bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP37: Predictors of Hemorrhage After Endovascular Therapy: Findings From the Interrsect Study
Authors: Yogendrakumar Vignan , Alajlan Fahad , Najm Mohamed , Puig Josep , Calleja Ana , Sohn Sung Il , Ahn Seong , Mikulik Robert , Asdaghi Negar , Field Thalia , Jin Albert , Asil Talip , Boulanger Jean-Martin , Hill Michael , Demchuk Andrew , Menon Bijoy , Dowlatshahi Dar ,   Interrsect Study Group
Published: October 2018

Background:
While recent endovascular therapy trials have had a minimal number of adverse events, intracerebral hemorrhage (ICH) still occurs. The predictors of ICH with endovascular therapy remain unclear. We assessed predictors of hemorrhage following endovascular thrombectomy using data from the prospectively collected, multicenter INTERRSeCT study.

Methods:
Patients undergoing endovascular therapy +/- intravenous alteplase (tPA) were enrolled and received baseline CT/CTA, follow-up CTA/Angiogram and 24-hr CT or MRI images. Primary outcome was any ICH as per the ECASS classification of hemorrhage. Secondary outcome was PH1/PH2 hemorrhages. We assessed the relations between ICH and baseline ASPECTS scoring, thrombus location, residual flow, collateralization, tPA use, and final recanalization state. Multivariable regression with stepwise selection was used to adjust for relevant covariates.

Results:
Of 242 patients who met inclusion criteria, 58 (24%) had an ICH at 24 hours (HI1 53%, HI2 19%, PH1 7%, PH2 21%). Post-procedure hemorrhage was associated with lower ASPECTS scores (p<0.001), ICA (p=0.004), proximal M1 (p=0.008), and mid-M1 (p=0.002) thrombus locations, and serum glucose (7.6 vs. 6.7; p=0.027). When adjusted for covariates, lower ASPECTS score (OR: 1.41 per point lost; 95% CI: 0.57-0.88; p=0.002), mid-M1 thrombus location (OR: 2.03; 95% CI: 1.03-4.01; p=0.041), and serum glucose (OR:1.15, 95% CI: 1.01-1.35, p=0.033) independently predicted the presence of post-procedure ICH. PH1/PH2 hemorrhages were associated with ICA thrombus (OR:2.96, 95% CI:1.05-8.33, p=0.04) after adjusting for relevant covariates.

Conclusion:
Early ischemia defined by imaging, mid-M1 thrombus location, and increased serum glucose are associated with increased risk of hemorrhage in patients undergoing combination tPA and endovascular therapy.
Abstract TP372: BRAIN ALERT: An Emergency Department Initiative to Improve Time Metrics for Patients that Walk in with Stroke Symptoms
Authors: Sangha Navdeep S , Nguyen Quyen , Gupta Atul , McCoy Nancy , Dhanji Raeesa , Castanon Marilen , McCartney David , Ajani Zahra
Published: October 2018

Introduction:
Patients with minor stroke symptoms tend not to call 911. They often come to the Emergency Department (ED) via personal transport, and walk in through the triage area. These patients historically have longer door to needle times. We established the Brain Alert (BA) nurse driven initiative with ED education on an algorithm applicable to patients who walk in with stroke symptoms. This study assesses the difference between time metrics before and after implementation.

Methods:
BA metrics were based on the TARGET:STROKE guidelines. The intervention was an ED wide education of all ED staff on F.A.S.T symptoms and the BA process. The ED triage nurse was empowered to page a BA and rapidly initiate the bedding of the patient. The BA page triggered the stroke team to rapidly come to the ED and examine the patient simultaneously with the ED physician. Data were recorded for 6 months pre and post implementation. Outcomes included door to initial MD evaluation, stroke team notification, CT scan initiation and interpretation and thrombolytic administration (DTN). Fisher’s Exact and Wilcoxon Rank Sum Tests were used for data analysis.

Results:
There were 38 walk in patients pre intervention vs. 36 post intervention. Thirteen (35.1%) BA activations occurred post intervention. The most common reason for not calling a BA was the patient did not have F.A.S.T symptoms. No differences in baseline demographics were found. CT scans were ordered and completed quicker post intervention (median ordered: 13.5 [IQR 7-18.5] mins post vs. 17.5 [IQR 12.5-22.5] mins pre, p=0.021), (median completed: 22.5 [IQR 18-27] mins post vs. 25 [IQR 20-30] mins pre, p= 0.024). A higher percentage of patients received thrombolytics ≤60 mins post intervention (84.6% vs. 78.7%), but was not statistically significant, p=0.41).

Conclusion:
The BA process improved door to CT order and completion times. There was higher percentage of patients who received IVtPA ≤ 60 minutes, which did not reach statistical significance likely due to the small number of patients involved in the study. Institution of a specific algorithm to address patients who walk in with stroke symptoms into a hospital triage area, can result in improved code stroke time metrics.
Abstract TP373: Regional Phoenix Stroke Work Group Improves Stroke Patient Care
Authors: Denke Nancy J , Duke Kimberly , Liable Deborah A , Loomis Ron , Martinez Hope ,   Phoenix Stroke Workgroup
Published: October 2018

Background and Purpose:
The Phoenix Stroke Workgroup (PSW) is comprised of volunteer staff of doctors, nurses and EMS to focus on the partnership between EMS and PSCs. Data is collected and shared within this workgroup to examine the delivery of emergent stroke care at each specific facility.

PSW evaluated yearly data by voluntary submission of predetermined critical metrics. PSW established benchmarks and set limits for each measure (i.e. Door to Needle (DTN) benchmark was 45 min with a limit of 75 min). Facilities exceeding the set limits were required to implement an action plan, review by EMS, and submit the next two quarters data for review by PSW.

