bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP53: Vessel Wall MRI: Adding value in the diagnostic evaluation of Cervical Artery Dissection
Authors: Khan Natasha , Tirschwell David , Mossa-basha Mahmud , Safwat Ahmed , Wang Maoxue , Kharaji Mona
Published: January 2025

Introduction:
Cervical artery dissections (CAD) are a leading cause of stroke, particularly among younger individuals. Timely and accurate diagnosis is crucial for appropriate treatment and preventing further complications. This study compares a commonly used imaging modality for evaluating CAD; computed tomography angiography (CTA) with a novel imaging modality; Vessel Wall MR Imaging (VW-MRI). The aim is to highlight distinguishing features of CAD on VW-MRI, demonstrating its ability to offer better visualization of vessel wall abnormalities in select cases compared to conventional CTA.

Methodology:
Patients were selected from the University of Washington (UW) hospital system between 2022 and 2024. The screened patients included those either admitted directly from the Emergency Department due to new onset of neurological symptoms or transferred from Telehealth and affiliated hospitals after extensive disease was detected on CTA head and neck scans as part of stroke protocols. In accordance with our institutional stroke protocol all patients had initial vessel imaging with CTA followed by a VW-MRI which was obtained using a 3.0 Tesla scanner.

Results:
A total of 47 patients were identified with intracranial abnormalities initially picked on CTA. Of the total cases, 20 were initially suspected of CAD based on CTA, but only 13 were confirmed with dissections on VW-MRI. Amongst the seven cases which did not have a CAD on VW-MRI - two of them turned out to be artifactual, one of them was Fibromuscular Dysplasia (FMD), three showed atherosclerotic plaque and one was suggestive of a vasculitic process. In two cases, intracranial dissections were easily picked on VW-MRI, and in one case mural hematoma and in other two cases intraluminal thrombus were seen easily on VW-MRI, which were primarily missed on CTA.

Conclusion:
Upon reviewing the patients during this period, it is evident that VW-MRI not only aids in localizing acute ischemic strokes but also plays a critical role in identifying CAD. Additionally, intracranial artery dissections, intramural hematomas, intraluminal thromboses and pseudoaneurysms had a better visualization on VW-MRI than on conventional CTA. VW-MRI adds value to the diagnosis of CAD, which can be beneficial in determining etiology of acute ischemic strokes for cases which have some degree of uncertainty and eventually may prove to be helpful in their long-term management.
Abstract TMP58: Impact of DWI-ADC Mismatch on Infarct Progression and Endovascular Thrombectomy Outcomes in Acute Stroke
Authors: Chiang Chen-Hua , Liu Chia-Chuan , Chen David Yen-Ting
Published: January 2025

Introduction:
An apparent diffusion coefficient (ADC) threshold of ≤ 620 × 10-6 mm2/s identifies irreversible infarcts and guides endovascular thrombectomy (EVT) decisions. However, in hyperacute ischemic infarcts, diffusion-weighted imaging (DWI) hyperintense lesions can show varying ADC values. This study investigates DWI-ADC mismatch, defined as the significant difference between DWI hyperintense lesion volume and ADC ≤ 620 × 10-6 mm2/s volume.

Methods:
This retrospective, single-center study included patients with acute large vessel occlusion in the anterior circulation who: (1) underwent MRI within 24 hours of stroke onset, (2) received EVT, and (3) had follow-up MRI within 5 days of EVT from January 2018 to January 2020. Neuroradiologists segmented DWI hyperintense infarcts with ADC hypointensity on pre- and post-EVT MRI, using Fluid-attenuated inversion recovery (FLAIR) sequences to avoid T2 shine-through effects. The DWI/ADC volume ratio was calculated by dividing DWI volume by ADC ≤ 620 × 10-6 mm2/s volume. DWI-ADC mismatch was defined as a DWI/ADC ratio ≥ 2, with no mismatch indicated by a ratio < 2. Final infarct segmentation included hemorrhagic transformation. DWI lesion reversal (DWIR) was defined as the volume of normal-appearing voxels on follow-up DWI but previously hyperintense. DWIR% = (DWIR/baseline DWI volume) × 100 was calculated. We compared demographics, radiological findings, clinical outcomes, and follow-up results between mismatch and no mismatch groups.

Results:
Among 73 patients, 20 (27.4%) had DWI-ADC mismatch. Baseline demographics and National Institutes of Health Stroke Scale (NIHSS) were similar between groups. The DWI/ADC ratio was higher in the mismatch group (2.9 vs. 1.5, P < 0.0001). Follow-up lesion volumes and functional outcomes were similar; however, the mismatch group showed a slower infarct growth rate (3.8 ml/h vs. 7.5 ml/h, P = 0.04), a higher likelihood of parent artery stenosis (65% vs. 20.8%, P < 0.001), and increased need for angioplasty or stenting (50% vs. 17%, P < 0.001). The mismatch group also had a higher DWIR% (37.7% vs. 21.2%, P = 0.02).

