bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WMP43: Health Care Disparities In Reperfusion Therapy For Patients With Acute Ischemic Stroke Across Hospitals
Authors: Park Jong-moo , Park Hong-kyun , Kim Seong-eun , Cho Yong-jin , Kim Jun Yup , Kim Beom Joon , Park Kwang-yeol , Lee Kyung Bok , Lee Soo Joo , Lee Ji Sung , LEE JUNEYOUNG , Bae Hee-Joon
Published: February 2023

Background:
Medical care disparities are wide, and stroke in no exception. Reperfusion therapy is the standard treatment for acute ischemic stroke, but its use may vary across hospitals.

Methods:
Data from 75,870 patients admitted to 247 acute stroke hospitals nationwide were obtained through the 2013-2018 acute stroke quality evaluation program conducted by the Health Insurance Review and Assessment Service. The primary outcome was the hospital reperfusion therapy rate (RTR), defined as the proportion of intravenous tissue plasminogen activator (IVT) and/or endovascular thrombectomy (EVT) cases in patients potentially eligible for reperfusion therapy (onset-to-arrival time ≤ 6 hours and initial NIHSS score ≥ 4). Hospital RTRs, adjusted for age, sex, onset-to-arrival time, and initial stroke severity, were analyzed with hospital characteristics.

Results:
During the study period, 10,513 stroke patients were potentially eligible for reperfusion treatment and were admitted to 247 acute care hospitals. The RTR of the study population was 52.9%. The mean hospital RTR was 34.8% [median (IQR) 37.5% (9.8 - 56.2)]. A higher number of beds and average monthly stroke admissions were associated with a higher hospital RTR. Multivariable analysis revealed the average stroke admission per month, presence of stroke unit, the average IVT per month, and the average EVT per month were the independent determinants for hospital RTR. Hospital RTR was inversely correlated with 1-year mortality regardless of hospital stroke volume.

Conclusions:
RTRs vary widely across hospitals. The higher the hospital stroke volume, the higher the hospital RTRs. High hospital RTRs correlates with low 1-year mortality regardless of hospital stroke volume.
Abstract WMP48: The Credibility Of Subgroup Analyses Reporting In Stroke Trials Is Poor: A Methodological Review.
Authors: Ademola Ayoola , Thabane Lehana , Adekanye Joel , Babatunde Samuel , Almekhlafi Mohammed , Menon Bijoy , Hill Michael D , Hildebrand Kevin , Sajobi Tolulope
Published: February 2023

Background:
Subgroup analyses are widely used to evaluate heterogeneity of treatment effects in randomized clinical trials. However, there is a limited investigation of the quality of prespecified and reported subgroup analyses in stroke trials. This study evaluated the credibility of subgroup analyses in stroke trials.

Methods and Analysis:
We searched Medline/PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from inception to March 24
th
, 2021. Three reviewers screened, extracted, and analyzed the data from the publications. Primary publications of stroke trials that reported at least one subgroup effect and had published corresponding study protocols were included. The Instrument for Assessing the Credibility of Effect Modification Analyses (ICEMAN) was used to examine the quality of the subgroup effects reported. The risk of bias was assessed using the Cochrane Risk-of-Bias tool for randomized trials version 2.

Results:
Seventy-four articles met the inclusion criteria and altogether reported 647 subgroup effects. The median sample size was 1264 (interquartile range (IQR): 380 - 3876) while the median number of subgroups prespecified in the protocol was 6 (IQR:2 - 10), and 61 studies (82.4%) used the univariate test of interaction. One hundred and thirty-nine subgroup effects (43.6%) in acute stroke treatment and 131 subgroup effects (35.03%) in studies published in 2015 or later had moderate credibility. Overall, 458 subgroup effects (70.8%) had low credibility, while 189 subgroup effects (29.2%) had moderate credibility.

Conclusion:
Subgroup analysis reporting quality in stroke trials remains poor. Trialists and medical journal publishers must ensure that reporting guidelines, such as ICEMAN, are adopted to improve the credibility of reported subgroup analyses in stroke trials.
Abstract WMP5: How Do Clinical Trial Exclusion Criteria Impact The Inclusivity Of Clinical Trials?
Authors: Kleindorfer Dawn O , Stanton Robert J , Sucharew Heidi , Broderick Joseph P , Khatri Pooja , Haverbusch Mary , Herbers Logan , Alwell Kathleen , Robinson David , ferioli simona , Flaherty Matthew L , Woo Daniel , Demel Stacie , De Los Rios La Rosa Felipe , Mackey Jason , Mistry Eva , Jasne Adam , Slavin Sabreena , MARTINI SHARYL , Walsh Kyle , Adeoye Opeolu M , Star Michael , Kissela Brett M
Published: February 2023

Intro:
Enrolling women and under-represented minorities into clinical trials is a top priority for the stroke community. Common trial exclusions for medical conditions or demographics may negatively impact enrollment for these groups. We sought to describe the potential impact that various exclusion criteria have on trial eligibility of ischemic stroke (IS) patients by race and sex within the large, biracial Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) population.

Methods:
The GCNKSS is a population-based study of 1.3 million people living in a 5-county area of southern Ohio/ Northern Kentucky. During 7/1/14-12/31/15 for blacks, and 2015 for whites, we captured all hospitalized ischemic strokes by screening ICD-9 codes 430-436 and ICD10 codes I60-I68, and G45-46. Commonly used exclusion criteria from stroke clinical trials were applied to the GCNKSS IS population, and were compared by sex and race. All comparisons were evaluated with chi-square test and corrected for multiple comparisons, as necessary.

Results:
In 2014-2015, there were 2806 ischemic stroke patients, which were 53% female, and 30% black. Table 1 presents common clinical trial exclusion criteria and the % excluded among IS patients, stratified by sex and race. Every trial exclusion evaluated had significant differences by sex, race, or both.

