bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP79: Inter-professional Implementation of an Evidence-based Bedside Swallow Screen
Authors: Nichols Shelley , Russell Scott , Perrin Stacy , DePriest Ashley , Calderon Jackellyne , Perdue Louise
Published: March 2022

Background:
Swallowing difficulties can affect 85% of acute stroke patients. A bedside swallow screen is standard of practice to establish whether potential acute stroke patients can safely swallow before receiving oral intake including medications. An inter-professional performance improvement team consisting of a Clinical Nurse Specialist, Speech Language Pathologist, Registered Dietitian, Stroke Coordinator, Unit Educator and Clinical Manager was formed. The purpose of the team was twofold; to standardize the process of performing a swallow screen in stroke patients in response to a recent decline in the screening compliance, coupled with the directive to implement an evidenced-based tool.

Methods:
A review of practice and policy identified insufficient evidence for our three sip swallow test. A literature review indicated a need for a defined volume. The volume dependent screen detects the more specific harm event, aspiration versus dysphagia. Throughout the literature 3 ounces was demonstrated to be the most frequently referenced volume. The Plan-Do-Study-Act model was then used to implement a new process for swallow screening. Re-educating the staff was paramount to the success of implementing a new process. Nursing staff along the continuum of care were educated with 91% currently trained on the new process. Essential to the process was updating the electronic medical record system to ensure accurate and consistent practice.

Results:
The team approach utilizing collaboration, open communication and problem solving resulted in the timely implementation of an evidence based tool. In addition, there was an increase in the average swallow screen compliance from 78% for 2014 to 84% for first quarter 2015. Currently, intensive weekly reporting of swallow screen compliance reviewed by the inter-professional team allows timely, individualized education as part of our ongoing monitoring.

Conclusion:
The inter-professional team proved to be an effective method to identify gaps in our practice and policy which led to a change in the defined volume for the swallow screen. The team approach resulted in the successful implementation of a new process utilizing an evidence-based tool and increased swallow screen compliance.
Abstract TMP85: The Protective Roles of Sleep Duration and Physical Activity on Stroke Risk: Analysis of the 2004-2013 National Health Interview Survey using Machine Learning
Authors: Seixas Azizi , Henclewood Dwayne , Williams Stephen , Zizi Ferdinand , Williams Olajide , Ogedegbe Gbenga , Jean-Louis Girardin
Published: March 2022

Introduction:
Health behavior profiles to reduce stroke risk are limited methodologically and hard to apply at the population level. Big data and machine learning was used to quantify dynamic omnidirectional interactions between physical activity, sleep, and stroke risk in the context of multiple socio-demographic, clinical, behavioral, and psychosocial factors.

Hypothesis:
Average sleep duration and moderate-vigorous physical activity will reduce stroke risk.

Method:
Analysis was based on the 2004-2013 National Health Interview Survey (N=288,888). We employed a machine-learning Bayesian Belief Network (BBN) to model the probabilistic relationships (independent and additive) of sleep duration and physical activity to stroke risk. Factors considered included demographic, behavioral, health/medical, and psychosocial as well as sleep duration (short, average, and long), and physical activity (leisurely walking/bicycling, slow swimming/dancing, and simple gardening activities).

Results:
Of the sample, 48.1% were ≤45 years; 77.4% were White; 15.9%, Black/African American; and 45.1% reported less than $35K annually. Overall, the model had a precision index of 95.84%. Average sleepers (7-8hours) were 25% (2.3% to 3%) less likely to experience a stroke. Respectively, long sleepers (>8hours) were 146% (3% to 7.5%) and short sleepers (<7 hours) 22% (3%-3.74%) more likely to report a stroke. A model-based adaptive method evidenced that the combined effect of health status, hypertension, heart condition, income, and alcohol consumption increased the likelihood of stroke from 3% to 90%. Healthy sleep (7-8 hours) and vigorous leisurely activity (30-60 minutes) three to six times per week significantly decreased stroke risk. Using the observational inference technique, we developed idiosyncratic profiles of protective behaviors (i.e. minutes and frequency of moderate or vigorous exercise per week and short, average or long sleep) that reduced stroke risk.

Conclusion:
Utilization of BBN analysis is important, as it provides a more dynamic risk stratification system. Healthy sleep and exercise routines reduced stroke risk, based on systematic iterations.
Abstract TMP9: Hospitals' Performance on Timely Reperfusion in Stroke and Myocardial Infarction is not Correlated
Authors: Sauser-Zachrison Kori , Levine Deborah A , Fonarow Gregg C , Cox Margueritte , DeVore Adam D , Smith Eric E , Suter Robert , Xian Ying , Bhatt Deepak L , Schwamm Lee H
Published: March 2022

Introduction:
Timely reperfusion is performed less optimally in acute ischemic stroke (AIS) than in acute myocardial infarction (AMI). The degree to which hospital performance is correlated on emergent AMI and AIS care is unknown.

Hypothesis:
There would be a positive correlation between hospital performance on door-to-balloon time (D2B) for AMI and door-to-needle time (DTN) for AIS; and hospital performance on D2B would predict DTN even after controlling for patient and hospital differences.

Methods:
Prospective study of all hospitals participating in both Get With The Guidelines (GWTG)-Stroke and -Coronary Artery Disease from 2006-09 and treating ≥10 patients. We compared hospital-level DTN and D2B before and after risk adjustment using Spearman’s rank correlation coefficients and hierarchical linear regression modeling. We also correlated hospitals’ DTN and D2B data from 2013-14 using GWTG (DTN) and Hospital Compare (D2B).

