bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP75: Vasomotor Reactivity As A Predictor Of Angiographic Collateralization And Outcome In Patients Undergoing Extracranial-Intracranial Bypass Surgery
Authors: Krementz Nastajjia , Khan Nickalus R , Campo Nelly , Koch Sebastian , Romano Jose G , Morcos Jacques J , Asdaghi Negar
Published: February 2022

Background:
Extracranial-Intracranial (EC-IC) bypass is increasingly used for treatment of hemodynamic failure in Moya-Moya disease (MMD) or syndrome (MMS). No specific imaging parameter has been established to determine bypass patency in these patients. We sought to determine if vasomotor reactivity (VMR) testing could be correlated with pre-operative angiographic data and predict bypass patency.

Methods:
All available pre-operative VMRs and diagnostic angiograms (DSA) in patients with EC-IC direct bypass surgeries performed at our institution from 2007-2019 were reviewed to determine the degree of pre-procedural hemispheric failure (by VMR to the inhalation of carbon dioxide and hyperventilation, abnormal defined by less than 70%) and collateral compensation (categorized as complete vs. incomplete collaterals by DSA). Bypass patency was assessed on follow-up imaging (either immediate in post-op angiogram and delayed subsequent CTA or DSA).

Results:
Of the 113 bypass surgeries performed, 68 had pre-operative VMR and DSA. A total of 52 patients were included, in which 16 had both hemispheres operated on (median age 46 [IQR 25], 74% women, 60% with Moya-Moya disease, 51% presented with ischemic stroke, 37% TIA, 10% intracerebral hemorrhage and 1% headache). Pre-operatively, 97% had an abnormal VMR, 24% had incomplete collateralization. A total of 79% had bypass patency (87% immediate, 76% delayed, median time 1 year 8 months [IQR 1 year and 6 months)) on follow up. Patients with patent bypass had significantly lower VMR (27 [SD ± 18.8] vs. mean 36 [SD ± 14.5], p=0.005) and higher likelihood of incomplete collateralization pre-operatively (mean 25.1 [SD ± 16.4] vs. mean 39.2 [SD ± 18.8], p=0.013) as compared to non-patent bypass patients. In multivariate analysis low pre-operative VMR was a significant predictor for bypass patency adjusting for age, presenting stroke type and gender (p=0.01).

Conclusion:
Vasomotor reactivity is a non-invasive, low-cost test which predicted angiographic vessel collateralization and bypass patency. Bypass patency remains important predictor of outcomes in this population.
Abstract TMP81: The Relationship Between Carotid Stenosis And Silent Cerebrovascular Disease
Authors: Lin Michelle , Demirer Mutlu , Middlebrooks Erik , Anisetti Bhrugun , Youssef Hossam , Elkhair Ahamed , Barrett Kevin M , Brott Thomas , Meschia James F
Published: February 2022

Introduction:
Patients with carotid stenosis may have silent cerebrovascular disease due to chronic hypoperfusion and atheroembolism. If so, progression of silent disease may be preventable through revascularization. We aim to evaluate the association between carotid stenosis/occlusion and cerebral small vessel disease (SVD) burden ipsilateral to the cervical carotid stenosis.

Methods:
Patients age ≥40 years with carotid stenosis or occlusion on carotid ultrasound who underwent MRI brain and intracranial angiogram with gradable SVD on MRI from 2011-2015 were included. Severity of carotid stenosis was defined using NASCET criteria as 50-69% (moderate), 70-99% (high-grade), or occluded. WMH volume was quantified using an automated artificial intelligence algorithm applied to axial T2 FLAIR images. Images were also scored for presence of chronic lacune, cerebral microbleeds (CMB), and silent infarcts using STRIVE criteria. Differences in WMD volume between hemispheres ipsilateral and contralateral to the carotid stenosis were calculated, and prevalence of SVD and silent infarct were compared across severities of carotid stenosis.

Results:
Of the 183 patients, mean age was 71±10 years and 38% were female. Moderate and severe stenosis was present in 36% and 46.5%, respectively, and 18% had carotid occlusion. Mean WMH volume was 7271±522mm
3
. Patients with carotid stenosis had greater WMH volume ipsilateral to the side of carotid stenosis than the contralateral side (mean difference 224±206mm
3
), and higher severity of stenosis was associated with greater hemispheric difference in WMH volume (moderate vs high; 164±274mm
3
vs 743±309 mm
3
, p=0.009). Silent infarcts were more prevalent in high-grade carotid stenosis than moderate grade (moderate vs high, 10.8% vs 36.5%; p=0.002). There were no differences in either lacunae or CMBs across severities.

Conclusions:
Greater than one third of patients with high-grade carotid stenosis had ipsilateral silent brain infarction, and the volume of WMH was greater on the side of carotid stenosis. Future analyses should consider the potential yield of screening for carotid atherosclerosis in patients with varying degrees of hemispheric WMH asymmetry.
Abstract TMP87: Higher Prevalence Of Autism Spectrum Disorder In Children With Perinatal Ischemic Stroke
Authors: Wu Clara , Lehman Laura L
Published: February 2022

Introduction:
Perinatal stroke leads to significant morbidity over a child’s lifetime. Following perinatal stroke, children are more likely to be diagnosed with attention-deficit/hyperactivity disorder, intellectual disability, and language disorders. However, to our knowledge, studies examining the prevalence of autism spectrum disorder (ASD) in children with perinatal stroke do not exist.