Conclusions:
DWI-ADC mismatch is associated with slower infarct growth, greater likelihood of parent artery stenosis, increased need for angioplasty or stenting, and more DWI lesion reversal in anterior circulation large vessel occlusion patients undergoing EVT. These findings suggest DWI-ADC mismatch could be important in EVT decision-making and outcome prediction.
Abstract TMP62: Early Intensive Blood Pressure Lowering within 6 hours of Intracerebral Hemorrhage Onset is Associated with Improved Functional Outcomes in Larger Trials, but Inconclusive Evidence Overall: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials
Authors: Rajith Gokul , Erzinger Gabriel , Rizwan Ahmed Aisha , Silva Yasmin , Noll Giovani , Hussain Masaraf , Premraj Lavienraj
Published: January 2025

Background:
Elevated blood pressure (BP) is common after Intracerebral Hemorrhage (ICH) and is linked with increased morbidity and mortality, partly due to hematoma expansion. We conducted a systematic review and meta-analysis to determine the effect of BP lowering within 6 hours of ICH onset on functional outcome at 90 days, including a subgroup analysis of undifferentiated stroke patients.

Methods:
We searched PubMed, Embase, Cochrane Central, Google Scholar, and Clinicaltrials.gov for randomized controlled trials (RCTs). Odds ratio (ORs) with 95% CI were pooled across trials using a random-effects model for the outcomes of 1) change in modified Rankin Scale (mRS) score at 90 days; 2) 90-day death; 3) combined death or disability (mRS>2); 4) significant hematoma expansion (>6ml or >33% of baseline) and 4) serious adverse events (SAEs). The above analyses were replicated in the patients with undifferentiated (radiologically unconfirmed) stroke who recieved pre-hospital BP lowering. Trial sequential analysis (TSA) was performed to determine cumulative evidence strength.

Results:
We included 9 RCTs with 11,773 patients; 5884 (49.9%) of whom received early BP control within 6 hours of ICH onset. Early BP lowering therapy was associated with a favorable change in 90-day mRS scores (OR 0.88; 95% CI 0.78-0.98; Fig.1A), a reduced risk of death (OR 0.86; 95% CI 0.75-0.98; Fig.1B), a lower risk of death or disability (OR 0.85; 95% CI 0.73-0.99; Fig.2A) and reduced risk of significant hematoma expansion (OR 0.74; 95% CI 0.58-0.95; Fig.2B) in larger trials. On pooling the results of smaller RCTs (<100 patients) with those from larger trials, none of the above outcomes were significant. The same was true for prehospital BP management in undifferentiated stroke. No increased risk of SAEs was observed. TSA indicated that the current evidence is inconclusive to reach definitive conclusions for both the 90-day death outcome and the combined death or disability at 90 days in the primary analysis.

Conclusion:
Early BP lowering within 6 hours ICH of onset had no increased risk of SAE and is associated with improved 90-day mRS scores, reduced mortality, lower combined death or disability rates, and reduced risk of hematoma expansion in larger trials, which becomes non-significant on pooled analysis of larger and smaller trials. TSA indicated the need for additional trials with larger sampling sizes to confirm these findings.
Abstract TMP63: Genetic investigation for cerebral small vessel disease genes in patients with spontaneous intracerebral hemorrhage
Authors: Miwa Kaori , Takahashi Atsushi , Kamatani Yoichiro , Matsuo Ryu , Kitazono Takanari , Toyoda Kazunori , Ihara Masafumi , Koga Masatoshi
Published: January 2025

Objectives:
Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small arterioles due to cerebral small vessel disease (SVD), commonly with hypertensive arteriolosclerosis (HTA) or cerebral amyloid angiopathy (CAA). Several genes associated with SVD or ICH have been reported in studies of European populations, but it is unclear whether these genes are associated with ICH in the Japanese cohort. The aim of this study was to assess genetic variants associated with SVD in patients with ICH.

Methods:
We analyzed 920 patients with primary ICH and genetic data available from an ongoing, prospective, cohort study. ICH was diagnosed according to CLASsification system for ICH (CLAS-ICH) by stroke neurologists, and mixed-SVD was classified as HTA. We focused on the 27 genes previously identified in SVD (
APOE, CETP, PMF1, SLC25A44, TRHDE, APP, NOTCH3, COL4A1, COL4A2, PARVB, FOXC1, FOXF2, TREX1, ZCCHC14, WDR12, ICA1L, GCH1, SH2B3, ACOX1, UNC13D, TRIM65, TRIM47, WBP2, PLEKHG1, EFEMP1, VCAN, HTRA1
) to investigate their association with the ICH phenotypes (ICH subtypes [HTA-ICH vs. CAA-ICH], hematoma location [non-lobar vs. lobar], modified Rankin Scale (mRS) at 90d [0-4 vs. 5-6]). Variants with minor allele frequency ≥0.05 were analyzed. Trend test was used to assess the association, and the significance level was defined as false discovery rate (FDR) <0.1. The reference allele was defined as a base allele of odds ratio (OR).

Results:
Characteristics of 920 patients with ICH are mean age 71 ± 13 years, 59% men, HTA-ICH vs. CAA-ICH:88% vs. 10%, non-lobar vs. lobar: 74% vs. 26%, and mRS 0-4 vs. 5-6: 78% vs. 22%. We assessed the 667 variants in 27 genes. In CAA-ICH vs HTA-ICH, two variants on
APP
(amyloid-β protein precursor) gene showed significance. One was rs2830008 (NM_000484:c.865+2696A>G, OR=2.67, p=5.9×10
-6
, FDR=0.039) and the other was rs73163761 (NM_000484:c.866-7085C>T, OR=2.59, p=1.9×10
-4
, FDR=0.064). These 2 variants were in linkage equilibrium (r
2
=0.93). The alternative allele frequencies of rs2830008: T>C and rs73163761: G>A were 0.182 vs. 0.077 and 0.166 vs. 0.071 in CAA-ICH vs. HTA-ICH, respectively, with the HTA-ICH frequencies aligning with those of the general population (0.081, 0.072, respectively). No significant association was observed for other phenotypes.