Discussion:
Within our population, we found that commonly-used age and disability clinical trial exclusion criteria exclude more women than men, and exclusion of milder strokes affects more men than women. Blood pressure, renal function, and early arrival time criteria exclude more blacks than whites, while older age exclude more whites than blacks. Optimal clinical trial design should be informed by epidemiology data to ensure representation of underrepresented populations in clinical trials. We will continue to provide epidemiology feedback on acute trial exclusion criteria to NIH StrokeNet proposals in the future.
Abstract WMP51: Baseline Ct Perfusion Parameters Differ In Large Vessel Occlusion Stroke Patients With Reduced Left Ventricular Ejection Fraction
Authors: McCullough-Hicks Margy E , Christensen Soren , Mlynash Michael , Heit Jeremy J , Albers Gregory W , Lansberg Maarten G
Published: February 2023

Introduction:
Reduced left ventricular ejection fraction (EF) is associated with worse outcomes after stroke. CT perfusion (CTP) is widely used in acute stroke evaluation; its reliability in patients with reduced EF is unknown. We hypothesized that patients with reduced EF would have abnormal dose-time curves that may impair standard perfusion maps and reduce their quality.

Methods:
A retrospective database of all patients presenting to Stanford University for large vessel occlusion (LVO) stroke between 2010-2019 was used. CTPs were post-processed using RAPID software. Concentration-time curve metrics—width of the venous output function (VOF) at half maximum amplitude and VOF peak amplitude—were assessed automatically for each case. A reader blinded to EF visually evaluated the VOF curve for evidence of truncation (yes/no) and graded the quality of the time to maximum (Tmax) map on a scale from 0 (excellent) to 3 (poor), based on the degree of “speckling” present on the map. Continuous parameters were compared using the t-test or Mann-Whitney test and dichotomous parameters with the Fisher’s exact or Chi-square test, where appropriate.

Results:
160 patients with sufficient quality baseline CTP and in-hospital echocardiogram were evaluated; 34 had EF <50%. Mean age, scan time, and cumulative contrast dose did not differ; men were more prevalent in the reduced EF group (68% vs 44%; p=0.016). Compared to patients with normal EF, patients with low EF more often had truncation of the VOF (11.8% vs 0.8%; p=0.007), had a lower VOF peak amplitude (mean 245.04 HU vs 299.07; p=0.013, 95% CI for difference 11.61 to 96.45), had wider VOF at half maximum amplitude (mean 17.84 seconds vs 14.56; p<0.0001, 1.9 to 4.65), and had worse Tmax quality (median 2 (IQR 1-3) vs 1 (0-2); p=0.002).

Conclusion:
Patients with reduced EF have dispersion of the contrast bolus as evidenced by a VOF curve that is wider and has a lower peak. Consequently, the quality of the Tmax map in patients with low EF is reduced, which may render automated CTP results unreliable. Additional studies are needed to determine to what extent poor CTP image quality in patients with low EF affects treatment decisions.
Abstract WMP53: Revascularization Improves Cerebrovascular Reserve In Moyamoya Patients
Authors: Zhao Moss , Duarte Armindo Rui Miguel , Moseley Michael E , Steinberg Gary , Zaharchuk Greg
Published: February 2023

Introduction:
Cerebrovascular reserve (CVR) reflects the change in cerebral blood flow (CBF) in response to a vasoactive stimulus and can be measured using a brain stress test whereby CBF is augmented using vasodilators. Studies have demonstrated that impaired CVR was associated with a higher risk of acute stroke and that bypass can reduce the risk of strokes. Arterial spin labeling is a quantitative MRI technique that enables non-invasive CBF and CVR measurement. Studies have shown the effectiveness of ASL in identifying CVR impairment in Moyamoya patients. Here, we compare the CBF and CVR of Moyamoya patients before and after bypass using single and multiple delay ASL techniques.

Methods:
MRI data were acquired from 24 Moyamoya patients (16-54 years, 3 males) using a 3T MRI system. All patients had unilateral or bilateral vessel occlusion at ACA, MCA and/or PCA. The scanning parameters of the single post-labeling delay pseudo-continuous ASL (single-PLD PCASL), delay pseudo-continuous ASL (multi-PLD PCASL, 5 PLDs) 2. ASL data were acquired simultaneously at baseline and 15 minutes after the injection of the vasodilator acetazolamide (15 mg/kg with a maximum 1 g). CBF was computed using the general kinetic model. CVR was computed as the percentage of CBF change compared with baseline CBF. Flow territories (right and left ACA, MCA, and PCA) were defined based on the Harvard-Oxford cortical and subcortical structural atlases. Mean CVR within the territories affected by occlusion and normal territories was computed for each subject. T-tests were performed to compare the mean CVR between the affected and unaffected territories.

Results:
For this cohort, our quantitative analysis revealed that CVR of the affected regions increased significantly by 12% and 21% measured by single and multiple delay PCASL respectively, implying improved CBF and lower risk for strokes.

Discussion:
ASL was effective to detect improved CBF and CVR in Moyamoya patients after bypass surgeries.
Abstract WMP6: Genetic Variation In KLF5 Is Associated With Initial Stress Glucose Ratio In Acute Ischemic Stroke
Authors: Heitsch Laura , Sun Yichen , Lee Jin-moo , Cruchaga Carlos , Ibanez Laura
Published: February 2023

Introduction:
Hyperglycemia has consistently been associated with worse outcome following an acute ischemic stroke (AIS). Recent studies have shown that a stress glucose ratio (SGR) may be a better predictor of critical illness than absolute hyperglycemia. An elevated initial stress glucose ratio (iSGR) was significantly associated with malignant cerebral edema and ICH after thrombectomy. We sought to identify genetic loci related to iSGR in a cohort of the GENISIS (Genetics of Early Neurological InStability after Ischemic Stroke) study.

