bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP165: Functional Outcomes at Discharge After Intracerebral Hemorrhage in Young Adults: Comparison by Sex and Pregnancy Status
Authors: Haghighi Noora , Sariyeva Mehriban , Booker Whitney , Petersen Nils H , Mitchell Amanda , Connolly Edward , Agarwal Sachin , Park Soojin , Ghoshal Shivani , Claassen Jan , Roh David , Miller Eliza C
Published: February 2024

Introduction:
Intracerebral hemorrhage (ICH) is a major cause of maternal morbidity and mortality. While sex differences exist in clinical outcomes of ICH in young adults, it is not known if outcomes differ between pregnancy-associated ICH (PICH) and non-pregnancy-associated ICH (NPICH).

Methods:
We performed a cross-sectional analysis of 134 adults, aged 18-44 years, admitted to an urban academic medical center with non-traumatic acute ICH between 01/01/2012-12/31/2021. Participants were identified using an internally maintained stroke registry as well as data collected from the ICHOP (Intracerebral Hemorrhage Outcomes Project) study. We compared ICH outcomes between three exposure groups: PICH, NPICH in females, and NPICH in males. PICH was defined as ICH occurring during pregnancy or within 3 months postpartum. The primary outcome was mRS at discharge, with good outcome defined as mRS 0-2 and bad outcome as mRS 3-6. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for the association of exposure group status with bad outcome, with non-pregnant females as the reference group.

Results:
Characteristics of the study population are detailed in the Table. Individuals with PICH had a lower proportion of chronic hypertension (p<0.0001) and smoking (p=0.02). Adjusting for age, hematoma volume, and ICH location, functional outcomes at discharge did not differ between groups (Figure).

Conclusions:
Functional outcomes at discharge after ICH were similar in young adults, regardless of sex or pregnancy status, despite a lower prevalence of vascular risk factors in patients with pregnancy-associated ICH.
Abstract TP167: Hemorrhage Severity Associates With Hospital Acquired Delirium During Intracerebral Hemorrhage
Authors: Potter Thomas B , Pan Alan P , Bako Abdulaziz , Borei Karim , Prince Taya , Britz Gavin W , Vahidy Farhaan
Published: February 2024

Introduction:
Delirium associates with poor outcome after intracerebral hemorrhage (ICH), yet its incidence and contributing factors are poorly characterized. We show delirium proportions among older ICH patients and identify factors that associate with hospital-acquired delirium (HAD).

Methods:
Data from older adult (≥70 years) patients with primary nontraumatic ICH were retrieved from electronic medical records. Delirium was assessed once every 12 hours or per shift using the modified Arousal, Attention, Abbreviated Mental Test-4, Acute change test. Delirium on admission (DOA) was defined as a positive screen within 48 hours of admission and HAD was defined as a positive screen among non-DOA patients. Population differences between HAD and non-HAD patients were assessed using Wilcoxon Rank Sum and Pearson’s Chi Squared tests. Factors associated with HAD were identified via multivariable logistic regression modelling. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results:
The cohort included 647 patients (median age: 79, interquartile range: [74-85]; 55.0% female) with an ethno-racial distribution of 57.6% White, 16.4% Black, 15.9% Hispanic, 8.5% Asian, and 1.6% Other. The median hemorrhage volume was 8.0 [1.6-24.7] cm
3
. DOA was present in 327 (50.5%) patients. Among patients without DOA (n=320), 90 (28.1%) developed HAD. In univariate analyses, patients with HAD (vs non-HAD) were significantly older and had lower admission Glasgow Coma Scale scores, larger hemorrhages volumes, more frequent intraventricular hemorrhage (IVH), and longer lengths of stay. In multivariable modelling, HAD was independently associated with older age (1.05 [1.01-1.10]), top-quartile hemorrhage volume (2.89 [1.08-7.75]), length of stay (1.14 [1.08-1.19]), and IVH (2.03 [1.08-1.19]) (Figure 1).

Discussion:
Older patients and those with more severe hemorrhage characteristics show greater odds of developing in-hospital delirium.
Abstract TP177: Functional Outcome Prediction in Primary Angiitis of the Central Nervous System
Authors: Nehme Ahmad , Isabel Clothilde , Dequatre Nelly , Arquizan Caroline , Régent Alexis , Guillon Benoît , Capron Jean , Detante Olivier , Lanthier Sylvain , Poppe Alexandre Y , Boulouis Grégoire , Godard Sophie , Terrier Benjamin , Pagnoux Christian , Aouba Achille , Touze Emmanuel , de Boysson Hubert ,   Cohort of Patients with PACNS study group
Published: February 2024

Introduction:
Predicting the probability of functional independence in patients with primary angiitis of the central nervous system (PACNS) may help guide treatment decisions and prognostication. We sought to develop a prediction model for functional independence in adults with PACNS.

Methods:
Adults with PACNS were included from an international, multicenter, retrospective, observational cohort (COVAC). Clinical and imaging variables were collected prior to immunosuppressant treatment. Univariable and multivariable logistic regression models were used to identify baseline variables associated with functional independence (modified Rankin Score 0-2), measured 12 months after diagnosis.

Results:
Among the 194 patients included, 60 (31%) were diagnosed with PACNS based on a positive biopsy. At 12 months, 124 (65%) patients were functionally independent and 12 (6%) were dead. In multivariable logistic regression models, variables predictive of functional independence at 12 months were presence of ≥ 1 intracranial stenosis on CT- or MR-angiogram (aOR 3.33, 95% CI: 1.34-8.77, p=0.01), headache (aOR 2.66, 95% CI: 1.29-5.62, p<0.01), and absence of an altered level of consciousness (aOR 0.09, 95% CI: 0.02-0.28, p<0.001), an acute brain infarct (aOR 0.13, 95% CI: 0.04-0.34, p<0.001), or cognitive impairment (aOR 0.32, 95% CI: 0.15-0.68, p<0.01). A predictive model including these five variables showed good discrimination (c-statistic: 0.79, 95% CI: 0.72-0.86). Purely lymphocytic PACNS (n=34) was not associated with higher odds of functional independence than granulomatous or necrotizing PACNS (n=26) (OR 0.97, 95% CI: 0.33-2.83, p=0.96).

