bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP114: Elevated Troponin Is Associated With Mortality In Patients With Acute Cardioembolic Stroke And Atrial Fibrillation
Authors: Moeini-naghani Iman , Patel Shraddha , Amar Jordan , Mistry Eva , Liberman Ava L , Asad Syed , Liu Angela , Nagy Muhammad , Kaushal Ashutosh , Azher idrees , Mac Grory Brian , Fakhri Hiba , Espaillat Kiersten , Pasupuleti Hemanth , Martin Heather , Tan Jose T , Veerasamy Manivannan , esenwa charles , Cheng Natalie , Moncrieffe Khadean , Siddu Mithilesh , Scher Erica , Trivedi Tushar , Lord Aaron , Furie Karen L , Keyrouz Salah G , Nouh Amre , de Havenon Adam H , Muhib Khan , Henninger Nils , Leon Guerrero Christopher , Yaghi Shadi , Giles James A
Published: February 2022

Introduction:
Stroke is the fifth leading cause of death in the US and a major cause of disability. Atrial fibrillation (AF) increases the risk of ischemic stroke fivefold. Cardioembolic stroke in patients with AF is associated with high mortality. The association of elevated cardiac troponin with mortality in patients with acute ischemic stroke has been studied previously; however, there is limited data in subgroups of ischemic stroke etiology. We sought to determine the association of troponin elevation at presentation with 90-day all-cause mortality in patients with acute ischemic stroke and AF.

Methods:
The
I
nitiation of
A
nticoagulation after
C
ardioembolic Stroke (IAC) study is a multicenter cohort drawn from eight US Stroke Centers. We included consecutive patients hospitalized with acute ischemic stroke and AF between 2015-2018, who had an initial baseline cardiac troponin I (bcTnI) obtained at presentation. The primary outcome was all-cause mortality at 90 days from stroke onset. We undertook multivariable logistic regression to determine the association between elevated bcTnl (≥0.1 ng/mL) and 90-day mortality.

Results:
Of the 2084 patients enrolled in IAC, 1889 patients had 90-day follow-up of which 1461 patients had bcTnI available. 239 of the included patients (16.4%) had an elevated bcTnl, and death within 90-days occurred in 323 patients (22.1%). Elevated bcTnI was associated with 90-day mortality in univariable analysis (49.4% vs 24.9%; OR 1.71, 95% CI 1.17-2.50, p<0.001). This association persisted after adjusting for potential confounders: age, NIHSS, coronary artery disease, congestive heart failure and initial systolic blood pressure (OR 1.71, 95% CI 1.17-2.50, p=0.006); and in sensitivity analysis adding CrCl to the adjusted model above (OR 1.57, 95% CI 1.03-2.39, p=0.037).

Conclusion:
In acute ischemic stroke patients with AF, elevated bcTnI was independently associated with 90-day all-cause mortality.
Abstract WP119: Admission Glycemic Gap In The Assessment Of Patients With Ischemic Stroke
Authors: Bulic Mirza , Sanossian Nerses , Kim-Tenser May A , Emanuel Benjamin , Nguyen Peggy , Bulic Sebina
Published: February 2022

Background:
Admission glycemic gap (AGG) is derived by using HbA1c levels to establish a baseline which is compared to admission glucose (AG) levels. High AGG has been correlated with increased post-stroke cognitive impairment and a worse modified Rankin scale. Our aim is to evaluate the association of AGG with poor outcomes.

Methods:
Stroke patients admitted to tertiary academic hospital between 2016-2020 were tested for AGG using the formula AG - (28.7xHb1Ac-46.7). AGG was dichotomized as high (>80) AGG (H-AGG) and low (=/<80) AGG (L-AGG). Poor outcomes were defined as in-hospital mortality or poor discharge destination (in hospital mortality, discharge to long term care, skilled nursing home, and hospice). We also looked at the necessity for tracheostomy, PEG, and mechanical ventilation. The Pearson chi-square test was used to test for significance. A binary logistic regression was used to verify the association. The statistical analysis was performed using SPSS.

Results:
Of 594 patients (mean age 67, 44% female), 30 had an elevated AGG (5.1%). 33 (5.6%) had tracheostomy. 7 had (1.2%) PEG. 32 (5.4%) required mechanical ventilation. 242 patients (40.1%) had a bad outcome of which 74 (12.5% of the total) died. The age of the H-AGG and L-AGG groups was comparable, as verified by an independent sample test. The H-AGG group was associated with hospital mortality (p < .001) and poor discharge destination (p < .001) The association between AGG and both mortality and poor outcome was lost when adjusted for age. The elevated AGG was not associated with PEG(p=.69), tracheostomy(p=.5), and mechanical ventilation(p=.49).

Discussion:
An elevated AGG was found to be associated with hospital mortality and poor discharge destination on univariate analysis, while there was no association with a tracheostomy, PEG and need for mechanical ventilation. The association was lost when adjusted for the patient's age
Abstract WP147: Impact Of Heart Failure With Reduced Ejection Fraction On Procedural And Functional Outcomes In Patients With Large Vessel Occlusion Stroke Undergoing Mechanical Thrombectomy.
Authors: Bhatt Nirav R , Mohammaden Mahmoud , Haussen Diogo C , Al-bayati Alhamza R , Bianchi Nicolas , Liberato Bernardo , Camara Pinheiro Agostinho , Frankel Michael R , Nogueira Raul G
Published: February 2022

Introduction:
Heart failure with reduced Ejection Fraction (HFrEF) is an important risk factor for ischemic stroke and has been shown to carry higher mortality among stroke survivors. However, data among patients with large vessel occlusion strokes (LVOS) undergoing mechanical thrombectomy (MT) is lacking. We aimed to investigate the impact of HFrEF on procedural and functional outcomes after MT.