Conclusion:
We found that 2 variants on
APP
genes were associated with CAA-ICH in the Japanese ICH cohort, confirming the link to amyloid β pathology.
Abstract TMP65: Prehospital Comprehensive Stroke Center vs Primary Stroke Center Triage in Patients with Intracranial Hemorrhage
Authors: Lawrence Molly , Prabhakaran Shyam , Fan Tracey
Published: January 2025

Background:
We aimed to evaluate whether the implementation of regional prehospital transport to comprehensive stroke center (CSC) protocol has any impact on inter-hospital transfer rate and neurologic outcomes of intracranial hemorrhage (ICH) patients.

Methods:
We performed a retrospective multicenter study comparing outcomes in patients with ICH arriving at 15 Primary Stroke Centers (PSC) and 8 CSC in Chicago, Illinois via emergency medical services transport from January 1 2017 and December 31 2023 - before and after implementation of a prehospital transport protocol in September 2018 which uses a 3-item stroke scale to identify patients with more severe stroke types and <6 hours from onset for transport to the closest CSC rather than closest PSC. Outcomes of interest included inter-hospital transfer rates, arrival to CT times, in-hospital mortality rate, favorable disposition location (discharged to home or acute rehabilitation) and favorable neurologic outcome at discharge (modified Rankin score [mRS] of 0-3).

Results:
Pre-implementation included 853 patients (mean age=63 [SD 15.0], 54% male, and 45% black), of which 232 (27%) were transported to PSCs (mean NIHSS=13 [SD 11.4]) and 621 patients (73%) to CSCs (mean NIHSS=13 [SD 9.3]). Post-implementation included 3506 patients (mean age=63 [SD 15.3], 63% male, 45% black), of which 891 (25%) went to PSCs (mean NIHSS=13 [SD 11.4]) and 2615 (75%) went to CSCs (mean NIHSS=15 [SD 10.5]). Initial NIHSS score was higher post-implementation compared to pre-implementation (13 [SD 9.9] vs. 14 [SD 10.7]), p=0.04). There were similar rates (41% pre-implementation vs 43% post-implementation) of inter-hospital transfer (p=0.39). Time from hospital arrival to CT imaging was significantly faster post-implementation (86 min vs 36 min, p<0.0001). Rates of favorable discharge disposition (49% pre-implementation vs. 47% post-implementation, p=0.28) and neurologic outcome (29% pre vs 26% post, p=0.13) were similar after adjusting for age, sex, time to CT, and initial NIHSS. However, in-hospital mortality was significantly higher post-implementation (15% pre vs. 20% post, odd ratio=1.4, 95% CI[1.1-1.8], p=0.02) after adjusting for initial NIHSS score.

Conclusion:
Implementation of a regional prehospital transport protocol to stroke center was associated with a shorter time to CT scanner but higher mortality. Our findings do not support prehospital policies to transport ICH patients directly to CSCs.
Abstract TMP70: Intracortical type of lobar cerebral microbleed predicts risk of recurrent intracerebral hemorrhage in spontaneous intracerebral hemorrhage survivors
Authors: Kuo Pin-Yan , Lee Bo-ching , Tsai Li-Kai , Tsai Hsin-Hsi
Published: January 2025

Introduction and Objective:
Lobar cerebral microbleed (CMB) is frequently found in patients with spontaneous intracerebral hemorrhage (ICH) and is closely linked to cerebral amyloid angiopathy (CAA) and risk of recurrent ICH. Lobar CMB could be further topographically categorized into intracortical type or subcortical white matter (WM) type, and our previous study showed that CAA is more related to the intracortical lobar CMB. The current study aimed to determine if the types of lobar CMB can predict risks ofrecurrent ICH and long-term vascular outcomes in patients with spontaneous ICH.

Methods:
A total of 587 patients with spontaneous ICH were included. Clinical data, neuroimaging markers, and 2-year follow-up outcomes (recurrent ICH, incident ischemic stroke, vascular mortality and composite outcome) were collected. We categorized patients into 4 different groups based on their lobar CMB types: Type 1 (strictly intracortical type, n=52), Type 2 (strictly subcortical WM type, n=127), Type 3 (mixed intracortical and subcortical WM type, n=86), and Type 4 (no lobar CMB, n=277). The associations between lobar CMB type and follow-up outcomes were assessed using multivariable Cox regression models with adjustment of age, sex, hypertension, diabetes mellitus and hyperlipidemia. We also examined the dose-relationship between intracortical lobar CMB number and ICH recurrence risk.

Results:
Compared to patients without lobar CMB (Type 4), patients with strictly intracortical lobar CMB type (Type 1) had higher ICH recurrence rate (HR 3.90[1.30-11.75], p=0.015) and composite outcomes (HR 2.55[1.26-5.17], p=0.009], p<0.001), while patients with strictly subcortical WM lobar CMB type (Type 2) was associated with high risk of composite outcomes (HR 2.22[1.31-3.79], p=0.003) and a trend toward risk of incident ischemic stroke (HR 2.12 (0.89-5.05), p=0.091) but not ICH (HR 1.66 [0.66-4.19], p=0.282). Mixed type (Type 3) was not associated with follow-up vascular events. For patients with at least one lobar CMB, three or more intracortical CMBs significantly elevated ICH recurrence risk (HR 2.85 [1.18-6.88], p=0.020).