Results:
There were 43 hospitals contributing data (1976 AIS and 59,823 AMI patients). Hospitals’ DTN times for AIS did not correlate with their D2B times for AMI (median DTN 85 min [IQR 77-99] vs. median D2B 72 min [IQR 62-81]; ρ=-0.09; p=0.55). There was no correlation between hospitals’ proportion of eligible patients treated within target time windows for AIS and AMI (median DTN<60 minutes: 21% [IQR 11-30]; median D2B<90 minutes: 68% [IQR 62-79]; ρ=-0.14; p=0.36). The lack of correlation between hospitals’ DTN and D2B times persisted after risk adjustment. From 2013-14, hospitals’ DTN performance in GWTG was not correlated with D2B performance in Hospital Compare (N=546 hospitals; see figure).

Conclusions:
We found no correlation between hospitals’ observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals’ performance of time-critical care processes for AIS and AMI in a coordinated rather than condition-specific manner.
Abstract TMP97: The Frequency of ED Visits for Headache Preceding a Subsequent Hospitalization for Subarachnoid Hemorrhage
Authors: Cahill Elizabeth A , Burnett Molly M , Tesfasilassie Tomas , Kim Anthony S
Published: March 2022

Introduction:
The incidence of sentinel headache (SH) in the days or weeks prior to a aneurysmal subarachnoid hemorrhage (SAH) has been reported to be as high as 10-43% and SH has been linked with early re-bleeding risk.

Hypothesis:
We evaluated whether ED visits for headache were more common in the month preceding a hospitalization for SAH and if this was associated with increased mortality after SAH.

Methods:
We identified all hospital discharges for SAH at all licensed nonfederal hospitals in California from 2008 -11 using comprehensive data from the Office of Statewide Healthcare Planning and Development. Encounters with invalid or missing record linkage numbers (based on social security number) or for non-California residents, and those with concurrent trauma diagnoses or external injury codes were excluded. We identified the first hospitalization for SAH during the study period for each distinct patient. We then identified any ED encounters for headache without SAH during the month prior to the admission for SAH and during a one-month period exactly one year prior to the index admission for SAH.

Results:
A total of 7,723 patients that were hospitalized for non-traumatic SAH during the study period met study eligibility criteria (mean age 59 years [SD 16], 62% female). A majority were white (62%) and non-Hispanic (73%), and 14% were Asian/Pacific Islander and 9% were black. Just 33 (0.4%) SAH patients had had an ED visit for headache in the preceding month compared to 2 ED visits (0.03%) for headache during a month-long period one-year prior to the hospitalization for SAH (RR 16.5, 95% CI 4.0-68, p<0.0001). SAH patients with a recent ED visit for headache had a similar length of hospital stay (10 vs 9.1 days, p=0.27), but were younger (59 vs 49 years, p=0.0002) had lower 30-day mortality (3.0% vs. 22%, p= 0.005), and were more likely to be discharged directly home (81% vs. 44%, p<0.001).

Conclusion:
We identified very few ED visits for headache in the month prior to a hospitalization for aneurysmal SAH, and SAH patients who had visited the ED for headache had lower mortality and better outcomes, though SAH patients with sentinel headache who did not visit the ED were not captured in our analysis.
Abstract TMP99: Risk Factors Related to Aneurysmal Rebleeding After Subarachnoid Hemorrhage: Characteristics in the Pre-, Intra- and Postoperative Period
Authors: Horie Nobutaka , Kaminogo Makio , Izumo Tsuyoshi , Maeda Hajime , Morofuji Yoichi , Nagata Izumi , Matsuo Takayuki
Published: March 2022

Background and Purpose:
Aneurysmal rebleeding prior to treatment is a major cause of death and morbidity in aneurysmal subarachnoid hemorrhage (SAH). Recognizing risk factors for aneurysmal rebleeding is particularly relevant and might help to identify the aneurysms that benefit from acute treatment. The aim of this study was to determine predictors for an aneurysmal rebleeding in pre-, intra- and postoperative period.

Methods:
The incidence of rebleeding, demographic data, and clinical data from 5001 patients with aneurysmal SAH were retrospectively collected from Nagasaki SAH registry since January 2000 to December 2013. All clinical variables were examined by univariate analysis, and a binary logistic regression analysis was performed to identify the risk factors related to rebleeding.

Results:
Rebleeding occurred in 10.3±0.5% of the 5001 aneurysm patients during the in-hospital stay (within 28 days), and the rebleeding rate was fairly constant over time. In the preoperative period, there was no difference in age, sex, aneurysm location and aneurysm number between rebleeding and non-rebleeding patients. However, Aneurysm size (P<0.01) and smoking (P<0.01) were significantly affected to the rebleeding. On the other hand, only aneurysm location (anterior communicating artery) was significantly affected to the intraoperative rebleeding (33.6% vs. 9%, P<0.01). Postoperative rebleeding rate was significantly lower in aneurysmal clipping compared with endovascular coiling, but was almost the same in the recent 5 years.

Conclusions:
Aneurysmal rebleeding after SAH has a characteristics in the pre-, intra-, and postoperative period. Aneurysmal size and smoking history could be a risk factor in the preoperative period, and aneurysmal location could be a risk factor in the intraoperative period. There was no difference in the postoperative rebleeding between clipping and coiling possibly due to the development of endovascular treatment.
Abstract TP105: Short-Term Intraventricular Infusion of IGF-1 Following Stroke Decreases Behavioral Phenotypes of Depression in a Rat Ischemic Stroke Model
Authors: Samorajski Justin , Sohrabji Farida
Published: March 2022

Background:
Post stroke depression effects over one third of stroke survivors and adversely effects recovery. When left untreated, post stroke depression can lead to an increase in mortality rates, poorer prognosis, and a decrease in the quality of life during recovery. The peptide hormone insulin like growth factor IGF-1 has been shown in short term studies to reduced infarct volume and suppress inflammatory proteins, when measured 24h and 5d after stroke. We hypothesized that acute IGF-1 treatment will reduce the incidence of post stroke depression and will in turn improve long term recovery from stroke.