Methods:
GENISIS is a multi-site international study that enrolled AIS patients within 6 hours of symptom onset. A sub-cohort with available initial glucose and HbA1c levels was selected. For all patients, Hg38 imputed genotypes were available. iSGR was calculated by dividing initial glucose by the estimated average glucose concentration (= 28.7 * A1c - 46.7) and normalized by log transformation for the GWAS. Association was adjusted by age, sex, baseline NIHSS, principal components and genotyping rounds. Samples were analyzed by country of origin and ethnicity using Plink2 and then meta-analyzed by ethnicity using METAL.

Results:
Three separate populations were identified (African-Americans n=299; European-Americans n=622; and Spanish n=625). Median age was 71 (IQR 60-80) with 46% female. Baseline NIHSS was 11 (IQR 5-16). A suggestive loci (chr13:rs9560146, p=9.88x10
-8
) was identified in the meta-analysis. Gene-based analyses suggested that the loci in chromosome 13 is driven by
KLF5
(p=0.002). In addition, rs9560146 is also associated with
KLF5
gene expression in brain (eQTL p=3.30x10
-3
; frontal cortex: Braineac).

Conclusions:
We demonstrated that a variant in
KLF5
may be associated with iSGR in a cohort of AIS patients.
KLF5
is induced under hypoxia conditions and interacts with HIF-1a to mediate glucose homeostasis. Recently, a pre-clinical study demonstrated that a micro RNA (miR-10b-3p) had neuroprotective effects against ischemia/reperfusion injury by targeting KLF5. Thus, investigating the genetic architecture of stress hyperglycemia may be informative and reveal variants, genes or pathways involved in ischemic brain injury. We plan to recruit a cohort for replication and sample size expansion.
Abstract WMP62: Stroke Severity Is The Primary Mediator Of Increased Stroke Mortality In The Elderly
Authors: de Havenon Adam , Bangad Aaron , Yaghi Shadi , Sharma Richa , Falcone Guido J , Sheth Kevin N
Published: February 2023

Background:
The risk of ischemic stroke mortality increases with age, but the impact of stroke severity on this relationship has not been fully examined.

Methods:
We included adults in the National Inpatient Sample from 2016-2019 who had a primary discharge diagnosis of ischemic stroke (I63*) and a baseline NIH Stroke Scale (NIHSS). The primary outcome was in-hospital death. The exposure of age had left skew, so we transformed it into deciles. We fit a logistic regression model adjusted for sex, race/ethnicity, diabetes, atrial fibrillation, hypertension, thrombolytic therapy, and endovascular therapy. We report the predicted probability of the primary outcome with and without NIHSS and use structural equation modeling (SEM) to estimate the proportion of age’s effect on the primary outcome that is mediated by stroke severity.

Results:
We included 138,637 individuals, of which 3.5% died in-hospital. The proportion of in-hospital death and an NIHSS violinplot by decile of age are seen in Figure 1, both of which had a positive linear relationship. The AUC of the multivariable model without NIHSS was 0.70 and with NIHSS was 0.86 (p<0.001). The predicted probability of death is seen without and with NIHSS in Figure 2, illustrating the importance of adjusting for NIHSS. In the SEM model, we observed that 57.7% of age’s effect on in-hospital death is mediated by stroke severity.

Conclusions:
We found that elderly individuals in the United States have more severe stroke and higher stroke mortality, but the effect of age on stroke mortality is primarily mediated by elderly individuals having more severe stroke. Additional research is needed to better understand this novel finding.
Abstract WMP66: Early Rising Pain Scores Predict Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage
Authors: Kardon Adam , Elmer Jonathan , Elsaesser Dina , Dickinson Kaitlyn , Podell Jamie , Jaffa Matthew N , Maciel Carolina , Jha Ruchira , Busl Katharina M , Morris Nicholas
Published: February 2023

Introduction:
Persistent pain following subarachnoid hemorrhage (SAH) is common and follows distinct trajectories. Cerebral vasospasm (CV) and delayed cerebral ischemia are late complications of SAH and may represent modifiable causes of secondary brain injury. Headache and CV share common risk factors including age, blood burden and cigarette smoking, however the relationship between pain and CV is unknown. We hypothesize that patients with increasing pain will be at increased risk for developing CV.

Methods:
We conducted a retrospective review of patients with non-traumatic SAH at two large academic medical centers from 2015-2022. Pain scores were recorded for 14 days. We excluded patients with onset of CV before post-bleed day (PBD) 4. We employed group-based trajectory modeling to identify distinct trajectories of 24 q2h pain scores during PBDs 2 and 3. Pain scores prior to PBD 2 were omitted due to the large amount of missing data. The incidence of CV was compared between trajectory groups using chi-squared analysis.

Results:
We identified 442 patients (median [IQR] age 56 [47-64] years, 294 (66%) women, 33 (7.4%) peri-mesencephalic, 330 (75%) Hunt-Hess 1-3, 393 (88%) modified Fisher 3-4) for analysis. We considered 3 through 8-group models and compared model fit by comparing AIC, BIC, and visual inspection of trajectories between models. Ultimately, a 4-group model fit the data best with four distinct trajectories of pain: persistently low (41% of patients), persistently high (24%), falling (18%) and rising (16%). Baseline clinical variables were comparable between trajectory groups. The median [IQR] day of CV onset was PBD 7 [5-10]. Patients with rising pain had significantly higher rates of vasospasm than those with persistently high or falling pain (54% vs 34% and 36%, respectively, Chi2 P = 0.02). Results were similar in a sensitivity analysis limited to patients with verbally reported pain scores.

