bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP42: Gait Adaptation in Virtual Reality: Does Baseline Spatio-temporal Asymmetry in Stroke Survivors Play a Role?
Authors: Mukherjee Mukul , Fayad Pierre , Rand Troy , Fujan-Hansen Jessica
Published: October 2018

Introduction:
Perception of self-motion through virtual reality (VR) provides a unique avenue to improve gait adaptation in chronic stroke survivors. In this ongoing study, stroke survivors adapted to a split-belt paradigm and perception of self-motion was provided in a VR environment. It was hypothesized that the relationship between baseline spatio-temporal asymmetry and gait adaptation would be different in VR than Non-VR (control) groups.

Methods:
Chronic stroke survivors (n=24; age=59.5±13.68years) participated in a split-belt adaptation paradigm and were randomly put into a VR or a Non-VR group. The recruited subjects included a wide range in lower limb Fugl-Meyer scores (11-46) and baseline gait asymmetries (spatial: -17% to +44%, temporal: -16% to +39%). The adaptation trials exposed the participants to different belt speeds for each leg. In addition, pre- and post-adaptation treadmill trials were performed at the participants’ preferred walking speed. The VR stimuli consisted of walking in an infinitely long virtual corridor. Spatiotemporal measures (step length and step time asymmetries) as correlates of adaptation were compared with baseline asymmetries using Pearson correlation coefficients.

Results:
Step length asymmetry during adaptation showed a significant relationship with baseline asymmetry only for the VR (r=0.722, p=0.012) but not the Non-VR group (r=-0.457, p=0.116). During transfer, a significant relationship was shown for both VR (r=0.752, p=0.008) and Non-VR (r=-0.616, p=0.025) groups. However, this relationship was positive for VR and negative for Non-VR. Step time asymmetry during adaptation showed a borderline relationship with baseline asymmetry only for the VR (r=0.569, p=0.068) but not the non-VR group (r=-0.014, p=0.964). During transfer, a significant relationship was shown only for the VR (r=0.614, p=0.045) but not the non-VR (r=-0.366, p=0.218) group.

Discussion:
The results indicated a potentially greater impact of VR in stroke survivors with high levels of spatial and/temporal gait asymmetries. Future studies will investigate the magnitude and mechanisms of this impact. This will help VR-based gait rehabilitation to be stratified and streamlined for greater benefit.
Abstract TMP46: Stroke Self-management Effectiveness Trial
Authors: Damush Teresa M , Mackey Jason , Saha Chandan , Slaven James , Myers Laura , Lincoln Flossy , Nicholas Gloria , Blackwell Layne , Fleck JD , Thomas Kurian , Ivan Cristina , Williams Linda S
Published: October 2018

Given the lack of patient-centered, self-care programs after stroke, we designed a stroke self-management program based upon social cognitive theory and stakeholder input.

Objectives:
We conducted a randomized controlled trial to evaluate the effectiveness of the program after stroke on stroke specific, quality of life, SSQOL, and maintenance at 1 year.

Methods:
We enrolled 258 participants within 90 days of a stroke, on average, stratified by stroke, n=218, or TIA, n=40, and by VA and nonVA healthcare systems. The program included telephone case management, support groups, and booster calls. Outcomes of SSQoL, PHQ9, self-efficacy were assessed at 0, 3, 6, and 12 months. We compared the intervention to usual care using linear mixed effects modeling.

Results:
We delivered the program with high fidelity: 16/19 elements were delivered to > 90%. Our sample included 19% women with an average age of 61.7 years with an average NIHSS=3. At 3 months, the groups did not differ. However, at 6 months, we report an adjusted intervention effect on mean change in total SSQoL, m=0.30, compared to usual care m=0.16, p< 0.05. We found a significant interaction effect, p<0.01, on the total SSQoL changes across the categories of the NIHSS stroke severity. We saw the largest change in the minor stroke impairment group. Moreover, we found significant intervention effects on the self-efficacy to manage stroke health p<0.04 and physical functioning domain, p<0.03. At 12 months, the group differences were no longer significant.

Conclusions:
A stroke self-management program is effective for improving the health-related quality of life, self-efficacy to manage health and physical functioning of patients after an acute stroke during the first six months post discharge. Long term maintenance may need additional support and resources. Finally, our results remained significant after adjusting for the healthcare system, patient demographics and whether the acute event was a stroke or TIA. Thus, healthcare systems may consider implementing such programs as patients transition after the acute health event.
Abstract TMP48: Subcortical Volumes Associated With Post-Stroke Motor Performance Vary Across Impairment Severity, Time Since Stroke, and Lesion Laterality: an ENIGMA Stroke Recovery Analysis
Authors: Liew Sook-Lei , Jahanshad Neda , MacIntosh Bradley J , Robertson Andrew D , Wang Junping , Soekadar Surjo , Marguiles Daniel S , Lotze Martin , Domin Martin , Byblow Winston D , Stinear Cathy M , Westlye Lars T , Ramos Ander , Birbaumer Niels , Wiest Roland , Ward Nick , Anglin Julia M , Winstein Carolee J , Aziz-Zadeh Lisa , Roberts Pamela , Goud Anil , Borich Michael R , Wittenberg George , Lang Catherine E , Kuceyeski Amy , Kautz Steven , Hanlon Colleen , Cramer Steven C , Thompson Paul M ,   on behalf of the ENIGMA Stroke Recovery working group
Published: October 2018

Associations between subcortical gray matter volume and motor performance post-stroke are unclear, partly because many stroke MRI studies are underpowered. Potential influences of the severity of motor impairment, lesion laterality, and time since stroke on these associations is also unknown.