We aim to determine if this collaboration has improved patient care, specifically: door to needle (DTN) times, complication rates, rates of tissue plasminogen activator and endovascular stroke treatments.

Methods:
Stroke coordinators volunteered all facility data from Get With The Guidelines AHA data base yearly with coordination from the local AHA chapter. We then compared clinical metrics from the 19 PSC’s for the years 2014, 2015, and 2016 for door to needle (DTN) times, complication rates, rates of tissue plasminogen activator and endovascular stroke treatments.

Results:
This collaboration decreased EMS DTN and POV (private vehicle) DTN times by 8 minutes and 9 minutes respectively during the 3-year study period. The utilization rate of TPA and endovascular treatment increased from 13.8 to 14.7% and 3 to 4.4%, but complications increased 2% from 3 to 5%.

Conclusion:
PSW collaboration improved the DTN times and utilization of both TPA and Endovascular treatment in the Phoenix metropolitan area. Future directions include collaboration to evaluate endovascular treatment times, bypass or transfer policies and statewide collaboration to continue to improve stroke patient care.
Abstract TP388: Targeted Sphingolipid Profiling Identifies Novel Biomarkers of Cerebral Microvascular Disease
Authors: Azizkhanian Ida , Lee Songmi , Kakarla Visesha , Sheth Sunil A , Hinman Jason D
Published: October 2018

Introduction:
Silent infarcts are associated with increased risk for symptomatic stroke, hemorrhagic transformation after thrombolysis, and global cognitive decline. Currently, there are no methods for detecting these lesions without imaging studies. We previously showed brain-specific sphingolipids (SLs) may serve as effective biomarkers of brain injury. Here, we evaluate the potential for these primarily white matter based molecules to identify clinically silent white matter injury.

Methods:
From our prospectively maintained institutional bio-bank, patients who underwent an MRI without acute stroke were identified. Plasma samples were collected at the time of MRI, and targeted SL profiling was performed by HPLC/tandem mass spectrometry. SLs were identified by exact mass. T2 Flair imaging was evaluated and scored according to the Fazekas scoring (FS) method. Data were analyzed with a dichotomized endpoint (FS 0-2 vs 3-6) with logistic regression.

Results:
Among 58 patients that met inclusion criteria, 28 (48%) were male, mean age was 66±17 and mean FS was 2.5 [IQR 2.5]. On MRI imaging, 46.5% scored FS 3-6 and 53.4% FS 0-2. Higher FS was associated with advanced age (29% vs 70% over 70yo, FS 0-2 vs. 3-6, p=0.002). 22 SLs could be definitively identified, consisting of ceramide (Cer) and sphingomyelin (SM) species. In univariate analysis, two species, SM 38:1 (OR 1.129, p=0.008) and Cer 34:1 (OR 1.118, p=0.007), accurately differentiated between FS 0-2 vs 3-6. The sum of these two SL intensities demonstrated excellent discrimination in ROC analysis (AUC= 0.729, p=0.003).

Conclusion:
Plasma levels of brain-specific SLs may serve as effective biomarkers of “clinically silent” white matter disease.
Abstract TP39: Endovascular Treatment Combined With Therapeutic Hypothermia and Decompressive Hemicraniectomy for Malignant Cerebral Venous Thrombosis: A Prospective Study
Authors: Chen Jian , Li Guilin , Jiao Liqun , Zhang Hongqi , Wu Yan , Ji Xunming
Published: October 2018

Background:
In malignant cerebral venous thrombosis (CVT) patients, although endovascular thrombectomy usually can open the occluded dural sinuses with full of thrombus, it is impossible to recanalize the ample thrombosed cortical and deep cerebral draining veins in short time, which will still cause severe brain edema and refractory intracranial hypertension. Therapeutic hypothermia is an effective measure to control refractory intracranial hypertension from cerebral injury. So these patients may benefit from endovascular treatment combined with therapeutic hypothermia and decompressive hemicraniectomy.

Methods:
Prospective case series. We included all consecutive patients who had a malignant CVT as defined: decreased consciousness, straight sinus thrombosis, or large space-occupying lesions from January, 2014 to June, 2016. These patients would first receive endovascular thrombectomy and thrombolysis to open the occluded thrombosed dural sinuses, then assigned to therapeutic hypothermia (33-35°C) for 3-5 days, and decompressive hemicraniectomy (only with cerebral herniation). Outcome was assessed at 12 months after operation with the modified Rankin Scale (mRS).

Results:
Fifteen patients (10 women) with a median age of 32 years (range 19-54 years) were included. Before surgery 9 patients had GCS < 9, 10 patients had normal pupils, 5 patients who had a unilaterally fixed and dilated pupil underwent unilateral decompressive hemicraniectomy, 12 patients had space-occupying intracranial hemorrhagic infarcts, and 2 patients had straight sinus thrombosis. No patients except one (with minor increase) had increased cerebral hemorrhage after endovascular thrombectomy. 10 patients recovered without disability at 12 months (mRS 0-1). Three patients had some residual handicap (mRS 2). One patient was moderate handicapped (mRS 3). One patient died from progressive cerebral edema due to the ample thrombosed cortical cerebral draining veins even after surgical decompression in short time.

