bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract HUP6: Area Deprivation Index Associated with Time to Presentation in Acute Ischemic Stroke and Eligibility for Standard Window versus Late Presenter Thrombolysis
Authors: Fritsche Colette , Corlin Laura , Leung Lester
Published: January 2025

Introduction:
Prior studies have demonstrated social determinants of health (SDoH) are associated with reduced rates of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), including in disadvantaged populations. Mechanisms of disparity may include financial/resource limitations and systemic bias. Neighborhood measures of socioeconomic status are predictors of interest in stroke research, as they may influence emergency response, transportation, and health seeking behaviors. We sought to identify SDoH factors influencing time to presentation for AIS.

Methods:
This is a retrospective cohort study of 432 patients ages ≥18 presenting to Tufts comprehensive stroke center with AIS and last known well (LKW) <24hrs from arrival, from 1/1/20-12/31/22. IVT was offered in the standard 0-4.5hr window and 4.5-24hrs through Tufts Late Presenter Thrombolysis protocol. Data were collected from the EHR including demographics, stroke severity, IVT, insurance, and zip codes to obtain Gini coefficient (national inequality) and Area Deprivation Index (ADI, state deciles, dichotomized as low, 1-5, and high, 6-10). Multivariable logistic regression assessed predictors of time to presentation among all patients who presented within 24hrs of LKW. A sensitivity analysis assessed predictors among a subgroup of patients who received IVT. All analyses were performed using RStudio 1.2.1335.

Results:
In an unadjusted analysis, high ADI was associated with increased odds of presenting late [OR 1.62, CI 1.06-2.56]. In an adjusted analysis including demographics and stroke severity, high ADI was similarly associated with increased odds of presenting late [OR 1.65, CI 1.05-2.61]. A second model including Gini demonstrated a similar association for ADI and late presentation [OR 1.67, CI 1.07-2.66]. In an adjusted sensitivity analysis of patients receiving IVT, high ADI was strongly associated with presentation in the later time window [OR 2.67, CI 1.03-7.22].

Conclusions:
Among patients presenting within 24hrs with AIS, individuals living in neighborhoods with greater socioeconomic disadvantage are more likely to present outside the standard time window for thrombolysis. High ADI being associated with late presentation indicates socioeconomic factors prohibit patients in these areas from accessing definitive emergency healthcare services in a timely manner after AIS. Protocols to treat patients outside the standard time window may help mitigate disparities in thrombolysis treatment rates.
Abstract HUP7: Development of a Specific Stroke Awareness Tool for the Haitian Community
Authors: Charles Jude , Sewart Leila , Gay emmanuel , Ancheta Selina , Spence Karelle , Gutierrez Carolina , Butler Valynncea , Marulanda Erika , Sur Nicole , Asdaghi Negar , Gardener Hannah , Rundek Tatjana , Romano Jose , Gordon Perue Gillian
Published: January 2025

Background:
Race-ethnic disparities in stroke care and clinical outcomes exist and may be driven by delayed symptom recognition which in turn limits access to time sensitive treatments. Current stroke awareness tools exist in English and Spanish in the USA, but none target the large Haitian population living in the United States. To address this gap in community outreach and stroke awareness education, the Florida Stroke Registry (FSR) collaborated with its Haitian stakeholders to develop a Haitian Creole specific stroke awareness tool.

Methods:
The BE-FAST (Balance, Eyes, Face, Arm, Speech, Time) acronym is a recognized stroke awareness tool which is linked to earlier patient arrival times at hospital and better treatment outcomes. We report on the methodology for creating a Haitian Creole specific stroke awareness tool through multiple iterations and feedback from the FSR stakeholders: FEL VIT and FE VIT. The FSR Education Core collected feedback from FSR stakeholders and community partners fluent in Haitian Creole to determine which of the two translations was most suited for the Haitian Creole speaking community in Florida.

Results:
A total of 46 healthcare professionals participated in the survey, 93% of whom agreed that translating the BE-FAST acronym to Haitian Creole would be a useful and important tool to increase stroke awareness in their organizations and community. FEL VIT: FIGI (face) EKILIB (equilibrium), LANGAJ (language/speech), VIZYON (vision/eye), IMOBILITE (paralysis/immobility) and TAN/TELEFON (time/call), was identified as the more effective translation of BE-FAST (43% vs 31% FE VIT p=0.37) and best conveyed the message of presenting to a hospital quickly once symptoms of stroke are recognized (48% vs. 28% p=0.035).

Conclusions:
Through an interdisciplinary and diverse Florida Stroke Registry stakeholder membership, we have successfully translated the BE-FAST acronym into a Haitian Creole tool termed FEL VIT. Future directions will measure the impact of this tool on the Haitian Creole speaking community in Florida.
Abstract HUP9: Framing a Complex Multilevel Blood Pressure Intervention after Stroke or Myocardial Infarction
Authors: Scott Lisa , Akhavan Setareh , Ayala-Rivera Monica , Casillas Alejandra , Morales Maria G , Ruiz Dania , Ow Garrett , Chen Steven , Lian Kendra , Mittman Brian , Towfighi Amytis
Published: January 2025

Background:
Blood pressure (BP) management is crucial for secondary prevention of stroke and myocardial infarction (MI); however, optimal BP control remains a challenge, particularly among historically disenfranchised populations. Effective interventions must address both medical and social determinants of health. BP-REACH (Blood Pressure disparities Reduction, Equity, and Access among safety net patients with Cardiovascular Health risk) is an RCT of a complex, individualized, multilevel team-based intervention to improve BP control after stroke or MI in a safety net public healthcare system. Pharmacists prescribe and titrate medications while community health worker (CHW) health coaches use motivational interviewing to collaboratively discern and address barriers with participants. Since the intervention is complex and individualized, it is crucial to frame it in a way that fidelity and tailoring can be assessed.

