bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP206: Transcranial Doppler Markers of Increased Microvascular Resistance After Successful Endovascular Revascularization Are Associated With Larger Infarct Volumes
Authors: Sambursky Jacob A , Surowiec Lisa , Krementz Nastajjia , Cabrera Frank , Cabrera Yosdely , Koch Sebastian , Romano Jose G , Del Brutto Victor J
Published: February 2024

Background:
Markers of increased microvascular resistance on Transcranial Doppler (TCD) obtained shortly after successful endovascular therapy (EVT) in patients with large-vessel occlusion (LVO) stroke have been associated with unfavorable outcomes. We aim to investigate whether post-EVT pulsatility index (PI) correlates with final infarct volume in this population.

Methods:
We analyzed consecutive anterior circulation LVO patients who underwent successful EVT (mTICI 2c-3) from 2012 to 2022. Patients with available TCD within 48 hours of EVT and brain MRI during admission were included. The TCD-derived PI was obtained from the ipsilateral middle cerebral artery. The ABC/2 method was used to estimate the final infarct volume in mL on MRI diffusion-weighted imaging. Pearson correlation and adjusted linear regression analysis were used to investigate the relationship between post-EVT PI and final infarct volume. Linear regression analysis was adjusted for age, NIHSS, and ASPECTS.

Results:
Out of 155 LVO patients with successful EVT during the study period, 40 were included in the analysis (mean age, 69 ± 16.7 years; 57% female; median NIHSS 15 (IQR 10); and median ASPECTS 9 (IQR, 2)). The median time from EVT to TCD and EVT to MRI was 21 hours (IQR, 17 hours) and 41 hours (IQR, 33 hours), respectively. Post EVT PI displayed a positive moderate correlation with final infarct volume (r=0.39, p<0.01; Figure 1). Larger PI values were independently associated with larger infarct volumes (β = 42.2 mL, 95% CI 37.0 - 47.5 mL).

Conclusion:
TCD-derived PI shortly after EVT correlated with final infarct volume in successfully revascularized LVO patients. TCD may serve as a valuable tool to identify those at risk for infarct progression and reveal potential therapeutic targets to maximize EVT benefit in this population.
Abstract TP208: Pre-Existing Dementia Should Not Be Independently Associated Short-Term Functional Outcome in Patients With Acute Ischemic Stroke: A Sub-Analysis of the PASTA Registry Study
Authors: kimura ryutaro , Suda Satoshi , Iguchi Yasuyuki , Yagita Yoshiki , Kanzawa Takao , Okubo Seiji , Fujimoto Shigeru , Kimura Kazumi
Published: February 2024

Background:
The aging of the population is associated with an increasing number of stroke patients with pre-existing dementia. However, the association between pre-stroke dementia and functional outcome after acute ischemic stroke (AIS) has not been fully investigated. We aimed to investigate the association between PED and functional outcome in patients with AIS.

Methods:
We conducted a sub-analysis of the PASTA registry, an observational, multicenter registry of 1,043 patients with stroke receiving oral anticoagulants in Japan, by including patients with AIS with atrial fibrillation (AF). PED was defined as any type of dementia that was present prior to the index stroke. Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-5 or death (mRS score 6). We compared the clinical characteristics and the rate of recanalization therapy between PED and non-PED and determined the effect of PED on stroke outcome.

Results:
Of all 493 participants (median age, 80 years; 212, 43.0% women), 86 (17.4%) had PED. PED were older (P<0.001), had a higher prevalence of congestive heart failure (P<0.001), a greater severity at onset and upon discharge compared to those with non-PED (P=0.0015 and P<0.001, respectively). Although the rate of rtPA was higher in patients with PED than those with non-PED (P=0.0398), there was no significant difference of the rate of mechanical thrombectomy (MT) and rtPA with MT (P>0.05) and intracerebral hemorrhage between PED and non-PED groups (Both P>0.05). The frequencies of poor functional outcome were significantly higher in patients with PED than in those without PED (80.2 vs. 57.0%, P < 0.0001). In multivariable analyses, age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00-1.09, P=0.0318], pre-stroke mRS (OR; 2.05, 95% CI 1.61-2.67, P<0.001), initial National Institutes of Health Stroke Scale score (OR; 1.21, 95% CI 1.16-1.27, P<0.001) and parenchymal hematoma type1/2 (OR; 5.35, 95% CI 1.15-24.88, P=0.0323), but not PED (OR; 1.74, 95% CI 0.76-3.98, P=0.1919), were associated with poor functional outcome.

Conclusions:
PED is not independently associated with poor functional outcome upon discharge after adjustment for baseline characteristics, pre-stroke dependency, initial stroke severity or stroke management.
Abstract TP217: Thrombus Migration in Acute Ischemic Stroke Patients Receiving Mechanical Thrombectomy
Authors: Eun Mi-yeon , Choi Woochan , Hwang Yang-Ha , Hwang Jaechun , Kim Yong-Won
Published: February 2024

Background:
Thrombus migration is occasionally observed during mechanical thrombectomy in acute ischemic stroke patients. However, the factors influencing migration and its impact on imaging and clinical prognosis remain unclear. We investigated the clinical and imaging predictors of thrombus migration and to evaluate the corresponding outcomes.

Methods:
We retrospectively analyzed data from patients with acute anterior circulation (internal carotid artery, M1, M2) stroke who underwent mechanical thrombectomy at two comprehensive stroke centers. Thrombus migration was defined as any distal movement of the proximal end of the thrombus on digital subtraction angiography (DSA) compared to pre-interventional computed tomography (CT) angiography. A comprehensive imaging review was performed, including Alberta Stroke Program Early CT Score, hyperdense vessel sign on non-contrast CT, collateral flow grading on CT angiography and DSA. Univariate and multivariable logistic regression analyses were performed to determine the association between clinical and imaging parameters and thrombus migration. In addition, we compared clinical outcomes according to the presence of thrombus migration.

