bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP266: Infiltrated CD36+ Monocytes/Macrophages are the Main Phagocytes in Acute Ischemic Stroke
Authors: Woo Moon-Sook , Beltran Cesar , Cho Sunghee
Published: March 2022

Introduction:
Stroke induces the infiltration of peripheral monocytes/macrophages [MMs] into the injured brain. As MMs share common lineage markers with resident microglia [Mig], defining their respective phenotypes and function has been a challenge. CD36, a multifunctional receptor, is expressed in mononuclear cells and microvasculature. Besides its involvement in stroke-induced inflammation, CD36 also functions in innate immunity by phagocytizing debris and apoptotic cells.

Hypothesis:
We hypothesized that infiltrated CD36+ MMs in the ischemic brain are major phagocytes.

Methods:
Adult Male C57 mice were subjected to a 30-min transient focal ischemia. Peripheral MM trafficking to ischemic brain was determined by adoptive transfer of GFP+-splenocytes 1 day (D) prior to sacrifice. Isolated brain immune cells at 3 or 7D post-stroke were analyzed by a flow cytometer (CD11b/CD45/CD36). Phagocytosis assay was performed using fluorescent bead in the absence /presence of salvianolic acid B (SAB), a CD36 inhibitor.

Results:
In CD11b+ cells, CD45Low was present in both hemispheres while CD45High was exclusively found in stroked hemisphere. The number of ipsilateral CD36+ cells was higher in CD45High than CD45Low subset (315±254 vs 46±38, n=7, p<0.01). Infiltrated GFP+ cells mostly belong to CD45High. Phagocytic activity measured in the brain immune cells at 7D post-stroke was positively correlated with CD36 expression (Fig), which was attenuated by SAB treatment (98±17 vs 75±8, n=5, p<0.05).

Conclusion:
The results show that CD45High subset represents infiltrated MMs and infiltrated CD36+ MMs are the main phagocytes in the post-stroke brain. With previously reported CD36 role in post-stroke inflammation, CD36-mediated phagocytosis in MMs provides further insights on the dichotomy of CD36 function in inflammation and subsequent resolution of post-stroke inflammation.
Abstract TP276: Mild Short-term Hypertension Exacerbates Amyloid Pathology and Microhemorrhages in Mouse Model of Amyloidosis
Authors: Vasilevko Vitaly , Kilday Kelley , Passos Giselle F , Cribbs David H
Published: March 2022

Introduction:
Multiple epidemiological studies link vasculature-affecting disorders, such as hypertension, diabetes mellitus, kidney failure and stroke, with dementia and Alzheimer’s disease (AD). Hypertension is an important modifiable risk factor for late-onset sporadic AD, and often associated with increased incidents of intracerebral hemorrhages (ICH) and cerebral amyloid angiopathy (CAA).

Hypothesis:
To examine the association between short-term mild experimental hypertension and the progression of AD pathology later in life, we pharmacologically induced mild chronic hypertension in the APP/Tg2576 mouse model of AD.

Methods:
Twenty-month old APP/Tg2576 mice (n=6) received N-Nitro-l-arginine methyl ester hydrochloride (L-NAME) in drinking water, for the daily doses of 100 mg/kg body weight for each mouse. Control mice (n=4) had regular drinking water. Treatment continued for 4 weeks. Blood pressure was measured 4 days before termination of the experiment with tail-cuff system (CODA). At the end of experiment mouse brains were collected and analyzed for amyloid-related AD pathology, inflammatory markers of glial activation and cerebrovascular pathology. Differences between groups were tested by t-test.

Results:
There was a significant mild increase in diastolic (109±5.1 vs 123±2.4 mmHg, p<0.05) and mean blood pressure (118±5.9 vs 135±2.8 mmHg, p<0.05) after 3 1/2 weeks of L-NAME treatment. Increased blood pressure had not induced stroke symptoms in treated mice. After 4 weeks of L-NAME treatment mice showed significant increase in amyloid-beta load, revealed by 20.1 antibody staining (6.09±1.12 vs 9.35±0.63 %, p<0.05). Short-term mild hypertension had not affected microglia (Iba1) and astrocytes (GFAP) activation. Short-term mild hypertension did not induced new microbleeds in Tg2576 mice, however, there was a strong trend (p=0.123) towards the increased size of pre-existing microbleeds.

Conclusions:
Our results suggest that short-term mild experimental hypertension late in life in APP/Tg mouse model of amyloidosis exacerbated amyloid pathology and cerebral microhemorrhages. Managing the blood pressure in the population at risk of AD should be considered as a potential preventive therapy for this neurological disorder.
Abstract TP280: Resveratrol Preconditioning Alters MicroRNA Expression Profiles to Induce Neuroprotection Against Ischemic Stroke
Authors: Lopez Mary S , Veumganti Raghu
Published: March 2022

