bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP216: Stroke Recurrence in Patients With Cryptogenic Stroke
Authors: Fujimoto Shigeru , Osaki Masato , Kanazawa Makoto , Tagawa Naoki , Oya Yuichiro , Kitazono Takanari
Published: July 2021

Background & Purpose:
In cryptogenic stroke or transient ischemic attack (TIA) patients, aortic arch atheroma or patent foramen ovale (PFO) evaluated by using transesophageal echocardiography (TEE) is well known as possible embolic source. These findings were sometimes associated with stroke recurrence. We investigated predictive factors for stroke recurrence in patients with cryptogenic stroke.

Methods:
From February 2008 to December 2013, among 1832 consecutive stroke or TIA patients, 315 patients (male, 57.8%; age, 73.3±10.9) who were admitted within 7 days after the symptom onset without both atrial fibrillation and significant stenosis (50% or more in diameter) in the cerebral arteries underwent TEE for evaluating embolic sources; embolism was the probable etiological mechanism for their event. Patients with malignancy, cerebral arterial dissection, or infarcts in the perforating artery territory were excluded. We observed stroke recurrence during one year and investigated predictive factors for stroke recurrence.

Results:
In TEE, spontaneous echo contrast in the left atrium, aortic arch atheroma of 4.0 mm or more in thickness (mean, 4.65±2.06 mm), PFO, and pulmonary arteriovenous fistula were observed in 24 (7.6%), 223 (70.3%), 26 (8.2%), and 20 (6.3%) patients, respectively. Stroke recurrence was observed in 39 (12.4%) patients. Aortic arch atheroma of 4.0 mm or more, male, and prior hemorrhagic stroke were more frequent, and the initial diastolic blood pressure (DBP) and HbA1c were higher in patients with than without stroke recurrence. On the multivariate analysis using those factors and age, aortic arch atheroma (OR 3.73, 95%CI 1.46–11.7) and the initial DBP (OR 1.03, 95%CI 1.00–1.05) were positive predictors for a stroke recurrence. With regard to the operating characteristic curve analysis, the most accurate cut off values for a stroke recurrence were 4.1mm (AUC 0.59) in aortic arch atheroma thickness and 91mmHg in DBP (AUC 0.58).

Conclusions:
In acute cryptogenic stroke, aortic arch atheroma was observed frequently. Aortic arch atheroma and DBP were significantly associated with one-year stroke recurrence. TEE was required for evaluating aortic arch atheroma in patients with cryptogenic stroke
Abstract WP222: Comparison of Two Methods of External Prolonged Cardiac Monitoring for the Detection of Atrial Fibrillation: Cardiophone - satellite Real Time Device vs Sorin (Automated Software) for the Peaace Study
Authors: Manosalva Herbert , Hasan Saad , Pervez Arif , Mohammad Askar , Hussain Dulara , Kalashyan Hayrapet , Saqqur Maher , Khan Khurshid , Tarhuni Wadea , Buck Brian , Butcher Kenneth , Jeerakathil Thomas , Hasan Yousef , Shuaib Ashfaq
Published: July 2021

Introduction:
Recent evidence has shown that prolonged cardiac monitoring is superior to 24 hour Holter for detection of atrial fibrillation (AF). We compared two methods of prolonged monitoring in patients with acute ischemic stroke and TIAs.

Objective:
Comparison of the Cardiophone and Sorin monitor for detection of AF.

Method:
In the first part of the study (PEAACE I; 2011-2013), we used the spiderflash (Sorin, Italy) for up to 21 days of monitoring. In the second part (PEAACE II; 2013-2015), Cardiophone with real time monitoring of the heart rhythm for 14 days was used.

Results:
102 patients in PEAACE I, (Mean age 72 +/-, 48.8% male) were compared to 120 patients in PEAACE II (Mean age 73 +/-, 70% male). Stroke type was “undetermined (cryptogenic) 92% and 91% in the two studies respectively. In PEAACE I, AF was detected in 43 out of 102 subjects (42%) (72% <30 seconds, 28% >30 seconds) with detection of 75% in the first week, 23% in the second, and 2% in the last week. In PEAACE II, 20 out of 120 subjects (17%) (70% <30 seconds, 30% >30 seconds) had AF, with 55% of detection in the first week, 45% in the second one (χ2 p=0.001). In PEAACE II, the results were available faster, within 2 days compared to 21 days in PEAACE I (χ2 p<0.0005). In PEAACE II, 90% of the patients received anticoagulation (93% of participants with A Fib <30 seconds, 83% with >30 seconds) compared to 77% in PEAACE I (68% with AF <30 seconds and 100% with AF >30 seconds) (χ2 p=0.021).

Conclusion:
There were significant differences noted in the rates of detection with the two techniques. Real-time monitoring resulted in recording of fewer events but lead to earlier initiation of treatment. All patients with >30 seconds of AF were anticoagulated whereas fewer patients with less than 30 seconds of AF were anticoagulated.
Abstract WP226: Short Lasting Runs (<30 sec) of Atrial Fibrillation are More Commonly Observed in Ischemic Stroke Patients in Comparison to Controls
Authors: Arsava Ethem Murat , Yetim Ezgi , Canpolat Ugur , Ozer Necla , Aytemir Kudret , Topcuoglu Mehmet Akif
Published: July 2021

Background:
The role of short-lasting (<30 sec) runs of atrial fibrillation (AF) in ischemic stroke pathophysiology is currently unknown. Although these non-sustained attacks are considered as a risk factor for future development of longer lasting, classical AF episodes, prior research has highlighted that associated clinical stroke features are not entirely similar between these two types of arrhythmias. In this study we determined the prevalence of short-lasting AF in stroke-free controls and compared it to a consecutive series of ischemic stroke patients.

