bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP89: A Pilot Project To Reduce Futile Ich Transfers Across A Large Hospital System
Authors: TOUMBS Randi R
Published: February 2022

Introduction:
Academic medical centers (AMCs) that are part of a large hospital system often act as the central facility for transfers and high acuity stroke cases which enhances the quality of care for critically ill patients. Mortality is an important metric monitored by CMS and other quality programs. Volume and acuity are higher at AMCs compared with sister facilities making it necessary to appropriately triage patients and accept transfers that would benefit from a higher level of care (HLOC) and reduce the transfer of futile cases. Stroke patients that are transferred and die within 48 hours (early death) of admission may be a valuable population to examine to determine if transfer is futile.

Methods:
Patients with DRG codes for ischemic and hemorrhagic strokes admitted to an AMC from July 2018-June 2020 were identified. Data were used to calculate mortality rates based on overall, transfer, and early death status. Transfer early death (TED) patients are defined as those who die within 48 hours of transfer into the AMC. Stroke characteristics (type, ICH volume, NIHSS, etc.) were also analyzed.

Results:
In our AMC, the total stroke mortality rate was 13% from July 2018-June 2020 (276 deaths out of 2,145 patients). There were 923 transfers of which 76 were TED (8%). Of the 76 TEDs, 31 (41%) were from within our health system, 45 (59%) were outside hospital transfers, and none received intervention. Median age of TED was 67, 39% were > age 70, median NIHSS was 27, 80% were ICH patients, and 63% had an ICH score 4-6 prior to transfer. The mean volume of ICH was 68mL (SD=55.2). Prior to transfer, one patient was DNR.

Conclusions:
Transfers of stroke patients with large ICHs represent a subpopulation to target for quality improvement. An IRB approved QI project has been designed to initiate goals-of-care discussions with families of catastrophic ICH patients by our AMC stroke team via phone/video-chat prior to transfer. The primary outcome is to reduce the transfer of ICH patients who would not benefit from a HLOC. This would potentially increase bed availability for patients that could benefit and improve resource utilization across hospitals. This project is aiding a multidisciplinary process review and implementation of futility guidelines within the system.
Abstract TP95: Characterization And Comparison Of Hospitalization Outcomes Between Symptomatic And Asymptomatic Urinary Tract Infection In Acute Ischemic Stroke Patients
Authors: Li Wenyang , Coskun Elif Pinar , LEE Jessica
Published: February 2022

Background:
Urinary Tract Infection (UTI) has been associated with increased cost of care and poor outcomes in stroke patients. Guidelines from the Infectious Disease Society of America do not support treating asymptomatic UTI in the absence of objective markers of infection.

Aims:
Characterize demographics and hospitalization outcomes of symptomatic (sUTI) and asymptomatic (aUTI) in stroke patients compared to a control group without infectious complication.

Method:
This is a single center retrospective cohort study using the 2019 ischemic stroke database at the University of Kentucky. Cases were defined as patients with confirmed UTI on urine culture or urinalysis, and without other infections. Cases were subdivided into sUTI (subjectively endorsing UTI symptoms or objective vitals suggestive of infection) and aUTI group (reason for urine studies being encephalopathy or leukocytosis without fever). Controls were defined as patients without evidence of infection, and matched to the case group by age and sex. Demographics (age, sex, and stroke mechanism) were compared using Chi-squared analysis. Outcomes included length of stay (LOS), change in pre-hospital to discharge modified Rankin Scale (delta mRS), delta NIHSS (difference between admission and discharge NIHSS), and % change in NIHSS ((highest NIHSS -lowest NIHSS)/admission NIHSS)). Mean and standard deviation between the 3 groups were compared using ANOVA.

Results:
A total of 120 cases were identified as having UTI (sUTI = 35; aUTI = 85), with nearly all receiving antimicrobials. No difference in demographics was observed between sUTI and aUTI, except for stroke mechanism (p=0.007 for chi-squared comparison of TOAST classification). Both sUTI and aUTI had greater morbidity as defined by delta mRS compared to control (p=0.0066; p=0.0001 respectively), but not to each other (p=0.0625). Only sUTI resulted in longer LOS compared to control (p=0). No difference in delta or % change NIHSS was observed between the 3 groups.

Conclusion:
Both sUTI and aUTI were associated with poor outcome in mRS, which may suggest impaired stroke recovery. Withholding antibiotic treatment in aUTI, as suggested by IDSA guidelines, may lead to worse outcomes. Further study is needed to determine the impact of non-treatment.
Abstract WMP104: Race And Regional Disparities In Prevalence Of Poor Metabolic Health Among Community Dwelling Adults With Stroke: Nationwide Analysis Of 2019 BRFSS Data
Authors: Vahidy Azfar A , Pan Alan P , Bako Abdulaziz T , Vahidy Farhaan S , Ifejika Nneka
Published: February 2022

Introduction:
High burden of Metabolic Syndrome (MS) results in incident stroke and poor outcomes. We report contemporary national estimates of stroke prevalence and quantify MS burden and its socio-demographic associates among stroke individuals.

Methods:
We analyzed 2019 Behavioral Risk Factor Surveillance System data; a nationally representative survey of health-related conditions and behaviors among community dwelling adults. We identified individuals with self-reported stroke and flagged 4 MS indicators (diabetes, hypertension, BMI ≥ 25 kg/m
2
, hypercholesterolemia). Individuals with ≥ 2 features were categorized as High MS (HMS). We compared socio-demographic characteristics (age, sex, race, education, income, marital and employment status, stroke belt residence) and healthcare utilization (insurance status and frequency of healthcare visits) among HMS and no-HMS groups. We fit survey design logistic regression models with appropriate sampling weights and report national estimates of stroke prevalence and HMS associates.