Resveratrol is a neutraceutical polyphenol that has been shown to improve outcome in several disease models including cancer, atherosclerosis and neurodegeneration. Resveratrol treatment prior to inducing experimental ischemic stroke results in neuroprotection reminiscent of ischemic preconditioning, a well-established mode of organ-specific tolerance to ischemia. MicroRNA are known to play a significant role in post-ischemic brain damage and plasticity. Recent studies also showed their involvement in ischemic tolerance induced by surgical preconditioning (a short duration middle cerebral artery occlusion). As resveratrol is known to be well-tolerated and easy to deliver, it is a better option than surgical preconditioning. Hence, we tested if resveratrol treatment induces changes in microRNA expression profiles with a goal to identify those microRNAs that are critical to inducing ischemic tolerance. When adult male C57BL/6J mice treated with resveratrol (10 mg/kg; i.p.) were subjected to a 1h transient middle cerebral artery occlusion after 3 days, the infarct volume (measured at 3 days of reperfusion) was significantly smaller compared to vehicle injected group (by ∼54%; p<0.05; n = 6/group). We conducted microRNA expression profiling using Affymetrix microarrays in the cerebral cortex of mice at 1 day and 3 days after resveratrol treatment in comparison to vehicle control treatment (n = 3/group). Resveratrol preconditioning altered the expression of 60 microRNAs (29 up-regulated and 31 down-regulated; by >3-fold) at both the time points studied compared to vehicle control (n =3 arrays/group). Of these, 30 were altered by >5-fold (17 up- and 13 were down-regulated). Bioinformatics analysis showed that axon guidance, transcriptional misregulation and Wnt signaling are the major biological pathways of the targets of the resveratrol-responsive microRNAs. Thus, our data shows that the ischemic tolerance afforded by resveratrol preconditioning might be mediated by microRNAs that target neuroprotective pathways.
Abstract TP287: Informed Consent for IV tPA in New York State Designated Stroke Centers: A Current Snapshot
Authors: Weintraub Michael I , Colello Anna D , Johnson Samantha A , McClellan Fabienne , Cole Steven P , Benesch Curtis , Rudolph Steven H , Levine Steven R
Published: March 2022

Introduction:
The New York State Department of Health (NYS DOH) began designation of Stroke Centers in 2004. Investigators sought to ascertain current informed consent procedures in the 0-3 hour and 3-4.5 hour treatment windows.

Hypothesis:
There is an association between IV tPA informed consent practices and hospital demographics among NYS DOH Stroke Centers across treatment windows.

Methods:
Hospitals were sent a 13-question on-line survey to determine whether written, verbal or no consent was required within the 0-3 hour and 3-4.5 hour treatment windows. Surveys were conducted in August and September of 2014. Hospital size, academic vs. non-academic and authorizers of consent were obtained. Chi-square tests were used to assess possible association between demographic measures and whether or not consent was required in either treatment window.

Results:
One hundred and eleven of the 117 Stroke Centers responded (95%). Within the 3-hour treatment window, 28% required written consent compared to 54% that required verbal approval. In the 3-4.5 hour treatment window, 97 (87%) used IV tPA with 59% requiring written consent, compared to 33% requiring verbal discussion only. Combining both treatment windows, 98% accepted a health care proxy or surrogate to give consent in lieu of the patient. Among hospitals with fewer than 500 beds, 86% (70/81) did require some form of written or verbal consent within the 3-hour treatment window, compared to only 70% (21/30) of hospitals with 500+ beds (p < 0.05). Beyond the 3-hour treatment window, there was no significant association between bed size and consent requirement. Fifty five percent of hospitals were academic vs. 45% non-academic. Academic status was not related to form of consent during either time window.

Conclusions:
The majority of hospitals did not require written consent within the 3-hour treatment window, but did require written consent for the 3-4.5 hour treatment window (2-fold increase in latter window). Smaller hospitals were significantly more likely than larger hospitals to require any form of consent in the 0-3 hour window. Further research should be conducted to determine whether this variability in consent for IV tPA affects clinical outcomes, which may in turn impact health policy and practice.
Abstract TP294: Get With the Guidelines Award Winning Hospitals Are Associated With Decreased Door to Needle Times in Michigan and Wisconsin
Authors: Ali Syed I , Mallas-Serdynski Lynn , Thomas Kathie
Published: March 2022

Background & Objectives:
Stroke is the fifth leading cause of death and the leading cause of disability in the U.S. Timely administration of IV tPA, can lead to reduction in the severity of disability and improved patient outcomes.Previous studies have concluded that for every minute of onset-to-treatment time saved, 1.8 days of healthy life is given to the patient.Get With The Guidelines (GWTG) Stroke is an in-hospital quality improvement initiative designed to improve care by promoting adherence to the latest scientific guidelines.Hospitals participating in GWTG are recognized with achievement awards for high levels of adherence to the evidence based guidelines and target stroke awards for performance related to the Target Stroke initiative, focused on reducing door-to-needle (DTN) time.The objective of the abstract is to examine the association between hospital adherence to GWTG and Target Stroke measures and the impact on DTN times in ischemic stroke patients.

Methods:
A retrospective review was conducted of DTN time from 63 hospitals(n=1602) using GWTG Stroke in Wisconsin and Michigan from January 2013-December 2014.Data was divided into GWTG achievement award hospitals, hospitals with a target stroke award, and GWTG hospitals that did not achieve award status.

Results:
In 2013, GWTG achievement award winning hospitals demonstrated an average median DTN time of 67 minutes, while target stroke hospitals average median DTN time was 60 minutes.GWTG non-award winning hospitals had an average DTN time of 78 minutes.2014 data indicated achievement award winning hospitals had an average DTN time of 55 min, target Stroke hospitals had an average DTN time of 53 min, and non-award winning hospitals had an average DTN time of 73 minutes.

Conclusions:
Hospitals achieving GWTG award recognition status through adherence of evidence based guidelines have a significantly shorter DTN time.Over a two year period, GWTG achievement award winning hospitals had an average median DTN time of 14.5 minutes faster than non-award winning hospitals, resulting in an additional 26.1 days of healthy living for the patient.This translates into significant healthcare cost savings, reduced severity of disability, improved patient outcomes, and additional healthy days of living.
Abstract TP297: Stroke Outcomes When Stroke is Treated by a Stroke Physician: A Prospective Cohort Study
Authors: Varma Daniel D , Kim Susan , Hakendorf Paul , Horwood Chris , Cheruvu Lata , Davies Owen , Whitehead Craig , Chen Celia S , Lee Andrew W
Published: March 2022

Introduction:
Stroke unit care is an established intervention for all stroke patients where the benefits derive from having a system which integrates acute reperfusion with secondary prevention and rehabilitation as needed. While most stroke units are staffed by dedicated stroke neurologists, in many parts of the world non-neurologist stroke physicians are in charge of stroke care.