Conclusions:
This study identified baseline clinical and imaging variables that may predict functional independence in adults with PACNS. Validation of these results is required in an independent cohort.
Abstract TP18: A 15-Minute Cognitive Screen Identifies Post-Stroke Cognitive Impairment
Authors: Drag Lauren , Mlynash Michael , Musabbir Muhith , Bradley Amy , Lansberg Maarten G , Allan Stuart , Smith Craig J , Aghaeepour Nima , Buckwalter Marion S
Published: February 2024

Introduction:
While comprehensive neuropsychological evaluations are a valuable part of post-stroke care, time-intensive assessments may not always be feasible or well-tolerated in certain clinical settings. There is a need for a brief cognitive battery that can detect post-stroke cognitive impairment while being efficient with regard to time and resources.

Methods:
As part of the parallel StrokeCog and Stroke-IMPaCT studies, 127 participants with chronic ischemic stroke completed comprehensive neuropsychological testing at Stanford. They underwent a cognitive battery consisting of 13 tests that encompassed 5 cognitive domains. Partial least square analyses identified a set of candidate tests that were most associated with cognitive impairment on this comprehensive battery, defined as 2 domain z-scores <-1 or 1 domain z-score <-1.5. We used these candidate tests to construct a brief battery of 5 tests (StrokeCog-Brief). Psychometric properties were compared amongst StrokeCog-Brief, the MoCA, and another established 30-minute battery (NINDS-30). Initial findings were cross-validated in an independent sample of 61 participants at University of Manchester.

Results:
The StrokeCog-Brief battery consisted of 5 measures of language, working memory, learning, and attention/processing speed (HVLT Immediate Recall, Trails A, Trails B, Digit Span Forward/Backward, Phonemic Fluency) that took approximately 15 minutes to complete. StrokeCog-Brief demonstrated high sensitivity (0.97) and adequate specificity (0.78) in detecting cognitive impairment on the comprehensive battery, outperforming both the MoCA (0.77, 0.73) and NINDS-30 (0.97, 0.35). In the cross-validation sample, StrokeCog-Brief similarly demonstrated high sensitivity (0.93) and adequate specificity (0.67), again outperforming both the MoCA (0.60, 0.86) and NINDS-30 (0.81, 0.08).

Conclusions:
We identified a brief, 15-minute battery of 5 tests that has high sensitivity in detecting cognitive impairment in people who have had a stroke. This brief battery covers multiple cognitive domains commonly impacted by stroke and represents an efficient means to identify chronic post-stroke cognitive impairment.
Abstract TP183: Endovascular Thrombectomy in Patients With Pre-Existing Disability Presenting With Large Vessel Occlusion Stroke
Authors: Mehta Amol , Caton Michael T , Kellner Christopher P , Shigematsu Tomoyoshi , Oxley Thomas J , Shoirah Hazem , De Leacy Reade A , Johanna Fifi , Mocco J D , Majidi Shahram
Published: February 2024

Introduction:
Despite representing a substantial proportion of patients who present with large vessel occlusion (LVO) acute ischemic stroke (AIS), patients with baseline disability are often excluded from endovascular thrombectomy (EVT) clinical trials. We present our institutional experience with EVT in this patient population.

Methods:
Prospectively maintained database from our comprehensive stroke center was retrospectively reviewed for consecutive cases from December 2014 to July 2023. Patients who underwent EVT were included. Two groups of patients were created; patients without existing disability (modified Rankin Score [mRS] 0-1) and those with existing disability (mRS≥2). Demographics and comorbidities were compared. Difference in 90 day mRS and baseline mRS (delta mRS) was calculated as primary outcome measure. Wilcoxon rank test and generalized linear regression were used for analysis.

Results:
Total of 1441 patients were identified, 347 patients (24.1%) had pre-existing disability.This group had higher average age (82 vs 68, p<0.01), a higher proportion of female patients (66.57% vs 41.13%, p<0.001), and elevated rates of comorbidities such as atrial fibrillation, diabetes, and hypertension. Additionally, they presented with a slightly higher median NIHSS of 18 (vs 15, p<0.001).There was no difference in the rate of successful reperfusion (TICI 2b-3:90.49% vs 87.53%, p=0.16), or symptomatic ICH (1.44% vs 1.83%, p=0.75) between the two groups. Higher rate of delta mRS=0 (return to baseline) was observed in patients with pre-existing disability (17.58% vs 8.98%, p<0.001). Similarly, delta mRS ≤ 1 was higher in this group (33.43% vs 22.36%, p<0.001). In multivariable analysis, after adjusting for initial stroke severity and ASPECTS, patients with pre-existing disabilities had higher rate of return to baseline functional status and similar rate of ICH. Pre-existing deficit predicted an increase in delta mRS ≤ 1 (β=1.04, p<0.001).