Methods:
We retrospectively examined all children seen in the Stroke and Cerebrovascular Center at Boston Children’s Hospital from August 2008 through April 2021. All children with a history of perinatal ischemic stroke, either arterial or venous, aged ≥15 months old at the time of last follow-up were considered for inclusion. We classified patients as having ASD if their medical record included an ASD diagnosis by a neurologist, neuropsychologist, clinical psychologist, or developmental pediatrician. Multivariable logistic regression was performed to examine association between stroke type and ASD.

Results:
Among 285 children with perinatal stroke, 22 children (7.71%) also had ASD. Males had 8 times higher odds of ASD compared to females (OR= 8.07, p=0.007). Children with perinatal venous stroke had 2.5 times higher odds of ASD compared to those with arterial stroke (OR=2.58, p=0.05), which approached significance. There was not a significant difference in odds of autism in children diagnosed with presumed perinatal stroke compared to neonatal stroke.

Conclusion:
In our perinatal stroke population, the prevalence of ASD is 4 times higher than the prevalence of ASD in the general U.S. population (1.85%) as per the CDC in 2020. Boys had higher odds of autism, similar to what has been found in the general population. Interestingly, patients with venous stroke had higher odds of autism compared to those with arterial stroke. In conclusion, prospective studies are needed to further investigate the role of perinatal stroke in ASD development.
Abstract TMP89: Temporal Trends In The Utilization Of IV TPA And Mechanical Thrombectomy In Pediatric Strokes Over The Last Decade
Authors: Kaur Navreet , Latorre Julius Gene S , Albright Karen C , Otite Fadar O
Published: February 2022

Background:
Although there are well-established guidelines for intravenous thrombolysis (tPA) and mechanical thrombectomy (MT) in adult acute ischemic stroke (AIS), limited data exists in children. This study aims to investigate current trends in the utilization of tPA and MT in the pediatric AIS population and identify predictors of use.

Methods:
We identified all patients <=20 years (weighted n=3,452) with a primary diagnosis of AIS in the KIDS Inpatient Database from 2009-2016. Age-specific rates of utilization of tPA and MT were calculated. Multivariable-adjusted logistic regression models were used to evaluate predictors of tPA and MT use.

Results:
Across the study period, 44.8% of AIS admissions were girls, and the mean age was 7.5 years (y). The overall frequency of usage of tPA was 5% and MT was 2.3% but this differed significantly by age (tPA 0-4y 0.5%; 10-14 y 4.5% and MT 5-9 y 2.4% vs 15-20 y 3.5 %). Overall tPA use increased by >100% over time: 2.5 % in 2009 to 6.3 % in 2016, but most of this increase was seen in patients 10-14 y and 15-20 y (figure 1). MT use more than doubled across the study period from 0.98 % in 2009 to 2.8 % in 2016 with the greatest increase in patients 15-20 y (figure 2). After multivariable adjustment for clinical and demographic factors, tPA use increased with age (10.8, 95%CI 2.8-41.3, for ages 15-20 vs 0-4 y). Compared to ages 0-4 y, patients 5-9 y had marginally significantly greater odds of MT use (7.6, 95%CI 1.2-48.4). There was no significant difference in odds of tPA and MT use by race and sex but patients hospitalized in the west were more likely to undergo MT compared to those in the Northeast (OR 3.7: 95%CI 1.4-9.7, p=0.008). Overall in-hospital mortality was 10.6% and this did not change significantly over the study period (p=0.791).

Conclusion:
Usage of tPA and MT in pediatric AIS patients increased in the US over the last decade but in-hospital mortality has not changed over time. Future studies targeted at improving stroke mortality in children are needed.
Abstract TMP9: Novel Single-cell Isolation From Cerebral Cavernous Angioma Specimens For Transcriptomic Studies
Authors: Li Ying , Srinath Abhinav , Ciszewski Cezary , Lightle Rhonda , Romanos Sharbel , Sone Je Yeong Y , Girard Romuald , Awad Issam A
Published: February 2022

Introduction:
Cavernous angiomas (CAs) are common neurovascular lesions predisposing patients to seizures and hemorrhagic stroke. Recent evidence shows non-endothelial cell autonomous effects contribute to CA pathogenesis within the dysfunctional neurovascular units (NVUs), consisting of endothelial cells, pericytes, astrocytes, and microglia. Herein, we developed a single-cell isolation protocol to study the transcriptome of each of these cell populations.

Method:
CAs and control brain tissue were frozen in optimal cutting temperature compound immediately after surgical resection. Tissue was enzymatically digested with Collagenase Type IV and DNase I. The cell suspension was then filtered, washed, and pelleted. Cell debris and myelin were removed using 25% Percoll. A multispectral LED light was used for 30 minutes to reduce background autofluorescence. Cells were stained with a CD31, CD45, CD13, P2RY12, CD49f, GLAST, CD24 and CD90 antibody cocktail. Size, granularity, and antibody-specific gating were set to sort each cell population using the BD FACSymphony S6 Cell Sorter. After isolation, RNA was extracted for each cell population, and the quality was assessed. Cell-specific genes including
VWF
(endothelial cells),
ACTA2
(pericytes ),
AQP4
(astrocytes ) and
IBA-1
(microglia ), as well as
GAPDH
were assessed with real-time qPCR (rt-qPCR) for validation.

Results:
Endothelial cells (CD31
+
, CD13
-
, CD45
-
, CD49f
-
, GLAST
-
), pericytes (CD13
+
, CD31
-
, CD45
-
, CD49f
-
, GLAST
-
), astrocytes (CD49f
+
, GLAST
+
) and microglia (P2RY12
+
, CD45
+
, CD31
-
, CD13
-
, CD49f
-
, GLAST
-
) were individually isolated from both 5 CA lesions and 5 control brain tissue using FACS sorting. RNA quantity ranged from 31 to 83 pg/μl, with RNA Integrity Number ranging from 1 to 8.7. Each cell population within the CA lesion was validated by showing differential expression of cell-specific genes.