Hypothesis:
As the benefits of a stroke unit are due to an organized system, we hypothesize that irrespective of the physician looking after the stroke, the more organized the system, the better the outcome.

Methods:
To test this hypothesis, a cohort study comprising of consecutive ischemic stroke patients presenting to a tertiary stroke centre between 2000 - 2015 was analysed. During this time, there was an evolution of stroke systems from admitting strokes under general medical units, to admitting strokes to a dedicated centre where stroke patients are looked after by a single stroke specialist. The specialists are geriatricians who work under the governance of a stroke neurologist director. Outcomes such as mortality, length of stay, discharge destination were analysed.

Results:
4794 stroke patients were analyzed. Median length of stay (LOS) prior to appointment of a stroke director was 7.3 days. An immediate reduction of 1.2 days to 6.3 days LOS (p=0.02) occurred in the first year after this appointment (2009-2010). Since SU care began (2010-2014), LOS has further reduced to 4.7 days (p=0.001), with mortality (OR=0.72, 95% CI=0.56-0.91, p=0.007) and transfers to aged care facilities (OR=0.50, 95% CI=0.38-0.67, p=0.001) also significantly decreasing. Transfers to rehabilitation hospitals also significantly increased from 19.6% to 34.5% (p=0.007).

Conclusion:
In this large cohort study involving a tertiary stroke centre with regional responsibility for stroke care, we demonstrate that stroke outcomes improve with better governance and adherence to strict protocols. The most dramatic improvement occurs following the appointment of a stroke director and outcomes continue to improve even when the physician looking after a stroke is a non-neurologist. Hence it is the comprehensive system and not the type of physician that makes the difference.
Abstract TP299: The Feasibility of the Aldrete-FAST Screening Tool to Detect Stroke in the Post Cardiac Catheterization Setting: FAST-PC Study
Authors: Johansen Michelle C , Worrall Bradford B , Southerland Andrew M , Hodges Matthew A , Ragosta Michael , Solenski Nina J
Published: March 2022

Introduction:
Peri-procedural cardiac catheterization related stroke (CRS) remains a feared complication. Risk estimates reach 7% but vary widely by institution and operator experience. Given the volume (>2 million/yr in US), the impact of CRS is substantial. Evidence-based data on diagnosis/treatment are lacking for these patients despite being ideal targets for acute stroke treatment. Many CRS go undetected due to a lack of a standardized assessment tool.

Hypothesis:
A novel screening tool will be feasible to perform and effective in standardizing rapid diagnosis of CRS.

Methods:
Two validated tools form the basis of this screen 1) Aldrete score: 10-pt scale used in anesthesia cases to assess activity, respiration, circulation, consciousness and color 2)FAST screen designed to reliably diagnose stroke in < 1 min: Facial droop, Arm weakness, Speech changes, Time. Patients are assessed pre/post procedure and catheterization sheath left in place until protocol completion to allow for CRS IA therapy. Feasibility criteria: Excellent if ≥80%; moderate if ≥50% had successful completion. Uni/multivariable logistic regression analysis assessed interaction with age, sedation & sheath location.

Results:
906 patients were enrolled over 7 months. Mean age was 64.9±13.6; 65% male. 727 cases completed 100% of Aldrete-FAST (80.2%, 95% CI: 77.5% - 82.8%). High dose Midazolam (>2mg) was associated with completion of Aldrete-FAST (P<0.001, OR 3.14 CI:1.79-5.52) while Fentanyl (100-200mcg) was a deterrent (P 0.027, OR 0.45 CI: 0.22-0.91). Fentanyl >200mcg had no association (30 patients). 748 maintained the sheath (88.0%, 95%CI: 85.6%-90.1%). There was no association between age, sex or access site location (femoral, radial or both) on outcomes.

Conclusions:
This single-center prospective study demonstrates that the Aldrete-FAST score is a simple, safe screening tool with excellent feasibility to evaluate for CRS. No association between age, sex or access site implies generalizability. We found an interaction with sedation as midazolam and fentanyl had an inverse relationship regarding successful completion of the score. Further study is warranted to determine the optimal anesthesia for high risk patients undergoing cardiac catheterization.
Abstract TP3: Endovascular Treatment for Acute Stroke and Weekend/off Hour Effect: Does it Really Exist ?
Authors: Khandelwal Priyank
Published: March 2022

Introduction:
Faster door to puncture times has been of the most important variables in recent success of endovascular treatment (EVT) trials. However it’s still unclear whether the door to puncture times would be impacted if patients presents at off hours/ weekends. We conducted retrospective analysis of all stroke patients going for EVT at our institution, to look for effect of weekend/off hour’s on door to puncture times.

Methods:
We collected demographics and time variables for EVT on sequential patients with AIS from 1/ 2008 to 2/2015. Patients were grouped according to time of presentation: daytime weekday (DT) hours vs. nighttime weekday (NT) hours vs. weekend (WE) hours. The baseline demographics, time of last known well to groin puncture (LKTP), door to groin puncture (DTP), and initial imaging to endovascular suite (ITS) were compared between these groups.

Results:
We analyzed 237 consecutive AIS patients who underwent EVT at our institution out of which 94/237 (40%) were transfers.