Conclusion:
Endovascular treatment combined with therapeutic hypothermia and decompressive hemicraniectomy is safe and effective for malignant CVT, and even allow a good functional outcome in patients with cerebral herniation.
Abstract TP396: Distinguishing Characteristics of Headache in Non-Traumatic Subarachnoid Hemorrhage
Authors: Mac Grory Brian , Vu Linh , Marcolini Evadne , Gottschalk Christopher , Greer David
Published: October 2018

Subarachnoid hemorrhage (SAH) is a life-threatening emergency that is frequently missed due to its varied and often subtle presentation. The most common presentation of SAH is with a severe headache. The classical adjective used in subarachnoid hemorrhage is “thunderclap;” however, this has not been well defined in the literature rendering it challenge to triage patients in clinical practice presenting with severe headache. We undertook a prospective, observational study at a tertiary academic medical center examining the clinical characteristics of the presenting headache in subarachnoid hemorrhage. We enrolled patients through the emergency department and from the neurosciences intensive care unit and documented clinical features of the headache including the time to peak intensity, location, associated symptoms and activities that caused worsening. One hundred and fifty-eight subjects were enrolled, of whom 20 patients had SAH and 138 did not. Notable distinguishing features on history included occipital location (55% in the SAH group vs. 22% in the non-SAH group, P<0.001), “stabbing” quality (35% in the SAH group vs. 5% in the non-SAH group, P<0.001), presence of prior headache (50% in the SAH group vs. 83% in the non-SAH group, p=0.002) and associated meningismus (80% in the SAH group and 42% in the non-SAH group, P=0.002). Sixty-five percent of patients with SAH reported that their headache peaked within 1 second of onset, compared with only 10% of those without SAH (p<0.001). This is the first study that has sought to examine in detail the clinical characteristics of the presenting headache in SAH. Our study suggests that the clinical features of headache with SAH are distinct from those associated with other headache syndromes,
Abstract TP402: The Cerebral Cavernous Malformation Disease Causing Gene Krit1 Participates in Epithelial Barrier Maintenance and Regulation
Authors: Shen Le , Wang Yitang , Zou Jinjing , Weber Christopher R , Awad Issam A
Published: October 2018

Background:
Cerebral cavernous malformation (CCM) patients develop mulberry-like microvessels in the brain. These lesions can bleed, causing clinical symptoms. Germline mutations of CCM genes have been identified in familial form of CCM, and decreased endothelial CCM protein expression leads to RhoA-Rho kinase (ROCK) dependent actin cytoskeleton reorganization and increased endothelial permeability. It is not known if CCM mutations, which occur in all cells of a familial CCM patient, can impact barrier function of other body cavity lining cells, such as epithelial cells. Understanding how CCM protein function in epithelia may help us identify risks of CCM patients to epithelium-related diseases.

Aim:
To determine if and how the CCM gene KRIT1/CCM1 affects epithelial barrier maintenance and regulation.

Methods:
KRIT1 knockdown (KD) intestinal epithelial Caco-2 cells were generated by stably transfecting an anti-KRIT1 siRNA expressing plasmid. Epithelial barrier function, measured as transepithelial resistance (TER) and size selective cation permeability was determined by current clamp. Protein expression and localization was determined by western blot and immunofluorescent microscopy, respectively.

Results:
KRIT1 KD intestinal epithelial Caco-2 cell monolayers have decreased TER and selectively increased permeability to small cations, along with decreased claudin-1expression. ROCK inhibition (Y-27632) and myosin motor inhibition (blebbistatin) both decreased TER in control Caco-2 monolayers, but not in KRIT1 KD monolayers, indicating KRIT1 is important for myosin regulation of epithelial barrier function. Tumor necrosis factor (TNF), a cytokine that decreases epithelial barrier function through inducing myosin contraction, caused more severe barrier loss in KRIT1 KD monolayers relative to control monolayers, which is blocked by pan-caspase inhibition (zVAD), indicating KRIT1 loss promotes TNF-induced barrier loss through inducing cell death.

Conclusion:
KRIT1 regulates epithelial barrier by affecting tight junction protein expression and impacting myosin- and apoptosis- dependent processes. These changes in epithelial function may increase familial CCM patients’ susceptibility to intestinal and other diseases.
Abstract TP406: Review the Association Between White Matter Hyperintensities on MRI and Carotid Stenosis
Authors: Hatfield Mandy , Seachrist Eric , Jacob Sneha , Duru Uzoma , Petrone Ashley , Eisenman Rhae , ALVI Muhammad M
Published: October 2018

Introduction:
The presence of white matter hyperintensities (WMH) is associated with stroke, dementia, depression and other medical problems. The presence of WMHs is an independent risk factor for stroke and is associated with worse outcomes after stroke. WMH is frequently seen on neuroimaging in above patients.

Hypothesis:
The pathophysiology behind the development of WMHs is poorly understood. It has been postulated that there is a link between the presence of carotid artery stenosis (CAS) and WMHs. The presence of carotid atherosclerotic disease could indicate the presence of atheromatous disease in smaller distal vessels leading to chronic small vessel disease and appearance of WMHs. Others have suggested chronic cerebral hypoperfusion resulting from CAS as the underlying mechanism behind the appearance of WMHs.

Methods:
We reviewed data for 99 stroke patients. We used CT angiogram to grade the degree of CAS. We developed a score of 0 to 3 based on the degree of stenosis. A score of 0 meant no stenosis while a score of 3 meant severe stenosis with > 70% stenosis. A score of 1 for mild stenosis (<50%) and score of two for moderate stenosis (50-69%). Score for right and left side were calculated and added, total range 0 to 6. Using the scoring system, we had 25 patients with no stenosis, 38 with mild, 11 with moderate and 25 with severe stenosis. Patients were matched according to age, NIHSS, CV risk factors. The degree of WMH was scored using Fazekas scoring system (0-3) using T2 FLAIR MRI.

Results:
Patients with any degree of CAS are 8.5 times more likely to have WMHs than patients without CAS (p>0.001). 74% of patients with CAS have WMHs compared to only 24% of patients without CAS. There is a significant correlation between increased CAS severity and increase WMHs (higher Fazekas score) (r=.324, p=.001). 39% of patients with CAS moderate to severe WMHs (Fazekas 2 or 3) compared to only 16% of patients without CAS.