Methods:
A total 235 controls, without any prior history stroke or AF, were evaluated with ECG and 24-hour Holter monitoring for the presence of <30-sec or ≥30-sec lasting AF episodes. The results were compared to a consecutive series of ischemic stroke patients without prior history of AF (n=456). Univariate and multivariate analyses were performed to determine demographic and cardiovascular factors related to <30-sec lasting AF and its association with ischemic stroke.

Results:
Expectedly, the frequency of newly diagnosed ≥30-sec lasting AF, detected either on ECG or Holter monitoring, was significantly higher in patients with ischemic stroke (18% vs. 2%; p<0.01). Non-sustained AF was positively related to old age (p<0.01), female gender (p=0.01) and hypertension (p<0.01) in univariate analyses. In multivariate analyses, after adjustment for demographic and cardiovascular risk factors, presence of non-sustained AF was significantly higher among both cryptogenic (OR 1.78; 95% CI 1.02-3.10) and non-cryptogenic (OR 1.84; 95% CI 1.15-2.94) stroke patients with respect to controls.

Conclusion:
Our study shows a higher prevalence of non-sustained AF episodes in ischemic stroke patients in comparison to controls. Whether this cross-sectional association translates into causality in terms of stroke pathophysiology will be the subject of future studies.
Abstract WP232: Prevalence of Positive Troponins and Association With Abnormal Echocardiograms in Acute Ischemic Stroke
Authors: Wrigley Peter , Alwell Kathleen , Eckerle Brian , Moomaw Charles J , De Los Rios La Rosa Felipe , Flaherty Matthew , Adeoye Opeolu , Woo Daniel , Ferioli Simone , Mackey Jason , Martini Sharyl , Khoury Jane C , Kissela Brett M , Kleindorfer Dawn O
Published: July 2021

Background and Purpose:
Acute Ischemic Stroke (AIS) patients may have high sensitivity serum troponin (cTn) levels drawn upon admission, although it is unclear how frequently cTn levels are elevated, and whether these levels are associated with cardiac causes of stroke as seen on echocardiogram. We investigated the prevalence and positivity of cTn and echocardiogram testing within a large biracial population that is representative of the US.

Methods:
Within a catchment area of 1.3 million we screened local hospital admissions in 2010 using ICD-9 discharge codes 430-436 and ascertained all physician-confirmed AIS cases by standardized retrospective chart review, including diagnostic test results. Any positive cTn was defined by the standard 99
th
percentile cutoff. Echocardiogram findings of interest were defined as in the table. Logistic regression was used for analyses, controlling for age, sex, race and prior history of cardiac disease.

Results:
Of the 1999 AIS cases that presented to an ED in the region 1706 (85.3%) had a cTn drawn and 1590 (79.5%) had an echocardiogram. A positive cTn was seen in 353/1706 (20.7%) and 160/1590 (10%) had an echocardiogram finding of interest. Of the 1377 that had both tests performed, a positive cTn was associated with an abnormal echocardiogram (
adjusted OR 2.9 95% CI 2-4.2
). A negative cTn did not significantly alter the odds of having an abnormal echocardiogram (
Negative Likelihood Ratio=0.66
).

Conclusion:
Testing with serum cTn and echocardiogram was common within our population. Troponinemia above the 99
th
percentile was prevalent and was associated with clinically relevant structural cardiac disease on echocardiogram. However absence of troponinemia was not informative regarding the probability of a normal echocardiogram, and therefore does not obviate the need for echocardiography in this at risk population.
Abstract WP239: Development and Validation of The California Stroke Subtype (CASS) Scale for Prehospital Identification of Intracerebral Hemorrhage
Authors: Sanossian Nerses , Liebeskind David S , Starkman Sidney , Eckstein Marc , Stratton Samuel , Pratt Franklin D , Conwit Robin , Sung Gene , Saver Jeffrey L ,   FAST-MAG Investigators and Coordinators
Published: July 2021

Background:
We sought to develop a clinical scale identifying intracerebral hemorrhage (ICH) using prospectively collected data elicited by paramedics in the field.

Methods:
Subjects were enrolled in the Field Administration of Stroke Therapy Magnesium (FAST-MAG) trial of prehospital neuroprotective therapy. Data obtained by paramedics in the field including vital signs, examination, demographic information, and medications. Subjects were randomly put into training (n=1133) and validation (n=567) observations. Logistic regression model using all 26 potential predictors as candidates was fit to the training data using backward stepwise variable selection with a liberal p < 0.10 retention criterion. A classification tree model using 26 potential predictors as candidates was used with a GINI equivalent to a p < 0.10 splitting criterion.

Results:
1700 cases were assessed by paramedics a median of 23 (IQR 14-42) minutes after symptom onset and 23% had ICH. Of the 26 candidates, 12 variables were retained in the logistic model. Holding the other factors constant, increasing Los Angeles Motor Score (LAMS), Glasgow Coma Scale (GCS) verbal sub-score, history of hypertension, Hispanic ethnicity, field systolic BP and taking anti platelet medication are associated with increasing risk of ICH. Increasing GCS eyes sub-score, diabetes, atrial fibrillation, valvular heart disease, age, female gender, and Black race are associated with decreasing risk of ICH. The training set model accuracy is 74%, sensitivity 65%, specificity 83% with C= 0.81 and the validation set accuracy is 67%, sensitivity 76%, specificity 58% with C= 0.73. For the classification tree seven predictors are retained: prehospital systolic BP, diastolic BP, Hispanic, ethnicity, history of atrial fibrillation, GCS verbal sub-score, age and Los Angeles Motor Score (LAMS). The tree forms 10 prediction groups (terminal nodes). Five of these ten predict ICH (“positive”) and the other five predict no ICH (“negative”). The training set accuracy for the tree was 71.9% with C=0.782 and the validation set accuracy was 63.2% with C= 0.632.