Direct Admits:
Compared to DT presentations, WE (180 vs. 200 min, p
=
0.2801) and NT had longer DTP times (180 vs. 210.5, p= 0.0156).

Transfers:
Compared to those presenting in DT, those presenting at NT had significantly longer LKTP time (348 vs. 417.5, p= 0.0083), DTP time (107 vs. 128, p= 0.0376), and ITS time (54.5 vs. 76.5, p= 0.0024). Compared with DT presentations, those presenting on WE had significantly longer DTP time (107 vs. 145, p= 0.0029) and ITS time (54.5 vs. 90, p= 0.00118).

Conclusions:
Our data show that patients presenting directly to our emergency room at NT had longer DTP times. In addition, our data revealed transfer patients had time delays across all time variables when presenting at NT and for DTP and ITS when presenting on WE. This data suggests that NT and WE presentations face unique challenges for rapid EVT.
Abstract TP317: Enteral Tube Feeding in Acute Ischemic Stroke Patients: a Multivariate Predictive Analysis
Authors: Medeiros Lais M , Honorato Maíra M , Oliveira Luiz Fernando R , Rocha Maria Sheila G
Published: March 2022

Introduction:
Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia. In the acute phase of stroke, the frequency of dysphagia is greater than 50%. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient.

Hypothesis:
The aim of this study was to identify predictive clinical factors associated with enteral tube feeding in acute ischemic stroke patients.

Methods:
The medical records of 326 acute ischemic stroke patients from our prospective stroke database were reviewed. Clinical factors as age, sex, comorbidities, blood pressure, glycemia, National Institutes of Health Stroke Scale (NIHSS) score and subscores, Glasgow Come Scale (GCS), previous Rankin, Alberta Stroke Program Early CT score (ASPECTS) and localization of acute stroke were analyzed. Logistic regression was used to develop a risk score by weighting predictors of enteral tube feeding placement based on strength of association.

Results:
Of the 326 patients, 84 used enteral feeding tubes (25.8%). The mean age (70.2 years - SD 13.1), mean GCS (12.7 - SD 2.1), mean NIHSS (12.6 - SD 5.6), and Aspect score (8.8 - SD 1.8) were significantly higher in the tube group. Logistic regression showed that only age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.6. P=0,025), NIHSS score (OR, 1.15; 95% CI, 1.05-1.25, P= 0,001) and NIHSS 10 (dysarthria) subscore (OR, 2.2; 95% CI, 1.2-4.05, P=0,011) were independent predictors of enteral tube feeding. A 3-item risk score was developed based on the regression model in order to identify those patients needing enteral feeding. A score ≥ 4 predicted tube feeding in 75% of cases.

Conclusions:
In conclusion, combining information about age, NIHSS, NIHSS 10 subscore, may be a useful predictor tool for clinical decision for enteral tube feeding in acute ischemic stroke patients.
Abstract TP323: The Relationships Among Hospital Volume, Processes of Care and Patient Outcome in Ischemic Stroke: J-ASPECT Study
Authors: Kamitani Satoru , Nishimura Kunihiro , Kada Akiko , Sayama Tetsurou , Nishimura Ataru , Kurogi Ryouta , Nakamura Fumiaki , Onozuka Daisuke , Ogasawara Kuniaki , Shiokawa Yoshiaki , Miyachi Shigeru , Yoshimura Shinichi , Toyoda Kazunori , Nakagawara Jyouji , Matsuda Shinya , Okuchi Kazuo , Aruga Toru , Ono Junichi , Nagata Izumi , Miyamoto Yoshihiro , Iwata Michiaki , Hagihara Akihito , Suzuki Akifumi , Kataoka Hiroharu , Ishikawa Koichi B , Iihara Koji
Published: March 2022

Introduction:
Higher hospital volumes have been related to better outcomes in previous researches. However, the mechanisms of the volume-outcome relationships in stroke have not been sufficiently figured out. The aim of this study is to uncover the roles of processes in acute phase stroke care among the volume-outcome relationships.

Hypothesis:
Processes of care mediate the volume-outcome relationships in stroke patients.

Methods:
We analyzed 45,598 acute ischemic stroke patients in 267 certified training hospitals in Japan. Data between April 1,2011 and May 31, 2012 was obtained from Japanese Diagnosis Procedure Combination Database. We divided annual hospital case volumes into two groups: high-volume and low-volume. Main outcome was 30-day mortality. We set following process of care as mediators: early initiation of aspirin prescription (less than 24 hours) and early initiation of stroke rehabilitation (less than 3 days). Multilevel mediation models were performed adjusting for age, gender, comorbidities, Charlson comorbidity index to examine the relationships among hospital volume, processes of care and outcome.

Results:
The early initiation of aspirin increased from 19.4% to 24.1%, the early initiation of rehabilitations increased from 59.6% to 65.6% and 30-day mortality decreased from 6.1% to 4.2%, for low-volume and high-volume hospitals. In the multilevel logistic regression analyses, admission to high-volume hospitals had 38% increased odds (OR = 1.38; 95% CI, 1.02-1.88) and 118% increased odds (OR = 2.18; 95% CI, 1.59-2.98) of early aspirin and rehabilitation initiation, compared with low-volume hospitals. Before adjusting for processes of care, admissions to high-volume hospitals had 30% decreased odds of death compared with admission to low-volume hospitals (OR = 0.70; 95% CI, 0.61-0.81). When processes of care were further adjusted, the volume-mortality relationship became non-significant. The early initiation of aspirin and rehabilitation accounted for 71% of the relationship (the regression coefficient was reduced from -0.355 to -0.102 when adjusted for processes of care).