Methods:
Middle aged (12 mo) female rats were used for these studies. All animals were pre-tested for sucrose preference and burrowing behavior and then subject to middle cerebral artery occlusion (MCAo). At 4h post-stroke, animals were randomly assigned to receive an intraventricular infusion of IGF-1 or artificial CSF control for 7 days. Animals were monitored for 5-9 weeks post stroke for survival and tested periodically for sucrose preference and burrowing (measures of anhedonia), and social interaction.

Results:
Sucrose preference, measured at d10, 20, 30 post stroke was reduced in both groups following stroke, however there was a significant effect of IGF-1, such that sucrose preference was better preserved in IGF-1 treated animals as compared to controls. In the case of burrowing activity, which is a species typical behavior, control animals showed a decline in burrowing activity over day 10 to day 60 post stroke, while IGF-1 treated animals showed no significant decline. Social interaction at 60 days post stroke, as measured by time spent with a conspecific, was significantly reduced in control animals as compared to IGF-1 treated animals. Mortality among IGF-1-treated animals was 16.6% while mortality among vehicle treated animals was 38.8%. Kaplan Maier analysis of post stroke survival indicated a trend toward decreased mortality due to IGF-1 treatment (p<0.14).

Conclusion:
The present data shows that behavioral phenotypes of depression are improved in IGF-1 treated animals. The data suggest that short term post-stroke IGF-1 treatment can exert beneficial effects on long term disability such as post stroke depression.
Abstract TP106: Acute Intravenous Multistem Infusion Restores Homeostasis of Immune and Spleen Responses After Ischemic Stroke
Authors: Savitz Sean I , Yang Bing , Hamilton Jason , Bogaerts Annelies , Mays Robert
Published: March 2022

Background:
In a phase II randomized, placebo controlled trial, MultiStem, an adult stem cell, was administered IV within 24 to 48 hrs after stroke onset. Earlier administration of MultiStem (<36 hrs) may have provided a benefit. In preclinical studies, we explored immune targets during this time frame that may underlie potential treatment effects.

Methods:
Rats underwent tandem CCA/MCA occlusion and then at 24 hrs were randomized to receive IV MultiStem or saline (N=3-6 per group). At 3 days after infusion, rats were sacrificed and RNA was isolated from the injured cortex and spleen. To assess differential expression, noninformative probes were removed with a variance cut-off and genes having p-value < 0.01 were retained for gene set enrichment analysis. Principal component analysis and hierarchical clustering were performed.

Results:
Among 364 selected genes within the brain, the gene expression profile of MultiStem treated stroke animals aligned with sham animals while there was a clear divergent profile of expression in vehicle treated stroke rats (fig). At 28d, samples from MultiStem treated animals clustered even more closely with shams and remained distinct from vehicle treated animals. Highly enriched gene expression categories downregulated by MultiStem included leukocyte activation, antigen presentation, and immune effector processing. Gene expression profiles in spleens derived from MultiStem treated rats closely resembled shams at 3 and 28 days. Using Ingenuity Pathway Analysis, MultiStem was shown to suppress the activation of various inflammatory signaling pathways regulated by TNF-α, IL-1β, IL-6, and IFN-γ, within peri-infarct tissue at 3 days after infusion.

Conclusion:
MultiStem restores expression of multiple genes and pathways involved in immune and inflammatory responses after stroke. Optimal therapeutic windows for acute stroke may depend upon targeting the activation of immune responses from peripheral tissues such as the spleen.
Abstract TP109: Quantitative Gait Analysis Demonstrates Significant Changes in Motor Function Post-ischemic Stroke and Simulated Intraparenchymal Therapeutic Delivery in a Porcine Model
Authors: Kaiser Erin E , Duberstein Kylee J , Platt Simon R , Lau Vivian W , Nguyen Trinh , Baker Emily W , Grace Harrison E , Howerth Elizabeth W , Holmes Shannon P , Wang Liya , Stice Steve L , Mao Hui , West Franklin D
Published: March 2022

Severity of stroke and subsequent recovery can be measured through gait changes of affected individuals. Recent failures of therapies tested in rodents to support safety and efficacy in human clinical trials has led to the development of a novel porcine ischemic stroke model with more comparable brain anatomy and physiology. Assessment of motor function changes is essential for determining the feasibility of the pig stroke model, the effect of therapies and the potential effects of modes of therapeutic delivery such as intraparenchymal injection. We hypothesized permanent occlusion of the middle cerebral artery (MCA) and the intraparenchymal injection process would lead to significant alterations in motor functions such as increased stride duration and decreased two limb support and stride swing time. Gait data was collected on 3 adult male Landrace pigs at 3 pre-stroke time points. Ischemic stroke was induced by permanent middle cerebral artery occlusion (MCAO) and pigs were evaluated at 1, 3 and 5 days post-stroke. Stride duration increased by >50% and percent swing time and percent two limb support decreased by >30% 1 day post-stroke. Increased stride duration and decreased relative swing time and two limb support phase persisted 3 and 5 days post-stroke. At 5 days post-stroke, pigs received PBS intraparenchymal injections and were recorded at 1 and 3 days and 1, 2, 4, 6, 9 and 12 weeks post-injection. Stride duration significantly increased between 5 days post-stroke and 1 day post-injection demonstrating injection had a negative effect on motor function. All other parameters showed no significant changes between 5 days post-stroke and 1 day post-injection. Despite significant changes in gait parameters at early time points post-stroke, by 12 weeks post-injection, pigs showed spontaneous recovery with no detectable changes in motor function as compared to pre-stoke time points. Collectively, these results demonstrate MCAO stroke and intraparenchymal injection led to gait impairments and show that gait analysis is a highly sensitive method to detect changes in motor function.
Abstract TP113: Beneficial Effect of Faster Cooling Elicited by Combination of TRPV1 Agonist (Dihydrocapsaicin) and Mild Physical Hypothermia in Ischemia/Reperfusion Injury
Authors: Liu Kaiyin , Zhang Jun , Duan Yunxia , Guthikonda Murali , Ji Xunming , Ding Yuchuan
Published: March 2022