Methods:
We conducted a retrospective analysis of a prospectively collected MT database of all consecutive anterior circulation LVOS (Intracranial ICA, MCA-M1, M2) patients undergoing MT at a large urban comprehensive stroke center from Jan,2015-Dec,2020. HFrEF was defined as LVEF ≤40% on transthoracic or transesophageal echocardiograms obtained during the same admission. Uni-multivariable analyses were performed to evaluate the predictors of first pass effect (FPE), mRS0-2 and mortality at 90 days.

Results:
Of 1466 patients included in the analysis, 293 had HFrEF. The HFrEF group had fewer females, higher median baseline NIHSS, higher rates of Atrial fibrillation (p<0.001), shorter median procedural duration (33 vs 37 min,p=0.006), higher frequency of FPE (47.1% vs 40.4%,p=0.038), higher 90-day mortality (26.9% vs 18.5%,p=0.005) and lower rate of 90-day mRS0-2 (41.4% vs 49.3%,p=0.03). On multivariable analyses, CHF was a predictor of FPE (OR1.33,95%CI[1.021-1.733],p=0.035), but not a predictor of mRS0-2 (OR0.784,95%CI[0.52-1.184],p=0.25) or mortality (OR1.443,95%CI [0.92-2.265],p=0.11) at 90 days.(Fig)

Conclusion:
Our single-center study showed that HFrEF was associated with better procedural outcomes but did not impact functional outcomes at 90-day. Large multi-center studies are warranted.
Abstract WP149: Mechanical Thrombectomy For Ischemic Stroke: Evaluating Outcome Associations With Race
Authors: Fuentes Angelica M , Du Xinjian , Pandey Dilip K , Ansari Sameer A , Amin-hanjani Sepideh
Published: February 2022

Introduction:
Prior evidence suggests that treatment outcomes after ischemic stroke differ based on racial background. For example, two studies that queried the National Inpatient Sample (NIS) found that White patients were more likely to be discharged home compared to non-White patients after treatment with mechanical thrombectomy or IV tPA. Although these database studies provide the advantage of substantial patient numbers, the NIS is an inpatient administrative dataset lacking stroke-specific outcomes such as modified Rankin Score (mRS) and follow-up data. Nevertheless, a relationship between race and clinical outcome after thrombectomy is suggested.

Methods:
We utilized the NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to collect demographic data, clinical information, and outcome measures on ischemic stroke patients treated with mechanical thrombectomy. Univariate and multivariate analysis was conducted to evaluate the relationship between race and outcomes such as mRS at discharge (0-2 vs. 3-6), discharge disposition, and 90-day mRS (0-2 vs. 3-6). Race was included in multivariate modeling as it was our predictor variable of interest. P<0.05 was used for statistical significance.

Results:
A total of 3,597 patients were included. Of the entire cohort, 15.8% of patients were Black. On univariate analysis, Black race was significantly associated with younger age at treatment, CHF, hypertension, diabetes, prior stroke, being a current smoker, and higher baseline NIHSS (16.4 for Black compared to 15.8 for non-Black, p=0.044). Non-Black race was significantly associated with atrial fibrillation and hyperlipidemia at baseline. On both univariate and multivariate analysis, Black race was not significantly associated with discharge mRS, discharge to home, or 90-day mRS (p>0.3 for all).

Conclusions:
In conclusion, though Black race seems to be associated with several comorbidities prior to ischemic stroke, we did not find a significant association between Black race and clinical outcome after mechanical thrombectomy.
Abstract WP15: Role Of Grade Among Glioma Patients And Risk Of Cerebrovascular Mortality: A Population-based Analysis
Authors: Jin Kai , Brennan Paul , Poon Michael T , Sudlow* Catherine , Figueroa Jonine
Published: February 2022

Introduction:
Glioma is the most common malignant type of brain tumours. Glioma patients are at higher risk for cerebrovascular mortality compared to the general population and other cancer types. Whether the risk differs by the grade, a marker of aggressiveness in gliomas, remains unclear.

Methods:
Using the US National Cancer Institute’s Surveillance Epidemiology and End Results program, we identified adult patients with a primary diagnosis of malignant gliomas in 2000 to 2018 (N=72,252). Age-, sex-, and calendar-year- adjusted standardized mortality ratios (SMRs) were calculated for cerebrovascular mortality comparing glioma patients with the general population. Gliomas were classified into four grades based on WHO definition in which increasing grade indicates the higher degrees of invasiveness. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox regression model to examine cerebrovascular mortality in patients with different grades of gliomas.

Results:
Over 80% of patients were diagnosed with high grade gliomas (Grade 3 & 4). Patients with gliomas in all grades had excess cerebrovascular mortality compared with the general population (SMRs 2.64-4.18, p<0.001). Younger patients (< 50 years) with glioblastoma (Grade 4), the most aggressive type, had substantially greater risk (SMR 12.73, p<0.001) than the general population compared to those with lower grades (SMR 7.14 & 6.31 in Grade 2 & 3, p<0.001). In grade 4, Hispanic patients had highest risk (SMR 6.23, p<0.001) than other ethnic groups (SMR 3.67 & 4.92 in White and Black respectively, p<0.001). In case-only analysis, patients with Grade 4 were significantly associated with increased cerebrovascular mortality compared to the lower grade (HR=1.41, 95% CI 1.01-1.97, p<0.01) after adjustment of socio-demographic and treatment (surgery, radiation and chemotherapy) characteristics.

Conclusions:
The findings of higher grades of gliomas associated with cerebrovascular mortality support further research to understand the role of aggressiveness and other risk factors in brain cancer-associated fatal stroke.
Abstract WP154: Presentation Blood Pressure Is Associated With Infarct Growth In Large Vessel Occlusion Acute Ischemic Stroke
Authors: Niktabe Arash , Kim Youngran , Tariq Muhammad Bilal , Abdelkhaleq Rania , Salazar-Marioni Sergio , Sheth Sunil A , Kim Hyun Woo
Published: February 2022

Introduction:
The optimal blood pressure (BP) in patients with large vessel occlusion (LVO) acute ischemic stroke (AIS). Here, we explore the relationship between CT perfusion (CTP) predicted infarct volumes and those seen on follow up MRI, to examine whether infarct growth is related to presentation BP.

