bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP129: Disparities in the utilization of inpatient rehabilitation facilities for stroke patients in the United States
Authors: Bako Abdulaziz , Potter Thomas , Pan Alan , Borei Karim , Vahidy Farhaan
Published: January 2025

Background:
We evaluate the contemporary trends and socioeconomic disparities in utilization of post-stroke rehabilitation using statewide inpatient data from 5 states with large and diverse populations.

Methods:
We used ICD codes (I60, I61, I63) to identify adult patients (≥18 years) discharged home (including home health), to IRF, or skilled nursing facility (SNF) with acute ischemic stroke (AIS), spontaneous intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) primary diagnosis from the inpatient databases of Florida, Georgia, Maryland, New York, and Washington (2016-2019). Utilizing multivariable logistic regression multivariable logistic regression with patient-level cluster-robust standard errors, we evaluate the correlates of discharge to IRF (vs. home and SNF) and report the adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results:
Overall, 335,521 stroke discharges (88.4% AIS, 8.1% ICH, 3.5% SAH) representing 312,316 unique patients (median age [IQR] of 69 [59-80] and 47.9% female) were included. Among these, 21.8% discharges were to IRF, 51.5% to home, and 26.7% to SNF. Between 2016 and 2019, the overall proportion of IRF discharges did not change significantly (21.8% in 2016; 22.1% in 2019). Patients with ICH (vs. AIS) were more likely to be discharged to IRF (vs. home) (aOR, CI: 2.17, 2.10-2.26). Patients discharged to IRF (vs. SNF) were more likely to be privately (vs. Medicare) insured (1.73, 1.66-1.79), and reside in the highest income quartile zip codes, vs. lowest quartile (aOR, CI: 1.31, 1.26-1.35). Conversely, non-Hispanic Black (vs. non-Hispanic White individuals were less likely to be discharged to IRF (vs. SNF) (aOR, CI: 0.92, 0.89 – 0.94). Stroke patients with higher comorbidity burden, as measured by Charlson Comorbidity Index (aOR, CI: 0.88, 0.87-0.89), and those undergoing invasive ventilation (0.79, 0.75-0.83) and tracheostomy (0.35, 0.32-0.38) were also less likely to be discharged to IRF (vs. SNF). We observed an age-dependent association between sex and IRF discharge whereby older females (vs. males) are less likely to be discharged to IRF in lieu of SNF (p-value for interaction <0.001; Figure 1).

Conclusion:
Less than 1 in 4 stroke patients receive post-acute IRF care, highlighting a critical gap in achieving optimal stroke recovery. Furthermore, notable sociodemographic disparities persist in IRF utilization. Maximizing pathways for optimal post-stroke recovery remains a critical gap in stroke systems of care.
Abstract WP131: Global Landscape of Stroke Rehabilitation: Access and Challenges
Authors: Saleh Velez Faddi , Yeung Elton Hau Lam , Bonin Pinto Camila , Mei Ling Tse , Carbonera Leonardo , Alet Matias , Ciopleias Bogdan , Yusof Khan Abdul Hanif Khan , Law Zhe Kang , lotlikar radhika , ramage emily , Xiong Carol , zuurbier susanna , Li Linxin , Mares Kathryn , KIPER PAWEL , Heldner Mirjam , Matuja Sarah , Johnson Louise , Caso Valeria , Saposnik Gustavo , Solomon John , Savitz Sean , Lau Kui Kai
Published: January 2025

Background:
Stroke is a leading cause of long-term disability worldwide. Timely and adequate rehabilitation is crucial for post-stroke recovery, but access is limited due to an overburdened healthcare system, medical personnel shortages, and insurance barriers. Rehabilitation access is especially limited for stroke survivors in rural and low-income regions. Innovative solutions like telerehabilitation are needed to expand access. This study examines current rehabilitation practices, costs, and global telerehabilitation models, as well as barriers to rehabilitation utilization.

Methods:
We conducted an online survey aimed at stroke care providers, affiliated societies, and partner organizations to collect comprehensive data on the availability and practices of post-stroke rehabilitation and telerehabilitation across various regions.

Results:
A total of 523 responses were collected from 62 different countries (Fig1), with the majority of respondents being physicians (66.7%), followed by physiotherapists (15.7%). Most respondents reported working in urban areas (82.9%) and were primarily employed in public community hospitals (40.5%), with a significant portion also working in academic institutions (35.3%). Regarding experience, 45.1% of respondents had over 10 years of experience in the stroke field. Telerehabilitation services for stroke were not offered by most of the surveyed sites (71.1%). Among those that did provide telerehabilitation, most sessions were individualized for a single patient (34.7%), followed by sessions involving two patients (24.8%). Notably, 18.36% of the sites offered sessions for groups of more than 10 patients at a time. The frequency of sessions varied, with the majority offering a single session per week (30.6%), followed by two sessions per week (20%), while only 8% provided sessions five days a week. On average, the duration of these sessions ranged from 31 to 60 minutes (53.1%). The most reported barriers to providing adequate telerehabilitation services included the availability of electronic hardware devices (12.9%) and internet access (12.9%). Other significant barriers included poor video call quality (10.4%) and the lack of clear guidelines and protocols (9.2%).