Conclusion:
EVT appears to be safe and effective in patients with baseline disability, often returning patients to their pre-morbid functional status by 90 days follow up. Although further studies are needed, it is reasonable to offer EVT for patients with baseline disability presenting with LVO stroke.
Abstract TP184: Outcomes and Clinical Features Associated With Emergency Conversion to General Anesthesia During Stroke Thrombectomy
Authors: Anderson Matthew N , Sen Rajeev , Galang Christine , Prijoles Keiko Lynne , Cha Nathaniel , Winter Ashtyn , Raub Spencer L , Langaroodi Lilac , Levitt Michael , Ghodke Basavaraj , Walker Melanie
Published: February 2024

Introduction:
Anesthesia options for ischemic stroke patients undergoing endovascular thrombectomy (MT) can include local anesthesia, conscious sedation, or general anesthesia. Recent meta-analyses show that patients requiring emergency conversion (EC) to general anesthesia (GET) have higher mRS post-discharge than non-converters. The aim of this study was to assess the immediate outcomes in EC patients and identify factors associated with EC risk.

Methods:
This retrospective study included 264 sequential patients undergoing MT for large vessel occlusion at a comprehensive stroke center. EC was defined as intra-procedural induction of GET during MT.

Results:
Twelve patients (4.5%) required EC to GET. Median times from puncture to first pass (49 vs. 27 mins) and puncture to reperfusion (88 vs. 47 mins) were nearly doubled in EC patients compared to non-converters. Though the median TICI scores were similar, EC patients required double the number of passes and experienced significantly more symptomatic hemorrhagic complications (OR 5.82; 95% CI 1.10-30.688; p=0.018). An increased trend towards in-hospital death was noted (OR 1.46; 95% CI 0.382-5.602; p=0.289). Tobacco use was the only correlated clinical factor reaching statistical significance (RR 2.05; 95% CI 0.878-4.783; p=0.048).

Conclusion:
Although EC patients have similar reperfusion scores based on radiographic criteria, more complications were observed, and nearly double the time was required for reperfusion. While there is no consensus on anesthesia type during MT, EC introduces unnecessary risk and should be avoided. Given the potential harm from EC, multidisciplinary communication prior to puncture is essential.
Abstract TP186: The Presence of Low Signal on T2*-Weighted Gradient Echo Magnetic Resonance Imaging Before MT Should Be Not Associated With Hemorrhagic Complications
Authors: kimura ryutaro , Kimura Kazumi , Watanabe Kaito , Nakagami Toru , Kohyama Shinya , Suda Satoshi
Published: February 2024

Background:
In patients with acute ischemic stroke with the large vessel occlusion (LVO), the presence of low signal including microbleeds on T2*-weighted gradient echo magnetic resonance imaging (T2*-positive) which suggestive of an old cerebral hemorrhage before mechanical thrombectomy (MT) may be associated with hemorrhagic change after MT, but the significance of this finding is unclear.

Methods:
Patients with acute stroke with LVO underwent T2* before MT. Patients were classified into two groups as T2*-positive and T2*-negative. We compared hemorrhagic change after MT, outcome at discharge and clinical characteristics between two groups. The occurrence of hemorrhagic change was assessed on CT after MT. Patients outcomes were classified into two group; good outcome as modified Rankin Scale (mRS) 0-2 and poor outcome as mRS 5-6, respectively. Clinical characteristics and imaging factors associated with any ICH after MT were evaluated by multivariate regression analysis.

Results:
348 patients (median age, 78 years; men, 60.1%; median NIHSS score, 16) were enrolled. The site of occlusion was the ICA (n=92, 26.4%), M1 (n=168, 48.3%), M2 (n=49, 14.1%) and BA(n=29, 8.3%). T2*-positive and T2*-negative were found in 73 (21.0%) and 275 (79.0%), respectively. There were no differences in age, history of hypertension, diabetes, atrial fibrillation and stroke, TOAST type, DWI-ASPECTS, NIHSS, use of tPA, or TICI≧2B rate between the two groups. Any ICH after MT was 28 (38.4%) in T2*-positive and 96 (34.9%) in T2*-negative (P=0.585). PH and SAH were 7 (9.6%) and 2 (2.7%) in T2*-positive and 40 (14.9%) and 25 (9.1%) in T2*-negative (P=0.337, and P=0.085), respectively. Poor outcome was 27 (37.0%) in T2*-positive and 65 (23.6%) in T2*-negative (P=0.025), respectively. Multivariate regression analysis demonstrated that T2*-positive was not associated with any ICH (odds ratio, 0.884; confidence interval, 0.473-1.654; P=0.700).

Conclusions:
In patients with acute ischemic stroke with LVO, low signal on T2* before MT should not be associated with hemorrhagic change after MT.
Abstract TP187: Comparison of Balloon Guide Catheter versus Non-Balloon Guide Catheter for Mechanical Thrombectomy in Distal Medium Vessel Occlusion
Authors: Orscelik Atakan , Kallmes David F , Bilgin Cem , Senol Yigit Can , Kobeissi Hassan , Elawady Sameh Samir , Cunningham Conor , Matsukawa Hidetoshi , Zandpazandi Sara , Sowlat Mohammad-Mahdi , Maier Ilko , Al Kasab Sami , Jabbour Pascal M , Kim Joon-Tae , Quintero Stacey C , rai ansaar , Starke Robert , Psychogios Marios , Samaniego Edgar A , Arthur Adam S , Yoshimura Shinichi , Cuellar Hugo , Howard Brian , Alawieh Ali , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles C , Park Min S , Levitt Michael , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade A , Chowdhry Shakeel A , Ezzeldin Mohamad , Brinjikji Waleed , Spiotta Alejandro M
Published: February 2024

Introduction:
While balloon guide catheters (BGCs) enhance safety and efficacy of mechanical thrombectomy in large vessel occlusions, their impact on distal medium vessel occlusion (DMVO) remains underexplored. This study aimed to compare the outcomes of BGC vs non-BGC in DMVO thrombectomy.

Methods:
This retrospective study focused on DMVO cases defined as occlusions in M2-M4 middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Baseline characteristics and technical and clinical outcomes were compared between the two groups, with subgroup analysis in first-line thrombectomy techniques, including ADAPT, stent retriever, and Solumbra. First pass effect (FPE) was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2C after the first pass.