Results:
Of the 365 patients enrolled, thrombus migration was observed in 81 patients (22.2%). In 40 of these, the thrombus migrated beyond the vessel segment. In multivariable analysis, hyperdense vessel sign (adjusted odds ratio [aOR], 5.41; 95% CI 2.9-10.07), older age (aOR, 1.04; 95% CI, 1.01-1.08), and onset-to-image time (aOR 1.00; 95% CI 0.99-1.00) were associated with thrombus migration. In particular, thrombus migration is an independent predictor of first-pass effect (aOR 2.17; 95% CI, 1.15-4.1). However, there was no significant effect on functional outcome as measured by modified Rankin Scale at 3 months.

Conclusions:
In large-vessel occlusion stroke, the location of the thrombus may change before mechanical thrombectomy compared to pre-interventional angiographic imaging. The composition of the thrombus, as indicated by the hyperdense vessel sign, may influence its tendency to migrate. While thrombus migration is associated with a first-pass effect, it does not influence functional outcomes.
Abstract TP218: Best Practices for Optimizing Door-to-Device Times: Road to Target Stroke Phase III
Authors: Sivapatham Thinesh , Albani Barbara J , Gannon Kimberly P , Nomura Jason T , Huisenga Doug P , Ciechanowski Mary C , McAndrew Reina W
Published: February 2024

Introduction:
The launch of AHA’s Target: Stroke Phase III in 2019 challenged stroke centers to achieve DTD ≤ 90 minutes (direct arriving patients) or ≤ 60 minutes (transfer patients) in ≥ 50% of patients treated with mechanical thrombectomy (MT). At the time of Phase III launch, we were achieving the DTD goal in 45% of patients at our CSC (> 200 MT/year).

Methods:
Our stroke team, in collaboration with the ED and other relevant departments, analyzed the stroke alert process and implemented changes as needed to improve DTD times:

• Early notification of neurointerventional surgery (NIS) by neurologist upon clinical evaluation for any possible MT candidate

• CT/CTP/CTA completed simultaneously (IV lytics given in CT if eligible)

• Utilization of RAPID.AI platform to allow immediate review of stroke imaging by NIS 24/7

• Decision to upgrade to MT made immediately after imaging completed

• MT code activation alerts nursing supervisor, NCCU, anesthesia, and IR team

• Patient transported immediately from CT to angio suite by ED nurse upon upgrade 24/7

• ED nurse transfers care to IR team and anesthesia during working hours, or to NCCU nurse and anesthesia during off hours (IR nurse assumes care upon arrival)

• Focus on efficient handoff process in angio suite

• Specific roles assigned to each team member

• Timer on wall started upon patient arrival to angio suite, with arrival to puncture goal < 20 min

• Efficiency maintained with simulation MT codes rotating members from IR, ER, NCCU, and anesthesia DTD times were collected at launch of Phase III in 2019, and after changes were implemented.

Objectives were to improve DTD times from baseline, in order to optimize care and achieve Phase III goals.

Results:
Figure 1.

Conclusion:
By implementing collaborative and focused interventions, our CSC was able to improve and optimize the workflow of stroke patients undergoing MT, allowing us to achieve the rigorous Target: Stroke Phase III goals and optimize patient outcomes.
Abstract TP219: Outcomes and Differences by Occluded Vessel in the Endovascular Treatment for Acute Ischemic Stroke Patients With Medium Vessel Occlusion
Authors: Matsukawa Hidetoshi , Uchida Kazutaka , Cunningham Conor , Sowlat Mohammad-Mahdi , Elawady Sameh S , Maier Ilko , Al Kasab Sami , Jabbour Pascal , Kim Joon-Tae , Wolfe Stacey Q , Rai Ansaar , Starke Robert M , Psychogios Marios , Shaban Amir , Arthur Adam , Cuellar Hugo , Grossberg Jonathan A , Alawieh Ali , Romano Daniele G. , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam , Osbun Joshua , Crosa Roberto , Matouk Charles , Park Min S , Levitt Michael , Brinjikji Waleed , Moss Mark , Dumont Travis , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade , Chowdhry Shakeel , Ezzeldin Mohamad , Spiotta Alejandro M , Yoshimura Shinichi
Published: February 2024

Introduction:
The outcomes of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) caused by medium vessel occlusions (MeVOs) in different vessels remains unknown. The aim of this study is to investigate MT outcomes in AIS patients with isolated MeVOs in different occluded vessel segments using the data from an ongoing international multicenter registry, the Stroke Thrombectomy and Aneurysm Registry (STAR). The aim of this study is to investigate MT outcomes in AIS patients with isolated MeVOs in different occluded vessel segments using the data from an ongoing international multicenter registry, the Stroke Thrombectomy and Aneurysm Registry (STAR).

Methods:
110 AIS patients with MeVO who undertook MT between January 2010 and December 2022 were retrospectively investigated. MeVO was defined as isolated occlusion of the A2 or A3 (A23O) segment of the anterior cerebral artery, M3 segment of the middle cerebral artery (M3O), and P2 or P3 segment of the posterior cerebral artery (P23O). The primary outcome measure was a 90-day modified Rankin score (mRS) 0-2. The 90-day mRS 0-1, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 90-day mortality were used as secondary outcomes. Outcomes were compared between A23O, M3O, and P23O.

Results:
Median (interquartile range) age was 68.3 (58.4-76.0) years and 49 patients were female (46.7%). MeVO included 17 A23O (15.5%), 60 M3O (54.5%), and 33 P23O (30.0%).Compared to patients with A23O (17.7%), those with M3O (56.7%) and P23O (45.5%) had a higher proportion of 90-day mRS 0-2 (M3O, adjusted odds ratio 10.3, 95% confidence interval 1.71-62.2, p = 0.01; P23O adjusted odds ratio 8.86, 95% confidence interval 1.32-59.3, p =0.02). Other outcomes showed no significant differences.