Methods:
From our prospectively collected multi-institutional registry, we identified patients with LVO AIS seen at 4 comprehensive stroke centers from January 2018 to March 2021. Patients were included if they contained anterior circulation LVO (defined as occlusion of the intracranial ICA, MCA or ACA) defined by CTA, included if they underwent CTP with RAPID (IschemiaView) post-processing at the time of presentation, and had final infarct volume (FIV) imaging with MRI 48-72 hours later. Infarct growth was defined as increase in infarct volume of at least 10 mL from CTP-RAPID core volume prediction to FIV. The primary outcome was the effect of presentation mean arterial blood pressure (MAP) on likelihood of infarct growth.

Results:
Among 329 patients that met inclusion criteria, median age was 68 [IQR 58-70], median NIHSS was 15 [IQR 10-20] and 49% were female. Median ASPECTS was 8 [6-9], median CTP-RAPID core was 6 mL [0-36 mL] and median FIV was 19 mL [5-57 mL]. Median arrival systolic BP was 153 mmHg [132-174 mmHg], diastolic was 83 mmHg [73-92 mmHg] and MAP was 105 mmHg [95- 118]. 161 (49%) of patients presented in the early time window. Infarct growth of at least 10 mL was seen in 23 (7%) of patients. FIV correlated with CTP-RAPID core more clearly for patients in the early vs. late window (R=0.77 vs 0.34, early vs. late window). In the subset of patients presenting in the early time window, those who underwent infarct growth of at least 10 mL were more likely to present with greater MAPs (mean MAP 118 vs. 106, infarct growth vs. no growth, p<0.05). This relationship was not seen in patients in the late window.

Conclusions:
Infarct expansion from presentation to FIV was seen in a substantial proportion of patients and associated with greater MAPs in the early but not late window. There are multiple possible explanations for this finding, including increased CTP inaccuracies in the early time window, and potentially with elevated BP. Further work on the optimal BP in LVO AIS is needed.
Abstract WP16: Characterizing Cd38 Expression And Activity In The Brain Of Spontaneously Hypertensive Stroke Prone Rats
Authors: Ewees Mohamed , Moore Jordan , Zweier Jay L , Hannawi Yousef
Published: February 2022

Introduction:
CD38 is an ectoenzyme that is the main source of age dependent decrease in NAD
+
levels. Its role in cerebral small vessel disease (cSVD) is unknown. We hypothesize that CD38 is over-expressed and activated in spontaneously hypertensive stroke-prone rat (SHRSP), a model of human cSVD.

Methods:
20 SHRSP and 20 age matched male Wistar Kyoto control rats (WKY) were studied. Systolic blood pressure (SBP) was measured weekly using tail-cuff plethysmography. Half of the groups were euthanized at 7 weeks of age (Wks) and the remaining rats were followed until 24 Wks. Routine histology and immunohistochemistry (IHC) were performed for nitric oxide synthase (NOS) subtypes, superoxides (DHE), NO (DAF), and NADPH. IHC was used to detect CD38 expression and co-staining determined expression on endothelial cells (eNOS), astrocytes (GFAP), microglia (Iba1), T cells (CD3), macrophages (CD68), neutrophils (MPO) and neurons (Neuon). CD38 activity was detected in the brain homogenate by using a substrate analog of NAD
+
with measurement of its conversion to the strongly fluorescent product (ε-ADPR).

Results:
Compared to WKY, SHRSP developed hypertension between (9 -12) Wks and sustained it afterwards (SBP: 19 Wks: WKY 142.5±11.8 mmHg vs SHRSP 180.3±12.8 mmHg, P<0.0001). At 24 Wks, SHRSP showed histological evidence of cSVD including microbleed, enlarged perivascular spaces, and lipohyalinosis. Compared to WKY, CD38 expression was increased in SHRSP brain (7 Wks: 102.6%, P=0.011, 24 Wks: 83.2%, p=0.0077). CD38 activity was also significantly higher in SHRSP (7 Wks: 11.8%, p=0.012, 24 Wks: 20.2%, p=0.0065). We identified CD38 expression on endothelial cells, astrocytes and microglia. In comparison to WKY, SHRSP showed lower levels of NADPH (7 Wks: 22.3%, p=0.029, 24 Wks: 65.5%, p=0.0065), NO (7 Wks: 39.3% p=0.0008, 24 Wks: 36%, p=0.04), endothelial NOS (7 Wks: 57.5%, p=0.02, 24 Wks: 50.6%, p=0.01) and higher superoxide (7 Wks: 131%, p<0.0001, 24 Wks: 163%, p<0.0001).

Conclusions:
The brain of SHRSP shows evidence for elevated CD38 activity and expression with associated oxidative stress, depletion of NADPH and eNOS dysfunction compared to normotensive WKY. These results suggest the potential role of CD38 based therapeutics in future management of human cSVD.
Abstract WP166: Endovascular Stroke Therapy For Posterior Circulation Ischemic Stroke Has Diminishing Benefits With Number Of Retrieval Attempts
Authors: Jeevarajan Jerome , Salazar-Marioni Sergio , Tariq Muhammad , Niktabe Arash , Abdelkhaleq Rania , McCullough Louise , Kim Youngran , Lhatoo Samden , Sheth Sunil A
Published: February 2022

Introduction:
The relationship between pass number during endovascular therapy (EVT) and outcomes in anterior circulation large vessel occlusion (LVO) acute ischemic stroke (AIS) has been well studied. However, the association between number of thrombectomy attempts and outcomes for patients with posterior circulation LVO remains undetermined.