Conclusion:
Distinct pain trajectories exist in the early hospital course following SAH. Our multicenter, retrospective cohort found that an initial rising pain trajectory is associated with development of CV. Future studies should validate this finding in separate cohorts and explore the pathophysiological mechanisms of this association.
Abstract WMP67: Cerebral Collateral Flow State Correlates With Stroke Severity And Functional Outcomes
Authors: Shah Smit , Pikel Karly , Thornton Kathryn , Peethambar Gowri , Kodumuri Nishanth , Lowe Forrest , Kothari Ravish A , Abdul Rahman Line , venkatesh yedatore s , Sen Souvik
Published: February 2023

Introduction:
Hypoperfusion index ratio (HIR) measured by computerized tomography perfusion (CTP) has been shown to predict collateral flow state in acute ischemic stroke (AIS). Low HIR (<0.4) is indicative of good collateral flow state.

Hypothesis:
Good collateral flow state correlates with lower stroke severity and better clinical outcome at discharge.

Methods:
Data from AIS patients who underwent CTP during initial stroke evaluation were linked with Get With the Guideline database in a comprehensive stroke center between 2018 and 2020. Patients with good collateral flow (HIR<0.4) were compared to those with poor collateral flow (≥0.4) group. They were stratified based on modified Rankin Score (mRS) at discharge into good outcome (mRS 0-2) or poor outcome (mRS 3-6). In addition to demographics, and risk factors data was collected on the initial stroke severity using the NIH stroke scale (NIHSS). Continuous variables were compared using t-test (parametric) and Mann-Whitney U test (non-parametric). Univariate and multivariable analyses (multiple logistic regression) were used to test the association between good collateral flow state and good discharge outcome.

Results:
CT perfusion data was obtained in 1442 patients, after excluding patients who underwent thrombectomy and all non-vascular etiologies of stroke like presentation, there was 890 patients (age 68±14, 52% male, 50% white, 50% black/others), of who 756 (85%) demonstrated good collateral flow and 134 (15%) showed poor collateral flow. Those with good collateral flow were younger (68±14 vs. 70±15, p=0.07) and lower median NIHSS (6 IQR 3-10 vs. 13 IQR 6-18, p<0.001). Good collateral flow was associated with good outcome on discharge (OR 2.2, 95% CI 1.5-3.3). The association remained significant after adjustment for age, gender, race, hypertension, diabetes, coronary artery disease, congestive heart failure and atrial fibrillation (adjusted OR 2.2 (1.4-3.3).

Conclusions:
In patients presenting with AIS, good collateral flow state was associated with lower stroke severity. It was independently associated with good outcome after adjustment for several comorbidities. Based on our study results, CT perfusion imaging may have utility in predicting stroke severity and discharge outcome.
Abstract WMP68: Machine Learning Approach In Prediction Of Nasoenteral Tube In Acute Ischemic Stroke
Authors: Dalfior Luiz , Machado Michel , Alves Percilia , Oliveira Pablo , da Silva Paola , Augusto Geovanna , de Freitas Júlian Letícia , R Oliveira Luiz Fernando , Terehoff Igor , Canedo Nalcer , Avezum Luisa , Piva Mariana , Tolentino Mateus , Domingues Pedro , Dousseau Gabriella , Santos Isabel , Rocha Maria Sheila G
Published: February 2023

Introduction:
Dysphagia occurs in about 20 to 50% of acute stroke patients, and it may persist longer than six months after stroke. Nasoenteral tube feeding (NTF) must be judiciously prescribed to avoid dysphagia complications and, at the same time, prevent its unnecessary usage, which is not free of adverse events.

Objective:
Our aim was to state independent predictive factors associated with dysphagia and nasoenteral tube feeding. Besides, we aimed to develop a prediction model for nasoenteral tube feeding through a machine learning modeling approach.

Methods:
This is a prospective cohort study. All consecutive ischemic acute stroke patients were included. All patients had phonoaudiological evaluation for dysphagia screening. Data analyzed included age, sex, Glasgow Coma Scale, NIHSS, Aspects score, Seattle comorbid index, Rankin scale at discharge, TOAST classification for stroke subtypes, presence of major stroke risk factors and data from CT scan of patients.

Results:
We studied 1101 acute stroke patients. Twenty-eight percent of stroke patients received NTF. They were older (p<0.001), had a more severe stroke (p<0.001), and presented consciousness disturbance and dysarthria more frequently (p<0.001 for both measures). These findings independently predicted nasoenteral tube feeding in acute stroke. The decision tree model disclosed a sensitivity of 75% and specificity of 87%, with 84% accuracy for predicting nasoenteral tube feeding. On the other hand, the artificial neural network predicted 83% accurately, disclosing a sensitivity of 70% and specificity of 86%.

Conclusions:
Dysphagia occurred in one third of cases. Older age, stroke severity, dysarthria, reduced conscious level at onset independently predict the need for nasoenteral tube. The tree decision model is an accurate tool for predicting NTF in acute ischemic stroke patients.
Abstract WMP69: Recreational Drug Use And Ischemic Stroke: Demographics, Stroke Mechanism, And Outcomes
Authors: Hall Julianne P , Grewal Parneet , Asthana Anjali , Uzoewulu Stella E , Quinn Jeffrey , Da Silva Ivan , Dafer Rima
Published: February 2023

Introduction:
Various recreational drugs have been linked to cerebrovascular events, especially in young adults, however, few studies have examined relationships between substance abuse (SA) and acute ischemic stroke (AIS) in detail. The objective of this study was to determine prevalence and stroke mechanism in a cohort of AIS patients with SA and the impact of SA on outcomes and recovery.

Methods:
A retrospective case-control study comparing adults hospitalized with AIS with positive urine drug screen (UDS, excluding cannabis and its related products) from January 2015 to December 2019 compared with matched AIS controls from Greater Chicago area. Logistic regression was used to compare demographics, mechanism of stroke, discharge outcomes as measured by modified Rankin Scale (mRS), and disposition outcomes.