Results:
A total of 1,508 patients were included, of whom 231 (15.3%) were in the BGC group and 1,277 (84.7%) were in the Non-BGC group. The BGC group was associated with a lower mTICI score ≥ 2C (overall: 43.2% vs. 52.7%, p = 0.01; ADAPT: 42.2% vs. 57.1%, p = 0.01; Solumbra: 32.4% vs. 51.4%, p = 0.005), longer puncture to intracranial access time (overall: 15 vs. 8 min, p < 0.001; ADAPT: 17 vs. 8 min, p < 0.001; Solumbra: 12 vs. 8 min, p = 0.02), and longer puncture to recanalization time (overall: 97 vs. 35 min, p < 0.001; ADAPT: 100 vs. 28 min, p < 0.001; Solumbra: 78 vs. 46 min, p < 0.001; Stent retriever: 95 vs. 45 min, p < 0.001 ). The BGC group also had a lower FPE rate (17.4% vs. 30.7%, p = 0.03) in the Solumbra subgroup. In terms of clinical outcomes, the BGC group had a lower rate of distal embolization (overall: 8.8% vs. 14.9%, p = 0.02), but there were no significant differences in other clinical outcomes between the two groups in first-line thrombectomy techniques.

Conclusions:
Our findings showed that the use of BGC in DMVO had a lower mTICI score, reduced FPE rates, decreased distal embolization, and longer procedure times.

Figure 1:

Figure 2:
Abstract TP2: Increase of EphrinB2/EphB4 Signaling Reduces the Severity of Brain Arteriovenous Malformation in Endoglin Deficient Mice Through Reduction of Angiogenesis and Inflammation
Authors: Shabani nabikandi Zahra , Barbosa Do Prado Leandro , Yadav Alka , Zhang Rui , Zhu Wan , Shaligram Sonali , Schuger Joana , Liang Rich , Press Kelly , Su Hua
Published: February 2024

Background and Purpose:
Vessels in brain arteriovenous malformations (bAVMs) have reduced mural cells and are prone to rupture, causing intracranial hemorrhage.
EphrinB2/EphB4
signaling has role in maintaining vascular integrity.

Hypothesis:
Reducing
EphrinB2
in endothelial cells (ECs) enhances, while increasing EphrinB2 reduces bAVM severity in endoglin (
Eng
) deficient mice.

Methods:
BAVMs was induced by
Eng
deletion in adult
Eng
-floxed mice (
Eng
f/f
) globally or in ECs using a rosa promoter driving (
Rosa-creER
) or a platelet-derived growth factor b promoter driving (
Pdgfb-
icreER) estrogen inducible cre.
Pdgfb-
icreER was used to delete
EphrinB2
in ECs. AAV-VEGF was injected into the brain to induce angiogenesis. Pre-clustered EphrineB2-Fc was delivered intraperitoneally to
RosaCreER
;
Eng
f/f
mice and
Pdgfb-icreER:Eng
f/f
mice twice per week for 2 weeks, starting 6 weeks after AVM induction. The brains were taken 8 weeks after AVM induction to study vessel density, dysplasia vessels, mural cell coverage, microhemorrhage and gene expression.

Results:
RNAseq data shown increased EphB4 in bAVMs of EC
Eng
deleted mice, suggesting an imbalance of EphrinB2/EphB4 ratio. Co-deletion of
EphrinB2
with
Eng
in ECs increased the penetrance of bAVM phenotype from 46% (EC
Eng
deletion) to 100%, smooth muscular negative vessels, and increased expression of leukocytes differentiation, inflammatory, and vasculogenesis genes. EphrinB2-Fc treatment reduced vessel density and dysplasia vessels; increased vascular pericyte and smooth muscle cell coverage; decreased microhemorrhage in bAVMs of mice with global or EC
Eng
deletion, and decreased the expression of pro-inflammatory, oxidative phosphorylation, and angiogenic genes.

Conclusion:
Co-deletion of
EphrinB2
with
Eng
in ECs enhances bAVM severity by increasing inflammation while EphrinB2-Fc treatment reduced bAVM severity in
Eng
deficient mice by reducing angiogenesis and inflammation.
Abstract TP203: Effect of SARS-CoV2 Infection on Endovascular Thrombectomy Outcomes - Data From the Florida Stroke Registry
Authors: Fountain Hayes B , Ramsay Ian , Yin Ruijie , Abdelsalam Ahmed , Silva Michael , Rose David , Jameson Angus , Alkhachroum Ayham , Ying Hao , Foster Dianne , Gutierrez Carolina M , Rundek Tatjana , Romano Jose G , Gardener Hannah , Asdaghi Negar , Starke Robert M
Published: February 2024

Introduction:
The outcomes of endovascular thrombectomy (EVT) in SARS-CoV2 positive patients with acute ischemic stroke (AIS) are not well studied. In the large Florida Stroke Registry we compared in hospital and discharge outcomes of patients with target vessel occlusions treated endovascularly with versus without a SARS-CoV2 positive infection status during their hospitalization.

Methods:
Data from Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry from March 2020 to December 2022 were reviewed. EVT patients with coding for SARS-CoV2 testing during their hospital stay were categorized into SARS-CoV2 positive or negative groups. Associations between SARS-CoV2 status and favorable EVT outcomes of good mRS (0-2) at discharge, discharge to home or to rehabilitation centre, and independent ambulation at discharge were examined using multivariate logistic regression modeling adjusting for demographics, vascular risk factors, and clinical characteristics with generalized estimating equations (GEE). Temporal analyses compared outcomes across the years 2020-2022.