Conclusion:
The survey results provide a comprehensive overview of current practices and availability of post-stroke rehabilitation and telerehabilitation, highlighting the global burden of post-stroke disability due to limited access to rehabilitation.
Abstract WP136: Implementation of a Standardized Timeout Procedure for Intracerebral Hemorrhage
Authors: Mulchan Nicholas , Davy Connor , Holland Cinthia , Davis Nicole , Fara Michael
Published: January 2025

Introduction:
Intracerebral hemorrhage (ICH) leads to the highest mortality among stroke patients. ICH expansion causes worse outcomes, especially with anticoagulant-associated ICH. Rapid management of ICH has been shown to improve patient mortality.

Hypothesis:
A standardized timeout procedure will improve timely treatment and functional outcomes in patients with ICH.

Methods:
A checklist was created to be filled out by the nurse, pharmacist, and neurology resident during a timeout procedure for patients with ICH presenting to the emergency department at a large academic medical center. The checklist tracks blood pressure (BP) management and calling a neurosurgery consult. Additionally, the checklist includes verification of antiplatelet and/or anticoagulant (AP/AC) usage with subsequent guidance regarding reversal, including agent used, dose used, and time administered. Training sessions and online modules on this process were required for staff members to complete prior to implementation. Data analysis involves comparing initiation times of steps on the checklist as well as difference in admission and discharge National Institutes of Health Stroke Scale (NIHSS) score pre- and post-intervention.

Results:
Data prior to intervention was compiled from January 2021 up to workflow implementation on August 12th, 2024. Post-intervention data is currently being collected from the implementation date onwards. Data analysis thus far has demonstrated significant improvements in patient management. Average time to BP medication initiation improved from 188 minutes pre- to 55 minutes post-intervention. Average time to AP/AC reversal improved from 238 minutes pre- to 50 minutes post-intervention. Time to neurosurgical intervention did not show improvement post intervention. In terms of functional outcome, the average improvement in discharge NIHSS score increased by 1.33 points post-intervention.

Conclusions:
This study demonstrates that a standardized timeout procedure for ICH can increase efficiency in patient management. Reducing delays to treatment has been shown to improve morbidity and mortality associated with ICH, and while data collection is still ongoing, this study already shows improvement in patient outcome.
Abstract WP140: Early Post Acute Care Pathways are Predictive of 1-Year Home Time among Patients with Acute Ischemic Stroke: Analysis of Clinical and Claims Linked Data
Authors: Pan Alan , Wozny Joseph , Schaefer Caroline , Bako Abdulaziz , Nicolas Charlie , Potter Thomas , Caballero Elizabeth , Nair Rejani , Ganduglia-Cazaban Cecilia , Kim Yejin , Jiang Xiaoqian , Vahidy Farhaan
Published: January 2025

Background:
Maximizing long-term home time (HT) for acute ischemic stroke (AIS) patients has patient-centered and health-system benefits. We evaluated the influence of early (30-day) post-acute care (PAC) pathways on 1-year HT.

Methods:
We analyzed a cohort of Medicare AIS patients at a 7-hospital stroke certified health system (2016 to 2020). Clinical data extracted from an EMR-driven registry were linked to PAC utilization information retrieved from a CMS Qualified Entity with ≥80% data for the Texas state population (including 100% of Medicare Fee-for-Service). All claims within 1 year of hospitalization were collated and grouped into corresponding care pathways. One-year HT (i.e., number of days at home across 1-year period) was calculated utilizing discharge dates from various healthcare settings. Low HT was defined as <50% of days at home. Event flags at 30-day (30-D) or 1-year (1-YR) post-discharge for inpatient rehab (IR), institutionalized care (skilled nursing, hospice), hospital readmission (HR), and death were created. Random forest (RF) classification and regression models were built to evaluate predictors of 1-YR outcomes (HR, death, and HT). Factors associated with 1-YR outcomes were evaluated via multivariate logistic regression. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results:
A total of 3,064 AIS survivors with matched claims data were analyzed (median, IQR age: 77, 70-84 years; 55.8% female; 63.6% White; 20.0% Black; 9.7% Hispanic). HR rates at 30-D and 1-YR post-discharge were 16.1% and 45.9%; 30-D and 1-YR mortality rates were 10.7% and 26.0%. Figure 1 depicts patient frequency distributions across the 1-YR spectrum of home time. The relative importance of all features included within each RF model is shown in Figure 2. In addition to known predictors (stroke severity, age, comorbidities), 30-D care pathways (IR and HR) were also strong contributors to 1-YR outcomes. Post-acute IR was associated with decreased 1-YR mortality (aOR, CI: 0.57, 0.46-0.71) and lower likelihood of low HT (aOR, CI: 0.62, 0.50-0.76) (Figure 3). HR was associated with greater than two-fold mortality risk (aOR, CI: 2.73, 2.14-3.48) and higher likelihood of low HT (aOR, CI: 2.37, 1.88-2.99).

Conclusion:
Our analysis underscores the importance of early PAC pathways for extending favorable recovery time at home. Interventions aimed at optimizing rehab resources and minimizing institutionalized care may improve health trajectories.
Abstract WP145: Neighborhood Economic and Demographic Landscape as Predictors of 90 Days Outcomes Post Stroke Hospitalization
Authors: Fakoori Farya , Johnson Karlon , Gardener Hannah , Gutierrez Carolina , Asdaghi Negar , Bishop Lauri , Brown Scott , Campo-Bustillo Iszet , Perue Gillian Gordon , Veledar Emir , YING HAO , Zhou Lili , Romano Jose , Rundek Tatjana , Marulanda Erika
Published: January 2025

Objective:
A thorough exploration of neighborhood environmental impacts on post-discharge stroke outcomes is lacking and crucial to identifying populations at high risk. We assess neighborhood economic and demographic characteristics associated with 90-day death or readmission post-stroke hospitalization.

