bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP221: Imaging Features and Prognostic Factors for Determining Outcomes in Cervicocerebral Artery Dissection
Authors: Lee Jun , Kim Min-Gyeong , Gwon Jung-Im
Published: March 2022

Introduction:
Imaging findings for the improvement of prognosis are not well established in patients with cervicocerebral artery dissection.

Hypothesis:
We aim to identify the imaging outcomes of cervicocerebral artery dissection and prognostic factors which influence improving the imaging outcomes.

Methods:
We included 162 consecutive patients diagnosed with cervicocerebral artery dissection on baseline vascular images. Imaging findings on the baseline were obtained within 7 days after symptoms onset, and follow-up vascular images were performed 6 months or 1 year. We compared the radiological features and the degrees of recovery (complete or partial recovery) between baseline and follow-up vascular images.

Results:
A total of 70 patients who underwent baseline and 6-month or a year vascular imaging were compared for these analyses. The patient mean age was 48 (SD 11), and the number of females was 21 (30%). The site of a dissection was more common in the posterior circulation (71.4%) and presence of infarction on baseline MRI was 84%. Regarding the lesion sites, a dissection was more common in the intracranial (83%). The baseline vascular images identified an aneurysm in 40% and stenosis or occlusion in 77%. Follow-up images showed complete improvement of the dissected vessels in 78% at 3 months and 83% at 6 months. Patients (n=15) who had an occlusion on the baseline images had partial or complete resolution in 38%. There were no significant differences in efficacy for the partial or complete improvement of vascular lesion on the follow-up images in patients who were treated with antiplatelet (OR=0.68 [0.15-3.10], p=0.72) or anticoagulation treatment (OR=1.38 [0.48-3.97], p=0.60). In the multivariate analysis, the odds ratio for complete or partial improvement on the follow-up vascular images from vertebral artery was 0.16 (0.48-0.52) (p=0.002) after adjustment for age, gender, and eGFR.

Conclusions:
In patients who diagnosed with cervicocerebral artery dissection on baseline vascular images, the rate of complete or partial recanalization was over 80% on the 6-month or 1-year follow-up images. Vertebral artery dissection are poor prognostic factors for the recovery of the vascular lesion after cervicocerebral artery dissection.
Abstract WP223: Factors Influencing Recurrent Stroke: TEE Study With Longitudinal Observation in Cryptogenic Stroke
Authors: Ueno Yuji , Yamashiro Kazuo , Tanaka Ryota , Kuroki Takuma , Hira Kenichiro , Kurita Naohide , Urabe Takao , Hattori Nobutaka
Published: March 2022

Background:
Transesophageal echocardiography (TEE) has been critical for investigating cryptogenic stroke (CS) after routine stroke evaluation fails to identify the etiologies of ischemic stroke, to examine potential embolic sources. So far, little information on the long-term outcome in CS patients has been available. This study sought to investigate the clinical characteristics and diverse embolic etiologies on TEE related to stroke recurrence in CS patients.

Methods:
From April 2008 to March 2014, stroke patients who were categorized to CS using the criteria of the Trial of Org 10172 in Acute Stroke Treatment after routine stroke examinations, and underwent TEE were included in this single-center observational study. Clinical characteristics, laboratory and MRI findings, and embolic etiologies on TEE were investigated. Follow-up data were obtained by reviewing medical records and survey questionnaires. Survey questionnaires were carried out in the out patient department, mailed to patients or families, or by telephone. The questionnaire included recurrence of ischemic stroke, cardiovascular events, and death that occurred since discharge from our hospital, and information of medical history.

Results:
A total of 175 patients (age, 64.0 ± 12 years; 127 males) with CS patients were enrolled. 25 patients had recurrent stroke (RS) and 5 had cardiovascular events, and 7 died. The RS group had higher frequency of diabetes mellitus (DM), multiple infarcts on diffusion-weighted image (DWI), and atheromatous aortic plaques ≥ 4 mm, and higher levels of serum glucose and C-reactive protein on admission (P<0.05, respectively). CAM score that was previously defined as consisting of the degree of calcification in the aortic arch (0-3 points), age (≥70 years: 1 point), and DWI findings (multiple infarctions in 1 vascular territory, VT: 1 point; 2 VTs: 2 points; more than 3 VTs: 3 points) was also higher in the RS group (P<0.05). Cox regression analysis showed that DM (HR: 2.76; 95% CI: 1.23 to 6.22; P=0.014) and the CAM score ≥ 3 points (OR: 3.02; 95% CI: 1.32 to 6.93; P=0.009) were associated with RS.

Conclusions:
DM and the CAM score but not embolic etiologies and treatments were associated with higher risk of recurrence in CS.
Abstract WP228: Stratification of Patent Foramen Ovale (PFO) Pathogenicity Using the RoPE Score Differs in Women and Men
Authors: Mono Marie-Luise , Michel Patrik , Thaler David E , Weimar Christian , Kahles Timo , Lemmens Robin , Serena Joaquin L , Krämer Markus , Thijs Vincent , Zedde Marialuisa , Engelter Stefan , Luft Andreas , Eberli Franz , Müller-Eichelberg Andreas , Collins Lester , Hemelsoet Dimitri , De Pauw Adinda , Armon Carmel , Arnold Marcel , Nedeltchev Krassen ,   The International PFO Consortium, NCT00859885
Published: March 2022

Background:
A patent foramen ovale (PFO) discovered in patients with cryptogenic stroke (CS) may be incidental or pathogenic. Recently, a Risk of Paradoxical Embolism (RoPE) score has been proposed to stratify patients by their PFO pathogenicity. Based on this score, the probability that a PFO is incidental (rather than pathogenic) increases with advancing age, deep stroke location, or the presence of cardiovascular risk factors (RF). Given that RF accumulate at a later age in women than in men, we hypothesize that there are gender differences in the variables used for RoPE score calculation.