Conclusion:
Paramedics can identify ICH in the field with moderate accuracy, allowing the opportunity to develop targeted prehospital therapeutics and care delivery.
Abstract WP242: A Prehospital Acute Stroke Trial has Only Modest Impact on Enrollment in Concurrent, Post-arrival-recruiting Stroke Trials
Authors: Johnson-Black Phoebe , Wong Greg , Starkman Sidney , Sanossian Nerses , Ali Latisha , Kim-Tenser May , Liebeskind David , Restrepo Lucas , Valdes-Sueiras Miguel , Stratton Samuel , Eckstein Marc , Pratt Frank , Conwit Robin , Hamilton Scott , Guzy Judy , Grunberg Ileana , Shkirkova Kristina , Hemphill Claude , Saver Jeffrey ,   FAST-MAG Investigators and Coordinators
Published: July 2021

Introduction:
Because “time is brain,” acute stroke trials are increasingly migrating to the prehospital setting. However, some study therapies are ill-suited for paramedic, prehospital delivery, including fibrinolytics, endovascular therapies, and surgical interventions. Best scientific and regulatory practice does not permit one patient to participate in two different therapeutic trials simultaneously. The potential reduction in enrollment in post-arrival trials due to earlier recruitment in a prehospital trial has not been well delineated.

Methods:
We analyzed all patients recruited into acute stroke trials at an academic medical center (AMC) from Jan 2005 - Dec 2012. Throughout this period, the AMC was participating in a prehospital treatment trial (NIH FAST-MAG trial), as well as diverse concurrent post-arrival acute trials.

Results:
During the 96 month study period, in addition to the prehospital trial, the AMC participated in 26 other acute, post-arrival stroke trials, 25 for ischemic stroke and 1 for intracerebral hemorrhage. Length of participation in each post-arrival trial varied, but at all times throughout the study period, the AMC was recruiting for at least 3 concurrent post-arrival acute trials. During this time, a total of 200 patients were enrolled in acute stroke trials, including 98 (49%) in FAST-MAG and 102 (51%) in concurrent, post-arrival acute trials. Among the patients enrolled in FAST-MAG, 67% were not eligible for any concurrent trial. Among the 33% eligible for a concurrent trial, 15% were eligible for 1, 7% for 2, 7% for 3, and 3% for 4. Of the 134 patients eligible for post-arrival trials, 102 (76%) were enrolled in post-arrival trials and 32 (24%) in FAST-MAG. Leading reasons that FAST-MAG patients were ineligible for post-arrival trials included: NIHSS too low (23.4%), intracranial hemorrhage (17.9%), deficit resolved to TIA (9.2%), IV tPA used in standard management (9.0%), NIHSS too high (7.1%), and age too high (5.2%).

Conclusions:
A prehospital hyperacute stroke trial with wide entry criteria reduced only modestly, by one-fourth, enrollment into concurrently active, post-arrival stroke trials. Simultaneous performance of prehospital and ED-based acute stroke trials in research networks is highly feasible.
Abstract WP26: Validation of Predictive Scales of Functional Outcome After Endovascular Therapy Using the REVASCAT Data
Authors: Perez de la Ossa Natalia , Rangaraju Srikant , Jovin Tudor , Dávalos Anoni ,   REVASCAT Trial Investigators
Published: July 2021

Introduction:
Various scales have been developed to predict long-term clinical outcome after endovascular therapy (EVT) in stroke patients. The objective of this study was to validate and compare five well-validated scales in terms of predictive accuracy for functional independence in a recent endovascular stroke trial (REVASCAT).

Hypothesis:
We hypothesize that predictive scales (PRE, THRIVE, HIAT2, SPAN-100, FAR) have good-excellent (AUC>0.7) predictive accuracy for good functional outcome and can predict the beneficial effect of EVT demonstrated in randomized clinical trials.

Methods:
REVASCAT (Randomized Trial of Revascularization with Solitaire-FR Device versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight Hours of Symptom Onset) enrolled 206 patients who were randomized to receive EVT or best medical treatment. Five scores (PRE-score, THRIVE, HIAT2, SPAN-100 and FAR-score) were retrospectively calculated on patients who received EVT. Receiver-operator characteristics (ROC) for good outcome (mRS 0-2 at 90 days) for each scale were compared. Using the highest predictive scales, the proportion of patients with good outcome by the score categorized in quartiles was analyzed.

Results:
103 patients received EVT in the REVASCAT trial (mean age 65.7, median NIHSS 17). Baseline NIHSS, baseline CT-ASPECTS, age and atrial fibrillation, but not previous iv tPA or DM, were associated with good outcome in multivariable analysis. AUC for good outcome was ≥0.70 for FAR (0.74) and PRE (0.70) scores while SPAN-100 (0.67), HIAT2 (0.65) and THRIVE (0.64) had lower AUCs although differences were not statistically significant. The higher the score on the PRE and FAR scores, the lower the proportion of patients with good outcome (PRE-score: 1QT 44.4%, 2QT 24.4%, 3QT 22.2%, 4 QT 8.9%; FAR-score: 1QT 57.8%, 2QT 22.2%, 3QT 6.7%, 4QT 3.3%). Benefit of EVT accordingly to the score on the different scales will be also presented.