Here, we addressed these questions using a large dataset (n=629) from the ENIGMA Stroke Recovery working group (http://enigma.usc.edu). Regression analyses examined brain volumes as predictors of motor scores. ENIGMA FreeSurfer protocols extracted volumes from 16 subcortical regions on T1-weighted MRIs; segmentations were manually quality controlled. Motor scores were calculated as a percentage of the maximum possible score (100% = no impairment). Covariates (e.g., age, sex, intracranial volume) were modeled. Statistical significance was assessed nonparametrically by permutation. Separate analyses were performed, stratifying by motor severity and time since stroke. Each analysis was also subdivided by lesioned hemisphere.

The
motor severity analysis
(Table 1A) used subgroups of mild (66.7-99.9%), moderate (33.3-66.6%), and severe (0-33.2%). Significant associations were found for mild and moderate, but not severe, stroke; only the left hemisphere stroke group showed further significant results.

The
time since stroke analysis
(Table 1B) used subgroups of acute (<1 month), subacute (1-6 months), and chronic (>6 months). Significant associations were found in chronic stroke, but not acute, subacute. Left versus right hemisphere lesions generated different results in chronic stroke.

Overall, these results show that the most significant associations between subcortical volumes and motor outcomes are in chronic mild-to-moderate stroke. Stroke subgroups may recover via disparate mechanisms; establishing biomarkers of impairment and disability across stroke subgroups may be useful for clinical trials.
Abstract TMP49: Impact of Aura and Status Migrainosus on Readmissions for Vascular Events After Migraine Admission
Authors: Velickovic Ostojic Lili , Liang John W , Sheikh Huma U , Dhamoon Mandip S
Published: October 2018

Background:
Multiple studies have identified migraine as a risk factor for stroke. The conclusions have often been contradictory and differ between subpopulations of migraine patients. No studies to date have assessed the risk of readmission for cerebrovascular events up to 1 year after an initial migraine admission. We sought to estimate readmission rates for acute ischemic stroke (AIS), transient ischemic attack (TIA), subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) after an index admission for migraine, using nationally representative data.

Methods:
The Nationwide Readmissions Database was designed to analyze readmissions for all payers and the uninsured, with data on >14 million U.S. admissions in 2013. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify index migraine admissions with and without aura or status migrainosus, and readmissions for cerebrovascular events. Cox proportional hazards regression was performed for each outcome with aura and status migrainosus as the main predictors. Models were adjusted for age and vascular risk factors.

Results:
Out of 12448 index admissions for migraine, 9972 (80.1%) were women, mean age was 45.5±14.8 years, aura was present in 3038 (24.41%) and status migrainosus in 1798 (14.44%). The 30-day readmission rate (per 100,000 index admissions) was 197 for AIS, 86 for TIA, 42 for SAH, and 17 for ICH. In unadjusted models, aura (compared to no aura) was significantly associated with AIS (hazard ratio [HR] 1.53, 95% CI 1.04-2.24) and TIA (2.43, 1.39-4.24), but not ICH (1.86, 0.45-7.79) or SAH (1.84, 0.44-7.75). After adjustment for age and vascular risk factors, aura remained significantly associated with TIA (2.13, 1.22-3.74) but not AIS (1.38, 0.94-2.03). Status migrainosus (compared to no status), in adjusted models, was significantly associated with readmission for SAH (4.83, 1.09-21.42).

Conclusions:
In this large, nationally representative database, migraine admission with aura was independently associated with TIA readmission, and status migrainosus was independently associated with SAH. Further research would clarify causal relationships underlying these strong associations.
Abstract TMP5: Acute Ischemic Stroke due to Large Vessel Occlusions: Incremental Benefits of IV tPA Alone and Mechanical Thrombectomy Added to IV tPA
Authors: Young-Saver Dashiell F , Gornbein Jeffrey , Starkman Sidney , Saver Jeffrey L
Published: October 2018

Background:
Quantifying the magnitude of benefit of mechanical thrombectomy (MT) add to IV tPA (IVT) versus IV tPA alone vs neither in patients with acute ischemic stroke due to large vessel occlusion (LVO-AIS) is crucial to optimal organization of regional systems of stroke care. But single RCT analysis cannot quantify these effect magnitudes as no IV tPA trial enrolled explicitly-identified LVO patients, and no thrombectomy trial enrolled early IV tPA responders.

Methods:
We performed a matched patient network analysis of the two NINDS-tPA trials and the SWIFT PRIME trial. Using 1:1 optimal inverse variance matching, with NIHSS ± 1 and age ± 5, triplet matched were made between the NINDS placebo (neither MT or IVT), NINDS tPA (tPA only), and SWIFT PRIME (MT+IVT) treatment groups, ensuring comparable LVO-AIS patients, and 90 day mRS outcomes analyzed.

Results:
Among 258 triplet matched patients (86 in each treatment arm), baseline characteristics were well balanced for age (MT+IVT 66.6, IVT only 66.5, neither 66.7, p=1.00) and presenting deficit severity (NIHSS 16.3 vs 16.4 vs 16.2, p=0.98). Dramatic early benefits of IVT, leading to foregoing of MT, occurred in 10.1% of patients. The Figure shows final 90 day mRS distributions for the 3 AIS-LVO treatment strategies. Freedom from disability (mRS 0-1) was higher with MT+IVT than IVT alone and neither (47.7% vs 31.4% vs 19.8%), as was functional independence (mRS 0-2, 64.2% vs 37.2% 30.2%), and severe disability/death (mRS 5-6) was lower (11.0% vs 29.1% vs 31.4%). Number needed to treat for 1 improved outcome over the entire mRS range (shift analysis) was 4.9 for IVT alone vs neither and 2.0 for both MT+IVT vs neither.