Methods:
We used a form and function method which has been used to frame other complex multilevel interventions. We identified key domains (overall goals of intervention), motivating needs (importance of targeting each domain), functions (methods for addressing motivating needs), and forms (tools, resources, methods for accomplishing each function).

Results:
Core functions included patient education and health literacy; ensuring evidence-based prescribing and titration of medications; exploring and addressing barriers to medication adherence and lifestyle change; enhancing digital health literacy; improving care coordination, and optimizing self-management skills. Forms included pharmacist management of BP medications; CHW health coaching calls; motivational interviewing; resource navigation; culturally tailored educational handouts and videos; self-management tools and coaching; and patient narrative videos. Figures 1-3 depict examples of domains, motivating needs, core functions, and their menus of forms.

Conclusion:
A form and function model is a useful tool to describe, analyze, and interpret complex interventions. Once the study is complete, the coaches and participants will be surveyed to determine the fidelity to functions and the adaptations and tailoring of forms in order to determine which were the most useful. This will be helpful for dissemination.
Abstract NS6: Relationship Between Social Determinants Of Health And Stroke Awareness In Sunset Park
Authors: Marmo Joanna , Zavotsky Kathleen , Coughlin Vincenza , Bass Benjamin
Published: January 2025

Background:
While overall death rates of stroke have decreased, minority populations continue to experience an increase in stroke related death. There are known sociodemographic variations in stroke awareness. The lowest reported knowledge of stroke signs is within the Hispanic (58%) communities, trailing behind the Black (64%) and white (71%) communities. Understanding the relationship between social determinants of health (SDoH) and stroke awareness may help bridge the gap between minority populations and stroke care.

Purpose:
The purpose of this study is to determine if relationships exist between SDoH and stroke awareness and severity in Brooklyn, New York.

Methods:
An exploratory descriptive retrospective secondary analysis was completed; examining data from patients discharged from a hospital in Brooklyn, New York. 1162 patients discharged with a diagnosis of stroke from January 2021 to July 2023 were included. Data was gathered from the Get With The Guidelines. Data included: demographics, arrival method, initial NIHSS score, symptom discovery time, arrival time, and discharge NIHSS score. Data was analyzed to determine if relationships exist between SDoH and stroke awareness.

Results:
There is a significant difference in timeliness to seek care based on race and ethnicity. After controlling for age, gender, zip code, and insurance type, Hispanic patients take three times as long to seek care, while Black patients take twice as long, and Asian patients take one time as long, compared to their white non-Hispanic counterparts. Payer status and race influence severity as evidenced by a significant difference in NIHSS, with Asian and public insurance patients having a higher NIHSS on arrival when compared to white non-Hispanic patients and those with private insurance. Lastly, a patient’s choice of transportation may be influenced by age and payer status, with those under 65 and/or with private insurance less likely to call an ambulance.

Conclusions:
This study highlights the importance of providing culturally and linguistically tailored education to populations in need. Using the findings of this study, the stroke program coordinator can provide targeted education rather than generalized education. This study supports the need for community-informed care for stroke patients, focused on increasing stroke awareness in minority populations. This study may act as a blueprint for stroke programs by providing a guide for planning community-centered education.
Abstract TMP1: Identification of True Biomarkers for Unruptured Cerebral Aneurysms through Revisiting Cerebral Aneurysm Transcriptomes
Authors: Chen Yi-Wei , Chien Aichi
Published: January 2025

A cerebral aneurysm (CA) is an abnormal artery deformation in the brain that may lead to hemorrhagic stroke, brain damage, coma, and even death when a CA ruptures. Studies have searched for biomarkers for CA to provide early and easy diagnosis of unruptured CA through blood transcriptome analysis; however, biomarkers from individual studies cannot be validated across studies due to sample size. We hypothesized that increasing CA sample size will allow more robust biomarker identification. We revisited unruptured CA transcriptomes, pooling 3 datasets from 6 manuscripts published between 2016 and 2021 for a total of 100 samples (38 normal and 62 unruptured CA). Reanalysis of the differentially expressed genes (DEGs) in the pooled transcriptomes filtered 603 genes from 39,376 (~1.5%) which showed a significant difference (p<0.05) and more than a 4-fold change in DEG (
Image 1
). Gene Set Analysis (GSA) for gene clustering, REACTOME for pathway enrichment, and STRING for hub gene networks were then applied to identify significantly altered pathways of filtered genes. In GSA, neuroactive ligand-receptor interaction (hsa04080), calcium signaling pathway (hsa04020), metabolic pathways (hsa01100), and diabetic cardiomyopathy (hsa05415) were the most enriched pathways in unruptured CA. REACTOME analysis identified peptide ligand-binding receptors (HSA375276) and 4 other GPCR-associated pathways (HSA373076, HSA388396, HSA372790, HSA500792) related to hsa04020, and cardiac conduction (HSA5576891) and 2 other associated pathways (HSA397014, HSA382551) related to hsa04020 (
Image 2
). STRING functional protein analysis highlighted as the hub genes networking to other genes: NTS (gut/brain regulatory peptide neurotensin), CDX2 (regulator involved in development, inflammation, and oncogenesis), ATGR1 (vasopressor hormone Angiotensin II), CASQ2 (calcium-binding cardiac muscle family member calsequestrin) (
Image 3
). Significantly, all these hub genes are known to participate in the above pathways. Finally, the expression levels of filtered genes were validated using another unruptured CA dataset from NCBI. 76.5% of the highly expressed protein-coding genes showed the same trend in validation and were confirmed as unruptured CA biomarkers. Intriguingly, only 7 of 141 previously claimed biomarkers were identified in this study. Overall, this study sheds light on discovering a more realistic set of biomarkers in unruptured CA and benefits the development of CA pre-diagnosis.
Abstract TMP18: Establishing Aggressive Time Targets for the Identification and Treatment of Intracerebral Hemorrhage Improves Patient Outcomes
Authors: Straube Garrett
Published: January 2025