Methods:
The distribution of RF (history of hypertension, diabetes or stroke/TIA, current smoking, and age categories as defined in the original RoPE score publication) was compared by sex in the entire cohort of 1044 CS patients as well as within the groups with low (0-5) and high (7-10) RoPE scores (due to lacking information on cortical versus deep stroke location, we excluded all patients with a RoPE score of 6, since they could be either classified with low or high RoPE score depending on stroke location). Furthermore, for each patient we calculated the age impact ratio (AIR): the points assigned for the corresponding age category divided by the RoPE score. Gender comparisons of AIR were drawn in the entire cohort and within the RoPE score strata.

Results:
Average age was 55.5 years and 635 patients (61%) were male. In the entire cohort, the distribution of age categories and RF as well as AIR did not differ between men and women. In the higher RoPE stratum (PFO likely pathogenic), women were younger than men (median, 38 years vs 45 years, P=0.036). The distribution of RF and the AIR did not differ between sexes. In the lower PFO stratum (PFO likely incidental), men were younger than women (median, 62 years vs 66 years, P=0.011). The AIR was lower in women than in men (mean, 0.24 vs 0.29, P=0.013). There were no gender differences in the distribution of RF.

Conclusions:
There are significant gender differences in age among patients with CS and PFO, with women being younger than men in the higher RoPE stratum and vice versa in the lower RoPE stratum. More women than men are classified as having an incidental PFO because of their advancing age rather than the accumulation of RF.
Abstract WP231: Risk Factors for Paroxysmal Atrial Fibrillation and Atrial Flutter Detection Following Cryptogenic Ischemic Stroke
Authors: Kahen Michael , Carrazco Claire E , Golyan Daniel , Schneider Jordana S , Arora Rohan , Salamon Elliott , Wright Paul , Libman Richard B , Katz Jeffrey M
Published: March 2022

Introduction:
Long-term post-stroke insertable cardiac monitor (ICM) implantation has resulted in increasing frequencies of paroxysmal atrial fibrillation and atrial flutter (PAF) detection in a significant proportion of cryptogenic ischemic stroke (CIS) patients. Determining risk factors for PAF detection specific to the CIS population could allow for better selection of patients for ICM implantation.

Methods:
A retrospective study of CIS patients (n=95; mean age 65.9 years; 56.8% female) implanted with the Reveal LINQ ICM between September 2013 to July 2015. Device implantation was performed during, or soon after, index stroke admission. The study cardiac electrophysiologist confirmed PAF diagnosis. Univariate and multivariate logistic regression analyses compared clinical, laboratory, ECG and echocardiographic variables between patients with and without PAF.

Results:
PAF was detected in 22/95 (23.2%) patients. Factors associated with PAF detection include older age (mean (yr) 74.0 vs. 63.4; p=0.003), prolonged PR-interval (PR>175 ms; OR 3.88, 95% CI 1.28-11.7), mitral regurgitation (MR; OR 3.36, 95% CI 1.24-9.08), left atrial diameter (LA diameter mean (cm) 3.80 vs. 3.51; p=0.039), and left atrial volume index (LAVI mean (cc/m2); 32.8 vs. 25.0; p=0.037). Controlling for age in the multivariate logistic regression model, obesity (BMI>30; OR 4.80, 95% CI 3.50-9.60) and MR (OR 4.47, 95% CI 3.15-5.79) are independently associated with PAF detection.

Conclusion:
Long-term cardiac monitoring identified PAF in a substantial number of CIS patients. Older age, prolonged PR, MR, and larger LA diameter and LAVI are significantly associated with PAF diagnosis. Controlling for age, significant independent risk factors include obesity and MR. A larger prospective study is warranted to confirm these findings and to identify other possible risk factors. Ultimately, a risk factor based algorithm could enable better selection of CIS patients for ICM implantation.
Abstract WP234: A Modified National Institutes of Health Stroke Severity Score for Stroke Localization
Authors: Lerner David P , Goldstein Larry B
Published: March 2022

Background:
The National Institutes of Health Stroke Scale (NIHSS) was not intended to be used to determine the stroke’s vascular distribution. The aim of this study was to develop, assess the reliability, and validate a computer algorithm based on the NIHSS for this purpose.

Methods:
Two cohorts of patients with ischemic stroke having similar distributions of Oxfordshire localizations (total anterior, partial anterior, lacunar, and posterior circulation) based on neuroimaging were identified. The first cohort (n=40) was used to develop a computer algorithm for vascular localization using a modified version of the NIHSS (mNIHSS) that included selected deficit laterality; the second (n=20) was used to assess the reliability of algorithm-based localizations compared to those of two vascular neurologists. The validity of the algorithm-based localizations was assessed in comparison to neuroimaging. Agreement was assessed using the un-weighted kappa K) statistic.

Results:
Agreement between the two raters using the standard NIHSS was slight to moderate (K=0.36, 95% CI 0.10-0.61). Inter-rater agreement significantly improved to the substantial to almost perfect range using the mNIHSS (K=0.88, 95% CI 0.73-1.00). Agreement was perfect when the two raters entered the data into the mNIHSS computer algorithm (K=1.00, 95% CI 1.00-1.00). Agreement between the algorithm localization and neuroimaging results was fair to moderate (K=0.59, 95% CI 0.35-0.84) and not significantly different than the localizations of either rater using the mNIHSS.