Introduction:
Pharmacologically induced hypothermia (PH) in stroke has been investigated. Achieving faster cooling after stroke would be important in the successful rescue of neurons and improve outcomes. However, drawbacks of PH and physical cooling are the time and large doses required to achieve neuroprotective hypothermia. The induced toxicity and possible drug complications largely limited PH translation in the clinics. Transient Receptor Potential Vanilloid (TRPV) 1 receptor and its agonist dihydrocapsaicin (DHC) have been reported to exert neuroprotective effects in animal stroke models by inducing hypothermia. It is proposed that TRPV1 agonism plays a central thermoregulatory role in possibly reducing thermoregulatory set-point. The combination therapy of physical cooling and PH may achieve faster cooling rates by increasing heat loss and decreasing heat generation. To this end, we assessed the
hypothesis
that combination of DHC and physical cooling leads to faster cooling and better neuroprotection.

Methods:
Sprague Dawley rats were subjected to 2 h middle cerebral artery occlusion (MCAO) and followed by 24 h of reperfusion. Ischemic rats in each group (n=8) received either: no treatment, mild hypothermia, low DHC (0.5 mg/kg), high DHC (1.5 mg/kg) or combination (low DHC plus hypothermia). Treatments lasted for 3 h. Rate to target hypothermia (31 °C) onset was measured. Infarct volume was determined using triphenyl tetrazolium chloride (TTC) staining.

Results:
Temperature decrease rate at which groups was determined as 0.1°C/min for hypothermia, 0.06°C/min for low DHC, 0.07°C/min for high DHC and 0.2°C/min for combination. The combination treatment was 3 times faster (p<0.05) than low and high DHC groups, while 2 times faster (p<0.05) than mild hypothermia. Infarct volume was largely and significantly reduced by combination therapy (19.2%), as compared to no treatment (49.5%), mild hypothermia only (50.0%), low DHC (36.6%), and high DHC (39.9%) groups.

Conclusion:
Combination of physical hypothermia and DHC elicited a faster reduction of body temperature and strong neuroprotection as compared to single treatments. This novel therapy may provide better opportunity for ischemic brain to reach therapeutic hypothermia temperature.
Abstract TP114: Modulation of Blood Accumulation and Angiogenic Responses by PGE2-EP3 Signaling After ICH in Aged Mice
Authors: Leclerc Jenna L , Lampert Andrew S , Dore Sylvain
Published: March 2022

With the population aging at an accelerated rate, the prevalence of stroke and financial burden of stroke-related health care costs is expected to continue to increase. Intracerebral hemorrhage (ICH) is a devastating stroke subtype more commonly affecting the elderly population, whom display increased mortality and worse functional outcomes compared to younger patients. This study aimed to investigate the contribution of the prostaglandin E
2
(PGE
2
) E prostanoid (EP) receptor subtype 3 in modulating anatomical outcomes and functional recovery following ICH in 24-mo-old mice. PGE
2
levels are dramatically upregulated following brain injury and have been shown to modulate the deleterious excitotoxic and neuroinflammatory processes resulting from activation of glial cells and infiltration of blood cells and proinflammatory molecules through its four EP receptors, EP1-4. EP3 is the most abundant EP receptor in the brain and we have previously shown that signaling through the PGE
2
-EP3 axis exacerbates ICH outcomes in young mice. Here, we show that EP3 receptor deletion results in 17.9±6.1% less ICH-induced brain injury (p=0.0336) and improves neurological functional recovery, as identified by lower neurological deficit scores at 48h (p=0.0013) and 72h (p=0.0063), and increased gross (p=0.0038) and fine motor (p=0.0556) movements and decreased resting time (p = 0.0280) at 72h. Immunohistological staining was performed to investigate possible mechanisms of EP3-mediated neurotoxicity. Identified mechanisms include reduced blood accumulation (p=0.0277) and modulation of angiogenic and astroglial responses, where EP3
-/-
mice have increased striatal astrogliosis (p=0.0498) and VEGF immunoreactivity (p=0.0115), and tended to have increased cortical astrogliosis (p=0.1874). Using this aged cohort of mice, we have confirmed and extended our previous results in young mice demonstrating the deleterious role of the PGE
2
-EP3 signaling axis in modulating brain injury and functional recovery after ICH, further supporting the notion of the EP3 receptor as a putative therapeutic avenue for the treatment of ICH.
Abstract TP122: Correlation Between Collateral Circulations, Cerebral Metabolisms and Posterior Cerebral Artery Stenoses or Occlusions in Moyamoya Disease
Authors: Eguchi Seiichiro , Nakagawara Jyoji , Sugata Sei , Maruyama Daisuke , Hamano Eika , Orita Yoji , Satow Tetsu , Kataoka Hiroharu , Takahashi Jun
Published: March 2022

Introduction:
It is reported that moyamoya disease (MMD) associated with posterior cerebral artery (PCA) stenoses or occlusions (PCS/PCO) progresses aggressively in clinical course and results in poor prognosis. In these cases, the thalamic perforating branches from PCA and the posterior choroidal arteries develop and present as moyamoya vessels. But it still remains unclear that the correlation between collateral circulations, cerebral metabolisms and PCS/PCO.