Results:
A total of 8,778 patients underwent EVT, of these, 193 (2.25%) were SARS-CoV2 positive. The odds of mRS 0-2 and independent ambulation at discharge were OR 0.194 (CI 0.035,1.077) and OR 0.794 (CI 0.168,3.75) in SARS-CoV2 positive relative to negative EVT patients. Outcomes of mRS 0-2 (OR 0.194, CI 0.035,1.077) and ambulation at discharge (OR 0.794, CI 0.168,3.75) were shy of statistical significance. Accounting for baseline differences SARS-CoV2 positive patients were less likely to be discharged home or to a rehabilitation centre (OR 0.671, CI 0.488,0.921) in multivariable analysis with GEE. Temporal analysis of SARS-CoV2 positive patients showed no significant differences across the years studied.

Conclusions:
In this large muliticentre stroke registry the results suggest that favorable outcomes post thrombectomy may be negatively impacted by SARS-CoV2 infection. Temporal assessment showed similar results across the years studied. These findings provide novel insight from a large database to add to the emerging literature examining outcomes of concurrent SARS-CoV2 infection in the setting of EVT for target vessel occlusion AIS.
Abstract TP212: 2b or Not 2b? TICI 2b Reperfusion Score in Endovascular Thrombectomy for Acute Ischemic Stroke Carries a Poor Functional Outcome
Authors: Welsh Connor , Teran Patricia , Gonzalez Daniel , Waters Michael , Kaur Supreet , Ashby Lynn , Schroeder Tracie , Sheehan Tiffany , Townley Liam , Wang David Z
Published: February 2024

Background:
Endovascular thrombectomy (EVT) for treatment of acute ischemic stroke (AIS) in the proximal cerebrovasculature has, since its inception, become part of the standard of care when addressing AIS. Overall, one in six individuals treated has improved neurologic and functional outcomes. Reperfusion following thrombectomy in the anterior cerebral circulation has long been graded by the modified Thrombolysis in Cerebral Infarction (mTICI) scale-and the score of mTICI (2b, or, “partial filling of more than 50% of the affected vascular territory” is considered the benchmark for “good” outcomes in EVT. It remains unclear whether this score at time of reperfusion reliably predicts a sustained improvement in neurologic or functional outcome.

Method:
This is a retrospective review of all anterior AIS patients with large vessel occlusion (LVO) at Barrow Neurological Institute between 01/01/2018 and 12/31/2022 who underwent EVT with mTICI 2b or greater. The study was approved by the local IRB. Demographic data of patients between the ages of 18 and 95 who had AIS with LVO in the anterior Circle of Willis or its supplying vessels were collected. Other variables collected and analyzed include mTICI score, and modified Rankin Score (mRS) at discharge and 90 days. The TICI grade was obtained via digital cerebral angiography post EVT. Descriptive statistics was used to examine the differences of mRS scores at 90 days.

Results:
Of 81 cases reviewed, 52 (65%) had a TICI 2b score and their average mRS was 3.7, 20 (25%) had a TICI 2c and their average mRS was 3.6, and 4 (5%) had a TICI 3 with mRS 3 at discharge. At 90 days, the average mRS for TICI 2b patients was 3.2, for TICI 2c patients 2.9 and for TICI 3 patients 2.3. No difference in the rate of intracerebral hemorrhage (ICH) following reperfusion between the TICI 2 and 3 groups (17%).

Conclusion:
Our results demonstrated that patients with a mTICI of 2b had a higher mean mRS at discharge and minimal improvement of mRS at 90 days compared against patients with a mTICI of 2c or 3 (average change in score was -0.6, -0.7 and -1.3 in the TICI 2b, 2c and 3 groups respectively). Therefore, a reperfusion score of mTICI 2b may not be sufficient to indicate a high probability of a good functional outcome. With EVT, reaching a TICI 3 should be attempted.
Abstract TP24: C-Reactive Protein, and Homocysteine as a Predictors of Post Stroke Depression Among Stroke Patients: A Meta-Analysis and Meta Regression
Authors: Jaiswal Vikash , Ang Song Peng , Suresh Vinay , Nasir Yusra , Joshi Amey , Kumar Danisha , Gupta Shiva , Ishak Angela
Published: February 2024

Background:
Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke associated with poor functional outcome and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD.

Aim:
To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without PSD.

Methods:
We systematically searched all electronic databases from inception until May 30th 2023. We performed a conventional meta-analysis and adopted the DerSimonian and Laird random-effect model for the study variations [30]. Outcomes were reported as standard mean difference (SMD), and their corresponding 95% confidence interval (95% CI).

Results:
A total of 12 studies with 3,230 Patients were included in this analysis. The mean age of the overall cohort was 65.7 years with PSD patients appearing to be older than non-PSD patients (mean 68.3 years versus 63.1 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (44.4% versus 40.7%). Compared to patients without post-stroke depression, it was found that patients with post-stroke depression had a higher levels of baseline CRP levels [SMD 0.16, (95% CI 0.08 to 0.25), p<0.001], and Hcy [SMD 0.14, (95% CI 0.05 to 0.22), p<0.001]. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, widowhood and family history of psychiatric disorder. For CRP there was no effect modifier, while for Hcy it was observed that a personal history of widowhood appeared as an only significant effect modifier (coefficient 1.998, p=0.038).

Conclusion:
Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression post stroke.
Abstract TP241: Correlation of Smartphone Pupillometry Parameters With NIH Stroke Scale and CT Perfusion Core to Penumbra Volume Ratio
Authors: Maxin Anthony J , Litz Hunter , Gulek-Bakirci Bernice , McGrath Lynn , Abecassis Josh , Levitt Michael
Published: February 2024

Introduction:
Objective pupillometry involves the quantitative measurement of the pupillary light reflex (PLR). We investigated changes in the PLR, National Institutes of Health Stroke Scale (NIHSS), and core infarct to penumbra volume ratio in acute large vessel occlusion (LVO).