Conclusion:
A computerized, modified version of the standard NIHSS can be used to reliably and validly assign the vascular distribution of an acute ischemic stroke.
Abstract WP235: A Novel Pre-notification System Using a Smartphone Application Improves Quality Indicator for Thrombolysis Therapy in Acute Ischemic Stroke
Authors: Lee Byung-Chul , Oh Mi Sun , Yu Kyung-Ho
Published: March 2022

Background and Purpose:
Prehospital notification of patients with suspected acute stroke by emergency medical services (EMS) personnel is recommended to reduce delays in time-dependent management such as thrombolytic therapy. We developed ” the Brain Saver”, which is a smartphone-assisted prenotification system using mobile application platform, and evaluated preliminarily the effects of this system on improving quality indicator for thrombolysis therapy in acute ischemic stroke.

Methods:
Through the Brain Saver, the EMS personnel sent the clinical information, such as age, sex, time of symptom onset, expected arrival time, neurological symptom of the patient with suspected acute stroke in the field, so that the stroke team prepared to prioritize the hospital resources such as computerized tomography (CT) and various laboratory test for suspected stroke patients. On arrival at emergency room, patients were transferred directly from triage onto the CT room on the ambulance stretcher, and the stroke team meet patient. Between September 2014 and July 2015, we compared quality indicators including door-to-needle time (DNT), door-to-imaging time (DIT) of patients with intravenous tissue plasminogen activator (tPA) with prenotification to those without prenotification.

Results:
During study period, time of onset to arrival in patients with prenotification using the Brain Saver was similar in those without. However, compared with tPA patients who arrived without prenotification, the median (interquartile range) DNT decreased from 55 (42-92) to 36 (32-42) minutes (p=0.003) and DIT was reduced from 11 (7-15) to 3 (2-6) minutes (p<0.0001).

Conclusions:
The Brain Saver was the efficient tool to communicate between EMS personnel and the stroke team for the prenotification of patients with acute stroke. The prenotification improved quality indicator of in-hospital stroke management by reducing time delay in thrombolytic therapy.
Abstract WP24: Utility of the Sheath Guide Specifically Designed for Transbrachial Approach in Endovascular Treatment of Neurovascular Diseases
Authors: Iwata Tomonori , Mori Takahisa , Tanno Yuhei , Kasakura Shigen , Yoshioka Kazuhiro
Published: March 2022

Background and purpose:
Transfemoral approach has been a common technique in endovascular treatment (ET) of neurovascular diseases. When aortic or peripheral arterial conditions limit transfemoral approach, transbrachial approach is attempted as the alternative. The purpose of our study was to report the utility of novel sheath guide specifically designed for transbrachial approach in ET for carotid or cerebral vascular pathology.

Methods:
Included in our analysis were patients who underwent transbrachial ET with the sheath guide for transbrachial approach between 2011 and 2014. The sheath guide has a 6Fr (2.24 mm, 0.088 inch) internal diameter (ID) with 90 cm in length, a soft distal part and a particular distal shape like a modified Simmons catheter. The MSK-guide 7.5 has 7.5 cm of the distal part in length for the common carotid artery and the MSK-guide 15 has 15.0 cm of the distal part in length for the internal carotid artery. Carotid artery stenting and external carotid artery embolization were performed with the MSK-guide 7.5, and ET for intracranial lesions with MSK-guide 15.

Results:
Two hundred and seventy patients underwent transbrachial ET with the particular sheath guide. The procedures included treatment of 143 extracranial carotid stenosis, 31 intracranial carotid stenosis, 50 intracranial aneurysms, 25 AVMs/DAVFs and 21 acute ischemic strokes. Transbrachial carotid cannulation was easy and successful in every case except for one case (0.4%) with brachial artery spasm. After transbrachial carotid cannulation of MSK-guide, procedures were performed easily through the sheath guide in every case. On sheath-related periprocedural complications, 2 pseudoaneurysms (0.7%) and brachial artery occlusions (0.7%) occurred after ET or a follow-up period, respectively.

Conclusion:
The sheath guide specifically designed for transbrachial approach provided a favorable impact upon ET of neurovascular diseases.
Abstract WP243: Identification of IV tPA Delays Can Improve Future Occurences
Authors: Deskin Sara R , Olson-Mack Lindsay , Rockwell Jean , Berger Lynn , Richetts Renee , Elshire Cortlyn , Tafreshi Gilda , Kalafut Mary , Aguilar Tabora LG
Published: March 2022

Introduction:
The American Heart and American Stroke Associations released their new Target: Stroke goal of IV tPA administration in under 45 minutes from arrival for all eligible patients. While many hospitals have improved with prompt IV tPA initiation, further analysis is necessary to determine reasons for ongoing delays in order to continue to improve door- to-needle (DTN) times.

Hypothesis:
We hypothesized that identifying trends in IV tPA initiation delays could guide development of process improvement (PI) geared toward decreasing DTN times.

Methods:
A retrospective cohort of 2,417 patients presenting to a five hospital campus system from January 2013 to March 2015 were studied to identify trends in IV tPA delays. Inclusion criteria: all patients presenting to the emergency department (ED) for which a code stroke was activated and IV tPA was initiated with DTN times greater than 60 minutes from arrival. Exclusion criteria: patients presenting to the ED for which a code stroke was activated but IV tPA was not administered, or IV tPA was initiated within 60 minutes of arrival.