Background and Issues:
Timely identification and intervention are critical for positive outcomes in acute intracerebral hemorrhage (ICH) patients. The 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association states that we should control blood pressure, reverse anticoagulation, and get the patient to a specialized inpatient stroke unit. Unlike multiple clearly defined target goals for ischemic stroke, there are no established measurable goals for ICH. The absence of specific target times for ICH leads to delays in identification and treatment, resulting in poor outcomes.

Purpose:
This project aimed to rapidly identify and aggressively manage ICH patients with clearly defined treatment times to reduce mortality and 30 day readmissions.

Methods:
The implementation of measurable goals for ICH in the Emergency Department (ED) was an approach to improve ICH patient outcomes by facilitating faster identification and treatment. The stroke team reviewed existing performance data and outcomes to determine reasonable times for completing the following interventions: Cat Scan imaging within 30 minutes of being ordered, blood pressure medications given within 30 minutes of diagnosis, reversing anticoagulation within 45 minutes of diagnosis, and moving patients to the Neuro ICU within 90 minutes of diagnosis. The ED team was educated on the new performance goals. The stroke team collected, analyzed, and reported the performance metrics of the ED team throughout implementation. Outcomes were measured using data for when the goals were being met versus not being met.

Results:
Outcomes were measured from 111 ICH patients from 2022-2023. When treatment time goals were not met, the mortality rate for ICH patients was 18.42% with an observed/expected (O/E) ratio of 1.25. The 30 day readmission rate was 12.9%. When treatment goals were met, the mortality rate decreased to 12.68% with an O/E ratio of 0.86. 30 day readmission rate dropped to 3.23%

Conclusions:
Having measurable goals for ICH has demonstrated a significant improvement in outcomes. Establishing clear time targets for getting imaging, initiating blood pressure control, reversing anticoagulation, and admission to Neuro ICU led to a reduction in mortality and 30 day readmissions. It is recommended to use clearly defined time goals to ensure prompt intervention and improved prognosis for patients with ICH.
Abstract TMP2: Flow diversion treatments for unruptured intracranial aneurysms: real-world perioperative outcomes, hospital readmissions, and impact of comorbid anxiety and mood disorders
Authors: Chen Huanwen , Khunte Mihir , Njonkou Tchoquessi Rosy Linda , miller tim , Cherian Jacob , Majmundar Shyam , Colasurdo Marco , Malhotra Ajay , Gandhi Dheeraj
Published: January 2025

Introduction:
Flow diversion (FD) is a minimally invasive treatment for unruptured intracranial aneurysms (UIA) and is often preferred over open cerebrovascular surgery; however, FD patients are at risk of post-procedural stroke and hemorrhage. Furthermore, UIA patients often have comorbid anxiety and mood disorders (AMD); whether these patients are at increased risk of adverse outcomes following FD is unclear.

Methods:
This was a retrospective analysis of the 2020-21 National Readmissions Database (NRD) in the United States. Patients who underwent elective FD placement were identified. Initial hospitalization outcomes were assessed. Patients who had an uncomplicated FD placement were followed for the calendar year for non-elective hospital readmissions. Risks of readmission for patients with and without baseline AMD were compared using Cox regression models adjusting for major confounders.

Results:
9,523 elective FD patients were identified, of whom 243 (2.6%) and 314 (3.3%) suffered perioperative stroke and intracranial hemorrhage (ICH), respectively, and 2,800 (29.4%) had baseline AMD. Six-month readmission rate for any reason, stroke or hemorrhage, and major stroke or hemorrhage (that led to patient morbidity or mortality) were 6.9%, 3.9%, and 1.8%, respectively (Figure 1). Patients with baseline AMD had a significantly higher risk of overall hospital readmissions than those without (adjusted hazards ratio 1.48 [95%CI 1.14 to 1.93], p=0.003; Figure 2). Further analyses revealed that patients with baseline AMD did not have a higher risk of any stroke or hemorrhage confirmed during readmissions (HR 1.25 [95%CI 0.78-2.00], p=0.36; Figure 3), but they did have a significantly higher risk of readmissions without confirmed stroke or hemorrhage (HR 1.72 [95%CI 1.18 to 2.51], p=0.005; Figure 3). Among readmitted AMD patients without confirmed stroke or hemorrhage, 15.4% suffered short-term morbidity, which incurred a median cost of $11,725 USD per patient.