Conclusions:
Processes of care mediated the volume-outcome relationships in stroke patients.
Abstract TP325: Impact of Nocturnal Desaturation on Early Neurological Deterioration Following Ischemic Stroke
Authors: Kim Tae Jung , Kim Chi Kyung , Kim Yerim , Jeong Han-Gil , Nam Kiwoong , An Sang Joon , Ko Sang-Bae , Yoon Byung-Woo
Published: March 2022

Introduction:
The mechanisms of early neurological deterioration (END) in patients with acute stroke remain unclear. Despite that systemic hypoxia is associated with stroke risk and poor outcome following acute stroke, the association between nocturnal desaturation and END remains to be elucidated

Hypothesis:
We assessed the relationship between nocturnal oxygen desaturation in the stroke unit and END in patients with acute stroke.

Methods:
A consecutive 225 patients with acute ischemic stroke who were admitted to the stroke unit within 7 days after stroke onset between July 2013 and June 2014 were included for analysis Physiological variables including pulse oximetry were sampled every 1 minute. The ODI was calculated using pulse oximetry data during 9 hours on the first night (10:00 PM-7:00 AM) of the stroke unit admission and nocturnal oxygen desaturation was defined as an ODI of 5 or greater per hour. We compared the clinical characteristics, nocturnal oxygen desaturation, laboratory findings, and radiologic findings in patients with and without END.

Results:
Among the total patients, 52.4 % were male, with a mean age of 66.8 years. Twenty patients experienced early neurological worsening after stroke onset. The proportion of patients with nocturnal desaturation was significantly greater in the group of patients who also showed END (40.0% vs. 9.8%, P < 0.001). Moreover, more patients with END showed poor outcomes at 3 months (65.0% vs. 28.8%, P = 0.001). The stroke lesion locations did not significantly differ between the two groups. After controlling for relevant confounding factors, we found that nocturnal oxygen desaturation was associated with a risk of END (Odds ratio, 5.81; 95% confidence interval, 1.57-21.51).

Conclusions:
In conclusion, our study found that recurrent nocturnal desaturation in the stroke unit was associated with END in patients with acute stroke. In this context, our data could suggest that intensive monitoring of nocturnal desaturation in the stroke unit could be an important factor in preventing the risk of END and poor outcomes following acute stroke. .
Abstract TP34: TNF Alpha is Detected in Clots Extracted From Neurointerventions in Patients With Acute Ischemic Stroke
Authors: Sengupta Amitabha , Kirmani Jawad , Korya Daniel , Mehta Siddhart , Moussavi Mohammad , Previtera Michelle
Published: March 2022

Introduction:
Cytokine profiles of peripheral blood and cerebrospinal fluid (CSF) are used to predict stroke outcomes. Yet, the cytokine profiles of some patients do not match the predicted outcomes.

Hypothesis:
We hypothesize that peripheral blood is not an accurate resource for cytokine profiling because the supply of cytokines in the blood and CSF is unknown. Specifically, we postulate that cytokine profiling from a resource that is local to the stroke site is a more accurate method for predicting stroke outcomes. In this study, we collected thrombi from thrombectomy procedures performed on stroke patients who presented to our university affiliated comprehensive stroke center and examined the presence of TNF-alpha.

Methods:
This study was approved by the IRB at our university affiliated comprehensive stroke center. All samples were collected with the consent of the donor. Thrombi were collected from stroke patients that underwent thrombectomies at our university affiliated comprehensive stroke center. Thrombi were placed in a lysis buffer containing protease inhibitors. Thrombi were stored at 4C in the neurointerventional lab for a maximum of 12 hrs. Thrombi were then frozen at -80C for long-term preservation. For controls, blood was collected from healthy volunteers. Blood was allowed to coagulate for 30 mins at room temperature to form a clot. The formed clot was then put in lysis buffer for 1 hr. Thrombi lysis from patients and healthy volunteers were subjected to Western bloting.

Results:
A total of 10 patients participated, clots were extracted within 8 hours of stroke onset in all. Ten healthy volunteers served as controls. Western Blot showed that TNF-alpha is detected in clots extracted from stroke patients that underwent thrombectomies, but not in clots formulated from healthy volunteers.

Conclusion:
Our results show that it is feasible to extract thrombi for cytokine profiling. TNF-alpha was elevated in thrombectomy-extracted clots and TNF-alpha was not detected in healthy volunteers. Our results suggest that proinflammatory cytokines are within the stroke area and our method is a feasible method for cytokine detection. In future studies, we will correlate cytokine quantity with NIHSS.
Abstract TP345: The Association Between Stress Hyperglycemia, Hemorrhagic Transformation (HT), and Functional Outcomes in Diabetics and Non-diabetics
Authors: Arora Kanika , Boehme Amelia , Albright Karen C , Gadpaille Alissa , Bavarsad Shahripour Reza , Lyerly Michael , Sands Kara , Sisson April , Shiue Harn , Khawaja Ayaz , Hays Shapshak Angela , Gropen Toby
Published: March 2022

Introduction:
Nearly 40% of stroke patients present with hyperglycemia, yet little is known about the mechanism by which hyperglycemia affects hemorrhagic transformation (HT) and functional outcome in diabetics as compared to non-diabetics.

Methods:
We performed a retrospective review of consecutive ischemic stroke patients presenting to our comprehensive stroke center (CSC) from March 2014 to April 2015. Demographic, clinical, and neuroimaging data were collected. Patients were divided into four groups: (1) no type II diabetes (DM) with glucose on admission <180 [reference group], (2) No DM with glucose >180, (3) DM with glucose <180, and (4) DM with glucose >180. Hemorrhagic transformation (HT) and poor functional outcome at discharge, as measured by modified Rankin scale (mRS) score 3-6, were compared amongst groups.