Results:
Sixty-seven patients met the inclusion criteria, and the following trends were identified: seven patients (10%) required management for other life threatening conditions prior to IV tPA, such as intubation or cardioversion; IV tPA was delayed in 28 patients (42%) due to an inability to determine eligibility. This was based on waxing and waning symptoms and/or uncertainty of last time known well (LKWT). Twenty patients (30%) required IV medications for hypertension and twelve (18%) patients and/or family members initially refused the drug.

Conclusion:
This study revealed that 90% of IV tPA initiation delays were due to potential modifiable factors. Indicating that through implementation of PI changes, hospital systems may be able to prevent similar delays from occurring. Examples include: collaboration with emergency medical services to transport witnesses to the ED for assistance with prompt identification of LKWT, earlier management of hypertension, and a streamlined approach for risk and benefit discussions between clinicians, patients and/or family to assist in a rapid informed consent process.
Abstract WP249: The “Bucket Test” may Improve Detection of Stroke in Patients With Acute Dizziness
Authors: Fattal Deema , Zafar Atif , Borte Berna , Elhawi Yasir , Maamar-Tayeb Ali , Ahmad Azeemuddin
Published: March 2022

The diagnosis of a stroke in the emergency department (ED) can be difficult when a patient presents primarily with dizziness. Approximately 1/3 of such patients are misdiagnosed with a benign ear condition. While MRI may detect a stroke in such patients, it may not be readily available in many ED. Therefore, there is a need to improve clinical recognition of strokes among acutely dizzy patients. The “bucket test” (BT) involves the use of a bucket that has inside of it a series of images arranged in a straight line that can be aligned with earth’s vertical. In research lab settings, more than 90% of patients with posterior circulation strokes misalign the images off the vertical. However, the utility of a portable version of BT in diagnosing stroke among dizzy patients in ED setting has not been evaluated. We hypothesized that BT can be used by ED physicians as a screening tool for stroke in dizzy patients. We tested a portable version of BT on dizzy patients in ED of a tertiary center. We prospectively enrolled 81 acutely dizzy patients presenting to ED between February 2012 and February 2015. Patients also had brain imaging (CT in 5, MRI in 22). Using MRI/stroke specialist as reference, a total of 7 patients had stroke/TIA. All had clearly abnormal BT and no patient with a stroke/TIA had a normal/equivocal BT (BT sensitivity 100%; 95% CI 59 to 100%). Meanwhile, MRI demonstrated stroke in 5/7 of stroke/TIA patients. One patient with negative initial MRI was diagnosed with AICA stroke later by blinded stroke specialist. And one patient had TIA, with initial negative CT, only to return to ED 12 days later with more dizziness and brain MRI then showed an acute stroke. Therefore, the sensitivity of brain MRI was 83%, consistent with prior literature. In sum, the bucket test is a simple bedside screening test that may improve the diagnosis of stroke in the emergently dizzy patient.
Abstract WP251: EMS Collaboration Reduces Door to Needle Times in Community Hospital
Authors: Funk Kathryn E
Published: March 2022

Introduction:
Reducing Door-to-Needle (DTN) times in the stroke population begins before the patient enters the doors of the hospital. The goal is to administer tPA within 60 minutes of patient arrival but there are often barriers to prevent this from occurring. Literature shows that partnership with Emergency Medical Services (EMS) has been shown to reduce DTN times.

Hypothesis:
We assess the hypothesis that partnering with EMS to draw blood prior to arrival and take patients to CT on EMS stretchers will decrease DTN times for acute stroke patients.

Methods:
Bon Secours Maryview Medical Center partnered with Portsmouth Fire, Rescue and Emergency Services (PFRES) in an effort to reduce our DTN times and better serve our community. There was a 2 pronged approach: EMS to take patients to CT on their stretchers and EMS will draw blood on acute stroke patients prior to hospital arrival. This was a 60 day trial to begin on April 1, 2015. Discussion began in February 2015 and fifteen PFRES super-users were trained in March. They trained 200 other PFRES partners. Packets were provided with materials necessary for blood draws, as well as instructions. The start date was April 1 with blood being drawn on that date and data tracking beginning. Additional Stroke education was provided to PFRES in May. Feedback was provided via a feedback form and a chart tracked Door to CT times and Door to Labs Received times.

Results:
For the three months of April-June, there was a 6-10 minute drop in door to CT times, an average of 53% improvement by utilizing EMS. There was a 7-10 minute drop in door to Lab received times, an average 46% improvement. DTN times for tPA have decreased from an average of 65 minutes the prior 3 months to 50 minutes for April-June, a 23% decrease. Our DTN time in July is 34 minutes, almost half of our totals for January -March.

Conclusion:
In conclusion, partnering with EMS on acute stroke patients lowers DTN times and provides better patient care.
Abstract WP264: Possible Epigenetic Modulation of Cerebral Angiotensin Type 2 Receptor in the Cognitive Function in Vascular Dementia
Authors: Iwanami Jun , Mogi Masaki , Tsukuda Kana , Wang Xiao-Li , Higaki Akinori , Kukida Masanori , Nakaoka Hirotomo , Yamauchi Toshifumi , Bai Hui-Yu , Shan Bao-Shuai , Min Li-Juan , Horiuchi Masatsugu
Published: March 2022

Introduction:
It is well known that activation of angiotensin type 1 (AT1) receptor results in cognitive impairment. In contrast, accumulating evidences suggest that angiotensin II type 2 (AT2) receptor stimulation might prevent cognitive impairment in mice. We recently reported that administration of compound 21, newly developed direct AT2 receptor agonist, improved cognitive decline in the mouse model of vascular dementia induced by bilateral common carotid artery stenosis (BCAS). Cerebral histone deacetylase (HDAC) 2 has been highlighted in terms of epigenetic modulation of cognitive function. These results led us to examine the effects of HDAC on AT2 receptor-mediated improvement of cognitive decline.