Conclusion:
In our patient sample, there seems to be a strong correlation between the presence of carotid artery stenosis and white matter hyperintensities.
Abstract TP409: Altered Expression of Microrna-15a and Kruppel-like Factor 4 in SAH Patients Contribute to Vascular Phenotype Alteration
Authors: Kikkawa Yuichiro , Kamide Tomoya , Uramaru Kouichi , Suzuki Kaima , Takeda Ririko , Tsuchiya Ryosuke , Ikeda Shunsuke , Shibata Aoto , Kurita Hiroki
Published: October 2018

Background:
Cerebral vasospasm (CVS) is a major determinant of prognosis in patients with subarachnoid hemorrhage (SAH). Alteration in the vascular phenotype contributes to development of CVS. However, little is known about the role of microRNAs (miRNAs) in the phenotypic alteration after SAH. We investigated the expression profile of miRNAs and the chronological changes in the expression of microRNA-15a (miR-15a) and Kruppel-like factor 4 (KLF4), a potent regulator of vascular phenotype modulation that modulates the expression of miR-15a, in the plasma and cerebrospinal fluid (CSF) of SAH patients.

Methods:
Peripheral blood and CSF samples were collected from eight aneurysmal SAH patients treated with endovascular obliteration. Samples obtained from three patients without SAH were used as controls in the analysis. Exosomal miRNAs were isolated and subjected to microarray analysis with the 3D-gene miRNA microarray kit. The time course of the expression of miR-15a and KLF4 was analyzed using quantitative real-time PCR.

Results:
Microarray analysis demonstrated that 12 miRNAs including miR-15a were up- or down-regulated both in the CSF and plasma after SAH within three days. Quantitative real-time PCR revealed that miR-15a expression was significantly increased in both the CSF and plasma, with a peak around 3 to 5 days after SAH, whereas the expression of KLF4 was significantly decreased around 1 to 3 days after SAH and remained lower than in controls.

Conclusion:
Our results suggest that an early and persistent decrease in KLF4 followed by an increase in miR-15a may contribute to the altered vascular phenotype, resulting in development of CVS.
Abstract TP41: Impact of Post-Endovascular Treatment Stroke Severity to Discriminate Long-Term Functional Outcome After Ischemic Stroke
Authors: Jeong Han-Gil , Kim Beom Joon , Yang Mi Hwa , Choi Jay Chol , Hong Keun-Sik , Jung Chulkyu , Han Moon-Ku , Bae Hee-Joon
Published: October 2018

Background and Aims:
About 40% of patients have poor functional outcome even after modern endovascular treatment (EVT), which is strongly requiring post-EVT therapies targeting damages from ischemia-reperfusion. Futile or effective reperfusion can be a significant noise in assessing efficacy of post-EVT therapies. Thus, we investigated whether post-EVT NIHSS score better discriminates long-term outcomes after EVT.

Methods:
We identified 566 stroke patients who received EVT at Seoul National University Bundang Hospital between Apr 2008 and Dec 2015. We prospectively collected post-EVT NIHSS score, which was measured by on-duty physician right after completion of EVT. The prognostic values of post-EVT NIHSS score, recanalization status and other baseline profiles in discriminating favorable 3-month outcome (modified Rankin Scale 0-2) were assessed using 4 different logistic regression models (Figure). The c-statistic was used as the primary measure of model discrimination. The integrated discrimination index (IDI) and the category-free net reclassification index (NRI) were also compared.

Results:
The post-EVT NIHSS score was 11.8 ± 7.8 pts, which showed overall improvement of 2.3 ± 6.3 pts compared to the baseline NIHSS score (14.0 ± 7.1 pts). Any change of NIHSS score was present in 79%. Favorable 3-month outcome was achieved in 47% of patients. Based on the results of differences among the c-statistics, both model 3 and model 4 were significantly more discriminative of favorable outcome than model 1 or model 2 (Figure). Model 4 showed significant improvement of both IDI and NRI as compared to all other models, but the magnitude from model 3 to model 4 was modest (IDI, 0.021; NRI, 0.322).

Conclusions:
Post-EVT NIHSS score was the strongest factor in discriminating long-term outcomes after EVT, which was superior to baseline NIHSS or recanalization status. Therefore, post-EVT NIHSS score should to be considered when assessing the efficacy of post-EVT therapies.
Abstract TP411: Biomarker Profiling of Neurovascular Diseases in Patients With Stage 5 Chronic Kidney Disease
Authors: Lee Justin , Bontekoe Jack , Bansal Vinod K , Biller José , Hoppensteadt Debra , Maia Paula D , Walborn Amanda , Fareed Jawed
Published: October 2018

Introduction:
Patients with stage 5 chronic kidney disease (CKD5D) have a higher risk for developing neurocognitive deficits. Stroke, cervical carotid artery disease (CCAD), and intracranial atherosclerosis (ICAD), are causes of such deficits in CKD5D. Chronic inflammation from renal failure elevates risk for these diseases through oxidative stress and vascular dysfunction. The adverse impact on the carotid and intracranial vasculatures contributes to the multifactorial pathophysiology of stroke.

Objective:
Profile levels of inflammatory and hemostatic biomarkers in CKD5D plasma, and relate measurements to neurovascular diagnoses.

Methods:
Eleven plasma biomarker levels in CKD5D patients (n=97) and healthy controls (n=17-50) were measured using sandwich ELISA method. Of the 97 CKD5D patients, 24 had CCAD, 19 had ICAD, and 23 had acute stroke. Data were collected in Microsoft Excel, and analyzed using GraphPad Prism. Statistics were performed with Mann-Whitney t-tests, Kruskal-Wallis non-parametric ANOVA, and non-parametric Spearman correlations.