Hypothesis:
In the current study, we assessed hypothesis that PCS/PCO leads to misery perfusion in the anterior circulation and results in unstable MMD.

Methods:
A total of 79 patients, 158 hemispheres were included in this study. The average age was 42.5±15.6 years and 53 patients were women. We divided them into 2 groups (PCS/PCO positive or negative group) and cerebral blood flow (CBF), cerebral blood volume (CBV), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) were examined by 15O-gas PET in following regions: anterior cerebral artery (rACA), anterior and posterior part of middle cerebral artery (rMCAa and rMCAp), and posterior cerebral artery (rPCA). Angiogram helped us to evaluate the development of the collateral vessels.

Results:
In PCS/PCO positive group, CBF and CMRO2 were reduced whereas CBV and OEF were elevated in rMCAp compared to negative group. These parameters were all statistically significant (p<0.05). In addition, collateral circulations including anterior meningeal artery (AMA), middle meningeal artery (MMA) and posterior choroidal artery (PchoA) sufficiently developed in PCO/PCS positive group (P<0.05).

Conclusions:
MMD associated with PCS/PCO has well developed AMA, MMA and PchoA because the stenotic or obliterative changes in the terminal portions of internal carotid artery have already progressed. In these patients, decreased CBF, increased CBV and OEF lead to misery perfusion in rMCAp despite the growth of the collateral flow. Early revascularization is recommended because PCS/PCO causes repeated stroke and unstable MMD.
Abstract TP123: RNF213 Polymorphisms as a Susceptible Gene for Intracranial Atherosclerosis: A High-Resolution MRI and Conventional Angiography Study
Authors: Chung Jong-Won , Hwang Jaechun , Lee Mi Ji , Choi Hanna , Cha Jihoon , Jeon Pyeong , Yeon Je Young , Kim Jong-Soo , Hong Seung Chyul , Ki Chang-Seok , Kim Gyeong-Moon , Chung Chin-Sang , Lee Kwang Ho , Bang Oh Young
Published: March 2022

Background:
Both intracranial atherosclerotic stenosis (ICAS) and moyamoya disease (MMD) are prevalent in Asians. We hypothesized that Ring Finger 213 (RNF213 p.Arg4810Lys) polymorphism, a susceptibility locus for MMD in East Asian, is a susceptible gene for ICAS confirmed by conventional angiography (absence of basal collaterals) and high-resolution MRI (HR-MRI, presence of plaque).

Method:
We analyzed 532 consecutive patients with ischemic events within the MCA distribution and relevant stenotic lesion on distal ICA or proximal MCA, but no demonstrable carotid or cardiac embolism sources. Additional angiography was performed in 370 (69.5%) patients, and HR-MRI in 283 (53.2%).

Results:
Based on angiographic and HR-MRI findings, 234 patients were diagnosed as ICAS, and 288 as MMD. The RNF213 variant was observed in 50 (21.4%) ICAS patients as well as 119 (69.1%) MMD patients. The RNF213 variant was observed in 25.2% (33 of 131) of patients with HR-MRI confirmed ICAS. Similarly, 15.8% (6 of 38) of ICAS patients in whom MMD was excluded by angiography had this variant. Among ICAS patients, RNF213 variant carriers were younger and more likely to have family history of MMD than non-carrier. Multivariate testing showed that age of ICAS onset was independent associated with RNF213 variant (odds ratio, 0.97; 95% CI, 0.944-0.99). Other clinical characteristics including vascular risk factors and HR-MRI findings were not different between them.

Conclusions:
RNF213 is susceptible gene not only for MMD but also for ICAS in East Asians. Further studies are needed on non-p.Arg4810Lys RNF213 variants in ICAS patients outside East Asian populations.
Abstract TP13: Mechanical Thrombectomy in Octogenarian Stroke Patients is Safe and Effective
Authors: Barral Matthias , Blanc Raphaël , Ciccio Gabriele , Redjem Hocine , Smajda Stanislas , Abrivard Marie , Piotin Michel
Published: March 2022

Introduction:
Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation acute ischemic stroke (AIS) improves functional outcome at 3-month. However, elderly patients (≥80 years old) are a growing and fragile population for whom data are scarce.

Hypothesis:
To determine the factors associated with a favorable functional outcome after endovascular treatment for anterior circulation AIS in elderly patients.

Methods:
All patients aged≥ 80 years old with anterior circulation AIS and a primary functional independence (mRS<2) referred for MT were included. Reperfusion success was defined as TICI2b/3. Functional outcome at 3-month (mRS), mortality, symptomatic intracranial hemorrhage (SIH), NIHSS at 24h and at discharge were collected. Initial NIHSS, gender, age, AIS and coronaropathy anteriority, glycemia and diabetes, hyperlipemia, hypertension, time to IV thrombolysis, time to groin puncture, successful recanalization, general anesthesia, DWI-ASPECTS, 24h intracranial hemorrhage, occlusion location and IV thrombolysis were evaluated as prognostic factors associated with a favorable functional outcome (mRS<2). Quantitative variables were evaluated using paired-sample Wilcoxon signed-rank test and qualitative variables were categorized as binary variables and compared using Chi-square test.