Conclusions:
Topographical type of lobar CMB may have clinical significance in predicting ICH recurrence risks and vascular outcomes in ICH survivors. Patients with lobar CMBs restricted in the intracortical region, or with multiple number of intracortical lobar CMBs, are predisposed to higher ICH recurrence rate.
Abstract TMP71: Delineating the Evolution of the Immune Response in Peripheral Blood, Hematoma and Peri-hematomal Brain of Intracerebral Hemorrhage Patients
Authors: Paouri Evi , Dhawan Andrew , Niazi Farshad , Kim Adam , Gasmi Nadia , Resser Tina , Bain Mark , Gomes Joao , Valadkhan Saba , Davalos Dimitrios
Published: January 2025

Background:
Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, but carries the greatest degree of mortality and morbidity. In addition to the primary injury due to mechanical stress and mass effect on adjacent brain regions, uncontrolled inflammation in the peri-hematomal area constitutes a secondary insult that can exacerbate tissue damage, leading to cerebral edema, neuronal death, and thus worse clinical outcomes. Prior efforts at controlling ICH-related inflammation reported mixed outcomes, likely reflecting our poor understanding of the evolving inflammatory cascade following ICH. In this investigation we sought to better characterize the cellular immune response in the acute period following ICH.

Methods:
Surgical candidates for minimally invasive hematoma evacuation were approached for participation in this study. We collected evacuated clots, and small biopsies from peri-hematomal brain, and matched peripheral blood immediately preceding surgical evacuation, and on days 1, 3, and 5-7 post-surgery. We then isolated all immune cells from each compartment and performed transcriptomic profiling by single cell RNA-sequencing, from 6 patients operated on at time points ranging from 4 to 29 hours after time of last known well.

Results:
Data from 5 male and 1 female patient 46-79 years old are reported. Our data analyses showed an evolving inflammatory cascade consisting primarily of neutrophils and macrophages that is very similar in the blood and clot compartments. Importantly, the time elapsed between ICH incidence and surgical evacuation is positively correlated with the emergence of an inflammatory osteopontin-expressing macrophage population in the blood clot, and a unique microglial signature in the peri-hematomal brain. We also found that the presence of a fibrin-laden blood clot in the brain initiates an early and evolving gene signature in neutrophils and microglia in the brain parenchyma, that is distinct from the inflammatory responses identified in peripheral blood.

Conclusions:
Our findings show that rapid surgical evacuation of the hematoma within the first 4-5 hours limits the inflammatory insult, and highlight key immune cell populations involved in the inflammatory response post-ICH. We also identified key pathways driving these inflammatory responses, thereby providing novel potential therapeutic targets for patients with ICH.
Abstract TMP76: Inadequate Pre-Procedure Antiplatelet Medication Use May Explain the Higher Risk of Peri-Procedural Stroke and/or Death with Carotid Stent Placement within First 7 Days after Qualifying Ischemic Event
Authors: Suri Fareed , Huang Yilun , Khan Sulaiman , Shakir Muhammad , Gomez Camilo , Qureshi Adnan
Published: January 2025

Background and Purpose:
In randomized trials, carotid artery stent (CAS) may have higher risk of periprocedural risk compared with carotid endarterectomy (CEA) if performed within the first 7 days after the onset of symptoms.

Methods:
We analyzed the data from Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). The time interval between the most recent qualifying ischemic event and CAS/CEA procedure was divided in four strata: 1-7 days, 8-14 days, 15-30 days and >30 days. We analyzed the effect of time interval strata between most recent qualifying ischemic event and procedure and procedure type (CEA versus CAS) on peri-procedural stroke and/or death after adjusting for age, gender, symptomatic status and initial severity of stenosis (≥70% versus <70%).

Results:
The rate of periprocedural stroke and/or death was significantly higher in patients who underwent CAS compared with CEA at 7 days or less after the qualifying event (5.4% versus 0%, p=0.031) but not significantly different in patients who underwent CAS compared with CEA at 8-14 days (3.8%versus 2.0%, p=0.68), at 15-30 days (5.1% versus 1.8%, p=0.26) days and >30 days (CAS 7.8% versus CAE 4.3%, p=0.12), after the most recent qualifying event. In the multivariate analysis, patients who underwent CAS had higher rate of peri-procedural stroke and/or death (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.25- 4.66) but timing of procedure were not associated with higher rate of peri-procedural stroke and/or death after adjustment for potential confounders. The interaction between procedure type and timing of procedure was not significant. The rate of peri-procedural stroke and/or death was significantly higher in CAS patients who received clopidogrel bolus (without 48-hour maintenance dose) among patients treated 7 days or less after the qualifying event compared with those undergoing CEA (6.6% versus 0%, p=0.012) but was not different between CAS patients who received 48 hours of clopidogrel maintenance and those undergoing CEA (0% versus 0%).

Conclusions:
The higher rate of peri-procedural stroke and/or death seen with CAS (compared with CEA) within the first 7 days may be attributed to factors such as inadequate pre-procedure antiplatelet medication use. The results of CAS and CEA may become comparable within the first 7 days after the qualifying ischemic event with use of newer generation P2Y12 platelet inhibitors that achieve rapid antiplatelet inhibition.
Abstract TMP82: First line aspiration versus stent retriever for posterior circulation stroke; A meta-analysis
Authors: Thapa Sangharsha , Chong Ji , Santarelli Justin , Al-Mufti Fawaz , Gandhi Chirag , Kaur Gurmeen
Published: January 2025

Introduction:
Aspiration and stent retriever thrombectomy are the primary approaches for endovascular management of posterior circulation stroke. However, the optimal first-line choice of surgical technique remains unclear. This study aims to conduct a systematic review and meta-analysis comparing first-line aspiration with stent retriever thrombectomy in terms of recanalization rates, complications, and clinical outcomes.

