bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T MP25: Recanalization of Acute Basilar Artery Occlusion Improves Mortality and Functional Outcome: A Meta-Analysis
Authors: Kumar Gyanendra , Alexandrov Andrei V
Published: July 2021

Background and purpose:
Randomized trial data supporting/refuting recanalization are sparse in acute basilar artery occlusion (BAO) with only one small RCT in literature. There is a wealth of data in the form of observational case series spanning several decades. We sought to synthesize outcome and mortality estimates from the available studies on acute BAO.

Methods:
MEDLINE, EMBASE, The Cochrane Library, and clinicaltrials.gov were searched with keywords “acute ischemic stroke” and “basilar artery occlusion”. Heterogeneity was calculated using Cochran Q (Q>df; p<0.5- significant), I2 and tau2. Dersimonian and Laird random-effects model was used to synthesize data. Pooled estimates were expressed as odds ratio (OR) and 95% CI. MIX Pro 2.0 was used for all analyses.

Results:
Thirty-seven studies provided mortality data (n= 1784), while 35 provided poor outcome data (n = 1755). In mortality synthesis, heterogeneity was significant (Q = 49.18, p = 0.07). Figure 1 shows OR for mortality with recanalization. ARR was 42.3% and NNT = 2.4. Subgroup analysis, separating IV TPA and IA therapy, revealed comparable ORs but heterogeneity was significant. In synthesis of poor outcome heterogeneity was not significant. Figure 2 shows OR for poor outcome with recanalization. ARR=35.3% and NNT=2.8. Subgroup analysis between IV TPA and IA therapy revealed comparable pooled ORs but significant heterogeneity in synthesis for IV TPA.

Conclusion:
Recanalization reduces mortality and poor outcome in BAO by OR of 0.19 and 0.20. These data do not support the notion that IA/mechanical intervention is superior to IV tPA since this effect persists when data are analyzed in each of these subgroups.
Abstract T MP26: Role of 99tc-hmpao Spect in the Assessment of Cerebral Hemodynamic Parameters After Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients With Severe Steno-Occlusive Disease of Intracranial Carotid and Middle Cerebral Artery
Authors: Batra Amit , Sinha Arvind K , Yeo Leonard L , Rathakrishnan Rahul , Paliwal Prakash , Chou Ning , Tsai Tseng , Teoh Hock Luen , Chan Bernard P , Chong Vincent F , Sharma Vijay
Published: July 2021

Background and Objective:
Although superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with symptomatic carotid occlusion failed to demonstrate any benefit, its role in symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated changes in hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass for impaired cerebral vasodilatory reserve (CVR).

Methods:
Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) evaluation and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged 99Tc-HMPAO-SPECT. STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were followed-up for cerebral ischemic events.

Results:
Of the 126 patients (80 male, mean age 56yrs; range 23-78yrs) that fulfilled our inclusion criteria, 84 (67%) showed impaired CVR HMPAO-SPECT. Fifty (60%) of them underwent STA-MCA bypass while 34(40%) received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. TCD BHI improved from a median (IQR) of -0.05 to 1.1 (p<0.001). Compared to 98% patients with impaired CVR on pre-operative SPECT, only 20% showed abnormal results on post-operative imaging (p<0.001). During follow-up (mean 35 months; range 8 to 49months), only 6/50 (12%) patients in bypass group developed cerebral ischemic events as compared to15/34 (44%) cases on medical therapy (absolute risk reduction 32%, p=0.006).

Conclusion:
99Tc-HMPAO SPECT with acetazolamide challenge is a reliable tool for the assessment of cerebral vasodilatory reserve in patients with severe steno-occlusive disease of intracranial ICA or MCA. STA-MCA bypass surgery in carefully selected patients results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.
Abstract T MP3: DWI Volume May Not Be a Single Stop Sign of Endovascular Revascularization Therapy for Acute Ischemic Stroke
Authors: Lee Jin Soo , Lee Manyong , Hong Ji Man , Sheen Seung Soo
Published: July 2021

Background and purpose:
This study was retrospectively designed to evaluate whether early huge DWI volume is a single ‘stop sign’ of intra-arterial (IA) therapy for acute ischemic stroke.

Methods:
Patients with acute ischemic stroke in anterior circulation territory and IA revascularization therapy were retrieved. DWI volume taken before the IA therapy was calculated with semiquantative method. Futile prognosis was defined as modified Rankin Scale 5-6 at 3 months. We divided patients into 4 groups. Group 1 represented with DWI volume less than 33.3 cm
3
, group 2 with 33.3 to 100 cm
3
, group 3 with 100 to 200 cm
3
and group 4 with more than 200 cm
3
. Baseline characteristics, imaging data and clinical outcomes were compared among groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were done.

Results:
Finally, 80 patients were enrolled in this study. Demographics and outcomes were described in Table 1. DWI volume more than 200 cm
3
was significantly associated with futile prognosis (Table 2). The area under the ROC curve for all DWI volumes was 0.686 (p=0.005). For predicting futile prognosis, sensitivity and specificity were 45.7% and 79.5% at DWI volume 100 cm
3
,

and 31.4% and 97.7% at 200 cm
3
, respectively.