Conclusions:
The strategy of IV thrombolysis plus direct mechanical thrombectomy unless immediate dramatic benefit occurs is highly power for LVO-AIS, improving outcomes in 1 of every 2 patients. IVT alone provides benefit in 1 in 5 patients.
Abstract TMP52: Association of Chronic Kidney Disease and Intracranial Atherosclerotic Disease by High Resolution Vessel Wall MRI: The ARIC Study
Authors: HAO Qing , Gottesman Rebecca , Qiao Ye , Sharma Richa , Liu Li , Selvin Elizabeth , Matsushita Kunihiro , Coresh Josef , Wasserman Bruce A
Published: October 2018

Introduction:
Chronic kidney disease (CKD) is associated with high risk of cardiovascular disease (CVD), independent of established cardiovascular risk factors, with cystatin C (cysC) demonstrating associations with CVD independent of creatinine-based kidney function. We tested the association between reduced kidney function (eGFR, cysC) and kidney damage (albuminuria) and intracranial atherosclerotic disease (ICAD) by vessel wall MRI (VWMRI) in the ARIC-Neurocognitive (ARIC-NCS) study.

Methods:
In this cross-sectional analysis, we sampled ARIC participants with kidney function measurements who completed intracranial VWMRI/MRA. eGFR was estimated by both creatinine and cysC(eGFRcr-cys). Albuminuria was assessed as urinary albumin-creatinine ratio (ACR). Presence and number of intracranial plaques and presence of ≥50% stenosis for individuals with plaques were considered as outcomes in separate multivariable binomial and multinomial logistic models, with adjustment for sociodemographic features, established cardiovascular risk factors, C-reactive protein, and use of antithrombotic and lipid lowering agents.

Results:
1762 participants (age 76.5±5.3) with interpretable MRI and kidney function measurements were included. eGFRcr-cys<60 ml/min/1.73 m
2
(vs≥ 60) was associated with plaque presence(adjusted OR 1.33, 95%CI 1.05-1.68). A similar association between ACR or cysC and plaque presence lost significance in adjusted models (ACR≥30 vs <10: OR 1.19, 95% CI 0.89-1.60; CysC: OR 1.19 for increase by 1 mg/L, 95% CI 0.78-1.82). In adjusted models, compared with eGFRcr-cys≥60 ml/min/1.73 m
2
, participants with eGFRcr-cys<60 had an OR of 1.47 (95% CI 1.1-1.96) for having 1 vs zero plaque, and an OR of 1.23 (95% CI 0.93-1.63) for having ≥2 vs zero plaques. eGFRcr-cys, CysC or ACR were not associated with ≥50% stenosis among those with plaques.

Conclusion:
In older adults in the ARIC study, reduced kidney function measured by eGFRcr-cys was independently associated with ICAD burden. The potential mechanism is unknown but may be mediated by decreased clearance of metabolic toxins or proinflammatory cytokines that may play roles in the pathogenesis of atherosclerosis. This finding may help to better identify a high risk population for ICAD.
Abstract TMP54: Stroke Incidence Among Atrial Fibrillation Patients Taking Novel Oral Anticoagulants (noacs) Compared to Warfarin
Authors: Shpak Max , Nadasdy Zoltan , Cowperthwaite Matthew , Ramakrishnan Anurekha , Orndorff Kevin , Fanale Christopher V
Published: October 2018

Introduction:
Atrial fibrillation (afib) patients are often prescribed anticoagulants to reduce stroke risk. Recently, NOACs have begun to supplant warfarin because of faster onset/offset of effects and purportedly lower hemorrhage risk. This study compares the efficacy of NOACs vs. warfarin in preventing ischemic stroke and hemorrhages.

Hypothesis:
We hypothesize a lower incidence of both ischemic stroke and hemorrhaging among afib patients taking NOACs than among those on warfarin because of the simpler NOAC dosing.

Methods:
Records of 5593 afib patients on a NOAC and 5796 patients on warfarin were obtained from St. David’s HealthCare hospitals (Austin, TX). The relative incidence of both ischemic and hemorrhagic strokes (as well as all other non-traumatic hemorrhages) among these patients was compared using Fisher’s tests. In order to establish that patients prescribed warfarin vs. NOACs do not differ according to confounding risk factors, demographic characteristics and medical histories were compared using t-tests.

Results:
There is significantly higher (Odds Ratio = 2.43, p <0.001) ischemic stroke incidence among patients taking NOACs. In contrast, hemorrhages generally (OR = 0.844, p=0.003) and hemorrhagic strokes in particular (OR = 0.21, p < 0.001) are much less frequent in patients taking NOACs. There was no significant difference between patients on warfarin and NOACs with respect to age. There is a higher proportion (54%) of male patients on NOACs, but no gender bias in the warfarin population. Patients on NOACs have a higher frequency of hypertension (OR = 6.6, p < 0.001) and of diabetes (OR = 2.3, p < 0.001).

Conclusions:
NOAC use is associated with a much lower risk of hemorrhaging (especially hemorrhagic stroke), but with a significantly higher ischemic stroke risk than warfarin. The results indicate that simpler dose control with NOACs can mitigate the risk of hemorrhages, at the cost of being less effective at preventing embolisms among afib patients. These findings suggest that closer monitoring of patients taking NOACs for ischemic stroke risk may be warranted.
Abstract TMP55: Periodontal Disease Associated With Atrial Fibrillation, a Stroke Risk Factor
Authors: Redd Kolby , Sen Souvik , Moss Kevin , Alonso Alvaro , Soliman Elsayed , Magnani Jared , Rosamond Wayne , Beck James , Offenbacher Stephen
Published: October 2018

Introduction and Hypothesis:
Previously we have reported that periodontal disease is associated with an increased risk of cardioembolic stroke. Atrial fibrillation (AF) is the most common reason for cardioembolic stroke. We assessed the hypothesis that periodontal disease is associated with incident AF.