Results:
Every biomarker was elevated in CKD5D plasma, except for plasminogen activator inhibitor-1 (PAI-1; p=0.9764), compared to controls. Statistical significance was only found between CKD5D (+) and (-)CCAD inflammasomes (NALP3; p=0.0299), and between (+) and (-)stroke D-dimer (p=0.0258). Ages between each (+) and (-) disease groups were also significant (p=0.0002 CCAD; p<0.0001 ICAD; p=0.0157 stroke). D-dimer was correlated with age in CKD5D (r=0.2115, p=0.0375).

Discussion:
Lack of difference in PAI-1 levels between CKD5D and controls could be due to anticoagulants. Elevated D-dimer levels in CKD5D stroke patients could be due to increased age instead of stroke. NALP3 is known to be connected to the stability of atherosclerotic plaques in CCAD. NALP3 elevates IL-1β and IL-18, which subsequently increases risk of CCAD and stroke. Lack of more significant differences in biomarker levels between (+) and (-) disease groups could due to the BBB, which might filter out the biomarkers of our study.

Conclusion:
Profiling biomarker levels of this study may not be useful in the risk stratification of neurovascular diseases in the CKD5D population, with the possible exception of NALP3 for CCAD.
Abstract TP414: Early and Delayed Onset Poststroke Depression
Authors: Wang Zhaolu , Lam Bonnie Y , Wong Adrian , Ho Ko , Lai Alexander Y , Soo Yannie , Leng Xinyi , Leung Thomas W , Mok Vincent C
Published: October 2018

Background and aim:
We aimed to investigate the predictors for early (3-month) and delayed (3-year) depression after stroke.

Methods:
Stroke or transient ischemic attack (TIA) subjects (n=1023) were recruited from the
C
hinese
U
niversity of Hong Kong -
ST
roke
R
egistry
I
nvestigating cognitive
DE
cline (CU-STRIDE). Clinical factors, drug use and neuroimaging markers of small vessel diseases (SVD) were collected at baseline. Geriatric depressive score (GDS) 15-items (≥ 6) was used to ascertain the presence of depression. Logistic regression was used to explore risk factors for presence of depression at 3-month and delayed-onset depression at 3-year, respectively.

Results:
A total of 394 (38.5%) patients had depression at 3-month after stroke/TIA, leaving 629 depression-free subjects. Among these 629 subjects, 350 received re-assessment of GDS at 3-year, and 49 (14%) developed depression. At 3-month, National Institute of Health Stroke Scale (NIHSS) score (OR=1.09, 95% CI: 1.04-1.14, p<0.001), Montreal Cognitive Assessment performance (MoCA) (OR=0.92, 95% CI: 0.89-0.96, p<0.001), and younger age (OR=0.979, 95% CI: 0.961-0.997, p=0.024) were associated with depression, while statins use (OR=0.69, 95% CI: 0.49-0.96, p=0.028) was associated with a decreased risk. At 3-year, presence of lacunes at baseline (OR=2.2, 95% CI: 1.1-4.3, p=0.022) and MoCA performance (OR=0.88, 95% CI: 0.81-0.96, p=0.003) were significant risk factors for development of delayed-onset depression, while long-term use of statins (OR=0.4, 95% CI: 0.2-0.9, P=0.021) was associated with a reduced risk of delayed-onset depression.

Conclusion:
Clinical severity and age influence early-onset depression, while SVD and cognitive impairment increase risk of delayed-onset depression. Statins use protects from development of depression.
Abstract TP415: Coated-Platelet Levels Are Elevated Among Native American Veterans With Vascular Risk Factors and Silent Brain Infarction
Authors: Kirkpatrick Angelia , Stoner Julie A , Mathews Eleanor , Dale George L , Prodan Calin I
Published: October 2018

Background:
Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, are elevated in patients with incident and recurrent stroke/TIA and mild cognitive impairment. We now report the association between coated-platelets and brain imaging correlates of vascular cognitive impairment in a pilot study of cognitive impairment among Native Americans Veterans.

Methods:
Coated-platelets, reported as percentage of cells converted to coated-platelets, were assayed in 60 Native American veterans with ≥2 vascular risk factors. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were administered to screen for cognitive impairment and depression. Brain CT or MRI performed within 12 months of enrollment were reviewed for silent brain infarction (SBI), small vessel disease and/or atrophy. SBI was defined as focal, ≥ 3mm, cavitary lesion with T1 hypointensity and T2 hyperintensity features on MRI or hypodense on CT and not associated with stroke history or focal neurologic findings. Differences in mean coated-platelet levels by imaging results were determined using the Kruskal-Wallis test.

Results:
MoCA scores were abnormal (<26) in 23 of 51 subjects (44%, 95%CI: 30%-59%) after excluding 9 with depression. Brain imaging was available for 36 subjects (97% male, mean age 63 range 50-86). Twelve (33%, 95%CI: 19%-51%) had normal results, 19 (53%, 35%-70%) had small vessel disease and/or atrophy, and 5 (14%, 5%-30%) had SBI. Median coated-platelets were significantly higher among those with SBI (51%, IQR 48%-59%) versus those without SBI having either normal results (36.5%, IQR 30.5%-48.1%) or small vessel disease and/or atrophy (33.6%, IQR 24.4%-47.3%), overall p=0.045.