Conclusions:
In routine United States clinical practice, the perioperative risks of stroke and ICH for FD patients were 2.6% and 3.3% respectively, and the risk major stroke or hemorrhage within 6 months after hospital discharge was 1.8%. Baseline AMD was associated with a significantly increased risk of hospital readmissions without confirmed stroke or hemorrhage, highlighting the need for a better understanding of how comorbid AMD may impact patient outcomes following FD.
Abstract TMP30: Combining the Los Angeles Motor Scale and the Muse Portable Electroencephalography System Improves the Accuracy of Large Vessel Occlusion Detection in Acute Stroke Syndrome.
Authors: Kate Mahesh , Thangeswaran Jeyaram , Duba Geetha Charan , Ishaque Noman , Thirunavukkarasu Sibi , Wilkinson Cassandra , Mathewson Kyle , Buck Brian
Published: January 2025

Background:
The prehospital scales have been developed to identify stroke patients with large vessel occlusion (LVO) to facilitate rapid transport to appropriate stroke centres. In practice, these stroke scales have moderate accuracy. There is a pressing need for adjunct easy-to-use and interpret diagnostic devices to improve prehospital stroke diagnosis and LVO detection. We aim to determine whether a machine learning algorithm using adjunct electroencephalography (EEG) Spectra can improve the accuracy of LVO detection

Methods:
Adult patients with suspected acute stroke were prospectively enrolled as soon as possible on arrival at the emergency department. A wearable Muse
TM
headband (InteraXon Inc, Canada) with an embedded 4-channel EEG was used for a resting 3-minute recording. EEG Spectra including relative alpha, beta, theta and delta spectral powers, delta-alpha ratio (DAR) and pairwise-derived brain symmetry indices (pdBSI) were calculated. These indices were compared between patients with LVO and non-LVO groups. The accuracy of LVO detection was tested with the aid of supervised machine learning(ML) algorithms including EEG Spectra, Los Angeles Motor Stroke Scale (LAMS), sex and side of stroke.

Results:
A total of 142 patients were included in the analysis with a mean age of 69.6±13.7 years, 60(42.2%) females, (Stroke Subtype:113[79.6%] were ischemic stroke, 22[15.5%] stroke mimics, 7[4.9%] intracerebral hemorrhage) and median NIHSS 5(2-11). Thirty-seven(26.1%) patients had LVO and EEG was acquired at a median of 6h 45m (3h 29m - 14h 15m) after symptom onset. Relative alpha spectral power was lower in both affected (p<0.0001) and unaffected hemispheres (p<0.0001) in the LVO group (Figure 1); there was no difference in the median affected hemisphere DAR (p=0.4). However, the median unaffected hemisphere DAR was higher in the LVO group compared to the no-LVO group (p=0.03) (Figure 2). The Support vector machine-based ML algorithm accuracy for detecting LVO was: 0.6 for clinical assessment (LAMS+ Side of deficit+ Sex) alone, 0.73 for EEG Spectra alone and 0.93 for clinical assessment + EEG Spectra (0.9 Sensitivity; 0.95, Positive Predictive value)

Conclusion:
Combining QEEG with clinical assessment significantly improves the overall accuracy of LVO detection versus LAMS alone in patients presenting with acute stroke syndrome. Future studies are ongoing to determine if a short EEG acquisition in the prehospital phase is useful for rapid triage.
Abstract TMP32: Use of Aspirin-Ticagrelor after Moderate Ischemic Stroke in Get With The Guidelines-Stroke
Authors: Liberman Ava , Zhang Cenai , Kamel Hooman , Navi Babak , Rostanski Sara , White Halina , Xian Ying
Published: January 2025

Introduction:
Facilitating evidence-based uptake of new medication regimens for disease prevention is a well-recognized public health challenge. Using data from GWTG-Stroke, researchers previously reported that, after minor ischemic stroke (NIHSS 0-3), the use of aspirin-clopidogrel for stroke prevention is highly variable despite guideline recommendations. We sought to explore potential changes in dual antiplatelet therapy (DAPT) use in patients with moderate ischemic stroke (NIHSS 4-5) after the publication of the THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial in 2020.

Methods:
We used the GWTG-Stroke registry to describe patterns of DAPT use in the U.S. from 2019 to 2023. All patients with a final diagnosis of ischemic stroke, NIHSS 4-5, hospital arrival within 24 hours, who lacked an indication for anticoagulation (e.g., atrial fibrillation) and were not treated with thrombolysis/thrombectomy were included in our study. Patients with NIHSS 4-5 (moderate stroke) were not included in prior randomized controlled trials of aspirin-clopidogrel for short-term stroke prevention but were included in THALES. We reported basic demographic features of our cohort and used the Cochran-Armitage trend test to report changes in aspirin-ticagrelor use by year.

Results:
We identified a total of 40,624 acute ischemic stroke patients with NIHSS 4-5 during the study period. The mean age was 68 years and 47% of patients were women. We found that a total of 20,293 (50%) patients were discharged on aspirin-clopidogrel whereas 1,335 (3.5%) were discharged on aspirin-ticagrelor. The use of both DAPT regimens significantly increased over time (Figure 1, p<0.001 for trend).

Conclusion:
Among patients hospitalized with moderate ischemic stroke at centers participating in GWTG-Stroke, about 50% were discharged on aspirin-clopidogrel, while aspirin-ticagrelor use steadily increased from 0% in 2019 to 3.8% in 2023.
Abstract TMP35: Comparative Effect of Tirofiban vs Dual Antiplatelet Therapy or Aspirin Alone on Neurological Deterioration in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis
Authors: Oliveira Mariana , Jesus Ana Carolina , Moro Izabela , Pinto Manoela , Leite Fatima , Queiroz Ivo , Ferreira Marcio
Published: January 2025

Introduction:
Studies have suggested efficacy of glycoprotein IIb/IIIa antagonists such as tirofiban for patients with acute ischemic stroke (AIS). However, neurological deterioration is still common in many of the recommended antiplatelet regimens. We aimed to evaluate the efficacy and safety of tirofiban versus dual antiplatelet therapy (DAPT) or aspirin in patients with AIS.