Methods:
The study population included 1329 stroke survivors in the prospective Florida Stroke Registry’s Transition of Care Stroke Disparities Study (91% ischemic stroke, 56% males, 51.5% Non-Hispanic White, 22.6% non-Hispanic Black, 21.8% Hispanic, median age 64). Publicly available data on the neighborhood (Zip+4) characteristics included socioeconomic status (NSES), race/ethnic composition, and business densities (food, tobacco/alcohol, gyms, medical services), which were used in factor analysis to create four main factors. Structured telephone interviews at 90 days post-discharge assessed stroke outcomes (death or readmission). Logistic regression models examined associations between the neighborhood characteristics and death/readmission, adjusting for individual demographics (race/ethnicity, sex, age), vascular risk factors and stroke severity obtained from Get with the Guidelines-Stroke®, and individual social/economic conditions (insurance, social support, living arrangement) from patient interviews.

Results:
Within 90 days post-discharge, 208 patients experienced death or readmission. Four main factors explained 56% of the variance in 24 neighborhood characteristics, of which factor 1 was associated with a 20% increased risk of death/readmission. Factor 1 was characterized by Hispanic dominance (above median %Hispanic), lower NSES (higher %below the poverty line, densely populated), and highly urbanized (primary Rural-Urban Commuting Area (RUCA) code of 1, higher densities of tobacco outlets, alcohol outlets, restaurants, grocery stores, gyms, and pharmacies).

Conclusions:
Living in predominantly Hispanic, highly urbanized, crowded neighborhoods with lower SES, predicted poor stroke outcomes independent of individual health or SES conditions. These findings can help inform the target population for community interventions aimed at improving stroke mortality and readmission rates.
Abstract WP147: The Impact of Electronic Consent on Participant Recruitment in an Acute Ischemic Stroke Clinical Trial
Authors: Davis Shannon Iris , Staugaitis Abbey , Rines Ian , ROY AKASH , Rogers Anthony , Stalin Karen , Bentho Oladi , Khatri Pooja , Adeoye Opeolu , Barreto Andrew , Broderick Joseph , Grotta James , Derdeyn Colin , Streib Christopher
Published: January 2025

Background:
Obtaining timely informed consent is a key barrier in acute ischemic stroke (AIS) clinical trial recruitment. Electronic consent (eConsent) allows electronic delivery and documentation of the informed consent process which may optimize recruitment. eConsent utilization in AIS clinical trials, however, is limited and understudied. We report eConsent adoption in MOST, a Phase III AIS clinical trial, and studied the impact on recruitment.

Methods:
Study databases were reviewed to determine informed consent modality for each participant: paper-in person, paper-remote, eConsent-in person, eConsent-remote (remote consent occurred when the study team and participant/legally authorized representative were in different physical locations). eConsent adoption trends, participant demographics, and diversity were reported using descriptive statistics. We utilized chi-square and Kruskal Wallis tests to compare individual site enrollment, remote consent utilization, baseline-neuroimaging-to-randomization times, data clarification requests (DCRs), and reportable unanticipated events (UEs), across consent modalities.

Results:
eConsent was utilized for 173 (33.7%) out of 514 participants. 32 of 57 sites (56.1%) utilized eConsent at least once: those sites had higher median enrollment than non-eConsent sites (7.5 [IQR 5-17] vs 3 [IQR 2-4], p<0.001). eConsent was completed remotely more frequently than paper consent (46.2% vs 1.2%, p<0.001). Participant diversity and baseline-neuroimaging-to-randomization times were similar between eConsent-in person and paper-in person consent (median 58.5 min [IQR 46.5-72.5] vs median 55 min [IQR 39-70]). Consent documentation adherence was superior with eConsent-in person compared to paper-in person including decreased DCRs (44 vs 81 per 100 participants, p<0.001) and reportable UEs (6 vs 25 per 100 participants, p<0.001).

Conclusion:
eConsent in MOST was associated with higher individual site enrollment, higher remote consent rates, and improved consent documentation adherence over paper consent. Our study outlines the potential advantages of eConsent adoption in future AIS clinical trials and stroke research networks.
Abstract WP153: Identifying the Experiences and Longitudinal Needs of Stroke Survivors and Caregivers from Bedside to Community
Authors: Fernbach Madalyn , Cooke Lily , Fiorentino Arianna , Sawyer Abbey , Putrino David
Published: January 2025

Introduction:
Despite the high incidence rate of post-stroke anxiety and mood changes, there is limited evidence for the integration of emotional and mental health support resources into acute care and long-term recovery. In this international survey-based study, we seek to better understand the emotional and mental health needs of survivors and caregivers.

Methods:
Participants were recruited via online advertising and advocacy groups. Eligibility included: ≥18 years, fluent in English, and identified as a brain injury survivor, caregiver, or healthcare worker. This analysis focuses on the stroke subgroup. Descriptive statistics were used for quantitative data and thematic analysis for qualitative responses.

Results:
410 individuals completed the survey (stroke: n=200). Most of them (n=158, 79%) were youth stroke survivors (aged <50 years). Both ischemic (n=59, 29%) and hemorrhagic stroke (n=141, 71%) survivors experienced an average of 3 impairments: fatigue was most common (n=150, 75%).