Results:
In 2019, there were 8,570,876 adults (≥ 18 years) with stroke in the US; translating into a nationwide prevalence of 3.4% (7.9% among ≥ 65 years). Overall, 94.4% had at least one MS feature; 77.4% had HMS. Advanced age, male sex, non-Hispanic Black (NHB) race and residence in stroke belt region were associated with HMS. Participants with high income (≥ $75,000) and health insurance coverage were less likely to have HMS. In the fully adjusted model, advanced age; Asian American / Pacific Islander race and Hispanic ethnicity (vs. Non-Hispanic White) and residence in the US stroke belt had higher likelihood of HMS (Figure). Healthcare utilization patterns and sex were not significantly associated with HMS. Updated 2020 BRFSS data will be presented.

Conclusion:
Racial and regional disparities exist in HMS burden among stroke individuals. Targeted MS prevention and management measures are needed for high-risk populations.
Abstract WMP108: Prevalence Of High-Risk Aortic Arch Atherosclerosis Features Among Patients With Embolic Stroke Of Undetermined Source
Authors: Boyko Matthew , Chaturvedi Surbhi , Beland Benjamin , Najm Mohamed , Demchuk Andrew M , Menon Bijoy K , Almekhlafi Mohammed
Published: February 2022

Introduction:
Embolic stroke of undetermined source (ESUS) comprises a heterogenous group. There is a need to further identify etiologies within this group to guide management strategies. We examined the prevalence of aortic arch atherosclerosis (AAA) in ESUS patients on CT angiography (CTA) to characterize high-risk plaque features.

Methods:
All patients from two prospective multicenter studies (INTERRSeCT and PRove-IT) were included if the CTA adequately imaged the proximal aortic arch and the etiology was recorded. Three independent readers analyzed the following AAA plaque features on CTA at the time of acute ischemic stroke: 1) thickness in mm (radial measurement at thickest point); 2) morphology (Figure a-c): none, smooth, ulcerated, or protruding; 3) location within the aortic arch (proximal, transverse, or distal); and 4) calcification (Figure a, d-f): none, single small, multiple small, single large, or diffuse extensive. Reader disagreement was resolved by consensus.

Results:
We included 1063 patients, of which 293 (27.6%) had ESUS (mean age 67.5 years; 46.4% men). The mean AAA thickness was significantly larger in ESUS versus non-ESUS patients (3.8 vs 3.0 mm, p<0.0001). The ESUS group had a significantly higher proportion of ulcerated or protruding plaques (17.4% vs 10.3%; risk ratio 1.7, CI
95
1.2-2.4, p=0.002). The location of AAA in the ESUS group was the ascending aorta in 37.9%, transverse arch in 42.3%, and descending aorta in 84.6%. Although AAA was mostly located in the distal aortic arch, ulcerated or protruding plaques were least common in the distal arch (p=0.002). There was no difference between ESUS and non-ESUS patients in plaque location (p=0.23) or calcification grade (p=0.092).

Conclusions:
ESUS patients had thicker AAA plaques and a higher prevalence of ulcerated or protruding plaques located more proximally within the aortic arch. High-risk plaque features could be a potential cause of acute ischemic stroke in the ESUS population.
Abstract WMP113: Protective Effects Of Adropin In Aged Mice Following Permanent And Transient Ischemic Stroke
Authors: Yang Changjun , Lavayen Bianca P , Pompilus Marjory , Sanz Brian D , Liu Lei , Larochelle Jonathan , Febo Marcelo , Butler Andrew A , Candelario-jalil Eduardo
Published: February 2022

Background:
Adropin is a peptide encoded by the
energy homeostasis associated gene
(
Enho
) highly expressed in the brain. Our unpublished data revealed robust effects of adropin on reducing neurovascular damage and behavioral impairments in young mice following stroke. However, it is unknown whether these protective effects of adropin are observed in aged animals after stroke.

Hypothesis:
Considering that aging is the most critical risk factor for stroke, we hypothesized that adropin provides neuroprotection in aged mice subjected to ischemic stroke.

Methods:
Aged (18-24 months old) male adropin knockout (
Enho
-/-
), adropin overexpressing transgenics (AdrTg), and their corresponding control littermates were subjected to permanent middle cerebral artery occlusion (pMCAO). Adhesive removal, nesting behavior, and novel object recognition test were conducted before and up to 14 days after MCAO. Infarct volume was quantified by MRI at 14 days post-MCAO. In a separate experiment, we utilized aged male
Enho
-/-
and AdrTg mice subjected to 30 min of transient MCAO (tMCAO). To investigate the potential therapeutic benefit of adropin in stroke, aged wild-type mice were randomly selected to receive a bolus injection of vehicle or synthetic adropin (900 nmol/kg; i.v.) at the onset of ischemia. Neurobehavioral tests were performed before and at 48h after stroke, and infarct size was measured by TTC staining at 48h.

Results:
Adropin deficiency consistently increased infarct volume and exacerbated neurological impairments in permanent and transient MCAO mice compared to
Enho
-/-
. In contrast, transgenic overexpression of adropin significantly improved neurological function compared to WT mice. Also, AdrTg mice displayed better recovery of recognition memory function, whereas

Enho
-/-

mice exhibited worse stroke outcomes compared to wild-type littermates following pMCAO. Similarly, treatment with synthetic adropin peptide resulted in a smaller stroke volume and better motor function recovery than vehicle-treated mice following tMCAO.