Conclusions:
This study indicates A2O might be related to poorer outcomes compared to M3O and P23 in MT treatment for AIS patients due to isolated MeVO. Efforts should be aimed at improving outcomes following A23O to match those at other MeVO locations.
Abstract TP220: Intracranial Dotter Angioplasty Using Tenzing for Symptomatic Atherosclerotic Stenosis: Initial Experience
Authors: Settecase Fabio , Khangura Rajkamal S , Kim Warren T , Alexander Matthew D , Gajjar Ashish A , Kim Jaehyun , Shaff Zachary , English Joey D
Published: February 2024

Introduction:
Traditional endovascular treatment for acutely symptomatic intracranial atherosclerotic disease (ICAD) includes balloon angioplasty and stenting. Catheter mediated angioplasty (or “Dotter” angioplasty) has been previously described for extracranial carotid and peripheral arteries. The Tenzing 7 (Route 92 Medical, San Mateo, CA), a novel shelf-reducing delivery catheter, has an atraumatic tapered distal tip that progressively enlarges to a 0.062 inch (1.6 mm) outer diameter, which may enable catheter-mediated Dotter angioplasty of ICAD, or Tenzing-plasty. We report our initial experience in treating symptomatic ICAD using Tenzing-plasty.

Methods:
After IRB approval, we performed a retrospective review of patients undergoing endovascular treatment for symptomatic ICAD with Tenzing-plasty as a first approach at our stroke centers from 2021-2023. All patients were treated using the Tenzing 7 delivery catheter in an off-label fashion. The Tenzing was slowly inserted across the ICAD stenosis in each case under roadmap fluoroscopic guidance. Subsequent balloon angioplasty and/or stenting were at operator discretion. We examined clinical, imaging, and procedural data.

Results:
We identified 14 consecutive patients with symptomatic ICAD stenosis who underwent Tenzing-plasty, either as part of an emergent thrombectomy procedure, or if medical management of ICAD had failed. The median age was 62±11 years and 6 were female (43%). Stenosis location was: 1 ICA, 7 M1, 4 M2, 2 vertebral. The average pre-treatment ICAD stenosis was 95±7%, including 6 patients (43%) with complete occlusion. In 100% of cases, Tenzing-plasty resulted in improvement in arterial caliber after median 1 pass (IQR1-1), with average stenosis improving to 64±15%. Subsequent balloon angioplasty was performed in 3/14 cases (21%). Stenting was performed in 10 cases (using Atlas, Wingspan, Onyx Resolute, Onyx Frontier). There were no instances of arterial perforation or symptomatic intracranial hemorrhage.

Conclusions:
Intracranial Dotter angioplasty as a first approach using the novel tapered tip Tenzing 7 catheter may be a feasible and safe alternative for improving luminal caliber and flow restoration of symptomatic ICAD lesions. Further study is warranted.
Abstract TP225: Prevalence of Patent Foramen Ovale in Patients With Cancer-Related Stroke
Authors: Steinauer Fabienne , Bücke Philipp , Göcmen Jayan , Mujanovic Adnan , Kaesmacher Johannes , Meinel Thomas , Seiffge David , Buffle Eric , Navi Babak , Fischer Urs , Arnold Marcel , Pabst Thomas , Berger Martin , Jung Simon , Beyeler Morin
Published: February 2024

Background and Purpose:
Cancer increases the risk for acute ischemic stroke (AIS) and deep venous thrombosis. The role of paradoxical embolization as a stroke etiology in patients with cancer is uncertain. Our study investigated the relationship between cancer-related stroke and the presence of a patent foramen ovale (PFO).

Methods:
We included AIS patients hospitalized at our comprehensive stroke center between January 2015 and December 2020 with available PFO status as detected on transesophageal echocardiography. Active cancer, including cancer known at the time of stroke as well as occult cancer newly diagnosed within one year after stroke, were retrospectively identified. The association between PFO status and active cancer was assessed with multivariable logistic regression and reported using adjusted odds ratios (aOR) and their 95% confidence intervals (CI).

Results:
Among 2236 AIS patients (median age 68.3 years, female sex 36.4%), 103 (4.6%) had active cancer, of whom 24 (23%) were diagnosed with PFO. This included 32 patients (1.4%) with occult cancer, of whom 19% were diagnosed with PFO. Conversely, among 2133 AIS patients without active cancer, 774 were diagnosed with PFO (36%). In multivariable analysis (Fig 1), the absence of PFO was associated with active cancer (aOR 2.62, 95% CI 1.28-5.38). This association appeared stronger when patients older than 80 years of age were excluded (aOR 3.06, 95% CI 1.42 - 6.58) and persisted among patients with occult cancer at the time of AIS (aOR 5.39, 95% CI 1.18-24.74).

Conclusions:
In patients with AIS, PFO was diagnosed more commonly among patients without cancer than those with cancer. This might be due to cancer-related stroke being related to arterial coagulopathy rather than paradoxical emboli resulting from venous thrombi. Further studies are needed to confirm these findings and to assess the diagnostic role of PFO in patients with cancer and AIS.
Abstract TP244: Racial and Ethnic Differences in Risk Factors and Outcomes in Young Patients With Intracerebral Hemorrhage
Authors: Vyas Vedang , Kherani Danish , Dongarwar Deepa , Kondapalli Swathi , Seol Hyeyoung , House Kayla , Norris Dominique , Sharrief Anjail Z
Published: February 2024

Racial and ethnic disparities in risk factors and outcomes for young patients with ischemic stroke (AIS) are well described. Less is known about disparities in risk and outcomes for young patients presenting with intracerebral hemorrhage (ICH), which is associated with higher short-term and long-term mortality. As such, it is important to review disparities in its evaluation and management. In this study, we aimed to evaluate racial and ethnic differences in risk factors and outcomes for young patients with ICH.