Results:
Out of 3229 AIS patients, 141 (6.5%) has positive UDS (SA group) and were compared to 282 controls. Illicit drugs used were cocaine (69%), opiates (21%), and the rest were amphetamines, phencyclidine, ecstasy, or multiple substances. Demographically, there were no significant differences in age [56.0±10.0 years vs 55.9±10.5], or sex [men 63.1% vs 60.3%]. Controls had higher rates of traditional stroke risk factors [diabetes (DM), p=0.0001 and hyperlipidemia (HLD), p=0.004], and a higher incidence of large artery atherosclerosis as suspected stroke mechanism than the SU group (p = 0.001). SA group at discharge had higher levels of disability [median mRS 2 vs 3 (p = 0.001)] and worse discharge disposition, i.e. subacute rehab/long term care facility/hospice/death vs home or acute rehabilitation (OR 0.49, p =0.009, CI 0.29-0.84), even after correcting for age, sex, HTN, DM, coronary artery disease, and HLD in a multiple logistic regression (OR 0.43, p= 0.004, CI 0.24-0.76).

Conclusion:
In our cohort, patients with AIS and SA were more likely to have a stroke mechanism of large artery atherosclerosis and poorer outcomes with higher levels of disability and worse discharge disposition.
Abstract WMP70: Young Adults With Cryptogenic Ischemic Stroke Have Longer Corrected QT Intervals Than Healthy Controls
Authors: Pirinen Jani , Eranti Antti , Lehto Mika , Aro Aapo , Tulkki Lauri , Martinez-Majander Nicolas , Putaala Jukka
Published: February 2023

Introduction:
In cryptogenic ischemic stroke, no definite etiology is found and high-risk cardiac sources of embolism are excluded. However, it has been hypothesized that many cryptogenic strokes could be cardioembolic especially in younger patients. We assessed whether resting ECG could reveal cardiac differences in young patients with cryptogenic ischemic stroke, as compared to healthy controls.

Methods:
We recruited prospectively 477 patients with cryptogenic ischemic stroke at age 18-49 and 455 controls at 19 European tertiary centers. We obtained vast clinical data and resting 12-lead ECG (at subacute phase from patients). From the ECGs we measured heart rate, presence of conduction blocks, QRS transition zone in precordial leads, presence of abnormal T-wave inversions, presence of ST depression and corrected QT-interval (QTc). We constructed multivariate models for each ECG parameter, adjusting for demographic and clinical data, using binomial logistic regression.

Results:
Median age for both patients and controls was 41 years, with 54.0% of patients and 54.6% of controls being men. Compared to controls, patients had higher prevalence of hypertension (38.8% vs. 30.0%, P=0.005) and obesity (38.8% vs. 30.1%, P=0.005), were more frequently heavy drinkers (14.6% vs. 7.6%, P<0.001), and were more likely to smoke (34.1% vs. 17.5%, P<0.001). Patients with cryptogenic ischemic stroke had longer QTc interval than controls (median QTc 416ms vs. 409ms, P<0.001). After adjustments, longer QTc interval was associated with stroke (odds ratio 1.12 per 10ms increase, P<0.001). There were no statistically significant differences in other ECG-abnormalities between patients and controls.

Conclusion:
Young patients with cryptogenic ischemic stroke have a longer corrected QT interval than healthy controls. The reason for this novel finding is unclear, and could reflect both underlying cardiogenic and neurogenic reasons.
Abstract WMP73: Border Zone Infarct Pattern Predicts Early Recurrence In Symptomatic Intracranial Atherosclerotic Disease: A Systematic Review And Meta-analysis
Authors: Das Saurav , Shu Liqi , Morgan Rebecca , Shah Asghar , Fayad Fayez , Goldstein Eric , Chahien Dalia , Maglinger Benton , Bokka Satheesh K , Owens Cory , Abbasi Mehdi , Kvernland Alexandra , Siegler James E , Mac Grory Brian , Tsivgoulis Georgios K , Nguyen Thanh N , Furie Karen L , Khatri Pooja , Mistry Eva , Prabhakaran Shyam , Liebeskind David S , Romano Jose G , De Havenon Adam H , Yaghi Shadi
Published: February 2023

Introduction:
Stroke secondary to intracranial atherosclerosis (ICAD) results in three distinct infarct patterns: (a) border zone infarcts (BZI) due to impaired distal perfusion (b) territorial infarcts due to distal plaque/thrombus embolization, and (c) perforator infarcts due to plaque progression. Previous studies indicate higher stroke recurrence in ICAD patients with BZI.

Methods:
This registered systematic review (CRD42021265230) comprised Medline and Web of Science search from inception to March 2022 for keywords (Intracranial Atherosclerosis OR Intracranial Stenosis) AND (Border zone OR Infarct Pattern) to identify papers and conference abstracts reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAD. Sensitivity analyses were performed for studies including any BZI vs isolated BZI and those excluding posterior circulation strokes. The study outcome included neurological deterioration and/or stroke recurrence. For all outcome events, corresponding risk ratios (RR) and 95% confidence intervals (CI) were calculated. Risk of bias assessments will be presented.

Results:
Literature search yielded 4478 studies,11 met inclusion criteria (n=1315 patients, 354 with BZI, weighted proportions summarized in figure). The meta-analysis of these studies with moderate heterogeneity (I
2
=38.7%) demonstrated that RR of outcomes in BZI group compared to non-BZI group was 2.10 (95% CI 1.52-2.90). Limiting analysis to studies including any BZI, RR (and 95% CI) was 2.32 (1.58-3.40), and 3.25 (2.09-5.07) for studies only including anterior circulation strokes with low heterogeneity for both (I
2
=0%). A non-significantly high outcome rate was seen with isolated BZI (RR 2.29, 95% CI 0.94-5.62) but with moderate heterogeneity across studies (I
2
=70.25%).