Conclusions:
These findings consistently show that transgenic overexpression of adropin or post-ischemic treatment with adropin peptide is neuroprotective in aged mice subjected to ischemic stroke.
Abstract WMP20: Association Of Periventricular And Deep White Matter Hyperintensity With Cognitive Performance In A Middle-aged Population
Authors: Hannawi Yousef , Vaidya Dhananjay , Yanek Lisa R , Kral Brian G , Becker Lewis C , Becker Diane M , Nyquist Paul A
Published: February 2022

Introduction:
White matter hyperintensity (WMH) has been associated with manual dexterity performance in apparently healthy middle-aged population. However, the relative effect of WMH topographic distribution on cognition remains unknown. We hypothesized that periventricular WMH (PVWMH) is more strongly associated with manual dexterity and cognitive measures compared to deep WMH (DWMH) given its proximity to the white matter tracts involved in motor and executive functions.

Methods:
Apparently healthy middle-aged participants in the Genetic Study of Atherosclerosis Risk with brain MRI and cognitive measurements were selected. Cognitive measures included delayed word recall short (DWRS) and long (DWRL), digit symbol substitution (DSS), word fluency (WF), digit span forward test (DSFT), backward (DSBT) and total (DSTS), and grooved peg board test (GPBT) including the dominant and non-dominant hand (GPBTD, GPBTnD). PVWMH and DWMH volumes were measured using semi-automated segmentation paradigm. The relative associations of these measurements with PVWMH and DWMH volumes as multiple measurements within the same individual further nested within families were determined using multilevel linear models adjusting for intracranial volume, age, sex and cardiovascular risk factors.

Results:
782 subjects were included (age 51.1±10.6, 58.4% female and 39% African American, PVWMH volume 437.4 [0-1646] mm
3
, DWMH volume 273.5 [76-665] mm
3
). Within the same subject, PVWMH showed greater association than DWMH with worse performance on GPBT, GPBTD, GPBTnD, DWRS, and DWRL (P=0.006, 0.01, 0.01, 0.01 and 0.03, respectively) after adjusting for age and other cardiovascular risk factors. There was no difference in the association of PVWMH versus DWMH volumes with DSS, WF, DSFT, DSBT, DSTS (P=0.19, 0.52, 0.13, 0.6, and 0.6, respectively).

Conclusions:
PVWMH shows greater association than DWMH with cognitive measures of manipulative manual dexterity and recall suggesting that PVWMH and DWMH may have different cognitive phenotypes in middle-aged population with cerebral small vessel disease.
Abstract WMP22: Association Of Life’S Simple 7 With Brain Imaging Outcomes Among Hispanics/latinos In The Hispanic Community Health Study/study Of Latinos And The Investigation Of Neurocognitive Aging Study: Preliminary Results
Authors: Trifan Gabriela , Cai Jianwen , Daviglus Martha L , Estrella Mayra L , Gardia-Bedoya Olga , Gallo Linda , Isasi Carmen R , Kaplan Robert , lamar melissa , Talavera Gregory A , Tarraf Wassim , Zeng Donglin , Stickel Ariana M , Gonzalez Hector , De Carli Charles , Testai Fernando D
Published: February 2022

Background:
Life’s Simple 7 (LS7) include not smoking, having a healthy diet pattern, adequate physical activity, healthy body weight, and healthy blood pressure, cholesterol, and blood glucose. Better cardiovascular health metrics, measured by increasing LS7 scores, was associated with improved cognitive function.

Purpose:
Investigate the effect of LS7 on brain imaging outcomes in Hispanics/Latinos participating of the SOL-INCA sub-study.

Methods:
Hispanics/Latinos adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) who participated in the SOL - Investigation of Neurocognitive Aging Magnetic Resonance Imaging (SOL-INCA MRI) ancillary study underwent 3T brain MR imaging. LS7 scores and brain volumes were calculated. Volumes of interest included total brain, total and regional grey matter (frontal, temporal, parietal, and occipital), total white matter, total CSF, lateral ventricle, and white matter hyperintensity (WMH). WMH values were log-transformed. All MRI volumes were residualized for total cranial volume prior to analysis. The influence of LS7 scores on MRI outcomes was investigated using linear regression analysis adjusted by baseline characteristics. These included sex, height, immigrant status and years of residence in the US, age at MRI scan, Hispanic/Latino background, level of education, household income, insurance status, and language preference.

Results:
A total of 1,534 participants (males 33%) were included in the study. The average age (mean±SD) was 60±10 and the average LS7 score 7±2. In the adjusted model, increasing LS7 scores were associated with larger cerebral white (β=1.40; p≤0.001) and frontal grey volumes (β=0.33; p≤0.001) as well as smaller CSF (β=-1.26; p≤0.001) and WMH volumes (β=-0.01; p≤0.001). The association of higher LS7 scores and better brain MR outcomes was observed in both males and females.

Conclusions:
Higher LS7 scores are associated with improved biomarkers of brain health. Further studies are necessary to determine if the anatomic changes observed correlate with cognitive performance.
Abstract WMP24: Plasma Proteomics Reveals Potential Biological Mechanisms Of Chronic Post-Stroke Depression
Authors: Zera Kristy A , Bidoki Neda H , Nassar Huda , Drag Lauren , Mlynash Michael , osborn elizabeth , Musabbir Muhith , Kim Da Eun , Mendez Maria , Lansberg Maarten G , Aghaeepour Nima , Buckwalter Marion S
Published: February 2022

Introduction:
Depression is common after stroke, and is a debilitating factor undermining recovery in approximately one third of stroke survivors. It is essential to understand the underlying mechanisms to develop better treatments. Such insight may come from identifying plasma proteins correlated with post-stroke depression. Previous work investigated inflammatory proteins.