Methodology:
This systematic review and meta-analysis followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Databases searched included PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov, focusing on studies comparing the efficacy and safety of first-line aspiration versus stent retriever thrombectomy for posterior circulation stroke. Data analysis was performed using RevMan version 5.4.1, with statistical significance set at p < 0.05.

Result:
A total of 21 studies, including 2,521 patients, were analyzed. First-line aspiration demonstrated a significant advantage in terms of successful recanalization (OR = 1.36; 95% CI: 1.04–1.76; p = 0.002) and complete recanalization (OR = 1.41; 95% CI: 0.91–2.20; p = 0.03), both favoring aspiration over the stent retriever technique. Additionally, first-line aspiration was associated with a significantly lower overall complication rate (OR = 0.58; 95% CI: 0.40–0.85; p = 0.005) and a shorter procedural time (SMD = -0.60; 95% CI: -0.81 to -0.40; p < 0.005). However, there were no statistically significant differences between the two techniques in the first pass effect (OR = 1.41; 95% CI: 0.95–2.09; p = 0.09), the need for rescue therapy (OR = 1.01; 95% CI: 0.71–1.44; p = 0.96), 90-day all-cause mortality (OR = 0.95; 95% CI: 0.71–1.27; p = 0.72), and 90-day favorable functional outcome (OR = 1.17; 95% CI: 0.97–1.41; p = 0.11).

Conclusion:
This meta-analysis suggests that first-line aspiration may offer advantages over stent retrievers for posterior circulation stroke, particularly in terms of recanalization success and procedural safety. However, no significant differences were observed in key clinical outcomes such as mortality and favorable recovery.
Abstract TMP83: Endovascular Therapy Vs. Medical Management In Isolated Posterior Cerebral Artery Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Weighted Study
Authors: Salim Hamza , Koneru Manisha , Pulli Benjamin , Abushehab Nimer , Lakhani Dhairya , Musmar Basel , Faizy Tobias , Heit Jeremy , Wintermark Max , Guenego Adrien , Dmytriw Adam , Yedavalli Vivek
Published: January 2025

Introduction:
Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.

Methods:
This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications.

Results:
A total of 177 patients were analyzed (88 MM and 89 EVT). Baseline characteristics were balanced using Inverse Probability of Treatment Weighting (IPTW). EVT showed a statistically significant improvement in 90-day mRS scores (OR=0.55, 95% CI=0.30 to 1.00, P=0.048), functional independence (OR=2.52, 95% CI=1.02 to 6.20, P=0.045), and a reduction in 90-day mortality (OR=0.12, 95% CI=0.03 to 0.54, P=0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups.

Conclusion:
EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. These findings emphasize on the potential benefits of EVT in this understudied patient group, highlighting the need for randomized controlled trials to further validate these results.
Abstract TMP90: Hidden Challenges: Mental Health Outcomes in Pediatric Stroke Survivors
Authors: Serafini Ludovica , Westmacott Robyn , Crosbie Jennifer , Robertson Amanda , Nichol Daniel , Ertl-Wagner Birgit , Khalvati Farzad , Abdalla Alhusain , Sheng Min , Domi Trish , Dlamini Nomazulu
Published: January 2025

Introduction:
The burden of disease from pediatric arterial ischemic stroke (AIS) includes non-visible disability in the form of mental health conditions such as depression and anxiety which impact the quality of life of children and families affected by stroke.

Objectives:
To determine the scale of the mental health phenomenon in the pediatric AIS population in a large single-center study, and to educate clinicians about this significant risk in pediatric stroke survivors.

Methods:
A retrospective analysis of a prospective single-center cohort of school-aged children diagnosed with AIS, enrolled between 2002 and 2020 was conducted. Depression and anxiety were evaluated with the Behavior Assessment System for Children (BASC, versions 1 and 3). Prevalence and scores for depression and anxiety were ascertained children with AIS and compared with general pediatric population scores. Somatization, a third internalizing subscale in the BASC questionnaire, was also included in the analysis.

Results:
AIS patients (N=161, 98 male; median age and range at stroke 1.9 years [0 – 13.8 years]) were assessed with neuropsychological measures at median age and range 9.1 years (5.6 – 16.7 years). Clinical scores for depression, anxiety and somatization, i.e., T= ≥ 70 in the Depression (mean = 81.0, SD= 8.7), Anxiety (mean= 76.6, SD=8.3) and Somatization (mean= 81.9, SD= 11.0) subscales, were found in 13%, 13.7% and 17.4% of school-age children with AIS respectively, with the median age ranging between 8.5 and 9.6 years,representing the age of greatest vulnerability in our cohort. In AIS patients, mean scores for mood, anxiety and somatization were higher compared to the general pediatric population. Age at stroke in the children within the Somatization Clinical group were older than 2 years age at time of stroke(p=0.034).