Methods:
A smartphone pupillometry application was used. Subjects with LVO were enrolled prior to intervention. PLR parameters obtained included: maximum diameter (MAX), minimum diameter (MIN), percent change (CHANGE), latency (LAT), mean constriction velocity (MCV), maximum constriction velocity (MAXCV), and mean dilation velocity (MDV). Computed Tomography Perfusion (CTP) and NIHSS values were also obtained prior to intervention. Pearson correlation was performed between the PLR parameters, NIHSS, and CTP core infarct to penumbra volume ratio. This ratio was used instead of the traditional mismatch ratio due to the presence of 0 mL core infarcts and a desire to bound these at a ratio of zero instead of leaving them unbounded at an infinite ratio value for analysis.

Results:
N=22 subjects were enrolled with mean age 69 years. A significant negative correlation between NIHSS and CHANGE (p=0.04) as well as MCV (p=0.005), was observed (Table 1). A significant negative correlation between the core infarct to penumbra volume ratio on CTP and MAX (p=0.04), CHANGE (p<0.001), and MCV (p=0.04) was observed (Table 2).

Conclusions:
This study illustrates the potential value of smartphone pupillometry as a bedside test in the early workup of LVO. Larger trials are needed.
Abstract TP258: Social Network Features Involved in Stroke Decision Making During Acute Stroke
Authors: Mastrangelo Carissa , Scoleri Gianna , Lalwani Dheeraj , Marshall Brandon D , Goedel William C , Bessey Sam , Rothfeld-Wehrwein Zach , Sheth Kevin N , Dhand Amar
Published: February 2024

Introduction:
80% of strokes occur in the company of others and 70% take place at home. However, research on prehospital delay has overlooked the social nature of stroke detection and triage. In the Time is Brain study, we aim to understand how a patient’s social network affects the decision to seek medical care during stroke symptom onset.

Methods:
We conducted in-depth interview in 78 patients (ages 30 to 90 years) in the longitudinal, multicenter Time is Brain study. During the interview, we mapped and examined relationships and interactions between patients and individuals involved in the decision-making process during the stroke. We enrolled during their initial stroke hospitalization at Mass General Brigham or Yale New Haven Hospital. Eligibility criteria include having an acute stroke syndrome presentation that may include diagnoses of acute ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attack (TIA). Trauma-related syndromes, such as subdural hemorrhage, were excluded.

Results:
82.5% (n=66) of patients were accompanied by at least one other person during symptom onset. 60% (n=48) contacted at least one other person. 82.5% (n=66) of strokes occurred in a home-setting and 17.5% (n=14) occurred at work or another public space. 36.25% (n=29) of patients identified their spouse as the first person made aware of symptoms. Men were more likely than women to be accompanied by a spouse (X
2
= 6.8211, p-value = 0.03302).

Conclusions:
Building on prior studies that have highlighted the important role of the social environment in stroke detection and triage, this is a high-resolution study of the social agents and behaviors driving stroke decision-making. These findings highlight the active and often lengthy communication, and unspoken observations that shape layperson decisions during stroke crises. These data are important to identify mechanisms of prehospital delay and build social network-based interventions to improve time-to-treatment.
Abstract TP259: Slower Early Mitral Inflow Velocity and Lesion in Anterior Circulation is Associated With Right-to-Left Shunt in Embolic Stroke of Undetermined Source Right-to-Left Shunt in Embolic Stroke of Undetermined Source
Authors: Kida Hiroyuki , Sato Takeo , Nakada Ryoji , Kitagawa Tomomichi , Komatsu Teppei , Sakai Kenichiro , Sakuta Kenichi , Mitsumura Hidetaka , Iguchi Yasuyuki
Published: February 2024

Background and Purpose:
Right-to-left shunt (RLS) is one of the potential embolic sources in embolic stroke of undetermined source (ESUS), but the eligibility of conducting shunt study to detect RLS in ESUS is still unknown. To reveal clinical features associated with RLS in ESUS, we aimed to compare clinical features including transthoracic echocardiography findings and imaging findings with and without RLS in ESUS.

Methods:
Consecutive ischemic stroke patients in a comprehensive stroke center were screened between April 2013 and April 2023. Inclusion criteria were: 1) who fulfilled the ESUS criteria based on NAVIGATE-ESUS trial, 2) who underwent transesophageal echocardiogram, and 3) admitted 7 days from the onset. We compared clinical features, including transthoracic echocardiography findings and imaging findings such as lesion characteristics (size, cortical or subcortical, and anterior or posterior), between ESUS patients with RLS (RLS-ESUS) and without RLS (non RLS-ESUS).

Results:
We screened 2,304 consecutive ischemic stroke patients, including 225 ESUS patients (166 [74%] male, median age 64 years old). Of all, 76 patients had RLS (59 [78%] male, median age 62 years old, Figure A). RLS-ESUS showed higher frequency of anterior circulation lesion (RLS-ESUS vs. non RLS-ESUS; 84% vs. 71%, p = 0.035), slower early mitral inflow velocity (E) (51.6 vs. 54.9 cm/s, p = 0.021). In multivariable analysis, E (OR 0.83, 95%CI0.70-0.99, p = 0.037) and anterior circulation lesion (OR 2.23, 95%CI 1.08-4.62, p = 0.036) were independently associated with RLS-ESUS (Figure B).