Methods:
We identified patients aged 18-45 from our inpatient stroke registry who presented to our comprehensive stroke center with non-traumatic ICH from 10/2016 to 11/2019, with exclusion of patients with primary subarachnoid hemorrhage. We abstracted baseline characteristics and compared ICH risk and outcomes amongst different racial groups and ethnicities through examination of sociodemographic and medical risk factors and outcomes using independent samples t-test for continuous outcomes, and chi-squared test for categorical outcomes. All tests were two-tailed and the error rate was set at 5%.

Results:
Among 430 patients who met inclusion criteria, 22.3% were non-Hispanic White (NHW), 31.6% Non-Hispanic Black(NHB), 28.6% Hispanic (HIS), 4.9% Asian, and 5.1% other. There were significant differences in insured status, with 50.4% of HIS having insurance compared to 67.6% of NHB and 68.8% of NHW patients. NHB and HIS patients were more likely to be single (55.1% and 44.7%), compared to NHW (32.3%) and Asian (38.1%) patients. Black patients had the highest likelihood of living alone (20.6%; p=0.07), while Hispanic patients were more likely not to not have a primary care provider (64.2%; p=0.02). NHB patients were more likely to have prior hypertension (72%), and diastolic dysfunction (27.2%) compared to NHW (53.1%, 13.5%), and HIS (50.4%, 11.4%) patients). No significant differences in overall discharge disposition or mRS was noted when comparing racial and ethnic groups.

Conclusion:
Although we did not find significant differences in measured outcomes, our study demonstrates underlying sociodemographic and clinical risk factors which may underlie racial and ethnic disparities in long-term outcomes for patients with ICH.
Abstract TP248: Genetic Predisposition to Diabetes and Risk of Stroke in Native Hawaiians
Authors: Brown Stacy C , Both Cameron , Dowsett Leah , Fox Keolu , Nakagawa Kazuma , Gerschenson Mariana , Falcone Guido J
Published: February 2024

Background:
Diabetes is a highly heritable stroke risk factor with numerous known genetic risk variants. However, the role of these genetic risk variants in the development of cerebrovascular disease in Native Hawaiians remains unknown. We sought to determine whether genetic predisposition to diabetes is associated with higher risk of stroke in a Native Hawaiian population.

Methods:
We conducted a genetic association case/control study using data from Native Hawaiians enrolled in the Population Architecture using Genomics and Epidemiology (PAGE) study. Stroke cases were ascertained by baseline questionnaires and matched by age and sex in a 1:10 ratio. We modeled genetic predisposition to diabetes through a polygenic risk score that contained independent genetic variants known to associate with diabetes at genome-wide levels (p<5x10
-8
). This polygenic risk score became the independent variable of logistic regression models for both diabetes and stroke.

Results:
A total of 440 self-identified Native Hawaiians were included (15% < 50 years of age, 85% ages 50-69, 65% females), including 40 stroke patients and 400 age/sex-matched control subjects. Genetic predisposition to diabetes was associated with a 23% higher risk of diabetes (OR 1.23, CI 1.01-1.51; p=0.04) and with a 45% higher risk of stroke (OR 1.45, CI 1.03-2.05; p=0.04).

Conclusions:
Among Native Hawaiians, genetic predisposition to diabetes is associated with higher risk of stroke. As research aimed at evaluating the role of polygenic risk data in clinical practice grows rapidly, our results emphasize the importance of including Native Hawaiians in order to avoid health disparities exacerbated by incomplete representation.
Abstract TP252: Forward Head Posturing as a Significant Risk Factor for Posterior Circulation Infarcts
Authors: Behzadi Faraz , Zywiciel Joseph F , Luy Diego D , GERMANWALA ANAND V
Published: February 2024

Objective:
Forward head posturing (FHP) has been associated with chronic anatomic vertebral artery disturbances possibly leading to posterior circulation ischemia. The data supporting FHP as a true risk factor of posterior circulation stroke has not been well established. We aim to study if patients with severe cervical myalgias and FHP have an increased risk of posterior circulation stroke.

Methods:
We identified all adult patients with posterior circulation stroke and diagnosis of cervical myalgia at Loyola University Medical Center from January 2018 to January 2023. Information on demographics and comorbidities were also collected. We then identified matched pair case-controls (based on age and gender) with non-stroke cervical myalgia patients in the same 5-year period. We compared the relevant comorbidities, C2 tilt angle, and C2-C7 tilt angle of patients to their matched controls to for statistical difference.

Results:
76 patients (38 cases and 38 controls) with an average age of 64 years, including 38 (50%) females met our inclusion criteria. The average C2 tilt of cases was 22.9 degrees compared to 17.7 degrees in controls, and the average C2-C7 tilt of cases was 18.9 degrees in cases compared 10.5 degrees in controls. There were no significant differences between relevant comorbidities (including hypertension, hyperlipidemia, diabetes, atrial fibrillation, hyper-coagulopathy, or body mass index) of cases and controls. There was a significant difference of 5.2 degrees higher C2 tilt and 8.1 degrees higher C2-C7 tilt in cases compared to controls respectively (p-value = 0.03).

Conclusion:
In this single-center retrospective analysis, we found that after controlling for age, gender, and comorbidities, patients with posterior circulation stroke were more likely to have significantly higher C2 and C2-C7 cervical tilt (worse FHP based on radiographic standards) compared to their matched control counterparts.
Abstract TP256: Comparison of Predictors of Seizure in Angiogram Negative Non-Perimesencephalic Subarachnoid Hemorrhage With Aneurysmal Cases
Authors: Haripottawekul Ariyaporn , Shah Asghar , Stretz Christoph , Reznik Michael , Furie Karen L , Mahta Ali
Published: February 2024

Background:
While predictors of seizure in aneurysmal subarachnoid hemorrhage (aSAH) patients have been explored, predictors for seizure in patients with angiogram-negative non-perimesencephalic SAH (an-NPSAH) are less understood. We sought to discern the common and differentiating predictors of seizure in aSAH and an-NPSAH cohorts.