Conclusion:
We have shown, for the first-time, feasibility of individual cell type isolation from frozen, surgically excised CA lesions. The RNA quantity and quality of each cell population was suitable for the establishment of cell-specific transcriptome libraries. These will help clarify individual cell type contributions to CA pathogenesis.
Abstract TP102: Hypoperfusion Intensity Ratio Predicts Infarct Growth After Successful Thrombectomy For Distal Medium Vessel Occlusions
Authors: Guenego Adrien , Ligot Noemie , Lubicz Boris
Published: February 2022

Background and Purpose:
We evaluated whether quantitative measurement of collaterals by the hypoperfusion-intensity-ratio (HIR) on baseline computed-tomography-perfusion (CTP) was correlated with infarct growth after successful endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusions (DMVO), as well as clinical outcome.

Methods:
We performed a retrospective analysis of consecutive AIS patients who underwent an initial CTP and were successfully recanalized by thrombectomy for DMVO. We evaluated the association of baseline HIR with infarct growth and clinical outcome.

Results:
Between January 2018 and January 2021, 40 patients suffering from an AIS with DMVO were successfully recanalized by MT (65% [26/40] female, median age 72 [65-83] years). Baseline HIR was strongly correlated with Infarct growth after successful recanalization (r=0.501, p=0.001). ROC analysis determined that a HIR<0.306 was an optimal threshold, it was associated with lower infarct growth compared to HIR≥0.306 (respectively 7.2 mL [IQR: 4.2-11.7] vs. 23.8 mL [IQR: 9.1-45.1], relative-risk of 0.38 [0.08-0.68], p = 0.015); as-well-as higher rates of good clinical outcome (75% [21/28] vs. 33% [4/12], p < 0.017, Odds ratio 6.0 [1.37-26.20]).

Conclusion:
Good collaterals on initial CTP assessed by an HIR<0.306 may be associated with less infarct growth and better clinical outcomes after MT recanalization for AIS with DMVO.
Abstract TP104: Agreement Of Hypoperfusion Intensity Ratio On CTP Derived By Rapid AI And Viz AI
Authors: Asimos Andrew W , Rhoten Jeremy B , Clemente Jonathan D , Strong Edwin , Prasad Tanushree , Karamchandani Rahul R
Published: February 2022

Background:
For anterior circulation large vessel occlusion acute ischemic stroke patients, Hypoperfusion Intensity Ratio (HIR) derived from automated Computerized Tomography Perfusion (CTP) software has been shown to predict the rate of collateral flow, speed of infarct growth, and clinical outcome. Published data have proposed an HIR threshold derived by RAPID AI (Menlo Park, CA) of either <0.5 or <0.4 as best predicting robust collaterals. The agreement between HIR derived from VIZ AI (San Mateo, CA) compared to RAPID AI is unknown.

Methods:
We identified 107 cases in which the middle cerebral artery was the most proximal site of occlusion on Computerized Tomography Angiography as confirmed by a neuroradiologist, and for whom a CTP performed on RAPID AI was diagnostic (e.g. lacking artifact from head motion, a failed bolus injection, poor scan timing, or low signal-to-noise). Those CTP acquisition data were subsequently processed on VIZ AI. We measured the agreement for HIR dichotomized at both <0.5 and <0.4 between RAPID AI and VIZ AI, along with the overall agreement.

Results:
For the HIR dichotomized at <0.5, the simple kappa coefficient between HIR derived from VIZ AI compared to RAPID AI was 0.714 (95% CI 0.581-0.846), versus 0.636 (95% CI 0.500-0.772) for the HIR dichotomized at <0.4. The intraclass correlation coefficient (ICC) between HIR derived from VIZ AI compared to RAPID AI was 0.78 (95% CI 0.694-0.844).

Conclusions:
In our sample of 107 cases, the level of agreement for the HIR derived from RAPID and VIZ dichotomized at <0.5 was in the moderate to very good range (Landis & Koch, 1977), versus in the moderate to good range when dichotomized at <0.4. Based on the ICC, agreement was in the moderate to good range. Further investigation of the agreement of HIR derived from RAPID AI and VIZ AI should be conducted before applying HIR thresholds derived from RAPID AI to CTP studies analyzed by VIZ AI to predict favorable collateralization.
Abstract TP109: Developing Novel Portable Neuroimaging To Deliver Urgent Prehospital Stroke Care
Authors: Balabanski Anna H , Dos Santos Angela , Skeats Anthony , Langenberg Francesca , McSkimming Thomas , Bivard Andrew , Gonzales Brian , Bishop Lara , Delnooz Chris , Rowland Peter , Easton Damien , Donnan Geoffrey A , Davis Stephen ,   Australian Stroke Alliance
Published: February 2022

Introduction:
Patients with stroke in rural and remote areas have limited access to time-critical stroke care and have worse outcomes. Mobile stroke units (MSUs) are increasingly used worldwide to deliver prehospital stroke care, improving treatment times. However, current brain scanners are too large, heavy, and costly to be used in standard ambulances to access rural regions. The Micro-X solution is a fixed gantry computed tomography (CT) device, using unique cold-cathode technology, in which microscopic carbon nanotubes emit electrons instantaneously when voltage is applied, without heat production, instead of the heated tungsten filament used in conventional CT. This novel technology reduces size and weight, enabling development of a novel CT scanner weighing under 50 kg, a ten-fold reduction compared to the scanner currently used in most MSUs.