Conclusions:
Of the 5 stroke scales, FAR and PRE had better predictive accuracy for functional independence after EVT. These tools may facilitate decision making for EVT in anterior circulation large vessel occlusion stroke.
Abstract WP282: DS-1040 an Inhibitor of the Activated Thrombin Activatable Fibrinolysis Inhibitor Improves Behavior in Embolized Rabbits
Authors: Lapchak Paul A , Boitano Paul D , Noguchi Kengo
Published: July 2021

Introduction:
DS-1040 is an inhibitor of the activated thrombin-activatable fibrinolysis inhibitor (TAFIa) being developed for the treatment of acute ischemic stroke (AIS). We evaluated the effect of DS-1040 infusiontreatment on rabbit TAFIa activity; plasma concentrations and we also determined if DS-1040 treatment affected behavioral outcome following embolization using the standard rabbit small clot embolic stroke model (RSCEM). Safety was assessed by measuring the effect of DS-1040 on intracerebral hemorrhage (ICH) and mortality.

Methods:
The inhibitory effect of DS-1040 on TAFIa was evaluated using hippuryl-Arg, a substrate of carboxypeptidase. The study was conducted randomized and blinded per RIGOR guidelines. Male New Zealand white rabbits (2-2.5kg) were embolized by injecting a suspension of small blood clots into the brain via an indwelling carotid catheter. Saline (control), tPA (3.3 mg/kg, i.v., 10% bolus/90% infusion for 0.5 h), high and low doses of DS-1040 (approx. 940 mg/per rabbit and 470 mg/per rabbit, respectively) were given 1 h following embolization as an i.v. bolus followed by a s.c. infusion for 47 h. Behavioral analysis was conducted 48 h following embolization, resulting in the calculation of an effective stroke dose (P50) or clot amount (mg) that produces neurological deficits in 50% of the rabbits. ICH was also assessed in all treatment groups.

Results:
DS-1040 inhibited rabbit TAFIa with an IC50 value of 11.7 ng/mL. Using the dosing regimen described above, the mean plasma concentration of DS-1040 at 48 h was 1838 ng/mL (high dose) and 591 ng/mL (low dose). Rabbits treated with high and low doses of DS-1040 had P50 values of 1.61 ± 0.23 mg (p<0.05) and 0.96 ± 0.32 mg, respectively; only the high dose significantly increased (p<0.05) the group P50 by 206% compared to control group P50 (0.78 ± 0.39 mg). The tPA group had a P50 value of 2.29 ± 0.46 mg (p<0.05). Neither the hemorrhage rate nor mortality rate were significantly affected by DS-1040 treatment.

Conclusions:
DS-1040 significantly improved behavioral function in small clot embolized rabbits, suggesting that DS-1040 should be further pursued as a treatment for stroke victims.
Abstract WP292: Discharge Disposition After Intracerebral Hemorrhage and Functional Outcomes
Authors: Osborne Jennifer , Sekar Padmini , Moomaw Charles J , Hwang David Y , Sheth Kevin N , Langefeld Carl D , Vashkevich Anastasia , Woo Daniel
Published: July 2021

Introduction:
Data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study previously reported racial/ethnic differences in discharge disposition after ICH hospitalization to home-like environments vs. medical facilities. We sought to explore how discharge disposition affects functional outcome for ICH patients with disability at time of hospital discharge.

Methods:
ERICH is a multi-center, prospective case-control study of ICH among whites, blacks, and Hispanics. Patients included in this analysis had pre-stroke modified Rankin Scale (mRS) < 3, available ICH volume measurements (log transformed), and mRS of 2-5 at discharge. The mRS at 3 months post onset was the primary outcome variable. Logistic regression was used to model the probability of 3-month functional disability (mRS≥3) against discharge disposition, adjusting for ICH score and dementia.

Results:
Between 08/2010 and 3/2015, 2964 ICH cases were enrolled, of whom 1627 qualified for analysis. Univariate analysis examined demographics, past medical history, social status (education level, marital status, employment), and type of insurance. In multivariate analysis, higher age, lower GCS, higher discharge mRS, non-lobar ICH location, higher ICH volume, presence of IVH, and history of dementia were independently associated with increased risk of mRS≥3 at 3 months. In a multivariate model that controlled for ICH score, patients who were mRS=3 at hospital discharge were more likely to be mRS ≥ 3 at 3 months if discharged to a medical facility rather than to home (p=.0153, OR 2.7, CI 1.2-6.2); additional independent predictors of 3-month mRS≥3 were presence of IVH (p=.002, OR 3.5, CI 1.8-6.6) and dementia (p=.04, OR 3.8, CI 1.1-13.7). However, patients who were mRS=4 at discharge were equally as likely to be mRS≥3 at 3 months, whether discharged home or to a medical facility (p=0.599, OR 0.9, CI 0.5-1.5).

Conclusion:
ICH patients with moderate disability at hospital discharge were more likely to have a favorable functional outcome at 3 months if discharged to a home environment vs. a medical facility. Future analysis is needed to look at the rate of complications for ICH patients at medical facilities vs. home-like environments that may affect 3-month outcome.
Abstract WP302: Atrial Fibrillation First Diagnosed at the Time of Ischemic Stroke: A Missed Opportunity
Authors: Singer Daniel E , Chang Yuchiao , Borowsky Leila H , Regan Susan , Greenberg Steven M
Published: July 2021

Introduction:
Atrial fibrillation (AF) is a major cause of ischemic stroke. Individuals with undiagnosed AF lack the stroke risk reduction afforded by oral anticoagulant therapy. In 1983 Wolf documented that 24% (95% CI 14-37) of AF-related strokes had AF first diagnosed at the time of stroke. Given increased medical and lay attention to AF-stroke, we sought to determine whether this percentage had decreased in contemporary care.

Hypothesis:
Less than 20% of patients with AF-related stroke have their AF first diagnosed at the time of stroke.