Results:
A total of 82 patients were treated for anterior circulation AIS with a recanalization rate of 87%. The NIHSS score was improved from 16.7 ± 6 [range: 3-27], to 12.2 ± 8.2 [range: 0-32] at 24h, (p=0.0001) and 9.3 ± 7.77 [range: 0-32] at discharge (p=6 x 10-7). We found a SIH rate of 1% while 40% of patients had intracranial hemorrhage, mortality was 27%, and at 3 months 29% of patients were functionally independent (mRS ≤ 2) and 16% had moderate disability (mRS=3). DWI-ASPECTS (p=0.007), low initial NIHSS (p=0.013), age (p=0.02) and IV thrombolysis (p=0.03), were associated with a favorable functional outcome. Use of general anesthesia (p=0.09), diabetes (p=0.05) and hyperglycemia (p=0.05) were associated with a poorer outcome at a lesser degree.

Conclusions:
MT of anterior circulation AIS in elderly patients is safe and effective.
Abstract TP133: Should Early Identification of Stroke Patients be Focused on Stroke Mimics or Chameleons? A Retrospective Study on the Hospital Stroke Chameleon Prevalence
Authors: Chompoopong Pitcha , Rostambeigi Nassir , Darine Kassar , Maud Alberto , Piriyawat Paisith , Cruz-Flores Salvador , Rodriguez Gustavo J
Published: March 2022

Background and Purpose:
Although we count with effective recanalization therapies for acute stroke treatment, the vast majority of ischemic stroke patients who present within 4.5 hours of symptom onset are still left untreated. We hypothesized that lack of early stroke recognition, mainly due to stroke symptoms disguising as “stroke chameleons”, is a possible explanation.

Methods:
Retrospective cross-sectional analysis was performed on 9-year hospital chart records. Patients with discharge diagnoses of ischemic stroke were traced back to their admitting diagnoses. Cases with non-cerebrovascular events admitting diagnoses were identified as possible stroke chameleons and sorted into groups according to the occurrence of presenting neurological or non-neurological manifestations.

Results:
Of 1,754 ischemic stroke cases, 678 (38.7%) were found to be possible stroke chameleons. More than half of the chameleons (58.6%) presented with neurological manifestations. The four most common ones were disorders of somatic sensation (31.7%), alteration of consciousness (31.5%), disorders of speech/language (10.8%), and disorder of motility (10.1%). The rest of possible stroke chameleons camouflaged themselves with presenting manifestations pertaining to conditions of other organ systems such as cardiopulmonary, gastrointestinal, systemic infection, trauma, and vascular events elsewhere.

Conclusions:
We found a large percentage of possible stroke chameleons. In this new era of effective recanalization therapies for ischemic stroke, more attention should be placed on stroke chameleons. More studies should confirm our results and the proper efforts should be taken to increase the number of patients treated for acute ischemic stroke that arrive within the therapeutic window.
Abstract TP139: Extracranial Carotid Occlusion: Incidence and Recanalisation Rates
Authors: Lee Moi-Pin , Gan Hui-Yee , De Silva Deidre A , Chang Hui-Meng
Published: March 2022

Introduction:
Internal carotid artery (ICA) occlusion can be found in up to 15% of patients with transient ischemic attacks and strokes. Common causes include cardiac sources, like Atrial Fibrillation (AF) or large vessel atherosclerosis. Spontaneous recanalization of an occluded ICA has been infrequently described, and most commonly occurs within a short period after the diagnosis of the presumed acute occlusion. The underlying disease will direct treatment plans of such patients. We aim to study spontaneous recanalization rates, and the clinical and sonographic features that may affect their recanalization rates.

Hypothesis:
Acute carotid occlusion by embolic thrombus is more likely to recanalize than that due to underlying ruptured plaque.

Methods:
A 5.5-year retrospective review of Singapore General Hospital Neurovascular Laboratory database from 2010, identifying all patients with acute symptomatic Extracranial Carotid Occlusion. The clinical and sonographic features were also collected.

Results:
We identified 178 (2.5%) patients with symptomatic ICA occlusion out of 7229 patients (mean age 64 years, 69% males, 74% Chinese). 88% of them had hyperlipidemia, 74% hypertension, 45% diabetes mellitus, 39% smokers, 28% ischemic heart disease, 16% previous stroke, 15% AF and 7% prior neck irradiation. Most (97%) had unilateral carotid occlusions. Underlying calcified plaques were found in 37% of patients while 63% had homogenous, echoic to anechoic lesions (of which 25% were also mobile). Sixteen of 81(20%) patients had recanalized on repeat scan (median time to scan: 95 days): Of the 16 patients, 1 had underlying calcified plaque which recanalized to severe stenosis. The other 15 patients had homogenous, echoic-hypoechoic lesions that recanalized to extensive, severe stenosis in 6 and focal, severe stenosis in 3.