Surveyors reported a lack of overall emotional (n=152, 76%) and mental health support (n=139, 70%), insufficient communication about anticipated recovery (n=145, 73%), and a desire for more discussion on rehabilitation options (n=108, 54%). Table 1 presents a thematic analysis of recovery.

Most experienced a high level of anxiety ( ≥6.5/10) about long-term recovery (M =6.6, SD =2.6), emerging symptoms (M =6.7, SD =2.7), uncertainty about the future (M= 6.9, SD=2.7) and financial and return to work concerns (M=6.5, SD=3.1).

Many were unfamiliar with brain injury before their diagnosis (n=152, 76%) and reported that no information about emotional or mental support was shared at discharge (n=136, 68%). Searching the internet was utilized most for seeking information (n=144, 72%).

A majority had no contacts who had lived brain injury experience (n=150, 75%) but desired someone to talk to in their transition from bedside to community; with a preference for in-person peer support. Qualitative analyses outline the ideal supporter as empathetic, resourceful, knowledgeable about recovery, and honest.

Conclusion:
The survey indicates a lack of and need for early integration of emotional and mental health support services and comprehensive informational resources into longitudinal recovery plans. This data could guide future peer support programs and inform other research studies by emphasizing the importance of continuous dialogue with community partners and people with lived experience.
Abstract WP154: Suboptimal Medication Possession Ratio is Associated with Increased Recurrent Ischemic Stroke Risk in a Veteran Population
Authors: Kern Kyle , Crossley Alexander , Mun Katherine , Dergalust Sunita , Hinman Jason
Published: January 2025

Objectives:
Recurrent stroke results in higher disability and mortality but might be mitigated through interventions that improve medication adherence. The medication possession ratio (MPR) is an objective proxy for adherence that may provide individualized risk assessment for recurrent stroke.

Methods:
This is a retrospective, longitudinal cohort study of patients with recent ischemic stroke or TIA referred to a Veterans Affairs vascular neurology clinic between 2010 and 2016. Through review of pharmacy and medical records over the years after incident ischemic event, we calculated average MPR quartile for four stroke-preventative medication classes. Traditional stroke risk factors were quantified using the Framingham Stroke Risk Profile (FSRP) score and TOAST stroke etiological classification was determined. We hypothesized that lower average MPR over all classes would relate to higher recurrent stroke risk more than FSRP or stroke etiology.

Results:
255 patients with stroke or TIA, (mean age 67 ±10 years; 95% male) had a median follow-up period of 5.0 years (IQR 2.0). MPRs during follow-up were similar across 4 medication classes (77.1% to 81.9%) and highly correlated (R
2
0.20 to 0.50). On average, MPR decreased by 4.3% per year after stroke (95%CI: 0.5 to 8%, p=0.025). Recurrent stroke occurred in 57 (22.4%) patients at median 604 (IQR 993) days, with cumulative rates of 4.7%, 8.7%, 13.7%, and 24.5% at 90 days, 1 year, 2 years, and 5 years respectively. In survival analysis covarying for FSRP and accounting for the competing risk of death, each quartile lower for average MPR was associated with higher cumulative incidence of recurrent stroke (subhazard ratio 1.63, 95%CI: 1.24 to 2.14, p<0.001; Figure 1). Neither FSRP nor stroke etiology were associated with recurrent stroke. However, when individual FSRP components were considered, higher baseline systolic blood pressure (SHR 1.16 per 10 mmHg, 95%CI: 1.02 to 1.32, p=0.026) was also independently associated with stroke recurrence.

Conclusions:
MPR is an effective proxy for quantifying medication adherence to assess recurrent stroke risk. Systems-based and individualized interventions to improve adherence are needed to reduce recurrent stroke rates in VA populations.
Abstract WP155: Cancer Related Stroke (CRS) in patients with Brain Metastasis; Prevalence and Outcomes.
Authors: Iqbal Rabia , Bajwa Ahmad Taimoor , Jaiswal Vikash
Published: January 2025

Background:
Cancer-related stroke (CRS) is a rare condition where a tumor or its metastasis can compress a blood vessel and result in stroke. Strokes in cancer patients, particularly those with brain metastases, can often be overlooked or misattributed to other causes, making it vital to investigate this association further. In this study, we wanted to see the prevalence of ischemic or hemorrhagic stroke in patients with metastatic cancer to the brain, the demographic characteristics, and associated comorbidities.

Methods:
We conducted a retrospective analysis using the National Inpatient Sample Database from 2016 to 2020. We used ICD-10 codes to diagnose patients with a primary diagnosis of brain metastasis (ICD-10 C7931). Patients were divided into those with strokes (ischemic or hemorrhagic) and those without strokes. We used multivariate analysis to derive the adjusted odds ratio, and all weighted analyses were carried out using STATA.

Results:
We diagnosed a total of 595,2863 patients with brain metastasis. Out of them, 0.066% (n=3935) patients were found to have ischemic stroke, while 1.8% (n= 109,470) patients had hemorrhagic stroke. For ischemic stroke, the age of the patients was 78 years (p-value 0.01); 49% of the patients were female, while 51% were male (p-value 0.3). For hemorrhagic stroke, the mean age of the patients was 71 years (p-value <0.01); 44% were female, and 56% were male (p-value <0.01). Both types of stroke were most common in the white race (p-value <0.001). The presence of both kinds of stroke was associated with increased mortality in the patients. For ischemic stroke, mortality was 8.5%, aOR 1.7, p-value <0.001, while 16% for hemorrhagic, aOR 3.7, p-value <0.001 for patients with hemorrhagic stroke. The mean length of stay (LOS) was increased in patients with ischemic stroke (6.5 days vs. six days) and hemorrhagic stroke (8.3 days vs six days), along with an increase in total hospital charges (USD) in patients with stroke as compared to those without stroke (Table 1 and 2).