Conclusions:
A huge DWI volume was associated with the futile prognosis. This imaging marker, however, could not be a single sign for stopping further aggressive IA treatment for acute ischemic stroke because the area under the ROC curve was relatively small. When IA therapy is considered, well known harmful factors including old age, high NIHSS score and huge DWI volume should be combined altogether for ‘no more to go’.
Abstract T MP32: T1-Weighted Magnetic Resonance Imaging Evaluation of Carotid Artery Outward Remodeling in Carotid Endarterectomy and Stenting
Authors: Maruyama Daisuke , Fukuda Kenji , Yamauchi Keita , Ishii Daizo , Kobayashi Norikata , Morita Kenichi , Satow Tetsu , Kataoka Hiroharu , Nakagawara Jyoji , Iihara Koji
Published: July 2021

Objective:
We evaluated carotid artery outward remodeling and plaque relative signal intensity (rSI) in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) by T1-weighted Magnetic Resonance Imaging (T1-MRI), in order to define their clinical significance in carotid revascularization.

Methods:
Eighty-eight lesions (51 CEA and 37 CAS; symptomatic at 54.9 and 45.7%, respectively) from 93 patients who underwent carotid revascularization at our institute were retrospectively considered. We evaluated the carotid artery remodeling parameter of luminal stenosis, which is determined by a ratio of external cross-sectional vessel area (CSVA) at maximum stenosis, and reference CSVA at the distal portion of the ICA (carotid remodeling index, CRI), and MR intensities of atherosclerotic plaque (rSI) using T1 MRI (magnetization-prepared rapid acquisition with gradient-echo [MPRAGE]), preoperatively. We divided carotid lesions into 4 groups using median CRI and rSI: L/L (CRI < 1.8, rSI < 2.5), L/H (CRI < 1.8, rSI ≥ 2.5), H/L (CRI ≥ , and rSI < 2.5), and H/H (CRI ≥ 1.8, rSI ≥ 2.5). The endpoint was defined as the detection of acute ipsilateral ischemia on diffusion-weighted imaging (DWI) within 72 h of treatment.

Results:
A significant correlation was found between CRI and rSI (r = 0.359, p = 0.0006). Mean CRI and rSI were significantly higher in lesions treated with CEA than with CAS. Small abnormalities were observed on DWI in 4 cases (7.8%) in CEA, and 10 (27.0%) in CAS (p = 0.01). In the CAS group, the observed frequency of DWI abnormalities in group L/L, L/H, H/L, H/H were 5.5%, 40.0%, 40.0%, and 55.5%, respectively (p = 0.03). In multivariate analysis, rate of stenosis (Odds Ratio [OR]: 1.19; 95% confidence interval [CI]: 1.04-1.48; p = 0.0082), and non-L/L lesions (OR: 29.65; 95% CI: 2.97-555.12; p = 0.002) were independent risk factors for cerebral embolism. In the CEA group, no significant relationship was observed between plaque parameters and DWI lesions.

Conclusion:
CRI and rSI are complementary parameters to predict a high-risk plaque for CAS, but not for CEA. Preoperative evaluation with T1 MRI is useful to make decisions about treatment strategy for carotid artery stenosis.
Abstract T MP49: Pre-Hospital Utility of Rapid Stroke Evaluation Using In-Ambulance Telemedicine (PURSUIT): A Pilot Feasibility Study
Authors: Wu Tzu-Ching , Nguyen Claude , Ankrom Christy , Yang Julian , Vahidy Farhaan , Grotta James , Savitz Sean
Published: July 2021

Objective:
Pre-hospital evaluation using audio/video telemedicine (TM) might accelerate acute stroke treatment with t-PA. We explored the reliability and feasibility of using TM via a mobile device in ambulances to help identify and evaluate acute stroke patients.

Methods:
Ten unique, scripted stroke scenarios with various levels of stroke severity were portrayed by trained actors retrieved and transported by EMS to our stroke center. Each scenario was conducted 4 times, for a total of 40 scenarios. Each scenario began when EMS arrived on scene and a vascular neurologist (VN) simultaneously logged on to the TM device remotely, and ended once the ambulance arrived at the emergency department. The VNs performed assessments in real-time, obtaining clinical data points and NIHSS using the In-Touch RP-Xpress TM device with Verizon 4G wireless connectivity. Each scenario was recorded for a subsequent evaluation by a second blinded VN.

Study feasibility was defined by the ability to conduct 80% of the sessions without major technological limitations. Reliability was defined by a 90% concordance between the data derived during the live/recorded sessions and the scripted scenarios; intra-class correlation (ICC) for NIHSS gathered during the live and recorded sessions was calculated. Audio/video quality and stability of connection were graded by paramedics and VNs for the live sessions on a scale of 1 to 5 (1=Poor; 2= Fair; 3= Good; 4= Very Good; 5=Excellent).

Results:
In 34 of 40 (85%) scenarios, the tele-consultation was conducted without major technical complication. The absolute agreement for ICC using the two-way mixed-effects model was 0.991 (95% CI 0.97-0.998) for the NIHSS obtained during the live sessions and 0.97 (95% CI 0.91-0.997) for the recorded sessions. Of the 34 live assessments, 30 (91%) matched the NIHSS by ±2 points, and 96% of the clinical information obtained by the remote neurologist matched those provided from the script. Audio/video quality and stability of connection were rated from good to very good by the EMS and VNs

Conclusion:
Mobile TM is reliable and feasible in assessing actors simulating acute stroke in the pre-hospital setting.
Abstract T MP53: Whole Blood Immuno-Chromatography for Rapid Detection of Cerebral Ischemia in the Pre-Hospital Setting
Authors: Pettigrew Luther C , Bradley-Whitman Melissa A , Lovell Mark A
Published: July 2021

BACKGROUND:
Pre-hospital detection of ischemic brain injury will exclude stroke mimics and refine patient triage. Using “dipstick” immuno-chromatography, we validated a rapid-sequence method to identify visinin-like protein-1 (VILIP-1), a neuronal injury marker, in blood sampled after focal cerebral ischemia in rats.