Methods:
Following PRISMA guidelines, we searched Pubmed, Embase, Scopus and Cochrane databases for studies comparing effects of tirofiban versus DAPT or aspirin alone in patients with AIS. Main outcomes were increase in NIHSS score, Modified Rankin Scale (mRS) scores at 90 days (0 to 2), intracranial hemorrhage (ICH) and mortality. Statistics analysis was performed using Review Manager 5.4.1 software. Heterogeneity was assessed with I
2
statistics.

Results:
We included 5 RCT and 5 non-RCT studies covering 1,857 patients, of whom 926 were treated with Tirofiban. Neurological deterioration, assessed by changes in NIHSS scores from baseline across four studies, was less pronounced in the Tirofiban group (MD -0.32; 9% CI -0.83-0.19; p<0.05, I
2
=52%). MrS scores at 90 days (0 to 2) analysis favored DAPT/aspirin group (OR 1.56; 95% CI 1.11-2.18; p<0.05; I
2
=33%). Outcomes of ICH (OR 0.90; 95% CI 0.53-1.52; p=0.69; I
2
=0%) and mortality (OR 0.74; 95% CI 0.39-1.41; p=0.36; I
2
=5%) were both not statistically significant.

Conclusion:
This systematic review and meta-analysis identified better effects on neurological deterioration in Tirofiban group and better mRS scores in DAPT/aspirin group, but no significant differences in other outcomes. Benefits of Tirofiban in patients with AIS are still inconclusive, requiring more studies to evaluate its efficacy and safety.
Abstract TMP45: To Walk-in or Not to Walk-in: A Tale of Two Regions on ED Arrival Mode Among Acute Stroke Patients
Authors: Nguyen-Huynh Mai , Alexander Janet , Sax Dana , Rho Howard , Ly An , Ghai Nirupa , Zrelak Patricia , Burnett Molly , Sangha Navi
Published: January 2025

Background:
Prior studies reported only half of stroke patients arrived at emergency departments (ED) via emergency medical services (EMS). Some studies found EMS arrival to be associated with more rapid evaluation and treatment which have been shown to be associated with better outcomes. We sought to explore ED modes of arrival for potential acute stroke patients in two large racial-ethnically diverse regional cohorts in California.

Methods:
Kaiser Permanente Northern California (KPNC) consists of 21 certified stroke centers, and Kaiser Permanente Southern California (KPSC) have 15 certified centers. Both regions have standardized Telestroke programs for all stroke centers to include video evaluation by a teleneurologist. From 1/1/2016 to 12/31/2022, the KPNC study cohort included all non-cancelled stroke alerts who were potential candidates for further workup for acute ischemic stroke treatment. Non-cancelled group was approximately 45% of the total stroke alert volume in the KPNC region. During the same period, KPSC study cohort included all stroke alerts who were evaluated by Telestroke for possible acute stroke. KPSC did not use a cancel-versus-non-cancel system. Assessment included demographics, ED mode of arrival, and neighborhood deprivation index (NDI).

Results:
During the study period, there were 17,437 patients from KPNC and 41,466 patients from KPSC yielding a combined total of 58,903 adults evaluated by Telestroke neurologists for possible acute stroke at 36 stroke centers in California. Overall, 31,533 (53.5%) arrived via walk-in rather than EMS. However, in Southern CA, patients were more likely on average, to arrive as walk-in (67.7%) compared to Northern CA (19.8%). Range of walk-in for KPNC facilities was 11% to 38.5%, and 34% to 86.1% for KPSC centers [Figure]. Patients who presented as walk-in tended to be younger and more Hispanic. Those from more impoverished communities presented via EMS more often than via walk-in [Table].

Conclusions:
In our combined cohort, there were several differences between walk-in patients and those who arrived via EMS. There was notable variation in ED arrival mode by facility and stark contrast between the two regions in California. Further research is needed to understand these differences and whether they are associated with outcomes, and to identify potential targets for future interventions to improve acute stroke care delivery for walk-in patients.
Abstract TMP46: Comparison of Local and Centrally Adjudicated Modified Rankin Scores in the MOST Trial
Authors: Shawkat Adham , Barreto Andrew , Broderick Joseph , Derdeyn Colin , Elm Jordan , Grotta James , Ingles James , Pizzella Stephanie , Rines Ian , ROY AKASH , Wilson Alastair , Adeoye Opeolu
Published: January 2025

Background:
The modified Rankin Scale (mRS) is a key measure of functional outcomes in stroke trials. To minimize variability and uphold trial integrity, structured tools like the Rankin Focused Assessment (RFA) and central adjudication are recommended. This study compares local versus centrally adjudicated mRS scores in the Multi-arm Optimization of Stroke Thrombolysis (MOST) trial.

Methods:
MOST was a Phase 3, single-blind trial evaluating argatroban, eptifibatide, or placebo in addition to standard IV thrombolysis. The primary outcome, the 90-day mRS score, was gathered through in-person video recordings by blinded local personnel. The RFA was encouraged and recordings were sent to central adjudicators for final scoring. During the trial, in-person visits became limited due to the SARS-CoV-2 pandemic; thus, remote telephone or video interviews were allowed. We hypothesized that local mRS scores would be moderately associated with central scores, with no trial outcome differences between local and central mRS. Fleiss-Cohen’s quadratic weighted kappa statistics were used to determine the strength of agreement between local and central scores, as well as by assessment mode, RFA usage, and baseline mRS scores.