Methods:
In partnership with the Australian Stroke Alliance, Micro-X is developing a novel lightweight brain scanner for use in ambulances. Based on data from an early prototype cadaver study, we are undertaking further validation studies, including a two-part preclinical study: (1) phantom study using 4 phantoms (CATphan, anthropomorphic, Jaszczak SPECT, and Nuclear Medicine); and (2) subsequent cadaver study, scanning cadavers within 24h of death, compared to standard CT.

Results:
The early prototype cadaver study demonstrated feasibility, including identification of lateral and third ventricles when compared to concurrent CT. Through technical improvements in hardware and software, including improved scanner geometry and algorithm development, the planned phantom study will provide data on contrast resolution, quantitative spatial resolution, identification of anatomical structures, and haemorrhage detection compared with conventional CT. The subsequent cadaver study will provide further validation on anatomy identification and artifact reduction and ensure whole-brain coverage.

Conclusion:
Preclinical evaluation of this novel lightweight technology compared with conventional CT will provide technical assessment and image validation. This will provide diagnostic confidence to perform pilot in-vivo studies, with the potential to revolutionise prehospital stroke care.
Abstract TP116: The Frequency And Associated Factors Of Deep Vein Thrombosis At Admission Of Acute Stroke
Authors: Mori Takahisa , Yoshioka Kazuhiro , Miyazaki Yuichi
Published: February 2022

Introduction:
Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission of acute stroke, IPC of the legs with DVT may cause migration of the thrombi resulting in pulmonary emboli. Therefore, whole-leg ultrasonography to detect DVT should be performed at admission; however, it is not always done in many institutions. Therefore, risk factors to estimate DVT presence at admission are necessary.

Hypothesis:
The frequency of DVT at admission is high, and IPC should not be used in patients with significant factors of DVT presence at admission.

Methods:
We included patients admitted within 24 h of stroke onset between 2016 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers. We evaluated variables with significant differences between groups of DVT presence and absence, excluded variables with multicollinearity, and conducted multiple logistic regression analyses to identify independent discriminants of DVT presence from absence. The threshold values of discriminants were identified by receiver operating characteristic curves.

Results:
Of 1936 stroke patients, 1461 met our inclusion criteria. DVT was detected in 255 patients (17.5%). Compared to patients without DVT (n=1206), patients with DVT were older, female sex, lower body weight, higher C-reactive protein levels, lower albumin or triglyceride levels, higher National Institutes of Health Stroke Scale score, and higher pre-stroke modified Rankin stroke scale score. Female sex, low albumin, high C-reactive protein, low triglycerides, and old age were independent DVT-presence discriminants. The threshold values of albumin, C-reactive protein, triglycerides, and age were ≤ 37g/L, ≥ 3450 ug/L, ≤ 1.569 mmol/L, and ≥ 79 years, respectively.

Conclusion:
The DVT-presence frequency of 17.5% at admission was high, and significant DVT-presence factors at admission were female sex, low albumin, high C-reactive protein, low triglyceride levels, and old age. Therefore, in patients with the five significant factors, IPC should be avoided, or whole-leg ultrasonography should be performed before IPC.
Abstract TP128: Do All Intracerebral Hemorrhage Need Intensive Care Unit Admission. The Influence Of Hospital Level Of Care
Authors: Safdar Adnan , Grose Noah , STEGALL HENDRIK , Qureshi Adnan
Published: February 2022

Background:
Admission to intensive care unit has been the standard of care in many institutions. Level of care in intracerebral hemorrhage patients play an increasingly important role in outcome, but this relationship between level of care and outcome is unclear.

Objective:
To evaluate the outcomes of intracerebral patients admitted directly to step down unit.

Methods:
A single center review was performed when selected intracerebral hemorrhage patients were directly admitted to step down unit. The step down unit provided nursing evaluation every 04 hours without management of mechanical ventilation or intravenous infusions that required titration at hourly intervals or more frequently. Need for intubation, length of stay, and discharge disposition was evaluated.

Results:
A total of 84 (33.6%) patients among 250 patients with intracerebral hemorrhage were admitted to step down unit. Patients admitted to step down unit had higher admission Glasgow coma scale (median 13.7 versus 9.9, p=<.0001) and were less likely to have hematoma volumes =>30 cc (6% versus 53%, p=<.0001) or intraventricular hemorrhage (16.3% versus 61%, p<.0001). A total of 4 (4.8%) of 84 patients admitted to step down unit required intubation/ mechanical ventilation. The mean duration of hospitalization was significantly lower among patients admitted to step down unit compared with intensive care unit (5.6±5.7 versus 11.9±12.5 days, p <.0001). The proportion of patients who were discharged home was significantly higher among those admitted to step down unit (45.2% versus 10.2%, p <.0001).

Conclusion:
One third of the patients with intracerebral hemorrhage may not require intensive care unit admission. Step down unit admission may reduce the duration of hospitalization in patients with intracerebral hemorrhage.
Abstract TP133: Diabetes/hyperglycemia Is Associated With Poor Six-month Functional Outcomes, But Is Not Associated With The Development Of Microvascular Ischemic Lesions After Intracerebral Hemorrhage
Authors: Lusk Jay B , Liu Li , Weikel Daniel P , Li Yi-Ju , Sekar Padmini , Demel Stacie L , Aziz Yasmin , Woo Daniel , James Michael L
Published: February 2022

Introduction:
Ischemic lesions seen on diffusion weighted imaging (DWI) are associated with worsened outcomes after intracerebral hemorrhage (ICH) and are thought to arise due to microvascular damage. While hyperglycemia and diabetes mellitus contribute to small vessel disease, it is not known if these factors contribute to the development of DWI lesions and associated outcomes after ICH.