Conclusion:
We demonstrate the presence of BZI secondary to symptomatic ICAD can be imaging biomarker to predict neurological deterioration and/or stroke recurrence.
Abstract WMP75: Community Deprivation And Healthcare Access/Utilization In Patients With Carotid Stenosis: Results From The
All Of Us
Research Program
Authors: Clocchiatti-Tuozzo Santiago , Renedo Daniela , Rivier Cyprien , Torres Lopez Victor M , Matouk Charles , Sheth Kevin N , Gill Thomas M , Falcone Guido J
Published: February 2023

Background:
Social determinants of health are emerging as a key group of risk factors for cerebrovascular disease. Carotid artery stenosis (CAS) is an important risk factor for ischemic stroke. We hypothesize that community deprivation, an exposure that captures several social determinants for health, leads to significant disparities in healthcare access in patients with known CAS.

Methods:
We conducted a cross-sectional study within the All of Us Research Program, a prospective population study that aims to enroll 1 million Americans. We included study participants with CAS, as defined by validated ICD-9/10 codes. We evaluated access to healthcare using 5 metrics included in the Health Care Access and Utilization Survey (Table 1). We evaluated community deprivation using the Deprivation Index, a novel compound metric developed by the American Community Survey. We tested for association between tertiles of the Deprivation Index (labeled low, intermediate and high community deprivation) and health care access using multivariable models adjusting for potential confounders.

Results:
Of 333,845 participants enrolled in All of Us, we identified 2,465 (0.74%) participants with CAS (mean age 69, 53% female). Of these, 259 (10.5%) could not afford prescription medication, 132 (5.4%) could not afford specialist care, 144 (5.8) skipped medications, 109 (4.4%) could not afford follow up care and 97 (3.9%) could not afford mental health care. In unadjusted analysis, higher community deprivation was associated with a higher prevalence of all 5 evaluated indicators of poor access to health. In multivariable analysis adjusted for potential confounder variables, difficulty affording prescription medication, specialist care and follow up care remained statistically significant (Table 1).

Conclusion:
Among persons with CAS enrolled in All of Us, community deprivation was associated with a lower likelihood of accessing and utilizing important healthcare services.
Abstract WMP79: Stroke Risk Prediction In Symptomatic Anterior Circulation ICAS: Post Hoc Analysis Of Regional QMRA Flow From The MYRIAD Study
Authors: Amin-Hanjani Sepideh , Du Xinjian , Romano Jose G , Liebeskind David S , Prabhakaran Shyam
Published: February 2023

Introduction:
Intracranial atherosclerotic disease (ICAD) remains a major source of stroke worldwide, with high recurrence risk. Prior evaluation of posterior circulation ICAD patients enrolled in the prospective VERiTAS and MYRIAD studies revealed regional hypoperfusion, assessed by large vessel flow measurements using quantitative MRA (QMRA), predicts subsequent vertebrobasilar stroke risk. We examined whether a similar approach to regional flow assessment using QMRA predicted stroke risk in anterior circulation ICAD patients enrolled in MYRIAD.

Methods:
MYRIAD enrolled patients with recent TIA or stroke attributable to 50-99% stenosis of proximal intracranial artery; the primary outcome was ischemic stroke in the territory of the stenotic artery with 1 year of follow-up. Secondary outcomes included new in-territory infarcts on MRI at 6-8 weeks. Flow was measured in the major intracranial arteries at baseline using QMRA. We designated patients as low- or normal-flow status based on an algorithm assessing distal flow and collateral capacity using age-normalized MCA and hemispheric (aggregate of ipsilateral ACA, MCA, and PCA) flows. Different thresholds for flow status categorization were tested to determine the optimal algorithm for stroke risk prediction.

Results:
Of 73 enrolled subjects with symptomatic anterior circulation ICAD, 7 (9.6%) patients had recurrent stroke. Z-score thresholds for age-normalized flow ranging from -0.5 to -1.5 were examined. The optimal thresholds identified were as follows: -1 for the MCA and -0.75 for hemispheric flow. 24 (33%) patients were categorized as low-flow status based on these thresholds; recurrent stroke occurred in 21% of low-flow patients vs. 4% of normal-flow patients (OR 6.2 (95% CI 1.1-34.7, p=0.04). However, flow status was not predictive of recurrent infarct on imaging among 61 patients with 6-8 week MRI (32% in low-flow vs. 26% in normal-flow patients).

Conclusions:
Similar to the predictive value in the posterior circulation, distal flow status assessed through QMRA regional flow measurement appears to be predictive for recurrent clinical (but not imaging-based) stroke. Identification of high-risk patients has implications for future investigation of therapeutic interventions.
Abstract WMP8: Tenecteplase Versus Alteplase For Acute Ischemic Stroke: Treatment Outcomes From A Large Northwest Us Stroke Registry
Authors: Lowenkopf Ted J , Kansara Amit , Corless Leslie , Zurasky John F , Lesko Alexandra C , Cox Kailey L , Bravo Christian Y , Lopez George A , Singh Tarvinder , Contreras Andrea , Polonchak Jillian
Published: February 2023

Introduction:
The American Stroke Association Guidelines on acute ischemic stroke (AIS) thrombolytic treatment endorse the use of tenecteplase (TNK) weakly (IIb) based on moderate quality (B-R) evidence. The use of alteplase for AIS is strongly recommended (I) with high quality (A) of evidence. Despite this, many healthcare systems have transitioned to the use of TNK based on limited clinical trial data. Our study presents real world outcome data comparing AIS patients treated with TNK vs alteplase.