Results:
Out of 514 enrolled subjects, 386 subjects had recorded 90-day visits available; 57 died, 8 withdrew consent, 1 terminated early, 26 were lost to follow-up, 33 lacked recorded video/audio, and 3 recordings could not be scored. Of the 386, 122 were in-person video, 157 remote video, and 101 remote audio-only (Table 1). Local assessors were blinded 97.3% of the time and 85.4% of visits used the RFA (Table 2). Overall agreement between local and central mRS scores was very good (weighted Kappa 0.86, 95% CI: 0.82-0.90). However, strength of agreement decreases for those with a baseline mRS greater than zero, (baseline mRS=0: 0.87, 95% CI: 0.83-0.90 versus baseline mRS≠0: 0.80, 95% CI: 0.68-0.91). Agreement by mode of assessment was 0.87 (95% CI: 0.81-0.92) for in-person video, 0.87 (95% CI: 0.82-0.92) for remote video, and 0.86 (95% CI: 0.76-0.95) for remote audio. Trial outcomes were unchanged when utilizing the local mRS versus central adjudication.

Conclusion:
Local mRS scores demonstrated strong agreement with central scores across all assessment modes (in-person video, remote video and audio). Caution remains necessary in patients whose baseline mRS is not zero. Central mRS adjudication in acute stroke clinical trials may not be necessary.
Abstract TMP48: Racial, Ethnic and Rural Disparities in Access to Acute Stroke Capabilities Persist even with Telestroke
Authors: Zachrison Kori , Hsia Renee , Boggs Krislyn , Gao Jingya , Messac Luke , Schwamm Lee , Reeves Mathew , Fung Vicki , Samuels-Kalow Margaret , Camargo Carlos
Published: January 2025

Background:
Telestroke may mitigate racial/ethnic and rural disparities in access to acute stroke expertise. Objective: to examine the relationship between patient race/ethnicity and presentation to an emergency department (ED) with acute stroke capabilities, including telestroke, and whether this varied by rurality.

Methods:
Data maintained by the California Department of Health Care Access and Information identified all statewide acute stroke encounters in 2021. ED capabilities were from the 2021 National ED Inventory-USA database (e.g., telestroke capability). ED acute stroke capabilities were defined as any stroke center status (including acute stroke ready hospital or equivalent) or telestroke capability. Logistic regression models examined the association between patient race/ethnicity, rurality and presentation to an ED with acute stroke capabilities, accounting for age, sex, and expected payer, overall and stratified by rurality. Our first outcome of interest was presentation to an ED with any stroke center status. Then, to examine whether access improved with inclusion of telestroke, the outcome included presentation to an ED with any stroke center status or telestroke capability.

Results:
In 2021, 264 of 325 California EDs (81%) had acute stroke capabilities, 52% with telestroke (with or without stroke center status). Of 63,252 encounters, 2,050 (3%) presented to an ED without capabilities. Overall, Hispanic, non-Hispanic patients of non-White race and rural patients had lower odds of access to acute stroke capabilities (Table 1). Odds of access did not improve with inclusion of EDs with telestroke (Table 1). When stratified by rurality, there were no differences in access by race/ethnicity for rural patients, but urban Hispanic, urban non-Hispanic Black and urban non-Hispanic patients of other race had lower odds of access relative to urban non-Hispanic White patients (Table 2).

Conclusions:
Most California EDs have acute stroke capabilities, with few patients presenting to non-capable centers. Overall, rural patients had lower odds of presenting to an ED with capabilities. Racial/ethnic disparities in access were distinct between urban and rural settings, with no racial/ethnic disparity among rural patients but lower odds of access for Hispanic and non-white urban patients. The inclusion of ED telestroke capability in the definition of acute stroke capabilities did not mitigate disparities in access.
Abstract TMP6: Intra-arterial Lidocaine Administration of Lidocaine in Middle Meningeal Artery for Treatment of Subarachnoid Hemorrhage-Related Headaches
Authors: Qureshi Adnan , Bains Navpreet , Bhatti Ibrahim , Jani Vishal , Suri Fareed , Bhogal Paul
Published: January 2025

Background and Purpose:
We report short- and intermediate-term effects on headaches with intra-arterial injection of lidocaine in the middle meningeal artery in patients with severe headaches associated with subarachnoid hemorrhage.

Methods:
We treated 7 patients with intra-arterial lidocaine in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). We recorded the maximum intensity of headache (graded by 11-point numeric rating scale) prior to procedure and every day for the next 10 days or discharge, whichever came first. We identified changes in the middle meningeal artery pre- and post-intra-arterial lidocaine administration and quantified from Grade 0 (no change) to Grade 5 (severe narrowing or near occlusion of anterior and posterior dural branches or proximal middle meningeal artery that precludes adequate imaging of distal branches).

Results:
We observed improvement in severity of headaches of headache in all 7 subarachnoid hemorrhage patients. The resolution of headache was immediate and complete in 4 patients, unilateral immediate resolution in one patient, and delayed complete resolution in patient. Only one patient met the definition of severe headache (defined as 2 or more days with maximum pain scores of 8 or greater or need for 3 or more different analgesics for 2 or more days) post treatment on Days 4 and 5. One patient had a relapse in headache with the severity matching pre-treatment severity and required a second treatment. On analysis of angiographic data, there was consistent narrowing of middle meningeal arteries after administration of intra-arterial lidocaine and was graded as 5 in 2 arteries, 4 in 10 arteries, and 3 in 2 arteries.