METHODS:
Transgenic (Tg) rats were constructed to over-express tumor necrosis factor-alpha (TNFα) in brain. Suture-occlusion of the middle cerebral artery (MCAO) was performed in TNFα-Tg animals and wild type (WT) littermates for 1 hr. Arterial blood was sampled at pre-ischemic baseline, after 60 min of MCAO, and at 15 min or 24 hrs of post-ischemic reperfusion. VILIP-1 immuno-reactivity was normalized to pre-ischemic baseline and compared to sham-ischemic animals. Brain infarct volume was measured at 24 hrs. VILIP-1 immuno-reactivity was then correlated with infarct volume to derive Pearson product moment.

RESULTS:
VILIP-1 immuno-reactivity was increased after 24 hrs of post-ischemic reperfusion in TNFα-Tg animals (133 ± 13 [SD]% of baseline) compared to sham-ischemic rats (100 ± 22;
p
≤ 0.05; ANOVA; n = 5 per group). At 15 min (159 ± 36%) and 24 hrs (above), VILIP-1 expression was greater than pre-ischemic baseline (
p
≤ 0.05). Immuno-reactivity of VILIP-1 at 15-min post-ischemic reperfusion was strongly correlated with infarct volume measured at 24 hrs in TNFα-Tg rats (Pearson 0.79;
p
≤ 0.01).

CONCLUSIONS:
Whole blood immuno-chromatography of VILIP-1 is feasible and correlates positively with infarct volume measured at 24 hrs in the rat. These promising results underscore the need to study VILIP-1 immuno-reactivity as an indicator of ischemic brain injury in the pre-hospital setting.
Abstract T MP66: Injury to the Head or Neck Increases Risk of Ischemic Stroke Three-fold After Trauma.
Authors: Fox Christine K , Numis Adam L , Sidney Steve , Fullerton Heather J
Published: July 2021

Background:
Over 2 million people under age 50 are seen in a U.S. emergency room monthly for non-fatal injuries. Our objective was to measure ischemic stroke incidence after traumatic injury in young patients and identify stroke risk factors.

Methods:
We performed a population-based study of ischemic stroke after trauma among people <50 years old in a Northern Californian integrated health care system. We electronically identified a cohort of patients with diagnostic codes for trauma (ICD-9 800-959.9) in emergency and inpatient encounters from 1997-2011, then identified ischemic stroke outcomes within 4 weeks. To determine stroke, we required an ICD-9 stroke code (433-438) plus a radiology report of brain imaging containing a keyword: stroke, infarct#, thromb#, ischemi#, lacun#, or dissect#. A neurologist reviewed the reports to exclude those inconsistent with ischemic stroke. We obtained clinical data such as injury type from electronic databases to calculate stratified incidence rates and risk ratios.

Results:
From 1.5 million trauma encounters, we identified 197 ischemic strokes. The 4-week stroke incidence after any traumatic injury was 0.013% (95% CI 0.011, 0.015). Patients with stroke had a mean age of 37.7 years (SD 12.2) versus 24.0 years (SD 13.8) in those without stroke (P<0.0001). Patients with injury to the head or neck were more likely to have a stroke compared to those with other types of injuries (Table). The 4-week stroke incidence after head or neck injury was 0.07% (95% CI 0.05, 0.09) among adults and 0.005% (95% CI 0.001, 0.01) among children (P<0.0001). Of the 197 stroke cases, 16% (95% CI 11, 22) had a diagnostic code for cranio-cervical dissection.

Conclusions:
A 4-week stroke incidence of 0.013% suggests that 260 young people have an ischemic stroke after a traumatic injury every month in the U.S. Further research is needed to identify the highest risk groups, such as those with head or neck injury, and opportunities for stroke prevention.
Abstract T MP68: The Concept of Frailty in Association with Patient Outcomes among Ischemic Strokes
Authors: Sucharew Heidi , Reeves Mathew , Khoury Jane C , Alwell Kathleen , Moomaw Charles J , Kissela Brett M , Woo Daniel , Flaherty Matthew L , Adeoye Opeolu , Khatri Pooja , Ferioli Simona , Kleindorfer Dawn O
Published: July 2021

Introduction:
The concept of frailty as a state of decreased reserve and cumulative decline in multiple physiologic systems resulting in poor outcomes is well accepted in geriatrics. However, the impact of frailty on outcomes after ischemic stroke is less well understood. Our objectives were to identify a frailty score based on age-related deficits and to determine its association with stroke outcomes.

Methods:
Ischemic strokes within a biracial population in the Greater Cincinnati area in 2005 were identified. Research nurses extracted information from the medical charts including 35 age-related deficits that included comorbidities and admission lab values. A frailty score was identified using exploratory factor analysis to eliminate deficits with poor fit, followed by a two-parameter logistic latent trait model. Logistic regression was then used to evaluate association between frailty score (tertiles) and in-hospital mortality (death or discharged to hospice), dependent at discharge (mRS ≥ 2), discharge home and 1 year mortality. Models adjusted for age, race, sex, NIHSS, and pre-stroke mRS.