Methods:
Data were retrospectively abstracted from AIS patients treated with IV thrombolytic (IVT) or IVT and endovascular therapy (EVT) discharged between 1/1/2019-6/30/2022 . Patients were grouped into alteplase w/wo thrombectomy and TNK w/wo thrombectomy. Primary outcomes were discharge disposition, complications (sICH, serious systemic hemorrhage), door to needle and door to device times, treatment complications and post-EVT TICI score. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported for likelihood to receive IVT within 45 minutes and 30 minutes of arrival for the IVT group, adjusting for sex, race, admit NIHSS, and previous stroke.

Results:
3733 patients were included in the IVT group: 90.7% received alteplase, 9.3% received TNK. 814 patients received IVT and EVT: 90% received alteplase and 10% received TNK. In the IVT group, the median [Q1, Q3] DTN for alteplase was 48 [35, 66] minutes TNK was 45.5 [34.75, 63.25] (p=0.067). There was no significant difference in the likelihood of receiving IVT within 45 minutes and 30 minutes between the two drugs. Patients with higher admit NIHSS were more likely to receive IVT within 45 minutes (AOR 1.031 95% 1.021, 1.041 p<0.0001) and within 30 minutes (AOR 1.025 95% 1.013, 1.037 p<0.0001). There were no significant differences found in median DTN, DTD or TICI score for patients receiving both IVT and EVT. There were no significant differences in complications for any group.

Conclusion:
In our study there were no differences in benefit, risk, or treatment logistics between alteplase and tenecteplase when used in treating acute ischemic stroke. Recanalization of large vessel occlusion prior to endovascular thrombectomy was not analyzed but will be the subject of study in this cohort.
Abstract WMP83: Arterial Dissection: A Still Underestimated Cause Of Lateral Medullary Infarction
Authors: Ha Jiyeon , Yang Wookjin , Kang Dong-wan , Lee Eung-Joon , Jeong Han-Yeong , Chung Matthew , Kim Youngjoon , Kim Jeong-Min , Jung Keun-hwa , Lee Seung-Hoon
Published: February 2023

Introduction:
Although the association between vertebral artery or posterior inferior cerebellar artery dissection and lateral medullary infarction (LMI) has been established, the actual prevalence of dissection among patients with LMI may still be underestimated.

Methods:
Consecutive patients with acute pure LMI admitted between 2010 and 2021 were included. High-resolution vessel wall MRI (VWMRI) and/or transfemoral cerebral angiography (TFCA) were performed in a part of patients and were regarded as gold standard tests for diagnosis of dissection. Factors associated with definite dissection based on VWMRI or TFCA findings were assessed. Risk scoring for dissection was created based on multivariate logistic regression and applied to estimate the number of possible dissection.

Results:
Eighty-seven LMI patients were eligible and 47 (54.0%) of them underwent VWMRI (n=43) and/or TFCA (n=7). Among these 47 cases, 24 were definite dissection. Three out of 40 patients without gold standard tests were diagnosed with definite dissection based on conventional MRI findings. Preceding headache and normal body weight were independently associated with dissection in LMI patients. A risk scoring which includes age, body mass index, and headache predicted dissection with 91.7% sensitivity and 69.6% specificity (area under the receiver operating characteristic curve, 0.889; 95% confidence intervals, 0.802-0.977) in our population. Additional nine out of 37 patients without gold standard tests nor diagnosis of definite dissection in conventional MRI could be considered as possible dissection based on the scoring. Definite and possible dissections together comprised 41.4% (n=36) of LMI in our study.

Conclusions:
Arterial dissection may be more prevalent among LMI patients than reported before. Thorough diagnostic effort for dissection is necessary based on scrutinizing risk stratification.
Abstract WMP84: Symptomatic Intracranial Atherosclerotic Plaques: Different Morphological Features In The Anterior Versus Posterior Circulation
Authors: Leng Xinyi , Ip Bonaventure Yiu Ming , Ma Sze Ho , Miu Anki , Ma Karen , Au Lisa WC , Fan Florence SY , Ip Hing Lung , Chan Anne Y , Lau Alexander Y , Soo Yannie OY , Leung Howan , Mok Vincent CT , Yu Simon CH , Leung Thomas W
Published: February 2023

Introduction:
We compared the morphology of intracranial atherosclerotic plaques in the anterior versus posterior circulation, using three-dimensional rotational angiography (3DRA).

Methods:
We prospectively recruited adult patients with acute ischemic stroke or transient ischemic attack attributed to high-grade (60-99%), atherosclerotic intracranial stenosis as confirmed by 3DRA. We assessed the plaque morphology in 3DRA, including the percentage of luminal stenosis, smooth/irregular/ulcerative plaque surface contour, plaque thickness, length, eccentricity, upstream plaque shoulder angulation, longitudinal distribution of the maximal stenosis, and adjoining branch atheromatous disease (BAD). We compared characteristics of patients with middle cerebral artery-M1 (MCA-M1) and basilar artery (BA) plaques, and the plaque morphology in the two subgroups.

Results:
Overall, 164 and 17 patients respectively with MCA-M1 and BA plaques were analyzed, with similar age (medians 60 versus 62 years), sex (male 64.6 versus 52.9%) and history of common vascular risk factors. The percentage of luminal stenosis (medians 77 versus 81%), proportion of smooth/irregular/ulcerative plaque surface contour, upstream plaque shoulder angulation (32.1 versus 25.8 °), longitudinal distribution of the maximal stenosis, and presence of adjoining BAD (56.7 versus 64.7%) were similar between MCA-M1 and BA plaques. However, BA plaques were thicker (1.5 versus 1.3mm; p=0.03) and longer (16.4 versus 8.4mm; p<0.001), but less likely eccentric (70.6 versus 88.4%; p=0.039).