Methods:
We recruited 85 subjects 5 months to 9 years after ischemic stroke, age >40, and able to perform cognitive testing. Mood was assessed with the Stroke Impact Scale (SIS3), transformed to a 100-point scale. Plasma was analyzed by O-link proteomics for 1011 proteins. Multivariable regression models were constructed to estimate SIS3 using proteomics and clinical data. Models were subject to bootstrapping for robustness, and cross-validation to ensure results were reported on subjects blinded during model training. Pearson correlation analysis identified linear associations between individual proteins and SIS3 scores. We also report differences in key proteins in subjects dichotomized into non-depressed (SIS3>63) or depressed (SIS3≤63) groups.

Results:
Proteomics results alone predicted SIS3 in multivariable models, and the best model also used age and time since stroke. A total of 180 proteins correlated significantly with SIS3. Plasma levels of IL-6 (p=0.0325), EGF (p<0.001) and TRIM5 (p=0.0011) were significantly elevated in subjects with post-stroke depression, while HPGDS was significantly reduced (p<0.001). There was no difference in plasma levels of IL-1ß (p=0.0830) or TNF (p=0.5287) between depressed and non-depressed subjects.

Conclusions:
We report that machine learning models can predict post-stroke mood from comprehensive plasma proteomics, and that age and time since stroke improves those models. Our findings also support other reports of elevated IL-6 in subjects with depression. We also identified proteins of interest including HPGDS (produces Prostaglandin D), EGF, or TRIM5 (upstream of NFkB) in post-stroke depression. Future studies are needed to replicate these findings, and studies in preclinical models may help uncover mechanistic relationships that could lead to new therapies.
Abstract WMP29: “Good Times”: Has The Change From Tissue Plasminogen Activator To Tenecteplase For Acute Ischemic Stroke Improved Treatment Times?
Authors: Robertson Betty , Steiner Nili , Wolber Nicole , Izzo Rachel , Figueroa Sonia , Nunez Nancy , Paletz Laurie B
Published: February 2022

Background:
Stroke is the leading cause of disability and the 5th leading cause of death in the US. The advent of tissue plasminogen activator (TPA) was a game changer in the treatment of acute ischemic stroke. Today at Cedars Sinai Medical Center, we have implemented the use of Tenecteplase (TNK) for our Code Brain patients, a more cost-effective, easier- to- use thrombolytic. TNK is non- inferior to TPA and studies show a potential benefit in reperfusion of large vessel occlusions (NEJM, 2018).

Hypothesis:
To decrease the ED and inpatient door-to-needle (DTN) times, and thrombolytic with thrombectomy (bridge) door-to-groin (DTG) puncture times, by June 20, 2021 using TNK, as measured by data acquired 6 months prior to TNK implementation (July 20, 2020 through January 19, 2021) and data acquired 6 months after TNK implementation (January 20, 2021 through June 20, 2021).

Implementation:
We performed a retrospective chart review of times for patients who received TNK alone and: for those who received bridge therapy after TNK implementation. These times were compared with 6 months of data prior to TNK implementation.

Results:
Our review of the data revealed that the median times for ED DTN, in-house DTN and bridge DTP were 46, 61.5, and 98.5 minutes respectively. Data for six months after the implementation of TNK reveals that the median times for ED DTN, in-house DTN and bridge DTP were 48, 51.5, and 88 minutes respectively.

Conclusions:
We discovered that although ED DTN times were unremarkable, our in-house DTN times and bridge DTP times markedly improved. In fact, for the first time, we have surpassed the American Heart Association benchmark of 90 minutes DTP times. We conclude that TNK is easier to administer, more cost effective, and decreased our treatment times for our in-house Code Brain patients who received TNK alone and our Code brain patients who received bridge therapy. We will continue to track and trend this data and seek out areas of improvement.
Abstract WMP31: Thrombotic Microangiopathy -? A Missed Diagnosis Of Cryptogenic Stroke
Authors: Visweshwar Nathan
Published: February 2022

Background:
Thrombotic microangiopathy (TMA) is a potentially life-threatening condition caused by small-vessel platelet microthrombi. The estimated incidence of clopidrogel-associated TMA is 1 per 1600 to 5000. The principal treatment is to withdraw clopidrogel. However, the diagnosis of clopidrogel induced TMA may be challenging because of the subtle presentation and co-morbidities confounding the diagnosis of TMA.

Case:
A 57 y.o. female presented with h/o hypertension, dyslipidemia with suspected cryptogenic strokes since 2018 (left thalamic stroke in 6/2020, left parietal stroke in 4/2020, chronic infarcts in frontal lobes from MRI brain on 9/17/2020 with normal CT angiogram of neck and brain and echocardiography ). She was on clopidrogel since April 2020. Patient was admitted on 6/14/2020 with racing thoughts for four weeks. The psychiatrist confirmed delirium. The EEG showed no focal lesion. Hematological workup revealed thrombocytopenia, elevated LDH and red cell fragments. The ADAMTS13 (a disintegrin and metalloproteinase, with a thrombospondin type 1 motif, member 13) level was <3%. Thrombotic microangiopathy was diagnosed. Steroids and plasma exchange were initiated and clopidrogel discontinued. Patient was discharged on prednisone. However, ADAMTS13 on 7/17/2020 was still <3%. As initial ANA and anti-ds-DNA were reported positive, patient was started on rituximab 375mg/m
2
weekly infusions with which ADAMTS13 increased to 75%. The repeat ANA and anti-ds-DNA were negative. When patient was reviewed on 5/20/2021 she was off steroids and independant of her ADLs.