Conclusions:
In ESUS patients, slower early mitral inflow velocity and lesion in anterior circulation was associated with RLS, suggesting shunt study should be conducted to reveal RLS in such patients.
Abstract TP26: Hypothermic and Non-Hypothermic Neuroprotection by Phenothiazine in Acute Ischemic Stroke: Modulation of NLRP3 Inflammasome-Related-Inflammation via Different Pathways of RIPK1/RIPK3-DRP1 or HIF-1α
Authors: Jiang Qian , Geng Xiaokun , Li Fengwu , Ding Yuchuan
Published: February 2024

Background:
Inflammation after successful revascularization worsened outcomes in ischemic stroke. NLRPyrin domain containing 3 (NLRP3) inflammasome mediated inflammatory responses, in which receptor-interacting protein kinase (RIPK1) activated dynamin-related protein 1 (DRP1) in a RIPK3-dependent fashion. Hypoxia-inducible factor 1α (HIF-1α) regulated ischemic inflammation through NLRP3 inflammasome complex, thus apoptosis after stroke. Phenothiazine, including chlorpromazine and promethazine (C+P), induced hypothermic and non-hypothermic neuroprotection. We determined effects of RIPK1/RIPK3-DRP1 or HIF-1α pathways underlying the dual neuroprotection by C+P.

Methods:
144 adult male Sprague-Dawley rats were subjected to 2 h of middle cerebral artery occlusion (MCAO), followed by 24 h reperfusion. 8mg/kg of C+P was injected at the onset of reperfusion. Infarct volumes, mRNA and protein expressions of HIF-1α, RIPK1, RIPK3, DRP-1, NLRP3-inflammation (NLRP3, ASC, Caspase-1, IL-1β and IL-18) and cytochrome C-apoptosis (cytochrome C, APAF-1, Caspase-9 and Caspase-3) were assessed. Apoptotic cell death, and the infiltration of neutrophils and macrophages were evaluated. Co-localization of RIPK1/RIPK3 and HIF-1α/NLRP3 were determined.

Results:
C+P significantly reduced brain inflammation, neuronal apoptosis and immune cell infiltration, with or without hypothermia. C+P with induced-hypothermia and RIPK1 inhibitor significantly reduced infarct volumes, the expression of RIPK1, RIPK3, DRP-1, NLRP3-inflammation process and cytochrome C-apoptosis, as well as the co-localization of RIPK1/RIPK3, suggesting the hypothermic effect underlying the RIPK1/RIPK3-DRP1 pathway. In non-hypothermia effect, HIF-1α expression was reduced by C+P or HIF-1α inhibitor, in concomitant with reduced NLRP3 inflammasome, cytochrome C-apoptosis, and decreased interaction of HIF-1α and NLRP3.

Conclusion:
Hypothermic and non-hypothermic neuroprotection of C+P involve different pathways. The hypothermic effect was via RIPK1/RIPK3-DRP1 signaling, while non-hypothermic effect was mediated by HIF-1α. This provides a theoretical basis for future precise exploration of hypothermic and non-hypothermic neuroprotection.
Abstract TP266: Utilization of Survey, Focus Group, and Referral Data to Plan a Targeted Intervention for Rural Stroke Disparities, Prevention, and Care Access
Authors: Curley Tom , Stevenson Lauren , Gainey Rebecca , Yourkiewicz Erika , Oyler Kimberly
Published: February 2024

Methods:
This project was a collaborative partnership between a healthcare organization, academic institute, and the local Faith Health Network. A 34-question survey (n=54 respondents) collected data on rural community knowledge of stroke risk factors, symptoms, and prevention. Three focus groups (n=40 total participants) were conducted to better understand experiences with stroke and obstacles to accessing wellness and healthcare in rural communities. The focus group questions centered on barriers, stroke impact, and solutions. Thematic summaries were aligned with stroke referral heat maps and demographics to develop a targeted plan for intervention.

Results:
Survey respondents reported gaps in awareness of stroke risk factors, stroke identification, and emergency response. Lack of motivation, followed by lack of time or energy, stress, lack of access to healthy foods, and community of support were barriers to healthy living. Cost, followed by transportation, access to medications, time, lack of insurance, and language differences were barriers to accessing medical care. Thematic analysis of focus group discussions was conducted for the three initial topics of barriers, stroke impact, and solutions. Dialogue on barriers revealed themes of lifestyle, access, and advocacy. Themes within stroke impact included mental health, access, and advocacy. For solutions, themes emerged as health education, lifestyle, access, and advocacy. Each theme had additional subthemes and direct participant quotes. Survey responses, focus group themes, and referral demographics were synthesized to form a plan to impact stroke prevention and care in these rural areas.

Conclusion:
A multi-faceted, targeted approach is necessary to increase rural stroke awareness, address disparities in care, and decrease barriers to healthy living and care access.
Abstract TP267: Cerebral Venous Thrombosis at High Altitude: A Comparison of Patients From Plateau and Plain in China
Authors: Sha Yuhui , Ci Yang , Cidan Zhuoga , Zhao Yuhua , Zhou Lixin , Ni Jun
Published: February 2024

Introduction:
Exposure to high altitude environment is a risk factor of cerebral venous thrombosis (CVT) probably due to the hypercoagulability. The study aims to explore the unique clinical, risk factors, and prognostic characteristics of CVT patients in high-altitude areas of China by comparing them with CVT patients in plain areas.

Methods:
We retrospectively included consecutive patients with CVT admitted to Tibet Autonomous Region People’s Hospital and Peking Union Medical College Hospital (PUMCH) between January 2015 and June 2022. The risk factors, clinical and radiological presentations, treatment, and outcomes were analyzed.