Conclusion:
Our study findings suggest that stroke, both ischemic and hemorrhagic, is associated with increased mortality and more extended hospital stays in this population. These results emphasize the importance of recognizing and addressing the elevated risk of stroke in patients with metastatic cancer to the brain, which can ultimately improve clinical outcomes and patient care.
Abstract WP159: Outcome Assessment For Reperfusion Therapy After Stroke: The Doctor-Patient Perception Mismatch
Authors: Khalife Jane , Penckofer Mary , Dubinski Michael , Koneru Manisha , Brown Danielle , Sprankle Kenyon , Hester Taryn , Gadea Marta , Rizzo Federica , Ribo Marc , Schumacher Hermann , Thon Jesse , Jovin Tudor , Hanafy Khalid
Published: January 2025

Introduction:
The long-term effects of ischemic stroke on cognition and mental health remain poorly understood, leading to mismatches in perceptions of overall disability despite otherwise qualifying as having ‘good’ or ‘excellent’ outcomes on traditional measures like the modified Rankin Scale (mRS). In our multicenter analysis, we aim to explore the prevalence and factors associated with patient-reported outcomes in patients who underwent reperfusion therapy and otherwise achieved good outcomes as defined by an mRS of 0-2.

Methods:
Retrospective registries of acute ischemic stroke patients at Cooper University Hospital (2021-2024) and Hospital Vall d’Hebron in Barcelona, Spain (2020-2021) were queried for patients who were treated with reperfusion therapy and achieved 90-day mRS 0-2. These patients were surveyed with the PROMIS Global-10 scale. The PROMIS Global-10 measures two domains: physical health (PROMIS-PH) and mental health (PROMIS-MH). The primary outcome was the rate of fair or poor PROMIS-MH scores (≤11), which was summarized as a frequency. Univariable and multivariable linear regressions for PROMIS-MH scores were performed to identify independently-associated factors.

Results:
Of 162 patients, 42% reported fair or poor (PROMIS-MH≤11) mental health outcome scores. Clinical factors independently associated with PROMIS-MH scores in a multivariable linear regression include: sex, tobacco use, PROMIS-PH score, and National Institutes of Health Stroke Scale at 3-day follow-up.

Conclusions:
Despite having mRS 0-2, patients do not necessarily have good long-term mental health outcomes. To better serve our stroke patients, emphasis should extend beyond traditional, limited measures and encompass additional dimensions of evaluation, including patient-reported mental health outcomes.
Abstract WP16: ROLE OF EPTIFIBATIDE IN POST-THROMBECTOMY STENOSIS
Authors: Lingam Sivani , Liu William , Sowers Sabriya , Houghton Margaret , Maali Laith
Published: January 2025

Introduction:
Currently, no level A evidence exists for the optimal rescue strategy for cases at high risk for re-occlusion following endovascular thrombectomy (EVT) in acute ischemic stroke. Glycoprotein IIb/IIIa inhibitors, which inhibit platelet aggregation and adhesion, show promise as adjunctive therapy, potentially yielding favorable outcomes, especially in residual stenosis cases.

Methods:
In this retrospective review study, we included patients aged ≥18 who underwent EVT at a comprehensive stroke center with TICI 2b or 2c outcome (admitted between 2019 – 2024), who were noted to have high-risk residual stenosis on angiography after EVT. We defined high-risk post-EVT stenosis as any stenosis with ≥50% lumen stenosis, associated dissection, re-occlusion during thrombectomy, and severe residual luminal irregularity. We excluded patients who had a clear contraindication to Eptifibatide, received a stent, or if the luminal stenosis was related to reactive vasospasm and any cases with TICI 0, 1, or TICI 3 scores.

Results:
Our sample size was 60 (51.7% male, 48.3% female, mean age 63.9). Mean National Institute of Health Stroke Scale (NIHSS) on admission was 16.6; 36.7% (n=22) received eptifibatide. The rate of re-occlusion was significantly lower in patients who received eptifibatide compared to those who did not (9.1% vs. 36.8%, p=0.032). There was no difference in pre-stroke modified Rankin scale (mRS), NIHSS on admission, mortality, discharge mRS, or 90-day mRS between these two groups, nor between patients who received intravenous thrombolysis (IVT) vs. those who did not. However, among the 16 patients who received IVT, those who also received eptifibatide had significantly lower mean discharge NIHSS (5.0 vs. 13.6, p=0.028), discharge mRS (1.3 vs. 4.5, p=0.009), and 90-day mRS (1.0 vs. 4.1, p=0.038) than those who did not. Ordinal logistic regression of discharge mRS and 90-day mRS in IVT recipients with vs. without eptifibatide usage also revealed significant odds of lower mRS at both timepoints with eptifibatide (OR 7.23, p=0.011 and OR 5.2, p=0.030 respectively).