Methods:
From our prospective multi-institutional registry including 4 comprehensive stroke centers in the Houston area, we identified consecutive LVO AIS patients who underwent EVT (01/2018-06/2021). The number of thrombectomy passes and per-pass reperfusion grades (TICI) were recorded at time of the EVT procedure. The primary outcome was the effect of number of passes on functional independence (modified Rankin Scale 0-2) at 90 days. Secondary outcomes included likelihood of attaining substantial reperfusion (TICI ≥2b).

Results:
Among 894 LVO AIS patients who underwent EVT, median age was 68 [IQR 58-78], 49% were female, and median NIHSS was 16 [IQR 11-21]. Of this cohort, 86 had posterior circulation LVO including 65 with basilar artery occlusion and 9 vertebral artery. The diminishing benefit on reperfusion and functional outcome after additional EVT passes was similar for anterior and posterior circulation AIS (Figure 1). Among patients with posterior circulation LVO, successful reperfusion with fewer passes was associated with greater likelihood of good outcomes (41.9% vs 6.7% mRS 0-2 with 1-2 vs ≥3, p=0.012). The likelihood of good outcomes with 1-2 passes for patients with posterior circulation LVO was comparable to patients with anterior circulation LVO (41.9% vs 40.2%, p=0.164).

Conclusions:
Similar to patients with anterior circulation LVO, patients with posterior circulation LVO undergoing EVT are more likely to achieve functional independence with successful reperfusion in fewer EVT attempts. Overall clinical outcomes are significantly better with fewer passes regardless of occlusion location.
Abstract WP168: Anticoagulation Therapy In Endovascular Thrombectomy Patients With Large Vessel Occlusion Due To Cardioembolism
Authors: Hong Jae Beom , Diprose William , Wang Michael , Barber P A
Published: February 2022

Introduction:
In ischemic stroke patients, cardioembolism, predominantly due to atrial fibrillation (AF), is a leading preventable cause of large vessel occlusion (LVO). Despite proven efficacy, inadequate oral anticoagulant (OAC) therapy continues to be a major problem in patients with AF, mechanical heart valves and other potential sources of emboli.

Aim:
To determine rates of cardioembolic LVO, the adequacy of OAC, and the association of OACs with clinical outcomes in LVO patients treated with endovascular thrombectomy (EVT).

Methods:
Trial of Org 10172 in Acute Stroke Treatment classification was used to determine stroke etiology in consecutive patients treated with EVT. Pre-stroke indication for OAC and the adequacy of anticoagulation were determined for patients with cardioembolic LVO. The primary outcome was 3-month functional independence (modified Rankin Scale score 0-2). Secondary outcomes included early neurological recovery (reduction in National Institutes of Health Stroke Scale score ≥8 points, or score of 0-1 at 24-hours), symptomatic intracranial hemorrhage, and 3-month mortality and modified Rankin Scale score.

Results:
Between January 2015 and December 2020, 784 patients were treated with EVT. There were 416 patients (213 men; mean±SD age 67.1±15.9) with cardioembolic LVO, including 221 (53.1%) prevalent AF, 99 (23.8%) incident AF, 48 (11.5%) mechanical heart valve, 10 (2.4%) cardiomyopathy-related LVO, 10 (2.4%) left ventricular thrombus-related LVO and 11 (2.6%) patent foramen ovale-related LVO patients. There was adequate anticoagulation in 8 (16.7%) mechanical heart valve patients. Of the 191 prevalent AF patients with pre-stroke indications for OAC, 59 (30.9%) patients had adequate anticoagulation, and were less likely to have internal carotid artery occlusion (6.8% versus 18.9%,
P
=0.03) and more likely to achieve functional independence (OR=1.97 [95% CI 1.01-3.83];
P
=0.04) than those with inadequate anticoagulation.

Conclusion:
Over half of EVT treated patients had cardioembolic LVO. Only one-third of patients with an indication for OAC at the time of LVO were adequately anticoagulated. This suggests that up to one in five patients with LVO requiring EVT may have been prevented with adequate anticoagulation.
Abstract WP173: Children’s Post-Stroke Expressive Language Outcomes Are Affected By Bilingual Exposure
Authors: Leung Kai , Dlamini Nomazulu , Westmacott Robyn , Molnar Monika
Published: February 2022

Introduction:
Approximately 2/3 of children face neurological deficits following arterial ischemic stroke (AIS). In neurotypical development, bilingualism is thought to confer certain linguistic and cognitive advantages. However, research on whether this may affect development in bilingual pediatric stroke patients is scarce.

Objectives:
To evaluate the effects of bilingual vs. monolingual exposure on language and cognitive outcomes in children following arterial ischemic stroke across two studies: (1) large-scale group analysis using the Pediatric Stroke Outcome Measure (PSOM); (2) exploratory case studies using neuropsychological measures.

Methods:
An institutional stroke registry and chart review were used to gather patient and stroke data, including the Pediatric Stroke Outcome Measure (PSOM) and standardized neuropsychological measures performed at several timepoints post-stroke in children with AIS. In Study 1, growth curve modeling based on PSOM subscales, predicted by age at stroke groups, language groups and their interactions was used. In Study 2, comparative case studies were conducted with a monolingual-bilingual pair, aged 7 and 8 at stroke onset.

Results:
In Study 1, 237 patients were identified (44%, bilingual patients). Patients were stratified based on age at stroke onset i.e. neonatal (<28 days of life), first-year (28 days-12 months) and childhood (13 months - 18 years). On the PSOM’s language expression subscale, an interaction revealed better post-stroke outcomes among bilingual children aged 1-12 months at stroke (beta = -0.32, t =-2.33, p = 0.02). In Study 2, the bilingual’s performance on neuropsychological assessments corroborated findings of Study 1, favoring a recovery of expressive language.