Results:
A total of 773 consecutive patients were admitted during the 14-month period (mean age 64, 49.3% women, and 36.6% Black). When compared to the reference group (n=467), patients without DM, but with glucose >180 (n=50) had higher odds of developing HT (OR 10.6, 95%CI 5.47-20.4, p<0.0001). This association persisted even after adjusting for age, stroke severity, IV tPA use, and endovascular therapy (NIHSS, OR 3.65, 95%CI 1.34-9.97, p=0.011). When compared to the reference group (n=467), patients with DM and glucose >180 (n=104) had higher odds of poor functional outcome even after adjusting for age, stroke severity, IV tPA use, and endovascular therapy (NIHSS, OR 1.88, CI 1.04-3.42, p=0.037).

Conclusions:
We observed that hyperglycemia on admission was associated with HT in non-diabetics and associated with poor functional outcome in diabetics. Reasons that diabetics with hyperglycemia do not experience HT remain unclear. A better understanding of the pathophysiology of acute hyperglycemia in patients with and without DM is needed in order to minimize the risk of HT and its adverse effects.
Abstract TP350: Determinants of Symptomatic Intracerebral Hemorrhage in Ischemic Stroke Patients After Endovascular Therapy
Authors: Bennett Alicia , de Havenon Adam , Wilder Michael , Sultan-Quarraie Ali , Ansari Safdar
Published: March 2022

Introduction:
Hemorrhagic transformation is a serious complication after endovascular therapy for acute ischemic stroke (AIS). Compared to the number of patients who have hemorrhage on follow-up neuroimaging, a fraction of patients develop symptoms related to the hemorrhage.

Hypothesis:
We sought to identify risk factors for developing symptomatic intracerebral hemorrhage (sICH) following endovascular therapy for AIS, as opposed to hemorrhage incidentally discovered on neuroimaging.

Methods:
We retrospectively reviewed AIS patients from 2005 to 2013 treated with endovascular therapy and identified those with any intracranial hemorrhage on imaging obtained 24 hours after treatment. We identified univariate associations with sICH that had a p<0.2 and fitted a multivariable logistic regression to the outcome of sICH.

Results:
Sixty-five patients had intracranial hemorrhage on imaging, 58% male, mean age 65 ± 13 years, mean admission NIHSS 17 ± 8, and 22/65 (34%) had sICH. In the univariate analysis, post-procedural TICI score, SBP standard deviation (SD) in the first 24 hours, and procedure length achieved significance, but only TICI score and SBP SD retained significance in the multivariable model (Table 1). Several univariates that were presumed to impact sICH proved uninformative (Table 2).

Conclusions:
In AIS patients who undergo endovascular treatment and have subsequent intracranial hemorrhage, recanalization status and SBP variability are associated with sICH. The later association is novel and warrants further investigation.
Abstract TP360: Clot Evacuation With or Without Decompressive Craniectomy for Spontaneous Supratentorial Intracerebral Hemorrhage: A Single Center, Prospective, Randomized, Controlled Trial
Authors: Hu Rong , Feng Hua
Published: March 2022

Introduction:
The optimum management for patients with spontaneous intracerebral hemorrhage (ICH) has not been well established. Decompressive craniectomy (DC) is a surgical procedure to relieve malignant elevation of intracranial pressure, which has been shown to be effective for patients with traumatic brain injury or malignant middle cerebral artery infarction. Some studies suggest that DC following surgical clot evacuation help relieve intracranial pressure and benefit the patients suffered ICH, especially with big hematoma. However some studies indicate that DC may not be essential after the hematoma is surgically evacuated, which induces long hospital stay and a second surgery for cranioplasty.

Hypothesis:
To compare the effect of clot evacuation with DC or without DC (non-DC) on the outcome of patients with spontaneous supratentorial intracerebral hemorrhage (ICH).

Methods:
89 consecutive spontaneous supratentorial ICH patients were randomized into DC or non-DC groups. We compared hematoma volume, operative duration, operation bleeding volume, the intracranial pressure fluctuation, mRS after 3 months, and postoperative complications. Statistical analysis was done using the t-test or Chi-square test, and the odds ratio was calculated.

Results:
Mean hematoma volume was 51.4±17.5 mL in DC group and 49. 8±14.6 mL in non-DC group. Clot clearance rate was 94.2±4.6% in DC group and 92.6±3.9% in non-DC group. Mean operation duration and bleeding volume in DC group were more than that in Non-DC group. After 3 months, the outcome of DC group was worse than that in non-DC group. Finally, intracranial pressure monitoring showed that intracranial pressure within five days after surgery fluctuated within 8.9∼16.1 mmHg in DC group and within 9.5∼18.9 mmHg in non-DC group (no significant difference).

Conclusions:
It is not necessary to do decompressive craniectomy in patients with supratentorial ICH when surgically performing hematoma evacuation.
Abstract TP364: Use of Do Not Attempt Resuscitation (DNAR) Forms Early in Haemorrahgic Stroke: Data From the Ongoing Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH-2) Study
Authors: Sprigg Nikola , Robson Katie , Bath Philip M
Published: March 2022

Introduction:
International guidelines recommend the avoidance of DNAR in the first few days after haemorrhagic stroke.

Methods:
The ongoing TICH-2 records, at days 2 and 7, whether the participant has a DNAR order. Baseline characteristics and outcomes were compared between those that had a DNAR and those that did not. Outcomes included; early death (died on or before day 7), day 90 modified Rankin Scale (mRS), Barthel index (BI), cognition and Euroqol-5D.