Hypothesis:
Indicators of diabetes/hyperglycemia will be associated with the development of DWI lesions and poor outcomes after ICH

Methods:
1123 patients with MRI data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study were included. Predictors with p<0.15 in univariate analyses were included in initial multivariable logistic regression models. Least absolute shrinkage and selection operator (LASSO) regression was used to identify final models.

Results:
In univariate analysis, no measure of diabetes or hyperglycemia (medical history of diabetes, insulin or non-insulin antidiabetic medication use, blood glucose obtained by emergency medical services, blood glucose on admission, fasting blood glucose, or hemoglobin A1c) was associated with the development of DWI lesions (p>0.05). Blood glucose on admission was incorporated into the initial multivariable model (p<0.15). Univariate analysis for poor six-month functional outcome (modified Rankin Score >3) showed that history of diabetes (p<0.001), blood glucose on admission (p=0.002), fasting blood glucose (p=0.049), and use of non-insulin antidiabetic medications (p=0.036) were associated with poor outcomes. Final multivariable logistic regression analyses are shown in Tables 1 and 2.

Conclusions:
While diabetes and hyperglycemia are associated with worsened outcomes after ICH, this relationship is unexpectedly not mediated by microinfarcts despite their association with cerebral small vessel disease.
Abstract TP136: Disparities In Care Of Patients With Intracerebral Hemorrhage According To Baseline Functional Status
Authors: Mistry Eva , Sucharew Heidi , Alwell Kathleen , Woo Daniel , De Los Rios La Rosa Felipe , Mackey Jason , Ferioli Simona , Demel Stacie L , Coleman Elisheva R , Jasne Adam , Slavin Sabreena , Walsh Kyle B , Star Michael , Haverbusch Mary , Kleindorfer Dawn O , Kissela Brett
Published: February 2022

Introduction:
Disparities exist in acute ischemic stroke care according to patients’ pre-stroke functional status. However, the effects of baseline disability on the presentation and care of patients with intracerebral hemorrhage (ICH) are unknown. We aimed to understand this using the Greater Cincinnati Northern Kentucky (GCNK) Stroke Study.

Methods:
We ascertained all hospitalized ICH patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 GCNK) population; all cases were physician-reviewed. Per-stroke functional status was ascertained by medical record review. Baseline NIHSS, Glasgow coma scale (GCS), imaging modalities (CT/MRI), in-hospital rehabilitative therapies (rate and frequency), initiation of antihypertensive treatment, and discharge disposition between patients with pre-ICH mRS 0-1 vs ≥2 were compared using Wilcoxon rank-sum or chi-square tests. Logistic regression was used to evaluate the association between pre-stroke mRS and in-hospital therapy, post-discharge therapy, and ICH workup adjusting for age, Glasgow score, insurance status, and ICH location.

Results:
Of 350 patients with ICH, 187 (53%) had a pre-ICH mRS ≥2. Compared to those with pre-stroke mRS 0-1, these patients had more severe clinical presentation as measured by NIHSS and GCS (table). Among patients who were not made comfort care, no association between pre-ICH mRS and performance of inpatient MRI or in-hospital and post-discharge rehabilitative therapies was found in adjusted analyses.

Conclusions:
Patients with pre-ICH mRS >2 were made comfort care at a higher rate, but for those not made comfort care there were no post-ICH disparities of care seen in the 2015 GCNK population-based cohort of 350 patients.
Abstract TP14: Translational Modeling Of Morphological And Physiological Features Of Vascular Dementia: A Review
Authors: Biose Ifechukwude J , Bhatnagar Somya , Gressett Timothy , Ouvrier Blake , Solch Rebecca , Narayanappa Amruta , Bix Gregory J
Published: February 2022

Vascular dementia (VaD) is the second-most common form of dementia, accounting for 20% of all dementia cases. Although the pathobiology of VaD is poorly understood and lacks effective treatment, clinically relevant factors such as age and sex are rarely considered in preclinical modeling. This places efforts to develop future therapies at a severe disadvantage, as clinically relevant translation of underlying pathobiology may be lost. We reviewed common morphological and physiological outcomes in six major rodent models of VaD in a total of 258 full-text publications: 1) chronic cerebral hypoperfusion, 2) high fat diet, 3) diabetes, 4) hypertension, 5) carotid arterial calcification, and 6) and CADASIL (Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy), and evaluated translational features relevant to human pathophysiology with an analysis of timepoints of observed pathology and rodent sex and age. We found that all models of VaD shared common features of decreased CBF and upregulation of inflammatory signaling molecules such as TNF-α, IL-1β, and IL-6, and reactive oxygen species (ROS) such as SOD and NOX, consistent with clinical presentations of VaD. Only the carotid artery calcification model showed inconsistent evidence for brain endothelial tight junction loss, astrogliosis, and macrophage reactivity, in disagreement with other models. We conclude that improved translational insight may critically depend on 1) inclusion of a constellation of comorbidities in preclinical modeling instead of modeling each in isolation to better capture human disease pathogenesis, 2) increased use of middle-aged and aged preclinical rodent models which are sensitive to clinically relevant disease presentation in middle-age and elderly individuals, and 3) inclusion of female animals in disease models as sex is a relevant biological factor which may better define future therapeutic strategy in real-world populations.
Abstract TP142: Platelet Count And Intracerebral Hemorrhage Expansion In The ATACH 2 Trial
Authors: Anadani Mohammad , Qureshi Adnan I , Sheth Kevin N , Yaghi Shadi , de Havenon Adam H ,   ATACH 2
Published: February 2022

Introduction:
The effect of platelet count on hematoma expansion in patients with intracerebral hemorrhage (ICH) has not been sufficiently studied. We performed a secondary analysis of the ATACH 2 trial to examine the association between platelet count and hematoma expansion.