Design/

Methods:
We conducted a retrospective study of a prospectively collected cohort of consecutive patients admitted to an academic center between July 2016 and July 2023. Patients were categorized into aSAH or an-NPSAH based on imaging findings. Clinical data and EEG findings were retrospectively retrieved and analyzed. Binary regression analysis was used to determine the association between predictors and outcomes including clinical and electrographic seizures as indicated by periodic epileptic discharges.

Results:
We reviewed 473 cases (63% female) including 79 an-NPSAH and 394 aSAH. Patients in an-NPSAH group were older (mean age 61.9 years [SD 15.9] vs 56.7 [SD 13.4]). Clinical seizure at presentation or during hospital admission was seen in 8 an-NPSAH and 48 aSAH patients (10% vs 12%; p=0.6). EEG (80% spot, 20% long-term monitoring) was performed in 259 patients (55%): epileptic features were captured in 12 an-NPSAH and 52 SAH patients (15% vs. 13%; p=0.63). Both groups had similar rates of clinical and/or electrographic seizures (25.3% vs 25%; p=0.99). Predictors of seizure in aSAH were Hunt and Hess grade (OR 1.25 per grade increase, 95% CI 1.05-1.49; p=0.011); modified Fisher score (OR 1.64 per point increase, 95% CI 1.25-2.15; p<0.001) and cerebral infarct at presentation or during hospital admission (OR 3.64, 95% CI 2.13-6.23; p<0.001). Neither intracerebral hemorrhage nor aneurysm securement modality was associated with seizure. None of these factors were associated with seizure in an-NPSAH.

Conclusions:
Clinical or electrographic seizures are seen with similar rates in both an-NPSAH and aSAH groups. However, predictors of seizures appear to be different between these groups. Larger prospective studies are needed to identify predictors of seizure in an-NPSAH patients.
Abstract TP265: Comparison of Medical Therapies on Outcomes From Index Vascular Event to PFO Closure
Authors: Silver Mitchell , Tzeng Diana L , Zhan Tingting
Published: February 2024

Introduction:
Recent trials have shown the benefit of PFO closure in recurrent stroke prevention. The literature has shown the benefit of PFO closure plus medical therapy versus medical therapy alone. In subgroup analyses of prior studies, recurrent stroke events between medical therapy only groups found decreased stroke recurrence in the anticoagulation (AC) group when compared to the antiplatelet (AP) group. The timeline of investigation was also notably over multiple years. There is no standardized practice to dictate appropriate AC/AP therapy in the setting of stroke secondary to PFO prior to closure. This study aims to compare recurrent stroke risk of AC versus AP therapy in the interim from index stroke/TIA to PFO closure in a more limited timeline.

Methods:
The study design was a retrospective cohort study, including patients discussed at an institution’s multi-disciplinary PFO committee meetings between September 2019 and October 2022. Chart review yielded key features of the patient’s stroke/TIA presentation, treatment and PFO characteristics. A total of 90 patient charts were reviewed, of which 26 underwent PFO closure and were analyzed for the primary outcome. The primary outcome was recurrent stroke/TIA events that occurred between the Index event and PFO closure.

Results:
The average time between index event and closure was 472 days. Of the 26 patients who underwent closure, 16 were in the AP group and 10. Primary outcome occurred in 2 patients within the AP group prior to closure versus 0 in the AC group, 12.5% v. 0% respectively.

Conclusions:
This outcomes analysis favors the use of AC therapy in the interim between the PFO index event and PFO closure. The results should be considered for AC/AP decisions, while appreciating that the average interim timeline was likely prolonged due to the COVID-19 pandemic with delayed elective procedures. The analysis was not powered to achieve significance due to sample size, however it did display some important trends.
Abstract TP277: Family Types and Stroke Risk Factors: Examining Hypertension and Obesity Prevalence Among Hispanic Adults in the SERVE OC Study
Authors: Ding Xueting , Wing Jeffrey J , Drum Emily , Albala Bruce , Boden-Albala Bernadette
Published: February 2024

Background:
The Hispanic community in the US experiences disproportionate burdens of stroke risk. Family types could impact health outcomes as a mechanism of social support, urging examination of their impact on stroke-related risk factors. We study associations between family types and hypertension/obesity prevalence among Hispanic adults and secondarily assess modification by nativity.

Methods:
The SERVE OC (Skills-Based Educational Strategies for Reduction of Vascular Events in Orange County) study, initiated in late 2022, is an ongoing community-based RCT focused on Hispanic populations to enhance their health behaviors. We collected baseline bio-measures, demographics, and household data. Hypertension and obesity were defined using AHA and CDC guidelines. We used logistic regression to estimate the odds of hypertension and obesity among family types adjusted for age and gender and assessed nativity modification using an interaction term.

Results:
Among 147 Hispanic adults, 56.0% had hypertension, 58.2% had obesity. The mean age was 44.9 years, with 68.5% females and 19.6% foreign-born. Family types included nuclear (44.4%), multigenerational (32.5%), and other (23.1%). Compared with nuclear, multigenerational households showed higher hypertension and obesity odds yet did not reach statistical significance. Individuals in other (6.52; 1.55-27.46) family types had significantly higher obesity odds and differential associations with obesity by nativity (interaction p=0.067). The modifying effect of nativity factors for hypertension was not steadily shown.