Results:
Of the 926 participants in TICH-2 who reached day 90, 156 (16.8%) participants had a DNAR at day 2 increasing to 194 (21.0%) at day 7; giving a total of 210 (22.7%) people having a DNAR. The patients with a DNAR were found to be older (79 versus 67), more likely to be female (56.2% versus 41.1%) and their average baseline severity (National Institutes of Health Stroke Scale, NIHSS) was worse (19 versus 10). There were 96 early deaths, 92 (95.8%) had a DNAR. Only 4 people without a DNAR died early. Early death, day 90 mRS, BI and Euroqol-5D were significantly worse for the people who had a DNAR (all p-values <0.0001). Cognition (p=0.0321) was also significant. All deaths by day 90 were analysed using a Cox proportional hazards model, giving a hazard ratio of 10.8 (7.2, 16.2), with p<0.0001. All models were adjusted for age, NIHSS and mRS at baseline.

Conclusion:
Use of DNAR early after intracerebral haemorrhage is common and an independent predictor of death and poor outcome, although use of early DNAR in some patients maybe appropriate.
Abstract TP368: Prediction of Hemorrhagic Growth Using Textural Pattern Analysis
Authors: Gray Katherine , Wolz Robin , Royle Natalie , Werring David , Xie Zhiyong , Tuthill Theresa
Published: March 2022

Introduction:
The subjective characterization of non-contrast CT “swirl sign” along with hematoma volume have been used to predict intracerebral hemorrhage (ICH) growth. As early assessment of patients with acute stroke symptoms can be used to optimize treatment, a more robust, quantitative biomarker set could improve patient care.

Hypothesis:
Quantification of ICH lesion texture from CT scans taken at less than 3 hours from onset could be used to predict hemorrhagic growth at 24 hours.

Methods:
Baseline and 24-hour CT scans on 71 ICH stroke subjects were obtained from the Virtual International Stroke Trials Archive (VISTA). Semi-automated segmentation of ICH was used to determine lesion volume. Based on treatment effects seen with hemostatic agents, a 6mL absolute increase was initially selected for the growth threshold. First order statistics of CT pixel values within the lesions along with spatial parameters extracted from grey-level co-occurrence matrices (GLCM) were computed, as well as baseline lesion volume, location (deep/lobar), number of connected components, and information about intraventricular hemorrhage. Linear support vector machines were used for classification with 10-fold cross-validation.

Results:
By the 24-hour scan, 19 subjects showed ICH growth and 52 were stable. In predicting growth based on the initial CT scan, the coefficient of variation and GLCM contrast had the highest sensitivities for discrimination. A combination of textural features provided a classification accuracy of 68% (sensitivity 65%, specificity 68%). Results for classifying “any growth” were comparable.

Conclusions:
Patterns noted in standard-of-care CT are indicative of an increased risk of hematoma expansion. Imaging biomarkers based on texture analysis can be used to classify patients and may aid in understanding mechanisms of ICH enlargement and acute treatment selection.
Abstract TP375: Vitamin D Deficiency Correlates With Stroke Severity on Presentation in Intracerebral Hemorrhage
Authors: Bakradze Ekaterina , McCullough Louise D , Staff Ilene , Nouh Amre
Published: March 2022

Introduction:
Vitamin D, a neurosteroid present in cerebrospinal fluid and metabolized by brain tissue regulates calcium signaling and scavenging of reactive oxygen species, which play a role in acute cell injury after ischemic stroke and intracerebral hemorrhage (ICH). Low vitamin D (measured as 25(OH)D), has been found to increase the risk of ischemic stroke, predict severity and poor functional outcome. No studies investigating impact of vitamin D level on ICH stroke severity exist.

Hypothesis:
We hypothesize that low 25(OH)D levels are associated with higher stroke severity of ICH on admission and poorer functional outcome.

Methods:
A single-center retrospective chart review between February 2012 and September 2014 was performed. A total of 109 patients with primary ICH and 25(OH)D levels on admission were identified. Serum 25(OH)D levels were dichotomized at <30 ng/ml as Vitamin D deficient and <10 ng/ml as severely deficient. Dichotomized 25(OH)D groups were compared for continuous outcome variables using non-parametric Wilcoxon rank-sum test. Severity measures including dichotomized NIHSS (>20 or <20) and dichotomized Glasgow coma scale (GCS of 3-5, 6-15) were compared to vitamin D groups using Pearson Chi-square test of proportion.

Results:
NIHSS on admission was higher in patients with severe vitamin D deficiency (p=0.016) with the odds ratio of having an NIHSS of >20 on admission 5.9 (95% CI --1.4-25.5). Patients with severe deficiency were far more likely to have very low GCS (3-5) (p=0.022; OR=8.8; 95% CI 1.7 - 45.5). Vitamin D deficiency was associated with lower pre-albumin level and older age (p=0.021 and 0.018, respectively). No statistical significance between 25(OH)D level and ICH score, ICH volume, location, presence of intraventricular hemorrhage, length of stay, mortality, disposition or pre-stroke and discharge modified Rankin Scale was found.

Conclusions:
ICH patients with severe vitamin D deficiency had significantly worse stroke severity. Patients with older age and malnutrition are at higher risk for severe clinical presentation of ICH. Larger scale studies identifying increased risk of morbidity and mortality from ICH in vitamin D deficient patients are needed.
Abstract TP386: Clinical Nurse Specialist Influence on the Implementation of Telestroke in a Community Hospital
Authors: Nozicka Nancy , Barnard Amy , Meller Laura A
Published: March 2022

Background
In 2013, a telestroke program was initiated within our hospital system. The Clinical Nurse Specialist (CNS) led the interprofessional team to implement the telestroke program at the spoke facility. Prior to implementation the hospital never successfully gave tPA in less than 60 minutes.