Conclusions:
Eptifibatide use is associated with lower re-occlusion rates in patients with residual high-risk stenosis after EVT. Among IVT recipients with post-EVT residual stenosis, eptifibatide use is associated with improved discharge mRS, discharge NIHSS, and 90-day mRS. Given our limited sample size, these findings need to be evaluated further with larger Randomized Control Trials.
Abstract WP161: STroke Research Initiative to adVance Equity (STRIVE): Integration of a Community Advisory Board to Promote Person Centeredness and Relevance of the Results
Authors: Daniel Sam , Hamilton Micah , McClure Wesley , MOHAN RAO POOJA , Denny Mary Carter
Published: January 2025

Introduction:
Striking racial inequities exist in stroke treatment, recovery, and survivorship. Health inequities are driven primarily by social determinants of health (SDoH), which are the conditions in which people are bore, live, work, play, and age. The STroke Research Initiative to adVance Equity (STRIVE) is a longitudinal cohort study of stroke survivors and their caregivers that aims to assess the impact of SDoH and experiences of discrimination on stroke recovery. STRIVE utilizes a community-engaged research approach with a community advisory board (CAB) that has been involved in all aspects of the study. We hypothesize that the integration of the CAB will enhance the recruitment and retention of participants and the relevance of the results.

Methods:
The CAB consists of twelve stroke survivors and their caregivers that reflect the socioeconomic, race, ethnicity, language, and geographic diversity of the greater Washington, D.C. area. The CAB members are individuals with longstanding trusting relationships with the princial investigator. The CAB has met monthly by Zoom since January 2023. All CAB members, study personnel, and trainee research assistants are given equal opportunity to voice their ideas during Zoom meetings. CAB members are renumerated for their time and expertise at the same rate at study coordinators.

Results:
From January 2023 to September 2024, the CAB has co-developed all aspects of STRIVE including setting priorities of what aspects of stroke recovery to assess; selecting the person-centered study outcomes (Stroke Impact Scale and modified Caregiver Strain Index); identifying discrimination as a key driver to assess; choosing the survey platform Qualtrics; and created a stroke recovery resource guide for study participants based on their lived experiences. In 9 months, 46 stroke survivors and 15 caregivers from 3 sites have been recruited to STRIVE with a 93% retention rate.

Conclusion:
Integration of a stroke survivor and caregiver CAB in STRIVE study design, recruitment and retention has ensured that the results will be person-centered and relevant not only to clinician researcher, but also to the community. The STRIVE study team encourages our colleagues to leverage the expertise of stroke survivors and their caregivers in current and future studies.
Abstract WP162: Lack of specialty neurology follow-up after stroke is associated with worse outcomes in stroke survivors
Authors: Skovhus Alana , Lee Eliot , Sreekrishnan Anirudh
Published: January 2025

Introduction:
Outpatient follow-up within thirty days of discharge home after an ischemic stroke is associated with reduced readmission rates. Current guidelines emphasize a primary care-based approach to follow-up care but provide little information regarding neurology-specific follow-up. This study aims to examine the rates of follow-up with non-neurology care providers and neurologists, and their association with patient outcomes.

Methods:
We conducted a retrospective cohort study using electronic health records collected of patients discharged home after admission on the neurovascular service from a tertiary care hospital from October 2020 to October 2023 who were then subsequently contacted via guideline-recommended seven-day phone call. Clinical demographics, follow-up with either a non-neurology care provider (e.g., primary care provider, cardiologist, endocrinologist) or neurologist, emergency department (ED) presentations, and mortality were analyzed using a Chi-square analysis.

Results:
We identified a total of 246 patients for this review, 232 (94.3%) of whom attended follow-up with a non-neurologist compared to 182 (74.0%) with a neurologist an average of 33.9 days and 77.5 days from hospital discharge, respectively. A total of 127 (51.6%) patients presented to the ED within the follow-up timeframe, with 31 (12.6%) patients presenting prior to any follow-up appointment. There was a noted difference in the ED presentation rate between patients who did not attend a neurology appointment (36/62, 58.1%) compared to those that did attend (91/182, 41.9%), however this was not statistically significantly different. Of the 16 (6.9%) deaths in the cohort, they occurred significantly disproportionately in the patients without a neurology follow-up appointment (8/62, 12.9%; p = 0.02).

Conclusion:
Our findings suggest that patients who do not attend a neurology-specific follow-up appointment after stroke may have worse outcomes, including higher mortality rates. Further research is needed to develop interventions that improve neurology follow-up rates, with the goal of reducing ED visits, hospital readmissions, and mortality in patients with stroke.
Abstract WP166: Congruence of the Stroke Specific Quality of Life (SSQOL) Domains and Stroke Survivors’ Perceptions on Physical Wellbeing: A Mixed-Methods Exploratory Sequential Study
Authors: Choksi Devanshi , Craven Mary , McVeigh Taylor , Mallick Akashleena , Ranman Tanzeela , Kourkoulis Christina , Mora Samantha , Rosand Jonathan , Yechoor Nirupama
Published: January 2025

Background:
The SSQOL is a stroke-specific measure to assess functional status and health-related quality of life. While the SSQOL has been validated previously, studies have not examined the congruence between SSQOL domains and stroke survivors’ perceptions through qualitative methods, which could provide insights into whether the SSQOL comprehensively captures relevant aspects of physical wellbeing. Using a mixed-methods, exploratory sequential design, this study aims to examine the congruence between SSQOL domains and stroke survivors’ perceptions on physical wellbeing.