Discussion:
Thrombotic microangiopathy is a medical emergency, with a mortality of 90% if untreated. Treatment with plasma exchange and corticosteroids significantly reduces the mortality to ∼10% to 15%. Early diagnosis of TMA is prudent, as recovery from TMA may appear to be complete, but patients may have persistent cognitive abnormalities if the diagnosis is not made early.
Abstract WMP41: Heart Failure, Age And Functional Outcomes After Ischemic Stroke
Authors: Ibeh Chinwe , Marshall Randolph S , Elkind Mitchell S , Khasiyev Farid , Gutierrez Jose
Published: February 2022

Background:
The presence of cardiovascular risk factors and associated diseases, including heart failure (HF), has been associated with worse outcomes following stroke. It is unclear however whether the association between HF and poor outcomes persists in younger cohorts, in whom HF is less often a consequence of long-standing cardiovascular disease. We hypothesize prevalent heart failure has differential associations with post-stroke functional outcomes across age groups.

Methods:
We performed a retrospective analysis of patients admitted with acute ischemic stroke at Columbia University Medical Center between 1990-2020 for whom adjudicated data was available at the time of analyses. Demographic, clinical variables including NIHSS and TPA administration, and functional outcomes were extracted. Good functional outcome was defined as a discharge modified Rankin score ≤ 2. Multivariable regression models were used to determine adjusted odds ratios (aORs) and 95% confidence intervals (95% CI).

Results:
Of the 855 patients hospitalized with ischemic stroke, 47% were women, 32% were ≤ 60 years, and 139 (16%) had pre-existing heart failure. Good functional outcome was seen in 456 (53%), in patients who had a mean age of 67.2 (16.4) years. Age as a continuous measure modified the effect of prevalent heart failure on the odds of good functional outcome (P = 0.001 for interaction). Among patients ≤ 60 years, after controlling for cardiovascular risk factors, NIHSS and TPA use, prevalent heart failure was associated with greater odds of good functional outcome (aOR: 1.33, 95% CI: 1.08-13.14) compared to young adults without HF. Among older stroke patients, HF was non-significantly associated with lower odds of good functional outcome (aOR: 0.86, 95% CI: 0.50-1.50).

Conclusion:
Premature heart failure (often due to congenital defects, hereditary cardiomyopathies, infections or other non-vascular etiologies) in younger stroke patients may be a marker of lower cardiovascular disease burden compared to young adults with stroke secondary to traditional stroke risk factors. These factors may play a larger role in post-stroke outcomes and recovery.
Abstract WMP48: Targeting The Action Selection Network During Functional Arm Training After Stroke: A Feasibility Study
Authors: Stewart Jill , Lewis Allison , Baird Jessica , Handlery Kaci , Lockhart Olivia , Blanck Erika , Fritz Stacy L
Published: February 2022

Introduction:
Interventions aimed at improving arm function after stroke primarily focus on movement execution. Approaches that target a specific motor planning process during training have been suggested but not systematically studied. Action selection (AS), or selection of a motor response, is an important planning process with well described behavioral (planning time) and neural (frontal-parietal network) correlates. The purpose of this study was to determine the feasibility of adding AS demands to task-oriented arm training in individuals post-stroke.

Methods:
Thirty individuals with chronic stroke (59.3±11.0 years of age; 34.9±35.6 months post-stroke) and mild to moderate motor impairment (Fugl-Meyer motor score: 41.4±14.7) completed 15 sessions of task-oriented arm training that included AS demands through abstract visual cues; cues dictated movement task or movement direction/distance/height. AS difficulty was progressed throughout training. Before and after training, individuals completed a joystick-based AS task during functional MRI.

Results:
Despite the added planning demand, movement repetitions were high (averaged 190.1±25.4 per session). AS accuracy (correct response selection) averaged more than 90% across sessions, even as AS difficulty increased. AS response times and activation in the AS neural network decreased from pre- to post-training, especially in premotor and prefrontal cortices. Gains were seen in upper extremity function (Action Research Arm Test: Pre: 38.0±16.3; Post: 41.4±15.3) and hand-related quality of life (Stroke Impact Scale Hand Domain: Pre: 47.2±23.7; Post: 61.8±24.1).

Conclusions:
Overall, it was feasible to add AS demands to functional arm training after stroke. Targeted engagement of the AS neural network through the addition of AS demands to arm training may challenge this component of the motor network in a manner that improves motor planning performance, upper extremity function, and neural resource utilization.
Abstract WMP57: Acute Stroke Interventions And Clinical Outcomes In Patients With Solid Organ Malignancies
Authors: Garg Aayushi , Chopra Saurav , Leira Enrique C. C , Shaban Amir
Published: February 2022

Background:
There is limited data regarding the safety of acute ischemic stroke (AIS) treatments in patients with solid organ malignancy (SOM). We aimed to evaluate the nationwide use of acute stroke interventions and clinical outcomes in this patient population.

Methods:
Adult hospitalizations with primary diagnosis of AIS were identified from the Nationwide Readmissions Database 2016-2018. Logistic regression was used to compare the differences in interventions and clinical outcomes in patients with and without SOM. Survival analysis was used to evaluate recurrent AIS after discharge.

Results:
There were 1385840 hospitalizations due to AIS (mean±SD age 70.4±14.0 years, female 50.2%). Of these, 50553 (3.7%) had a concurrent diagnosis of SOM. Patients with SOM were older, more likely to be male, and had a lower prevalence of comorbid cerebrovascular risk factors, except atrial fibrillation and tobacco use. The five most common malignancies were of lung, prostate, breast, pancreas, and colorectal origins. After adjustment for baseline differences, patients with SOM were more likely to have intraparenchymal hemorrhage (IPH) [odds ratio (OR): 1.1, 95% confidence interval (CI): 1.0-1.2], in-hospital mortality (OR: 2.1, 95% CI: 2.0-2.2), and discharge disposition other than to home (OR: 1.6, 95% CI: 1.6-1.7). The risk of IPH was higher only in pancreatic cancer, in-hospital mortality in all types except prostate cancer, and adverse discharge disposition in all types except prostate and breast cancers. Patients with SOM were less likely to receive intravenous thrombolysis (tPA) but more likely to undergo endovascular thrombectomy (ET). Among the subgroups of patients treated with tPA or ET, outcomes were comparable between patients with and without SOM, except patients with lung cancer remained at a higher risk of mortality and adverse disposition despite these interventions. Patients with SOM had higher risk of readmission due to recurrent AIS within 1 year of discharge (hazards ratio: 1.2, 95% CI: 1.1-1.3), and this risk was entirely driven by lung and pancreatic cancers.