Conclusion:
Platelet procoagulant potential is increased among Native American veterans with vascular risk factors and SBI versus those with normal scans or with small vessel disease and/or atrophy. These results suggest a role for coated-platelets as a biomarker of SBI in vascular cognitive impairment, and are consistent with previous findings of increased risk of ischemic stroke among non-Native Americans. Further studies are warranted to confirm these results and explore mechanisms involved.
Abstract TP419: Cognitive Correlates of Posterior Circulation Insufficiency
Authors: Lin Po-Chen , Chien Chun , Chung Chihping , Wang Pei-Ning
Published: October 2018

Background:
The territory of posterior circulation, supplied by vertebrobasilar artery (VA/BA) and their branches, includes brainstem, cerebellum, thalamus and temporal/occipital lobes. These regions are known to be involved in cognitive processes; however, the role of posterior circulation insufficiency in cognition has not yet been studied.

Objective:
To determine the cognitive correlates of posterior circulation insufficiency.

Methods:
Prospectively recruited (1) patients with >70% stenosis of the VA or/and BA and (2) age-/sex-matched controls. Patients with additional anterior circulation abnormalities (>70% stenosis or/and infarcts), dementia, major depression and functional independence (mRS>1) were excluded. All participants underwent brain MRA and neuropsychological tests containing cognitive domains of verbal memory, language, visuospatial and executive functions. Multivariate linear logistic regression analyses were used to determine the association between the presence of severe VA/BA stenosis and the scores of neuropsychological tests.

Results:
There were 30 patients (26 males; mean age: 61.4, 28-79 years) and 30 age/sex-matched healthy subjects free of cerebrovascular abnormality included. Among patient group, infarcts were found in pons (n=11), cerebellum (8), medulla (4) and temporal lobe (1). Seven patients had no brain infarcts. The patterns of vascular involvement were: unilateral VA (9, 30%), Unilateral VA and BA (5, 16.7%), bilateral VA (4, 13.3%), bilateral VA and BA (11, 36.7%), and isolated BA (1, 3.3%). Multivariate analyses adjusting for age, sex, education years, and vascular risk factors (HTN, DM, hyperlipidemia and cigarette smoking) showed that VA/BA severe stenosis was associated with a lower scores on verbal memory test (regression coefficient = -1.7,
p
= 0.003) and visuospatial function test (-2.3, 0.015) but not the other neuropsychological tests. Statistical significance remained when the presence of infarct was taken into adjustment.

Conclusion:
VA/BA severe stenosis is associated with a poorer performance on verbal memory and visuospatial functions. Our results suggest that the role of posterior circulation in vascular cognitive impairment might be underestimated.
Abstract TP44: Trans-Radial Approach in Mechanical Thrombectomy in Anterior Circulation Large Vessel Stroke; Two Center Experience
Authors: Khandelwal Priyank , Bhatt NIrav , Saini Vasu , Brunet Marie , Bo Ryan , Arcot Karthikeyan , Parrella David Turkel , Gordon David S , Liff Jeremy M , Selas George , Frontera Jennifer , Yavagal Dileep R
Published: October 2018

Background:
Trans-femoral access (TFA) is used conventionally for mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke. Trans-radial access (TRA) is not only an alternative access route when TFA is not successful but has been shown to significant advantages over TFA in cardiac interventions in large prospective studies. In LVO stroke also, TRA may have several advantages over TFA, including greater technical ease of selection of great vessels at the arch in Type 2 & 3 arches in older stroke patients, avoidance of aorto-illiac disease and less frequency of access complications. We assessed the technical feasibility and safety of TRA for MT in Anterior Circulation LVO in 2 large tertiary care hospitals.

Methods:
This is a retrospective two-center study of patients undergoing MT for anterior LVO via a TRA from January 2015 through June 2017. From the institutional database of patients receiving MT we identified consecutive patients in whom a TRA was performed for MT for anterior circulation Large vessel occlusion. A 6F guide sheath and 6F Guide-catheter system introduced through the radial artery with or without balloon at distal tip was used for the MT procedure with a standard microcatheter MT technique. We measured workflow metrics, complications and feasibility and safety in this cohort.

Results:
27 out of 390 (6.9%) MT patients underwent TRA MT for anterior LVO during the study period. There were 8 males (29.6%) and 19 females (70%). There were 9 patients (33.3%) in whom a TFA was attempted initially and had to be converted to a TRA due to inability to catheterize the great vessels via TFA. In rest of the patients, TRA was the first line approach. The mean age of patients was 80 ±12, females 84.5±9.6 years, males 74.1±16.2 years. Median time from access to reperfusion was 60 minutes (IQR 37 to 94). 22 (81.4%) had excellent rates of revascularization (TICI 2b, 3). Symptomatic ICH was observed in 3 patients (11.1%). There were no access related complications were noted in any of the patients.

Conclusion:
TRA for MT in patients with anterior circulation LVOs is feasible, safe and achieves rapid reperfusion similar to TFA for MT. Apart from being an alternative when TFA is not feasible, it should be studied further as a first line approach for MT in LVO stroke.
Abstract TP45: Analysis of FLAIR Hyperintense Vessels by the Different Phase of Multiphase CTA in Acute MCA Occlusion
Authors: Lee Kyung-Yul , Cheon Kyeongyeol , Han Sang Won , Park Joong Hyun
Published: October 2018

Background:
It is well known that hyperintense vessels (HV) on fluid-attenuated inversion recovery (FLAIR) image suggest slow collateral flow in case of large arterial occlusion. Multiphase CT angiography (CTA) is an imaging technique that provides time-resolved images of pial arteries. We analyzed the correlation of HVs on FLAIR image with collateral vessels on the different phases of multiphase CTA.

Methods:
FLAIR images and multiphase CTA was analyzed in 7 patients with proximal MCA occlusion. We counted the number of discrete FLAIR HVs distal to the occlusion site and investigated whether the FLAIR HVs could be seen at the same area in different phases of multiphase CTA.