Methods:
Ten-week-old male wild type (WT) (C57BL/6) or AT2 receptor knockout (AT2KO) mice were subjected to BCAS. HDAC inhibitor (SAHA; 25 mg/kg/day) was administrated from 4 weeks after BCAS operation. The Morris water maze task was performed 6 weeks after BCAS operation. HDAC2 and inflammatory cytokine levels in the hippocampus were determined. Cerebral blood flow (CBF) were assessed by laser speckle flowmetry.

Results:
HDAC2 protein level in the hippocampus did not differ between WT and AT2KO mice at 10 weeks of age, whereas HDAC2 of AT2KO mice at 20 weeks of age was higher compared with that of WT mice. Cognitive impairment after BCAS was more marked in AT2KO mice. Treatment with SAHA attenuated BCAS-induced prolongation of escape latency in the Morris water maze test both in WT and AT2KO mice; however this effect of SAHA was more marked in AT2KO mice. Decrease in CBF after BCAS was not affected by SAHA treatment. Expression of inflammatory cytokine mRNA was increased by BCAS and this increase was attenuated by SAHA treatment.

Conclusions:
We speculate that modulation of cerebral AT2 receptor could be new therapeutic tool to prevent cognitive impairment via epigenetic abnormalities.
Abstract WP273: Focal Knockdown of Matrix Metalloprotease 3 Reduces Hemorrhagic Transformation and Improves Neurobehavioral Outcomes in Hyperglycemic Stroke
Authors: Hafez Sherif , Abdelsaid Mohammed , Elshafey Sally , Fagan Susan , Ergul Adviye
Published: March 2022

Matrix metalloprotease 3 (MMP3) is an endopeptidase with broad substrate specificity that can target and degrade the components of the neurovascular unit. MMP3 was shown to be a critical mediator of the tPA-induced hemorrhagic transformation (HT) after stroke. The role of MMP3 in mediating neurovascular injury in hyperglycemic stroke was not previously reported. Accordingly, this study tested the hypothesis that MMP3 focal knockdown in the brain reduces HT and improves functional outcomes in hyperglycemic stroke.

Methods:
MMP3 shRNA lentiviral particles or an empty vector (EV) was injected into both hemispheres to the lateral ventricles of male Wistar rats. Two weeks later, Control and mildly HG rats (140-200 mg/dl, achieved by 30% glucose injection (IP) 15 min prior to surgery, n=7-9/group) were subjected to 90 min middle cerebral artery occlusion and 24 h reperfusion. At 24 h, neurological deficit, infarct size, edema, Hb content in ischemic hemispheres and HT occurrence rate (HT index) were measured. In an additional group of animals, the spatial expression of MMP3 within the neurovascular unit was determined by immunohistochemistry.

Results:
MMP3 knockdown significantly reduced HT index, Hb content and edema with no effect on infarct size and this was associated with improved functional outcomes (Table). MMP3 expression was more evident in HG animals and co-localized with the neurons, blood vessels and pericytes but not astrocytes.

Conclusion:
MMP3 knockdown reduced the vascular injury and improved the functional outcomes. Our findings point out MMP3 as a potential therapeutic target in hyperglycemic stroke.
Abstract WP277: Non-invasive Tracking of CD4
+
T Cells With a Paramagnetic and Fluorescent Nanoparticle in Brain Ischemia
Authors: Jin Wei-Na , Yang Xiaoxia , Li Zhiguo , Li Minshu , Shi Samuel Xiang-Yu , Wood Kristofer , Liu Qingwei , Fu Ying , Han Wei , Xu Yun , Shi Fu-Dong , Liu Qiang
Published: March 2022

Introduction:
Recent studies have demonstrated that lymphocytes play a key role in ischemic brain injury. However, there is still a lack of viable approaches to non-invasively track infiltrating lymphocytes and reveal their key spatiotemporal events in the inflamed central nervous system (CNS). In the present study, we describe an
in vivo
imaging approach for sequential monitoring of brain-infiltrating CD4
+
T cells in experimental ischemic stroke.

Methods:
CD4
+
T cells were obtained from splenocytes of C57BL/6 mice. After
in vitro
incubation with SPIO-Molday ION Rhodamine-B (MIRB) for 24 h, CD4
+
Rh-B
+
T cells were sorted and purified with FACS followed by subsequent passive transfer into Rag2
-/-
recipient mice (lack of T and B cells). After sham or 60 min of MCAO procedures with designated time of reperfusion, MIRB-labeled cells were sequentially visualized using 7T-MRI and Xenogen imaging. In separate groups of Rag2
-/-
mice that received MIRB-labeled CD4
+
T cells prior to sham or MCAO surgeries, brain, liver and spleen sections were obtained from these animals after MRI scans and immunostained with CD4 specific antibody, and the images were captured by a fluorescence microscopy.

Results:
We show that MRI or Xenogen imaging combined with labeling of MIRB can be used to monitor the dynamics of CD4
+
T cells in a passive transfer model (Figure 1). MIRB-labeled CD4
+
T cells can be longitudinally visualized in the mouse brain and peripheral organs such as the spleen and liver after cerebral ischemia. Immunostaining of tissue sections showed similar kinetics of MIRB-labeled CD4
+
T cells when compared with
in vivo
observations.