Methods:
We included patients with a baseline platelet count, volumetric measurement of ICH hematoma volume in mL on a baseline and 24-hour follow-up CT, and excluded those who had surgical evacuation in the first 24 hours. To address the right skew of ICH volume, the primary outcome was the log difference in ICH volume from baseline to 24-hour follow-up. The exposure was baseline platelet count and secondary exposure was the mean of the baseline and a 24-hour platelet count value. We fit unadjusted linear regression models and models adjusted for patient age, sex, race/ethnicity, smoking, baseline ICH volume, GCS, ICH location/side, and randomization arm.

Results:
We included 945 patients in our primary analysis (mean age 62.3, 62% male, 22.7% white, 57.1% Asian). The mean baseline platelet count was 220.7±61.9 with a standard distribution (Figure 1). There was no association between log difference in ICH volume and baseline platelet count (unadjusted p value=0.616, adjusted p value=0.730) or the mean platelet count over 24 hours (unadjusted p value=0.509, adjusted p value=0.853). The relationships are shown graphically in Figure 2.

Conclusion:
In patients with supratentorial ICH enrolled in the ATACH-II trial, there was not a significant association between platelet count and hematoma expansion.
Abstract TP143: Endovascular Treatment With Versus Without Tirofiban For Stroke Patients With Large Vessel Occlusion: The Multicenter, Randomized, Placebo-controlled, Double-blind RESCUE BT Clinical Trial
Authors: Qiu Zhongming , Li Fengli , Sang Hongfei , Yuan Junjie , Luo Weidong , Song Jiaxing , huang jia cheng , Liu Shuai , Li Linyu , Wu Deping , Yue Chengsong , Yang Jie , Zi Wenjie , Yang Qingwu
Published: February 2022

Background:
As a glycoprotein IIb/IIIa receptor inhibitor, tirofiban may help reduce the risk of vascular complications during percutaneous transluminal coronary intervention. However, evidence on whether tirofiban improve the outcomes of stroke patients with large vessel occlusion who are receiving endovascular treatment is limited.

Objective:
This trial aims to assess whether additional intravenous tirofiban therapy can improve the clinical outcomes of stroke patients with large vessel occlusion who undergo endovascular treatment within 24 hours of symptom onset.

Methods and Design:
The Endovascular Treatment With versus Without Tirofiban for Stroke Patients With Large Vessel Occlusion (RESCUE BT) Trial is an investigator-initiated, randomized, placebo-controlled, double-blind, multicenter trial. Up to 930 eligible patients will be consecutively randomized to tirofiban or control group in 1:1 ratio over three years from approximate 50 endovascular-capable stroke centers in China.

Outcomes:
The primary end-point is the disability level measured by overall distribution of the 90-day modified Rankin Scale score. The primary safety end-points are symptomatic intracerebral hemorrhage at 48 hours and mortality at 90 days.

Trial status:
The trial screening and enrollment began on 10 October, 2018, and now the randomization is still ongoing. We expect that the enrollment will be end in October 2021, and the trial results will be revealed in February 2022.

Trial registry number:
ChiCTR-INR-17014167 (
www.chictr.org.cn
).
Abstract TP155: Sex Differences In Outcome And Workflow Of Endovascular Treatment In Late Window Stroke Patients
Authors: Bala Fouzi , Casetta Ilaria , Nannoni Stefania , Herlihy Darragh , Goyal Mayank , Fainardi Enrico , Michel Patrik , Thornton John M , Power Sarah , Saia Valentina , Pracucci GIOVANNI , Demchuk Andrew M , Mangiafico Salvatore , Boyle Karl , Hill Michael , Toni Danilo , Ademola Ayoola , Kim Beom , Menon Bijoy K , Almekhlafi Mohammed
Published: February 2022

Background and Purpose:
Sex-related differences exist in many aspects of stroke and were mainly investigated in the early time window with conflicting results. However, data regarding sex disparities in late presenters are scarce. Therefore, we sought to investigate differences in outcomes between women and men treated with endovascular treatment (EVT) in the late time window.

Methods:
Analyses were based on the Selection Of Late-window Stroke for Thrombectomy by Imaging Collateral Extent Consortium, which was an individual-patient level analysis of seven trials and registries. Baseline characteristics, functional independence (modified Rankin Scale ≤ 2), mortality, and symptomatic intracranial hemorrhage (sICH) were compared between women and men. Effect of sex on the association between age, successful reperfusion (Thrombolysis in cerebral infarction 2b-3) and outcomes was assessed using multivariable logistic regression with interaction terms.

Results:
Among 608 patients treated with EVT, 50.5% were women. Women were older than men by median 4 years and had a lower prevalence of tandem occlusions (14.0% vs. 22.9%). In the subset of patients with available perfusion volumes (n= 195), women had smaller penumbra (median IQR:97 mL [60- 130] vs. 109 mL [73-189]; p= 0.008), and mismatch volumes, (79 mL [49-101] vs. 91 mL [57-158] ; p= 0.02). Pre and intrahospital times were similar between sexes. Outcomes did not differ between women and men, and there was no sex-by-age interaction on functional independence. However, men had higher likelihood of mortality (p
interaction
= 0.004) and sICH (p
interaction
= 0.016) with advancing age. Sex did not influence the relation between successful reperfusion and outcomes.