Conclusion:
Clinical outcomes of AIS in the setting of SOM vary according to the malignancy site. Acute stroke interventions when performed, appear to be safe in most patients with SOM.
Abstract WMP63: Artificial Intelligence Assessment Of Non-contrast Ct Increases Intracranial Occlusion Detection As Compared With Ct-angiograhy Readings
Authors: Olive-Gadea Marta , García- Tornel Alvaro , Requena Manuel , De Dios Lascuevas Marta , Boned Sandra , Boned Sandra , Rubiera Marta , Molina Carlos A , tomasello alejandro , Hernandez David , Piñana Carlos , Marti Cristian , Granés Cristina , Garcia Alba , Facundo Diaz , Ribo Marc
Published: February 2022

Artificial Intelligence (AI) can assist in vessel occlusion (VO) identification in acute stroke patients. We aim to investigate the impact of using an AI-based software for automated VO detection on non-contrast CT (AI-VO) as compared to CT-Aangiograpphy (CTA).

Methods:
From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT / CTA / CTP and were treated accordingly. Hypoperfusion areas defined as Tmax>6s on CTP (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO: ground truth). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated CT and CTA to identify intracranial VO (CTA-VO). AI-VO was automatically determined by an AI-based software (Methinks).

Results:
Of the 338 patients included, 157 (46.5%) showed a CTP-VO (median Tmax>6s: 73[29-127]ml). Overall sensitivity to detect CTP-VO was 50.3% for CTA-VO and 66.9% for AI-VO; specificity was 97.8% for CTA-VO and 86.2% for AI-VO. EVT was performed in 103 patients (EVT-VO: 65.6% of CTP-VO; Tmax>6s: 102[63-160]ml); sensitivity to detect EVT-VO was 69% for CTA-VO and 79.6% for AI-VO; specificity was 95.3% for CTA-VO and 79.6% for AI-VO. The probability to detect a CTP-VO was higher with AI than with CTA for distal occlusions (figure). Accordingly, AI-VO sensitivity was higher than CTA-VO for angiographically confirmed M2/M3-MCA occlusions (80.7% vs 34.6%; p=0.002) but not for M1-MCA/ICA occlusions (82.1% Vs 88.1%;p=0.467).

Conclusion:
AI-assisted vessel occlusion identification on non-contrast CT may be a useful tool in acute stroke evaluation, especially for distal VO identification, potentially increasing endovascular treatment in these cases.
Abstract WMP73: Surgical Timing In Infective Endocarditis Patients With Intracranial Hemorrhage -a Systematic Review And Meta-analysis
Authors: Musleh Rita , Schlattmann Peter , Caldonazo Tulio , Kirov Hristo , Günther Albrecht , Witte Otto , Doenst Torsten , Diab Mahmoud
Published: February 2022

Background and Purpose:
Cardiac surgery is indicated in more than half of patients with infective endocarditis (IE); however, it is performed in only 60% of the indicated cases. Majority of patients with surgical indications who were denied surgery due to certain reasons die within 30 days. Intracranial hemorrhage (ICH) is one of the main causes for denial of surgery despite the presence of surgical indications. We aimed to evaluate the impact of early surgery (within 30 days) in IE-patients with ICH on postoperative outcome and to elucidate the risk of 30-day mortality in patients for whom surgery was denied.

Methods:
Three libraries (MEDLINE, EMBASE and Cochrane Library) were assessed for studies evaluating the postoperative outcome in early vs. late surgery in IE-patients with preoperative ICH. The primary outcome was all-cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed.

Results:
We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early vs. late) and were included in the meta-analyses. Only one study examined the fate of IE-patients with ICH who were treated conservatively despite of having an indication for cardiac surgery, showing higher mortality rates than those who were operated (11.8 % vs. 2.5 %). We found no significant association between early surgery, regardless of its definition, and a higher mortality (relative risk [RR]= 1.46; 95% confidence interval [CI]: 0.98-2.17). However, early surgery was associated with higher risk for neurological deterioration (RR= 1.97; 95% CI: 1.15-3.38).

Conclusions:
Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with increased rate of neurological deterioration. Thirty-day mortality in IE-patients with ICH for whom surgery was denied has not yet been sufficiently investigated. This patient group should be analysed in future studies in more detail.
Abstract WMP9: Pharmacological Characterization Of The Water Soluble Neurosteroid NTS-104 In The Rat Embolic Stroke Model
Authors: byrne robin , Gertz Steven , Woodhouse Colleen , Verdoorn Todd , McCutcheon Jolie , Poulsen David
Published: February 2022

Background:
Our objective was to characterize the pharmacodynamic changes induced by NTS-104/105 within the brain and plasma in rats following embolic middle cerebral artery occlusion (eMCAO). Previous pharmacokinetic analysis indicated that NTS-104 is rapidly metabolized in the blood to form the active compound NTS-105, which is readily detected in the brain. In contrast, NTS-104 does not cross the blood-brain barrier.

Methods:
Adult, male Wistar rats were subjected to eMCAO. Stroke severity was defined by Neurological Severity Score (NSS) assessment. Only rats that scored >8 on a 13-point scale were included. Rats were dosed IM with vehicle, or NTS-104 (5mg/kg or 20mg/kg) at 6 hours after stroke. Brain and plasma samples rats were collected at 6, 12, or 24hrs after injection. Samples were screened for expression of AKT, pAKT and against a panel of 67 cytokines by quantitative ELISA.