Methods:
In the Dental Atherosclerosis in Communities Study (DARIC) study, participants were subjected to full-mouth clinical periodontal measurements (seven indices) collected at six sites per tooth from 6,501 subjects without prior AF. They were graded into seven distinct periodontal profile classes (PPC: A or periodontal health, F through G, based on increasing severity of periodontal disease). These patients were followed for AF adjudicated using electrocardiograms, hospital discharge codes, and death certificates, over the subsequent 17 years. Cox proportional hazards models adjusted for AF risk factors that can potentially confound the relationship between PPC and AF (Age, Gender, Race, Hypertension, Diabetes, Smoking, Coronary Artery Disease and Congestive Heart Failure).

Results:
Of 6,501 assessed on Visit 4 without prior history of atrial fibrillation, 883 were found to have AF over a 17-year follow-up period. Periodontal disease (PPC classes B-G) compared with periodontal health (PPC-A) was associated with higher rate of AF (HR 1.3 95% CI 1.1-1.5, Kaplan Meier plot, log rank p=0.0008). On univariate analysis PPC-D (HR 1.4 95% CI 1.1-1.7) PPC-E (HR 1.4 95% CI 1.2-1.8) PPC-F (HR 1.6 95% CI 1.3-2.0) and PPC-G (HR 1.4 (95% CI 1.04-1.8) were significantly associated with AF. On multivariate analysis only, PPC-F or severe tooth loss (adjusted HR 1.3 95% CI 1.01-1.6) was significantly associated with AF.

Conclusions:
We report a significant association periodontal disease and AF. Among the PPC, PPC-F or severe tooth loss is independently associated with AF. The association may explain the cardioembolic stroke risk noted with periodontal disease.
Abstract TMP63: Simplified SAVE Large Vessel Occlusion Prediction Scale Performs Similarly to More Complex Scales
Authors: Keenan Kevin J , Smith Wade S
Published: October 2018

Introduction:
Prehospital Large Vessel Occlusion (LVO) prediction scales report accuracies near 80% but vary in complexity and exam items tested. NIHSS subscores of Best Gaze, Motor Arm, Visual fields, and Best Language and/or Extinction are most predictive of ICA, M1, or M2 LVOs. Complex scoring and exam distinctions could limit the adoption of prehospital LVO scales.

Hypothesis:
We hypothesized that SAVE, a 4 item clinical scale with absent/present scoring and avoidance of nuanced exam distinctions, would predict LVOs as well as the 5 item and 9 point Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale.

Methods:
Retrospective analysis of the prospective Screening Technology and Outcomes Project in Stroke (STOPStroke) Study included 735 patients with suspected acute ischemic stroke or TIA evaluated in emergency departments with NIHSS scores and computed tomography angiography. Receiver operating characteristic analyses assessed the ability of the 4 point SAVE scale to predict the presence of ICA, M1, M2, or Basilar artery LVOs. The SAVE scale assigns 1 point for any NIHSS abnormalities in Speech (Best Language and/or Dysarthria), Motor Arm, Visual fields, or Eye deviation (Best Gaze). The results were compared to the published FAST-ED scale, which was derived from the same STOPStroke cohort and performs similarly to other published scales.

Results:
The prevalence of ICA, M1, M2, or Basilar artery LVOs was 31%. The SAVE scale area under the curve (AUC) was 0.79 and the FAST-ED scale AUC was reported as 0.81. SAVE ≥1 and ≥2 are equivalent to FAST-ED ≥1 and ≥2. SAVE ≥3 is equivalent to FAST-ED ≥4. SAVE ≥4 is equivalent to FAST-ED ≥6.

Conclusions:
The SAVE scale performed similarly to the FAST-ED scale at predicting ICA, M1, M2, or Basilar artery LVOs. The SAVE scale focuses on 4 items with present/absent scoring and avoids the nuances of aphasia and neglect to reduce the complexity of prehospital LVO prediction. Prospective prehospital validation is needed.
Abstract TMP8: Intravenous Thrombolysis and Endovascular Treatment in Chronically Anticoagulated Patients With Ischemic Stroke in the United States: Analysis of Nationwide Inpatient Sample From 2006 to 2014
Authors: Hassan Ameer E , Afzal Mohammad Rauf , Saeed Omar , Chaudhary Saqib , Qureshi Adnan I
Published: October 2018

Objective:
To investigate the contemporary trends in use of intravenous thrombolysis and endovascular treatment among chronically anticoagulated ischemic stroke and associated outcomes patients in United States using NIS data from 2006 to 2014

Materials and Methods:
Acute ischemic stroke (AIS) patients were divided into those who underwent intravenous thrombolysis, those who underwent endovascular treatment, and those who did not receive either treatment. Temporal trends were quantified and the rates of in hospital mortality and none to minimal disability in each group were compared after age and All Patients Refined DRG (APR-DRG) severity of disease adjustment.