Conclusions:
Mental health disorders represent a significant problem in pediatric stroke survivors, with the end of primary school appearing to be the time of greatest vulnerability. These mental health outcomes, (depression, anxiety, somatization) could be associated with age at stroke. The symptoms manifested due to these mental health challenges are frequently overlooked. Therefore, early detection and intervention are essential to change patient trajectories and improve outcomes and quality of life.
Abstract TMP92: Circadian Variability in Pediatric Stroke
Authors: Lee Sarah , Sreekrishnan Anirudh , Mlynash Michael , Balut Fernanda , Pearson Rachel , Harrar Dana , Surtees Taryn , Mailo Janette , Hassanein Sahar , Dlamini Nomazulu
Published: January 2025

Introduction:
Ischemic stroke in adults demonstrates circadian variation in the timing of onset of symptoms, with the highest risk between 6am and noon (1-4). The influence of circadian timing on stroke biology may differ between children and adults, possibly related to the immature circadian system, variations in school versus work schedules, and diverse stroke pathophysiology (5). The goal of our study was to assess whether timing of ischemic stroke onset demonstrates circadian variability in children.

Methods:
We queried the International Pediatric Stroke Study, an international multicenter observational registry of children <18 years with arterial ischemic stroke (AIS). Included patients were aged 29 days-18 years with outpatient AIS and known time of stroke symptom onset. Clinical and radiographic features were compared according to 4 distinct time epochs: 6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening) and 00:00-5:59 (night). Clinical outcomes were defined by the Pediatric Stroke Outcome Measure (PSOM). Baseline, clinical and outcome characteristics were compared between the 4 time epochs using independent samples Kruskal-Wallis and Chi-square tests. Pairwise comparisons were conducted where needed.

Results:
A total of 478 patients met inclusion criteria, 54% male, mean age 9.9±SD 5.7 years. Time of stroke onset by hour is shown in Figure 1. Most strokes occurred in the afternoon (n=185, 38.7%), followed by morning (n=156, 32.6%). Table 1 shows demographic and clinical characteristics by time epoch; clinical and arteriopathy risk factors were more prevalent in nighttime strokes (23/36, 70%, p=0.034). Median PSOM scores at 6 months appeared to be better after evening strokes (0.5, IQR 0-1.5) as compared to morning strokes (1, IQR 0.5-2) and afternoon strokes (1, IQR 0.5-3, p=0.033), but failed adjustment for multiple comparisons (figure 2).

Conclusion:
Circadian influence on stroke timing appears to differ between adults and children. Further prospective studies with larger sample sizes are needed to understand the impact of circadian rhythm on stroke in childhood.
Abstract TMP93: Utility of the MAGIC Flow-Directed Microcatheter for the Management of Pediatric Cerebrovascular Pathology: A 29-Year Single-Center Series
Authors: Philbrick Brandon , Devarajan Alex , Rao Akhil , Monnig Emery , Bazil Maximilian , Jagtiani Pemla , Berenstein Alejandro , Fifi Johanna , Shigematsu Tomoyoshi
Published: January 2025

Introduction:
Flow-directed catheters are popular for their low profile and ease of navigability, making them a favorable option for catheterization of tortuous, small-caliber feeding vessels. These catheters have been FDA-approved for adults, but no catheter has been indicated for pediatric use. However, high-flow pediatric cerebrovascular lesions are often difficult to treat due to their extensive small-caliber arterial supply. As a result, flow-directed microcatheters like the MAGIC (Balt, Montmorency, France) have been used off-label since their introduction to the market. Here, we characterize our longitudinal experience with the MAGIC microcatheter in pediatric neurointervention.

Methods:
A single-center retrospective chart review from 1995 to 2024 identified all patients under the age of 18 with cerebrovascular pathology (dural and pial arteriovenous fistula, Vein of Galen malformation (VOGM), intracranial and extracranial arteriovenous malformation (AVM)) that required treatment with the MAGIC microcatheter. Clinical data, imaging, and procedural parameters including anatomic approach, embolic material used, complications and technical success were reviewed.

Results:
2,172 MAGIC microcatheters were utilized in 923 procedures to treat cerebrovascular pathology in 341 pediatric patients. The median patient age was 3.26 years and patients underwent an average of 2.71 ± 2.31 endovascular procedures requiring the MAGIC. The MAGIC was most frequently navigated in conjunction with a 4F Berenstein guide catheter (60.3%) or a 5F Envoy distal access catheter (24.9%). The most common pathology treated was VOGM (44.4%), followed by intracranial AVM (42.6%). The MAGIC was typically navigated by transarterial approach (97.0%) and was able to successfully catheterize selected pedicles with a 91.4% success rate. The MAGIC was able to successfully embolize in 845 (91.5%) cases: n-BCA was utilized in 96.3% of embolizations. Intraprocedural complications (wire perforation, contrast extravasation, etc.) occurred in 28 (1.3%) catheter uses, of which 5 (0.2%) were catheter-related (retention/rupture).

Conclusion:
We report a large cohort of MAGIC usage in the treatment of pediatric cerebrovascular disease over approximately 3 decades. The MAGIC flow-directed catheter is safe and effective with an important niche in pediatric neurointervention.
Abstract TMP95: Risk Factors, Stroke Characteristics and Outcomes in Children with Inpatient Versus Outpatient Strokes
Authors: Lee Sarah , Teeyagura Prathyusha , Jackson Karla , Gauna Jeilo , Mayne Elizabeth , Cheronis Chrisoula , Lansberg Maarten
Published: January 2025

Children who suffer arterial ischemic stroke (AIS) while hospitalized are often critically ill and may have distinct acute and chronic risk factors, stroke characteristics and outcomes compared to those with outpatient strokes. We sought to evaluate demographic, clinical and imaging profiles of children with inpatient versus outpatient strokes, and compare mortality between the two groups.

