7°C,
P
=0.002), and to a lesser extent, rectal temperature (ΔT = -0.3±0.1°C,
P
=0.03) were observed. Linear regression analysis of all 66 MRSI scans showed a brain temperature-by-time gradient of -0.53°C per hour (
P
=0.001). In the stroke patients, the temperature-by-time gradient within the infarct was -0.60°C per hour (
P
=0.01). HC was well-tolerated, heart rate and blood pressure remained stable, the median (IQR) Numerical Pain Rating Scale score was 2.5 (1-3) at 80 minutes, and none developed shivering.

Conclusions:
HC was well-tolerated and resulted in potentially clinically meaningful reductions in brain and infarct temperature, with only slight reduction in systemic temperature. Future research should investigate the feasibility of HC as a potential neuroprotective strategy in patients being considered for acute stroke therapies such as mechanical thrombectomy.
Abstract TP24: Indicators Of High Morbidity And Poor Functional Outcome In Acute Ischemic Stroke Patients With Concurrent Covid-19
Authors: Iliceto Alessandro , Pisano Thomas , Mehta Deviyani , Rybinnik Igor
Published: February 2022

Objectives:
Evidence suggests an association of increased cerebrovascular accidents frequency in patients diagnosed with the novel coronavirus disease, COVID-19. Coagulopathy resulting from the 2019 novel coronavirus (SARS-CoV-2) infection is suspected. This study aims at evaluating thrombotic markers in relation to stroke severity and functional outcomes in a patient cohort of acute ischemic stroke (AIS) with concurrent COVID-19.

Methods:
We performed a retrospective observational cohort study of 28 patients who tested positive for SARS-CoV-2 via polymerase chain reaction and concomitant AIS confirmed by brain imaging. We analyzed data regarding initial stroke presentation, markers of coagulopathy, and 90-day functional outcomes.

Results:
The patient cohort displayed high rate of comorbidities with 78.6% having at least 1 vascular risk factor. NIHSS had a median of 16 at initial presentation and median stroke volume of 52 mL. Median NIHSS at discharge or prior to death was 19, and median 90-day mRS was 4. Highest fibrinogen level recorded showed a median of 759.54 mg/dL (IQR 653.75-940.75), D-dimer and lactate dehydrogenase (LDH) showed a median highest recorded value 24,106 ng/mL (IQR 6105.00-80165.00) and 442 ng/mL (IQR 277.00-545.50), respectively. LDH (p=0.0008), D-dimer (p=0.001), and maximum fibrinogen levels (p=0.049) near the time of stroke significantly predicted final NIHSS and functional outcome 90-days after discharge.

Conclusions:
Adult patients with acute ischemic stroke and concurrent COVID-19 disease exhibited abnormally high markers of coagulopathy, and LDH, D-Dimer, and fibrinogen levels were predictors of morbidity and neurological disability at 90-days in this patient population. Further research is necessary to establish a definitive pattern and assess the ability to use these markers as prognostic elements of 90-day functional outcome.
Abstract TP240: Novel Lipid Mediators C-36:6 And C-38:6 Administered Intranasally Are Neuroprotective In Experimental Ischemic Stroke
Authors: Reid Madigan M , Khoutorova Larissa , Mukherjee Pranab K , Lewis William , Shelvin Kierany , Park Bohyung , Desai Neehar N , Jun Bokkyoo , Obenaus Andre , Belayev Ludmila , Bazan Nicolas G
Published: February 2022

Objective:
Ischemic stroke induces multiple pathophysiological processes involving oxidative stress, loss of homeostasis, excitotoxicity, disruption of the blood-brain barrier and neurovascular unit, contributing to neuronal death. In the early phases following the onset of ischemic damage, neuroinflammation contributes to tissue damage and enlargement of the infarct area. Elovanoids (ELVs) are a class of pro-homeostatic lipid mediators that are derivatives of very long-chain polyunsaturated fatty acids (VLC-PUFAs). VLC-PUFAs are synthesized by ELOVL4 an enzyme primarily expressed in neurons. ELVs have been shown to reduce infarct volume and promote cell survival when administered IV following 2h of middle cerebral artery occlusion (MCAo). This study aimed to test the neuroprotective efficacy of these VLC-PUFA ELV precursors when administered intranasally (IN) in a model of experimental ischemic stroke.