Conclusion:
Overall, we found no negative consequences of a bilingual environment on post-stroke outcomes. Additionally, it is possible that bilingualism has a faciliatory effect on expressive language development post-stroke. Further research should evaluate linguistic advantage effects prospectively in bilingual children with stroke and a control group.
Abstract WP182: Association Of The
RNF213
p.R4810k Variant With Thyroid Disease And Autoantibodies In Ischemic Stroke
Authors: Yoshimoto Takeshi , Hattori Yorito , Yamaguchi Eriko , Chiba Tetsuya , Ishiyama Hiroyuki , Saito Satoshi , Nakaoku Yuriko , Nishimura Kunihiro , Toyoda Kazunori , Koga Masatoshi , Ihara Masafumi
Published: February 2022

Background:
Thyroid diseases and elevated thyroid autoantibodies are associated with moyamoya disease (MMD). MMD susceptibility variant
RNF213
p.R4810K is known to increase the risk of ischemic stroke (IS), but whether thyroid diseases and thyroid autoantibody levels are altered in IS patients carrying the
RNF213
p.R4810K variant remains elusive.

Methods:
Of the consecutive adult IS patients from 2011 to 2020 admitted in our institute, patients who signed a consent form for
RNF213
genotyping were included, while definitive MMD patients were excluded. We compared the patient background, history of thyroid disease (hyperthyroidism or hypothyroidism), and levels of serum triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), antithyroperoxidase antibody (TPOAb), and antithyroglobulin antibody (TgAb) between the variant carrier and non-carrier. Each thyroid autoantibody was measured by the electro-chemiluminescent immunoassay method.

Results:
Of the 1570 patients (525 women; 72 years of median age) analyzed, 74 (4.7%) patients had the
RNF213
p.R4810K variant. The variant carriers were more likely to be female (52.7% vs. 35.3%,
P
<0.01), younger (58 years vs. 73 years,
P
<0.01), and have a history of hypothyroidism (18.9% vs. 1.8%,
P
=0.01), middle cerebral artery M1 stenosis (29.7% vs. 6.0%,
P
=0.01), and large-artery atherosclerosis (47.3% vs. 25.0%,
P
<0.01) than the variant non-carriers. Both mean TPOAb (17.60 IU/mL vs. 3.96 IU/mL,
P
<0.01) and TgAb levels (25.09 IU/mL vs. 15.64 IU/mL,
P
<0.01) were higher in the variant carriers, and there were no inter-group differences for history of hyperthyroidism, TSH, free T3/T4, and administration of levothyroxine sodium hydrate. A multivariate regression analysis showed that hypothyroidism(odds ratio [OR], 8.30; 95% confidential interval [CI], 2.83-24.33) and the elevated TPOAb levels (OR per 1 IU/mL increment, 3.32; 95% CI, 1.43-7.78) were independently associated with variant carriers versus non-carriers.

Conclusions:
Hypothyroidism and elevated TPOAb levels were frequently observed in IS patients with the
RNF213
p.R4810K variant, which may be associated with immune aberrancies relevant to or underlying thyroid autoimmunity, contributing to the different features of IS.
Abstract WP19: Diaschisis Of The Blood-brain Barrier
Authors: Leigh Richard , Kern Kyle , Wright Clinton B
Published: February 2022

Background:
Focal ischemia is thought to have global effects on the brain. Chronic cerebrovascular disease is associated with blood-brain barrier (BBB) disruption. We aimed to determine if ischemic stroke has a remote effect on the BBB.

Methods:
Patients with acute ischemic stroke who were imaged with MR perfusion weighted imaging (PWI) on presentation and again 24 hours later were included in the study. PWI source images were used to measure BBB disruption as a percentage of the signal that is due to gadolinium leakage. BBB was averaged within a region of interest (ROI) consisting of supratentorial white matter (WM) contralateral to the ischemic stroke. The ROI was defined using a group-averaged diffusion tensor imaging (DTI) fractional anisotropy map. For infratentorial strokes the ROI consisted of bilateral supratentorial WM. For bilateral strokes, the ROI consisted of WM in the less affected hemisphere after removal of the infarct. Segmentation algorithms were used to define infarct volume in mL on DTI at 24 hours and WM hyperintensity volume (WMHvol) on the initial FLAIR image. Average percent BBB disruption was compared with age, baseline modified Rankin scale (mRS), NIHSS, stroke volume, and WMHvol using linear regression.

Results:
44 patients were included with a median age of 74, 39% female. Median NIHSS was 4; mean stroke volume was 10 mL. The baseline mRS ranged from 0-3 with a median of 0. The median BBB was 0.86% (IQR:0.72%-1.09%). Higher average BBB disruption measured in the WM remote from the acute stroke was associated with larger stroke volumes (p=0.006, r
2
=0.17, beta 0.410, CI:0.003-0.018), larger WMHvol (p<0.001, r
2
=0.26, beta 0.51, CI: 0.10-0.32), and higher NIHSS (p=0.039, r
2
=0.01, beta 0.312, CI:0.002-0.064) but not with age (p=0.447), sex (p=0.729), or baseline mRS (p=0.093). In multiple linear regression stroke volume (p=0.008) and WMHvol (p<0.001) were independently associated with remote disruption of the BBB but not NIHSS (p=0.684).

Conclusions:
Focal ischemia resulted in a proportional disruption of the BBB in the WM remote from the acute lesion. This effect was independent of the severity of WMHvol, a measure of cerebral small vessel disease. These findings support the concept of ischemic stroke having global effects on the brain.
Abstract WP196: Tricuspid Regurgitation And Its Association With Cardioembolic Stroke
Authors: Kim Yong Soo , Jeong Han-gil , Hwang In-chang , Kim Beom Joon , BAE Hee-joon , Han Moon-Ku
Published: February 2022

Introduction:
Tricuspid regurgitation (TR) is a common valvular heart disease and traditionally known to develop secondary to cardiopulmonary comorbidities. Since isolated TR without structural heart disease are known to be related with poor outcome, clinical course of TR itself has been focused recently. However, relationship between TR and ischemic stroke had not been investigated. In this study, we aimed to explore the association between characteristics of TR and subtypes of ischemic stroke.