Results:
A total of 2,092 first event ischemic cases were identified in 2005. The median age was 72 years, 23% black, 56% female, median NIHSS 4 (IQR 2, 8). Of the 35 deficits, 15 loaded on the frailty factor: assisted living, aid to walk, dementia, depression, congestive heart failure, cardiac pacemaker, carotid artery disease, coronary artery disease, atrial fibrillation, impairment from prior stroke, hypertension, diabetes, elevated cholesterol, peripheral vascular disease, and abnormal hemoglobin. Higher frailty score was associated with increased in-hospital mortality, poor discharge mRS, and 1 year mortality (Table 1).

Discussion:
We created a frailty score based on 15 age-related deficits and showed strong association with poor outcomes. This frailty score could be useful for clinical care, as well as research, to identify age-related physiologic decline.
Abstract T MP69: Do Neighborhood Characteristics Elevate Post-Stroke Mortality?
Authors: Osypuk Theresa , Moon J. Robin , Ehntholt Amy , Glymour M Maria
Published: July 2021

Background:
Neighborhood context predicts long-term mortality of both stroke patients and stroke-free general community populations. If the association of neighborhood characteristics and mortality is stronger among stroke survivors than in the general population, it would implicate stroke-care-specific mechanisms. We hypothesized that neighborhood risk factors predict post-stroke mortality, and that these associations are stronger than in stroke free populations.

Methods:
Health and Retirement Study participants age 50+ free of stroke at baseline (n=15,974) were followed up to 12 years for incident stroke (1,809 events) and mortality (5,578 Deaths). We compared mortality hazard ratios associated with both objective neighborhood measures (census tract poverty, racial composition, residential stability, and foreign born) and self-reported neighborhood social integration (social ties and informal socializing), among stroke-free and post-stroke individuals, using covariate adjusted Cox models.

Results:
Stroke predicted elevated mortality (HR= 1.98; 95% CI: 1.85, 2.13), as did residence in census tracts in the highest quartile of % non-white (HR= 1.12; 1.22, 1.04). Percent non-white was more strongly related to mortality among stroke patients (HR= 1.32; 1.52, 1.14) than among stroke-free individuals (HR= 1.08; 1.00, 1.18; p for interaction=.013). Low neighborhood social integration also significantly predicted mortality, but the relative effects were similar for stroke survivors and stroke-free individuals.

Conclusions:
In this large cohort, neighborhood racial composition and social integration predicted survival. Neighborhood racial composition had larger effects on post-stroke survival than on survival in the general population. Post-stroke care available to residents of non-white neighborhoods may be less effective than care available to residents of predominantly white neighborhoods.
Abstract T MP86: Quality of Stroke Care in India: the Indo-US Stroke Project
Authors: Singhal Aneesh B , Sylaja PN , Kaul Subash , Khurana Dheeraj , Padma Vasantha , Thankachan Tijy K , Arora Deepti , Titus Pritty , Schwamm Lee H , Pandian Jeyaraj D
Published: July 2021

Background:
There is limited information concerning the quality of care and outcomes after stroke in developing countries like India. We investigated stroke quality in 5 high-volume academic tertiary hospitals across India, using quality measures derived from the AHA GWTG-Stroke program.

Methods:
The Indo-US Stroke Registry and Infrastructure Development Project, jointly funded by NINDS and the Indian Department of Biotechnology, currently has 5 centers in India and one in the US. Trained MD co-investigators and research coordinators prospectively collect data on consecutive adult patients admitted with imaging-confirmed ischemic stroke <2 weeks after symptom onset. Data is entered into a central web-based electronic database.

Results:
From 11/12 to 6/13, 967 patients were enrolled across the 5 Indian centers. Mean age 59.7±14y (range 20-92), 66% males. Eighty-four (8.7%) arrived within 3h and 50 (5.2%) arrived 3.0-4.5h after onset and proved eligible for thrombolysis; of these, 104 (78%) received IV or IA thrombolysis. NIHSS was documented prospectively in 39%, retrospectively in 41%, and not obtained in 20%. Before the end of Day 2, 91% received antithrombotic therapy and 46% received DVT prophylaxis. Dysphagia screening prior to oral intake was completed in 760 patients (79%), of whom 34% failed the screen and 24% remained NPO during hospitalization. In-hospital complications included pneumonia (16%), DVT/PE (4%), and UTI (14%; nearly all had indwelling Foley catheters). LDL cholesterol was documented in 86%. Discharge medications included antiplatelets (85%), anticoagulants (22%), and lipid lowering agents (76%). Of 105 patients with atrial fibrillation, 59 (44%) were discharged on anticoagulation. Discharge education included information about stroke risk factors and awareness (93%), emergent evaluation for new symptoms (53%), prescribed medications (93%), smoking cessation counseling (13%). In-hospital mortality was 6%, 40% were assessed for rehabilitation but 83.5% were discharged home .

Conclusions:
These early data provide insights about stroke quality of care in large academic Indian hospitals, and suggest underuse of guideline-based care. Opportunities exist for establishing programs like GWTG-Stroke in India.
Abstract T MP88: Algorithms for Identification of Acute Stroke Hospitalizations in Medicare Data
Authors: Fuller Candace , Banerjee Arindam , Pankow James S , Lakshminarayan Kamakshi
Published: July 2021

Background:
Medicare claims (MC) are a source of nationwide data on various disease conditions including stroke. We developed and tested algorithms to accurately identify acute stroke hospitalizations in MC data using a population-based acute stroke hospitalization database.