Methods:
Twelve stroke survivors and caregivers were recruited to participate in virtual focus group discussions on factors that influence physical wellbeing. A semi-structured interview guide was developed to assess physical wellbeing through questions including “Did you have difficulty with accessibility in the home?”, “What were expected challenges in the community?”, and other questions designed to address physical functioning. The SSQOL was administered after focus group sessions. Interviews were transcribed and coded using NVivo software. Three independent coders analyzed transcripts. Framework method analysis was used generate parent codes and identify themes related to physical wellbeing and its impact on recovery.

Results:
Analysis of qualitative data revealed three major themes: (1) the loss of independence on physical wellbeing; (2) feelings of shame affecting reintegration within communities; (3) challenges in the home environment due to limited mobility. Findings indicate that while stroke survivors’ perceptions of mobility were effectively captured by the SSQOL, it did not adequately reflect perceptions on loss of independence and feelings of shame (Table 1).

Conclusion:
The findings suggest that perceptions related to mobility and balance aligned with the SSQOL, while experiences related to loss of independence and shame were not captured by the SSQOL. Future studies are required to understand the mechanisms through which these unique barriers identified by stroke survivors are addressed by clinicians and the impact their recovery and wellbeing.
Abstract WP168: Creating an Artificial Intelligence-Driven Chatbot to Triage Patients for Mechanical Thrombectomy
Authors: Roy Joanna , Musmar Basel , Ghanem Lucas , Atallah Elias , Sizdahkhani Saman , Modak Anurag , Karadimas Spyridon , Koduri Sravanthi , Tjoumakaris Stavropoula , Gooch M. Reid , Rosenwasser Robert , Jabbour Pascal
Published: January 2025

Introduction:
Mechanical thrombectomy (MT) is the standard of care in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Early recanalization is critical to restoring blood flow to ischemic brain tissue. Previous literature has reported disparities in access to MT capable centers in patients with AIS. Early identification of MT eligibility could help stratify access to MT capable centers. Our study created an artificial intelligence (AI)-driven chatbot to help determine eligibility for MT.

Methods:
Guidelines established by the American Heart Association (AHA) and evidence from randomized clinical trials were used to determine MT eligibility based on presence of LVO, absence of intracranial hemorrhage (ICH), National Institute of Health Stroke Scale (NIHSS) and ASPECTS score. These criteria were utilized to develop a custom chatbot using the Python library for Open AI (San Francisco, California). The chatbot was used to determine eligibility and report reasons for each decision. Responses on MT eligibility were compared to the surgeon’s decision on MT eligibility at our institution between May 2024- August 2024.

Results:
34 patients presented with AIS and 52.9% (n= 18) underwent MT. The chatbot’s response agreed with the surgeon’s decision in 61.7% patients (n= 21). All patients who underwent MT were successfully identified by the chatbot. There were 13 cases of disagreement where the chatbot deemed patients to be ineligible for MT, however, the surgeon chose to perform MT after outweighing the benefits and risks of intervention. The chatbot was made available in the form of an open access web application (Figure 1, 2). https://huggingface.co/spaces/thrombectomypredictor/MT_eligibility

Conclusion:
Our AI-driven chatbot identified all instances of MT eligibility and could be incorporated into AI-based imaging software to streamline the process of referrals to MT-capable centers.
Abstract WP17: Efficacy of Edaravone Dexborneol in Real-World Patients With Acute Ischemic Stroke Receiving Reperfusion Therapy
Authors: Zuo Yingting , Ma Gaoting , Mo Ran , Wu Yifan , Lei Shaoyuan , Meng Shujuan , Wu Yue , Jiang Ziying , Zhong Lianmei
Published: January 2025

Background:
Edaravone dexborneol is a multitarget brain cytoprotection composed of antioxidation and anti-inflammation. We aimed to assess the effect of edaravone dexborneol on functional outcome in patients with acute ischemic stroke receiving reperfusion therapy.

Methods:
This study was a post hoc analysis of the EXPAND (The Effectiveness and Safety of Edaravone Dexborneol in Acute Ischemic Stroke) study, which was a prospective, multicenter cohort study that enrolled 4684 patients from January 2023 to October 2023 at 72 centers in China. Of these 4 684 patients, 1 035 patients aged 18 years or older, had a clinically diagnosed acute ischemic stroke symptom from onset to admission within 14 days, received reperfusion therapy (either intravenous treatment or endovascular treatment or intravenous bridging endovascular treatment), modified Rankin Scale (mRS) score of 0-1 prior to onset, and the ability to provide informed consents. Patients were divided into two groups (edaravone dexborneol or no edaravone dexborneol). The primary outcome was the proportion of patients with a favorable outcome based on 90-day mRS that was adjusted for baseline stroke severity (an mRS socre of 0 in patients with baseline National Institutes of Health Stroke Scale [NIHSS] score of 0 to 7; an mRS of 0 to 1 in patients with a baseline NIHSS score of 8 to 14; and an mRS score of 0 to 2 in patients with a baseline NIHSS score greater than or equal to 15). The secondary outcome was the score on the mRS score (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days. Data were analyzed using multivariate regression after adjusting for the potential confounding factors.

Results:
Of 1 035 patients (of whom 706 were men [68.2%]; median [interquartile] age, 65 [56-72] years) were recruited into the study, 629 were treated with edaravone dexborneol and 406 were not. A 90-day favorable functional outcome occurred in 301 patients (47.8%) in edaravone dexborneol group and 159 patients (39.2%) in no edaravone dexborneol group (adjusted odds ratio, 1.38; 95% CI, 1.06-1.80). The distribution of the mRS score showed that good functional outcome favoring the edaravone dexborneol group (adjusted common odds ratio, 1.30; 95% CI, 1.02-1.64).