Methods:
Patients with ischemic stroke who were admitted to a single tertiary hospital from 2011 to 2020 were screened. Subtypes of stroke were divided into two groups (cardioembolic (CE) and non-CE). Echocardiographic indices including E/e’ ratio, left ventricular (LV) ejection fraction, left atrial volume index (LAVI), right ventricular systolic pressure, severity of valvular heart diseases (no/trivial, mild, moderate/severe) were assessed. Logistic regression models were constructed to determine the association of severity, subtypes of TR and CE stroke. Modifying effects of demographic characteristics and echocardiographic indices were also tested.

Results:
Among 6,472 consecutive patients with ischemic stroke, 12.5% of patients had TR and CE stroke was diagnosed in 24.7%. Patients with CE stroke were related to impaired LV systolic and diastolic function, pulmonary hypertension, and elevated LAVI. TR was more frequently observed in CE stroke group (6.2% vs. 32.7%,
p
-value < 0.01). After adjustment for covariates which were selected from bivariate analysis, TR shown significant association with CE stroke (OR [95% CI], 3.24 [2.61 - 4.02]). This association persisted across models which subdivided TR according to severity (mild TR, 2.91 [2.32 - 3.64]; moderate/severe TR, 5.58 [3.62 - 8.61]) and presence of cardiopulmonary comorbidities (isolated TR 2.04 [1.59 - 2.63]; non-isolated TR 2.15 [1.57 - 2.96]). There were no significant interactions for any of the predefined potential effect modifiers.

Conclusions:
Our study demonstrated that TR has significant association with CE stroke. TR related hemodynamic change within cardiac chamber and accompanying atrial cardiopathy might be an underestimated risk factor for CE stroke.
Abstract WP197: Timing Of Anticoagulation After Ischemic Stroke In Patients With Atrial Fibrillation: An International Survey
Authors: Alrohimi Anas , Kate Mahesh P , Thirunavukkarasu Sibi , Jeerakathil Thomas , Jickling Glen , Shuaib Ashfaq , Buck Brian H , Butcher Ken
Published: February 2022

Introduction:
The timing of direct oral anticoagulant (DOAC) after atrial fibrillation (AF)-related stroke is unknown. Most guidelines are inconsistent and based on expert opinion. We conducted a survey to evaluate the global practice patterns of this common clinical scenario.

Methods:
We used an electronic survey with practice-related demographic and clinical questions of 10 cases with different stroke severities and sizes: transient ischemic attack, small, medium, large, and strokes with hemorrhagic infarction and parenchymal hematoma.

Results:
A total of 242 clinicians from 21 countries completed at least one clinical scenario. The majority of the respondents were from Australia (36.4%) or Canada (22.7%). Stroke-specific sub-specialty training was self-reported in 82.2% of the respondents. Median (IQR) time spent dedicated to stroke patient care/research was 70 (60) % of total working hours. Only 14% of responding clinicians reported current participation in a randomized trial of DOAC initiation timing after AF-related stroke. Stroke size, severity, and the grade of hemorrhage if present seem to be determinants of the decisions. Lack of consensus was observed in moderate stroke, multi-territory infarcts, large stroke, and in the presence of HT. The majority of respondents would be willing to randomize patients with different stroke sizes and severities with/without HT in a clinical trial of early versus delayed initiation of DOAC after AF-related stroke.

Conclusions:
Decisions related to the timing of DOAC initiation after AF-related stroke vary globally. The variability in clinical practice will continue until randomized controlled trials are completed.
Abstract WP20: Under The Influence: Exploring The Role Of Cannabinoid Use In Ischemic Stroke
Authors: Lail Navdeep , Yaghi Shadi , Tracy Madsen , Burton Tina , El JAMAL SLEIMAN , Sacchetti Daniel , Reznik Michael , Furie Karen L , Indraswari Fransisca
Published: February 2022

Background:
Cannabinoids are hypothesized to cause cardiovascular disease including stroke; this is potentially due to dysregulation of endogenous lipid mediator endocannabinoids and their G-protein coupled receptors. Our aim is to investigate cannabinoid use in patients with acute ischemic stroke and determine associations between stroke subtype and functional outcome at 90-days.

Methods:
This is a retrospective, observational, cohort study of consecutive patients admitted with acute ischemic stroke to our Comprehensive Stroke Center. We included patients 60 years or younger who had a drug screen performed during their acute stroke hospitalization. We compared demographic factors, stroke subtype, and 90-day functional outcomes between the two groups (Cannabinoid positive vs. Cannabinoid negative). Stroke subtype was determined based on TOAST criteria, ESUS criteria and good outcome was defined as mRS 0-1 at 90-days.

Results:
We identified 256 patients who met inclusion criteria. Mean age was 50 years, 61% were men and 20% were cannabinoid positive. Cannabinoid positive patients were younger (47.0 ± 10.7 vs. 50.5 ± 8.5, p = 0.032) and more likely to test positive for cocaine (17.3% vs. 3.9%, p = 0.002). Gender and vascular risk factors including smoking were similar between cannabinoid positive and negative patients. Cannabinoid positive patients were more likely to have a stroke related to large artery atherosclerosis (23.0% vs. 10.3%, p = 0.020). In an adjusted binary regression analysis, cannabinoid use was associated with non-significantly lower odds of good outcome (OR 0.61 95% CI 0.31 -1.23, p = 0.1).

Conclusions:
Cannabinoid use is associated with atherosclerotic stroke subtypes and a non-significantly reduced likelihood of good functional recovery. Larger studies are needed to further test these associations.
Abstract WP200: Dementia Risk Following Ischemic Stroke: A Systematic Review And Meta-analysis Of Factors Collected At Time Of Stroke Diagnosis
Authors: Waziry Reem , Claus Jacqueline , Hofman Albert
Published: February 2022

Introduction:
Delineating predictors of dementia among ischemic stroke survivors is critical to reduce dementia burden and to improve quality of life in this population.