Conclusion:
Our results demonstrated the use of MIRB coupled with
in vivo
imaging as a valid method to track CD4
+
T cells in ischemic brain injury. This approach will facilitate future investigations to identify the dynamics and key spatiotemporal events for brain-infiltrating lymphocytes in CNS inflammatory diseases.
Abstract WP283: Temporal Changes in Mortality and Hospitalization Days in Nationwide Hospital Cohort According to Stroke Subtype and Comprehensive Stroke Care Capabilities: J-aspect Study
Authors: Kurogi Ryota , Kada Akiko , Nishimura Kunihiro , Kamitani Satoru , Nishimura Ataru , Sayama Tetsuro , Nakagawara Jyoji , Ogasawara Kuniaki , Ono Junichi , Shiokawa Yoshiaki , Aruga Toru , Miyachi Shigeru , Toyoda Kazunori , Matsuda Shinya , Yoshimura Shinichi , Okuchi Kazuo , Nakamura Fumiaki , Iihara Koji ,   J-ASPECT Investigators
Published: March 2022

Introduction:
Evidences of comprehensive stroke center regarding mortality and hospitalization days are insufficient.

Hypothesis:
To examine temporal changes in mortality and hospitalization days in patients with ischemic and hemorrhagic stroke according to stroke subtype and comprehensive stroke care capabilities in a nationwide hospital cohort in Japan.

Methods:
We conducted annual nationwide survey from 2011 to 2014 using data from the Japanese Diagnosis Procedure Combination database on patients hospitalized with ischemic and hemorrhagic stroke in a nationwide hospital cohort in Japan (J-ASPECT Study). Comprehensive stroke care capabilities were evaluated by 25-items score (Comprehensive stroke center (CSC) score) developed by this study group based on the institutional survey conducted in 2011, including 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. The effect of year on stroke mortality and hospitalization days was analyzed by mixed effect model with age, gender, Japan Coma Scale, and CSC score as a fixed effect, and hospital as a random effect.

Results:
The total numbers of patients were 252,940 in ischemic stroke (IS), 97,236 in intracerebral hemorrhage (ICH), and 30,521 in subarachnoid hemorrhage (SAH). The mortality in IS decreased from 6.3% to 5.7% over the four years (P < 0.001 for trend), and the effect of year was larger in hospitals with high CSC score (<17) than low CSC score (≧17); adjusted odds ratios (95% confidence interval) per year were 0.92 (0.90 - 0.95) and 0.96 (0.93 - 0.98) respectively. The mortality of patients with ICH and SAH did not show significant change as from 15.1 to 16.9 and 25.9 to 26.2, respectively. The median hospitalization days changed from 19 to 17 in IS, from 28 to 24 in SAH, and from 21 to 22 in ICH.

Conclusion:
Over the last four years, mortality in patients with ischemic but not hemorrhagic, stroke significantly decreased, especially in hospitals with higher comprehensive stroke care capabilities in Japan. The hospitalization days decreased in IS and SAH patients through four years.
Abstract WP289: Patient Satisfaction Survey Prior to Discharge in Neuroscience Unit: Evolving Gap in Hospital Operational Models and Patient Requests
Authors: DeRosa Peter , Shenai Mahesh , Mancini Barbara , Ecklund James , Cochran John W
Published: March 2022

Background:
Patient satisfaction (1), is increasingly tied to Medicare payments. Current standardized surveys (2) collect data 48h to 6wk after discharge.

Hypotheses:
Patient needs can be identified during the hospital stay, and inform clinical practices .

Methods:
Prospective, patients hospitalized. All patients admitted to our Neuroscience Unit were eligible for inclusion. Exclusion criteria were patient refusal and inability to communicate. A 10 question survey was developed and administered to in-hospital patients. Two questions asked perceived health and prior hospital experiences. Eight questions competitively presented the following domains of patient care: 1. Skills of Physicians and Nurses; 2. Communication of Physicians and Nurses; 3. Patient Knowledge of Medical Condition 4. Empowerment; 5. Responsiveness to Needs; 6. Logistics of Care; 7. Amenities.

Results:
Patients reporting hospital experiences as “frustrating, “mixed” or “good” selected Communication and Responsiveness as first and second most important domains respectively. Patients reporting “excellent” prior hospital experiences selected Knowledge and Skills of Physicians and Nurses as first and second most important domains respectively. See Table 1. During survey period, negative HCAPHS survey comments decreased from 46.9% to 2.4%.

Conclusion:
In-hospital, real-time, satisfaction data improves identification of specific patient needs. This can be used to align the unique needs of the Stroke patient with hospital practices.

1. Centers for Medicare and Medicaid Services; Value-Based Purchasing; 2. Centers for Medicare and Medicaid Services; HCAPHS
Abstract WP293: Patient and Hospital Characteristics Associated With Assessing Stroke Patients for Rehabilitation During Acute Stroke Hospitalization: Findings From the National REGARDS Study
Authors: Howard Virginia J , Douberly Jeralyn J , Reeves Mathew J , Fadairo Abimbola , Rhodes J D , Martin Kimberly D , Gamboa Christopher M , Kissela Brett M , Blackburn Justin , Safford Monika M
Published: March 2022

Background:
“Assessment for rehabilitation” (AFR) is an acute stroke care quality measure that is included in clinical guideline recommendations. Previous reports from “Get With The Guidelines (GWTG)” and the Coverdell Registry have shown compliance rates as high as 90 to 94% in stroke patients. These studies showed that blacks, males, and older patients were more likely to receive AFR.