Conclusion:
Our study reveals the interrelation of family types and stroke risk factors, particularly obesity, in Hispanic populations. This highlights the need for culturally tailored prevention strategies. SERVE OC emerges as a vital platform to dissect these intricacies and formulated targeted interventions, alleviating stroke risk within the Hispanic community in the US.
Abstract TP279: Atrial Cardiopathy and Intracerebral Hemorrhage in Patients With Acute Ischemic Stroke
Authors: Lei Hanhan , Fang Fangshuang , Wu Xiaomin , Lin Huiying , Yuan Qilin , Huang Huayao , Huang Huapin , Liu Nan , Du Houwei
Published: February 2024

Background and Purpose:
Atrial cardiopathy is recognized as a potential contributor to cardiovascular events. Whether atrial cardiopathy is associated with the risk of intracranial hemorrhage in acute ischemic stroke (AIS) remains uncertain. We aimed to investigate the relationship between atrial cardiopathy and intracerebral hemorrhage risk in patients with AIS.

Methods:
This single-center observational study included 631AIS patients (median age: 70 years [IQR] 61-78; 31.5% female). Atrial cardiopathy was defined as any presence of ≥1: left atrial diameter ≥ 52 mm (males) or ≥ 47 mm (females), elevated P-wave terminal force in V1 (PTFV1) > 5000 μV·ms, or serum NT-proBNP >250 pg/ml. Our primary outcomes included any intracranial hemorrhage (ICH) and symptomatic ICH (sICH) during follow-up. Our secondary outcome was ischemic stroke recurrence. The association between atrial cardiopathy and outcomes was analyzed using Cox hazards regression models.

Results:
During a median of 1.57 years follow-up, 67 (10.6%) AIS patients experienced any ICH, and 18 (2.9%) patients developed sICH. In Kaplan-Meier analysis, the rate of any ICH or sICH during follow-up was more frequent in patients with atrial cardiopathy compared to those without (log-rank test, p < 0.001, respectively;
Figure 1
). After adjustment for CHA
2
DS
2
-VAS
C
, atrial cardiopathy was significantly associated with the risk of any ICH (HR 3.99, 95% CI 2.20-7.22, p < 0.001) or sICH (HR 7.93, 95% CI 1.77-35.51, p = 0.007). There was no significant association of ischemic stroke recurrence with atrial cardiopathy.

Conclusions:
This investigation suggests a potential link between atrial cardiopathy and an increased risk of intracranial hemorrhage in patients with acute ischemic stroke.
Abstract TP28: The Effects of Social Isolation on Cerebral Amyloid Angiopathy
Authors: Jiang Danye , Khan Romeesa , Garg Shivi , McCullough Louise D
Published: February 2024

Introduction:
Cerebral amyloid angiopathy (CAA) is characterized by amyloid β (Aβ) deposition in the cortical and leptomeningeal vessels, and it is a largely untreatable cause of intracerebral hemorrhage and dementia. Studies estimate a 10-50% prevalence of CAA in the general elderly population, positioning it as one of the strongest vascular contributors to age-related cognitive impairment. With aging, the prevalence of social isolation (SI) also increases. Isolated individuals have an increased risk of Aβ-related cognitive decline and heightened inflammatory response to stress. Yet, whether and how SI exacerbates CAA-induced cognitive decline is unknown.

Methods:
TgSwDI mice harboring Swedish, Dutch, and Iowa mutations of human amyloid precursor protein were used as a mouse model of CAA. Male and female C57BL6 wildtype (WT) and CAA mice were randomly assigned to paired housing (PH) or SI at 3 months. Neurobehaviors were measured at baseline and every 3 months using the novel object recognition test (NORT), tail suspension test (TST), and fear conditioning (FC). At 12 months, microglia phenotype, vascular structure, and Aβ burden were assessed using flow cytometry and immunostaining.

Results:
Both WT and CAA isolated animals displayed significantly greater immobility in TST at 9 months post-SI, suggesting a depression-like behavior (n=10-15/grp, p<0.0001). Isolated CAA mice displayed exacerbated cognitive deficits in NORT and FC while WT mice showed intact cognition (n=10-15/grp, p<0.05). Specifically, SI-induced cognitive deficits were more prominent in the female CAA mice compared to males (n=5-8/grp, p<0.01). Sex differences were also observed in CAA mice in frequencies of Aβ-containing endothelial cells (CD31
+
) and vessel-associated microglia (VAM, CD45
int
CD11b
+
CD31
+
) as well as in microglial phagocytosis of Aβ (n=3/grp, p<0.05). SI increased the frequency of Aβ-containing microglia in isolated CAA mice compared to their PH littermates.

Conclusion:
SI induced behavioral deficits in both WT and CAA mice but exacerbated cognitive decline only in the CAA SI mice. SI also influences microglial phagocytosis of Aβ. Further research is needed to determine the cellular and molecular mechanism underlying SI-induced changes in CAA.
Abstract TP283: Histone Lactylation and Neuronal Autophagy: Insights Into the Penumbra-Core Transition and Potential Biomarker in Ischemic Stroke
Authors: Bai Shangying , Geng Xiaokun , Li Fengwu , Ding Yuchuan
Published: February 2024

Objectives:
The dynamic evolution of ischemic penumbra to core has implications for stroke outcomes. Optimizing outcomes remains challenging despite advanced recanalization. We examined the intricate molecular interplay between lactylation and RNA m6A modifications, to unravel the H3K18la-Tfeb m6A-autophagy-neuron-injury pathway, understanding mechanisms underlying penumbra-core transition and investigating potential biomarkers indicative of injury severity.

Method:
Adult SD rats underwent 2, 6, and 24 h of middle cerebral artery occlusion (MCAO) and subsequent reperfusion. The penumbra-core transition-induced brain damage was quantified by infarct volume post 48 h of reperfusion. Employing CUT&Tag and ChIP, H3K18la enrichment in promoter regions was identified. The mRNA and protein levels of lactylation, methyltransferase like 3 (METTL3), transcription factor EB (TFEB) and autophagy-related molecules (LC3, P62, LAMP1) were examined. METTL3 and TFEB localization was determined using immunofluorescence, while serum H3K18la levels were analyzed.