Conclusions:
In this multicenter analysis of late presenters treated with EVT, sex was not associated with clinical outcomes. However, sex influenced the association between age and safety outcomes with men experiencing worse outcomes with advancing age.
Abstract TP157: A Systematic Review And Meta-analysis Of Mechanical Thrombectomy In Acute Basilar Artery Stroke
Authors: MALIK ABID , Drumm Brian , Banerjee Soma ,   Imperial Stroke Consortium
Published: February 2022

Background:
The evidence for mechanical thrombectomy in posterior circulation strokes is unclear. This systematic review and meta-analysis will summarise the available evidence for the use of mechanical thrombectomy in acute basilar artery occlusion.

Objectives:
To assess the effect of mechanical thrombectomy in acute basilar artery occlusion on disability, mortality, reperfusion and adverse events compared to best medical treatment (BMT).

Search:
We conducted a systematic review of randomised and prospective, clinically controlled trials using MEDLINE and EMBASE. We reviewed the Cochrane Central Register of Controlled Trials (CENTRAL), grey literature sources and reviewed the reference lists of key papers. No time limits or language restrictions were used.

We used the modified Cochrane Collaboration tool to assess the risk of bias for randomised controlled trials and the The Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for prospective non-randomised clinical trials.

Results:
Five studies met the inclusion criteria (n = 1416). Three were cohort studies and two were randomised controlled trials. We used the random-effects model to combine the data. We found better functional outcome (mRS 0-3, 1.90 [1.07-3.35] p=0.03) and a trend towards decreased mortality (0.75 [0.62-0.91], p= 0.003) in the mechanical thrombectomy (MT) group. The improved outcomes were in the context of significant statistical heterogeneity driven by the difference in methodology between the trials. The improved outcomes were seen in the cohort studies. No significant difference in disability or mortality were found in the randomised controlled trials. We found higher reperfusion rates (TICI 2b/3: 4.75 [1.70-13.28] p=0.003) in the mechanical thrombectomy group with higher rates of symptomatic intracranial bleeding (3.90 [1.03-14.79] p=0.04).

Conclusions:
Our study reflects the complex nature of posterior circulation strokes and the lack of large randomised controlled trials in this field. We did find a trend towards better mortality and functional outcomes in the included cohort studies but this was not reflected in the randomised controlled trials. We also found higher reperfusion rates in the intervention groups with higher levels of sICH.
Abstract TP166: Association Of Hemoglobin Trend And Outcome In Aneurysmal Subarachnoid Hemorrhage
Authors: Shah Asghar , Snow Ryan , Stretz Christoph , Potter Nicholas S , Wendell Linda C , Thompson Bradford B , Reznik Michael , Furie Karen L , Mahta Ali
Published: February 2022

Introduction:
Anemia has been linked to delayed cerebral ischemia and worse outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the association of hemoglobin (Hb) trend on outcomes has not been well studied. We sought to determine predictors of Hb trend and its association with outcomes in aSAH.

Methods:
We conducted a retrospective cohort study of consecutive patients with aSAH who were admitted to an academic center from 2016 through 2021. Multiple linear regression analysis was used to identify factors associated with Hb difference from admission to discharge (continuous variable). Binary logistic regression analysis was used to test the association of Hb values (on admission, discharge, trend and difference from admission to discharge) with outcome measures including vasospasm (based on transcranial Doppler criteria) and worse functional outcome defined as modified Rankin scale (mRS) 4-6 at 3 months after discharge.

Results:
We included 312 patients with confirmed aneurysmal etiology (mean age 57 years, SD13.6; 62% female; 70% white). Mean Hb on admission was 13.5 g/dl (SD 1.7) and on discharge was 11.1 g/dl (SD 2). Forty-three patients (14%) required blood transfusions. Greater Hb drop from admission to discharge was independently associated with higher risk of vasospasm (OR 1.16, 95% CI 1.02-1.30; p=0.018) but not worse outcome after adjustment for age, sex, Hb on admission, Hunt and Hess grades, modified Fisher scales. Predictors of Hb drop on multiple linear regression analysis were lower Hb on admission (beta=0.61, p<0.001), longer ICU length of stay (0.5 mg/dl drop per 10 days, p<0.001), female sex (beta=0.66, p=0.008) and higher Hunt and Hess grades (beta=0.34 per grade, p=001).

Conclusions:
Greater hemoglobin drop was associated with higher risk of vasospasm but unlike lower Hb at discharge, it was not associated with worse outcome. Further studies are needed to use Hb trend to guide transfusion threshold in these patients.
Abstract TP175: Atrial Fibrillation Modifies The Effect Of Air Pollution On Ischemic Stroke
Authors: Yq Tan Benjamin Y , Ho Jamie SY , Ho Andrew , Pek Pin Pin , Sia Ching-Hui , Yeo Leonard L , Sharma Vijay , Ong Marcus E , Aik Joel Cze-Loong , Zheng Huili
Published: February 2022

Background:
Acute ischemic stroke (AIS) is significantly associated with gaseous pollutants. There is early evidence that susceptibility to air pollution interacts with traditional stroke cardiovascular risk factors, but data on AF is limited. We investigated the effect of AF on the association of AIS episodes with short-term exposure of air pollutants.

Methods:
In this nationwide, population-based case-only study, and all daily cases of AIS in Singapore from 2009 and 2018 were collected. We compared the outcome AF across different levels of air pollutants (PM
2.5
, PM
10
, O
3
, NO
2
, SO
2
and CO) in cases of AIS. Multivariable regression analysis adjusted for time varying meteorological effects. Prespecified subgroup analysis based on age (<65 years and ≥65 years), and smoking status were performed.