Results:
The mean duration between symptom onset and acquisition of multiphase CTA was 5.6 hours and mean duration between CTA and MRI was 0.6 hour. A total 32 FLAIR HVs were observed in 7 patients. Of these, 13 HVs were observed in the 1
st
phase CTA, 25 HVs in the 2
nd
phase, and 26 HVs in the 3
rd
phase. Six HVs were not observed in all three phases of CTA.

Conclusions:
In cases of acute proximal MCA occlusion, the collateral vessels shown as FLAIR HVs are more frequently observed in the late phase of multiphase CTA.

Fig 1. A
74-year-old man with acute occlusion of left middle cerebral artery. FLAIR image (A) shows 3 discrete HVs at left temporoparietal area. These FLAIR HVs are most clearly seen at 3
rd
phase contrast enhanced CTA (D)
B, C:
1
st
and 2
nd
phase contrast enhanced CTA
Abstract TP48: Fluid-Attenuated Inversion Recovery Hyperintense Vessel Predicts Pre- and Post-Recanalization Infarct Lesion
Authors: Amano Tatsuo , Nakanishi Kaoru , Honda Yuko , Suzuki Rieko , Kawano Hiroyuki , Unno Yoshiko , Torii Masataka , Okano Haruko , Shiokawa Yoshiaki , Hirano Teruyuki
Published: October 2018

Background and Purpose:
In patients with emergent large vessel occlusion (ELVO), fluid-attenuated inversion recovery (FLAIR) hyperintense vessel (FHV) has been linked to cerebral hypoperfusion. However, the association between FHV and infarction lesion after successful recanalization by endovascular thrombectomy (ET) remains unknown. In this study, we investigated the relationship baseline FHV and baseline or post-ET diffusion weighted imaging (DWI) positive lesions.

Methods:
From April 2012 to August 2016, fifty-nine patients were received ET for ELVO of the anterior circulation. We included twenty-five patients of them who obtained successful (Thrombolysis In Cerebral Infarction score 2b/3) recanalization of ICA or M1 occlusion. All patients had DWI before and after ET and FLAIR before ET. Infarct lesions and FHV were evaluated in seven cortical lesions which divided according to cortical area of Alberta Stroke Program Early CT (ASPECT) scoring (I, M1-M6). The association between baseline or post-ET DWI positive and baseline FHV was analyzed in each one hundred seventy-five lesions.

Results:
DWI positive lesions were present in 65/171 (37%) and 108/175 (62%) lesions on baseline and post-ET DWI, respectively. FHV was present in 89/175 (51%) lesions on baseline FLAIR. Baseline DWI positive lesion was significantly higher at FHV positive lesion than FHV negative lesion (FHV (+) vs. FHV (-): 56% vs. 17%, p<0.0001). In one-hundred ten baseline DWI negative lesions, FHV positive lesion was likely to become post-ET DWI positive than FHV negative lesion (FHV (+) vs. FHV (-): 51% vs. 32%, p=0.052). In patients who obtained successful recanalization within 6 hours from onset, post-ET DWI positive lesion was significantly higher at FHV positive lesion than FHV negative lesion (FHV (+) vs. FHV (-): 55% vs. 29%, p=0.0234).

Conclusion:
Baseline FHV positive lesions have already been infarcted before ET and likely to become infarction after successful recanalization compared to FHV negative lesion. Because FHV positive lesion became infarct despite early successful recanalization, FHV seemed to suggest severe hypoperfusion.
Abstract TP50: Blood Brain Barrier Leakage Rates and Ischemic Tissue Outcomes in Patients With Advanced White Matter Disease
Authors: Etherton Mark R , Wu Ona , Giese Anne-Katrin , Lauer Arne , Boulouis Gregoire , Mills Brittany , Cloonan Lisa , Donahue Kathleen , Copen William , Schaefer Pamela , Rost Natalia
Published: October 2018

Background:
The structural integrity of normal appearing white matter (NAWM) predicts outcomes after acute ischemic stroke (AIS); however, the underlying mechanisms are unclear. We evaluated blood-brain barrier (BBB) permeability and microstructural NAWM integrity in association with ischemic tissue outcomes.

Methods:
In a prospective observational study of patients with moderate to severe white matter hyperintensity (WMH) burden, 43 AIS patients had brain MRIs with dynamic susceptibilty contrast (DSC) perfusion performed within 12 hours and at 3-5 days after stroke onset. Acute infarct volume on diffusion-weighted imaging (DWIv) and final infarct volume (FIV) on follow-up FLAIR sequences were determined using a validated semi-automated method. Infarct growth (IG) was calculated from the acute DWIv subtracted from FIV. Median diffusivity metrics and BBB leakage rates (K2 coefficient) were measured in contralesional NAWM. Pearson correlation and linear regression were used for statistical analysis.

Results:
The K2 coefficient correlated with acute DWIv (ρ=0.30; p=0.046) and, marginally, with FIV (ρ=0.28; p=0.073). In univariate analysis, history of atrial fibrillation (β=23.8; p=0.009), and acute DWIv (β=1.2; p<0.0001) were predictive of IG. Contralesional NAWM diffusivity metrics and K2 coefficient were not predictive of infarct growth. In the multivariable model, only acute DWIv independently predicted IG.

Conclusion:
In a prospective study of AIS patients with moderate to severe WMH burden, BBB leakage rates correlate with acute infarct volume. These findings suggest that NAWM microvascular integrity contribute to the severity of ischemic tissue outcomes.
Abstract TP52: Neurite Density and Orientation Dispersion are Decreased in White Matter in Patients With Advanced Leukoariaosis
Authors: Wu Ona , Etherton Mark R , Lauer Arne , Boulouis Gregoire , Giese Anne-Katrin , Mills Brittany B , Cloonan Lisa , Donahue Kathleen L , Copen William A , Schaefer Pamela W , Rost Natalia S
Published: October 2018

Background:
Alterations to microstructural integrity in white matter hyperintensities (WMH) in patients with severe leukoaraiosis are poorly understood. Neurite density and orientation dispersion imaging (NODDI) produce better estimates of myelin density than diffusion tensor MRI (DTI) and therefore may provide additional in vivo insight into WMH pathophysiology.