Methods:
We abstracted data from ischemic stroke hospitalizations that occurred between 2003-2012 within REGARDS, a national US cohort study of blacks and whites aged > 45 at time of enrollment. The definition of AFR included any of the following: consult by rehab services, assessed by rehab team member, receipt of rehab during hospitalization. Independent patient and hospitalization characteristics associated with AFR were identified by logistic regression.

Results:
Information on AFR was determined in 536 of 546 ischemic stroke hospitalizations. The median age was 73.8+ 8.6 years, 50% were women, 46.8% were black. Three-quarter of the patients (406/536) had AFR. In univariate analyses, participants who were older, black, those with higher modified Rankin Score (mRS) and those evaluated by a stroke team were more likely to be assessed for rehabilitation, while participants in the west region of the US were least likely to be assessed. After multivariable adjustment, those who were older, those with a higher mRS, and those evaluated by an acute stroke team remained more likely to be assessed, while there was no statistically significant association of race, sex, or region (Table).

Conclusions:
The proportion of stroke patients assessed for rehabilitation was lower in this national sample compared to previous registry based reports. However these results corroborate prior findings that assessments are more common among older patients, blacks and those with more severe strokes. Further examination of patient and hospital characteristics is warranted.
Abstract WP297: Healthcare Transitions, Service Use, and Home-time Among Stroke Survivors With Depression
Authors: Harris Gabrielle , Prvu Bettger Janet , Lang Li , Thomas Laine , Duncan Pamela , Reeves Mathew , Xian Ying , Peterson Eric D , Bushnell Cheryl
Published: March 2022

Background:
Depression following an acute ischemic stroke (AIS) is associated with poor functional recovery, less social activity, and mortality. Patterns of health service use in the 90 days after an AIS have not been described by depression severity.

Methods:
Data from Get With The Guidelines-Stroke and a prospective cohort of AIS patients enrolled in the AVAIL (Adherence eValuation After Ischemic Stroke Longitudinal) study were linked with Medicare claims. AVAIL patients depressive symptoms were measured by the PHQ-8 90 days after hospital discharge by phone and categorized as no/minimal depression (0-4), mild (5-9), and moderate-severe (≥10). The number of transitions was defined as the number of acute and post-acute inpatient and outpatient services in the claims data within 90 days of the index admission. Home-time was the number of days alive and out of inpatient care. Differences in clinical characteristics and service use were evaluated between depression severity groups.

Results:
Of 538 AIS patients examined, 63% had no/minimal depression, 24% mild and 14% had moderate-severe depression 90-days post-stroke. Patients experienced up to 6 care transitions in 90-days; the 10 most common care patterns representing 80% of this sample (Figure). Across categories of increasing depression severity (no/minimal, mild, moderate-severe), use of services increased from no/minimal to those with depression (% with ≥1 service after discharge: 71%, 87%, 85%; p=0.002), and home time decreased (mean±SD: 82±16, 75±23, 77±23; p=0.006), although rehospitalization within 90 days was 19% for each group (p=0.984).

Conclusion:
This study demonstrates an association between post-stroke depression and worse outcomes following stroke. Research is needed to determine whether targeted care coordination interventions can improve outcomes among stroke patients with depression.
Abstract WP298: Patient and Caregiver Physical Health During the First Year Post-stroke
Authors: Cameron Jill I
Published: March 2022

Background:
Patients and their family caregivers collaborate to optimize patients’ recovery post-stroke. The literature suggests that stroke can negatively affect patient physical health and providing care can negatively affect caregiver wellbeing. We do not know how patient and caregiver health are linked. Therefore, the objective of this research was to examine the influence of patient, caregiver, and caregiving factors on patient and caregiver physical health.

Method:
Secondary analysis of a longitudinal cohort study of survivors of their first stroke and their family caregivers (n=399 dyads). Participants completed standardized surveys 1, 3, 6, and 12-months post stroke. Patient data included demographic information, Canadian Neurological Scale, stroke type, stroke location, and the Mini Mental Status Exam. Caregivers provided demographic information and completed the Caregiver Assistance Scale, Mastery Scale, Brain Impairment Behaviour Inventory-revised, and Centre for Epidemiological Studies Depression Scale. Patients and caregivers completed the SF-36 and the physical component score was used in the analyses. Hierarchical Linear Modelling was used to test full regression models using the longitudinal data.

Results:
Patients’ physical health was better when they were younger, had a milder stroke, fewer symptoms of depression, better cognitive health, and their caregiver had fewer symptoms of depression, provided less assistance, were female, and their spouse. Caregivers’ physical health was better when the stroke survivor had fewer memory problems, and caregivers had fewer symptoms of depression, were younger, and were male.

Conclusions:
Patient and caregiver factors were associated with each other’s physical health during the first year post-stroke. Caregiver depression symptoms were associated with poor physical health in both the patient and the caregiver. This suggests programs to address caregivers experience of depression may benefit both patients and caregivers physical health.
Abstract WP304: Improving Safety of Stroke Prevention Strategies in AF: Effect of Online CME
Authors: Spyropoulos Jelena S
Published: March 2022

Introduction:
Evidence-based anticoagulant therapy is the cornerstone of stroke prevention in patients with atrial fibrillation (SPAF); however, patients are often inappropriately treated, resulting in preventable morbidity and mortality.

Hypothesis:
A video-based online continuing medical education (CME) activity can improve the knowledge and competence of cardiologists regarding clinical safety and appropriate use of non-vitamin K oral anticoagulants (NOACs) in management of SPAF.