Result:
Ischemia duration was directly linked to elevated neuronal lactylation, particularly H3K18la, and autophagy. Increased H3K18la enrichment was observed in Mettl3 promoter regions, promoting Mettl3 gene transcription. This leads to METTL3-induced tfeb m6A modifications, enhancing TFEB expression and its nuclear translocation. Administering C646 (lactylation writer inhibitor) suppressed METTL3, TFEB, LC3, P62, and LAMP1 expressions, which mitigated brain injuries, underlining lactylation's key role in excessive neuronal autophagy initiation. All molecular alterations were strongly tied to the penumbra-core transition. Markedly, ischemic rats presented elevated serum H3K18la levels, which correlated with dynamic neurological damage.

Conclusion:
Our study elucidates molecular dynamics driving the penumbra-core transition in ischemic stroke. H3K18la initiatives METTL3-associated tfeb m6A modifications, activating the autophagy-lysosome pathway, thus enhancing autophagy and neuronal death. Serum H3K18la variations emerge as potential indicators of neuronal damage severity, suggesting effective biomarkers for assessing post-stroke prognosis.
Abstract TP286: Spatial Transcriptome Profile of Stem Cell-Mediated Recovery in Stroke-Injured Rat Brains
Authors: Habib Pardes , Liang Xibin , Zatulovskaia Yulia , Du Fang , Tigchelaar Seth S , Dong Chen , Wintermark Max , Bliss Tonya M , Steinberg Gary K
Published: February 2024

Introduction:
Intraparenchymal stem cell transplantation shows therapeutic promise for chronic ischemic stroke patients. Our previous phase 1/2a trial revealed a transient T2-FLAIR (fluid-attenuated inversion recovery) MRI signal in the premotor cortex following intraparenchymal stem cell transplantation, the size of which positively correlated with the extent of clinical recovery. We sought to elucidate the underlying molecular mechanisms in this FLAIR region that may facilitate post-stroke recovery using spatial transcriptomic profiling in stroke-injured rat brains.

Methods:
Adult male SD rats underwent 30 min transient middle cerebral artery occlusion followed at 1 month by transplantation of human ES-derived neural stem cells (NR1) or buffer into the ipsilesional striatum. Whisker paw test and various MRI sequences (T2, FLAIR, DWI) were performed at multiple time points. The Visium platform (10X Genomics) was used for unbiased spatial transcriptome analysis in two stem-cell and two vehicle-treated brains at the peak of FLAIR.

Results:
We successfully replicated transplant-induced FLAIR after chronic stroke in rats and found a positive correlation between FLAIR and improved neurological outcomes. Visium identified specific gene clusters for the stroke injury, transplant/needle-track, stem cell graft, and the cortical ‘FLAIR’ region. The latter consisted of a central core containing the gene signature of the needle track and blood, and a wider region around this core which encompassed the FLAIR lesion seen by MRI. This wider FLAIR region displayed a predominantly microglia/inflammation-associated signature and was best characterized by the upregulation of apoptosis-associated genes. Pathway analysis of the differentially-expressed genes in the FLAIR cluster revealed a significant representation of immune cell responses (e.g. phagocytosis, immune cell migration, cytokine signaling), as well as ER stress mechanisms.

Conclusion:
This pilot study provides initial evidence that altered immune responses in the stem cell transplant-induced FLAIR region may promote recovery after chronic stroke. Further research on the role of microglia/neuroinflammation is needed to understand the mechanisms of stem cell-mediated brain repair.
Abstract TP287: Estrous Cycle Stages and Cerebral Blood Flow: Implications for Ischemic Tolerance in Stroke
Authors: Liang Xibin , Chen Hansen , Bliss Tonya , Steinberg Gary
Published: February 2024

Introduction:
Previous stroke studies in female rodents have demonstrated that the severity of ischemic damage is differentially impacted by the estrous cycle. Estrogen is considered to be neuroprotective, but it is unclear whether this protection is dependent on the vasodilator properties of estrogen. In this study, we investigated the impact of estrus cycle stage on stroke lesion volume and whether that impact was dependent on cerebral blood flow (CBF) changes during stroke.

Methods:
Ischemia was induced in adult ( 10 weeks) male and female Sprague-Dawley rats by 30 minutes middle cerebral artery occlusion (MCAO) using the suture model. Prior to the stroke procedure, the phases of the estrous cycle (proestrus(P), estrus(E), metestrus(M) and diestrus (D)) were determined by vaginal smear tests in female rats. Cerebral blood flow (CBF) was measured by laser doppler and infarct volume were measured by TTC staining at d2 post-stroke.

Results:
Females in proestrus and diestrus (P/D) stages of the estrous cycle, which have reportedly high levels of estrogen, had significantly (p<0.05) smaller CBF decreases during ischemia and a trend for smaller infarcts than those in estrous and metestrus stages, which have lower estrogen levels. This suggests that the protective effects of estrogen may be related to effects on blood flow. However, when compared to male rats, females in P/D stages had significantly (p<0.05) smaller brain infarcts despite having similar CBF decreases. This implies that additional mechanisms are responsible for the neuroprotection observed in females when compared to males.

Conclusion:
Estrous cycle stage affects CBF decrease during ischemia, but this does not account for the difference in infarct size observed between male and female rats. Our study indicates that multiple mechanisms are responsible for ischemic tolerance in specific stages of the estrous cycle. Keywords: stroke, estrous cycle, CBF, estrogen
Abstract TP288: Selective Brain Hypothermia Induced by Thermoelectric Cooling
Authors: Alarnous Hanan , Phan Paula , Abdellatif Youssef , Wang David , Thomas Megan , Pizziconi Vincent
Published: February 2024

Background:
Stroke or Traumatic Brain Injury (TBI) are leading causes of disability and death in the United States. Hypothermia is a known neuronal protectant. Current hypothermia interventions include intravascular, intranasal, and surface brain cooling technologies but these interventions have not been well utilized clinically. Cooling the brain a few degrees below normothermia (T<36°C) has been shown to yield significant neuroprotective effects. Noninvasive surface cooling methods are most desirable given their less patient complications, provided the desired therapeutic hypothermia effect (T 33-36°C) can be maintained.