Conclusions:
We found that intra-arterial injection of lidocaine can result in consistent amelioration of headache in patients with subarachnoid hemorrhage. The therapeutic benefit may be related to vasoconstriction (reversal of vasodilation) in the middle meningeal arteries after administration of lidocaine.
Abstract TMP72: Lower High-Density Lipoprotein Cholesterol Level Is Associated With Hematoma Expansion Following Acute Intracerebral Hemorrhage
Authors: Sato Takeo , Tsuchimochi Yuka , Hamada Yuki , Kawabata Yutaro , Iwamoto Kana , Takaguchi Go , Matsuoka Hideki
Published: January 2025

Background&Aims:
A certain lipoprotein, especially lower low-density lipoprotein cholesterol (LDL-C), has been said to be a risk of developing intracerebral hemorrhage (ICH). However, the correlation between lipoprotein levels and hematoma expansion (HE) following ICH remains unknown. We aimed to elucidate the relation between LDL-C and high-density lipoprotein cholesterol (HDL-C) levels and HE following acute ICH.

Methods:
Consecutive patients with acute ICH admitted between July 2012 and November 2023 were retrospectively screened using Kagoshima Medical Center Stroke Database. The inclusion criteria were as follows: 1) onset to door time within 7 days; 2) availability of serum LDL-C and HDL-C levels evaluation on admission; and 3) availability of HE evaluation, defined as an increase of 12.5 mL and a 33% relative increase in hematoma volume on CT performed more than 24 hours after admission compared to baseline. We investigated the association between LDL-C and HDL-C levels and HE by performing Poisson regression analyses with a robust variance estimator adjusted by the following prespecified risk factors for HE: sex, age, use of antiplatelet drugs and anticoagulants before admission, body mass index, and systolic blood pressure on admission. Further, as a sensitivity analysis, we performed the same analysis above by limiting the patients with onset to door time within 24 hours.

Results:
We screened 608 consecutive ICH patients. Of them, 538 were identified (279 [52%] males, median age 76 years). HE was observed in 51 patients (9%). In multivariable analysis, lower HDL-C was independently associated with HE (prevalence ration (PR) 0.819, 95% CI 0.677-0.990,
p
= 0.039, Figure 1A). Further, a negative linear trend was observed between HDL-C quartiles and HE in reference to HDL-C Quartile 4 (Q1: PR 2.910, Q2: PR 1.860, Q3: PR 1.251, Q4: PR 1.000,
p
= 0.008 for trend, Figure 1B). On the other hand, LDL-C was not associated with HE (PR 1.011, 95% CI 0.935-1.094,
p
= 0.777). In a sensitivity analysis, lower HDL-C was also independently associated with HE (PR 0.752, 95% CI 0.591-0.956,
p
= 0.020, Figure 2A) with a negative linear trend (Q1: PR 3.784, Q2: PR 1.658, Q3: PR 1.161, Q4: PR 1.000,
p
= 0.001 for trend, Figure 2B). LDL-C was not similarly associated with HE (PR 1.030, 95% CI 0.946-1.122,
p
= 0.493).

Conclusions:
In acute ICH patients, lower HDL-C was associated with HE. HDL-C might have a protective role for HE following ICH.
Abstract TMP8: Alcohol Consumption and Carotid Intima–Media Thickness in Different Genders: A Cross-Sectional UK Biobank Study
Authors: Sui Yao , Zhang Runhua , Liu Yanli , Liu Gaifen , Zhang Yaqing , Du Yongjie , Qin Haiqiang , Ma Li
Published: January 2025

Introduction:
The role of alcohol consumption as an independent risk factor for atherosclerosis remains controversial. Carotid intima-media thickness (CIMT) is a recognized marker of atherosclerosis and can serve as a predictor of cardiovascular events. This study aims to explore the impact of alcohol consumption on CIMT across different genders and assess the variations in this relationship.

Method:
We analyzed data from 31,239 participants in the UK Biobank, categorizing them based on their average weekly alcohol consumption into the following groups: never drinkers, former drinkers, light drinkers (≤112g/week), and moderate-heavy drinkers(>112g/week). CIMT measurements were grouped into quartiles. Ordered logistic regression was employed to examine the association between alcohol consumption and CIMT in males and females.

Result:
The study included 16,342 males (52.3%) and 14,897 females (47.7%). Among never-drinking males, 95 (31.6%) were in the lowest CIMT quartile and 57 (18.9%) were in the highest quartile, while among moderate-heavy male drinkers, 2,541 (24.1%) were in the lowest quartile and 2,746 (26.0%) were in the highest quartile. For never-drinking females, 146 (26.1%) were in the lowest CIMT quartile and 153 (27.4%) in the highest, compared to 1,608 (24.9%) in the lowest and 1,584 (24.5%) in the highest quartile among moderate-heavy female drinkers. Multivariate ordered logistic regression showed that moderate-heavy male drinkers had a significantly increased risk of CIMT thickening compared to never drinkers in the fully adjusted model [OR 1.25, 95% CI 1.02-1.55]. However, this association was not significant in females [OR 1.05, 95% CI 0.89-1.24](table).