Methods:
The Stanford Pediatric Stroke Registry retrospectively and prospectively enrolled children with acute AIS who were admitted to our tertiary care pediatric hospital between 2007-2024. For this analysis we included patients who met the following criteria: 1) age 30 days-18 years old; 2) new diagnosis of AIS; 3) acute neuroimaging available for direct review. Inpatient strokes were defined as strokes that occurred while the child was hospitalized, either at our center or at an outside facility prior to transfer. Demographic, clinical and radiographic data were compared using chi-squared or Fishers Exact test for categorical variables and Mann-Whitney U test or t-test for continuous variables. Outcomes were reported using descriptive statistics due to the hypothesis-generating nature of the report.

Results:
A total of 208 children with acute AIS met inclusion criteria; 99 (47.6%) experienced a stroke while hospitalized. Inpatient stroke patients were overall younger and had higher rates of congenital heart diease and cancer than children with outpatient strokes, while trauma was more common in outpatient strokes (Table 1). There were no significant differences in imaging characteristics between groups. Cardioembolism and periprocedural strokes were more prevalent in inpatient strokes, whereas arteriopathy and cryptogenic stroke were the most common stroke etiologies in outpatients (Table 2). A significantly higher proportion of inpatient stroke patients died compared to outpatient strokes (27.3% vs 3.7%, p<0.0001); most patients died prior to discharge (Table 3).

Conclusions:
In our pediatric AIS cohort, nearly half had a stroke while hospitalized. Our study suggests that stroke and risk factor profiles differ between inpatient and outpatient strokes in multiple domains, and that children with inpatient strokes have higher rates of death. Further prospective studies are needed to determine factors contributing to higher mortality in order to tailor appropriate prevention strategies.
Abstract TP101: Predictors of Stroke Functional Prognosis in Cerebral Amyloid Angiopathy Hospitalized for Rehabilitation
Authors: Tsai Hsin-Hsi , Lin Meng-Ting , Wu Hao-Wei , Wang Yu-Fen , Lai Ting-Ju , Lu You-Lin , Wu Chueh-Hung
Published: January 2025

Background and objective:
Cerebral amyloid angiopathy (CAA) is one of the major causes of intracranial hemorrhage (ICH) and consequent functional impairments in the elderly. Currently, there is a lack of predictors of functional prognosis for CAA patients suffering after lobar ICH event. This study aimed to assess the clinical and neuroimaging factors that can predict functional outcomes in patients survived CAA-related ICH.

Methods:
Conducted as a retrospective cohort study from May 2014 to May 2022, this research included ICH survivors meeting the Boston criteria 2.0 of probable CAA. Rehabilitation metrics and neuroimaging features from MRI, including lobar cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), perivascular spaces of the centrum-semiovale, and white matter hyperintensities (WMHs), were systematically assessed and subjected to analysis. CAA score was computed as a sum of these markers. Prognostic indicators, comprising the modified Rankin Scale (mRS) and Barthel Index at one month after ICH were evaluated. The data were analyzed with generalized linear models and logistic regression to examine the associations between the identified parameters and the prognostic indicators. The incidences of recurrent ICH or mortality within a six-month follow-up window were also assessed using survival analyses.

Results:
A total of 73 patients were included. In the multivariate analysis, predictive factors for higher mRS included impaired initial sitting balance (p<0.001), compromised initial ability to sit up (p<0.001), and higher CAA score (p=0.01) after adjusting covariants for age, sex, antithrombotic use, and pre-morbid mRS. During 6-month follow-up after ICH, a lower CAA score was associated with lower ICH recurrence (p < 0.05), while better sitting balance was associated with lower mortality rate (p < 0.05).

Conclusion:
In patients with CAA-related ICH, compromised sitting ability and higher CAA score predicted unfavorable functional outcomes.
Abstract TP106: Cognitive Impairment in Young Adult Ischaemic Stroke Survivors: a Systematic Review And Meta-analysis
Authors: Kok Charlene , Yeong Nicole , Kwok Gabriel Yi Ren , Sia Ching-Hui , Yeo Leonard , Yq Tan Benjamin
Published: January 2025

Background:
Post-stroke cognitive impairment is especially devastating for young adult patients, who are in their most productive years. Despite its significant impact, this remains under-studied in this growing and clinically distinct patient group.

Methods:
We systematically searched PubMed, Embase, Scopus, and Cochrane CENTRAL for studies including ischemic stroke patients aged 18-50 years from January 2000 to July 2024. This meta-analysis evaluated the pooled prevalence of post-stroke cognitive impairment (CogI) and specific cognitive domains, as well as the associations between baseline characteristics and CogI.

Results:
A total of 4 studies with 1060 patients were included in this systematic review and meta-analysis. Overall, 35.9% (95% CI 27.2-45.5; Figure 1) of patients experienced post-stroke CogI with a mean follow-up time of 11.7 months (95% CI 8.00-15.4). One study was not included in the meta-analysis of proportions of overall cognition as this information was not available. The prevalence for individual domains was: visuospatial construction (23.1%; 95% CI 14.7-34.4), episodic memory (18.5%; 95% CI 9.7- 32.5), delayed memory (16.0%; 95% CI 13.5-18.9), working memory (18.8%; 95%CI 11.8-28.6), and attention (9.3%; 95%CI 3.2-24.0) with a mean follow-up time of 8.11 months (95% CI 3.50-12.7). Male patients had significantly higher odds of CogI (OR 1.58, 95% CI 1.05-2.38, p=0.030; Figure 2). Hypertension, diabetes mellitus, current smoking and dyslipidaemia were not significantly associated with CogI.