Purpose:
Implement telestroke into existing processes to ensure early access to neurological consultation and improve D2N time for eligible patients.

Methods
The CNS used the National Association of Clinical Nurse Specialist’s core competencies to help guide the implementation of telestroke. Collaboration: established shared vision and goals between the hub and spoke to identify and optimize outcomes. Collegiality: identified and engaged key stakeholders. System leadership: managed interdisciplinary workflow, empowered others to influence clinical practice. Evaluation of clinical practice: defined key goals and metrics, monitored data, provided feedback to clinicians and disseminated performance metrics. Consultation: local expert on existing processes, provided data analysis and quality monitoring to assess effectiveness of the program. Research: identified best practices, used evidence to drive process changes. Ethical decision making: provided clinician education to ensure competence with new equipment and processes while maintaining a patient centered approach. Coaching/direct patient care: provided bedside assistance to clinicians.

Results
Visibility of CNS influence on the redesign of the stroke patient care delivery process is evident in the following outcomes: time to activation of neurology consult reduced by 20 minutes, since implementation tPA given in < 60 min 68% of the time.

Conclusions
The CNS utilized core competencies to successfully implement telestroke. The redesign of this care delivery process required the CNS to influence the care for complex stroke patients, empower clinical staff to change practice and create a system wide approach to care of stroke patients. As a result, patient outcomes improved, demonstrating CNS impact on the safety, efficiency, reliability and quality of care for these complex patients.
Abstract TP389: Improving 30 Day Event Monitoring Compliance for Patients Transferred to Acute and Subacute Rehabilitation Facilities
Authors: Turner Heather , Currie Lillian
Published: March 2022

Background and Issues:
Current AHA guidelines recommend prolonged cardiac monitoring in patients with cryptogenic stroke. Studies show that the more hours a patient is monitored, the more likely it is a-fib will be detected. At our institution, standard post-discharge monitoring in cryptogenic stroke patients is usually done with a 30 day cardiac event monitor that is managed by the patient and/or their caregiver. For patients discharged to acute inpatient rehabilitation (AIR) or skilled nursing (SNF) facilities it was often assumed that the facility would take responsibility for managing the monitor. However, these facilities had little to no educating regarding the maintenance of event monitors so this assumption frequently resulted in incomplete studies and even lost monitors.

Purpose:
The goal was to improve 30 day event monitoring compliance in patient discharged to AIR and SNF facilities.

Methods:
Our improvement process was twofold. 1. We developed a standardized method of ordering 30d event monitors that requires the ordering MD to identify a caregiver to receive education and be responsible for supporting the maintenance of the 30d event monitors for patients who cannot fully maintain the monitor themselves regardless of patient disposition. If a patient is discharged to AIR or SNF their caregiver will be a champion for monitor compliance, helping educate the facility and confirming that standard maintenance and documentation is occurring. 2. For the receiving facilities, we condensed the 30 page event monitor handbook into a single handout summarizing the basics regarding the daily replacement of electrodes and batteries, charging the monitor, recording symptoms and completing ADLs.

Results:
In the seven months prior to project implementation, 6/15 (40%) patients discharged to AIR or SNF were monitored for <240h (10d worth of data), mean monitoring time= 395h. In the seven months after project implementation, 100% of patients (10/10) were monitored for >240h, mean monitoring time= 535h, a 35% increase.

Conclusion:
Identifying an invested caregiver and providing even limited education to receiving facilities can significantly increase 30d event monitor compliance in stroke patients discharged to AIR or SNF facilities.
Abstract TP401: Can Leveraging the Electronic Medical Record Improve Compliance With Dysphagia Screening?
Authors: Helton Mary , Fisher Julie
Published: March 2022

Background and Issues:
Stroke is the leading cause of dysphagia with 42% to 67% of patients presenting with dysphagia within 3 days. Patients admitted to Fisher-Titus Medical Center with stroke-like symptoms were often missed for dysphagia screening or given oral medication prior to a screening. After investigation, it was discovered that the screening process and the electronic medical record (EMR) were too lengthy, hard to remember to complete, and not mandatory fields. The purpose of this initiative was to leverage the EMR to improve staff compliance rates to Healthcare Facilities Accreditation Program (HFAP) stroke accreditation standards of dysphagia screening for TIA and ischemic stroke patients.

Methods:
A multidisciplinary team was formed to analyze factors contributing to missed dysphagia screenings. The team then modified the EMR to make it more lean and effective. Changes to the EMR included: addition of a mandatory “Risk Factors for Stroke” check box targeting vague stroke symptoms; auto-population of the dysphagia screen form when a “risk factor” was selected; and implementation of a rapid screen format. Dysphagia screening rates were monitored over 16 quarters.

Results:
The purpose of the initiative to improve the EMR, streamline the screening process, and increase staff compliance rates of dysphagia screening to HFAP standard of >85%. This goal was met. Prior to the changes in the EMR, compliance rates in 2011 were inconsistent and significantly below threshold. The multidisciplinary team was formed in Q1 2012, began changes in the EMR Q3 2012, and concluded changes in Q1 2014. Since conclusion of EMR revisions the threshold has been consistently exceeded.

Conclusions:
Our data suggests that optimizing the use and functionality of EMR formats improve compliance rates of dysphagia screenings. In our sample, after completion of EMR changes compliance rate averaged 96%. Other institutions who wish to improve compliance rates of dysphagia screenings (and potentially other clinical standards) should consider evaluating their current EMR format, delineating its strengths/weaknesses by interviewing team members, and revising to optimize compliance.