Methods:
We identified patients admitted to Massachusetts General Hospital from 01-01-2010 to 12-31-2013 with a new ischemic stroke and either previously or newly diagnosed AF by searching comprehensive hospital databases for stroke and AF ICD-9 codes in conjunction with a hospital stroke registry. Physician reviewers screened 1037 potentially eligible patients, categorized AF as previously known or newly diagnosed, and performed a structured chart review of the stroke event. To confirm the diagnosis of AF was new, we conducted automated searches for AF terms in the patients’ electronic medical records (EMRs) prior to the stroke admission.

Results:
We validated 856 cases (83%) as AF and ischemic stroke. AF was considered newly diagnosed in 156/856 (18%; 95%CI: 16-21). In the newly diagnosed group, no patient was on oral anticoagulants and the strokes were consequential (median NIHSS=12; 60% with mRankin of ≥3 at discharge, including 15% deaths). Pre-stroke CHA
2
DS
2
-VASc score was ≥2 in 89%. About half (76/156) had a prior medical encounter in the EMR. Evidence of pre-stroke AF was found in 8/76 records, often peri-procedural, but the AF diagnosis was not carried forward.

Conclusions:
In this large, contemporary cohort, nearly one in five AF-related strokes occurred in patients who did not carry a pre-stroke AF diagnosis, similar to Wolf’s 1983 finding. The vast majority would have been at high enough pre-stroke risk to merit anticoagulation. Our findings support screening for AF in patients before they have strokes. Further, patients with past transient AF identified via automated EMR searches might merit more intensive screening.
Abstract WP323: Bridging The Gap Between Acute Care and Public Health
Authors: Moore Kari D , Bobo Bonita , Rock Peter , Wise Elizabeth
Published: July 2021

Background:
The WHO estimates that only 50% of patients with chronic illness adhere to treatment recommendations. The Affordable Care Act targets hospital readmission rates as cost savings opportunities. Readmission rates reported in the literature range from 6-33%. Transitional care programs have been shown to improve patient outcomes.

Purpose:
To reduce readmission and recurrent stroke, the Stroke Patient Education and Navigation (SPEN) Project sought to enhance the continuum of care post discharge by forming collaboration between the University of Louisville Stroke Center (UL), Taylor Regional Hospital (TRH) and the Department for Public Health. Primary outcomes of this three-year project were hospital readmission, medication adherence, utilization of community resources, and National Quality Forum (NQF) 18: blood pressure less than 140/90.

Methods:
Stroke patients transferred from TRH to UL discharged home from October 2013 to January 2015 were invited to participate. After discharge nurses made 3 home visits at 2 weeks, 3 months, and 6 months to assess outcomes, biometrics, and blood pressure self-management. A follow up phone call was made at one year.

Results:
44 patients participated (mean age 70, 28 male, 16 female). 32/44 (73%) completed all 3 visits. 36/44 (82%) with medication adherence. 2/44 (5%) readmitted within 30 days (1 with TIA and 1 with pneumonia). 2/24 (8%) participated in a community resource (smoking cessation program and diabetes classes). Reasons for not using community resources were lack of transportation and “not needed”. Results of NQF 18 goals achieved: 29/44 (66%) at visit 1 and 12/28 (43%) for all 3 visits. At one-year post discharge 10 patients had been readmitted, 3 for vascular events (1 TIA, 1 MI, 1 HTN). Cost of project per patient was $306.62.

Conclusions:
the SPEN project achieved low 30-day readmission rate and positive medication compliance, but did not achieve utilization of community resources or satisfactory NQF 18 results. Future projects should consider methods to improve resource utilization and cost effective methods of follow-up, such as multiple telephone or telehealth interactions.
Abstract WP332: Updating the Structure of Stroke Clinical Research Data: Version 2 of the Stroke Common Data Elements From the National Institutes of Health/National Institute of Neurological Disorders and Stroke
Authors: Esterlitz Joy R , Saver Jeffrey L , Warach Steven , Brott Thomas G , Sacco Ralph L , Sheikh Muniza , Ala'i Sherita , Odenkirchen Joanne
Published: July 2021

Introduction:
In order to increase the efficiency and effectiveness of neurovascular clinical research studies, increase data quality, facilitate data sharing, help educate new clinical investigators and reduce study start-up time, the National Institute of Neurological Disorders and Stroke (NINDS) convened a Working Group (WG) that developed Version 1.0 (published 2010) Stroke-specific Common Data Elements (CDEs). Since their initial publication, intervening advances in science and initial experience with the CDEs identified a need to update them and refine guidance on their deployment.

Hypothesis/Objective:
The NINDS has updated guidance on uniform data structures for use in cerebrovascular research in epidemiology, clinical trials and imaging studies in order to advance the prevention, acute treatment and recovery from cerebrovascular disease.

Methods:
The NINDS convened experts in research and data element design drawing strongly from investigators in the NIH StrokeNet and other NINDS clinical research projects.

Results:
Stroke CDE leadership developed a revised process for classifying Stroke CDEs among the four hierarchical categories of Core, Supplemental - Highly Recommended, Supplemental and Exploratory. Due to the heterogeneity of stroke conditions and study types, the classification of Supplemental - Highly Recommended was used for study type (clinical trial or observational), disease type (e.g., ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) and disease phase (primary prevention, acute, recovery and secondary prevention).

Conclusion:
The second iteration of NINDS CDE recommendations for neurovascular disease is an important step towards more efficient study start-up time and improved data sharing. The updated CDEs were released on the NINDS CDE website in May 2015. The information at this meeting will include examples of how the Stroke CDEs may be used by a research study, an explanation of the new CDE classifications, and examples of navigating and selecting CDEs from the NINDS CDE website.