Methods:
Male Sprague-Dawley rats received 2h of the middle cerebral artery occlusion (MCAo). Treatment with C-36:6, C-38:6 (1μg/μl, 20 μg) or vehicle (saline + ethanol) was administered at 1, 24, and 48h after onset MCAo. Behavior was evaluated using a composite neurological battery; a grading scale of 0-12 was employed (normal score=0, maximal deficit=12). Behavior testing was performed on days 1, 2, 3, and 7, followed by ex vivo MRI for lesion volumes and edema (T2WI) and immunohistochemistry on day 7.

Results:
Following drug administration, no behavioral side effects were observed. Neurologic function was improved on days 1, 3, and 7 by 24%, 37%, and 28% in animals receiving C-36:6 and by 26%, 26%, and 29% in the group receiving C-38:6. Total, core, and penumbra lesion volumes, computed using T2WI, were reduced with C-36:6 by 60%, 68%, and 53%, and C-38:6 by 35%, 43% 25% vs vehicle. Total, cortical and subcortical infarct areas and volumes were reduced by treatments with C-36:6 (by 42% 48% and 34%) and C-38:6 (by 28% 31% and 20%) vs vehicle.

Conclusion:
IN delivered ELV precursors demonstrated neuroprotective efficacy improving behavior and reducing infarct volume compared to vehicle. We are exploring neuroprotective molecular mechanisms exerted by intranasally delivered VLC-PUFAs as an experimental therapeutic approach.
Abstract TP242: The Suppression Of Leukocyte Rolling Via Blocking P-selectin After Stroke Is Not Sustained In Mice With Type 2 Diabetes
Authors: sato yoshimichi , Wong SuWai , Rabiller Gratianne , Liu Jialing
Published: February 2022

Introduction:
Diabetes is associated with worse stroke outcome, yet the mechanism contributing to a more severe ischemic brain injury is not well understood. Neutrophils invade the cerebral veins as early as 30 minutes after stroke and play a major role in acute ischemic brain injury and thrombosis. Leukocyte rolling on the activated endothelium is an early event of transendothelial migration and parenchymal infiltration of leukocytes including neutrophils, which involves p-selectin. The current study sought to determine the effect of blocking p-selectin in reducing leukocyte rolling in the cerebral vessels of diabetic mice after stroke.

Methods:
Stroke was induced in 4-month old diabetic
db/db
and control
db/+
mice via middle cerebral artery occlusion (MCAO). P-selectin blocking antibody (P-aby) was administered intravenously 30 min after MCAO at 20 mg/kg. Adherent or rolling leukocytes was quantified at baseline before MCAO and after ischemic reperfusion by repeated 2-photon microscope imaging with fluorescent tracers. Infiltrating neutrophils and plasma soluble p-selectin were determined via FACS and ELISA, respectively.

Results:
Leukocyte rolling was immediate detected in the veins 1 hr after reperfusion and significantly increased 1d after MCAO in both genotypes of mice. Rolling tended to last days longer in the db/db compared to db/+ mice, and was often seen in the arterioles of the former but not in the latter mice. Increased infiltration of neutrophils was detected in db/db compared to db/+ brain parenchyma 1-3 ds after MCAO by FACS. Three to 5 fold-reduction in rolling by was detected 1 hr after reperfusion in both genotypes following P-aby treatment. However, rolling resumed in db/db mice 1 d after MCAO and antibody treatment, compared to a sustained suppression of rolling seen in the db/+ mice till days later. Elevated soluble p-selectin was also detected in the plasma of db/db compared to db/+ mice.

Conclusions:
Stroke-induced leukocyte rolling was only temporarily suppressed by P-selectin blocking antibody in db/db mice. Ongoing studies will determine the effect of P-selectin blocking on microthrombi formation, cerebral blood flow, neuroprotection and the role of soluble p-selectin in dampening the treatment effect.
Abstract TP252: Intranasal Insulin Treatment Improves Stroke Outcome In Both Male And Female Mice
Authors: Smith Crystal J , Kinley-Cooper Serena , Nguyen Stacey , Williams Alexus , Mcleod Taylor , Robinson Catrina
Published: February 2022