Results:
The proportion of patients with AIS with chronic anticoagulation admitted increased from 3.96% (2006) to 7.17% (2014) (estimated annual percentage change: +9.01%, p = <.0001). The proportion of patients receiving intravenous thrombolysis with AIS patients with chronic anticoagulation increased from 2.2% (2006) to 4.8% (2014) (estimated annual percentage change: +13.1%, p = <.0001) and those receiving endovascular treatment increased from 0.05%(2006) to 1.33% (2014) (estimated annual percentage change: +481.5%, p = <.0001). The rates of in hospital mortality were significantly higher among patients on (than those not) on chronic anticoagulation receiving intravenous thrombolysis (9.80% versus 7.96%, adjusted odds ratio [OR], 1.02 95% CI 0.86 - 1.20). There was no difference in the rates of in hospital mortality among patients on chronic anticoagulation receiving endovascular treatment (19.2% versus 18.2%, adjusted OR, 1.3 95% CI 0.95 - 1.8). The rates of none to minimal disability were lower in chronically anticoagulated patients receiving intravenous thromboysis (adjusted OR, 1.0 95% CI 0.89 - 1.13) but no in those receiving endovascular treatment (adjusted OR, 1.0 95% CI 0.69 - 1.45) when compared with patients not on chronic anticoagulation.

Conclusions:
We observed an increase in proportion of chronically anticoagulated ischemic stroke patients receiving intravenous and/or endovascular treatment in United States. The short term results appeared to favor endovascular treatment rather than intravenous thrombolysis in chronically anticoagulated patients.
Abstract TMP81: Nationally Representative Estimates of Readmission Rates After Extracranial-Intracranial Bypass Surgery for Moyamoya Disease
Authors: Kahn Amanda , Kaur Gurmeen , Stein Laura , Tuhrim Stanley , Dhamoon Mandip S
Published: October 2018

Background:
International trials have suggested benefit of extracranial- intracranial bypass (ECICB) for Moyamoya disease (MMD). However, nationally representative US data on demographics and adverse outcomes after ECICB in MMD are lacking. We aimed to estimate nationally representative 30, 60 and 90-day readmission rates for ischemic stroke (IS), subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) after an index admission for MMD with ECICB.

Methods:
The Nationwide Readmissions Database contains data on >14 million discharges for all payers and the uninsured in 2013. Index admissions for ECICB for MMD, and readmissions for IS, SAH, and ICH, were identified using validated International Classification of Diseases, 9th Revision, Clinical Modification codes. We summarized demographics, comorbidities, and the Charlson Comorbidity Index (CCI) during the index admission, and calculated 30-, 60-, and 90-day readmission rates per 100,000 index admissions. Preventable causes of admission were determined by Prevention Quality Indicators.

Results:
Among 201 index admissions for ECICB for MMD, mean age (SD) was 41.7 (12.6) years; 75% were female; 24% had diabetes; 53% had hypertension; 40% had hypercholesterolemia; and mean CCI (SD) was 3.2 (1.5). For concurrent or previous cerebrovascular events, 3% had ICH; 16% had IS; and 1% had SAH. ECICB was performed at large hospitals in 83%, urban hospitals in 85%, and teaching hospitals in 97%. 80% were discharged home. 1% died during index hospitalization. 34% had a readmission during follow-up, 3% of which were preventable. Leading reasons for readmission up to 90 days included MMD (62%), postoperative infection (10%), sickle cell crisis (4%), ischemic stroke (4%), epilepsy (2%), subdural hemorrhage (2%) and headache (2%). Readmission rates (per 100,000 index admissions) were 559 at 30 days, 1829 at 60 days, and 2027 at 90 days for IS. There were no readmissions for SAH or ICH.

Conclusions:
This analysis of nationally representative US data suggests that although readmission after ECICB for MMD is not uncommon, cerebral hemorrhagic events during the 90-day postoperative period are rare. Readmission for ischemic stroke, in comparison, is more prevalent, and only 3% of readmissions were preventable.
Abstract TMP85: Serial Body Temperature and Acute Clinical Deterioration in Stroke
Authors: Margolin Emily , Saver Jeffrey L , Starkman Sidney , Liebeskind David S , Hamilton Scott , Sanossian Nerses ,   FAST-MAG Investigators and Coordinators
Published: October 2018

Background:
Studies on the effect of body temperature on outcome in stroke are conflicting with most demonstrating that elevated body temperature is associated with poor outcome in stroke, and some indicating that very early body temperature elevation is associated with better outcomes. We sought to characterize the relationship of body temperature and clinical deterioration by evaluating serial measurements over 24 hours.

Methods:
All subjects were enrolled <2 hours after stroke symptom onset into the Phase 3 NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial testing magnesium for prehospital neuroprotection. Presenting temperature in the emergency room and follow-up temperatures at 8, 16 and 24 hours after arrival were recorded. Acute deterioration was defined as 4 point worsening on NIHSS from presentation to 24 hours. Mean temperature was compared at all time points for deteriorators and non-deteriorators utilizing t-test. All measures were in °C.

Results:
Of 1700 subjects 1586 (93%) had temperature recorded on ED arrival, 1594 at 8 hours, 1611 at 16 hours, and 1594 at 24 hours (1385 had all 4 recorded). Mean age was 69 years, 43% were women, final diagnosis cerebral ischemia in 73.3%, intracranial hemorrhage in 22.8%, and mimic in 3.9%. Mean body temperature for deteriorators was not different at presentation (36.5 vs. 36.6, p=0.221), but was significantly higher at 8 hours (36.8 vs. 36.6, p<0.001), at 16 hours (37.0 vs. 36.7, p<0.001) and 24 hours (37.0 vs. 36.7, p<0.001). Of cerebral ischemia cases (N=1150) the same temperature relationship held true (presentation: 36.6 vs. 36.6, p=0.744, 8-hours: 36.7 vs. 36.6 p=0.002, 16 hours: 36.8 vs 36.6 p<0.001, 24 hours: 36.9 vs. 36.7, p<0.001). In cases of ICH elevated temperature was not significantly higher until 16 hours after arrival (presentation: 36.5 vs. 36.6, p=0.173, 8-hour: 36.9 vs. 36.8 p=0.313, 16 hour: 37.2 vs. 36.9 p<0.001, 24-hour: 37.1 vs 36.9 p=0.036).