Methods:
Data were obtained from year 2000 Minnesota Stroke Survey (MSS), a surveillance study of stroke incidence and prevalence in the Minneapolis-St. Paul metro area. Stroke cases were ascertained with acute stroke discharge codes (ICD-9 431, 432, 434, 436, 437) and validated with clinical criteria after medical record abstraction. Stroke was defined as a neurological deficit of vascular origin lasting at least 24 hours or until death. MSS subjects aged 65-74 years (n=464) were linked to MC hospitalization claims. A random sample of non-stroke MC hospitalization claims was included in the dataset (n=1,384). We randomly selected 2/3 of the data for training and 1/3 for testing. Classification and Regression Tree (CART) models were used for algorithm development. We report algorithm sensitivity (SN), specificity (SP), likelihood ratio positive and negative (LR+/LR-), discriminative performance (AUC) and total misclassification error (ME).

Results:
The CART algorithm showed high discriminative performance on training and test data (Table). Test data performance was: SN=91%, SP=95%, LR+=19.97, LR-=0.09, AUC 0.93, ME=6%. The algorithm automatically selected these MC variables as informative about stroke hospitalizations: diagnostic group code, hospital discharge codes, hospital discharge destination, number of private room days, physical and occupational therapy charges.

Conclusion:
Our CART algorithm shows good performance and is available for validation with other data sets. Potential utility of developed algorithms has broader implications for stroke epidemiology and health services research.
Abstract T MP90: Effect of Race and Early Blood Pressure Control on Long-Term Blood Pressure Control and Recurrent Stroke Risk
Authors: Nguyen-Huynh Mai N , Tucker Lue-Yen , Klingman Jeff , Young Joseph D , Sidney Steve
Published: July 2021

Background:
Many studies have documented racial disparities in blood pressure (BP) control. However, little is known about how race and short-term BP control affect hypertension control in the long-term and recurrent stroke risk.

Methods:
We utilized data on patients with ischemic stroke included in a randomized quality improvement trial focused on secondary stroke prevention, conducted in 14 Kaiser Permanente hospitals in Northern California 01/2004-09/2006 (QUISP). Patient characteristics, diagnoses, health care utilization, BP measurements and medications were gathered from administrative and clinical databases. We used multivariable logistic regression to examine race and 6-month BP control (<140/90 mmHg) as predictors of BP control and stroke recurrence at 1 and 5 years after index event among patients, adjusted for socio-economic status, age, gender, and risk factors, and dementia.

Results:
There were 2971 patients in the initial cohort including 66% non-Hispanic white, 14% Blacks, 11% Asian, 8% Hispanic, and 1% other. BP was controlled in 74% of cohort at 1 year, and 80% at 5 years (Table). Having BP control at 6 months post-stroke was associated with having BP control both at 1 year (OR=2.33, 95% CI 1.83-2.96, p<0.001) and 5 years (OR=1.98, 95% CI 1.45-2.68, p<0.001) follow-up. Blacks (OR=0.71, 95% CI 0.51-0.98, p=0.04) were less likely to have BP controlled at 1 year compared to whites. Blacks had an increased risk of recurrent stroke at 1 year (OR=1.70, 95% CI 1.07-2.70, p=0.02) post index event.

Conclusion:
Early BP control was associated with long-term BP control. Despite having equal healthcare utilization, and antihypertensive prescriptions, blacks had poorer long-term BP control and higher recurrent stroke risk compared to whites. Greater efforts in reducing racial disparities in early hypertension control after stroke are needed.
Abstract T MP91: Association of Gender-Age Interaction With Outcome After Intracerebral Hemorrhage in Multiple Ethnicities
Authors: James Michael , Sekar Padmini , Langfeld Carl , Moomaw Charles , Worrall Bradford , Sheth Kevin , Frankel Michael , Martin Sharyl , Osborne Jennifer , Woo Daniel
Published: July 2021

Introduction:
Female sex is associated with better functional outcome in preclinical models of intracerebral hemorrhage (ICH). However, recovery is impaired after ischemic stroke as women age, relative to men, independent of stroke severity. We sought to define gender-age interactions for long-term neurological outcome after ICH across ethnicities.

Methods:
Clinical and radiographic data from subjects in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH; NS069763) and Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS; NCT00930280) studies prior to January 2013 were used. Relationships between sex, age, and outcome in 473 black, 437 Hispanic, and 801 white subjects were evaluated after ICH using multivariable logistic regression analysis. Poor outcome was defined as modified Rankin ≥3 at 3 months after ICH. Age was modeled as a quadratic; gender-age interaction was modeled as centered cross-products to reduce collinearity.

Results:
Evidence of an interaction effect for gender and age on outcome at 3 months was found after ICH (p=0.054). The figure shows overlayed plots of the interaction between gender and age with regard to poor outcome. Women had lower risk of poor outcome at younger ages but higher risk at older ages. When testing this effect in different ethnicities, there was significant evidence of a gender-by-age interaction (p=0.005) within black patients.

Conclusion:
We found evidence of better outcomes in younger aged women than men, independent of comorbidities and severity of stroke. This trend reversed in elderly women. The gender-age interaction in outcome after ICH, seen especially in black subjects, may result from hormonal changes due to aging. Future studies to evaluate the impact of estrogen and progesterone in age/ethnic groups as a potential mediator of outcome are currently under design.
Abstract T MP93: High 1- to 5-Year Mortality and Morbidity in Stable Patients Without Early Complications After Stroke or TIA
Authors: Swartz Richard H , Fang Jiming , Kapral Moira K
Published: July 2021

Introduction:
Stroke prevention efforts are increasingly focused on early risk after TIA/stroke to facilitate initiation of risk-modifying therapies. Few clinics can follow patients for years after an event, yet even stable patients may remain at high risk.

Hypothesis:
Patients discharged from hospitals with TIA/stroke who survive 90 days without complications, will remain at high risk of adverse outcomes for years after their event.