Methods:
An online CME activity was developed as a 25-minute roundtable discussion with 3 leading experts on the role of NOACs in the setting of SPAF. The activity included a transcript of the discussion and a downloadable slide deck to highlight and reinforce key data. The effects of education were assessed using a linked pre-assessment/post-assessment study design. For all questions combined, the McNemar’s chi-square test was used to assess differences from pre- to post-assessment. P values are shown as a measure of significance; P values <.05 are statistically significant. Cohen’s d was used to calculate the effect size (> 0.8 are large, 0.8-0.4 are medium, and < 0.4 are small).

Results:
For cardiologists who participated in the CME activity, comparison of individually linked pre-assessment question responses to the respective post-assessment question responses demonstrates statistically significant improvements (N = 489;
P
<.05), with an overall large effect size of 0.865 (Table).

Conclusion:
The significant improvements observed in this online CME roundtable discussion demonstrate the benefits of educating the large target audience base with aptly designed educational activities using adult-learning principles. This assessment identified education gaps that support the need to develop additional CME activities on SPAF management for cardiologists, including appropriate use of NOACs to optimize safety while preventing further strokes.
Abstract WP311: In-hospital Depression and Anxiety and History of Depression Predict 3 Months Post-stroke Depression and Anxiety
Authors: El Husseini Nada , Duncan Pamela , D’Agostino Ralph , Ambrosius Walter T , Bishop Laura , Gesell Sabina , Prvu-Bettger Janet , Bushnell Cheryl
Published: March 2022

Background:
Multiple factors may impact a patient’s response on a depression screen during hospitalization for stroke. The EQ-5D-3L is a standardized measure for use as a health outcome, and comprises the dimension of anxiety/depression. We examined the relationship between pre-hospital history of depression and in-hospital and 3 months anxiety/depression on EQ-5D.

Methods:
We captured 3-month outcomes on patients with stroke or TIA discharged home between September 2011 and April 2015. EQ-5D-3L dimension of anxiety/depression at 3 months dichotomized as “no symptoms” or “at least some symptoms” was the primary outcome. Two stepwise logistic regression models adjusting for age, history of congestive heart failure , and baseline NIHSS were generated: 1) using pre-hospital depression as the main predictor (N=124) and 2) using in-hospital depression as the main predictor (N=69 because of missing data in this variable). History of pre-hospital depression and in-hospital depression were highly correlated with each other and were not included in the same model.

Results:
The sample included 124 patients (98 with ischemic stroke, 18 hemorrhagic strokes and 8 TIA). The mean age was 66.0 y (SD12.3), 45% women, 73% white, and mean NIHSS 4.0 + 5.2. Anxiety/depression was reported by 30/69 (43%) subjects in the hospital and by 23/124 (18%) at three months post-stroke. In the first model, previous history of depression was associated with 3 months EQ-5D-3L anxiety/depression (p=0.038). In the second model, in-hospital anxiety/depression was associated with 3-month EQ-5D-3L anxiety/depression (p=0.027) (table).

Conclusion:
Self-reported depressive and anxiety symptoms in the hospital and history of depression were associated with 3 months post-stroke depression and anxiety. This confirms the importance of screening in subjects with acute stroke for history of depression and for in-hospital depression/anxiety.
Abstract WP316: Incidence, Risk Factors, and In-Hospital Outcomes Associated With Hospital-Acquired Conditions and Patient Safety Indicators In Spontaneous Intracerebral Hemorrhage
Authors: Rumalla Kavelin , Rajan Ashna , Mittal Manoj K
Published: March 2022

Introduction:
The Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) and the Agency for Healthcare Research and Quality patient safety indicators (PSIs) are standardized quality metrics linked to reimbursement. Spontaneous intracerebral hemorrhage (ICH) is associated with a poorer prognosis than other types of stroke. The incidence, risk factors, and in-hospital outcomes associated with HACs and PSIs in ICH admissions have not previously been reported.

Methods:
The Nationwide Inpatient Sample was queried from 2002 to 2011 to identify all ICH patients (ICD-9-CM code 431). The incidence of HACs and PSIs was determined. Multivariable logistic regression analyzed the effect of patient and hospital factors on HAC/PSI occurrence and the effect of HAC/PSI occurrence on prolonged length of stay (defined as ≥ 75th percentile), increased hospital costs (defined as ≥75th percentile), and adverse discharge (except routine).

Results:
A total of 12,870 HACs and 260,048 PSIs were identified among 643,660 hospitalizations for spontaneous ICH. The HACs with the highest incidence were falls/trauma (n=1,198), postoperative poor glycemic control (n=895), stage III/IV pressure ulcers (n=622), and iatrogenic pneumothorax (n=620). The PSIs with the highest incidence were postoperative respiratory failure (n=194,859), postoperative sepsis (n=19,045), pressure ulcer (n=17,826), and deep vein thrombosis (n=15,759). Comorbidity score (19.7%, 18.9% increase per comorbidity, p<0.0001) and Medicaid insurance (31.5%, 21.4%, p<0.0001) were independent predictors of HAC and PSI occurrence, respectively. Black race (15.7%, p<0.0001), urban hospitals (69%, p<0.0001), and teaching hospitals (35.2%, p<0.0001) were independent predictors of PSI occurrence only. Both HAC and PSI occurrence increased the odds of prolonged LOS (64.9%, 36.9%, p<0.0001), increased hospital costs (70.8%, 72.9%, p<0.0001) and adverse discharge (32%, 167.1%, p<0.0001).

Conclusion:
HACs and PSIs occur frequently in ICH hospitalizations and are associated with poor in-hospital outcomes. Awareness of the factors that increase the likelihood of incurring HACs and PSIs may contribute to new quality protocols targeted at these factors.