Support:
This project was funded by HHSN271201200034C.
Abstract WP338: Combined Coiling and Allogeneic Mesenchymal Stem/Stromal Cell Therapy Could be a More Cost-effective Alternative to Coiling Alone
Authors: Adibi Amin , Sen Arindom , Mitha Alim P
Published: July 2021

Introduction:
Recurrence of intracranial aneurysms following endovascular therapy in 20% of patients remains the only major disadvantage of this treatment. For this reason, a significant amount of research has been carried out, focused on reducing the incidence of recurrence. In recent years, a variety of cell therapy modalities using fibroblasts, smooth muscle cells, endothelial progenitor cells and Mesenchymal Stem/Stromal Cells (MSCs) have been tested in animal models as a means to improve the outcome of the treatment. However, it remains unclear whether preventing recurrence using cell therapy is a more cost-effective alternative to retreating recanalized aneurysms. In this study, we have used a Markov model approach to determine efficacy thresholds at which combined coiling and cell therapy becomes a more cost-effective treatment than coiling alone.

Hypothesis:
Combined coiling and cell therapy will be more cost-effective than coiling alone, if it reduces the need for retreatment by 50% or more.

Methods:
The cell therapy was assumed to be aimed at reducing the need for retreatment. A Markov model was used to compare coiling alone with combined coiling and autologous/allogeneic cell therapy. Model inputs were mostly taken from meta-analyses. Sensitivity analysis was performed to predict efficacy thresholds that make cell therapy more cost-effective than coiling alone. Robustness of the model was assessed through further sensitivity testing focused on variables with the highest impact on the outcome.

Results:
Sensitivity analysis showed that coiling with autologous cell therapy becomes more cost-effective than coiling alone, if it reduces the need for retreatment by 39.9% or more. When allogeneic cell are used, a reduction of 13.3% or more in the need for retreatment is enough the make combined coiling and cell therapy more cost-effective.

Conclusions:
Our preliminary analysis suggests that efficacy thresholds at which combined coiling and cell therapy becomes more cost-effective than coiling alone are modest - especially for allogeneic MSC therapies. This makes combined coiling and cell therapy a viable alternative to the current standard-of-care from a cost-utility standpoint, and justifies further research and investment in the field.
Abstract WP339: Cerebral Blood Flow Response to Bolus Normal Saline
Authors: Mullen Michael T , Parthasarathy Ashwin B , Zandieh Ali , Baker Wesley , Kasner Scott E , Yodh Arjun G , Detre John A
Published: July 2021

Introduction:
Intravenous infusion of 0.9% normal saline (NS) is used routinely after acute ischemic stroke (AIS). Since cerebral autoregulation is impaired after AIS, volume expansion due to NS infusion holds potential to increase cerebral blood flow (CBF). Here, we use transcranial optics to quantify the CBF response to a NS bolus.

Hypothesis:
An increase in CBF during a 500cc bolus of NS will be detectable using transcranial optics.

Methods:
Adults ≥ 18 years with unilateral supratentorial AIS were enrolled within 96 hours of onset. Relative CBF was noninvasively monitored bifrontally using diffuse correlation spectroscopy with a 15 minute baseline, followed by a 500cc bolus of NS administered over 30 minutes, and a 15 minute post-bolus period. Repeated measures ANOVA and piecewise linear regression were used to quantify the effects of NS bolus on CBF.

Results:
Data from 36 subjects was analyzed (mean age: 64.7±13.5; median NIHSS: 4.5 (IQR 2-9)) at a mean of 66 ± 18 hours after symptom onset. Mean arterial pressure increased during the NS bolus (mean 3.4±9.0 mm Hg). Mean CBF during NS was 22±17% higher than baseline in the ipsilateral hemisphere (p<0.001), and 21±17% higher in the contralateral hemisphere, (p<0.001). Piecewise linear regression estimated an average rate of CBF increase during NS of 0.71%/min in the ipsi and 0.68%/min in the contralateral hemispheres. An average rate of CBF increase of 0.44%/min and 0.48%/min was also observed during the baseline period in the ipsi/contralateral hemispheres.

Conclusion:
NS infusion was associated with a significant increase in CBF from baseline in both hemispheres in patients with subacute stroke. CBF responses to NS infusion were heterogeneous across subjects, suggesting the potential of bedside CBF monitoring for personalized CBF management in patients with AIS.
Abstract WP344: Vascular Unloading Technique for Continuous Non-invasive Blood Pressure Monitoring After Intravenous Thrombolysis in Acute Ischemic Stroke: Interim Analysis of a Prospective Method Comparison Study
Authors: Siepmann Timo , Koehler Anne , Barlinn Kristian , Kepplinger Jessica , Prakapenia Alexandra , Lesser Martin , Penzlin Ana Isabel , Buchmann Sylvia J , Zerna Charlotte , Illigens Ben M , Reichmann Heinz , Pütz Volker , Ziemssen Tjalf , Bodechtel Ulf
Published: July 2021

Introduction:
Elevated arterial blood pressure (BP) increases the risk of intracerebral hemorrhage after intravenous (IV) thrombolysis with tPA in acute ischemic stroke (AIS). While arterial BP is usually monitored using intermittent oscillometric measurements with an upper arm cuff, the vascular unloading technique (VUT) provides non-invasive continuous BP monitoring with a finger cuff.

Hypothesis:
We hypothesized that VUT monitoring is feasible in AIS patients receiving IV tPA, is comparable to the standard technique, and allows detection of BP peaks that might be missed in oscillometric BP monitoring.

Methods:
We performed an interim analysis of an ongoing prospective method comparison study. AIS patients were simultaneously monitored over 24 h following IV tPA bolus using VUT and contralateral oscillometric BP assessment every 30 min.