Insulin resistance has been linked to increased risk of stroke recurrence, death, and poor outcome following stroke. Insulin resistance, a common phenomenon following stroke, is associated with elevated levels of insulin circulating in the periphery, which leads to brain insulin deficiency. Brain insulin promotes neuroplasticity and synaptogenesis, has anti-inflammatory, anti-thrombotic, vasodilatory, and anti-apoptotic properties. The impact of brain insulin deficiency and the therapeutic potential of increasing brain insulin levels has yet to be fully understood. Hence, purpose of this study is to assess the potential therapeutic benefits of intranasal insulin treatment on stroke outcomes in a mouse model of brain insulin deficiency. Ischemic stroke was induced using a 30 minute middle cerebral artery occlusion (MCAO) in 16 week old (12 week diet) male and female mice on either a standard diet (control) or a high-fat diet induced at 4 weeks of age, a model of brain insulin deficiency. Recovery assessments begin on day 0 following stroke and continue until day 14 post stroke. Recovery assessments entail observing survival, neurological, motor, and cognitive function after receiving either intranasal saline (0.9%) or intranasal insulin (1.75 U). These assessments were evaluated by survival, and completion of the neurological severity score, ladder, and problem solving tasks on days 0-14 post stroke. High-fat diet-induced brain insulin deficiency was associated with worse survival and neurological deficits following ischemic stroke, intranasal insulin improved stroke mortality and neurological assessments in high-fat diet mice. Thus, intranasal insulin may be a useful therapy for improving stroke outcomes.
Abstract TP261:
Oenanthe Javanica
, A Potential Therapeutic Agent For Dual Antiplatelet Therapy To Overcome Clopidogrel Resistance
Authors: Kim Hoon J , Shin Dong H
Published: February 2022

Background:
Dual antiplatelet therapy with clopidogrel and aspirin prescription is standard for various clinical settings such as Acute Coronary Syndrome. However, the therapy is less effective on a large portion of the Asian population due to clopidogrel resistance.
Oenanthe javanica
(O. J.) has been used in traditional Chinese medicine for a range of ailments. In this study, we aimed to evaluate
Oenanthe javanica
extract’s antithrombotic effects and its potential to be used in Dual Antiplatelet Therapy (DAPT) to overcome clopidogrel resistance.

Method:
Prothrombin time (PT), activated partial thromboplastin time (aPTT), ADP and ASPI were measured using blood samples collected from 2 healthy volunteers. One volunteer took 2 75mg clopidogrel (CPG) tablets 2 hours before the experiment. The blood samples were incubated with O. J. extract for 30min before the measurement. For in vivo experiments, FeCl
3
thrombosis were induced to right common carotid arteries of Sprague Dawley rats (270-300g). The rats were divided into 5 groups (N=5-6): Control group, O. J. group, CPG group, CPG+O. J. group, and CPG+ASA group. O. J. extract was orally administered 200mg/kg per day for 3 days. CPG and ASA were orally administered 10mg/kg 2 hours before the experiment. Thrombosis was induced using filter paper doused with 10μL of 20% FeCl
3
solution. After the induction, blood flow was measured for 55min and thrombus weight was measured.

Results:
O. J. extract did not have any effect on PT, aPTT, and ASPI. However, O. J. extract did have an effect on ADP value, even though the volunteer had clopidogrel resistance. In FeCl
3
thrombosis model, O. J., CPG, CPG+ASA, and CPG+O. J. group all significantly increased the time-to-occlusion (TTO) compared to the Control group. This was true for thrombus weight as well.

Conclusion:
Our results indicate that O. J. extracts is a potential antiplatelet agent for dual antiplatelet therapy for patients with clopidogrel resistance.
Abstract TP28: Stroke Care Doesn't End At Hospital Discharge: What Patients Need After Hospital Discharge May Not Always Be Obvious
Authors: Olson-Mack Lindsay , Rockwell Jean M , Lugo Sabrina , Brandstein Kendra , Calara Robin
Published: February 2022

Introduction:
Mood disorders after stroke are common, with up to one-third of patients developing depression and/or anxiety. Identifying those at greatest risk may be challenging in the acute care setting. We sought to better understand post-hospital barriers impacting emotional well-being for those who suffered a stroke and to evaluate needs for additional resources post hospital discharge.