Conclusions:
Symptomatic carotid occlusion is not common in our patients. However, about 20% showed evidence of recanalization and more than half to severe stenosis. Such patients may benefit from carotid revascularization. This highlights the importance of repeating carotid studies in Acute Carotid Occlusion. Further prospective studies may provide insights into the recanalization mechanisms of an occluded carotid artery.
Abstract TP14: Final Infarct Volume as an Early Indicator the Clinical Outcome: Insight from ESCAPE Trial
Authors: Al-ajlan Fahad , Goyal Mayank , Menon Bijoy K , Demchuk Andrew M , Eesa Muneer , Rempel Jeremy L , Thornton John , Roy Daniel , Roy Daniel , Jovin Tudor G , Willinsky Robert A , Sapkota Biggya , Lum Cheemun , Frei Donald F , Montanera Walter J , Poppe Alexandre Y , Silver Frank L , Shuaib Ashfaq , Tampieri Donatella , Williams David , Bang Oh Young , Baxter Blaise W , Burns Paul A , Choe Hana , Heo Ji-Hoe , Holmstedt Christine A , Jankowitz Brian , Kelly Michael , Linares Guillermo , Hill Michael D
Published: March 2022

Background and Purpose:
The goal of reperfusion therapy in acute ischemic stroke is to limit the extension of the ischemic core. The objectives of the present study were to assess the relationship between endovascular treatment and final infarct volume.

Methods and Results:
ESCAPE is a multicenter prospective randomized open-label trial with blinded outcome evaluation that enrolled 315 patients (endovascular treatment n=165; control n=150). Of these, 314 patient infarct volumes at 24 hours on CT or MRI were measured blinded to clinical data. Because infarct volumes were non-normally distributed, final infarct volumes were analysed by quartiles. Final infarct volumes were compared by treatment assignment and recanalization/reperfusion status measured by 2-8h CT angiogram in the control group and by formal angiography in the intervention arm.

Results:
Median final infarct volume among all study participants was 21 mL (IQR: 7 to 72). Median final infarct volume in endovascular treatment arm at 15.5 mL (IQR: 5 to 46.5) was significantly lower than median final infarct volume in control arm 33.5 mL (IQR: 11 to 95; P=0.0004). Small infarcts, defined as 1st quartile of infarct volumes were more common in the endovascular group compared to control (relative risk [RR] 1.5, CI95 1.02-2.3). Successful recanalization and reperfusion was highly associated with small infarcts (RR 2.2, CI95 1.4-3.4). The proportion of large hemispheric stroke (defined as an infarct volume in the 4th quartile) was much less frequent in the endovascular treatment arm (RR 0.6, CI95 0.3-0.8).

Conclusions:
This analysis supports the primary results of ESCAPE trial as endovascular treatment was associated with significantly smaller final infarct volumes. Recanalization/reperfusion was associated with smaller final infarct volume.
Abstract TP143: Effects of Aerobic Exercise Intensity on Novel Blood Biomarkers of Neuroplasticity After Stroke
Authors: Whitesel Dustyn , Boyne Pierce , Carl Daniel , Westover Jennifer , Meyrose Colleen , Wilkerson Johnny , Khoury Jane C , Gerson Myron , Seroogy Kim , Hatter Kristal , Reisman Darcy , Kissela Brett , Dunning Kari
Published: March 2022

Introduction:
Aerobic exercise (AEX) may facilitate neurologic stroke recovery. Among healthy adults, intense AEX is known to upregulate brain-derived neurotrophic factor (BDNF), a critical facilitator of neuroplasticity, motor learning and cognition. Increased blood lactate during AEX appears to be a key mechanism underlying this effect. Intense AEX also increases blood ionized calcium (Ca++). In animal studies, some of this increased Ca++ has been shown to be transported to the brain and enhance synthesis of monoamine neurotransmitters (e.g. dopamine) that are associated with neuroplasticity and motor learning. Thus, increased blood lactate and Ca++ during AEX represent potentially important biomarkers of central neurologic benefits, but neither has been previously studied in persons with stroke.

Hypothesis:
High intensity AEX will elicit significantly larger lactate and Ca++ responses than moderate intensity in chronic stroke.

Methods:
Using a crossover design, eight subjects (mean ± SD age, 57 ± 8 years; years post stroke, 8.7 ± 2.7) performed one 20 minute session each of moderate and high intensity treadmill AEX in random order. Blood lactate and Ca++ were measured at baseline and multiple time points during and after AEX. Mixed effects models were used to examine changes within and between protocols using an alpha of 0.05.

Results:
Blood lactate response was significantly greater for high vs moderate intensity AEX (p<0.0001). While moderate intensity showed no significant changes with time (p=0.60), high intensity showed significant increases during and immediately after AEX (all p<0.0001). Blood Ca++ showed no significant protocol by time interaction (p=0.08) but did show a significant time effect (p<0.0001) with increases during (p<0.0001) and immediately after (p=0.01) AEX.

Conclusions:
Unlike moderate intensity AEX, high intensity elicited a robust lactate response. This has promising implications for the effects of high-intensity AEX on BDNF post-stroke. Both protocols combined showed an increase in Ca++, which has promising implications for the effects of AEX on monoamine neurotransmitter synthesis after stroke.
Abstract TP154: Recovery of Slow-5 Oscillations in a Longitudinal Study of Ischemic Stroke Patients
Authors: La Christian , Nair Veena , Mossahebi Pouria , Stamm Julie , Birn Rasmus , Meyerand Mary E , Prabhakaran Vivek
Published: March 2022

Introduction:
Functional networks in resting-state fMRI are identified by characteristics of their intrinsic low-frequency oscillations, more specifically in terms of their synchronicity. In advanced aging and clinical populations, this synchronicity among functionally linked regions is known to decrease, which may be associated with the observed cognitive and behavioral changes. Previous work from our group has revealed oscillations at the slow-5 range (0.01-0.027 Hz) are particularly susceptible to disruptions in aging and stroke.

Hypothesis:
In this study, we aim to characterize longitudinally slow-5 oscillations in stroke patients for hope to observe a recovery of those impaired oscillations in the later stage of the stroke.