Results:
We present interim data from 15 out of 24 AIS (4 m, 11 f; aged 72.5±14.9 y, mean±SD) receiving IV tPA. Nominal significance level was set to 0.029 in accordance with Pocock’s rule. Missing data were less than 5% for both techniques. There was a positive correlation between VUT and oscillometric BP assessment (Pearson’s correlation coefficient r=0.91, p<0.001 for systolic BP; and r=0.88, p<0.001 for diastolic BP). Bland-Altman analysis confirmed this agreement (figure 1). The mean difference between VUT and oscillometric BP measurements was 9.4±6.1 mmHg for systolic, and 4.5±3.0 mmHg for diastolic BP (p=n.s.). Peaks (systolic BP>180 or diastolic BP>110 mmHg) were detected by VUT monitoring (at least one episode≥5 min) in 12 patients, and by oscillometric BP assessment (≥one time point of measurement) in 7 patients (p<0.01).

Conclusions:
Our interim data suggest that VUT-based BP monitoring is feasible in AIS patients receiving IV tPA, and might be more sensitive than intermittent oscillometric BP assessment in detecting potentially harmful blood pressure peaks.

Figure 1:
Bland Altman plot
Abstract WP374: Validation of a Novel Claims-Based Stroke Severity Index in Patients Hospitalized with Intracerebral Hemorrhage
Authors: Hsieh Cheng-Yang , Sung Sheng-Feng , Hung Ling-Chien
Published: July 2021

Introduction:
Stroke severity, an important outcome predictor after intracerebral hemorrhage (ICH), is usually unavailable in administrative databases.

Hypothesis:
A claims-based stroke severity index (SSI) with seven predictors is valid for patients with ICH.

Methods:
Consecutive 1,360 ICH patients of three stroke centers with stroke registry data linked to the National Health Insurance Research Database constituted the study cohort. The admission National Institutes of Health Stroke Scale (NIHSS) and the 3-, 6-, and 12-month modified Rankin Scale (mRS) were the reference standards of concurrent and predictive validity, respectively, and were compared with SSI using Pearson’s correlation coefficient. We fitted base logistic regression models (age, sex, and Charlson’s Comorbidity index) to predict mortality at 3, 6, 12 months, added the NIHSS or the SSI separately to the base models, and compared the model discrimination with the base model.

Results:
The SSI correlated with the admission NIHSS (r = 0.731, 95% CI: 0.705-0.755) and mRS at 3, 6, and 12 months (r = 0.696, 95% CI: 0.665-0.724; r = 0.685, 95% CI: 0.653-0.715; and r = 0.664, 95% CI: 0.622-0.702, respectively). Adding the SSI or the NIHSS to the base models increased model discrimination. The areas under the curve (AUCs) of the base models for 3-, 6-, and 12-month mortality were 0.694, 0.689, 0.706; they improved after adding either NIHSS (AUCs: 0.905, 0.893, and 0.884) or SSI (AUCs: 0.843, 0.831, and 0.840) to the base model.

Conclusions:
The SSI might be a valid NIHSS proxy and enable adjustment for severity in ICH outcome studies using an administrative claims database.
Abstract WP38: Lower Fluid Attenuated Inversion Recovery Magnetic Resonance Imaging Signal Intensity After Acute Ischemic Stroke is Associated With Better Discharge Outcomes in Thrombolysed Patients
Authors: Wu Ona , Siddiqui Khawja A , Oliveira-Filho Jamary , Boulouis Gregroire , Bouts Mark J , Vader Priyadarshini , Kimberly W. T , Copen William A , Schaefer Pamela W , Schwamm Lee H
Published: July 2021

Background:
Increases in FLAIR MRI signal intensity (SI) after acute ischemic stroke (AIS) have been proposed as “tissue clocks”, reflecting the degree of ischemic injury and potential for recovery in brain tissue. We hypothesize that lower SI increases will be a biomarker for less severe tissue injury and hence is potentially salvageable. To test this, we investigated patients who were treated with tPA to determine whether better outcomes were associated with lower FLAIR SI.

Methods:
Using our Get with the Guidelines database, we retrospectively analyzed AIS patients admitted between 2011 to 2013 who received full-dose tPA based on institutional protocols. Patients were included if they received a CT scan at our hospital before tPA therapy, and MRI performed < 1 h post CT included a usable FLAIR scan and evidence of stroke on acute DWI. SI ratio (SIR) was calculated on the FLAIR by selecting region of interests in hyperintense FLAIR areas that coincided with the acute DWI lesion and matching contralateral regions. Logistic regression analysis was performed using forward stepwise analysis to combine age, sex, admission NIHSS, SIR and onset-to-treatment (OTT) time to predict discharge outcome. Good outcome was defined as discharge to home or in-patient rehabilitation hospital.

Results:
There were 129 AIS patients who received tPA, and 57 met our imaging criteria. Patient characteristics were: mean±SD age 70±15 years, median [IQR] NIHSS 13 [7-18], OTT 2.1±1.1 h, time-to-MRI 2.1±1.0 h, 58% female and median SIR 1.13 [1.05-1.26]. On a univariate basis, only age (P<0.0001) and NIHSS (P=0.005) were significant predictors of outcome. However, multivariate analysis showed that combining age (P=0.019), NIHSS (P=0.022), and SIR (P=0.018) was able to predict good discharge outcome with 100% [95% CI 63-100%] specificity and 90% [77-96%] sensitivity. Using age and NIHSS alone, resulted in the same specificity but only 71% [56-83%] sensitivity.