Methods:
A Stroke Transitional Care Program (STCP) was initiated at a large two-campus hospital in Southern California in October 2020. All patients discharged home with acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA) received a follow-up phone within 3-7 days of hospital discharge from a community health worker familiar with the community and language. An initial needs assessment was completed over the phone to evaluate barriers for post-hospital care, address social and economic needs, and help patients navigate the healthcare system. Data from the initial needs assessment results were analyzed and 30-day readmission data reviewed.

Results:
A total of 145 patients with a stroke diagnosis were discharged home between October 2020 and June 2021. Of those, 68.3% were discharged with AIS, 21.4% with TIA, and 10.3% with HS. Initial assessments of the 100 patients accepting enrollment into the STCP were reviewed. Fifty-six patients required additional resources, of which 55% required counseling, emotional support, and/or mental health resources. Nine percent of patients were readmitted to the hospital within 30 days. Of these, 22% were admitted for isolated psychiatric issues.

Conclusion:
A large portion of the stroke patients in our analysis required additional resources post discharge to support emotional well-being, and 22% of patients who required hospital readmission were admitted for psychiatric issues. As a result of these findings, our STCP incorporated the PHQ-2 screening as a standard part of initial post-discharge assessment and implemented a referral process to mental health services. Our results suggest the need for stroke programs to consider implementing processes to assess emotional/psychiatric needs for stroke patients post discharge by incorporating community-based models of care.
Abstract TP31: Use Of Validated Tool To Guide Nutritional Support Pathways In Patients With Dysphagia After AIS
Authors: Skeels Katelyn , Jijakli Amr , Leung Lester
Published: February 2022

Background and Issues:
Dysphagia is a common complication of AIS. Previously, there was no evidence-based predication tool to accurately predict the duration of post-stroke dysphagia. Without a prediction tool, post-acute rehabilitation facilities may not be able to accept patients with dysphagia without a gastrostomy tube. This may lead to some acute hospitals inadvertently placing gastrostomy tubes in patients who have a low likelihood of prolonged dysphagia. Dysphagia can also result in a prolonged acute hospital length of stay.

Purpose:
The goals of this quality improvement (QI) initiative were to reduce acute hospital length and improve selection of patients for gastrostomy in patients with dysphagia as a results of AIS.

Methods:
A multidisciplinary group from a Comprehensive Stroke Center (CSC) and a post-acute rehabilitation center identified an evidenced-based tool to help predict the duration of dysphagia after AIS. The CSC created a local practice guideline using the Predictive Swallowing Score (PRESS). PRESS was used to help predict a patient’s potential for recovery of swallowing, in order to help stratify patients into treatment pathways and guide decision making on nutritional support for post-stroke dysphagia. Stakeholders at both centers identified potential issues, including lack of a process for discharging patients to rehabilitation with a nasogastric tube (NGT). To address concerns, return-for-service pathways were developed; NGT replacement in the emergency department and outpatient gastrostomy tube placement.

Results:
This QI initiative and multidisciplinary collaboration across the care continuum, resulted in earlier identification of patients in need of gastrostomy placement for prolonged dysphagia, ultimately resulting in a reduced acute hospital length of stay. The pathways also helped reduce uncertainty for post-acute rehabilitation centers to accept patients with a NGT, allowing for more patients to be discharged with a NGT.

Conclusions:
In conclusion, it is feasible and beneficial to patient care to develop and implement pathways using an evidence-based tool to guide individualized nutritional support plans related to post-stroke dysphagia.
Abstract TP37: Teach-back Method And Hospital Readmission
Authors: Sanchez Jasper L
Published: February 2022

Introduction:
The transitions of care can be stressful and challenging to the AIS survivors and their families as each adjusts to unfamiliar roles. During care transitions, patients are faced with self-care challenges that can often lead to unplanned readmission. Patient education is an essential component of supporting the patient and family in preventing secondary stroke and promoting self-management. However, 40-80% of the medical information during education sessions is forgotten immediately, and can be misunderstood.

Hypothesis:
The researcher hypothesized that age of ≥ 75 years old; LOS ≥ 5 days; the presence of multiple modifiable risk factors; a NIHSS score ≥ 5; discharge destination to a SNF; and/or a high LACE score are the characteristics that will be seen most often among AIS patients with a 30-day readmission. The researcher also hypothesized that patient education using the teach-back method will decrease all-cause 30-day hospital readmission rates of patients with AIS.