Conclusions:
Higher body temperatures were noted in those experiencing clinical deterioration 8 hours after arrival. Early elevations in body temperature may be a predictor of clinical deterioration in acute stroke.
Abstract TMP87: Non-Invasive Respiratory Impedance Enhances Cerebral Perfusion in Acute Stroke Patients
Authors: Favilla Christopher G , Forti Rodrigo M , Zamzam Ahmad , Detre John A , Mullen Michael T , Yodh Arjun G , Kasner Scott E , Busch David R , Baker Wesley B , Messe Steven R
Published: October 2018

Introduction:
Optimization of cerebral blood flow is a cornerstone of clinical management in a number of neurologic diseases, most notably acute ischemic stroke. Intra-thoracic pressure influences cardiac output and has the potential to impact cerebral blood flow (CBF). We aimed to quantify cerebral hemodynamic changes in acute ischemic stroke patients during increased respiratory impedance using a non-invasive oral device.

Methods:
Cerebral perfusion was measured during low (6cm H
2
0) and high (12cm H
2
0) levels of respiratory impedance in 20 patients within 72 hours of acute ischemic stroke. Microvascular CBF was measured by optical diffuse correlation spectroscopy, and middle cerebral artery mean flow velocity (MFV) was assessed by transcranial Doppler ultrasound.

Results:
High level respiratory impedance resulted in a 10% increase in MFV. Low level respiratory impedance resulted in a smaller (4%) non-significant change in MFV. Changes in cortical CBF were non-significant (figure). MFV varied across all studied levels (baseline vs low vs high, p=0.0017) with a significant test of trend (p=0.001), but this was not seen with microvascular CBF (p=0.33). Heart rate, cardiac output, and end tidal CO
2
remained stable during all levels of respiratory impedance. There was a small increase in mean arterial blood pressure at the low and high level of respiratory impedance, 4% (p=0.013) and 6% (p=0.017) respectively. All patients completed the protocol in its entirety, and the respiratory impedance exercise was well tolerated.

Conclusions:
Manipulating intrathoracic pressure via non-invasive respiratory impedance was safe and produced a small but measurable increase in cerebral blood flow in acute stroke patients. Future studies are warranted to assess whether respiratory impedance is feasible during hyperacute stroke management, and to determine the effect of volume status on the hemodynamic response to respiratory impedance.
Abstract TMP89: Early Heart Rate as an Outcome Predictor in Atrial Fibrillation Related Acute Ischemic Stroke
Authors: Lee Keon-Joo , Kim Beom Joon , Han Moon-Ku , Kim Joon-Tae , Cho Ki-Hyun , Shin Dong-Ick , Yeo Min-Ju , Cha Jae-Kwan , Kim Dae-Hyun , Nah Hyun-Wook , Kim Dong-Eog , Ryu Wi-Sun , Park Jong-Moo , Kang Kyusik , Lee Soo Joo , Oh Mi-Sun , Yu Kyung-Ho , Lee Byung-Chul , Hong Keun-Sik , Cho Yong-Jin , Choi Jay Chol , Park Tai Hwan , Park Sang-Soon , Kwon Jee-Hyun , Kim Wook-Joo , Lee Jun , Lee Ji Sung , Lee Juneyoung , Bae Hee-Joon ,   Clinical Rsch Collaboration for Stroke in Korea (CRCS-K) Investigators
Published: October 2018

Backgrounds:
Previous studies demonstrated the association of resting heart rate with cardiovascular outcomes while there were only few evidence for patients who experienced ischemic stroke. As atrial fibrillation (AF) is characterized by rapidity and irregularity of heart rate, heart rate characteristics might be a predictor for future vascular event in patients with AF acute ischemic stroke.

Methods:
From a multicenter prospective registry of stroke patients, acute ischemic stroke patients with AF who admitted within 48 hours after stroke onset were included. Heart rate data during the first 24 hours after admission were collected and level and variability of heart rate were assessed by mean and coefficient of variation (CV). Primary outcome was a composite of stroke recurrence, myocardial infarction and all-cause death, which was prospectively captured until 1 year after stroke onset.

Results:
A total of 2,046 patients were included for the final analysis. There were 102 (5.0%) stroke recurrence, 9 (0.4%) myocardial infarction and 440 (21.5%) death events within 1 year after stroke onset. Proportional hazards regression models were constructed and the non-linearity of effects of heart rate parameters were examined for outcome events. Among all the associations, effects of mean heart rate on primary outcome and all-cause mortality were non-linear (
p’s
for quadratic effect = 0.017 and 0.032, respectively). The overall effects were significant only for effects of mean heart rate on primary outcome and all-cause mortality (P =0.013 and P=0.006, respectively). Effects of CV on outcome variables were not significant.

Conclusion:
This study suggests that mean heart rate during the first day of hospitalization was a predictor of future vascular events in AF patients presenting with acute ischemic stroke and the association seems to be non-linear ‘J shaped’. However, heart rate variability did not affect.
Abstract TMP91: White Matter Lesion Progression and Cognitive Function Over 5-Years in a Young Susceptible Population
Authors: Nyquist Paul A , Yanek Lisa R , Kral Brian G , Becker Lewis C , Vaidya Dhananjay , Becker Diane M
Published: October 2018

Introduction:
Cerebrovascular disease (CVD) and vascular risk factors cluster in families of patients with early-onset coronary artery disease (CAD). In a prior cross-sectional study of 714 healthy middle-aged relatives, we found a high prevalence of early white matter hyperintensity lesions (WMHL) and associated lower cognitive function. Prior WMHL studies have included elderly or demented subjects. Rate of WMHL progression and cognitive decline in quiescent preclinical healthy middle-aged persons remains unknown.