Conclusion:
Moderate-heavy alcohol consumption (>112g/week) is an independent risk factor for increased CIMT in males, even after adjusting for potential confounders. However, this association was not observed in females. These findings suggest a gender-specific impact of alcohol consumption on atherosclerotic risk, warranting further investigation.
Abstract TMP9: What Drives Early Recurrence in Intracranial Atherosclerosis: A Multicenter Study
Authors: Yaghi Shadi , Wu Moxin , Shu Liqi , Stipanovich Ava , Heldner Mirjam , Goldstein Eric , Kvernland Alexandra , Raz Eytan , Hakim Arsany , Radojewski Piotr , Mordasini Pasquale , Antonenko Kateryna , Almiri William , de Havenon Adam , Prabhakaran Shyam , Liebeskind David , Nguyen Thanh , Furie Karen
Published: January 2025

Background:
Intracranial Atherosclerosis carries a high recurrence rate. Single center studies have shown that impaired distal perfusion is a driver of early recurrence. In this study, we aim to identify predictors of 30-day ischemic stroke recurrence in a multicenter cohort.

Methods:
This is a pooled analysis of individual patient data from four comprehensive stroke centers of hospitalized patients with symptomatic intracranial arterial stenosis (50-99%) of the intracranial ICA and proximal middle cerebral artery (M1 or proximal M2). The study outcome was recurrent ischemic stroke by day 30. We compared baseline demographics (age, sex, race, ethnicity), vascular risk factors (hypertension, hyperlipidemia, diabetes, atrial fibrillation), NIHSS score, last known well to arrival, home medications (aspirin, anticoagulation), imaging variables (prior infarct in territory, degree of stenosis, perfusion delay volume, borderzone infarct pattern), and in-hospital treatments (thrombolysis, dual antiplatelet therapy, statin, permissive hypertension). Variables with p<0.1 on univariate analyses were included in a Cox regression model to identify important outcome predictors. Missing data was imputed as absent for categorical variables and at the median for continuous variables.

Results:
We identified 274 patients hospitalized with symptomatic intracranial stenosis who met the inclusion criteria; 70 patients (25.5%) had a recurrent ischemic stroke within 30 days. In unadjusted Cox regression models, predictors of early recurrence were mismatch volume of 25 ml or greater at T max of 6 seconds (HR 2.19 95% CI 1.37-3.51, p = 0.001), 70-99% (vs. 50-69%) stenosis (HR 3.34 95% CI 1.05-10.60, p = 0.041), diabetes (HR 1.60 95% CI 1.0-2.57, p = 0.048), home aspirin (HR 1.77, 95% CI 1.06-2.95, p = 0.029), and home statin (HR 1.73 95% CI 1.04-2.89, p = 0.039). In adjusted Cox regression, the only predictors of 30-day recurrence were T max 6 mismatch volume 25 mL or more (adjusted HR 2.14 95% CI 1.27-3.61, p = 0.004), and 70-99% (vs. 50-69%) stenosis (adjusted HR 3.37 95% CI 1.05-10.84, p = 0.041).

Conclusions:
One in four medically treated patients with proximal anterior circulation symptomatic ICAS have a recurrent stroke within 30 days with impaired distal perfusion being an important driver of recurrence. Studies are needed to validate these findings and test reperfusion strategies in those with impaired perfusion.
Abstract TP1: The Association Between Time and Reperfusion in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Tenecteplase in an Extended Time Window: A Post-hoc Analysis of the Chablis-T Trials
Authors: Hong Lan , Lin Longting , Ling Yifeng , Liu Xinyu , Li Siyuan , YANG LUMENG , Wang Xinru , HE ZHIJIAO , Zhang Anqi , Cao Nan , Parsons Mark , Cheng Xin , Dong Qiang
Published: January 2025

Background and Objective:
The effect of time from onset to treatment on reperfusion in an extended time window remains unexplored. This study aimed to investigate the relationship between the time to treatment and the probability of reperfusion in acute ischemic stroke patients with large vessel occlusion treated with tenecteplase in an extended time window, using data from the Chinese Acute tissue-Based imaging selection for Lysis In Stroke Tenecteplase (CHABLIS-T) trials.

Methods:
This study included patients treated with intravenous tenecteplase from the CHABLIS-T1 and CHABLIS-T2 clinical trials, both of which screened patients in the extended window using CT perfusion (CTP) imaging. Major reperfusion was assessed through follow-up CTP or digital subtraction angiography (DSA) imaging. Time variables, including the time from last known normal (LKN) /symptom onset to hospital arrival/ administration of tenecteplase were entered as continuous, categorical, and cubic spline variables in multivariable logistic regression models to explore their association with the probability of post-thrombolytic reperfusion.

Results:
A total of 199 patients arrived within 4.5-24 hours from LKN were included in this study, of whom 67 achieved post-thrombolytic major reperfusion. Cubic spline analysis indicated a linear correlation between time variables and the probability of reperfusion. Therefore, time variables were entered as continuous or categorical variables in the regression models. Multivariable logistic regression analysis revealed that a longer time from LKN to hospital arrival was associated with a lower probability of major reperfusion (continuous variable: OR=0.998, P=0.018,
Figure 1
). Similarly, a longer time from LKN to thrombolysis was associated with a lower probability of reperfusion (continuous variable: OR=0.996, P=0.020,
Figure 2
; categorical variable: OR=0.043, P=0.005,
Figure 3
). The analysis of time from symptom onset to hospital arrival/thrombolysis and reperfusion drew similar results

Conclusion:
In acute ischemic stroke patients with large vessel occlusion treated with tenecteplase in an extended time window, a longer time to treatment was associated with a lower probability of post-thrombolytic reperfusion. Therefore, rapid reperfusion treatment should still be required even in patients with large vessel occlusion in an extended time window with a good collateral flow, in order to optimize treatment effect.