Conclusions:
There were differences in the morphology of symptomatic atherosclerotic plaques in anterior and posterior circulations, independent of demographics and common vascular risk factors. Different artery geometry and the hemodynamics may underlie such differences.
Abstract WMP91: The Penumbra Salvage Index (PSI) As A Novel Measure Of Successful Reperfusion
Authors: Al-Shaibi Faisal , Pujara Deep , Saidi Yazid , Hassan Ameer E , Abraham Michael G , sitton clark , Shaker Faris , Duncan Kelsey R , Chugh Arunit S , Sundararajan Sophia , Hu Yin , Abhishek Ray , Sila Cathy A , Bambakidis Nicholas C , Albers Gregory W , Campbell Bruce , Sarraj Amrou
Published: February 2023

Objective:
We propose a novel measure, the PSI, to evaluate procedural success and prognostication after EVT and compare its prognostic ability with successful reperfusion (mTICI ≥2b).

Methods:
SELECT EVT patients with adequate follow-up MR DWI imaging were stratified based on PSI [ratio of salvaged tissue volume (Tmax >6s volume at baseline – f/up DWI infarct volume) to the Tmax >6s volume at baseline] into good (PSI≥50%) and poor penumbral salvage (PSI<50%). Multivariable regression models examined the association of PSI with functional outcomes as well as predictors of PSI. ROC curve analysis evaluated the predictive ability of PSI and compared it with mTICI≥2b.

Results:
142/206(69%) had good penumbral salvage, with better CT ASPECTS (Good PSI: 9(7-10) vs Poor PSI: 7(6-9),p<0.001), baseline core infarct (Good PSI: 5.9(0.0-20.0)ml vs Poor PSI: 19.4(3.4-46.3)ml, p<0.001) and mTICI≥2b (Good PSI:91% vs Poor PSI: 64%, p<0.001). Good PSI was independently associated with higher odds of mRS 0-2 (Good PSI: 69% vs Poor PSI: 26%, aOR:5.89, 95%CI:2.25-15.45, p<0.001) and mRS 0-1 (Good PSI: 56% vs Poor PSI: 16%, aOR: 4.98, 95%CI:1.86-13.31, p=0.001). Predictors of a good PSI included a lower presenting NIHSS (aOR: 0.93, 95%CI: 0.87-0.99, p=0.026), smaller ischemic core (aOR: 0.96, 95%CI: 0.95-0.98, p<0.001) larger Tmax>6s volume (aOR: 1.01, 95%CI: 1.00-1.02, p=0.003) and mTICI≥2b (aOR: 8.84, 95%CI: 3.16-24.71, p<0.001). PSI demonstrated better AUC values (0.811) as compared to mTICI≥2b (0.786) in the ROC analysis.

Conclusion:
Good penumbral salvage is associated with higher odds of functional independence, and has a better predictive value than successful reperfusion on cerebral angiogram after EVT. Prospective studies are needed to confirm the predictive utility of the PSI.
Abstract WMP96: A Prospective Trial Of The Rapidpulse
Tm
Aspiration System As Frontline Approach For Stroke Thrombectomy (RapidPulseFS)
Authors: Nogueira Raul G , Geyik Serdar , Bajrami Arsida , Erdem Eren , Ertugrul Ozgur Z , Montalverne Francisco Jose , Lima Fabricio O , Gallego Leon Jose I , Sagredo Barra Antonio I , Sanchez Blanco Fernando S , Dominguez Rodriguez Carlos , Barbieri Giorgio , Rayón-Aledo Jose Carlos , Serna Candel Carmen , Kupcs Karlis , Kidikas Helmuts , Vetra Janis , Gal Gyula , Diaz Anabel , Rocha Felipe A , Mendes George , Silva Henrique C , Braga Cruz Guedes de Morais Alessandra , Carm Hellen , Bandeira Diego , Bezerra Jose , Andrade Lidemarcks I , LUCENA ADSON F
Published: February 2023

Introduction:
First-pass effect (FPE) is associated with improved clinical outcomes and reduced mortality in mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS). However, FPE is achieved in only 30-40% of patients with the current devices. The RapidPulse
TM
Cyclic Aspiration System (RP) is a novel technology consisting of a valve box that precisely cycles pressure from full to no vacuum multiple times per second adding kinetic energy to the suction forces. Initial clinical evaluation suggests that the system can achieve FPE rates in the 70% range. We aim to evaluate the RP as a frontline approach in LVOS.

Methods:
Prospective, multicenter, open-label, core lab adjudicated, two-arm study comparing the safety and efficacy of the RP System with non-randomized retrospective controls who were consecutively treated at the study sites based on similar eligibility criteria. Patients with LVOS involving the anterior or posterior circulations in whom the target lesion could be treated with the Medtronic React 71 aspiration catheter up to 24 hours from stroke onset were included in the RP arm. Controls consisted of comparable patients treated with 070-072 ID catheters. The primary outcome was the rate of FPE (complete/near reperfusion [mTICI ≥2c] after a single pass). Secondary outcomes include frontline technical success (defined as mTICI ≥2b after final device pass with no rescue therapy), final mTICI after all passes, symptomatic ICH, device-related complications, the proportion of patients achieving a modified Rankin Scale score of 0-2 at 90 days, and all-cause 90-day mortality. The study will enroll a maximum of 100 participants in the RP and 200 in the control arm at 5 centers in Spain, Turkey, Denmark, Latvia, and Brazil.

Results:
Final results will be presented at the conference.

Conclusion:
RapidPulseFS is the first prospective clinical trial aiming to compare cyclic versus standard aspiration technologies. This novel device may allow clinicians to achieve faster and better reperfusion while significantly reducing the disposable device costs associated with treating LVOS (ClinicalTrials.gov Identifier: NCT05122637).