METHODS:
We analyzed data from the Registry of the Canadian Stroke Network. We identified all patients discharged from hospital with a diagnosis of TIA or ischemic stroke from 2003-2011. We excluded patients with any event within 90 days of discharge: any hospitalization, stroke, TIA, myocardial infarct (MI), death, long-term care (LTC) admission. A composite outcome of stroke, MI, death or LTC admission was examined from 1 to 5 years after the first 90 days.

RESULTS:
30% of patients (n=10, 293) were excluded for events in the first 90 days. Of the remaining 70% (n=24,011) event-free at 90 days, 53% were male and mean age was 69.9 +/- 14.1. 61% had ischemic stroke and 39% TIA. 86% were mild (Canadian Neurological Scale (CNS)>=8), 9.9% were moderate (CNS 5-7) and 4.1% were severe (CNS 0-4). The combined outcome (stroke, MI, LTC or death) occurred in 9.4% of this “mild” group one year AFTER the highest risk period was over and in 35% by 5 years. Death was the most common event (1 year: 5.4%; 5 years: 26.8%), followed by stroke (1 year: 2.6%; 5 years: 7.9%). Among those who survived the first year, the event rate remained at 5% per year at both 3- and 5-years.

CONCLUSIONS:
Patients who survive the initial 90-day period after TIA/stroke without events are similar to those seen routinely in stroke clinics. These patients remain at high risk of negative outcomes: almost 10% patients have died, or had a stroke, MI or LTC admission in the first year and 5% more occur per year, up to 5 years. Strategies for efficient and effective long-term follow-up to modify these risks are needed for stroke clinic patients.
Abstract T P100: Effect of Carotid Endarterectomy on Cerebral Hemodynamics Using Quantitative Magnetic Resonant Angiography
Authors: Du Xinjian , Amin-Hanjani Sepideh , Charbel Fady
Published: July 2021

Objective:
To examine the effect of carotid endarterectomy (CEA) on cerebral hemodynamics using quantitative magnetic resonance angiography (QMRA).

Methods:
A total of 42 patients with severe carotid artery stenosis were studied (6 patients had asymptomatic stenosis). 6 of 42 patients had contralateral carotid artery occlusion. Pre- and post-op blood flow measurements of major cerebral arteries were performed using QMRA (NOVA,Vasol, Inc.).

Results:
Patients ranged from 39 to 85 (mean 66) years old, 17 female. Ipsilateral carotid artery flow was significantly increased after CEA, 253 ± 110 ml/min compare to 159 ± 79 ml/min (p<0.001). Middle cerebral artery (MCA) flow was not significantly increased (p=0.11), 127 ± 39 ml/min versus pre-op 115 ± 33 ml/min after CEA. Ipsilateral anterior cerebral artery (ACA) flow direction of 6 patients changed to anterograde, 5 patients’ ipsilatral posterior communicating artery (PCOM) flow direction changed to posterior, 1 patient had both flow direction of Ipilateral ACA and PCOM changed after CEA. Post-op Ipsilateral hemisphere flow (IHF), defined as the sum of MCA, ACA2, and PCA flows, was increased (p=0.05) from 220 ± 45 ml/min to 251 ± 83 ml/min.

Conclusions:
Carotid stenosis can result in ICA flow compromise, and CEA can increase the flow rate of the ipsilateral carotid artery significantly. However, the collateral capacity of the circle of Willis appears to be the more important determinant of Intracranial ipsilateral MCA flow.
Abstract T P103: Vertebral Artery Hypoplasia Should Play Important Role for Posterior Circulation Ischemia
Authors: Mitsumura Hidetaka , Komatsu Teppei , Miyagawa Shinji , Sakamoto Yuki , Hirai Toshiaki , Sengoku Renpei , Kono Yu , Kamiyama Tsutomu , Iguchi Yasuyuki
Published: July 2021

Purpose:
Vertebral artery hypoplasia (VAH) is congenital anatomical variation, which is frequently observed in clinical situation. In previous reports, it was not unclear whether VAH was the independent risk factor for posterior circulation ischemia. The purpose of this study is to evaluate an impact of VAH on posterior circulation ischemia.

Methods:
Subjects were patients with acute ischemic stroke who underwent brain MRI and carotid ultrasonography. The diameter of vessel and flow velocities of extracranial vertebral artery (VA) was measured by carotid ultrasonography. Diagnostic criteria of VAH was as follows: 1) diameter of VA <2.5mm, 2) diameter of VA <3.0mm and a side difference equal or greater than 1:1.7, 3) diameter of VA <3.0mm, peak systolic velocity <40cm/sec, and resistance index value >0.75. We divided all patients into three groups by the location of the acute ischemic stroke evaluated by MRI: ischemic lesion on posterior circulation (P group), on anterior circulation (A group), and multiple lesions on both anterior and posterior circulation (AP group). Then, the prevalence rate of VAH was compared between P group and A+AP group. In order to evaluate independent factors of VA occlusion, we conducted multivariate regression analyses.

Results:
We evaluated a total of 129 consecutive patients (87 male, median age; 71 years). P group was 36 patients, and A+AP group was 93 patients. VAH was seen in 39 patients (31.5%), and VA occlusion was found in 15 patients. The prevalence rate of VAH in P group (44.4%) was significantly higher than in A+AP group (24.7%, p=0.034).