Methods:
We followed a group of ischemic stroke patients (n=20) and healthy older adults (n=14) over two visits separated by a minimum period of three months. For the stroke patients, one visit occurred in their subacute window (10 days to 6 months after stroke), the other happened over their chronic window (> 6 months after stroke). Using a groupICA on 10-minutes eyes-close resting-state fMRI data, we assessed the frequency distributions of component’s representative time-courses for differences between the two time-points, in particular in regards to slow-5 spectral power.

Results:
Slow-5 oscillations exhibited lower amplitudes in the stroke patient in their subacute stage in comparison to their healthy counterparts as was presented previously. Over time in their chronic stage, those patients show a recovery of those oscillations (p<0.005), reaching near equivalence to the healthy older adult group.

Conclusions:
Our results indicate disrupted network dynamics in the subacute stroke population and demonstrate that return to normal level of spectral power by the chronic stage, potentially marking a recovery of the cortical system. This also verifies the implication of slow-5 oscillations in the integrity of network function in normal, but also in injured cortical systems.
Abstract TP157: See, Imagine, Move - Upper Limb Action Therapy (SIMULATe): iPad-based Mental and Physical Motor (re)Learning for Stroke Recovery
Authors: McCormick Sheree A , Holmes Paul S
Published: March 2022

Background:
Self-led therapy has the potential to extend rehabilitation and enhance recovery after stroke. Evolving technology can add support and structure to this approach. Our objective was to develop and evaluate the See, Imagine, Move; Upper Limb Action Therapy (SIMULATe) application; an iPad-based, cognitive and physical training intervention focused on (re)learning activities of daily living after stroke.

Method:
The SIMULATe application was developed using a user-centered approach (ISO 9241-210). The therapy exploits the putative human mirror neuron system to enhance physical practice and positive affect. To evaluate SIMULATe, community dwelling stroke survivors (N=13) between 3 months and 5 years after stroke entered a single group trial. Participants accessed SIMULATe via an iPadTM and observed, imagined and physically practiced functional activities for up to 90 minutes a day for 18 consecutive days. Primary outcome measures included: adherence; retention; usability (System Usability Scale; SUS); and adverse effects. Secondary measures (pre- and post-test) included: the Action Research Arm Test (ARAT); 9 Hole Peg Test (9HPT); Grip Strength (GS); and the Positive and Negative Affect Scale (PANAS). Where appropriate, results are reported as median scores (IQR).

Results:
The intervention was feasible. There was >80% retention, participants completed >33% of the maximum target time, the usability (SUS: 0-100) was 91.2 (87.5 - 92.5) and no adverse effects were reported. ARAT scores (0-57) increased from 43.0 (39.5-54.0) to 45.0 (39.0-53.0); GS (N=11*) increased from 28.3 (26.0-44.3) to 35.7 (30.2 - 49.2); 9HPT (N=7*) decreased from 81.1 (38.2-132.83) to 39.9 (33.51-55.7); Positive Affect (10-50; N=10*) increased from 34.2 (29.5-38.0) to 36.0 (32.5-47) and Negative Affect (10-50; N=10*) decreased from 22.0 (13.2-29.2) to 16.5 (11.5-23.25). *Some participants could not complete all measures.

Conclusion:
Technology-dependent, self-led therapy appears to be feasible, safe and acceptable to stroke survivors. Further development and investigation in a randomized controlled trial with a usual care comparator is warranted.
Abstract TP16: Intraarterial Treatment for Acute Ischemic Stroke: Analysis of Outcomes of Dissection vs. Non-Dissection Mechanism in 445 patients
Authors: Jensen Judd , Salottolo Kristin , McCarthy Kathryn , Loy David , Frei Donald , Wagner Jeffrey , Whaley Michelle , Bar-Or David
Published: March 2022

Introduction:
The safety and efficacy of intraarterial treatment (IAT) for acute ischemic stroke (AIS) due to cervical artery dissection (CAD, carotid and vertebral) has not been studied in a controlled trial.

Hypothesis:
There will be no differences in safety and efficacy of IAT for AIS due to CAD compared to non-CAD mechanism.

Methods:
We studied consecutive admissions with AIS who received IAT between 1/2010 - 4/2015 and compared outcomes for AIS patients who presented with CAD mechanism vs. other causes. Outcomes included in-hospital mortality, symptomatic intracerebral hemorrhage (sICH), procedural complications, and functional independence (Modified Rankin Score ≤ 2 at 90-days or discharge, or discharge home). Outcomes were univariately analyzed with Chi-square tests. Co-primary outcomes of functional independence and sICH were analyzed with multivariate logistic regression.

Results:
Of 3,671 patients with AIS, 445 patients received IAT and comprise our study population: 24 with CAD (5%: 18 carotid, 6 vertebral) and 421 with another cause. Patients with CAD were younger (median age: 52 vs. 70, p < 0.001) with less severe stroke (median NIHSS: 13 vs. 18, p=0.03) than those with another cause of AIS. Unadjusted outcomes were similar by AIS cause (Table 1). After adjustment for NIHSS and age, the odds of achieving functional independence (OR: 0.58 [0.19-1.78], p=0.34) and sICH (OR: 0.57 [0.07-4.66], p=0.60) were not significantly different in patients with CAD vs. other mechanism.

Conclusions:
Intraarterial treatment appears to be as safe and effective when used in patients with ischemic stroke due to CAD as in AIS patients with other causes. Following the major advances in IAT for AIS in the general population, IAT should be considered in patients with AIS due to a CAD.