Methods:
A Metaanalysis compliant with Preferred Reporting Items for Systematic Reviews and Metaanalysis was conducted. Analysis included absolute risk, incidence rates and patient level predictors (demographics, CVD history,TIA, stroke location, disability, chronic brain changes and stroke mechanism). Additional predictors included study setting, method of dementia diagnosis and inclusion of patients with recurrent or first ever stroke. A random effects meta-analysis was undertaken.

Results:
4,325 studies were screened and a total of 21 studies were included in metaanalysis, representing 55183 patients with ischemic stroke, with average age of 70 years (range 65-80 years) and average followup of 29 months. Overall rate of dementia after ischemic stroke was 13.0 per 1000 py (95% CI 6.0, 36.0). Incidence rates were eight times higher in hospital based studies (17.0, CI 8.0, 36.0) compared to registry-based studies (1.8, CI 0.8, 4.0). Absolute dementia risk after stroke was 20% at 5 year, 30 at 15 years and 48 at 25 years of follow-up. There was 33 difference in dementia incidence in the later study periods (2007-2009) compared to (1996-2006). Statistically significant predictors of dementia after ischemic stroke included female gender (OR 1.2, CI 1.1-1.4), hypertension (1.4 CI 1.1-2.0), diabetes mellitus (1.6 CI 1.3-2.1), atrial fibrillation (1.9 CI 1.2-3.0), previous stroke (2.0 CI 1.6-2.6), presence of stroke lesion in dominant hemisphere (2.4 CI 1.3-4.5), brain stem (0.5, CI 0.3-0.9) frontal lobe (3.7 CI 1.2-12.0), aphasia (7.9, CI 2.4-26.0), dysphasia (5.8 CI 3.0-11.3), gait impairment (1.7, CI 1.1-2.7), white matter hyperintensities (3.2 CI 2.0-5.3), medial temporal lobe atrophy (3.9 CI 1.9-8.3) and transient ischemic attack as the predisposing aetiology for ischemic stroke (0.44 CI 0.22-0.88).

Conclusions:
Factors routinely collected at time of admission are key in monitoring patients at highest risk of progression to dementia after acute ischemic stroke, in particular stroke location and presence of stroke related disability.
Abstract WP207: Switching Antiplatelets In Breakthrough Ischemic Stroke: Long Term Outcomes And Safety
Authors: Cheng Pamela , Ajani Zahra , Le Duy , Gaffney Denise , Cline Trevor E , Ho Ngoc , Sangha Navdeep S
Published: February 2022

Introduction:
Previous studies have shown that switching antiplatelets after having an ischemic stroke on aspirin may have better outcomes. However, these studies included patients who were switched to dual antiplatelets, which have an established benefit in the immediate post-stroke period. The purpose of this study is to assess outcomes in patients who continue aspirin versus switch to clopidogrel after having a cerebrovascular event on aspirin.

Methods:
We retrospectively identified patients within 14 Southern California hospitals using ICD-9 and ICD-10 codes who had a diagnosis of ischemic stroke on aspirin from January 2017-December 2019. Outcomes included recurrent hospital admission or emergency room visit for ischemic stroke, TIA, or intracranial hemorrhage up to two years post index event. Patients were grouped by which antiplatelet was prescribed at discharge. Those prescribed dual antiplatelets or an anticoagulant were excluded. Cox regression analysis was used to estimate risk of readmission.

Results:
Of the 580 patients who met the inclusion criteria, 372 (64%) continued aspirin and 208 (36%) switched to clopidogrel. Those with coronary artery disease (55.0% versus 45.0%, p = 0.015), dyslipidemia (61.4% versus 38.6%, p = 0.001), diabetes (59.5% versus 40.5%, p = 0.007), and a higher NIHSS score (mean 6.06 +/- 6.96 SD versus 4.08 +/- 4.32 SD, p = 0.001) were more likely to be discharged on aspirin. There were no differences in recurrent ischemic stroke {18.8% versus 15.4%, HR 1.12 (95% CI, 0.74-1.72), p = 0.587}, ischemic stroke plus TIA {19.9% versus 18.3%, HR (95% CI, 0.84-1.86), p = 0.253}, systemic embolism {25.5% versus 21.6%, HR 1.16 (95% CI, 0.82-1.66), p = 0.413} or intracranial hemorrhage {3.2% versus 2.4%, HR 0.94 (95% CI, 0.34-2.70), p = 0.919} between those discharged on aspirin versus clopidogrel, respectively.

Conclusion:
This study suggests that switching antiplatelets after having an ischemic stroke on aspirin may not be warranted.
Abstract WP213: Risk For Recurrent Stroke In Subjects Newly Diagnosed With Cancer Varies Significantly According To Previous History Of Stroke
Authors: Lun Ronda , Cerasuolo Joshua , Carrier Marc , Gross Peter L , Kapral Moira K , Shamy Michel , Sutradhar Rinku , Siegal Deborah
Published: February 2022

Background:
Cancer is an important yet understudied risk factor for ischemic stroke. We sought to examine the relationship between previous stroke and risk for future stroke in individuals newly diagnosed with cancer.

Methods:
Using a provincial administrative database, we conducted a population-based matched cohort study of adults in Ontario, Canada, from 2010-2019. Individuals with a new diagnosis of cancer and a history of ischemic stroke were matched (1:4) by age, sex, year of cancer diagnosis, cancer stage, and cancer site to cancer patients without a history of stroke. The cohort was followed until death, stroke, or March 31, 2020, whichever occurred first. Cumulative incidence function (CIF) curves were created for the incidence of stroke (primary outcome), with the date of cancer diagnosis as the index date. Sub-distribution adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated, where death was treated as a competing event. We further stratified those with a history of stroke by the timing of their most recent stroke: 0-1 years, 1-2 years, 2-5 years, or 5-10 years. Regression analyses were adjusted for baseline characteristics.