In univariate analysis, the patients with VA occlusion were higher rates of hypertension (p=0.066), large artery atherosclerosis (p=0.095), posterior circulation ischemia (p=0.001), and the presence of VAH (p=0.038). Multivariate regression analysis demonstrated that large artery atherosclerosis (odds ratio, 6.3; 95% confidence interval, 1.3-30.1), posterior circulation ischemia (odds ratio, 12.0; 95% confidence interval, 2.8-51.2) and VAH (odds ratio, 4.2; 95% confidence interval, 1.2-15.0) were independently associated with the presence of VA occlusion.

Conclusion:
VAH was independent factor of VA occlusion, and should be associated with posterior circulation ischemia.
Abstract T P111: The Use of Smartphone Applications to Provide Information to Patients and Their Carers
Authors: Floyd Christopher N , Williams Steven E , Williams Michelle C , Hoffman Alex , Rudd Anthony
Published: July 2021

Introduction:
Patients and their carers find it difficult to access information following a stroke or transient ischaemic attack (TIA). To improve the provision of this information, the Royal College of Physicians' National Clinical Guideline for Stroke (4th edition, 2012) was accompanied by a booklet designed for patients and their carers. Dissemination of the information was enhanced with the development of smartphone applications that are freely available on both iOS and Android devices. Here we present a report into the use of these applications.

Methods:
The applications were designed to reflect the content of the booklet with the information primarily accessed via a scrollable index, with separate sections to provide information on support services available in the UK. Data on usage were anonymously collected during the first eight months following global release. The hypothesis that users would preferentially access information on particular topics was tested.

Results:
The smartphone applications were downloaded a total of 2,046 times (1,503 iOS and 543 Android), of which 61.3% was by individuals in the UK. Topics covering rehabilitation were most commonly accessed, accounting for 33.2% of all application usage. Within this category, ‘Care after a stroke or TIA (principles)’ represented 14.5% of use and ‘Sex after stroke’ represented 13.1%. The next most commonly accessed category was ‘Specialist early care’ with 25.0% of total application usage, of which the topic ‘Brain scan’ accounted for 24.5%. Overall, the most commonly accessed index item was titled ‘Stroke, what is it?’, and this represented 8.27% of total application usage. Within the category of support services, 45.6% of usage was directed towards accessing information on ‘Local health services and stroke clubs’.

Conclusions:
Smartphone applications are useful adjuncts for the dissemination of information to patients and their carers following a stroke or TIA. Users exhibit a preference for information on rehabilitation and specialist early care. Future publications should target these topics for more in-depth discussion.
Abstract T P12: Pretreatment With IV tPA Does Not Impact Outcome in Patients Undergoing Endovascular Stroke Treatment
Authors: Shah Kavit B , Tita Anne C , Zaidi Syed F , Jumaa Mouhammad A
Published: July 2021

Objective:
We sought to compare the clinical outcomes of patients who underwent Intra-arterial Treatment (IAT) IAT with or without IV tPA pretreatment at our center.

METHODS:
We reviewed records of AIS patients who underwent IAT at our center from July 2012 - Jul 2013. The following data were collected and analyzed: patients’ demographics, baseline characteristics, treatment times and methods, rate of symptomatic and asymptomatic intracerebral hemorrhage, and favorable clinical outcome defined as modified Rankin score (mRS) ≤ 2 at 90 days or at last observation for patients treated within the last 89 days

RESULTS:
Seventy consecutive patients who underwent IAT were identified. Overall 33 (47.1%) patients had favorable outcome. There were 15/70 (21.4%) asymptomatic and 2/70 (2.8%) symptomatic hemorrhages following IAT. Pretreatment with IV tPA 32/70 (45.7%) had no significant impact on the rate of asymptomatic (6/32, 18.7% versus 9/38, 23.6%) or symptomatic (1/32, 0.03% versus 1/38, 0.03%) ICH, p=0.8. There were no instances of retroperitoneal or groin hemorrhagic complications in either group. Rate of recanalization was comparable between the IV tPA (26/32, 81.2%) and non-IV tPA groups (32/38, 84.2%).Also the rate of favorable outcome was comparable between the IV tPA pretreatment (15/32, 46.8%) and non-IV tPA (18/38, 47.3%) groups. In a multivariate analysis, young age was the only predictor of favorable clinical outcome in this cohort (OR: 0.93; 95%CI: 0.88-0.99; p=0.03).

CONCLUSION:
Our results suggest that IV tPA pretreatment has no impact on eventual patient outcome following endovascular stroke treatment. This finding may be helpful in designing future randomized trials.
Abstract T P124: Effect of Neuromuscular Magnetic Stimulation on the Hemiplegic Upper Extremity in Subacute Stroke Patients
Authors: Sohn Min Kyun , Lee Hyun-keun
Published: July 2021

Objects:
To investigate effects of neuromuscular magnetic stimulation (NMMS) on the wrist and hand muscle comparing with neuromuscular electric stimulation (NMES) in subacute stroke patients.

Subject and Method:
20 Patients with subacute hemiplegic stroke were randomized into 2 groups; NMMS group (N=10) and a NMES group (N=10). Stimulation delivered 10-minute session, twice a day, 5 days a week for 3 weeks in both group to the affected forearm in alternating extensor/flexor muscle. The stimulation parameters required to produce slow movement through the full range at maximum patient comfort: NMMS (10 Hz, 10 s stimulation, 20 s rest, 10 min treatment time and 2,000 total pulse) and NMES (a symmetrical biphasic waveform, 30 us pulse width, 40 Hz).The hand function (Box and blocks test, Jebson-Taylor hand function test), hand performance (Wrist and hand muscle strength, grip power) and spasticity were done at baseline, after 1 week, and at the end of the treatment period (after 3 weeks). Repeated measurement ANOVA was used for statistical analysis.