Conclusions:
A significant proportion of young adult ischemic stroke survivors experience CogI. Longitudinal prospective cohort studies are needed to better characterise the post-stroke cognitive trajectory in this important group of patients.
Abstract TP108: Virtual Reality Smart Glove May Improve Hand and Arm Function After Stroke
Authors: Yan Ling , Muccini Julie , Lugo Leonel , Mlynash Michael , Michiels Laura , Verheyden Geert , Saenen Leen , Dirlikov Ben , Ali Arshad , Lanphere Julie , Huie Henry , Lemmens Robin , Lansberg Maarten
Published: January 2025

Introduction:
Upper extremity impairment is common after stroke. The Neofect Smart Glove is a novel virtual reality-based portable rehabilitation system that may help restore hand and arm function.

Objective:
To assess the effect of the Smart Glove on functional recovery and total dose of rehabilitation among subacute and chronic stroke patients with upper extremity impairment.

Design:
Multi-center, prospective, randomized, open-label, blinded-endpoint (PROBE) phase 2 trial consisting of a 12-week active treatment period followed by a 12-week follow-up period.

Methods/Interventions:
Patients in the intervention group were instructed to use the Smart Glove for at least one session per day for at least 5 days per week in addition to their usual care during the 12-week active treatment period. Patients in the control group received their usual care only.

Outcomes:
The change from baseline to week 12 in the Jebsen-Taylor Hand Function Test (JTHFT) was the primary efficacy outcome and the change in the Upper Extremity Fugl-Meyer Assessment (UE-FMA) was secondary. Feasibility was assessed by determining the total dose of rehabilitation.

Statistics:
Differences between treatment arms were compared using analysis of covariance (ANCOVA) in the overall population and, separately, in the subset of patients with mild to moderate upper extremity impairment (baseline JTHFT ≤ 500).

Results:
During the 12-week active treatment period, there were no differences between the intervention (n = 18) and control (n = 24) groups in the change in the JTHFT (median -64 vs. -69 sec,
P
= 0.88), the change in the UE-FMA (median 8 vs. 8 points,
P
= 0.61), or the total dose of rehabilitation (median 1434 vs. 584 min,
P
= 0.18) (Figure 1). Among the subset of patients with mild to moderate symptoms (baseline JTHFT ≤ 500, n = 31), Smart Glove assignment was associated with a greater improvement in the JTHFT (median -72 vs. -40 sec,
P
= 0.01) and a greater dose of rehabilitation (median 1739 vs. 510 min,
P
= 0.04) during the active treatment period (Figure 2). There was a trend toward a greater improvement in the UE-FMA (median 10 vs. 8 points,
P
= 0.15).

Conclusion:
While the trial did not show a benefit in the overall study population, Smart Glove use was associated with enhanced recovery of hand and arm function and a higher dose of rehabilitation among patients with mild to moderate upper extremity impairment, suggesting that the Smart Glove may be an effective treatment in this population.
Abstract TP117: Efficacy And Safety Of Ambulance-Based Prehospital Transdermal Glyceryl Trinitrate In Patients With Acute Presumed Stroke. A Meta-Analysis Of Randomized Controlled Trials.
Authors: OBI OGECHUKWU , Cavalcante Deivyd , Nweze Uchenna , Asonye Patricia , Ariahu Nonso , Lee Timothy
Published: January 2025

Background:
Uncontrolled high blood pressure is a risk factor for acute stroke and a predictor of poor stroke outcomes. Less is known about the efficacy and safety of early ambulance-delivered blood pressure reduction on clinical and functional outcomes in patients with undifferentiated acute stroke.

Methods:
PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials that compared intervention (with glyceryl trinitrate) to usual blood pressure care or sham in patients with undifferentiated acute stroke; the outcomes of day 90 modified Rankin scale (mRS) maximum score of 6, EuroQol-5D score, National Institutes of Health Stroke Scale (NIHSS ) score at hospital admission, death within 90 days, Barthel index at 90 days, and home time. Heterogeneity was examined using I
2
statistics.

Results:
We included 3 RCTs with 3547 Patients, of whom 388 received intervention with glyceryl trinitrate. The pooled results of the included 3 RCTs comparing Intervention with glyceryl trinitrate to usual care or sham treatment showed that the death within 90 days (21.9% vs 21.1% respectively; OR = 1.05; 95% CI [0.89, 1.24]; I
2
= 0%; p = 0.546), EuroQol-5D-5L score (MD = -0.00; 95% CI [-0.03, 0.03]; I
2
= 0%; p = 0.98), NIHSS score at hospital admission (MD = 0.18; 95% CI [-0.70, 1.06]; I
2
= 0%; p = 0.69), day 90 mRS maximum score at 6 (MD = 0.01; 95% CI [-0.25, 0.27]; I
2
= 0%; p = 0.94), NIHSS score at 24 hours (MD = 0.56; 95% CI [-0.16, 1.27]; I
2
= 0%; p = 0.13), Barthel index at 90 days (MD = -2.56; 95% CI [-7.90, 2.78]; I
2
= 0%; p = 0.35), and home time (MD = 0.22 days; 95% CI [-5.02, 5.46]; I
2
= 0%; p = 0.93) were not statistically different between the intervention and the usual care groups.

Conclusion:
These findings suggest that early ambulance-delivered blood pressure reduction does not have superior efficacy and safety profiles for clinical and functional outcomes compared with usual care or sham treatment in patients with undifferentiated acute stroke.