Results:
We found that NTS-104 treatment induced a significant reduction in IL-6, GM-CSF, MCP-1, IL-1α, RAGE, VEGF, and ICAM-1 levels within the brains of rats following intramuscular injection of 20 mg/kg NTS-104 at 6-hours after eMCAO compared to vehicle treated control rats. In contrast, treatment with 5mg/kg NTS-104 did not induce similar time and dose dependent changes in these specific cytokines relative to vehicle treated controls. NTS-104 treatment also significantly reduced IL-6 and GM-CSF levels, while increasing galectin-1 levels, within the plasma of these same rats in a time and dose dependent manner similar to what was observed within the brain. We further detected a significant increase in the levels of phosphorylated AKT (pAKT) within the brains of stroked rats treated with 20 mg/kg NTS-104 but not with 5 mg/kg.

Conclusion:
These data demonstrate that treatment with NTS-104 results in the significant activation of the AKT cell survival signaling pathway and significantly reduces critical neuroinflammatory signaling after stroke in a time and dose dependent manner.
Abstract WMP90: Patients With MEVO Take Longer To Treat With Endovascular Thrombectomy Because Of A Longer Time To Identify Candidates For Therapy (door To Groin Puncture) As Well As Longer Procedural Times (groin Puncture To First Thrombectomy Pass)
Authors: Baraban Elizabeth , Stuchiner Tamela L , Martin Neil , Bavarsad Shahripour Reza , Kelly Daniel , Teitelbaum George P , Ovando Renee , Tarpley Jason W
Published: February 2022

Introduction:
The seminal trials of thrombectomy in 2015/16 enrolled a relatively homogenous population of patients with acute ischemic stroke due to ICA terminus or M1 occlusion. However, with advancing technology and technique, EVT eligibility is broadening to include more distal occlusions also known as Medium Vessel Occlusions (MEVO). There may be unique challenges to identifying and treating MEVO patients as quickly as more proximal LVO patients. Here we compared speed of treatment for MEVO and LVO. Specifically, we evaluated time to identify candidates for EVT (Door to Groin Puncture) and the procedural speed (Puncture to first thrombectomy pass) in patients with proximal (ICA/M1) vs distal (M2/M3/M4) occlusions in the anterior circulation.

Methods:
Data obtained from the Providence Enterprise Stroke Registry included patients discharged from January 2015 to May 2021 with a diagnosis of ischemic stroke who had an occlusion in the ICA terminus, MCA M1, M2, M3 or M4 and were treated with EVT. Generalized linear models assessed if patients with an ICA terminus or M1 occlusion were more likely to have door to groin puncture (GP) in < 60 minutes, GP to first pass (FP) in <30 minutes or door to FP in < 90 minutes compared to those who had M2, M3 or M4 occlusions. Transfers and inpatient strokes were excluded. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported, adjusting for age, race/ethnicity, sex, and IV alteplase treatment.

Results:
A total of 1,035 (69.2%) patients with an M1/ICA terminus and 460 (30.8%) with M2, M3 or M4 occlusions were included. The M1/ICA terminus patients had greater likelihood of door to GP in < 60 minutes (AOR=1.59, 95% CI: 1.20, 2.10), greater likelihood of GP to FP in <30 min (AOR=1.25, 95% CI: 1.07, 1.46) and door to FP in<90 minutes (AOR=1.38, 95% CI: 1.07, 1.78) compared to patients with M2, M3 or M4 occlusions.

Conclusions:
Patients with distal anterior circulation occlusions take longer to treat with Endovascular thrombectomy. This delay is driven by longer times required to identify candidates for therapy (Door to Groin Puncture) as well as longer procedural times (Groin Puncture to First Thrombectomy Pass). Future efforts are required to improve speed of identification and treatment for MEVO.
Abstract WMP95: Values Of Collateral Status On Treatment Decision-making And Individualizing Time Window In Patients With Acute Basilar Artery Occlusion In Endovascular Treatment
Authors: Li Jing , Wang Pengfei , sang hongfei , Li Zhenguang , Qiu Zhongming , Zi Wenjie , Zhu Lina
Published: February 2022

Bankground:
Basilar artery occlusion (BAO) is related to a high risk of morbidity and mortality. Our aim was to investigate the values of posterior circulation collateral score (PC-CS) on treatment decision-making and individualizing time window of patients with acute BAO in endovascular treatment.

Methods:
The BASILAR study was a nationwide prospective registry of consecutive patients presenting with symptomatic, radiologically confirmed within 24 hours of symptoms onset. Patients were divided into two groups according to the treatment they received: standard medical therapy alone and medical therapy plus endovascular therapy (EVT). We used a 10-points grading system based on computed tomography angiography to quantify the potential for collateral flow in the posterior circulation. We defined modified Rankin Scale score &It;3 within 3 months as favorable outcome, as well as mortality within 90 days were included as primary outcomes.

Results:
A total of 828 eligible consecutive patients with acute BAO were enrolled in our study with trichotomized PC-CS. EVT was associated with higher rate of favorable outcomes (adjusted odds radio with 95% CI, 7.02 [1.48-33.29]; 4.84[1.82-12.87] and 6.16 [2.69-14.08]; respectively) and lower mortality (57.4% versus 84.8%,
P
=0.001; 47.4% versus 75%
, P
&It
;
0.001 and 34.9% versus 58.8%,
P
&It;0.001) than standard medical therapy group in the trichotomized PC-CS. And higher PC-CS is associated with favorable outcomes in EVT group. More importantly, the patients received endovascular treatment with poor collateral circulation (PC-CS 0-3) could benefit only within 6 hours of symptom onset, while the time window will be extended to 24 hours in the patients with good collateral circulation (PC-CS 4-10).