Method:
A chart review of 955 medical records over 2 years was collected using a researcher-designed spreadsheet. Data were analyzed through descriptive and inferential statistics using measures of central tendency, Mann-Whitney, and Chi-Square Comparison.

Results:
The research study showed a high readmission rate on patients with a LOS ≥ six days (p=.006), discharge destination to SNF (p=.008), NIHSS score of ≥ 6 points (p=.03), and high LACE score (p=.008). However, there is a weak correlation between each variable and readmission. There was no significant difference in readmission rate between the pre-intervention group (3.3%) and the post-intervention group (4.35%) (p = .40).

Conclusion:
The researcher concluded that patient characteristics such as a higher length of stay, discharge to a SNF, high NIHSS score, and high LACE score can influence the risk of readmission. Since the contributing factors to 30-day hospital readmission are complex and multifactorial, identification of high-risk patients may allow opportunities for specific interventions such as patient education using the teach-back method. However, interventions must be patient, and family-centered, and targeted at the transitions of care.
Abstract TP38: Evaluation Of A Stroke Survivor To Survivor Program
Authors: Barnard Amy , Winiecki Christine M , Picou Kylie , Santana Adela
Published: February 2022

Background:
Since 2015 a Primary Stroke Center in the Midwest has had a Stroke Survivor to Survivor Program (SS2S). The SS2S program was developed by a local non-profit organization whose mission is to provide advocacy, support, education and resources to stroke survivors and their families. SS2S is a telephone-based peer support program that aims to encourage, support, network, and provide resources to stroke survivors post discharge. The SS2S program provides at least 2 monthly calls from trained SS2S stroke volunteers to participants and/or caregivers. The volunteers educate on treatment and appointment adherence, offer community resources, information on support groups, access to Podcasts, and a connection to survivors and/or caregivers with other survivors.

Purpose:
An evaluation of SS2S was conducted to inform program effectiveness, as well as identify opportunities for program improvement for replication and scalability.

Methods:
The evaluation study was a one-group, post-only design. Adults who experienced a stroke and received treatment at the study hospital were eligible to participate. Participants who met the inclusion criteria were invited to participate in the SS2S program evaluation. A third party conducted the interviews using a semi-structured interview guide approved by the IRB. Interviews were transcribed and coded for themes using an inductive and deductive thematic approach and analyzed using NVivo 12.

Results:
Interviews were conducted for four months. 32 participants were contacted, 6 agreed to a full interview and 2 agreed to provide limited feedback. The majority were male and had at least 2 calls with a SS2S volunteer. The majority indicated they had a positive experience. Both participants and coordinators agreed that stroke survivors with residual stroke complications, limited resources and limited social support would benefit from the program the most. The majority of participants agreed that they enjoyed receiving a follow up phone call and were encouraged by them.

Conclusions:
Although the study sample size was small, the results support the SS2S program aims. The program works best when it connects patients with relevant and timely resources as well as offers the survivors the emotional support to talk freely and feel heard.
Abstract TP45: Promoting High Value Care For Stroke Patients Within A Stroke System Of Care: Reducing Unnecessary Hospital Transfers For Patients Not Taken For Thrombectomy
Authors: Duncan Kelsey R , Fussner Julie M , MONTGOMERY Kelly M , SILA Cathy A
Published: February 2022

Introduction:
High value care aims to provide the best patient outcomes while avoiding defects and waste. Our previous work determined that 39% of patients transferred for possible thrombectomy based on clinical criteria and CT only did not have a large vessel occlusion (LVO) which led to a health system-wide guideline to improve transfer selection by adding criteria for emergent CT angiography. This study aims to describe the impact of that guideline and reanalyze the reasons why patients transferred for consideration of thrombectomy do not receive the procedure.

Methods:
All patients transferred from within and outside of the health system as a potential thrombectomy candidate between 1/1/19- 6/30/21 were reviewed for reasons why thrombectomy was not pursued.

Results:
Over 30 months, 316 patients transferred for possible thrombectomy were not taken to the angio suite primarily due to absence of LVO on vessel imaging (26.3%), lack of suspicion of LVO on assessment (18%) and significant improvement in clinical symptoms (12%). Other reasons included too large of core infarct (13.3%), CT head ASPECT score (8.2%), lack of perfusion imaging mismatch (6.3%), poor baseline functional status (4.7%), lesion too distal (3.8%), ICH (3.2%), time since last known well (1.9%), chronic ICA occlusion preventing access to acute lesion (1.9%), and medically unstable (0.3%).