Results:
A total of 51,673 episodes of AIS were identified, and 10,722 (20.7%) had AF (Table 1).

The risk of AIS was higher for patients with AF for every unit increase in CO (adjusted OR 1.193; 95% CI 1.050-1.356; p=0.007) and O
3
concentration (adjusted OR 1.005; 95% CI 1.003-1.007; p<0.001) than those without, but lower for every unit increase in SO
2
(aOR 0.993; 95% CI 0.990-0.997; p<0.001). AF had no significant interaction effect with PM
2.5
, PM
10
and NO
2
(Table 2).

The risk of AIS associated with O
3
and CO concentration remained elevated in patients with AF for up to 5 days from exposure; O3 (OR 1.004; 95% CI 1.002-1.006; p<0.001) and CO (OR 1.206; 95% CI 1.064-1.367; p=0.003) respectively.

Conclusion:
AF increased the risk of AIS driven by air pollutants O
3
and CO but reduced the risk of AIS associated with SO
2
.
Abstract TP187: Contemporary Estimates Of Poor Cardiovascular Health Among Individuals With Stroke: Nationwide Analysis Of The American Heart Association’s Simple 7
Authors: Vahidy Azfar , Bako Abdulaziz , Pan Alan , Vahidy Farhaan S , Ifejika Nneka L
Published: February 2022

Introduction:
The American Heart Association’s (AHA) “Simple 7” are lifestyle behaviors for maintenance of ideal cardiovascular health (CVH).

Methods:
We analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data (nationally representative, annual, health-related survey of community dwelling US adults), and flagged individuals with a stroke diagnosis. Among stroke individuals (SI), we identified validated CVH features (diabetes, hypertension, BMI ≥ 25 kg/m
2
, hypercholesterolemia, smoking, poor eating habits, and lack of exercise) based on AHA’s simple 7. SI with ≥ 5 CVH features were categorized as ‘Poor CVH’ (PCVH). We evaluated socio-demographic, regional and healthcare utilization factors associated with PCVH. We fit survey design logistic regression models, and report nationally representative estimates as adjusted Odds Ratios (aOR) and 95% confidence intervals (CI).

Results:
The 2019 estimated national count of SI is 8,570,876 translating into a nationwide stroke prevalence of 3.4% among US adults (7.9% among ≥ 65 years). SI who were divorced/separated (vs. married), non-Hispanic Black or Native American (vs. Non-Hispanic White - NHW), had lower income, resided in the stroke belt had higher likelihood of PCVH. In our adjusted model (Figure), males had a significantly higher PCVH aOR (CI) 1.26 (1.00 - 1.59). Moreover, Asian American and Pacific Islanders vs. NHW demonstrated higher PCVH, aOR (CI) 4.74 (1.25 - 17.95). Compared to the New England region, residence in following divisions was associated with higher PCVH; aOR (CI) for West South-Central: 1.73 (1.05 -2.85), East North Central: 1.64 (1.11 - 2.43), East South Central: 2.29 (1.37 - 3.83), South Atlantic: 1.74 (1.18 - 2.57). Analyses for 2020 BRFSS data will be presented.

Conclusion:
National stroke prevalence rates are provided. Poor CVH among stroke individuals continues to be disparately high. These analyses are important to identify and target high-risk population sub-groups.
Abstract TP188: Predicting Ischemic Stroke And All-cause Mortality Risk In Patients With Heart Failure With Reduced Ejection Fraction And Sinus Rhythm: A Secondary Analysis Of The Warcef Trial
Authors: Sharma Richa , Krumholz Harlan M , Sheth Kevin N , Faridi Kamil , Kamel Hooman , Merkler Alexander E , Sharma Richa
Published: February 2022

Introduction:
There is a known risk of ischemic stroke (IS) and mortality among patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm. We identify predictors of IS and all-cause death in patients with left ventricular ejection fraction (LVEF) < 35% and sinus rhythm by a machine-learning approach.

Methods:
We performed a post-hoc analysis of the WARCEF trial which randomized patients with LVEF < 35% and sinus rhythm to either aspirin or warfarin. We built two Random Forest for Survival, Longitudinal, and Multivariate (RF-SLAM) algorithms to model the outcomes of IS and all-cause death separately using all baseline variables with missingness < 10%. The training data set was comprised of 70% of observations and the testing set of the remaining 30%. To assess variable importance in outcome prediction, Mean Decrease Accuracy was computed for each variable over all out-of-bag cross-validated predictions.

Results:
In 2,298 participants (median age 61.5 years [IQR 54.3-69.6], 20% female) during a mean follow-up of 3.5 years (SD 1.8 years), 84 (3.7%) patients had an ischemic stroke and 547 (23.8%) died. Patient-specific characteristics contributing most to ischemic stroke prediction with variable Mean Decrease Accuracies ≥ 2.5 were prior transient ischemic attack, CHA
2
DS
2
-VASc score, age, prior stroke, glucose, and blood urea nitrogen (model accuracy 0.95; 95% C.I. 0.93-0.97). Age, hemoglobin, glucose, INR, platelet count, BUN, and systolic blood pressure were the most important patient-specific predictors of all-cause death with variable Mean Decrease Accuracies ≥ 2.5 (model accuracy 0.76; 95% C.I. 0.72-0.79).

Conclusions:
Clinical and serologic characteristics identified by the RF-SLAM algorithm predict IS and all-cause death risks in patients with HFrEF and sinus rhythm. Future studies are needed to assess the impact of these factors on treatment effects in heart failure trials evaluating outcomes which include stroke.