Conclusions:
The PC-CS is a vital marker for predict favorable outcomes and treatment decision-making and individualizing time window in patients with acute BAO in endovascular treatment.
Abstract WP111: Deployment Of Portable, Bedside, Low-field Magnetic Resonance Imaging In The Emergency Department To Evaluate Patients With Acute Stroke
Authors: Chavva Isha R , Mazurek Mercy H , Yuen Matthew M , Prabhat Anjali M , Crawford Anna L , Cahn Bradley A , Schindler Joseph L , Sansing Lauren H , Matouk Charles C , Hebert Ryan M , de Havenon Adam , Sharma Richa , Payabvash Sam , Sze Gordon , Aydin Ani , Parwani Vivek , Ulrich Andrew S , Brown Kelli , Sheth Kevin N , Wira Charles R
Published: February 2022

Background and Aims:
MRI is critical for diagnosing acute stroke and guiding candidate selection for potential reperfusion therapy. However, rapid stroke evaluation using MRI is often dissuaded by the time required for patients to travel to access-controlled, high-field (1.5-3T) systems. Advances in low-field MRI enable the acquisition of clinically valuable images at the bedside. We report neuroimaging in patients presenting to the Emergency Department (ED) with stroke symptoms using a low-field portable MRI (pMRI) device.

Methods:
A 64mT pMRI device was deployed in the Yale-New Haven Hospital ED from August 2020 to July 2021. Patients presenting as a “Stroke Code” or “Intracranial Hemorrhage Alert” with no MRI contraindications were scanned. Exams were performed at the bedside, in the vicinity of ED room equipment. Research staff acquired imaging via tablet, with images available immediately after acquisition. Sequences obtained and axial scan times (in minutes) included T1-weighted imaging (4:54), T2-weighted imaging (7:03), fluid-attenuated inversion recovery imaging (9:31), and diffusion-weighed imaging with apparent diffusion coefficient mapping (9:04). Patients’ demographic information, hours from the time of patients' last known normal (LKN) to time of scan, and discharge diagnoses (determined from final imaging interpretation) were assessed.

Results:
pMRI exams were obtained on 54 patients (28 females, 51.9%; median age 71 years, 20-98 years). Discharge diagnoses included ischemic stroke (42.6%) no intracranial abnormality (31.5%), intraparenchymal hemorrhage (7.4%), atherosclerosis (7.4%), tumor (5.6%), subdural hematoma (3.7%), and intraventricular hemorrhage (1.9%). Patient LKN times ranged from 2 to 144 hours (median of 12 hours; 3 patients with no LKN excluded). The pMRI did not interfere with ED equipment and no significant adverse events occurred.

Conclusion:
We report the use of a pMRI for bedside neuroimaging in the ED. This approach suggests that pMRI may be viable for supporting rapid diagnosis and treatment candidate selection in patients presenting with stroke symptoms to the ED.
Abstract WP113: Cerebrospinal Creatine Kinase BB Isoenzyme: A Biomarker For Predicting Never Awakening In Patients Treated With Therapeutic Hypothermia After Cardiac Arrest
Authors: Singh Amita , Davis Arielle , Lerma L. Angelica , Johnson Nicholas , Tirschwell David L , Longstreth W T , Khot Sandeep P
Published: February 2022

Introduction:
Creatine kinase BB isoenzyme (CK-BB) levels in CSF after cardiac arrest (CA) have been shown to predict never awakening though have not been evaluated in patients treated with therapeutic hypothermia (TH). Clinically, CSF CK-BB is tested in those who have not already awakened and are suspected of having a poor prognosis. We aimed to evaluate CSF CK-BB as a prognostic biomarker in the era of TH.

Methods:
We performed a retrospective cohort study at a single institution of CA patients admitted between 2010 and 2020 and with CSF CK-BB assayed between 36 and 84 hours after CA. We examined the proportion of patients who awakened at hospital discharge and latest follow up in the electronic health record for various CSF CK-BB thresholds. We examined concordance and additive value somatosensory evoked potentials (SSEP). Awakening was defined as following commands or having comprehensible speech.

Results:
Among 214 eligible patients, mean age was 55 ± 15 years, 72% were male, 33% were non-white, 17% had initial ventricular fibrillation or tachycardia, 90% were out-of-hospital CA, and 83% had TH. A total of 19 (9%) awoke at a mean of 22 ± 28 days. Two patients in a vegetative state at discharge later awoke at 73 (CSF CK-BB 163 U/L) and 101 days (228 U/L). A CSF CK-BB cut-off of ≥ 230 U/L predicted never awakening with a specificity of 100% (binomial 95% CI 82-100%) and a sensitivity of 69% (95% CI 62-76%). When combined with bilaterally absent SSEP, the specificity remained 100% while the sensitivity increased to 80% (95% CI 73-85%). Results were similar after excluding 165 (77%) who had withdrawal of life-sustaining treatment. Discordant findings among 149 patients who had both studies were seen in 13 (9%) with intact SSEP bilaterally but CSF CK-BB ≥ 230 U/L and in 20 (13%) with absent SSEP bilaterally but CSF CK-BB < 230, none of whom awoke.

Conclusion:
CSF CK-BB levels accurately predict never awakening among CA survivors treated with TH. As part of multimodal prognostic testing with SSEP, the CSF CK-BB cutoff of 230 can optimize sensitivity while maintaining a specificity of 100%. These results are susceptible to a self-fulfilling prophecy, and specificity has a large confidence interval because only a small number of eligible patients awakened.