Methods:
We studied WMHL and cognitive function over 5 years in 20 healthy relatives, age 50-59, of patients with CAD <60 years of age (one subject per family). Persons with any physical or neurological abnormality were excluded. At baseline and follow-up, subjects underwent 3-Tesla brain magnetic resonance imaging. WMHL volumes were determined using automated segmented volumes measured from FLAIR and MPRAGE using a previously described automated pipeline. Cognitive function was measured with the: Delayed Recall, Digit Symbol Substitution, Verbal Fluency, Digit Span, and Grooved Pegboard tests.

Results:
Our 20 participants were: 50% male, 45% African American (AA), average age was 54.1 (SD 1.57) years, 45% with HTN, 15% smokers, and 50% obese. WMHL prevalence was 92%. The average change in WMHL volume was 819 mm
3
(P<0.0008); this was significant for men (p=0.006), women (p= 0.062), AAs (p= 0.019), and European Americans (EA) (p= 0.018). Decline occurred in all cognitive function tests (average P across all tests was <0.001) in all races and sexes. Vascular risk factors did not change from baseline to follow-up.

Conclusion:
These striking findings are among the first to demonstrate significant quantitative WMHL volume progression and cognitive decline in a healthy middle-aged population over just 5 years, in AA and EA and both sexes. This small pilot study suggests that early quiescent brain white matter lesion progression and early multidimensional cognitive decline can be detected in healthy susceptible populations using state-of-the-art quantitative volumetric imaging techniques.
Abstract TMP93: Early Intervention in Vascular Mild Cognitive Impairment Improves Treatment of Vascular Risk Factors and Decreases Hospitalization Rates
Authors: Kirkpatrick Angelia , Vincent Andrea S , Ross Elliott D , Guthery Leslie , Prodan Calin I
Published: October 2018

Hypothesis:
Early intervention in VaMCI leads to improved management of vascular risk factors and decreased utilization of hospital resources.

Methods:
An individualized patient and family education session encouraging increased supervision of medication use, specifically for antiplatelets, statins, antihypertensives, diabetes medications and anticoagulants, was implemented at the time of diagnosis and continued at 6-month intervals. Medication adherence, treatment parameters and number of individuals with emergency room (ER) visits or hospital admissions were recorded in 72 consecutive patients for 12 months before and after the VaMCI diagnosis. Treatment parameters included average systolic (SBP) and diastolic (DBP) blood pressure, LDL, HgA1c and percentage of INR within therapeutic range. Non-adherence was defined as a lag of ≥3 months in refills over 12 months.

Results:
Improved adherence for antiplatelets (55% to 94%), statins (68% to 94%) and antihypertensives (59% to 93%; p’s <0.0001), decreases in average SBP (-8.6 mmHg, p<0.0001), DBP (-3.2 mmHg, p=0.01), LDL (-9.4, p<0.0001), and HgA1c (-0.4%, p=0.001) and increased percentage of INR within therapeutic range (+21%, p=0.001) were noted after the intervention. The number of ER visits and/or hospital admissions declined after the intervention (36 vs 20, p=0.001) with a decline in one ER visit or hospital admission for every three patients receiving the intervention. Logistic regression showed that improved adherence to antiplatelets was the only significant predictor of a decline in ER visits or hospital admissions (OR=3.0, p=0.04).

Conclusions:
Medication adherence counselling for VaMCl patients leads to improved treatment of risk factors and decreased utilization of hospital resources. The strongest predictor of reduced ER visits and admissions in our cohort was improved adherence to antiplatelet therapy.
Abstract TMP98: Aspirin and Anticoagulant Usage on Outcomes After Ruptured Arteriovenous Malformation: A Nationwide Sample Analysis
Authors: Khatri Rakesh , Afzal Mohammad Rauf , Qureshi Mohtashim A , Maud Alberto , Cruz-Flores Salvador , Vellipuram Anantha R , Rodriguez Gustavo J
Published: October 2018

Title:
Aspirin and anticoagulant usage on outcomes after ruptured arteriovenous malformation: a Nationwide Inpatient Sample analysis

Background:
Recently in nationwide study, neither long-term aspirin nor anticoagulant use were associated with differential mortality or complication rates after aneurysmal subarachnoid hemorrhage however their impact on outcomes of ruptured arteriovenous malformation is unclear.

Methods:
Data from the Nationwide Inpatient Sample (NIS; 2006–2014) were analyzed in patients with a primary diagnosis of SAH and/or ICH with a diagnosis of an arteriovenous malformation. These patients were divided in two groups: receiving long-term aspirin or anticoagulant use versus neither. Multivariable logistic regression was performed to calculate the adjusted odds of in-hospital mortality, a nonroutine discharge (any discharge other than to home), or a poor outcome (death, discharge to institutional care, tracheostomy, or gastrostomy) for patients with long-term aspirin or anticoagulant use. Multivariable linear regression was used to evaluate length of hospital stay. Covariates included patient demographics, comorbidities, APDRG severity scale, and treatment of AVM including embolization, surgical resection and radiosurgery.

Results:
Our study examined 11066 patients with ruptured AVM. Patients taking either aspirin (2.5 %, n =273) or anticoagulation (1.7 %, n =185) were significantly older and had a greater burden of comorbid disease (hypertension, hyperlipidemia, atrial fibrillation and renal disease, p < 0.001). Inpatient mortality (10.9 % either aspirin/anticoagulation vs 9.2 % neither, p = 0.63) Length of stay (9.3 ± 8.7 days vs 11.0 ± 13.5 days p = 0.11) were not significantly different. In multivariable logistic regression models for outcome, discharge disposition was better in ASA/Anticoagulation group (home discharge OR 2.36, CI 1.40-3.98, p = 0.001) but inpatient mortality was not different (OR 0.79, CI 0.34-1.82, p=0.58).