Conclusions:
For patients with acute ischemic stroke receiving reperfusion therapy, edaravone dexborneol use was associated with a higher proportion of patients achieving a favorable functional outcome compared with no use.
Abstract WP176: Patients’ and Surrogates’ Perspectives on Consent for an Acute Stroke Clinical Trial
Authors: Rantanen Petra , Speight Candace , Adeoye Opeolu , Davis Shannon Iris , Linke Michael , Dickert Neal
Published: January 2025

Introduction:
Informed consent for clinical trials in the acute stroke setting is challenging. There is a need for context-appropriate approaches to consent, but few data exist regarding implementation of innovative approaches. In the Multi-Arm Optimization of Stroke Thrombolysis (MOST) trial (NCT03735979), a consent process was designed in collaboration with patient advisors that included a short consent form and a companion information sheet. This approach was implemented at all study sites, and participants’ experiences were assessed using a post-enrollment survey.

Methods:
All participants enrolled in MOST were eligible for the survey. The person who provided consent for enrollment (patient or surrogate) was asked to fill out the survey. The survey was adapted from a prior survey of patients’ and surrogates’ experiences with consent in acute care research and was cognitively pre-tested. Descriptive statistics were tabulated. Likert scale responses on a scale of 1-5 with 1 being strongly agree and 5 being strongly disagree and on a scale of 1-5 with 1 being extremely helpful and 5 being not helpful at all were collapsed into agree (1-2)/not agree (3-5) and helpful (1-2)/not helpful (3-5), respectively.

Results:
There were 195 completed surveys out of 514 enrollments in the MOST trial (overall capture rate 37.9%). Seventeen surveys were excluded due to mismatch between who consented to MOST and who completed the survey (total n=178 analyzable surveys). Patients completing the survey (or for whom a surrogate completed the survey) were similar to the overall enrolled population in terms of age, sex, race, and stroke severity (Table 1). The average age of survey respondents was 60.1 years, with 42.1% being male and 61.8% being surrogates (Table 2). Overall patients’ and surrogates’ experiences were positive. Post-enrollment communication and consent materials were viewed favorably (Table 3). Open-ended feedback was positive; participants acknowledged that time stress was intrinsic to the situation, encouraged simplicity, and offered few suggestions for improvement.

Conclusions:
A patient-centered consent process in an acute stroke trial was positively viewed by both patients and surrogates. Embedding assessments of patients’ and surrogates’ experiences within clinical trials offers an important opportunity for understanding the impact of innovation regarding consent.
Abstract WP184: Impact of serum calcium and phosphate on carotid atherosclerotic plaque characteristics by high-resolution MR vessel wall imaging
Authors: Song Xiaowei , Wu Jian , Pengmao Zhuoma , Hou Duoduo , Zhao Hongliang
Published: January 2025

Objective:
High calcium (Ca), low phosphate(P), and Ca-P product (CPP) levels are associated with cardiovascular disease and coronary artery atherosclerosis in patients with chronic kidney disease. However, whether this relationship persists in individuals with carotid artery atherosclerosis of acute ischemic stroke is unknown. We investigated the association of serum Ca, P, and CPP to carotid artery atherosclerotic plaque assessed by high-resolution MR vessel wall imaging in acute ischemic stroke patients.

Methods:
A total of 251 ischemic stroke participants with carotid artery atherosclerosis (mean age 68 years old, male 80.1%) were consecutively included in a comprehensive stroke center. Serum Ca, and P were obtained from blood tests after admission, and carotid artery plaque characteristics including plaque burden and vulnerability were evaluated using high-resolution MR vessel wall imaging, then the association between serum Ca, P, CPP, and atherosclerosis plaque characteristics was analyzed in multi-variate linear or logistic regression analysis； Finally, the consistency was also explored in different subgroups.

Results:
The mean±SD of serum Ca and P in this population is 2.26±0.11 and 1.16±0.19 individually. Serum P and CPP were associated with carotid artery plaque burden, presented as maximum wall thickness (max WT), wall area, and lipid-rich necrotic core (LRNC), in univariate analysis, with β=-0.205，95% CI (-0.348,-0.061), β=-0.258，95% CI (-0.405,-0.113), OR=0.182, 95% CI (0.034,0.975) for P, and β=-0.203，95% (-0.346,-0.059), β=-0.221，95% CI (-0.366,-0.074), OR=0.466, 95% CI (0.237,0.915) for CPP, respectively. In multivariate regression analysis, after further correction of age, sex in model 1 and cardiovascular risk factors in model 2, P level is associated with wall area independently, β=-0.211, 95% CI (-0.367, -0.052), while CPP is associated with wall area marginally, with β=-0.147, 95%CI (-0.300, 0.008) in model 1, and β=-0.157, 95%(-0.314, 0.004) in model 2. In subgroup analysis, the independent relationship between P and wall area can still be consistent in age＞65 years (β=-0.222, 95%CI [-0.400, -0.011]), male (β=-0.219， 95%CI [-0.446,-0.045], and hypertension (β=-0.314， 95%CI [-0.513, -0.130] subgroups.

Conclusion:
Lower serum P was associated with increased carotid artery plaque burden presented with wall area, and this relationship could differ in different age, sex, and hypertension subgroups.