Results:
We examined 65,525 individuals with a new diagnosis of cancer, including 13,105 with a history of ischemic stroke and 52,420 without; the incidence of stroke outcome following cancer diagnosis was 5.5% and 1.8%, respectively. Cancer patients with a history of previous stroke had an increased risk for stroke after cancer diagnosis compared to those without a history of stroke (aHR 2.70 95%CI [2.42-3.00]). Individuals with stroke within the preceding 1 year of the cancer diagnosis had the highest risk of recurrent stroke with aHR 3.64 (95%CI 3.17-4.17).

Conclusion:
Individuals who have a history of stroke prior to a diagnosis of cancer were more likely to suffer stroke after cancer diagnosis, especially if that stroke had occurred within the year preceding the cancer diagnosis. This finding has potentially important implications for advancing strategies to prevent stroke in patients with cancer.
Abstract WP215: Population Attributable Risks For Potentially Modifiable Risk Factors Of Cerebrovascular And Cardiovascular-related Mortality In The National Health And Nutrition Examination Survey
Authors: Sharma Richa , Baker Anna , Mszar Reed , Leasure Audrey C , Khera Rohan , de Havenon Adam , Lu Yuan , Jasne Adam , Forman Rachel , Sheth Kevin N , Krumholz Harlan M , Sharma Richa
Published: February 2022

Introduction:
Stroke and heart disease are leading causes of mortality in the United States. We studied population attributable risks (PARs) for potentially modifiable stroke and cardiovascular-related mortality risk factors in the National Health and Nutrition Examination Survey (NHANES)-National Death Index (NDI) linked dataset.

Methods:
Adult NHANES participants surveyed from 1999-2014 with linked NDI data were included in this sample-level analysis. The primary outcome was death secondary to stroke (ischemic or hemorrhagic) or cardiovascular disease as recorded in NDI. Exposures were behavioral, environmental, clinical, and laboratory variables dichotomized at the sample median collected in NHANES. Missing data were imputed. PARs were calculated using adjusted hazard ratios from Cox proportional models.

Results:
We included 47,356 participants (median age 46 years [IQR 30-64]; 51.8% female; 261 stroke- and 1,112 cardiac-related deaths, 2.9%). Mean follow-up time was 97.2 months (SD 54.4 months). Among men < 65 years, characteristics with the top 3 PARs were elevated cholesterol (PAR 42%), elevated systolic blood pressure (PAR 30%), and low platelet count (PAR 23%) (Table 1). Among women < 65 years, not using food label nutritional fact panels (PAR 29%), prescription medication use (PAR 34%), and an elevated white blood cell count (PAR 27%) were the top 3 risk factors by PAR. Among men ≥ 65 years, not using food label nutritional fact panels (PAR 32%), elevated systolic blood pressure (PAR 22%), and cigarette smoking (PAR 20%) were the top 3 factors by PAR. Among women ≥ 65 years, not using food label nutritional fact panels (17%), elevated cholesterol (29%), and elevated creatinine (22%) were the top 3 risk factors by PAR.

Conclusions:
We provide age- and sex-specific adjusted PARs of potentially modifiable risk factors of stroke and cardiovascular-related mortality. These findings may inform targeted stroke and cardiovascular risk prevention strategies.
Abstract WP217: Key Role Of Translocator Protein (TSPO) In Stress-aggravated Ischemic Injury After Stroke
Authors: Zhu Yuequan , Geng Xiaokun , Li Fengwu , Ding Yuchuan
Published: February 2022

Introduction:
Ischemic stroke is the leading cause of death and disability worldwide. It was recently reported that mental stress could aggravate stroke damage. However, the causal relationship between mental stress and stroke outcomes remained unclear. In current study, we determined whether mitochondria dysfunction was induced by mental stress and thus enhanced brain damage after ischemic stroke. The translocator protein (TSPO) is a transmembrane protein located on the outer mitochondria membrane (OMM) and induced mitochondrial dysfunction. This study focused on the key role of TSPO in stress aggravated ischemia/reperfusion injury.

Methods:
Six-week-old male C57BL/6J mice were divided into four groups: control, chronic restraint stress (CRS), TSPO antagonist (PK11195, 3mg/kg, i.p.) and TSPO antagonist+CRS. Mice in CRS were placed in ventilated 50mL tubes 6 hours/day for 28 days. On the day 29
th
, behavioral tests were conducted to measure the depressive-like levels. Mice then were subjected to middle cerebral artery occlusion (MCAO). At 6/24 hours after MCAO, TTC staining and modified scoring systems were applied to analyze infarct volume and neurological deficits, and the expression of TSPO was detected using immunofluorescence. Apoptotic cell death and apoptotic proteins (Bcl-2, Bax and caspase-3/9) were measured by TUNEL and Western blot. Effects of TSPO on mitochondrial membrane potential (MMP) and mito-ROS were measured by JC-1 staining and live cell imaging dyes (mitoSOX and DCFDA)
in vitro
.

Results:
As depressive model, CRS aggravated infarct volume and neurological deficits after MCAO, with increased levels of apoptosis (cell death and protein expressions), in association with increased TSPO levels. TSPO antagonist could decrease stress-aggravated stroke injury and apoptotic cell death, indicating TSPO was involved in stress related stroke outcomes.
In vitro
, MMP was increased and mito-ROS was decreased after TSPO siRNA transfection, suggesting TSPO may induce mitochondria deficits through producing more mito-ROS.

Conclusions:
Mental stress by CRS exacerbated ischemic injury after stroke. Importantly, the results showed that TSPO may play a key role in inducing mitochondrial dysfunction in stress-aggravated stroke damage.