Conclusions:
Despite the institution of a system-wide protocol for acute CTA imaging to guide patient selection, the major reason for not proceeding to thrombectomy was still absence of LVO, some of which was related to out-of-system hospital transfers. Drawbacks of unnecessary patient transfer include increased cost of care, moving patients farther away from their home and family, and non-essential use of tertiary hospital bed space, particularly in the setting of a pandemic. Given the prevalence of potentially preventable unnecessary transfers, protocols that support in-the-field triage and transport based on clinical criteria alone, without CT or CTA, are destined to worsen health system efficiency and decrease the value of care for patients with major acuteischemic stroke.
Abstract TP6: Determinants Of Thrombolytic Administration For Acute Ischemic Stroke At A Large Tertiary Center In Lebanon
Authors: Ibrikji Sidonie , El Ayoubi Nabil , El Ayoubi Nabil
Published: February 2022

Background:
Thrombolysis remains underutilized for acute ischemic stroke (AIS) in healthcare systems in low- and middle-income countries.

Aims:
We aimed to investigate the factors associated with utilization of intravenous thrombolysis in an academic medical center in Lebanon.

Methods:
Patients presenting to a tertiary medical center in Lebanon between January 2015 and October 2019 were reviewed. Inclusion criteria were age greater than 18 years and presenting to the emergency department within 48 hours from last known well. Patient, disease, and health system response characteristics were collected and those eligible for and those who received thrombolysis within 4.5 hours onset by guidelines criteria were identified by chart review. Descriptive statistics, bivariate and multivariate analyses were performed for association with thrombolysis administration.

Results:
Of 373 AIS patients presenting within 48 hours of onset to the hospital, 65 (17.4%) were deemed to be candidates for thrombolysis. Forty (61.5% of eligible) received thrombolysis. Those receiving thrombolysis compared to eligible but not receiving thrombolysis were younger (median 72 vs 86, p=0.018), had higher NIHSS (median 11.5 vs 7, p=0.032), had greater likelihood of stroke code activation (79% vs 41%, p=0.011), and no anti-platelet use (22.5% vs 56%, p=0.021). The multivariate analysis showed that thrombolysis among eligible patients associated with younger age (OR 1.05 [1.01-1.10], p=0.029), a higher NIHSS (OR 1.12 [1.01-1.25], p=0.041), and stroke code activation (OR 2.81 [1.16-6.81], P=0.022).

Conclusion:
A good proportion of eligible AIS patients did not receive thrombolysis. To increase thrombolysis use in low- and middle-income countries, more consistent stroke code activation and education on age and stroke severity in eligibility are needed.
Abstract TP70: Preliminary Associations Between Quality Indicators, Motor Status, And Self-efficacy In Early Stroke Rehabilitation
Authors: Vaughn Rachel M , Gangwani Rachana , Mark Jasper I , Cassidy Jessica M
Published: February 2022

Introduction:
Recent changes in reimbursement policies for inpatient rehabilitation facility (IRF) providers prompted the adoption of Quality Indicators (QI) on the IRF Patient Assessment Instrument leading to the discontinuation of the Functional Independence Measure (FIM). Given that the FIM has shown associations with motor assessments and self-efficacy measures during early stroke recovery, the purpose of this study was to confirm if similar associations exist with QI.

Methods:
Participants with acute ischemic and hemorrhagic stroke completed a battery of assessments at the time of IRF admission and discharge: Total QI (summation of self-care and mobility items), Upper Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), and Stroke Self-Efficacy Questionnaire (SSEQ). We determined associations between QI and these measures by computing correlation coefficients with an alpha value=.01 denoting significance following a Bonferroni correction.

Results:
Fourteen individuals (7 females, age=65.9±9.0 years, 8.1±3.5 days post-stroke) with moderate-severe motor deficit completed study procedures. Table 1 summarizes admission and discharge scores and associations with QI.