Results:
There were statistically significant improvements in measures of wrist flexor and hand flexor/extensor strength over the treatment period (p<0.05), but not significantly different between the groups. Although box and block test improved at 3 weeks in both groups, this was not statistically significant. Other measured outcome were not significantly improved.

Conclusions:
The both NMMS and NMES improves wrist and hand muscle strength in subacute hemiplegic stroke patients, with no significant difference between the stimulation. Therefore magnetic stimulation of peripheral muscle could be useful as much as a electrical stimulation. However, long term period follow-up was needed.
Abstract T P133: Hot and Humid in Alabama: Atmospheric Parameters and Stroke Admissions
Authors: Bavarsad Shahripour Reza , Tsivgoulis Georgios , Sands Kara A , Lyerly Michael J , Kumar Geyanendra , Bitaraf Saeid , Sisson April , Alexandrov Anne W , Alexandrov Andrei V
Published: July 2021

Background&Purpose:
evidence is conflicting on the effects of atmospheric conditions on the incidence of acute ischemic stroke (AIS). Since acute stroke patients are often brought to hospitals in clusters, we sought to examine the correlation of local weather parameters with AIS admission rates in a region of the United States affected by wide fluctuations in temperature and humidity.

Subjects&Methods:
Basic patient demographics, stroke severity and admission dates were collected from our prospectively collected registry of consecutive acute ischemic strokes at our tertiary center. Atmospheric temperature (°F) and humidity (%) levels were obtained for each month for 3 consecutive years (2010-2012) using http://weatherspark.com/averages publicly available data.

Results:
A total of 2014 consecutive AIS patients were admitted (47% women, mean age 63±15 years, median NIHSS 5, IQR 8). Ischemic stroke admissions increased linearly with both minimum (r=0.52; p=0.001) and maximum (r=0.51; p=0.001) temperature increases. Maximum humidity levels were negatively correlated with AIS admissions throughout the year (r= - 0.39; p=0.010) while minimum humidity levels yield opposite correlation with IS admissions (r=0.43; p=0.007). There was no effect of age, gender or race on these correlations. When the different seasons were evaluated separately, the strongest correlation between lower humidity levels and IS admissions was noted during summer (r=0.474; p=0.197), while higher humidity levels appeared to correlate more strongly with hospital admissions during autumn (r= - 0.596; p=0.090).

Conclusions:
our study showed that humidity levels and temperature rises may affect the number of acute ischemic stroke admissions in a humid subtropical climate. Non-random clustering of IS admissions during the year underscores a potential role for atmopsheric parameters in determining allocaton of resources to treat stroke.
Abstract T P145: Physiological Parameters and Radiological Findings of Cerebral Small Vessel Disease
Authors: Doijiri Ryosuke , Saito Kozue , Motoyama Rie , Tsutsumi Yukiko , Uchiyama Shinichiro , Matsumoto Masayasu , Fujishiro Kentaro , Tadokoro Yasuhiro , Kitagawa Kazuo , Takekawa Hidehiro , Yamamura Osamu , Tagaya Masafumi , Nagatsuka Kazuyuki
Published: July 2021

Background and Purpose:
Lacunar infarction and intracerebral hemorrhage (ICH) are closely related. Although they are classified as different stroke subtypes, both are associated with cerebral small-vessel disease (CSVD). Previous studies showed a positive correlation of CSVD with physiological parameters such as pulse wave velocity (PWV) or with radiographical findings such as cerebral microbleeds (CMB); however, the role of these parameters remains controversial. Therefore, we assessed whether there is a relationship between stroke subtypes and these potential CSVD-related parameters.

Methods:
In a multicenter, prospective study from 8 hospitals, we enrolled 342 patients with a history of cerebral infarction or ICH who underwent both carotid ultrasound and MRI examination between February 2011 and December 2012. Ischemic stroke subtypes were determined based on the Trial of Org 10172 in Acute Stroke Treatment criteria, and patients with small vessel occlusion (SVO) or large artery atherosclerosis (LAA) were included in this study. We evaluated the PWV, ultrasonographic parameters [max-IMT, plaque score, pulsatility index (PI), and the diameter of common carotid artery (CCA)], and MRI findings [periventricular hyperintensity (PVH) and CMB]. The severity of PVH was determined according to the Fazekas classification.

Results:
Of 342 patients, 130 (38%) were classified into the LAA group, 64 (19%) into the ICH group, and 148 (43%) into the SVO group. There were no significant differences in the parameters between the SVO and ICH groups; however, the parameters of the SVO or ICH groups were different from those of the LAA group. After adjustment for vascular risk factors, the following parameters in both SVO and ICH groups were significantly different from those in the LAA group: lower plaque score, higher PI of the internal carotid artery (ICA), higher PVH grade, and greater CMB frequency.

Conclusion:
The SVO and ICH groups showed alterations in imaging parameters reflecting the underlying pathophysiology of CSVD, including lower plaque score, higher PI of ICA, greater CMB frequency, and higher PVH grade, compared with those of the LAA group.
Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors
Authors: Rexrode Kathryn M , Mitchell Braxton D , Ryan Kathleen A , Kittner Steven J , Ay Hakan , Wassertheil-Smoller Sylvia W , Rundek Tatjana
Published: July 2021

Introduction:
The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described.

Hypothesis:
We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities.

Methods:
The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke.

Results:
Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70.

Conclusions:
In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.