Results:
A total of 43 patients with CVT from Tibet and 111 patients from PUMCH were included. The median age was 31 and 35 years old, and women accounted for 65.1% and 54.1% respectively. Headache (90.7% vs. 71.2%, P=0.01) and altered consciousness (32.6% vs. 15.3%, P=0.017) were more common in patients from Tibet. Hemorrhage (44.2% vs. 19.8%, P=0.002) and venous infarction (51.2% vs. 25.2%, P=0.002) were more prevalent in Tibetan patients. The proportion of pregnant or postpartum patients in plateau areas was significantly higher than that in plains (27.9% vs. 5.4%, P=0.000). The levels of C-reactive protein (17.9 vs. 3.28 mg/L, P=0.011) and D-Dimer (2.15 vs. 1.1mg/L FEU, P=0.014) were greatly higher in patients from Tibet. The percentage of patients receiving anticoagulant therapy was lower in Tibet than that in PUMCH (67.4% vs. 92.8%, P=0.000). All three Tibet patients who died in hospital had recent infections, and two in-hospital deaths in PUMCH were attributed to severe pneumonia and cerebral hernia. Favorable outcome (modified Ranking Score, mRS 0-2) at follow-up was observed in 81.6% of patients in Tibet and 89.9% of those in PUMCH, with the median follow-up time of 396 days and 913 days respectively.

Conclusions:
The clinical and imaging manifestations are more severe in patients from Tibet. Pregnancy or puerperium is more common in patients from Tibet. The levels of inflammation and coagulation indexes in Tibetan patients are significantly higher than those in plain. Although the proportion of anticoagulant therapy in patients with high-altitude CVT is relatively low, the prognosis is good.
Abstract TP284: Transcriptome Profiling of Peripheral Blood Mononuclear Cells in Moyamoya Disease
Authors: DEMIRAG ZEYNEP , Uchino Haruto , Tokairin Kikutaro , Rao Shailaja , Chiang Terrance , Lee Alex , Cheng Michelle Y , Steinberg Gary
Published: February 2024

Objectives:
Moyamoya Disease (MMD) is a progressive occlusive cerebrovascular disease with unknown etiology and pathogenesis. Studies have reported dysregulation in extracellular matrix-related molecules and increased circulating inflammatory cytokines/chemokines in MMD patients, suggesting a role of immune responses in the development of MMD. In this study, we utilized single-cell RNA sequencing (scRNA-seq) to investigate the circulating transcriptome immune cell signatures in MMD.

Methods:
Whole blood samples were collected from bilateral MMD (n=3), non-MMD patients (n=2, aneurysm, or cavernous malformation) and healthy controls (HC) (n=2). Peripheral blood mononuclear cells (PBMCs) were isolated and cryopreserved. Single Cell 3’ Gene Expression libraries were generated and sequenced. Data were demultiplexed and mapped using the CellRanger. Differentially expressed genes (DEGs) were identified and top biological functions and pathways in each cell type were analyzed.

Results:
ScRNA-seq data showed differences in several key cell types between MMD and HC, such as CD8+ NKT, Naïve CD8+ T, CD4+ NKT, Naïve B cells and non-classical monocytes. Further analyses of DEGs for CD8+ NKT, Naïve CD8+ T and CD4+ NKT highlighted in MMD revealed a predicted activation in cell death and predicted inhibition in cell viability, cell movement, proliferation, and migration. In addition, eIF2 (eukaryotic initiation factor-2) activation was detected in all three cell types, most prominently in CD8+ NKT cells. Pathway analysis revealed an inhibition in natural killer cell signaling and autophagy pathways.

Conclusion:
In this study, we identified circulating immune cell signatures in MMD and highlighted the role of CD8+ NKT cells, Naïve CD8+ T cells and CD4+ NKT cells. These cell types manifest distinct pathological processes involved in cellular stress, including inhibition of natural killer cell signaling and disruption in autophagy, which can lead to impaired cytotoxic functions. Active investigations address validation of key cell-type and genes with additional patient cohort. This investigation elucidates the intricate immune responses associated with MMD, providing integral insights for discerning the disease's pathophysiology.
Abstract TP289: Protein Lactylation Regulation in Ischemic Stroke: Role of MeCP2 Lactylation in Repressing Apoptosis-Associated Gene Transcription
Authors: Sun Min , Chen Yanting , Xu Siyi , Jia Junqiu , Zhang Yuxin , Mao Rui , Xu Yun
Published: February 2024

Introduction:
Lactate plays a vital role in various pathophysiological conditions including ischemic stroke. However, an unexplored dimension is the epigenetic modification originating from lactate, lysine lactylation (Kla), and its potential role in cerebral ischemia. Our research sought to elucidate the possible regulation of protein Kla in ischemic stroke, and its underlying mechanisms.

Methods:
Lactate concentration and pan-Kla levels were assessed in mice subjected to transient middle cerebral artery occlusion (MCAO) . Neurological functions and ischemic infarct volume were investigated through foot fault test and 2,3,5-triphenyltetrazolium chloride staining respectively. Proteomics analysis was used to examine protein Kla and key related proteins in the penumbra after one day of MCAO. Immunofluorescence, western blot, proximity ligation assay, and coimmunoprecipitation were performed to evaluate the cellular localization and modification sites of methyl-CpG-binding protein 2 (MeCP2). Joint CUT&Tag and RNA-sequencing analyses were utilized to identify MeCP2-Kla target genes.

Results:
We confirmed the accumulation of brain lactate and global protein Kla following cerebral ischemia. MeCP2 was identified as the central protein with Kla modification in ischemic stroke. Furthermore, the potentially beneficial role of neuronal MeCP2 lactylation in ischemic stroke was investigated. Our findings indicated that MeCP2 could protect against stroke-induced neuronal death through transcriptionally inactivating apoptosis-associated genes. It is showing various heterochromatin foci enrichment pattern in neuronal nuclei of different Kla level groups. In addition, it was found that MeCP2 Kla (Lys-210 and Lys-249) suppressed Pdcd4/Pla2g6 mRNA expression, thereby alleviating neurological deficit.

Conclusions:
MeCP2 lactylation exerts neuroprotection by transcriptionally regulates neuronal apoptosis, indicating it as a potential therapeutic target for ischemic stroke.