Discussion:
Controlling for age and admission NIHSS, we found that lower FLAIR SIR was a significant predictor of discharge outcome while OTT was not. This suggests that “tissue clocks” may be more accurate than “time clocks” for predicting tissue outcome, and ultimately functional outcome.
Abstract WP384: Redesigning the Information Highway - Using Video to Improve Nurse Satisfaction with Patients’ Transitions from the Emergency Department to the Neuroscience Unit
Authors: Richardson Melissa , Salehi Omid , Hinkelman Kevin , Tyan Clarke , Young Teresa , Meyers Melissa , Holbert Lori , Vandergriff Melissa
Published: July 2021

Background:
An effective hand-off process promotes transfer of critical information during transitions of care, thus decreasing the risk of adverse events. For patients with neurological symptoms, exchanging information over the phone may not provide the complete clinical picture of the patient and may contribute to the receiving nurse under appreciating early neurological changes. However, having the nurse leave a busy emergency department (ED) to perform bedside hand-off on the neuroscience unit (NSU) is often not realistic.

Purpose:
To improve nursing satisfaction with the hand-off process between the ED and the NSU, comparing video and phone report.

Methods:
The population consisted of stroke patients admitted from the ED to the NSU over a three month period. The intervention was offering a computer with video for the ED nurse to share pertinent information and perform a neurological exam, a process which allowed the receiving nurse to ask questions and interact with the patient. Nurses who used the video hand-off (n=24) were surveyed at the end of the pilot project to measure their satisfaction.

Results:
Overall, the nurses were more satisfied using video. (Figure). The increase in percentage of nurses answering “Strongly Agree”/ “Agree” were noted in these areas: 71%-85% for relevance of information, 68%-81% for efficiency, 54%-58% for staff relationships, 33%-63% for patient engagement, and 42%-75% for reducing risk for error.

Conclusions:
The use of video during transition of care provides an option for hospitals to employ an interactive handoff between departments without the sacrifice of time. Nursing should further explore the benefits of video technology during transitions of care, particularly inter-departmental transfers for special populations.
Abstract WP394: The Proteasome Subunit α Type 6 Rs1048990 Contributes To The Risk Of Ischemic Stroke And Its Subtypes: New Data And Meta-analysis
Authors: Yu Lihua , Zhang Jingjing , Guo Jian , Fang Jinghuan , Chen Ning , He Li , He Li
Published: July 2021

Background and purpose:
The proteasome subunit α type 6 (PSMA6) is an important proteolytic protein regulating the expression of genes involved in inflammation. Recently, a functional polymorphism rs1048990, located in
PSMA6
, has been reported with the susceptibility to ischemic stroke (IS) in several ethnic cohorts, but the results were inconsistent. Moreover, it still lacks the data in Asian. The purpose of the present study was to determine whether this polymorphism confers significant risk to IS in a Chinese population.

Methods:
A total of 1102 IS cases and 975 healthy controls were analyzed in our study. We genotyped rs1048990 with ligation detection reaction (LDR) method and then performed a meta-analysis.

Results:
Significant association between rs1048990 in
PSMA6
and ischemic stroke was observed in all comparison models (genotype,
p
=0.016; allele,
p
=0.004; CG+GG vs. CC, adjusted
p
=0.006; GG vs. CG+CC, adjusted
p
=0.038). Further stratification for stroke subtype, similar differences also can be found in large artery atherosclerosis and cardioembolism, but not small vessel occlusion. In addition, in the analysis of genotype-phenotype correlation, the onset ages of allele-G carriers have a trend to be older than non-carriers’ (
p
<0.001). In the meta-analysis, there is no significant difference between rs1048990 and ischemic stroke, for the great discrepancy of the genotype composition between Caucasian and Chinese.

Conclusion:
Our study suggests that rs1048990 contributes to the risk of IS and its subtypes in Chinese population, but these associations may vary in different ethnic populations.
Abstract WP395: Improving Data Quality for Stroke Performance Measures: A Comprehnsive and Systematic Approach to Inter Rater Reliability in Ohio
Authors: Liskay Alice ,   Ohio Coverdell Leadership Team and Hosps
Published: July 2021

Background:
Ohio has been funded from the Centers for Disease Control and Prevention for the Paul Coverdell National Acute Stroke Prevention Program for over ten years. This data driven program focuses on reducing stroke mortality and morbidity with emphasis on stroke systems of care throughout the continuum. Inter rater reliability is required to confirm reliability and inform quality initiatives. The objective of this study is to determine the annual inter-rater reliability, utilizing Item Specific Percent Agreement (ISPA),after comprehensive abstractor training, in 45 Ohio Coverdell hospitals.

Methods:
We developed a comprehensive abstraction training program which included: in-person, all-day training for abstractors and reabstractors; reference binders; Question and Answer webinars; abstraction updates at statewide tri-annual Coverdell meetings and easy access, prompt, technical assistance communications for specific questions. Results are shared with individual hospital identifying specific areas for improvement. We examined 395 randomly selected charts from 45 hospitals to determine the overall state and individual hospital ISPA during 2014 to 2015. Up to 67 national stroke performance measure and Coverdell data elements were reviewed for agreement according to eligibility. Charts were abstracted and reabstracted by hospitals using Get With the Guidelines®-Stroke and securely transmitted for analysis. The number of charts provided by hospitals was determined by the previous year’s stroke volume. The statistical package “Rstudio” was used for analysis.

Results:
A total of 13,528 elements were reviewed. The overall state ISPA was 94.9%, compared to 94% during 2013 to 2014. Hospital agreement scores ranged from 78.2% to 99.6%, compared to the previous 83.1% to 99% in the previous year.

Conclusion:
The comprehensive abstraction training program developed by Ohio Coverdell has resulted in excellent inter rater reliability scores. ISPA is a feasible method of performing inter-rater reliability.