Methods:
NODDI was acquired in a prospective study of acute ischemic stroke patients with advanced white matter disease (N=36). Neurite density (ND), and orientation dispersion (OD) were calculated along with model-free diffusion parameters: mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) and fractional anisotropy (FA). Median values were measured in in the hemisphere contralateral to the incident stroke in regions of WMH and in normal appearing white matter (NAWM) and compared (paired Wilcoxon-exact test). Linear regression was performed to evaluate univariate predictors of log-transformed WMH volumes (log WMHv).

Results:
Patient characteristics were: mean±SD age 69±10 y, time-to-MRI 2.8±1.2 days, median [IQ] normalized WMHv 4.7 [2.3-9.3] and 61% men. MD, AD and RD were greater, while FA, MK, AK, RK, OD and ND were lower in WMH compared to NAWM (P<0.001, see Figure). Increased MD (P=0.004), AD (P<0.0001) and AK (P=0.01) in NAWM and decreased OD in NAWM (P=0.01) were significant predictors of increased log WMHv.

Discussion:
Diffusivity, kurtosis and ND and OD in acute stroke patients with moderate to severe leuokoaraiosis differed significantly between NAWM and WMH in the contralateral hemisphere. Reduced neurite density is suggestive of microstructural injury. Reduced OD is typically associated with greater organization, but might also reflect restricted extracellular space diffusivity. The association of MD, AD, AK and OD in NAWM with WMH burden suggests there is ongoing risk for developing future WMH.
Abstract TP55: Tour Stroke Imaging Project: A New Algorithm for Stroke Outcome
Authors: Kerleroux Basile , Christophe Tomasino , Silvia Moura Fernando , Cottier Jean Philippe , Gaudron Marie , Bibi Richard , Janot Kevin , Mariam Annan , Narata Ana Paula
Published: October 2018

Introduction:
Eloquent areas of brain have been identified more precisely using functional MRI but not often applied for stroke patients. Furthermore, it is widely accepted that stoke outcome depends on a number of factor including age, stroke lateralization, baseline NIHSS and brain imaging. This study aims to develop a new deconvolution algorithm for stroke outcome incorporating the concept of brain eloquent areas. We assessed the effectiveness of a new model, the Tours Stroke Imaging Project (TOSIP), to predict the outcome at three months compared to the conventional ASPECT.

Methods:
Patients (n=130) with cerebral infarction on the carotid territory were included. A map of the brain eloquent area was created based on previous MRI mapping. 24 h CT-scan were analyzed by 2 senior neuroradiologists that noted ASPECT score and each eloquent area. Independently, demographic data and outcome (score on the modified Rankin scale at 3 month) were collected by 2 vascular neurologist. A Bayesian estimation algorithm were use to create a prognostic model. Spearman’s rank correlation coefficient was used to test the association between this new model, ASPECT score and the functional outcome.

Results:
We observed a strong correlation between TOSIP and outcome at 3 month. (OR = 3.47 [2.96; 4.07], P<0.0001). For the same patients, delay ASPECTS value is not as well correlated (OR = 2.8 [2.23; 3.39], P<0.0001).

Conclusions:
TOSIP seems to be a promising new tool to predict more precisely the clinical outcome at 3-month after ischemic stroke. A more important sample is necessary for further validation.
Abstract TP56: Comparison of Collateral Status in Acute Ischemic Stroke: Simulated 2-phase CTA versus Simulated 3-phase CTA
Authors: Shin Dong Hoon , Kim Eung Yeop
Published: October 2018

Purpose:
We hypothesized that two-phase (the arterial phase and the phase between the peak and late venous phases) CTA may work comparably with 3-phase CTA, and sought to compare a simulated 3-phase CTA with a simulated 2-phase CTA for assessment of collaterals.

Methods:
We enrolled 155 patients (76 male; median, 72 years) who underwent 9.6-cm, 70-kVp perfusion CT (PCT) for 60 seconds within 8 hours after symptom onset and had occlusion in the ICA (ICA with/without M1; n=63) or M1 segment (with/without M2 segment; n=92). PCT data were reconstructed with a section width of 1 mm, and were used to create the simulated 3-phase CTA (3-CTA; peak arterial, peak venous, and late venous phase; 3 seconds each) with an increment of 4.5 seconds. Another 3-second CTA immediately after peak venous phase was additionally generated, which consisted of the second CTA of the simulated 2-phase CTA (2-CTA) with the peak arterial CTA. Each CTA was reconstructed into 25-mm axial maximum intensity projections, and was assessed by 2 independent reviewers at a separate session. For the 2-CTA, good collaterals were determined when the ipsilateral side showed both similar vascular filling and enhancement (ASPECT>7) compared to the contralateral brain on the peak arterial CTA. For the 3-CTA, we followed the published criteria to determine good/poor collaterals.

Results:
Interobserver agreements were excellent (k=0.931 for 3-CTA; k=0.929 for 2-CTA). Consensus review determined good and poor collaterals in 97 and 58 patients, respectively, on 3-CTA. All 97 patients with good collaterals on 3-CTA showed good collaterals on 2-CTA; 2 out of 58 patients with poor collaterals on 3-CTA were determined to have good collaterals on 2-CTA, showing no significant difference (P=0.5, McNemar test).

Conclusion:
Compared to the simulated 3-phase CTA, the simulated 2-phase CTA has comparable diagnostic performance for determining the status of collateral circulation.