Conclusions:
Significant associations between motor assessments and QI from this ongoing study parallel similar associations involving the FIM. The implementation of QI in IRFs necessitates additional work to validate our findings and to determine psychometric properties of QI to enhance clinical research in stroke rehabilitation.
Abstract TP72: Cost Effectiveness Of Smoking-Cessation Interventions Following Ischemic Stroke And Transient Ischemic Attack
Authors: Wechsler Paul M , Liberman Ava L , Restifo Daniel , Abramson Erika , Navi Babak B , Kamel Hooman , Parikh Neal S
Published: February 2022

Introduction:
The cost effectiveness of smoking-cessation interventions after ischemic stroke and TIA has not been evaluated. We performed a cost-effectiveness analysis of smoking-cessation interventions in this population.

Methods:
We constructed a decision tree model to compare brief counseling alone to 3 interventions: varenicline, any pharmacotherapy with intensive counseling, and monetary incentives. Direct health care costs of interventions and outcomes were modeled. The outcomes were recurrent stroke, myocardial infarction, and death using a 5-year horizon. Estimates and variance for the base case (42% cessation), costs and effectiveness of interventions, and outcome rates were imputed from the stroke literature. Using standard techniques, we calculated incremental cost-effectiveness ratios (ICER) and net-monetary benefits (NMB). An intervention was considered cost effective if the ICER was less than the standard willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) or when the NMB was maximized. Sensitivity analyses and a probabilistic Monte Carlo simulation modeled the impact of parameter uncertainty, including for the base case cessation rate and costs and effectiveness of interventions (TreeAge Pro).

Results:
All three interventions were cost effective based on the ICER: varenicline - $7,422/QALY, pharmacotherapy with counseling - $14,550/QALY, and monetary incentives - $23,280/QALY. In one-way sensitivity analyses, interventions costing up to $1,729 remained cost-effective. In a two-way sensitivity analysis varying the cost and effectiveness of smoking-cessation interventions, all three interventions were cost effective based on NMB (Figure). In 10,000 Monte Carlo simulations, smoking-cessation interventions were cost effective 90% of the time, as compared to brief counseling alone.

Conclusion:
Smoking-cessation strategies are cost effective in secondary prevention after stroke and TIA.
Abstract TP73: Use Of A Novel Patient Simulation Application To Assess Physicians’ Knowledge In The Management Of Atrial Fibrillation And Stroke Prevention
Authors: Iancu Igal , DRAZNIN Boris
Published: February 2022

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia that contributes to over 150,000 deaths each year. Hypertension, ischemic heart disease, and smoking are among the leading risk factors for AF. Historically, it is well-accepted that AF is treated by cardiologists and frequently by specialists of heart electrophysiology. However, an overwhelming majority of patients with AF initially present to their primary care physicians (PCP). Yet, the assessment of PCP skills in the management of AF has not been well studied. We used the Edocate® virtual patient simulation platform and smartphone application to test the skills of physicians in a “virtual” clinic where their decisions in selecting diagnostic and management steps over several encounters were used for analysis of their knowledge and as a learning tool. We applied this application to assess the level of knowledge in managing AF in 25 PCP. The virtual patient was a 68-year-old man (an active smoker) with hypertension, hyperlipidemia, myocardial infarction 5 years ago, presenting with a 30-day history of palpitations and shortness of breath. On presentation, his blood pressure was 145/93 mmHg, ECG showed AF with a ventricular rate of 132 bpm. He was on atorvastatin 40 mg/d, aspirin 100 mg/d, and ramipril 5 mg/d. Total cholesterol was 155 mg/dl and LDL 85 mg/dl. Comprehensive analysis of the PCP choices via the Edocate platform revealed that only 62% of the participants elected to refer this patient to cardiology. While 65% addressed smoking cessation, only 38% achieved LDL levels of <75 mg/dl and none achieved better control of hypertension. Eighteen percent started anti-arrhythmic drugs within 3 weeks, (89% amiodarone, while 1 PCP started propafenone and 1 sotalol) and 82% started novel oral anticoagulants (dabigatran, rivaroxaban or apixaban - in approximately equal numbers). These results, albeit in a small sample size, clearly show a superb utility of the Edocate patient simulation application to reveal the level of competency of participating physicians. In the case of AF and stroke prevention, the data demonstrated a significant gap in the guideline-based knowledge in participating PCP and indicated that educational effort must be increased substantially among this group of providers.