Conclusion:
In this nationwide study, neither long-term aspirin nor anticoagulant use was associated with differential mortality after ruptured arteriovenous malformation. Aspirin/anticoagulant use was associated with favorable discharge to home.
Abstract TP100: Angiotensin Type 2 Receptor Stimulation With Compound 21 Improves Stroke Outcome in Female Rats: Possible Role for Peroxisome Proliferator-activated Receptor Gamma
Authors: Eldahshan Wael , Pillai Bindu , Sayed Mohammed , Ishrat Tauheed , Ergul Adviye , Fagan Susan
Published: October 2018

Introduction:
The angiotensin type 2 receptor (AT2R) agonist, compound 21 (C21), has been shown to be neuro-protective, pro-angiogenic and anti-inflammatory after stroke in male rats. Here we aimed to study the effect of C21 treatment on ovary-intact female rats after stroke.

Methods:
Female Wistar rats were subjected to 3 h middle cerebral artery occlusion (MCAO) using a silicone-coated monofilament and treated at reperfusion with IP C21 0.03 mg/kg. Rats were sacrificed at 24 h and brains collected for infarct analysis. Another cohort of female rats were subjected to MCAO and treated at reperfusion with C21 for 2 days. Animals were followed up and sacrificed at 72 h. Behavioral tests (Bederson, Paw grasp, Beam walk and Rotarod) were performed at 24 h and 72 h, and whole brains were collected for western blotting.

Results (mean±SEM):
C21 treatment in females resulted in a decrease in infarct size, improvement in Bederson, Paw grasp and rotarod scores. Interestingly, C21 treatment showed a trend toward increased expression of the transcription factor PPARγ at 72 h in sham and stroked animals suggesting a novel crosstalk between the AT2R and PPARγ after ischemic stroke. In addition, stroke surgery resulted in a decrease in the AT2R expression. However, sham treated animals had an increase in the AT2R expression.

Conclusions:
AT2R stimulation using C21 improves stroke outcome in ovary-intact female rats.
Abstract TP11: Thromboaspiraiton vs Stent Retriever Thrombectomy for Basilar Artery Occlusion
Authors: Haussen Diogo C , Al-Bayati Alhamza , Grossberg Jonathan , Barreira Clara , Frankel Michael , Nogueira Raul G
Published: October 2018

Background:
Thromboaspiration and stent retriever thrombectomy perform similarly in anterior circulation large vessel occlusions. We aim to compare performance of modern thromboaspiration against stent retriever technology in basilar artery occlusions.

Methods:
This was a retrospective analysis of a prospectively collected databank in a comprehensive stroke center. Inclusion criteria: thrombectomies in which stent-retrievers (Trevo or Solitaire) or modern thromboaspiration devices (Penumbra 5max, 64 or 68) were used as the first-line strategy from Sep2010-Mar2017. We excluded cases of combined retriever plus local aspiration. Primary outcome was first-pass reperfusion (modified TICI2b-3 with first pass).

Results:
Of 1204 thrombectomies within the study period, 68 patients were included (48 retrievers and 20 thromboaspiration cases). Age, gender, comorbidities, systolic blood pressure, NIHSS, IV tPA use, and last known normal to puncture times were comparable between groups. First-pass reperfusion was achieved in 58% of the retriever group vs 55% in the aspiration group (p=1.00). Parenchymal hematoma type-2 was observed in 2% vs 0% in the retriever and aspiration groups (p=1.00), respectively. At 90 days, good outcome (mRS0-2) was observed in 31% of the stent retriever patients compared to 41% in the aspiration group (p=0.55) while mortality was 53% and 41% (p=0.56), respectively.

Conclusions:
Stent retrievers and modern thromboaspiration were observed to have similar performance in achieving first pass reperfusion in patients with basilar artery occlusions. Further studies are warranted.
Abstract TP112: Differential Effects of Deferoxamine Treatment on Neurological Deficits in Young Diabetic Female Animals After Embolic Stroke
Authors: Li Weiguo , Dong Guangkuo , Menk Paul T , Abdul Yasir , Ward Rebecca , Fagan Susan C , Ergul Adviye
Published: October 2018

Premenopausal women have lower stroke risk and mortality than age-matched men, a finding replicated in preclinical models. However, we recently reported that female diabetic rats developed greater hemorrhagic transformation (HT) after embolic stroke and thrombolysis with tPA, leading to poor short term outcomes, despite no change in infarct size. Given that iron chelation therapy with deferoxamine (DFX) in the recovery period improves long term functional outcome in male diabetic rats that develop HT after embolic stroke, the current study tested the hypothesis that DFX will improve neurological recovery in diabetic females, especially with tPA combined treatment. Control and type 2 diabetic female animals were subjected to embolic middle cerebral artery occlusion. DFX (100 mg/kg) or vehicle was given every 12 h for 7 days after stroke. tPA (1 mg/kg) was given at 90 min post-occlusion to diabetes group. The composite score (Bederson’s score and beam walk), adhesive removal (ART) and novel object recognition (NOR) were assessed at day 3, 7 and 14 after the surgery. DFX improved sensorimotor deficits in both groups, and the combination with tPA in the diabetes group had a similar effect to DFX alone. Control vehicle group regained cognitive function but there was no change in diabetic animals which had deficits at baseline. Interestingly, cognitive deficits increased in the control DFX and diabetes tPA+DFX group. These results suggest that DFX treatment may improve the long term sensorimotor deficits in diabetic females after stroke but the impact on cognitive outcomes needs further evaluation.