Method:
These investigators propose a novel noninvasive solid state technology that employs addressable Peltier thermoelectric cooling elements to generate hypothermia. ThermoPelt’s closed-looped microcontroller design provides the ability to address individual Peltier elements to selectively reduce the temperature of localized regions of the brain, thus allowing precision therapeutic hypothermic conditions to be realized.

Results:
Assessment of ThermoPelt performance was accomplished with use of virtual prototype (engineering mathematical model representations of the brain) and early, in vitro experimental physical prototype testing. Preliminary results obtained from virtual and physical prototype tests verify ThermoPelt feasibility to achieve hypothermic conditions.

Conclusion:
In this new method of generating hypothermia, the preliminary findings demonstrate that our noninvasive ThermoPelt technology is capable of reducing brain temperature at controlled rates to selectively target specific head and neck regions.
Abstract TP29: Neurodegenerative Plasma Biomarker Associations With Cognitive Resilience in Adults With High White Matter Hyperintensity Volume: A Post-Hoc Analysis of Systolic Blood Pressure Intervention Trial Memory & Cognition in Decreased Hypertension (SPRINT MIND)
Authors: Stulberg Eric
Published: February 2024

Introduction:
Although high cerebral white matter hyperintensity volume (WMHv) is associated with cognitive decline, many adults with high WMHv show no cognitive deficits. Neurodegenerative plasma biomarkers may be associated with cognitive decline via vascular processes causing higher WMHv such as cerebral amyloid angiopathy & inflammatory small vessel disease. We determined associations of plasma amyloid β 42 (AB42), amyloid β 40 (AB40), AB42/AB40, total tau, & neurofilament light chain (NfL) with cognitive resilience (CR) in adults with high WMHv using baseline MRIs & measurements from SPRINT MIND.

Methods:
This study included baseline data from 186 SPRINT MIND participants who were in the highest WMHv tertile & had available plasma biomarker concentrations & Montreal Cognitive Assessment (MoCA) scores. We defined CR two ways: A) MoCA score >25 or B) MoCA score >22. We determined univariate & adjusted odds ratios (OR) & 90% confidence intervals (CI) for each aforementioned plasma biomarker with CR. Confounders in adjusted models were: age, sex, race-ethnicity (Non-Hispanic white, Non-Hispanic Black, Hispanic, or other) education (no college education, college education, or post-graduate education), smoking history (never smoker, prior smoker, or current smoker) physical activity (0, 1-4, or ≥ 5 days of vigorous physical activity), diabetes, having insurance, & average systolic blood pressure. Residual confounding and effect modification by WMHv were tested in sensitivity analyses.

Results:
In our sample, the mean age was 72.6 years, 45.7% were female & 66% were Non-Hispanic white. The median WMHv was 10.0 cm
3
(25%-75% range: 6.3 - 16.9 cm
3
).
.
CR defined as MoCA scores > 25 & >22 was present in 28.5% & 56.5% of participants respectively. Lower plasma AB40 was marginally associated with CR using a MoCa cutoff of >25 (OR 1.003, 90% CI: 1.001-1.006) in univariate analyses. There were no other significant (P>0.1) univariate or adjusted associations between plasma biomarkers with CR using either MoCa cutoff, nor significant confounding or effect modification by WMHv (P> 0.1).

Conclusion:
There were no significant adjusted associations between any plasma biomarker with CR. Future work should identify factors associated with CR in adults with high WMHv.
Abstract TP290: A Pilot Study of a Novel Brain Penetrant Mn(III) Porphyrin-Based Sod Mimic on Middle Cerebral Artery Occlusion in Female and Male Mice
Authors: Uchikawa Hiroki , Ishiguro Taichi , Margaryan Tigran , Tovmasyan Artak , Wendt Trevor S , Gonzales Rayna J , Hashimoto Tomoki N
Published: February 2024

Introduction:
Oxidative stress exacerbates acute ischemic stroke (AIS). Manganese Porphyrin (MnP)-based superoxide dismutase (SOD) mimics have shown therapeutic benefits for AIS. However, earlier MnP versions faced limited blood-brain barrier (BBB) penetration and hypotension. A novel SOD mimic MnP-05 is designed to overcome the limitations of previous generation structural analogs. Our study aimed to assess whether MnP-05 improves transient middle cerebral artery occlusion (tMCAO) outcomes in mice.

Methods:
Male and female C57BL/6J mice aged 12-14 weeks were used. Initially, a safety study was conducted using uninjured mice to establish safe dosage levels independent of hypotension. Subsequently, pharmacokinetic (PK) analysis assessed BBB penetration of MnP-05. Finally, efficacy studies of MnP-05 were assessed following a 45-minute tMCAO. Intravenous administration of 0.5mg/kg of MnP-05 occurred 5 minutes before recanalization, followed by intraperitoneal implantation of an osmotic pump delivering 2.5mg/kg/day of MnP-05 for 72 hours after tMCAO. The concentration of MnP-05 was evaluated in ischemic core and contralateral normal brain by LC-MS/MS. The neurological symptoms were assessed at 72 hours.

Results:
The safety study revealed that doses of 10mg/kg or less were considered safe (Fig.1). In the PK study, MnP-05 demonstrated preferential distribution to ischemic lesions. In the efficacy study, MnP-05 group demonstrated improved neurological outcomes, although statistical significance was not achieved (Fig.2).

Conclusions:
We established the safety of MnP-05 in tMCAO mice. Our findings suggest that MnP-05 is a promising therapeutic agent for AIS.